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Wednesday, June 25, 2014

The Durable General Power of Attorney: Friend or Frenemy?

Many people may not know that banks and other financial institutions in many
states can refuse to accept powers of attorney that were executed more than
three to five years prior to the date they are presented for use. CSAs should
be aware of this issue in order to protect their clients.

Understanding what a general power of attorney is and does can be complicated. In
Colorado, a general power of attorney, commonly known as a financial power of attorney
or power of attorney for property, is a document granting authority to a named agent, known as an Attorney-in-Fact, to act on behalf of the person creating the power of attorney. The person creating the power of attorney is the “Principal.”

A general power of attorney is valid until the Principal is declared incapacitated, unless the general power of attorney is durable. In contrast to the general power of attorney, a durable general power of attorney, which designates the same authority as a general power of attorney, will remain valid upon the Principal’s subsequent incapacity. That is, if a Principal is diagnosed with dementia, the Attorney-in-Fact may still act on the Principal’s behalf with a durable general power of attorney, whereas the Attorney-in-Fact’s authority would cease with only a general power of attorney. 

By executing this document, the Principal designates authority to the Attorney-in-Fact. Such authority commonly includes the power to manage and access bank accounts and investment accounts, access safe deposit boxes, as well as to buy or sell property, make gifts, and to financially care for and support the Principal and any dependents. This document is useful in a variety of situations, such as when the Principal is out of state or out of the country, is bedridden or hospitalized, is incapacitated, or is simply unavailable to attend to the matter at issue. When one of these situations arises, the Attorney-in-Fact can act for the Principal to resolve the matter without the Principal’s involvement. This article will specifically address issues concerning incapacity and the use of a power of attorney at banks and financial institutions.

A Case Study: Amanda and Tyler Smith

Amanda, age sixty-eight, and Tyler, age seventy-two, are a financially responsible  married couple living in Colorado. In addition to their joint accounts, each of them maintains individual checking and savings accounts, as well as retirement accounts. In 2006, Amanda and Tyler went to their estate planning attorney and each executed a Last Will and Testament and a Durable General Power of Attorney, appointing each other as their designated Attorney-in-Fact.

In February 2013, Tyler received a diagnosis that he was in the late stages of dementia. In order to pay for everyday living expenses and in-home care for Tyler, Amanda needs to access the funds in Tyler’s individual accounts. Since Amanda is named as Tyler’s power of attorney, she brought the document to Tyler’s bank and requested a withdrawal of the account funds.

Why did this happen, and how could it have been avoided?

In our case study, Amanda and Tyler executed a durable general power of attorney. Since the power of attorney that Tyler executed is durable, the document remains valid in spite of his dementia and authorizes Amanda to continue to act on his behalf. Now, how is it that the bank refused to accept the durable general power of attorney that was properly executed, had not been revoked, and clearly named Amanda as the Attorney-in-Fact? 

Although a power of attorney may be plainly valid, local and national banks and financial institutions have refused to accept powers of attorney that were executed more than three to five years prior to the date they are presented for use. How can they refuse to accept a valid legal document? This is a question that continues to be argued by estate planning attorneys and the legal departments of financial institutions. Since this issue has occurred with national companies, it is possible that it could, or does, occur in your state. Therefore, it is important for estate and financial planners in states outside Colorado to understand their state laws and how to best protect their clients. In Colorado, the law specifically states that a person (in this case the financial representatives) may not require an additional or different form of power of attorney for authority granted in the power of attorney presented. By refusing to acknowledge valid powers of attorney, these banks and financial institutions are violating statutory law. 

What should be done now?

While a mentally competent person may execute a document affirming or re-affirming an older, existing power of attorney or sign the new power of attorney provided by the financial institution, those dealing with Alzheimer’s, dementia, or similar diagnoses are unable to affirm or sign a power of attorney. Only a person who is considered mentally competent may execute a general power of attorney or a durable general power of attorney. If the individual is competent and signs the institution’s power of attorney, this may entirely invalidate any previously executed powers of attorney and leave the Attorney-in-Fact powerless to act on behalf of the Principal. In light of these obstacles, if a bank, financial institution, or other company continues to refuse to honor a valid durable general power of attorney or a general power of attorney, it is highly likely that judicial recourse will be necessary. 

First, the Attorney-in-Fact may pursue a court order mandating acceptance of the power of attorney. Unfortunately, while this can provide relief and enforce compliance, the court process can be quite timely, extending for several weeks, months, or potentially even in excess of a year! By that time, Amanda and Tyler could become impoverished and unable to meet their daily needs. The Colorado statutes provide that a company will be liable for the Attorney-in-Fact’s legal fees and costs if the court makes an order in the Attorney-in-Fact’s favor. However, such payment is not typically recouped until the end of the court process, and there is the possibility of further delay in the collections process.

Alternatively, the Attorney-in-Fact may petition a court to appoint a conservator for the Principal. A conservator is appointed by the court to administer a person’s property. In our case, Amanda would be required to petition the court to be appointed as Tyler’s conservator. Once Amanda completes the requisite background checks and completes the court documents, a hearing will be held to determine whether a conservator is necessary and whether Amanda is entitled to serve as conservator. Then, once she is appointed,
she will be required to file annual reports with the court regarding her actions and Tyler’s financial state. While this alternative is effective, an additional time commitment is imposed on the conservator due to the court’s continuous oversight.

How can this be avoided?

To avoid a legal battle, Amanda and Tyler should have considered a revocable living trust. A revocable living trust is a trust created by the Grantor during the Grantor’s lifetime. The trustee of the trust is responsible for managing the trust assets. The Grantor may fund the trust with all of the Grantor’s property and assets, or the Grantor can choose only certain assets. Typically, the Grantor is the initial trustee of the trust, and a successor trustee(s) is named to serve in the event of the Grantor’s incapacity. The successor trustee(s) may begin to manage the trust assets immediately upon the Grantor’s incapacity, without being appointed by the court (assuming terms to the contrary are not drafted in the trust agreement). A power of attorney would only be necessary for assets that are not transferred to the trust, if any.

Amanda and Tyler could have executed revocable living trusts nominating each other as co-trustee and/or successor trustee of each trust. Upon Tyler’s incapacity, Amanda would then continue to serve as trustee and manage the assets in Tyler’s trust without the need for court intervention or a power of attorney, and thus significantly reducing the risk that Amanda would be denied access to Tyler’s accounts. 

