Tuesday, September 29, 2015

A VA Travel Guide: The Road to VA Health Care and Benefits

As veterans transition from military service to civilian life, seeking health care from the VA can leave them feeling overwhelmed, underserved, and even unaware of benefits they’re eligible for.

The history of the United States Department of Veteran’s Affairs (VA) dates back as far as 1636. However, it’s modern presence as a hospital system began in 1811, when the first domiciliary and medical facility for veterans was established by the federal government (VA 2014). Its presence has expanded throughout the years into three distinct branches:

• Veteran’s Health Administration (VHA), the largest branch responsible for the medical care of veterans.

• Veteran’s Benefits Administration (VBA), responsible for the financial needs of veterans (including GI bill, home loans, compensation and pension).

• National Cemetery Association (NCA), responsible for the respectful and honorable burial of veterans.

The encompassing VA system is predicated on noble intentions to support veterans as they transition from military to civilian service. However, its actualization has not always upheld its intentions. Successfully navigating the VHA should not be as difficult as it sometimes is. Veterans and their families seeking healthcare from the VA often end up feeling overwhelmed, underserved, and even unaware of benefits for which they are eligible. Having a guide can alleviate some of the complications in receiving care, and also help veterans to receive better and broader care.

As of the 2014 census, there are 21.8 million veterans in the United States, 9.866 million of whom are age sixty-five and older (Census Bureau 2012, VA 2014). Any professionals who work with older adults are almost guaranteed to also work with veterans and their families. Given the medical needs of older populations, professionals will encounter the need to aid clients in navigating the VHA especially. This article will serve to provide information predominantly on navigating the VHA, but also information on navigating the VBA, especially in ways where compensation and pension directly relate to the receipt of health care. One article alone can’t provide all the information needed on navigating the VA, so it is recommended that professionals seek additional information from its comprehensive website, www.va.gov, as well as local VA hospitals and regional offices serving veterans. The accompanying case study will give you a real-world example of how advocacy and care can be achieved.

Enrollment in VA Health Care
Most present-day veterans are given the option to enroll in the VA upon their discharge, but previous generations were often not made aware of their VA benefits. Many have never enrolled in VA health care, and some are not even sure if they are eligible for enrollment. The general rule for enrollment in the VHA is that any veteran who served active duty in the U.S. military and was discharged for any reason other than dishonorable, is eligible to enroll (VA 2014). Most veterans who enlisted after September 7, 1980 need to serve active duty for at least twenty-four months in order to meet enrollment requirements. However, there are additional factors that may contribute to enrollment eligibility.

When in doubt, apply. The VA will simply say no if a veteran doesn’t meet requirements. Some veterans are exempt from having to enroll due to already being service connected for a disability or seeking examination for an environmental health hazard to which they may have been exposed during their service, such as agent orange or a burn pit. Even if a veteran is exempt
from enrollment, the VA still strongly encourages going through the enrollment process, because this allows the VA to better prioritize care. When it comes to VA enrollment, “all roads lead to Rome.” Whether a veteran presents in person to a local enrollment office, calls the enrollment hotline 1-877-222-VETS (8387), or completes the enrollment online, he or she will need to fill out VA Form 10-10EZ. It’s very helpful to direct veterans and their families to this form online to learn what information they will need to have.

Once a veteran is enrolled in the VHA, he or she is given a priority, ranging from 1 (highest) to 8 (lowest). Priority 1 veterans are often disabled at 50 percent or higher due to a disability incurred during or because of their military service. Veterans in the 8 priority group often have strong incomes and private medical insurance. While they are wholly eligible to receive care at the VA, they may not be prioritized above other veterans who are unable to afford going outside of the VA. Each stage in between has its own characteristics, which are provided in more detail in the resources section of va.gov/health benefits.

Once enrolled, they may now begin receiving health care. The VA has transitioned to a Patient-Aligned Care Team (PACT) model where patients can receive a multitude of services through their primary care team. Many primary care teams have doctors, pharmacists, nurses, and specialty care like behavioral health, in one common setting. Within this setting, there should be social workers present or on call who can aid veterans in understanding additional health care services available at the VA, if needed, as well as benefits for which veterans will have to contact the VBA.

Navigating the VA System
It is after a veteran becomes enrolled in VA health care and begins receiving services, like primary care, where many veterans become confused by the system. Some believe that receiving health care means they are service connected for the condition for which they are receiving care. Some believe the VA is paying for all of their care when their private insurance is actually being billed, and they are shocked when they receive bills for copays and deductibles. These and other assumptions often leave veterans feeling confused, underserved and also lacking in important benefits for years.

The first step to resolving some of these issues is to understand the differences between the branches of the VA. The VHA provides health care and its affiliated needs (helping patients obtain durable medical equipment, or providing information on assisted living facilities in the area). It does not provide income, so veterans who assume that the VHA is paying their medical bills or providing them with pensions are misinformed.

Applying for VA Financial Benefits. The financial needs of veterans, including compensation, home loans, vocational rehabilitation, education, and others
are met by the VBA. In order to receive any of these benefits, a veteran must apply through the VBA. This means that even though veterans may be enrolled in and receiving VA health care, they may be eligible for additional benefits, which they are not receiving because they haven’t applied for them. Many of these benefits are tied intimately to a veteran’s care with the VHA, including service connection, and aid and attendance. Additional benefits available through the VBA include survivor’s pensions, life insurance, special monthly compensation, assistance for homeless vets, and others. Information on the full range of benefits the VBA has to offer can be found on its website.

For the most part, a veteran can apply for benefits one of three ways: online at ebenefits.va.gov, through an appointed representative (an attorney or a Veteran’s
Service Officer (VSO) who is appointed at the state or federal level), or in person at a local regional office. Once the application has been submitted, a veteran may need to complete additional documents or present in person to a regional office.

Service-Connection. A service-connection is a diagnostic designation, such as tinnitus (ringing in the ears), that has been determined by the VA to originate during, be exacerbated by, or result from one’s military service. A service-connected disability provides a monthly stipend, ranging from $44 to $3447.72, depending on the percentage for which someone is service-connected (0-100 percent) and how many dependents a veteran has. It also designates free or reduced-cost care through the VA for the service-connected disability. For example, a veteran who is 100 percent service-connected for post-traumatic stress disorder (PTSD), who is married with dependent children, may receive up to $3,447.72 per month and free VA services to treat his or her PTSD, including
psychiatric care, medication, and so on.

