Aging with Altitude

Life can change in an instant, and when it does, it can often feel like you're facing it alone. Hear from an incredibly inspiring community leader who has dedicated her life to supporting others who have faced challenges similar to her own.Rebecca Shields is a true example of resilience and service. She lives by the powerful belief that life isn't about what you can get from others, but what you can give. In 2008, Rebecca founded New Vision Professional Services, a community-centered organization that provides vital resources to individuals experiencing vision loss or navigating other quality-of-life challenges.Rebecca takes us through her personal journey, her educational background, and the mission that drives her work. Through New Vision, she offers a variety of classes designed to empower and promote independence, including braille, cooking, daily living skills, financial management, and orientation and mobility training.New Vision Professional Services: http://www.newvision4you.com/Contact Rebecca Shields: 719-635-8996Learn more at:Pikes Peak Area Agency on Aging - https://ppacg.org/pikes-peak-area-agency-on-aging/Or call 719-471-2096 PEARLS Program of Colorado - https://pearlsprogram.net/

Looking for a place where you can stay active, learn new skills, and connect with others in the community? The Senior Center is the perfect destination.Tom Lathrop, the passionate Operations Director at the Senior Center, is dedicated to creating engaging opportunities for seniors. Tom details the exciting new senior center opening in August 2025 (the current temporary location is within the Pikes Peak YMCA in downtown Colorado Springs). The new center will feature larger spaces for classes, community activities, and more. Tom provides information on how and when to sign up for classes, emphasizing that the new space will allow for more classes, more flexible scheduling, and improved accessibility for all seniors.Tom also shares details about the upcoming Colorado Senior Games, which will be held in Colorado Springs this June. The games will offer seniors a chance to compete and engage in a fun event within the community. To learn more, visit: https://coloradoseniorgames.org/sports/To access information on events and programs at the Senior Center visit: https://seniorcenter.ppymca.org/events-programs/Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country. We talk about both the everyday and novel needs and approaches to age with altitude – whether you're in Ft. Lauderdale, Florida or Leadville, Colorado. The Pikes Peak Area Agency on Aging is the producer. Cynthia Margiotta with PEARLS Program of Colorado and All About Dignity is our moderator. Learn more at:Pikes Peak Area Agency on Aging - https://ppacg.org/pikes-peak-area-agency-on-aging/Or call 719-471-2096 PEARLS Program of Colorado - https://pearlsprogram.net/

Silver Key offers an array of senior services, including meals, a food pantry, activity centers, behavioral health, companionship, and transportation. Jason DeaBueno, a Colorado Springs native who has been with Silver Key since 1982 and now serves as its President and CEO, offers insight into Silver Key's history and the essential programs it provides for seniors. He and host Cynthia Margiotta discuss the growing challenges in senior care, particularly in the region, and passionately emphasize the importance of volunteer work. Throughout the conversation, Jason reflects on his personal experiences with Silver Key, sharing heartfelt stories that highlight his deep connection to the organization. He also explains how listeners can get involved and support Silver Key's mission.For more information about Silver Key and the services they offer, visit their website at https://silverkey.org or call 719-884-2300.Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country. We talk about both the everyday and novel needs and approaches to age with altitude – whether you're in Ft. Lauderdale, Florida or Leadville, Colorado. The Pikes Peak Area Agency on Aging is the producer. Cynthia Margiotta with PEARLS Program of Colorado and All About Dignity is our moderator. Learn more at:Pikes Peak Area Agency on Aging - https://ppacg.org/pikes-peak-area-agency-on-aging/Or call 719-471-2096 PEARLS Program of Colorado - https://pearlsprogram.net/

Making quality senior dental care accessible to all is the mission of Michelle Vacha, founder and executive director of Community Dental Health. With a background in dental hygiene, she recognized a critical gap in oral health care for seniors and took action by establishing what was originally known as Senior Mobile Dental. She shares her firsthand experiences witnessing the neglect of senior oral care, and her passion for creating lasting change in the field.Michelle takes us through her journey into dental care, the evolution of Community Dental Health into the organization it is today, the crucial role of oral health in overall well-being, the unique dental care opportunities available in Colorado, and how access to these services has expanded over time.If you are interested in contacting her, her number is 719-310-3315, and you can find more information about Community Dental Health here: http://www.communitydentalhealth.org/ Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country. We talk about both the everyday and novel needs and approaches to age with altitude – whether you're in Ft. Lauderdale, Florida or Leadville, Colorado. The Pikes Peak Area Agency on Aging is the producer. Cynthia Margiotta with PEARLS Program of Colorado and All About Dignity is our moderator. Learn more at: Pikes Peak Area Agency on Aging - https://ppacg.org/pikes-peak-area-agency-on-aging/Or call 719-471-2096 PEARLS Program of Colorado - https://pearlsprogram.net/

How can, and should, families monitor, help and support their elder members? Area Agency on Aging has staff who can help you with that. Dr. Sara Qualls, Ph.D., ABPP shares wisdom and guidance for navigating the delicate and vital process of aging. Based in Colorado Springs, she specializes in supporting individuals and families through the challenges of later life in her psychotherapy practice. She is also a Professor Emeritus of Psychology at the University of Colorado at Colorado Springs, where she developed innovative programs for nearly 40 years. Dr. Qualls has received national recognition for her contributions to the field of clinical geropsychology and has published extensively on topics like mental health and aging, caregiver interventions, and geropsychology, including books such as Caregiver Family Therapy and Aging and Mental Health.In this episode, Dr. Qualls shares insights into the changes she has witnessed in aging over her 45 years of work, the evolution of government support programs for older adults, and the impact of initiatives like PPAAA on communities. She also discusses potential consequences of government program cuts for older adults and reflects on the slow decline toward death—an often challenging but thought-provoking topic. Dr. Qualls offers valuable perspectives on the challenges and opportunities faced by older adults and emphasizes how privileged she feels to have been part of this important work. Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country. We talk about both the everyday and novel needs and approaches to age with altitude whether you're in Ft. Lauderdale, Florida or Leadville, Colorado. The Pikes Peak Area Agency on Aging is the producer. Cynthia Margiotta with PEARLS Program of Colorado and All About Dignity is our moderator.Learn more at:Pikes Peak Area Agency on Aging - https://ppacg.org/pikes-peak-area-agency-on-aging/Or call 719-471-2096 PEARLS Program of Colorado - https://pearlsprogram.net/

It's nothing short of amazing the array of services available to older adults, and their caregivers, through the Pikes Peak Area Agency on Aging. In this special episode, we continue our celebration of the Agency's 50th anniversary by speaking with Jody Barker, Director of the Pikes Peak Area Agency on Aging, and Andy Gunning, Executive Director of the Pikes Peak Area Council of Governments (PPACG), which houses the Agency on Aging. They share their insights on why this milestone is so significant and catalog the many services available. They discuss the agency's funding sources, the importance of the Older Americans Act and Older Coloradans Act, and the wide range of services and contractors they provide to support seniors. Jody and Andy also explain how adults can access or qualify for these services, the challenges involved, and opportunities for volunteering.Finally, they offer a glimpse into the future of the PPAAA and its continued role in serving older adults in the Pikes Peak region.Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country. We talk about both the everyday and novel needs and approaches to age with altitude whether you're in Ft. Lauderdale, Florida or Leadville, Colorado. The Pikes Peak Area Agency on Aging is the producer. Cynthia Margiotta with PEARLS Program of Colorado and All About Dignity is our moderator. Access services, volunteer, donate, or learn more at:Pikes Peak Area Agency on Aginghttps://PikesPeakAreaAgencyonAgingOr call 719-471-2096Pikes Peak Area Council of Governmentshttps://ppacg.org/PEARLS Program of Coloradohttps://PEARLSProgramofColorado

Get to know Cynthia Margiotta, the heart and voice of Aging With Altitude! As the moderator of nearly every episode, she brings a wealth of experience and passion for senior care that is both inspiring and invaluable. In addition to moderating the podcast, Cynthia is also the executive director of PEARLS (Program to Encourage Active Rewarding Lives for Seniors). With over 50 years of experience in senior care and advocacy, Cynthia's journey began in high school and has shaped her entire career. Throughout this time, she has gained a unique perspective by working in various states, including New York, West Virginia, California, Colorado, and Wyoming, before returning to Colorado Springs. In this conversation, Cynthia reflects on her path to where she is today, including how she became involved with the Pikes Peak Area Agency on Aging. She also discusses the drive and commitment that fuels her work and the many changes she's witnessed in senior care over the past five decades. Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country.  We talk about both the everyday and novel needs and approaches to age with altitude - whether you're in Ft. Lauderdale, Florida or Leadville, Colorado. The Pikes Peak Area Agency on Aging is the producer. Cynthia Margiotta with PEARLS Program of Colorado and All About Dignity is our moderator.  Learn more at: Pikes Peak Area Agency on Aging https://ppacg.org/pikes-peak-area-agency-on-aging Or call 719-471-2096 PEARLS Program of Coloradohttps://pearlsprogram.net/ If you live in the Pikes Peak region, find your new favorite local podcast at  https://studio809podcasts.com

If you're caring for someone with Alzheimer's, you're not alone, and there is a world of support available. In honor of November being National Family Caregivers Month, we're excited to welcome RoseMary Jaramillo, Director of Community Engagement for Southeast Colorado at the Alzheimer's Association, to discuss advances in understanding Alzheimer's. In this special episode, RoseMary reflects on the history of Alzheimer's and the significant shifts that have occurred over the last 50 years in public understanding and perception, as well as the importance of support for caregivers. The conversation includes the tragedy of caregivers not caring for themselves, Alzheimer's Association's 24/7 help line, and keeping loved ones with dementia engaged – with special advice around the holidays. Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country.  We talk about both the everyday and novel needs and approaches to age with altitude whether you're in Ft. Lauderdale, Florida or Leadville, Colorado. The Pikes Peak Area Agency on Aging is the producer. Cynthia Margiotta with PEARLS Program of Colorado and All About Dignity is our moderator.  Learn more at: Pikes Peak Area Agency on Aginghttps://ppacg.org/pikes-peak-area-agency-on-aging Or call 719-471-2096  PEARLS Program of Colorado https://pearlsprogram.net/ Alzheimer's Association – Colorado Chapterhttps://www.alz.org/coOr call 800-272-3900  Follow Aging with Altitude so you don't miss an episode. Visit https://studio809podcasts.com to find your new favorite LOCAL podcast!

Caring for a loved one can be one of the most rewarding, and most challenging, roles you can take on. As it has evolved over time it is important to recognize that supporting yourself as a caregiver is just as important as the support you provide to those who depend on you.  In honor of November being National Family Caregivers Month, we're excited to welcome Lucy Crandall, Supervisor of the Family Caregiver Support Center at the Pikes Peak Area Agency on Aging, to discuss the evolving role of family caregiving. With over 25 years of experience serving older adults and their families, Lucy has found her true passion helping family caregivers. In this special episode, Lucy reflects on the history of aging services and the significant shifts that have occurred over the last 50 years since the creation of the Area Agency on Aging. She explores how caregiving has evolved, what has driven these changes, and why support services are more essential than ever. Lucy also discusses the meaning of caregiving and how the growing need for these services has shaped the way we care for older adults today.  Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country.  We talk about both the everyday and novel needs and approaches to age with altitude whether you're in Ft. Lauderdale, Florida or Leadville, Colorado. The Pikes Peak Area Agency on Aging is the producer. Cynthia Margiotta with PEARLS Program of Colorado is our moderator. Learn more at: Pikes Peak Area Agency on Aginghttps://ppacg.org/pikes-peak-area-agency-on-aging Or call 719-471-2096 PEARLS Program of Colorado https://pearlsprogram.net/ If you live in the Pikes Peak region, find your new favorite local podcast at https://studio809podcasts.com  

Learn about changes coming to Medicare, and why the time is now to consider making a change, or to enroll for the first time if you're newly eligible – during open enrollment October 15 – December 7. This is the period when you get into, out of, or switch Medicare Part D or Medicare Advantage plans – to take effect January 1, 2025. The State Health Insurance Program (SHIP) can answer your questions and guide you through the process if you wish. In this episode, Roma Costanza, local SHIP representative, fills us in. To reach SHIP in El Paso, Teller, Park, Lake, Chaffee, Custer, Las Animas, Huerfano and Fremont counties, call 719-635-4891 or email seniorinsur@ppacg.org. Make an appointment soon! Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country. We talk about both the everyday and novel needs and approaches to age with altitude whether you're in Ft. Lauderdale, Florida or Leadville, Colorado. The Pikes Peak Area Agency on Aging is the producer. Cynthia Margiotta with PEARLS Program of Colorado is our moderator. Learn more at Pikes Peak Area Agency on Aging http://www.ppacg.org/aging/  and PEARLS Program of Colorado  https://pearlsprogram.net/ If you live in the Pikes Peak region, find your new favorite local podcast at  https://studio809podcasts.com

Grammy award nominated musician Melanie DeMore will lend her soulful voice to lift the pain of our losses at A Community Gathering of Song and Healing on October 9, 2023. Sarah Lee, Program Director for Voices of Grief Support and Education Center shares details about the event, and about the concept behind it. People of all ages in the Pikes Peak region are invited to join this celebration of hope and remembrance. A second event on October 10 will offer a panel of local art therapy experts joining Melanie to explore how the professional community might weave the arts into our caregiving roles to foster growth and resilience in those we serve. The event will also feature art displays highlighting work being done locally by outstanding local art therapists. A Community Gathering of Song and HealingOctober 9, 2023 (professional panel October 10)Information and ticketswww.voicesofgriefcenter.org/events Ent Center for the Arts5225 N. Nevada Ave.Colorado Springs  Sarah has spent more than 20 years in non-profit administration. Her professional experience includes hospice chaplaincy, event planning, fundraising and human resources. In addition to grief support training, Sarah holds a BA in psychology and an MA in Theology. Sarah has partnered with Kathy Sparnins and Voices of Grief since 2020, facilitating support groups and expanding grief support and education programs in the Pikes Peak Region through the Voices of Grief Support and Education Center.  Voices of Grief Support and Education Centerhttps://www.voicesofgriefcenter.org Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country. We talk about both the everyday and novel needs and approaches to age with altitude whether you're in Ft. Lauderdale, Florida or Leadville, Colorado. The Pikes Peak Area Agency on Aging is the producer. Cynthia Margiotta with PEARLS Program of Colorado is our moderator. Learn more at Pikes Peak Area Agency on Aging http://www.ppacg.org/aging/  and PEARLS Program of Colorado  https://pearlsprogram.net/ If you live in the Pikes Peak region, find your new favorite local podcast at https://studio809podcasts.com  

Learn how the financial, legal, health and even social determinants of retirement can and will impact your future. For the past nine years, Ent Credit Union has partnered with the Pikes Peaks Area Agency on Aging to present retirement preparation classes. In this episode, two of the masterminds behind the classes, Pamela Haugard of Pikes Peak Area Agency on Aging and Bree Shellito of Ent Credit Union join host Cynthia Margiotta to explain what the series covers and how to attend the classes. All classes will be held virtually and at no cost to the participants. This year, the series has been expanded and offers an even more in-depth view of what stepping into retirement can look like. Included in this series will also be the latest information on Social Security and Medicare. Attend one class or the entire series for important information and tools to jump-start your retirement planning NOW! More information about the classes and registration:https://www.ppacg.org/aaa-events/ Ent Credit Union https://www.ent.com/ Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country.  We talk about both the everyday and novel needs and approaches to age with altitude whether you're in Ft. Lauderdale, Florida or Leadville, Colorado.  The Pikes Peak Area Agency on Aging is the producer.  Cynthia Margiotta with PEARLS Program of Colorado is our moderator.  Learn more at Pikes Peak Area Agency on Aging http://www.ppacg.org/aging/  and PEARLS Program of Colorado  https://pearlsprogram.net/ Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country.  We talk about both the everyday and novel needs and approaches to age with altitude whether you're in Ft. Lauderdale, Florida or Leadville, Colorado.  The Pikes Peak Area Agency on Aging is the producer.  Cynthia Margiotta with PEARLS Program of Colorado is our moderator.  Learn more at Pikes Peak Area Agency on Aging http://www.ppacg.org/aging/  and PEARLS Program of Colorado  https://pearlsprogram.net/ If you live in the Pikes Peak region, find your new favorite local podcast at https://studio809podcasts.com

Support groups and system changes are just two ways discussed to minimize elder abuse. We also continue our discussion of sex. June 15 is World Elder Abuse Awareness Day, and the Pikes Peak Area Agency on Aging can link you to, or help you organize, a small group conversation about this topic during the week of June 11. Lori McGinnis, regional director of the ombudsman program for the agency, shares insights with host Cynthia Margiotta. The ombudsman helps make sure elders are aware of their rights. If there are issues with an assisted living or long term care facility, an ombudsman is the one to call for help. To contact the ombudsman: Lori McGinnis: 719-471-7080 ext. 132 lmcginnis@ppacg.org Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country.  We talk about both the everyday and novel needs and approaches to age with altitude whether you're in Ft. Lauderdale, Florida or Leadville, Colorado.  The Pikes Peak Area Agency on Aging is the producer.  Cynthia Margiotta with PEARLS Program of Colorado is our moderator.  Learn more at Pikes Peak Area Agency on Aging http://www.ppacg.org/aging/  and PEARLS Program of Colorado  https://pearlsprogram.net/

A father-daughter team share their breathtaking tale of overcoming barriers and aging stereotypes that embody Aging Unbound, the theme for Older Americans Month 2023.  Dr. Tom Kilroy is the father of Pikes Peak Area Agency on Aging staff and podcast sponsor Melissa Marts. These two adventurers and aquaholics (that's right, not alcoholics) tell the story of how they became self-supporting, multi-day stand up paddleboard pros and lived through the Moab storm of the century on the Green River. Aging Unbound challenges all of us to question the stereotypes of age and share stories of how we push past our own barriers and boundaries to live a rich, rewarding life.  As you listen, think about the labels and stereotypes you have experienced and what barriers you are pushing past. Share your story: mmarts@ppacg.org Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country.  We talk about both the everyday and novel needs and approaches to age with altitude whether you're in Ft. Lauderdale, Florida or Leadville, Colorado.  The Pikes Peak Area Agency on Aging is the producer.  Cynthia Margiotta with PEARLS Program of Colorado is our moderator.  Learn more at Pikes Peak Area Agency on Aging http://www.ppacg.org/aging/  and PEARLS Program of Colorado  https://pearlsprogram.net/

What are the ways our elders can be subject to abuse and how can we guard against them? Abuse can be subtle and so not blatantly obvious to the victim. Abusers can also be adept at putting on a good show when others are around. June 15 is World Elder Abuse Awareness Day, and the Pikes Peak Area Agency on Aging can link you to, or help you organize, a small group conversation about this topic during the week of June 11. Lori McGinnis, regional director of the ombudsman program for the agency, shares insights with host Cynthia Margiotta. The ombudsman helps make sure elders are aware of their rights. If there are issues with an assisted living or long term care facility, an ombudsman is the one to call for help. Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country.  We talk about both the everyday and novel needs and approaches to age with altitude whether you're in Ft. Lauderdale, Florida or Leadville, Colorado.  The Pikes Peak Area Agency on Aging is the producer.  Cynthia Margiotta with PEARLS Program of Colorado is our moderator.  Learn more at Pikes Peak Area Agency on Aging http://www.ppacg.org/aging/  and PEARLS Program of Colorado  https://pearlsprogram.net/  

Medicare CAN be expensive, but there are ways to minimize the costs. Pikes Peak Area Agency on Aging's Roma Costanza shares information about the costs and ways to shrink them. Medicare Savings Programs can help you cover the cost of Medicare Part B. A Low-Income Subsidy can help cover the cost of Medicare Part D. Over 50% of the people in our area who qualify for these programs are not taking advantage. Determining eligibility and applying for these programs can be quite easy if you invite a SHIP counselor to help you. This episode is hosted by Cynthia Margiotta, CEO of Pearls program of Colorado. Roma Costanza is Medicare Specialist and State Health Insurance Program (SHIP) Coordinator at the Pikes Peak Area Agency on Aging. For more information:(719) 635-4891seniorinsur@ppacg.org Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country.  We talk about both the everyday and novel needs and approaches to age with altitude whether you're in Ft. Lauderdale, Florida or Leadville, Colorado.  The Pikes Peak Area Agency on Aging is the producer.  Cynthia Margiotta with PEARLS Program of Colorado is our moderator.  Learn more at Pikes Peak Area Agency on Aging http://www.ppacg.org/aging/  and PEARLS Program of Colorado  https://pearlsprogram.net/  

State Health Insurance Program (SHIP) Medicare Counselors are the best kept secret for seniors looking for non-biased Medicare support.  SHIP counselors can be identified through their Area Agency on Aging.  These counselors walk seniors through many healthcare options and are not associated with any health insurance company.  They receive extensive training in order to best support seniors in selecting plans that make sense for them.  Listen in for more and check your SHIP office out today.

