Slow Medicine

OPINION:
GUEST COLUMNIST OPINION:
Martha Bauman
Slow Medicine
A friend recently suggested that I write
about slow medicine. Slow medicine? I
want my health problems fixed as soon
as possible. Doesn’t everyone? But with
further conversation, reading and
thinking, I revised my view.
Slow medicine is grounded in research at
the Dartmouth Medical School.
Physicians are encouraged to think twice
about the high risks and limited rewards
of aggressive treatment for
persons who are near the end
of life or whose health is
already compromised. Patients
and families are also
encouraged to consider
carefully the risks and rewards
of treatment.
Slow medicine is not the same as the end
of life choices that we make in our living
wills. A living will states preferences for
the time when one is near death and
unable to communicate one’s choice
about life support measures. Slow
medicine allows a patient to decide that
he or she does not want to experience the
impact of a possible procedure or course
of treatment. This decision does not
mean that treatment for other conditions
will also be withheld.
Nor is slow medicine a variety of
hospice care, though there are
similarities. Palliative care, to ease the
symptoms of the condition is a critical
component of slow medicine. Much has
been learned from the experience of the
hospice movement.
The practice of slow medicine can be
seen at work among residents of Kendal,
a senior community in Hanover. An
article in the New York Times (May 5,
2008) gave an example, provided by
resident Edie Gieg, age 85. Her husband,
Charlie, 86 at the time, was suffering
from a heart problem, an intestinal
disorder and was in the early stages of
Alzheimer’s disease, when doctors
suspected that he also had throat cancer.
A specialist outlined what he was
facing: “biopsies, anesthesia, surgery,
radiation or chemotherapy.” His ability
to tolerate these diagnostic and treatment
procedures was of concern to both Mr.
and Mrs. Gieg. They feared that a period
of decline and dependence would follow.
There was concern about the
risk of anesthesia, which could
accelerate the dementia. They
decided to forego further
diagnosis and treatment for the
suspected cancer.
This is not a decision made
lightly, even with the support of
Kendal’s on-site medical staff. People
who live at home may feel less secure in
deciding to forego possible treatment.
For one who does not have good family
support, this would surely be a lonely
time. Who will be there to help the
patient with daily life, if need be? The
support of nurses and physicians who
understand this approach is critical. If
possible, family and/or close friends
should be involved in making the
decision and should plan to support the
patient throughout the months to follow.
The idea of refusing treatment is
startling. We live in an age of
possibilities for medical treatment that
sometimes seems miraculous. Doctors
want to make people well, at almost any
cost. Specialists want to use and perfect
new techniques for diagnosis and
treatment. The prevailing mind-set of
June 2009
Volume 4, Issue 6
EngAGING NH NEWS
EngAGING NH
9 Eagle Drive
Bedford, NH
The idea of
refusing
treatment is
startling.
June 2009
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2
ENH welcomes all points of
view and invites your
submissions. Send articles to:
lcamst38@peoplepc.com
both the medical community and
the public is “Do all you can.”
Martha Bauman enjoys growing
older in the Monadnock Region.
She writes a weekly column on
senior issues for the Keene
Sentinel and Senior Life articles
for New Hampshire Magazine.
She serves on the Advisory
Council of the Endowment for
Health and is involved in Cheshire
Hospital's Vision 20/20 project.
END OF LIFE VIEWS:
HAVE YOU AND YOUR
FAMILY HAD THE TALK?
Be sure to let your family know
your wishes.
• 97% Having family “listen to
them” is support they expect to
need;
• 96% Having family “know what
they want when they die” is
support they expect to need;
• 86% Think total physical
dependency on others would be
worse than death;
• 75% Think being unable to
communicate their wishes or
needs would be worse than
death;
• 84 % Agreed that dying is an
important part of life;
• 71% Feel it is very important to
be off machines that extend life;
• 72 % Think it is very important
to have family relationships
settled.
Source: MA Commission on End of Life
Survey 2005
FINANCES:
IDENTITY THEFT
Think it can’t happen to you? You
might want to think again! There
has been a rash of thefts in the
Concord Area with people being
targeted in local stores and
parking lots. Such rings operate in
several states and they look for
easy targets.
What is an easy target? A purse
left in a grocery cart, credit cards
or wallets left in cars, a purse
hanging off the back of or under a
chair while someone reads, uses a
laptop or goes to pick up coffee.
Not only can your cards be used,
by your identity can be stolen to
apply for new cards, create false
documents including driver’s
licenses, and to purchase gift cards
which can be used long after you
shut your credit card accounts
down. If you have debit cards or
online banking, those accounts are
vulnerable too.
Prevention and Protection
• Always use a zipped bag and
make sure it is closed.
• Make a copy of everything in
your wallet and keep it on file.
• Sign your credit cards— and
add "check ID".
• Only carry with you what you
will need for each specific trip.
Don’t treat your wallet like a
filing cabinet!
• Create a file with your credit
card information including the
full number and expiration
date. Add the fraud call-in
numbers to it--And don’t
forget to update as needed.
If It Happens:
® Call your credit card
companies immediately and
report the problem
® Call the police and provide
the credit card companies with
the police report number
® Request a fraud alert from
the Fraud Department at the
three major credit bureaus:

Equifax 800-525-9285,
www.equifax.com, to order a
report 800-685-111

Experian 800-397-3742,
www.experian.com to order
a report 800-397-3742

Trans Union 800-916-8800,
www.tuc.com , to order a
report 800-916-8800
® Notify your bank and credit
union. Ask you bank about
their policies for changing
account information. (Look for
banks that require a secure
face to face transaction.)
® Notify the NH Department of
Motor Vehicles, to request a
duplicate license ($10) if
necessary.
® Notify the Social Security
Administration 800-269-
0271, email:
oig.hotline.ssa.gov
® Contact the Federal Trade
Commission Consumer
Response Center 877-438-
4338 or
www.consumer.gov/idtheft
News You Can Use
June 2009
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3
Grandmothers
have an
extraordinary
power
® Contact your US Postal
Inspection Services
www.usps.gov/websites/depart
/inspect
® Contact the NH State
Attorney General’s Office.
BANKING CHANGES
Like credit card companies, banks
are making small changes to the
way services are provided and the
fees charged. Some of the changes
you may see include:
• Allowing overdrafts on debit
cards and charging a fee or
increasing fees on this feature,
if you have it in place;
• Charging or increasing fees for
using ATMs out of network;
• Increasing or changing the
way late fees are calculated.
If you have a good reputation you
may be able to negotiate and you
don’t need to go to a supervisor, as
most personnel have been
authorized to make changes.
Resource: www.mint.com
GRANDMOTHERS CAN
REALLY MAKE A
DIFFERENCE
In an effort to preserve the
knowledge and skills of
grandparents, famous Irish chef
Darina Allen launched Slow Food
International Grandmother’s Day
to be celebrated every April 25.
Is Grandmother’s Day just a ploy
to persuade people to buy
grandmothers presents every
year?
“No, the goal is to create a
fraternity of grandmothers right
around the globe. The idea is that
grandmothers gather their
grandchildren and pass on the
abilities these elders have within.
Many of these are forgotten skills:
how to garden, how
to cook, how to fish.
The idea is for
grandmothers to
exchange knowledge
and strengthen bonds
with their
grandchildren.”
How did you think up the idea?
“My friend Alice Waters [a
famous Chez Panisse chef] and I
came up with the idea together.
She’s a wannabe grandmother and
I’m a grandmother six times over.
I realized how important it is for
us to pass on our cooking and
growing skills.”
What do grandmothers know that
others don’t?
“A whole generation has never
seen their mothers cook in the
kitchen because nowadays, in
most households, both partners
work, and many schools no longer
teach cooking or home economics.
Most grandmothers still have these
important life skills. They still
know how to cook, sew, sow
seeds, keep chickens.”
Do you think kids will listen to
their grandmothers about this kind
of stuff?
“Grandmothers have an
extraordinary power and influence
over kids, and so we can really
make a difference. Of course, it
depends how close the relationship
is, but kids absolutely love to
cook, peel, mix, grate, chop—
anything from pancakes to apple
pies. In my experience, children
who are involved in sowing seeds
and growing vegetables will eat
absolutely everything they grow,
even if they shivered at the
thought before.”
What exactly will change if
grandmothers pass on
their knowledge?
“There is a drastic
deterioration in the quality
of food people eat these
days. When you know
how to cook, you can whip up a
meal for family and friends at a
moment’s notice using fresh,
seasonal ingredients. It’s less
expensive, more nutritious, more
delicious. Grandmothers can also
teach the joy of sitting down
around the kitchen table again.”
And what about the grandfathers?
“We want grandfathers to
participate and especially teach
grandchildren how to fish and
garden.
Source: Ode Magazine
May 2009
HOME ENERGY COSTS
Unitil announces an online home
energy calculator: www.unitil.com
RETIREMENT INSECURITY
At the Long Term Care (LTC)
Legislative Caucus’ June 22
meeting, the NH Women’s Policy
Institute (www.nhwpi.org)
provided a presentation on issues
NH women face in retirement.
Retirement Insecurity covered
facts that are well known: women
earn less than men, are more likely
to take a leave of absence for care
giving, and often give part or all of
their savings to children and
Legislative Update
June 2009
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The average
Social Security
benefit for an
older woman is
$800 per month
grandchildren. These factors erode
the base amount on which
retirement benefits are calculated.
NH women, over age 65 who live
alone, have the lowest incomes
among the state’s older
population. Sixty-two percent
(approximately 28, 000 women)
have incomes that do NOT cover
their basic cost of living.
Based on the 2006 Livable Wage
Study, the Institute estimates that
an older woman living alone needs
about $20,000 a year to cover her
basic cost of living. The primary
source of retirement income for
most of these women is Social
Security. Yet the average benefit
for a woman age 65 and over is
about $800 a month!
Given these facts, we
can assume that older,
poorer women will
become significantly
dependent upon NH’s
public assistance
programs. For example, by the
year 2020, Medicaid can
anticipate a 46% increase in
spending to care for elder women.
That’s a cost of $351 million!
As the Caucus examines the
variety of issues coming under the
umbrella of long term care and
supports, it is critical that such
issues be considered. So often,
LTC is oversimplified to mean
medical services/care and the
related costs.
But in reality, LTC means creating
environments that support the
needs of a changing population as
it ages. The more successful we
are at creating livable and
responsive communities, and the
more we create policies that
address tangential issues, the more
we will reduce the dependency on
public assistance.

We note that Sen. Jean Shaheen
is sponsoring a bill to create case
management services for elder
persons discharged from hospital
care. The RN case managers
would monitor the post
discharge routine to insure that
the appropriate treatments were
in place. Massachusetts hospitals
have already adopted such a
policy and have had a decrease
in recidivism and inappropriate
use to emergency
rooms, saving
hospitals a great
deal of money.
Given that the nation
has a shortage of
nurses, we hope that
the use of a nurse and Social
Worker team will be considered.
Good case management is the
backbone of successful, noninstitutional
care. Social
Workers play a critical role in
education, involving families,
developing resources and
insuring that non medical
supports are also in place.