Aid & Attendance. 

Aid & Attendance (A&A) 

and Housebound Pensions are stipends that may be added to existing pension amounts, meaning a veteran must first be pension eligible tor receive these benefits. A&A and Housebound are mutually exclusive pension
supplements, meaning veterans may not receive both at the same time—they either receive A&A or Housebound. As of 2015, a single veteran is eligible for up to $1,788 per month. A veteran with a spouse is eligible for up to up to $2,120 per month, and a surviving spouse may be eligible for up to $1,149 per month.

A non-service-connected (NSC) pension is a financial stipend similar to social security that can provide for the needs of lower income veterans whose annual income is below a certain threshold. This will allow veterans who are receiving no or minimal social security income to increase their income to more of a livable wage. A disability is not required.

All veterans may apply for VA benefits, and they are encouraged to apply for as many benefits as they need. It is not uncommon for a veteran to receive multiple benefits, such as pension income, home loans, and educational benefits, at the same time.

Symbiosis of the Systems
As you can imagine, understanding which aspect of the VA supports which need can be confusing. It is very easy for veterans to assume that they are receiving all
of the benefits for which they are eligible, even though there may be a whole avenue of care that is unexplored. Although this article has focused on the surface level aspects of obtaining basic healthcare and financial benefits, truth is that VA healthcare is among the most encompassing and best medical care in the United States (Longman 2012). However, part of the process of obtaining that care is knowing how to get enrolled and connect with the right care providers. An additional aspect of the process is applying through a separate system for additional benefits that may directly relate to the receipt of health care, or indirectly provide for a better quality of life that improves veterans’ wellness.

Growth and Change
One often thinks of the VA as a very fixed system, but in truth, it is constantly changing and growing. The VA is opening and further developing programs, such as those that aid LGBT populations, victims of military sexual trauma, and homeless veteran populations. They have developed local recovery coordinators to work with community resources to serve more veterans, and recently implemented changes, like the Veteran’s Choice Act have expanded VA care to private providers outside of the VA that meet certain criteria. Sometimes even the healthcare providers within the system are unaware of some of the changes and expansion of services, which is why it is important for veterans to have outside advocates and be aware of how and whom to contact about benefits.

VA hospitals have come a long way since 1811, as have the needs of the veteran population. Knowledge of the inner workings of the system as well as how to navigate the basic enrollment and application procedures provides the solid foundation that veterans need to establish care and learn about the multitude of options they have for support as they reintegrate into civilian life, or live out the remainder of their years with the impact of their military service. As professionals who serve older populations, we have a unique opportunity to “serve those who have served” by helping them to understand, establish, and navigate care in this comprehensive system. •CSA

Carilyn Ellis, PsyD, is a resident psychologist with the Samaritan Waldport Clinic in Waldport, Oregon, a part of Samaritan Health Services. Previously, she was a Fellow at the Boise VA Medical Center. She has specialized training in geropsychology, palliative care, oncology, neuropsychology, and integrated primary care. She may be contacted at cellis@samhealth.org, or 541-563-3197.

A VA Travel Guide: The Road to VA Health Care and Benefits was featured in CSA Journal 63.

Blog posting provided by Society of Certified Senior Advisors.

Friday, September 25, 2015

Hospice Provides Emotional Comfort to the Dying

Rather than trying to cure someone who is terminally ill, hospice works to ease physical pain and make the patient comfortable so they can enjoy the last days or months with family and friends, ideally at home.

Hospice arose from the idea that dying people shouldn’t have to suffer in their last days or months, either from medical care that may be unnecessary or from being alone in a hospital. In hospice, the terminally ill receive comfort through drugs that can ease physical pain and through emotional support from a hospice team working with the patient’s family and friends, ideally at home.

Beginning of Hospice

At one time, the medical world treated dying as a medical condition, rather than a time for a dying person to let go, say goodbye to family and friends, and make peace with themselves and the world.

The hospice movement began with a British doctor, Cicely Saunders, who advocated pain management for the dying. Up to that point, doctors didn’t want to give pain-killing drugs to terminally ill patients because of unfounded fears of addiction. She “insisted that dying people needed dignity, compassion and respect,” and “abolished the prevailing ethic that patients should be cured, that those who could not be cured were a sign of failure and that it was acceptable and even desirable to lie to them about their prognosis” (the BMJ). In 1967 Saunders founded St. Christopher’s Hospice in London.

How to Choose a Hospice
Find the hospice that’s best for you or your loved one (from the American Cancer Society):
  • Does Medicare certify this hospice program? Medicare-certified programs have to meet at least minimum requirements for patient care and management.
  • If your state requires it, is the program licensed? You can check with your state health department to find out.
  • Does the hospice agency have written statements outlining services, eligibility rules, costs and payment procedures, employee job descriptions and malpractice and liability insurance?
  • How many years has the agency been serving your community? Can the agency give you professional references?
  • Does the hospice create a care plan for each new patient? Is the plan carefully and professionally developed with input from you and your family?
  • Are there references on file for home care staff? Ask how many references the agency requires for each staff member who gives home care (two or more should be required).
  • How does the hospice handle payment and billing? Get all financial arrangements – costs, payment procedures, and billing – in writing.
  • Does the agency have a 24-hour telephone number you can call when you have questions or problems? How does the hospice respond to calls?
  • During your first visit, talk about all of the treatments, such as dialysis or blood transfusions, that you are currently getting and that you want to continue.

Hospice care came to the United States in 1974, in Connecticut, and started expanding in the 1980s, especially when Medicare recognized hospice’s value and cost savings and therefore started paying for hospice care. By 2000, more than 3,000 hospices and palliative care programs were serving the needs of the dying and sick. Today, the medical industry fully accepts hospice and palliative care principles, and hospice is an official medical subspecialty.

In fact, studies have shown that hospice care can save healthcare costs by reducing aggressive medical interventions. One study showed that hospice can significantly lower hospitalization rates, intensive care unit admissions and invasive procedures for cancer patients (“Hospice Care Lowers Cost and ICU Use in Cancer Patients,” Nov. 11, 2014, Medscape).

What Is Hospice?

One of the biggest misconceptions about hospice is that end-of-life care is only provided in an institution. However, most people get hospice care at home and thus are able to spend their last days with family and friends rather than in an institutional setting. Hospice care is also offered in nursing homes and other senior living facilities as well as hospitals.

