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YOU R RoADMAP TO THE GooD LIFe

PALLIATIVE MEDICINE • AGING IN PLACE • FINANCIAL WELLNESS HEALTH CARE COMMUNITIES • CAREGIVING • CAREERS

CONTENTS PALLIAtIVe MeDICINe FoR SeRIouS ILLNeSS by Dr. Ira Mandel | 4 What is your palliative medicine IQ?

SPRING CHeCKuP by Thomas W. Duff & Joel M. West

| 6

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StAY SAFe WHILe You AGe IN PLACe by Kerri Watson-Blaisdell | 10 Many senior citizens have the goal of living at home as long as possible. Here are some tips on how to stay safe while enjoying life.

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It tAKeS A HeALtH CARe CoMMuNItY by Sarah Dubay | 12 A team approach to care transitions and reducing hospital readmissions.

WHAt’S NeXt? by Lori Parham | 14 Tips for reimagining your career, becoming a best employer, or starting your own business.

CoNCeRNS FoR CAReGIVeRS by Carol Higgins Taylor | 18 Balancing the care you give to others and the care you give to yourself is often a juggling act. Here are some things to watch out for and some suggestions on making life a little easier.

eASteRN AReA AGeNCY oN AGING’S MoSt FReQueNtLY ASKeD QueStIoNS | 21 Answers to the most often asked questions.

Route 55 is produced by metro Publishing, LLC. Cover photo © Catherine Yeulet/iStockphoto/Thinkstock.com

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Route 55 by Bangor Metro • 3

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By Dr. Ira Mandel Pen Bay Healthcare

4 • Route 55 by Bangor Metro

WHAt IS YouR PALLIAtIVe MeDICINe IQ?

rue or False? Palliative medicine and hospice care are two very different treatment approaches for people with serious conditions. Answer: False. The goal of palliative medicine for patients with serious illnesses is to improve patients’ every day quality of life and help patients feel better physically, psychologically, and emotionally. Palliative care helps them focus on doing things that are important to them, and allows them to use their time to their best advantage. Those who receive palliative medicine may live significantly longer than patients who receive standard treatments alone. Hospice covers the same services as palliative medicine, but includes additional services and supplies to help with the patient’s care. When the doctor thinks the pa-

tient’s condition may result in death within six months, and the patient no longer wants intensive medical treatment and simply wants to feel better and live life as they wish, hospice is a very helpful service. Hospice services include home visits by doctors, nurses, nursing assistants, social workers, chaplains and trained volunteers. Hospice services also cover the cost of some medications and equipment related to the hospice illness. True or False? Talking openly and honestly about approaching death and using hospice services should be avoided to prevent demoralizing patients and families. Answer: False. Hospice and palliative medicine care can maintain quality of life when cure is no longer possible. Many doctors and patients shy away from talking about

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Palliative Medicine for Serious Illness

it, often with the mistaken belief that discussing the truth will be depressing to the patient and not lead to anything positive. Ironically, the opposite is true. Having an open and honest discussion ultimately leads to less stress and better coping with the illness, with more time spent enjoying the life that remains, while avoiding additional treatments. Also, it has been proven that families have much less difficulty with grief if they have had open and honest conversations earlier in the patient’s illness. True or False? Hospice and palliative medicine focuses only on dying. Answer: False. Hospice and palliative medicine focus primarily on “living well.” While hospice and palliative medicine can help patients have a more peaceful death with much less suffering, the majority of the care is actually focused on living as well as possible. Hospice and palliative medicine’s primary goals are to ease symptoms of people with serious illness and to help them live their lives as fully and as long as possible. True or False? Hospice is provided in a specialized “hospice house.” Answer: False. Hospice is a service that is provided wherever the patient resides. It is most often provided in patients’ homes but may also be provided to nursing home residents and to patients requiring hospitalization. While some hospice organizations build and use “hospice houses” for some of their patients, this is usually reserved for patients whose symptoms cannot be managed in other settings. Pen Bay Healthcare is planning to construct a hospice house for the Midcoast community in the future.