A durable general power of attorney is a useful document for managing the Principal’s property and affairs, but in certain situations it may not be sufficient to avoid costly and time-consuming complications. Attorneys continue to assert Colorado’s statutory authority when these issues arise, but unfortunately these matters are not always resolved without court intervention. Until we begin to see some reform within the legal departments of such financial institutions, estate planning attorneys should be aware of this issue in order to advise and protect their older clients. •CSA

The author, Kirsten N. Jacobs, is a licensed attorney in the state of Colorado and practices estate planning, estate and trust administration, and elder law at The Law Center P.C. in Denver. She is an active member of the Colorado Bar Association and its Trust and Estate Section. She graduated from Syracuse University College of Law where she concentrated her studies in estate planning and gerontology, and served as an editor of the Journal of International Law and Commerce. She can be contacted

The Durable General Power of Attorney: Friend or Frenemy? was published in the Spring 2014 edition of the CSA Journal.

Blog posting provided by Society of Certified Senior Advisors

Monday, June 23, 2014

Finding an Apartment the Second Time Around

Seniors are opting to rent apartments for many reasons, including freedom from a big house, yard and upkeep, which can be expensive. Those looking for a rental for the first time since their youth will find a vastly different challenge. Looking on the internet might be the first step.  

Older adults have many reasons for wanting to rent rather than stay in their houses:
  • Free up home equity that can be invested to generate interest and/or dividend income
  • Eliminate the need for and cost of home and garden maintenance
  • Travel without the worry of taking care of property
  • Need to divide the equity after a divorce
  • Financial inability to continue to pay a mortgage
  • Desire to move near friends and relatives
Older women, particularly, are renting. Not only do they comprise a larger percentage of the 65-plus population, but many have lower retirement income, especially those who outlive husbands or are divorced.

Seniors who rented apartments when they were young may remember thumbing through the want ads in the local newspaper and calling the landlord (on landline phones, of course). If the place was available, you checked it out in person and talked to the landlady, who decided on the spot if she trusted you and then asked for the first and last month’s rent.

Today, seniors will find an entirely new process. Instead of the newspaper, they can go online to Craigslist or another online source, such as When they find an apartment of interest, they’ll visit with references already in hand and maybe even a copy of their credit report.

Another issue that older adults may not have experienced their first time around is a tight-rental market (“Rental Market Analysis: A Tight Forecast,” June 13, 2013, More people across the country are opting to rent for various reasons—from foreclosed homes to young people delaying their first home purchase. This is pushing up the demand for rentals and raising rent costs.

Because competition is intense, experts advise acting quickly on any new listings, being prepared to make a fast decision and having your checkbook and references ready.

Looking for a Place 

Making a list of what’s most important to you will help you stay focused when looking at multiple apartments.

First, determine what neighborhood is most desirable, so you can streamline the process and visit several places at once. Do you prefer older and more established neighborhoods, the ones with tree-lined streets, or a recently developed neighborhood with newer and larger apartment complexes? Do you want to live close to public transportation and be able to walk everywhere? Do you want to live near trails and other recreational outlets?
How important is safety? High-rise complexes can provide more security, while smaller apartments in older neighborhoods may be less safe but can provide more interaction with different types and ages of people. (See sidebar for other factors that older adults might want to consider.)

Second, figure out how much space you require. How many bathrooms do you need? Do you want a guest bedroom? Do you need a lot of storage space?

Not every apartment accepts pets, so make sure to ask up front. Many properties will only allow certain types of pets and may specify breeds and weight limits.

It doesn’t hurt to drive through or walk by the area you’re interested in and look for “for rent” signs. In a tight market, use all your resources, including your network of contacts and friends to spread the word that you’re looking for a place. 

Checking Out the Apartment 

Many places offer virtual views online, but it’s always best to see for yourself. Beyond ensuring that what you see is what you’re going to get, you can check out the neighbors (discreetly) and the area. For example, you may notice that neighbors blast loud music or there is significant traffic noise. Experts advise checking out apartments at night as well as during the day (especially if natural light is important to you) because neighborhoods can become different places when the sun goes down.

Look at the public spaces in the apartment complex, such as hallways and lobbies. Are they clean? Are there any strange smells that might make you think the place is not being cared for properly?

Inside the apartment, make sure the stove, refrigerator and other appliances work. You might want to even check out the water flow in sinks and the shower, and flush the toilet. Check under the sinks for signs of mold and critters. Look inside closets: Is the storage space enough?

If security is a concern, check the locks on the front door to make sure they work and ensure the lighting in the hallways and parking areas is ample. If the apartment has security gates and doors, make sure they function properly.

Easily compare different places by creating a checklist that includes information about storage space, security concerns and so forth. To aid your memory, snap a picture of each property.

In your initial conversation with the landlord, ask what the monthly rent includes and if there are any additional fees you should be aware of. What may have looked like a bargain at first may not hold true if utilities are not included and you end up paying for electricity, water and garbage pick-up. Inquire about other “extras” such as parking fees, and check if there are perks such as free public transportation, on-site health club memberships or discounts to local gyms. Other amenities could include window treatments, customizable cable hook-ups or Wi-Fi in the building. 

Getting the Documents in Order 

Before you sign the lease, property owners will generally ask for a security deposit and the first and last month’s rent. In addition, they may request an application fee, a broker or finder’s fee, references and/or a credit check. Be prepared.

For your protection, before signing the lease, find out (and, if necessary, include in the lease) if your security deposit is refundable; your options if you decide to move out before the lease is up; and how much notice the landlord must give before notifying you that your lease won’t be renewed. If the property owner has agreed to make certain repairs (a new refrigerator or repainting the walls, for example), make sure you get it in writing, especially if that’s a condition for you moving in.

Although much of the language in a lease is standard, read your agreement entirely so you know what’s expected of you and the landlord.

Before moving in, take photographs to document any pre-existing issues to avoid having part of your security deposit withheld for damages. That way when you leave, you can prove that the scratches on the door were made by the previous renter’s dog or that the nail holes in the wall were put there by someone else. 

“5 Tips for Senior Apartment Living” How Stuff Works 
“6 Tips For Renting An Apartment,” 
“10 Things You Should Do Before Signing a Lease,” July 18, 2013 The Shared Wall 
“11 Apartment Hunting Tips for Renters” Houzz 
“Seniors Only Apartments” Senior Resource

Finding an Apartment the Second Time Around was featured in the February 2014 Senior Spirit newsletter.

