Mature Lifestyles - January 2018

MATURE

Lifestyles January 2018

a special publication by

2 - Mature Lifestyles - January, 2018 - TheIntelligencer.com

Trips to the ER often the tipping point for elder health

By JUDITH GRAHAM Kaiser Health News

Twice a day, the 86-year-old man went for long walks and visited with neighbors along the way. Then, one afternoon he fell while mowing his lawn. In the emergency room, doctors diagnosed a break in his upper arm and put him in a sling.

Back at home, this former World War II Navy pilot found it hard to manage on his own but stubbornly declined help. Soon overwhelmed, he didn’t go out often, his congestive heart failure worsened, and he ended up in a nursing home a year later, where he eventually passed away.

“Just because someone in their 70s or 80s isn’t admitted to a hospital doesn’t mean that everything is fine,” said Dr. Timothy Platt-Mills, co-director of geriatric emergency medicine at the University of North Carolina School of Medicine, who recounted the story of his former neighbor in Chapel Hill.

Quite the contrary: An older person’s trip to the ER often signals a serious health challenge and should serve as a wake-up call for caregivers and relatives.

Research published last year in the Annals of Emergency Medicine underscores the risks. Six months after visiting the ER, seniors were 14 percent more likely to have acquired a disability — an inability to independently bathe, dress, climb down a flight of stairs, shop, manage finances or carry a package, for instance — than older adults of the same age, with a similar illness, who didn’t end up in the ER. These older adults weren’t admitted to the hospital from the ER; they returned home after their visits, as do about two-thirds of seniors who go to ERs, nationally.

The takeaway: Illnesses or injuries that lead to ER visits can initiate “a fairly vulnerable period of time for older persons” and “we should consider new initiatives to address patients’ care needs and challenges after such

visits,” said one of the study’s coauthors, Dr. Thomas Gill, a professor of medicine (geriatrics), epidemiology and investigative medicine at Yale University.

Research by Dr. Cynthia Brown, a professor and division director of gerontology, geriatrics and palliative care at the University of Alabama at Birmingham, confirms this vulnerability. In a 2016 report, she found sharp declines in older adults’ “life-space mobility” (the extent to which they get up and about and out of the house) after an emergency room visit, which lasted for at least a year without full recovery.

“We know that when people have a decline of this sort, it’s associated with a lot of bad outcomes — a poorer quality of life, nursing home placement and mortality,” Brown said.

Other research suggests that seniors who are struggling with self-care (bathing, dressing, toileting, transferring from the bed to a chair) or with activities such as cooking, cleaning and managing medications are especially vulnerable to the aftereffects of an ER visit.

Why would seeking help in an ER often become a sentinel event, with potential adverse consequences for older adults?

Experts offer various suggestions: Seniors who were previously coping adequately may be tipped into an “I can’t handle this any longer” state by an injury or the exacerbation of a chronic illness, such as diabetes or heart failure. They now may need more help at home than what’s available, and their health may spiral downward.

Other possibilities: Seniors who fall and injure themselves — a leading cause of ER visits — may become afraid of falling again and limit their activities, leading to deterioration. Or, underlying vulnerabilities that led to an ER visit — for instance, depression, dementia or delirium (a state of acute, sudden onset confusion and disorientation) — may go undetected and

unaddressed by emergency room staff, leaving older adults susceptible to the ongoing impact of these conditions.

In response to concerns about the care older adults are receiving, the field of emergency medicine has endorsed guidelines designed to make ERs more senior-friendly. With the rapid expansion of the aging population, which accounts for more than 20 million ER visits each year, “our traditional model of emergency medicine has to shift its paradigm,” said Dr. Christopher Carpenter, associate professor of emergency medicine at Washington University School of Medicine in St. Louis.

The guidelines call for educating medical staff in the principles and practice of geriatric care; assessing seniors to determine their degree of risk; screening older adults deemed at risk for cognitive concerns, falls and functional limitations; performing a comprehensive medication review; making referrals to community resources such as Meals on Wheels; and supplying an easily understood discharge plan.

Starting in January, the American College of Emergency Physicians (ACEP) is launching an accreditation program for emergency rooms, certifying at least a minimal level of geriatric competence — another effort to improve care and outcomes for older adults. Three levels of accreditation — basic, intermediate and advanced — will be offered.

For each of these levels, ERs will be required to provide walkers, canes, food and drink, and reading glasses to older patients. For intermediate and advanced accreditation, physicians will have to oversee improvement initiatives, such as limiting the use of urinary catheters in older patients. Also, changes to the ER environment such as nonslip floors and enhanced lighting will be required, along with amenities such as hearing devices, thicker mattresses and warm blankets.

Family members can also help older adults during and after a visit to the

ER. “My biggest piece of advice is get there and stay by their side throughout the experience, because things happen very quickly in emergency rooms, and these are difficult environments to navigate under the best of circumstances,” said Dr. Kathleen Unroe, associate professor of medicine at Indiana University School of Medicine.