The most recent discussion
around health are reform have
begun to include LTC issues.
Most notably are the talks of
eliminating the Medicare
Advantage Plans (Medicare Part
C) and shifting the savings to
Prescription Drugs.

Another critical issue for
Medicare Prescription Drugs is
the ability to negotiate costs.
Following is a local comparison
made by an ENH Board
member.
Medication: METFORMIN

Walmart –3 months: $10 all
strengths

Costco: 100 – 500 mg. $6.99

CAREMARK 3 months
[including $4 co-pay: $37.97

TARGET--$10 all strengths
Medication: PRAVASTATIN

Walmart: 10-40 mg. $10

Costco: 100, 20-mg: $10.83

100, 40 mg: 43.44

TARGET $10

CAREMARK: $154.80
Medication: SIMVASTATIN
Walmart: N/A

Costco: 100 tabs-more than 90
day supply: $10.83

TARGET: N/A

CAREMARK: $79.34
The June 22, 2009 Boston Globe
featured an interesting article
entitled, “The Purposeful Life”.
(Are they on our mailing list?)
Based on research conducted by
Patricia A. Boyle and a team from
Rush University Medical Center in
Chicago, reported in the June 15th
issue of Psychosomatic Medicine,
older people who find meaning in
their lives have a lower risk of
dying than adults who felt their
lives had little direction. The study
Purposeful Living
Health Care Updates
June 2009
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5
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also supported that having a sense
that life has meaning also makes
for a more positive outlook.
Perhaps the most significant
finding is that the results did not
change when depressive
symptoms, neuroticism, disability,
the number of medical conditions
and income were factored in!
“Positive factors such as having a
sense of purpose in life may
provide a buffer against negative
health outcomes, particularly in
old age,” the authors wrote.
A sense of purpose does not
necessarily mean grandiose goals,
altruistic projects, or even
volunteering. It can be simple
things like caring for a pet.
How to make a difference in your
own life?

Create a phone tree and check in
daily with older friends who live
alone,

Spend time with a grandchild or
neighborhood children,

Read to someone who is home
bound, even if it’s over the
phone.
The ways to bring a sense of
meaning into life are as varied as
we are. But it begins with the
choice to assume responsibility for
asking what needs to be done.
Happy New Year! July 1, 2009
marks the beginning of the State’s
biennium budget cycle.
Many of those involved in the
process grimace while they justify
the underfunding or elimination of
services and programs that will
have a profound impact on all of
us. NH has always been frugal,
often overestimating revenues and
underestimating expenses.
But this time, things are different.
We are not an island, but part of a
global economic restructuring.
Government officials talk about
the need to reinvent departments,
be more efficient, eliminate
duplication and waste; the bottom
line is that even if we do all those
things, it might not be enough.
We still base our budgets and our
plans as if the level of federal
funding will remain constant. In
fact the Government Accounting
Office has twice pointed out that
the Medicaid Reimbursement
formula should be revised to
reduce the differences among
states for medical care coverage of
the poor, to distribute the burden
more fairly. NH was named in
both reports as a state that should
have its rate lowered.
But this is not just about health
care; Medicaid reimbursement is
also important funding for our
schools. We need to start
planning, broadly at all levels of
government for an increased need
for supports and lower levels of
public assistance.
One approach that the ENH Board
supports is focusing on livable
communities. And we are not
alone. Several organizations are
looking at long term care reform
and what is needed to create
services and supports in a
changing world.
• Seniors Count Making Seniors
Visible: Policy and Advocacy.
(livable communities issue) 603-
644-2240, Report available at
www.seniorscountnh.org
• AARP Long Term
Independence. 1-866-542-8168.
www.aarp.org/health/longtermcare
• Home Health Care Association.
Help US Choose Home is a new
public information campaign.
800-639-1949,
www.homecarenh.org.
Know of others? Please let us
know!
It is time for us to also look at
differences in access to services
and supports in NH, and how
fairly the burden is distributed.
Can we take the frugal NH way
and create models that work for all
of us?
We encourage you to become
EngAGED. Get informed. Share
what you know!
Board Notes
June 2009
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6
© 2008 EngAGING NH,
All Rights Reserved
EngAGING NH Newsletter
articles may be copied for
personal use, but proper notice of
copyright and credit to
EngAGING NH must appear on
all copies made.
This permission does not apply
to reproduction for advertising,
promotion, sale or other
commercial purposes.
Easy, cheap, good food
EGGS GOLDENROD
2 slices TOAST
2 hard boiled EGGS
White Sauce:
Heat 1 tbs. butter; add 1 tbs. flour
Add 1 cup of milk to thicken.
Add salt, pepper, onions, garlic, Worcestershire to taste
Chop egg whites and add to sauce.
Pour over toast, and crumble yolks over it all. Add left over
vegetables, or crumbled cheese as desired.
Clip & SAVE
When times are tight, you can still eat well. We are sharing a favorite
Depression era recipe from ENH board member Maida Sengupta. Do
you remember a favorite dish or comfort food? Consider sharing your
recipe with us so we can publish it.
MAKE A DIFFERENCE!
PLEASE--share this
newsletter with family,
friends, neighbors and others
in your community.
EngAGING NH
9 Eagle Drive
Bedford, NH 03110
ADDRESS
CORRECTION
REQUESTED

Long-term Care – We must be Engaged.