Hospice care usually starts when your physician tells you that medical treatment can no longer help you, and you have six months or less to live. Hospice treatment helps relieve disease-related symptoms but does not cure the disease, although many people improve under hospice care and may even “graduate” for a period of time. Its main purpose is to improve your quality of life.

First, you need to find hospice care. Many larger communities have more than one organization. (See sidebar for how to find one.) Most home health agencies, as well as independently owned hospice programs, offer home hospice services. Some states, such as Kentucky, restrict a hospice agency to a certain county.

The hospice organization sets up a team that will develop a plan for pain management and symptom control 24 hours a day, seven days a week. That includes the patient’s caregiver(s), personal physician, hospice physician (or medical director), nurses, home health aides, social workers, clergy or other counselors and trained volunteers.

Services Provided

Among its major responsibilities, the interdisciplinary hospice team:

  • Manages the patient’s pain and symptoms
  • Assists the patient with the emotional, psychosocial and spiritual aspects of dying
  • Provides needed drugs, medical supplies and equipment
  • Helps keep family members informed about the patient’s condition and advises the family on how to care for the patient
  • Shares information with all involved services, including the inpatient facility, the home care agency and doctor
  • Makes short-term inpatient care available when pain or symptoms become too difficult to manage at home, or the caregiver needs respite time
  • Provides bereavement care and counseling to surviving family and friends for up to one year after a patient’s death
  • Sets up spiritual care to meet the patient’s needs, including helping the dying person with how to say good-bye or with coordinating a religious ceremony or ritual.

Volunteers are a large part of hospice and can help the caregiver by visiting the patient, reading, taking walks, writing letters, sharing music, supervising visits with pets, shopping or doing household chores. They give family caregivers the opportunity to get some time away from the home.

Differences Between Palliative and Hospice Care

Hospice care is a form of palliative care that usually takes place in the dying person’s home, while what is often called palliative care, which is centered around reducing pain, is provided in hospitals or medical settings.

Both hospice and palliative care patients receive a combination of medications, daily care, bereavement counseling and symptom treatment through a single program. However, hospice care is usually limited to those who are likely to die within six months, while patients can receive palliative care at any time and at any stage of illness, whether terminal or not. While hospice care focuses on providing comfort rather than life-prolonging treatment, palliative care offers both.

Recently, however, Medicare announced a new pilot program that will blend hospice care with medical treatments such as chemotherapy or hospitalization. “The test program is based on research that shows that patients with access to both so-called palliative care and traditional medicine often end up with a better quality of life and less expensive, intense medical treatment. The approach may even offer the patients a longer life span than those treated with traditional medicine alone” (“Medicare to Try a Blend of Hospice Care and Treatment,” July 22, 2015, New York Times).

Medicare (and the Department of Veterans Affairs and Medicaid, in most states) covers hospice programs, while regular medical insurance often covers palliative care, because it’s provided in a hospital or other medical settings.


“Hospice Versus Palliative Care,” National Caregivers Library

“Hospice Care,”
National Hospice and Palliative Care Organization

“Hospice Care,” April 8, 2014,
American Cancer Society

“Dame Cicely Saunders,
founder of the modern hospice movement, dies,” July 18, 2005, the BMJ

“Palliative or Supportive Care,”
American Cancer Society

“Research Validates the Benefits of Hospice,” Nov. 17, 2014,
National Hospice and Palliative Care Organization

“What is the history of hospice?”

“A Short History...,”
Hospice Education Institute

“Become a Volunteer,”
Hospice Foundation of America

Hospice Provides Emotional Comfort to the Dying was featured in the September Senior Spirit Newsletter

Blog posting provided by the Society of Certified Senior Advisors

Monday, September 21, 2015

Beware of Home Repairs Too Good to Be True

Watch out for contractors who knock on your door and offer their services, especially after storms or tornadoes have caused extensive damage in the area. Seniors, especially, are vulnerable to these fly-by-night repairmen who often take your money and flee or do substandard work.

The headlines tell the story: “Pair targets elderly in home-repair scam,” ”Dallas police arrest man in home-repair scams targeting the elderly” and “He lost more than $60,000 in home improvement scam.”

In one case, an elderly woman in Lincoln County, Missouri, was approached by a man who said he had done work for her late husband. After he told her the lightning rods on her house needed work, she wrote a check to the man for $1,800, who took it and never returned. In Dallas, the con artist’s line was that his “daddy” was working on a house behind the home of the person and saw a squirrel come out of the attic.

In many cases, victims get in over their heads and don’t know how to get out. In Indianapolis, three men knocked on the door of Bill Smiley, an elderly retiree, and told him that his gutters were leaking and his roof was in bad shape. The first check was for $3,000, but, by the end, Smiley had shelled out $65,000, plus he was missing a diamond ring and a Rolex watch. 

Most Common Home Repair Scams

Beware of contractors coming to your door and saying your home needs attention related to these topics (from “The 9 Biggest Home Repair Scams,” May 31, 2015, Money):
Termites. Treatment is only needed when there is evidence of termites inside the house or close to the foundation, so be wary of warnings about termites in wood piles or fences not connected to your house.
Driveways. Roaming contractors will offer to seal your driveway—usually for a ridiculously low price—using leftover sealant from a local job they just finished, or so they say. Instead, they’ll apply a cheap imitation that doesn’t work and usually washes away after the first big storm.
Roofs. Beware of roofers who tell you they’ll do the work for a discount, that you need a whole new roof or that you need to replace the wood base beneath the shingles, an expensive repair that is rarely needed.
Heating and air conditioning. Scammers will try to replace perfectly good parts with new ones, or replace bad parts with used ones that still work.
Basements. Deceitful contractors will recommend digging out your entire foundation and waterproofing it to fix a damp basement, something that can cost $20,000 or more. Often the problem can be easily fixed for far less by simply reducing moisture along your foundation.
Plumbing. Common ploys include recommending an expensive repiping job when a less-expensive rooter service is all that’s required, and using pipes that are the wrong size or made of inferior material.
Mold. Unless you have a health issue, mold is not a problem, so don’t necessarily believe vendors who offer expensive mold identification services.
Painting. Fly-by-night painters will cut corners by doing very little prep work or by using substandard paint.

"I had to rely on their honesty,” Smiley told the Indystar in explaining how the bills added up. “And once I got into it, it was one of those deals where you can't just walk away from it. They had my roof torn off, and the weather was bad. I needed them to get it fixed."

