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8 Things to Know Before Buying a Retirement Condo

March 15, 2019

In many ways, this purchase is much different than buying a house

By Deb Hipp
January 31, 2019

When Marsh Williams and his wife, Carol, of Columbus, Ohio, wanted to buy a low-maintenance home in 2013, they knew a condominium would let them travel without fretting about forgoing necessary yard work or exterior upkeep. The couple, both then 61, thought they’d found the ideal unit. Marsh reviewed the condo association’s financial statements, budget and board minutes, determined everything was in order and closed the deal. Two years later, though, they were hit with a $17,000 assessment for a new roof — as was every condo owner in the building.

Before purchasing the condo, the Williamses didn’t know they should have scrutinized a document called the reserve study, an independent analysis of the condo association’s reserve fund for large expenditures. If they had, they would’ve seen that the building was estimated to need a new roof between 2015 and 2018.

Marsh knew he was in trouble after he moved in, got a copy  of the reserve study and compared the reserve fund amount with the funds needed. “It wasn’t even going to be close,” he says. The reserve account had been underfunded for years. “People here were very upset,” says Marsh. ”

Buying a Condo Isn’t Like Buying a House

As a condo owner, unlike being the owner of a single-family home, you’re part of a community where majority rules. That can lead to frustration. The condo board might use a portion of your monthly homeowners’ association (HOA) dues to pay for amenities you don’t want. Other condo owners in your building might vote against improvements you favor.

“You co-share ownership with neighbors, and you can’t pretend you’re there on your own,” says Reba Haas, a Seattle real estate agent.

That’s why it’s so essential to review the condo building’s financial records, budget, bylaws and other documents before purchasing. Friendly warning: they can range from 125 to 200 pages. “Most people get bored after the first three pages,” says Haas. “That’s a mistake.”

Before purchasing a retirement condo, make sure you investigate these eight factors to ascertain whether it’s likely to be a retirement haven or an investment hell:

  1. What information must the seller provide? Condo seller-disclosure laws differ by state. For example, Washington state requires the seller to provide the buyer with a resale certificate that includes a copy of the current reserve study, declaration budget, bylaws, assessments and other documents.

You can look up your state’s disclosure laws here, but it’s a good idea to verify on your state legislature’s site.

  1. Is the reserve fund adequate? HOA dues pay for things such as grounds maintenance and, if the location warrants, snow removal. However, a portion of those fees also goes into the reserve fund, a separate account for large expenditures like insurance and major repairs.

The condo association likely has a copy of the current reserve study analyzing whether the reserve fund has enough money to cover upcoming expenditures. Ideally, the reserve fund should contain a minimum of 10 percent of the capital budget. Ask the seller for a copy of the current reserve study.

In Marsh’s case, the board funded the reserve at just the minimum required by state law. “They didn’t know that would lead them to be upside down in the reserve fund,” he says.

  1. What’s in the annual budget? Request copies of the last two years’ budgets from the seller, suggests Beth Grimm , an HOA attorney in Pleasant Hill, Calif. Examine them for red flags like high utility bills, ongoing repairs and steadily increasing HOA dues. Also keep an eye out for annual legal fees exceeding $2,000 to $5,000, which could signal potential or pending litigation.
  2. Are there assessments? Haas has sometimes discovered “massive assessments” from $10,000 to $100,000 while reviewing condo documents for potential buyers. There may be small assessments for insurance increases or repairs, and that’s fine, but a history of large assessments could indicate poor financial management.

Look for assessments in the budget or mentioned in board minutes.

  1. Is the condo warrantable? That means its loan is eligible to be sold to government-backed Fannie Mae or Freddie Mac. Most condos are warrantable, but some are not. If the one you want to buy is not warrantable, you may have trouble getting financing for it or may be charged a higher mortgage rate.

Watch for these factors, which can cause mortgage problems:

  • Inadequate reserve fund. Neither Fannie Mae nor Freddie Mac will purchase a condo mortgage if the condo association or management company has less than 10 percent in its reserve fund.
  • Too many investor-owned properties. Neither Freddie Mac nor Fannie Mae will purchase a mortgage on a condo in a complex of more than 21 units if more than 10 percent of them are owned by an individual or single investment entity. Smaller condo communities also have specific restrictions.
  • Delinquent HOA fees. Freddie Mac and Fannie Mae won’t buy the mortgage if more than 15 percent of the total number of units are over 60 days delinquent in HOA fees.
  1. Is there pending or potential litigation involving the complex or the unit? Ask the seller. Not all states require disclosure of litigation, so be sure to check your state’s condo laws. Often, you can perform free searches of city, county and state court systems online for lawsuits.
  2. What is the master insurance policy deductible? Your condo association’s master insurance policy covers your building from your unit walls out, but you’ll have to chip in with other owners on the deductible — that can be $10,000 or more per claim.

You’ll need to purchase a “walls-in” policy covering all parts (excluding walls) of the actual condo, says Gerald Grinter, an insurance agent in Seattle. Grinter recommends a policy of at least $75,000 coverage plus a minimum of $20,000 for personal property.

It’s also wise to get loss assessment coverage of at least $5,000, which costs about $20 annually and covers your portion of the condo association’s insurance deductible.

  1. How well-managed is the homeowners’ association? Ask the seller to obtain the last two years of minutes from the condo board for your review. Look for past or pending special assessments, talk of litigation, infighting or ongoing problems.