OPINION:
GUEST COLUMNIST OPINION:
Carol Stamatakis, Esq.
Long-term Care –
We must be Engaged
A caucus of legislators has recently
come together to work on the issue of
long-term care. I want to be hopeful, but
a little voice in me says, “Here we go
again.” One of the first tasks of the caucus
has been to pull together legislative
and other important reports going back
many years. Many of these reports conclude
the same simple facts:
People who are aging overwhelmingly
prefer to stay in their homes (or in their
communities), and the cost of home care
is on average less costly
than institutional care. So
why hasn’t more progress
been made?
Reports over the years consistently
identify the same
barriers, often described as of a lack of
“infrastructure.” Agencies claim that reimbursement
rates are so low that they
cannot attract staff. The lack of public
transportation in most communities
means that for many, the loss of a
driver's license results in painful isolation
or the “final straw” that costs an
older person their ability to live independently.
Policymakers seem to
lack the collective political will to
make the investments in a home and
community-based system that are
needed for options to be more
available. Few publicly funded supports
exist for those who are not
eligible for Medicaid, and their
needs seem to fall under the radar of
social service agencies and legislators.
At the local level vulnerable
adults are often not visible to those
who make decisions affecting quality
of life and how “livable” a community
is for those who are aging.
A number of political realities seem to
conspire against the public interest.
Nursing home care is mandated by federal
law (for States that participate in
Medicaid), but home and communitybased
supports are not. The nursing
home lobby and that of other special interests
is strong, and private citizens
cannot easily make their voices heard.
Citizens have not been well organized
politically around long-term care policy,
and many people are unaware of the realities
facing those who need long-term
supports until they are faced with a personal
crisis. Many do not realize that
private insurance and Medicare do not
cover long-term care.
In New Hampshire, the
political landscape has
been further complicated
by a recent change in how
Medicaid long-term care services are
funded. The counties now pay all of the
costs (subject to certain limitations) of
both nursing home and home and community-
based care, whereas in the past
this was a shared State-County responsibility.
While the State continues to administer
the programs, the political
May 2009
Volume 4, Issue 5
EngAGING NH NEWS
EngAGING NH
9 Eagle Drive
Bedford, NH
In Memory
David Robar
1964-2009
A friend
in advocacy.
An inspiration
for all of us.
People who are aging
overwhelmingly prefer
to stay
in their homes
May 2009
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2
reality has been that the counties
have a much stronger voice than in
the past on State policy and funding
issues.
Unfortunately, those representing
the counties' interests have not
been supportive of efforts to expand
community-based options,
focusing solely on short-term costs
without understanding the social
and economic benefits.
Real change must begin at the local
community level. Community
events focusing on long-term care
policy and the real challenges facing
older adults of all economic
means can educate policymakers
and the public alike and inspire
people to get involved.
We must not overlook our County
commissioners and other County
officials when planning local efforts.
An organized effort to educate
County officials about longterm
care issues, through people in
their own communities, could
eventually influence them to support
more responsible policies at
the State level.
One way that people in all communities
can help make a difference
is by taking the time to discuss
these issues with their
friends, organize events at their
town hall, senior center or church,
and talk with their own Senator
and representatives about the
needs and challenges facing older
people in their communities. Engaging
the public, establishing relationships
with local leaders, and
keeping the discussion going will
eventually make a difference!
Carol Stamatakis, Esq. is Director of
Planning and Policy for the NH Council
on Developmental Disabilities.
CHANGING WORLD OF AGING
To the Editor: I am deeply appreciative
of the April ’09 article by
Joanne Dodge. Her points are well
made and underscore that marginalizing
any group is a disservice to
us all. It is therefore ironic that the
repeated use of “senior” inadvertently
does just that! It demonstrates
how easily we all fall victim
to the programming. It is so
important that all people have the
opportunity to be participants in
an inclusive community,
but labels,
such as “seniors”
do more to exclude
and separate than
homogenize. Paradoxically,
like Ms.
Dodge, I want to point out the
value of older adults in part because
that boost is so badly needed
by all generation. I’m not even
sure how we go about achieving a
balance. But perhaps the first step
is to watch the words we use.
ERL
Editor’s Note: Like other minority
groups, nomenclature changes
with time. Where you find yourself
in the aging continuum may
influence your “term of art”.
ENERGY AUDITS
To the Editor: Thank you for another
great issue and in particular
the article on Home Energy Efficiency.
It was helpful and useful.
Your readers may also be interested
to know that some utility
companies provide home energy
audits at no cost to the homeowner.
New Hampshire homeowners
would be wise to contact
their local electric service providers
or fuel dealers to inquire about
their programs to promote energy
efficiency.
In the case of this reader, a contractor
for the utility company
came to our home and gave us
suggestions for reducing our energy
usage. In addition, the representative
replaced all light bulbs
with energy efficient bulbs and offered
a subsidy for replacement of
the refrigerator with a more energy
efficient model. The result was a
substantial reduction in energy
use. And there
was no cost for
the audit!
Public Service
Company of
NH may offer
audits for
homeowners who qualify and for
those who heat with electricity.
Reach them at 800-662-7764. Call
the National Grid at: 800-322-
3223, and NH Electric Coop at:
800-478-4328.
Readers will also find useful information
about making their
homes more energy efficient at:
www.repa-nh.org/consumerguide/home
energy audits.
CWD
Editor’s Note: Unitil also conducts
audits for homes heated with
electricity. We will continue to
bring you information
STATE: BUDGET GOES TO
COMMITTEE OF CONFERENCE
Legislative Updates
From Our Readers
ENH welcomes all points of
view and invites your submissions.
Send articles to:
lcamst38@peoplepc.com
May 2009
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3
The Senate Conferees have not
been officially named as of this
newsletter’s publication.
The House Conferees for HB 1
(the budget) and HB 2 (the budget
trailer bill) are:
Reps. Margie Smith -d, Sharon
Nordgren -d, Dan Eaton -d, Susan
Almy -d, & Neal Kurk -r.
Alternates for HB 1 are: Reps. Peter
Leishman -d, Benjamin
Baroody -d, & Doug Scamman -r.
Alternates for HB 2 are: Reps.
John DeJoie -d, William Hatch -d,
and Norm Major -r.
Since Republicans seem committed
to not voting for the budget,
this means that in the end, Neal
Kurk will likely be replaced
by Rep. Mary Jane Wallner or another
Democrat to get the unanimous
vote needed by the Committee
of Conference to pass the
budget and send it back for a final
up or down vote in both houses.
NH Cares
NH ARRA FUNDS
Federal stimulus money through
ARRA (American Recovery &
Reinvestment Act) will soon be
available for Medicaid services in
NH. It is currently estimated that
about $14 M will be available to
DHHS between now and FY 12
and the bulk of these funds will be
going to NH’s counties for long
term care costs. According to
Commissioner Toumpas, these
funds can be used to provide home
and community based services.
Talk to your County administrators
and Commissioners to make
certain they are aware of this important
information. This money
may help to offset anticipated cuts
to Social Service Block Grant services
such as Adult Day Care and
Homemaker.
FEDERAL: THE CLASS ACT
We've all heard that over 45 million
Americans lack health insurance
but did you know that 200
million Americans also lack long
term care insurance?
Almost every American family
will have to navigate and coordinate
a wide array of health care
and supportive services a person
needs over an extended period due
to limited functional capacity or a
chronic health care condition.
Many people think Medicare will
foot the bill, but it only covers certain
short-term needs. Unless you
have less than $2,000 in savings,
Medicaid won't help either.
In response to skyrocketing need,
Senator Edward Kennedy and
Rep. Frank Pallone introduced
The CLASS Act last March to establish
a social insurance program
to help functionally disabled
adults pay for the services and
supports they need.
According to S. 697 and HR 1721,
the CLASS Act will establish a
national insurance program, financed
by voluntary premium
payments collected through payroll
withholding (not to exceed
$30 a month) and placed in a "National
Independence Fund." People
who have contributed to the
program for a minimum of 60
months and are unable to perform
two or more activities of daily living
(ADL), such as feeding, dressing,
bathing, toileting, or walking;
or individuals who have an
equivalent cognitive disability will
be eligible to collect a benefit.
Eligibility for benefits will be determined
by state disability determination
centers on two cash
benefit tiers. Tier 1 benefits
($50/day) will be for individuals
who are unable to perform two or
more activities of daily living
(ADLs) or have the equivalent
cognitive impairment. Tier 2 benefits
($100/day) will help those
who are unable to perform four or
more ADLs or who have the
equivalent cognitive impairment.
Write to NH's congressional delegation
and let them know that affordable
access to long term care
insurance should be part of health
reform discussions! (Links to our
delegation are provided on the
next page.)
TALKING POINTS
• Our nation lacks a coordinated,
national public-private
system for adequately and efficiently
delivering highquality
long-term services and
supports in a fiscally responsible
manner. This has extreme
negative consequences for
emerging older adults, baby
boomers, and younger persons
with disabilities.
• The CLASS Act is a critical
piece in creating a new, voluntary
national insurance program
to help individuals who
need assistance stay independent
and remain in their communities.
• The CLASS Act promotes the
principles of independence,
choice, and empowerment in a
fiscally responsible way, and
amplifies nationwide discussions
about the serious longterm
care challenges we face.
May 2009
…………………………………………………………………………………………
4
• The CLASS Act should be a
part of any health care reform
conversation and legislation.
It provides a strong foundation
of protection while providing
opportunities for personal
planning that include a role for
private sector options.
WHAT CAN CONGRESS DO?
• We urge you to support S. 697
and H.R. 1721, which would
improve the lives of millions
of Americans and their families;
if you are not a cosponsor
of this legislation, we urge you
to consider becoming one.
• Support this legislation and include
it in the health care reform
package.
Alliance for Retired Americans
CONNECTING THE DOTS
Medicare Advantage Plans:
As the discussions on Health Care
Reform progress, there will be
great pressure from the health care
and related industries to minimize
profit loss. And, those who fear or
oppose a single payer system may
see Medicare as a threat.
The attempts to create a public
image of Medicare as a failure are
both overt and hidden. Medicare
Part C “Advantage Plans” Programs
are often being sold to the
healthier beneficiaries in a scheme
that some call “Cherry Picking
and Lemon Dropping”. These
plans may place restrictions on the
benefits that are associated with
long term or chronic illness, or the
out-of-pocket expenses may be
very high. The plans may drop
you if you fall into these categories.
Reading the fine print is
strongly encouraged.
When these plans were first proposed,
they were promoted as a
savings to Medicare. Later there
was pressure to pay the plans at
least the same rates as traditional
Medicare and today they receive
higher rates, 13-17% more than
the same services than the original
Medicare. All Medicare beneficiaries
pay an extra $3 per month
in their Part B premiums to subsidize
these over payments!
Not only that, but by “lemon
dropping” the sickest patients into
the traditional plan, claims can be
made that Medicare is too costly.
One proposed way to deal with the
“donut hole” in the Part D prescription
coverage would be to
eliminate overpayments to Advantage
Plans and use the savings to
fill the “hole”.
Part D Plans have not driven
down drug costs. Studies show
that 73% of seniors, 91% of pharmacists
and 92 % of doctors think
Part D is too confusing.
Is this intentional? The annual review
is so complicated that many
decide to continue plans if the
premium cost remains the same or
are slightly increased. But choosing
low or no change in premiums
may have hidden costs, including
increases in co-pays from a flat
rate to a percentage on increased
drug costs. There are a variety of
programs to help assess your particular
situation.
When that cycle comes around
again, we will provide resources.
For now, consider contacting your
congressional delegation to support
our government’s right to
bargain for bulk drug prices and to
increase our consumer rights to
change plans mid-year.
Any discussion of reforming our
health care system must include
Medicare. Decisions must not be
based on separating a system
and allowing the savings of one
part to shift to the other.
SOCIAL SECURITY:
Trustees project Social Security
will be able to pay full benefits
until the year 2037. After that,
Social Security will have sufficient
revenue to pay about 75% of
benefits. The change in short-term
projections is a fiscal problem,
not a Social Security problem.
Social Security’s trust fund surplus
is not disappearing as some
have claimed.
So here’s what’s happening. The
annual cash surpluses collected in
payroll taxes are below last year’s
projections due to the economic
downturn. (I.e. when folks are laid
off, they no longer pay into Social
Security.) Moreover, Trustees report
a healthy $2.6 trillion in accumulated
Social Security assets,
and project that, even after factoring
in the effects of the recession,
full benefits will be paid for another
28 years.
But, low inflation could mean two
years of no cost of living increases
for beneficiaries. By statute,
zero COLA’s would also
mean no Medicare Part B premium
increase for about threequarters
of all beneficiaries.
Medicare & Social
Security Update:
May 2009
…………………………………………………………………………………………
5
However, the remaining beneficiaries,
including newly enrolled
seniors and higher income seniors,
will see larger premium hikes in
Part B to cover the difference.
Premiums for Part D, the prescription
drug benefit, are not subject
to this limitation and are expected
to continue increasing by 11% annually
through 2018.
Source NCPSSM
Question: Should COLAs be based
on inflation, when the major expenses
of many beneficiaries,
food, transportation, medical care
and fuel are increasing at rates
higher than inflation?
HEART MUSCLE FINDING:
Swedish scientists have succeeded
in measuring a highly controversial
property of the human heart:
the rate at which its muscle cells
are renewed during a person’s lifetime.
The finding disputes the long
held belief that your heart is essentially
the same from birth to death-
-a most important findings in cardiovascular
medicine.
REMEMBERING DAVID
On May 24th David B. Robar, 44,
passed away due to pneumonia, a
complication of his disability. His
loss is felt deeply by his family,
friends, the disability community
and all who were graced by his
charm, wit, passionate advocacy
and dashing good looks.
At age 26, David was in a motorcycle
accident that left him paralyzed
from the chest down and unable
to move his hands. An avid
skier and jumper who had tried out
for the 1988 Winter Olympics, he
met his new challenge with the
same warrior outlook. “I'm still a
full human being and I can still
make a difference.” When first injured,
he said, “My life will be different,
but my life will be good."
Despite the enormity of his situation,
he indeed did make a difference.
For 17 years he worked at
Granite State Independent Living,
edited the non-profit's newsletter,
coordinated events and was a passionate
advocate. While working
on a contest for adaptive technologies
he met Dean Kamen and
became an early tester for the inventor's
iBOT wheelchair, a
predecessor to the Segway. More
than just a wheelchair, the iBOT
allows users to reach high shelves,
climb up and down staircases, and
cross uneven terrain.
As a politically involved advocate,
he worked to pass a law that allows
adults with disabilities to
work and keep their Medicaid
benefits. In today’s high tech
world, jobs are different from
those when Medicaid rules were
written. Even the most severely
disabled may be gainfully employed,
fully participating members
of society.
But in a ‘Catch 22’, the financial
gain could make them ineligible
for Medicaid and unable to cover
the cost of the care needed in order
for them to work. This denied
people who could and wanted to
work that option. He spoke with
Bill Clinton about the issue at a
roundtable during the president's
second term. When speaking in
support of changing the law, Clinton
often used David’s story!
David spoke about that desire to
work and his need for assistance at
the 2000 Democratic National
Convention. When the Federal law
changed and states could follow,
David’s dream came true. In 2001,
he was present when Gov. Shaheen
signed this important change
into New Hampshire law.
On a more personal level he would
meet with individuals who had recently
suffered spinal cord injuries.
While acknowledging their
difficulties, chronic pain and chal-
Purposeful Living
Rep. Paul Hodes (D)
1317 Longworth House Office
Building
Washington, D.C. 20515
Phone: (202) 225-5206
Website link:
Rep. Hodes' website
Rep. Carol Shea-Porter (D)
1330 Longworth HOB
Washington, DC 20515
Phone: (202) 225-5456
Website link:
Rep. Shea-Porter's website
Sen. Judd Gregg (R)
201 Russell Senate Office Bldg
Washington, DC 20510
Main: (202) 224-3324.
Website link:
Sen. Gregg's website
Senator Jeanne Shaheen (D)
520 Hart Senate Office Building
Washington, DC20510
Ph: (202) 224-2841
Website link:
Sen. Shaheen's website
Health & Wellness
May 2009
…………………………………………………………………………………………
6
lenges, he was a role model for
living a life full of purpose. His
gentle encouragement and presence
saved many from the downward
spiral of hopelessness.
I remember the last time I saw
David. It was at a meeting about
long term care services and long
after the meeting was over, we
were still venting in the hallway.
On the way to the parking lot, I
pushed on the bar to open the door
and walked through leaving David
behind me. He called my name
and softly said, “Ah, could you get
the door for me?” Shocked and
dismayed at my behavior I blurted
out an apology and he grinned and
said, “I took it as a compliment
that you forgot I was disabled.”
It’s true. I had forgotten as I often
did, because all I saw was a remarkable
person. And that is the
way I will always remember him.
Carol Currier
Kudos
ENH Board member Beverly Arel
was recently recognized for her
outstanding work as an elder advocate.
She was chosen as the
Hillsborough County Older Volunteer
and presented with the
Vaughan Award by Governor
John Lynch this past May.
ONGOING ADVOCACY
Few NH adults aren’t aware of the
fiscal crisis facing our State government,
or for that matter, our local
governments.
ENH NH Board members participate
in a number of groups including
the Elder Rights Commission,
the Legislative Caucus on Long
Term Care, the DHHS Long Term
Care Stakeholders and NH Cares
to name a few. What we are hearing
from these groups leaves us
deeply concerned. While the Bureau
of Elderly and Adult Services
through their listening sessions
confirms what we have known for
years--people want to age in place
at home or in their communities--
much of what we hear makes that
seem like an impossible dream.
From the LTC Ombudsman’s Office
we learned that more nursing
homes are beginning to feel
stressed and may eventually need
to reduce services or in the worse
case scenario, close. When homes
are talking about feeding residents
for $2.16 per day, things are bad.
From the Home Health Care Association
we hear that many of the
non-profit agencies just simply
can’t provide services under the
rates paid for by State programs.
So some areas of the state are now
underserved.
And further, the Senate cut all the
funds from the senior volunteer
programs (Foster Grandparents,
Senior Companions and RSVP).
Without even a dollar appropriation,
they are no longer part of the
Senate Budget. Serving 700 families,
these programs did much to
promote volunteerism and foster
intergenerational relationships.
The state’s cost of $320,000
brings $1.8M into NH.
NH, tied with FL, has the 4th oldest
population in the country. We
are concerned that the infrastructure
is crumbling and that there is
no Statewide planning for the inevitable.
Service providers will turn to
those who can afford to pay higher
rates, even in the short term. A
Long Term Care System will
emerge, market driven, expensive
and inadequate. We must look beyond
Medicaid and other funding
sources. We must consider both
medical and supportive needs. We
must build relationships amongst
various pilots, programs, volunteers
and people of all ages.
Since the newsletter is our main
tool for communicating, linking,
and sharing, we hope to expand
regular features. We welcome
your suggestions and comments.
Starting next month we will begin
a feature on shopping and cooking
food. And here’s a thought:
Many people who live alone find
it difficult to cook for just one.
Here’s a spin on the dinner part
idea: Why not get together a couple
of single people you know and
rotate nights for sharing a meal.
And don’t forget those younger
single friends.
MAKE A DIFFERENCE!
PLEASE--share this newsletter
with family, friends, neighbors
and others in your community.
Board Notes
Join Our Voices!
To add your name to our
mailing list, contact:
lcamst38@peoplepc.com