When the men left without finishing the work, Smiley had to spend thousands more to repair the uncompleted and shoddy work left behind. "I have no one to blame but myself,” he says. “It's one of those things I've criticized others for doing—for not investigating guys like that before doing business with them."

Scammers Target Seniors

Seniors are more vulnerable to home repair scams for several reasons. They are more likely to be home during the day when contractors come knocking on doors; old age infirmities may make it harder to do repairs, so it is likely that the house may need work; older adults may have more disposable cash, even stored in their homes; seniors tend to be more trusting than younger age groups and those who live alone may welcome a friendly face.

When severe weather events, such as hailstorms or tornados, cause damage, out-of-state contractors arrive in the hard-hit area, promising quick and cheap fixes. Although some are reputable, many are not. After hailstorms hit parts of Texas in 2011-2012, the problem of unscrupulous fix-it companies prompted one organization to start an awareness campaign, known as “Who’s on Your Roof?” to help prevent home-repair scams, including asking the victim to pay the full amount upfront (after which the contractor leaves and never completes the work), something a legitimate home-improvement company would never ask.

Watch Out for These Signs

Common scams involve driveway paving, roof repair, gutter cleaning and mulching. (For a list of other common home-repair scams, see the sidebar.) If the homeowner pays for the work upfront, the con artists often do an inadequate job and leave the home in worse shape after completing their “repairs” than it was before they started.

These other signs caution that a home repair outfit may not be legitimate (from the National Consumers League). Beware if the contractor:
  • Appears uninvited at your doorstep or calls or emails you out of the blue
  • Says they are doing work in your neighborhood and claims to have “extra material” left over
  • Pressures you to make a decision and sign a contract for the work immediately
  • Offers a “special deal” available “today only”
  • Points out a “problem” with your home that you never noticed before. Some unscrupulous scam artists have been known to offer “free” inspections and then break something on purpose so they can be paid to “fix” the problem
  • Lacks identification, such as a permit from the city or locality.
  • Offers a discount so that your home can be used as a “model” or if you find additional customers for them
  • Offers to help finance the project, either from their own funds or the funds of an associate, especially if your home equity or home deed is involved
  • Insists you come and examine “damage” with him (while an associate steals valuables from your home).
What You Can Do

If a contractor approaches you, take precautions before agreeing to any repairs (or paying any money).

First, anyone who comes to your door to solicit work is not likely to be reputable. Competent roofers usually have enough work without going door-to-door. Also, in the case of a hailstorm that ruined your roof, for example, your insurance adjuster should be the first one to examine the damage. An illegitimate roofer can do more damage, sometimes deliberately, to convince the homeowner that work is necessary. You may also take these additional safeguards:

  • Get multiple estimates on any home repair job before signing a contract.
  • Check out the contractor’s references and visit the site to check out the quality of the work itself, if possible.
  • Check for complaints with the Better Business Bureau and make sure the contractor is registered with your state board of contractors and your local building inspection office.
  • Never pay in full upfront, especially if cash is the only payment accepted.
  • Make sure the contractor is insured and bonded.
  • Document in writing the scope of the work to be done, the complete cost and time necessary to complete the job and how payment will be handled.
  • Remember that if a deal sounds too good to be true, it probably is.

(From National Consumers League and the National White Collar Crime Center.)

In addition, you can ask friends, neighbors or people you trust for recommendations for a good contractor. Google the company to see if people have posted negative reviews. Check out the business on Angie’s List, the paid-subscription online service that posts reviews of contractors and other businesses.


Home Repair Scams Target the Elderly,” April 24, 2014, National White Collar Crime Center

“Personal Finance,” National Consumers League

“He lost more than $60,000 in home improvement scam,” January 2, 2015, Indystar

“Pair targets elderly in home-repair scam,” April 10, 2015, KSDK

“Dallas police arrest man in home-repair scams targeting the elderly,” Feb. 16 2011 Dallas Morning News

Beware of Home Repairs Too Good to Be True was featured in the September Senior Spirit Newsletter

Blog posting provided by Society of Certified Senior Advisors.

Friday, September 18, 2015

Exercise Your Brain: Play Video Games

One way to keep your brain active is to learn something new, such as video games. If the often-popular violent games turn you away, check out some of the newer games, which promote more complex topics, such as creating new civilizations or traveling around the globe.

Research is showing that challenging your brain as you get older can help prevent cognitive decline. One recommendation is to learn something new, like a different language. For older adults who are not electronically inclined, playing video games is like mastering a whole new medium.

If you have children or grandchildren, especially boys, who play games, you may have noticed that many video games focus on blowing up things. Fortunately for older adults who are looking for something more complex, many new games focus on more peaceful topics, such as detective work or travel.

The following suggestions come from several websites (see list of sources below). You can play some on your computer at home, some on your smartphone and tablets and others using a home video game console such as Wii or Xbox. Prices range from free to $50.

80 Days. Based loosely on the Jules Verne novel, Around the World in 80 Days, you plot your own route across the globe.

Angry Birds. This popular game has you launching the birds against their enemy, green pigs that are hiding in flimsy structures. It’s a simple but satisfying endeavor, according to the hundreds of thousands who have played this game.

Civilization V. Build your own civilization, from a roving tribe to an advanced high-tech society, while learning about how science and culture develop.

First Draft of the Revolution. Your high-ranking husband has cast you aside for reasons you don’t understand. You’re given clues in the form of letters, through which you must figure out what’s going on.

I Am Alive. The premise of this post-apocalyptic action-adventure is that most of the world’s population has been wiped out, and you are returning to the dust-covered city of your home, where you have to climb, scavenge and fight your way to survival.

Journey. Steeped in mystical and religious imagery with simple visual design and intuitive controls, Journey lets you find your path, and rewards you when you succeed.

Kentucky Route Zero. In this visually beautiful game that incorporates magical realism, you point and click on where you want to walk, decide which characters and objects to interact with and choose your responses.

L.A. Noire. As a detective in post-war Los Angeles, you solve cases by investigating crime scenes, collecting evidence and interrogating witnesses.

Labyrinth 2. You guide metal balls through a maze that offers tricks and traps to slow you down.

One Chance. When a pathogen kills all living cells on Earth, you must choose how to spend your remaining six days.