Marsh, who is now president of his condo’s homeowners’ association, recommends meeting with, or calling, at least two condo board members before buying a condo. That, he says, will help you get a feel for the management.

“In our case, the board was completely dysfunctional, which I found out after speaking with two members the day we moved in,” says Marsh.

By Deb Hipp

Deb Hipp is a Kansas City, Mo.-based freelance writer who covers elder and caregiving issues, personal finance and popular culture. Her work can be found at www.debhipp.com.

A Nurse's Journey

March 13, 2019

We love when our team members share their stories, especially when it shows growth within their career at Presbyterian SeniorCare Network. Read about Kathy LaVan, Director of Nursing at Oakwood Heights, our Oil City campus, and why she has stayed with us since she became a nurse 22 years ago!

“I started at Presbyterian Homes (now Presbyterian SeniorCare Network) in November of 1995 as a graduate practical nurse. I never dreamed that over 22 years later, I would still be here. Those first few years, I was as scared as can be! I had patient teachers and even more patient residents as I learned to be more competent in my nursing skills. The residents I provide care to became part of my family, and watched me as my family grew to include three beautiful children. Through the years, I have sat with residents as they passed away, held hands with family members and provided comfort to families, residents and team members during difficult times. I had wonderful nurses who mentored me and coached me when I needed it. My hope is to pass my knowledge and experience on to the next generation of nursing to instill in them the art of caring for people.

I think one of the most remarkable things I have watched as a nurse has been the evolution of the long-term care world. When I came here in 1995, we had posey vests, lap buddies, four-point restraints, set meal times and horseshoe tables in which to feed multiple residents at the same time. We have grown from the institutional setting of the 1980’s to a community where we care about each resident as an individual with their desires in mind. I am very proud to work here and could not imagine working anywhere else.”

Like Kathy, do you have a story about Presbyterian SeniorCare Network that you would like to share? We would love to hear it! Click here to visit our web page. Once there, please click on the button, Share My Story. Once you have submitted your story, you will automatically be entered into a random drawing to win a $50 Visa gift card! Winners will be pulled the first Monday of every month.

Our Brains Need Exercise, Too

March 12, 2019

Learn the ways you can have a positive effect on your cognitive health
By Paula Spencer Scott

The basics of heart health have been drilled into our brains: Eat less saturated fat. Keep moving. Know your “numbers” for cholesterol, blood pressure and BMI.

But what about that brain itself? Although life expectancy has more than doubled since 1900, our “mindspan” — how long we stay cognitively healthy — hasn’t kept pace.

Forgetfulness, slower processing and feeling less sharp plague most of us as we age. One in five people develops mild cognitive impairment, a decline in thinking skills beyond normal aging, which may or may not advance to dementia. After 65, your odds of developing Alzheimer’s disease are one in 10.

It doesn’t have to be that way, mounting research suggests.

“The very term ‘age-related memory loss’ may be a misnomer,” says neurologist Dr. Richard Isaacson, an Alzheimer’s specialist at Weill Cornell Medicine in New York.

Time and genetics alone don’t erode brain functions. How we spend our lives managing the modifiable risk factors that affect our genes is highly significant for our brain health, researchers say.

That’s why you’re likely to hear a lot more in the coming years about brain health and what you can do for your own. Educating the public on this is, in fact, one of the four core purposes of the Centers for Disease Control’s Healthy Brain Initiative, which recently kicked off its 2018-2023 road map for public health agencies, says program leader Lisa McGuire.

Brain Health: Stop Thinking There’s Nothing You Can Do

“Awareness of the steps to improve cognitive brain function is at least a generation behind that of heart health,” says cognitive neuroscientist Sandra Bond Chapman, director of the Center for Brain Health at the University of Texas at Dallas.

When our fathers and grandparents died of a heart attack or stroke, we chalked it up to tragic luck. Clogged arteries, high blood pressure and high cholesterol were considered normal features of aging before 1948, when Congress commissioned researchers to begin tracking the cardiovascular lives of some 5,200 residents of Framingham, Mass.

The Framingham Heart Study (now three generations old and still going) introduced the phrase “risk factors” to the medical lexicon and helped prove which prevention tactics work.

Today, it’s the brain we’re in the dark about. In a review of public awareness studies by PLOS One, a nonprofit, peer-reviewed, online scientific journal, nearly half of the respondents mistakenly believed Alzheimer’s disease is a normal process of aging that you can’t do anything about. In reality, a third or more of dementia cases can be delayed or prevented by lifestyle factors, according to a 2017 report sponsored by the Lancet Commission on Dementia Prevention, Intervention and Care.

Read on to find out what we can do to help our brains stay in shape.

Use Brain Health to Motivate Your Health Habits

Advances in neuroimaging kicked off this new era of brain health by allowing scientists to see inside the brain. Intervention studies on how lifestyle affects brain function are newer still.

One of the largest such investigations to date, the BrainHealth Project, launched in December. Researchers across more than a dozen institutions will study 120,000 subjects to find out how cognitive training, sleep, nutrition, exercise and more can extend mental strength over time.

What’s already clear: All health roads lead to the brain. “The No. 1 cause of cognitive decline is healthy people letting their brains decline,” says Chapman, the BrainHealth Project’s director.

That’s powerful motivation the next time you’re tempted to skip a workout or not opt for a healthy meal, do nothing about stress or loneliness, or avoid treatment for conditions like depression, anxiety, diabetes and sleep apnea. Effects of all of these choices, and many others, travel north.