Blog posting provided by Society of Certified Senior Advisors 

Friday, June 20, 2014

Agencies Strive to Keep Seniors Independent

One of the advantages of aging is that the government—local, state and federal—has devoted resources to making sure seniors are taken care of, particularly in maintaining their independence. Perhaps you have questions about the financial impact of your spouse’s nursing home stay or where you can find respite care as a full-time caregiver. We list the main resources. 

For older adults who need assistance, the government has your back. If your spouse goes into assisted living, how will that affect your finances? If you’ve broken your leg and can’t drive to the doctor, where can you find easy transportation? If you’re taking care of your spouse full-time, where can you find some relief?

One of the advantages of aging is that the government—local, state and federal—has devoted resources to making sure seniors are taken care of, particularly in maintaining their independence.

The 1965 Older Americans Act established a network that includes 56 state agencies and 629 Area Agencies on Aging (AAA) across the nation. Their role is to identify the most important service needs of the age-60-and-older population, develop plans of action to address those needs and serve as advocates for older Americans. State agencies and county or regional AAAs tailor themselves to fit the needs and resources of the community, so each is different.

Free or low-cost services can include legal assistance, home-delivered meals, insurance counselors and help with household chores. The goal of these agencies is to maintain independence for older adults. “Nearly sixty percent of AAAs currently have a program to divert [older adults] from institutional care, and of those, nearly seventy percent facilitate transitions from institutional placement to living in the home and integrated with the community” (“Area Agencies on Aging: Recent Trends,” Autumn 2013, CSA Journal 56.)

Although some services are restricted to low-income seniors, many strive to serve as many older adults as possible, and are mandated to serve the most vulnerable regardless of an individual’s income.

Sample of Assistance Resources 

A wide range of government assistance programs are generally available to eligible seniors. Here are a few from the Elder Care Directory  

Long-term care ombudsman: The office of the ombudsman has the responsibility and authority to investigate and resolve complaints from seniors and their family members regarding the quality of care in long-term care facilities, including nursing homes, assisted living facilities, board and care homes and specialty care facilities such as dementia day-care programs. The ombudsman's office can also assist seniors and their family members in their dealings with other government agencies, to ensure that elderly patients and residents receive all of the medical, rehabilitation, legal, financial and social services to which they are entitled by law. 

Free meals: Eligible seniors can receive free nutritious meals, which are professionally prepared and served daily in congregate settings such as senior and community centers. Most communities also have programs, such as Meals on Wheels, that offer seniors the option to have meals delivered to them every day in their own homes. 

Nutrition counseling: To help older adults make healthy meal choices, many local agencies for the aging offer seniors and caregivers nutrition counseling services as well as advice and recommendations for the most nutritious food when dealing with various illnesses. 

Caregiver assistance services: Most states have caregiver respite programs that provide family caregivers with temporary relief from their caregiving responsibilities. Through the respite program, caregivers can arrange to have a substitute come in to their home and provide care to their elderly family member, or the elderly care recipient could receive temporary care in an alternative residential care setting, such as a nearby adult care home. 

Legal aid: Qualified attorneys answer seniors' legal questions, provide legal advice and advocacy, prepare and review legal documents and represent seniors in legal proceedings. A non-government source for legal questions is the National Academy of Elder Law Attorney. When seeking advice, it is advisable to find an attorney who specifically practices in elder law, as well as one in your state, as many legal documents and asset preservation strategies are state specific. 

State Health Insurance Assistance Program (SHIP): Trained insurance counselors can provide accurate and objective information and guidance regarding public and private health insurance options available for the elderly in their states. This information can include Medicare and Medicaid benefits, Medicare Advantage and Supplement Plans and state-sponsored prescription assistance programs for the elderly. 

Senior companion programs: Seniors can interact socially with a volunteer, usually another senior citizen. Volunteers may also take out seniors for recreational activities or help with light chores around the home. 

Chore and homemaker assistance: Seniors can apply through their local AAA to receive help with routine household chores such as shopping, laundry, general housecleaning, meal preparation and yard work. 

Transportation service: In most communities, seniors can call their local office for the aging to arrange transportation to and from medical appointments, shopping centers and other locations as needed to manage their personal affairs. Seniors who use a wheelchair or have other mobility impairments should call well in advance of their scheduled appointment to ensure the availability of handicapped-accessible vehicles. 

Home repair and modification assistance: Various types of financial aid, ranging from grants that do not have to be repaid, to low-interest loans, are available to eligible seniors who need help paying for necessary home repairs or who need to make handicapped-accessible modifications to their home.

Heating and energy assistance: The federal government makes funds available to states to help low-income seniors pay for a portion of their winter heating and summer cooling costs. Although this is a federal program, it is supervised at the state level and usually administered at the county or local level. The income limit for receiving energy assistance varies based on state median income, federal poverty level and family size.

Agencies Strive to Keep Seniors Independent was featured in the May 2014 Senior Spirit newsletter.  

Blog posting provided by Society of Certified Senior Advisors 

Tuesday, June 17, 2014

Virtual Retirement Villages: Supporting Aging in Community

Older adults searching for meaningful lifestyles as they retire are finding a
sense of community and belonging in the rapidly growing Village movement.

What do you do with a generation of social innovators who marched for civil rights, stood up for equal rights for women, defended our country in multiple wars and conflicts, and developed the entire technological infrastructure on which we communicate as a world today? The answer: Find a new movement. The Village movement sweeping the nation for the last ten years has become a place where baby boomers can influence social norm and create a vision for aging in community. The Village to Village Network is a national peer-to-peer network supporting communities and leaders to innovate the Village models in their community to support older adults to remain in the community as they age.

Dorothy Weinstein is a good example of how the Village can help. For sixty years, she ran a boarding house for medical students in Boston. Understandably, as she got older, it became more difficult for her to do the work on her own. At age one hundred, Dorothy finally decided she needed help making beds and cooking for the students. Her son, who worried for her health and safety, thought that it might be time for her to move to a retirement community. But for Dorothy, it would never be time to move. 

Dorothy’s story might be unique in that she was able to run an in-home business—and a labor-intensive one at that—for so many years, but her spirit and will to live independently is nothing if not normal. In fact, according to a variety of market research data, older adults today overwhelmingly prefer to age in place and are increasingly seeking options that allow them to continue to live in their own homes and communities (MetLife Mature Market Institute 2010).