This episode was recorded in June for World Elder Abuse Awareness Day. El Paso County Colorado has one of the busiest Adult Protective Services (APS) offices in the State if not the Nation.  With over 3300 cases this past year, it is hard to believe that this number is actually lower than previous years.  APS notes this number is concerning because they believe the number should be higher and that COVID has led to a decline in recognizing and reporting abuse.  This episode explores the work of APS, who are mandatory reporters and how to connect to resources. Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country.  We talk about both the everyday and novel needs and approaches to age with altitude whether you're in Ft. Lauderdale, Florida or Leadville, Colorado.  The Pikes Peak Area Agency on Aging is the producer Ms. Cynthia Margiotta with PEARLS Program of Colorado is our moderator.  Learn more at Pikes Peak Area Agency on Aging   and PEARLS Program of Colorado

State Health Insurance Program (SHIP) Counselor Roma Costanza discusses how to avoid being a victim of Medicare fraud.  One message, Protect Your Card.  Learn about Senior Medicare Patrol and SHIP.  Taxpayers want to see tax dollars working for us, unfortunately Medicare fraud hurts with increased costs to the program if criminals get away with it.  Learn how to be proactive and protect the value Medicare provides for us. Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country.  We talk about both the everyday and novel needs and approaches to age with altitude whether you're in Ft. Lauderdale, Florida or Leadville, Colorado.  The Pikes Peak Area Agency on Aging is the producer Ms. Cynthia Margiotta with PEARLS Program of Colorado is our moderator.  Learn more at Pikes Peak Area Agency on Aging   and PEARLS Program of Colorado

Families continue to learn daily how to live with a family member or friend who has been diagnosed with Alzheimer's.  Last year 5 million Americans were diagnosed, this year over 6 million.  The disease is devastating but we can learn to live better.  RoseMary Jaramillo, Regional Director for the Central and Southern Chapter of the Alzheimer's Association shares insight about the differences of dementia and Alzheimer's.  Exploring the confounding findings of earlier onset Alzheimer's and how the brain and central nervous system operate.  There are ways to live with Alzheimer's with education, understanding and new ways of communication that can provide hope.

A special day for seniors with a complimentary lunch and live music.  The Westside Community Center knows how to host a fun time.  Andrea Fuller, Marketing Coordinator with the Center, highlights the types of resources and experiences for older adults that also includes a flea market and other unique activities.

Many older adults find purpose in volunteering, and then some need the support of volunteers to help them age with dignity.  Cory Smith, Project Manager with COS I Love You is responsible for rallying congregations in the region to provide priceless volunteer services to residents.  From helping new moms, to shoveling snow to prepping older adults for downsizing and moving, COS I Love You is looking for the special projects to serve and also giving opportunities to vibrant older adults looking to continue to give back.

The Association for Community Living highlights the best parts of aging during the month of May with Older American's Month.  Across the country older adults share stories of how they are aging their way this year.  From a 79 year old paddleboard racer to the intergenerational and multi-racial women's group who does tea, there are many great examples of how we Age our Way.  This year Colorado Springs is hosting a multi-cultural food box give-away of heritage comfort foods for our residents.

The Pikes Peak Family Caregiver Pampering Day celebrates 19 years of pampering caregivers.  Kent Mathews, MSW with the Pikes Peak Area Agency on Aging shares, you know you're a caregiver when you don't have time, you put others first, you do more and more.  Caregivers can take time to nurture themselves through Pampering Day or take away fun ideas from this podcast.  Keynote for this event is Cyndy Noel who has written Courageous Hearts, a Journey through Alzheimers.

There are so many unknowns when it comes to retirement and so much to look forward to.  Ent Credit Union and the Pikes Peak Area Agency on Aging (PPAAA) co-host a free retirement series in the spring and fall.  This year kicks off on April 11 and runs through May 16.  Bree Shellito, Ent's Senior Manager of Community Impact and Pamela Haugard, Medicare Insurance Counselor with the PPAAA share about aging by design, estate planning, Medicare and Social Security 101. 

Not happy with your Medicare Advantage Plan? You can make changes during traditional Open Enrollment but also between January 1 - March 31. Roma Costanza, with Colorado's State Health Insurance Program (SHIP) provides tips and answers for how to get the best out of Medicare and Medicare Advantage plans. SHIPs are the best resource for non-biased Medicare counseling. They are funded by the federal government to assist those in Medicare with getting their needs met. SHIP is not associated with any insurance program so they can talk about ALL options. Roma has over 22 years of health insurance counseling experience and is a true Medicare advocate in Colorado.

Not happy with your Medicare Advantage Plan?  You can make changes during traditional Open Enrollment but also between January 1 - March 31.  Roma Costanza, with Colorado's State Health Insurance Program (SHIP) provides tips and answers for how to get the best out of Medicare and Medicare Advantage plans.  SHIPs are the best resource for non-biased Medicare counseling.  They are funded by the federal government to assist those in Medicare with getting their needs met.  SHIP is not associated with any insurance program so they can talk about ALL options.  Roma has over 22 years of health insurance counseling experience and is a true Medicare advocate in Colorado.

PEARLS is the Program Encouraging Active Rewarding Lives for Seniors and is run by Cynthia Margiotta.  Cynthia has a Bachelors in Social Work and a solid history of supporting older adults in the Pikes Peak region.  From her work teaching direct care staff best practices to her volunteering with the Alzheimer's Association and the Family Caregiver program with the Pikes Peak Area Agency on Aging, Cynthia has the best background to support older adults who are struggling with anxiety and mental health needs.  The PEARLS program is a unique in-home 19 week program focusing on goal setting and much more.  PEARLS of Colorado Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country.  We talk about both the everyday and novel needs and approaches to age with altitude whether you're in Ft. Lauderdale, Florida or Leadville, Colorado.  The Pikes Peak Area Agency on Aging is the producer.  Learn more at Pikes Peak Area Agency on Aging.   Transcript: You're listening to studio 809. This is what community sounds like.   Melissa Marts: Hi, welcome to all. This is the Pikes Peak Area Agency on Aging's Aging with Altitude podcast hosted at studio 809 podcast. We provide answers, assistance, and advocacy for people over 60 and their caregivers. Thank you for joining us today. I am Melissa Marts, program administrator with the Pikes Peak Area Agency on Aging. Our topic today is about behavioral health, but let's just call it kind of anxiety and frustrations that our older adults, some of our best friends, go through and are suffering with and some ideas about how to help them. And to talk about this today we have Cynthia Margiotta with us. Cynthia is typically our podcast host so you'll recognize her voice from other podcasts, but today she is our special guest. Last year during COVID, Cynthia launched the PEARLS Program of Colorado, a unique behavioral health program here in El Paso County with goals to spread it around Colorado, but she started it here in our region. Cynthia is also a strong advocate for older adults, and she's supported the aging community for years with her All About Dignity courses, her volunteering with the family caregiver support program at the Pikes Peak Area Agency on Aging, and many other programs. Then also today we have a special masters of ceremony, Ms. Jenny Nihill, who is a military fellow, and she is currently doing this with the Pikes Peak Area Agency on Aging, so thank you Jenny for joining us. Thank you for your over 20 years of military service and jumping in today as the emcee with Cynthia. I'm going to turn it over to Jenny.   Jenny Nihill: Alright, thanks Melissa for the introduction. I'm happy to be here learning and working with Melissa and the Area Agency on Aging. Now I'd like to introduce Cynthia and learn more about the PEARLS Program of Colorado, so let's get started. Can you tell us what is the PEARLS Program of Colorado and who is eligible to use the program?   Cynthia Margiotta: PEARLS Program of Colorado, we just call it PEARLS for short, but PEARLS program of Colorado is a program that is specifically set up to help seniors in our community. We work with the folks 60 plus population. It is an evidence-based program that I took many classes for in order to hold that program here.   Melissa Marts: Cynthia, what does PEARLS stand for?   Cynthia Margiotta: PEARLS stands for Program Encouraging Active Rewarding Lives for Seniors. Melissa Marts: Thanks. It's funny how we get so used to just saying PEARLS and then we forget to actually, to call out those really special words that PEARLS means.   Cynthia Margiotta: Yeah, it's a great one. I wish I had thought of it.   Jenny Nihill: So before we came here today I did go looking on the website so I could learn a little bit more about the organization. It did mention that there were coaches. Can you tell us about the coaches, who they are, what kind of training they might have gone through?   Cynthia Margiotta: I am the only coach in El Paso County, so I travel all over El Paso County from top to bottom, to left to right, but the training. Oh my. So the training I took for this particular program is out of Washington State University. About a year and a half ago now wasn't it. Then there were some other programs that I also took on my own to make it even more valuable like actually what to do when a person has a seizure. There's a difference if they have a seizure and they're known seizure victims or unknown. Different classes like that through the past year and I am currently in a class where I am becoming a PEARLS master trainer.   Jenny Nihill: That sounds good. Can you tell us what the stool concept of PEARLS is?   Cynthia Margiotta: The stools concept. You're very smart. Yes, the stools concept is a great part of the PEARLS program. The way we think of it is a three-legged stool and each leg holds up the person. So those three legs are one leg is the socially active. We encourage people to be socially active, whatever that means to them, and another one is to be physically active. Being physically active actually reduces depression and anxiety so that's important as well, and then also to be like planning an activity of interest. And I don't mean planning to go to Mexico in three years, but maybe going to have supper with a friend next week. So those three legs, and then it's held up by the floor, and the floor is actually in our program, the psychologist and the nurse practitioner so they in a sense they supervise me and help me to understand the medications people are on and what might be a better approach with any particular person. There is really a team of us that do that.   Jenny Nihill: Great. So when participants are enrolled in your program, can you tell me what they can expect to get out of the program?   Cynthia Margiotta: A great deal of joy. That is what I hear from people. Yesterday I took on a new client who was suffering with pretty high depression. She's just getting through the denial stage that people have of her husband's dementia where, I don't know. I don't understand fully why, but it's very common for people to say “oh mom you're going crazy, dad's fine,” “Why is she crazy and he's not having problems?” It's very common and so when I went to visit with her, I spent about an hour explaining a little bit about his disease, his kind of dementia to him. I'm also a longtime volunteer with the Alzheimer's Association so having that knowledge has helped being able to explain that particular dementia. Helping her understand the difference between what she felt. She believes that she's guilty for his dementia and explaining the difference between guilt and regret. I think when we were done a few hours later she was so much happier. She's OK, that's not her fault. That she's not going crazy. And I liked seeing that in people. I like helping people. This is what really enthralled me about the program. Moving people toward more joy. Just because you're over 60 doesn't mean you have to sit on the couch all day.   Melissa Marts: And Cynthia, as you bring up that story and talk about that personal experience that you had with this woman. I think we haven't talked about it yet, where does PEARLS happen? When you are meeting with these folks, where are you actually meeting with them?   Jenny Nihill: Yeah, especially during COVID now because we are still doing a lot of social distancing, with the elderly being a vulnerable population.   Cynthia Margiotta: They are. Oh yes. I do offer to meet with them over the phone if they would prefer. My preference is to go to their home and be there for them. I see and experience things that you wouldn't if you meet in the office. I love to always talk about experiences without names. There is one client I have worked with where she was going blind and deaf at the same time, and her husband. Let me explain how it is. She would sit in the chair and had one chair facing her to talk to her. Her husband would sit in a couch behind her. And I would not have known that if I had not gone to that home. What I suggested to her husband is, go to one of the ARC Thrift Shops and buy a chair so that you have a chair where you can sit where she can hear you when you're talking to her. That's important in a relationship, but if they had met me in an office, I would have never known that.   Jenny Nihill: Right, so when you go meet them, how long are you there for? And how long does this program last? Is it a few sessions, is it just continuous as needed?   Cynthia Margiotta: Actually, the visits are rather long because I try to talk to them about what's on their mind, what are their needs. It's not where I set up a goal for them. They tell me what they need help with. Those depend on you know, a little goal of like figuring out how to I don't know, toast. Using the toaster is easy you know. Where figuring out the difference between depression and anxiety's a little bit more time consuming. And so they tend to vary in time and length per session, usually somewhere around an hour and a half, and then the period in months we started out with this weekly. Then we go every other week or so. Then about once a month, and then about a phone call every now and again kind of thing. And so slowly over a period of many, many, many months we see them and talk to them less frequently.   Melissa Marts: And can I jump in again?   Cynthia Margiotta: Yeah. Oh please.   Melissa Marts: I'm just kind of curious how you see PEARLS being different than kind of a psychotherapy appointment and how, how is this a different approach for older adults? And along with that maybe answering the question of how it's paid for too?   Cynthia Margiotta: People here don't know, but my husband is a psychologist and so I, and I had nothing wrong with psychology. What I see is a psychologist is there to hear and listen and reflect back. My job is to discuss with them, and to find what it is that they want to work on and help them, so we start from today. What's going on today. And how can we change those problems into goals and meet those goals? Our funding comes through the Old Age Act, which is part of the Area Agency on Aging, and so we do have a grant through them and we are so appreciative because I love being able to go to people's homes and say I'm not gonna charge you for these services. So I can see people who have like no money, or have nothing to spend. And yes, we do take donations don't get me wrong, but you know. It's nice to be able to see somebody who says “I, I don't have money to pay you.” It means a lot to me.   Melissa Marts: I know, and I'm glad that we have that opportunity to do that because oftentimes with counseling people have to somehow come up with money to pay for a counselor, and this is a resource that people can access for free. But again, Cynthia's point about taking donations, you know the funds are limited. It's not an unlimited budget, and so for people who can pay it forward when they have appointments with Cynthia and be able to you know, make a donation so that the program can go a little bit further maybe for the next person and other folks down the line is, is really appreciated of course.   Cynthia Margiotta: Absolutely. I so appreciate that and send thank you notes to folks in hopes that they will keep us in mind in their future.   Melissa Marts: Great.   Jenny Nihill: You mentioned earlier that PEARLS here in Colorado Springs is under a larger program of PEARLS. What level is that at, and then where did you see the need arise in El Paso County to start the PEARLS program here?   Cynthia Margiotta: Where did I see the need? You got three days to talk? No, there are so many folks that believe that once you're about 60 or so, you should be happy with what I call “glued to the couch.” Where there's no life. There's no interests. That you look out the window and wish, and you can't do things. I'll use myself as an example. I do suffer with depression. And there are times, my friends all know that I'm a “plantaholic,” if you've ever heard of one of those. I am a plantaholic. I love plants. I've got more than a hundred at home, in the house. Some are taller than I am. That's crazy, but I bring that up because there are days I know I need to water my plants. I have a few that say, “water me now or I'm going to die tomorrow.”   Jenny Nihill: Those are the ones at my house.   Cynthia Margiotta: Yes, bring them over. I'll babysit. But in any case, there are times when I can look right at that plant and I can't get off the couch.  I cannot get off the couch to go water them and that's depression. And that's a lot of the folks we work with that can't get off the couch. I see my job as, what gives me more joy than anything is when I see them get up off that couch, when want to go do things. When they talk to me and they say I wanna go to the senior center.  I want to go volunteer at Area Agency. I want to do things. That gives me a lot of joy.   Melissa Marts: And I'll add a little bit to how the need kind of came to be in our region around behavioral health. You know we, a couple of years ago realized that there were lots of conversations happening at the governmental level around behavioral health and suicide, but no one was talking about it from an older adult perspective. Even our county health plan didn't have a chapter to address older adults and behavioral health. It was really focused completely on people who were under the age of 60, and of course especially adolescents, which we know there was a significant need in that area, but yet we also discovered there is a significant need for older adults, and that the suicide rate for older adults is considerably high.  It might not be a blatant overdose or a blatant suicide, but what it is it's an accidental overdose of medications that people, as Cynthia refers to sitting on the couch and depressed, and they decide to take their own life with the medications that they have. The reality was we have many folks in our area that are alone, isolated, sad, depressed, anxious. We have two programs in our area that were able to provide behavioral health at the time when Cynthia started PEARLS, and they had waitlists. And so people couldn't even get help if they wanted it. And many folks were not comfortable calling Aspen Point at the time. Now it's called Diversus, but Aspen Pointe is kind of the emergency call for behavioral health relief and people didn't want to call that. Especially older adults who are just sitting on the couch and feel like “well my life is over anyway and why should I call and ask for help.” At the Area Agency on Aging, we really wanted to see an additional resource around behavioral health and in the two years that we've been working on this we have seen exponential growth in funding, resources, support, conversations around the needs of older adults who would like to get extra support to feel better about their lives. PEARLS is a nice addition to a more clinical model approach. This is a home-based, much more personal and as Cynthia says, just really getting down and talking about goals. What do you want to do and how can we get there? It's a great addition to our community.   Cynthia Margiotta: Pre covid statistically the population of folks over 60 who were depressed, it was somewhere around 20%. And that's people who acknowledged it. Most folks we find who are depressed say this is just the way it has to be so they don't acknowledge it. We find a lot of them instead of saying they're depressed they say, “we're anxious.” The medication that people take for depression is the same medication they take for anxiety. So even then sometimes doctors don't even mention to them “well I think you're depressed. Here's something for your anxiety.” And again, grin and bear it. It's that population, grin and bear it.   Jenny Nihill: PEARLS sounds like a great program with lots of benefits for our senior population. How can they reach out to you to participate in this program?   Cynthia Margiotta: They can reach out to me, or the family can reach out to me by calling very easily. They can call my phone number. My phone number is 719-459-2017. They can look on the internet. Our website is PEARLSprogram.net. And they can call Area Agency on Aging, talk to people there and say, “hey I need to get a hold of the people at PEARLS.” Family, they can tell family and have family call me. I do prefer to call them because folks who are depressed tend to not get off the couch.   Melissa Marts: So, Cynthia, again, thanks for sharing about how people can get in touch with the PEARLS program. That's good information to know. Is there anything that we didn't ask you? Maybe another story you want to share or something else that we forgot to ask.   Cynthia Margiotta: Well, thank you for asking. I want to thank you Melissa. You're the one who introduced me to PEARLS. When you first told me about it, it was like love at first sight. I'd been doing something very similar to this for many, many years where going to people's homes and visiting with them and trying to encourage them. And to have a formal program that really helps me to do what I see as a better job has been wonderful and I hope that we can spread the PEARLS program throughout Colorado and get more of the Area Agencies on Aging to be involved with PEARLS. And I'll do everything I can to help them do that.   Melissa Marts: Well, I know you will and I appreciate you saying thanks to me. You know the funny story is is that when I was looking for more behavioral health resources in the community and I heard about PEARLS and I knew that Cynthia had a bachelor's in social work and I knew the work that you had been doing, and in my mind, I was kind of hoping that maybe she would be interested. When we did talk about it, I was just kind of throwing it out there, hoping. So yes, you did jump in with both feet and I'm glad that you did. So thank you for that because it is a needed resource when people, again, I can't emphasize enough how unique the model is to be kind of more on a personal level even during COVID right now. That can be a challenge, but that more personal touch where you do go into people's homes and you can kind of see what's going on and be in the real space with them is a good addition to the resources that are here already, and one that we really needed. So any other pieces before we turn this back over to Jenny and alright?   Cynthia Margiotta: I'll probably think of something tomorrow morning at 2 a.m.   Melissa Marts: That's right.   Jenny Nihill: Well, I'd like to thank you for joining us today on Aging With Altitude, a Studio 809 podcast. Aging With Altitude is hosted by the Pikes Peak Area Agency on Aging. For more information on all things aging, we can be found online at www.ppacg.org or by phone at 719-471-2096.      

