Well, I’d like to lose neither but Americans did lose both last year – whether from tax-payer funds dedicated to senior citizens, or private wealth of seniors saved over a lifetime of work.

These numbers may be much higher given that elderly victims of fraud don’t report the crime.

In order to get ahead of this pandemic, it’s important to understand why aging Americans are targeted, how extortion happens, and why current solutions may not be effective.

1. Aging Americans make an excellent target

A few simple reasons:

1. There are many aging Americans & they have lots of money: If you think of fraud as a business and do customer segmentation to find the highest ROI segment, you’ll quickly realize that individuals over 65 are the largest growing demographic in the U.S. And unlike the millennials, this customer segment has a massive amount of private wealth in retirement savings, private pension, and home equity (median savings of $260K).
2. Aging Americans are the key to a massive pot of public gold: Medicare, Social Security, and parts of Medicaid are dedicated public programs for individuals over 65. Therefore stealing the identity of an American over 65 (or leveraging their health and needs) is worth a lot of public money. Medicare alone spent $672B in 2016 on healthcare for individuals over 65.
3. Individuals who live alone are more susceptible to fraud: As we age, many of us end up living alone (40%+ of individuals over 65 live alone). This creates a feeling of vulnerability, and an inability to seek council from a trusted partner who is in close proximity.
4. Cognitive decline makes for easy exploitation: The 13% of Americans over 65 who have some form of cognitive decline are an easy prey and can be confused into handing over their assets and power of attorney to a fraudulent caregiver.

2. Scams come in all shapes and sizes

As expected, human creativity is at it’s best when there’s a large expected payoff. The list below is by no means exhaustive but a good sampling of common types of fraud used against America’s aging population.

With Medicare fraud, one might think that there’s no direct impact on the individual since this is theft from public funds. That’s incorrect. Medicare doesn’t offer unlimited coverage. If an individual is covered for one procedure, and a fraudster has already claimed it, then the individual will likely not get Medicare coverage for this procedure when they actually need it. Also, there are no consumer protections with Medicare fraud and people can get into legal trouble even if their Medicare ID is stolen and abused by someone else.

Finally, the more fraud within Medicare, the less resources are available for other forms of public assistance.

Why doesn’t private health insurance have such high fraud rates?

Because Medicare is legally bound to process claims within 30 days of filing. This limit is not imposed on private health insurance providers. Legacy systems and lack of efficient data flow combined with a 30 day cycle means Medicare can only check 1.8% of all claims filed for fraud.

Many older individuals experience loneliness. Over 40% live alone. The need for human connection and affection can override caution. These scams are also the least likely to get reported since there’s shame associated with being tricked by someone in exchange for love. Also, in cases where the manipulation is coming from a caregiver (family member or professional), the power dynamic makes it unsafe to report the fraud.

3. Existing mechanism are not working

Despite there being lots of literature available on this topic, elderly fraud is on the rise and represents 5M individuals every year. There are public and non-profit hotlines to report scam, but awareness and market penetration is low. Harvard University predicts that only 1 in 40 scams is ever reported by an aging individual. So why aren’t the existing systems working?

1. Shame: In order to protect individuals from fraud, we can’t just take a logical approach. We have to account for the tremendous shame that people feel when they discover they have been duped. Much like other forms of abuse, victims blame themselves for it.
2. Fear of giving over the reigns: Very often individuals fear that if they share their story with a younger family member, they will be judged and deemed unfit to live independently.
3. Post, not pre: While there are several public and volunteer services where scams can be reported after they have happened, there are no scaled out solutions where an individual can ask a trusted professional if some unusual activity in their lives could result in a scam.
4. I didn’t know myself: Medicare and Social Security fraud often goes unnoticed for a long time because people don’t review their medical claims – it’s tedious and irrelevant to their day to day life – until it’s not, and by then it’s too late.
5. Too much information, not enough help: The nature of scams evolves rapidly. In order to stay on top of it, people are expected to do ongoing research and remain informed. Imagine if we expected every computer user to know everything about every computer virus out there, because that was the only way to stay protected. It just wouldn’t work.

In order to protect individuals from scams, we need to learn from the tactics of scammers since they’re so effective. Scammers understand the psychology of their victims, and leverage human connection and technology effectively to manipulate them.

