Generations Michigan
Published quarterly by Michigan’s Area Agencies on Aging
Winter 2007
TM
Welcome to Michigan Generations Michigan is divided into 16 AAAs, each serving a different part of the state.
11
They are:
AAAs— Gateways to Community Resources
10
9
8
7 5
14
3A 3B
4
3C
4 Region IV Area Agency on Aging 5 Valley Area Agency on Aging 6 Tri-County Office on Aging 7 Region VII Area Agency on Aging 8 Area Agency on Aging of Western Michigan 9 NEMCSA Region 9 Area Agency on Aging 10 Area Agency on Aging of Northwest Michigan 11 Upper Peninsula Area Agency on Aging 14 Senior Resources of West Michigan Visit the AAA’s state website at www.mi-seniors.net
6
The services offered by Michigan’s 16 AAAs cover a broad spectrum of needs, such as information and referral, case management, in-home services, home-delivered meals, senior centers, transportation, and special outreach. To read more about each of Michigan’s AAAs and the services available, turn to page 8 of this issue. MI
1A
1B
2
1C
Michigan
Generations WINTER 2007 Published quarterly through a cooperative effort of Michigan’s Area Agencies on Aging.
For information contact: Jenny Jarvis 248-262-9202 jjarvis@aaa1b.com
Editorial Project Development: JAM Communications, Atlanta, GA Design and Production: Wells-Smith Partners, Lilburn, GA Michigan Generations is a:
2006
On the Cover: Today, doctors treat more and more seniors who are living into old age with numerous chronic conditions. Managing the health regiment of these older patients has become increasingly complex. Here are some of the most promising advances in diagnosis and treatment. See story, page 4.
Winter 2007, Volume 4, #3 © 2007 by the Michigan Area Agencies on Aging. The information contained herein has been obtained from sources believed to be reliable. However, the Michigan Area Agencies on Aging and JAM Communications make no warranty to the accuracy or reliability of this information. No part of this publication may be reproduced or transmitted in any form or by any means without written permission. All rights reserved.
MAP PHOTOGRAPHY COURTESY TRAVEL MICHIGAN
Whether you are an older adult yourself, a caregiver or a friend concerned about the well-being of an older adult, Area Agencies on Aging (AAAs) are ready to help. AAAs in communities across the country serve as gateways to local resources, planning efforts, and services that help older adults remain independent. AAAs were established under the Older Americans Act in 1973 to respond to the needs of Americans aged 60 and over in every community. The services available through AAA agencies fall into five general categories: information and consultation, services available in the community, services in the home, housing, and elder rights. A wide range of programs is available within each category.
1A Detroit Area Agency on Aging 1B Area Agency on Aging 1-B 1C The Senior Alliance 2 Region 2 Area Agency on Aging 3A Kalamazoo Co. Health & Community Services Dept. Region 3A 3B Burnham-Brook Region IIIB Area Agency on Aging 3C Branch-St.Joseph Area Agency on Aging IIIC
CAREGIVINGNews&Notes FROM
Preparing for an
EMERGENCY
s a caregiver for an older adult, you are most likely concerned about emergency situations that might occur — and how to respond when they do.This simple list of steps to take, in case of an emergency, should help prepare you for any unforeseen situation. Keep a list of emergency contacts clearly posted in your home. Don’t delay getting help for serious health symptoms. If you call 911, be prepared to give the operator clear instructions.
A
Make sure your house number is clearly visible from the street. If help is on the way, unlock and open the front door to your home. Always keep a well-supplied first-aid kit on hand. Keep up-to-date records of your loved one’s medications and allergies. Keep insurance cards handy. Get a medical I.D. bracelet for him or her. Visit www.medicalert.org or call 1-888-633-4298. Condensed from Focus on Healthy Aging
Heart…
Head
TO
Doctors say they have identified factors that could predict who is likely to suffer dementia in later years. And by making healthy lifestyle changes, you or a loved one might be able to lower your risk of the debilitating disease. The risk factors they have identified include high cholesterol, high blood pressure and obesity, which are virtually identical to those associated with heart attack and stroke, according to Focus on Healthy Aging newsletter. Bottom line: Take care of your heart, and you’ll be taking care of your brain as well.
PLANNING WHAT’S NEXT IN LIFE
Legally SPEAKING tatistics consistently show that the vast majority of caregiving for elders is provided through informal arrangements with family members providing most caregiving services. Because of these informal/family caregiving arrangements, elders are often able to remain in the community and may never need to enter an institution. However, legal problems can arise in these situations. One issue relates to the payment or withholding of income taxes for a caregiver. Often caregivers don’t charge for their services or are being paid “under the table.” Such “under the table” arrangements can create serious problems with the Internal Revenue Service — both for the employer (elder) and for the employee (caregiver). Employers who fail to withhold taxes may be subject to IRS sanctions, and employees who get paid without reporting their income can face problems with the IRS and lose the right to claim their earnings when they go to obtain Social Security benefits. Similar issues can arise through the failure of informal caregivers to have workers compensation insurance coverage, if a caregiver should get injured in the process of their employment. Courtesy Douglas G. Chalgian, certified elderlaw attorney, and Amy R. Tripp, attorney at law.
S
Winter 2007
“LIFE PLANNING” CONTINUES TO DRAW ATTENTION as more and more prospective retirees ponder the post-employment years. Advice used to focus on financial planning — how not to run out of money after you stop working. But many organizations are now integrating that information with other lifestyle decisions, according to a recent article in BusinessWeek magazine. For seniors wishing to learn more about life planning, the National Center for Creative Retirement at the University of North Carolina in Asheville offers a two-day workshop focusing on mindset and lifestyle. Topics cover such concerns as leisure activities, social relationships and relocation. If you want to learn more about the workshop, visit www.unca.edu/ncccr. For local programs in Michigan, check out adult education classes, community colleges and financial advisors in your region.