Terry Cassidy, Occupational Therapist and owner of Health Partners specializes in the evaluation and support for older drivers.  The week of December 7 is Older Driver's Awareness week and an ideal time to learn more about safe and comfortable drivers to take into their senior years.  To see more about the week's activities visit https://www.aota.org/Conference-Events/Older-Driver-Safety-Awareness-Week.aspx Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country.  We talk about both the everyday and novel needs and approaches to age with altitude whether you're in Ft. Lauderdale, Florida or Leadville, Colorado.  The Pikes Peak Area Agency on Aging is the producer.  Learn more at Pikes Peak Area Agency on Aging.   Transcript:   This is Studio 809.   Cynthia Margiotta: Hello everyone. This is Area Agency on Aging, Aging with Altitude Podcast. Welcome to all of you. This is where we provide answers, assistance, and advocacy for our elders. Thank you for joining us today. Our topic today is Older Driver Safety Awareness Week that's coming up in a couple of days, yes?   Terri Cassidy: Starting December 7th.   Cynthia Margiotta: So let's get that in our heads. I'm your host, Cynthia Margiotta. I'm a geriatric social worker and a volunteer with the Pikes Peak Area Council of Governments Area Agency on Aging. That's a mouthful. And CEO of a program called PEARLS Program of Colorado. With me today is Terri Cassidy. Thank you for being here today, Terri. Thank you. She's got all these wonderful letters after her name so I'm gonna just tell you what they are. The first one is OTD. What is that?   Terri Cassidy: Doctorate in Occupational Therapy.   Cynthia Margiotta: And then the second one is OTR/L.   Terri Cassidy: And that's just licensed and registered occupational therapist in the state of Colorado.   Cynthia Margiotta: There's no “just.”   Terri Cassidy: No just. Cynthia Margiotta: No just. And the third one is CDRS.   Terri Cassidy: Certified Driver Rehabilitation Specialist.   Cynthia Margiotta: And that's a mouthful girlfriend. I like the letters. OK, she's here to talk to us today about Older Driver Safety Awareness Week. Terri has her doctorate in occupational therapy and is a certified driver rehab specialist, as she mentioned. As the owner of Health Promotion Partners, she empowers people to take positive action toward their health and well-being. She and her team provide driver evaluations and home evaluations to help older adults stay independent and connected with our community. Wonderful, wonderful. So let's get started with some of the questions. I have a million of them. What is Older Driver Safety Awareness Week?   Terri Cassidy: Yes. Well, thank you, Cynthia. I'm excited to be able to be here and talk about this topic. Older Driver Safety Awareness Week has such a long title, partially because it's trying to explain what it is. It was started through the American Occupational Therapy Association really to have a set time to raise awareness to this topic. Just safety of older drivers really in a way that's non-threatening. That's really just about a topic that people don't like to talk about, maybe. So trying to bring some attention from different sectors. So starting with AOTA, but there's a lot going on even statewide with the Colorado Department of Transportation, nationally with AARP and other partners to promote this week. It's always the first full week of December so this year is December 7th through the 11th to encourage people to think about and talk about older driver safety.   Cynthia Margiotta: That's a very important thing. There's so many out there and it would be helpful, yes?   Terri Cassidy: Yes.   Cynthia Margiotta: So what do you do as a driver rehab specialist? Terri Cassidy: So in my role as a driver rehab specialist, I do driving evaluations and driver training. As an occupational therapist is really the background that I bring to this driving perspective. So particular to older drivers, I might see somebody when there is some concern or question either by the family, sometimes by the physician, sometimes by the client themselves. Am I still doing well with driving? Is this still something I should be doing? And so we do see clients and we do an evaluation here in the clinic and then also out on the road to give people feedback about maybe how age related changes are or are not affecting their driving. For some people that's just giving them a really good baseline of this is what's going on now so that if there's concerns in the future, they could come back.   Cynthia Margiotta: And this office is so easy to get to. You're just off of Filmore and on Beacon which is not far from I-25 in Colorado Springs.   Terri Cassidy: Yes. I'm glad that you were able to get here today.   Cynthia Margiotta: Yeah, me too.   Terri Cassidy: Something I like a lot about this space is our, we have a very accessible parking lot so it's a good place for a driving program.   Cynthia Margiotta: I even parked in it. Not so straight in the line.   Terri Cassidy: Oh I didn't look at your car.     Cynthia Margiotta: Don't look, don't look, don't look. I backed into a parking spot. What are some trends related to older drivers?   Terri Cassidy: Well, I would say just for starters that when we're talking for me, talking about driving evaluations, or even in general, for older driver safety. To me it's not so much about age. I'm really looking at function overall. So for anybody that we're talking about driving with, I don't see that you know, a certain age means yes or no in terms of driving or anything like that. Like we're really looking at physical skills, visual skills, cognitive skills is what makes up a lot of that. And older drivers tend to be more safe drivers. They tend to have less risky driving behaviors, tend to drive less at night, less overall miles. However, the data does show that over the age of 75, the fatality rate for individuals over 75 increases quite a bit compared to drivers of any other age. Except new drivers kind of mirrors that. So the concern becomes, you know, are there just changes that are happening that are affecting ability to drive and there is also an issue of frailty adding to the increased fatality rates. So somebody who's 80 who's involved in a crash is more likely to have more injuries, potentially life threatening injuries than a 40 year old person involved in that same crash. So there's a couple of factors going on there, but I think overall older drivers have good driving habits, safe driving habits. We just want to find ways to keep them safe.   Cynthia Margiotta: That makes a lot of sense to me. How do we, you know, what's the biggest barrier to having discussions with folks about older drivers? Those barriers that, you know, I'm fearful of losing my driver's license. She's going to take my driver's license away.   Terri Cassidy: You said it. I mean that's basically. You know, it's a type of topic, and like I said in the beginning, people don't always like to talk about this subject. Once you bring it up, so when I'm out talking to people, it doesn't matter the population of people I'm talking to, everybody has a personal story about a relative, a family member, a friend where driving was iffy or where that person successfully decided on their own to stop driving. It's a type of thing that everybody can relate to, but it's touchy. Because, I think the biggest reason that it goes so far into our own identity and our independence of being able to drive. So if your child comes to you and says, “I have some concerns, dad, about your driving.” I think it can be hard to not take, get defensive around that discussion. So I would say the barrier is almost this stigma around removing driving, or stopping driving and really, what I would love to see is that our focus, or our value is on being engaged in the community, continuing to do things that are important to you. If you're the driver or the passenger, it's ok. You know, how can we just keep people involved in what they're doing. But sometimes we get really stuck on the who's in the driver's seat.   Cynthia Margiotta: Yes, yes. I have known multiple women who haven't driven in 20 or 30 years because the husband, or even sometimes the wife, has to be the driver. You take their driver's license away and it's almost, and I can't, you know, it's for people, I guess for women to understand because it's generally men who are very sensitive about losing their driver's license. The closest I can think of to coming to that is you take away a woman's home, her ability to care for her home. Because the generation we're talking about, you know, women's homes were their jobs. And you take that away from them, maybe they would understand a little better about their husband's feeling about losing their driver's license. Am I off?   Terri Cassidy: Yeah, I appreciate that because I think it does go back to the person's role. And so, you know, in your example, talking about the husband as the primary driver, that's his role. And when we're talking about changing that it's a big deal. So yeah, no, that's a good analogy of taking, shifting, or changing that person's role there.   Cynthia Margiotta: We don't like losing our roles.   Terri Cassidy: It's true. It's true and I think any ways we can help redefine our roles as we age, but hold on to, kind of figure out what the most important piece of that is, but on the surface it's a discussion people tend to shy away from.   Cynthia Margiotta: Yeah. Oh yeah. What are some good ways to make sure you're a safe driver?   Terri Cassidy: So, yes. There's a great quote. I think it's a Dave Barry quote that says, “Everybody feels they're an above average driver.” Something along those lines. Everybody thinks they're a safe driver. It's just kind of our mentality. But things change in our bodies as we age and so sometimes it's worth having those things checked up. In terms of being a safe driver, it's not just important for your own self-perception. I felt safe during that drive, but doing kind of just routine medical visits. That's going to affect your safety as a driver. Vision is a huge one, so getting an eye exam, talking to your eye doc about driving. Certainly, just medical routines, typical health examinations, things like that. There are some self-assessments of driving that are available online. I know both triple A and the AARP have those on their websites that people could fine. They're just asking you questions about your driving. I feel like when it comes to family members, a good question is do you feel comfortable having your children in the car with your loved one. You know, so I think sometimes if you're the older adult who's interested in being like, how am I doing? How's my driving going? Asking people who have driven with you. Just being, opening up to that feedback a little bit of do you feel comfortable driving. Usually, it comes the other way. Usually comes after the fact where people are saying, they're finding out about it for another reason.   Cynthia Margiotta: So what you're saying really, I guess I can equate that to people who have not had glasses. And they get their very first pair of glasses. And they look out the car window. I've heard this story from lots of people. And they say oh my gosh. I can see the leaves on the trees.   Terri Cassidy: Right. I've had that experience, yes.   Cynthia Margiotta: Right. It's a shock because an older driver thinks they're being safe, being careful, but maybe they're driving, maybe they're weaving a little bit. Or they aren't using their blinker in time. You know, a hundred things, right. So that's what I can equate it to that might help listeners to hear gee yeah, I remember when I first got glasses.   Terri Cassidy: Yeah, and that idea of oftentimes things change slowly so we don't notice the change. Vision is a great example of that. Of your vision, and something we see a lot is trouble with contrast. So a lot of people maybe their night vision isn't as good anymore, but they don't notice it because they've just gotten used to it slowly over time. And that's where I do feel an outside, objective opinion or evaluation can be really helpful.   Cynthia Margiotta: Yes, that way we can't blame the kids. We can't blame the doctor. We can blame that lovely lady, Terri.   Terri Cassidy: Yes! Absolutely.   Cynthia Margiotta: It's all her fault. OK. So driving concerns about an older family member have long been considered a family issue. Shouldn't this topic just be addressed by family members?   Terri Cassidy: Yeah, and that kind of gets back to the barriers question and I feel like that has in the past been a big, just part of our culture of, in a different time. Let's say where people say “Oh, Mr. So and So is not safe behind the wheel. We know what his car looks like and we just try to avoid it” for example.   Cynthia Margiotta: Yes, yes. I remember that person.   Terri Cassidy: But our world has changed and sped up and there's, there's too many cars on the road to keep track of which ones to stay away from. And I think that, you know the research that's been done in terms of focus groups, talking to older adults about who do you, who would you want to bring up problems with driving, or concerns that could potentially could affect your driving. The answer has tended to be spouse. Although for a certain percentage the answer is definitely not spouse, so that's kind of a tricky one. The other person that ranks high is the doctor. So a lot of individuals feel like my doctor will tell me if I'm not safe enough to drive.   Cynthia Margiotta: Whoa, yeah. Wait a minute.   Terri Cassidy: It doesn't necessarily happen that way.   Cynthia Margiotta: Yeah.   Terri Cassidy: But I think that's a perception of, you know, they're looking at my health. They're going to look at these decisions with me. And that's where, you know, a lot of my education is to the medical community. Say hey people are looking to you for making these decisions, here's some suggestions on some ways that we can do this together.   Cynthia Margiotta: How could a doctor do that? I don't understand how they could. Seriously I don't because I'm thinking of my doctor visits, um, my doctor doesn't ask about my vision, doesn't ask about my reflexes and maybe that's down the road a little bit. Maybe they will, you know, but I have been with many, many people over the years in their doctor's visits and I can't recollect a single one doing an eye exam or even checking those kinds of questions.   Terri Cassidy: Yeah, it's really interesting because I think of like from my sphere of being in the medical world, we think of somebody's had a stroke. It should be their doctor that talks to them about, finding out if they're safe to drive before they go back to driving. So maybe the medical professional in the sense of an acute injury or illness, so this person had a fall, had an injury. But when you say it like you're saying it, it does seem like a big leap to ask the doctors to then be talking about driving. And so I think there's potential there. Like I think there's definitely room for that discussion. And I have, even in town, spoken with some of the doctor's offices who've said “oh, yeah, maybe that's something we should add to our general questions.” You know with the Medicare health, the physical, yearly physical there's questions about just about everything else. You know, in terms of emotional state, and alcohol use and all of these different things, but there isn't something specific to driving. So I think it would be really interesting. There has been some research around primary care physicians and how they could be, just tapping in and asking some of these questions and mostly what they came down to was that it was too much to ask a doctor's office to perform a screening or some kind of test related to driving. They really found though, just having the physician's office ask the question: “How's driving going for you?” Like just even that would be a huge improvement over what we have going on right now. And I love the idea of normalizing that conversation so that you're asked that every year. And so you're not defensive when somebody asks you. It's just an honest conversation of I've started to notice that sometimes I think I'm pressing the break and I'm actually pressing the gas. And that can relate back to sensation and that could be something the doctor could help you manage.   Cynthia Margiotta: Right, so it would lead into so much more information for the doctor. So what kind of solutions are there for someone who has an injury and is having trouble with driving?   Terri Cassidy: So I mentioned some medical diagnosis. So I mentioned a stroke and for example there are a variety of things that a driving rehab specialist can do with a client to help them get back to driving after something like a stroke. Some of that is going to be in an OT clinic so that might be part of outpatient therapy before somebody comes to see me. Really focusing on reaction time and multitasking and some of these pieces, these higher judgement pieces that we use all the time when we drive and we don't really think about it. To me the other answer that though has to do with adaptive equipment. So for example, if someone's had a stroke, and they, let's say they can't use the left side of their body. They can still do gas and break with their right foot, but they usually would have done their turn signal with their left hand. So there's some equipment we can put in the vehicle to make it safer for that person to steer with one hand, to access their turn signal and to keep their attention on the road through that whole time. Or another example would be somebody who has an amputation. We do training for use with hand controls, so you don't need to use your feet at all for accessing gas and break and steering. So there are some really great ways to keep people driving safely even after there have been some injury or illness changes.   Cynthia Margiotta: Yeah. Wonderful. And are those expensive? Are those expensive adaptive types of equipment?   Terri Cassidy: You know, expensive is a good question because it's all relative. So for someone to get equipment, you know, hand controls can be about $2000. There's also training involved with that. Evaluation involved with that. That could be another thousand dollars. To me, when you're looking at that amount versus not driving, you know, so I think the expensive part is hard to answer. It depends on everybody's particular situation. Driving a vehicle, owning a vehicle is expensive. Paying for insurance is expensive, you know. So it's all of these pieces, yeah. It needs to be weighed for each person's situation.   Cynthia Margiotta: Right, right, but it's out there. And it's great. And you have those contacts.   Terri Cassidy: Yes.   Cynthia Margiotta: And so people going through your program, if they discover they need some adaptive equipment, you could put them in touch with the correct person.   Terri Cassidy: Yes, yes. We can help with that whole process.   Cynthia Margiotta: That's great. That's great. So what should I do if I'm concerned about a family member's driving?   Terri Cassidy: And this I'm going to go back to the idea of start the conversation. You know, so often people are concerned, but they're, don't want to mention it. And I feel like a lot of times just coming from a place of concern, and not necessarily making any decisions, but just saying that I noticed that, you know, whatever it is. Give concrete examples if possible. But just first, bring up the topic. Say I'm a little bit concerned about this, what do you think? Maybe next time when we go to your doctor, we see what your doctor thinks. Because a lot of timed that is how it comes to the doctor's attention is family members bringing up at the doctor's appointment, which I think is appropriate and it helps kind of have more people give input to a decision. Because there's all kinds of personal things that come up in these family discussions so getting more and more toward objectivity, I think is really helpful in those discussions as well, but I would say having that discussion, having an open mind. There are some great tools online to be done proactively. There's like a driving contract that someone would sign with their children and the children saying things that I'm worried about with your driving. I'm going to let you know and also give you every opportunity to fix it, or to prove me wrong basically. And the older adult saying I agree to this process. I'm probably not explaining it great, but there are some driving agreements that can be a nice thing to do before there is anything going on that you're worried about.   Cynthia Margiotta: Nice, nice. Do you also have them here in the office?   Terri Cassidy: I have access to them. They are mostly online. So yeah. I can give you guys that info.   Cynthia Margiotta: That would be good for folks. You know, who've come to your program and visit with them as well. Maybe there's no problem now, you've done the plenty, no problem, but here's something you and mom can talk about and come to conclusions what works for you in your family.     Terri Cassidy: And that's a great point because the majority of people that we see, do pretty well. So I don't want to make it seem like send them to Terri and that'll be the end of their driving. I would say 80% we see, the recommendation is to continue driving. Maybe with some equipment. Maybe with some restrictions. Maybe just with some training. But we are always talking about the fact that we as a society are living longer, and it will become more and more common for us to outlive our ability to drive. So, it's going to happen to all of us. And so the more we can be prepared and be thinking about these things, the easier it'll be.   Cynthia Margiotta: Absolutely, good for you. So you know, there's a big problem with losing your driver's license and I think that's probably a national issue. I really don't know but losing connectivity with the things outside of our home is a fear. So, if someone needs to stop driving, how can they stay engaged with their community?   Terri Cassidy: And that's a great, a great topic. A great piece of this and really a great question to be asking because that, like I was saying earlier, that's really the key. So a lot of times, you know, if it's somebody we're seeing here we will try to facilitate that process. There are some really good tools online as well for family discussions of like write down where you go on a weekly basis and then have some input into the best ways to get there. So sometimes, a lot of times the family members are willing and able to help with a ride to the hair dresser, the ride to the doctor where maybe they want to be there anyway as an extra set of ears. There's a lot of community rides in terms of neighbors going to church anyway and it's easy to bring you. So some of that is done best kind of with family discussions and kind of circles of support. There's also ride services that are available. There's quite a few things available in Colorado Springs. So services such as Silver Key, such as Envida. There's things through, I think Fountain Valley Senior Center does transportation. There's a variety of transportation alternatives and it's just really helpful to learn more about those because there are different requirements for different ones although we're seeing more collaboration which is encouraging to me. So as different transportation providers collaborate, it cuts down your wait time because the next bus coming by can pick you up and take you on the way. So there's some good things happening in our community that way. Other options that are maybe less familiar, but can be really helpful are these ride sharing services like Uber and Lyft because a lot of things I hear, people want their transportation on demand. They don't want to have to schedule two weeks ahead for a ride somewhere. And it works for a doctor's appointment, but maybe not for some other things. There's a great service called Go Go Grandparent and it's essentially like a concierge service for Uber and Lyft. So you don't have to have a smart phone. You can call from a landline. I could call and arrange a ride for my mom. It's still going to be an Uber driver that comes and picks her up, but the communication and the payment piece of that is, doesn't all have to be done through an app. So that can be a good bridge.   Cynthia Margiotta: And that's Go Go Grandparent?   Terri Cassidy: Yeah, yeah.   Cynthia Margiotta: I like it.   Terri Cassidy: Yeah, and it's nationwide. It's growing which is cool. So that's a good one to check out. The other thing I'll say around this is, I think it's really helpful to learn about some of these services before you need it and that's always a really difficult thing. For example, we might see somebody here for a driving evaluation and the recommendation is that they drive to their familiar locations within five miles of home, but the once a year doctor's appointment on the other side of town, let's start finding some alternatives for that. So maybe they figure out Silver Key and use Silver Key for that ride. Just bits and pieces so I don't feel like you have to be completely giving up your car to start exploring some of these other options.   Cynthia Margiotta: Right. I mean just listening to you I can think of, you know, maybe you have a friend who's still driving. You can set up your doctor appointment to match their doctor appointment or be right there if they're willing and take them to lunch.   Terri Cassidy: Yes, and I think that's a thing a lot of people don't want to be a burden, of course. And I think some of that is a shift in how we think about things, and there's things you could do for them. Take them to lunch, bake them cookies, you know, there's things you could do reciprocally that you both feel good.   Cynthia Margiotta: So December 7th is around the corner. The beginning of the week. Can you tell us just a little bit about the different themes for Older Driver Safety Awareness?   Terri Cassidy: Yes, so each day has a different theme. I'm just going to kind of read through them here. There will be more information available online as well. So Monday the theme is “Anticipating Changes That Can Affect Driving.” And that kind of relates back to some of the changes that we're saying could happen slowly that you don't really notice. Tuesday is “Family Conversations,” which as we've alluded to here can be a really, a huge topic. Wednesday is “Screening and Evaluations with an Occupational Therapist.” And some of that could happen at an outpatient clinic, not always a full driving program. For example, in town there are a couple of occupational therapists who will do kind of a screening to give you some information there. Thursday, “Interventions that Empower Drivers and Families.” So really around adaptive equipment and what types of things can help somebody stay safer longer. And then Friday, “Staying Engaged in the Community with or Without a Car.” So these topics are really put out there with the hopes that other people will pick them up and start talking about them. So I think there will be a lot on social media during that week, but kind of related to each theme each day.   Cynthia Margiotta: Right. Wonderful. So how can someone stay or get in touch with you through Health Promotion Partners? Phone numbers, email?   Terri Cassidy: Sure. Phone always works great so Terri Cassidy, Health Promotion Partners. My number is 719-231-6657. Our website is HealthPromotionPartners.com. And then email, it's Terri@healthpromotionpartners.com. And I'm happy to talk to anybody even if it's just questions and wondering about their specific situation. Happy to take those calls.   Cynthia Margiotta: Wonderful, and thank you so much for your time, Terri. This has been very enlightening. I appreciate it.   Terri Cassidy: Thank you. It's been a pleasure.   Cynthia Margiotta: So that's the show. And thanks to all of you for being with us today. Until next time, take good care of yourself and your loved ones.   Terri Cassidy: Thank you, Cynthia.   Hi, this is Dave Gardner. I just want to make sure you know that during these unusual times peakradar.com/virtual brings local arts and entertainment right into your home. From local music to gallery tours, to classes in dance, yoga, writing, and more. Our community is still creative and invites you to join in at peakradar.com/virtual          