Consequently, many older adults purposefully seek out supportive communities reminiscent of a time when neighbors were a significant part of each other’s lives and provided a helping hand with no expectation of reciprocation. Today, the experience of aging could be viewed as a constellation—one that is multi-dimensional and interrelated as a result of recent health care policy trends and the realization that the “one size” approach to service delivery does not fit all.

Older adults—especially baby boomers who have experienced their own parents’ aging—are searching for meaningful lifestyles as they retire and alternatives to nursing homes, assisted living, or continuing-care retirement communities, which are increasingly perceived as lacking a sense of community. It’s been proven that aging in a community-based setting improves the quality of one’s life and health (Kaye et al. 2009). In response, new models are beginning to emerge to support aging in the community that provide “one-stop shopping” through a single point of entry. Over the past ten years, one of the innovative models to emerge is the Village model, which creates a wide array of support services and facilitates social connections so that older adults can enjoy a rich, independent, and healthy quality of life.

The Village Model

When Dorothy Weinstein realized she needed help, she contacted Beacon Hill Village, a community-based membership organization in Boston that empowers older adults to remain active and engaged in their communities as they age. She told the Village staff how she was having trouble navigating the stairs at home. It’s understandable why her son thought she should move to a retirement community, but Dorothy hoped there was another way.

There was. The Beacon Hill Village was able to coordinate neighborhood volunteers to provide Dorothy with companionship, light cleaning for the boarders, rides, home care services, and delivered meals and groceries—including pizza on some Fridays. On days Dorothy felt well, she joined lunch groups and lectures organized by the Village. This support meant that Dorothy was able to age in her own home, still actively engaged in the world around her. “At age one hundred-and-two, my mom died in her own bed, in her own home, with her family at her side,” said Dorothy’s son. “If it weren’t for the Village, this might never have happened.”

At the heart of the Village model is the focus on the individual as the core of the community. In this model, older adults are active members in the service delivery process and provide essential assistance in the planning and implementation of a wide range of programming offered. Villages offer members a network of resources, services, programs, and activities that revolve around social, cultural, and educational programs; ongoing health and wellness activities; a trusted referral source for local businesses; and member-to-member volunteer support.

Built on cooperative principles, Villages facilitate access to community support services and connection to ongoing civic engagement. Most Villages are nonprofit organizations governed by their members. Since the first Village, Beacon Hill Village in Boston, opened in 2002, one hundred and twenty Villages have opened across the country, providing full-service programs to nearly thirty thousand older adults. Membership levels range from 100-800 people, with an average membership of two hundred. Currently, at least one hundred and twenty communities are in the development phase, which could result in an implementation of at least seventy-five new Villages within the next two years (Greenfield et al. 2012).

Villages share the following hallmark principles: 
  • They are self-governing, self-supporting, grassroots membership-based organizations.
  • They consolidate and coordinate services to members.
  • They create innovative strategic partnerships that leverage existing community resources and do not duplicate existing services.
  • They are holistic, person-centered, and consumer-driven. 
  • They promote volunteerism, civic engagement, and intergenerational connections.
Furthermore, Villages focus on expanding choice and access to their members. They create social networks within the community, and provide assistance to secure long-term services and supports. Villages currently derive their revenue from member fees, corporate and foundation investment, and individual donations. Without reliance on public funds, Villages are able to work with their members to create a system of supports that can adapt to their needs based on level of care, financial circumstances, informal care network, and preference of the member.

Research shows that the most damaging threat to well-being in later life is not fear of absolute destitution or poor health, but loss of life purpose and boredom (Moody, undated). Villages address directly what recent research has documented as health-related problems caused by social isolation, including depression, increased risk of morbidity, mortality, cardiovascular disease, dementia, and Alzheimer’s disease (Holt-Lunstad 2010). Real-life social networks decrease isolation, the likelihood of institutionalization, and mortality, and increase longevity. The Villages’ emphasis on volunteering provides not only manpower for Village programs, but more importantly, provides an organized way to engage members in their community and improve their morale by making a difference in their lives. Villages provide a model for aging in the community with a keen focus on four core tenants. 

1. Villages keep people healthier. In a recent survey, 40 percent of Village members report feeling healthier than they used to. Forty percent of members are more likely get access to the medical care they need through their Village membership, and 45 percent agree they have an easier time taking care of themselves and their homes since joining the Village. Forty percent of members think health services are most important to supporting aging in community (Scharlach and Graham 2013). Villages offer a variety of services and supports that provide access to transportation, care transition support, and offer activities that enhance health and wellness such as exercise classes, yoga, and tai chi. 

2. Villages help people retain a higher quality of life. They build and provide an outlet to social networks within the community. Villages help people retain a higher quality of life (QOL) with 52 percent of members in agreement that their QOL has improved; 34 percent of Village members report feeling happier than they used to, and 40 percent leave their home more often to engage with peers (Scharlach and Graham 2013). 

3. Villages allow people to remain financially in control. The same survey found that 75 percent agree they are more likely to age in their homes because of their Village membership, and 47 percent are less worried about preserving their wealth and finances, which mitigates one fear—becoming destitute or “spending down” assets in order to access public long-term care supports (Scharlach and Graham 2013). Villages provide members with the tools they need for long-term life planning and access to a preferred provider network that coordinates group purchasing benefits. This allows them access to critical discounted services (e.g. home health care, home maintenance, transportation). Villages mobilize volunteers within the community to offer a helping hand and access
to free services as part of the membership, thus providing cost savings to members. 

4. Villages keep older adults civically engaged. Members report feeling more connected to their communities and less lonely because of Village services and activities offered through membership. Thirty-six percent agree they use community services more often as a result of more access and awareness through Village membership. Not only is this a benefit to members, but communities are able to rely upon this volunteer labor force as a resource and reduce reliance on existing public services. Fifty-three percent of members also volunteer back to their village providing an informed, active group of civically engaged members who are providing the “manpower” behind the local Village (Scharlach and Graham 2013). This “neighbor helping neighbor” focus provides opportunities for intergenerational connections, further strengthening the demographic fabric of the community. Additionally, Villages provide encore career and leadership opportunities for older adults to give back and remain valued and relevant in the community.

Recent changes to public health policies through the Affordable Care Act have highlighted the value of comprehensive, person-centered care plans that combine health interventions with social supports, leading to better health outcomes and efficiencies in local health and aging service systems. Additionally, implementation of readmission penalties and an increased focus on wellness and prevention through this new policy provides a greater opportunity for solutions to connect health and medical community. This has created a new space for innovative models, like the Village model, to support cost effective and person-centered delivery systems that build upon the best assets and resources the community has to offer.