Any solutions to combat this threat should consider doing the same.

This is the 3rd post in an 8 part series on the topic of aging.

Work is an integral part of our adult lives. Not only does it provide the financial means to support ourselves, it also occupies the largest part of our day, often representing a thriving community, a place for learning, and a sense of meaning and self-worth. But as we age, the question of “Should I retire?” comes up. It’s a tricky question to answer with many factors of consideration, which are explored in this post.

#1: Americans are working longer

When confronted with the “Should I retire?” question, many Americans are choosing the employment path for longer as evidenced by these numbers from Pew Research Center.

While retirement age is increasing for both genders, it is more significant in males. Although less than 45% of the total 65+ population are men, they represent more than 55% of older workers. Within the male population Asian Americans and White Americans are more likely to work longer than other racial/ethnic groups.  

#2: White collar professionals work longer

Management, sales and office administration represent the top 3 areas of employment for older individuals.

This ranking looks different if we consider older individuals as a percentage of the total number of people in specific role types.

#3 Older employees will be the fastest growing segment of the work force for the next 10 years

Due to lower birth rates and slower immigration rates among other factors, the overall U.S work force is growing slowly, at a rate of 0.5%. However the older work force is growing at a rate of 1.8%. This can be attributed to the tidal wave of baby boomers as well as government incentives to postpone retirement. Combine these two trends and it’s evident that the % of older workers as a % of all workers will continue to rise – from 19% currently to almost 30% by 2060.

#4 Working longer can be advantageous for all

Postponing retirement and participating in the work force can be advantageous for the individual and also for the economy. From the individual’s perspective, there are three key benefits to consider:

1. Income & Social Security: Full eligibility for social security benefits kicks in at age 67, but individuals can start receiving it at age 62. If they opt for this, they get 70% of the benefit each month.  This can be significantly impact their quality of life in the last 20+ years. In parallel, life expectancy is on the rise and most individuals need every extra dollar they can generate as income and put towards retirement planning to cover for health and home care costs.
2. Health insurance: Medicare typically kicks in at age 65 (with some exceptions). If individuals decide to retire earlier than this, they have to get private insurance to cover health care costs. Premiums for private insurance can run high since it’s a cost driver for insurance companies and individuals cannot benefit from group rates.
3. Personal well-being: While studies remain conflicted on the impact of retirement on physical & mental health (some suggesting that individuals are 40% more likely to get a stroke within the first year of retirement, others suggesting that the use of anti-depressants and anxiety medication drops after retirement), it’s universally accepted that transitioning from full-time work to no-work is a stressful experience and unless it’s considered a process rather than an event, it negatively impacts  one’s sense of community, routine and purpose.

The government has been encouraging individuals working longer both through legislation (like the Age Discrimination in Employment Act) and incentives (moving the Social Security eligibility from 65 to 67 years). This is beneficial because:

1. U.S. dependency ratios are on the rise, which creates pressure on government programs as well as working citizens. By encouraging the aging population to work, their dependence on the other constituents declines.

2. The longer individuals participate in the economy, the more they can contribute to government programs like Social Security. While Social Security has $3 trillion in reserves today, 2018 is the first year it had to dip into the trust to cover costs. It is expected that by 2034 this reserve will be depleted, at which point eligible individuals will receive 75% of their benefits instead of the full 100% today. About 60.5 million individuals receive Social Security benefits today and this number will rise to approximately 80 million over the next 20 years.

#4 Yet, most individuals do not work to eligible retirement age

Even though older individuals are working longer, more than two thirds are out of the work force by age 66. This increases to 85% by age 75.

#5 Ageism is rampant

The Age Discrimination in Employment Act forbids workplace discrimination against anyone 40 years or older. However many sources suggest that ageism is rampant in corporate America, and incredibly hard to prove. This makes it difficult for individuals to retain their jobs after they turn 50, to find new jobs if they are terminated or decide to leave, and get promotions or rewards within a current job. In a mass scale study with 40,000 job applications across 12 cities in 11 states, resumes were submitted for 3 types of jobs. The resumes were identical except for the applicant age and gender. The results highlighted 3 key points:

1. Older applicants had a significantly lower callback rate than younger applicants
2. Older female applicants were discriminated against more than any other candidate group
3. Callback rates were lowest for the oldest age group, followed by the middle age group

#6 The ideal job

After conducting 60+ interviews with individuals over 55, I have crafted traits of the ideal job based on what I’ve heard.

