Choosing a Long-Term Care Residence

Ask These Questions When Choosing a Long-Term Care Residence

Making the decision to move from independent or assisted living into a long-term care residence is usually never easy. But asking the questions below can help you sort through the available choices and select the best long-term care residence for your situation.

You can find long-term care residences in your zip code area on Medicare’s website, rated for quality. A five-star quality rating system gives an overall picture of individual residences and points out meaningful differences among them: www.medicare.gov/nursinghomecompare/search.html.

If possible, visit residences and meet their staffs. In your conversations, be sure to cover these questions:

 

Facility Certification

• Is the residence Medicare-approved (certified)?

 

Staff Credentials

• Is the nursing home administrator licensed by the state?


• Does the staff possess the necessary credentials to qualify for their professions?


• Is licensed staff on duty, including an RN for all shifts?


• Which level of staff is available to deal with social service needs?


• Is a licensed physician on duty during the day and on call at night?

 

Availability

• Are beds currently available? If not, how long is the waiting list?


• Is there a memory unit for those with dementia, as well as a unit for those who depend on a ventilator?

 

Location

• Is the residence close enough for family and friends to visit?


• What are the visiting hours?

 

Quality of Care

• Is a quality of care report available?


• How are any deficiencies being addressed?


• Are the residents clean, well-groomed, and appropriately dressed?


• Is the facility clean and free of overwhelming or unpleasant odors?

 

Atmosphere

• Are there enough appropriate activities?


• Is the temperature comfortable?


• Are furnishings comfortable, homelike, and safe for residents and visitors?


• Are nutritious snacks available throughout the day?


• Is water readily available at all times?

 

Staffing

• Does the residence conduct background checks (including criminal checks) on all staff at the time of hire?


• Does the residence provide ongoing education and training for staff on topics such as recognizing elder abuse, fall prevention, and other age-appropriate topics?


• How does the relationship between staff and residents appear: warm, polite, and respectful?


• What is the staffing ratio of CNAs to residents?

 

Provided Services

• Does the residence provide rehabilitative services, including physical, occupational, and speech therapies?


• Does the residence provide activities that promote healing and quality of life, including music and art therapies?


• Do the residents have a choice in when and what to eat or in their daily routine?


• Does the residence have an arrangement with a nearby hospital in case of emergency?

 

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Sources

Society of Certified Senior Advisors, Working with Older Adults: A Professional’s Guide to Contemporary Issues of Aging (2015).

The Working with Older Adults course offered by the Society of Certified Senior Advisors gives professionals a practical, comprehensive understanding of health, social and financial issues that are important to many older adults, including ethical issues specific to aging. For more information, or to enroll in a class, click here.

Tax Deductions for Home Health Care

Many older adults want to stay in their own homes but cannot do so because of health or other reasons. A home health care agency might be able to help them find an aide to come to their homes for a certain period each day or on some other set schedule.

Who pays the home health care aide determines the tax issues for the older adult. Therefore, when an aide is hired, the method of payment needs to be discussed before the hiring occurs.

Home Health Care Aides as Agency Employees

How the aide is paid might depend on the practice in the older adult’s region of the country. Some home health care agencies pay aides as employees; contracts are then between the agency and clients, who pay the agency directly. The caregiver (the aide) is not part of the payment arrangement. The agency submits a bill to the client and prepares a paycheck for the aide.

This arrangement is the easiest way for an older adult to pay for help, and the agency’s invoices provide proof of the medical expense for tax purposes. The older person does not need to keep paperwork other than the service contract with the home health care agency and payment receipts.

Home Health Care Aides Hired Directly by the Older Adult

In some cases, the home health care agency provides the older adult with a list of possible aides; the older adult then hires an aide and pays the agency a finder’s fee.

In this situation, the relationship between the agency and the older adult usually ends there. The older adult is an independent employer and must pay the aide directly; and pay the employer’s portion of FICA, Social Security, and Medicare taxes; and withhold the employee’s portion of these taxes from the aide’s payments.

In certain cases, depending on the amount paid to the aide, the older adult must also issue a W-2. The older adult must also follow specific rules to deduct the payments to the aide as a medical expense.

The invoices submitted by the health aide must state the charges for various services; not all services are deductible medical expenses. For example, housecleaning, driving to the grocery store or completing errands, or making phone calls for the older person are not deductible medical expenses.

In all cases, remember that home health care expenses that have been reimbursed (for example, by Medicare, Medicaid or long-term care insurance) are not eligible for income tax deductions.

Consult with a qualified tax expert to identify reimbursable health care and medical expenses that you are allowed based on your adjusted gross income (AGI). Certain medical expenses that exceed 7.5 percent of AGI are tax deductible for those 65 or older who itemize through December 31, 2016; then the threshold becomes 10 percent.

 

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Sources

Gordon, Paul. "Special Issue Brief. Medical Expense Tax Deductions: A Guide for Senior Living Providers and Residents," The American Seniors Housing Association (Summer 2012).

Internal Revenue Service. www.irs.gov.

Society of Certified Senior Advisors, Working with Older Adults: A Professional’s Guide to Contemporary Issues of Aging (2015).

"Tax Aide Program," AARP.

"Proposed New Requirements for Tax Return Preparers," Tax Information for Tax Professionals (2010).

TaxBook 1040 Edition (2012). 2012 Tax Year. Minnetonka, MN: Tax Materials Inc.

The Working with Older Adults course offered by the Society of Certified Senior Advisors gives professionals a practical, comprehensive understanding of health, social and financial issues that are important to many older adults, including ethical issues specific to aging. For more information, or to enroll in a class, click here.

New Online Courses from ASA and USC on Elder Mistreatment

The Society of Certified Senior Advisors believes that Certified Senior Advisors, when working with older adults, their families, and caregivers, are uniquely positioned to be the “eyes and ears on the ground” looking for signs of abuse and neglect targeted at older adults. Here is a new course offered to deepen understanding about this very important topic.

New Online Courses

The American Society on Aging has added two more courses to the online series offered in conjunction with USC Leonard Davis School of Gerontology. In addition to the popular Fundamentals in Gerontology and Managing Health and Chronic Conditions in Older Adults courses, you can now take courses in Understanding and Preventing Abuse and Neglect. All courses will be available in early 2017.

Successful participants will earn a certificate of completion from USC and 10 CSA CEUs (per course completion).

Click here for course descriptions and registration information.

For a limited time, ASA is offering a discount on membership to those who sign up for online courses. Enter discount code CSA6 when enrolling and membership will be only $195, a $60 discount off regular rates.

"Retirement" is a Misnomer

Not only are there more adults over age 50 than at any time in history; this new consumer majority is the wealthiest, best educated and has access to quality healthcare. Yet the media, political and social leaders seem determined to focus only on the potential problems of an aging population rather than the incredible potential. Employers likewise ignore the incredible amount of wisdom available by screening out older applicants.

