MATURE
Lifestyles October 2016
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Trusts available to take care of your pet
By Diane C. Lade Sun Sentinel
FORT LAUDERDALE, Fla. — All dogs may go to heaven, but what happens if their owners die before they do? It’s a question anyone with a pet should ask, experts say. And there are South Florida professionals and organizations helping animal lovers find an answer, which can include everything from setting up private pet trusts to endowing a rescue group in exchange for lifetime care. “There still are too many people who have a concern about their animals but don’t know what to do,” said Plantation, Fla., elder law attorney Stephanie Schneider. “When we start talking about our own mortality, it’s scary.” Orphaned animals are more likely to be left in shelters, and possibly euthanized, if their parents haven’t made plans in advance. “Typically, what happens is someone tragically passes away, or becomes incapacitated, and the family brings
the animals to us because there is no one to care for them,” said Rich Anderson, executive director and CEO of the Peggy Adams Animal Rescue League, Humane Society of the Palm Beaches, in West Palm Beach, Fla. The shelter started receiving calls from people “asking us if we had any kind of program that would give their pet a home,” Anderson said. That led Peggy Adams to start its Peace of Mind program in October. It guarantees, for a minimum $25,000 bequest left in a will, that the shelter will take in any animal immediately after the owner passes away. “It’s not surprising more people are trying to figure out how to ensure their animals will be afforded the same lifestyle they had before,” Anderson said. “A lot has changed in the last 20 years in terms of pets and how they are seen as family.” Peace of Mind will provide routine veterinary care for the animal’s life and immediate placement with a foster family during the search for a new forever home. Pets that prove unadoptable will live out their days with a Peggy Adams volunteer, Anderson said. Continued on Page 3
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Pets Continued from Page 2 Jackie Sims, of Delray Beach, Fla., enrolled in Peace of Mind because her son, who moves frequently for his job, is her only relative in the United States. Who would take her two beloved cats, Lexi and Kumi, if she were gone? Sims was impressed by the Peggy Adams staff and their promise that both animals would go to the same adoptive home. “It would be heartbreaking for them if they were separated,” said Sims. “They’re always together.” South Florida is fertile ground for lifetime pet planning because of its high number of retirees, many living alone, with no family nearby, said Deborah Goodall, a Boca Raton probate and trust attorney with the firm Goldman, Felcoski & Stone. She remembers one case when pets were unintentionally left without food and water “longer than anyone would have liked” because their owner had died unexpectedly and no one knew to retrieve the animals. “We talk specifically with people about who will take the dog or cat, and how that will happen,” said Goodall, who is chair-elect of The Florida Bar ’s real property, probate and trust law section. Goodall said Florida changed its trust code in 2006,
making requirements for animal trust options clearer. Animals have limited legal rights as they are considered property by law. The amount she places in a trust depends on an animal’s age and health and the lifestyle to which the pet has become accustomed. Hotel magnate Leona Helmsley left Trouble, her white Maltese, a $12 million inheritance. After Helmsley died in 2007, Trouble was moved to Sarasota. The dog’s annual living expenses reportedly were estimated at $190,000. Owners designate in advance who will be the pet’s caretaker; who will oversee the trust; how the money will be used (sometimes the caretaker draws a fee); and what will happen to any funds left after the pet dies. Schneider suggests also naming an alternate caretaker in case the first choice can’t take the pet, and giving directions about what to do with the animal’s remains upon death. While pet trust and estate bequests usually require attorney fees, experts say there are some things forward-thinking pet owners can do that cost nothing. These include: carrying a wallet card to notify emergency personnel in the event of an accident that you have unattended pets at home; creating a pet document, kept with your personal papers, that lists your pet’s veterinarian and emergency caretakers; and posting a door sign stating there are pets inside your house. Continued on Page 4
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Pets Continued from Page 3 The Humane Society of Broward County in Fort Lauderdale also has a program called Peace of Mind, similar to what’s offered by Peggy Adams. Bequest requirements start at $25,000, said senior vice president Kathy Tricomi, and $100,000 ensures all of a pet’s medical costs and special dietary needs are covered for life. What attracted Plantation dog owner Sue Bracco about this particular program, she said, is that her money would go to support the society’s shelter, where she has done volunteer work. “You can’t take it with you, and I don’t have kids,” said Bracco, 53, a senior insurance consultant who owns two pooches, Fausto and Miabella. “A lot of people don’t know about the program. I hand out pamphlets about it to my friends.” Tri-County Animal Rescue, based in Boca Raton, Fla., started what it calls an “entrusted long-term pet care” program about 18 years ago. It is raising money for a new building with the hopes of expanding its program. The nonprofit organization, which runs a “no-kill”
shelter, does not euthanize animals unless they are suffering. “People are very worried if no one will take their animals. But they don’t want to take them to a shelter because they are afraid they will be put down,” said co-founder and executive director Suzi Goldsmith. Seniors who pass away often leave behind older pets with serious medical problems, making them less adoptable, said Goldsmith. “We don’t want them to be discarded like old garbage,” she said. There is no required amount for an estate bequest, she said, and pets who can’t be placed in new homes live out their days in private quarters at the shelter. While will bequests are revenue generators, representatives of the three organizations agreed the best reason to encourage lifetime pet planning is to keep animals out of shelters. Tricomi said seeing frightened animals brought in by relatives after their owner unexpectedly dies or goes into a nursing home “is one of the most difficult situations we face.” Many times, these people are seniors “and the pet was very attached to them,” she said. The animal is looking around like, ‘What happened? Why am I here?’”