Older adults have continued to receive much needed services and many new ones during COVID19, with the help of Area Agencies on Aging.  These agencies were started in the late 1960's as part of the Older Americans Act.  Over the years, thanks to advocacy, more funding has come available to add services like counseling, vision support and much more to a program that originally focused on food and transportation.  During COVID19, even more support has been provided by these agencies and their community partners.  Mr. Jody Barker, Director of the Pikes Peak Area Agency on Aging shares many of the ways this region stepped up. Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country.  We talk about both the everyday and novel needs and approaches to age with altitude whether you're in Ft. Lauderdale, Florida or Leadville, Colorado.  The Pikes Peak Area Agency on Aging is the producer.  Learn more at Pikes Peak Area Agency on Aging.     Transcript: Cynthia: This is Aging with Altitude, welcome to all. This podcast is brought to you by the Pikes Peak Area Council of Government's Agency on Aging. We strive to provide answers, assistance, and advocacy for our elders. Thank you for joining us today. Our topic today is COVID-19 Now. I am your host, Cynthia Margiotta, a geriatric social worker and volunteer with the Pikes Peak Area Council of Government's Area Agency on Aging. With me today is Jody Barker.   Jody Barker: Thank you, Cynthia.   Cynthia: Thank you for coming. A little bit about Jody... Jody is the director of the Pikes Peak Area Agency on Aging, which serves three counties: El Paso County, Park County, and Teller County in Colorado. He has served in many roles in his twenty-two-plus years in senior service organizations in Colorado. Among those roles have been editor of the Life After 50 newspaper, the director of operations for a home care agency, Central Colorado Regional Director of the Alzheimer's Association, and director of the Colorado Springs Senior Center. Jody's greatest joy is matching services with seniors and their families or enabling staff and services to do so. Jody has served on various boards and commissions over the years and currently is on the Colorado Commission on Aging, appointed by Governor Hickenlooper. I'm impressed!   Jody Barker: Thank you, Cynthia.   Cynthia: Well, thank you, Jody! I have known you through several of those organizations, all are so great.   Q: So, let's get started with our first question about COVID if you don't mind? Jody, how are you at the Area Agency on Aging? How are you still meeting the needs of our community?   Jody Barker:   A: Well thank you, Cynthia, it is a pleasure to be with you today. When the governor's order began in early March, we knew that we would have to continue operating even if we had to close our doors. March 17th, St Patrick's Day, as a matter of fact, we packed up what we needed to serve our community. That included telephones and paperwork and our computers and we began to work remotely. So, even a sense March, even with our doors closed to the physical building, we are still 100% operational. We have even added services that I'd like to share with you later. The exciting thing is that our staff has taken this as a really exciting challenge. We continue to answer all phone calls, we're reaching out to our clients, we're reaching out to past clients, we are reaching out to our community to continue to serve them every day.   Cynthia: It's amazing how much you're doing and I can't wait to talk about that. As the emergency orders have changed we are seeing changing guidelines. As of today which is June 3rd, 2020, in case you're listening to this a little bit further down the road, we are at the Safer at Home stage or in the Vast Great Outdoors.   Q: What does that mean?   Jody Barker:   A: There's a lot of interesting thoughts around the changes in the orders that have been provided by Governor Polis. Originally, as you know, we were in a Stay-at-Home order. It was necessary for all involved to really flatten that curve. This way, we could really understand more about the disease and how it was affecting our community. Of course, because covid affects upper respiratory issues, it has been very challenging for older adults, especially those with underlying health conditions. The Stay-at-Home order was crucial, to begin with. As those in leadership, especially those in the healthcare field, began to understand more about the disease in early May they changed the order to Safer-at-Home. This allowed us to have a little more movement, like maybe going to the grocery stores or getting out and about to pick up a restaurant order instead of sitting in a restaurant to eat. That was was crucial.   Now, with this most recent phase, The Vast Great Outdoors, it simply is an encouragement for people who are able to enjoy the outdoors. Here we are now, on the very front end of summer and this week has been more like summer than June! It feels more like July and August kind of weather. It is very hot! The great thing about this new phase is that it is an encouragement to people who are able to get out and go to their local parks with appropriate social distancing or maybe go for a walk in their neighborhood. There was concern earlier on about even just stepping outside your home. Now, people are encouraged to open those windows and get some fresh air and to lessen the social isolation that was so important early on. Now, we want to encourage people who can, to get out there. There are actually a couple of exciting changes with our providers who are helping to promote the new orders that we will touch on.   Cynthia: It is so important to get some fresh air and to get a little exercise, even if it's just walking around the block to take take the dog for a walk. I mean, I have a neighbor who takes his wheelchair and he goes and walks his dog. I think it's important to do that!   Jody Barker: Even in my neighborhood here in town when we are able to get out for a walk, we see so many people out walking their dogs or going to the park. It is people of all ages, you know? So it's really exciting to see people moving about! It's an interesting change from the last two months but when we think about what it truly means for older adults, it's crucial. This is because the older Americans Act, which is a major source of our funding to the AAA, was written in 1965 to reduce social isolation. That is the primary directive around our funding and our programming. Imagine what that's had to look like in the last two months with the Stay-at-Home and even the Safer-at-Home safer orders in place. People we have served in a variety of areas, whether that's senior center programs, transportation to doctor visits, transportations to church or classes at the Senior Center, lunches at the Senior Center, all of those had to change on a dime. All of that was intended to help protect the safety, health, and well-being of older adults, as well as the rest of the community. But, it's probably been most difficult on our older population because someone who lives at home, to begin with, and maybe looks forward to that three to five days lunchtime with their friends at the Senior Center, suddenly are being asked to stay at home. That can be extremely challenging to their health and mental well-being.   Cynthia: Yeah, absolutely! We could talk about that for hours, gotta get out gotta be involved as much as a person is able.   Jody Barker: Exactly! An interesting comment came to me a few weeks ago from one of our volunteers who said she was talking with some neighbors. One of her neighbors, who is an older adult, said, "you know, I feel useless because I'm used to volunteering and now, I'm not allowed to. I feel useless." And so, one of the things that our advisory committee is working on is actually not only volunteering for seniors but involving those seniors in that volunteer project. This is to give people a purpose and to give people activities and things to look forward to. I know what will touch on it here in a little bit, but there's so much going on to not just serve the seniors but incorporate the seniors into the process. We're all working on this together.   Cynthia: In a sense, that's serving them.   Jody Barker: Absolutely!   Cynthia: You know you've known me for a while and I'm a big advocate of volunteerism. I think it's a very important part of being part of the community. I think, you know, if you can when you retire don't go sit on a chair! It drives me crazy! If you can, go out and volunteer. If you can't go anywhere, find a way to volunteer from home. People can write notes or they can make phone calls. I can talk about it for hours...   Jody Barker: I think what we have to remember is that there are opportunities for outreach, not just to our older population but for those older adults to participate in that process. Maybe there's an assisted living or retirement community or a skilled nursing facility in your neighborhood. Call those places and say "I'd like to write someone a letter." You have no idea how much of a positive impact that person can make.   Because maybe you live at home but you might have three or four rooms to move about in. But someone right now, during this time, who lives in assisted living or a skilled nursing facility is being asked to stay in their room. Their meals are delivered to them, their activities are brought to them in the hallway, and they are being asked not to leave their room due to social distancing.   So even just taking the time to write a note to an older adult who lives in a community near you could make a world of difference. You don't have to ask permission, you don't have to be part of a larger group, to do that. You can pick up the phone, you can write that letter on your own, and it will be such a positive impact on the staff and on the residents.   Cynthia: Just the thought of me being in a room for a month... I'm an extrovert and I would have no hair because I pulled it all out. I absolutely think those are wonderful things we can do. I mean, we can even write a note to our neighbor. It doesn't have to be an official volunteer program.   Q: So tell me, what are some of the service delivery changes and supports that have been implemented that you have found interesting or effective or both?   Jody Barker:   A: That's a great question! As you might imagine, as we started hearing more about this virus and as it began to grow, even at the end of February, before we closed our physical building, before the Stay-at-Home orders came from the governor, some of our providers were already beginning to make plans and make changes to their service delivery. For example, one service provider who many of you will know is Silver Key Senior Services. They are the primary meal site provider for El Paso County. So, when you think of meal sites, you're thinking of Colorado Springs Senior Center, Fountain Valley Senior Center, and the Mountain Mennonite Church in Palmer Lake. Those places receive meals from Silver Key Senior Service's kitchens. They're hot and fresh meals that get delivered to people who come into a congregate site. These people meet up with their friends. They might come early for a class or stay late for a concert. That is their time to get together. As you might imagine, as soon as that Stay-at-Home order came into place in mid-March, that service had to stop.   So, what did Silver Key do? Silver Key immediately implemented appropriate social distancing. They increased their home-delivered meals. They increased their pantry of delivered meals instead of people coming in via transportation on a Silver Key bus, going to the pantry to do their own shopping, and then get back on the bus to go home. Silver Key tried to reduce that contact in their pantry. The pantry is big until you start putting 15 people with shopping carts in there. You know, it can get very crowded. It is shoulder to shoulder sometimes. To avoid this, what they started doing is packing up those pantry boxes and delivering those to their regular pantry clients.   That was one thing that they did, another thing that they did is they converted those congregate meal sites into what are called grab and go sites. For example, every Monday at the Colorado Springs Senior Center, the Silver Key Senior Services blue meal truck shows up. Instead of daily pickup, they prepare multiple meals and flash freeze them. This way, clients have all five meals for the week. Clients also have the opportunity to pick up fresh produce, dairy products, and things like that depending on what silver Key has on hand or what has been donated.   The Senior Center, normally provides classes such as educational classes, moving for better balance, tai chi, and more. Those are the kind of programs that we fund with the Older Americans Act and Older Colorado Act dollars that we administer. For obvious reasons, they had to close as they were not allowed to do congregate-type programs like those physical classes. So what they did was they started making calls of reassurance. The YMCA and the Colorado Springs Senior Center host over 16,000 members who are over 60 years of age. So, staff and volunteers began picking up the phone and calling in to check on their constituents. In addition to this, they created what they call a phone buddy program. Silver Key would invite someone to the program and have that person tell a little bit about themselves. They would then collect a little bit of information from an older adult who is interested. They then paired volunteers with participating older adults. So, think of it almost like a pen pal program, but by phone. The Senior Center has begun to host those pairings of phone buddies. Instead of Senior Center staff making those calls out daily, weekly, twice a week, those phone buddies can now be a lifeline to one another. All they have to do is pick up the phone to check in with each other, talk about common interests, and that kind of thing.   Silver Key is also providing some meals to people who do not have access to the Senior Center to pick up their own meals. They're delivering those meals on a case-by-case basis. The Fountain Valley Senior Center, as you know, is one of those congregate meal sites. They have now become and one of the Silver Key grab and go sites. Under the front of the building, they have set up a drive-through system. People line up in their cars and they can pick up the meal, they can pick up information, they can check-in and see how they're doing. One of the exciting things that I heard about, as it relates to Fountain Valley Senior Center, was that the city of Fountain did not layoff their staff, but sent a great many of them home to work remotely. This is because they did not have the same functions during that early stay-at-home process. Someone from the city government contacted the Fountain Valley Senior Center director, Jolene Hausman, and said what can we do? How can we help at this time? And they began with 20 city employees making those calls of reassurance. These employees were making over 100 calls a day. At first, it was only going to be a couple of weeks. Now, it is becoming an ongoing project because the seniors love it and staff from the city love it. Now, Jolene is talking about when things slow down, she would like to have a barbecue so the city employees can meet their phone buddy. The Senior Center is actually been talking about putting on something when it's safe to do so. So that those phone buddies can meet one another.   It's just been really neat to see those programs, even some of the smaller programs like Teller County Senior Coalition, based out of Woodland Park. This group has provided fresh fruits, vegetables, and even restaurant meals to their clients. This way clients are getting choices and variety, not just the same box of food every week. There is just a lot of neat things going on.   Unfortunately, some of our providers were limited. Providers who were contracted with us to provide certain services like transportation, suddenly found themselves not allowed to provide their service. So, they reached out in other ways like helping with telehealth or counseling services to make sure that people's needs are being met.   The irony in all of this is that it's changing almost daily, and definitely weekly, as our providers determine what needs must be met. Providers are determining what the outreach needs to look like as they plan for the future. Right now, we don't know what congregate programs are going to look like for the next few months or the long term. However, I would encourage people to take a look at the Colorado Springs Senior Center website at epymcappymca.org.   On the website, they can find the Colorado Springs Senior Center. They have already begun art classes using the online zoom system. So, zoom, if you're not familiar, is really more of a teleconferencing system where you can log in and see each other if you have a smartphone or a computer at home. Using the camera on your computer or smartphone, you can see one another and you can see your teacher. They began art classes using that online platform last week and they had something like 16 or 20 people from all over join that class. So, they are going to be doing a variety of both free and fee-based classes as they begin to look at what serving the community needs to look like with these new circumstances.   Cynthia:   Q: These are some mighty changes, yes?   Jody Barker:   A: Yes! These changes are distinctly different than what we traditionally thought of about senior services. I'm really excited that so many of our providers are looking at how they can continue to serve the needs of our community in a new way.   We have about half a dozen services that we provide directly out of our offices by our staff. These services include family caregiver support services. We are also going to be doing our own support groups via zoom and by electronic media. The exciting thing about this is that it means we can provide services to those who are caring for older adult family members, spouse, or parent. Instead of just the caregiver coming to a support group, he or she can invite family members from across the nation to join the caregiver in that support group. We now have the electronic technology in place to be able to do that. So, real silver linings are coming out of the challenges that we've faced due to COVID-19.   Cynthia: Yeah! You know national support groups would be an asset ongoing.   Jody Barker: Absolutely!   Cynthia:   Q: I like that idea! Will there be issue-specific support groups, or will they be more generalized?   Jody Barker:   A: I believe they're going to start somewhat general to begin with, but there is discussion around some more specific topics. So, if someone has a specific challenge or need in a certain area that person will be able to sign up for that specific support group. To expand on that, you know the Colorado Chapter of the Alzheimer's Association is also doing something very similar. It may be nationwide, but they're beginning to do a lot more online support groups for that very reason. Again, it's one of those silver linings that has come out of the changes that we are having to make as we do our best to meet the needs of our constituents. Even though we can't be face to face, we're taking advantage of technology to meet those needs.   So, even internally, where we would normally have a Medicare class here in the office, right now everything is converted to the webinar. We were able to have more of those classes and are able to partner with other agencies in town so that we can make sure we get the word out. Because these classes are done by webinars, we don't have to worry about partner space and social distancing. It gives the people a lot more flexibility in getting the resources that they need, as well.   Cynthia: I take the Medicare 101 class almost every year and I'll tell you I don't know how Roma does that! There seems to be a different rule every year with Medicare, so I think those would be great classes!   Jody Barker: Absolutely, absolutely! You know, if our listeners are interested in getting more information about those classes, they can go directly to our website at PPACG.org and click on the aging banner. That will take them to a variety of pieces of information where they can sign up for those webinars. If you're not sure about that, you can also call us directly at 719-47120964712096. That phone number is manned during regular office hours and it is very likely that you would need to leave a detailed message with your contact information and name so that someone will get back to you. Our staff is fully operational.   Cynthia: And for those of you who don't have a paper with you, we're going to repeat all of these wonderful sites at the end. Jody is watching me take notes here so that I get them right, which won't happen so you'll have to correct me.   Q: Next question, what thoughts and discussions have come up around serving different populations such as rural areas, different ethnicities, lower-income, and, of course, our seniors?   Jody Barker:   A: As you might imagine, the Area Agency on Aging primarily focuses on our population who is 60 years and over. That's who the Older Americans Act was written specifically to provide services to. Most of the conversations we have are around that. However, we do partner with several other agencies like the Independent Center, the Resource Exchange, and others like that which provide services to adults with disabilities. So sometimes there's some crossover in information. So, if someone's not sure who best to call, always feel free to call us at that main number (4712096) and we will help guide you. You know, we will ask a few questions and determine if that is a service that would come from us, or if it's a service that might come from one of our providers, or if we should be referring you to a partnering agency. It's always good to have that phone number in mind. That's the primary phone number here at the office and it will also lead you to our senior information assistance network staff.   As you may know, we also have a yellow book that we just got printed! COVID did not stop us, it delayed us a little bit. Really, COVID didn't stop us. Those are now being delivered. Even if you're used to coming to the office to pick those up, you can still do that! We were the generous recipients of two newspaper-style boxes that are located at our parking lot. So you can drive right up and pick up both our yellow book and our Adult Medicaid and VA Guidebook. We still have those available, even though we might not be here in the office. I wanted to make sure we talked about that.   Conversations around serving other parts of our population can really be a challenge. You know, zoom and Skype and similar platforms like that, as it relates to technology, not all of our seniors have those capabilities. That can sometimes be a challenge. Despite the state budget shortfalls that we're expecting, there is still discussion about how to bring broadband to our rural areas. That discussion has not stopped. So, for those of you might who live in a more rural area and don't have access to the Internet, know that you're not forgotten. That still continues to be a high priority for many of our legislators. With that being said, we're just looking at greater opportunities to work with partners. As you may know, even though AAA serves primarily three counties, that's our region (region four) for the state of Colorado. Our S.H.I.P that's our State Health Insurance Program, counselors actually serve more counties than that. So we typically work with partners in those outer regions anyway. This extends all the way down to the New Mexico border, to make sure that we're reaching those populations. Right now, it's a continued and ongoing conversation. I can't really say that we've figured out how best to do it, but it's certainly important for us to make sure that we're remembering those populations as we're figuring out how best to reach those areas. A couple of opportunities that we're exploring is greater reach into eastern El Paso County, for example. So some of our providers, including Invida who run a bus service, have reopened their rural area bus services. So if you live in the Calhan area, that bus service has restarted. Or if you live in the southeastern portion, along Hwy 94, Invida has restarted that route as well. There's increased outreach and increased opportunities to get engaged. Now we're just looking at all those opportunities to see what that's going to look like in the future.   Cynthia: Good for you. You got to keep working!   Jody Barker: We have not stopped. Like I said, even from the day that we had to physically close our doors, we continue as a staff. Our providers out in the region continue to serve. As I said, some of that is changed. The service delivery might look a little different but know that we're all still working on this making sure that our seniors and their families have the services that they need or know that they have access to services.   Cynthia: I'm sure some of these changes are going to be ongoing.   Jody Barker: That the expectation, yes! Because we don't really expect to have traditional congregate programs for some time yet. Now, even as we're speaking here on June 3rd, this afternoon there's going to be a presentation by the governor's office around what the next phase of opening may look like. It is intended to be specifically focused around senior services. Right now, a lot of those recommendations are coming to us as things to consider. The requirements are really following the guidelines of the health departments in particular regions around the State.   Cynthia:   Q: Do you know where people can listen to that? Will it be on TV?   Jody Barker:   A: This is very last minute, we were just alerted to this about an hour before we began this conversation. So I don't know where it will be if it will be recorded, if it's going to be a press conference, or if it's going to be just service delivery information. I don't know yet but as we know more we will certainly update our website. You can also go to the El Paso County Health Department website to keep track of things like that, as well.   Cynthia:   Q: What has the collaborations and leadership looked like across Colorado?   Jody Barker:   A: That's really been exciting to be part of in this time. Despite the challenges in the State of Colorado's State Unit on Aging, which is a division of the Colorado of Department of Human Services, has been extremely helpful. I'm also part of an organization that includes all of the AAA directors around the state. So collaborating between the State Unit on Aging and the Area Agency on Aging has been really exciting to be part of right now. There's a lot of discussions, there's a lot of questions, there's a lot of idea sharing, and that collaboration has been really positive. We've also included the in those conversations service providers so that they can hear and ask questions directly of our state office as well. It's been very positive right now. There has been a lot of flexibility in how we're able to use not just our regular funding but some of the emergency funding that we're starting to see come into our area.   Cynthia:   Q: Then what does planning look like going forward? Where can people get information and resources?   Jody Barker:   A: As part of the Governor's discussion this afternoon, we expect to hear some recommendations and potential guidance around what reopening phases might look like. It's going to take some time though, so we don't really know. We would ask people to be patient around that because there are a lot of unknowns that we are all dealing with. Even just two weeks ago our messaging was very different than it is today because things are changing so often. I would encourage people to go to or call, the El Paso County Health Department if they have questions. They can also contact their direct service providers if they are already a client of Silver Key, Invida, or Fountain Valley Senior Center. Those providers are getting the same information that we are. Of course, they can always contact us here through our main phone number: 4712096 that we talked about. As I said, that's our senior information and assistance hotline. Typically, you can leave a message anytime, twenty-four hours a day, seven days a week. Our operating hours are typically from about 9:00 am to 4:00 pm. We try to get back to you just as soon as we can or forward your voicemail to the appropriate staff member who will call back. There are two areas right there. We're trying to continue to keep our information as up-to-date as possible.   Cynthia: You know family members that are out of the area, I just want to add 719-471-2096. You can call about services for mom and dad! Yeah, you are very welcome to do that.   Q: My last question here, is well second to last, but some of us would like to continue getting updates on COVID?   Jody Barker: Specifically, around COVID-19, there's a lot of information out there online, on the news, on TV, and on the radios. Sometimes it's a little challenging to really understand what's real. Yes, that's a good way to put it, what's real? I would encourage people to follow up with the county health department in their area, whether that's here in our area, El Paso County Health Department. Teller County has its health Department. Park County has its own Health Department. I would encourage them to find a way, whether by website, phone calls, or regular media information, to get connected so that they can get that direct source of information about what's most crucial for their area. As you might imagine, around the State every County typically has a Health Department. Their rules and requirements might be a little bit different and their expectations and recommendations might be a little different from County to County. I would encourage people to get connected with their specific county. Don't look at information from a neighboring state, don't look at information necessarily even from a neighboring county, it could be very different. Find the one in your area and stay connected. That way, you can get the most accurate information anytime. For us here in El Paso County, as I said, it's just simply ElPasoCountyHealth.org.   Cynthia: I think that would be a better place to find things then, I don't want to insult Facebook, but Facebook. Some folks might hear it from the wrong person and they would put that on Facebook and it may or may not be true.   Jody Barker: Correct, the El Paso County Health Department has medical professionals who are specialists in disease control, population information, and what's going to be best for our area. That's really where I would recommend people get directed for that very specific disease information.   Cynthia: Every area is a little different.   Q: Now, let's talk a little bit about the new programs and the providers that you have started here over at the Area Agency on Aging?   Jody Barker:   A: Sure! As I mentioned earlier, we have about a half dozen programs that we provide out of the Area Agency on Aging that include our senior information and assistance program that we've referenced. It also includes our family caregiver support center, that's where we do some of our support groups and caregiver support, just like it sounds. We also do this senior insurance and assistance program that's our S.H.I.P. program. We also are the region's ombudsman office and the ombudsman, if you're not familiar with that terminology, is simply an advocate for older adults. In our case, the ombudsman specifically advocates for those who live in long-term care facilities like assisted livings and skilled nursing facilities. So our ombudsman serves in that area as well. We also, through some of our funding, are able to provide homemaker and personal care services. Those are our primary services internally.   Now, our partnering with agencies that we contract with might be some of those like we've mentioned, such as Silver Key Senior Services. A lot of people think of Silver Key as meals-on-wheels, the congregate meal programs, and transportation, but they do so much more! We're very proud to partner with them. Some of the other services that they do, like case management and so on so. We also have providers who provide additional homemaker services or respite care for those family caregivers. For example, we partner with Colorado Legal Aid, which provides legal services free for folks. We also provide some services around visually impaired services, dental and dentures, mental health screening and counseling, caregiver counseling, home safety renovations. As you might imagine, more people are staying at home. Actually, we've seen an increase in requests for grab bars, railings, and that kind of thing. So we're proud to contract with several other providers like that. We are also able to provide nutritional counseling and education. So, if someone wants to receive nutrition education, they can simply pick up the phone and call their primary provider like Silver Key, in our area, or the Teller Senior Coalition. We will get you routed, but you can call Silver Key directly. We received that education and then those health and exercise classes we talked about that are provided at the senior centers and other congregant programs. Again, some of those have changed. You know how that works has just had to change because of COVID-19. There's a lot of exciting ways that our providers have reached out to make those changes to continue to reach their constituents and clients in making sure that social isolation is reduced as much as possible.   Cynthia: There's a lot more going on in this office than the few employees that are sitting in the building when that was possible.   Jody: Exactly and even for us, even though we have our regular programs, because of COVID-19 we also started doing what we call "calls of reassurance". Some of our providers do that as part of their programs, but we started doing that as well. As you might imagine, someone who may have come in in February to have questions answered around Medicare, suddenly find themselves without transportation and unable to go grocery shopping. You know, we're asking them to stay at home or be safe at home, and maybe they don't have access to those some of those services. So we took it upon ourselves to begin working backward through our contacts and making sure that clients that we had served, for whatever reason in the past, know that they can call us for questions. They can use us for referral services to get referred to other services throughout the community and ultimately just to be reassured that they know that they can call us at any time. As you might imagine, our providers have seen an uptick in those who signed up for services because folks are trying to stay safe and healthy. If that means receiving a few meals a week versus going to the grocery store than those people are reaching out for those services. So it's been really exciting not just working with our staff here as we've made those changes, but also working with our providers who are juggling and making those changes and adding to those services.   Cynthia: Making those changes! It's a great idea. I'm just going to repeat some of the different things that were brought up if you have paper and pencil. One is if you're interested in the yellow book, there's a website where you can also look and see the website. So for those of you who are family out of the area, you might look at that website is ppacg.org yellowbook. Or, you can call the phone number to talk to someone and you might need to leave a phone number and message but that phone number is 719-471-2096. You can get that information along with the Medicaid Veterans Benefits Book. You can stop by here, at our office, and pick up yellow books as well as the Medicaid book. They have a little kiosk outside. The location is not really a difficult location to understand. We are located about two blocks north of Colorado Ave on Chestnut, and you go through these big gates which are open during the day, I don't know at night. During the day, you can just drive through and you'll find it in there. That's where the offices are as well. Whenever it opens, you can always come to visit during that time. Another one that Jody mentioned was the YMCA ppymca.org. They're doing online and zoom art classes and other classes as well.   Jody Barker: They're going to be doing some exercise classes, art classes, as well as some presentations.   Cynthia: That is so great.   Q: Then, are there others that you wanted to bring up that I missed?   Jody Barker:   A: Sure, yeah! As you might imagine, all of our providers are listed on our website. The easiest way like, like Cynthia mentioned, is just going directly to ppacg.org and clicking on the aging button. That really gets you into the Area Agency on Aging portion of the website where you could find an electronic copy of the yellow book, an electronic copy of the Medicaid program, and an electronic copy of the VA benefits guidebook. You can also find listings of our service providers. There some that are local that will provide the largest percentage of our programs and organizations like Silver Key. You can also just go to silverkey.org or you can call them directly. If you're calling locally, the number is 719-884-2300. They will route you to the appropriate department, depending on the service you need. If you're calling for a family member and you're out of state or out of the area just remember the 719 area code. Again, that phone number is 884-2300. You're always welcome to call us here. As I said, leave a detailed message, your name, and telephone number, and we'll get back to you as soon as possible. We will ask a few questions and we're happy to get you referred to the right services. You can save yourself a lot of time. Sometimes it can be challenging to go through the amount of information that's available to us so we're going to help you with that. Give us a call directly and we would love to do that on your behalf and get you pointed in the right direction.   Cynthia: Wonderful, thank you so much. I appreciate your time here with me Jody. That's the show and thanks to all for being with us today! Take good care of yourself.  