Dr. Kevin Biese, chair of the board of governors for ACEP’s geriatric ER accreditation initiative, offers these recommendations: Escape the crowd. “Ask for a room, instead of letting your loved one stay out in the hallway — a horrible place for seniors at risk of delirium. Tell staff, who may have put Mom in the hallway because she’s a fall risk and they want to keep an eye on her, ‘I’ll watch Mom and make sure she doesn’t get out of bed.’” Supply a full list of medications. “And ask the doctor or nurse to make sure that your list is the same as what’s in [the hospital’s] computer. If not, have them update the computer list. Don’t leave without knowing which medications have been stopped or changed, if any, and why.”

Focus on comfort. “Bring eyeglasses and any hearing-assist devices that can help keep your loved one oriented. If you think Mom is in pain, encourage her pain to be treated.” Educate yourself. “Know what happened in the ER. What tests were done? What diagnoses did the staff arrive at? What treatments were given? What kind of follow-up is being recommended?” Communicate effectively. “Utilize teach-back. When the nurse or doctor says, ‘OK, you’re supposed to do this when you get back home,’ say, ‘Let me see if I understand.

I hear you say take this medication on this schedule. Did I get that right?’”

Follow through. “Ask ‘How is Mom’s regular doctor going to know what happened here? Who’s responsible for telling him — do you make that call or do I? And how soon should we try to get in for a follow-up appointment?’”

Keep tabs on your loved one.

TheIntelligencer.com - January, 2018 - Mature Lifestyles - 3

Daughter puts here life on hold for elderly parent

By DAN D’AMBROSIO Burlington Free Press

BENSON, Vt. (AP) — Millie Coursey is eating lunch at the breakfast bar in her daughter’s kitchen.

She polishes off a yogurt mixed with trazodone — an anti-anxiety medication — and moves on to a small container of spaghetti with tomato sauce.

Coursey, 90, has Alzheimer’s disease. Her daughter, Lauren Mohan, said Coursey receives trazodone three times a day.

“It keeps her at a nice even keel,” Mohan said.

“When it starts to wear down, you notice it. Her personality is angry. She’s a little grumpy today.”

Two years ago, Mohan quit her job at The Lodge at Otter Creek, a senior living community in Middlebury, in anticipation of taking care of her mother full-time at home. She gave up a salary of $46,000 annually.

There are an estimated 30,000 Vermonters providing unpaid care to loved ones with Alzheimer’s and dementia.

Mohan was resident service director at Otter Creek for five years. She previously worked at Middlebury College for 13 years, and together with her husband, owned a convenience store in Forest Dale after leaving Middlebury College. Mohan has worked all her life but felt she had to give up her career for her mother.

“I wanted to do it,” she said. “It was something that in my heart I felt was the right thing to do.”

After leaving The Lodge at Otter Creek, Mohan went to work full time for a small telephone company in nearby Shoreham called OTT Communications, making $13 per hour. Mohan took a three-month family medical leave from the job to get her mother settled into her house in Benson.

“After I got my mom here I realized there was no way I could go back full time because of her needs,” Mohan said. “I ended up asking if I could come back part time until the situation possibly changed, and they flatly refused me.”

Respondents said their supervisors were often unsympathetic when it came to balancing work and caregiving. Others cited a stigma associated with the topic, leaving many feeling uncomfortable discussing the issue with employers.

Mohan said she has had a couple of offers for parttime jobs but didn’t feel she could accept them.

“It’s just too much to juggle the job with the caregiving part,” Mohan said. “I think it would have been too stressful for mom and myself to try to balance the job and visiting nurses. We chose not to do

it, so we’re cutting back and riding it out.”

The Home Instead study found many women feel forced to give up their careers, often around the age of 50, to care for an aging parent. Mohan is 58.

The study also showed that women are twice as likely as men to spend more than 30 hours a week on caregiving. Home Instead Inc. surveyed 1,001 working female caregivers, aged 45-60, in the United States and Canada in March, 2017.

According to the Society for Human Resource Management, working female caregivers average nearly double the amount of time caring for aging loved ones, compared to male counterparts — 9.1 hours a week vs. 5.7 hours.

Mohan talked to her husband about quitting her job after her mother spent a month in a nursing home while Mohan and her sisters tried to figure out how to deal with the disease that had changed their mother’s life.

“It was like a revelation,” Mohan remembered. “I said, ‘This has got to happen. I want to quit my job. I want her here. This is going to be my life for a while.

There’s no other choices. Are you OK with us doing this?’”

Mohan’s husband said he was, if that’s what she wanted.

“He’s been a saint, even though I get angry with him sometimes,” Mohan said. “He’s been very supportive. I couldn’t do this without him.”

Coursey has a small, sun-filled room just off the living room in Mohan’s modest home. On the walls of Coursey’s room are photos of her and her husband, and another of her and her sister when they were little girls in the 1930s.

“We had to hang up the pictures because she will take clothes or a plastic bag, gather her photos and put them in there, ready to go home,” Mohan said.

“That breaks my heart, but I don’t take it personally.”