Osmos. This multi-media experience reimagines evolution as a battle between ghostly spheres that could be tiny organisms or massive galaxies. To grow and survive, you have to absorb smaller creatures.

Minecraft. The hugely successful and creative game allows you to explore vast landscapes and construct your own houses, castles and whatever else you want to make, while avoiding zombies.

Monument Valley. Players must guide their character through a series of landscapes that combine optical illusions and the irrational architecture of an M. C. Escher print. This stylish and evocative game was considered one of 2014’s best tablet titles.

Papers, Please. Winner of 2014’s prestigious GameCity prize, you play the role of a border guard at an Eastern European country and must decide who can pass through and who must be turned away based on a series of ever-changing rules.

Red Dead Redemption. You’re a retired, Wild West outlaw who is pressed into hunting down your former gang. Plotlines come from classic Western movies.

The Sims. 3 In this popular game, you create virtual people called "Sims" and place them in houses you build or that already exist. You help satisfy their desires, whether for love or material goods. In this third version, you travel the world and learn about local customs and cultures.


“Games for Humanity,” Rock Paper Shotgun

“Top 20 best video games for beginners ,” Feb. 19, 2015, Guardian

“Top 10 Video Games for Grown-Ups,” April 11, 2012, Next Avenue

“Phone and Tablet Games for Grown-Ups,” March 19, 2013, Next Avenue 

Exercise Your Brain: Play Video Games was featured in the July Senior Spirit Newsletter. 

Blog posting provided by Society of Certified Senior Advisors.

Monday, September 14, 2015

The Joys of Travel: older adults are embarking on adventures of a lifetime in unprecedented numbers.

Travel among older adults is increasing exponentially. It’s the perfect time in life to embark on new adventures. But there are also many practical matters that should be addressed beforehand.

Traveling in later life can be the adventure of a lifetime. It’s never too late. When people reach their retirement age or older, they sometimes stop traveling for many reasons. They don’t have a traveling companion, they move at a slower pace, have mobility or health issues, or just plain cold feet. But these reasons shouldn’t stop them from packing their  bags and taking the leap from the status quo. When working with older clients who want to travel but have concerns, it is up to the advisor to be the detective and find out what they might be.

Engage them in a conversation about their travel experience—whether on family vacations, road trips, or to other countries. Once identified, create a wish list of their top three things to do or places to see. Include reasons why they want to go, whether they would travel alone or with someone, the type of transportation needed to get there, accommodations, and travel costs.

This will be a good start in determining if the trip they want to go on is realistic. Being honest with clients about what they can do is important and will enable them to plan an adventure around places they want to go and things they want to do and see.

There are many things people need to consider when making travel arrangements, such as navigating through airport security, seating on the airplane, hotel and room accommodations, transportation from the airport to the hotel, getting around on the cruise ship, shore excursions, and organized tours.

Before embarking on the trip, make a list of important items to take. It should include such things as phone chargers, converters, medications, if any, toiletries, and camera. Preplanning and researching destinations and attractions suitable for the individual will also ensure the success of any trip. Know before you go.

Foreign Travel

If traveling outside the United States, passports are required and need to be valid at least six months after the return date of the trip. Some destinations require visas with the costs varying according to the destination. It’s a good idea to research time zones, as well as weather conditions in the travel areas to avoid typhoons, monsoons, or other weather issues. Immunizations may be necessary for travel to certain areas. An excellent information resource is the U.S. State Department’s Passports and International Travel site, which includes a traveler’s checklist. It advises travelers to make two copies of their travel documents, and leave one at home with friends or family, and who to contact in case of emergency. Check out their Smart Traveler Enrollment Program. 


Cruises are popular vacations for many travelers, including cruise ships, ocean liners, riverboats, paddle wheelers, yachts, and schooners. Each vessel varies in size, number of passengers, amenities, destinations, accessibility, and style. It is a great way to see many places in one trip and you only have to pack and unpack your suitcases once. 

Cruise ships can carry approximately 900-4,500 passengers with a choice of cabins: inside, ocean view, balcony, and suite. On a ship, the passenger cabins usually start on the third deck to the top of the ship, which could be deck seventeen or higher. There are accessible cabins in each category, depending on the need. Cabins differ in size, floor plan, and location on the ship (front, middle, or back). Cruise ships also offer a myriad of activities that range from very active to sitting in a lounge chair watching the clouds float by. Activities vary from ship to ship, and that information can be found on the cruise lines’ websites or by calling them. The entertainment and dining options on these amazing vessels are as varied as the activities. The modern cruise ship is a vacation destination in itself. 

Many cruisers like to go on excursions when they reach a port to enjoy the cultural experiences that specific area offers. Passengers can leave the ship by “tenders,” which are usually the ship’s life boats used to shuttle people to and from the land dock, if the ship is anchored away from the shore. Passengers using wheelchairs can get off at a port by an accessible walkway from the ship. However, not all ships port where there is a walkway. The cruise line can advise about this. 

River cruises in Europe have become very popular over the years because they are smaller in size, and carry fewer passengers. These cruises stay further inland while cruising the Rhine, Maine, Danube, and Elbe, allowing for beautiful views of the countryside while on board. River cruising has a variety of unique activities, such as glass blowing demonstrations, local dancers and musicians, storytellers, and wine pairing talks. Each cruise highlights the food and wine of the featured culinary area they are sailing through. Meals are included and most often the shore excursions as well, specifically focusing on the town where the ship is docked. The accessibility of these boats varies and may not be the best choice for wheelchair users. The cruise line will need to be contacted for better direction. Some of the popular brands in Europe are AMA Waterways, Viking River Cruises, and Avalon Waterways.

There are many cruise options in the U.S. as well. Modern paddle wheelers ply the Ohio, Mississippi, Cumberland, Snake, and Columbia rivers, offering relaxed, historical perspectives of our country. The cabins are spacious, the food is delicious, and the cruise schedules are plentiful, though seasonal. Two of our domestic cruise lines are American Cruise Line and the American Queen Steamboat Company.

Rail Travel

Vacations by rail have become popular for many reasons—it’s a great way to see the country and not be the driver. As you sit near a window, order your food, and enjoy the ambience of the scenery passing by or engage in the conversation with other passengers. There are different room types within the train ranging from the traditional coach to the smaller sleeper cars (roomettes) and the family sleeper car. Make reservations well in advance to get the one you want.