Villages are poised to provide a new systems coordination model to integrate innovative solutions and services to link both medical and social supports. Research has shown that integrating services to address social factors can reduce health care use and costs and improve patient outcomes (Shier et al. 2013). Villages are mindful not to replicate or replace services and supports that already exist in the community, thus providing many opportunities to build strong local and regional partnerships. Each local Village crafts its member services and programs based upon the community’s unique needs. 

The Village movement is growing but not every community has an active Village. The Village to Village Network is the national hub for the Village movement. This membership-based organization provides a platform for shared knowledge exchange, innovative discovery, and research on health and social impacts of the Village model. For more information on how to connect with or start a Village in your community, visit the Village to Village Network at or call 617-299-9638. CSA

The author, Candace Baldwin, is Director of Strategy for Aging in Community for NCB Capital Impact and the Village to Village Network, LLC. She is on the board of the National Family Caregiver Association, and is certified as an Economic Development Finance Professional by the National Development Council. She can be contacted at 

Virtual Retirement Villages: Supporting Aging in Community was recently published in the Spring 2014 edition of the CSA Journal. 
Blog posting provided by Society of Certified Senior Advisors

Friday, June 13, 2014

Living Within Your Means—and Assets

Living on your retirement savings can be a constant balancing act: between maintaining your standard of living and making sure you don’t outlive your savings. How do you know if you’re withdrawing too much from your financial portfolio and threatening your ability to enjoy life as you age? Or maybe you’re taking out too little, refraining from the kind of activities you desire, such as traveling, only to end up with more than adequate assets when you die. There are no easy answers to this dilemma, although retirement experts offer a few suggestions.

The 4 Percent Rule

Under this formula, retirees add up their retirement savings, such as 401(k)s and IRAs, and then withdraw 4 percent of the portfolio’s overall value in the first year of retirement. The next year, the retiree takes out another 4 percent plus the rate of inflation, and so on. Although it’s called the 4 percent rule, the typical withdrawal range is between 4 and 5 percent.

A similar method is to base withdrawals on the value of the financial market. One expert found that withdrawing at a rate around 5.5 percent when markets are strong and reducing the withdrawal amounts when times are tough is a better standard than withdrawing at a fixed rate.

Annuities offer another simple way to withdraw retirement funds because you’re promised the same income payments for life. However, most annuities aren’t inflation adjusted, which means your payments won’t keep up with inflation. Plus, if you die early, you may forfeit any money left in the annuity. One other drawback to an annuity is that your money is tied up in investments, preventing access to emergency cash.

Newer Models

Another fixed approach is to base your retirement withdrawals on your life expectancy. The Social Security Administration provides tables that give averages. Of course, you need to keep in mind your health and your genetic disposition toward life-threatening diseases such as cancer.

In its simplest form, to figure out how much you could withdraw each year, divide your savings/investments by your remaining years. For example, if your life expectancy is 20 more years, you could withdraw one-twentieth every year. However, if your assets keep growing, you might have more left than you planned, and that money may have been better used when you were younger and more active.

Market Watch advocates a slightly different approach. The “Safety First Withdrawal Idea” focuses first on what you need to maintain your standard of living during retirement and then matches your financial resources to your required expenses. The basic idea is to use conservative investments to preserve your standard of living, such as U.S. Treasury Inflation Protected Securities (TIPS), lifetime annuities from blue-chip issuers and federally insured savings accounts. Social Security is a key part of this type of safety-first portfolio, because the retirement benefits are guaranteed and predictable. Once you’ve created an income plan from your conservative investments, you can invest your remaining money in riskier funds. If you get good returns, you can spend that money on more frivolous purchases.

More Flexible Approaches

J.P. Morgan Asset Management recommends a more flexible approach to retirement withdrawal strategies. Rather than sticking to one formula, the asset manager suggests reacting to changes in wealth, age and income streams by periodically adjusting withdrawal rates and portfolio asset allocations (Investment News). For example, as a retiree gets older or has maintained her assets, she could raise her withdrawal rates.

To figure out the ideal withdrawal rates for each age, J.P. Morgan’s model weighs five factors: the individual’s preference for timing and amount of withdrawals, lifetime income, current age and life expectancy, the predictability of the market and extreme events, and the retiree’s need to spend the money.

The website Can I Retire Yet recommends a withdrawal system that sells in response to your own “routine income” needs rather than in response to market events.” The “total return approach” or “active safe withdrawals” concept means selling some of your most appreciated assets once or twice a year, when the money is needed.

“This is where asset allocation comes into play,” writes Darrow Kirkpatrick. “For me, it makes no sense to live off your conservative cash and bond buckets when stock markets are up. That’s like dipping into the storehouse when there is fresh, healthy grain available in the fields. Much better to be selling volatile equity assets when they are in favor, and to preserve your safe ‘buckets’ for the bad times.

“When those bad times come, as they inevitably will, then the flexible withdrawal approach begins dipping into the safe cash and bond buckets that have been set aside.” He says new research suggests that it may be better to spend bonds first, which goes against traditional advice, producing a rising equity allocation for the long term. In fact, continuing low interest rates mean retirees are no longer depending on bonds, as they once were. dubs a similar approach in “lifestyle-driven investing.” Erin Botsford, a financial planner in Frisco, Tex., and author of The Big Retirement Risk, urges clients to divide their expenses into four categories: needs, wants, likes and wishes.

Then she recommends relying on “lifestyle investments”—those that produce income, either now or in the future, and are safe, predictable or guaranteed—to cover basic needs. “Food and shelter take a higher priority than vacations and luxury cars,” she says. “Shouldn’t your investment plan reflect this reality?”

If your current savings aren’t enough to support your projected retirement lifestyle, you may have to forgo some of your wants, likes or wishes, or be willing to save more or work longer to afford them, she says.

In the end, most of us will borrow bits of different withdrawal systems to create what works best for us and adjust our retirement plans and withdrawals according to our own set of circumstances—whether it’s poor or good health, still-dependent adult children or the urgent need to live in a warm climate.

Calculators and Simulations

You can plug your figures into various retirement withdrawal calculators and simulations. Here are a few:

Vanguard’s tool determines how much you can withdraw each month based on how much you’ve saved, your asset allocation (whether conservative, moderate or aggressive), how long you expect to spend in retirement and which withdrawal method you plan to use.

