Compass & Clock is proud to share the Fall/Winter 2018 Publication online with our readers. Look for our magazine in your neighborhoods that helps educate & empower individuals and families to strengthen their quality of life as they age. It's all about the journey & enjoying life.
The publication will be in distributed in the WestSound, Gig Harbor to Port Angeles by November 1st 2018. It is a FREE publication and can be found in HealthCare Provider Offices, Housing Communities, Financial Institutions, Professionals Offices, Places Where People Hang Out, Chambers of Commerce, Senior Centers, Auto Dealerships & Repairs, Hair Salons & Restaurants, and so much more.
Our audience are folks 40 + older. We are trying to reach the Adult Kids & their Aging Parents. Having knowledge and doing a little pre-planning will set you up to be better equipped to deal with unanticipated life events. There are solutions! That's why we are so proud to present our 2nd edition of Compass & Clock as your comprehensive guide to:
Don’t wait until you’re overwhelmed by illness and uncertainty. Hold on to that independence you seized as a young adult by taking advantage of the vast services Compass and Clock has to offer; from complex legal advice, to simple recommendations for remaining healthy and active, or enjoying a night on the town.
We will help guide you through middle age, retirement & your senior years. Welcome to a community conceived to guide you into your best future!
Navigating life today to remain independent tomorrow
&C MPASS CL CK
FALL/WINTER 2018 WESTSOUND, GIG HARBOR TO PORT ANGELES
Role Reversal 16
Role Reversal 16
NEW Stroke Center
in Kitsap 28
NEW Stroke Center
in Kitsap 28
• Elder Law
• Estate Planning
• Medicaid Planning
• Wills & Probates
• Powers of Attorney
• Special Needs Trusts
• ...and More
“If you fail to plan, you have
planned to fail.”~Benjamin Franklin
What does the future hold for you?
Let us help you plan for the future with practical
tools and advice to guide you to a comprehensive
Life Care Plan™ that addresses your future housing,
healthcare, financial and legal needs.
FREE Legal + Estate
Life Care Planning Seminars
19717 Front Street NE
Poulsbo, WA 98370
Richard C. Tizzano
Elder Law & Estate
Text MYNEWSLETTER to
42828 to receive our FREE
PEACE OF MIND
Richard’s book, Accidental Safari: A
Guide for Navigating the Challenges
that Come with Aging, is available
NOW at www.Amazon.com
Owner and Operator, Compass &
Past President, Board of Directors,
Director of Marketing, Homeport
Member of Kitsap Provider Group
Member of Jefferson County
Member of Silverdale Chamber of
Member of Aging Smart Gig Harbor
WELCOME TO COMPASS AND CLOCK
Richard C. Tizzano, JD
Elder Law Attorney and Principal
of Sherrard McGonagle Tizzano &
Specializes in Elder Law & Estate
Planning, Personal Healthcare Crisis
Management, Strategic Health
Cost Risk Mitigation, Sustainability
of Care, Guardianships, and
Member of the Washington &
California State Bar Assocation
Member of the Kitsap County Bar
Association / BV-Rated Lawyer by
Board Member, Puget Sound Youth
Member of Poulsbo Rotary &
Past President, Kitsap Community
Community educational instructor/
speaker on estate planning & elder
Published Best Selling Author:
Accidental Safari, a guide for
navigating the challenges that come
with aging. Available on www.
Compass & Clock is far more than these pages.
It’s an educational program with a mission to help you become financially and
physically strong. Strong enough to “age in place.” To protect your home, your savings,
and your health well into your senior years.
It’s a community of experts in financial planning, legal guidance, health care, housing,
and family support - all represented in this publication and dedicated to the mission.
I’d like to share a shining example of this dedication.
Vivian had been weakened after a hospitalization and transferred to a rehabilitation
(rehab) facility to regain her strength. When she was well enough to go home, she
learned she could not.
Discharge required a safety assessment of her home. They found her husband David
too frail to care for her, and the house in such disrepair it was deemed unsafe. The
facility would not discharge her to a dangerous environment.
This lovely couple, both in their 80s, had no children, relatives or friends capable of
assisting them. Distraught, David turned to his attorney, Richard Tizzano, a specialist
in elder law and estate planning and, fortunately, a member of the Compass & Clock
Mr. Tizzano contacted Joan Qvigstad, a reverse mortgage specialist with Fairway
Mortgage. He knew a reverse mortgage would allow the couple to convert a portion of
their home’s equity into cash for repairs.
That one call triggered a remarkable cascade of events.
When Ms. Qvigstad visited David at home, she was dismayed to discover their living
situation was dire. The couple had been physically unable to maintain the home
for years. Damage was extensive, along with clutter and unsanitary conditions
compounded by pets. And with the bedrooms upstairs, the floor plan was unsuitable
for Vivian’s walker.
Ms. Qvigstad quickly processed the loan application; upon its approval the couple
secured half the market value of their home in cash. She then went above and beyond
the role of any mortgage specialist. Backed by the entire Compass & Clock community
• Massive renovations by Blue Cedar Construction. Teri Tennyson of Kitsap Seniors
Real Estate specializes in seniors’ estate preservation. Her network of contractors
• Senior advocacy. Sue-Marie Casagrande of Care Plans Plus liaised with physicians,
home health care, and insurers. Medical beds were delivered and a stair chair lift
• Clutter removal by Sheila Taylor of Clutter Controllers.
Meantime, Vivian remained safely in rehab where Ms. Qvisgstad visited almost
daily. The project was completed in six weeks and Vivian was moved to tears by the
astonishing transformation of their home.
I am so proud of the extraordinary response from our community to safeguard this
If you’re lucky, you too will live long enough to grow old. Compass & Clock was
founded to help protect your senior years from being consumed by anxiety, confusion,
and financial ruin. And when illness inevitably strikes Compass & Clock can help.
Frankly, I’d rather you didn’t wait that long.
By Carol Fisher for Compass & Clock
We are Proudly Printed in the USA!
Creative Services - Print
Better Days Writing & Editing
4 How to Break the Ice Around Family Finances
6 Do You Need Renters Insurance?
7 Is LTC Insurance a Good Option?
8 Repaying the Debt
10 Buyer Beware
12 A 911 Buddy
14 Tips for Handling the Financial Challenges of Alzheimer's
16 The Caregiving Role Reversal
18 Feel Good Without the Paranoia
20 16 Steps for Diabetic Foot Care
22 Eat Well and Stay Healthy
24 Preventing Falls
26 Avoiding Food Fights
27 10 Ways to Love Your Brain
28 Exclusive Stroke Recovery Help
30 Portable Businesses Making Staying at Home Easier than Ever
31 Products to Help You Age in Place
32 Should I Stay or Should I Go?
34 Care Solution Assessment
36 Shopping for a New Home
37 Senior Housing Community Notes
38 To Will or Not to Will? That is the Question
40 Join the Ranks of the Self-Employed
42 Project Bucket List
44 Sunday Driving
46 Explore the World
48 9 Facts About Sun Protection
50 Caring for the Vulnerable
51 Are You Prepared For When Disaster Strikes
52 Volunteering Feeds the Soul
54 Multi-Generational Living and the Benefits of Being a
55 RESOURCE DIRECTORY
Table of Contents
We are a group of compassionate,
dedicated to your well-being
and safety. Our goal is to share
knowledge, tools & resources to
educate & empower you, and help
you strengthen your quality of life
as you age.
Navigating life today to remain independent tomorrow
&C MPASS CL CK
Nurse Manager of Marina Unit
Martha & Mary
4 Fall/Winter 2018
hat’s the hardest thing to talk about?
Death, religion, politics? Would it
surprise you to know that one of the
most difficult things to discuss is money?
When polled, 44 percent of Americans
claimed that personal finance was the hardest to discuss –
beating out politics and even death.
Perhaps this is because money represents more than a
topic – it can represent control, power, embarrassment,
insecurity, fear. For some people, the hesitation stems
from a natural reluctance to confront their own mortality
or their potential for future disability. For others, avoiding
the topic is caused by the perception that planning is
associated with complicated—and expensive—legal and
Silence Can Be Harmful: Avoiding these sometimes
difficult conversations can have detrimental outcomes and
unexpected consequences for your family, such as:
Passing On Bad Habits - Talking to your children about
money now can help them avoid mistakes in the future.
The key is to talk about what money means to you and
why you worked hard to achieve your success. It involves
being open about the challenges and responsibilities
that accompany wealth – including what you might have
wished you’d done differently when younger. And, most
important, it’s about your values and what you wish
for yourself and your children to accomplish with your
privilege. The conversation can serve as an empowering
first step to forming a healthy relationship with wealth.