Currently, Amtrak offers people age sixty-two and older a 15 percent discount on the lowest available rail fare on most Amtrak trains. There are limitations, so visit the website or call them. Using the rail system in Europe is an outstanding way to travel.

Rail Europe offers those over the age of sixty discounted rates. The discounts offered are on certain passes and specific trains. These senior rates are generally on first-class travel only.


There are many types of tours available for the traveler. Scheduled tours have specific travel dates, itineraries, minimum and maximum number of passengers required for the tour, and they take care of any visas required if traveling to more than one country. Themed tours are becoming quite popular, such as culinary, wineries, heritage, or religious travel.

For those who want a more flexible schedule, customized trips can be planned. This gives the flexibility of staying in a destination longer, visiting places that are of more interest, and maybe have the option of traveling by different means. A customized trip could include a private guide to take travelers to out-of-the way places a tour bus isn’t scheduled to go. It also allows for spur-of-the-moment travel changes. 

If traveling with people similar in age is important, then a senior group tour is the best choice. Some tour companies have organized trips but may not go to many destinations. An alternative is to get a group of friends who want to travel to the same place, and plan a customized trip. The destination, activity level, accommodations, and excursions will be tailored to what the group wants.

Adventure and Educational Travel

Adventure travel can mean many things from mountain climbing, cycling tours, scuba diving, as well as volunteering.

One of the best known organizations that provide educational travel tours primarily geared to older adults is Road Scholar, formerly known as Elderhostel. Alongside local and renowned experts, travelers experience in-depth and behind-the-scenes learning opportunities, from cultural tours and study cruises to walking, biking, and more. The nonprofit offers 5,500 educational tours in all fifty states and 150 countries.

From America’s National Parks to Bar Harbor Music Festival in Bar Harbor, Maine, to the Galapagaos or Machu Picchu, Road Scholar has an adventure ready. Elder Treks, the world’s first adventure travel company designed exclusively for people fifty and over, is another resource worth investigating.

Senior Volunteer Travel

Volunteer vacations, sometimes called “voluntours” or “service learning tours,” offer the opportunity to give something back while traveling, whatever your skills or interests. Ken Budd’s article in AARP Magazine (2010) offers a thorough overview of this kind of travel.

He advises that those considering such a trip should ask themselves three important questions:

1. What kind of work do you want to do?

2. Where do you want to do it?

3. How long do you want to stay?

Carefully consider all aspects of your trip before you decide, and be clear about just how adventurous you want to be and what kind of experience you want to have.

Special Needs Travel

For travelers with physical disabilities or health issues, the tour operator can advise as to whether or not a particular tour is appropriate or whether the hotels they use are appropriate. Again, depending on the circumstances, a customized trip might be a better option. 

Travel agencies can help make arrangements for accessible travel. Look for websites that have the ADA (Americans With Disabilities Act) symbol or talk about accessible travel. Special Needs at Sea has a list of travel professionals who are Certified Special Needs Advocates.

Preplanning and researching destinations and attractions suitable for the individual will also ensure the success of any trip. Should medical equipment or special arrangements be necessary, they can be handled by a travel professional months prior to the trip. Special Needs at Sea is one of the preferred companies travel professionals use, as they are dedicated to offering services such as sand wheel chairs, oxygen services, transport chairs, and so on.

Travel Insurance

Traveling is an investment, and it is advised to purchase travel insurance to protect that investment. Some of the coverages include lost luggage, flight delays, missed flights, medical expenses, and trip interruptions. The amount of coverage varies and the premium can vary depending on the company. Some premiums are based on age and some on trip amount.

Airlines offer travel insurance for flights, but if a trip includes a cruise, tour, or excursions, the airline doesn’t offer total coverage. Insurance to cover everything is available through Travel Guard, www.travelguard.com, or Travel Insured at www.travelinsured.com. Many travel professionals have access to travel insurance as well.

One important thing to know about travel insurance is that replacement of lost items are paid for by the traveler, who then files a claim with the insurance company for reimbursement. Health insurance from one country is not accepted in another, including Medicare. Travel insurance offers medical benefits, for various coverage amounts. If medical assistance is needed, the claims department should be called and they will help find a doctor or medical facility. They can even arrange for transportation if necessary. They will work with the medical facility on payment.

Making Travel Arrangements

Finding companies that offer travel options is plentiful and overwhelming. There are things to consider when choosing a company for your trip. Make sure they are reputable. Just because they have a web presence and you can talk to them on the phone, doesn’t mean the company isn’t based in Canada or another country operating under foreign regulations. The best place to start is with referrals from friends and family. The services of a reputable travel professional can offer advice on companies or tours of interest, suggest alternatives that might be more favorable, help with flights, travel insurance, and be the personal liaison for the entire trip.

Don’t forget about websites for various tourism boards that offer information on a given city, region, or country.

The most important thing to do for any trip is research, research, research. Then enjoy every minute. After all, travel is good for us. It gives us new perspectives and challenges, and gets us out of our comfort zones. Whether the trip is short or long, at home or abroad, professionals can help their clients set sail. •CSA

Sharon Sloane is the owner of Continuum Travel Agency, LLC, in Greenwood Village, Colorado. She is a Certified Special Needs Advocate specializing in accessible travel. Contact her at sharon@continuumtravelagency.com, 303-771-3044, or visit www.continuumtravelagency.com.

The Joys of Travel was featured in CSA Journal 63.

Blog posting provided by Society of Certified Senior Advisors.

Thursday, September 10, 2015

How to Share Photos Online

When we were young, we would collect our photos in a scrapbook, but today, we take digital pictures and share them online. For many, the first choice is Facebook, but numerous other websites are available where you can edit photos, set up a system to store and organize them and create online scrapbooks.    

When we were young, we would collect our photos in a scrapbook and sit down with friends and family to show them pictures from our family vacations. Today, we take digital photos, and when we want to share pictures of a family wedding, our trip to Yellowstone or the newest grandchild, we share them online. For many, the first choice is Facebook, but numerous other websites are available, some dedicated only to editing, storing and organizing photos. You can even create online scrapbooks. Some sites allow the ability to order prints.