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Older addicts squeezed by opiod epidemic By CHRISTINE VESTAL Stateline.org
PORTLAND, Maine — When Clifton Hilton decided to quit drinking last month, he called a residential drug and alcohol detoxification center on a Friday afternoon and was told a bed was available for him. But by the time he arrived on a bus from Bangor the next morning, the bed had been taken. “I just walked the streets for five days,” Hilton said. It wasn’t until Wednesday that the Milestone Foundation had an open bed for him. Hilton, 70, is more fortunate than most of Maine’s growing number of low-income seniors with drug or alcohol problems. He was able to find help for his alcohol addiction and said he expects to get a spot at Milestone’s sober housing facility once he gets “straightened out.” As the nation’s opioid addiction epidemic expands, older adults in Maine and other states face mounting barriers to getting help for abuse of alcohol and opioid painkillers — not the least of which is finding they are squeezed out of scarce treatment facilities by younger people with prescrip-
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tion drug or heroin habits. And that’s only if they seek help. Many older Americans are reluctant to ask for it out of shame of being an addict at this point in their lives — creating what addiction experts call a silent epidemic. The silent epidemic also distorts the true toll that addiction has on the nation. Drug-related deaths of the elderly are often undercounted because it’s assumed on death certificates that they died of their age-related illness, not an overdose of pain pills, said Dr. Andrew Kolodny, who runs a New York-based group of addiction treatment centers. Despite the relatively low number of older adults reported dying from an overdose, a new analysis from Stanford University shows that people covered by Medicare — the federal health care program for people 65 and older and those with disabilities — have “among the highest and most rapidly growing prevalence of opioid use disorder.” More than 6 in 1,000 Medicare patients are diagnosed with an opioid disorder, compared with 1 in 1,000 patients covered by commercial insurance plans, the report says. Continued on Page 7
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Addicts Continued from Page 6 But getting treatment can be expensive. Seniors who do seek help find that Medicare does not cover most types of addiction treatment, something advocates have been trying to persuade the federal government to change for years. Low-income seniors who are unable to pay for treatment have few options in Maine and 18 other states where Medicaid coverage for the poor has not been expanded under the Affordable Care Act to cover able-bodied adults. Like Hilton, many older addicts face waiting lists at treatment facilities. And elderly people with prescription painkiller or heroin addictions often are less able to cope with the wait because they lack transportation, family support and the stamina to persevere. For the vast majority of addicted seniors, habitual and heavy drinking is the problem. Because elders are often isolated from family and friends, particularly in rural areas, their drinking problems go undetected until they end up in hospitals from a fall or serious alcohol-related health problems. When elderly alcohol addicts are referred to treatment, they often end up in a situation similar to the one Hilton faced in Portland.
“Just two years ago, 90 percent of our beds were available for people with alcohol disorders,” said Milestone’s director Bob Fowler. “Today, more than half are taken by people with opioid addictions.” Hilton, a native of Damariscotta, a small town up the coast from Portland, says alcohol was all he ever used. As a trucker in his working years, he said, he once smoked a joint. “It put me in a coma,” he said. “A six-pack of beer would do the same thing for me. I was never into drugs, never. I couldn’t see the price of it.” The vast majority of people 65 and older with substance abuse problems use alcohol, according to national surveys conducted by the U.S. Substance Abuse and Mental Health Services Administration. It is more culturally accepted among older people here in Maine and in most of the country — and more readily available. While younger people may have access to heroin and illicit prescription drugs through social contacts, many elders see alcohol as their only option to ease the pain and loneliness of aging. But a growing number of seniors are becoming addicted to prescription pain medicines such as OxyContin, Vicodin and Percocet, and sedatives such as Xanax, Valium and Ativan. A new study by researchers at Texas State University and the University of Michigan indicates a significant increase in the abuse of prescription painkillers and sedatives among people age 65 and older since 2003. Continued on Page 8
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In Maine, where the median age is 44, making it the oldest state in the country, there is a need to expand addiction treatment and prevention for older residents. The aging of the baby boomers portends an expanding elderly drug abuse epidemic nationwide. So far though, state responses to the opioid epidemic have largely been aimed at younger people and those involved in the criminal justice system. As states and the federal government devote more money to expanding access to medication-assisted addiction treatment, seniors may benefit with everyone else, Kolodny said. But most state and local programs, including outreach and education, are not tailored for older people. “It’s an underreported problem that needs addressing,” he said. Nationwide, the prevalence of seniors addicted to prescription medications has been growing for more than a decade. Since the mid-1990s when doctors began liberally handing out opioid painkillers, elderly people as a group have received a disproportionate share of those prescriptions because of age-related pain. Many became addicted, but typically were able to continue taking their medications because doctors considered their worsening pain a natural part of the aging process. But in recent years, tighter prescription drug monitoring
laws have made it more difficult for seniors and others to continue taking high doses of opioid medications prescribed by their doctors. In many states, physicians must check patients’ prescription drug history to see if they are taking pills prescribed by more than one doctor. If so, they may limit patients’ doses, prescribe fewer pills or cut them off altogether. As a result, some seniors have begun seeking illicit drugs, making their addictions more visible in places like needle exchanges and public health clinics. Maine’s prescription drug law, enacted in April, is among the strictest in the nation. It limits both the duration and the dosage of prescriptions, and requires doctors to check a patient’s opioid painkiller and sedative prescription history before handing out more pills. The new law, combined with Maine’s relatively old population and abundant supply of illicit drugs, makes the opioid problem among the elderly particularly acute in Portland. The fallout from the opioid epidemic on older people is complicated, said Dr. Jabbar Fazeli, a geriatric specialist in Portland. “The opioid frenzy is getting so much attention that it affects patients and families,” he said. “Many are afraid to take painkillers even when they are recommended. We’ve gone from a concern that we’re undertreating pain to the other extreme.” Still, he said, Maine is doing the right thing to restrict opioid and sedative prescribing. But time will tell whether curtailing the number of pills doctors prescribe will lower the overdose death toll. So far, that hasn’t happened in Maine.
