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How do shuttling snowbirds handle their health care?

Photo by Nancy Conner
Minnesota snowbird Wade Dickey trims a flowering
bush he planted in his Florida back yard at the Villages,
his winter retreat.

This article is part of a yearlong, occasional series on late-in-life health care. The series is funded through a regrant by Allina Health from the Robina Foundation.

After his wife died, Wade Dickey bought a house in Florida. A native Minnesotan, he spends each spring and summer in his home in New Brighton. And every fall, he heads south for the winter.

Dickey is a seasoned snowbird. At 82, he makes the most of every day. Almost 20 years ago, he and his late wife, Bobbie, began splitting their time between the Twin Cities and a Florida retreat overlooking the gulf. "Even then, we knew the term 'snowbird,' " he said.

“Snowbird” has been a household word for several decades. But not much is known about them, State Demographer Susan Brower said. And Minnesota studies are 15 years old or more.

Snowbirds emerge as somewhat of a motley crew. They flee winter for a variety of inviting warm-weather communities, some designed just for them. Many pursue physical activity, enlightenment and new experiences in their 60s, 70s and 80s.

Considering that many people at that life stage experience significant health problems, the snowbird lifestyle poses a pressing question: How do people who potentially face a number of health issues tend their care while living in two places?

Those with chronic illnesses are advised to get a medical checkup before leaving home for an extended time and another checkup when they return, said Beth Wodrich, a registered nurse at Entira, a physician-owned network of medical clinics in the Twin Cities. And patients on a heart medication such as Coumadin must be regularly monitored to determine the appropriate dose.

For snowbirds away from home who have difficult health conditions, “It is a challenge to keep things together,” she said. 

Different definitions of care

"Minnesotans who head south in winter are likely to notice differences in health care between Minnesota and the southern states,” she said. “Health care is defined differently in different parts of the country.”  

Minnesota is considered to be at the forefront of health care, Wodrich said; Mayo Clinic and the University of Minnesota Medical Center have contributed to that high standard. Our state provides “a higher quality of care” than do many southern states, she said. Patients in Minnesota go through testing in “a certain cascade.” It starts, for example, with an X-ray before you get your MRI.

“If you go to the hospital with chest pain, you get the proven best standard of care,” she said.

'Best of both worlds'

By 1995, both Wade Dickey and his wife, Bobbie, had retired. He left his job after three decades as manager of the University of Minnesota’s student center on the St. Paul campus. Bobbie had worked in a health clinic there.

The couple had family ties in Florida, and for four months each winter, they rented a condo overlooking the Gulf. Bobbie wanted to live there the year around. Her husband said, “I think we’ve got the best of both worlds.” And the Dickeys continued making their annual round trip.

Almost 20 years later, Wade Dickey spends winters at The Villages, a planned community in central Florida north of Orlando. Like many similar communities geared to retirees, The Villages offers homes and apartments for sale or rent, along with recreational and educational opportunities, leisure activities and dining and entertainment options.  

St. Paulites Jerry Conner, a retired college professor, and his wife, Nancy, a retired journalist, have spent part of winter at The Villages for the last three years. They chose the community largely because their son and daughter-in-law live in a nearby Florida community. 

Courtesy of the Conner Family
St. Paulites Jerry and Nancy Conner chose The Villages largely because their son and daughter-in-law live in a nearby Florida community.

The Villages’ website promotes the community as “America’s Healthiest Hometown.” Its developer has created several medical clinics at the Villages and plans a hospital expansion to keep pace with its growing population.   

Many residents and visitors at The Villages are younger active retirees, Nancy Conner said. “Most people here want to play tennis, pickle ball and bocce ball.  We like the activities,” she said. She hustles to get a spot in a popular morning yoga class before it fills up. “I get up and go 45 minutes early, put my mat down and get to know some people,” she said.

A former classmate of Nancy’s and his wife were visiting the Conners at The Villages when the classmate’s wife needed an emergency appendectomy. “She had to wait several hours,” Nancy said. "If a problem comes up while you’re here, you probably need to have it taken care of. If you have a heart attack, you go to emergency.”

For snowbirds away from home who have an ongoing health problem, she said, “It’s an ongoing concern.”

Insurance issues

The Conners have sought health care at The Villages only once this winter. “Jerry had a sore leg and wanted to see if it was anything serious,” Nancy said. The first clinic they visited at the Villages wouldn’t accept their Blue Cross Blue Shield insurance. When they tried another clinic, there wasn’t a problem.

The pertinent lesson: Snowbirds planning to use health care away from home need to do their research and plan accordingly for their specific needs.

A common complaint about health insurance stems from terminology that’s unfamiliar to many policyholders.  When the information gets confusing, policyholders get frustrated. The task for snowbirds can be more complicated and require phone calls and longer waits for prescriptions when they’re away from their familiar turf.

Molly Bartscher, a longtime snowbird and registered nurse who lives in Woodbury, relates to frustration at times in “juggling our insurance,” she said.

More complex: two countries

The task is more complex for snowbirds who live part of the year in Mexico. Minneapolitans Larry and Norma Schuh have been spending six months in Puerto Vallarta for 18 years.

“We have a network of  wonderfully qualified and accessible physicians whom we can call on for our medical needs, including a cardiologist for my husband’s heart issues,” Norma said.  She and Larry “feel especially lucky,” she said, to have a bilingual nurse who serves as their patient advocate. She helps to connect them with the proper specialist and bridges the gap if there is one with respect to the language barrier between patient and provider.

Courtesy of Larry and Norma Schuh
Minneapolis snowbirds Larry and Norma Schuh captured this dramatic sunset from their deck in Puerto Vallarta.