Surfing the Net Each issue of Michigan Generations offers several websites of interest to older adults and their caregivers … right at your fingertips.
www.yourdiseaserisk.har vard.edu helps readers figure out how high — or low — their risk factor is for each of five diseases: cancer, diabetes, stroke, heart disease and osteoporosis. www.c-c-d.org showcases the efforts of the Consortium for Citizens with Disabilities, a coalition of national consumer, advocacy, provider and professional organizations that advocate for disabled Americans. 3
A NEW LOOK AT
Age-related
ILLNESSES By Martha Nolan McKenzie
It’s a complicated question facing more and more doctors: How do you best treat elderly patients who suffer from a host of chronic conditions?
Thanks to remarkable medical advances, more people are living longer with chronic conditions than ever before,” says Dr. Vincent Elie, an internist who does geriatric home care in Chelsea. “It’s not uncommon to see an 80-year-old who has five or six chronic medical problems. These patients have increasingly complicated medication regimens, so managing their health becomes very complex.” Doctors and researchers have been working hard to unravel that complexity. The result: many promising advances in diagnostic techniques and treatments for common age-related illnesses. “We live in a culture that values youth, so we have tended to marginalize the elderly and their health needs, blaming all their physical ailments on the aging process,” says Dr. Sharon Brangman, chief of geriatrics at SUNY Upstate Medical University in Syracuse. “We would not do that in any other phase of life. But that is rapidly changing. More and more, geriatrics is being recognized as a distinct medical entity, and more research is focusing on the conditions of the elderly.” Here’s a look at some of the newest advances in the most common age-related illnesses:
FRAILTY One of the most troubling mysteries in aging is why some people can reach their 70s and 80s while remaining healthy, strong and 4
mentally acute, while others become frail — slowing down, becoming weak and suffering cognitive loss. Doctors are searching for clues, and finding some. “Doctors and patients often thought frailty was a normal part of aging,” says Brangman. “But we are starting to recognize that it is a medical condition. Something is happening on the cellular level that is changing the way the body handles the stresses of the environment.” Indeed, frailty has now been identified as a distinct medical syndrome with diagnosable symptoms. Specifically, people with three or more of the following symptoms generally are considered frail: weight loss, decreased daily activity, muscle weakness, exhaustion and slow walking speed. Medical experts are still debating the cause, or causes, of frailty. Possibilities include undetected cardiovascular disease, malnutrition, chronic inflammation and anemia. “There’s increasing evidence that the early stages of frailty might be prevented or modified,” says Dr. Linda Fried, director of the Center on Aging and Health at Johns Hopkins University in Baltimore. “That’s so important, because people who become frail are at a very high risk for a number of things — falls, difficulty remaining independent and dying.” As with any condition, prevention is better than treatment. “Prevention is the key,” says Dr. Khaled Imam, associate director in the division of geriatrics at Beaumont Hospital in Michigan Generations
Southfield. “Exercising, getting good nutrition and staying mentally and socially connected may help stave off the decline into frailty.”
CARDIOVASCULAR DISEASE
“The risk for almost all cancers increases with age,” says Dr. Michael Kraut, medical director of the Providence Cancer Institute in Southfield. “So as the population ages, we are going to see an increase in the total number of people with cancer.” Happily, advances in diagnosis and treatment will improve the odds for many cancer victims. Perhaps the biggest advance in early cancer detection is the use of increasingly sophisticated scanning technologies, such as PET scans and CAT scans. (With a PET scan, the patient drinks radioactive glucose and then a scan shows what areas of the body are most actively metabolizing it, which can indicate cancer.) “Results from a 12-year study were just published in October that showed CAT scans were able to detect over 400 lung cancer cases in a screening of 30,000 high-risk asymptomatic people,” says Dr. Elisabeth Heath, a medical oncologist and the medical director of the chemotherapy unit at the Barbara Ann Karmanos Cancer Institute in Detroit. “The scans picked up the tumors while they were small and curable. This study adds important information to a growing body of literature that suggests that screening for lung cancer may be effective.” Treatments for cancer have also come a long way. A new generation of “personalized medicines,” which target just the cancer cells and leave the rest alone, have eliminated some of the debilitating side effects of chemotherapy and radiation. Such medications are now available to treat lung, breast and colorectal cancers. And treatments likely will become even more personalized in the future. “Everybody has a unique genetic makeup that can affect how they respond to certain drugs,” says Kraut. “In the next five to ten years, I think we will be able to determine the patient’s genetic makeup and the cancer’s
Cardiovascular disease claims more lives each year than the next four leading causes of death combined (cancer, chronic lower respiratory disease, accidents and diabetes). “It’s like having a 9/11 every day,” says Dr. Shukri David, co-leader of the St. John Health Cardiovascular Network in Southfield. “Almost 5,000 Americans die each day from heart disease.” That death rate, however, is falling, thanks to a reduction in cigarette smoking, growing awareness of the importance of diet and exercise, and advances in diagnosis and treatment. The emerging use of CAT scans for cardiac screening, for example, can detect heart blockages without any invasive procedure. Up until now, the standard procedure for checking for blockages was cardiac catheterization, where a probe was inserted into a blood vessel in the groin and snaked up toward the heart. By contrast, a CAT scan uses an advanced x-ray procedure to take many pictures of the heart, from which computer programs generate amazingly detailed threedimensional images. “This is a very powerful diagnostic tool, and though it is still in its infancy, it’s already in use in some places,” says David. “Within the next five years, this technology will replace the cardiac screening tests we have now.” Treatments for blockages have also advanced. In the past, doctors would insert a balloon to open up a blocked artery. However, in up to half of the procedures, the artery would renarrow in a few months’ time. Today, doctors can insert stents that are coated with a drug that prevents renarrowing. “These new stents have cut the re-narrowing rate to less than 10%,” says David. “And they have reduced the number of patients requiring open heart surgery “As the we are going by about 20% nationally.” For patients with congestive heart failure, re“to see an synchronization defibrillators are now available to “number of people with cancer.” make their hearts beat more efficiently. These — Dr. Michael Kraut devices, which are surgically inserted, can also send a shock to restart the heart if it stops. Researchers have also identified a protein in the blood that genetic makeup, and then determine the best treatment for tends to rise in people with congestive heart failure. “That this particular cancer in this particular patient.” can be an early marker in people who come in reporting DIABETES fatigue or shortness of breath,” says Elie, the Chelsea While death rates due to cardiovascular disease and caninternist. “By testing for this protein, doctors may be able to cer have declined, death rates due to diabetes have increased pick the condition up earlier and hopefully keep the patient by 45% since 1987. Today, about 21% of people age 60 and out of the hospital.” older have diabetes. That’s due in large part to the epidemic CANCER of obesity that is overtaking the country. “About 65% of the Cancer is the No. 2 killer in the U.S., accounting for 23% U.S. population is overweight,” says Charlotte Davenport, of all deaths. Of those, lung cancer claims the lion’s share, diabetic educator with the Joslin Diabetes Center Affiliate at followed by colon/rectal cancer, breast cancer and prostate Providence Hospital in Southfield. “Being overweight is a cancer. Although death rates from cancer have actually fallen direct contributor to developing diabetes.” over the past decade (to 190 people per 100,000 population That’s the bad news. The good news is there has been an in 2002 from 216 in 1990), the total number of people with explosion of new therapies to treat diabetes over the last cancer is growing. several years. Several new classes of non-insulin drugs have