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Hospital stays can take a toll on the elderly By ANNA GORMAN and HEIDI DE MARCO Kaiser Health News
SAN FRANCISCO — Janet Prochazka was active and outspoken, living by herself and working as a special education tutor. Then, in March, a bad fall landed her in the hospital. Doctors cared for her wounds and treated her pneumonia. But Prochazka, 75, didn’t sleep or eat well at Zuckerberg San Francisco General Hospital and Trauma Center. She became confused and agitated and ultimately contracted a serious stomach infection. After more than three weeks in the hospital and three more in a rehabilitation facility, she emerged far weaker than before, shaky and unable to think clearly. She had to stop working and wasn’t able to drive for months. And now, she’s considering a move to Maine to be closer to relatives for support. “It’s a big, big change,” said her stepdaughter, Kitty Gilbert, soon after Prochazka returned home. “I am hopeful that she will regain a lot of what she lost, but I am not sure.” Many elderly patients like Prochazka deteriorate mentally or physically in the hospital, even if they recover from the original illness or injury that brought them there. About one-third of patients over 70 years old and more than half of patients over 85 leave the hospital more disabled than when they arrived, research shows. As a result, many seniors are unable to care for themselves after discharge and need assistance with daily activities such as bathing, dressing or even walking. “The older you are, the worse the hospital is for you,” said Ken Covinsky, a physician and researcher at the University of California, San Francisco division of geriatrics. “A lot of the stuff we do in medicine does more harm than good. And sometimes with the care of older people, less is more.” Hospital staff often fail to feed older patients properly, get them out of bed enough or control their pain adequately. Providers frequently restrict their movements by tethering them to beds with oxygen tanks and IV poles. Doctors subject them to unnecessary procedures and prescribe redundant or potentially harmful medications. And caregivers deprive them of sleep by placing them in noisy wards or checking vital signs at all hours of the night. Interrupted sleep, unappetizing food and days in bed may be merely annoying for younger patients, but they can cause lasting damage to older ones. Elderly patients are far different than their younger counterparts — so much so that some hospitals are treating some of them in separate medical units.
San Francisco General is one of them. Its Acute Care for Elders (ACE) ward, which opened in 2007, has special accommodations and a team of providers to address the unique needs of older patients. They focus less on the original diagnosis and more on how to get patients back home, living as independently as possible. Early on, the staff tests patients’ memories and assesses how well they can walk and care for themselves at home. Then they give patients practice doing things for themselves as much as possible throughout their stay. They remove catheters and IVs, and encourage patients to get out of bed and eat in a communal dining area. “Bed rest is really, really bad,” said the medical director of the ACE unit, Edgar Pierluissi. “It sets off an explosive chain of events that are very detrimental to people’s health.” Such units are still rare — there are only about 200 around the country. And even where they exist, not every senior is admitted, in part because space is limited. Prochazka went to the emergency room first, then intensive care. She was transferred to ACE about a week later. The staff weaned her off some of her medications and got her up and walking. They also limited the disorienting nighttime checks. Prochazka said she got “the first good night of sleep I have had.” But for her, the move might have been too late. “She will not leave here where she started,” Pierluissi said several days before Prochazka was discharged. “She is going to be weaker and unable to do the things you really need to do to live independently.” How hospitals handle the old — and very old — is a pressing problem. Elderly patients are a growing clientele for hospitals, a trend that will only accelerate as baby boomers age. Patients over 65 already make up more than one-third of all discharges, according to the federal government, and nearly 13 million seniors are hospitalized each year. And they stay longer than younger patients. Many seniors are already suspended precariously between independent living and reliance on others. They are weakened by multiple chronic diseases and medications. One bad hospitalization can tip them over the edge, and they may never recover, said Melissa Mattison, chief of the hospital medicine unit at Massachusetts General Hospital. “It is like putting Humpty Dumpty back together again,” said Mattison, who wrote a 2013 report detailing the risks elderly patients face in the hospital. Continued on Page 12
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Hospital Continued from Page 11 Yet the unique needs of older patients are not a priority for most hospitals, Covinsky said. Doctors and other hospital staff focus so intensely on treating injuries or acute illnesses — like pneumonia or an exacerbation of heart disease — that they can overlook nearly all other aspects of caring for the patients, he noted. In addition, hospitals face few consequences if elderly patients become more impaired or less functional during their stays. The federal government penalizes hospitals when patients fall, get preventable infections or return to the hospital within 30 days of their discharge. But hospitals aren’t held accountable if patients lose their memories or their ability to walk. As a result, most don’t measure those things. “If you don’t measure it, you can’t fix it,” Covinsky said. Improving care for older patients requires an investment that hospital administrators are not always willing to make, experts said. Some argue, however, that the investment pays off — not just for older people but for hospitals themselves as well as for a country intent on controlling health care spending. Though research on the financial impact of problematic hospital care for the elderly has been limited, a 2010 report