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Ira Mandel, M.D., MPH is a palliative medicine physician and is the medical director of Pen Bay Healthcare’s Hospice and Palliative Care program. Route 55 by Bangor Metro • 5

Spring Checkup

By Thomas W. Duff, Branch Manager & Joel M. West, Financial Advisor, Duff & Associates

6 • Route 55 by Bangor Metro

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pring has arrived, and with it, the warmer weather brings a sense of relief after a long winter. But before you head out to enjoy another sunny season, think about conducting a springtime checkup on your personal finances, so you can fully enjoy the warm season with less worry. When was the last time you checked the beneficiaries of your IRAs, 401ks, and Life Insurance policies? As we rightly try to focus on long term investing, we often have these accounts and policies for many years, if not decades. Unfortunately, we also sometimes forget to make sure our beneficiaries are kept up-to-date with our changing life events. Have you experienced a marriage, divorce, or perhaps the death of a spouse or loved one? If so, did you remember to change the beneficiaries on your plans to reflect your current circum-

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Get YouR FINANCIAL ACCouNtS IN oRDeR NoW So tHAt You CAN HAVe A WoRRY-FRee SuMMeR.

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stances? We frequently find that beneficiaries have not been kept up-to-date with people’s changing life circumstances. You can imagine how financially devastating it could be to your current partner or loved one, if your nest egg were inadvertently left to a former spouse. Beyond the emotional trauma, the financial impact could dramatically change your surviving partner’s financial future, and there is likely little recourse they could take to keep the assets in their estate. Unfortunately, this sort of event happens nearly every day. The good news is, a pe-

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riodic check of your beneficiaries can prevent this and ensure that the transfer of your assets after your passing reflects your current life circumstances and wishes and protects the loved ones currently active in your life. In addition to making sure the beneficiaries of your current accounts and policies are up-to-date, it is just as important to make sure your other legal documents are current. When was the last time you reviewed or updated your Durable Power of Attorney, Advanced Health Care Directives, will, or trust documents? Do these documents name the people that you want to help you while you are alive but sick and/or unable to handle your affairs? Contemplating our own demise is never pleasant; as thus we frequently neglect processing necessary changes in our estate documents. This

inaction can have disastrous and irreversible effects on our surviving loved ones. If there is a need for change, consult with your legal professional as soon as possible. Consolidating accounts allows you, as the investor, an opportunity to have a more refined asset allocation in your portfolio. While past performance is never indicative of future results, we do know that a properly diversified portfolio reduces various investment risks and, over time, should better enable you to achieve your financial goals. With consolidation and working in conjunction with your investment professional, you should be able to develop a comprehensive plan that represents your current life circumstances and helps you achieve your financial goals. However, there may be even more advantages to consolidating

IRAs and employer sponsored retirement plans, such as 401ks and 403bs, etc. People over the age of 70.5 are typically required by the IRS to take a Required Minimum Distribution or RMD, from their Traditional IRAs and retirement investments every year. Failure to do so can result in substantial tax penalties. Consolidating these types of accounts can help to ensure you have an accurate accounting of all your qualified accounts, and have fully completed your entire RMD. Fulfilling the RMD requirement may help you avoid costly and aggravating penalties. There are times when it may not be in your best interest to consolidate accounts, particularly retirement accounts. There are many rules and choices governing the many types of retirement plans, so be sure to work with an investment professional to make an in-

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formed decision on what works best for you before taking any action. Simplicity in reviewing and tracking is one advantage to consolidating eligible accounts. Fewer statements from fewer providers generally means less paperwork that needs to be filed, as well as properly purged later, when they are no longer needed. In addition, having all of your investment information on one statement makes it easier for most investors at tax time. Another point to consider when consolidating accounts is lessening the burden, for the surviving spouse and heirs, of locating financial documents after one’s passing. Taking a few moments now to ensure your beneficiaries and agents accurately reflect your wishes and working to consolidate accounts should allow you to go out and enjoy warmer weather, knowing you’ve taken care of some very important financial matters.