Lost Opportunities - It’s never too early for your children to
understand the value of creating a wealth plan that takes
family members’ needs into account. Family members may
not be aligned on priorities, such as long-term health care
needs, charitable giving and generational gifting strategies,
and taking the time to establish common goals is the first
step in understanding how all members can participate in
The reality is that 70 percent of families lose their wealth
by the second generation. Lack of communication can
ultimately lead to misunderstandings and divergent
objectives that could jeopardize your legacy and work
against your values.
Costly Procrastination - Perhaps the hardest of
conversations to have as an adult is with your aging
parents. This is where the danger of putting it off grows
exponentially. According to the U.S. Department of Health
and Human services, 70 percent of people over 65 will
require some long-term care at some point in their lives.
[i] Once a crisis hits, it’s often too late. Now is the time to
determine if sufficient long-term health care plans have
been made, as well as who will make financial decisions
on your parents’ behalf if they lose the ability to safely
handle their money. Proper planning gives you time to
discuss your decisions with family members. This open
communication can help to reduce, if not eliminate, the
risk of family discord, resentment or conflict.
Having a hard time starting a conversation about family
finances? Here are a few questions that can make it easy
How to Break the Ice Around
Money is one of the trickiest topics to discuss. But avoiding the conversation
can lead to problems. Learn how to start the dialogue with your family
• At what age do you hope to retire?
• When is it OK to borrow money?
• Is it important to talk about money as a family?
• What’s your favorite charitable cause and why?
• How is your generation different from the generations
• Should children give to charity?
Align Your Goals with Strategies for Reaching Them
Morgan Stanley’s goals-based wealth planning framework
strives to guard against more than just market volatility.
We believe that a successful planning strategy must meet
the following criteria:
1. Your plan should be customized to reflect what you care
about most. It should address both the goals you hope to
achieve and the risk of outliving your assets.
2. Your plan should address the shifting nature of issues
and unknowns you face at different stages of your life and
consider risks beyond market volatility, like inflation.
3. Your plan should seek to mitigate judgment and
behavioral risks such as panic selling in difficult markets or
Smash the Taboo: We know it’s hard. Sitting down to
discuss your parents’ long-term health needs or checking
in with your siblings to see if you are all on the same
page relating to any inheritance isn’t easy. What about
your children; do they value the same causes that have
moved you all your life? Is your spouse prepared should
something happen to you?
The tough part is getting started, and that’s where
bringing in an objective financial professional can help.
We understand that wealth is about much more than
just money, and can guide the conversation down those
difficult paths to uncover the things that matter most to
you and your family. We don’t believe in having a single
conversation, but rather a series of talks that shift as your
life changes. It’s a road. And you don’t have to travel it
It starts with family, but doesn’t have to end there. We are
ready to provide the guidance, tools and information that
can help you tackle these difficult topics and transform
them into meaningful discussions for your future. Uncover
what matters most to you and find a Morgan Stanley
Financial Advisor to help guide the conversation. Because
the road starts here.
This material does not provide individually tailored investment advice. It has been prepared without regard
to the individual financial circumstances and objectives of persons who receive it. The strategies and/
or investments discussed in this material may not be suitable for all investors. Morgan Stanley Wealth
Management recommends that investors independently evaluate particular investments and strategies,
and encourages investors to seek the advice of a Financial Advisor. The appropriateness of a particular
investment or strategy will depend on an investor’s individual circumstances and objectives.
Morgan Stanley offers a wide array of brokerage and advisory services to its clients, each of which may
create a different type of relationship with different obligations to you. Please consult with your Financial
Advisor to understand these differences.
6 Fall/Winter 2018
f you are looking at selling your home and moving
to an apartment, downsizing to a smaller home or
even an assisted living center, it is important to have
protection for your remaining assets. Often, these
are the most valuable and need special consideration.
The main benefit of renters insurance is that it will replace
lost or stolen items, but it also includes personal liability.
Most policies come with standard levels of liability to cover
such things as dog bites for your favorite little fur baby
or if you accidently start a fire that damages an adjoining
apartment or home. It is that liability that saves you from
huge mistakes and protects your hard-earned life savings
Even better, renter’s insurance will cover your possessions
and liability outside your apartment or rented home.
If you are traveling or visiting your grandchildren, rest
assured, your computer and jewelry can be covered. Some
people call renter’s insurance “worldwide coverage.” If you
travel, you will want this insurance.
What about living at an assisted living facility? Yes, even
then, renter’s insurance can be a smart option. For
example, many of the newer facilities allow you to keep
your small pets with you. What protection would you
have if your dog bites or cat scratches visitors or workers
in your building? Without liability insurance, you can be
responsible for any medical expenses. In addition, most
facilities encourage you to bring in your own personal
items. Protecting those family heirlooms and items from
loss and theft can be covered under your renter’s policy.
For peace of mind, the price of renter’s insurance can run
as low as $8.00 per month. The greater the value of the
items covered, the higher the premium. A safe range to
start with is between $20,000 to $30,000. Some of the
confusing choices can be whether to choose Actual Cash
Value (ACV) or Replacement Cost Value (RCV). ACV will
include depreciation, so a couch you purchased 5 years
ago will have a lower value, based on age and use. RCV
will give you the value of a new couch at time of loss. RCV
coverage costs more but is likely worth it.
Another good idea is to know what level of coverage to
have for more expensive items such as jewelry, tech items,
and even securities kept in the home. Each company will
have different maximum limits. Most companies offer
higher limits or the ability to insure individual items at
a “Stated Value.” Usually stated value requires recent
appraisals, so be prepared to get those to your agent.
Finally, there are some additional coverages that you may
want to add. Two of those include Flood Insurance and
Sewer Backup. Flood insurance is an option if your rental
qualifies for this based on National Flood Maps. Sewer
Backup Insurance covers your personal items if they are
damaged by sewer lines getting clogged and backing up.
Typically, these coverages are not included in standard
renter’s policies. High-value items like artwork, music
equipment, antiques and even your wedding ring, may not
be covered in the base renter’s policy but can be added.
Loss of use is another good possibility to add. This helps
you if your residence is uninhabitable from a covered loss.
It will help with the temporary housing for a limited time
and limited coverage. Identity protection, and credit card
coverage is relatively new, but important to add to your
policy in these uncertain times.
Finding an agent that has experience working with
downsizing age groups is important. Renters insurance
for a young couple starting life is much different than
someone with years of memories and possessions to
protect. Review your policy so you know what additional
coverages you may want to add.
Keith Hafner, Account Executive
Farmers Insurance, Thompson Agency
1703 SE Sedgewick Rd, Suite 103, Port Orchard WA
Do You Need Renters Insurance?
INSURANCE YOU CAN
DESIGN TO MEET YOUR
EVER CHANGING NEEDS
Restrictions apply. Discounts may vary. Not available in all states. See your agent for details. Insurance
is underwritten by Farmers Insurance Exchange and other affiliated insurance companies.Visit farmers.
com for a complete listing of companies. Not all insurers are authorized to provide insurance in all states.
Coverage is not available in all states.
Call 360.602.6999 today!
For Home, Auto, Life and Business.
1703 SE SEDGWICK RD STE 103
PORT ORCHARD, WA 98366
■ Farmers Identity Shield fraud assistance
■ Insurance you can tailor to meet your needs
■ Products and services to meet all your insurance needs
By Keith Hafner
18442 WA-3 in Allyn
(up to 60 minutes)
My office has over 25 years
of work experience with
State Farm. We are a trusted
resource for both personal
and business insurance
needs. We also provide flood
insurance and FREE notary
services. We look forward
to working with you!
Paula K Weissinger
Agent, CPCU, CLU
175 Parfitt Way SW, Ste 180
Bainbridge Island, WA
AUTO • HOME • LIFE • HEALTH • BANK • BOAT • BUSINESS
Bainbridge Island, Kingston and Poulsbo Chamber Member
Is LTC Insurance a Good Option?
My grandma purchased long-term care (LTC) insurance
back in the 80s. I remember that her new husband was
not happy because it seemed extremely expensive and
it was pretty new-fangled. However, unlike all the other
things that commissioned sales people got her for, the LTC
insurance turned out to be a good deal. There are plenty of
people since that don’t have much beyond bird cage liner.
However, at the time, my grandma’s premium was “locked
in” and though it was a great deal more expensive than
homeowner’s insurance or even car insurance it turned
out to be a bargain due to the years she lived needing
In the 80s, senior housing began to mean more than the
local nursing home. The problem was that health care
insurance didn’t cover what was a really expensive health
care option and people went bankrupt paying for that care.
By the late 80s, more and more health care organizations
offered LTC insurance. It was wildly popular and everyone
sold it. Everyone wanted what my grandma had. It was a
good time for the insurance companies until people got
sick and started needing that coverage.