1. Part-time – 15 – 25 hours a week instead of high-stress 50 hours a week
2. Flexibility – ability to set my one’s own hours, work from home and also come into the office, potential to take time off in the summer
3. Engaging – The job is interesting, and leverages existing skills and intellect
4. Learning – The job offers opportunities to learn new skills
5. Giving back – An avenue to help others who are earlier in their career
6. Dignity in the hiring process – The hiring process doesn’t insult their decades of experience by asking questions one would ask a college hire
7. Connection – There are opportunities to talk to other people and lightly collaborate
8. Compensation – There is some (not market rate) financial compensation associated with the work
9. Healthcare benefits – There is an option to leverage group rates for health insurance, even if it means the individual is paying out of pocket

Parting thoughts

It is in our collective best interest to re-think the cliff that is Retirement. Instead of a precipitous fall, perhaps we can craft a glide path for willing older individuals such that they can continue to participate in the work force in traditional and new types of roles, generating income for themselves and adding value to the economy. There are also opportunities to offer the skills of older white-collar Americans in an international marketplace. Finally, employers need to update benefits and employee programs to account for a workforce that is 30% 65 years and older.

Other posts on aging

Aging in America – At a glance

Aging in America – Where is home?

Aging in America – Are Aging Americans rolling in money or struggling?

This is the second post in an 8 part series on aging in America. In this post, I will explore the concept of “home” as individuals age. Before data diving, I want to share that one of the top two things I’ve heard from the 56 individuals I’ve interviewed is their strong desire and intention live independently forever, ideally in their current home. If that’s not possible, then a smaller and more age-appropriate home, but their domain nonetheless.

Here are the 7 lesson’s I’ve learned about housing:

#1: There are many housing options available, but have low uptake

Other can traditional home ownership or renting options, there are many housing options for aging individuals, each type differentiating on the cost/level-of-assistance/level-of-community dimensions from others.

I’ll pick out two to illustrate the spectrum.

1. Continued Care Retirement Communities (CCRCs): This option offers clients aging-in-place. Residents start off by living independently in a house or apartment within the CCRC, with optional services like house-keeping. They make friends with neighbors and age together. As needs expand, clients get more assistance, eventually moving to a nursing home within the CCRC. This is one of the most expensive options, typically associated with a large upfront free (ranging from $250,000 to $1 million) and monthly charges ranging from $1000 – $10,000.
2. Assisted Living: This option offers a semi-independent lifestyle to residents who need help with activities of daily living (bathing, dressing, medication management, transportation and meal services) and also have additional services available (housekeeping etc). The average cost is $3600 per month with variation based on quality and geography.

#2: Americans are aging in the homes they raised their kids in

While this pie chart looks different for the 65-75 age cohort and 75-85 cohort (with the latter representing higher shifts to assisted living and living in another family member’s home), these differences are small.

Other interesting facts to add color:

Households run by someone over 65 are on the rise relative to total household increase

#3: Health changes can make aging at home challenging

Despite the rise of chronic conditions like heart disease and diabetes, Americans are living healthier lives. Still, physical disabilities steadily increase.  The most common disability among all aging sub segments is lack of mobility. This poses challenges in maintaining the house, cooking, cleaning and running errands etc.

There are two types of needs to consider:

1. Health care – this includes medication, hospital bills, prescribed physical therapy, speech language pathology etc. Most of these expenses are paid for by Medicare and Medicaid, however there are gaps in coverage which are paid for out of pocket, or via supplementary insurance.
2. Custodial/home care – this includes help with medication management, cooking, transportation, bill management etc. Most of these expenses are not covered my Medicare. Medicaid provides some coverage but is only available to individuals in poverty. Most of these expenses are paid for out of pocket, by an adult child or family member, or via long term insurance (however most individuals don’t have this coverage).

Single-individual households are most likely to need assistance and represent over 44% of the 65+ households.

#5: Financial liquidity and the desire to age at home can be at odds with each other

I’ll cover the complete financial picture of individuals over 65 in a subsequent post. Needless to say, there’s a massive need for home and health care, and a large portion of it must be paid for out of pocket. That’s where housing comes into focus.