Perhaps it is time to retire the term ‘retirement’ along with other stereotypical terms used to describe older adults and the programs designed to ‘serve’ them. As a concept, retirement hasn’t been around that long. It arrived with the Industrial Revolution as businesses needed a justification for pushing older people aside to make room for younger, “more productive” workers. While much of the work then was hard manual labor, age was a factor in productivity; however, that is hardly the case in today’s automated information age. In fact, age and wisdom should be positive “productivity indicators” in this new millennium.

In the last three decades, we have increasingly viewed the aged as a group to be catered to and cared for. In the 1960s, we began developing programs to feed, house, transport, and entertain them; but few focused on the importance of meaning and significance in later life. In spite of a new army of “aging service providers” and billions of Federal dollars, the older population became more sedentary, health care costs began to rise along with demands for higher levels of government care and support.

Somewhere in the creation of an aging network of service, we failed to recognize that when people loose significance and purpose the immune system erodes and self-fulfilling prophecies of aging can begin taking their toll. Retirement, therefore, is not just an outdated concept; one might argue that it is a contributing factor to the health problems that plague the world’s aging populations. As Hippocrates theorized thousands of years ago – any part of the body that is not used tends to atrophy, even the mind.

According to my good friend Dr. Roger Landry, a respected preventive medicine physician, “… successful aging is not about being safe, preparing for death or avoiding all risk. Successful aging is about living as vital a life as possible, i.e. at the highest level of functioning.” It is time to stop treating aging as some type of disease and start celebrating the positive aspects.

For three decades, government has been creating and funding programs and services to care for the elderly, which The Older Americans Act defined as everyone over the age of 60. Thousands of agencies, programs, services were created and funded to meet both real and perceived needs. Billions of dollars later, many of these well-meaning efforts may have done as much harm as good. We have all too often replaced purpose with pills; productive lives with early retirement packages; personal significance with shallow volunteer opportunities; and meaningful involvement with mindless activities. One might make a case, that “retirement” itself is a root cause of rising healthcare costs, the growing incidence of Alzheimer’s disease, diabetes and depression.

Still there is hope. Organizations such as Civic Ventures launched programs to involve older adults in meaningful roles. The Eden Alternative and founder Bill Thomas’ innovative Greenhouse Project has had some success redefining long term health care through the eyes of consumer and treating the body, mind and the human spirit in the process. But there is still much to do as ageism remains the last bastion of discrimination.

As Roger Landry so eloquently put stated, “Successful agers are not fatalistic about the slings and arrows of aging, but actively intervene to change the course of what was previously considered inevitable. They identify risks and work with available medical knowledge and technology to change the future.” That’s not a bad prescription for how to go about changing the way we design, develop, market and operate “retirement” communities.

Simply stated, the term “retirement” has become a misnomer for what should be a rewarding and life stage. A good start would be to never use “retirement” to define a planned community for older adults if you intend to celebrate individual autonomy and wisdom and committed to making a difference in the lives of those they serve.

- By G. Richard ‘Dick’ Ambrosius

Richard Ambrosius is the President of Positive Aging LLC, a national marketing consulting and training. He has been educating companies, nonprofit organizations and public agencies on how to better communicate with and serve middle age and older adults for 35 years and was among the first in the U.S. to realize the potential of the new consumer majority and specialize in older markets. He has delivered keynote addresses and motivational workshops in 49 states and is the author of the Choices & Changes…a positive aging guide to life planning (Xlibris Publishing, 2006). Ambrosius can be reached by email at ambro@positiveaging.com.

What is Polypharmacy and Why Should We Care?

When I was still a Pharmacy technician, I remember a customer named Mrs. Johnson who had been coming to our pharmacy for as long as I could remember. She was a sweet 75 year old woman and she usually picked up her medications for diabetes, glaucoma, and high blood pressure along with Benadryl for allergies. One day she came in to pick up 2 new prescriptions that she had dropped off the day before, one for Amitriptyline (uses include depression, nerve pain and sleep aid) and one for Clonazepam (uses include anxiety, sleeping). I asked Mrs. Johnson if she recognizes them and she thought for a second, and said she started seeing a new psychiatrist who added them because of her having trouble sleeping. I was in the process of continuing the conversation when the phone started ringing, a customer rang the bell at the drive thru and there were already three other customers behind her so, I handed the prescriptions to her, quickly rang her up and sent her on her way.

As people are living longer, the prevalence of chronic diseases is increasing as is the responsibility of practitioners to appropriately prescribe for and manage multiple disease states within the same patient. The word “poly” is derived from the Greek word meaning “more than one,” and “pharmacy” refers to the Greek word for drug “pharmacon.” Therefore the literal meaning of the word polypharmacy is simply “more than one drug.” However, today polypharmacy is defined anywhere between taking 5 to 10 or more drugs at a time! There is no consensus cut off amount of medications or strict definition for polypharmacy, though generally the term inappropriate polypharmacy can be defined as the use of more medications than are clinically appropriate or medically necessary.

When patients are taking too many medications, especially ones that are not medically necessary, the ramifications can be severe. The burden of taking too many medications has been directly and indirectly associated with significantly increased adverse drug events (ADEs), drug-drug interactions, drug-disease interactions, inappropriate dosing regimens, decreased medication adherence rates, reduced functional capacity, and multiple geriatric syndromes. All of which lead to increased hospitalizations, primary care visits, emergency room visits, and ultimately increased healthcare costs as well as increased medication-related morbidity and mortality.

Polypharmacy can be especially problematic in the elderly population who make up less than 15% of the population yet consume over a third of all prescription medications prescribed each year. The high rate of drug consumption along with the significant physiologic changes that occur with aging put this population at a very high risk for experiencing serious consequences from polypharmacy. According to the US census bureau nearly 1 in 5 U.S. residents is expected to be aged 65 or older by the year 2030. This age group is projected to more than double to over 88.5 million in 2050. The age group of 85 years and older is expected to increase about 4-fold to over 19 million by 2050. As our elderly population grows, the number of elderly patients with concurrent medical conditions who take multiple medications also continues to grow, contributing to the ever-expanding problem of polypharmacy.

Two months later Mrs. Johnson is back at the pharmacy, this time she was dropping off new prescriptions again. Per usual she smiled and asks how my day was going then handed me her prescriptions. They were for Senna (Laxative) and Docusate (Stool Softener) for constipation that she’s been having, which has become very troublesome for her. So we filled her prescriptions and sent her on her way. Next month Mrs. Johnson came back yet again, this time again with 2 new prescriptions, Donepezil for Alzheimer’s disease and eye drops for dry eyes. She says she’s having trouble keeping track of all of her medications and is starting to get very forgetful these days so her doctor put her on another drug that should help her memory. A few weeks later she came back with a new prescription for oxybutynin for some “bladder problems” she’s been having.