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The information has been obtained from sources considered to be reliable, but we do not guarantee that the foregoing material is accurate or complete. Any information is not a complete summary or statement of all available data necessary for making an investment decision and does not constitute a recommendation. Any opinions are those of Thomas W. Duff and Joel M. West and not necessarily those of RJFS or Raymond James. Expressions of opinion are as of this date and are subject to change without notice. Past performance may not be indicative of future results. You should discuss any tax or legal matters with the appropriate professional. Duff and Associates, An Independent Firm, 470 N.Main St, Brewer, ME (207) 989-6082. Securities offered through Raymond James Financial Services, Inc. Member FINRA/SIPC.

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Mhat are you missing? s The punchline of a funny story? s Conversations at dinner? s The dialogue of a great movie? s The score of the Red Sox game? s Your partner’s bid at the card table? s Key points at meetings? s Details of your client’s order?

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veryone wants to feel safe in their own home, but for some, it can be difficult. Regardless of your age, sometimes health concerns can make you worry about your safety. Living in a very rural area without neighbors nearby can also be a cause for concern. “There are many things you can do to ease your fears,” says Nadine Lamoreau, family nurse practitioner at Fort Fairfield Health Center. “With these tips, you can reduce the risk of injury around your home and continue to feel safe while living independently.” Clear the floor Whether it’s your slippers or an extension cord, trip hazards are everywhere. Create a clutter-free floor, so that you can move about your home without tripping or slipping on something. This is extremely important if you have stairs! Do not set anything on the stairs—keep them completely clear and clean. Do not allow pets to be on the stairs with you, either, as they can get underfoot and cause you to lose your balance.

MANY SeNIoR CItIZeNS HAVe tHe GoAL oF LIVING At HoMe AS LoNG AS PoSSIBLe. HeRe ARe SoMe tIPS oN HoW to StAY SAFe WHILe eNJoYING LIFe. By Kerri Watson-Blaisdell, The Aroostook Medical Center

10 • Route 55 by Bangor Metro

Light it up We all want to save energy and reduce our electric bills, but be sure you can see where you’re going. A lower electric bill doesn’t mean much if you just broke your arm after you tripped on something you couldn’t see. Replace old bulbs with the new compact fluorescent light (CFL) bulbs to cut your electric bill and keep your home illuminated. Use LED nightlights in areas that

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Stay Safe While You Age in Place

It’s electric Take the time to inspect all outlets and cords in your home. Do not overload outlets, surge protectors, or extension cords. Overloading outlets increases the risk of electric shock, blowing a fuse, or even starting a fire.

need illumination at night, like hallways and bathrooms. Be prepared for power failure Getting a power outage kit together is another important safety tip, especially during the cold Maine winters. Keep flashlights in strategic places, like nightstands. That way, if the power goes out, you have quick access to a flashlight. If possible, keep ice ready in your freezer, in the event that a power outage lasts for more than a few hours. You can use the ice in a cooler to keep specific items from your refrigerator cold. Keep nonperishable goods in your cupboards in the case you’re unable to get to the store for a day or two. This is especially important in the winter, when Mother Nature can dump over a foot of snow on us at any moment. A cell phone or corded land line gives you access to emergency services if you need them: a cordless phone will not work when the power is out. “I’ve been a physician for several years in a rural community,” says Mary Coffin, family nurse practitioner at Fort Fairfield Health Center. “I treat patients who are accustomed to their independence, and I work to keep them independent for as long as possible. Sometimes it’s just a matter of reminding them of these simple tips.” “Staying healthy is also about staying safe,” Lamoreau says. “That message is important for young and old alike.” Remember that during the winter months it is important to keep walkways and external stairways clear and salted. In bad weather, if you don’t really need to drive anywhere, don’t. Keep yourself safe in your home and wait out the storm. Kerri Watson-Blaisdell is a communications specialist for The Aroostook Medical Center in Presque Isle. Route 55 by Bangor Metro • 11