by the Department of Health and Human Services’ Office of Inspector General found that more than a quarter of hospitalized Medicare beneficiaries had suffered an “adverse event,” or harm as a result of medical care. Those events, such as bed sores or oxygen deficiency, cost Medicare about $4.4 billion annually, according to the report. Physicians who reviewed the incidents determined that 44 percent could have been prevented. In addition to outright mistakes, poor or inadequate treatment in hospitals leads to needless medical spending on extended hospital visits, readmissions, in-home caregivers and nursing home care. Nursing home stays cost about $85,000 a year. And the average hospital stay for an elderly person is $12,000, according to the Agency for Healthcare Research and Quality. “If you don’t feed a patient, if you don’t mobilize a patient, you have just made it far more likely they will go to a skilled nursing (facility), and that’s expensive,” said Robert Palmer, director of the geriatrics and gerontology center at Eastern Virginia Medical School and one of the brains behind the idea of ACE units. ACE units have been shown to reduce hospital-inflicted disabilities in older patients, decrease lengths of stay and reduce the number of patients discharged to nursing homes. In one 2012 Health Affairs study, Palmer and other researchers found that hospital units for the elderly saved about $1,000 per patient visit. Continued on Page 13
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Hospital Continued from Page 12 After coming home, Prochazka said she felt weak. It took weeks of walking her labradoodle, Gino, to regain strength. Her stepdaughter, Gilbert, said Prochazka has started to improve. “We knew she was getting better when she was getting ornery,” she said. But Prochazka, who is highly educated, still has some short-term memory loss, Gilbert said. Prochazka knows that her life after hospitalization is different from before — she will have to depend more on others. It’s not an easy adjustment, she said. “I have been somebody who has always been both mentally and physically active,” she said. “Before I fell … I was respected for what I have and what I did and all of a sudden, I’m not.” She said her time at San Francisco General was frustrating. Getting the infection just as she was starting to recover was especially hard, she said. “I felt like I had been dealt a blow I really didn’t need.” For other patients, being admitted proactively to the special geriatric unit can stave off such precipitous declines. Rosenda Esquivel, 80, spent 18 days at San Francisco
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General, much of it in the unit, this spring. She suffered no noticeable setbacks, physical or mental, during her time in the hospital, according to Annelie Nilsson, a clinical nurse specialist in the unit. Esquivel, an animated woman who used to work as a home caregiver, was admitted with intense arthritic pain and, while hospitalized, underwent a procedure to address an abnormal heartbeat. Soon after her arrival, Pierluissi, the ACE unit medical director, speaking to Esquivel in her native Spanish, sought to determine how independent she was at home. He learned that a friend helped take care of her but that she took pride in cooking and cleaning for herself. The doctor noticed that Esquivel needed help to get up from a chair but that she could get around with a walker. Her memory, though, wasn’t too strong. A few minutes after hearing three words — “honesty,” “baseball” and “flower” — she could only recall one of them. Pierluissi came up with a plan for her time in the hospital: Get Esquivel’s pain under control. Make sure she walks three or four times a day. Arrange for her to have a caregiver at home to remind her to take her diabetes and blood pressure medications. Then, release her as fast as possible. “The less time she spends here, the better,” Pierluissi said.
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As boomers retire, knowledge transfer is key By REX HUPPKE Chicago Tribune
As members of the baby-boom generation continue to selfishly retire, waltzing off to engage in ridiculous activities like “enjoying life” and “relaxing,” the rest of us are left with the drudgery of work and, in many cases, a notable lack of institutional knowledge. According to the Pew Research Center, 10,000 baby boomers are reaching age 65 each day. While it’s been on the horizon for years, the reality of the boomer brain drain is still catching companies off guard, making “knowledge transfer” the buzzword du jour. Before veteran workers depart, it’s crucial they pass along not just a rough outline of how they do their jobs or a filing cabinet stuffed with old manuals and reports but some of the deeper knowledge gained from years of experience. It’s something Dorothy Leonard, a professor of business administration at Harvard Business School and co-founder of the consulting firm Leonard-Barton Group, calls “tacit knowledge.” “There’s a big difference between information and knowledge,” Leonard said. “Information is what you can get off of Google and what you can get from repositories. Knowledge, I would argue, is partially based on experience. So what I mean by tacit knowledge is stuff in your head that’s never been written down, never been documented. Maybe you’ve never even articulated it.” That’s why companies often fail to retain that deeper variety of knowledge once a longtime employee retires — they don’t think to look for it, and it’s not something a person writes in his or her carry-over note before racing out the door for the last time. “Experts with a large experience base have a system perspective,” Leonard said. “They can look at something and say, ‘That’s going to affect X, Y, and Z down the road.’ It could be a doctor who says, ‘This eye problem is actually linked to your immune system.’ They have a sense of what interacts with what. That comes with experience, but some of it can be passed on.” One of the means of transferring that form of knowledge is something Leonard calls “mini experiences.” She told me about an experienced designer at a defense contractor that makes and assembles missiles who knew how important it was for design engineers to understand the assembly process. “So this expert took (the person he was mentoring) to the end of the assembly line on the assembly floor where a technician was giving the final test,” Leonard said. “There you can see all the mistakes that can occur when you put together individually assembled components.”