We’ve all gotten a little complacent about it because
every year for years now the news covers how the cost
of health care rose in the double digits. Well, insurance
companies determine the cost of their insurance coverage
by determining their risks and what they found was that
they really miscalculated their risks. The result was that
over very short periods of time, LTC insurance premiums
doubled or worse. People who purchased LTC insurance
found they couldn’t afford to continue paying for their
premiums and they lost what they put into their coverage
as they dropped the coverage.
Over the course of the last two decades, most of the
hundreds of insurance companies offering LTC insurance
disappeared. There is only a few dozen left. It doesn’t mean
that LTC insurance doesn’t have its uses because it does
but it isn’t your only option. A lot is going to depend upon
your health and age, whatever support system you have,
your ability to withstand heavy increases in premiums and
whatever savings you might have. If you think you want to
consider LTC insurance, spend time talking to an elder law
attorney so you know your options and have a realistic view
of what it can and cannot do for you.
8 Fall/Winter 2018
Eligible Wartime Periods
The VA uses the following wartime periods to determine eligibility for VA Pension benefits:
•Mexican Border Period (May 9, 1916 – April 5, 1917)
•World War I (April 6, 1917 – Nov. 11, 1918)
•World War II (Dec. 7, 1941 – Dec. 31, 1946)
•Korean conflict (June 27, 1950 – Jan. 31, 1955)
•Vietnam (Feb. 28, 1961 – May 7, 1975 in the Republic of Vietnam; otherwise Aug. 5, 1964 – May 7, 1975)
•Gulf War (Aug. 2, 1990 – through a future date)
orty-five years ago, as the Vietnam War drew to
a close, the United States entered a new era in
its military power as it switched from the draft to
an all-volunteer army. The result of that change
was that today less than 1 percent of Americans
join the military compared to the more than 12 percent
that served during World War II. Of the nearly 18.5 million
American Veterans alive today, more than half (about
55 percent) are 60 or older. Yet few older veterans (or in
some cases their spouses) take advantage of benefits that
exist specifically with them in mind (estimates indicate
that roughly 5.5 percent of eligible individuals receive
Pension benefit). Leaving those assets on the table is akin
to foregoing a retirement benefit. For many veterans and
their families utilizing veterans’ benefits is the difference
between a retirement lacking basic essentials and one that
Early in my career, a woman grasped my hand, hugged
me quite hard for someone only three quarters my height
and thanked me profusely. I was amazed and profoundly
touched. One because someone had actually read
something I wrote, remember it was early in my career,
but two because that something was a sidebar. A sidebar is
that bit of information along the side of a page sometimes
used as a filler and sometimes as a way to add a bit more
information to an article without actually being the article.
The sidebar in question was about veterans benefits. The
specific piece of information that granted me a warm hug
was about Aid and Attendance and the reason I got a hug
was that a spouse of a deceased veteran was living in near
poverty and after reading that article was able to improve
her circumstances dramatically.
Disability Pension and Death Pension are disability VA
programs available to veterans, veteran spouses or the
surviving spouse of a deceased veteran. Disability is not
Compensation, the other pension program available
through the VA. Compensation is for veterans injured or
with an illness that they incurred while still on active duty.
We will not be covering compensation in this article. You
cannot receive disability and compensation at the same
Aid and Attendance is a benefit paid in addition to a VA
basic pension. Veterans must meet service, disability, and
income and asset requirements.
The service periods are listed below. The veteran
must leave the service under conditions that are not
dishonorable and have served 90 days of continuous
military service (active duty) with at least one day during
the wartime periods listed below.
If the veterans or surviving spouse is at least 65 years old,
he or she meets disability requirements if they require
aid from another for activities of daily living (ADLs) such
as bathing, feeding, dressing, or toileting. Medical and
non-medical expenses associated with long-term care
options such as nursing care, assisted living, or home care
require significant outlays of money and usually trigger the
There is also an income requirement, which must be below
a yearly limit set by law. The amount differs depending
upon whether the veteran is single, married, or married
to another veteran and whether the household includes
dependents. In 2018, that amount is as low as $1176 per
month for a surviving spouse to up to $2903 per month for
two veterans married to each other.
Repaying the Debt
Long-term care benefits for vets and their families
10 Fall/Winter 2018
or those of you who don’t know me, I am a
funeral director in Kitsap County and I am not
only 4th generation but also have 32 years’
experience in my profession. When I started,
things were much different and certainly much
more traditional. Families contacted their preferred funeral
home (family-owned of course), and the funeral director
would immediately begin making arrangements for the
funeral. The family would come in to make arrangements
and usually would choose an appropriate casket and all the
services and other items necessary to provide the most
fitting tribute...right down to the limousine.
Well, as we all know, things have certainly changed. Today,
over 65 percent of people in our area of the country
choose cremation. Gone are the days of the pomp and
circumstance of the “traditional funeral.” Even the family-
owned funeral homes have diminished in numbers due to
the entrance of large “Death Care Providers” as they are
called, into our profession.
Not all of the changes are bad however. Transparency in
pricing and giving people choices is certainly beneficial.
The changes in types of services and the way people
choose to remember their loved ones has brought to
light that life should be celebrated and death should
not be hidden and feared, but rather respected and
embraced. People’s views towards death have changed as
well, leading to families discussing wishes more openly so
as not to leave anything undone.
So where is the increasing problem I have seen, you ask?
The answer to that question is actually quite evident
and that is in the number of alternative providers in our
profession. You will see the “low cost providers” with the
ads that tout that funeral homes are overpriced and taking
advantage of people. Or those that have you join a group
or society as some are called, and for your membership
you are guaranteed to be cared for by the organization to
which you belong regardless of where your death occurs in
the world. There is even one organization I recently found,
that uses the word “affordable” in their name online
claiming that there is a network of providers nationwide
willing to provide these affordable services.
This is where I repeat the title of this article...”Buyer
Beware!” There are two sayings I like to use; the first is
an old familiar piece of advice. “If it sounds too good to
be true, it usually is” and one I have created recently.“If
they have to buy you lunch or dinner you are probably
paying too much!” Folks, I will tell you from experience
that funerals cost a determinable amount of money. I’m
not saying that you have to spend a fortune for services,
but you do have to spend something to be provided with
quality, reputable service.
Time and time again, I receive calls from survivors who are
finding out after the fact, that their loved one has been
taken to an undisclosed location somewhere out of the
area and that there is a lot of difficulty dealing with the
provider. They are requiring payment up front before any
services, including transportation, are being provided.
There are mistakes and extended time delays, or the family
is left to figure things out on their own. Or you have the
opposite side of the coin where the price advertised has
some very small print stating “cremation or burial only”
which leads to everything else being an additional cost.
As for the “affordable” company I mentioned earlier, I did
some simple figuring of my own, and determined they
are actually more expensive and leave a lot of questions
I hope this helps and please remember that a good
reputable funeral home will be more than willing to help
you walk you through this difficult time.
Owner, Cook Family Funeral Home
163 Wyatt Way NE, Bainbridge Island, WA 98110
100% Trusted/Insured Funds
Affordable and Portable
Payment plans available
Plan ahead. For peace of mind.
Burial and Cremation Plans
Burial and Cremation Plans
BY Tim Dinan
12 Fall/Winter 2018
ost Accidental Safari’s begin suddenly,
with an unwelcome surprise such as
a fall, stroke, or heart attack. Are you
prepared for the sequence of events that
usually follows that first 911 call?
If you are the one who has just entered the Safari, you
need an advocate! An advocate is someone who will be
in your corner and at your side, from the moment the
gurney is forced through the emergency room doors. Your
sudden arrival kicks into motion a series of events that
can mean the difference between life or death, recovery
or remaining in a care facility. Some of these decisions will
save or cost you thousands of dollars.
Once you are inside the emergency room, the physician
will order tests that he or she thinks is necessary to
determine or confirm your condition. If the tests indicate
a serious problem, you will be admitted to the hospital as
a “patient” for treatment. If the test results are negative,
you will be sent home.
But what happens when the test results are inconclusive?
The test results may suggest that there could be an
underlying, undiagnosed issue. If the hospital has sent
you home and you collapse soon afterward from that
“unknown something connected to the test that showed a
little something was going on”, the hospital could be liable
for not taking additional measures to avert your ensuing
ride through town under sirens and flashing lights.