The first step Mohan and her sisters had to take, once it became apparent their mother was suffering from dementia, was to go to court to have her declared incompetent.

Physically, Coursey is in excellent shape for a 90-year-old, Mohan says. Mohan has to keep the doors locked.

“Her dementia is so severe she has what’s called a wandering risk, which means she has to be in a locked facility, because she will wander off and get lost,” Mohan said.

“She wants to run away, no matter where she is,” she said. “We’re kind of shut-ins. I take her out every day to go for walks around the yard.”

Coursey tried to climb a wooden fence and escape during her brief stay at a nursing home. Mohan says her mother has a “violent nature” without medication.

“It’s all part of the dementia,” she said. “It’s a terrible disease.”

Mohan butters a piece of bread and slides it toward her mother, who has finished her spaghetti. Coursey pushes the bread away.

Coursey sits silently, munching on a star-shaped cookie. Mohan says her mother often calls her the “boss,” in what is probably not a term of endearment.

The mother she knew is gone, Mohan said, but every once in a while, there are glimpses. Like after Mohan had been shoveling snow and came back inside for a break.

Mohan’s mother came up to her and put her hands on her cold, red cheeks.

“She said, ‘Oh thank you, you did such a good job,’” Mohan remembered. “I’m like, ‘Who’s this woman?’” Mohan remembered, laughing. “Those are the kinds of things you let go of. You have to recognize who she is now. She’s a different person now.”

Mohan and her husband had planned to sell their house in Benson and move to Bristol to be near their daughter and grandchildren. They also wanted to buy a home with two bathrooms to better accommodate Coursey’s needs. Their house was still on the market last month but the prospects of moving are dim.

“Unfortunately there’s a possibility we’re going to take it off this month, just because the dynamics of having my mom here has affected our income,” Mohan said. “We’re having a tough time trying to obtain a loan for a new home.”

The bank can only take her husband’s income into account for a loan, Mohan said, and the amount they could get would not buy a “large enough, nice enough house.”

Mohan has not looked into whether any assistance is available from the state, but she said her sister, who is her mother’s guardian, is paying her the same wage she was making at OTT Communications — $13 per hour — for a 40-hour week as a caregiver.

The money is coming for their mother’s estate.

“So we’re managing to squeak by,” Mohan said.

“We’re not destitute. I know how to manage money.

It’s tight, but you do what you have to do.”

Mohan and her husband have also had to put off travel plans. But she said she has no regrets.

Especially when she sees her mother smile.

4 - Mature Lifestyles - January, 2018 - TheIntelligencer.com

TheIntelligencer.com - January, 2018 - Mature Lifestyles - 5

92-year-old man has delivered meals to needy for last 20 years

By ELYSIA CONNER Casper Star-Tribune

CASPER, Wyo. (AP) — Elmer Hoke took his time walking across the icy parking lot.

Hoke, 92, carried a disposable tray holding hot pot roast, mashed potatoes and vegetables. A plastic bag dangling from his fingers contained fruit, milk and other food. He gripped a rail with the other hand and walked up the snow-covered steps.

The meal was destined for a man who lived at the top of three flights of stairs. Hoke walked up those stairs and placed the food in a cooler outside the door.

Outside of another apartment, a man stepped out of a doorway as Hoke eased his white Dodge sedan into the parking lot.

“I’ll be darned, I didn’t think they were going to be around today,” the man said, smiling. Hoke handed the packages through the car window to a woman, who passed them to the man.

“We fooled you!” Hoke called, grinning back.

The World War II Veteran has volunteered as a driver for Meals on Wheels of Natrona County for about 20 years. He drives every weekday, and logs the most days a year among the volunteers, Meals on Wheels volunteer coordinator Debbie Cardinal said.

He’s always liked to stay busy, he said, and enjoys the people he meets on deliveries and fellow volunteers.

“And I get a lot of satisfaction out of it. You’re bound to,” he said. “You’re out and around, why sit home and look at four walls?”

HELPING OTHERS Hoke wore a light jacket and high-top leather shoes with thick tread as he delivered food to 10 recipients on a recent Thursday afternoon.

He volunteers at Meals on Wheels every weekday as a substitute driver for those who can’t make it in.

The Casper native’s route for the day made a loop through a neighborhood off the Old Yellowstone Highway. Decades ago, the road was the main route

to Yellowstone National Park, he said. At one delivery, he noted an apartment building that once was one of many motels lining the route through Casper.

Then came the four-lane interstate.

He pointed a few blocks west down Old Yellowstone to the former Sandbar district, once infamous for its flourishing brothels. He’d helped at a friend’s liquor store there, where clientele included prostitutes.

“Besides the rassel houses, they had apartments, bars, cafes,” he added. One cafe had the best green chili in town, and an eatery called Fanny Bells served its signature fried chicken until the wee hours, he recalled.

Hoke was born in a two story house that used to be a hospital. His six siblings were all born at home.

His parents had emigrated from Germany, and his father worked for the Burlington Railroad. He died of cancer when Hoke was 10.