Resist Too Much Habit and Routine

A particular challenge from midlife and beyond is the brain’s natural inclination to steer toward efficiency. It figures out the easiest, most comfortable ways to get something done and hits repeat.

But while toweling dry in the same mechanical pattern every morning allows you to get on with the day quickly, running your whole life as a creature of habit — doing the same things, seeing the same people — deprives the brain of something else it craves: newness and challenge.

Hallmarks of brain-stimulating activities that improve cognitive abilities, according to a 2017 report by the Global Council on Brain Health (GCBH) are novelty, high engagement, mental challenge and enjoyableness.

If you like crosswords, fine, but push beyond to new games and challenges. Good examples from the GCBH: Tai chi, researching genealogy, picking up an old hobby you dropped, making art and community volunteering. When activities include a social component, so much the better.

Be Aggressive About Blood Pressure

In 2018, a groundbreaking study became the latest persuasive link between heart health and brain health. Researchers at Wake Forest University in Winston-Salem, N.C., showed for the first time that lowering blood pressure can significantly reduce the risk of mild cognitive impairment (MCI).

Standard medical care had long included a systolic blood pressure of above 140 as the target defining hypertension and requiring treatment. (Systolic pressure is the first number in a blood pressure reading, as in “140 over 80.”) In 2017, that definition was revised to 130 by the American Heart Association and American College of Cardiology.

The recent, long-term, large-scale SPRINT-MIND clinical trial, sponsored by the National Institutes of Health, found that the more aggressively high blood pressure was treated toward reaching a systolic pressure below 120, the lower the risk of MCI. Treatment measures included a combination of not smoking, medication management, nutrition counseling, social and cognitive stimulation and exercise.

Work Your Brain Harder, But Not by Multitasking

Your brain grooves on doing — but only one thing at a time. Multitasking stresses it.

Researchers say one better alternative is a cognitive exercise called “strategic attention.” The Strategic Memory Advanced Reasoning Training program at the University of Texas at Dallas, advises this: Every day, pick two substantial tasks requiring fairly deep thinking. They might be tracking and analyzing your household budget, planning a vacation, writing a memo or following a complex new recipe.

Then carve out two 30-minute sessions to focus without interruption. Turn off email alerts. Shut the door. No quick scrolls through your news feed that will take you off your task. It takes up to 20 minutes to refocus after a disruption.

Over time, you’ll find that you’ll achieve much more, and much more quickly, with improved attention. It’s the equivalent to your brain of a good workout at the gym.

Do (the Right Kind of) Nothing

It’s not all about activity. The brain needs two kinds of downtime to function optimally: Rest and sleep.

Rest means taking intentional breaks from active thinking. Try taking five minutes, five times a day, to sit still and do nothing, Chapman says. Other routes to mental R&R include mindfulness, meditation and yoga nidra (also known as iRest and sleep yoga).

Not least, there’s sleep itself. Our awareness of how important it is to the brain grew with the discovery of the body’s glymphatic system — a kind of internal trash-hauling system — less than a decade ago. The system’s pace increases by over 60 percent during sleep, a possible link to why getting more sleep is linked with a reduced dementia risk. Alzheimer’s prevention experts recommend eight to nine hours a night, Isaacson says.

By Paula Spencer Scott

Paula Spencer Scott is the author of Surviving Alzheimer's: Practical Tips and Soul-Saving Wisdom for Caregivers and An Oral History: Preserve Your Family's Story. A longtime journalist, she's also an Alzheimer's and caregiving educator.@PSpencerScott

All You Need is a Smile

March 7, 2019

A partnership that emphasizes our person-centered focus and commitment to the dignity of every life is our collaboration between Transitional Employment Consultants (TEC) and our Washington campus. The TEC program enables students with disabilities to build confidence and skills in a professional setting.

Lori McAfee, volunteer coordinator at the Washington campus, says, “More than 25 TEC students have worked at our Southmont skilled nursing center and Southminster Place personal care community. They have been passionate extensions of our team, serve as escorts to transport residents in wheelchairs to the salon or to therapy, and as assistants in the lifestyle engagement department and dining rooms. Even for the kids who are the most challenged, one hour of work makes a difference in their lives because they know their jobs are valued.”

There is no greater example of commitment to excellence than through TEC student, Wyatt Green. Wyatt has been a part of the Presbyterian SeniorCare Network family since June 2017. Each day, Wyatt transports residents to and from their room at Southmont to the rehabilitation suite for therapy.

Wyatt is a friendly face not only to the residents of Southmont, but also for families and fellow employees. At any minute of the day, you will witness Wyatt bringing a smile to someone’s face. It may be in the hallway of a neighborhood or in the café. He lifts the spirits of everyone with his quick witted humor or profound thought of the day’s events.

Lori reflects, “Wyatt always has a way of looking at the positive side of everything. Everyone should see life through the eyes and heart of Wyatt.” Wyatt is proof that a good day starts with a smile!

Protect Yourself Against Social Security Identity Theft

March 5, 2019

This kind of fraud is alarming and it's growing
By Amy Zipkin

Last fall, after the Equifax breach, Jim Borland, acting deputy commissioner for communications at the Social Security Administration wrote a blog post on the agency website headlined “Protecting Your Social Security.”  He said: “A my Social Security account is your gateway to many of our online services. Create your account today and take away the risk of someone else trying to create one in your name, even if they obtain your Social Security number.”