It was a small mentoring moment, but: “The way our brain works, we attach new experiences to something that’s already there. Now that new engineer not only has some new insights but a comprehension of the need to think about the assembly when designing. And to that experience he can attach new experiences. It creates receptors in our brain.” Duke Energy Nuclear in North Carolina has 6,000 workers in its nuclear division, and half of them are eligible to retire in the next five years. The company assessed its knowledge transfer tools — everything from basic succession planning to mentoring — and found gaps in what workers benefited from and what was being used. “An approach we’ve taken recently is based on the question, ‘What knowledge do you want to retain?’” said Lee Causey, a senior nuclear engineer. “How do you break it down? At the departmental level, we’ve reached out to different managers and said, ‘What are the critical skills that your team performs?’ Next you look at how many people are fully competent at that, and how many people are in development or maybe not quite there. That way you can identify gaps and address them.” In working on knowledge transfer at his company, Causey has learned the importance of having open lines of communication between younger workers and veterans. Put simply, the greener employees can’t feel afraid to admit that there’s something they don’t know, and the veterans need to be willing to share what they do know. “The cultural shift I see is how willing we are to identify our knowledge gaps,” Causey said. “I’m seeing more individual contributors come to their managers and say, ‘I’d like to improve my skills in this arena’ or, ‘I’d like to work with this expert in our group.’ That’s a big change. We come in as total hotshots, we’ve got everything figured out. Just put me at my desk, and I’ll get everything done. It’s hard to admit that I don’t know something. But I’m seeing a shift in that among young employees.” Another point he raised is that knowledge transfer can’t be viewed as a one-and-done problem. It requires study and evaluation, and a willingness to acknowledge when something isn’t working. “We still have a long way to go,” he said. “You have to respect the evolution of knowledge transfer and the diversity of it.” And you have to start making this a priority. Because once that knowledge walks out the door, it’s likely to go park itself on a beach somewhere and turn its phone off. And that puts us nonbeachgoers with our phones on at a distinct disadvantage.
TheIntelligencer.com - October 2016 - Mature Lifestyles - 15
16 - Mature Lifestyles - October 2016 - TheIntelligencer.com
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Positive change for you AND a loved one By KIM ZAKRZEWSKI Marketing Director at the Cambridge House of Maryville
When I was 18-years-old, my grandfather lived about 30 minutes away from our home. I was in the middle of attending college full time and also worked a part-time position at a restaurant in town. Thirty minutes may not seem that far, but with a full schedule it became almost impossible to spend quality time with my grandpa. Sunday night was the one night each week that I could visit with him. I would bring his groceries, ask him what he needed at home, and he would always read me the trivia question he would find in his daily newspaper. His regular day-to-day routine consisted of him sitting in his recliner watching sports. My grandpa was perfectly comfortable in his isolation. He sat for long hours in a dimly lit living room. After losing his wife in 1981, he was used to taking care of his self. After living alone for over 30 years, my grandpa lived off of a diet of fast food, Prairie Farms ice cream, and the occasional soup (all he knew how to make in the slow cooker) that he would eat on for the entire week. One Christmas Eve night, during a family get together that my grandpa couldn’t wait to leave from, he fell on the sidewalk in front of our house. He had fractured his hip. Doctors recommended rehab for him, where he stayed for 2 months. During those two months, my mother, an only child, had a difficult decision to make. She sold his home. She sold the home where he had lived “just fine” for the last 30 years. She sold the home where he had fallen countless times, on the back porch, in the living room, on the basement stairs. He of course, became furious. He could not understand why he could not stay in his home. I believe that even at the time, we did not have the right words to say. How do you tell someone you love that they cannot return home? You start by telling them how much you care about them. You tell them how much guilt you feel every time you leave them alone. You tell them how worried you are when they don’t answer the phone. You let them know that you are only human, and that with life’s constant demands—work, school, relationships, and everything else that comes along with the day-to-day routine, sometimes…you just need more help than what you can provide. Moving out of your home is never an easy decision, and often times, you stay in your own comfort zone so long that you surpass the point where you can live an independent lifestyle. Even with 30 or more years of living alone and being isolated from pretty much everyone except his aging neighbor, luckily my grandpa had the chance to remain independent. We moved him into a Supportive Living Community, which was suggested to us from the Social Services Coordinator at his rehab unit. Again, he hated it. He hated change, and of course the fact that he was no longer in control. I worked that summer at his apartment community as a
dish washer. I wore a hair net, and washed liver and onion pans every week. I came home soggy and sore, but I got to spend my lunch breaks with my grandpa. I helped him adjust and get a new routine together. I remember leaving him each night, not with the resentment and guilt that I had felt before. Instead, I would leave and tell him to “be good” to all the staff and the other residents because he was still a little grumpy toward others—his way of rebelling. After only a few months, his daily activities were to have breakfast, read the newspaper, watch the news, and take a nap before Jeopardy and then have dinner. I am not even sure if he noticed it, but his routine was very much the same as it was before his move. It was different, but it was his new home. There was always someone there to have a conversation with, whether it was another resident, a staff member, or even another resident’s family member. Children, babies, and even pets would come to visit, bringing a smile to his face and