Test results with “gray areas” present a serious quandary
for hospitals, which must maintain a balance between
compassionate care and financial stability. In order to
admit you as a “patient,” they must be able to check
enough of the required boxes on the Admittance Form
to satisfy Medicare’s admission requirements. Medicare
controls how much the hospital gets paid for the services it
provides and the sad reality is that hospitals must consider
that Medicare might not pay and, even worse, that a
Medicare audit could suggest that the hospital is guilty of
Faced with this conundrum, the safest option for the
hospital is to place you in a hospital room, “under
observation”. Sadly, this will NOT be the best option for
you! Whether you are admitted as a “patient” or placed
in a room “under observation” will determine who will
pay for your future treatment. If you are admitted to
the hospital as a “patient” for three full days, and are
subsequently moved to a rehabilitation facility, Medicare
will pay all the costs of the first 20 days of rehab, where
costs can easily exceed $500 per day. Medicare will
also pay all but the first $157 per day for the following
80 days in rehab. Also, most Medicare supplemental
health insurance plans will cover the first $157 per day if
Medicare is paying the back end.
Being in the hospital “under observation”, but not a
“patient” of the hospital, will not qualify you for Medicare
to pay for your future rehabilitation period. This is where
your advocate should step in to protect you. The advocate
should confirm your status in the hospital from day one:
“patient” or “under observation”? If you are “under
observation”, the advocate needs to immediately ask two
important questions: 1) Why aren’t you a “patient” and 2)
What can be done to allow the hospital to check enough
boxes on the Medicare form to admit you as a patient. The
hospital knows how the system works and although they
would like to admit you as a patient, you must meet the
Medicare requirements. By asking the medical team what
is missing from the form, your advocate may be able to
provide the additional information necessary to qualify you
as a “patient”.
Advocacy is an essential part of your life care plan. Do
you know who your best advocate is or will be? More
importantly, does your advocate know that you are
expecting them to step up on your behalf? Does he or she
know what the issues are that you are expecting them to
An Accidental Safari often begins in the Emergency
Room, and the dangers there are as perilous as those in a
jungle. Let’s take the steps to prepare to meet whatever
challenges may come around the next turn in the road.
Written by Richard C. Tizzano, a Poulsbo, WA attorney. Richard
specializes in the field of Estate Planning, Elder Law and Long
Term Care Crisis Management, Strategic Care Cost Risk Mitiga-
tion and Sustainability. 360-779-5551 / www.westsoundlegal.
A 9-1-1 Buddy
14 Fall/Winter 2018
f you are, or will be, a caregiver for elderly parents or
another close family member living with Alzheimer’s
disease, you may experience some emotional stress
– but you also need to be aware of the financial
issues involved and what actions you can take to help
You will find few “off the rack” solutions for dealing with
the financial challenges associated with Alzheimer’s. For
one thing, family situations can vary greatly, both in terms
of the financial resources available and in the availability
and capabilities of potential caregivers. Furthermore,
depending on the stage of the disease, people living with
Alzheimer’s may have a range of cognitive abilities, which
will affect the level of care needed.
Here are some general suggestions that may be useful to
you in your role as caregiver:
• Consult with family members and close friends. It’s
extremely hard to be a solo caregiver. By consulting with
other family members or close friends, you may find that
some of them have the time and ability to help.
• Consider obtaining durable power of attorney. If you
possess a durable power of attorney for finances, you can
make financial decisions for the person with Alzheimer’s
when he or she is no longer able. With this authority,
you can help the individual living with the disease – and
your entire family – avoid court actions that can take
away control of financial affairs. And on a short-term
basis, having durable power of attorney can help you take
additional steps if needed. You’ll find it much easier to
acquire durable power of attorney when the individual
living with Alzheimer’s is still in the early stage of the
disease and can willingly and knowingly grant you this
• Gather all necessary documents. You’ll be in a better
position to help the individual living with Alzheimer’s if
you have all the important financial documents – bank
statements, insurance policies, wills, Social Security
payment information, deeds, etc. – in one place.
• Get professional help. You may want to consult with an
attorney, who can advise you on establishing appropriate
arrangements, such as a living trust, which provides
instructions about the estate of the person for whom
you’re providing care and names a trustee to hold title to
property and funds for the beneficiaries. You also might
want to meet with a financial advisor, who can help
identify potential resources and money-saving services.
And a tax professional may be able to help you find tax
deductions connected to your role as caregiver.
Finally, use your experience as a caregiver to reminder
yourself of the importance of planning for your own needs.
For example, a financial professional can suggest ways of
preparing for the potentially huge costs of long-term care,
such as those arising from an extended stay in a nursing
Caring for an individual living with Alzheimer’s has its
challenges. But by taking the appropriate steps, you can
reduce uncertainties – and possibly give yourself and your
family members a greater sense of security and control.
This article was written by Edward Jones for use by your local
Edward Jones Financial Advisor.
Tips for Handling the Financial
Challenges of Alzheimer's
16 Fall/Winter 2018
The Caregiving Role Reversal
Managing a Healthy Caregiving Relationship
with Your Aging Parent
t is no secret. Being a caregiver for an aging parent
is hard work. The role reversal that takes place in
the “adult child-parent” relationship as parents age
frequently makes the difficult job of caregiving all the
more stressful for both parties.
Cynthia is in her mid-80s and still lives fairly independently
at home not far from her son Eric’s home. Eric, Cynthia
only child has taken on the role of primary caregiver. He
keeps close tabs on his mom with the help of paid in-home
caregivers who visit her three time a week to help tidy the
house, ensure there is food in her fridge and remind her to
take her medications.
Despite this well-working arrangement, as his mother’s
caregiver, Eric has had to make some tough decisions
to ensure Cynthia’s health, safety, and wellbeing. For
instance, after a fender-bender, Cynthia no longer drives
because Eric felt she didn’t see well enough to manage
driving safely. Additionally, Eric cancelled her credit card
account because Cynthia was using it recklessly, ordering
various decorative items from television shopping shows
and quickly draining her financial resources.
Although Eric’s motives were purely from the heart and
with the best of intentions, these decisions were not
well received by Cynthia. In fact, animosity has grown
substantially between the two of them, with Eric feeling
rather upset that his mother is not only unappreciative
of his efforts to keep her safe and healthy, but downright
angry with him.
Many would say that Eric and his mom are dealing with
the expected symptoms related to their role reversal -
that they have simply switched sides in the parent-child
dynamic now that Eric is his mother’s caregiver, meaning
that he has taken on the parental responsibility of caring
for his parent as he might for his own child.
But, that isn’t exactly true. The change-up in their
relationship is really much more complex.
First off, Eric’s mom isn’t like a child. Children are learning
and maturing little people that can be reasonably expected
to grow out of the dependency on their parents with
each passing year. The same does not hold true for older
people. Cynthia likely will continue to decline with age and
eventually need more support, becoming less independent
over time. Cynthia recognizes that point all too well and
that is likely contributing greatly to her hostility towards
So, is caregiving for one’s aging parent doomed to be a
bitter and emotionally draining experience? Hopefully
not! To keep resentment at bay, there are things to be
mindful of to establish a healthy and successful caregiving
relationship with your elderly parent:
Change your mind-set: When serving as your parent’s
caregiver, keep in mind that you are not “parenting” your
parent. Instead, your primary goal is to help your parent
deal effectively with the changes they are experiencing as
Be Honest …and Respectful: There is nothing to be gained
by pretending you don’t notice changes in your parent’s
health and wellbeing. Speak honestly and respectfully with
them about any worries you may have about their health
and safety. As your parent learns to accept any limitations
brought on by aging, they will need to ask for support from
you with the same honesty. Work to establish a respectful
tone with your parent about these matters, so that going
forward, you can together assess your parent’s overall
wellbeing and look for warning signs of any emerging
Don’t Over-Rescue: Your elderly parent will be stronger if
you allow them to do as much for themselves as they still
can. Your parent’s role should not be to become overly
dependent on you, while your goal should be to help them
take full responsibility for themselves by acknowledging
when they need help and providing help when needed.
Manage Your Stress: Don’t let stress interfere with your
ability to appropriately and compassionately care for your
aging parent. Easier said than done, for sure! Removing
unnecessary stress is critically important for the wellbeing
of both you and your parent. The stress of caregiving may
be getting to you if you find yourself making judgmental
or patronizing remarks to your parent, such as “you could
do this by yourself,” “you’re just not trying” or “let’s see if
we can put our own clothes on today.” It is crucial that you
find effective ways to manage your stress before it gets in
the way of maintaining a positive relationship.
Get Some Help: You may be the designated primary
caregiver for your parent, but you simply can’t do it all.
You just can’t. Many caregivers start by asking siblings and
family members for help, but give up when these folks
won’t make the commitment to assist. Don’t give up!
By Jennifer Bailey
Investigate resources in your community to find alternative
support options, including respite stays at area senior care
centers or help from a reputable home care agency that
will send trained caregivers to your parent’s home.
Take Care of You: Help with your caregiving duties is
essential, but so is taking care of yourself. Make rest, a
healthy diet and exercise a priority. Even a daily 20-minute
walk can substantially relieve personal stress. If it gets to
be too much, you might consider consulting with others
for support and a new perspective on your situation.