I took Borland’s advice, since anyone 18 or older with a Social Security number, an email address and a mailing address can open a mySocialSecurity online account and maintain it for decades before claiming benefits. But fewer than nine months after I opened the my Social Security account, I received an unexpected email from the Social Security Administration. It said: My account was being deactivated at my request.

Why Was My Social Security Account Deactivated?

I was mystified since I hadn’t contacted the agency. And no one else had access to personal details to change my password. So I called the next morning and requested a direct deposit block on my Social Security account to prevent any additional suspicious activity. (Even though I don’t collect Social Security benefits yet, a block offers two apparent safeguards: It prevents changes to direct deposit information through a financial institution or through the Social Security site. And it prevents someone else from changing my mailing address through the Social Security site.)

I also asked the Social Security Administration to notify its Inspector General about suspected fraud.

Then I tried to find out what happened.

The U.S. PIRG (Public Interest Research Group) website offered a possible clue. “With full name, birth date and Social Security number a thief can try to open a  my Social Security account in your name and change your direct deposit information to his or her checking account.”

It continued, “Coupled with other information that can easily be found online such as place of birth, a thief can try to claim your benefits over the phone.”

The Rising Trend in Compromised Social Security Accounts

My compromised account, it turns out, was not alone.

In its 2018 Identity Fraud Report, the Javelin Strategy and Research firm found nearly a third (30 percent) of U.S. consumers were notified of a breach in 2017, up from 12 percent in 2016, to the tune of $16.8 billion dollars. And for the first time, Social Security numbers were compromised more than credit card numbers in breaches. What this means, according to Javelin, is that 35 percent of individuals who were notified that their personal information was involved in a breach in 2017 had their Social Security numbers compromised.

One reason Social Security number theft is up: scammers seem to have shifted tactics. “Over the past couple of months, our helpline has received fewer reports of the IRS scam [a con artist pretending to be from the Internal Revenue Service, demanding money] while complaints about scammers impersonating the Social Security Administration have been on the increase,” said Amy Nofziger, an AARP expert on frauds and scams.

“I am aware advisories have been put out for consumers to beware of impersonation schemes,” said Mike Litt, Consumer Campaign Director at U.S. PIRG based in Washington, D.C.

How to Safeguard Your Future Social Security Benefits

How do you safeguard your Social Security benefits if you are months or even years away from collecting them?

Perhaps its counterintuitive, but experts recommend signing up for a my Social Security account and closely monitoring it.

The way to do that, says Mike Litt, consumer campaign director at U.S. PIRG, is by logging into your Social Security account regularly and checking your personal information, such as your address or date of birth. If you see changes to the information you entered when you opened the account or information that doesn’t belong to you, contact the Social Security Administration (800-772- 1213 or by email: https://secure.ssa.gov/emailus).

“It may mean someone has tried to claim your benefits, perhaps by telephone,” Litt said.

To report possible fraud or identity theft, Nofziger suggests casting a wide net. “The more reporting entries the better,” she said. Besides the Social Security Administration Office of the Inspector General, the Federal Trade Commission and the Senate Select Committee on Aging fraud hotline 800-303- 9470 are options. (Note: The Federal Trade Commission is currently closed due to the lapse of government funding.)

If You Have a Password Problem

The Social Security Administration says that if you have password problems with your my Social Security account, call Social Security and answer “helpdesk” when the auto prompt asks the nature of your call.

The Social Security Administration uses Equifax credit reports for personal identification verification. “If a person has a security freeze, fraud alert or both with Equifax, a my Social Security account could not be created,” the agency said in an email.

While reporting this story I checked back with the Office of the Inspector General to find out why my account was closed without my authorization. “Due to privacy and law enforcement concerns, we cannot comment on any investigative action we take on the allegation going forward,” communications director Andrew Cannarsa wrote in an email.

After checking my credit report and making sure it was accurate, I then opened another my Social Security account. The block is still in place and Social Security sent me a confirmation. But if I call to request direct deposit or mailing address agencies, the agency said, I may be asked to visit my local Social Security office to confirm my identity.

How to Find a Pet-Friendly Retirement Community

March 1, 2019

Locating one can be key to your happiness if you're an animal owner
By Ronni Gordon

If you’re a pet owner and considering moving to a retirement community, you will have more options than in years past. Roughly 75 percent of for-profit senior living residences accept pets. But finding the right fit at a retirement community for you and your pet can take some digging.

Sometimes, especially for low-income people on restricted budgets, it’s impossible to find a pet-friendly facility they can afford.

A Pet-Friendly Retirement Community and Your Happiness

Yet locating a pet-friendly retirement community can be vitally important for your happiness.

At Brightview Senior Living in Randolph, N.J., Laura Berger, 71, says that when she decided to leave her condo 2 1/2 years ago, she wouldn’t have moved without her 8-year-old Jack Russell Terrier, Misty. “She’s a great companion,” the retired teacher says. “We do everything together. She plays ball outside. She likes riding the elevator too. I wouldn’t trade her for the world.”

As Kathy Lehmeyer, senior manager of partner development at A Place for Mom, notes, for many owners, “their pet is like their child. For a lot of people, it’s their reason for getting up every day.” When people with pets transition to various level of care, she says, “they acclimate better if they can take their pets with them. It helps them to make new friends.”

Adds Jill Vitale-Aussem, president and chief executive officer of the Eden Alternative, an early proponent of pets in “elder-centered” communities: “Pets can bring purpose to the people who care for them.” The roughly 350 senior living communities on the Eden Alternative’s Eden Registry are likely to allow pets as part of a holistic approach.