population ages, increase in the total
Winter 2007
5
been approved, for example. “These new drugs help sensitize our bodies to our own insulin and help restore our insulin levels naturally, rather than by injecting artificial insulin,” says Dr. Gary Edelson, president of the Michigan affiliate of the American Diabetes Association. “That means we’re starting to treat diabetes by getting to the root of the problem rather than by overcoming the results of the problem.” Older insulin users will find that delivery methods have improved markedly, as well. For example, a slow-release insulin has been approved, so a patient just needs one shot a day, rather than several throughout the day. There are disposable pen devices, about the size of a highlighter, which are filled with insulin. The patient just screws a little needle on the end and dials in a dose and injects — no more drawing up a dose out of a vial. Another insulin doser has a large push button and large, easy-to-read numbers on the dial, making it very senior-friendly. And researchers are working to eliminate the need for injections altogether. Recently, an inhalant form of insulin was released. Insulin that can be taken orally or in the form of a nasal spray are currently in trials. These advances promise a brighter future for older diabetics. “The better controlled the diabetes is, the less likely patients are to develop complications from diabetes, such as nerve ending damage in the feet and fingertips, loss of eyesight and kidney failure,” says Edelson.
A Closer Look at Minority Populations
ALZHEIMER’S DISEASE The No. 1 risk factor for Alzheimer’s disease — the most common cause of dementia — is age. Indeed, one in ten people age 65 and older have Alzheimer’s, and nearly half of those over age 85 are affected. “So far we don’t have a cure, but we do have promising medications to decrease the symptoms and increasing knowledge of prevention strategies,” says Beaumont Hospital’s Imam. “We now know, for example, that the things that are good for the heart are good for the brain. Regular exercise and a healthy diet help control blood pressure, diabetes and cholesterol levels, which, in turn, help reduce the risk of Alzheimer’s.” Several drugs that have been approved for use in the early stages of the disease have recently gotten approval for use in the moderate and late stages. These drugs can’t stop or reverse the course of the disease, but they can slow the development of symptoms. The fact that the FDA has approved them for use in the latter stages of Alzheimer’s shows these medications can benefit patients even after the disease has progressed. Researchers are hoping to be able to use scanning techniques to diagnose Alzheimer’s in its early stages. Toward that end, the Alzheimer’s Association just funded its largest grant with the National Institutes of Health (NIH) to determine whether brain imaging — specifically PET scans and MRI scans — can help predict onset and monitor progression of Alzheimer’s disease. “The diagnosis of Alzheimer’s has been a process of elimination,” says Eric J. Hall, CEO of the Alzheimer’s Foundation of America. “Doctors had to rule out other causes of memory loss, such as stress, vitamin B deficiency or a reaction to other treatments. If the scans prove effective, they could eliminate the guesswork and allow for earlier diagnosis.”
New diagnostic techniques and treatments for many age-related illnesses offer a host of benefits; unfortunately, they won’t be shared equally. In fact, the populations that need them most are likely to get the smallest share. “Overall, minority populations are more impacted by chronic diseases than non-minorities,” says Dr. Peter Lichtenberg, director of the Institute of Gerontology at Wayne State University in Detroit. “Many are living in poverty, in unhealthy environments and without access to health care. But even when access and economics are equal, minorities receive less screening, aren’t referred to specialists as often and are not considered for advances procedures as often as non-minorities.” Consider diabetes. The disease affects 8.7% of the Caucasian population, but 13.3% of the African-American population. And the latter group is more likely to suffer from the disease’s serious complications and to die. Heart disease shows the same pattern.The death rate from heart disease for African Americans is 200 deaths per 100,000 population, compared to 120 deaths per 100,000 for Caucasians. “We need to improve access to the health care system for minorities,” says Lichtenberg. “We need to work to stress health promotion behaviors and push to get chronic diseases diagnosed in the same early stages in minority populations that we do in non-minorities.We need to do these things before the benefits of recent medical advances can be enjoyed by all seniors.”
6
ARTHRITIS AND OSTEOPOROSIS Although most forms of arthritis are not deadly, the diseases can be debilitating. About one in five adults in the U.S. have been diagnosed with some form of arthritis, and almost half of the 65-plus population suffers from it. One of the best treatments for arthritis is decidedly low-tech — exercise. “Numerous studies have shown how important exercise is in managing arthritis,” says Barbara Berent, associate vice president for programs of the Arthritis Foundation’s Michigan Chapter. “Exercise releases endorphins, which help us feel better. It causes fluid in our joints to flow more, lubricating the joints and carrying impurities out. And it strengthens the muscles around the joints so they are carrying their share of the load.” A particularly debilitating disease related to arthritis — osteoporosis — is characterized by bone loss that can lead to fractures and breaks. Women are four times more likely than men to suffer from osteoporosis. Although there is no cure, several Michigan Generations
medications — such as Fosomax and Actenol — can slow or halt bone loss. The drugs, however, require a stringent regimen — patients must take them daily with lots of water on an empty stomach, remain upright and wait 30 minutes before eating. A new medication — Boniva — can be taken orally once a month or by injection once every three months. “This medication makes compliance much easier,” says Dr. Jonathan Krant, director of teaching service in rheumatology at Berkshire Medical Center in Pittsfield, Massachusetts. “Combine this medication with calcium and vitamin D and you have a wonderful therapy which, in the majority of cases, will prevent more bone loss.” A new procedure promises to help prevent one of the hallmarks of osteoporosis — stooped posture. Called kyphoplasty, this minimally invasive surgical procedure is used to treat people who have had fractures in their vertebrae. A physician inserts a balloon into the collapsed vertebrae, pumps it back up to its normal size and then fills it with a cement. It is most suited for people who are experiencing severe pain or difficulty breathing as a result of vertebral fractures. Researchers are also trying to identify biomarkers that could help determine people at risk for developing arthritis so preventive actions can be taken. “People mistakenly believe that arthritis is a part of aging and they just have to live with it,” says Berent. “The more they believe that and fail to get an early and accurate diagnosis, the more arthritis takes hold of their body and does its destructive work.”