The Changing World

GUEST COLUMNIST OPINION:
Joanne Dodge
The Changing World
of Aging
One size doesn’t fit all. Unfortunately, with all good intentions, we seem to want to look upon our senior population that way. It would make the lives of caregivers and medical practitioners so much easier. Trying to explain to someone the mistake we too often make in talking about seniors, I put my hands together and said, “This represents babies and little children and how they are so much alike. Then I threw my arms wide and said, “This represents all of our adult life, the differences, the talents, the ideas, the interests.” Once again I held my hands together and said, “And this represents how society sees seniors today. But we aren’t all alike. We have different interests, beliefs, and talents.
Once, and sometimes twice a year, there is a performance at a local church starring residents of the County Nursing Home, three assisted living homes and Dearborn Senior Housing in Hampton. Months of preparation with the help of supportive staff make this possible. On the day of the performance, the vans roll into the parking lot and the wheelchairs roll off. Families are there, some with flowers. And the tears roll down!) The world should be there to see what can happen when seniors are given a chance.
In recent years, with seniors living longer and the cost of nursing home rising, “home based care” has been the answer. “Keep seniors in their own homes”, often followed by “where they want to be”. But nobody actually asks the seniors what they want or where they want to be. Is home based care a way to avoid the high cost of nursing home care for the counties? I wonder. Is it the best solution for seniors? I wonder even harder. Having a home health care aid come in and help Mr. Smith bath and dress, then leave him alone until evening when the whole routine is reversed isn’t what all seniors would want. Meals on Wheels stops by to deliver lunch but there’s no time for chatting. For too many who are living that way, extreme loneliness, depression and safety issues can be major problems.
And all around us in every community, senior facilities are being built. Some have assisted living on one side and independent living on the other. There are wonderful meals and bus rides to all sorts of events. The activity room is buzzing with crafts and entertainment. Everything one could possibly want is under one roof. But it is far too expensive for many seniors.
The whole world of aging has changed. Not that long ago, people died in their 70’s. The remaining spouse packed up and moved in with one of the kids--A simple solution that doesn’t work anymore. Wives are working and can no longer stay home and take care of Grandmother. We are living longer and are far more active. Many who are caregivers to their parents are starting to need some care themselves. This is a real dilemma for those in the caregiving field. The growing needs are outpacing the recourses.
“Keep them in their own homes. That’s what they want.” An easy solution, but not always the right one. We aren’t all helpless. We can be stubborn and sometimes frustrating. We still have much
to give. Shutting us out is a major loss to the community. Helping with mailings, making phone calls to other shut-ins, reading to children, and so much more can be very ably handled, even by someone in a wheelchair. Believe it or not, we don’t all like to play bingo!
So, let’s call a summit on aging and invite those seniors who are caught up in this situation. Not the “healthy/wealthy”, not caregivers who want to speak for seniors, just the real people who are at the center of this issue. Others can come and watch and listen but let this be just for the seniors who are at the core of the “problem”. Serve a great meal and I’ll bet you’ll fill the house.
For over 10 years, Joanne Dodge has encouraged seniors, living in nursing and rehab facilities, to write and act and laugh with each other and encouraging the rest of the world to pay attention.



SOCIAL SECURITY TRUST FUND:
Thanks for another great issue (March ’09). I appreciate CWD’s response to my article. However, I must disagree on one point.
Without change, the Trust Fund will eventually run out of money, but Social Security will still take in enough in payroll taxes to meet most of its obligations.
The question is “how to make up this shortfall”, NOT, “how to save the system”. Please note that CWD did not misconstrue this point in her letter.
I agree that we don’t need to reduce benefits or increase the retirement age. I believe that the Ball-Altman plan http://tiny.cc/NSDsz provides a reasonable blueprint for addressing these issues.
Steve Gorin



HOME ENERGY EFFICIENCY
The cost of heating oil this coming 09/10 season is expected to rise, so a pre-buy arrangement continues to be an advisable consideration. But, of greater concern is the heat loss that most of our older homes experience. Research shows that there is greater carbon footprint from our homes than from our cars!
As previously reported, energy audits cost between $250 and $500 on average. However, if you heat with electricity, your utility company may perform the audit for free.
Federal stimulus money is available for weatherization to income qualified households. The Office of Energy and Planning can provide you with the latest information. (www.nh.gov/oep)
Despite the increase in advertising around replacement windows, it isn’t necessarily the top priority in improvements. In many of our older NE homes, insulation may be a bigger concern. While there are differing points of view on the pros and cons of various materials, cellulose appears to be somewhat more efficient. Qualified audit professionals can help you evaluate choices.
BACK YARD FUEL CELLS
Japan, Korea, Germany and Denmark are among the countries experimenting with installing back yard home fuel cells to generate electricity. Japan has installed cells in some 3,000 houses and has seen a drop in both electrical demands and CO2 emissions.
Canada and Japan are working with Ballard Power of Canada to install fuel cells on some 20 buses that will be used in the 2010 Winter Olympics.

Weatherization:
www.nh.gov/oep
Free Cell Phones:
Free cell phones and services provided to qualified individuals, particularly food stamps or Medicaid recipients.
www.safelinkwireless.com
Telephone Shortcuts:
Dial 2-1-1 for telephone assistance to find health and human services help in NH.
For emergencies, Dial 9-1-1.


The forecasts, by the Obama administration and the Congressional Budget Office, indicate that Social Security beneficiaries will not receive any cost-of-living (COLA) increases in 2010 or in 2011.
The COLA is intended to preserve the purchasing power of Social Security, by increasing benefits to keep pace with consumer prices. In the last year, overall inflation has been low, largely because of the economic downturn and a decline in energy prices.
A freeze in Social Security benefits would have major implications for Medicare because the COLA, in effect, puts a cap on premiums for Part B of Medicare, which covers doctors’ services.
If there is no cost-of-living adjustment for Social Security, about three-fourths of beneficiaries will not see any change in their basic Part B premiums, federal officials said.
But some beneficiaries do not have this protection and could face substantial increases in their Part B premiums. In addition, millions of beneficiaries could see higher premiums for drug coverage, provided under Medicare Part D.
Social Security and Medicare trustees will describe the outlook for benefits and premiums in their annual reports this month.
Source NY Times


