The holidays are supposed to be a joyful time of good cheer, parties and family gatherings, but it is not unusual for many of us to feel sad, lonely or even anxious during the holidays. This condition, which has come to be called “holiday blues,” can occur with any holiday or vacation time. It commonly happens at the end of the year when it can seem that just about everyone is celebrating in some way, while those with the holiday blues feel pressured with the high expectations of the season.

Why are seniors susceptible?

“Many factors can contribute to feelings of sadness that seniors may feel around the holidays. The holidays can heighten feelings of grief and loss for seniors adjusting to changes related to the process of aging, such as life without a loved one or close friends, ill health, or a move from a lifelong family home into a retirement home or senior community. They may feel guilty about having feelings of sadness which may in turn intensify those feelings of sadness,” says Karen A. Briskie, RN, MSN, Director of THE MEDICAL TEAM’s Journey Behavioral Health Program.

How to manage the holiday blues?

The holiday blues can be a normal response to a stress-filled time of the year, but seniors don’t have to suffer unnecessarily. Mental Health America, a non-profit dedicated to helping Americans lead mentally healthier lives, offers the following tips for coping with stress:

• Keep expectations for the holiday season manageable. Try to set realistic goals. Make a list and prioritize the important activities.
• Remember the holiday season does not banish reasons for feeling sad or lonely; there is room for these feelings to be present, even if the person chooses not to express them.
• Leave “yesteryear” in the past and look toward to the future. Life brings changes. Don’t set yourself up in comparing today with the “good ol’ days.”
• Do something for someone else. Try volunteering some of your time to help others.
• Enjoy activities that are free, such as taking a drive to look at holiday decorations.
• Be aware that excessive drinking will only increase your feelings of depression.
• Try something new. Celebrate the holidays in a new way.
• Spend time with supportive and caring people. Reach out and make new friends, or contact someone you haven’t heard from in a while.
• Find a family member, friend, member of the clergy, or a physician or professional counselor you can talk with who can help you through this difficult time.

When is it more serious than just the holiday blues?

While they may be intense and unsettling, holiday blues are usually short-lived, lasting for a few days to a few weeks prior to or just after the holiday. “However, it is important for family members, physicians and other caregivers to be alert to signs of something more serious than just seasonal sadness. Many elderly individuals may feel that depression is a natural part of aging and may not seek treatment on their own,” says Karen Briskie, RN, MSN.

Depression is a very real and serious disease that can be treated and managed, but can be life-threatening if left untreated. The signs of depression include: sadness that won’t lift; loss of interest or pleasure; changes in appetite and weight; thoughts of death or suicide. If you notice that a loved one seems depressed, encourage them to talk to their healthcare provider.

How can home care help?

If diagnosed with depression, elderly patients may respond more readily when receiving psychiatric care in the comfort of home, surrounded by their family and possessions. THE MEDICAL TEAM offers an in-home care program to assist patients, families and caregivers affected by depression and other behavioral health disorders to journey towards wholeness. Services include crisis stabilization, medication management, family interventions and long-term management. The program is based on established research outcomes and meets all Medicare standards.

Source: Mental Health America, www.nmha.org

“These active adults are the largest, wealthiest and fastest-growing segment in the population and they are searching for products, services and programs that are designed specifically for them,” says Lisa Puma, senior director of Marketing of GHA Community Management. Essentially, these individuals are looking for a maintenance-free, activity-filled, and well-managed community where they can begin their transition into retirement.

An option that perfectly complements the lifestyles of these vigorous individuals””while shifting from the common misconceptions surrounding senior housing””are Active Adult Communities, a unique form of housing where individuals move in at the age of 55 or older to enjoy the perks of various amenities. Many communities offer the option of purchasing a home or renting to further accommodate individual financial needs.

As with any other housing option, it is recommended that individuals speak to residents and the management of prospective communities in order to become familiar with their philosophy. It is also important to understand how the management of active adult communities differs from multi-family management.

“Unlike multi-family, active adult communities are unique because they require more complex management to serve the lifestyle of the homeowners,” says Lisa.”The goal is not only to achieve a successful homeowners association, but to build social involvement, exercise, education, stress reduction and a balanced lifestyle.”

