A nurse fits a blood pressure monitor on a senior woman at a kitchen table

One of the challenges of obtaining home health care for seniors is its cost, which is often beyond the means of people and their families. The cost barrier is especially true of aides hired through private home health agencies, which is often considerably more expensive than hiring an aide directly. On my Risking Old Age in America podcast, I recently talked with Wendy Adlerstein, co-owner of First Light Home Care in west suburban Boston, about the benefits of hiring assistance through an agency and what goes into the extra cost. She also calls for statewide licensure of home health agencies to make sure they all provide what they promise. Here are some extracts from our discussion: Risking Old Age in America…

Little girl with her parents sitting on sofa and putting coin in

Last year’s tax bill created a new savings vehicle that starts as early as birth – the Trump account. While these accounts resemble IRAs in some ways, they offer distinct contribution rules, investment limits, and distribution provisions. Like other tax-advantaged accounts – IRAs, Roth IRAs, and 529 plans – Trump accounts come with important nuances. What follows is a concise overview of how they work and what families should consider for their children. The “Growth Period” Trump accounts are expected to be available beginning in July 2026. According to IRS guidance, the accounts can be set up through IRS Form 4547 or an online application at trumpaccounts.gov. A defining feature of the Trump account is the “growth period,” which begins…

How Much Will Your Long-Term Care Needs Cost? It Depends on How Average You Are

The consulting firm Milliman recently published its 2025 Long-Term Care Index, calculating that – on average – 65-year-olds should set aside $135,000 for their future high-intensity long-term care needs. Great Variability While an average figure can be a helpful anchor point, Milliman’s estimates show substantial variability based on gender, location, and health status, among other factors. For instance, the average cost for women is $171,000 and that for men is $98,000, largely because women live longer. As a result, they may need care for a longer period of time and are less likely to have a spouse available to assist them at no cost. According to Milliman, almost half of men and four out of ten women will need no paid care at…

March 5, 2026

Stop Me Before I Open Another Account!

Reducing the number of your accounts can provide a clearer view of your overall financial picture, supporting greater confidence and control. Hello, I’m Luke, and I’m addicted to credit card points. I have one credit card for groceries, another for restaurants, one for gas, and a fourth for everything else. This behavior is normal, according to data from Experian, which has found that the average American has four active credit cards. But this collection of credit cards probably consumes more of my brainpower than it’s worth. Having multiple bank accounts is common as well. I have clients who came to me with a dozen accounts spread across multiple banks. Primary checking, primary savings, money market, CDs, an account for t…

February 19, 2026

Medicaid Coverage of Home Health Care is Growing: But Will the Trend Last?

Most seniors want to stay in their own homes when and if they need care. In response to this desire and the generally lower cost of home health and assisted living services compared to nursing home care, Medicaid has expanded its coverage of home-and-community-based services (HCBS) over time. According to the Centers for Medicare & Medicaid Services, in 2023, 8.4 million Medicaid beneficiaries received assistance paying for care at home or in assisted living facilities – a substantial increase of 8 percent from 7.8 million in 2022. In comparison, 1.5 million beneficiaries received institutional care – mostly in nursing homes – a more modest 3-percent increase over 2022. However, the overall costs for institutional services grew by 17 percent compared to…

February 5, 2026

New Tax Break for Seniors

Part of the recently passed tax bill includes what the administration is calling “No Tax on Social Security.” The bill does not directly remove taxes on Social Security payments, but it does provide an additional deduction for seniors under certain income limits. This provision may effectively reduce – or, in some cases, even eliminate – federal taxes paid by people ages 65+. First of all, it should be noted that this tax break worsens the tenuous fiscal condition of Social Security. Social Security actuaries estimate that the new tax provisions will move up the trust fund depletion date by roughly six months – from the 3rd quarter to the 1st quarter of 2034. Nevertheless, current beneficiaries will see the benefits…

January 22, 2026

Family Caregivers: How Many and Who Are They?

Two recent reports on family caregivers capture the size and nature of caregiving activity. In terms of the number of people caring for adult family members, the reports — the first from the Bureau of Labor Statistics (BLS); and the second from the National Alliance for Caregiving (NAC) and AARP — peg the figure at 38 million and 59 million, respectively.  It’s a big range, but the main reasons for the difference are simply that the BLS includes only unpaid family caregivers for older Americans while the NAC and AARP figure covers all family caregivers (unpaid and paid) for adults of all ages. BLS Results The BLS finds that, in 2023 and 2024, 14 percent of Americans ages 15+ were providing some form of unpaid…

January 8, 2026

Aging Event Highlights Ways to Improve Senior Care Worldwide

I recently attended the joint Leading Age and Global Ageing Network conference in Boston. Leading Age is the trade association of the nonprofit elder care providers, covering senior care facilities and home health. The Global Ageing Network (based in Britain) promotes the sharing of ideas and experiences among elder service providers internationally. The event – titled “The Power of Purpose: Creating Ripples of Change” – attracted more than 6,000 people from around the world to learn how they can improve the lives of seniors and people with disabilities in their care. The attendees participated in dozens of breakout sessions, most of which addressed the nitty gritty of running an elder care facility or program. The exhibit hall was overwhelming with over 100 vendors hawking…

December 18, 2025

Preventing Cyber Scams that Target Seniors

“Your Microsoft account has been compomised [sic]. Click this link to reset your connecton [sic].” Does this message look familiar, typos and all? We’ve all seen suspicious emails or calls attempting to steal personal information. One unfortunate drawback of our tech-enabled world is that scams are increasingly common. According to the FBI’s Internet Crime Complaint Center, people ages 60+ submitted more than 140,000 complaints and reported nearly $5 billion in direct losses in 2024. Sadly, most estimates suggest that unreported costs from scams and fraud are much higher. Despite growing awareness of fraudsters, the numbers have been steadily trending upward. As a financial advisor, I undergo annual cybersecurity training and weekly lessons on common scams and cybersecurity threats in order…

December 4, 2025

Study Finds High Level of Inequality Among Older Massachusetts Residents

In a recent podcast, I talk with Laura D. Quinby of the Center for Retirement Research at Boston College (CRR) and Luc Schuster of Boston Indicators  about their study Wealth Gaps in the Golden Years: Economic Insecurity for Older Adults in a High-Cost State. They examined economic insecurity for older adults in Massachusetts through both quantitative analysis carried out by the CRR and focus groups with low-income seniors conducted by Boston Indicators. The Data It’s no surprise that Massachusetts seniors typically have more wealth than the national average, but it’s also more unevenly distributed than in most states – the top third holds over $3.5 million on average while the bottom third has just over $50,000. A large part of the wealth inequality comes from…

November 20, 2025

The Fed, Mortgage Rates, and Home Prices

I recently spoke with a couple who wants to sell their home. Their realtor told them the market was a little soft but added that interest rates were likely to come down this year. The suggestion was that falling rates would boost home prices. That’s a common assumption, but it left me wondering whether it is always true. Two key questions here are worth asking. First, do mortgage rates always go down when the Federal Reserve cuts interest rates? And second, even if mortgage rates decline, should we expect home values to rise as a result? To help answer these questions, I spoke with Eric Steuernagle, owner of Fairground Real Estate in Great Barrington (MA) and a housing expert. I…

November 6, 2025