At this point Mrs. Johnson has started 7 new medications just in the last few months, so I decided to ask the pharmacist to take a look at her medications. The pharmacist opened her profile, took a look at her medication list and then took Mrs. Johnson to the side to speak with her as I helped the next customer in line. A few minutes later the pharmacist came back and told me she’s going to call Mrs. Johnson’s doctor and make some recommendations for changes. Apparently the medication Amitriptyline she started a couple of months ago commonly causes side effects such as urinary retention, dizziness, constipation, and dry eyes which is why she was prescribed the Senna and Docusate for constipation and the eye drops for her dry eyes. On top of that, taking Amitriptyline, clonazepam, and Benadryl together can lead to increased confusion and put elderly patients at an increased risk for falling which was also likely contributing to her new onset of psychiatric problems leading to the Donepezil being started, which in turn caused overactive bladder issues leading to the oxybutynin being prescribed. Luckily we were able to catch the problem and take her off 7 clinically inappropriate and unnecessary medications before a serious hospitalization or fall occurred. A case could be made that the Pharmacist and or Doctor should have caught this issue earlier but that’s a discussion for another blog topic. Cases like Mrs. Johnson’s are far more common than we may think and really emphasize the importance of correcting polypharmacy.

Increased adverse drug events (ADEs) are one of the most deleterious and extensively studied problems associated with polypharmacy. Up to 35% of outpatients and up to 40% of inpatient elderly patients have been reported to experience an ADE annually in the U.S. On top of that about 10% of emergency room visits have been attributed to an ADE annually. The addition of each new drug to a medication regimen has been found to increase the risk of an ADE. One population based study found that patients taking 5 or more medications had an 88% increased risk of an ADE compared to those taking less than 5 medications. Rates of ADEs in nursing home residents taking 9 or more medications have been found to be twice as high as patients taking fewer medications. A separate study found that older veterans taking more than 5 medications were 4 times as likely to be hospitalized from an ADE.

Another well studied consequence of polypharmacy is drug-drug interactions (DDIs), which lead to increased medication related morbidity and mortality. A cohort study found that a patient taking 5-9 medications had a 50% risk of a DDI, while patients taking 20 or more medications had a 100% risk of DDIs. In a separate cohort study, the prevalence of a potential hepatic cytochrome enzyme-medicated DDI was 80% in older hospitalized adults taking 5 or more medications. A study from the Women’s Health and Aging Study found that the use of 5 or more medications was associated with a reduced ability to perform instrumental activities of daily living (IADLs). A number of studies have also associated polypharmacy with increased falls, cognitive impairment, urinary incontinence, and malnutrition in the elderly. One cohort study found that 50% of patients taking 10 or more medications were malnourished or at risk of malnourishment.

With rapidly rising healthcare costs every effort needs to be made to find solutions to reduce expenditure. The US Center for Medicare and Medicaid Services estimates that polypharmacy alone is responsible for $50 billion in avoidable costs to health plans annually. Adverse Drug Events in the United States were found to cost an estimated $76.6 billion annually in the ambulatory setting alone. These figures make it clear that targeting and correcting polypharmacy stands to save the healthcare system billions of dollars each year.

Many times polypharmacy, or taking multiple medications, can not only be appropriate but be necessary for a patient presenting with multiple medical conditions. For example a patient with heart failure and diabetes is required to be on several medications to slow the progression or reduce the symptoms of disease as well as to improve the quality of life and hopefully prevent complications. However, this is not always the case and many patients often fall victim to the negative consequences of polypharmacy, especially the geriatric population, making it of utmost importance to consistently evaluate a patient’s medication regimen and ensure each patient is on optimal therapy.

Looking back at our case of Mrs. Johnson we see how easy it is for polypharmacy to go unnoticed and potentially cause serious damage to the patient both medically and financially and this is if the customer uses only one pharmacy for their medications. If they use multiple pharmacies to try and save money then this issue can be dramatically compounded. Like I indicated earlier this story was from the time when I was a pharmacy technician, without any real knowledge in healthcare but I was still able to facilitate a discussion that significantly benefited the patient. It doesn’t have to be the doctor or the pharmacist to catch something wrong, anyone that interacts with the patient, even someone without any real training or knowledge in medications can point out something that just doesn’t look right and bring it to the attention of a doctor or a pharmacist to be corrected. Now as a practicing Pharmacist, this experience reminds me how taking a little extra time and effort can make such a big difference to a patient suffering from the consequences of polypharmacy.

There is no easy fix and there are many factors that contribute to polypharmacy including time constraints on health professionals, multiple prescribers, patient-driven prescribing, low health literacy, and frequent transitions in care. Drug-related adverse effects may also not always be apparent in the elderly. Many adverse effects such as increased falls, sedation, confusion, urinary retention, failure to thrive, and decreased nutrition status are all problems that present frequently in the elderly. Failing to recognize some of these effects as drug-related may result in prescribing another medication to alleviate the problem, which may cause other problems for which another drug is prescribed, and the process continues only making matters worse, this is otherwise known as a prescribing cascade, as seen in the case of Mrs. Johnson. On top of prescription medications, the increased usage of OTC and herbal supplements can also significantly contribute to drug-drug interactions and medication related morbidity and mortality. With so many factors in play it is becoming increasingly difficult for practitioners to address the overall needs of patients while ensuring appropriate medication use. It is evident the issue of polypharmacy can be extremely costly to the healthcare system as well as damaging to the individual patient, and strategies need to be developed and implemented to tackle this ever-growing problem.

- Dr. Zeshan Mahmood, PharmD

Dr. Zeshan Mahmood, PharmD, is the Clinical Director of Healthcare Strategy at Pharmacist Partners, a national healthcare service and clinical knowledge organization of pharmacists. He is a practicing pharmacist for Walgreens licensed in Washington DC and Virginia. Zeshan also currently works with NovaScripts Central, a non-profit pharmacy that provides free medications to uninsured patients, on patient education and outreach initiatives.

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Sources

“Clinical Consequences of Polypharmacy in Elderly,” National Institutes of Health.

“A Study on Polypharmacy and Potential Drug-Drug Interactions among Elderly Patients Admitted in Department of Medicine of a Tertiary Care Hospital in Puducherry,” National Institutes of Health.

85-Year-Old Runner Still Breaking Records

Ed Whitlock follows his own regimen, including daily runs through the local cemetery.