DEPRESSION Physicians and patients alike have long thought of mental health as separate and distinct from physical health. More and more studies, however, are revealing a link between the body and the brain. “The major contributor to depression in late life is disabling or chronic conditions,” says Dr. Gary J. “The major Kennedy, director of the Division of Geriatric Psychi“in late life is atry at the Montefiore Med“conditions.” ical Center, Albert Einstein College of Medicine in the Bronx. “If you look at seniors who are living out in the community independently, the majority of them have no symptoms of depression. But studies have shown that up to 25% of people who suffer from conditions such as heart disease, stroke, dementia and diabetes are depressed. So it is not age that is driving depression, it is physical illness and disability.” Some conditions, such as heart disease, are so strongly linked to depression that doctors believe they may cause biological changes in the brain that can lead to depression. And when patients are depressed, they are less likely to adhere to their treatment regimen, so their medical condition worsens, initiating a vicious cycle. However, the majority of depressed patients, regardless of their age, respond well to treatment. And finding the treat-
ment that works has just gotten easier. “Within the past six months, results from a National Institute of Mental Health study called STAR*D have been released that offer reliable data about which drug or combination to try if the first effort didn’t work,” says Kennedy. “That’s huge, because only one half of depressed patients respond to the first medication.” For patients who don’t respond to antidepressants and talk therapy, ECT (electroconvulsive therapy) can be effective. “Even though it sounds extreme and conjures up images of One Flew Over the Cuckoo’s Nest, EST, as it is performed today, is quite safe,” says Dr. Helen Kales, director of the geriatric psychiatry clinic and investigator for the health services research and development at VA Ann Arbor Health Care System. “It’s also more effective for treating severe depression than any other treatment. In those cases where a patient has not responded to medication, ECT can be really miraculous.” An even more promising treatment — transcranial magnetic stimulation, or TMS — is being studied. An electric coil generates a magnetic field, which causes electrical changes in nerves in the brain. “Unlike ECT, the treatment does not induce a seizure and the patient does not need to be sedated,” says Kales. “So there is less chance of side effects, such as short-term memory loss.” With all the medical advances, it’s easy to lose sight of the age-old, common-sense treatments and prevention strategies. “The therapies that are still the most effective for age-related
contributor to depression disabling or chronic
Winter 2007
— Dr. Gary J. Kennedy
illnesses, such as heart disease, diabetes, cancer and dementia, are weight control and exercise,” says Dr. Brent C. Williams, a geriatrician at the Turner Geriatric Center at the University of Michigan in Ann Arbor. “They are not sexy and not high-tech, but very good evidence shows they are effective. And it doesn’t take much. Just getting your heart rate up a little bit every day can make a world of difference.” MI
REGIONALNews In communities across the U.S.,
11
Area Agencies on Aging (AAAs) serve as gateways to local resources, planning efforts and services that help older adults remain independent. Here are the programs and services offered by Michigan’s AAAs.
Detroit Area Agency on Aging Area Agency on Aging 1-B The Senior Alliance Region 2 Area Agency on Aging 3A Kalamazoo Co.Health & Community Services Dept. Region 3A 3B Burnham-Brook Region IIIB 3C Branch-St.Joseph Area Agency on Aging IIIC 4 Region IV Area Agency on Aging 5 Valley Area Agency on Aging 1A 1B 1C 2
9
10
7
8
6 Tri-County Office on Aging 7 Region VII Area Agency on Aging 8 Area Agency on Aging of Western Michigan 9 NEMCSA Region 9 Area Agency on Aging 10 Area Agency on Aging of Northwest Michigan 11 Upper Peninsula Area Agency on Aging 14 Senior Resources of West Michigan
5
14 6 4
1B
3A 3B 3C
2
1A 1C
S POTLIGHT O N …
Area Agency on Aging of Northwest Michigan Offering information and funding senior services in the 10-county area of Northwest Lower Michigan
Promoting Culture Change in Nursing Homes
O
ne of the goals of the Long-Term Care Ombudsman Program is to improve the quality of life for individuals receiving care in nursing homes and other long-term care settings. Quality of life can only be truly achieved with a commitment to changing the culture of care to one that is person-centered, allowing individuals to experience real autonomy, the dignity of choice, the dignity of risk, respect in one’s daily life, and being empowered to assert one’s rights and preferences. Citizens for Better Care, the ombudsman program in Region 10, has supported culture change in nursing homes by co-founding and supporting the Best Practices of Northern 8
from Northern Michigan nursing homes will join together for the 9th Annual Best Practices ConferMichigan (BPNM) ence at Kirtland Community Committee.The College in Roscommon. This BPNM Commitconference will focus on the tee was formed importance of building relain 1997 by Nancy tionships between residents, Turner, ombudsNancy Turner, Region 10 staff, family and community. man in Region 10, ombudsman and co-founder of These valuable relationships and Janice the BPNM Committee. have the power to alter the Osborn, now nursing home culture in a way that retired ombudsman from Region 9. positively transforms each individual’s The goal of the committee continues experience to one that is truly personto be the promotion of educational centered. opportunities supporting culture For more information about the change in nursing homes by offering conference or the ombudsman monthly educational meetings and an program, call Citizens for Better Care at annual conference. 1-866-485-9393 (from Region 10) or On May 23, 2007, advocates plus 231-947-2504. administrators and direct care staff Michigan Generations
Detroit Area Agency on Aging Serving Detroit, Highland Park, Hamtramck, Harper Woods and the five Grosse Pointes in Wayne County
“Own Your Future”: A New Curriculum for Planning Ahead
I
f Paul Bridgewater has his way, Detroit area residents will trigger a renaissance in long-term care. Bridgewater, president and CEO of the Detroit Area Agency on Aging, has spent 27 years in the field. He’s a long-time community organizer and senior advocate who also teaches gerontology classes at Wayne County Community College. Now, with a planning guide available from the Centers for Medicare and Medicaid Services, he’s armed to promote the most important adult education course ever: “Own Your Future.” “Own Your Future” is a free toolkit to plan for long-term care. It presents planning options for individuals of all socio-economic backgrounds, including the need for long-term care insurance. Many Americans are unaware that most health insurance plans do not cover long-term care. Nursing facilities may cost $50,000–$60,000 annually — either for a family or the government. Reducing the cost of these services is important to all citizens. “So much in life cannot be predicted or controlled,” says Bridgewater. “The least we can do for ourselves and our loved ones is to understand what it takes to maintain our independence. We have options — and we need to know them as early as possible.” For the Detroit Area Agency on Aging, the “Own Your Future” toolkit is the catalyst for a community-wide campaign on living long and living well. Throughout 2007, the Detroit Area Agency on Aging will work with its community partners to present community workshops, lecture series and forums on finances, long-term care insurance, legal directives, healthy lifestyle activities, home help options, Winter 2007
and trends in residential housing for older persons. DAAA will also provide its own employees with vital information to better plan for their own futures. “Our staff is a microcosm of our service area,” Bridgewater explains. “Our average age is 50. We are busy parents and grandparents raising children and caring for our aging parents.