The Keys to Finding a Pet-Friendly Housing Complex

The keys to finding a pet-friendly place are knowing how to find ones that welcome pets and knowing the questions to ask before agreeing to move in. Most pets at senior living communities are dogs and cats, but there are also birds, ferrets, guinea pigs and the occasional rabbit. (There is often a weight limit for dogs, but at some places, it can be negotiated.)

Affordable housing subsidized by the U.S. Department of Housing and Urban Development (HUD) must allow pet ownership, says Linda Couch, vice president, housing policy at LeadingAge, the national association of nonprofit providers of aging services.

But if a city or county doesn’t allow a certain kind of animal — for example, no pit bull ownership is permitted in Prince George’s County, Md. — “then these local laws trump HUD rules on pets,” Couch says.

Problems for Low-Income Pet Owners

Variations in pet policies and rules restricting their size or breed can be especially hard on low-income adults who can’t afford to shop around to find a housing complex, said Caryl Shulman, president of the Pet Adoption League of New York.

“A lot of times, they have to put their dog into the pound because they’re going into assisted living and they can’t find a place to take a dog. Or they [the facility] will take one, but not necessarily a big dog,” Shulman says. “I have seen people hysterically crying, handing over their pet. It makes people want to give up on living.”

Fortunately for pet owners, places from Kittay senior apartments in the Bronx, N.Y., to Ida culver house in Seattle, welcome them, if they can afford to live there.

A Pet Owners Support Team

Rose Villa Senior Living, in Portland, Ore., has definitely gone to the dogs… and cats. About 250 humans live there, joined by more 40 dogs 20 cats and an African Grey parrot, says community relations manager Jenna Miller. Residents can get dog treats in the lobby and join up for events like a “dog days of summer party” at their off-leash dog park. A Pet Owners Support Team offers assistance and recommendations on pet-related matters.

At the Ida Culver House and several other of Era Living’s eight communities in the Seattle area, dogs and human residents regularly gather for  “yappy hour.” The dogs get a “shot” of gravy and special treats while their owners receive wine and beer and human-friendly appetizers, says spokesperson Nicole Francois.

TigerPlace, an independent living facility in Columbia, Mo., operated by Americare in affiliation with the University of Missouri Sinclair School of Nursing and College of Veterinary Medicine, goes all-out to be pet-friendly at every level of care. Residents with pets receive visits from pet care assistants and have access to veterinary care. “PAWSitive” visits bring in interesting animals and an endowment fund enables foster care for pets who outlive their owners.

Questions to Ask

Here are some key questions to ask in your search for a pet-friendly retirement community:

  • Do the living spaces have enough room to accommodate pets?
  • Is there a place where a dog can get exercise, such as a dog run or park?
  • Are there safe grounds to take the pets for a walk?
  • Are the premises well lit?
  • Do staffers help take care of pets, and are pet sitters or dog walkers available nearby? (Ask about fees for such people. They will vary based on travel distance, the number and types of pets you have and the number of times you want this kind of support.)
  • What kind of pets do you allow to live with me, and how many can I have?
  • Is there a size restriction on the pet? (Some limit size to no more than 20 or 30 pounds, but others have no limit and base decisions instead on a dog’s personality and how the animal would fit into the community.)
  • Is a pet deposit required? If so, how much and is it refundable? (Most places require non-refundable deposits of around $250 to $300.)
  • Is there an additional monthly fee for having a pet? (Some don’t have one; at others, the fee could be $10 to $50 a month.)
  • What veterinary care services are required before I may bring a pet?
  • Is a vet located nearby?
  • If a resident gets sick, are there provisions for taking care of pets?

If you visit the Pet Friendly Senior Living site, you can put in your ZIP code to get a list of nearby pet-friendly communities and their policies.  Seniorliving.org is similar, but requires you to put in your name and address for a free referral.

Also, your local Area Agency on Aging can refer you to facilities in your area.

By Ronni Gordon

Ronni Gordon is a South Hadley, Mass.-based freelance writer and editor and a former newspaper reporter. She has written for The New York Times, The Philadelphia Inquirer, the alumni quarterlies of Smith and Vassar and elsewhere.

Puzzles and Friends

February 28, 2019

We love when our team members share their stories, especially when it shows their love for our residents!

Read about Rachel Ellis, a CNA at The Willows, the skilled nursing community at our Oakmont campus, and how putting together a puzzle blossomed into a friendship.

“I've been working at Presbyterian SeniorCare Network for five years. At first, I was as a team member at Westminster Place, our personal care community, for a little over a year before I decided to become a CNA and work at The Willows, our skilled nursing community.

Before I had changed positions, I met a new resident at Westminster Place while she was doing a puzzle. I decided to take a little break and join her to talk while we both worked on the jigsaw. Just the other day, I was working at The Willows and my “puzzle friend” had transferred from Westminster Place, so I found myself taking care of her. It had been about three to four years since I had seen her, and to my surprise, she remembered my name and the puzzle! She even remarked on how much she loved that I would make time to talk to each resident and care for them as family. It's so exciting when you make such a positive impact on someone's life. It makes my day to put a smile on someone's face!”

Like Rachel, do you have a story about Presbyterian SeniorCare Network that you would like to share? We would love to hear it! Click here to visit our web page. Once there, please click on the button, Share My Story.