Few 85-year-olds can run marathons, but Ed Whitlock not only completes them but sets records. The Canadian recently broke the record for the Toronto Marathon men’s 85-89 age group by more than 30 minutes, running the race in 3 hours and 56 minutes and shattering the previous mark set in 2004. Over the last couple of decades, the retired engineer from Milton, Ontario has achieved a reputation as one of the great masters runners. His accomplishments include running a full marathon at age 73 in 2 hours and 54 minutes and running a marathon at age 80 in 3 hours and 15 minutes.

Whitlock’s running regimen is a far cry from his younger cohorts. He doesn’t listen to music, do ice baths or massages, or use heart rate monitors. When his knees start hurting, he stops running for a while. His running shoes are 15 years old, and his daily 3-hour runs are through the nearby cemetery, mostly because it’s cool in summer.

“I don’t follow what typical coaches say about serious runners,” he told Runner’s World in 2010. “I have not strong objections to any of that, but I’m not sufficiently organized or ambitious to do all the things you’re supposed to do if you’re serious. The more time you spend fiddle-diddling with this and that, the less time there is to run or waste time in other ways.”

He doesn’t seem to particularly enjoy running. It’s the competition that gets him going, although even breaking the record in a Waterloo, Ontario, marathon in April was somewhat disappointing.

“I should have been able to run a bit faster than that,” Whitlock told the Wall Street Journal. “I wasn’t entirely satisfied.”

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Sources

“At 85, Ed Whitlock Breaks Four Hours in the Marathon,” Oct. 17, 2016, Runners World.

“Time Can’t Beat Ed Whitlock: Running’s 85-Year-Old Legend,” May 4, 2016, Wall Street Journal.

Blog posting provided by Society of Certified Senior Advisors
www.csa.us

Famous & 65

Look Who’s Turning 65

Nov. 7—Lawrence O'Donnell

The host of The Last Word with Lawrence O'Donnell, an MSNBC opinion and news program, O’Donnell graduated from Harvard College, where he wrote for the Harvard Lampoon. From 1977 to 1988, O’Donnell worked as a writer, including as the author of Deadly Force, about a case of wrongful death and police brutality in which O'Donnell’s father was the plaintiff’s lawyer. From 1989 to 1995, he was a key legislative aide to Senator Daniel Patrick Moynihan; his work included being staff director of the United States Senate Committee on Environment and Public Works and staff director of the United States Senate Committee on Finance. From 1999 to 2006, he produced and wrote the NBC series The West Wing (and played the role of the president's father in flashbacks). O’Donnell won the 2001 Emmy award for Outstanding Drama Series for The West Wing, and was nominated for the 2006 Emmy for the same category.

In 2002, O’Donnell was supervising producer and writer for the television drama First Monday, and in 2003, he was creator, executive producer and writer for the television drama Mister Sterling. He is also an occasional actor, appearing as a recurring supporting character on the HBO series Big Love, portraying an attorney. Before getting his own show on MSNBC in 2010, he frequently filled in as host of Countdown with Keith Olbermann on MSNBC. O'Donnell has also appeared as a political analyst on The McLaughlin Group and The Al Franken Show.

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Nov. 9—Louis “Lou” Ferrigno

The retired professional bodybuilder is best known for his title role in the CBS television series The Incredible Hulk, for which he vocally reprised the role in subsequent animated and computer-generated incarnations. As a young boy in Brooklyn, Ferrigno suffered a series of ear infections and lost most of his hearing, which caused him to be bullied by peers during his childhood. “I think my hearing loss helped create a determination within me to be all that I can be, and gave me a certain strength of character too,” he later said. Ferrigno started weight training at age 13, and after graduating from high school in 1969, won his first major titles—IFBB Mr. America and IFBB Mr. Universe, four years later. His attempts to beat Arnold Schwarzenegger in the Mr. Olympia competition were the subject of the 1975 documentary Pumping Iron, which made Ferrigno famous.

In 1977, Ferrigno was cast as the Hulk in The Incredible Hulk, with Bill Bixby as Hulk's "normal" alter ego, and continued playing the role until 1981. Later, he and Bixby co-starred in three The Incredible Hulk TV movies. Ferrigno played himself during intermittent guest appearances on the CBS sitcom, The King of Queens, from 2000 to 2007. He made cameo appearances as a security guard in both the 2003 film Hulk and the 2008 film The Incredible Hulk, in which he also voiced the Hulk. Ferrigno appeared as himself in the 2009 feature film comedy I Love You, Man. He trained Michael Jackson on and off since the early 1990s, and in 2009, helped him get into shape for a planned series of concerts in London. Ferrigno has served as a volunteer officer in Los Angeles County; Maricopa County, Ariz.; San Luis Obispo County, Calif.; and Delaware County, Ohio. He has his own line of fitness equipment called Ferrigno Fitness.

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Nov. 15—Beverly Heather D'Angelo

The actress and singer has appeared in over 60 films, although she is best known for her starring role in the National Lampoon's Vacation films (1983–2015). D'Angelo began acting in the theatre in 1976 and made her television debut in the first three episodes of the TV mini-series Captains and the Kings in 1976. After getting a minor role in Annie Hall in 1977, she appeared in a string of hit movies, including Every Which Way But Loose, Hair and Coal Miner's Daughter, the latter earning her a Golden Globe nomination for Best Supporting Actress for her performance as Patsy Cline and a Country Music Association award for Album of the Year. Her biggest break came in 1983 starring with Chevy Chase in National Lampoon's Vacation in the role of Ellen Griswold. She reprised this role in four Vacation sequels and a short film between 1985 and 2015. In the 1980s, she starred in many other major comedy films, and as of the mid-90s acted primarily in independent movies.

In 1994, D'Angelo returned to the stage and won a Theatre World Award for her performance in the Off-Broadway play Simpatico. She received an Emmy Award nomination for her performance in the 1984 TV movie version of A Streetcar Named Desire. She later had main roles in numerous made-for-television dramatic films, including Slow Burn, Judgment Day: The John List Story and Sweet Temptation. In the 2000s, D'Angelo had a recurring role on Law & Order: Special Victims Unit as defense attorney Rebecca Balthus. From 2005–2011, she appeared in the HBO series Entourage playing the role of agent Barbara "Babs" Miller. In 2006, she starred in the independent film Gamers: The Movie.

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Nov. 25—Russell "Bucky" Dent

The Major League Baseball player and manager earned two World Series rings as the starting shortstop for the New York Yankees in 1977 and 1978, and was voted the World Series MVP in 1978. Dent is most famous for his home run in a tie-breaker game against the Boston Red Sox at the end of the 1978 season. The 3-run home run gave the Yankees a 3-2 lead in the 1978 AL East division playoff game against the Boston Red Sox. This was all the more remarkable because Dent was not known as a power hitter. Indeed, the home run was one of only 40 he hit in his entire 12-year career. Further, Dent occupied the ninth spot in the batting order, not generally considered a power slot. The Yankees went on to win the game 5-4, securing the division title in the process. Dent continued his unusually high production by batting .417 in the 1978 World Series, earning Series Most Valuable Player honors, as the Yankees defeated the Los Angeles Dodgers.