DEMENTIA AND MUSIC:
Researchers and clinician findings show that when all other means of communication have shut down, people remember and respond to music. Familiar songs can help people with dementia relate to others, move more easily and experience joy. “Tom” had forgotten his name and couldn’t utter one word, but hearing Sinatra prompted him to dance!
Alicia Clair, University of Kansas, noted that Alzheimer’s is retrograde: “Things fall off in the opposite order from the way they were acquired.” So if someone sang to you as a baby, before you even knew words, you’ll respond to music after words are gone.
Music memory is preserved better than verbal memory, according to Ms. Clair, because music, unlike language, is not seated in a specific area of the brain but processed across many parts. “You can’t rub out music unless the brain is completely gone.”
Further, learning to play an instrument, if you are not already a musician, helps to build new neuron pathways, exercises the brain and may delay dementia onset.
PETS:
Research shows that people who have feline pets are 40% less likely to die from heart attacks than non-cat owners. Dogs do not provide quite the same benefit, but owning a pet in general is seen as beneficial. A California study showed that owning a pet reduces the risk of developing non-Hodgkins lymphoma, while fish tanks help focus people with Alzheimer’s.
Source: Boston Globe
We, in NH are rightfully proud of the influence we have in our national primary process. But did you know that a well know elder program has it’s roots in NH?
Marty P. Knowlton, a world traveler fought ageism by cofounding Elderhostel at the University of New Hampshire, a program that pioneered learning vacations for mature adults,
When he was about 50, Marty became annoyed by two things-- the prevailing wisdom that "as you got older your mind automatically began to fail" and the government notifying him that "old age begins at 55".
A self-described hippie--although he was born in 1920 in Texas and fought during World War II in the Philippines--Marty decided to grab his rucksack and challenge such notions of aging.
For the next four years, he traveled through Europe, mainly on foot, and stayed in youth hostels. He recalled being struck in the early 1970s by the number of Europeans well into their 80s who remained active.
After returning, Marty was director of a youth hostel program at the University of New Hampshire, where David Bianco was residential life director. The pair were mulling nontraditional educational approaches in 1974 when they hit upon the idea of serving older students who could fill unused dorms in summer.
The term “elderhostel” came to David when he saw the white-bearded Marty sitting on a porch beneath a “youth hostel” sign.
“It was a very unusual juxtaposition,” David said. “You couldn't look any more like an elderhosteler than Marty.”
The program was started in summer 1975 on five college campuses in New Hampshire. Six people enrolled in the first session on local and oral history and the Old Testament book of Job.
“Marty liked to call them the six apostles," David said, "because those six people spread the word and started us on a spectacular adventure.”
Initially, Elderhostel's minimum age for participants was 60, but it was lowered to 55. “From the very beginning, we've had people lie about their age to get in,” Marty said. “It's always tickled us, but it's also a good measure that the product is good.”
By 1977, Elderhostel had turned into a nonprofit that contracted with academic institutions but was affiliated with none in particular. Marty and his cofounder stepped away from the organization.
“I rode that horse a couple of years, then jumped to save my life,” Marty told the Los Angeles Times in 1995.
Eventually, Elderhostel, which is now based in Boston, grew into an international enterprise. More than 4 million people have experienced its programs.
“Marty Knowlton was an extraordinary, dynamic, unconventional man - truly one-of-a-kind in his vision of the world and of how people could make a difference,” said James Moses, president of Elderhostel.
After Marty moved to Ventura, about 50 miles northwest of Los Angeles, in the early 1990s, he and David launched the Center for Studies of the Future, an Elderhostel affiliate.
Marty died of natural causes on March 12, 2009 at a nursing home in Ventura. He was 88.
Source LA Times
Just what is Long Term Care (LTC)? More often than not people will jump to nursing home care as the response. Given some time, and depending on personal experience, they may add in Assisted Living, Continuing Care Retirement Communities, Home Health Care, Visiting Nurse, and Personal Care Services. And certainly, this is one aspect of Long Term Care, one that is driven by the need for complex or complicated medical care. But let’s take a step back.
What happens before most people get to this level of need? More often than not, problems begin when there is a decline in a person’s ability to handle all the responsibilities of living independently.
It may be hard to find reliable repair people and routine home maintenance slips. Paying bills may become more confusing. Isolation can occur. Nutrition and fitness get less attention until the accumulate affect kicks in. And there can be pressure from children, to “be safe” - move.
Around the country, communities are cropping up called “Villages”. Appealing to individuals with an independent streak, these villages and their services are based on the needs and choices of their members, who pays a fee to join.
“I’ve never had to rely on other people, and I never wanted to,” Ms. Spiro of the Capital Hill Village said. “But I’d rather pay a fee than have to ask favors.”
What can the NH’s LTC Caucus learn from all of this?
• We do have to address a medical model; and
• Seniors can and should be called on to design local solutions.
NH’s medical model approach to LTC is more or less in place. There could be improvements, better public awareness, improved access and workforce recruiting, but the framework is there. But these services and supports have been shaped by public funding, chronic disease/conditions and the political influence of providers.
What we don’t have in NH is a plan that clearly defines the continuum of LTC needs, beginning with prevention at the community level. Such a plan needs to tackles short and long term goals and build on individual and community strengths. EngAGING NH is now working with other elder advocates to help our legislators draft a LTC plan.
But we need your help. Without significant consumer input from rest of us, a medical model could prevail as THE view of LTC.
What do you want to see? Send your suggestions to any of the following:
LTC Caucus Chair: Kate Miller
katemiller@metrocast.net
Contacting your own State house legislators (find my legislator):
http://www.gencourt.state.nh.us/house/members/wml.aspx
EngAGING NH board members who regularly attend:
Carol Currier: lcamst38@peoplepc.com
Barbara Salvatore:
bsalv@hotmail.com
Or consider attending one of the meetings. The next LTC Caucus meeting is scheduled for Monday, May 18 at 3 pm in room 205 of the Legislative Office Building in Concord.
“Almost all profound, pervasive and persistent challenges we face in our lives, our organizations, and our world can be solved. They can be solved because these challenges don’t require solutions that defy the laws of nature; they require people to act differently. “ (The Influencer)

Join Our Voices!
Since the newsletter is our main tool for communicating, linking, and sharing, we hope to expand regular features. We welcome suggestions and comments from our readers.
If the issues addressed here and other local, state and/or national issues concern you, think about getting together a small group of like-minded people to discuss them. Think about how you might, individually or together, address them. Have ideas? Share your ideas with us.

An “Elevator Talk”