Home equity represents a substantial percentage of the net wealth of individuals over 65. This trends downwards among wealthier individuals, who also have more dispensable income to spend on home care.

Reverse mortgages offer home owners federally backed loans such that they can free up the equity in their homes without needing to sell their home and move. However they have incredibly high premiums, insurance costs, complexity of terms, and recently have made the news for litigation, which means equity is not being unlocked effectively for most households who need it.

Moving to a smaller home is potentially the most efficient way to unlock equity to pay for home and health care, but is perceived to be difficult and overwhelming.

#7: Within challenges exist opportunities

Many of my friends in the technology industry spend time thinking about defying age and out-living death. While that’s intellectually interesting, there are real needs today that need to be met. Every need presents an opportunity, every opportunity welcomes creators to find new and elegant solutions. I’ll share my personal heat map of opportunities as I look at aging and home ownership.

I hope you learned something new and it piqued your interest. The next post will be on employment after 60.

Other posts on aging

1. Aging in America – At a glance
2. The aging workers of America

Why does Kim Kardashian instagram naked selfies on a random Monday evening?

Why do we poo-poo the selfie culture and yet turn ourselves into circus monkeys with props in a photo-booth at some random party?

Why must we believe that the customer is always right when she’s just another flawed human being doing the best that she can?

Why are marketers spending billions of dollars trying to personalize customer experience?

Selfies, personalization, bespoke experiences, the cult of celebrity….where is this coming from?

I grew up in a culture where collective identity overrides individual identity. Your values are your family’s values, your choices are for the betterment of your family, not for the pursuit of your own vanity. You are not driven by passion. You are driven by duty. In turn, your family is part of a biradari (literal translation: brotherhood; liberal translation: community). Your family’s honor and respect are measured by how well it fulfills its duties towards the aunts and uncles that make up this community; every tea party, every family dinner, every wedding an opportunity to comply, an opportunity to affirm the norms of the brotherhood. In this culture, the pursuit of acceptance is the unsaid law of the land.

I resisted this culture the entire time I lived in Pakistan. My poor mother had to explain to her biradari why her twelve year old had an eye brow ring, didn’t attend weddings because she didn’t believe in the institution and picked fights with uncles over women’s rights. I recall reading Atlas Shrugged when I was 15, and feeling a tremendous sense of vindication and relief – there were others like me who believed in individual excellence and uninhibited individual expression through creation of value and beauty in the world.

Choosing to live in the U.S. wasn’t just an economic choice but a philosophical one. To me, it represented a culture where the individual is celebrated above all else. Parents encourage their children to find their own path and optimize for their own happiness. There is space and time to discover oneself and create value from that place of self-awareness. And it’s been all of those things for me.

And yet, over the last two years I’ve become aware of something corrosive that’s come along for the ride on this adventure of self-exploration and expression.

And that is self obsession. I see it in myself. I see it in my friends. I see it in my co-workers. I see it in random people I meet at social events.

My goals. My travel. My spirituality. My stress. My happiness. My story.

Somehow self-awareness morphed into navel gazing. Self-reflection became blatant narcissism.

I don’t think the answer lies in one culture or another. Both are essentially the same with the line of “Self” being drawn in a different place. The outcome I’d like to explore is to remain an individual with a strong sense of self, but with a purpose that’s Other-oriented, where Other is not just a connection of blood, love or money, but a connection of empathy that should exist between any two living beings.

This journey begins with creating awareness (with ruthless honesty) of who I am serving with my time, my energy and my money. Once that is apparent, the next step will be to make durable life changes to orient towards service of others as the core mission, while staying true to myself.

Very scary. And also feels exactly right.

P.S. And no selfies!

Last week, I shaved my head. Many friends and family members have asked why. Many have assumed.

Perhaps it’s an assertion of freedom, a visualization of Zero-Fucks-Given. It is not. I give many fucks about many things and don’t go through life with a sense of entitlement about absolute freedom. I find this idea to be irresponsible. As a person on this planet, consuming massive amounts of oxygen and food, and outputting tons of waste and debris, each one of us better give a serious fuck.