A 3-time All-Star, Dent remained the Yankees' shortstop until 1982, when he was traded to the Texas Rangers, but finished his career that season with the Kansas City Royals. After retiring as a player, Dent managed in the Yankees' minor-league system, notably with the Columbus Clippers. He served the Yankees as manager of the big-league club for portions of two seasons, compiling an 18–22 record in 1989 and an 18–31 record in 1990. In 1989, Dent opened a Delray Beach, Fla. baseball school, which featured a miniature version of Fenway Park. Although Dent had his greatest moment as a player at Fenway Park, his worst moment also came at Fenway Park when he was fired as manager of the Yankees. From 1991 to 1994, Dent served on the coaching staff of the St. Louis Cardinals under manager Joe Torre, moving to the coaching staff of the Texas Rangers from 1995 to 2001.

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Source: Wikipedia

FAMOUS & 65 is a featured article in the November 2016 Senior Spirit newsletter.

Blog posting provided by Society of Certified Senior Advisors
www.csa.us

How to Avoid Tech Support Scams

Con artists promise to fix your computer, but instead steal your identity and money by installing malware.

While scams are proliferating in almost every facet of life, the internet is an especially popular platform with con artists who want your money, your identity or both. One of the more common internet scams is fooling people into buying tech support that they don’t need and that will damage their computer with malware, making their personal information easily accessible.

One 65-year-old disabled man reported his experiences to the Federal Trade Commission (FTC):

“I received a cold call from a company claiming to be a division of Microsoft, called the Microsoft Care and Support Corp., claiming that my computer had been hacked...They said my security certificate was going to be revoked if I didn’t upgrade through their engineers and technician, leaving my computer unable to legally operate in the United States... I said how much does this cost? NOTHING. I said OK reluctantly... After half an hour or more of dilly dallying around, I was told I had to fork over $396 for a lifetime certificate or $296 for a 2-year permit to operate with a corrected security certificate. OTHERWISE my computer would be disabled and "blocked" so it cannot ever operate again. He caused my PC to crash and said THIS is how that happens so pay up... Based on his crashing my PC a couple of times before I tried to pay, I am sure my computer is rigged to fail.”

Over the past few years, tech support scam complaints have risen dramatically. The FTC received roughly 30,000 complaints about these in 2015. These scams, which disproportionately affect older adults, come in several different forms.

How It Works

You get a call from someone identifying themselves as part of a well-known computer company, and they inform you that they’ve detected a virus on your computer. If you give them permission to remotely connect with your computer, and pay them with a credit card, you are not only losing money but giving them your credit card information for future use. They will tell you they are installing software that will fix the problem, but they are actually installing malware that will let them access your files and personal information. The caller may also hack into your email account and send out spam emails, thus enlarging their circle of contacts to spam.

These tech support scams also arrive via pop-ups on your computer, telling you that a virus has been detected and you need to take immediate action. In addition, scammers can target you through paid advertisements. For example, if you Google a question such as “how do I fix my browser,” relevant websites will appear at the top of the page. Not all of these paid-advertisement websites are scammers, but many are. Though some may advertise that they can fix your computer for free, halfway through the fix, the scammer may demand money to finish the job.

What to Do

To determine if a pop-up warning is legitimate, close your web browser (Google, Firefox, etc.). If the pop-up disappears, it was fake. If it's still there, make sure it's from the antivirus software (such as Norton) that you subscribe to. If not, then leave it alone.

The FTC also provides advice on how to avoid being scammed:

• Don’t give control of your computer to anyone who calls you offering to “fix” your computer.


• Never give out or confirm your financial or sensitive information to anyone who contacts you.


• Getting pressure to act immediately? That’s a sure sign of a scam. Hang up. If you have concerns, contact your security software company directly. Use contact information you know is right, not what the caller gives you.

You can also complain to the FTC by calling 877-382-4357 or going online at ftc.gov.

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Sources

“What You Need to Know About Tech Support Scams,” Aug. 4, 2016, Next Avenue.

“Official-sounding calls about an email hack,” April 5, 2016, Federal Trade Commission.

“10 Worst Online Scams and How to Avoid Them,” Feb. 12, 2016, Tom’s Guide.

Blog posting provided by Society of Certified Senior Advisors
www.csa.us

Find the Best Deals on Cruises

Before you board, research and planning can help save money on your next vacation. Once onboard, watch out for costly extras.

While cruises might already seem like a bargain, you can save even more money by checking websites that show the best deals or consulting a travel agent. And once onboard, beware of high costs for items like soda and alcohol. Here are tips from cruise experts.

Timing Is Everything

For a long time, the consensus was to either book early or late to get the best deals. Twelve to 18 months before the cruise, companies will lure you with better deals, including more perks. However, if you wait until one to three months before the cruise, the belief was that, if the ship isn’t full, the cruise line would slash prices. However, Cruise Critic says that cruise lines are becoming more aggressive with early offers and are not offering as many slashed prices closer to departure. To get the best deals, this site recommends making a reservation no later than six to eight months before the cruise. If you are set on a certain cruise at a certain time and want the best cabin, it’s always best to reserve early.

At certain times of the year, ships are “repositioned.“ For example, liners may leave Alaska in the early fall for spots on the Caribbean in winter. Repositioning requires an unconventional route not normally in the cruise line’s itinerary, plus often a longer time at sea. Thus cruise companies lower prices to attract travelers and offer different amenities, such as history talks. You might visit places otherwise not on your radar, like stopping in a Russian port on a cruise ship’s repositioning from the U.S. West Coast to Japan.

Experts concur that sailing anytime kids are in school brings better deals, because families make up a large part of cruise lines’ business. One travel agent says you can pay double during peak times, such as spring and summer breaks, and recommends traveling in slower seasons, such as between Thanksgiving and mid-December and right after New Year’s Day or Labor Day. Often, the best prices can be found in the off season or shoulder season, the weeks before or after peak times—May or September in Alaska, for example, when the weather might not be ideal.

One travel expert recommends booking during wave season, between January and March, when cruise lines promote their offers for the coming year. She says travelers can save up to 75 percent plus get extras, like onboard credits. Another tip is to travel on the cruise lines’ smaller ships, which can be cheaper because they don’t offer as many amenities.

Do the Research

Whatever you do, don’t accept the cruise line’s listed price before looking around for better deals. Most travel experts recommend you use a travel agent, because they have relationships with the cruise companies and can often get better rates and last-minute deals, some of them unadvertised.