The resilient second-halfer through wisdom and personal stories is prepared and empowered for the second half of life.  Tom Rasmussen, Income Protection Specialist with Clear Solutions, shares his proven insights about how to thrive through life happenings.  This two part podcast explores first what makes a good life and second how to financially build resiliency. Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country.  We talk about both the everyday and novel needs and approaches to age with altitude whether you're in Ft. Lauderdale, Florida or Leadville, Colorado.  The Pikes Peak Area Agency on Aging is the producer.  Learn more at Pikes Peak Area Agency on Aging.   Transcript: You're listening to Studio 809. This is what community sounds like.    Cynthia Margiotta:   This is Aging with Altitude, welcome to all! Brought to you by the Pikes Peak Area Council of Governments Area Agency on Aging. We strive to provide answers, assistance, and advocacy to our elders. Thank you for joining us today. Our topic today is Life Happens. What is your plan? I'm your host, Cynthia Margiotta, a geriatric social worker and volunteer with Pikes Peak Area Council of Governments Area Agency on Aging. With me today is Tom Rasmussen, Rasmussen, Rasmussen, I will never get your name right. He is an income protection specialist with Clear Solutions Insurance Services. Tom is an income protection and longevity health planning specialist advising on life, disability, extended care, and health care planning. Tom has helped thousands of people with income protection planning across the country. He was a national broker to hundreds of agents across the country, and as a received top awards for management and production. He's published articles for industry magazines and local papers as well been interviewed on radio several times now a podcast regarding senior issues and the importance of planning. He's a member of the nonprofit Long Term Care Forum Panel of Colorado, advising state legislators and industry experts on long term care planning issues in the state of Colorado. He holds the designation of CLTC, which classifies him as a certified long term care specialist. Tom is currently doing educational workshops and seminars on income protection throughout Colorado. He's the co-host of the streaming TV show New Horizons, Living Life to the Fullest, which illustrates how resilient and empowering the second half of life can be. Tom contributed to Kevin Gussman's Amazon bestseller Retire with Freedom and Confidence, and released his own book called Are you Protecting your Greatest Asset in December of 2018? You've done a lot, haven't you?    Tom Rasmussen:  Well, I like to keep busy.      Cynthia Margiotta:  Yes!    Tom Rasmussen:  Don't we all?    Cynthia Margiotta:  Don't we all? Yes. So let's get started with some of our questions. First off, what is meant by "second halfers"?    Tom Rasmussen:  Well, that's a great question, and appreciate you allow me to be on the show here. So, "second halfers"...you know, there's a term that has been used for a number of years called seniors. And I've never liked that labeling, because it identifies that certain segment of society as being maybe has no value. I mean, that, you know, we're in a society that let's face it, our particular culture doesn't really cherish seniors. And I decided to coin a new phrase of " second halfers", because it doesn't identify somebody by what you would consider their age. And so, if I said senior to somebody, what age do you define that by? Sixty-five or older would generally be the response? If I say "second halfer"? You mean 45, 48? Sure, why not? It just it's a way to break down this the perceptions of society that you know, seniors are not ready to put out to pasture.    Cynthia Margiotta:   Alright, I like your term, by the way, I think it's a really useful thing. I think we should switch it up a little, huh? You did something like that. So what is resiliency?    Tom Rasmussen:  Resiliency is an interesting word because when I do workshops, I always ask the audience, are they resilient? And it's interesting, the puzzled look you get from people. And so I have to go a little bit further and I ask, have you ever made it through a challenge, whatever that challenge may be? Oh, yeah, yeah, for sure I have. Well, the dictionary defines resiliency as recovering strength and I always have to point out that resiliency is achieved by pushing through a challenging situation. So, resiliency is something that we probably have all experienced in our lives. But I don't know if we have identify it as such, when we actually achieve it.    Cynthia Margiotta:  Yeah, well, it's hard to be resilient. I think that that's a good term to use. I don't think that's used very often in our society.    Tom Rasmussen:  Well, for resiliency was easy than everybody be doing it.     Cynthia Margiotta:  I mean, it's not used that word, you know, either you did it or you didn't do it. Not that you became more resilient in and learned from it.    Tom Rasmussen:  Well, it's words are powerful. And I tried to take a very strong look at the words I use to identify either meanings beyond what people perceive certain things to be, or change the perception of what people think, like seniors to "second halfers".    Cynthia Margiotta:  So, what is empowerment?     Tom Rasmussen:  Well, I use those two words together, because sometimes people identify them as being the same thing. And they're really not, you know, where I stated the dictionary basically defines resiliency as recovering strength. Empowerment is defined as to give power to. So even though they're not the same thing, they're very much connected. Because when somebody pushes through a challenging situation, and is resilient, by doing so they empower themselves. And so that's where the connection comes from. And so that's why I like to use those two words. Because it really came about when I was writing my book, it dawned on me after I was about three quarters away of writing it that after thirty some odd years of doing what I do, nobody actually looked at putting a planning strategy together as empowerment. And I had to ask myself, and other people as well, why do we not think of that as empowerment? And so we had to define what was empowerment? Well, empowerment is anything that gives you the ability to be resilient. And so empowerment, on one hand, can come from resiliency or you can empower yourself to provide you more resiliency.    Cynthia Margiotta:  So they are wrapped up in each other very strongly. And they, like a circle, they come and they go. The circle can go clockwise, as well as counterclockwise.    Tom Rasmussen:  I mean, from the standpoint of putting together strategies that help what I call "life happens events", what's more empowering, to have a funding plan in place to help you push through those "life happens events", like a disability, an extended care situation, and unexpected death. You know, that should be a more prideful ability to say, look what I did, then to push it away, don't talk about it, and then not have it at all, and then have those things come into your life. And then is that the thing that could have created the resiliency to get through that? And because of that you didn't you achieve resiliency?    Cynthia Margiotta:  Hey, smart to be prepared?    Tom Rasmussen:  Well, we'd like to think so. Yeah, I wish everybody would take that a little more seriously.     Cynthia Margiotta:  So they definitely relate to each other. Absolutely. Yes. So what does this have to do with the second half of life then?    Tom Rasmussen:  Well, with having thirty-plus years, working with, you know, the "second halfers" that I have, there's things that we have to understand that as we go through our seasoned years, so to speak. Then, can we better position ourselves back to the preparedness and planning to be able to be more empowered to get every moment to its fullest capacity? You know, that's that's how it relates. I mean, there's several different things that I always attribute to when I give workshops and seminars and regards to how do you achieve empowerment and resiliency. And there's four things that I always talk about. So it's decluttering, telling your story, doing the paperwork, and have a funding plan.    Cynthia Margiotta:  Is that are part two? Is that the question for our part two? I don't want to ask that yet. So don't let don't get there yet. Oh, good. What are some of the things one can do to bring about resiliency, and empowerment to the second half of their lives?    Tom Rasmussen:  Well, like I mentioned decluttering, let's talk about that. So decluttering is a very interesting thing because who we as maybe a human nature, we like to keep things, collect things, gather things, for whatever reason. And I don't know about you, but through my life when I've had either four situations or by design, or I decluttered my life, it was very freeing. I use an expression many times that, do we own things or do things own us, you know, the more things we have, it takes a lot more of our time to maintain those things, whether it's time or financially contributed to the maintaining those things. So decluttering is one of those things that as we go into our second half of life, the more we declutter, it's two things, it's less for us to worry about as we get closer to our end result, which let's face it, we're all gonna pass away someday. And it doesn't leave that burden to our loved ones, to figure out what the heck they do with all your stuff. And a lot of times, we have this assumption that they want our stuff. And if we don't have that dialogue, we don't know if they want it or not. And so I've always said this, the decluttering can take away from the experience of embracing the whole passing of a loved one, because they can't fully be in that embracing of that passing and that cycle of life because they're stressed out about what to do with the stuff.    Cynthia Margiotta:  Stuff is a pain in the back!    Tom Rasmussen:  And declutter, it's part physical, material. But it's also emotional.  Cynthia Margiotta:  Okay. Okay.    Tom Rasmussen:  Have we decluttered the emotional regrets that we might have, because of relationships because of things that were said one way or the other? You know, that's part of decluttering, too.    Cynthia Margiotta:  It's important to do that maybe, for our mental health. You make me think, Tom,    Tom Rasmussen:  I've always said that. If we know, the two certainties in life, that we're going to age and we're going to pass away someday. Then, if we can, as mentally as we can think through this, especially as we come being in our second half of life, as opposed to doing how do we define a good life lived? Is that how much stuff we have? Or how many moments and impactful events that we had with other people as well as to ourselves?    Cynthia Margiotta:  For me, I'd say it'd be the people. Think of how many people have been positively affected by my life?    Tom Rasmussen:  Well, if we don't actually ask that question of ourselves, how do we ever know what that means to us personally, before we can go forward, and have that good life left.    Cynthia Margiotta:   Right. Good questions. You're throwing questions back at me, Tom. I'm supposed to be interviewing you!    Tom Rasmussen:  Yeah. Okay.     Cynthia Margiotta:  So how does telling your story bring about empowerment?     Tom Rasmussen:  Well, I've found that we're not capturing our life stories, as much as we probably should. And I'll give them my own personal story with that. My mother did a lot of genealogy had many different records, and she had boxes and boxes of photographs when she passed. Well, I inherited those. But what I didn't realize is none of those photographs had any information on them. So I had no idea who these people were. And so it got me to think that if we're able to pass on the wisdom that we have learned in our second half a life, how can we pass that on, if we don't record it in some nature, whether it's written, whether it's video, whether it's just, you know, audio? If we don't tell our story, it's lost when we're gone. And even to our own children, because our own children only know us from the time that birth was given to them going forward. They've really don't know who we were prior to that unless we had those conversations. If they don't know it, how can they pass it on to our grandkids and great grandkids?    Cynthia Margiotta:  Right. Information is important to share within families. Yeah, my mother had, I ended up with all her photos, and everything had initials, which is better than you got, I will say. But, you know, one of those many pictures was marked CJ. And it was lots of pictures of CJ. Who's CJ? Well, CJ was my mother, Claudia Jones.    Tom Rasmussen:  Oh!    Cynthia Margiotta:  When she married my father, she became Claudia Cleaver. So who was CJ? So those pictures, you know? It took a little, I guess, hard guesswork to figure out that those younger pictures have that 10-to 15-year-old were actually my mom.        Tom Rasmussen:  You know, it's not only telling our story so we don't lose ourselves once we're gone, and that can be passed on to generations and generations. But there's a real important thing that has to be, I'd say it has to be earned. I don't know if everybody agrees with that. It's called wisdom. Are we passing wisdom on to our generations that will precede us? Because if we can help them understand, as they get to a point where they can learn, maybe they don't have to go through those failures and mistakes to learn that wisdom. If we can pass it on, prior to them having to learn that on their own.    Cynthia Margiotta:  But, the young people don't want to hear mom and dad's wisdoms.    Tom Rasmussen:  You know, it's funny. Maybe you had the same scenario that I did. But I've heard this from people and I and I have actually experienced this. It's amazing how smart my parents became the older that I got.    Cynthia Margiotta:  Right? Yeah, my mom suddenly got a brain. And I was like, wow, who knew?    Tom Rasmussen:  You know, they couldn't turn on the TV but boy, we can't mistake wisdom for, I guess, intellect. You know, there's a lot of smart people that I've met through my life, but I wouldn't say that we're really wise. So there's a difference between intellect and wisdom, wisdom is learned. And life will continue to give us these lessons to learn the you know, and if we don't, we'll repeat them. But the only way that we gain wisdom is acknowledging how we get past that lesson, resiliency. Empowerment comes from the knowledge of understanding of I shouldn't do that again.    Cynthia Margiotta:  Learn from my past mistakes. What is that saying? You know, something about doing it over and over again?      Tom Rasmussen:  Einstein said the definition of insanity is doing the same thing over and over again, expecting a different result.    Cynthia Margiotta:  There you go. That's the exact saying! It was Einstein, huh? Yeah, he should be my hero. So how does doing the paperwork bring about empowerment?    Tom Rasmussen:  Well, that kind of goes back to the decluttering. If we've decluttered the things in our lives and we've told our story, then we have the documents in place to help our loved ones know what to do with our passing. Or, if we just become incapacitated or incompetent. You know, they have to step in and take over our lives. How do they know what to do? Do they know who to contact, you know, so advanced directives, a will, or a trust, who is my insurance agent, my banker, my attorney? If we don't put this in some form of writing, whoever is supposed to fill in for us can go to and have those contacts, as well as have the authorization through, you know, the proper forms, to be able to make those decisions like the power of attorneys and, and those kinds of things. Then again, we're putting that burden and that stress on our loved ones when it wasn't necessary because we didn't want to get around to that.     Cynthia Margiotta:  I think it's so important to do that. Get those papers in order, have them all, you know, somewhere. Tell the people that are involved in those papers where they are and how to get to them. You want your power of attorney to know what's going on, what your expectations are, what your needs are, what your wishes are. And if you don't do that, they're lost.    Tom Rasmussen:  Even getting down to the details of who you want to step in for your financial matters, that might not be the same person you want to step in for your health issues. You might want to separate those two.         Cynthia Margiotta:  I think that's brilliant, separate them. In most cases, it's very important. When I became my mother's medical power of attorney was very good. I did not want her financial powers of attorney. And so my sister kept those and she was in charge of the money. And I was in charge or, no offense, but in charge of the body. And I think it worked out well for us in our family. But what if you only have one kid, you know?    Tom Rasmussen:  There are other ways to have, you know, people that can fill in those roles, like fiduciaries. You know, there's there's different ways that you can have people fulfill those roles.  I hate to say it, but I've seen situations where the individual who had the purse strings was also making the medical recommendations. And because they knew if they spent money on the medical, that they would reduce their inheritance. So that played a role in their decision making.    Cynthia Margiotta:  Right? And that's where some of the problems start, right? You know, between the two people. Then when you're only at one, okay, so you have you just shared the one if one person's in charge of both. If you have two people, you can sometimes have the problem. It's sort of the opposite where the medical wants to do one thing like, oh, let's say mom needs a new hip, we got to get her a new hip, we've got to pay for that. Let's do that. And then the financial power of attorney says, "no, I don't want to spend that money".    Tom Rasmussen:  That's not what that's about. It's putting the proper paperwork in place so you're the one that dictates who has that power. Because if it's health related, and it's established properly within the documents, that says, "all my assets are to be used for my health and welfare until such than the financial person has to follow through with that". But it's based on the legal aspects of how that's written and put into place.    Cynthia Margiotta:  And that's why you need paperwork.     Tom Rasmussen:  So ultimately, we have the power to define how we want that to work. So maybe we don't want to have these last miracle efforts. And just you know, and that goes back to the advanced directive, right? You want to know what it ultimately comes back to? Is having what I call the kitchen table chat, the conversation. And that's where all of this is lost. Because I talked about the two certainties of life earlier, when we talked about, well, let me just throw out there. When I do workshops, I ask what are the two certainties of life?    Cynthia Margiotta:  Birth and death?    Tom Rasmussen:  That's not what people answer. They answer death and taxes. And so you're absolutely right. But I knew you knew that. But I always go, "no, you're only half right". Taxes were not always a certainty of life. It's become that. But aging and death are certainties of life. And so then to follow up with that, when do we start aging? At birth? And so could you honestly say, when do we start dying? At birth? They're tied together. So these are two certainties in life that we can't dispute. Then, how come we can't talk about these issues? How come we don't have conversations with our loved ones, and talk about the cycle of life? So we can honestly address these issues, because we want to bury our head in the sand and pretend that we're never going to age, and we're probably never going to die. Until we do.    Cynthia Margiotta:  In our household, my poor kids grew up talking about death, dying, hospice, more than we talked about them ever getting married, which probably shouldn't have been that way. But...    Tom Rasmussen:  But they are prepared for it, arent they?     Cynthia Margiotta:  I think they are more so than people their age as a general rule, I don't know.    Tom Rasmussen:  As prepared for it as anyone can be. You know, we always think, oh,  I'm ready. And you know, the emotional aspect can never be realized until we're in that that space. But we still have to have the conversation.    Cynthia Margiotta:  I'm sixty-three years old, and I'm starting to see more and more of the people, because I work in the aging industry, like yourself, more and more people that are my age, that do work in this industry, coming to see that it's almost aging is coming home. And they're starting to see it in themselves. And I don't wish them ill, don't get me wrong. But I like being able to see that they're identifying more with the older people that they are working with. They are feeling those pains too.    Tom Rasmussen:  Well, it's an interesting situation, because there's been a few books written on the progression of life. And I talked about second halfers, the first phase of life is is kind of been presented as the doing. It's when we get our careers, it's when we get married, we have kids. So when people say to you tell me about yourself, "well, I'm a father, I'm this, I'm that". Well, that's not who you are, that's what you do. But somewhere along the line, most of us, not everyone, transitions into the being. We no longer are the doing, we start getting closer to our inner being. And that's I think, what's we're talking about, the acceptance of life.    Cynthia Margiotta:  Who am I?    Tom Rasmussen:  Who am I? And what do I want. And that's I think that's all part of the wisdom aspect too.    Cynthia Margiotta:  But do some people think that when they talk about themselves in that way or think of themselves that way? Do they think that they're being selfish?    Tom Rasmussen:  I don't think so.     Cynthia Margiotta:  Okay. It was a question.    Tom Rasmussen:  I think it's a revelation. You know, if we don't know ourselves, then how can we know anything else? I mean, that's a whole different subject. And maybe we can do another time on that. But that's the being. That's when you get down to the nitty gritty of who am I really?    Cynthia Margiotta:   Yeah, I've volunteered at several different places, as you know. And I could probably walk through those places and tell you the people who are in that stage.    Tom Rasmussen:  But I said, not everybody gets there.    Cynthia Margiotta:  And not everybody gets there. And I think, being aware of themselves so intimately. Is that a good way, being aware of who they are as themselves, as opposed to what they do? I think really changes how they project themselves. And it's quite beautiful, actually.    Tom Rasmussen:  It is.    Cynthia Margiotta:  I like that.    Tom Rasmussen:  It's almost a rebirth.    Cynthia Margiotta:  So our last question, before we break. Then we'll do our second half another day. So what does a funding plan bring to resiliency?    Tom Rasmussen:  Well, that's a great question. And I've been told on a few occasions that this is where I bring in the buzzkill of any kind of great emotional interconnected discussion that's going on. Because when I call it  "the buzzkill" I always bring in the reality of the financial, that touches everything in life. And so I kind of touched on a little earlier, all these things we're talking about. aging, passing away, maybe we have health health issues, maybe we don't maybe we need caregiving, what have you. There is a financial side to that. And too many times, because we don't address our funding plans of when those might happen, we can't be resilient. And we basically turn a medical crisis into a financial crisis. So that's the last thing that I like to emphasize, when we're talking about empowerment. It goes back to again, when I was writing my book is what strategies have we put in place to empower our loved ones and ourselves with funding plans to help us through these "life happens events".    Cynthia Margiotta:  We need to make plans and be prepared as much as we can.    Tom Rasmussen:  Well, you know, in my book, I wrote about the three approaches that I've seen through my thirty some odd years of doing business. And those three approaches, what I find. people's biggest decisions in life are either they tell an elaborate story about how it's all gonna play, or they make an excuse, or they actually have a plan. And I will tell you of all the years I've been doing this, not one time have I not seen a plan be a story and excuse every single time. But we still want to tell the stories. And we still want to make excuses.    Cynthia Margiotta:  My friend's husband, no names, but his plan is to die in bed. And he wants his wife to leave him there. That's his plan.     Tom Rasmussen:  No, that's his story.    Cynthia Margiotta:  That's his story!    Tom Rasmussen:  That's not a plan, thats a story.     Cynthia Margiotta:  That's his story. And it's like, don't worry, you don't have to do that. You know, so I get that. So, we're gonna break here, and we're gonna have a second half. And that second half of our podcast, really the main question will be, so don't answer this, what are the four options for Life Happens Events? So we'll come back and do that, I guess in about two weeks. With that we're gonna close. That's our show. And thank you to all of you for being with us today. And until next time, take good care of yourself. Tom, thank you so much for being here with us today.    Tom Rasmussen:  Thank you so much. 