Once you plug in those figures and answers, its interactive tool shows how much money you could have withdrawn from your portfolio during the time the returns were calculated, using the dollar-adjusted withdrawal method. In general, Vanguard suggests making withdrawals at rates no greater than 3 percent to 5 percent at the outset of your retirement, depending on your withdrawal method.

E*Trade Easy Retirement Calculator asks for your expected age of retirement, how much you’ll get in Social Security, your assets (savings and investments), your investment status (conservative to aggressive) and an estimate of how much you’ll have when you retire. After you input your retirement monthly expenses (mortgage, healthcare, home expenses, etc.), the tool produces a retirement plan comparing how much you’ll need versus how much you’ll have.

Monte Carlo Retirement Calculator factors in market volatility, running random iterations, so you can see your chances of meeting your goal. To determine your goal, provide your desired annual withdrawal amount and the number of years you want the account to last. The outcome, which is slightly different each time you perform the exercise, shows your chances of failure and success.


“4% withdrawal rate in retirement unrealistic in real world, researchers say,” February 2014 Investment News
“Easy Retirement Calculator,” E-Trade
“Monte Carlo Retirement Calculator,” Money Chimp
“New Strategies to Ease Into a Secure Retirement,” March 2012
“Retirement Withdrawal Strategies,” December 2013 Can I Retire Yet
“The ‘Safety First’ Guide To Retirement Withdrawals,” September 2013, Forbes Next Avenue

Living Within Your Means—and Assets was featured in the May 2014 Senior Spirit newsletter. 

Blog posting provided by Society of Certified Senior Advisors 

Wednesday, June 11, 2014

Networking: Business Benefits, Partnerships, and Best Practices

The importance and power of networking can’t be overstated.
Organizations, businesses, and individuals must continually
develop new connections and relationships to succeed.

Most of those connected with the aging industry have heard that networking and
partnerships are critical to long-term success. Although this concept appears to be
pretty straightforward and obvious, many of us question the value of these activities. How do we “network and partner” to ensure we reap the rewards? Our resources and time are precious. How do we keep from wasting human capital and money as we build relationships to build our business? 

Having been in the aging industry for quite a while, I have had the opportunity to build relationships in many different settings. Through memberships in professional associations and networking groups; enrollment in civic organizations; presenting at national, state and local conferences; participation on non-profit boards; and community volunteering, I
have found connections that have helped me to fulfill my business goals while helping others strengthen their organizations. What is the trick to successful networking? Why
take networking to the next level through the development of partnerships? This article will help you to clarify methods, benefits, and best practices.

Definition of Networking defines networking as “Creating a group of acquaintances and associates and keeping it active through regular communication for mutual benefit. Networking is based on the question, ‘How can I help?’ and not ‘What can I get?’” What defines a successful networking situation? Successful networkers use terms like mutual benefit, give and take, reciprocity, helping others, and being willing to give to receive. Note that all of these approaches focus on service before self. Successful networking requires that you put your personal needs on the back burner, take the time to build trust and relationships, and be friendly and approachable.

On February 23, 1905, Paul Harris, a small-town Vermonter who moved his practice to Chicago, founded the world’s first civic group to build networking opportunities—Rotary. Now an international success story, thirty-three thousand Rotary clubs are still based on Harris’ founding principle, “Service before Self.”

Ivan Misner, Ph.D, founder of Business Network International (BNI), reveals two important things:

1. Networking is an essential professional skill and practice.
2. Putting others first is powerful.

Dr. Misner states, “A good networker has two ears and one mouth and should use them appropriately. When you meet someone in a networking environment, you should listen more than you talk.” In other words, be patient. It may take some time before your business benefits from your networking efforts, but you will find that time is well invested (Blasingame 2011).

Methods for Networking
Sharon Michaels, author of the membership site,, has developed five key networking tips (Michaels 2013).  

1. Understand your target market. Do your research and attend networking functions where you can connect directly with your market. 

2.Know exactly what you bring to the networking table. Ask yourself, “Why would people want to network with me?” What do you have to offer? 

3. What is your networking goal? Have a realistic understanding of how networking fits into your overall business plan. 

4. Networking rule of thumb: Give value to receive value. Build solid trust relationships. 

5. Follow up promptly to develop and maintain win-win relationships. Get to know, like, and trust one another.

The aging industry has a variety of network groups across the country. Many communities have provider network groups who have monthly luncheons to bring aging businesses together, providing a chance to educate, network, and build relationships. Organizations such as the Gerontological Society of America (GSA) have local chapters that bring providers together for continuing education opportunities and monthly meetings. The Geriatric Social Work Initiative ( references state and international network groups for emerging professionals in aging such as, The Chicago BRIDGE: Emerging Professionals in the Field of Aging, EmergingAgingNYC, Boston Bridge, Eldercare Professionals of Ohio, GenPhilly (Generation Appreciation Philadelphia), and others.

As you determine how to approach networking nationally and locally, consider the following:
• Attend meetings and events of your professional associations
• Present at your professional associations conferences
• Join an advisory or governing board
• Join an online network, such as LinkedIn
• Get to know the colleagues in your business
• Invite colleagues to lunch or coffee
• Work on cross-functional or cross-industry teams
• Attend training classes and programs
• Volunteer to work on projects where your specific expertise is needed
• Volunteer at charities, nonprofits, fundraisers 

The CSA Leaders Network—A New Networking Opportunity
In March 2013, the Society of Certified Senior Advisors® supported the development of a pilot chapter program in Denver, Colorado, called the CSA Leaders Network, Denver Chapter, made up of Denver-area CSAs who have united for the purpose of building a strong network. Its goals include developing valuable strategic partnerships, furthering members’ education, and working together to inform and educate the public about the CSA Difference. The CSA difference is what makes CSAs exceptional due to their knowledge and experience, compared to someone in the same industry who is not a CSA. 

The CSA Leaders Network—Denver provides presentations and education programs, as well as outreach to the Denver Metro area older-adult communities through volunteering with older adults, and for causes such as fighting against fraud and abuse. In addition, it works with SCSA to assist the organization in its mission to inform professionals who work with older adults about the importance of educating themselves about health, social and financial issues.

The foundation of a network of CSAs is that all individuals have studied the same body of knowledge and passed the exam, are background checked and hold the CSA credential in good standing. This is a network of resources valuable to the CSA in their business and ultimately for their clients. How many networks can state that all members are background checked? The CSA Leaders Network will be a valuable asset for all older adult consumers. 