Although family or friends might prove to be great
sounding boards, don’t discount the skills of a professional
Relationships change over time and the one you have with
your elderly parent when you begin caregiving for them
will surely change, too. Your attitude is key to leading
this new relationship on a positive and proactive path as
you begin this journey together. By keeping acceptance,
honesty, and faith in one another at the center of the
relationship, you and your parent have an excellent chance
of managing and adapting to your new roles with one
Jennifer Bailey is the Marketing and Communications Manager
at Martha & Mary, a non-profit care organization that has been
serving children, seniors and families since 1891.
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18 Fall/Winter 2018
Feel Good Without the Paranoia
What You Should Know About Cannabidiol (CBD)
By Carol Fisher for Compass & Clock
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any cannabidiol (CBD) users sing
its praises a holistic alternative to
conventional opioids and antipsychotic
medications. Now that CBD is legal nearly
everywhere, the market has exploded
with brick-and-mortar businesses and online sellers. As a
result, regulations and quality control have lagged behind
the rapid growth of this young industry; thus, not all CBD
products are created equal. Before you shop, understand
what it is you’re buying.
What is Cannabidiol? Cannabidiol, commonly known as
CBD, is one of dozens of unique compounds produced
by the plant genus Cannabis; varieties of which include
marijuana and hemp. When obtained from hemp CBD
contains no delta-9 tetrahydrocannabinol (THC), the
compound that induces euphoric sensations, or a “high”.
What does CBD do? Most notably, CBD is not
psychoactive. It does not change the user’s state of mind.
When taken without the popular compound THC, the user
does not experience the effects of getting stoned.
Some early scientific research suggests CBD has medical
and therapeutic benefits. Users have found CBD useful in:
• Acne treatment
• Pain relief
• Fighting cancer
• Diabetes symptoms
• Sleep disorders
• Smoking cessation and drug withdrawal
• Treatment of mood disorders such as post-traumatic
stress disorder (PTSD), general anxiety disorder, panic
disorder, social anxiety disorder, eating disorders, and
• Treatment of some types of epilepsy as a result of its
• Neurological diseases such as multiple sclerosis
(MS), Parkinson’s, and Alzheimer’s disease (AD).
Initial research published in the Journal of Alzheimer’s
Disease found that CBD might help people in the early
stages of AD retain the ability to recognize the faces of
people they know.
How does CBD work? While extremely complex, in simple
layperson’s terms, it is thought that CBD acts upon our
endocannabinoid system which has receptors throughout
the brain, organs, connective tissues, glands, and
immune cells. This system appears to have an important
modulatory role in brain function, endocrine, and immune
tissues, regulating the secretion of hormones and response
Currently, the medical community knows very little
about CBD. While the World Health Organization (WHO)
announced in December 2017 that CBD does not appear
to pose any harmful effects to users, there are no studies
yet on its long-term effects. Nevertheless, should you have
questions do not be discouraged from discussing CBD with
your healthcare practitioner, especially if you are already
on medication. If you decide to use CBD, be sure to include
it as a supplement whenever asked to provide a list of your
Your dog and CBD: Similar to the benefits experienced by
humans, early research is promising, and your beloved
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• Pain relief
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• Reduction of inflammation
• Protection of the heart and the nervous system
• Stimulation of appetite
While CBD is available in dog treats, consider purchasing
the oil as a tincture. This will allow you to adjust the
dosage drop by drop.
Buying CBD: Hemp-derived CBD oil is legal in Washington,
as it is in all fifty states, and can be purchased locally or
online. First-time buyers might do well to visit a local
dispensary to browse their inventory and ask questions. It
is imperative to find a trusted manufacturer as high-quality
CBD oil should provide the full spectrum of its health
A trusted CBD oil manufacturer will:
• Source their CBD oil from 100% organic, non-GMO (non-
genetically modified organism) certified hemp
• Use CO2 extraction (SCFE) as their method of collecting
the oil from the plant
• Provide certification of licensed laboratory analysis
for cannabinoid content and potency, potential
contaminants, and mycotoxins
• Use the full spectrum of cannabinoids in their extracts
• Outline a clear shipping and return policy
Cannabidiol receptors are found throughout the entire
body. Therefore, CBD is available in a mind-boggling array
of products including oils, vaporizers, ointments, balms,
moisturizers, shampoos, facial cleansers, edibles, capsules,
protein powder, CBD-infused teas, tinctures, and bath
Be mindful of product labeling and note the dosage and
actual active CBD in the product. CBD oil should contain no
THC, or trace elements less than 0.3 percent. Remember,
non-organic oil may contain solvents, pesticides, or
When shopping for CBD oil locally or online, it would be
wise to choose a company based in the United States
with a solid reputation. Be diligent, request expert advice
whenever possible, and thoroughly investigate consumer
reviews. Look for high-quality CBD; be wary of bargain-
20 Fall/Winter 2018
iabetic foot care is imperative to your overall
health and can be dangerous to your feet
with possible serious consequences. Diabetes
can cause nerve damage that takes away the
feeling in your feet. In many cases, numbness
or tingling in the feet is the first clue patients have of their
new diabetes diagnosis. Diabetes may also reduce blood
flow to the feet, making it harder to heal an injury or resist
infection. Because of these problems, you may not notice
injury or blisters to your feet, often resulting in diabetic
foot ulcers. Ulcers often lead to infection or a nonhealing
wound that could put you at risk for an amputation. To
avoid serious foot problems that could result in losing a
toe, foot or leg, follow these guidelines provided by the
American College of Foot and Ankle Surgeons at ACFAS.org
1. Inspect your feet daily. Early detection is key!! Check
for cuts, blisters, redness, swelling or nail problems.
Use a magnifying hand mirror to look at the bottom
of your feet. Call your doctor if you notice anything.
Avoid blisters; if you have shoes that are giving you
blisters, talk to your doctor about special diabetic
shoes and inserts
2. Bathe feet in lukewarm, never hot, water. Keep
your feet clean by washing them daily. Use
only lukewarm water—the temperature you would
use on a newborn baby.
3. Be gentle when bathing your feet. Wash them using
a soft washcloth or sponge. Dry by blotting or patting
and carefully dry between the toes.
4. Moisturize your feet but not between your
toes. Use a moisturizer daily to keep dry skin from
itching or cracking. But don’t moisturize between the
toes—that could encourage a fungal infection.
5. Cut nails carefully. Cut them straight across and file
the edges. Don’t cut nails too short, as this could
lead to ingrown toenails. If you have concerns
about your nails, consult your doctor. IF YOU HAVE
NEUROPATHY OR BLOODFLOW ISSUES- your nails
should be trimmed by your Podiatrist!
6. Never treat corns or calluses yourself. No
“bathroom surgery” or medicated pads. Visit your
doctor for appropriate treatment.
7. Wear clean, dry socks. Change them daily.
8. Consider socks made specifically for patients living
with diabetes. These socks have extra cushioning, do
not have elastic tops, are higher than the ankle and
are made from fibers that wick moisture away from
9. If your feet get cold at night, wear socks. Never use
a heating pad or a hot water bottle.
10. Shake out your shoes and feel the inside before
wearing. Remember, your feet may not be able
to feel a pebble or other foreign object, so always
inspect your shoes before putting them on.
11. Keep your feet warm and dry. Don’t let your feet
get wet in snow or rain. Wear warm socks and shoes
in winter. If your feet may get wet (especially in the
Northwest!), carry an extra pair of dry socks
12. Consider using an antiperspirant on the soles
of your feet. This is helpful if you have excessive
sweating of the feet.
13. Never walk barefoot. Not even at home! Always
16 Steps for
wear shoes or slippers. You could step on something
and get a scratch or cut, resulting in dangerous foot
14. Take care of your diabetes. Keep your blood sugar
levels under control.
15. Do not smoke. Smoking restricts blood flow in your
16. Get periodic foot exams. Seeing your foot and ankle
surgeon on a regular basis can help prevent the foot
complications of diabetes.
Follow up with your Primary Doctor or Endocrinologist
regularly for help managing your diabetes. To find out
what Diabetes-specific care our office can offer you,
For more information of how to care for your feet and
other common foot conditions, go to https://www.
foothealthfacts.org/ or ACFAS.org.
Article submitted by:
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million Americans have
pay more than
for the emotional, physical and
financial burdens created by diabetes
9.4% of Americans have
25% of seniors with diabetes
of death in the
Diabetes by the numbers
Compiled from the American Diabetes Association
22 Fall/Winter 2018
here are many aspects important for maintaining
health as we age. Inarguably, good nutrition
is one of the most important of these factors.