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t 71, Sally, a type-1 diabetic and breast cancer survivor with chronic heart failure, has experienced every type of care transition possible. These included the ambulance rides from her home to her local hospital, the transfer to the large, tertiary care hospital, and the transfer to the rehabilitation facility. At each stop, there was a new set of faces and names to learn and to trust. All of these transitions can be stressful, as each one alters the routine and comfort of home—a new regimen of medications to learn, new treatment plans to adopt, and new follow-up appointments to schedule with specialists and primary care physician. Sally is lucky, as her family can help her manage these changes. Her husband, Paul, 75, is healthy and cognizant enough to follow the changes in prescriptions, make the appropriate phone calls to the insurance companies, and set up the necessary

12 • Route 55 by Bangor Metro

A teAM APPRoACH to CARe tRANSItIoNS AND ReDuCING HoSPItAL ReADMISSIoNS

home health care servicin five Medicare patients es needed—all the while discharged from a hostaking over the role of pital—approximately 2.6 homemaker, allowing his million seniors—is readwife to just focus on feelmitted within 30 days, at ing better. a cost of over $26 billion Sally’s story is similar every year. Even more to what many Maine seconcerning for patients niors face, but many of and their family memher friends and neighbers, is the fact that the By Sarah Dubay, PCHC bors lack the necessary third leading cause of support system to stay death in the United States out of the hospital once they return is due to hospital-related infections home. In Bangor, Penobscot Com- and complications. munity Health Care (PCHC) develDr. Larry Smith, medical director oped a system of geriatric focused for PCHC’s Community Care and primary care and care manage- Geriatrics, explains that the best soment, partnering with other health lution to reduce readmissions and care organizations, to coordinate keep seniors well is a team approach care and care transitions for pa- between primary care, hospitals, tients like Sally, and for those who nursing homes, home medical care, aren’t as lucky. and home health services—a comLike the ones Sally experienced, munity of health care providers all care transitions occur when a pa- working together focused on the tient moves from one health care specific needs of seniors. provider or setting to another. Ac“You’re talking about better cocording to the Centers for Medicare ordination of care once the patient and Medicaid Services, nearly one leaves the hospital,” Smith says. “Our

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It Takes a Health Care Community

model of care includes getting that patient back into their medical home, providing follow-up with home care services, and working with nursing homes to coordinate care.� “Bangor truly is a health care community,� says Kathryn Bragdon, RN, PCHC transitions care manager and clinical lead for care management. “It has been exciting to see area primary care practices, hospitals, nursing homes, and home health agencies, all work together to improve opportunities for patients to make gains after they leave the hospital. I’ve seen the very real difference that the team approach can make to people’s post-hospital care and their health.� This model for care has taken hold in primary care organizations and hospitals across the country. When a patient is discharged, someone from the care management team will call them within 48 hours of returning home. Patients are helped by a case manager or health coach over the phone, working to adapt to new medications or their treatment plan. Some providers these days are going back to making house calls, if their patients are too frail to see them in the office. “We have to care about what happens after a patient leaves the hospital or nursing home and take action before somebody has to go back in,� Bragdon says. “There is so much that happens to people after they leave, which really affects their health.� Smith agrees. “It’s about getting to know the patient and getting a feel for where they are going to be successful and where they might have barriers. The goal is to provide the right care, at the right time, in the right setting, to maximize our patients’ quality of life.� Sarah Dubay, M.Ed., MMEL, is the director of communications at Penobscot Community Health Care.

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What’s Next? tIPS FoR ReIMAGINING YouR CAReeR, BeCoMING A BeSt eMPLoYeR, oR StARtING YouR oWN BuSINeSS. By Lori Parham, AARP

14 • Route 55 by Bangor Metro

Photo: kali9/thinkstock.com

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eimagining Your Career In today’s challenging economy, many older employees are staying in the workforce longer than they had originally anticipated. Some find that they must defer retirement in order to boost their savings. Others, who have already retired, find they must return to the workforce or simply choose to do so, because they miss the interpersonal and intellectual engagement a job can bring. Still, other experienced workers are shifting the focus of their careers to explore new fields or to pursue a lifelong dream. Whatever path leads you to a job change or even just a job search, having the right tools to successfully achieve your goals can make the process much easier. In 2012, AARP launched an interactive tool called Work Reimagined to serve as a gateway to the resources one needs to get the right job. Work Reimagined is based on the online social networking model. The AARP website, located at www.workreimagined.org, uses the popular LinkedIn platform, which has more than 175 million users worldwide. By offering information on specific job opportunities, access to up-to-theminute job search information, and advice, Work Reimagined provides wonderful insights for experienced workers, which can make the difference in today’s job market. It is worth noting that most companies currently hiring are doing so through social media networking. If you are not using social media to find your next job, you may be missing out on the best opportunities. AARP’s Work Reimagined can help you get started and empower you to pursue your own goals and dreams. Many employers and recruiters already recognize the benefits of employing workers aged 50 or older. These employees are typi-