GHA Community Management has a specialty division that provides professional management and lifestyle services to meet the needs of active adult communities. This includes services ranging from in-home maintenance to energy and utility management as well as various consulting services, including those for community lifestyle directors and amenity and recreational building design reviews.

Although many do not offer healthcare services, active adult communities are an appealing housing option with their extensive list of amenities and homes that are low maintenance and easily accessible. The communities are typically adjacent to recreational facilities and golf courses, and often include tennis courts and swimming pools among other perks.

With all of these aspects of a community, it is the responsibility of active adult management and key members of the staff to establish a relationship with residents that ensures the different facets of their home suits their needs and overall lifestyle.

When her mother developed dementia, Karen realized she only had one week to empty her Pikesville condominium and prepare if for sale. During that same week, she also had to move her father from a nursing home to an assisted living facility.

As someone who is first to admit she is not the greatest organizer, Karen realized she needed support to ease the overwhelming of moving. She called Senior Transitions, a Maryland-based service that offers moving and downsizing assistance.

At first, Karen and Mary Ellen, a staff member, found nothing surprising-lots of paper, clutter, and the like. However, on the last day of sorting, they stumbled across an envelope with six $10,000 savings bonds.

The find came as an enormous relief to Karen, whose mother had dwindled her savings by generously giving money away to other relatives, friends and worthy causes. She was excited about the prospect of having more money to provide quality care for her mother.

The day wasn’t done, however. A search of a file drawer uncovered lost family documents that included passports belonging to Karen’s grandparents, who moved during the holocaust to escape death. When they died, Karen’s family did not receive any of their historical belongings. Now she had something to treasure from years to come.

In one week, Karen was able to make arrangements for the sale of the condo. Her mother is adjusting and she has treasured mementos she never dreamed would be seen again.

Both retired public school teachers, the Taylors raised two kids of their own and put them both through college, all the while saving adequately for their retirement. Their annual income consists of their pension from the county school system, social security benefits, and income from other investments such as their retirement plans.

While they lived a comfortable retirement lifestyle, their dream of owning a vacation home was not something they thought they could afford. Mr. and Mrs. Taylor heard about the reverse mortgage program and decided to investigate further. They contacted Robert Ready of East West Mortgage Company, which deals primarily in reverse mortgages. After meeting with him, their life-style dramatically changed.

The Taylors decided to use the proceeds from their reverse mortgage to help purchase their dream vacation home in Ocean Pines, MD near Ocean City, MD. They received approximately $175,000 from the reverse mortgage on their primary residence and combined it with an additional $50,000 in savings to make the vacation home purchase. With a reverse mortgage, they managed to achieve a primary residence in Anne Arundel County with no payments for as long as they own their own home. Plus, they now have a vacation home for which they paid in full with cash.

Having made this purchase several years ago, the Taylors have seen the value of their vacation home appreciate dramatically. They’re happy and their children and grandchildren are delighted to have a family vacation retreat. The Taylors are just one of many couples and individuals using the reverse mortgage program to supplement their income for unique reasons.

One of Mrs. Pyle’s friends mentioned that they needed assistance at the public library. She went into the interview looking for a part-time job and left with a career. Mrs. Pyle worked her way up through the library system and ended her career as manager of clerical and Technical Services in the Library’s Central Office.

Several years ago, Mrs. Pyle made the decision to downsize from her family home in Timonium to a more manageable condominium. Her husband had passed away three years earlier, and their home was becoming more than she could handle alone. She lived in her condo for 13 years. Recently, Mrs. Pyle began to contemplate moving again. She recalls, “I wanted to find a community where I could feel secure, but also be as independent as I want to be.”

Mrs. Pyle’s search for a retirement community to meet her needs took her to several local properties. After touring communities and reviewing their offerings, she chose Mercy Ridge, a Continuing Care Retirement Community (CCRC) in Timonium, MD. “I knew that Mercy Ridge was it as soon as I saw it,” she says. “It is so new and gorgeous, and we have so many options in terms of dining and amenities.”

Finding the right retirement community proved to be easy, but Mrs. Pyle knew from experience that “downsizing and moving is hard-really hard.” When she moved to her condo, her children took care of everything but she did not want to call on them again.