sometimes even a chuckle. He was also fortunate to have 24 hour care available to him. So, when mom and I would leave him at the end of our visits, we would know that there would always be someone to assist him if he needed them. After five years of staying in the Supportive Living Community, his dementia had advanced. He had reached a point where he needed more care and was required to move to a nursing home setting, or skilled nursing. I continued to visit with him there until he passed away two years later. He was one of the most amazing people I have ever known, and to this day I miss our conversations. I miss updating him on my job and all the good and bad things that happen in life. I feel that had he not broken his hip and moved into the Supportive Living Community, I would have missed out on a lot of quality time with him. I may not have worked at his apartment community washing dishes, and spending my lunch breaks chatting with him and fixing his remote control. I may not have popped in just to watch jeopardy after class, and then walked with him down the hall to his dinner table. In fact, had he suffered that serious fall at his own home, he may not have survived at all. In late 2015, I accepted a position at the Cambridge House in Maryville. As Marketing Director, my role is to provide education to the community so that they know why and when a move is necessary. It is also my role, and the role of the entire staff at the Cambridge House, to provide resources to individuals and families who are in need of information on levels of care and do not know where to begin. For anyone who is considering having a difficult conversation with their parent, friend, or loved one, we want to help. It isn’t very often that someone calls our phone number and says, “Please sign me up today!” Continued on Page 19
18 - Mature Lifestyles - October 2016 - TheIntelligencer.com
Financial firms embrace all-digital approach to managing retirement assets
By TIM GRANT Pittsburgh Post-Gazette
More financial services firms are betting on higher demand for “robo” financial advice services, which allow clients to use a computer rather than flesh-and-blood advisers to help them make decisions on investing their money. But a recent study found most baby boomers still prefer the human touch when it comes to managing their retirement assets. A survey by GfK, which is headquartered in Nuremberg, Germany, but has operations in more than 100 countries, including the U.S., found less than 5 percent of people 50 years old or older said they would embrace an all-digital service approach from their investment firms. The level of trust in robo advisers was highest among the 25-34 age group and lowest among those age 65 and above. To address the concerns that some middle-aged and older investors have with computer-based investing, several companies have launched their own hybrid versions of robo investing that bridges the gap between a human connection and tech platform. “We are robo for boomers,” said Scott Puritz, managing director for Rebalance IRA in Bethesda, Md. “Rebalance IRA
has always combined the efficiency of robo investing with the human dimension of a traditional advisory company. For boomers in their 40s and 60s, the pure computer experience is not satisfactory. “Our typical client is in their 40s and 60s and they want a live human, a seasoned experienced financial adviser to guide them through the complexity of their retirement choices and needs,” he said. “Typically, they have more assets — a home, mortgage and often more than one retirement account. They are frequently married with kids and they need more guidance.” Rebalance IRA was among the first companies to offer robo investing for retirement accounts when it started four years ago. Today, the company manages about $400 million in client funds. Other large companies that offer robo investing along with human advisers include Vanguard, Schwab, BlackRock and Ellevest, which is the first to offer the robo service just for women. The rise of robo advice platforms over the past year has been significant, according to the financial services industry trade publication InvestmentNews. Continued on Page 19
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Change Continued from Page 17 A major life change like moving out of a home is not something that people are generally excited to do. There are a lot of emotions associated with moving, anxiety is probably the most common. However, it is extremely important to know what signs to look for in an individual who may need to make a move in the near future. Some of the warning signs that we often encourage families to look for are frequent falls, isolation, and forgetfulness with medications, imbalanced diet, dehydration, regular emergency room visits, or regular phone calls to first
Assets
Continued from Page 18
Assets in the robo channel have increased 61 percent to $150 billion during the 12-month period ending
TheIntelligencer.com - October 2016 - Mature Lifestyles - 19 responders. Another concept that is extremely important is to know when to make a decision that can drastically change a life for the better. Timing is everything, or so they say. Too often, we are approached by a family who wants to have an apartment for their loved one. Upon a pre-admission screening, we find that the individual has suffered mental or physical decline and has a need for a higher level of care. Most importantly, remember that you are not alone in your journey. So many individuals and families are taking the same steps to find the right care. Some are “just beginning to look around at options”. Others know that a change needs to take place but are hesitant because of the emotions that change
can bring. My advice is to consider all the facts: how a move to a new home can affect you or your loved one in a positive way, how much you value peace of mind and knowing that there is care and companionship available 24 hours every day, and how much your own relationship can be bettered by committing to making a change.
March 31, according to researchers at the New York-based publication. Based on their study, they expect the rate of growth for robo advising to maintain, if not accelerate, in the near term as assets continue to flow to this model, particularly as more large industry players get involved in this market.
Robo-advisers automatically invest client money in diversified strategies, using boundaries set based on an individual’s goals and risk tolerance. Mutual funds and exchange traded funds are chosen based on what the algorithms and calculators decide is the best risk-reward profile for that client.
