Looking Beyond Retirement: Planning for the 4th Quarter

Many patients are faced with a challenging transition following retirement, and planning for this inevitable time in our lives is often overlooked. While most prepare financially for retirement, and many plan for the end of their life by filling out living wills, health care power of attorney paperwork, etc., little thought is often given to the other planning needs that arise in what is known as the 4th Quarter of our life; the time between retirement and death. Better planning and preparation for the 4th Quarter helps patients have more control and remain in their homes longer as medical conditions worsen. In addition, a study published in 2014 in Psychological Science, showed that having a sense of purpose could add years to your life. Retirement planning should begin early and be updated often. The following tips can help you stay active, involved, and fully enjoy your retirement:

Staying Healthy

  1. As long as approved by your physician, aim for 150 minutes of physical activity per week. A combination of aerobic, strength training, balance training (Tai Chi), and resistance training is best. Joining a gym is also a great way to make new friends. Exercise is associated with better physical and mental health and helps improve your memory!
  2. Limit screen time. Try substituting time spent in front of the TV or computer for a new hobby or interest.
  3. Follow a well-balanced, high fiber diet. The Mediterranean diet is excellent for your health and memory! Focus on eating more fruits, vegetables, olive oil, and fish; while limiting your intake of red meats and simple carbohydrates.
  4. Quit Smoking Now. It is never too late to see the health benefits of not smoking.
  5. Continue preventative health. See your primary care doctor regularly and make sure you are up-to-date on all recommended immunization and cancer screenings.
  6. Focus on your emotional health. Make time for yourself, work on stress management, and consider trying yoga or meditation, both of which have been shown to decrease stress and anxiety.

Being Financially Prepared

  1. Talk with a financial planner. Know your current assets and designate a financial power of attorney. Consider whether downsizing your home is right for you and your family.
  2. Consider when to take out your social security benefits. Taking benefits as soon as possible at age 62 locks in payments that are only 75 percent of what they would be at age 66. Delaying benefits until age 66 will raise them by 8 percent a year until age 70, after which benefits do not increase with age.
  3. Take advantage of senior perks. Discounts on meals, services, and shopping are frequently available.  Check out the AARP website for more ideas and ways to save.
  4. Review your health and insurance plans. Make sure your benefits are adequate. For help when applying for Medicare or for more help with understanding your benefits contact your local SHIP (Senior Health Insurance Program Counselor); a free service provided to help you and your loved ones understand Medicare and your benefits. You can find your local SHIP here: https://www.shiptacenter.org/
  5. Explore whether Long Term Care Insurance is right for you. Policies differ in coverage and cost, but some can provide coverage for hired caregivers, assisted living facilities, memory care facilities, and living in a nursing home.
  6. Know what Medicare covers. Medicare often covers outpatient physical/speech/occupational therapy (with limits on number of days per year covered), medical equipment (canes, wheelchairs, walkers, hospital beds-with a limited number of times covered and based on your diagnosis), rehabilitation in a skilled nursing facility (limited number of days covered after a qualifying hospital inpatient admission). For more information on coverage, check out http://www.medicare.gov/. Medicaid is the primary public funding source for nursing home care (44% of all U.S. nursing home costs). For more information, check out http://www.ssa.gov/planners/benefitcalculators.htm.
  7. Know what Medicare doesn’t cover. Hired caregivers, assisted living facilities, memory care units, living in a nursing home, and retirement community living are not covered by Medicare.

Exploring Interests and Hobbies

  1. Plan trips. If you enjoy traveling, now is the time, even if only locally.
  2. Volunteer. Become politically active, attend city council meetings, help at the local food pantry, library, hospital, nursing home, art or science museum.
  3. Continue your hobbies. You may need to modify them to fit your physical needs, but there is no reason to stop doing the things you enjoyed before you retired. Aim for having 3-4 hobbies to help keep your calendar full. Find and join groups with similar hobbies- your local library, parks and recreation departments, and senior centers are great resources; or join a “MeetUp” group that shares your interests. https://www.meetup.com/
  4. Socialize. Keep up with old friends and look for ways of making new ones. Spend time with family. Forming new connections with people helps to keep your mind stimulated and can improve your memory.
  5. Go back to class. Many colleges allow seniors to take classes for free. If you are homebound, try taking an online class.
  6. Play games. Look at senior centers, MeetUp groups, religious organizations, or online for bridge, chess, or other card game groups.