Hoke started working at a young age to help support the family, and he joined the U.S. Navy during World War II before graduating high school. He

6 - Mature Lifestyles - January, 2018 - TheIntelligencer.com

For the Intelligencer

Cambridge House resident John Mars.

Cambridge House resident keeps busy with projects

By KIM ZAKRZEWSKI Marketing Director

John Mars has always had a keen eye for design.

With nearly 20 years of sales experience, a degree of Fine Arts, and a spectacular singing voice, he approaches every task with the sense of a true artist.

His family members also share in those artistic abilities, as Mars’s niece Laurie Metcalf is a four-time Tony Award nominee for her work on Broadway.

Metcalf most recently won the Tony Award for Best Actress in a Play in 2017 for her role in A Doll’s House, Part 2.

Mars, 87, has been a resident at the Cambridge House of Maryville since January of 2016. Some of his afternoons are spent serenading the other residents during his “Sinatra performances”. He enjoys the classics like, “Fly Me to the Moon”, and “I’ve Got

You Under my Skin”.

In August, the U.S. Navy Veteran became determined to design a new set of signage for the Supportive Living Community that he calls home.

Working with the community’s Marketing Director & Administrator, he quickly worked up multiple designs that were pitched to the corporate level of management.

“If you like a fun place to live, and something busy and exciting, then Cambridge House of Maryville is a place for you. This is a place where you can really enjoy life. The reason we decided to create a design was that there was an older outdated sign, and it really needed a more creative approach.”

The signage can be seen alongside Route 162 in Maryville as motorists pass the three-story senior apartment building.

“I think it’s important to work together with our

residents on project such as this one,” explained Administrator Kendra Garnto. “Mr. Mars is always looking for new ways to make our community better for our residents, and with the new signage I know we will start reaching more and more families so we can inform them about who we are.”

“It feels good to have the signs up. I’ve been in sales all my life, and I am a creative person. This was a chance to put my mind to use and with the opportunity there I just took it.”

The Cambridge House offers the Supportive Living Program, which is available in Illinois to seniors 65 & older who need help maintaining their independence regardless of their financial resources.

The community is located at 6960 State Route 162 in Maryville. For additional information, visit www. cambridgehouse-maryville-slf.com or call 618-2882211.

TheIntelligencer.com - January, 2018 - Mature Lifestyles - 7

Benefits of strength training and staying functional

By CHAD CAMPBELL Functional Fitness Images

There are many benefits to staying functional and being strong enough to do everyday activities. Working out doesn’t always have to consists of heavy weights and exten-

sive hours in a gym. At Functional Fitness Images we offer a variety of training for all ages.

Age is nothing but a number.

You can get all the fitness you need using body weight and proper form with exercises. We offer suspension training which is done with straps

suspended from the wall. This is all bodyweight oriented geared towards a low-impact workout that is beneficial for your tendons and joints.

Also, as we age stretching is very important before and after exercise.

Even if you work at a seated or

stationary position it is still a good idea to stretch every few hours.

Hopefully, you find this information helpful and we hope to see you soon at Functional Fitness Images located at 2712 Corner Court Alton, IL. Contact Campbell at 618-365-1427.

When to make end-of-life care decisions

By KRISTEN MCCONNELL Los Angeles Times Modern medicine has developed the God-like power to stabilize the vital signs that spiral out of control as a person approaches death, and to then keep that person alive despite their inability to breathe, eat or drink. It wields this power liberally.

But the American healthcare system never taught the public that preventing a natural death often results in a wholly unnatural life.

As an ICU nurse, I am haunted by memories of patients who were stabilized in intensive care so that their catastrophic injuries or diseases did not kill them, but who were left unable to communicate or do anything but receive medical care.

I think of a young woman whose family was so torn apart over whether to take her off life support after a hemorrhagic stroke left her comatose that by the time she died of a complication, weeks later, nobody came to be by her side.

When she was first admitted to the hospital, her family crowded her room. But when she didn’t get better, they

drifted away. She stayed, her flesh peachy after weeks of tube feeding, though speckled with the tiny bruises of bloodthinning heparin shots.

She died of a perforated bowel leaking fecal matter into her abdomen and causing sepsis. Her family had declined emergency surgery over the telephone, giving permission for her to die. At the very end, there was only a nurse, dialing up morphine as the patient’s organs failed.

I can only imagine the immense suffering her family endured, and I know that every time they were asked for a decision regarding her care, they tried to make the right one.

But I wonder: If what was left of the girl in the hospital wasn’t enough to come say goodbye to, if she was too far gone to hold hands with as she drew her last breaths, why was she still there?

I also think of an elderly patient with a history of strokes and dementia who was brought to the emergency department after another large stroke. He was already completely immobile, dependent on care and unable to communicate. His breathing was

inadequate and his heart went into a dangerous rhythm — dangerous if the goal is to stay alive. He was intubated and taken to the ICU. The poor man was awake.