Talking about death doesn't make it happen, yet so many of us are afraid that this will be the case.  Join MSW, Kent Mathews, as he discusses the differences in palliative care, hospice, what Medicare may pay for and how families can ask for help. Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country. We talk about both the everyday and novel needs and approaches to age with altitude whether you're in Ft. Lauderdale, Florida or Leadville, Colorado. The Pikes Peak Area Agency on Aging is the producer. Learn more at Pikes Peak Area Agency on Aging. Transcript: You're listening to studio 809. This is what community sounds like. Hi, this is Dave Gardner. I just want to make sure you know that during these unusual times peakradar.com/virtual brings local arts and entertainment right into your home. From local music to gallery tours to classes in dance, yoga, writing, and more. Our community is still creative and invites you to join in at peakradar.com/virtual   Michaela Nichols: Hello and thank you for listening to Aging with Altitude, a podcast series elevating the issues that matter. This series is produced by the Pikes Peak Area Council of Governments Area Agency on Aging. Today's episode is about end of life issues. My name is Michaels Nichols and I'm here with Kent Mathews. Kent is a care manager in the Family Caregiver Support Center at the Pikes Peak Area Agency on Aging. He has over 27 years of experience as a social worker and has worked in hospice care as well. End of life issues can often be hard to talk about. Many people hope that they will be able to make their own decisions or that a loved one will be able to make their own decisions toward the end of their life, but in many cases they lose that ability so being unprepared can put loved ones in uncomfortable positions. So can you talk a little bit about what barriers individuals experience when beginning to make end of life plans?   Kent Mathews: The most common barrier I hear coming from caregivers when I was doing hospice work coming from even hospice patients was when it comes to like the advanced directives, they would say well I'll execute them. I'll fill them out when I need them not knowing that they probably wouldn't be able to execute them when they needed them because they would be like in a physical state where they were unresponsive, couldn't speak or something like that where they wouldn't be able to even begin to fill out those documents. So I think that's one barrier. Another one is we don't like to think about our end of life. We don't like to think about our deaths, and we live in a very death aversive society. Generations ago when we were still a very rural society and weren't as urbanized as we are now, and still a lot of people living on the farms or out in nature and what not, we were still very much in touch with the cycle of creation. Earth, life, death. All of that. And now, we're really, really removed from that. And so that's a huge barrier as well. I think another barrier that comes to mind is, people don't have an easy place to go to get good information about what's really going on with their physical condition. I recently ran across a statistic that said that if asked to do a treatment and a doctor knew that the treatment wouldn't do any good for you, 40% of doctors still said they would recommend the treatment, which is in my estimation is just rather appalling that they would even do that. So a lot of times people rely on their doctors to give them that information to tell them what's really going on, but most doctors aren't equipped to do that. They don't have the skills to do that. They may have the knowledge, but they don't know how to communicate that in a way that is comfortable for them and therefore makes their patients comfortable. Everybody's kind of walking around in the dark. You know, the medicines that we take, a lot of the medicines for chronic illnesses cover up the symptoms which then creates the illusion that I'm not as sick as I really am, which is another barrier. Why would I want to execute that because I feel fine? I may be taking 8 to 15 different medications, but I'm not going to die so why would I want to execute those things. So those are some of the barriers that I've been encountering in my career.   Michaela Nichols: In the confusion around what end of life care is, can you talk about the differences between nonmedical and medical decisions that they need to think about?   Kent Mathews: So I get phone calls from caregivers and they're wanting to know where they can go to hire a nurse. And then talking with them on the phone, they're looking for somebody to come out to the house to help mom or dad or a family member with like maybe bathing or dressing, and maybe making sure that they are taking their medications. You really don't need a nurse to do that. In the home care industry, there are different levels of skill that a home care worker has. In Colorado when they required home care agencies to be licensed, they established a two-tier system. There is a class A and a class B license. The class B license is the nonmedical. The class A license is the medical or what's often called the skilled. The two differences between those two licenses, there's a number of them, but the major difference is the A license, or the skilled license, is that home care agency has what is known in the healthcare world as skilled positions, so you have the nurse. An RN, an LPN,  maybe a NP. You also have skilled positions like the therapist, the occupational therapist, the speech therapist, the physical therapist or what's called the OT/STs. Those are all skilled positions. CNA's are considered a skilled, semi-skilled position. And the class A's have CNAs. The class B's have what are called personal care workers and homemaker companions. When you're looking at home care agencies, and you're looking for what kind of care, if you're needing somebody to come out and help mom or dad with maybe some light housekeeping or some bathing and dressing kind of a thing, you don't need a nurse to do that. You don't even need a CNA. You could use like maybe a homemaker companion who could do the light housekeeping, the light meal preparation. If you wanted them to help with bathing and dressing, you'd have to have like a personal care worker because that person then can legally touch your family member and provide that hands on, physical care. And going back through all those levels, the least amount that you're going to pay per hour is a homemaker companion. In the Colorado Springs area, that's probably running $18/$19 an hour right now. Then the next higher level would be like a personal care worker. That's going to run in the low $20 per hour. Then you're going to CNAs. That's going to run in the mid to upper 20's. And then when you get to like a registered nurse, you're looking at $30 or more per hour kind of a thing. So to pay, you can choose between somebody that has the same skills a personal care worker who you could pay maybe around middle 20's or so or an RN, you're paying 30 or higher. You're saving money to go with a personal care worker. And so that's some of the difference between medical and nonmedical.   Michaela Nichols: What are some misconceptions around these different types of decisions that people have to make?   Kent Mathews: I'll go into like, because I did 15 years of hospice social work. Some misconceptions, one of the huge misconceptions about hospice care is you have to be bed-bound. Now there is nothing in the rules or regs by Medicare which licenses and oversees the hospices. There's nothing in the Medicare rules and regs that say you have to be bed-bound. But most people have that misconception that if my family member is up and walking around and able to do stuff, then they're not sick enough to be on hospice care. And in reality, what qualifies a person for hospice care is not what they're doing or not doing. It's do they meet the specific medical criteria for a specific condition or disease to qualify. And oftentimes people can meet those conditions and still qualify for hospice care, but be able to do a lot of taking care of themselves. I had hospice patients in my career that were going on two-week cruises and going on vacations to Disney Land and Disney World or Las Vegas or travelling eight or nine hours across country to go visit family members for 7 or 5-8 days and they were the ones doing the driving, but they were still on hospice care. So it's not qualifying for hospice care is not about what you can or cannot do. It's about do you meet the medical criteria. Another misconception is people think that their doctor has to say that they're ready for hospice care. I teach a concept called hospice 101 and basically after listening to a caregiver tell me what's going on with their family member physically, what kind of chronic illnesses they have, often times I will say so have you thought about hospice care and they will say my doctor hasn't said that dad's ready for it. Most doctors, unless they have done time as a hospice medical director, do not know all of the specific medical criteria that go into qualifying a person for hospice care. And doctors like all of the social workers, healthcare professionals, even people on the street, we all have our misconceptions, misunderstandings about hospice care. So if doctors have those misunderstandings and misconceptions, they may not be willing to recommend somebody for hospice care. Years ago when I was in Arizona, I was working for a hospice who also had a homecare and the hospice was having difficulty getting people from their homecare over to the hospice side for a lot of different reasons. Some of them for the misconceptions we've talked about. I remember this one daughter was taking care of mom. First time I went out to visit her as the home care social worker, mom was living in her own apartment and mom had cancer. We talked about everything, and mom said I'm not ready for hospice care. I'm still doing treatment. I said that's ok. And then, oh I don't know, maybe three, four months later I was asked to go back out again as home health and this time mom had moved into daughter's house. Daughter greeted me at the door and when we were walking down the hall we walked by mom's room and mom was laying in bed. Her bed was elevated at a 45 degree angle and mom's jaw was relaxed so it was dropped. Her mouth was open, her eyes were rolled back in her head and she was doing what we call chain breathing, so really rapid and in succession. So when I sat down with the daughter I said I think your mom is starting to enter what we call in hospice the active dying process. So before I could stop her, daughter picked up the phone and called the oncologist and the oncologist was screaming at the daughter and demanded who told her that mom was dying and she said well I have a hospice social worker in here and he said put him on the phone. I held the phone about two feet away from my ear and I heard the oncologist perfectly because he was yelling that loud into the phone and he was accusing me of practicing medicine. He was saying how did I know she was dying. Only doctors knew that kind of stuff. And he said if she stops her treatment now she is going to die because she needs to finish her chemo treatments in order to stay alive and all of that kind of stuff. I hung up the phone and had a conversation with the daughter. We figured out a way to go to another doctor to get an order, which then allowed our hospice to send out one of the hospice nurses to do the evaluation. Long story short, mom died the next day. We got her into hospice care that night. She died the next day. Sometimes, all of us have our misconceptions and this oncologist evidently had his own misconceptions about what hospice was. I'm not even going to speculate what those were, but that happened over 20 years ago and I still have a vivid memory of it. So when it comes to this whole end of life issue, because we have a lot of barriers, we also, and because we're not talking about it anymore. It's not an easy conversation. When I talk to caregivers, sometimes they talk about well, you know. I'm thinking dad's really sicker than he really is and then they begin to apologize because they think that by talking about death, and that's another misconception. If you talk about death, it's going to happen. We can talk about death all we want, but that doesn't mean it's going to happen. But that's how deep our fears go as human beings when it comes to death and dying is we believe that when we invite it in, it's going to kill us.   Michaela Nichols: That's a really powerful story. And it shows that people rely on their doctors as well and they're not always the specialist in end of life issues.   Kent Mathews: Right.   Michaela Nichols: So I guess, along the line of medical care, and you were talking about hospice care. Can you talk a little bit about the different between palliative care and hospice care?   Kent Mathews: So I'm going to try to give as good of a verbal picture about this as possible. The picture is, draw a circle about the size of a quarter and then draw another circle that's about the size of a small plastic lid on a container. And that small circle, the size of a quarter, needs to be inside that larger circle. And so you've got a small circle inside a big circle. So palliative care is the big circle. Hospice care is the small circle. So with that said, all hospice care is palliative care, but not all palliative care is hospice care. And there's differences. The biggest difference between palliative care and hospice care is on palliative care you can continue treatment for whatever your hospice diagnosis may be. So let's say it's chronic obstructive pulmonary disease or COPD which means your lungs aren't working well and it's difficult to breath and it's going to lead to your death. And so, if you're on palliative care any treatment that you were doing for the COPD you can continue. On hospice care, any treatment that was “to cure the COPD” you can't do. I think a better example than COPD would be like cancer. So on palliative care you can continue to get your oncology, your radiation for the cancer. When you're on hospice care you cannot do the oncology. You cannot do the radiation. You have to stop those. So that's the biggest difference. Another difference between palliative care and hospice care is the support level. When people are in hospice care the support they get is really well defined because Medicare pays for the hospice care and Medicare says that hospice care is provided by a team, and the team consists of a registered nurse, a CNA, a social worker, a chaplain and a volunteer. Medicare says in those policies that the only person that the hospice patient has to see is the nurse and the nurse has to visit them at least once every two weeks. Most people when they're on hospice care take the full team. The nurse, the CNA, the social worker, the chaplain, and they even ask for a volunteer. On palliative care, it's not as well regulated because I've had conversations with professionals in the community who are involved with the palliative care programs and the palliative care program is struggling to figure out a way to properly bill Medicare. Under hospice care there is very specific billing codes you use. Under palliative care there's not. So you can get reimbursed by Medicare for palliative care, but it's not easy to do as a provider. The other is because it's not regulated by Medicare like hospice care is, you can have a palliative care program where it consists of a registered nurse or a nurse practitioner going out and visiting the patient once every three or four weeks to check on things like their pain level or their medications and maybe make some adjustments in the medications or what not, but that's it. Nursing visit once every three or four weeks kind of a thing. There are some palliative care programs where they will allow a CNA to go out to help with maybe some of the physical care. I know of maybe one, possibly two palliative care programs in our community where they offer the full team. A nurse, a CNA, they'll maybe pull the social worker from maybe the hospice side kind of a thing. A chaplain would be from the hospice side kind of a thing. No volunteer, but those four people to go out and support the person while they're on palliative care. To be really honest, those programs that are doing that are really losing money off of the palliative care because Medicare doesn't reimburse well for palliative care. I've had conversations with professionals in the community that have said, I have said until Medicare decides to license and regulate and oversee palliative care like they do hospice care, palliative care is not ever really going to catch on and take off because hospice care was suffering from the same thing back in the early 70's and what not when hospice care came over. All of the organizations that were doing hospice care were non-profits and the professionals were volunteering their time or if it was a very organized non-profit they'd raise the money so they could at least pay the nurses and maybe the doctors, but the rest of the team were volunteers. And it wasn't until Medicare came up with the hospice Medicare benefit which is under Medicare Part A, that hospice really began to take off and flourish. My point is, the same is going to happen with palliative care. It's going to struggle, but when Medicare decides to regulate it and license it like they have hospice care, it's going to take off. But those are some of the major differences. You can be on palliative care, but not on hospice care. You can be on hospice care, but that also means you're getting palliative care and there's restrictions either way. The other similarities between hospice and palliative care is it's provided wherever you are at. So if you're in a home, if you're in a care facility, assisted living or nursing facility, palliative care can go there. Hospice care can go there. When I was doing hospice work in Arizona, I had one patient who the hospice care started. He was living under a bridge and then the other hospice patient that I remember, he was living in three large cardboard boxes in the middle of the dry riverbed of the Salt River. But hospice care, that's another misconception. People often think that hospice care is a place. It's not. It's a type of care and hospice care will go wherever you are at.   Michaela Nichols: End of life issues are so hard to talk about and America has a fear of talking about death. How would you recommend someone going about talking about it for themselves, talking to their children or loved ones or for a child talking to their parent about what they want?   Kent Mathews: So I'll start with the easy one first. So an adult child talking to their parent about what they want. The adult child needs to be thinking about what they know mom and dad have said to them. So why is the adult child coming over to take care of them? It's because mom and dad want to stay in their home for as long as possible. OK, What mom and dad don't understand is that they have to put some certain things into place to absolutely guarantee that. So a good starting point would be to say, dad I know that you really want to stay in the house and I've been coming over to help you stay in the house, but to really guarantee that you stay here until you die, which is what you told me, we need to be talking about some things like powers of attorney, like a medical power of attorney, a financial power of attorney. And yes, I know you don't want me in control of your money because you've told me that. But without that power of attorney and something happens to you, I can't access your money to pay the bills. I can't tell doctors what to do because I don't have the authority. And that's what the purpose for those powers of attorney are. Is when you name me as the agent, then that means that if you can't tell anybody, I have the authority to step in and tell the bank how to pay a bill or to contact your long-term care insurance company to get your long-term care insurance policy started. Without that power of attorney, you don't get the care in the home because I can't talk to the long-term care insurance company. They will not talk to me. You know, if you really don't want to go to the hospital and the paramedics show up, I've got to have a medical power of attorney where you've named me as the agent because if you can't respond and they can't get anything out of you, then I should then have the authority to say no. He wants to stay here. He doesn't want to go to the hospital. Now that's not a guarantee, but I now have the authority to do that. Without that, guess what dad? You're going to the hospital and you're going to be some place that you don't want to be. By the way, when you execute those documents usually there's a place where you can say when I sign the document it means it takes effect immediately. Now that doesn't mean I'm going to step in and overrule you because I love you and I'm going to let you continue to make your own decisions, but it means it's in effect already. Another line that will say it goes into effect when I'm incapacitated, and one or two other doctors say I'm incapacitated and can't make my own decisions. So that one would be a good one if you're not comfortable with having that authority take place right away. You can check off on that one. It doesn't go into effect until you're incapacitated, but either way those two types of documents help me to help you because we live in a society where we value the rights of the individual so much that without those documents, I can't do anything. Even if your safety is being jeopardized, without those documents I can't do anything. So that would be one way to have that conversation. Along with powers of attorney there are things like advance directives. Those are usually like what are called DNRs. Like do not resuscitate and that usually covers the two major areas of breathing and heart function. So like if your heart stops and you've signed a do not resuscitate that means you don't want anybody to do anything to get your heart started again. You don't want anybody to do anything to get you breathing again. In Colorado, we have what's called the MOST form which stands for Medical Order Scope of Treatment. Other states have similar programs, but their acronym is like POLST. I'm not sure what that stands for, but I can only speak about Colorado. So in Colorado with the MOST form, medical order scope of treatment, it is like an advanced directive on steroids. Meaning, on an advanced directive it's where you list everything you do or do not want done to keep you alive or not keep you alive. The MOST form has the same thing, but at the bottom it has a place for your doctor to sign. Once your doctor signs it, it makes it a medical order. Why is that important? It's important because I saw this happen in my hospice career both in Colorado and in Arizona. So a person would sign an advanced directive, something would happen at the home and they would be transported to the hospital and the paramedics would be doing everything against the advanced directive and ER would be doing everything against the advanced directive because the advanced directive that they were working from, even though it was legally signed and notarized by the patient and by the notary or a lawyer, it didn't function in the hospital world, or medical world because it wasn't a medical order. The MOST form takes care of that problem. So you have everything that you do or do not want done. You have it on this MOST form and it's signed by doctors. So now, if something happens and you find yourself going to the hospital emergency room or for whatever, you produce that, and they have to back off because it's a medical order signed by a doc.   Michaela Nichols: Thank you so much, Kent, for joining me on this episode of Aging with Altitude. For those interested in learning more about what the Pikes Peak Area Agency on Aging offers, you can go to ppacg.org or call at 719-471-2096. Thank you.   Kent Mathews: Thank you.