When she found information about moving coordinators in her move-in packet, Mrs. Pyle was intrigued. She called Senior Transitions, a moving coordination services firm, and spoke with Charna Kinneberg, the owner of the company. “When Charna came in and told me about everything they could do to make sure that my move was smooth-which was pretty much anything I needed-I knew that I wanted their help,” Mrs. Pyle says.

The day before the move Senior Transitions’ staff came to Mrs. Pyle’s house and packed the bulk of her belongings. They brought boxes, packing paper, and all the necessary supplies with them.

Mrs. Pyle remembers, “On the day of the move, they finished up with the packing, and then they went to the new place and unpacked everything and set it up.” From assembling her bed to unpacking and dusting her china, Senior Transitions made sure that Mrs. Pyle’s new home was as comfortable as possible. “It looked like I had been living here for awhile on the very first day. Even some of the staff members commented on how quickly I was settled in,” Mrs. Pyle concludes. “I didn’t have to worry about anything with the move. They really took care of it all, and that was a wonderful feeling.”

“I was atypical in that I held almost all of the positions you can have with the Marine Corps during my career,” says Colonel James Hecker. During his nearly 30 years in the military, Colonel Hecker served as an Officer during war, completed a sea duty, worked as a recruiter, and was the administrator for an ROTC program. While Col. Hecker enjoyed the diversity of his positions, he realized early on that a career military man needed to serve time in combat zones in order to be successful.

Having served in WW II, Korea, and Vietnam, Col. Hecker reflected on the very different public perceptions of those engagements. He says, “WW II touched everyone. Korea was marginally accepted. Vietnam was not at all accepted, and we felt that. I returned to the airport in Los Angeles after Vietnam and was harassed and spit at.” Despite some challenging moments, Col. Hecker states, “I am thankful to the military. I grew in a poor family in Southern New Jersey. Without the military, I would not be where I am today.”

The dedicated assistance of his wife, Kathleen, was also a major factor in his success. Katherine, he says, “always dealt with the time away and the moves so well. She really made it possible to have a family and be in the military.” The couple has two children and three grandchildren.

After retiring from the Marine Corps, Col. Hecker served as a nursing home administrator for 20 years. The couple had been retired for several years when they began to consider a move to a retirement community closer to their children.

Near the end of their exhaustive search, the Heckers visited Classic Residence by Hyatt, a luxury senior living community in Chevy Chase, MD. He recalls, “As soon as we got here, we just thought, ‘This is quality.’ The facility and the staff are superb in every way.”

During a pre-admission seminar at the community, the Heckers learned about the services of moving coordinators. Transitional Assistance & Design, a local downsizing, moving, and design firm, was recommended to them.

Col. Hecker admits, “We had moved 26 times in 30 years, and it was pretty evident that at our age, one more move could be too much.” The Heckers decided to meet with Susan Danick, the Owner of Transitional Assistance, based in Gaithersburg, MD, which helps seniors facilitate every step of the downsizing process.

“Within the first few moments, it was obvious that we were going to use her services. She really is an expert,” he recalls. Susie and her staff helped the Heckers with everything from downsizing and packing to planning and setting up the new home. “She made a to-scale diagram of the home that included where all the furniture would go,” Col. Hecker explains.

In addition to helping the Heckers plan their new space, Susie arranged for packers, movers, and haulers to transport all of their belongings. Her management helped the couple ensure that everything was carefully packed and organized.

In their new home, Transitional Assistance set up everything. “It was all done,” says Col. Hecker. “The closets were unpacked, and the dishes were put away. The pictures were even hung. It was really like we had already been living here.” Col. Hecker concludes, “I can’t imagine why anyone would not want Susie’s help with their move.”

After just a few months in their new community, the Heckers are thankful that they had such an effortless transition. They are still debating on which of the various community activities and programs they want to become involved in. Right now, they are just enjoying the “unencumbered” lifestyle that for them epitomizes retirement.

According to a study conducted by Harris Interactive, 37% of Americans aged 62-75 ranked fear of fraud ahead of concern for health crises and terrorism. An estimated five to ten percent of all health care expenses are due to health care fraud. Medicare alone lost more than $16 billion to fraud, abuse, and errors in 2004.

Health care fraud is an intentional deception which often results in an unauthorized Medicare or Medicaid benefit. Providers engaging in fraud will frequently bill for services or supplies that are not provided.