He would occasionally squeeze a hand when asked to, but he never responded to questions. Because there was no fear of him pulling out his breathing tube, he was on minimal sedation, getting drugs only when he breathed rapidly or started “bugging out his eyes,” as one nurse put it. Aside from a list of diagnoses and meds, there was little information in his history, and no family contacts.

When asked directly by the ICU, the patient’s case manager and his general physician both refused to serve as his proxy and would not participate in a conversation about whether the patient would rather switch from lifesustaining measures to “comfort care,” which would have meant removing the plastic tube from his trachea and allowing him to die naturally, with supportive care and medicine to make him comfortable. So we kept him alive.

When I am face to face with a patient like this — someone

who will never again be able to communicate, and who has been placed on the treadmill of continuous medical care — I feel the same type of shame as when I walk by a cold, crippled homeless person on the sidewalk. The wrongness is just as obvious.

When I stick a needle into his arm, or a catheter into his urethra, it feels as though I am kicking a homeless person.

The incapacitated ill are profoundly disenfranchised, and the manipulation of their bodies is extraordinarily invasive and consequential.

It’s a moral crisis hiding in plain sight, yet the people involved claim to be mere cogs in the machine. When I asked an ICU attending physician why families aren’t given data and clear explanations of probable outcomes rather than best-case scenarios and “only time will tell” conversations, he said, “palliative care people can do that. In the ICU, we don’t really have time.”

Another physician mentioned the “inertia of the system.”

It falls to the general public — the patients — to take the initiative in reforming the excesses of modern medical care.

You can determine your fate by completing an advance directive. This is a legal document in which you can explain what measures should be undertaken if you are unable to communicate; name a healthcare proxy who can communicate your wishes to medical providers; and lay out how you envision the end of your life.

Medicare began reimbursing physicians for advanced care planning in 2016. And many states have adopted POLST programs — Physician Orders for Life Sustaining Treatment — in which medical orders can be written in advance. Still, two-thirds of Americans do not have an y type of advance directive in place.

These documents are critically important.

If you don’t want to be kept alive on life support, you can indicate as much in your advance directive. If you want the longest life possible no matter what, you can affirm this wish. Either way, families and care providers should know. It will help move our medical system toward a more humane approach to end-oflife care.

8 - Mature Lifestyles - January, 2018 - TheIntelligencer.com

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Son reunites with father in S.D. nursing home

By STU WHITNEY Argus Leader

CANISTOTA, S.D. (AP) — The old man reclines in his wheelchair, thankful for a simple routine and oblivious to his past.

He watches birds frolic in a display case in the sitting room of the Good Samaritan nursing home in Canistota as a television drones nearby, setting a familiar scene.

The difference on this morning is that James O’Reilly, 84 years old and suffering from severe dementia, has a visitor, a cause for excitement among his caretakers. For years they knew little about their patient’s background and viewed that uncertainty as a puzzle that needed to be solved.

His namesake, James O’Reilly Jr., enters the room and kneels next to his father, reaching for his hand. The son starts talking about youthful memories, random moments, such as the time he turned pages for a church organist while his father sang in the choir.

He lives in Seattle and is married to a woman named Dina, he tells his dad.

They have a 7-year-old daughter who was thrilled to learn that her grandfather is alive and residing in a place called South Dakota.

Her middle name, the son explains, is Maxine, the name of James Sr.’s deceased mother. At that moment the old man’s eyes grow moist and rise in recognition, sparked by the spirit of rediscovery.

“There’s Dad,” said the son with a smile. “I knew he was in there.”

For more than a decade, up until just recently, it seemed perfectly reasonable for James O’Reilly Jr. to believe that his father was dead.

He lost contact in 2004, when James Sr. moved from a Rapid City hotel into a home for indigent adults as his mental acuity began to fade.

The retired phone company employ-

ee, who installed communications lines for nearly 40 years, became harder and harder to track down.

“One day I called the home and the phone was disconnected, with no forwarding number,” said James Jr., a 43-year-old systems engineer for a software company. “Shortly after that I moved from California to Seattle, and we lost each other in the wind.”

With little paper trail and no money for a private detective, James had no way to reach his father, with whom he had always kept in touch despite a sometimes rocky relationship.

As months and then years piled up, it seemed realistic to assume the worst.

“I kind of wrote him off,” admits O’Reilly. “I figured he died as some John Doe somewhere in the Upper Midwest, so I told my daughter that her grandpa was gone. She knew him only as a photograph.”

The bond between father and son was buoyed by their willingness to find common ground while acknowledging their own limitations.

The elder O’Reilly was born in Omaha but raised in Texas and briefly saw action as a Marine corporal in the Korean War. He later became a drill instructor but was told he didn’t have the right look to serve in the color guard.

He entered civilian life in the early 1960s and married Patricia Otis in 1971.

By the time their son was born three years later, O’Reilly was working for the phone company in Oakland and facing the demands of raising a family.

He openly favored his biological son over his wife’s two daughters from a previous marriage, creating a fragile household dynamic that eventually splintered.

When James and Patricia divorced in 1980, James Jr. went to live his father and grandmother in Alameda, about a half-mile from his previous home.

