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January 2018 Columns

Savvy Senior – January Columns

  1. Don’t Eat This if You’re Taking That

  2. Help With Home-Care Bills

  3. Financial Tips for Retiring Abroad

  4. What To Do When a Loved One Dies

  5. How to Find Volunteer Opportunities in Retirement

 

Don’t Eat This if You’re Taking That

Dear Savvy Senior,
If the prescription label says “take with meals,” does it matter what you eat? I currently take eight different medications for various health problems and would like to know if there are any foods I need to avoid.
Over-Medicated

Dear Over-Medicated,
It depends on the medication. Many meds should be taken with food – any food – to increase their absorption and reduce the risk of side effects. But some foods and medications can interact, reducing the medications’ effectiveness or increasing the risk of harmful side effects.

To stay safe, you should always talk to your doctor or pharmacist to learn the ins and outs of your prescriptions, along with what foods and beverages to avoid while you’re on it. In the meantime, here are some foods you should stay away from for some commonly prescribed drugs.

Cholesterol Medications: If you take a certain statin drug to control high cholesterol like Liptor, Zocor, Altoprev, Mevacor, or generics atorvastatin, simvastatin or lovastatin, you should avoid grapefruit and grapefruit juice. Grapefruit can raise the level of the drug in your bloodstream and increase the risk of side effects, especially leg pain.

Blood Pressure Medicine: If you take an ACE inhibitor drug like Capoten, Vasotec, Monopril, Zestril and others to lower your blood pressure, you should limit food that contain potassium like bananas, oranges, tomatoes, spinach and other leafy greens, sweet potatoes, and salt substitutes that contain potassium. ACE inhibitors raise the body’s potassium levels. Eating too many potassium rich-foods while taking an ACE inhibitor can cause an irregular heartbeat and heart palpitations.

Blood Thinning Medications: If you are taking Coumadin, Jantoven, or the generic warfarin, you should limit kale and other greens, including broccoli, cabbage, spinach, and brussels sprouts that contain vitamin K. These foods can block the effects of these blood-thinning medications putting you at risk for developing blood clots. You also need to watch out for garlic, ginger, vitamin E and fish oil supplements because they can increase these medications blood-thinning abilities putting you at risk for excessive bleeding.

Antidepressants: If you take a monoamine oxidase inhibitor (MAOI) antidepressant like Marplan, Nardil, Emsam, Parnate, or generic isocarboxazid, phenelzine, selegiline or tranylcypromine, avoid aged cheeses, chocolate, cured meats and alcoholic drinks. These contain tyramine, which can raise blood pressure. Normally, the body controls tyramine levels with an enzyme called monoamine oxidase, but the MAOI antidepressant block that enzyme.

Thyroid Medications: If you take a medication for hypothyroidism like Synthroid, Levoxyl, Levothroid or generic levothyroxine, you should avoid eating tofu and walnuts, and drinking soymilk. All these can prevent your body from absorbing this medicine.

Anti-Anxiety Medications: If you take medication for anxiety like Xanax, Klonopin, Valium, Ativan, or generic alprazolam, clonazepam, diazepam or lorazepam, you should avoid alcohol. These medications act as sedatives, binding with the brain’s natural tranquilizers to calm you down. But when you mix these drugs with alcohol, the side effects intensify, and can cause you to feel lightheaded, sleepy and forgetful.

Antibiotics: If you’re taking an antibiotic like Sumycin, Dynacin, Monodox, or generic tetracycline, doxycycline or minocycline, you should avoid dairy – milk, yogurt, and cheese, and calcium supplements and fortified foods – for a couple hours before and after taking the medicine. Calcium in dairy products binds to the antibiotic and prevents your body from absorbing it, making it ineffective.

To find more dietary guidance on the drugs you take, see reliable health sites like MedlinePlus.gov or MayoClinic.org, or consider the excellent new AARP book “Don’t Eat This If You’re Taking That: The Hidden Risks of Mixing Food and Medicine” available at Amazon.com and BN.com for $13.

Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book.