Best Practice: Six Rules for Networking
In his book, Collaboration: How Leaders Avoid the Traps, Create Unity, and Reap Big Results (2009), Morten Hansen, a management professor at the University of California, Berkeley, clarifies the Six Rules for Networking within an organization. Although these six network rules apply to networking within an organization, they offer valuable lessons that can be applied to external networking—especially when you are running a small business. Hansen’s philosophy is to “build nimble networks which embrace individuals who can work in a collaborative way.” 

1. Build outward, not inward. Your network is stronger if you connect with professionals outside of your own organization. 

2. Build a diverse network, not just a large network. Include people with different expertise and additional know-how. Add contacts who can attack challenges from a different perspective. 

3. Networking is a case where weak ties are surprisingly better than strong ties. You are better placed if you know lots of people you contact infrequently than if you have just a few close friends you know well and talk with all the time. Weak ties are good because they form bridges to resources you don’t often access.  

4. Work hard to develop bridges. Bridges are people who are uniquely positioned to help others find what they want based on the strength of their personal networks. 

5. Always try and swarm the target. When you meet someone to make a proposal, inform them of all the influencers you know and network with. Invoke common links and use these links to persuade. 

6. Know when it’s time to switch to your strong ties. When working on something complex, sooner or later you have to stop dealing with superficial matters and get down to the details. Deal with the people who can help you accomplish your goals and get the details done.

Taking Networking to the Next Step: Public Private Partnerships
More communities and organizations across the country are realizing the benefits of partnering together in order to meet the needs of the growing aging population. In McKinsey and Company’s December 2009 report, “Public-Private Partnerships,” they state that public-private partnerships are “gaining momentum,” and collaborative efforts between public, private, and civil sectors often accomplish far more than any can do alone. The very mixture of differing approaches and expertise is the added value that these partnerships bring, making them far more than just the sum of their parts.

Leading business professionals in the aging industry are taking networking to the next step by providing their expertise to help communities, including other aging service providers, build and enhance their services. These efforts are improving the quality of life for older adults, helping them to remain active, independent, and connected to their communities. Public-private partnerships, often called PPPs, can be powerful vehicles to help companies create and capture opportunities for their core business. They can help boost demand for a company’s products and services, provide a mechanism for joint investment and risk-sharing to create new markets, products or services.

It has become clear that developing successful public private partnerships requires commitment and persistence. For example, in 2005 The SAGE Institute—a nonprofit research organization advancing aging service best practices nationally—developed and facilitated partnerships among ten “aging service network teams” with four hundred aging-focused businesses from all forty-five counties across South Carolina. These teams included elder attorneys, financial planners, geriatric physicians, nurses, home health providers, government-supported aging service providers (Area Agency on Aging directors and senior center directors), geriatric care managers, nursing home administrators, CCRC Directors, hospital administrators, professors, transportation administrators and small business owners. Participants worked together to identify weaknesses and gaps in aging services and work to eliminate those gaps through partnering to create new services and replicate best practices.

As facilitator and objective third party, the SAGE Institute was able to help this mix of for-profits, nonprofits, healthcare, and government successfully accomplish their goals. What an enlightening experience it was to help all participants work together, learn each other’s languages and develop new aging services based on each other’s strengths! As a result, new cross-sector programs were developed and communities across South Carolina benefited. These programs include senior transportation (now provides seniors with over ten thousand rides a year in Charleston, South Carolina); two community-case management programs (care transition programs) were developed among hospitals, geriatric care managers, and non-profits; community-wide aging planning commissions were born, and additional successes emerged.

A key rationale for creating PPPs is the recognition that many challenges do not fall neatly into either public, civil, or private sectors, but require joint efforts from all sectors. For example, if making an effort to promote economic development, communities often are more likely to succeed when including the public and private sectors. The most effective PPPs understand that part of their strategy must be to explain to companies the benefits of greater involvement, and to create an environment to engage their private sector partners more deeply. PPPs are not a one-size-fits-all solution (McKinsey & Company 2009).

Successful PPPs depend on the people involved and require strong executive/project leadership, strong communication channels, clear planning, and defined processes. The following table lists the “Principles of Public and Private Sector Collaboration” as defined in a 2006 brief from the National Association of State Chief Information Officers (NASCIO). Although some of these methods are “technology specific,” aging businesses and partnerships can learn from these suggestions on addressing the differences among the public and private sectors. 

To Network or Not to Network 
So, where do you as an advisor and aging product/service provider stand on this issue? You must decide if you have the time, resources, commitment, and know-how to move in this direction. Ask yourself the following questions:
 • How will my business benefit from forming partnerships or strategic alliances?
 • How do I identify and screen potential partners?
 • How do I develop and maintain trust with those whom I collaborate?

As you consider the answers to these questions, remember that the Golden Rule of networking is “Don’t keep score. Build Opportunities.” • CSA

Erika T. Walker, MBA, MSeD, CSA, is owner and CEO of SAGE WAVE Consulting, LLC, in Gainesville, Georgia. She conducts strategic planning with businesses and communities across the country, helping them to prepare for the growing aging population. With over twenty-five years of experience, she has served as Director of the SAGE Institute and Director of Geriatrics at Greenville Hospital System. She may be contacted at 678-971-4778,, or at  

Networking: Business Benefits, Partnerships, and Best Practices was recently published in the Spring 2014 edition of the CSA Journal. 
Blog posting provided by Society of Certified Senior Advisors

Monday, June 9, 2014

Dental Health and Aging: The Connection to Overall Health

Researchers are discovering that a healthy mouth is associated with more than just looking and feeling good - it can have a significant impact on our overall health. 

A hundred years ago people wouldn’t have expected to live well into their seventies, eighties, and nineties, much less with most of their natural teeth intact. Today, however, people are living longer and thanks to advances in dentistry, they are also retaining more teeth. Researchers are discovering that a healthy mouth is associated with more than just looking or feeling good—it can have a significant impact on our overall health. Poor dental hygiene can cause mouth pain, swelling, and fever, and it has even been linked to malnutrition and dehydration in older adults. Perhaps most surprising is the link between oral health and serious medical conditions such as heart disease. As we age, dental issues become more common, and make routine dental care even more important.