“My dad had a history of not paying

his bills on time, even though he had the money,” recalls James. “There were a couple times that the lights went out while I was sitting there talking to him, and he’d finally have to pay. My mom called him ‘Finally O’Reilly.’”

In the fall of 2014, an elderly man was dropped off at the emergency room at a Sioux Falls hospital, suffering from dementia and unable to speak coherently, the Argus Leader reported .

He had been in the custody of a couple who served as guardians for several older men in Rapid City and Sioux Falls, but they were moving out of state and wanted to abruptly end the arrangement.

The man’s name, they told hospital officials, was James O’Reilly. Few other biographical details were provided.

After hospital officials tried and failed to locate family members, the case was turned over to the Department of Social Services, who transferred O’Reilly to the Good Samaritan facility in Canistota.

But state workers, facing the rare circumstance of a non-verbal individual with memory loss dropped off by nonrelatives, continued their quest to connect the dots.

“We collected things that we found out about James,” said Kristine Chrisopulous, a long term services and support specialist in Sioux Falls. “We saw that he had written letters that mentioned a son, but we didn’t have much to go on. It became a matter of working out different possibilities with our colleagues in Pierre, hoping to solve the mystery.”

After graduating from high school and attending junior college, James Jr. tried on a series occupations to see how they fit — delivering pizzas, driving a forklift, painting cars.

Before long he was hired as part of computer technical support for a startup bank, helping to set up the com-

munications network.

“I was pulling cable through a wall in a building one day and stopped and thought, ‘Oh my God. I’m my Dad,’” he said.

The notion made him smile. He recalled the days living with his father in Alameda, when James Sr. grumbled about his son watching too much TV while thrusting his worldview upon him.

“Back then Japan was doing really well with cars and electronics, so my dad thought they were taking over,” recalls James. “He told me, ‘You’re going to have to learn Japanese,’ and actually put me in a Japanese language class, which is what every 11-year-old boy wants to do on a Saturday.”

James Sr. sometimes referred to his son as “Kozo,” meaning disciple or novice. When he lived in Atlanta, continuing his phone company duties, his son went to visit him as a high school kid sporting a mullet, with his grades and future in flux.

It was an awkward visit at times, but James Sr. had only one son and James Jr. had but one father. It was within that reality that they found their common ground, alternating Korean War stories with tales of girlfriend drama in California, with neutral silences in between.

By the time James Jr. returned home, he was ready to get his act together and plot a path forward. If the uncertain steps of that journey occasionally resembled those of his wayward father, that would be all right with him.

Dina O’Reilly was on her Facebook page in late September when she saw a message that caught her eye. It was from a social services staff worker in South Dakota, and she immediately grasped its importance.

“You’ve got a James M. O’Reilly and we’ve got a James M. O’Reilly,” the message read. “Are they related by any chance?”

TheIntelligencer.com - January, 2018 - Mature Lifestyles - 11

New technology attends to seniors’ health, quality of life

By NANCY DAHLBERG Miami Herald

Who hasn’t worried about elderly family members and wished it was easier to keep up with them from afar?

Now there’s technology that offers better care for the seniors and peace of mind for the family caregivers, employing advances in artificial intelligence, big data and voice technologies.

One company has a solution that tracks and analyzes a senior loved one’s activity and routines and will alert caregivers when something is out of the ordinary. Another startup supplies “grandkids on demand” to help with transportation, chores and companionship. Still other companies have rethought the daily phone call, supplied elder-friendly multilingual hospital discharge instructions and matched up the elderly with others who have room in their homes. Yet another enhanced alerts for when your elder falls and can’t get up.

It’s a large and growing market. More than 50 million Americans are over 65, and 10,000 more reach that age every day. While that age group is now about 13 percent of America’s population, it will jump to 19 percent by 2030 — about 72 million people — according to a U.S. Census Bureau report. About $1.2 trillion is spent on health care for American seniors each year, according to government estimates.

Perhaps most important, this technology can keep seniors safe and independent, allowing them to live in their homes — their overwhelming preference, according to surveys. Some of the technology could also prevent life-changing injuries caused by falls.

The big vision is to empower the elderly to live more safely on their own while easing the worries of their loved ones.

Through its mobile app, website or 800 number, Miami startup Papa provides assistance and socialization to seniors through young and enthusiastic team members called Papa Pals. It’s like grandkids on demand, said CEO Andrew Parker.

Parker came up with his startup idea from a personal need. Andrew Parker’s grandfather had been diagnosed with early onset of dementia that progressed into Alzheimer’s disease. As a family, the Parkers had a lot of difficulty managing his daily needs and supporting his primary family caregiver, Andrew’s grandmother.

Papa started as a simple concept, said Parker, who previously worked at telemedicine provider MDLIVE, which was founded by his father. “Our

grandfather and grandmother need support; others must as well. There is a huge senior population that continues to grow on a daily basis. There are also a lot of amazing college students who want to become future nurses, doctors and other leaders. Let’s connect these inter-generational groups and I bet something amazing happens.”