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Help With Home-Care Bills

Dear Savvy Senior,
Do you know of any resources that can help with my mother’s home-care bills? Mom is recovering from a stroke and needs in-home care, but I understand Medicare doesn’t cover it, and she doesn’t have long-term care insurance.
Stressed-Out Daughter

Dear Stressed-Out,
Depending on your mom’s circumstances, there are a number of government and not-for-profit programs that can that either subsidize or pay for your mom’s home care or offer aid in other ways. Here’s where to look for help.

Medicare Coverage
If your mom is recovering from a stroke, the first thing you need to know is that Medicare does cover a variety of in-home health care services. To be eligible your mom must be “homebound,” and her doctor will need to approve a “plan of care” confirming that she needs skilled-nursing care or skilled-therapy services from a physical or speech therapist. Her doctor can also request the services of an occupational therapist and a non-medical home aide to assist with activities of daily living like bathing, dressing and using the bathroom.

However, be aware that Medicare will not pay for non-medical home aide services alone, if your mom does not need skilled-nursing or skilled-therapy services too. Homemaker services, such as shopping, meal preparation and cleaning are not covered either.

For more information on how this works, call 1-800-MEDICARE or see Medicare.gov/coverage/home-health-services.html.

Medicaid Options
If you mom’s income is low enough, she may qualify for Medicaid, which offers different programs that can pay for non-medical home care, home health care and other in-home support services. These programs, often referred to as Home and Community Based Services, are state-specific and their eligibility and benefits will vary. To find out if your mom is eligible, contact her state Medicaid agency (see Medicaid.gov).

State Programs
If your mom doesn’t qualify for the Medicare or Medicaid options, check to see if her state offers any state-funded home-care programs. These programs may provide caregivers or vouchers that can help pay for care. To find out about these services, call the Area Agency on Aging near your mom – see ElderCare.gov or call 800-677-1116 for contact information.

Also investigate PACE, which stands for “Programs of All-Inclusive Care for the Elderly.” PACE, which is currently available in 31 states – though not in every community – provides in-home care, including help with activities of daily living, such as meals, dental and medical care, prescriptions, and chaperoned transportation, among other benefits.

Medicaid-eligible patients get PACE for free, but if your mom is not eligible for Medicaid, she may be charged a monthly premium, though far less than she would pay a private service. To see if PACE is available in your mom’s area, see NPAonline.org.

Veterans’ Benefits
If your mom is a veteran, or a surviving spouse of a veteran, the VA also offers some benefits that can help pay her in-home care.

One is “Aid and Attendance or Housebound Allowances,” which are supplemental monthly benefits for veterans already receiving a monthly VA pension and requiring healthcare. Veterans and surviving spouses qualify if they have certain disabilities or need help with activities such as dressing, bathing, and feeding, among other criteria. Go to Vets.gov/pension for more information.

Another option is the “Veteran-Directed Care” program. This program, available through VA medical centers in 38 states, as well as in Washington, D.C., and Puerto Rico, provides as much as $2,000 a month that can be used to pay a professional or family member or friend for home care. The program is open to any veteran who meets the criteria, including requiring help with three or more activities of daily living. Visit the “Home and Community Based Services” section at VA.gov/geriatrics for information.

To look for additional programs in your area that can help pay your mom’s home care, go to PayingForSeniorCare.com and use their Eldercare Financial Assistance Locator tool.

Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book.

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Financial Tips for Retiring Abroad 

Dear Savvy Senior,
What are some financial factors to consider when retiring abroad? My husband and I will be retiring in a few years and are interested in living in a foreign country that’s cheaper than the U.S.
Frugal Couple 

Dear Frugal,
Retiring abroad has become a growing trend for millions of U.S. retirees who are looking to stretch their retirement savings. Here are some tips and resources to consider that can help you prepare.

Researching Tools
For starters, you can find lots of information and articles on the countries and cities you’re interested in retiring to at websites like InternationalLiving.com and EscapeArtist.com.

Another good tip is to talk or network with some expatriates who have already made the move you’re thinking about making. They can give you tips and suggestions on many issues, as well as the advantages and disadvantages and day-to-day reality of living in a particular country. Some popular sites for finding expat resources are ExpatExchange.com and ExpatForum.com.