Perhaps it’s a statement about how a woman’s worth does not lie in her physical appearance. This topic is certainly relevant, as we continue to suffer the Trump presidency and to be horrified by the weekly exposés of powerful men using their powerful platforms to wave their dicks around (literally and figuratively). As much as I’d like to say that was my motivation, it was not.

This is about sadness at profound loss, about the inability to accept what cannot be changed after 38 years of railroading my way through life’s toughest challenges. This is about looking on the outside how I feel on the inside – being trapped in a straight jacket, ever-tightening, inducing panic, inducing madness. The mind is impotent in such a state. The heart is broken in the clench of it’s own pain.
This is about returning to prayer, because rationality only goes so far.

Grant me the serenity to accept the things I cannot change,
And the courage to change the things I can

P.S. A difficult post to write, especially as I didn’t provide any specifics, which is annoying to anyone who reads it. However, it’s not my story to tell. The reason for sharing on a public forum is to process my own thoughts and feelings, and also remain emotionally honest with people who interact with me on two fronts

1. I do not want to take credit for noble missions I am assumed to be associated with, but are not my motivation in this instance.
2. I don’t want to just write about things that make it seem like I have my shit together and life is a string of perfect sunsets, travel and quality time with friends and family. The struggle is real.

He was larger than life – booming laugh, sharp wit, deep voice, sinfully handsome face, his long beautiful fingers absently playing with his smoking pipe and tobacco tin box. Eyes followed him around the room, the party moved to his rhythm, women turned into teenage girls, men into adoring young pups seeking patronage. Growing up, I watched my father cast his spell on thousands of people at our extravagant parties, musical gatherings and literary events. I was in awe of his performance.

Today, as my Facebook feed fills up with Father’s Day tributes, I wonder what this day would be like for us if he were alive. Would we do brunch together? Would we go for a walk and discuss the books we were reading, the politics that was on our minds? Would I ask for his advice on a difficult relationship or whether to buy a house? Would he ask me for advice on whether to sell his impractical gas guzzler in favor of a Tesla? Would we talk about life and death and all that’s in between?

Or perhaps we would not see each other at all. Perhaps we would pretend the other did not exist.

I can’t say.

My father died shortly after I turned twelve.

I cried for weeks, confused by the grief that was pouring out of me. I felt guilty because I had prayed for that very phone call that told us he had ceased to exist. I felt gutted even though I had gotten exactly what I had prayed for.

I recall the same inner conflict clenching at me as a kid every time someone told me I was just like my dad. I wanted to be just like him. He was powerful. He was in control. He was admired. He was invincible. At the same time, I loathed the idea of even being related to him. He was unpredictable. He was unfair. He was violent. He hated women. And he had the sinister discipline to only reveal this dimension of his personality to the people closest to him, the people that were bound to him through blood and dependency, the people that couldn’t escape.

In my early twenties, I figured I’d processed all that there was in this complex relationship. I had concluded that my dad was not a good person and therefore not a part of my mind or my heart. So imagine my surprise when I heard myself raging at a friend’s father who felt “bad” about me not having one and offering to be a “father figure” to me. I told him I was not in the market for substitutes and walked out of their home. How dare this motherfucker suggest he could replace my dad. Wait, what? Where is this anger coming from? Why get so prickly about an innocent offer of kindness, especially given how much I disliked my own father?

Because he’s my father. Un-substitutable. Irreplaceable. Irreplaceably mine.

A man of many faces, many moods, a brilliant yet unhinged intellect, deeply flawed, infinitely sensitive, and entirely worthy of my love. Over the decades, I have learned accounts of his quiet generosity, supporting family, friends and strangers with his wealth. I have heard how he was an inspiring professor. I have read his letters to my mother when they were in love.

Who was my father? Was any facet more true than the other? I don’t know and I can’t know. The trouble with posthumous relationships is that the conversation is entirely a monologue. No one ever answers back. Unlike the movies, there isn’t a tidy conclusion, so one must be fabricated. So here’s where I choose to let this conclude.

Mohammad Akmal set many lives on a higher path, much like my own. And he left deep scars. His truth lies in his complexity. His capacity to be whoever he wanted to be lives within me. We have chosen very different lives. We manifest in the world very differently.  But his song hums in my blood and I know that I am my father’s daughter.