So Parker gathered a small team and started Papa to support his grandfather, whom he called “Papa,” and other seniors. The service now has about 150 Papa Pals on board. Most are college students earning extra money.

Recently, Papa Pal Valeria Sosa, a Broward College student, took Olga DeMartino, 92, to her weekly hair appointment. After Sosa walked with her to the car and buckled her in, they chatted and joked about each other’s families.

Regina DeMartino, Olga’s daughter-in-law, said before they found Papa on social media, family members took turns taking time off work to take her to her appointments.

“She loves them – she finds them all really interesting and loves being with younger people,” Regina said of the Papa Pals. They walk her out of her appointment and always have an umbrella so her hair won’t get wet, she said. “If she needs help around the house, they do that too.”

On Valentine’s Day last year, a Papa Pal brought Olga a rose. “How sweet is that?” Regina DeMartino said.

Like Papa, Room2Care also leverages the sharing economy but in a different way. The Miami startup is creating a network of vetted private caregiver homes, which provide less expensive and more personalized care than assisted living, said Richard Ashenoff, who founded the company with Dr. Todd Florin.

Room2Care is licensed and doing business in five states –– Florida, West Virginia, Texas, Arizona and California –– and has over 5,000 users and id growing daily, Ashenoff said.

While Room2Care and Papa use tech to connect seniors with humans for companionship, assistance and caregiving, technology steps in to help at other times, too.

CarePredict, an elder-care platform powered by artificial intelligence, makes bracelets that help track an elderly resident’s every activity. Currently it is available only to large group senior-living facilities and home care agencies, but the company hopes to offer the device directly to consumers in the future.

In an office space above a Boston Market in

Plantation, more than a dozen engineers and data scientists are working on computers in an office adorned with large portraits of senior citizens. In the next room, another worker is carefully assembling the devices.

Founder and CEO Satish Movva keeps a portrait of his parents near his office as a reminder of his mission. His parents, who are now 90 and 80, live just 10 miles away. Still, despite frequent calls and visits, he couldn’t trust the answers he was getting from them about their health.

“No matter how many times I would call them during the week, when I showed up on Saturday I’d find new things I didn’t know about. It was frustrating,” Movva said. “I wanted a wearable device that would answer all the questions I have about them every day.”

Changes in activity and behavior patterns show up well before the underlying issues manifest into medical conditions, said Movva, who has been an innovator in healthcare technology for 23 years. He wanted a system to observe his parents continuously but privately, so he could be alerted to changes early enough to intervene. After finding the existing technologies inadequate, he set out to develop CarePredict in 2013.

The idea is to monitor daily activities like eating, drinking, walking, bathing, cooking, sleeping, Movva said. “We couple that with contextual cues to surface insights like self-neglect, for example, due to depression.” The data can also help predict falls or suggest malnutrition, dehydration or infections before the senior or another person reports them.

Angel, an artificial intelligence- and voice-powered virtual nurse assistant, can play a similar role. She reaches out via low tech but clinically intelligent phone conversations, said Wolf Shlagman, founder and CEO of Care Angel.

“You look at the aging market and 90 percent or so choose to age at home … managing themselves the best they can,” he said. “Angel is meant to be an assistant that will help family caregivers by being able to simply call mom just as a nurse would, asking a series of questions.”

Angel asks a series of questions such as “how did you sleep last night?” “did you take your medication today?” and “what was your glucose reading today?”

If it detects cause for concern, Care Angel alerts caregivers via app, text message or phone. “Our mission is to help millions of people take better care of their families for a fraction of the cost of anything else out there,” Shlagman said.

12 - Mature Lifestyles - January, 2018 - TheIntelligencer.com

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14 - Mature Lifestyles - January, 2018 - TheIntelligencer.com

Des Moines family business to close after 122 years

By KIM NORVELL Des Moines Register

DES MOINES, Iowa (AP) — The shelves at H.B. Leiserowitz Co., one of Des Moines’ longest running businesses, are slowly emptying.

A decade ago, those shelves in the nondescript brick building at 13th and Walnut streets were packed with boxes and boxes of Snickers, Tootsie Rolls and Frito Lays. Forty years before that there were cigarettes, stereos, baseball cards and toasters — “anything to make a buck,” said longtime employee Glenn Lewis.

“The amount of stuff we used to sell was unbelievable,” he said.

Today, only photography equipment and supplies remain, some pieces old enough to remind employees of when business was booming.

But that was another time.

With slowing sales and the death of its patriarch over the summer, the 122-year-old company is packing up and saying goodbye to its remaining customers, the Des Moines Register reported .

Its final day was Dec. 3.

H.B. Leiserowitz was started by Al Leiserowitz’s father in 1895 at Fourth Street and Court Avenue in downtown Des Moines. It moved to a narrow building on Keosauqua Way before settling into the cavernous warehouse at 213 13th St. in 1977.

But for 78 years, one thing always stayed the same: Al Leiserowitz was there, working six days a week chatting up customers and taking pride in the familyowned business, said Rick Leiserowitz, his nephew and a 32-year employee of the store.