But before committing to location, most experts recommend that you visit multiple times during different seasons to see whether you can envision yourself living there and not just exploring the place as a tourist. Also, consider these financial factors:

 Cost of living: Retiring abroad used to be seen as a surefire way to live beyond your means, and for some countries it still is. But the U.S. dollar isn’t what it used to be, so your money may not stretch as far as you think. See Numbeo.com for a country-by-country cost of living comparison.

 Taxes: No matter what foreign country you decide to retire in, as long as you’re a U.S. citizen you must file an annual tax return reporting all income above certain minimums, not matter where it’s earned. For details see the IRS publication 54, “Tax Guide for U.S. Citizens and Resident Aliens Abroad” at IRS.gov/pub/irs-pdf/p54.pdf.

Health care: Most U.S. health insurance companies do not provide coverage outside the U.S., nor does Medicare. Check with the embassy (see USembassy.state.gov) of your destination country to see how you can be covered as a foreign resident. Many countries provide government-sponsored health care that’s inexpensive, accessible and just as good as what you get in the states, or you may want to buy a policy through Medibroker (Medibroker.com) or Bupa Global (BupaGlobal.com).

Also know that most people who retire abroad eventually return to the U.S., so you should consider paying your Medicare Part B premiums. If you drop and resume Part B, or delay initial enrollment, you’ll pay a 10 percent premium penalty for every 12-month period in which you could have been enrolled.

Banking: Opening or maintaining a bank account abroad has become more difficult because of the Foreign Account Tax Compliance Act, a U.S. law designed to prevent Americans from hiding assets abroad. So, you may have to establish a savings and checking account with an institution that has international reach like Citibank. And/or consider maintaining your U.S. bank account that you can access online, and get U.S. credit and debit cards that don’t charge foreign transaction fees.

Renting vs. buying: Buying a home in a foreign country can be complicated, so it’s usually cheaper and simpler to rent, unless you know you’re going to live there for a long time.

Social Security: You can receive your monthly Social Security benefits almost anywhere you live around the world (see SSA.gov/international/payments.html). Your benefits can be deposited into your bank account either in the U.S. or in your new home country, but there are some exceptions.

The U.S. State Department offers a handy checklist that can help you think through all the issues on retiring abroad. To access it visit Travel.state.gov and search for “retirement abroad.”

Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book.

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What To Do When a Loved One Dies

Dear Savvy Senior,
This may seem like a strange question, but can you tell me what steps need to be taken after a loved one dies? My 80-year-old father has a terminal illness, and I would like to find out what I will need to do when he passes.
Only Daughter

Dear Only Daughter,
I’m sorry about your father’s situation but this is a great question many families inquire about when a loved one’s death becomes imminent. Here’s a run-down of some things you can do now, and after his death, that can help keep a sad event from becoming even more painful.

Before Death Occurs
There are several tasks you can do now while your father is still living, that will make things a lot easier and less hectic for you after he dies.

For starters, find out where your dad keeps all his important papers like his will (also make sure it’s updated), birth certificate, marriage and divorce certificates, Social Security information, life-insurance policies, military discharge papers, financial documents, and keys to a safe deposit box or home safe.

Also, if your dad doesn’t have an advanced directive, help him make one (see CaringInfo.org for free state-specific forms and instructions). An advanced directive includes a living will that specifies his end-of-life medical treatments, and appoints a health-care proxy to make medical decisions if he becomes incapacitated.

In addition, you may also want to get a do-not-resuscitate (DNR) order, which will tell health care professionals not to perform CPR when your dad’s heart or breathing stops. Your dad’s doctor can help you with this.

You should also pre-arrange his funeral and burial or cremation.

Immediately After Death
Once your father dies, you’ll need to get a legal pronouncement of death. If no doctor is present, you’ll need to contact someone to do this. So, if your dad dies at home under hospice care, call the hospice nurse, who can declare his death and help facilitate the transport of the body.

If he dies at home without hospice care, call 911, and have in hand his DNR document. Without one, paramedics will generally start emergency procedures and, except where permitted to pronounce death, take the person to an emergency room for a doctor to make the declaration.

If no autopsy is needed, you will need to call the funeral home, mortuary or crematorium to pick up the body. If your dad is an organ or tissue donor, contact the funeral home or the county coroner immediately.