Agents can steer you toward the best cruises and deals that meet your interests and budget. They can help you wade through the different price structures for various cruise lines. Travel agents can organize group travel, which saves money and can bring extra amenities, such as exclusive shore tours or shuttle service. Using a travel agent can not only save you money but also the time it would take to pore over all the cruise line’s offers and websites reviews.

Check with Websites

There are many websites, including traditional travel sites, such as Expedia and Travelocity, that can help you find the best deals. These might not necessarily be the cheapest, because getting free amenities can add up in savings, so be sure to check what’s included.

The previously mentioned independent website, Cruise Critic, is a subsidiary of TripAdvisor and the world’s largest cruise review site and online community, with 100,000 reviews. You’ll find information here on just about every aspect of cruising. Other popular websites focus on the best deals:

• Cruisesheet tracks 12,000 cruises to find the best deals and displays cheap last-minute offers.


• Cruisecompete compares offers from multiple travel agencies.


• Vacations to Go works with travel agents and often has better deals because it can negotiate directly with cruise lines, but there are added fees.


• Cruise Deals offers personalized service as well as an online search for specials and deals. You can subscribe to its weekly deals newsletter.

How to Save Onboard

Although cruise ships bill trips as all-inclusive, that is becoming less so every year, with many cruise lines following airline pricing models that charge extra for certain amenities. They might lure you with cheap fares, but then nickel and dime you once you’re onboard. To save money, figure out what you don’t really need and what you can arrange on your own.

Seniors Can Cruise for Deals Because retired seniors have the luxury of traveling in the off-season as well as taking the longer repositioning cruises, they are well situated to save money and get deals. In addition, cruise lines offer special discounts for those older than 55. If only one person in a cabin has reached that age, the discount applies to everyone. Check with individual cruise lines about their discounts. For a quieter cruise, seek out mid-size ships. Because they don’t have as many “fun” attractions, such as water parks and rock climbing walls, as the largest ships, they aren’t as attractive to families. Cruises that have more “party” destinations, like the Caribbean and Mexico, also tend to attract young families and couples. In addition, certain cruises target older adults. River cruises—in Europe, Russia, Asia and elsewhere—focus on fine dining and cultural tours. American Cruise Lines caters to older adults with its history-focused itineraries along inland waterways and rivers, the eastern seaboard and Alaska. Cunard, with its British tradition, and Azamara Club Cruisers, which caters to older adults, offer refined and luxurious environments. Sources “5 Top Cruising Tips for Seniors,” U.S. News: Travel “See the best cruises for seniors,” July 1, 2014, USA Today

Drinks. Alcoholic beverages and soda are not included in the cruise fares on most lines. Some lines permit you to bring one bottle of wine or a case of beer onboard, but many are increasingly forbidding this practice. If you enjoy alcoholic drinks or soda, be prepared to pay top prices. To save money on a glass of beer or wine, look for daily drink specials. For both soda and alcohol, some ships are offering packages that allow you unlimited drinks, but make sure you would drink that much before paying often hefty prices (almost $50 a day on Carnival). Iced tea, water and juices are free.

Shore excursions. Guided tours arranged by the cruise line are often more expensive than what you would pay if you booked your own by visiting your destinations’ websites and finding a local tour guide. Towns often provide self-guided walking tours at no charge, and travel agents can suggest reputable tour guide operators.

Laundry. Onboard, you pay per article of clothing washed—between $2 and $3—which can add up. Instead, wash your own clothes (don’t forget to bring a small bottle of detergent), bring enough clothes to last for the whole trip or see if the ship has its own self-serve launderette.

Eating. While the bulk of a ship’s restaurants are part of the all-inclusive fee, many cruise lines are now offering specialty restaurants that charge. Because the ship’s “free” restaurants offer a range of dining options, in most cases, there is no need to pay extra for the fancy places. If you prefer specialty restaurants, you might be able to buy a dining package before you depart.

Photos. Although it might be tempting to buy the group photo of you and your family that the ship’s photographer takes, it’s also expensive. Instead, use your own camera. Also, make sure you have enough batteries and memory cards with you, because buying them onboard will be more expensive than at home.

Internet. Onboard internet prices are high—from 50 cents to $1 a minute—and connections are slow. Some ships offer a package deal, but if you don’t need to be online, it’s cheaper to wait until you arrive in port and find a place that offers Wi-Fi. Similarly, phone calls are also expensive.

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Sources

“Last Minute Cruising: 9 Tips for Getting a Deal,” Cruise Critic.

“How to Find the Best Cruise Bargains in 2016” Cruise Critic.

“How to Take a Cruise for as Little as $30 Per Day,” March 4, 2014, Nomadic Matt.

“How to Score a Deal on a Cruise,” May 14, 2015, Clark.

“Wallet-friendly cruising: 10 money-saving tips,” Jan. 21, 2015, USA Today.

“10 Easy Ways to Save Money on a Cruise,” Oct. 26, 2015, Smarter Travel.

“Cruising Cost Control,” Cruisediva.com.

“How to find the best cheap cruise deals,” Aug. 18, 2014, Moneywise.

Blog posting provided by Society of Certified Senior Advisors
www.csa.us

The Golden Rule Becomes the Fiduciary Rule

Article written by Richard M. Weber, MBA, CLU, AEP

New federal requirements could mean a different relationship between you and your financial adviser.

“Do unto others …” is not only a good idea to maintain healthy relations with friends, neighbors and acquaintances, it’s also at the heart of most of the world’s major religions. When it comes to professional relationships, such as those between fee-based financial advisers and their clients, the golden rule becomes the fiduciary rule. Now the Department of Labor (DOL) has expanded the reach of the fiduciary rule to include any adviser, regardless of credentials or licenses, who recommends moving money into, out of or between retirement plan resources. This includes IRA, IRA rollovers, Roth plans and even Health Savings Accounts. Also, the new rule applies even if your adviser recommends not moving money.

Rationale Behind the New Rule

Perhaps you’re already working with a financial adviser who puts your interests above their own and whose compensation is reasonable. That’s the basic standard for a fiduciary, as put forward in the DOL’s new mandate, which goes into effect in spring 2017. (See sidebar, “What’s a Fiduciary?”) But if you are working with more than one adviser or broker, or are not sure about their legal obligations or how they are paid for their services, here is what this big change might mean for you.

What’s a Fiduciary? A fiduciary is someone who holds a legal or ethical relationship of trust with another person (or group), typically responsible for money or other financial assets. In addition to putting your interests ahead of their own, a fiduciary acts with “prudence” and uses the skill, knowledge, care, diligence and good judgment of a professional. A fiduciary doesn’t mislead clients, but in fact goes out of her way to provide conspicuous, full and fair disclosure of all important facts. A fiduciary avoids conflicts of interest, if possible, and discloses and fairly manages in the client’s favor any unavoidable conflicts.