GUEST COLUMNIST

Who says no one reads the newspaper?
After writing an article where I
revealed some of my “aging secrets”, I
have had some very interesting
conversations and several invitations
to speak to groups – creating
somewhat of a challenge.
Can I condense years of experience
and research into a ten-minute talk on
the complexities of aging? There are
so many issues of economics, politics,
medicine and maladies, as well as
advice about nutrition, exercise,
volunteerism and spirituality that I
could write a book or teach a course.
Actually, I have done that already, but
all that knowledge base transmits to a
pretty simple formula I call The Aging
Self-Fulfilling Prophecy, which I will
use for my “elevator give my talks.
I begin with a handout silhouette of a
woman entitled “What Do You See?”
The reverse image may be viewed as
either an old hag or a beauty queen.
Then I tell a tale of two wolves passed
on by an old Cherokee chief to his
grandson about a battle that goes on
inside people. He said, "My son, the
battle is between 2 wolves. One is
Evil. It is anger, envy, sorrow, regret,
greed, arrogance, self-pity, guilt,
resentment, inferiority, lies, false
pride, superiority, and ego. The other
is Good. It is joy, peace, love, hope,
serenity, humility, kindness,
benevolence, empathy, generosity,
truth, compassion and faith."
The grandson sat by the fire thinking
about it for a long time and then finally
asked his grandfather, "Which wolf wins?”
The old Cherokee simply replied, "The
one you feed." And so it is with one’s
perspective on aging.
At a recent family gathering in the hills of
Vermont, my sister, upon reading the my
article, found meaning in the quote of my
outlook: “When you are looking from the
inside out, you don’t see the wrinkles;
your body begins to break down over time,
but if you have the spirit to stay on top of
that, you can live to a ripe old age with a
high quality of life”.
When a young person once asked me how
I felt about being old, I was delighted to
have the opportunity to teach a little about
the difference between aging and “getting
old”. Decisions we make earlier in life
have an impact on our older age so it is
important for all of us, but especially
young people to think and act with aging
in mind. It matters what you take into your
body, mind, and spirit at any age, but
practicing healthy fitness at a young age is
an investment in one’s future.
The results of an 80-year Harvard Adult
Development study of the physical and
emotional lives of 824 men and women,
begun in the 1920’s on folks from their
teen years into their eighties, verify that
we control how well we age. The study
director, Dr. George Vaillant, records his
findings in the book Aging Well:
Surprising Guideposts to a Happier Life
from the Landmark Harvard Study of
Adult Development (Little/Brown 2002).
It comes as no surprise to me that there is
no magic in his “secrets to a long happy
life”, because the seven keys to aging well
are already on my list:
• Not Smoking or Quitting Early
• The Ability to Take Life’s Ups and
Downs in Stride
March 2009
Volume 4, Issue 3
EngAGING NH NEWS
EngAGING NH
9 Eagle Drive
Bedford, NH
March 2009
…………………………………………………………………………………………
2
• Absence of Alcohol Abuse
• Healthy Weight
• Solid Marriage
• Physical Activity
• Years of Education
The Harvard study concludes with
a powerful aging wellness
challenge –“living with a full heart
is vital to successful aging. This
means that you open your heart to
the world and everyone in it;
hoping and planning for the
future; being grateful, forgiving
and optimistic; being empathetic,
that is having the ability to see the
world as it seems to the other
person; and having the capacity to
reach out to do things with other
people”.
We are all role models and need to
think about our own philosophy of
aging. For me, the gift of older age
is that I am very comfortable and
confident with my life. I don’t
despair over that old person that
lives in my mirror, but embrace
the aging outlook of an
anonymous email writer:
”I would never trade my amazing
friends, my wonderful life, my
loving family for less gray hair or
a flatter belly. As I've aged, I've
become kinder to myself, and less
critical of myself. I've become my
own friend. I don't chide myself
for overeating or other extravagant
behavior. I have seen too many
dear friends leave this world too
soon, before they understood the
great freedom that comes with
aging. Old age is a gift - I like
being old. It has set me free. I like
the person I have become. I am
not going to live forever, but while
I am still here, I will not waste
time lamenting what could have
been, or worrying about what will
be. And now I can eat dessert
every single day!”
Guest Columnist Owen R.
Houghton is a geriatric
consultant, a member of the
Monadnock Senior Advocates and
Chair of the NH State Committee
on Aging. His regular column in
the Keene Sentinel focuses on
issues of aging well. Contact him
at: nohoughton@myfairpoint.net
Social Security Solvent
To the Editor:
Thank you for the very
informative article on Social
Security in your February 2009
ENH newsletter. Professor Gorin
is to be commended for helping us
to better understand that the crisis
in the Social Security program is
largely manufactured.
However, it does seem important
to clarify that the Social Security
Trust Fund will not run out of
money in 2049. At that time, the
Fund may be able to meet only
84% of its obligations. This
projection is based on certain
assumptions that may be faulty,
namely that there will be a
reduction in the number of
workers paying in to the system.
These assumptions do not account
for immigration, nor do they allow
for an increase in the birth rate.
In any event, there are reasonable
solutions available to address the
issue. These include taxing all
wages, including those above
$90,000 per year; including all
workers in the program; imposing
a slight increase in the
contribution rate for both
employers and employees; and
changing the formula for
calculating the annual cost of
living increase.
(http://tiny.cc/NSDsz) None
involve a reduction in benefits.
I hope that these notes are helpful
to our readers.
CWD
Home Heating Costs
It is expect that heating season,
2008-'09, prices will continue to
rise next fall and winter for 2009-
'10. Estimates range from $2.75 to
$3.25. Unfortunately, as the
economy improves, oil prices will
go higher. Last season, dealers
took a beating during the days of
$4.70 pre-buys. Therefore they are
drastically tightening up their
contracts. Look over your
proposed pre-buy contracts closely
before signing; once you sign, you
are probably locked in.
Weatherization
The Office of Energy and
Planning (OEP) announced the
availability of stimulus money to
assist with weatherization. For
details go to www.nh.gov/oep. We
will continue to monitor and bring
you updates.
News You Can Use
PLEASE NOTE:
ENH welcomes all points of
view and invites you to
submit your thoughts to:
lcamst38@peoplepc.com
Your Letters
March 2009
…………………………………………………………………………………………
3
Social Security Stimulus
Individuals receiving Social
Security (including disability
payments), Supplemental Security
Income (SSI), Railroad Retirement
Act benefits, and Veterans
Administration benefits are
eligible for a $250 stimulus
payment. A person meeting the
criteria for more than one type of
stimulus payment will receive
only one.
If both partners of a married
couple are receiving benefits, each
will receive a check. The checks
will be sent automatically by the
agencies. Delivery is expected to
be completed by the end of May
2009, although they are apparently
ahead of schedule at this time.
NOTE: Working individuals
are eligible for a $400 payment.
Therefore, seniors who also
receive Social Security benefits
are advised to ask their payroll
departments to change their
withholding so it reflects only
$150. ($400 tax credit - $250
check + $150 withholding)
Time Banking/Antrim
You may have seen the coverage
of the ‘Time Banking” on
WMUR’s Chronicle last week.
The citizens of Antrim are
participating in a project of
donating their skills into a pool of
services.
Skills may professional or not.
Pet sitting, errands, drive someone
to an appointment, roofing,
carpentry, etc—all have equal
value in this Bank. An hour given
is an hour earned.
This idea has been around for
awhile, known as the “Time
Dollar” program. Now is a great
time to encourage such efforts!
Is your group or community
involved in a project that helps
people to remain in their homes?
Tells us about it!
Eyeglasses
AAA members may receive a
discount on glasses from Lens
Crafters. Be sure to ask if you are
eligible.
Blood Sugar & Forgetfulness
“Senior Moments” the term we
toss around to cover those times
when we just can’t seem to
remember what we going to say or
where we put those keys is just a
sign of the aging brain. Another
aging fact is that blood sugar
levels tend to rise.
Researchers using MRI scans
reviewed the images of 181
subjects age 65 and older with no
history of dementia. They found
that elevated sugar levels impaired
the function of that section of the
brain associated with memory.
The body’s ability to breakdown
blood glucose is connected to the
amount of exercise. Once again,
diet and exercise are key factors in
overall health, regardless of age.
Herbs and Bacteria
A derivative of coconut oil known
as Lauricidin has been shown to
inactivate harmful bacteria in the
body without affecting the good.
Approved by the FDA it is being
used to treat a number of bacterial
infection related diseases
including oral and genital herpes,
Epstein-Barr, Chronic Fatigue,
Mono, HIV, Hepatitis C, measles,
influenza, leukemia and MRSA.
Long Term Care Cause
Created
HB 380 Establishing a Long Term
Care Commission was tabled and
replaced by the establishment of a
caucus. The Caucus, chaired by
Rep. Kate Miller, met March 31
and got off to a promising start.
Summit participants Rep. Alida
Millham (Guilford) and Rep.
James Pilliod (Belmont) attended
the organizational meeting. Other
representatives in attendance
included Joan Schultz (Nashua),
Tom Donovan (Claremont), Cindy
Rosenthal (Nashua), and John
Cebrowski (Bedford). If a
representative from your area did
not attend, please let them know
about this crucial effort.
ENH was represented by Board
Members Carol Currier and
Barbara Salvatore. In addition,
summit participants Judy Pilliod
and Tim Gormley and summit
organizers Michelle Winchester,
JD, Carol Stamatakis, JD, and
Judith Jones, JD provided
suggestions and guidance to the
discussion.
Open to the public, the next
meeting is scheduled for Monday,
April 20 at 3pm in room 205 of
the Legislative Office Building. A
Health & Wellness
Community Updates
Legislative Updates
March 2009
…………………………………………………………………………………………
4
special thanks to Rep. Miller for
her efforts to address this
important issue.
THE BIRDMAN
When I mention ‘The Birdman’
some of you will immediately
think of Steve the Birdman from
the Wild Bird Depot who is our
local expert on our feathered
friends. Those of you who are
musical and who are old enough
will think of the great jazz alto
saxophonist Charlie Parker who
Flo Cummins (our local Queen of
Real Estate) knew very well.
Those of you who are basketball
minded probably think of the
Celtic’s Great -- Larry Bird. It’s
Larry who I have in mind.
Larry was an unusual player in
that although he was not the
tallest, the fastest, the biggest, or
the fanciest player on the court ---
many of us still considered him to
be the best player out there. When
asked what made him so great –
Larry would answer that it was
because he always went to where
he knew the ball was going to go.
It was as though Larry was always
seeing 3 seconds into the future. In
basketball those 3 seconds are the
difference between being good
and being great!
Recently, I was a Panelist at
Eldercare 2009, a conference for
families and older adults called.
My job was to address Aging
Issues and Trends, but instead of
focusing on the laundry list of
changes happening, I used the
time to get people thinking about
“Why” things are changing the
way that they are.
We have come to what Malcom
Gladwell calls a “Tipping Point”.
Think of an old fashion roller
coaster where the cars are slowly
raised to the top and once that top
is crested – they go flying down!
Right now we are approaching the
top–and soon changes are going to
come fast and furious– but not for
the reasons that you might think.
Historically, the older generation
set the standards for expectations
that following generations would
then in turn change and adjust.
Those days are gone! The days of
incremental change in the
retirement world
are gone! Today
we are getting a
look over the top
of that roller
coaster; today a
Larry Bird is
looking ahead and
seeing not more
of the same, but
something very different. Once we
get to that ‘tipping point’ nothing
will be the same.
The huge numbers of Baby
Boomers are some 15 years away
from moving to retirement
communities, but they are shaping
the decisions that their parents are
making today! The Boomers are
demanding that the retirement
world provide their parents with
what the Boomers are going to
want for themselves. Instead of a
gradual change, we are going to
have wholesale change and we are
going to have it in a hurry.
As a society, we have moved from
defensive retirement–based on the
needs of retirement age people to
provide security for health
problems and financial protection–
to one that is proactive–driven by
the desire to not only protect, but
to enhance one’s lifestyle in a
financially conservative manner.
This is a very big change. At the
Conference a gentleman, who I
guess is a lot closer to 90 than I
am to 40, stopped by to talk. Here
was a guy who clearly had a
number of significant medical
problems. Even though he was
interested in retirement
communities he never asked one
question about healthcare support
or special services. He was only
interested in
learning what was
available in the
form of intellectual
activity! He knew
how manage his
physical problems;
he was interested
in knowing about
what kinds of
things would be
available to help keep himself
active, socially and intellectually.
He wanted to know about
language courses and book clubs
and not about special diets.
This is a great guy, and a great
example of how people are
looking for very different things
today, than they were just a couple
of years ago. The Boomers are
shaping the face of not only their
own retirement, but the face of
their own parents’ retirement as
well and it is happening faster than
any of us dared to predict.
Being a Boomer myself, I think
that it is a wonderful thing. For too
long, retirement has been focused
We have truly reached
a ‘tipping point’ that
means that not only
will the future be
different, but that it
will be suddenly and
dramatically different.
Purposeful Living
March 2009
…………………………………………………………………………………………
5
on how to protect oneself from
inevitable decline, instead of
focusing on the truly unlimited
opportunities that abound.
Retirement isn’t about grabbing a
seat in God’s Waiting Room; it is
about putting yourself in a
situation to grow, to learn, to serve
and to have fun.
So let me take a Larry Bird
perspective and say that in order to
meet the needs of the future, we
need to go where the ball is going
and not where it is or has been.
We have truly reached a ‘tipping
point’ that means that not only
will the future be different, but
that it will be suddenly and
dramatically different.
Hold on tight because the ride is
just starting to get interesting. Age
Well.
Howard Chandler has worked in
elder services for over 35 years
and is Vice-President of Meredith
Bay Colony Club along with being
a Partner of White Mountain
Eldercare Solutions. Your
comments are always appreciated.
chandler@metrocast.net
No matter where you look these
days you will see books and
articles on how to create change in
your life. What they all seem to
have in common is a progression
of stages that begins with
identifying what you don’t want.
(Some call this the
revolting/revolution stage). The
second stage is to know what you
do want (clearly and precisely
stated), and the third stage is the
“saboteur”. We’ve all been there;
think about one thing that you
want and 5 things pop up as to
why it can’t be.
Or in the case of the legislative
process, need it, want it, can’t
afford it.
At the Long Term Care Caucus
meeting, chair Rep. Kate Miller
asked if a long term care system
included services and supports in
addition to medical care. This is
an excellent question, and perhaps
the most critical issue on the table.
The Time Banking project in
Antrim is a perfect example of
how local efforts can become the
backbone of a support network
that is part of a long term care
initiative without becoming a
financial burden to the State
budget. Of course we need to look
at the medical and related
systems/structures that serve an
aging population. But we also
need to move beyond the Saboteur
stage into ways that investigate
what we can do together to create
and sustain livable communities
for all citizens.
Participants in the Summit
indicated several issues affecting
all NH residents, but the one issue
everyone agreed that they would
be willing to work on was just
that—the commuity. As we go
through this process with the
caucus, make your voice heard.
Let us know how we can best
represent you.
This newsletter is our main tool
for communicating, linking, and
sharing. We continue to expand
regular features. We welcome
suggestions and comments from
our readers on what they find most
helpful. Guest editorials and
reader’s letter’s are welcome.
If the issues addressed here and
other local, state and/or national
issues concern you, think about
getting together a small group of
like-minded people to discuss
them. Think about how you might,
individually or together, address
them. Consider sharing your ideas
with us. You can make a
difference!
And, PLEASE--share this
newsletter with family, friends,
neighbors and others in your
community.
Board Notes
To add your name to our
newsletter mailing list,
contact
lcamst38@peoplepc.com.
Join Our Voices!
© 2008 EngAGING NH,
All Rights Reserved
EngAGING NH Newsletter
articles may be copied for
personal use, but proper notice of
copyright and credit to
EngAGING NH must appear on
all copies made.
This permission does not apply
to reproduction for advertising,
promotion, sale or other
commercial purposes.

CHANGE ISN’T COMING IT’S HERE!