Once you have submitted your story, you will automatically be entered into a random drawing to win a $50 Visa gift card! Winners will be pulled the first Monday of every month.

What’s New for Medicare in 2019?

February 22, 2019

A rundown of the changes in premiums, deductibles and coverage
By Joe Baker President, Medicare Rights Center

Medicare costs change each year, so if you’re 65 or older, it’s important to understand and review your benefits for the upcoming year. Some new rules affect the cost of prescription drugs covered under Part D (Medicare’s prescription drug benefit) and change the times when you can revise your Medicare health and drug coverage.

Medicare Premiums and Deductibles in 2019

Medicare premiums and deductibles have risen a bit since 2018.

Medicare Part A covers inpatient hospital services, skilled nursing facility services, home health care and hospice, and people who have worked for more than 10 years — about 99 percent of Medicare beneficiaries — generally do not need to pay a premium. If you have worked between 7 ½  and 10 years, your Part A premium will increase to $240 per month in 2019, and if you have worked fewer than 7 ½  years, your Part A premium will be $437 per month.

The Part A deductible and coinsurances are also increasing this year. The hospital deductible will be $1,364. Beneficiaries must pay a coinsurance amount of $341 per day for the 61st through 90th day of a hospitalization in a benefit period. For beneficiaries in skilled nursing facilities, the daily coinsurance for days 21 through 100 of extended care services in a benefit period will be $170.50

Medicare Part B covers physician services, outpatient services, certain home health services and medical items. This year, the standard monthly premium for Part B is $135.50 for individuals with a yearly income below $85,000 ($170,000 for a married couple). If your income is higher than that, you may have to pay an income-related monthly adjustment amount, also known as an IRMAA. In that case, your monthly premium will be between $189.60 and $460.50, depending on your income.

The Part B annual deductible is $185 in 2019, and you will continue to pay 20 percent for most Part B-covered services after meeting your deductible in 2019.

Medicare Prescription Drug Costs in 2019

The amount you pay for your prescription drugs on Medicare depends on which Part D prescription drug plan you are enrolled in and which coverage period you’re in. Every Part D plan has a premium; this year, the national average for Part D premiums is $33.19 per month.

Many Part D plans also have a yearly deductible. Deductibles vary from plan to plan, but no deductible in 2019 can be higher than $415. After meeting the deductible, you’ll pay your plan’s regular copays or coinsurances for any drugs you take (if you’re not sure of these amounts, call your plan using the number on the back of your membership card), until the total costs that you and your plan have paid for drugs in a year totals $3,820.

Once you and your plan have together paid $3,820 in drug costs, you will enter what is known as the donut hole or coverage gap. After falling into the donut hole, the amount you pay for prescription drugs increases, until you’ve spent $5,100 in out-of-pocket drug costs for the year. At that point, you enter the coverage phase known as catastrophic coverage. During this period, in 2019, you pay 5 percent of the cost of each drug, or $3.35 for generics and $8.25 for brand name drugs — whichever is greater.

Because of federal legislation, the donut hole will be closing for brand-name drugs in 2019. That means in this coverage period, you will be responsible for paying for 25 percent of the cost of your brand-name drugs. The coverage gap will close for generic drugs in 2020, at which point you will pay 25 percent of the cost of your brand-name drugs.

The Medicare Advantage Open Enrollment Period

If you have a Medicare Advantage Plan in 2019, you’ll have the opportunity to change your coverage using the Medicare Advantage Open Enrollment Period, which occurs from January 1 to March 31. During this time, you can switch from your Medicare Advantage Plan to another one or to Original Medicare, with or without a stand-alone Part D prescription drug plan.

If you make a change during the Medicare Advantage Open Enrollment Period, it will become effective the month after the month when you make the switch.

The Extra Help Special Enrollment Period

If you have Extra Help, the federal Part D Low-Income Subsidy program that helps pay for some to most of the out-of-pocket costs of Medicare prescription drug coverage, your opportunities to switch Part D prescription drug plans will change in 2019. Previously, people with Extra Help had a Special Enrollment Period to enroll in a Part D plan or switch between plans once every month. Starting in 2019, this Special Enrollment Period will be available once per calendar quarter for the first three quarters of the year. To qualify for Extra Help, your monthly income currently must be less than $1,538 ($2,078 for married couples) and your assets must be below specified limits.

If you have Extra Help, these new limits may mean that you are locked into a drug plan at certain times of the year. For this reason, it is important to make sure that any drug plan you enroll in covers as many of your drugs as possible with the fewest restrictions on coverage.

Increased Medicare Advantage Plan cFlexibility

Beginning in 2019, Medicare Advantage plans have increased flexibility in their plan offerings. This means that plans may be able to reduce cost-sharing for certain benefits, offer extra benefits or charge different deductibles for some enrollees who meet specific medical criteria.

Medicare Advantage plans are also gaining the ability to offer new supplemental benefits that are not directly considered medical treatment. Some services that plans can begin offering in 2019 include nutrition services, in-home supports and home modifications.

These changes mean that there may be more Medicare Advantage Plan options available in 2019, and it may become more complicated to compare these options. Remember to carefully review your Medicare Advantage plan’s Evidence of Coverage and any other materials from the insurer. If you need help understanding your plan’s benefits or reviewing your coverage options, call your State Health Insurance Assistance Program for assistance, 877-839-2675, or visit www.shiptacenter.org.