Before the new rule, commission-based stockbrokers and insurance agents have been subject to a suitability standard with the products they recommend and sell. That means they’re supposed to match your circumstances (income, assets, tax bracket, financial lifestyle, time horizon and risk tolerance, among other criteria) to a range of compatible investment and insurance options, including annuities. The suitability standard means that the broker must have a reasonable basis for the recommendation that is offered to you. But suitability doesn’t mean lowest cost, and a suitability standard doesn’t prevent a potential conflict of interest between the recommendation and the broker/agent who makes the recommendation. Brokers and agents have not typically been required to give your best interest their first consideration, although many do as a matter of their professional commitment to their clients.

At the other extreme are fee-only Registered Investment Advisors (RIAs). Individual advisers working for such firms are referred to as Investment Advisor Representatives (IARs), and they and their firms for many years have been governed by the fiduciary standard—where they are required by laws and rules to put your interest first.

If you had a choice between advisers working as commissioned agents, and not previously held to a best-interest standard, versus advisers working solely by fee, why wouldn’t you want to work exclusively with a fee-only, best-interest adviser?

Fee-only advisers typically don’t “sell” or manage annuities or life insurance, and only a few insurance companies make their products available directly to consumers. That’s for good reason: annuities and life insurance are complicated financial assets that need professional assessment of your situation and explanation to your satisfaction that they’re right for you. An insurance agent is an intermediary, an individual licensed by a state insurance department and authorized by the insurance company to sell its life insurance and annuities.

Fees and commissions—and the disclosure of these costs—are only one part of the overall structure of any investment or insurance, whether it’s a mutual fund or an annuity or a life insurance policy. Often the expenses are “baked in” and may not be easy to define or describe. With insurance products, commissions are paid by the insurance company and are not subtracted from your account unless you surrender the policy within the surrender charge period, which can range from 5 to 15 years. The major issue should be that if you need an annuity, what are the benefits, and does it help make you financially more secure, less anxious and/or comfortable that you’ve made a good decision?

How Will This New Rule Affect Me?

Insurance companies and stock brokerage firms are already working to conform to the rules that are now less than half a year away. Bank of America’s Merrill Lynch, for example, recently became the first major firm to announce it would no longer pay commissions for investment recommendations made for IRA accounts; rather, its brokers will be compensated by ongoing fees through its advisory platform. Other options may include self-directed (i.e., do-it-yourself) accounts and even artificial intelligence-powered “robo" advisers. If that latter option sounds like science fiction, it isn’t. Computer-driven robo advice is one of the hot innovations in financial services, propelled even more quickly because of the changes needed to accommodate the new fiduciary rules. While some seniors may prefer to self-direct or automate their own way through a volatile stock market, many more clients will likely be comfortable with human, professional-to-client advice, compensated through a small percentage of assets assessed annually to the portfolio. This would presumably allow the focus to be on advice rather than just selling investment and insurance products. However, if you don’t have at least $50,000-$100,000 of retirement assets to invest, you may not readily find a qualified adviser willing to work with you, and “robo” may be your only option.

What’s Best Interest? What’s Reasonable Compensation?

In 1,023 published pages, the new DOL regulation does not explain “client’s best interest,” and it’s likely something that means different things to different people at different times. The concern is that along with the requirement that advisers receive only reasonable compensation, it may take years of litigation through state and federal courts to better define these new standards.

So consider: if you believe you have been well-served in relationships with financial service professionals, what was it that made you feel that way? Ideally it was a sense that the adviser listened and understood your circumstances and issues. The adviser likely addressed things that you wanted to fix, accomplish or avoid and brought to your attention planning ideas and investment or insurance products that would help you reach your objectives. In other words, such an adviser provided enough relevant information and guidance that you could make a decision you believed was in your best interest. As for compensation, ask yourself: if you are well served through a relationship of financial intimacy with a qualified financial professional, how important is it to you what the adviser is paid?

What Can You Expect From a Financial Adviser?

If you’ve been working with a commissioned insurance agent or stockbroker, some products fitting under the broader umbrella defined by the DOL will require a written contract between you and the financial institution. If nothing else, this gives you a more explicit understanding of what to expect from the agent and her institution. It’s also likely that more stock brokerage firms will follow the Merrill Lynch initiative and only offer managed funds as opposed to mutual funds or individual stocks for IRA and similar retirement plans. Either way, here are some questions you may want to explore with your existing or new adviser:

• When these new rules kick in, what will be different in the way you work with me? And how will that affect my portfolio from the standpoint of costs and products?


• What are my options for receiving information and services and acquiring any products you recommend, and how will you get paid?


• How should I evaluate this new process? What are reasonable benchmarks to measure if I’m achieving my goals? How will I be able to evaluate if this is working for me?


• (For the adviser choosing to meet narrow exceptions in order to continue to receive commissions while still held to a fiduciary standard), “What will be different?”


• (For the financial planner charging fees and selling no products), “How will you evaluate my need for insurance and/or annuity solutions and how will you provide me with access to those solutions?”

Although the new fiduciary rule is being challenged in court, the inherent customer focus of fiduciary standards will likely ultimately survive. To this end, it’s important for seniors to talk to their current advisers and, regardless of current or future rules, assure themselves of services and products that meet their needs.

- Richard M. Weber, MBA, CLU, AEP

Richard M. Weber, MBA, CLU, AEP, is a 50-year veteran of the life insurance industry. He has been a successful agent and insurance company executive, and for the last 20 years has worked as a fee-only insurance fiduciary.™ He is the author of more than 300 articles encompassing insurance products, sales practices and the due diligence necessary to buy and sell insurance and annuities. Richard served as the 2012-2013 national president of the Society of Financial Service Professionals.

Seniors Biggest Users of Opioids

The crisis with painkiller abuse affects older adults for many reasons. For one, aging brings on more aches and pains.

It seems every day we read headlines about the increasing use and abuse of opioids—strong painkillers such as OxyContin, Percocet and Vicodin. They are often prescribed after surgery to relieve severe pain or for chronic conditions such as back pain. According to the Centers for Disease Control and Prevention, more than 19,000 Americans died from prescription opioid overdoses in 2014.

While we might picture the typical opioid addict as a young adult slumped over in a vacant doorway, older adults are the biggest users and abusers. An article in JAMA Psychiatry found Medicare beneficiaries had the highest and most rapidly growing rate of “opioid use disorder.” Six out of every 1,000 Medicare recipients struggle with the condition, compared with one out of every 1,000 patients covered through commercial insurance plans. According to the study, more than 300,000 Medicare recipients battle with opioid use disorder, and hospitalizations due to complications caused by opioid abuse or misuse increased 10 percent every year from 1993 to 2012.