For free copies of the “Own Your Future” planning guide for long-term care, call 1-866-752-6482 (PLANLTC).
We battle high blood pressure, diabetes and heart disease.We know we should exercise more and make healthier food choices.We’re responsible for our future, and now we’re saying, ‘Let’s own it!’” This initiative started with a letter from Michigan Governor Jennifer Granholm to promote the long-term care toolkit among Michigan residents ages 45–65. She wrote: “Many of us do not like to think about getting older, or the possibility
that at some time in the future we may not be able to perform such routine tasks as bathing and dressing. The truth is that most of us will need some type of long-term care in our later years. While this is a normal part of aging, many of us don’t plan for it adequately. Then, when we need long- term care, it becomes a time of crisis for ourselves and our families.” Family caregivers often add the financial obligations of their aging parents to their own expenses, without learning an important lesson about long-term care insurance. “Unfortunately, too few focus on long-term care, whether we’ve saved adequately or not,” continues Bridgewater. “If we’re fortunate to live into our 80s and 90s, even with our health and mobility, we may still need help with health care or personal needs and activities.” For DAAA, the job is to define long-term care for an urban population. Most seniors prefer to stay in their own houses and communities as long as possible, making community and home health care services among the most significant options in longterm care. Through DAAA’s in-home help programs, seniors will be provided assistance so that they can manage caring for themselves, handle household chores and make the necessary repairs for a safe, healthy home environment. Bridgewater concludes: “We’re going to give our senior population a new vision of aging, and when it comes to long-term care, we’ll underscore: Own Your Future!” To contact the Detroit Area Agency on Aging, call 313-446-4444. 9
Area Agency on Aging 1-B Serving the counties of Livingston, Macomb, Monroe, Oakland, St. Clair and Washtenaw
Independence in Art and Life
A
rthritis, neuropathy and vision problems haven’t stopped 87-year-old Anne Hearshen from pursuing her art. Anne is an accomplished artist whose watercolors continue to win prizes at exhibitions. She is also a member of a writing group, often expresses herself through poetry and loves to sing and bake. Anne lives in her own apartment at Teitle Senior Apartments. Less than 10 years ago, Anne was still working as a market researcher. After she had a few falls and continued difficulty with her mobility and vision, it was suggested that she consider getting assistance to help her remain living in her home. At first, Anne was reluctant, but eventually she concluded that some assistance would be
Help Is a Phone Call Away The Area Agency on Aging 1-B is the first resource for older adults, caregivers and persons with disabilities to call when looking to resolve problems or locate the resources they need to improve the quality of their life. When individuals call the tollfree service at 1-800-852-7795, they speak with a certified Resource Specialist who accesses a database of over 2,000 community agencies and mails the individual a complete listing of relevant services and providers.
Call us. We can help.
1-800-852-7795 10
valuable — and she accepted help with transportation, laundry, housework and personal care, which would allow her to remain independent and able to pursue her interests. Today she continues to paint, exhibiting her paintings frequently. She still bakes, participates in her Ann Hearshen and a selection of her artwork. writing group and now enjoys playing bridge. The Area Agency on For more information on services and Aging 1-B, the Jewish Apartments, resources available in the community to Jewish Family Services and Anne’s help an older adult remain living in their family help her to remain living indeown home, contact the Area Agency on pendently in her own home while Aging 1-B at 1-800-852-7795. pursing the activities she loves.
Organizations Receive Over $27 Million in Funding to Provide Senior Services
T
he Board of Directors of the Area Agency on Aging 1-B (AAA 1-B) granted funding requests to organizations in Livingston, Macomb, Monroe, Oakland, St. Clair and Washtenaw counties for a three-year period, from October 1, 2006, to September 30, 2009. Total funding for the first year of the three-year period is $9,213,028. Funding will continue at that level for the subsequent two years, resulting in over $27 million dollars allocated to local senior services across the six-county geographic
region served by the AAA 1-B. Services supported by this funding include adult day services, home injury control, home-delivered and congregate meals, grandparents raising grandchildren, legal services, elder abuse prevention, chores, the ombudsman program and services for the deaf and visually impaired older adult. Older adults, their caregivers and other interested individuals are invited to call the AAA 1-B at 1-800-852-7795 for more information on these services.
