Tuesday, April 19, 2011

Madadayo (“Not Yet”)

Just watched the wonderful 1993 Japanese movie Madadayo that means “not (ready) yet” in English.  It is the last film by one of the greatest film directors/writers Akira Kurosawa  黒澤 who brought world’s attention to Japanese films 60 years ago with his classics like Rashomon in 1950 and Seven Samurai in 1954.   The film Madadayo is based on the true story of Professor Hyakken Uchida and focuses on his retirement life after age 60.  Through the tidbits of little things in life and the annual birthday parties his former students organized for him, the film explores an old man’s attitude towards to life and death as he kept his humor, perseverance, compassion, and humility with the love and support of his wife and former students.

It was not a coincidence that I rented this movie from Netflix although I first got interested in it because at first sight, it is a movie about a teacher and his students.  After watching the movie and in reflection,  I realized that I seem to have done more things to get myself “ready” since my retirement, starting first by getting our wills, living wills and estate planning matter in order.   My ears and mind seem to naturally become more sensitive to news, statistics, stories, photos, music and literature related to matters on health, aging, and the eventual death.  I suppose before retirement, I, like many others, was simply too pre-occupied with living?  We hardly have enough time just to take care of urgent issues and schedules to get ourselves through days, weeks and months ahead.  How much time and energy can one spend on things might not happen in decades?   In the same token, why would or should young folks be concerned with things that might not happen in half a century?

Several weeks ago, I bought and began reading the book A Widow’s Story: A Memoir by Joyce Carol Oates (JCO), after I heard an interview on NPR (National Public Radio).  JCO is a 72 years old renowned and prolific writer who has been teaching at Princeton University for sometimes.  She was just awarded 2010 U.S National Humanities Medal by President Obama.   Her writing is full of emotion and grace that one gets distracted by the beauty of her language even for dreadful events like death of her husband of 48 years.  As she detailed and cherished her delicate feelings and memory of life and death with her late husband Ray Smith’s, we can only began to appreciate and imagine the enormity of the challenges brought by the death upon those loved ones who have to endure and continue their lives.  That is exactly the reason I wanted to read the book – to understand better what my loved ones may feel and face and to make sure I can do my parts to lessen their struggles.

The only comforting thought is that a recent longevity study suggests widows’ longevity does not appear to be correlated with if the widow remarries. NPR’s Brian Lehrer Show recently interviewed Professors Howard Friedman and Leslie R. Martin, the authors of that study The Longevity Project: Surprising Discoveries for Health and Long Life from the Landmark Eight-Decade Study.  Their analysis was based on data collected by a Stanford University team started in 1921 by Dr. Lewis Terman.  The subjects were 1548 “high IQ” young students born in 1910 in San Francisco area. 

Among other things, the study found, perhaps not surprisingly, a strong correlation between longevity and social ties/networks (loners be careful!).  What is interesting however is the existence of gender difference.  For one, widowers who remarried tend to live longer while such correlation does not exist for widows!  The reason given is that men have more of their social ties from work and rely more on wives for their social ties.   Now I can appreciate more those anecdotal stories that many widows had little interest in getting married again.  Quoting an outspoken widowed mother of one of our friends, “why do I want to wash the dirty socks of a man, now I can finally enjoy my days traveling and playing Mahjong with my friends!

Joyce Carol Oates remarried to Professor Charles Gross of the Psychology Department and Neuroscience Institute at Princeton in early 2009, a year after her husband’s death.

Back to the meat and potato business.  Like most, I had my shares of grieves when family members and closed ones had serious health issues or passed away.  For the cases of my parents and my sister-in-law’s father, there were significant expenditures of long term cares even though they lived in Taiwan where the care cost is much cheaper than in U.S.  The concern for the financial impact prompted us to look into the possibility of purchasing an increasingly talked-about Long Term Care insurance.

According to the agent we spoke to and the insurance company literature, close to 1 in 2 people in U.S. ended up needing some form of long term care for some period of time before they pass away.   This ratio is probably increasing as we speak as we tend to stretch our lives with modern medicines and medical technologies.  Clearly such a high rate of occurrence suggests more needs for financial preparedness.  Unfortunately, it also suggests that there is a much more limited risk pooling effect that tends to result in higher premium for such an insurance policy.  Worse yet, reasonable insurance for catastrophic events don’t seem to exist.

I also learned some interesting data and statistics such as the average length of use of any kind of long term care (at home, assisted living, and nursing care) is about 2.5 years and the average length of stay at nursing care facility is about 6 months (I guess a majority of them never returned after the stay?!)   For us who live in a high cost area like New Jersey (and for the matter, California), it turns out that for at home care, it runs about $20-$25/hr with a minimum of 4 hrs.  For assisted living, it costs about $4-$6K/month.  For nursing homes, it costs about $6-$9K/month.  You can do the arithmetic to know any non-trivial length of needs can make a huge dent to one’s nestegg.  The good news is that Medicare (for those beyond 65 years old, for now) covers 100% for the first 20 days and 75% for the subsequent 80 days after each incident.  If your asset beyond 1 car and 1 house is gone or used up, Medicaid assistance is available but don’t expect 4 star services.  Dollars and cents aside, the biggest emotional challenge is that such an event could put your loved ones and their loved ones in a difficult or conflicting position while trying to balance the financial burden with quality of care.

When all said and done, I figured that a better way to think of the Long Term Care insurance is to consider it a form of investment just like you buy stocks and bonds and mutual funds in your diversified portfolio.  The way many policies are formulated give rise to a distinct “use-it-or-lose-it” characteristics of the return on investment (or anti-return of investment). If you are “unlucky”, the annual premiums you paid (the “investment”) will generate payouts up to a contracted maximum amount (the best-case “return”).  If you (and your loved ones) are lucky, you could lose all your investments.   The net result is if you purchase such an insurance, it could provide an additional financial cushion for your loved ones.  The only question is if it is worth it.  Of course, you have other alternatives such as putting away the premium (or other amount) for the explicit purpose with a more predictable but likely smaller returns.

We don’t know yet if the insurance company consider us “insurable” and how much the actual premium will be.  It turns out that the Insurance Company we spoke to assess the risk rigorously.  They so far have done a phone interview with us by a registered nurse.  Among other things such as getting our health history, the nurse conducted some cognitive and short term memory tests over the phone but I already forgot many of the questions she had asked!

In all, I found all these exercises educational at the least.  The planning and preparations help me to put my mind more at ease, knowing I have done my best for my loved ones.  I have neatly put all documents and directives in place so that they can have the least amount of burden, anxiety, and stress whenever the eventuality strikes or when I can no longer think coherently or express myself.

Now I shall relax and enjoy more my retired life.   Before I go, I must ask you “Mahda-kai?” ("Are you ready?")

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