Don’t Buy the
Entitlement Crisis
By Steve Gorin, Ph.D., MSW
In recent years, numerous commentators, pundits and politicians have argued that the US faces a looming fiscal crisis, driven to a large extent by entitlements, particularly Social Security and Medicare. The solution to this crisis, so the argument goes, is to slow the rate of growth in Social Security and Medicare (http://tiny.cc/VuaPJ). While there is a grain of truth in the entitlement crisis argument, it is only a grain, and a small one at that.
Proposals to cut Social Security benefits are misguided for at least two reasons. First, the program is not in crisis. According to the Congressional Budget Office, the Social Security Trust Fund will not run out of money until 2049; at this point it will still take in enough in taxes to meet 84 percent of its obligations (http://tiny.cc/N6Qy9). This is an issue but hardly an imminent or insurmountable one. (For a sensible approach to addressing the problem, see the proposal by Robert Ball and Nancy Altman (http://tiny.cc/NSDsz). Second, cutting benefits, or even the threat of doing so, would likely deter consumer spending at a time when the economy desperately needs it and prolong the current recession
The grain of truth in the entitlement crisis argument is that Medicare costs have increased rapidly in recent years and, in the absence of change, will continue to accelerate (http://tiny.cc/z7ITZ). However, it is important to put this into perspective. Since 1983, when Medicare’s prospective payment system was introduced, it has had a better record controlling average annual per-enrollee spending growth than private plans (http://tiny.cc/qaRVy). The real crisis is not with Medicare but our health care system generally (http://tiny.cc/5dKqg).
How should we address this? My first choice would be through a single-payer system, such as Medicare. However, I have reluctantly concluded that this is not possible politically.
During the campaign, President Obama proposed an approach that would force regulated competition between private plans and a new public option, like Medicare, which would be open to anyone (http://tiny.cc/KkD7A).
I believe this offers our best hope for reforming our system and reducing costs and perhaps eventually leading to a single-payer system.
Stephen Gorin, a social worker and professor of social work at Plymouth State University. He is a co-founder and incorporator of EngAGING NH. Any views expressed are his own.






Home Heating Fuel Update
Oil, credit: $2.177/gal
Propane, credit: $2.750/gal
Kerosene, credit: $2.872/gal
Electricity: $0.16441/kwh
Natural Gas, first tier:
$1.4098/therm
Natural Gas, second tier:
$1.2692/therm
Gasoline, self-serve regular:
$1.864/gal
Diesel: $2.319/gal
Source: OEP 3/9/09
There is an expectation that despite the global economic situation, demand will continue to drive the cost of home heating fuel up. It may therefore be wise to consider joining a purchasing cooperative, using pre-buy options and to consider ways to make your home more energy efficient.
Home Energy Audits generally cost between $200 and $500. Your local utility provider can assist with a home audit. Other resources include:
Information on audits, weatherization, tax credits including Renewable Energy, solar, geothermo and wind projects. www.energystar.gov
For information on weatherization including eligibility for assistance, check the Office of Energy and Planning www.nh.gov/oep
The New Hampshire Residential Energy Performance Association (REPA) is an organization made up of individual Residential Energy Auditors and Weatherization Professionals providing Energy Efficiency Services in NH. Its objective is to improve/expand understanding of residential energy efficiency technology, skills, and delivery of the "House as a System". www.repa-nh.org
Tax Credits: You may qualify for federal tax credits if you replace windows, doors, roofs or insulation. And audit can help you decide which improvements will provide the greatest advantage.



This is a busy time of year in the Concord. The biggest issue, the state budget, is still playing out. The Governor’s budget was relatively kind to senior services, but not all programs were protected. Projected cuts include eliminating several senior volunteer programs, including the foster grandparent and the retired senior volunteer programs.
Here are a few highlights from this year’s legislative activities to date:

Bills Ought to Pass
HB 279 establishes an alert program for missing adults with cognitive or developmental issues.
SB 42 establishes a committee to study the cost and feasibility of implementing a hospice benefit under Medicaid.
SB 62 establishing a commission to study creating a statewide plan for addressing Alzheimer’s disease in NH/
Bills Retained
HB 380 As we go to press, we understand that the bill to create a Long Term Care Commission will be retained by the Health, Human Services and Elderly Affairs Committee. Expressing concerns about the cost of a Commission in this time of government frugality, study committee members express interest in establishing a legislator caucus as an alternative to address issues identified in this bill.
HB 626 requires that a voter present a valid photo identification to vote in person. Voters without photo identification may vote by provisional ballot. This bill also eliminates the fee for nondriver’s picture identification cards.
Bills Failed
HB 121 to establish a board of residential building and remodeling contractors to register and regulate contractors, subcontractors, and residential contracting contracts
HB 397 to establish a property tax relief program based on taxpayer income.
HB 400 increasing the reimbursement rate for personal care attendants and personal care services providers.



Scientists seek genes for growing new teeth
Tooth loss from gum disease is a major problem in the US and abroad. Dentures or dental implants, while helpful, can have their own problems. Study of animals that have more than one row of teeth (like sharks) has lead scientists to investigate related genes. Research reveals that a single gene bred into mice caused additional teeth to grow. If scientist can learn how to trigger growth of a single tooth, they may eventually be able to use the knowledge to stimulate regeneration in adults. The gene, Osr2, may also lead to a break through for treating cleft palates.
Unraveling the secrets of Alzheimer’s
“Alzheimer’s disease is probably a very complex disease with many things happening simultaneously,” said Kishore Kuchibhotlas of Harvard. But one indicator that appears to be a major contributing factor is the build up of plaque. A team at Massachusetts General Hospital and Harvard Medical reported that they have discovered a certain plaque, amyloid, agitates a brain cell needed for normal brain functioning. The studies of how the amyloid plaques become toxic may lead to a better understanding of how the disease works and drugs that can better treat symptoms.
Arthritis and heart disease patients may fear exercise
The US Centers for Disease Control and Prevention report that patients suffering from arthritis and heart disease may be afraid to get the exercise they need to improve their health. Yet studies show that even a little exercise may help to relief symptoms of both conditions. Two national studies find that 57% of adults with heart disease also have arthritis. 29% of this group admits that they rarely or never exercise, primarily because they are unsure of which activities are not harmful to their conditions. Regular exercise can help relieve joint pain, which in turn leads to beneficial activity to manage heart problems. Consider adding a discussion about exercise to your next health care provider visit.

Margaret looked forward to her retirement years, filled with things she enjoyed, such as reading, watching TV, exercising, keeping in touch with family, and traveling. It was great as first, but she soon recognized that she needed more. “Everyone needs to feel needed and to have a purpose in life, especially retirees.”
While she was working and bringing up her children, it was not difficult to know she was needed. While she was working she did volunteer work on a limited basis and always thought about devoting more time to it when she retired. However, she did not realize how important such activities would become to her.
Margaret became politically active, working on recent elections and participating in issue related activities. She still considers herself a strong advocate for the elderly. Today she willing serves on a number of non-profit boards of directors. Her life experience not only makes her an asset to the Boards; it also reinforces her self-confidence and worth.
This sense of making a meaningful contribution in turn enhances her family relationships. She has been a strong source of support for both her mother and her daughters. “Having had the opportunity to spend more time with my mother in her final years is still a source of comfort to me “.
Time spent with her grandson is important and mutually beneficial. “Because children grow up so quickly if we don't spend time with them when they are young, that opportunity does not come around again,” she stresses. Margaret feels that the quality of her grandchildren's lives is enriched from learning from their grandparents. And there is of course, the enjoyment of the time spent together.

When people gather around the desire to affect social change they often fail because all their energy goes into dealing with immediate crisis rather than planning for mid and long term. The ENH Board has developed a long term strategy and will continue to refine the steps we take to achieve our goals. That being said, most of the January meeting discussion was around budgets, the economy and the decisions being made that impact NH’s long term care delivery systems. In other words, we cannot escape the immediate needs our seniors face.
We have a growing demand for services to be provided in the community, and we have a shrinking work force. Yet, we do not have the funds to continue service delivery in the manner to which we have been accustomed. These facts can not be disputed.
We are pleased to be at the table with the Department of Health and Human Services in discussions on how to realign the way the Department serves its clients, including older adults. Likewise, we welcomed the opportunity to serve on the study committee for establishing a Long Term Care Commission.
Many of these discussions shift to a very limited focus of “can we afford to pay for a specific service”, rather than a broad view. Our frustration continues to be the lack of a significant consumer voice. Elders have more to contribute besides wearing organizational tee-shirts at public hearings.

Dealing with the immediate can be an opportunity, if senior advocates give focus to certain outcomes:
• Older Adults need to be seen as a valuable asset in dealing with a work shortage, and as knowledgeable contributors to planning;
• We need a comprehensive plan as NH ages, that looks to incentivize efficient uses of limited resources;
• We need to consider which services or practices create greater savings through prevention; and
• We need to have public involvement to create changes that support the greater good.
There are many opportunities for you to hear budget proposals and to weigh in. We strongly encourage you to do so.
A system will emerge either by default or by design. It’s up to us.

Join Our Voices!
Since the newsletter is our main tool for communicating, linking, and sharing, we hope to expand regular features. We welcome suggestions and comments from our readers on what they find most helpful.
If the issues addressed here and other local, state and/or national issues concern you, think about getting together a small group of like-minded people to discuss them. Think about how you might, individually or together, address them. Consider sharing your ideas with us. You can make a difference!
And, PLEASE--share this newsletter with family, friends, neighbors and others in your community. To add your name to our newsletter mailing list, contact lcamst38@peoplepc.com.

OPINION:

Government entities are protected from unfunded mandates by the NH Constitution. The public is not protected from the costs associated with fragmented, isolated, stop-gap measurers.
In the 2009 session, NH’s Legislature will hear public comment on a proposal to formally create a Long Term Care Commission (LTCC). While ENH has some general concerns about creating too many commissions, we do support HB 380 and encourage our readers to make their voices heard.
A sizable group of LTC stakeholders was organized by, and with the support of AARP, as an advisory committee to the Joint Legislative Committee on Elder Affairs. This workgroup, including providers, advocates, county representatives, DHHS staff, ENH and others has been meeting for several months to consider rebalancing the LTC system and strengthening options for community care. Despite the variety of needs, perspectives and concerns (in fact, probably because of them), the group came together with a finalized report to support a values-based approach to the aging experience. Included in the report is the following recommendation:
“New Hampshire should establish a Long Term Care Commission to respond to issues related to the increased demand for long-term care services and supports. The Commission would be responsible for evaluating the capacity of the current long-term care system and recommending ways to develop the needed infrastructure, services and supports for the near-term and longer-term needs of New Hampshire citizens. The Commission would work with existing bodies addressing related issues and would build upon ongoing work. The Commission would address the following subjects at a minimum:
• Home and community-based care options for New Hampshire citizens in all geographic areas;
• Family caregiver services;
• Shortage of health care, long-term care and direct care workers, including medical professionals trained in gerontology;
• Reimbursement rates for long-term care services;
• Prompt financial and clinical public benefit determinations; and
• Services and supports for New Hampshire citizens which embody respect, dignity, choice and control until the end of life.”
ENH Summit participants indicated that expanded home and community-based care was their number one issue, and we believe this Bill is critical to establish a foundation towards that end. More importantly, it provides the unification so badly needed in this fragmented system, and adopts consistent values for NH, which to date have not been clearly articulated and adopted.
Those opposing the bill appear to have two major concerns: unfunded programs and/or services; and the lack of inclusion of the non-Medicaid population. In our December issue, ENH addressed the approach used by Oregon officials who felt that the 20% Medicaid population could not and should not drive the LTC system. In fact, the belief was that the 80% non-Medicaid population, if served well, would create an efficient and effective system that would in turn benefit Medicaid recipients. HB 380 would begin to establish that focus for all aging citizens of NH by creating a cooperative approach that capitalizes on collective intelligence.
Funding shortfalls is an issue which everyone is facing. Creating a clearinghouse approach to ideas and strategy strengthens the probability
of using resources effectively. It could prevent, or at least minimize, the tendency to spend down to Medicaid eligibility at a faster rate than is necessary or desirable. In fact, it may the one thing we can do.
There are also those individuals who still cling to LTC Insurance as a necessary component to any design. They may be right. However, a dependency on the private sector insurance industry in this economy is hardly prudent, and should not hinder forward movement towards rebalancing LTC. Reshaping the system will include ideas that prevent or avoid potential costs. While such concepts may be more difficult to demonstrate, they are probably as valuable in the long run as targeted numbers that may not be met. ENH therefore supports the Bill and will testify, monitor and report updates on its status for you.
The NH Constitution protects the government entities from unfunded mandates. The public is not protected from the costs associated with fragmented, isolated, stop-gap measurers. To date, our state’s approach to LTC has been just that—a crazy quilt of programs and services primarily focused on the medical aspects of aging.
We need holistic state-level planning that includes, but is not driven by, a single state agency. We need to consider the impact on our property taxes, given the recent court decision that leaves the Counties with the payments, the citizens with the tab and the State with setting the policies. We can do better. HB380 is the next step needed to make NH a better place in which to grow old.
Legislative Updates:
There are several bills that affect seniors that we are following. You may find these summaries of interest:
HB 241 allows taxpayers who are age 65 or older, and whose adjusted gross income is less than $50,000, to pay less interest and dividends tax as a result of an additional $2400 exemption. Approximately one-third of older taxpayers will save around $120 in taxes if passed.
HB 121 provides consumer protection to the citizens of NH against residential contractors and subcontractors who fail to meet the requirements of a contract (written or verbal) with the homeowner, including labor, goods and service. All contractors must register with the state, and a person who wishes to hire an individual contractor can access the registry to ensure that this person meets the qualifications of the Board of Residential Building and Remodeling Contractors.
We are also aware of several proposals that we don’t yet have bill numbers for. In upcoming newsletters we hope to bring you a more complete listing and summaries on certain ones. You can track bills and hearing notifications by going online:
http://www.gencourt.state.nh.us/bill_status/quick_search.html
(Tip: Enter the bill number--HB121--with no space between the letters and numbers. HB stands for House bill; SB is for Senate Bill.)





Care Giver Resources:
Family Caregiver Alliance
www.caregiver.org
1-800-445-8106

Nursing Home Ratings:
NH facilities rank highest in New England for 5 stars rankings: National Average is 12.1%, RI 14.1%, MA 16.6%, VT17.5%, ME. 23.2% and NH 24.4%.
For specific information on NH facilities, go to
www.medicare.gov/nhcompare

Forgetting Can Be Good:
A study done by researchers at Duke University and the University at Alberta, and reported in the January issue of Psychological Science looked into possible ways to improve memory. The study found that as people age, they tend to dismiss negative memories and retain positive ones. This tendency may be as rooted in a more mature perspective on life as it is a result of biological changes! As people age they regulate anger and other negative emotional reactions better. Also associated with dismissing certain memories is improvement in some conditions such as phobias, as our brain acts as a filter. The findings may help with the development of drugs that treat memory loss, while recognizing the benefits resulting from brain changes.



Suicide & Older Adults
By Kenneth Norton LICSW
Suicide is a serious issue among older adults. In NH, the suicide rates are highest for males over the age of 75. Across the US, older adults account for a disproportionately high number of suicides. According to the Substance Abuse and Mental Health Services Administration, although adults age 65 and older account for 13% of the total population, they account for 20% of the suicides. This totals over 6,000 deaths per year. Like other suicide deaths, this number may be under reported.
An important factor to understand about older adult suicide is the low number of attempts vs. deaths. Over age 65, there are an estimated 4 attempts to every death. One reason for this is that older adults tend to have less ambivalence about dying and use much more lethal means. For instance over 75% of males and almost 40% of women age 65 or older who die by suicide, use a firearm. Thus restricting access to lethal means should be an important consideration when working with older adults who may be at risk.
Stigma plays an important role in older adult suicide. While attitudes toward getting help for mental illness or treatment for addictions, alcohol, or substance use are improving for younger generations, older adults often have negative views of counseling and are reluctant to ask for help. This is compounded by views regarding depression and older adults. Given that older adults are more frequently dealing with medical illnesses and the death of spouses, friends and family, there is often an attitude of, “well of course they’re depressed, I would be depressed too…” yet depression is not a normal part of the aging process and our failure as a society to recognize this can have lethal consequences.
Research is demonstrating a high correlation of depression with physical illnesses such as diabetes, seizures, heart disease, and cancer. However, depression often goes undiagnosed and untreated despite the fact that effective treatment is available; likewise for addictions and alcohol/substance use. Pain is a serious risk factor for older adults. It is also a complicated one because medication to treat pain can also be used to suicide.
Other important risk factors for suicide in older adults with (or without) serious medical conditions is the issue of burdensomeness. If people perceive that they are a burden to others this may increase their risk for suicide. Social isolation is also an important risk factor for suicide. Individuals living in rural areas may be much more likely to be socially isolated particularly as they age. Loss of a spouse, particularly for males, can significantly increase risk. Financial stress and/or a potential change in living situation, especially circumstances that increase dependency are also significant risk factors for older adults.
One particularly disturbing statistic is that over half (58%) of adults over the age of 55 who die by suicide have had contact with a primary care provider within one month of their death (Louma et Al 2002). Health care providers are in a unique position to discuss important issues like loss, medical concerns, pain, burdensomeness, advanced medical directives, quality of life and end of life issues and can elicit information about depression and thoughts of suicide. This should not be a one time discussion, but should be a regular ongoing process. Health care providers should also be cautious about the potential lethality of medications prescribed for older adults have access to and consider limiting their quantity.
Education is an important suicide prevention tool for older adults and their caregivers. It is important for older adults, caregivers and family members to learn about the symptoms of depression, the risk factors and warning signs for suicide as well as the resources available to assist an individual who may be depressed and/or at risk. One educational resource specific to older adults is NAMI NH’s guidebook, “A NH Guide to Mental Health and Healthy Aging for Older Adults and Caregivers.” NAMI NH also offers an educational program for caregivers of older adults called Side by Side. For more information contact Bernie Seifert bseifert@naminh.org
There are a multitude of services and resources available to assist older adults. One of the best ways to learn about or access them is through ServiceLink. This free service provides information and referrals for older adults and their caregivers to connect them with resources and needed supports. There are Service Link offices in each county in NH. For more information call 1-866-634-9412 or go to www.servicelink.org
It is everyone’s responsibility to prevent suicide. Warning signs include: talking about death or dying, isolation, anger/rage, hopelessness, increased use of alcohol or other drugs and mood changes. If you are worried about someone you think is at risk of suicide call the National Suicide Prevention Lifeline 1-800-273-TALK (8255).
For more information contact Ken Norton 225-5359 or knorton@naminh.org
Reprinted with permission from NH Chapter NASW News. Winter 2009, and NAMI-NH; edited for length

Are You a Human Doing or a Human Being?
There is a tendency in our society to measure a person’s value in terms of productivity or potential productivity, as if we are human doings rather than human beings. Too little attention is given to valuing people for who they are. With age comes the possibility to redefine your own value as well as noticing the simple acts of others.
We are introducing a new feature called Purposeful Living focusing on those who continue to contribute and live a life with purpose and meaning.


Last year, long-term care community residents worked to raise funds to cover the daily operational expense for N.H. Food Bank.
It all began with a simple premise. In the Spring of 2008, the resident community of Pleasant View Center, a nursing home in Concord, was grateful for having enough to eat every day. They decided that it is unacceptable for people in New Hampshire to go hungry. They also worried that high fuel costs would seriously compromise the ability of many NH citizens to balance the financial demands of feeding their families with those of heating their homes. Figuring that their peers in other long-term care communities across the state might feel the same way, they decided to try something big to address the problem and invited them to join Seniors Feed NH.
Using conference calls and email, and with assistance from their homes (NH Heath Care Association, the NH Association of Counties, and NH Food Bank) the group began planning. The goal was to "eliminate a day of hunger in New Hampshire" by raising $16,000--one day's operational expense to run NH Food Bank. Fundraising efforts were varied: raffles, silent auctions, bake sales, and making and selling crafts.
Quality of life for those who live in long-term care communities is too often associated only with issues related to clinical care. While crucial to quality of life, clinical care is only part of the equation. Furthermore, a person's identity should not be defined by their need for long-term care or the fact that they live in a long-term care community.
The members of Seniors Feed NH defined themselves by their compassion, ability, energy and dedication. They are grateful for what they have and want the same for everyone. Most importantly, they are involved in meaningful activities giving their lives a sense of purpose, contribution and excitement.
Today, Seniors Feed NH is a group of seniors living in 52 long-care and independent living communities all over NH. Last year, their goal was met and exceeded, raising more than $42,000 for the NH Food Bank. This year, they look forward to continuing their work and forging collaborative relationships with key state leaders.




The Board met on February 5, 2009, the first time since November. We seem to have an uncanny ability to schedule meetings on dates that coincide with snowstorms!
The vision when we started down this path a couple of years ago was, by this time, to have grants and funding to hire staff, to create a database and web-site, to take over the newsletter function, expand our circulation to those without email, and have trainers to work with developing community leaders.
But that was a different time and a different economy. Like everyone else, we are reassessing how we can do more with less. And at a time when service providers are struggling to meet the needs of our frailest elders, we hesitate to compete for limited grant funds.
We have completed the State level incorporation process as a not-for-profit. This year, we will complete

the federal 501(c)(3) process, seeking donations for the $750 filing fee. To help us, the Disabilities Right Center, acting as our fiscal agent, has set up an online means to receive funds.
We will concentrate our efforts to enhance our communication network, and increase our non-financial support through volunteerism and partnerships. We will continue our focus to strengthen the voice and presence of older adults in NH’s pubic policy arena.
In short, we will be operating on a shoestring, being frugal and as creative as possible. And maybe that’s a good thing, being in synch with the times. It may stimulate a network that involves people in innovative problem solving, rather than political pressure for funding.
Since the newsletter is our main tool for communicating, linking, and sharing, we hope to expand regular features. We welcome suggestions and comments from our readers on what they find most helpful.
If the issues addressed here and other local, state and/or national issues concern you, think about getting together a small group of like-minded people to discuss them. Think about how you might, individually or together, address them. Consider sharing your ideas with us. You can make a difference!
And, PLEASE--share this newsletter with family, friends, neighbors and others in your community. To add your name to our newsletter mailing list, contact lcamst38@peoplepc.com.