Michigan Generations
Resources to Help with Difficult Driving Decisions
S
ome seniors may reach a point where they are no longer sure if they should continue to drive, but are afraid to give up their license for fear of losing their independence. Alternatively, children of many seniors often wish their mother or father would stop driving but are not sure how to initiate this conversation. The Area Agency on Aging 1-B has two free resources available to help seniors and their families with this difficult decision. “How’s My Driving: Simple Tips for Maintaining Driving Skills” — developed by the Michigan State Police Third District Headquarters — provides a short self-assessment test for seniors to determine if they should change their driving habits. The guide also lists local resources available if seniors want more information on refresher skills and other options. The resource titled “We Need to Talk… Family Conversations with Older
A change in driving habits enables many seniors to continue using their cars.
Drivers” — developed by the Hartford Financial Services Group — provides a wealth of information to family members who are concerned about an older loved one’s driving ability. This guide gives ideas on when it is a good time to begin talking about
driving, how to prepare for serious conversations about limiting or stopping driving and many other essential topics. To obtain copies of these two resources, contact the Area Agency on Aging 1-B at 1-800-852-7795.
Region 2 Area Agency on Aging Serving Hillsdale, Jackson and Lenawee counties
Senior Citizens of the Year
I
n cooperation with the Michigan State Fair and Consumers Energy, the Michigan Commission and Office of Services to the Aging have selected Bob Oliver of Adrian and Kenneth Lautzenheiser of Hillsdale as the two Senior Citizens of the Year for 2006. Oliver, 73, was selected as the winner in the Service category, and Lautzenheiser, 82, won in the Leadership category. Both were honored at the Michigan State Fair in Detroit on August 28, 2006. “Mr. Oliver sets an example for all of us on the importance of staying active and involved in our community,” says Sharon Gire, director of the Michigan Office of Services to the Aging. Oliver is a vibrant and dedicated volunWinter 2007
Senior Citizens of the Year are Bob Oliver (left), 73, of Adrian, Lenawee County, in the Service category, and Kenneth Lautzenheiser (right), 82, of Hillsdale County, in the Leadership category.
teer for numerous organizations in Adrian. He serves as vice president of the advisory board for the Adrian Senior Center and helps with all center activities. For a number of years, Oliver has been a driver for the Meals
on Wheels program. Gire continues, “Mr. Lautzenheiser’s leadership qualities and dedication to seniors have made a positive impact on so many lives.” As a member of the Board of Directors for LifeWays, the local community health agency, he has shown commitment to improving the lives of seniors. Lautzenheiser is also an active member of the Area Agency on Aging Advisory Committee, chair of the Tri-County Health Board, and a member of the Hillsdale County Planning Commission. Each winner received a congratulatory letter from the Governor. In addition, this year, each winner was surprised with a $500 award from Consumers Energy. For more information, contact Barbara Stoy at the Region 2 AAA, 1-800-335-7881 or 517-467-1909. 11
Branch–St.Joseph Area Agency on Aging IIIC Serving a two-county area surrounding Sturgis, Three Rivers, Coldwater and Quincy
Your Local Long-Term Care Connection
F
or almost ten years, the mission of the Branch-St. Joseph Area Agency on Aging has been to provide a full range of high-quality services, programs and opportunities that support the independence and dignity of older and disabled adults. In keeping with our mission, the Area Agency on Aging (AAA) performs three primary activities: • Advocates on behalf of older and disabled persons, • Identifies needs of the elderly and disabled, and creates plans for meeting those needs through a system of in-home and community services to enable people to maintain their independence and dignity, • Administers federal, state and
local funds to support those services. Over the past year, our agency has been actively involved in preparing for change. In recognizing our strengths as an Area Agency on Aging, as well as the strengths held among our numerous community partners, we are positioned to move long-term care reform forward. As we mentioned in the Summer 2006 issue of Michigan Generations, we are busy implementing the Southwest Michigan Long-Term Care Connection, a single point of entry demonstration project. We are committed to being a highly visible and trusted source of information and assistance about longterm care, aiding individuals and families with planning and access to
needed services and supports. Call our office today to speak with our caring staff. We will listen to your needs, respect your privacy and honor your preferences. Southwest Michigan Long-Term Care Connection Toll-free: 1-866-642-4582 Phone: 517-279-8009 Fax: 517-278-2494 For further information, please contact the Branch-St. Joseph Area Agency on Aging at our new phone and fax number: 517-278-2538 or toll-free 1-888-6158009; fax: 517-278-2494.Visit our website at www.bhsj.org/AAA.
Region IV Area Agency on Aging Covering Michigan’s Great Southwest including Berrien, Cass and Van Buren counties
Seniors Going Back to School
S
enior citizens in Southwest Michigan are going back to school. They go not to learn but to make a difference in the life of a child.Yet if you ask the seniors, they will tell you that they learn a lot too. These seniors are volunteer Foster Grandparents through the Region IV Area Agency on Aging. They go to school four mornings a week and serve children who need the attention of a caring adult. Volunteer Foster Grandparents make a difference in the lives of children in Southwest Michigan. Foster Grandparents spend time reading to children, helping ear. Some serve in day care programs, with spelling and giving hugs. In higher rocking babies and singing lullabies. grades they help with homework and Cora Buncom says that the stubefriend students who need a listening 12
dents she serves have made wonderful progress. “This is what gets me up and out the door every day. I get choked up when I talk about them … I love them all so much.We learn a lot together.” Another grandma reports, “My life is so much better. I thought I was all used up, that nobody needed me. I was wrong! These kids need me. I make a difference for them every day.” Foster Grandparents can earn a monthly tax-free stipend of up to $200 along with other benefits, but as Grandma Inez says, “I get paid in hugs!” For more information, call Pat Arter at 269-983-7058 or 1-877-660-2725.