For more information on Medicare costs, visit Medicare Interactive, the free online resource powered by the Medicare Rights Center, and download the Medicare Rights Center’s free guide, Medicare in 2019.

Understanding the Types of Rehab for Stroke Therapy

February 15, 2019

A breakdown of the various offerings and where insurance fits in
By Lisa Fields

After a stroke, only about 10 percent of people recover almost completely without intervention. For everyone else, therapy is a crucial part of the recovery process. Whether you need physical, occupational and/or speech therapy following a stroke depends on your needs, but the goal is the same: to help you regain control of your body and be independent once again. The therapy you receive should be tailor-made to suit your lifestyle.

“Is the goal returning to driving or returning to work, or (is the person) a retiree who needs to take care of their own bodily functions and participate in playing with a grandchild?” says Glen Gillen, professor and director of programs in occupational therapy at Columbia University in New York and a fellow of the American Occupational Therapy Association.

Kinds of Rehabilitation Facilities

Most stroke patients stay in the hospital for five to six days. Their therapy needs are assessed within the first two days, and therapy may begin on the second. Some patients are sent home from the hospital right away. They may receive outpatient therapy sessions three times a week or get therapy at home from visiting nurses or therapists.

“If they’re higher-functioning, they can potentially go to outpatient therapy, if they have the means to get there,” Gillen says. “That is a challenge for many.”

Many stroke patients are discharged from the hospital to inpatient rehabilitation facilities, where they receive therapy at an intensity that’s best for their needs, based on the severity of the disability. Some go to acute inpatient rehab facilities, which offer the most intense therapy for the most responsive patients. Those with a greater degree of impairment may be sent to “subacute rehab” facilities, where the therapy isn’t as intense as acute rehab.

At acute rehab facilities, “people are guaranteed a minimum of three hours of therapy a day, and a physician visits six days a week,” says Dr. Alexander Dromerick, professor of rehabilitation medicine and neurology and chairman of rehabilitation medicine at Georgetown University Medical Center in Washington, D.C. “(At a subacute facility), they may get a few minutes a day, up to two hours a day, of therapy, and a physician visits every few weeks. They’re very different levels of intensity of care.”

Patients who are making great strides in a subacute facility might be moved to an acute facility for more intense therapy. Those who don’t have the endurance to tolerate an acute facility’s therapy, might be transferred to a subacute facility. “A subacute unit can be a way station back to the community,” Dromerick says, “or it can be a way station to go to a nursing home for the long term.”

Types of Therapy for Stroke Patients

Stroke patients often need physical therapy to strengthen their muscles, retrain their sense of balance and coordination and relearn certain movements. They may need occupational therapy to ensure they can do the tasks associated with daily living, like getting dressed, feeding themselves, showering or relearning skills necessary to return to work. Speech therapy also might be required to relearn how to speak or swallow food.

“Sometimes occupational therapists and physical therapists work together, but occupational therapists focus more on mobility activities that have to do with returning to work or returning to their role in their family or community,” says Carolee Winstein, professor of biokinesiology and physical therapy and director of the Motor Behavior and Neurorehabilitation Laboratory at the University of Southern California. “Physical therapists work on fundamental skills that are needed to be functional in their particular life, whatever it is. We work a lot on mobility. We teach people a lot about the importance of remaining physically active.”

Physical therapists help patients overcome physical challenges — this includes when a stroke has weakened or partially paralyzed one side of the body. Medical professionals refer to that side as “paretic.”

“If they’re having trouble reaching and grasping with their paretic side, I have them do it with their less paretic side to remind them what it should feel like,” Winstein says. “A lot of motor skills are implicit — we don’t think; we do it automatically.”

Occupational and speech therapists also address cognitive challenges.

“We consider most tasks physical, like dressing yourself, (but) all tasks that we do across the day have a cognitive component,” Gillen says. “With getting dressed, it’s the sequence of the clothing: which goes on what body part, which goes on first. If cognition is involved after a stroke, it’s a time-consuming process. We know it will take much longer, much more repetition of practice to get them there.”

Insurance Plans Could Limit Therapy

Health insurance may limit how much therapy a person can receive during a single calendar year or during his or her lifetime. If a person can afford to pay out of pocket, he or she may continue therapy without interruption. Otherwise, many therapists offer plans that patients can follow at home or at a fitness center either on their own or with the help of a family member, friend or personal trainer.

“You can keep working on the stroke problems indefinitely,” Dromerick says.

Therapists hope to get stroke patients functioning independently again, even after their sessions are complete.

“They may need a cane and a brace, but (we teach) them how to navigate with their disability so their disability does not become a barrier in their participation of being active,” Winstein says. “If there are certain things they can’t do, we show them what they can do and get them to work on those things.”

To learn more about stroke rehab and recovery, check out the American Stroke Association’s website.

By Lisa Fields
Lisa Fields is a writer who covers psychology and health matters as they relate to the workplace. She publishes frequently in WebMD and Reader’s Digest.

Losing Herself in Art and Finding Joy

February 12, 2019

A lifetime of challenges has never slowed the author's spirited mother
By Donna Trump

Part of the Vitality Arts Special Report

My mother, Anne Pols, celebrated her 87th birthday in November. In that same month, she also made her art show debut, exhibiting a half-dozen freehand colored pencil drawings at the Long Island Museum in Stony Brook, N.Y.