Efforts are being made to check this crisis. In recent years, states have instituted laws that monitor people’s medication use to ensure they are not getting more drugs than their doctor prescribed. The state of Washington, for example, has a website that a pharmacy or doctor can check to make sure a patient isn’t acquiring medications from more than one pharmacy. If so, they may limit patients’ doses, prescribe fewer pills or cut them off altogether.

Seniors More Affected by Opioids

Seniors are more susceptible than the rest of the population to addiction, and the consequences can be more serious for several reasons:

• Older adults have more pain, in general, and rely on opioids to relieve the pain. In fact, chronic pain is cited as the main reason for taking opioids, compared to younger people, who may take them for relaxation.


• Seniors have more issues with memory, so they are more liable to forget they took a dose and retake it. For certain medications, that can be fatal.


• Falls are more likely for seniors on opioids, significantly raising their risk for potentially serious fractures.


• Seniors take more prescription medications, as well as over-the-counter drugs, than other age groups—consuming one-third of all prescription drugs in this country. In addition, because most older adults take more than one medication, the risk of harmful interactions is high.


• Diagnosing addiction is more difficult because seniors have medical issues, such as fatigue or confusion, which can hide the symptoms of addiction.


• As we age our liver function decreases, and it can be harder to filter medicines from our bodies. Because we metabolize synthetic drugs at different rates, some seniors can become addicted or overdose easily.


• Alcohol abuse is a serious problem among seniors, thereby raising the risk for a sometimes deadly combination of alcohol and painkillers.


• For conditions such as spinal stenosis, surgery is not an option for some elderly, because of the risks, so painkillers are the only solution.

Alternatives to Opioids

At first, physicians prescribed opioids primarily for short-term relief immediately after surgery or an accident. But increasingly, the drugs are being used for long-term chronic pain. Unfortunately, there are not a lot of good alternatives to ease acute pain, especially for older adults.

Under Medicare Part D, the only effective drug therapy for opioid use disorder is buprenorphine-naloxone, but few doctors prescribe it because of cumbersome government regulations, including having to take an eight-hour class. In 2013, according to JAMA Psychiatry, doctors wrote far fewer prescriptions for buprenorphine-naloxone than for opioids.

A non-prescription medication, acetaminophen has been shown to work with opioids, so patients can use less of the opioid. The active ingredient in Tylenol, acetaminophen, can also be combined with nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, making opioids more effective. However, patients often need to limit use of over-the-counter drugs like Tylenol and Advil. Too large a dose over a period of time can cause long-term problems, especially in older adults, such as liver or kidney damage.

Opioid Use Continues After Hospital Visit It’s a common scenario: Someone checks into a hospital for surgery or an illness and leaves with a prescription for an opioid painkiller, opening the door to long-term use and dependence. A recent study examined this pattern and found the prescriptions are used and renewed more often than you might imagine. Researchers analyzed the pharmacy claims of a random sample of more than 623,000 Medicare beneficiaries who were hospitalized in 2011. They only included people who did not have a prescription claim for opioids for at least 60 days before being hospitalized. The results, first published online in JAMA Internal Medicine in June, showed that 14.9 percent of the hospitalized beneficiaries filled a prescription for an opioid within a week after being discharged. Of those who filled the first prescription, 42.5 percent had another pharmacy claim for an opioid painkiller at least 90 days later. “Presumably, they were prescribed it and continued on it because of some sort of chronic pain,” said Dr. Anupam Jena, associate professor of health care policy at Harvard Medical School and the study’s lead author. Still, there are many ways to treat pain, Jena noted, and hospitals are supposed to look at other approaches. Source: Reprinted from “Despite Opioid Concerns, Seniors Often Exit the Hospital With Prescription: Study,” July 15, 2016, Kaiser Health News.

Others treatments are available to ease pain:

• Anti-depressants inhibit serotonin, which transmits signals between nerve cells in the brain, and can lessen nerve pain.


• Muscle relaxants can relieve muscle spasms and low-back pain.


• Radiofrequency ablation decreases pain signals, especially from ailments such as arthritis. This technique places a needle close to the nerve that is sending pain signals to your brain and then sends an electrical current through the needle.


• Anticonvulsants, which primarily treat epilepsy, can also soothe neuropathic pain, migraine headaches and fibromyalgia by suppressing the flow of pain signals from the brain.


• Steroids, such as prednisone, ease inflammation, but the pain returns once you stop getting the shots, and steroids have serious side effects. Other injections for pain include nerve and epidural.


• Massage, acupuncture and other alternative therapies can be combined with other treatments to lessen the use of opioids, although studies of their effectiveness for pain management are scarce. Also, health insurance rarely covers alternative treatments.

People who visit hospital emergency rooms come mainly because of severe pain, so hospitals tend to be the starting point for those who become addicted to opioids. However, one hospital, St. Joseph’s Regional Medical Center in Paterson, N.J., has opted to take a different route. Instead of treating patients who come in for migraine or kidney stone pain, for example, with opioids, the emergency department, one of the country’s busiest, has provided alternatives that include nonnarcotic infusions and injections, ultrasound guided nerve blocks, laughing gas, “energy healing” and a harpist, according to the New York Times.

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Sources

“Silent Epidemic: Seniors and Addiction,” Dec. 2, 2015, U.S. News.

“‘Astounding’ number of opioids prescribed to elderly, report finds,” June 22, 2016, Stat News.

“Seniors and Prescription Drug Addiction,” June 9, 2016, Aging Care.

“Older Addicts Squeezed by Opioid Epidemic” July 26, 2016, Pew Charitable Trusts.

“Use of Opioid Agonist Therapy for Medicare Patients in 2013,” JSeptember 2016, JAMA Psychiatry.

“Trends in older adult nonmedical prescription drug use prevalence: Results from the 2002-2003 and 2012-2013 National Survey on Drug Use and Health,” September 2016, Pub Med.gov.

“The Quiet Epidemic of Senior Drug Abuse,” Jan. 22, 2014, A Place for Mom.

“Study: Medicare Beneficiaries May Face ‘Treatment Gap’ For Painkiller Abuse, Misuse,” July 20, 2016, Kaiser Health News.

“A growing number of people 50+ are abusing prescription painkillers, sometimes with fatal consequences,” June 2016, AARP Bulletin.

“Prescription Drug Abuse in the Elderly,” Family Doctor.

“Opioid-Free Ways to Live Well With Chronic Pain,” Everyday Health.

“Chronic Pain Relief: New Treatments,” WebMd.

Blog posting provided by Society of Certified Senior Advisors
www.csa.us