Navigating the Healthcare System

  1. Hospitalizations-Over 30% of patients over the age of 70 who were living independently before hospitalization, leave the hospital requiring assistance in at least 1 ADL (ability to bath, dress, eat, groom, go to the restroom on your own). For each day in the hospital it can often take several weeks for a patient to recover to their prehospital level of functioning. Rehab following your hospitalization can help to shorten this time period and help people regain prehospitalization function. In the unfortunate event you have to be hospitalized, knowing what your options for rehab include and what your preferences are can be extremely helpful.
  2. Rehab Terms and Options-Rehab often includes physical therapy, speech therapy, or occupational therapy; depending on your needs. This can be done in the following settings: Outpatient Therapy (you go to an outpatient gym for therapy), Home Therapy (therapist comes to your home if you are homebound-meaning it is hard to leave your home unless going out for religious services or doctor appointment), Acute rehab (done in a rehab hospital), or sub-acute rehab (done in a nursing home or skilled nursing facility, called a SNF).
  3. What is Covered and Involved in Rehab-Home based and outpatient therapy typically occurs 2-3 times per week for about 1 hour each session. A certain number of days each year are often covered by Medicare.  Acute rehab involves 3-5 hours of therapy per day and requires you staying in a rehab hospital. A certain number of days are often covered by Medicare if you have a qualifying hospital stay (at least 3 inpatients nights). Sub-acute rehab involves 1-3 hours of therapy per day and requires you staying in a nursing home or SNF. A certain number of days are often covered by Medicare if you have a qualifying hospital stay (at least 3 inpatients nights).
  4. Know Before You Go-Having an idea of which subacute rehab facility you would like to use is helpful. Medicare provides a helpful website that shows information about different facility near you with ratings from 1 (lowest) to 5 (highest) that can be found at: https://www.medicare.gov/nursinghomecompare/search.html?

Early Consideration of What Next Level Care Looks Like for You

  1. Know where you want to live. Begin to think about where you would like to live as you age. For some this is in their homes, for others it is living independently in a smaller home, and some prefer joining retirement communities, such as CCRCs (Continuing Care Retirement Communities). Explore your options to see what is best for you and your loved ones.
  2. Prepare for now for when next level care is needed. While the goal is always to age at home and live independently as long as possible, everyone should prepare for what next level care may look like for them. Do you want to stay in your home as long as possible and bring help in when needed, or do you prefer moving into a retirement community or assisted living facility, where the care is brought to you? Many resources are available that can help seniors who wish to stay in their homes as long as possible:
    1. The Home Care Association of America, which can help you find hired privately paid caregivers. http://www.hcaoa.org/
    2. Your area agency on aging; which can help with meals, transportation, activities, and more. In Charlotte: http://centralina.org/centralinaaging/
    3. The Village Network, a grass-roots organization, run by volunteers and paid staff to help seniors stay in their homes by helping to coordinate access to affordable services
      including transportation, inspiring health and wellness programs, home repairs, social and educational activities and trips http://www.charlottevillagenetwork.org/
    4. Some services available to older adults include Meals on Wheels, fuel assistance, caregiver support, respite, and transportation services. Find out what resources are available in your community by checking your local governmental listings or visiting http://www.eldercare.gov.

Everyone will have their own, unique, 4th Quarter, but knowledge and intentional preparation can ease the transition and allow you to enjoy the years to come.


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  2. Covinsky et al. Care of the Aging Patient. Hospitalization-Associated Disability “She Was Probably Able to Ambulate, but I’m Not Sure” JAMA, October 26, 2011—Vol 306, No. 16
  3. Lindquist et al. Advanced life events (ALEs) that impede aging-in-place among seniors. Arch Gerontol Geriatr. 2016 May-Jun;64:90-5. doi: 10.1016/j.archger.2016.01.004. Epub 2016 Jan 12.
  4. http://www.everydayhealth.com/news/how-live-purposeful-life-after-retirement/ Access date 9/7/16.
  5. http://www.wikihow.com/Enjoy-Life-After-Retirement Access date 9/7/16.
  6. http://money.usnews.com/money/blogs/the-best-life/2013/05/07/10-retirement-concerns-to-prepare-for Access date 9/7/16.
  7. https://www.apa.org/pi/aging/lifespan.pdf Access date 9/7/16.