The nurse also helps with translation of services and bills, “which we then try to have reimbursed through our state-side private insurance company,” Norma said.  “Though it is a long process, it has worked in most cases.”

They also have their own personal internist and cardiologist in Minnesota. “We keep records of treatment received in both places and make an effort to inform our doctors in both locations to assure that they are up-to-speed with what has transpired health-wise when not under their direct care or supervision,” she said.

They try to fill prescriptions stateside before leaving for Mexico, she said. “It is usually a hassle to get vacation overrides for amounts exceeding three months. But generally we have managed to make it work, although not without frustration.”

Dealing with the unexpected

A decade ago, Wade and Bobbie Dickey were relaxing in their rental apartment in Florida. They looked forward to celebrating the holidays there. They didn’t expect what was coming next.

Bobbie Dickey told her husband that she thought something was wrong with her. She couldn’t speak very well, she said. Back home again in Minnesota, she saw a neurologist at a University of Minnesota clinic, who said she’d had a small stroke. She had speech therapy from that time forward. An MRI showed she’d had a grand mal seizure. After more seizures, surgery and radiation treatments, the Dickeys were told she had six to nine months to live.

On the couple’s wedding anniversary in 2004, her husband arranged for hospice care in their home. He knew that would mean reliable around-the-clock care from skilled professionals.  He was glad to get them there, he said. “It was hard on me physically to move her around,” Wade said.  And it had been a 24-hour-a-day job to take care of her.

'It's hard to believe it's happening to you'

“I tried to keep hope alive for some kind of miracle,” he said. But no miracle appeared. Wade later placed Bobbie in a residential hospice in a bungalow on a lake in Robbinsdale. “She really didn’t have any pain,” he said. His wife died two months later. 

After 49 years of marriage, he said, “It’s hard to believe it’s happening to you.” It’s a foreshadowing of a scenario that many aging people will likely face as a patient or a caregiver.

Despite a blockage in an artery in his heart a year ago that called for inserting a stent, Wade said, “I really am quite healthy.” He bowls three times a week, plays basketball almost every day and shoots baskets for a half hour almost as often. He has some back problems that “are pretty much under control,” he said. 

He walks three miles four or five times a week, and is also known to take a shorter hike to a town square offering food, music, entertainment and movies. He weighs the same as he did in high school. “I think all that helps a lot," he said. "I try to eat a fairly low-fat diet. All you can do is hope for the best.”

He bought a house at The Villages and planted flowering bushes in the yard. “I like it there so much,” he said. “The people here are tremendously friendly. Wherever you go, people wave and smile at you. Even if they don’t know you. Over the years, I’ve made a lot of friends here. There are so many things to do.  And several hundred clubs. I feel very fortunate to do what I’m doing, even though I miss my wife tremendously.”

Left Texas early — and may end snowbird life

Molly and Louie Bartscher left their “winter Texan” retreat early this year after Louie’s doctor requested he return to Minnesota for a three-month appointment related to a health issue he has had. It was only a few weeks later when the doctor ordered him back to the Twin Cities for another appointment. Coming or going between those destinations, every leg of the car trip is 1,550 miles.

During their six months each year back at home in Woodbury, the Bartschers have made a point of getting together often with their large extended family in the Twin Cities. Shortly before going to Texas in the fall of 2013, they attended the bat mitzvah of granddaughter Julia. “We had the time of our lives,” Molly said. They realized how much they had missed their Minnesota family.

Some snowbirds quit being snowbirds, said Tom Gillaspy, longtime and now-retired state demographer.  

For the Bartschers, this might be the time. Their Texas home is for sale. While they may decide to rent a place and visit again, they think they might be ready to change their agenda. Louie would  be relieved, he said, to give up the complexity of owning a home in the south along with the one they own in Minnesota.

The couple has come to a new juncture in their lives. As for dealing with Minnesota winters, they know the territory. “We’re from here,” Molly said. 

This yearlong examination of issues faced by late-in-life patients and their families is conducted in conjunction with media partners Ampers and TPT, whose documentaries will focus on Minnesotans enrolled in a multiyear Allina study involving patients at this time of life. TPT's documentary "Late Life: Redefining Care" can be seen here.

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Comments (2)

Alzheimer's Care and Other Care Services in The Villages

Interesting story. That's going to be a lot of people who will have Alzheimer's and other chronic care needs in the "Healthiest Hometown in America." I'm just curious what options residents of a huge community like that have for long-term supportive services. Do they have home care where they can stay in their home or assisted living services in The Villages?

Good article - for as far as it goes

Having spent a lot of time out of the country, and being a patient in other countries, there are many issues that were not addressed or even hinted at here. For example:
- Medicare. If you are 65+, Medicare will cover you all over the U.S. However, your particular Advantage or Supplement plan may be very local, only in Minnesota. You'll need to check your policies. Medicare, however, does not offer any coverage outside the U.S. There, you will need to pay out of pocket for all care, and submit receipts for possible reimbursement. I'm not sure Medicare will reimburse for any care that is not a sudden injury or illness.
- If you're under 65, like myself, you will need to do a *lot* of research into the plan you choose. Some BCBS plans are national in coverage, some are even international, and some are local, for instance. Other plans, like uCare, Medica, HealthPartners, are only local and will not cover you in another state or country. I had to make dozens of phone calls and do hundreds of hours of research before I chose a plan.
- If you do snowbird out of the country, you may find that the local health care is very good and extremely inexpensive out of pocket. It pays to ask local friends and others for referrals; find the doctors and clinics you are likely to need before you go. Most other countries have health care costs that are completely transparent, and you can call and ask how much everything will cost. You can't do this for out of pocket health care in the U.S.

These are just a few musings about the subject.