Any practice that is inconsistent with sound medical or business practices is considered abuse. Charging excessive amounts for services, filing claims for unnecessary services, or billing improperly are all incidents of abuse.

SMP is combating these abuses by enlisting the assistance of trained volunteers to work with beneficiaries to prevent, discover, and end fraud. The heart of the SMP program is education. Beneficiaries receive essential information about the prevalence of fraud and abuse and how to stop it.

Nationwide, SMP has over 45,000 trained volunteers and counselors. The program has already reached more than 1.8 million seniors in their communities and has played a role in the recovery or savings of over $103 million.

On the local level, the Virginia Association of Area Agencies on Aging (V4A) administers the SMP program. The association spearheads state-wide SMP outreach initiatives and utilizes the network of 24 Area Agencies on Aging to distribute educational information throughout the state. During a six month period in 2005, the V4A held over 370 educational events throughout the state, reaching nearly 15,000 beneficiaries.

This important effort not only helps seniors avoid losing money or benefits, but it also helps them to avoid the potential illnesses, injuries, and frustrations that can result from working with dishonest providers or utilizing bad equipment. In order to spot fraud and abuse before it occurs, consumers must be vigilant and informed.

Knowing what to look for and how to report suspected violations is the first step toward ending the abuses that are damaging our health care system. Informed consumers are a powerful defense against unnecessary spending and unscrupulous providers.

Medicare or Medicaid beneficiaries who suspect that they have been the victim of fraud or abuse should call 1-800-938-8885 (in Virginia only).

What to look for in a Nursing Care Facility
Before choosing a facility, contact the long-term Care Ombudsman Program of your Area Agency on Aging. Ombudsman programs promote the highest quality of life and care for residents of nursing facilities and can help families and staff with inquiries and complaints.

Tell the ombudsman which facilities you are considering and request any information they have about the facility. Visit prospective facilities at different times of day. Talk with residents and staff members. Be persistent about getting your questions answered.

Entering and Adjusting to Nursing Home Life
Although some people enter a nursing home temporarily for a short-term stay, it is still a sad day for most people and sad feelings are normal. Reassurance from family and friends that love and contact will be maintained can ease the transition. In addition, there are steps to take that may help lessen the trauma of the change:

–Talk about the admission in advance
–Visit the home with the prospective resident beforehand, if possible
–Involve the prospective resident as much as possible in the decision-making
–Describe the home in detail before moving there
–Decide together what items to bring to the nursing home
–Get to know the administration of the nursing home
–Maintain contact with the resident after admission
–Maintain contact with the home after admission
–On the day of admission, be available the entire day to help settle the resident and provide emotional support.

Paying for a Nursing Care Facility
Medicare, Medicaid, private insurance, and personal assets are all used under various circumstances to pay for services in a nursing care facility. If a facility is not certified by Medicare and Medicaid, the care will have to be paid for entirely with personal funds.

In general, Medicare pays for skilled nursing care following hospitalization for the same illness or condition at 100% of the cost for days 1 – 20. However, on days 21 – 100 the Medicare subscriber is responsible for a co-pay. Medicaid, a government program for the indigent, covers nursing home care for individuals who meet strict medical and financial eligibility requirements. Some long-term care insurance pays for nursing home care; insurance payments are usually a fixed amount for a specified number of qualified days. On the subject of buying long-term health care insurance, the National Council on Aging can be helpful, providing practical, objective information on what to look for. Call 1-800-373-4906 and request the “Long-Term Care Insurance” booklet. The cost for the booklet is $14.95 for non-members. Information is also available online: www.ncoa.org.

The “Consumer’s Guide to Nursing Home Contracts,” published by Legal Services of Northern Virginia, Inc., provides additional information and advice on paying for nursing care services. Below is an excerpt from the guide.

What is the Basic Daily Rate?
The basic daily rate is the standard charge the nursing home bills to all residents, which covers the fundamental services every resident receives, including rent for the room, housekeeping, meals, and general nursing care.

It is important to understand all the services and amenities that are not included in the basic daily rate. The fees and charges for “supplemental services” often increase the expense of the nursing home bill dramatically, to the surprise and dismay of the recipient of the bill. Often services expected to be included in the basic daily rate, such as extra nursing services, pharmaceutical needs, and telephone services are extra charges.