Diseases such as diabetes, hypertension,
cardiovascular diseases, and cancer are linked to
diets lacking adequate nutrients and/or having an excess
of fat or calories. Good nutritional intake is necessary for
managing illness. In addition to prevention of disease
there are many benefits to good nutrition including
increased energy, improved mood and cognitive function,
maintenance of muscle and bone mass and achieving and
maintaining an ideal body weight. A nutritious diet is a
key factor in ensuring you remain healthy and energetic
throughout your life.
The great news is that regardless of where you are
currently in your nutrition and health journey, making
changes to improve your nutritional intake now can make
a difference in your health and wellbeing. Most people are
familiar with the food groups: fruits, vegetables, grains,
proteins, dairy, and oils. For more information on your
suggested intake and details about each food group visit:
http://www.choosemyplate.gov/olderadults. I would also
encourage you to share your nutritional goals with your
physician and if needed meet with a registered dietitian
who can help you reach your dietary goals.
Aside from the general nutritional recommendations,
there are additional considerations for different life stages.
As adults age, they need fewer total calories, but also need
an increase in certain nutrients. These needs can be met
by choosing foods that are nutrient-rich. The following is
a list of specific nutrients along with good sources and/or
suggestions for ensuring adequate nutrient intake.
Calcium helps to maintain bone strength and keep bones
and teeth healthy. Older women in particular suffer a
higher rate of bone loss after menopause: Calcium can
be found in dairy (milks and cheese products), fortified
soy and nut milks, tofu, calcium fortified cereals and fruit
juices, canned sardines or salmon with bones and some
green leafy vegetables such as collard and turnip greens,
kale and bok choy.
Vitamin D boosts your immune system, keep your
nerves healthy, and helps turn the food you eat into
energy: Vitamin D is found naturally in very few foods,
but amazingly, is produced in our skin when we absorb
sunlight and is found in fatty fish, such as salmon, tuna and
mackerel, beef liver, and egg yolks. Manufacturers fortify
it into cow’s milk, soy and nut milks, and sometimes into
juices and cereals.
Vitamin B12 is important for creating red blood cells and
DNA, and for maintaining healthy nerve function: Meats,
dairy products, and fortified breakfast cereal provide good
sources of B12.
Potassium is vital for cell function, helps reduce high
blood pressure and the risk of kidney stones, and keeps
bones strong: Potassium is found in fruits and vegetables,
especially bananas, citrus, melons, raisins, dates, apricots,
cucumbers, cooked spinach and broccoli, peas, mushrooms
Fiber is an important nutrient to ensure a healthy and
active digestive tract.: Whole grains, beans, legumes,
fruits and vegetables are fiber full, so be sure to include
these regularly in your dietary intake. Choose whole grain
products, whenever possible. You might be surprised by
how much tastier whole grain pastas, crackers or baked
Protein is vital for muscle maintenance, immunity, and
recovery: Try to include a high protein item with each
meal. You can pump up your protein intake by adding
protein rich food to your snacks such as seeds, nuts, nut
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butters, cheese, hard-boiled eggs, plain yogurt or sliced
deli meats. Increase the fiber and protein content of many
dishes by simply adding canned or frozen beans
When shopping for groceries, a good suggestion is to buy
most of your groceries from the perimeter of the typical
grocery store layout. Visit the inside aisles for some pantry
staples and whole grains. Most of the processed “junk
foods” are found in inside aisles. If you need to lessen the
amount of work to prepare meals, already chopped or
frozen fruits and veggies are a great convenience.
Choosing to shop only sale/discounted items and using
coupons can help with the affordability of groceries. Other
tips include first checking the day old rack from the baked
goods and looking for the discounted stickers often put on
foods in the refrigerated section that need to sell quickly.
Bargain grocery stores or outlets and wholesale grocery
chains that sell bulk items are often the better option for
those needing to maximize their grocery budget. It also
is worth noting that many chain stores offering groceries
online will deliver to your home or bring items out to your
car. These services can be beneficial to those with mobility
Local farmer’s markets and farm stands provide
another means of accessing fresh fruits and vegetables.
Most markets open in early spring and remain
open through late fall. For a complete list of state-
approved markets, visit http://wafarmersmarkets.org/
Purchasing and preparing nutritious foods is not easy,
especially for those on a limited budget or with mobility
issues. Fortunately, there are programs that help. The
Senior Nutrition Program is available to all adults 60 and
older and is available in counties all around the Olympic
Peninsula. The location and contact info to find out more
about each of these programs is available in the directory.
These programs provide a nutritious meal that is designed
to meet at least one third of the daily recommendations
for nutrients and are served in a communal dining setting.
For those who are unable to travel to a meal site due to
mobility or health issues, many of these programs also
offer home delivery options.
Good nutrition is important to living a healthy, happy life.
Older adults ideally need more of certain nutrients as part
of a healthy intake. Smart grocery shopping techniques
and participating in the Senior Nutrition Program are great
ways to reach your nutritional recommendations.
By Christine Michelle Hamilton
Registered Dietitian Consultant
Meals on Wheels Kitsap
24 Fall/Winter 2018
r. Daniel Morris practiced internal medicine for
35 years before retiring in 2010. As a retired
physician, Morris knows the risk factors for
falls – such as muscle weakness, vestibular
(inner ear) dysfunction, cardiovascular
disease, and environmental factors. However, he didn’t
relate those factors to his own life until he was injured in a
“I knew I had some muscle weakness, but I didn’t realize
how extensive it was,” he says. “And I didn’t realize I had as
much vestibular dysfunction.”
On a cold January morning last year, Morris rushed up the
short ramp to his workshop outside his house, slipped on
ice, and fell. Attempting to break the fall, he dislocated and
fractured his right shoulder. For a month, Morris couldn’t
drive and was limited in his ability to perform routine tasks
such as eating and dressing.
When he started a rehabilitation program for his shoulder
at Kitsap Physical Therapy (KPT), he wanted to understand
what factors contributed to his fall. With a referral from
his primary care physician, Morris undertook a fall-risk
evaluation at KPT, where he learned the extent of his
muscle weakness and vestibular dysfunctions.
The evaluation includes a full assessment of all the
involved systems: musculoskeletal, neuromuscular,
cardiovascular/pulmonary, proprioceptive (space
perception), vestibular and the cognitive changes that
need to be managed as part of the aging process.
Additionally, there’s a vision screening, prescription review
and a discussion of the home environment.
“We try to evaluate all the modifiable risk factors that
we can improve upon,” says Richard McDowell, a board-
certified geriatric physical therapist at KPT. “If a risk factor
is not modifiable, then we look at adaptive techniques,
such as using equipment.”
The evaluation placed Morris in the high-risk category for
falls. He advocates for an evaluation for anyone who has
fallen or has had an injury, is afraid of falling or has balance
issues. He feels that self-knowledge and self-awareness
would have made a difference in preventing his fall.
Adults are at an increased risk for falling as they age.
Most often, patients do not report a fall to their family or
primary care physician due to fear of losing independence.
Unfortunately, that is counter intuitive, since reporting the
first fall can save your life.
According to the National Council on Aging:
• Every 11 seconds, emergency rooms treat an older
adult for falls. Two thirds of those who fall will fall again
within six months.
• One in 3 people aged 65 years and older fall at least
once every year. One in 40 of those will be hospitalized
and only half of those hospitalized will survive the year.
• Sixty percent of fatal falls occur in the home.
Imagine preventing the fall from happening in the first
place. “Our evaluation can provide a risk predictor for
falls,” McDowell says. “During the treatment, we’ll
challenge the patient’s systems in a risk-free environment.
To improve your balance, you need to be near a fall and
the best way to do that is in an environment where a
physical therapist can support you.”
For Morris, the risk decreased from high to low after
just 15 physical therapy sessions. With a year of physical
therapy now behind him, his recovery and the return of
90-95 percent of his shoulder function took a lot of work.
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Yes (2) No (0) I have fallen in the past year.
Yes (2) No (0) I use or have been advised to use a cane
or walker to get around safely.
Yes (2) No (0) Sometimes I feel unsteady when I am
Yes (2) No (0) I steady myself by holding onto
furniture when walking at home.
Yes (2) No (0) I am worried about falling.
Yes (2) No (0) I need to push with my hands to stand
up from a chair.
Yes (2) No (0) I have some trouble stepping up onto a
Yes (2) No (0) I often have to rush to the toilet.
Yes (2) No (0) I have lost some feeling in my feet.
Yes (2) No (0) I take medicine that sometimes makes
me feel light-headed or more tired than usual.
Yes (2) No (0) I take medicine to help me sleep or
improve my mood.
Yes (2) No (0) I often feel sad or depressed.
Add up the number of points for each “yes” answer. If
you scored 4 points or more, you may be at risk.
Contact one of KPT’s geriatric specialists
with your results for a FREE screening and
recommendations to help you stay independent
and active for life.
Ask Yourself These
Circle “Yes” or “No” for each
He’s also taken preventive steps in his home environment
by installing a handrail on his shop ramp.