Michigan Generations
Tri-County Office on Aging A consortium of Clinton, Eaton and Ingham counties and the cities of Lansing and East Lansing
Senior Refugee Transportation Program
T
he Tri-County Office on Aging, in collaboration with the Refugee Development Center in Lansing, is providing the Senior Refugee Transportation Program.Through this program, senior refugees are taken by van to the local farmer’s market to shop for fresh produce.There have been three to four trips provided per week. Each senior refugee also receives a five-dollar voucher to apply toward produce. After shopping, the group goes to a senior dining site for lunch and socialization.The only criteria for the program is that the participants have a current refugee status, and are 60 years or older. The program has been a great success. It has provided an opportunity
older adults at the senior dining sites.The refugees have been welcomed at the meal sites. Cultural awareness presentations were also provided at the dining sites by Vincent Delgado of the Refugee Development Center. This program is partially funded by a Senior Refugee Support Project, a grant through the Department of Human Services.The grant is administered through the TriParticipants in the Senior Refugee Transportation Program. County Office on Aging.The Tri-County Office on Aging has confor 34 older refugees to have transtracted with the Refugee Development portation to the market once a week. Center to implement the Senior Even more important, it has provided Refugee Transportation Program. a social outlet for people who otherFor further information, contact the Triwise have few opportunities to get out County Office of Aging at 517-887-1440 in the community, to gather with or 1-800-405-9141. peers, and to assimilate with other
Region VII Area Agency on Aging Serving Bay, Clare, Gladwin, Gratiot, Huron, Isabella, Midland, Saginaw, Sanilac and Tuscola counties
and so on.These appointments do not have to be in one of the three counties, and some volunteers drive as far as Ann Arbor and Detroit.The pron three of the ten counties that the gram was developed to help seniors Region VII Area Agency on Aging maintain their health, reduce isolation serves (Huron, Sanilac and Tuscola), the and promote independent living. Human Development Commission The process begins with the senior (HDC) coordinates a service called making a phone the Senior call (1-800-843Transportation 6394) to the Program.The senior transprogram transportation coorports seniors, dinator at 60 years and HDC. The senolder, to and ior will tell the from commucoordinator nity facilities when he or she such as docwishes to be tor’s offices, picked up and pharmacies, Volunteer MaryAnn Szpunar and transportation where he/she meal sites, hoscoordinator Carol Wieland help Geraldine Neveau, at needs to be left, get into MaryAnn’s car. pital services
Riding with Pride
I
Winter 2007
taken. This message is given to the volunteer driver, and the transportation coordinator confirms the date and time of pickup with the senior. The volunteer ensures that the senior is placed in the car safely and stays with the senior while at the appointment. The volunteer’s driving and criminal records are checked through the state before they can join the program. Last year, HDC serviced 183 seniors, and the volunteers drove 51,235 miles and donated over 2,327 hours of their time. There are currently 23 volunteer drivers, who are very special and caring people. For additional information on programs and services, contact the Region VII Area Agency on Aging, 1615 S. Euclid Ave, Bay City 48706, 1-800-858-1637, ww.region7aaa.org. 13
NEMCSA Region 9 Area Agency on Aging Covering 12 counties of Northeast Michigan
Parkinson’s Resources Provide Support
P
arkinson’s disease is a neurological disease that affects the function of the body’s muscles and movement. Approximately one million Americans have Parkinson’s disease, including three out of every one hundred people over the age of 60. The key signs of Parkinson’s disease are: tremor (shaking), slowness of movement, rigidity (stiffness) and difficulty with balance or changes in walking (gait). Even though there is no cure for Parkinson’s disease, by identifying individual symptoms and determining a course of treatment, most people with the disease can live fulfilling lives. The Northeast Lower Michigan region has a number of Parkinson’s
resource and support groups. Affiliated with the Michigan Parkinson’s Foundation (MPF), groups in West Branch, Alpena and Gaylord are active in
helping those affected by Parkinson’s disease. Led by Carol Gillman and Jennifer Raymond from the Ogemaw County Commission on Aging, Parkinson’s meetings are held at the West Branch Regional Medical Facility’s executive meeting room the second Thursday of each month, 12:30–2:00 p.m. Otsego County holds their Parkinson’s meetings the fourth Thursday of
each month, 3–5 p.m., at the Diocesan Pastoral Center in Gaylord. Pam Morgridge is the facilitator, along with assistance from the Otsego County Commission on Aging. The Alpena Area Resource and Support group meets the fourth Monday of each month at the Educational Service District building at 1:00 p.m. Kara LaMarre from the Area Agency on Aging Region 9 co-facilitates the meetings with Georgene Anderson, who started the group over 20 years ago. MPF offers assistance with medication costs, adult day care funding, neurologist and community referral, educational programs and advocacy. For more information regarding Parkinson’s disease and area support groups, call the MPF offices at 1-800-852-9781.
Upper Peninsula Area Agency on Aging Serving all 15 counties of Michigan’s Upper Peninsula
Take the PATH to Better Health!
C
hances are, you know someone who is struggling to cope with a chronic disease such as diabetes, arthritis or cardiovascular disease. It is estimated that almost 75 percent of those age 65 and older have at least one chronic illness.These chronic conditions can often lead to severe disabilities such as hip fractures and stroke, as well as progressive disability that slowly erodes the ability of elderly people to care for themselves. The good news is that there is a new program in the Upper Peninsula to teach older persons self-management techniques that reduce both the cost and pain associated with chronic diseases. PATH (Personal Action Towards Health) was developed by
14
Stanford University and has proven to be a cost-effective tool in helping people manage their chronic illnesses. The Upper Peninsula Diabetes Outreach Network (UPDON) recently sponsored leadership training to certify those interested in becoming trainers for this innovative program.Tonya LaFave, a registered dietitian with the U.P. Area Agency on Aging, attended the event and became a certified trainer. “People with a chronic disease can often feel isolated and helpless. PATH can help them learn to manage their symptoms and maintain active and fulfilling lives,” states LaFave. Those who want to participate in the program will attend a workshop once a week for six weeks in a com-
munity setting such as senior centers or libraries. People with different chronic health problems attend together. Participants will learn such things as: • Techniques to deal with frustration, fatigue, pain and isolation • Exercises for maintaining and improving strength and flexibility • Appropriate use of medications • Communicating effectively with family and health professionals • Proper nutrition • How to evaluate new treatments The U.P. Area Agency on Aging plans to begin offering workshops throughout the Upper Peninsula after the first of the year. For more information about PATH or to schedule a workshop in your area, please contact UPAAA’s Senior Helpline at 1-800-338-7227, or dial 2-1-1. Michigan Generations
ASKtheExpert
Katana Abbott, CFP,CSA
The Designated
Daughter
s women, we are often expected to fill multiple roles: that of a loving mother, career woman, supportive wife or partne … and, at some point for many, a new role — that of caregiver to our parents or loved ones. Women often take on this role willingly out of love or even guilt, but without proper planning this role can take a toll on a woman’s health emotionally and physically.