Does the basic daily rate include all the nursing care I will need? Probably not. The basic daily rate includes “basic” or “general” nursing services. What is provided with basic or general nursing care may vary from nursing home to nursing home.

But the basic daily rate often does not include many common nursing services. Physical therapy, glucose monitoring, incontinent care, hand or tube feeding, etc. might each involve extra fees. In addition, prescription and non-prescription medicines are not included in the basic daily rate.

How can I avoid being surprised by added costs?
To understand which additional services (and additional costs) a resident will require, the first place to look is the Resident Assessment. This assessment is required by law and analyzes what kind of nursing and other care the resident needs. For example, if the new resident is incontinent, the assessment should indicate this fact.

To get an accurate assessment of the costs, make sure you understand what is covered by the basic daily rate. Then, ask the nursing home representative to discuss the resident assessment and to explain to you what additional nursing and services, beyond what is covered by the basic daily rate, are necessary. The nursing home should give you an itemized list of supplemental services and the costs above the basic daily rate.

Also, decide what additional amenities you want (telephone, beauty care, etc.) and add these costs in. Request an estimate of the total bill. You should have this estimate long before the end of the first month, so that you know exactly what to expect.

Since paying for care in a nursing care facility can be both expensive and confusing, it is a good idea to contact your local department of social services or Area Agency on Aging for more information.

Evaluating Nursing Homes

Use this checklist to judge and compare the nursing homes you call and/or visit.

– Is the facility accepting new patients?
– Does the facility offer skilled nursing care?
– Is the facility Medicare-certified and/or Medicaid-certified?
– Are the home and its current administrator licensed?
– What type of education and training do staff members have? How many Registered Nurses (RNs) and Certified Nursing Assistants (CNAs) are on staff?
– Are background checks conducted on all staff members?
– Is there a care plan developed for every resident?
– Are care plans reviewed and updated by providers and family members?
– Is the interaction between residents and staff members warm and respectful?
– Are public areas and resident rooms clean and comfortable?
– Are there a variety of activities available for residents?
– What is the staff to patient ratio at night and on weekends?
– Do staff members respond to residents requests for assistance promptly?
– Are there enough staff members available to assist residents during meals?
– Does the food in the dining room look and smell appealing?
– Are there handrails in hallways and grab bars in bathrooms?
– Are exits clearly marked?
– Is the facility outfitted with smoke detectors and sprinklers?

Adapted from Medicare’s Nursing Home checklist. For more information, see www.medicare.gov.

Advance directives (living wills, powers of attorneys, and health care proxies) are legal documents that express an individual’s wishes with regard to medical decisions. They are intended to provide direction to a designated “agent” to speak on behalf of a person who is unable to speak for himself.

An agent under an advance directive has legal authority to make any decisions and take any actions for the individual who appointed them. It is important for an individual to appoint a trusted person to speak for him when he is unable to speak for himself with respect to medical and end-of-life decisions. Once that person is appointed, it is vital that the individual explains his directions as to the type of medical care he does or does not want.

The format and form of advance directives vary by state. Consultation with an attorney is critical to address the legal nuances, personal preferences, and state differences. When drafting advance directives, an individual’s wishes for health care and end-of-life decisions must be specifically addressed to assure that they will be carried out. This includes following religious preferences, personal preferences, and preferences for or against specific medical procedures. Considering the significance of these decisions, it is important to appoint an agent who will follow the individual’s directions even if family members, medical professionals, or friends disagree.

Things to Consider While Planning Advance Directives
The National Academy of Elder Law Attorneys (NAELA) advises consumers to consider five key items when speaking with an elder law attorney about a living will, health care power of attorney, and health care proxy:

1. Who will serve as your Agent for Health Care? Who will serve as the alternate?

2. Are there certain medical treatments or pain control measures you want or don’t want?

3. Do you wish to take or refuse any medication that may reduce or eliminate the ability to communicate?

4. Do you have any particular directions regarding specific health care facilities, religious preferences, disposition of your body, donation of bodily parts for transplant or research, etc.?

5. What directions will you provide related to end-of life decisions specifically regarding:
if you can no longer eat, drink, or breathe on your own
if you cannot function independent of machines
if you are confined to bed
if you have no cognitive ability

For more information about elder law attorneys and the National Academy of Elder Law Attorneys, visit www.naela.org.