As a physician, he knows the importance of prevention
as well as of maintaining progress. This perhaps explains
why, unlike a typical patient, he not only continued
physical therapy for an entire year but also went in for a
risk reevaluation several times. “With most major injuries,
you’re never as good as before and it’s important to
maintain what you’ve gained through physical therapy,”
he explains. “It’s easy to get distracted with everyday life,
and physical therapy is adding one more routine into your
“I really believe that being fit and continuing the physical
activity really makes a difference,” he says. “I put balance
and strength training in the same category as brushing and
flossing -- we all know we need to do it, but we don’t all
do it, and then we pay the consequences.” Morris, who
lives in Indianola, is thankful that he could use the fitness
center at KPT’s Kingston clinic for exercising.
According to McDowell, research suggests that creating
any significant change takes 120 hours of physical
activity. That’s why it’s critical to exercise at home or
in the community after going through physical therapy
treatment. An individual walking program or a group
exercise program like SAIL can help older adults maintain
their physical fitness and reduce the likelihood of falls.
For a free screening, contact any of the KPT’s seven
locations. For more program information, visit www.
In collaboration with the Kitsap County Fall Prevention
Coalition, Kitsap Physical Therapy is one of the first
organizations to offer SAIL (Stay Active and Independent
for Life) classes in the county. SAIL is an evidence-based
program for adults 65 and older that helps improve
strength, balance and cardiovascular fitness.
Classes are conducted two times a week by staff who are
SAIL-certified instructors. The class is designed to help
increase energy, improve walking and flexibility, maintain
healthy weight, and improve self-image and sleep. It uses
a group approach, providing a social environment where
peers interact and can create new relationships. KPT
currently offers classes at the following locations:
Village Green Community Center: (360) 297-1263
Bainbridge Island Senior Center: (206) 842-1616
The Washington Department of Health in alliance with Wellness
Place, Inc. administers the SAIL Program in Washington State. KPT’s
commitment to SAIL is part of a larger Kitsap area effort to help seniors
age in place. KPT is joined by the Retired and Senior Volunteer Program
(RSVP) of Kitsap, CHI-Harrison, and local, county, and state agencies for
older adult services. The common goal is for aging to be safe, healthy,
26 Fall/Winter 2018
Early Stage Memory Loss
Washington State Chapter
Serving Washington & Northern Idaho
Information and support for people
affected by Alzheimer’s and dementia.
Proper nutrition is important at every stage of life but it
can be especially important for people with dementia as
poor eating habits may increase behavioral issues and
cause weight problems. People with dementia may have
no desire for food or drink. Skills such as using utensils
may disappear and favorite foods may no longer entice
the same response they once did. Understanding which
strategies work and which do not will help eliminate some
of the frustration.
Let’s start with the don’ts. Luckily this list is short.
• Don’t harass, harangue or argue with someone who is
not interested in eating.
• Don’t force them to sit with the food in front of them
once it becomes clear they are not interested in it.
• Keep distractions limited. Too many options, too
much activity, too much clutter all limit the ability to
focus on eating. If only a spoon, a bowl and a glass is
needed, don’t add a fork, a knife and other items in
order to have a proper place setting. Keep tablecloths
plain, dishes unadorned, and decorations out of the
view of your loved one. People with dementia often
have perception problems so make sure dishes and
tablecloths or placemats are different colors. AARP
advised in one article that a study found that people
with dementia ate more food if it was served on a red
plate rather than a white plate.
• Switch to finger foods or cut chewy items into smaller
pieces. Feed smaller meals more often. Consider
feeding only one item at a time.
• Use unbreakable place settings. They will limit the mess,
improve the ability to grasp and make cleanup easier
and safer. There are dementia friendly place settings
available that make holding and using utensils easier.
Straws can make liquids easier to handle.
• Allow time to eat. Use that time to sit with your loved
one and assist if necessary. All people need some
companionship. It does not go away with dementia.
• Make sure that there is not a physical reason such as
poor fitting dentures or mouth sores getting in the way
• Make sure food is the right temperature to eat at the
Avoiding food fights
10 Ways to Love Your Brain
When possible, combine these tips to achieve maximum
benefit. If it seems overwhelming, start with one or two
changes and build on them gradually. The most important
thing is that you start now. It’s never too late or too early to
incorporate healthy habits!
Growing evidence indicates people can reduce their
risk of cognitive decline by adopting key lifestyle habits.
Healthy behaviors known to combat cancer, cardiovascular
disease and diabetes are also good for your brain health.
These include staying mentally active, engaging in regular
physical activity, and eating a heart-healthy diet. Here are a
few tips to get you started:
Studies show regular cardiovascular
exercise that elevates your heart rate and
increases blood flow to the brain and body
can reduce the risk of cognitive decline.
Education in any stage of life will help
reduce your risk of cognitive decline and
dementia. Take a class at a local college,
community center or online.
Evidence shows smoking increases risk of
cognitive decline. Quitting smoking can
reduce the risk to levels comparable to
those who have not smoked.
Evidence shows risk factors for
cardiovascular disease and stroke –
obesity, high blood pressure and diabetes
– negatively impact your cognitive health.
Take care of your heart and your brain will
Brain injury can raise your risk of cognitive
decline and dementia. Wear a seat belt, use
a helmet when playing sports or riding a
bike, and take steps to prevent falls.
Eat a healthy and balanced diet
lower in fat and higher in fruit and
vegetables. Although research on diet
and cognitive function is limited,
certain diets, including Mediterranean
and Mediterranean-DASH (Dietary
Approaches to Stop Hypertension), may
contribute to risk reduction.
Not getting enough sleep due to
conditions like insomnia or sleep apnea
may result in problems with memory
Take care of your mental health. Some
studies link a history of depression
with increased risk of cognitive decline,
so seek medical treatment if you have
symptoms of depression, anxiety or
other mental health concerns
Pursue social activities that are
meaningful to you. Find ways to be part
of your local community or share in
activities with friends and family.
Challenging your mind may have short
and long-term benefits for your brain.
Build a piece of furniture, complete a
jigsaw puzzle, do something artistic,
or play games that make you think
Article provided by:
Alzheimer’s Association Washington State Chapter
alzwa.org | 1.800.272.3900
28 Fall/Winter 2018
2701 Clare Avenue
Bremerton, WA 98310
Points of Difference ~ Service ~ Care Options
• Member of the National Stroke Association
• Close proximity to Hospital
• Direct ER Admissions
• Therapy provided 7-days a week
• State of the Art Rehabilitation Gym &
• 24-hour licensed Nursing Care
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• Respiratory, Palliative, Renal Disease and
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• Medicare and Medicaid Certified
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Convalescent and Rehabilitation
troke is the sixth leading cause of death in
Washington and the leading cause of adult
disability in the United States. When it comes
to stroke, time lost is brain lost because while a
stroke causes permanent damage, most people
recover. The significance lies in how well they recover.
The patient’s fight to return to normalcy does not end
with discharge from the hospital. Recovery requires time
and advocacy. The most likely candidate for a stroke is
someone who has already had a stroke so rehabilitation
has to be immediate to avoid a recurring stroke.
Stroke victims need a partner in their corner.
Unfortunately, said Matthew Macklin, the Executive
Director for Bremerton Nursing and Rehabilitation (BHR),
until recently there was a gap in meeting the needs for
inpatient rehabilitation in Kitsap. The Kitsap area didn’t
even have a support group. If recovery partners existed at
all, they often existed in Tacoma, and were insufficient for
Tacoma let alone for those in other areas of Washington.
“Everyone does stroke rehab,” said Macklin, so the
question became “how can we do it better.” BHR extends
the level of skilled nursing therapy with a one of a kind
program called Project Endogeny. Endogeny refers to
development or growth from within. The program seeks
to fill the gap between intense inpatient rehabilitation
and traditional skilled nursing therapy by utilizing stroke
recovery technology not available in any other facility in
Project Endogeny uses the best and most recent
technology for therapy relying on patterned electrical
neuromuscular stimulation (PENS) to reeducate and treat
muscle atrophy caused by stroke. PENS is used to enhance
muscles and coordination used for swallowing. Therapists
are able to see the swallowing and convert it to a game.
“No one else in the state can do that,” said Macklin.
Macklin is extremely proud of his team at BHR because
while the technology is innovative it needs support, so BHR
invested heavily in people. All BHR clinical and support
staff are certified to support stroke recovery, prevention,
and intervention. He extends an invitation to anyone in the
community who would like a tour to see what makes them
Exclusive Stroke Recovery Help
30 Fall/Winter 2018
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nce upon a time, the milkman delivered
his products to your doorstep; the tinker
stopped at your door and offered to sharpen
your knives; and someone went door-to-door
offering encyclopedias. In fact, while you
would certainly go to town for some items, many services
and products were offered in your parlor. For the last few
decades, the trend has been to have products and services
move to the big box stores as a cost saving measure and
a convenience—to the business. Only the very wealthy
experienced anything different.