A
As the “Designated Daughter,” it is up to me to make all arrangements for my mother’s care. She is now in a nursing home. How do I deal with people who feel a need to voice their opinion about my decisions, but won’t raise a finger to help? — NR, Commerce, MI YOUR SITUATION IS RATHER COMMON
for many Designated Daughters who are trying to balance career and families while still attending to aging parents. Years ago it was easier to take care of relatives in the home because most women didn’t work outside. Having to place a parent or spouse in a facility can create guilt and stress for all. You may want to call for a family meeting and allow everyone to address their concerns to the group. You may also consider doing this at the nursing home with a member of the staff present. Be sure someone is there to moderate the discussion and to help keep conversations nonemotional. You could also request that questions and suggestions be submitted in advance, so you can be prepared for a productive meeting. At the meeting, you can also ask for volunteers to be part of a visitation
Do you have a caregiving question? Contact Jenny Jarvis, Area Agency on Aging 1-B, 29100 Northwestern Hwy., Ste. 400, Southfield, MI 48034; jjarvis@aaa1b.com. Winter 2007
schedule. If they are unwilling or unable to do this — or even attend the meeting, thank them for their concern and then let them know that decisions will be addressed by you and the staff. Then you need to let this go. Our father-in-law passed away suddenly last June. A CPA by trade, and dedicated to his profession and family, he made sure clients had their financial affairs in order. Surprisingly, his children discovered his finances were not, and significant brokerage money was lost because his account could not be accessed. It took months to sort everything out, pay creditors and sell assets. Katana, how would you approach someone who is perceived as an expert about their financial business, especially if they are your parents? — JF, Canton, MI WE OFTEN FEEL UNCOMFORTABLE
discussing financial or caregiving issues with our parents. I believe having this difficult conversation early is crucial. A good way to do this is to find the right time to ask your parents the question, “What would you do if I was in an accident and couldn’t speak or make choices for myself?” Once they are thinking about how they would feel in this situation, it will make sense for you to ask them about their own situation. You should ask what role you would take, who their advisors are, and when their current plan was last updated. If they are not open to discussing this with you, you may have to get the assistance of someone they respect and trust and have them approach your loved one on this topic. Another way to start this conversation is to get your own planning done and talk to them about what you are doing; then ask them the question above. The key here is to have this conversation before it’s too late and your planning options are limited.
My mother retired 15 years ago with an income she felt would be adequate for her future needs. However, she is feeling overwhelmed with the rising costs of living, including higher prescription costs, higher condo association fees and assessments, and dental problems that are not covered under insurance. She is actually considering finding a job, at 79 years old! What can I do to help her feel more in control of her life, reduce her stress and find the right long-term solution for her? —JR, Lapeer, MI HEALTH CARE IS BECOMING A MAJOR
issue for so many seniors. They never dreamed that medical costs would be as high as they are today. This letter is a perfect example of how important it is to consider things like medical, dental and prescription costs, inflation, and its impact on the cost of living — even if your home is paid off when planning for retirement. For your mother, areas to consider include reviewing her current health insurance options and comparing them to other plans. Depending on her income needs, she may find that a part-time job is enjoyable and fills the income gap; she may even qualify for low-income senior housing benefits. I recommend meeting with a professional early to determine the appropriate amount of retirement dollars and long-term care insurance she needs to meet potential medical and long-term care costs. KATANA ABBOTT is founder and vision coach of www.SmartWomensCoaching.com and helps women prepare for taking care of their aging parents. For a copy of her article, “The Designated Daughter—How to be prepared for that call in the night,” email at katana@smartwomenscoaching.com or call 248-366-0137. 15
SPONSORS American House Adult Communities with Services Unlike Any Other Stop by any of our 31 locations in Oakland, Wayne, Macomb, Washtenaw and Genesee counties or visit is online at www.americanhouse.com
Chalgian & Tripp Law Offices PLLC • Elder Law • Estate Planning • Special Needs Planning Offices in East Lansing, Jackson and Ithaca. 1-888-956-9600.
Presbyterian Villages of Michigan Senior Living Communities Serving seniors of all faiths since 1945. To find out more, visit our website, www.pvm.org, or call 248-281-2020 for a brochure describing the variety of housing and services Presbyterian Villages of Michigan offers. Thanks to these companies and organizations for their generous support. For more information on becoming a sponsor of Michigan Generations, please call Jenny Jarvis at 248-262-9202 .
How to Stay Well During Winter Months
W
ith a little thought and preparation, you and your loved ones can safely enjoy the winter season. Here’s a checklist to make sure you’re ready for Jack Frost: Keep up with exercise programs. Look for indoor opportunities. Dancing, bowling, weekly exercise classes and yoga are just a few of the activities that older adults can continue to partake in, even as temperatures hit seasonal lows. Dress appropriately. Snow and ice can make sidewalks treacherous for everyone. Make sure to wear waterproof shoes with wide soles that provide sufficient traction. Canes should be fitted with new rubber guards. Dressing in layers can help older
adults stay comfortable indoors and out. If going outside, remember a hat, gloves and scarf to minimize exposure to the elements. Fill the calendar with activities. Seeking out family, friends and colleagues, volunteering, and participating in holiday activities can help keep the winter blues at bay.Talk to a professional, if you or your loved one is feeling blue for longer than a few weeks. Plan ahead. Winter storms can limit access to many services. Older adults should have one to two months of prescription medications on hand in case they cannot get to a pharmacy. Keep a
contact list for emergency and community services in your area that can assist with snow removal and transportation. Eat, drink, and stay merry. Culinary treats make the holiday season fun, but remember to stay within the dietary guidelines provided by the doctor or dietician.Think about adding nutritious winter vegetables, such as squash and turnips, to your diet. Ask for help. Call on neighbors and friends to shovel the walk or sand icy patches. To avoid dangerous falls, stay indoors on snowy, icy days. If outdoor trips are necessary, be especially mindful of icy patches on sidewalks and streets. Look for grocers who offer delivery services. — Courtesy Medical News Today