“He was a fixture here,” Leiserowitz said. “He just loved to be here, he loved to talk to everybody and this was his life.”

The elder Leiserowitz’s office is filled with customers’ photographs, newspaper clippings and awards.

There’s a photo of the 2011 honor flight he took as a World War II veteran and a copy of the original H.B. Leiserowitz catalog with photographs of everything once sold in the store.

Added recently is a framed portrait of Al Leiserowitz that was used in his obituary.

He died on July 8 at 96 years old.

Al did not name a successor to take over his business, so it will close to settle his estate, Leiserowitz said. Both the building and the surface parking lot to the west will be sold.

It’s the end of an era, but his nephew says the family is grateful for the business that kept his uncle going. Al worked from open to close each day until

March, when he suffered a fall.

“He pretty much said he had three secrets to his success: Working here, walking the area — he walked three miles a day — and he just swore by blueberries,” Leiserowitz said.

The retail landscape has changed drastically over the last century, and so too has H.B. Leiserowitz’s inventory.

Diversity was key to the business’ longtime success.

“Everybody would come in for something different,” Leiserowitz said. “We had a tremendous amount of diversity back then.”

H.B. Leiserowitz operated almost like a Sears department store, offering everything from KitchenAid mixers and popcorn machines to lighters and diamond jewelry. It delivered wholesale candy, soda, chips and cigarettes to area mom-and-pop grocery stories and corner gas stations.

“It used to be nothing to order half-a-million cigarettes” to sell for the week, said Lewis, who’s been a salesman there for 37 years.

The business then moved to Polaroid cameras, film and the chemicals needed to process photographs.

It most recently moved into selling digital cameras, equipment and printer ink.

Leiserowitz stopped wholesaling candy about 10 years ago when the company realized it couldn’t compete with places like Sam’s Club or Costco.

It’s now become difficult to compete with camera manufacturers and websites where customers can purchase equipment without sales tax, Leiserowitz said. Prices are generally cheaper if purchased directly from the manufacturer, he said.

And the move to digital photography means customers have fewer supplies to purchase. A camera and an SD memory card are the most anyone needs these days, Lewis said.

“Business has been slowing down the last couple of years,” Leiserowitz said.

But that transformation in buying habits didn’t change the loyalty of H.B. Leiserowitz’s customers.

Leiserowitz said people have been coming in every day to say goodbye and share memories of Al and their time spent in the store. His uncle’s habit of walking every day meant he was well-known to a lot of people in the area, especially the owners and CEOs of neighboring businesses, he said.

“It’s almost like being alive for your own wake,” he said. “It’s meant a lot.”

Joleen Weller stopped by Nov. 20 after hearing the news that H.B. Leiserowitz would soon close. The

East High School photo teacher has been going to the store for eight years to buy equipment and get advice for her students, she said.

She said she always recommended H.B. Leiserowitz to students who wanted to move past their phones and purchase a “big camera.”

“They’ve been super kind and super good here, and I’m sad,” Weller said. “This is a serious blow.”

H.B. Leiserowitz had a front-row seat to the changes in downtown Des Moines over the last century.

The building is part of the Western Gateway, which houses the Pappajohn Sculpture Park and the Des Moines Public Library just blocks away.

“Al would just marvel at the changes when he came back” from his daily walks, Leiserowitz said.

“We used to have to walk four of five blocks to find the first restaurant, and now you can walk to a dozen places within a two- or three-block area here.

“It’s a fantastic, thriving area.”

Land south of the business of was once completely wooded. It’s now home to the Des Moines Fire Department’s central station and the Central Iowa Shelter & Services.

Other smaller-scale developments have popped up in the area, like Noce jazz club, Magnolia Wine Kitchen, Horizon Line Coffee, Art Terrarium and Exile Brewing Co. A 90-unit market-rate apartment building, called Flux, is under construction at 1400 Walnut St. It will have first-floor retail and commercial space.

“It’s one of the rapidly growing neighborhoods of downtown” anchored by Meredith Corporation and Nationwide Insurance, said Des Moines Assistant City Manager Matt Anderson.

H.B. Leiserowitz’s 29,712-square-foot building — complete with a fallout shelter — and the 16,000-square-foot parking lot will be sold. Combined, they’re assessed at $1 million, according to Polk County records.

Leiserowitz said the family does not yet have a buyer, but Anderson suspects the properties will be purchased quickly. There’s potential for “any type of development” there, but housing or office space seems the most natural, Anderson said. It’s likely the cavernous warehouse would be torn down rather than re-purposed, he said.

“It’s a prime development area,” Anderson said.

“Whatever goes there will be exciting.”

H.B. Leiserowitz will hold an auction of its remaining items at noon on Dec. 3. A formal preview will be held the two days prior, but customers are welcome any time to see what’s left, Leiserowitz said.

TheIntelligencer.com - January, 2018 - Mature Lifestyles - 15

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16 - Mature Lifestyles - January, 2018 - TheIntelligencer.com

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