While encyclopedias will probably never return to being
a door-to-door product, many of those other in-home
services are experiencing a resurgence. We’ve returned
to the days of milk delivery but while that is useful, it isn’t
just products offered at your home. Much of the newest
and hottest industries revolve around the change brought
on by the advent of technology in nearly everyone’s life.
Whatever you need or want, in today’s world, there’s an
app that addresses it and one of the things those apps
address is how to offer services to customers outside the
sphere of the corporate office. Just as a significant number
of Americans work from their own homes, a growing
number has begun to work from their customers’ homes.
You may be quite familiar with some of them. Most
auto glass is replaced at your home; there are portable
mechanics for RVs and other vehicles; and there is an army
of people who offer mobile pet wash services, mobile spa
services, mobile barbershops, or mobile beauty shops.
Some banks and lawyers offer mobile notarized services.
Mobile services cut down on the costs for the storefront
for the business but they also make certain services more
convenient for people who are housebound, for pets that
don’t like the panic induced ride to the vet, and for people
who lead really busy lives.
Mobile services also make it possible to live just about
anywhere. If you want to stay at home rather than live in
a nursing home, hire an in-home care service to provide
meals, housekeeping, and personal care. There is Meals on
Wheels if you need food and companionship, or a growing
number of delivery services if you just want some of Billy
Bubs All You Can Eat Ribs because it is Friday night.
What’s more, if leaving home isn’t convenient due to
health reasons, some doctors have returned to making
house calls. Some labs offer portable x-ray services and
portable prescription services. In addition, most places,
regardless of isolation, offer in-home health care for
those with medical needs. It’s not just care services being
offered. The Kitsap Library offers mobile services to some
of their borrowers who can’t get out for health reasons.
That can be just as important if you are missing the latest
bestseller due to an accident on the ski slope keeping you
immobile, as it is if you are bedbound.
These services are no longer for those living in big cities
either. It’s a good guess that if it would make your life
easier to have a service offered at home, it will make many
other people’s lives easier as well. If there is a demand,
someone is doing it. If no one is doing it then someone
might if they knew there was a need for it. Please call one
of our advertisers in your area of need. They will be able to
offer recommendations for businesses that do offer mobile
services if they do not provide those services themselves.
Portable Businesses Make Staying
at Home Easier Than Ever
We’re by your side so
you can stay in your
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hen we think technology we often think
mobile apps and for good reason. There
are apps for just about everything if you
want to learn, do, or watch something.
There are apps to order food from your
favorite restaurant or to get you from point A to point B
but technology isn’t limited to just your smartphone. The
sheer volume of new technology designed to help older
adults can be overwhelming. Here are a few items you may
not be aware of:
• These days nearly everyone walks around with a Fitbit
or similar item for tracking their daily activity and food
intake. That same type of technology can monitor if
someone falls, provide a location for someone who
wandered away and keep track of whether or not
meals are being eaten.
• At least as important as eating is making sure that
medications have been taken and at the right time.
Programmable Medication Management Systems alert
the user about medications and dosage.
• We’ve come a long way since the “Help I’ve fallen and
I can’t get up” ads. While the ads are hokey, the need
is not. Those emergency alert devices are smaller than
ever so it isn’t as obvious that someone is wearing one
and yet for a monthly fee one of these devices can go
anywhere its user goes.
• Touchscreen technology takes a lot of the fuss out of
computer use. The iPad and other tablets make it easy
to set up and keep up with email and social media.
Safety features for your home can also be built into
a smart device such as the Ring Video Doorbell that
allows users to see who is at the door on your tablet
before you open the door.
• New technology makes driving a vehicle easier and
safer than ever. Back up cameras, automatic braking
systems, lane departure warnings, and blind spot
detection are just a few of the new safety features that
add to a driver’s ability to avoid a crash.
• The Amazon Echo can play music, read a book, and
make phone calls all by voice command.
• It’s easy for even the most conscientious of us to
leave something on the stove unattended but the
Stove Guard CookStop will turn the stove off if it is left
unattended for a predetermined time.
Products to Help
You Age in Place
32 Fall/Winter 2018
KITSAP SENIORS REAL ESTATE
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firstname.lastname@example.org 9226 Bayshore Dr. NW, #140 Silverdale, WA 98383
Should I stay or should I go,” is the title of a 1982
popular song by The Clash. That same question
is just as relative today, as many Baby Boomers
ask themselves, “Should I stay” and retire in my
current home or “should I go,” and find the new
home I have always dreamed about?
As with any major life change, it is always wise to have
your local experts assist you. After all, “you don’t know
what you don’t know.” In your community, you have a
Seniors Real Estate Specialist professional who can consult
with you. The National Association of Realtors created a
designation requiring additional education for realtors
to meet the needs of boomers. This specialist will work
alongside you in considering affordability, current equity
availability, home style, maintenance costs, property taxes,
community security, mobility barriers both now and in the
future, lifestyle convenience, proximity to family, universal
design, legal options, home adaptability considerations,
and costs. They can provide you with a cost analysis for
remaining in your current home or making a move. This
additional knowledge and advice are at no additional fee
to you. Its comprehensiveness serves as a reminder that
not all Real Estate Professionals are created equal.
Many seniors are choosing to do a home conversion. A
Seniors Real Estate Specialist can identify and calculate
these costs and discuss financing options including the
potential use of a reverse mortgage. In addition, they can
schedule contractors and trades to handle changes such
as, zero clearance curbless showers, creating a bedroom
on the main floor, laundry relocation, and eliminating stairs
by converting to ramp entries. The installation of stair lifts,
if appropriate, may be utilized on the interior or exterior
of the home and are permitted, licensed and inspected by
Labor & Industries for compliance.
Your local Seniors Real Estate Professional has the
experience to come alongside you or your family members
to create an plan for successful and safe independence.
The desire to remain at home after retirement continues
to be extremely important as Americans age. A September
2018 report from AARP found that almost 80 percent
of adults age 50 and older want to remain in their
communities and/or homes as they age. However, for
many older homeowners, a monthly mortgage payment,
rising property taxes and maintenance costs, drains savings
or retirement funds, and makes staying in their home
difficult. Increasingly, Baby Boomers are considering the
Should I Stay or Should I Go?
(360) 337-5700 (800) 562-6418
• Preserve and promote choice
in how individuals and
families receive long term
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• Support families in caring for
loved ones while increasing
the well-being of caregivers
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FHA- insured Reverse Mortgage as a way to pay for their
home and living expenses. There are three ways you can
access the funds;
1. A lump sum to eliminate your mortgage payment, (and
pay taxes, insurance, and maintenance of the home)
2. A tax-free line of credit; flexible withdrawals and
growth option (applied to unused funds)
3. Monthly term or tenure payments. If you qualify, you
can have a combination of the three.
It was a dream come true for David and Vivian D., to
continue to live in the home they built over 40 years ago.
The 80-year-old couple mentioned in our publisher’s
welcome article, owned their home free and clear.
However, they did not have the cash to make the needed
repairs and modifications for Vivian to live at home, forcing
her to reside in a nursing home for six months until their
attorney advised them that they could qualify for a reverse
mortgage. They used a portion of their tax-free line of
credit from their reverse mortgage to pay for the required
home modifications and repairs necessary to make a safe
and secure environment for Vivian and David. Fortunately,
they both have long-term care coverage that pays for
eight hours of daily in-home care. At Vivian’s homecoming
celebration, she said, “Getting the Reverse Mortgage saved
my life and allowed me to live in the comfort of my home. I
am so grateful.”
An H4P reverse mortgage loan combines a reverse
mortgage loan with the equity from the sale of your
previous home – or from other savings and assets to buy
your next primary home in a single transaction.
How does an H4P work? Regardless of what happens to
your home’s value or how long you live in the home you
only make one down payment towards the purchase.
However, you must continue to pay taxes and insurance
(and homeowner association dues if applicable), and
maintain the home. You can use any additional equity after
paying the down payment, for upgrading your new home
or any other expenses that you might have.
The basics factors in qualifying for an H4P are:
• You must be 62 years or older
• Current interest rates
• The lesser of the home’s purchase price or the appraised
value determines the amount of the down payment.
• The new property must be your primary residence for
more than six months out of the year.
Contributors to the Article:
Teri Tennyson, SRES Kitsap Seniors Real Estate 360-
440-6211 www.KitsapSeniorsRealEstate.com Joan
Qvigstad, Reverse Mortgage Specialist Fairway
Independent Mortgage Corp 360-271-5946 www.
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