Within a Few Days
If funeral plans were not pre-arranged, you’ll need to make arrangements and prepare an obituary. If your dad was in the military or belonged to a fraternal or religious group, you should contact those organizations too, because they may have burial benefits or conduct funeral services.

Up to 10 Days After Death
To wind down your dad’s financial affairs, you’ll need to get multiple copies of his death certificate. These are typically provided by the funeral home.

If you’re the executor of your dad’s estate, take his will to the appropriate county or city office to have it accepted for probate. And open a bank account for your dad’s estate to pay bills, including taxes, funeral costs, etc.

You also need to contact your dad’s estate attorney if he has one; tax preparer to see if estate or final income taxes should be filed; financial advisor for information on financial holdings; life insurance agent to get claim forms; his bank to locate and close accounts; and Social Security (800-772-1213) and other agencies that provided benefits to stop payments and, if applicable, ask about survivor benefits. You should also cancel his credit cards and, if relevant, stop household services like utilities, mail, etc.

For more information on the duties of an executor, a great resource is “The Executor’s Guide: Settling A Loved One’s Estate or Trust” available at Nolo.com for $32.

Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book.

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How to Find Volunteer Opportunities in Retirement

Dear Savvy Senior,
What resources can you recommend for locating interesting volunteer opportunities? Since I retired, I’ve been doing some volunteer work but most of the opportunities I’ve tried haven’t been very satisfying.
Unsatisfied Volunteer

Dear Volunteer,
For many retirees, finding a volunteer opportunity that satisfies your interests, utilizes your talents and matches your availability can be challenging. To help you find an interesting and satisfying volunteer opportunity, here are some tips and online tools that can help you search.

Getting Started
Volunteering is a great way for retirees to make a positive contribution to their community and stay actively engaged, not to mention it’s good for your health too. But how can you find the right opportunity for you? Start by asking yourself some basic questions like: What types of organizations or activities are you interested in? What kind of skills can you offer a volunteer organization? How much time are you willing to give? What do you want to gain from your experience (for example, meet new people, learn new skills, help those in need, exposure to a particular issue)?

Once you get a general idea of what you’d like to do, there are dozens of volunteer websites that can help you search for different opportunities in your area.

Most sites work like search engines that let you choose an area of interest and type in your ZIP code or city and state. The sites will then give you a list of opportunities that you can check into. Depending on your interest and expertise, here are some top websites to help you get started.

General volunteer matching sites: To find a wide variety of volunteer opportunities in your community, check out VolunteerMatch.orgIdeaList.org and AllForGood.org – a Point of Light website (the world’s leading volunteer service organization) that lets you search for local volunteer opportunities or start your own project and invite others to help you. Also see HandsOnNetwork.organother Point of Light enterprise that connects volunteers to opportunities through more than 250 volunteer centers throughout the U.S.

Retiree volunteer sites: If you’re interested in opportunities targeting older adults and retirees, some good options include AARP’s CreateTheGood.org, along with SeniorCorps.gov, which matches retirees with community projects and organizations that need experienced volunteer help.

Senior Corps offers three different programs: RSVP, which has a variety of volunteer activities with flexible time commitments; the Senior Companion Program that brings together volunteers with homebound seniors who have difficulty with day-to-day living tasks; and the Foster Grandparent Program that matchers volunteers with kids in the community that have exceptional needs.

Government-sponsored sites: There are also a number of government-sponsored websites that can help you look for different volunteer opportunities. To locate dozens of general options in your area visit Serve.gov. To find natural and cultural volunteer opportunities in places like national and state parks, see Volunteer.gov. If you’re interested in emergency preparedness and disaster response volunteer services go to Ready.govOr, if you’re interested in longer-term volunteer opportunities check out AmeriCorps.gov and PeaceCorps.gov/50plus, which offers a bevvy of three-month to two-year programs in the U.S and abroad.

Professional and executive sites: If you have expertise in areas like business planning and development, marketing, communications, finance, fund raising, web and graphic design, or writing and editing there are sites – like Catchafire.orgTaprootPlus.org and ESCUS.org – that can link you to volunteer opportunities with nonprofit organizations in need. Or, you can help entrepreneurs and small business owners through the SCORE.org volunteer mentoring program.

Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book.

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