Most photo storage sites offer trial periods and are free for a limited amount of storage. It’s a good idea to try several to see what is best for your needs. Some focus on the editing aspect, others on easily sharing photos and others on ease of navigating. Some popular options include:

Flickr. One of the original photo websites, this option is still popular for picture storage. From Yahoo, Flickr has a large community of photographers with whom to interact and groups for just about any interest. You have the option to make your photos public or private. Using mobile apps and from any device, you can upload, edit and browse photos from your friends and groups. There are many ways to organize photos, such as chronologically or by subject. However, recent design changes have made it more confusing to navigate the site.

With a free Yahoo account, Flickr offers free storage up to 1 terabyte (TB), enough for 500,000 photos, with a 200 megabyte (MB) size limit for each photo. This service comes with advertisements, but you can skip the ads by paying $6 per month. You may also purchase more storage.

Google Photos. If you want, Google Photos will do all the work for you. Not only will it automatically edit your photo, the site will also put together panoramas. On mobile apps, it will routinely upload photos from your phone or tablet. Using its “Stories” feature, Google Photos automatically organizes your photos from trips or other notable events into an album, which places photos on a timeline and includes maps. The site can turn your shots into animated “movies.” You can also manually create and edit albums. You decide how public or private to make your photos. One of the disadvantages for more serious photographers is that Google compresses photos larger than 16 megapixels and videos with a higher resolution than 180p.

With a free Google account, you get 15GB of space for free, and pay for extra storage, either $1.99 per month for 100GB or $9.99 per month for 1TB.

Amazon Prime Photos. If you have an Amazon Prime subscription ($99 annually), you get unlimited photo storage and space for up to 5GB of video or non-photo images, such as documents. The site is simpler than other photo-sharing sites. Amazon organizes your pictures into albums by default and shares photos in an email, through Facebook or on your computer or device, or you can organize them yourself. You can use apps for PC, iOS, Android and Kindle Fire to upload and view your photos, or you can do so on Amazon's website. If you don’t have a Prime subscription, the Unlimited Photos plan costs $12 per year, with a three-month free trial.

Photobucket. This popular site offers unlimited photo and video storage (with file size limits), album organization, Facebook integration and mobile apps. It offers basic editing tools, such as red-eye removal, sharpening and cropping, plus filters, frames and stickers.

One of Photobucket’s strengths is the many ways to share photos with others: You can create albums where friends can contribute photos, videos and text of their own, and you can post pictures to Facebook, Twitter and Google+. Photobucket’s large community of users can post pictures to a public photo feed, with comments, so you can reach beyond your family and friends. Photobucket automatically creates URLs for sharing and embedding your photos.

Photobucket is free for up to 2GB of storage, with an extra 8GB if you use the Photobucket mobile apps for iOS and Android. For 20GB, it’s $2.99 per month.

ThisLife by Shutterfly. If you want the ability to turn your photos into books and other photo gifts, this is a good site, because it’s connected to Shutterfly, a popular photo printing service. ThisLife will collect your pictures scattered throughout the Internet, including Facebook, Picasa and Flickr, and organize them by date and place. You can further organize pictures by category and people tags, or create “Story” galleries that you can share through email. However, ThisLife doesn't offer any editing tools, other than cropping. One feature is a joint account, where two people can upload photos, keeping a constantly updated collection. Photo storage is free and unlimited, but if you want to upload videos too, you'll need to pay.

Apple iCloud Photo Library. Apple’s photo storage communicates with an iPhone and Mac computer. This program is mainly for organizing and sharing photos and is not meant for editing. You can organize photos and videos by date, time and location. You can also create albums, including shared albums, where multiple people, such as friends or travel companions, can share photos in one space. 

iCloud gives you just 5GB of storage for free, but you can get more storage for a monthly fee. Costs start at $1 per month for 20GB.
Other Options

If all you are looking for is a site just to share photos with others, without any editing or organizing tools, you can use cloud-sharing sites that will also serve as a backup for your photos (as well as other types of files). These include Google Drive, Dropbox and OneDrive.

For roughly $10 monthly, these sites generally supply generous storage space, provide unlimited file sizes, let you download photos to any device and offer sharing options and public links, so that you can share photos with friends and family.

If you’re a serious photographer and want to connect with others who love photography, check out 500px and Smugmug. When compared to other photo-sharing websites, these sites offer more design choices for displaying your work.

500px is free for 20 uploads a week. Plans start at $2.08 per month and allow unlimited uploads and the ability to organize photos into sets.

Smugmug also gives photographers control over licensing, download options, watermarking and more. The site always uploads photos and videos at full resolution. Unlike other photo-sharing sites, there are no free options except for a two-week trial period. Plans range from $40 to $300.


“Flickr, Google Photos, Photobucket and more: Which photo storage service is right for you?” June 10, 2015, CNET 

“The Best Photo Sharing Sites,” Aug. 11, 2014, Techlicious 

“Five Best Image Hosting Web Sites,” Jan. 18, 2015, Lifehacker

“All-time greatest album,” The Verge

How to Share Photos Online was featured in the August Senior Spirit Newsletter.

Blog posting provided by Society of Certified Senior Advisors.

Tuesday, September 8, 2015

Retired? Part-Time Work May Be Just the Ticket

For many retirees, working part-time is the best of both worlds because it brings in some income while allowing time for leisure activities. The good news is that there are plenty of options out there—from working at retail stores to being a tour guide to driving around others. 

For many retirees, working part-time is the best of both worlds because it brings in some income while allowing time for leisure activities. Plus, having a job keeps you involved in the world, which research on aging has shown keeps you sharp and happy.

Surveys indicate that many Americans plan on working in retirement, for financial reasons and to stay active. The good news is that there are plenty of options out there—from working at retail stores to being a tour guide to driving around others.

A Range of Part-Time Jobs

Some jobs require professional education, while others use life skills. Pay varies according to skill level.

Senior-Friendly Retail Employers
Here are some of the best retail employers who are hiring seniors (from Employment Spot):
  • Home Depot
  • Borders Group
  • CVS/pharmacy
  • Walgreens
  • Staples
  • Target
  • Walmart
  • Verizon Wireless
  • AT&T Wireless
Bookkeeping. For those who like to work with numbers, bookkeeping can be a good part-time job because many small businesses can’t afford a full-time bookkeeper. In most cases, you’ll need to be a certified public accountant. Similarly, accountants are highly sought-after, and tasks may include preparing financial reports, processing payroll checks, invoicing and tracking down delinquent accounts. Many bookkeeping and accounting jobs can be done at home, although some places require your physical presence. 