Mouth Issues Increase as We Age 

People are reaching old age with more of their natural teeth intact than those of previous generations. This is due to advancements in dentistry including anesthesia, public health campaigns, and a change in the cultural valuation of a healthy mouth (Kiyak and Reichmuth 2005). Despite these advances, older adults are still more at risk for periodontal (gum) disease, tooth loss, the use of dentures, and xerostomia—dry mouth (American Dental Association 2013). Among adults age sixty-five and over, about 65 percent have moderate to severe periodontal disease, 43 percent have lost six or more teeth, and a little over 18 percent have lost all of their teeth (Centers for Disease Control NOHSS; Eke et al. 2012). Seniors are also at a higher risk of developing xerostomia, in part due to their higher use of prescriptions drugs, which can cause the condition (Ettinger 1992). Dry mouth is associated with sore throat, hoarse voice, trouble swallowing, and even tooth loss. 

The risk of developing diabetes, Alzheimer’s disease, or dementia increases with age and those with these conditions tend to have poorer oral health. Diabetics— and especially those who are not properly managing the disease—are more likely to have periodontal disease (Soskolne and Klinger 2001). Alzheimer’s disease or dementia can put individuals at a greater risk of mouth issues if the decline in mental functioning inhibits or prevents proper oral hygiene or access to dental care. 

The Effects of Oral Health on Other Medical Conditions 

Heart disease is the leading cause of death for persons aged sixty-five and over (Centers for Disease Control 2013). Researchers have found links between periodontal disease, heart disease, and stroke. The number one cause of heart attack and stroke is atherosclerosis, or hardening of the arteries due to plaque buildup. The plaque that builds up in the arteries is different than the plaque that builds up on teeth, so researchers were puzzled when they found the association between heart attack, stroke, and the frequency of dental cleanings. The current hypothesis is that the inflammation caused by gum disease bacteria leads to inflammation in other parts of the body, including the blood cells in the arteries, thus leading to an increased risk of a blood clot (Beck et al. 2005; Pussinen et al. 2004). Researchers are also investigating the proteins produced by gum disease as a possible cause of artery hardening. These proteins might eventually end up in the bloodstream and latch onto existing plaques, making them even larger (Paoletti et al. 2004; Scannapieco et al. 2003).

Older adults who are in hospitals or nursing homes are at risk of developing pneumonia. Poor oral health has been linked to respiratory infections including pneumonia. The mouth harbors billions of bacteria, and when pneumonia-causing bacteria like Staphylococcus aureus are left unchecked, they can lead to infection. Proper dental care has been shown to decrease the number of organisms in the mouth that cause pneumonia (Adachi et al. 2007). Diabetes is a risk factor for developing mouth problems because the disease makes it more difficult to fight infections like the ones that cause periodontal disease. This relationship is fairly well established. However, researchers are beginning to explore the relationship in the opposite direction (American Diabetes Association 2013). For example, studies are examining the link between gum disease and the onset or aggravation of diabetes and the relationship between gum disease and hyperglycemia (high blood sugar). Some small, sample-size studies have found insulin resistance in those individuals with periodontal disease (Kuo et al. 2008).

Barriers to Oral Care

The American Dental Association (ADA) recommends the following to maintain a healthy mouth:
  • proper nutrition
  • brushing twice a day with fluoride toothpaste
  • flossing at least once a day
  • regularly replacing toothbrushes
  • regular dentist visits

However, there are some significant barriers that seniors face in adhering to the ADA’s recommendations. 

Perhaps the most important barrier is the acceptance of poor oral health as a normal product of aging. Studies have demonstrated that despite having mouth issues (and dental insurance in many cases), many older people will not seek dental care because of a general acceptance of their condition as a fact of life (Kiyak 1987; Abrams, Ayers, and Lloyd 1992).

Paying for routine dental exams, or for more extensive dental services like root canals or dentures, can be difficult for seniors. Medicare does not cover dental care, except under very rare circumstances. Medicaid dental coverage varies by state with some states providing no coverage at all while most others provide only emergency dental care. According to Oral Health America’s “State of Decay” report (2013), only 30 percent of older adults have dental insurance.

Living in a long-term care setting can make it difficult for older adults to obtain needed dental care. Although licensed nursing homes are federally required to provide access to dental care, many seniors in institutionalized settings are not receiving it. Assisted living facilities may be required to provide dental care by the state in which they operate. Staff in long-term care settings has little to no oral health training and few dentists are willing to provide care in these situations. Staff are usually focused on health-related tasks other than dental care. 

When nursing staff does provide dental care, it is often not sufficient. For example, the use of lemon glycerin swabs in place of brushing and flossing is a common practice despite the fact that they are so acidic they can destroy tooth enamel. Another popular replacement for brushing is foam swabs, but these, too, are not good replacements because they don’t control plaque (Coleman 2002). Another issue in long-term care settings includes declines in the ability to perform activities of daily living. For example, declines in mental functioning might make it difficult to remember to brush and floss, or to physically complete the tasks without assistance. Those with dementia might become confused, and in turn become combative when staff try to assist them in oral care.

Oral Health Improvement

How can advisors help seniors improve their oral health? The first is to promote the idea that older age does not have to equal poor dental health. Adhering to a regular mouth care routine including regular dentist visits can help to maintain oral health, regardless of age. For those who are diabetic, maintaining proper insulin levels is key to avoiding dental complications. Another strategy would be to encourage seniors to buy dental insurance since Medicare and Medicaid won’t pay for it. This website can be used to locate dentists in your state, financing options, transportation and more:

Finally, the long-term care industry should adopt policies and procedures that will promote clients’ oral health. Certified nursing assistants should receive additional training on how to provide routine dental care and be able to spot oral health problems. Dental care should be included in staff members’ daily routine. For residents with dementia, caregivers can ease the confusion and resistance to routine care by holding the toothbrush with the resident, placing their hand over the resident’s hand, distracting the resident by playing music or watching television, and so on (see Chalmers, 2000 for more techniques).

Oral health can have a profound effect not just on how we feel about ourselves, but our general health too. People are now reaching older ages with better mouth health than ever before, a trend that will hopefully continue. • Lori Moore, Ph.D.

Lori Moore, Ph.D., is a Research Associate at Florida State University’s Claude Pepper Center. Her research interests include healthy aging and long-term care settings. She has published in peer-reviewed journals and presented her research at several academic conferences. She can be reached at 

Dental Health and Aging: The Connection to Overall Health was recently published in the Spring 2014 edition of the CSA Journal
Blog posting provided by Society of Certified Senior Advisors