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cally loyal, maintain a strong work ethic, have lower rates of turnover and absenteeism, are dependable in crises, and are committed to quality work. Work Reimagined showcases employers who are not only hiring, but who value the skill set of experienced workers. Best Employers In addition to Work Reimagined, AARP is also committed to promoting the best practices of employers who use innovative techniques to recruit and retain a mature workforce. Now in its 11th year, AARP’s Best Employers for Workers Over 50 Award is a biennial recognition program for companies whose best practices and policies address the issues impacting our aging labor force, and who create roadmaps for the workplaces of tomorrow. Best Employers winners are ahead of the curve when it comes to recruiting and retaining experienced workers. In Maine, both LL Bean and Cianbro are past winners of the Best Employers award. If your company values an experienced workforce, go to www. aarp.org/bestemployers to find out more about how to apply in 2014. Encore Careers It may be surprising to know that almost 7.4 million Americans over the age of 50 work for themselves. Some self-starters are launching their own business because they were laid off and have not been able to regain a salaried or wage position. Others are starting their own business, because it is something they have always wanted to do. Still others want to give back to their communities, and so their businesses have a more social purpose. AARP is working with the Small Business Administration (SBA) to help these entrepreneurs by connecting them to small business development resources, including live workshops, conferences, and men-

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toring programs. We have also created an online resource to serve as a starting point for everything you may need as you think about your own entrepreneurial ideas. If you go to www.aarp.org/startabusiness, you will find tools for building the perfect marketing plan and tips for every aspect of starting your own business. Here in our state, businesses that want to maintain long-term

competitiveness should consider a commitment to building a multigenerational workforce. Through the development of policies and practices that attract, educate, and retain age-diverse employees, we can build a stronger economic future for Maine. Lori Parham is the AARP director for the state of Maine.

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BALANCING tHe CARe You GIVe to otHeRS AND tHe CARe You GIVe to YouRSeLF IS A JuGGLING ACt. HeRe ARe SoMe SuGGeStIoNS to MAKe LIFe A LIttLe eASIeR.

By Carol Higgins Taylor, EAAA 18 • Route 55 by Bangor Metro

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very day, as the population ages, more and more people find themselves in the role of “caregiver” for ill spouses, aging parents, other loved ones, or elderly friends. But what does the term “caregiver” really mean? One or more “yes” answers to the following questions can give insight into the definition of a caregiver. • Do you provide transportation to an older person, such as to medical appointments? • Do you prepare meals or grocery shop on a regular basis, in an attempt to ensure that that your loved one is eating properly?

• Do you help with housecleaning and laundry? • Do you assist with personal care, such as bathing and dressing? • Do you monitor medications to guarantee proper usage? • Are you handling paying their bills? These tasks may not seem like much, especially on an occasional basis, but over time, they can make a caregiver feel stretched pretty thin. For caregivers with children and jobs, caregiving duties added to the mix could be a recipe for burnout, which may result in health problems. While caring for a loved one can be enormously rewarding, it