With an increase in activity comes a greater likelihood of injuries. But don’t expect seniors to be scared off by this. Injuries, instead, have become temporary roadblocks to a commitment they have made to live an active and healthy life.

Throughout the Washington D.C. metropolitan area, senior leagues in softball, soccer, and baseball accommodate seniors who desire to maintain an active lifestyle and who continue to play for the thrill of competition. Walking, jogging and other aerobic activities remain popular forms of exercise for others.

The fact that seniors as a whole are not slowing down is certainly encouraging news. But while exercise and physical activity is important to maintain throughout a person’s life, the older a person gets the more prone he or she is to sustaining injuries to joints, muscles and bones.

Dr. Raymond Thal is an orthopedic surgeon with Town Center Orthopedic Associates in Reston. He has noticed a growing trend among his patients: More seniors are seeking treatment for their sports- and activity-related injuries. Contrary to years past, common knee and shoulder injuries are not sidelining seniors for good, Dr. Thal said. Instead of quitting many seniors are opting for treatment, which sometimes requires surgery, so that they may continue to pursue their passion for playing or staying active.

“Attitudes are changing among those in their 50s, 60s, 70s and even 80s,” Dr. Thal said. “In many cases, if a patient’s choice is to either quit playing because the pain it too great or have surgery and fix the problem, they choose surgery. That was much less common 20 or 30 years ago.”

Dr. Thal is a leading sports medicine expert in the Washington D.C. area, and serves as a team physician for the Washington Redskins. He cites advancements in orthopedic medicine as a reason why more seniors choose to undergo surgery. Arthroscopic surgery, for example, is preferred today for repairing injuries to a person’s shoulder or knee. It is a less invasive method that requires smaller incisions and less tissue trauma.

“Arthroscopic surgery allows patients to recover faster,” Dr. Thal said. “More people are willing to undergo surgery because they can recover in less time and they experience less pain. That means they will be back on the playing field that much quicker.”

For example, a common injury among softball and baseball players is a rotator cuff tear in the athlete’s shoulder. Surgery to repair this injury usually required a hospital stay and potentially six months of recovery time. Today, arthroscopic surgery to repair a rotator cuff involves an outpatient stay (in and out of the hospital on the same day) and allows athletes to return to activity in much less time.

Undergoing surgery is never an easy decision to make, but it’s a decision that more and more active baby boomers and seniors commonly face.

In 2000, at age 64, Eddie Horstkamp tore his rotator cuff. The injury jeopardized the Annandale, VA man’s active lifestyle. Debilitated and in tremendous pain, he didn’t hesitate to undergo surgery with Dr. Thal.

“I would have never played again had I not had my rotator cuff fixed,” Horstkamp said. “The pain was too great. I wanted to get treated quickly, so that I could compete again.”

Horstkamp also had arthroscopic surgery on his knee in 2002 to remove bone chips. Since then, he has competed as frequently and as intensely as he ever has. Just last year he helped his softball team from Fairfax, VA, the Virginia Cavaliers, win a national title in the 65-and-over division.

“I feel great,” said Horstkamp, who at 69 continues to play hard, participating on three softball teams and in a recreational basketball league.

Injuries occur in many ways. Dr. Thal sees patients who have reaggravated an old injury, who sustain an injury on the field or court, who have lived with aches and pains that become unbearable during an athletic event, and those who sustain injuries because they rush too quickly into athletic activity.

Dr. Thal points out that non-surgical treatment is often effective and should be considered first for most injuries. When non-operative treatments fail, surgery can often help to decrease pain and get the athlete back in the game. He discusses all treatment options regarding a given injury with his patients, always first exploring physical therapy, medication, and other nonsurgical treatment methods.

“We help the patient to select the best treatment option for the given injury,” Dr. Thal said. Maybe your activity level has dropped off as you’ve aged, or you haven’t been very active your entire life. It’s not too late, says Dr. Thal, to get started or to resume exercising or competing. Regular exercise can actually help reduce some of the pain in your joints as well as the progression of conditions associated with aging. Before you begin, talk to your doctor about what you should, or shouldn’t, do. Your doctor can help you tailor a program to your own level of ability and needs.