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As Americans live longer, attitudes toward death change By SOUMYA KARLAMANGLA Los Angeles Times
LOS ANGELES –– When doctors told Robert Stone last year that he had terminal cancer, he didn’t feel afraid. Stone said he’d come to accept death as a natural part of life. What he did fear was having too little energy or too much pain to enjoy his remaining days. So last month Stone, 69, became one of the first people in California to obtain lethal medications under a new state law that allows doctors to write prescriptions for terminally ill patients to kill themselves. Stone said he won’t take the pills until the growing fatigue caused by his bone marrow cancer becomes debilitating. “I’ll know that by how I feel,” he said. “It gives me some comfort in having control over what the end of my life will be like.” Americans are planning for the possibility of living into their 80s or 90s, said Len Fishman, director of the Gerontology Institute at the University of Massachusetts, Boston. “They also know that that can mean living with serious physical and cognitive disease, and it’s making them think about what choices they would want to make if they were in that situation,” he said. That’s led to more patients refusing intensive medical treatments just to prolong their lives, because there might be “some things worse than death,” Fishman said. More controversially, it’s also contributed to a recent surge in the number of states looking into legalizing physician-assisted suicide — seen as either a humane option for the sick or the beginning of a dangerous trend in medicine. Generally, attitudes toward death are changing in part because baby boomers — the oldest of whom reached retirement age five years ago — were the first generation to see their many of their parents live into their 80s, Fishman said. They probably saw health conditions they wouldn’t want for themselves. Stone recalled his mother’s last months with a grimace. He remembers that when she was hospitalized for congestive heart failure in 1992, her hands were strapped to a hospital bed, a tube down her throat. She eventually ended up in a coma before dying weeks later at age 80. Stone said his mother, father and uncle endured “excruciatingly painful” situations before they died. “If they’d had a choice, I don’t think they would’ve done so,” he said. In October, Stone’s doctors told him that his chemotherapy had stopped working and that he probably had one to two years left to live. But unlike his mother’s, Stone’s last months will be peaceful, he said. Since his diagnosis, he’s traveled to Vietnam and Japan, two countries he’d always wanted to visit. He recently read through stacks of letters written as long ago as 1962, fondly
remembering old friends. And for these happy final months, “I’m very thankful,” he said. Since November 2014, legislators in more than 25 states have introduced bills that would legalize physician-assisted suicide — a fivefold increase from 2013, according to data collected by Compassion & Choices, an organization that advocates such laws. California is the fifth state — after Oregon, Washington, Montana and Vermont — to allow the practice. When Gov. Jerry Brown signed the End of Life Option Act into law in October, he wrote that he believed it would be a comfort to have this option if he were “dying in prolonged and excruciating pain.” In part, states are looking into physician-assisted death because of Brittany Maynard, a 29-year-old Californian with terminal brain cancer who decided to move to Oregon in 2014 to take advantage of that state’s aid-indying law. Jessica Grennan, national field and political director for Compassion & Choices, said she thinks the widespread attention Maynard received — she ended up on the cover of People magazine — and the subsequent passage of California’s law pushed physician-assisted suicide into the national dialogue. “I was at a bachelorette party and everyone was asking me questions about this,” she said. A Gallup poll last year found that 68 percent of Americans thought doctors should be allowed to help terminally ill patients commit suicide — a 10 percent increase from the previous year. Such laws face heavy opposition from some quarters. Opponents say they fear these laws could be the beginning of a societal shift in which some people’s lives are deemed less valuable. “It’s a very utilitarian attitude toward human life,” said Camille Giglio, head of the anti-abortion advocacy group California Right to Life. “To say simply because you’ve got an illness or you’ve got a disability … you should do the right thing and take yourself out of the world.” Many doctors have historically been opposed to such laws, saying they go against their oath to save lives. A group of physicians in California has sued to overturn the state’s law. In Oregon, Dr. Kenneth Stevens, an oncologist, has been fighting physician-assisted suicide since Oregon became the first state to legalize it in 1998. “It’s changing what doctors do, what hospitals do,” he said. “I can’t fathom why a doctor would do this.” In 2000, a terminally ill woman with inoperable cancer who refused treatment asked Stevens for a prescription for lethal medications. He encouraged her to try chemotherapy and radiation instead and fight for the chance to see her son graduate from the police academy and perhaps see him get married. She agreed and is still alive 16 years later.
22 - Mature Lifestyles - October 2016 - TheIntelligencer.com
Is it best to wait for flu shots?