She and six other residents of her assisted living program at Jefferson’s Ferry contributed 25 pieces to a show called “Through Our Eyes.” The accomplishment is particularly sweet for my mother for several reasons. She has lived with a physical disability for most of her life. She took up drawing at 86. And six months prior to the show, she lost, in a single instant, most of the vision in her left eye.

One of my sisters said that days after the eye failed, my mother told her she was working on regaining her appetite. “Well, you’ve been though a lot in the last few days,” my sister said. To which our mother replied, “That’s history.”

She returned to her art classes a few weeks later.

Through Her Eyes

In our youth, my three sisters and I were never far from seeing a somewhat terrifying childhood through our mother’s eyes. At six, she nearly died from a ruptured appendix. In the hospital, she was forced to lay on her belly for a month to allow infected fluids to drain from the open surgical incision. A well-meaning relative doused the wound with perfume to diminish the odor. “That hurt,” our mom told us with a whistle.

At nine, she suffered a stroke — likely a burst aneurysm. There were no CAT scans or MRIs then, so the diagnoses ranged, she told us, from cerebral palsy to polio to some kind of infectious disease. In any case, she lost the use of the right side of her body and her speech as well. Her Irish immigrant family didn’t have much, so she was treated at public hospitals. She recalled for us the times she was paraded, naked or partly clothed, across a stage for a roomful of doctors-in-training. “I’d rather do that than go to the dentist any day,” she’d tell us.

When she was 12, her mother died of her own cerebral hemorrhage. Her father followed her mother to his grave within months, succumbing either “to the drink” or tuberculosis or a broken heart, depending on the telling. It didn’t matter why, we learned. What did matter was that her beloved Aunt Mary (barely a decade older than my mother at the time) and Uncle Bill took my mother and her siblings in after they were orphaned. These fine people supported my mother through years of physical therapy and multiple orthopedic surgeries in her teens, and, in fact, for the rest of their also tragically brief lives.

Mild but persistent right-sided weakness and a tendency of her right arm to tighten in spasticity kept my mother from nothing but learning to drive. An occasional word-finding problem showed up most often in calling her four sons-in-law by the wrong names, errors over which she was frequently the first to laugh out loud.

Learning to Draw

At the exhibit, my mother’s drawings are small in scale but realistic, colorful and expertly shaded. In some, she uses a brush to wash over the pencil for a watercolor effect. The subject is generally still life: a cornucopia, a parrot, a bowl of fruit, daffodils.

The daffodil drawing was one of my mother’s first, and when I saw it, it took my breath away. Not only was it was expertly drawn, it reminded my sisters and me of one of my father’s favorite poems. He was the love of her life but is gone nearly six years now, yet another in a series of losses which our mother appears, most times, to take in stride.

My mother started Saturday morning art classes about a year ago, with an accomplished Long Island artist she knows only as Jill. The class is one of many offered by the fine recreational therapy staff at my mother’s assisted living home. She enrolled in part because there wasn’t a lot of other programming on weekends: “It was something to do on a Saturday morning,” she said, adding, “something I was interested in.”

Although she writes with her weaker right hand (assisting with a steadying grip on the wrist with her left hand) she draws with the left. “It’s easier to control,” she said.

The class started with simple coloring of already-drawn designs, which my mother enjoyed, but soon prompted her to tell Jill, “Let me see if I can copy that.” She did. “Then I colored it and watercolored it, too,” she said with satisfaction.

Jill is a constant source of expertise, support and encouragement. “She taught me all about the shading,” my mother said. “That’s what makes it 3-D.”

I do not recall one incident in my mother’s life up to now where she made art for its own sake. She cooked just about every meal we ate, crocheted hats and blankets and sewed some of our clothes — surely artistic endeavors — but always in service to her family.

Not this time. Not with this pursuit of drawing. One of my favorite things about the exhibit was watching my mother, now unable to stand or walk independently and so using a wheelchair for mobility, crane her neck upwards toward exhibit attendees (mostly strangers) to respond to their comments and questions. Her face is animated. She laughs often. Her hands fly up in enthusiasm. She is an artist discussing her work, her process. Her self.

Self and Others

Contrary to much of today’s advice about being one’s own biggest advocate, my sisters and I were raised (in a fairytale compared to our mother’s childhood) with the understanding that “Self-praise is no praise at all.”

I hope it was not only me, among the four of us sisters, whose ego was periodically trimmed by our mother’s quick-tempered, “Who the hell do you think you are?” Let’s just say there wasn’t much discussion about self-actualization.

And yet, the image of her animation at the exhibit stays with me. What is it in drawing that gives her this joy?

In our daily phone calls what I hear most is how time flies — how, in fact, she loses her self — when she’s drawing. “I look up and two hours have passed,” she says. “It relaxes me. It’s like meditation.”

When pressed, she offers just a touch more: “I think that something special came out of me when I started those classes.” I ask her if she feels in any way that she has found herself through this art. “I know who I am,” she informs me, somewhat curtly. “I don’t need to find myself.”

As to the question of what might have come of it all had she started earlier, she is adamant: “I never think about that. My life went the way it did and it was full of love, consideration and respect.”

And now, Saturday morning art classes with Jill.

Donna Trump’s work has been published in december magazine (forthcoming in November 2018), Ploughshares and Mid-American Review, among others. She has received several Pushcart Prize nominations.  Honors include a Loft Mentorship, mentorship with Benjamin Percy, a MN Emerging Writer grant and the selection of her story “Portage” by judge Anne Tyler for first prize in a 2018 contest sponsored by december.

 

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