Go vote!  Shelly Roehrs, President with the Pikes Peak Region League of Women Voters reminds us the deadline to postmark a ballot is coming.  If you mail it in, it must be postmarked 8-10 days before November 3.  Yet, ballots can be dropped off at drop-box locations anytime up to 7:00 PM on voting day and of course you can vote in person.   Find drop-box locations at govotecolorado.gov. The League has been an active, non-partisan voice encouraging voter engagement and understanding of issues since 1937.  Visit 411.org to review summaries submitted by candidates and issue sponsors. Visit the local League at lwvppr.org for more information.  Additional ballot issues are discussed at the League podcast at lwvppr.org.   Transcript: Cynthia: Hello everyone, this is Cynthia Margiotta with the Area Council of Government's Area Agency on Aging, volunteering some time to do an interview with Shelley Roerhrs. She is with the League of Women Voters of the Pikes Peak region and their mission is to empower voters and defending democracy, thank you. The League of Women Voters has fought since 1920 to improve our systems of government and impact public policy through citizen education and advocacy. The League is a nonpartisan and grassroots organization. The League of Women Voters from the Pikes Peak area region has been active since 1937. Members actively promote voter and civic education by registering voters in high schools and nationalization ceremonies, attend city and council government meetings, present the pros and cons of the issues of our elections, and much more. The League of Women Voters has two separate and distinct roles: better service and citizen education and action advocacy.   What this means to you guys who are listening, is the league's mission is to inform voters about the issues and candidates on our ballots. Candidates and issue organizations fill out information provided to them in an online voter guide and voters can visit vote411.org for this convenient information. The League also encourages active participation, whether it's in the office of an elected representative, City Council meetings, writing a letter to the editor, or at rallies. The program also empowers voters by emphasizing the power of the voter and promotes voting in every election: presidential, gubernatorial, municipal, primaries, and special elections.   Wow, you guys do a lot!   Shelley Roerhrs: We do, we do. We keep pretty busy, especially in a presidential year.   Cynthia: I bet you do! Now, it's like every commercial out there is about elections.   Shelley Roerhrs: It is, it is. We try to strive like you mentioned the presidential, gubernatorial, and municipal, we want you to vote in every election. We don't care who you vote for, we are a very nonpartisan group. But again, it doesn't matter who you vote for! For us, as long as you vote in every election, that includes your primaries, municipal elections, and special elections as well.   Cynthia: Yes, I agree with you it's important to vote. We are leaving ourselves out of the discussion if we don't vote.   Shelley Roerhrs: Yes, ma'am.   Cynthia: Let's get to our first question!   Q: We are a mail-in-ballot state. Is there a lot of voter fraud in a mail-in-ballot state? Will my vote be counted?   Shelley Roerhrs: So, yes, 100%! Mail-in-ballots are safe. The unique thing about Colorado is that we've been a mail-in-ballot state for quite a while. They are pretty much the grade A of how other states basically relate to and say "this is what we want to do in compared to Colorado." So, you know, there are no issues with mailing in your ballot, as long as you mail it in on time. We'll get to kind of some dates later on as far as when you're supposed to mail it in. But yes, mailing your ballot or you know, what's even more convenient is if you don't want to Mail it in, the El Paso County has all of those drop boxes. So, they are located all over the city and the county. Just go to one of those drop boxes and drop off your ballot if you don't feel like mailing it in. Again, so another convenient way the drop-off box.   Cynthia:   Q: Where do the drop-off boxes tend to be?   Shelley Roerhrs: I think like there sixty-something boxes across the county. I know there's one on that, of course, the El Paso County Clerk and Recorder on Garden of the Gods typically have them. DMV places typically have them. Community centers, like your Municipal Court, have them. City locations, anywhere a lot of people congregate, that is a government facility, are typically where they're going to have one of those drop boxes. I know there's one down at the courthouse downtown as well.   Cynthia: Yes, that's typically where we drop ours off.   Q: Do you have a calendar of important upcoming dates?  Shelley Roerhrs: Well, I want to go back to when you said is there a lot of voter fraud. I want to solve voter fraud because you see a lot of that coming from our leaders who say mail-in ballots are not safe. I think just a couple weeks ago there was a time when our president was actually telling people to vote twice. That's actually not a good thing, right? We don't encourage that. It's actually a felony in some states to vote twice. So from a voter fraud perspective, this is from Chuck Broerman, we have our own podcast called "Making Democracy Work" and we interviewed Chuck Broerman for this specific reason regarding voter fraud. Because, honestly, my dad thinks that mail-in-ballots are rot with fraud. Now, he comes from a state that does not have mail-in-ballots, so we try to educate him. Again, one of those things that the League of Women Voters does is try to educate voters. In my case, I'm trying to educate my father as a voter. Your mail-in-ballot, if you do choose to mail it in, is safe. It is not going to be manipulated. It will count. The great thing, again M. Broerman, the Clark County Recorder you know? They have specifically designed our ballots so they have a special barcode on special weighted paper that they know exactly when they come in. That might be a fraudulent ballot and the number of fraudulent ballots that actually come in is very, very minuscule. I think it's a matter of the ones, that he said that came in, and someone voted twice. And again, it was very small. So the thought that we need to spend money on trying to fight voter fraud is, I think, somewhat comical actually. You know, if some people think that there's voter fraud out there I would encourage them to actually talk to their Clerk and Recorder. The Clerk and Recorder is the person who deals with your voter registration in your elections. They know exactly what is going on. Just don't believe everything that you see on T.V. or look at in the paper. It's not necessarily the truth. But your last question was; will your vote be counted? I think yes, as long as you vote. That's the most important thing, right? The most important thing is that you vote and yes, it will be counted.   Cynthia: They have a specific weight, you know? I don't know how anyone would mimic that so well.   Shelley Roerhrs: There are some smart people out there, but again, I think that they're doing things in other ways to manipulate our elections rather than this voter fraud that we're focusing on. I think, for your listeners, yes drop it off if you feel that the mail-in- ballot is rot with fraud. Mail it in or go ahead and drop it off in one of those drop boxes knowing that that goes directly to the Clerk and Recorder's office. There's no in-between man and the post office is not in there. But, again, mail-in-ballots are safe. Here's the thing, the military people didn't have a choice, right? Overseas, people don't have the choice to mail it in. You know, they have to mail-it-in.   Cynthia: Right!   Shelley Roerhrs: Your other question was about important upcoming dates. I'll just kind of move into your other question! Military and overseas voters, they have already started mailing those ballots. So they are arriving in the next couple of days if you haven't already received them. So, those specifically were already mailed in. Our ballots, for everybody else, will be mailed out on October 9th.   Cynthia: Okay, good!   Shelley Roerhrs: So that's when we should be looking for them in the mail.   Cynthia: That gives us plenty of time to do our individual research to see, you know, who do we want to vote for? I like that you guys are nonpartisan, that's an important part of who you are because you're not trying to convince people to vote one way or the other.   Shelley Roerhrs: For candidates, I will say that. I'm going to preface that a little bit because we are going to get into some ballot issues, right? We do not specifically tell you who to vote for, especially candidates as a League of Women Voters. You know, that's not our job. There are certain ballot issues that we do take a stance on, just because it goes with our advocacy. Whether that's the park's air quality or the water, right? Those are big, important issues of the league and for us. We do kind of take and give you. There is one proposition, 113, which is a state ballot issue. The national popular vote is coming up. And, again, we will get into those ballot issues. That is one where we would like you to vote yes, right? We don't want the same issue to happen again with the Electoral College. You know, we want every vote to count and that is exactly how every vote counts, is the national popular vote.   So, that is one thing but another date that is going to be important for your listeners. In the state of Colorado, two notices come out. One is a state notice that the state puts out, and it's on state issues. Those come out around the same time as our local ballot issues, which are local to El Paso County and the city and certain things. The state does a blue book, and we have a tabor notice for the local stuff. So, there are specific things, you know, those are coming out probably in the next few weeks that you'll see that. I know from vote 411, for your listeners, the League of Women Voters does vote for 411.org for candidates and any other issues pros and cons. You can go to vote411.org and get any information on the candidates. Now, the candidates have to fill it out and if you see that a candidate did not fill out the League of Women Voters nonpartisan vote 411 information, that tells you a lot about that candidate. They don't even want to take the time to give you the information.   This is a national thing so it's not like just Colorado. This is a really good thing for candidates and issues, right? If you got an issue like Amendment B and Amendment C, we got a lot of stuff on the ballot this year. They try to shove it all in one year so it kind of is a lot. It really is. Well, the presidential year is obviously the biggest turn out here, right? The most turn out, it's I think it's like over 70% turn out, in a presidential year. So, it's got a lot on the ballot.   Cynthia: So, if we could get it to 95%, that would be great!  Q: When do I need to mail it back?   Shelley Roerhrs: So, if you're going to be mailing it, you want to mail it at least seven days in advance. They're actually even recommending 8 to 10 days, right? I would even say you want to get it in the mail 8 to 10 days in advance of November 3rd. It cannot be postmarked November 3rd and have it count here in the state of Colorado. They actually have to receive it by Election Day for it to count. In other states, as long as it's postmarked it counts. In this state, you have to mail it in and it has to be received by November 3rd.   Cynthia:   Q: So eight to ten business days?   Shelley Roerhrs: Correct! Or, drop it off the day of. Remember, at those drop-off centers, you can drop it off the day of the election, just like you're voting on Election Day. Drop it off that day. If you mail it, it is 8 to 10 days in advance. If you drop it off, you can go the day of.   Cynthia: That would be good!   Q: Do they have lines at those things?   Shelley Roerhrs: Typically, you might have one or two cars in front of you. Usually, they have people out there making sure that things go pretty smooth.   Cynthia:   Q: What do I do with it? Where do I take it?   Shelley Roerhrs: Again, those drop-off centers. I will tell you two places in Colorado Springs. You can visit govotecolorado.gov or the El Paso County Clerk and Recorder Ofice website. They have a list of the drop-off boxes there.   Cynthia: Good.   Shelley Roerhrs: If you have questions, call them. Their website has, literally, locations for ballot drop boxes and voter services centers. I forgot to mention one thing, they have these things called voter service centers here. El Paso County has them on Garden of the Gods, there are voter registration office. Then, they have these voter registration offices that are all kind of on steroids, just little pockets of accounting where you can go as well. So those are kind of, you know, all over. I would recommend going to the clerk and recorders office to kind of find exactly which one is closest to you.     Cynthia:   Q: Yeah, and if I'm not registered, how do I get registered? What do you do to be registered?   Shelley Roerhrs: If you're not registered, you can do it online or you can go in-person. With COVID, you know, online is best, as long as you have a driver's license or ID. Go to votecolorado.gov, just go on there and it literally says "click register to vote." OK?   Cynthia:   Q: It's that easy?   Shelley Roerhrs: It is that easy. Now, if you have a problem because sometimes it doesn't accept your driver's license or whatever, then you do have to go in-person. Again it's a really simple registration here in Colorado. So you can go on the day of the election on November 3rd.   My son did it, he turned 17 this spring so he was not 18 when the primaries came up. In the state of Colorado, if you are 17, you can register to vote and vote in a primary if you'll be 18 before the general election. So we went the day of. he registered that day, and he voted in the primary. Now, of course, he's voting in the general election as well because he turned 18. So, for that instance, you know, again, Colorado makes it so easy to vote.   I find it hard to believe sometimes when people have an excuse not to vote, right? There's something else that I forgot to mention, in the state of Colorado, if you are a convicted felon, as long as you have served your time or you're out on probation, you are good to go. You can go and register to vote as well.   Cynthia: Oh!   Shelley Roerhrs: I know, isn't that amazing? So, again, if you served your time, whether you're a convicted felon or not, you should not lose that right to vote. It is one of the fundamental things that we have. So, again, Colorado, if you know someone who is disenfranchised because they think "gosh I'm a convicted felon, I don't have that right anymore," they do in the state of Colorado! Some other states do as well. Here, go and register, I recommend it!   Cynthia:   Q: What if they are still in prison? Can they vote then?   Shelley Roerhrs: Oh no, so if they had been convicted and they are in prison, I do not believe so. If they are awaiting trial, and not convicted, 100%! If they are still kind of in limbo, not yet, they can't. Again, if you're out and you served your time, go and register.   Cynthia: Good!   Shelley Roerhrs: One of the things is updating your information. It is not just about registering to vote, because a lot of people that we come across have already registered, right? You're like, "gosh, what is the league doing if everyone is already registered?" It's also important to update your information because there are a lot of inactive voters. That's what they are called, "inactive voters." You might not get a ballot, right? So, if you think "I may have moved since the last time I voted" ...if the last time you voted was in the presidential year in 2016, or if something is happened, right? You know, there are a lot of military around here and a lot of people moving in. So we also encourage you to go to govotecolorado.gov because you can update your information right there as well. It's really convenient to get your ballot.   Cynthia: Yes, get that corrected.  Q: If you don't have a driver's license, what can you use as an ID to register?   Shelley Roerhrs: That's a very good question and I'm going to have to refer to the Clerk and County Recorder's Office. Typically, you're going to need a passport, you're going to need a military ID, or some other type of state-issued ID is what they require. You know you don't have to have a driver's license because the state will give you an I.D for free, right? In those instances, my first instinct is to say your passport, your free ID, or birth certificate. If you need to prove your identity, like to get a driver's license. they would take any of those types of things. But, I'm going to refer to the Clerk and County Recorder's Office, just to kind of confirm. It will say on there, govotecolorado.gov, exactly what you need. For online registration, you actually have to put in your driver's license or state ID number, it does not let you put in your passport. So, if you have something other than that, you have to go to the office.   Cynthia: Some people, when they're no longer driving, they just let it expire.   Shelley Roerhrs: Correct.   Cynthia: They don't need, in their opinion, they don't need another form of identification.” I'm eighty, so I don't drive anymore,” kind of thing. So that would be helpful, thank you.   Shelley Roerhrs: I still think they need some form of ID, though. At some point, right? Usually, you know for any type of Medicare or Medicaid, don't they need an ID?   Cynthia: I think so, but some people just let it go and they just show their expired license. If their doctor says "no more driving" they may not drive anymore but they still have that.   Q: So, what do I do if I don't receive that ballot?   Shelley Roerhrs: So go to govotecolorado.gov, or check with our El Paso County Clerk and Recorder. Their phone number, I'm going to give you that real quick, just because there are a lot of questions that we refer to them. That number is 719-575-8683 to vote. Again, 719-575-8683. You can go update your information with them. Again, go to govotecolorado.gov and you can update your information there. If you don't receive your ballot, I would 100% either go to the El Paso County Clerk and Recorders Office or call them and find out why.   Cynthia: Very good.   Q: So, voting during COVID this year, what do the listeners here need to be careful of when voting during COVID?   Shelley Roerhrs: Well, I think the main thing is, if you do go and vote in person, you want to wear the mask and take all those protocols. But, you know, if you don't have to go and vote in-person, and you want to just drop off your ballot, that's probably the best thing to do. Because of COVID, the only thing I can say is just don't not vote. It is so easy to vote, even in the current situation. We have it much, much better than some states. I come from South Carolina and I think their representatives just allowed, so there if you want to vote in-person or get a mail-in-ballot, you have to have an excuse. You actually need to have a reason to get that. The excuse might be "I have to work" or "I'm out of town" ... and, you know, a lot of people falsified that document because they didn't want to vote on Election Day for whatever reason.   But now, because of COVID, they've made it so that you don't have to have an excuse. IT's called "no excuse voting " which should be that way anyway, just like in Colorado. It makes it so much easier for people to vote and why wouldn't we want to make it easier for people to vote?   Cynthia: Right!   Shelley Roerhrs: So, in that case, again, during COVID, if you're going to vote in person, I guess wear a mask. Other than that, it's pretty easy to mail in your ballot or drop it off at one of the locations.   Cynthia: There's lots of incorrect information out there.   Q: So, where do you go for the facts? You know, if you should really test the system and vote twice?   Shelley Roerhrs: So, I'm going to go to the experts on this! We mentioned there is a lot of incorrect information out there, and again from even from some of our leaders who have basically said "let's test the system, I want to see if it really works and if there is voter fraud?" Go to your County Clerk and Recorders Office, get information from there, and go to vote411.org. Again, the links have nonpartisan information. We don't put that information in there, but candidates and the issues people if they are either pro or con, they put that information in there. That's not us, okay?   So that is nonpartisan information and that gives you the ability to make those decisions, rather than hearing it on TV from somebody that says, you know, somebody is going to take away your Second Amendment rights. Take those things with a grain of salt. They're there to, you know, to sensationalize and hit on hot button issues that are going to make you all riled up. For a candidate to do that in a commercial, article, the news, a press release, or in an interview, something like that, they're literally just trying to ignite. Maybe we need a little less of that, I guess and a little bit more of, you know, a common sense and down-to-earth kind of thinking. I don't necessarily think just because somebody is telling me, like a star on television, a commercial, or another leader, another representative, telling me who to vote for. You know, I don't necessarily take that.   I'm not going to tell you who I vote for, in particular, but a lot of people will. That is my vote and I hold it very sacred to me. I think, from a voter perspective, where you get your facts is extremely important. Try to find a neutral place rather than the exact same place where you get your news from. That might be a little bit biased, right?   Cynthia: You know, the wording for these things can be so confusing. I will be honest, my husband will both read the wording and try to share our interpretations. It's horrible! The double negatives, and all of that stuff. So, you know finding the pros and cons is very important.   Shelley Roerhrs: It is, and that's where vote411.org comes in! For the League of Women Voters, we've invested a lot of time, resources, and energy into getting this right. We've been doing this for a long time, like you said, that's a compilation of all of that information into one location. It doesn't matter if you are in Kentucky, South Carolina, or Texas, they are specific to every single municipal election or ballot issue. You've got a couple of ballot issues, a couple of parks, and local issues, so those people who are pros and cons to each side of those are sending in their information now. You will be able to go to that but for vote411. It's usually right around the same time as we get our ballots. You know October 5th, look for that. It might not be all up to date right now. Some may have put in candidates and put in early, thinking ahead. Others wait until the last minute, so we kind of know how that is. Some may not do it at all. If you have a candidate you're about to vote for who has not put in information into this portal, it says a lot about your candidate. I would encourage people to go to thatvotefor11.org.   Cynthia:   Q: So when the candidate puts it in, does the League look at that to make sure that it's clear to the voter?   Shelley Roerhrs: No, we do not. I mean we what they put in is what they put in. They submit it. Now, I'm not on that technology end of it. I don't think we go and, you know, scrutinize it or edit it. Basically, what they put in has a word limit, right? They have certain questions that we ask them that say "how would you vote on this issue?" There's a bio and then there are some questions that we do tend to ask. In that instance, we don't edit them we just submit them and let the voters decide.   Cynthia: If they have a word limit, I bet they gotta keep it concise! I like that.   Q: Is there anything special the League has coming up that you want to mention?   Shelley Roerhrs: Well, obviously the election! You got 43 days from the time we are recording this. There are 43 days until the election. Tomorrow, September 22nd is national voter registration day, for us so that's kind of a big day. The League of Women Voters tends to do a lot of voter registrations during this week, whether it's a presidential year or not. That's our focus is registering voters. For us, registration days are also for updating your information. I encourage your listeners to go to govotecolorado.gov and check out if your voter registration information is updated or if it is not.   Then, a special thing for us, the League, of course, most people know we've been celebrating in August was the 100th celebration of the women's right to vote. We know that not all women have had the right to vote for 100 years. White women have had that privilege. African American women have not had that privilege for 100 years. Asian American women and American Indian women have not had that right. We still have a long way to go on that. We do have a special celebration that was kind of postponed because of COVID in honor of the 100th anniversary of women's right to vote. Also 100 years of going forward and what that looks like for women. It will look very different. We're celebrating with a mural, as well as some other billboards around town or some other art around town to celebrate the women's right to vote in the 100 years backward and forwards. If there's anyone interested in joining the League, to help us with that, our website is LWVPPR.org. They can become a member there and they can help us with a mural, and they can if donate if they like. Again, we are A501C6, which we are working on our 501C3 transition, so we will be a tax-deductible organization. The mural itself, again, we're starting our call to artists. Our committee and getting our jury together, but we're also doing donations.   Obviously, our League educates voters and empowers voters to take that step, right? We make sure you're voting because it is so important. We also celebrate, on the other end, that we are women and we do bring something different to the table. I think for a little while it's been to where we've...well, the Equal Rights Amendment hasn't been ratified yet, right? For us, that was kind of one of those back burner things. We are still working to ratify the E.R.A. today, in 2020!! There's so much work to be done and I do encourage listeners, whether you're 17, whether you are 40, whether you're 75, right? If you could take that step if you wanted to do more than just voting, come see us at the league.   We encourage men, too. We do love that because it is a different perspective for us, right? You know, we are the League of Women Voters, but some men also advocate for women's rights and equal rights for women and they are part of our membership as well. We do not discriminate against men.   Cynthia: That's important.   Q: Then, my last question; if listeners want to become a member of the League of Women Voters of the Pikes Peak region, what should they do?   Shelley Roerhrs: It's really simple, all they need to do is one of two things. You can either go to our website which is LWVPPR.org which stands for the League of Women Voters Pikes Peak region. Again, LWVPPR.org. Or, they can call us, since not everybody's on the web. Give us a call at 520-5381. Whether you want to be on our voter services team, helping voter registrations, or updating information, or on the communications team. We've also got our advocacy who deal with air quality and they go and attend those meetings. We've got lots of different committees that you could participate in, whatever your passion is. We want your talents! Come on and join us and find the one that fits and move on in and get it done.   Cynthia: Exactly!   Q: Is there anything else you want to add that we didn't talk about?   Shelley Roerhrs: Basically, we have some upcoming podcasts that are specifically ballot-related. We kind of dive into those specific ballot issues like prop 113, which is a national popular vote. You've also got amendment B. There are a couple of local issues regarding parks and the tabor amendment, right? For those things, you know, we've got a couple of podcasts. Go to our website, again, LWVPPR.org. Click on our podcasts if you want more information. Again, go to vote411.org because there's such a wealth of information there. Listeners can't go wrong.   Cynthia: That would be great! So, with that Shelley, we will end. I really, really appreciate your time, thank you. Thank you all for all our listeners, I hope you can join us again for our next podcast. Have a great day, I will talk to you soon!  