Child care. Many busy parents need someone to help out with their children, whether driving them to and from school, taking them to swimming and music lessons, picking up groceries for the kids’ dinner or watching the youngsters until the parents get home from work. Seniors’ maturity is a bonus for parents looking for someone responsible.

Consulting. Using the skills and knowledge you’ve gathered from your work life, you can hire yourself out as a consultant, working as little or much as you like and from your own home. You can find jobs through companies you’ve worked for or use contacts from past business relationships. Alternatively, many companies need people to come in on a project basis or are looking for freelancers to fill gaps in their staff.

Customer service. Because older workers tend to be more polite and easygoing than younger ones, companies have good reasons to hire them for “help desk” jobs that require diplomatic public interaction. These jobs often can be done by phone and at home.

E-business. The Internet offers many possibilities for part-time work, especially for those who can create their own business. Can you offer a product (books or records, for example) or service (at-home exercises, cooking lessons, travel guidance)? Also, you can make money as a broker for those who want to sell items on Craigslist or eBay.

Driver. There are many job possibilities for people who are willing to drive others around, including drivers for special event limos, shuttle services (such as at an airport) and school and tour buses. Uber, the ride-sharing service, hires drivers who use their own cars to ferry clients around, and you can work as much or as little as you want. Generally, the only requirement for driver jobs is a clean driving record.

Government. Many federal agencies have seasonal and part-time work; plus, the federal government forbids age discrimination. (To start, go to www.usajobs.gov.) Three federal agencies in particular—the IRS, the U.S. Small Business Administration's Disaster Assistance office and the Peace Corps—have been receptive to workers over the age of 50, although these may not necessarily be part-time jobs.

In addition, the federal government has two programs aimed specifically at those 55 and over. The Environmental Protection Agency’s Senior Environmental Employment Program and the U.S. Department of Agriculture’s Agriculture Conservation Experienced Services Program are run through a cooperative agreement with a handful of national aging groups including the National Older Worker Career Center. The two federal programs provide the career center with available jobs (either full or part-time), and the center posts the job and screens candidates.

You can also check out jobs in state, county and city governments.

Handyperson. In an age where fewer people know how to make small repairs, a good handyperson is invaluable, especially helping older people who may not have full use of their arms or legs. This job allows you to work as much or as little as you want.

Instructor. Many organizations need teachers for enrichment (noncredit) classes such as yoga, swimming, painting or cooking. Contact your local arts center or parks and recreation office, or start your own class, using your skills. Tutoring is another option for instructional part-time work. Demand is high for adult literacy teachers working with students from different countries who are learning English as a second language (ESL). Please note that some states require ESL teachers to have an ESL certificate.

Medical records. Health information technology jobs are expected to grow 22 percent between 2012 and 2022, according to the U.S. Bureau of Labor Statistics. This is a much faster growth rate than the average for all occupations. Candidates need computer proficiency, word processing skills and some knowledge of diagnostic procedure lingo and medical abbreviation. You should be comfortable working with electronic health records systems. Employers range from doctors' offices to hospitals.

Nonprofits. Although the pay may not be as good as in the business world, many nonprofits offer more flexible schedules and part-time work, and welcome seniors who are enthusiastic about the organization’s mission. Nonprofit jobs can be fulfilling, especially if the organization supports a cause you believe in. Because of the lower pay, there is less competition for the job.

Personal assistant. Similar to child care, many busy professionals can use help with all kinds of tasks, including running errands, walking the dog, organizing the house or preparing meals.

Retail. Many retail businesses offer part-time work and a flexible schedule, ideal for seniors who want time to play golf or babysit the grandkids. For those who are social, retail work is an easy way to interact with people. Retail jobs include cashier, greeter, stock room associate or even management positions. Consider what you excel at and enjoy. For example, if you are a seamstress, look for a job at a fabric store. If you love the outdoors, seek out stores that sell hiking or camping equipment. Check out local stores, especially ones you already patronize, or look for a major retailer. For some of most senior-friendly employers, see the sidebar.

Keep in mind that employers need to increase their staff during certain seasons such as holidays, gardening season and back-to-school.

Teacher's aide. If you’re interested in working with children, this job provides plenty of interaction and can be done on a part-time basis. Responsibilities can include grading papers, setting up equipment, entering data into the computer or providing one-on-one tutoring. Teacher’s aide positions may require education beyond high school or on-the-job training. For more information, visit the websites of the American Federation of Teachers and the National Education Association.

Seasonal Jobs

You may also want to consider temporary seasonal positions. These jobs, which last only a few months, such as garden centers, are good for those who like to travel.

Tax preparation. Tax-related positions are ideal for those willing to work hard from January through April. You can create your own business or apply with big accounting firms or tax preparation businesses, such as H&R Block, looking for extra help. Some of these companies provide tax preparation classes free of charge if you work with the company during the tax season.

Tour guide. This seasonal job is often in the warmer months, and tour jobs may include showing tourists around historical monuments or local sight-seeing attractions. This is a good opportunity for those who want to share stories about where they live, especially with people coming from elsewhere, and enjoy the challenge of making the information interesting and lively. You can also devise your own business if you’re familiar with the landmarks where you live, such as a walking tour of the historic downtown or a visit to the city’s well-known music spots.

Sports. Another seasonal opportunity is working for sports teams, whether football in the winter or baseball in the summer. These jobs include ushering, selling hot dogs or handling tickets. Similarly, many local teams, such as high school programs or youth and amateur leagues, need coaches, referees, umpires or scorekeepers. It’s a chance to enjoy your favorite sport while working with young people.

Convention Center. Because conventions are temporary, convention centers in major cities offer part-time jobs, good for those who want occasional employment. Jobs include positions as a nurse, parking lot attendant or cashier, set-up worker/cleaner, usher or information booth attendant. There are also often food service opportunities, such as line cooks or servers.


“5 Part-Time Jobs for Retirees,” updated April 2014, AARP

“7 great jobs for golden oldies,” Bankrate.com

“8 Great Part-Time Jobs for Retirees,” June 12, 2013, U.S. News & World Report

“Part-Time Jobs for Seniors,” Employment Spot

“Part-Time Jobs for Workers 50+,” Oct. 13, 2014, AARP

“Federal Agency Jobs Just for People 55+,” May 15, 2015, Next Avenue

Retired? Part-Time Work May Be Just the Ticket was featured in the July Senior Spirit Newsletter.

Blog posting provided by Society of Certified Senior Advisors.