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Concerns for Caregivers

can also take its toll. Seeing an ill or aging parent or spouse become increasingly dependent on outside help may give way to fear, anger, frustration, and subsequent guilt. Symptoms of depression or anxiety and a weakened immune system (meaning increased susceptibility to colds and flu) are a few of the stress-related conditions caregivers my esperience. Caregivers may also feel overwhelmed, may sleep too much or too little, feel tired most of the time, become easily irritated or angered, and feel constantly worried. Being aware of the potential problems associated with caregiv-

ing is the best way to prevent them. First, watch for the signs of burnout. If you’re unusually tired, cranky, quick- tempered, or overly emotional, it may be time to reach out and talk to someone about what you are going through. Support groups are a wonderful place to share these feelings and thoughts. “Meeting other caregivers can relieve your sense of isolation and will give you a chance to exchange

stories and ideas,” says Deb Poulton, director of family caregiver services at Eastern Area Agency on Aging. “By focusing on what you can do, you may be able to free yourself from some of the worrying about what you can’t do and then concentrate on being supportive and loving.” She advises caregivers to take care of themselves by eating nutritious foods and squeezing in some exercise. While this may seem like Route 55 by Bangor Metro • 19

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just one more thing heaped onto an already overflowing plate, if you are not strong and healthy, the parent or spouse for whom you are caring may suffer the consequences, Poulton says. “You cannot give to someone else what you don’t have yourself. Eighty-six percent of the caregivers we see at Eastern are between the ages of 60 and 84,� Poulton says. “They are seniors themselves and dealing with aging. Now is not the time for undue stress. If they don’t tend to their own needs, they won’t have the energy, strength, compassion, and endurance to see through the role of caregiving.� Secondly, don’t be afraid to ask for help. Often friends and family members are willing to pitch in but aren’t sure what to do. Making a list of things that need to be done provides others a good way to help and feel useful. Simple things, such as raking the leaves or walking the dog, can relieve some of the pressure. Above all, don’t feel guilty when you aren’t able to be the perfect caregiver, Poulton says. “All this does is increase guilt and stress. The likelihood is that you weren’t a perfect parent, either. No one is perfect so just do the best you can. Be grateful for the things you can do, and forgive yourself for the things you can’t.� Each Area Agency on Aging in Maine has a family caregiver program with specialists who spend their days working with individuals and families that have found themselves in a caregiver role. “From making referrals to advocacy to a weekly phone call ‘just to check in,’ these specialists tailor the program to suit the individual,� Poulton says. And a little help can go a long way. Carol Higgins Taylor is the director of communications at Eastern Area Agency on Aging.

Eastern Area Agency on Aging

Frequently Asked Questions: How do I receive homemaker services in my home?

Photo: digital vision/thinkstock.com

People should contact their healthcare providers and ask if they are eligible for a Goold assessment to determine what level of care they require. There is currently a waiting list, but EAAA has lists available of the home services that charge an hourly fee paid through a private agency/person.

Are there any programs that will help me pay for my prescription drugs? There are several options, including Medicare Savings Program (MSP), MaineCare, Low Cost Drugs for the Elderly (DEL), or Maine Rx Plus. These are income-based.

Are there any programs that will help me pay for my Medicare?

The Medicare Savings Program helps pay for Part B premiums. This is income- based.

I am turning 65 in several months. What am I supposed to do? EAAA offers Medicare 101 seminars that educate people about senior benefits and provides them with information about Medicare prescription drug plans, Medicare Advantage, and Medigap or other supplementary Route 55 by Bangor Metro • 21

we offer a

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insurance plans. Seniors can also log on to www .medicare.gov.

My 90-year-old parents live in their own home but are no longer able to care for their home or each other. I am not able to give them the help they need. What can I do? EAAA has a Family Caregiver Services program that specializes in working with caregivers. This program provides support, education, referrals, and information on community services.

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What is assisted living and where can I get information about what is available? The Assisted Living Federation of America defines assisted living as a long-term care option that combines housing, support services, and health care, as needed. As-

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Can I get help with transportation if I am unable to drive? Eastern Area Agency on Aging has programs for transportation to medical appointments. Calling 211 can put seniors in touch with other resources.

How Confident Are You about

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sisted living is designed for individuals who require assistance with everyday activities such as meals, medication management, bathing, dressing, and/or transportation. Some residents may have memory disorders, including Alzheimer’s, or they may need help with mobility, incontinence, or other challenges. Residents are assessed upon movein, or anytime there is a change in condition. The assessment is used to develop an Individualized Service Plan. For questions specific to Maine assisted living information, visit www.maine.gov.

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