By JULIE APPLEBY Kaiser Health News
The pharmacy chain pitches started in August: Come in and get your flu shot. Convenience is touted. So are incentives: CVS offers a 20-percent-off shopping pass for everyone who gets a shot, while Walgreens donates toward international vaccination efforts. The start of flu season is still weeks — if not months — away. Yet marketing of the vaccine has become an almost year-round effort, beginning when the shots become available in August and hyped as long as the supply lasts, often into April or May. Not that long ago, most flu-shot campaigns started as the leaves began to turn in October. But the rise of retail medical clinics inside drug stores over the past decade — and state laws allowing pharmacists to give vaccinations — has stretched the flu-shot season. The stores have figured out how “to deliver medical services in an on-demand way” which appeals to customers, particularly millennials, said Tom Charland, founder and CEO of Merchant Medicine, which tracks the walk-in clinic industry. “It’s a way to get people into the store to buy other things.” But some experts say the marketing may be overtaking medical wisdom since it’s unclear how long the immunity imparted by the vaccine lasts, particularly in older people. Federal health officials say it’s better to get the shot whenever you can. An early flu shot is better than no flu shot at all. But the science is mixed when it comes to how long a flu shot promoted and given during the waning days of summer will provide optimal protection, especially because flu season generally peaks in mid-winter or beyond. Experts are divided on how patients should respond to such offers. “If you’re over 65, don’t get the flu vaccine in September. Or August. It’s a marketing scheme,” said Laura Haynes, an immunologist at the University of Connecticut Center on Aging. That’s because a combination of factors makes it more difficult for the immune systems of people older than age 65 to respond to the vaccination in the first place. And its protective effects may wear off faster for this age group than it does for young people. When is the best time to vaccinate? It’s a question even doctors have. “Should I wait until October or November to vaccinate my elderly or medically frail patients?” That’s one of the queries on the website of the board that advises the Centers for Disease Control and Prevention on immunizations. The answer is that it is safe to make the shots available to all age groups when the vaccine becomes available, although it does include a caution. The board says antibodies created by the vaccine decline in the months following vaccination “primarily affecting persons age 65 and older,” citing a study done during the 2011-2012 flu season. Still, while “delaying
vaccination might permit greater immunity later in the season,” the CDC notes that “deferral could result in missed opportunities to vaccinate.” How long will the immunity last? “The data are very mixed,” said. John J. Treanor, a vaccine expert at the University of Rochester medical school. Some studies suggest vaccines lose some protectiveness during the course of a single flu season. Flu activity generally starts in the fall, but peaks in January or February and can run into the spring. “So some might worry that if [they] got vaccinated very early and flu didn’t show up until very late, it might not work as well,” he said. But other studies “show you still have protection from the shot you got last year if it’s a year when the strains didn’t change, Treanor said. In any given flu season, vaccine effectiveness varies. One factor is how well the vaccines match the virus that is actually prevalent. Other factors influencing effectiveness include the age and general health of the recipient. In the overall population, the CDC says studies show vaccines can reduce the risk of flu by about 50 to 60 percent when the vaccines are well matched. Health officials say it’s especially important to vaccinate children because they often spread the disease, are better able to develop antibodies from the vaccines and, if they don’t get sick, they won’t expose grandma and grandpa. While most people who get the flu recover, it is a serious disease responsible for many deaths each year, particularly among older adults and young children. Influenza’s intensity varies annually, with the CDC saying deaths associated with the flu have ranged from about 3,300 a year to 49,000 during the past 31 seasons. To develop vaccines, manufacturers and scientists study what’s circulating in the Southern Hemisphere during its winter, which is our summer. Then — based on that evidence — forecast what flu strains might circulate here to make vaccines that are generally delivered in late July. For the upcoming season, the vaccines will include three or four strains, including two A strains, an H1N1 and an H3N2, as well as one or two B strains, according to the CDC. It recommends that everyone older than 6 months get vaccinated, unless they have health conditions that would prevent it. The vaccines can’t give a person the flu because the virus is killed before it’s included in the shot. This year, the nasal vaccine is not recommended for use, as studies showed it was not effective during several of the past flu seasons. But when to go? “The ideal time is between Halloween and Thanksgiving,” said Haynes at UConn. “If you can’t wait and the only chance is to get it in September, then go ahead and get it. It’s best to get it early rather than not at all.” Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.
TheIntelligencer.com - October 2016 - Mature Lifestyles - 23
Study: Elderly’s family caregivers need help, too By RACHEL BLUTH Kaiser Health News
Elderly Americans’ well-being is at risk unless the U.S. does much more to help millions of family caregivers who sacrifice their own health, finances and personal lives to look out for loved ones, reported a study released Tuesday. Nearly 18 million people care for a relative who is 65 or older and needs help, yet “the need to recognize and support caregivers is among the most significant challenges” facing the nation’s swelling elderly population, their families and society, according to the report from the National Academies of Science, Engineering, and Medicine. Describing family caregiving as “a critical issue of public policy,” a committee of experts in health care and aging said the next presidential administration in 2017 should direct a national strategy to develop ways to support caregivers, including economically. According to the report, people who help elderly family members with three or more personal tasks a day devote 253 hours a month to caregiving — almost the equivalent of two full-time jobs. Five years is the median duration that family members care for older adults with high needs, the report said.
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For some Americans who accept that responsibility, that can mean taking a less demanding job, foregoing promotions or dropping out of the workforce. Lost wages and benefits average $303,880 over the lifetimes of people 50 and older who stop working to care for a parent, according to a study cited in the report. That’s not all: A lower earnings history also means reduced Social Security payments for caregivers when they become eligible. A possible fix for that problem, proposed by researchers in 2009, is to provide caregivers with a Social Security credit for a defined level of deemed wages during a specified time period, the report said. Leave programs do exist for some workers shouldering caregiving duties, but many lack such job protections. The federal Family and Medical Leave Act doesn’t cover 40 percent of the workforce. It allows eligible employees to take 12 weeks of unpaid time off to care for certain family members, but the law only applies to those who work federal, state and local governments and private companies with more than 50 employees. But ineligible family relationships for leave include sons- and daughters-in-law, stepchildren, grandchildren, siblings, nieces and nephews.
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