PART 2:  The Pikes Peak Elder Abuse Coalition has been working to keep vulnerable adults safe for 15 years and that work continues during COVID19 times.  Dayton Romero, Chair of the Coalition and Director of Senior Assistance Programs with Silver Key, discusses the extenuating circumstances and challenges being faced during COVID19.  Fraud abounds with specific COVID scams and abuse is heightened as people lack support and have more stressors.  Learn how the Coalition is meeting the needs. Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country.  We talk about both the everyday and novel needs and approaches to age with altitude whether you're in Ft. Lauderdale, Florida or Leadville, Colorado.  The Pikes Peak Area Agency on Aging is the producer.  Learn more at Pikes Peak Area Agency on Aging.   Transcript: You're listening to Studio 809. This is what community sounds like.   Cynthia Margiotta: This is Aging with Altitude. Welcome to all. Brought to you by the Pikes Peak Area Council of Governments Area Agency on Aging. We strive to provide answers assistance and advocacy to our elders. Please know that our guest today and I are sitting about 10 feet apart and we are practicing the social distance protocol, and I hope you are too. We are in the middle of the COVID-19 pandemic and one of the issues is elder abuse and how it's increasing. My guest today is Dayton Romero. He works for Silver Key, has been there since 2015. He's responsible for overseeing the administration and operations of several programs there at Silver Key. These programs include case management, guardianship, behavioral health, food pantry, and commodity food programs. and the Silver Key's different lines of services. We have been talking about abuse in the home, also called mistreatment. There are several kinds that people deal with and so we are going to continue that discussion here. My name is Cynthia Margiotta. I'm a geriatric social worker and a volunteer with the Pikes Peak Area Council of Governments Area Agency on Aging, so let's get started with our next question. When there's financial exploitation, in particular, it's done by an insider. That's someone they know. A family member, relative, a loved one, a caregiver, someone. With the loss of income for many people, are families turning to their parents now for money?   Dayton Romero: We have yet to anecdotally hear about those situations. I can say regardless of COVID, we see that too often already where there is a codependence among an adult child or another who's actually living in the home with that senior who owns the home really kind of depending on that person too…   Cynthia Margiotta: Support them.   Dayton Romero: Support them. Yep, and you know it also could be, again, the codependence as well. We've seen it kind of one sided. One person moving in and really relying on the support of that person all the way to the point where an individual really reaches that level where they need a higher level of support. And I mean that in care support. Whether it be in need of assisted living or skilled nursing, we've seen kind of challenge decision making where people, if mom moves to a nursing home, what does that mean for me? And so it really compromises the health and safety of mom. Those are difficult situations to see, hear of, and be in for a lot of people. It's prevalent. It happens, especially whenever we are talking about low-income families. With that, I think it's important for adult children or the caregivers, relatives, whoever is in those homes and are in that position of financially exploiting. A lot of times there is self-justification in financial exploitation especially in those in-home arrangements of I'm going to the grocery store. I'm picking up all of these things and so I can pay myself this or buy me a little of that sort of thing. So that self-justification could really put everyone in a bad position, in a compromised position. I think it's important that the caregiver have resources as well, so they are able to be preventative in being in those situations. I get in some it's going to happen. There's good intentions and bad intentions, but those especially we call, I forget who coined the term, but the accidental caregiver who started off by making runs to the grocery store for the person as a favor. Then really kind of find themselves a little bit deeper in helping medications, cleaning up the home, and then really being at the home, to the point of handling the debit card, run to the bank. And in those situations, I think it's really important that they have the tools. The caregivers as well as the senior have the tools to really recognize where are those boundaries so they are able to kind of protect themselves and really refrain from being in that sort of position. I understand it's a complex thing to navigate whenever you're talking about anyone's livelihood and safety, and even means of shelter. They're complex situations, but we see it all too often where there's and over dependence on the senior and they may be making, again, $1200 a month and they're sharing that between two people. And it's again, making sure both people have the resources so that they do have options. There's options for seniors in terms of resources. There's options for others in our community which we're fortunate to have that can also provide supports for those individuals so those individuals who are so dependent, if they are given those resources maybe they are less likely to be so dependent on their mom, dad, or senior.   Cynthia Margiotta: Right. So how can a senior decipher for themselves what is appropriate and what is not appropriate in the accidental care giver situation?   Dayton Romero: Yeah so, I think it's, there's a combination so really whenever it comes to financial exploitation, sending debit cards with people really puts an individual at risk. It's just essentially handing people money. And although again, starts with good intentions, there's some self-justification of you know I could buy me this and that tends to escalate the more it happens, that cognitive dissonance going on. I think just keeping apprised of what are those protection measures of yourself, so not giving your debit card to people. Also being aware of what is your level of support needed. How dependent are you on that person to get around even because that could also be, I don't want to exaggerate, but it can be weaponized. If you depend on a person as a means of transportation and getting out and getting around and that is your sole resource. That person has leverage or a way of keeping you socially isolated away from others or again, self-justifying in terms of I'm driving you everywhere and this sort of thing. So these are pieces to just kind of be aware of. Making sure where is your level of dependence and when is it a good idea to kind of get another party involved. I think checking signals with others around you is important as well. Really bouncing your circumstance and what's going on with people who care about you and other supports around you to really kind of get a third lens to the situation. It's so easy to get tunnel vision whenever you're living it, breathing it, doing it. To get someone else's take on what's going on could be helpful and also a means of making sure those pathways, those other resources may be available for you as well. Cynthia Margiotta: So using the example you just brought up, let's say child “Jane” is living with mom, and mom is depending on Jane to give her a ride everywhere and Jane says to mom, well I can't give you a ride unless you pay to have my car fixed. That's not mom's total job. Maybe contributing some gas would be appropriate, but not paying for the transmission, right?   Dayton Romero: Right, that's exactly right.   Cynthia Margiotta: That's a good example. Yeah, yeah.   Dayton Romero: And again, to that social isolation piece and relying on people for transportation and being connected in general. It's very important to have a secondary resource. That dependence. Once you have all your eggs in one basket, it really makes for a tough situation and so really making sure that everyone has in terms of preventable measures, everyone has resources. Making sure should an arrangement naturally happen, then resources are very critical to have in that arrangement so that both parties whether it be respite for the caregiver to get away to do their thing, do some self-care, or even for the other person who's being cared for, for them to have, you know…   Cynthia Margiotta: Friends.   Dayton Romero: Friends that could come pick them up, or even a delivery system through the grocery store or what have you. Just knowing how to navigate those pieces that help you maintain your independence is very critical because in situations where it becomes so dependent there are those situations where people can basically take you away from your support network and really kind of isolate you to the point where they're the only person you're talking with. That really could shape your world too, in terms of manipulation. Even in terms of financial exploitation, checking for signals and should you be accompanied your caregiver and you're going to the bank and caregiver is talking for you, running the show with the bank teller, that's a red flag. Luckily, we have some great financial institutions in our community who are on the lookout for those sort of things. In fact, we had our bank safe initiative through AARP here in Colorado Springs. We were a pilot, a pilot state. Colorado was for bank safe AARP where we were training. There was an initiative for training front line bank staff on how to recognize any signs of financial exploitation that could happen. So we're fortunate to have that in place. As far as the senior checking in for themselves, if they do notice that caregiver is accompanying them more and more to the bank and speaking on their behalf more and more. Those are times to really advocate for oneself and if that person does not have any sort of financial power of attorney or any of these other pieces, they should have no dealings with your financials unless you have given that permission.   Cynthia Margiotta: Right. My bank took that bank safe program and I've talked with them about that on numerous occasions. It's a great program, helps them to be more aware. This is our bank tellers, that's not their focus, that kind of situation. So for them to be more aware of those possibilities is great. It's broadening their horizons as well as helping our seniors in our community so power to that program. I didn't realize it was through AARP. Yay AARP. So to change the subject a little, one of the things that's happening now is the scammers. The phone scammers. So stranger scammers are preying on the isolation and loneliness of older adults even more now. Can you share some tips to prevent these scams?   Dayton Romero: Yes, absolutely. Again, you see there just within that line, social isolation is such a big risk factor for situations like this of being taken advantage of and so on. We're at a point in light of the situation while we're all at home, and staying in the home for long periods of time, a phone call would be nice. Hearing someone, talking to someone, but with that, that is being taken advantage of by scammers. Sometimes it may be by like a robocall. Some scammers are using illegal robocalls to pitch everything from coronavirus treatments to work at home schemes. The recording might say that pressing a number will let you speak to a live operator or remove you from their call list, but it might lead to more robocalls. There's a lot of kind of clever scams going on right now, unfortunately. It's really protecting yourself like fact checking information. If a scammer calls in, I always encourage skepticism and asking more questions and trusting your instinct. If there are those pieces where someone is pushy about selling you something regarding the coronavirus, or even the stimulus check that's going on, is another sort of arrangement that could easily be taken advantage of. Someone could call and claim that they are the government and they need you bank account information so they could deposit your check. That is not happening right now. The government is not reaching out and telling you these things or asking these things. Really just being aware and connected to information and also just the normal practices around not clicking on sources you don't know. Also, you know, being aware in terms of, I think another one that I'd heard of was around vaccinations, and there is no vaccination. And so those scammers that get you to buy products that aren't proven to treat or prevent the coronavirus, sometimes online or over the phone. The overall awareness of there being no FDA authorized home test kits or coronavirus vaccinations is very essential. I would encourage people to do their homework when it comes to the coronavirus. Although watching the news too much could be a little detrimental in some cases so I would generally suggest that people keep apprised through experts like the Centers for Disease Control and the World Health Organization. They have some excellent information posted online. They're continuously updating their information and data and keeping up with the continuous changes. Lastly, I think donations. I think doing homework on donations. There may be outreach around, you know, this country is very poor. They can't afford test kits, so we need your money in order to make that happen. I'm sure that may be the case and I'm sure that's happening somewhere, but really doing your homework in those initiatives that are outreaching to you and asking for your bank account information for that stuff because, yeah. Knowing who you are donating to, not letting anyone rush you into making a donation and know that if someone wants donations in cash, by gift card or by wiring money. Those are some indicators that it may be a scam.   Cynthia Margiotta: 19:00 Yes, I think that I have been contacted and I hope it's because I'm interested in geriatrics and not because of my age, but I think, oh maybe 10 or 15 times being told that my social security is going to be cut off, my bank is closing and I need to transfer it to another bank, they're going to come and arrest me. I mean it's almost weekly so I choose to believe it's because I'm involved in those geriatric things and they think I must be over 65. I'm going to believe that for a few more years. So you're right. We need to stay away. Anybody asking for any personal information at all, it should be the biggest red flag I ever saw. And wave your little white flag and say well I'll call my financial institution. I'll call my mortgage company. Thank you for the call, goodbye. End of it.   Dayton Romero: That's exactly right. And also bouncing situations, not only is relying on your support networks applicable for the financial exploitation and prevention of that, and also even caregiver neglect and these other pieces, but also for vulnerability for scams. So relying on your support network and say you know, calling up your friend, have you guys received this same phone call. I received a phone call that's asking for my bank account information so they could get that stimulus check that everyone is talking about in my bank account. Did you guys ever receive anything like this and really kind of having that dialogue because again, these scammers. They have scripts. They are very manipulative and are very intentional on who they're targeting. Protecting yourself by being aware, staying connected, doing your homework, and leaning on your support networks are good examples of just protecting yourself.   Cynthia Margiotta: Right, right. So there is no preventative. There's no way to cure it.   Dayton Romero: As of now, no.   Cynthia Margiotta: OK, everybody hear that? There's not a cure. There are protections. You know, I've got my little, my homemade mask on that I made. Little protections, but there is no cure.   Dayton Romero: Right. And again, I am not a health expert so I would suggest that everyone looks and uses the valuable resources that the Centers for Disease Control and Prevention and the World Health Organization put out. They speak on things from coping and dealing with stress as a result of everything going on. They have some excellent resources for that. They also have some excellent resources in terms of keeping you up to date on what's going on whether that be a vaccination or other safety precautions that they are recommending like the social distancing, like the masks, like the hand washing and these other pieces are critical to kind of keeping everyone safe. Those are the two go-to's for me at least. I tend to share that information among my staff and some clients as well who are looking to get some information. I would just google World Heath Organization or CDC. They have made it very accessible, and readable too. A lot of the information I've seen is not medical jargon or these complex research articles or anything like this. It's plain, simple writing on keeping us informed on what's going on. Easy to understand so that we all can respond appropriately and put some different measures in place that we need to for our own safety and others around us.   Cynthia Margiotta: I've been getting CDC newsletter for years. I actually love it. It is in English. We can understand it rather than big ole jargon stuff, so thank you. My last question would be how can we protect our parents or grandparents when they're ones that are the most vulnerable? The coronavirus, they are saying they are very vulnerable. I know that young people are as well into the grocery store, young people are not wearing the mask as frequently gives me heart failure to be honest with you. I sort of look at them and say, “don't you care about anybody besides what's going on?” I stay out of it. So how can we as young people protect our parents and grandparents?   Dayton Romero: I think we can assist in many ways. Primarily by developing safe communication pathways so keeping connected, checking in with our parents or our grandparents, great-grandparents. Those phone calls, as simple as it may sound, are valuable. They're a big deal and in an event like this, it's essential that, especially our seniors are connected. Whether it be a five-minute phone call or an hour phone call where you find out 50 minutes in, oh, you don't have food. And so from there, facilitating those sort of arrangements whether you're going to pick up groceries for them or arranging for a delivery of food over there, signing mom up for a program like Calls of Reassurance. Really just ensuring that mom, dad, grandma, grandpa have those resources and if they need some support in navigating those resources, being there, being available to help facilitate that is really, really helpful. And we're talking about information as well. You know, some may not be as savvy as others in terms of jumping on google and typing in WHO and doing these things, navigating these websites. So even just simple, communicating what's going on as well. You're a trusted person, ideally and if you're really well intentioned and wanting to support, making sure that they're getting accurate and concise information, digestible information. I think everyone is kind of on information overload right now from all channels, but really being able to get to those points of this is what's happening. This is where we're at. This is what we need to do sort of thing, really breaking it down in a digestible way and not a way where we're stoking the fire essentially because like we mentioned at the very beginning, stress levels are high. People are on edge. Things are uncertain right now, and so as long as we are able to lean on one another, especially our seniors and supporting them, we're able to give them that accurate, digestible information. Let them know where we're at and then be there as a communication path. And then also be there as a facilitator if needed. I think those are three primary ways we can make sure they're heard, they're supported, and they're apprised right now in this uncertain time.   Cynthia Margiotta: Yeah, yeah. Maybe we can even share with our elders when somebody's called us and tried to scam us, and even turn it around and say well this is what happened to me. Have you had any of those to try and encourage them to share and then they feel more comfortable because I think it happens to everyone. The scammers are calling everybody.   Dayton Romero: You're absolutely right. And I think that just mentioning that it is a reality right now. That people, scammers and such are taking advantage of the situation and it's unfortunate, but it is a reality. And so giving those tips that we've talked about I think also could be a means of giving the tools to seniors to protect themselves. Do your homework, be apprised, keep connected with me. Let's have those conversations. What kind of phone calls your getting that just didn't quite feel right? Or what's going on inside the home with your new caregiver, let's say? Tell me a little bit more about that arrangement and how things are going with that. Asking questions, open ended questions and giving them the opportunity to communicate. Like you said, encourage them that they can share what's going on and you as the support and the senior are kind of in it together to make sure that everyone is protected and safe.   Cynthia Margiotta: Yeah, yeah. So with that, is ther anything else that you wanted to share that we haven't covered?   Dayton Romero: You know, I'm all about the resources. We've shared the CDC and the Center on Disease Controls and the World Health Organization. In terms of specifically elder abuse victims during the COVID-19 pandemic, there is some work being done by the National Center on Elder Abuse and some other organizations. There's the Consumer Financial Protection Bureau as well. Be on the lookout for our statewide coalition, the Colorado Coalition for Elder Rights and Abuse Prevention. All of those places, all of those entities are putting out information as it relates to elder abuse, so their prime focus is on elder abuse. And the National Center on Elder Abuse actually just put out a powerpoint highlighting some of the varying things that are going on right now as a result of the pandemic and how it relates to elder abuse. So there are resources. Again, the CDC, World Health Organization, National Center on Elder Abuse, and the Colorado Coalition for Elder Rights and Abuse Prevention. And then our local chapter here, the Pikes Peak Elder Abuse Coalition are all working on putting information out so people are able to know what are those trends in elder abuse that are taking place as a result of the COVID-19 pandemic.   Cynthia Margiotta: Well, thank you so much. I do want to reiterate Silver Key's phone number, the Calls of Reassurance number. Please call if you're either interested in having someone call you one to three times a week, is what you said. Or if you've got some spare time where you can give time to making those calls. So that phone number again is 719-884-2300 and it's called Calls of Reassurance. I think that can kill a lot of birds with one stone if you know, you're looking at it that way. For an extrovert like me I think it would be great to make those calls. So thank you very much. I appreciate your time, Dayton. This has been great. That's the show and thanks to all of you for being with us today. Stay safe. Stay well. And stay home. Until next time, take good care of yourself. Thank you very much.   Hi, this is Dave Gardner. I just want to make sure you know that during these unusual times peakradar.com/virtual brings local arts and entertainment right into your home. From local music to gallery tours, to classes in dance, yoga, writing and more, our community is still creative and invites you to join in. That's peakradar.com/virtual

PART 1:  The Pikes Peak Elder Abuse Coalition has been working to keep vulnerable adults safe for 15 years and that work continues during COVID19 times.  Dayton Romero, Chair of the Coalition and Director of Senior Assistance Programs with Silver Key, discusses the extenuating circumstances and challenges being faced during COVID19.  Fraud abounds with specific COVID scams and abuse is heightened as people lack support and have more stressors.  Learn how the Coalition is meeting the needs. Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country.  We talk about both the everyday and novel needs and approaches to age with altitude whether you're in Ft. Lauderdale, Florida or Leadville, Colorado.  The Pikes Peak Area Agency on Aging is the producer.  Learn more at Pikes Peak Area Agency on Aging. Transcript:  This is Aging with Altitude. Welcome to all. Brought to you by the Pikes Peak Area Council of Governments Area Agency on Aging. We strive to provide answers, assistance, and advocacy into our elders. Please know my guest today and I are sitting about 10 feet apart and practicing the social distance protocol for the coronavirus. I hope you are too.   Thank you for joining us today. Our topic today is elder abuse and how it is increasing during the Coronavirus pandemic. Domestic violence goes up whenever families spend more time together, such as the holidays, long weekends and summer vacations. Seniors have it several ways, physical abuse, sexual abuse, psychological abuse, financial exploitation, and neglect are all forms of elder abuse. And it can occur in any family or any setting. We are here today to talk about two ways abuse occurs; one through trusted folks like family as there may be more time together, and then there are the more fun scammers.   I am your host Cynthia Margiotta, geriatric social worker and volunteer with The Pikes Peak Area Council of Government Area Agency on Aging. With me today is Dayton Romero. Dayton is the co-chair of the senior abuse coalition and works at Silver Key here at Colorado Springs CO. Silver Key is a non-profit working with seniors doing many things to assist our elders. Dayton joined Silver Key in 2015 and serves as the director of senior assistance programs. He holds a BA in psychology with a minor in gerontology from the University of Colorado, Colorado Springs. Currently he is pursuing a masters degree In Public Health with a concentration in leadership and public practice at the University of Colorado Anschutz Medical Campus.   He is responsible for overseeing the administration and operations of several programs at Silver Key; including case management, guardianship, behavioral health, food pantry and commodity food programs and Silver Key Silver Line. He also acts as Guardian to court appointed wards and develops partnerships in collaboration with community partners. Dayton has a strong technical knowledge and serves as Silver Key's senior assistance database administrator and data analysist. Dayton also actively participates on other nonprofit boards of directors and serves as chair of both the Pikes Peak elder abuse coalition and the Colorado coalition for elder rights and abuse profession.   Cynthia - Do you spend anytime at home?  Dayton: I yeah, quite a bit of time and just some being very involved with the community.  Cynthia – You are. you have a lot going on I'm very impressed.  Q - So let's get started with our first question about family or persons and trusted physicians in our lives. I'm sure you've been getting some very distressing calls, showing just how intense psychological as well as physical mistreatment can get when people are kept 24 hours a day together within a reduced space. can you share some stories you have heard? With no names of course.  A - Yeah Cynthia, I think in general that the climate is a little uncertain, it's uneasy. We're at a time where stress levels are high and if you compound that in an already strenuous arrangement whether it be a caregiver who's experiencing caregiver burnout, or in a situation where they have lost their job as a result of these sort of things. Those higher stressed positions really make for not so great environment and so it really is an uncertain time that's really kind of positioning people for uncertain circumstances. In terms of phone calls, I think primarily what we're seeing is individuals who are distressed by social isolation, and it's really ironic to me, (with) kind of the emphasis we're always putting out there of encouraging older adults or seniors to get out of their home, get involved, be active with the community and this totally just one 80 degree turn where we are having to self-isolate and in many cases stay home and kind of work around all the ways of getting out and getting exposed. And so social isolation really is a one of the higher risk factors for putting people at risk for mistreatment. Whether it be physical abuse, or financial exploitation, or scams, we really see those things coincide a lot of the time, so combating social isolation by keeping our clients connected has been our way of really doing our part to prevent those sort of things from happening.  Q - Often physical abuse doesn't come from a stranger it comes from someone you know and trust. At this time physical abuse is increasing. Can you tell our listeners about the reasons?  A – Again, I think it's really just the overall pressures and uncertainty of whether, you know the shelter in place I think causes some added pressure and keeping people in confined spaces as you mentioned and again you compound that with people like caregivers specifically where they really look to take care of these people and a lot of the time they rely on external resources (for) respite and getting out and really doing some self-care and those options may have some limitations now. And so again, that aspect of not really having alternative options or means of really getting away and distancing and really having some boundaries. It's a tough time to do that and so again the added stresses really adds to it. I pulled an article from the American Journal of Internal Medicine and it mentions how family members are the most common perpetrators of financial exploitation, and other forms of abuse. Which is then followed by friends and neighbors and then after that home care aides. And so really you see that trend in individuals who are those trusted entities, those trusted people in that older adults life and it's just really unfortunate to see where, (and) unfortunate to see those situations where people are just limited and really kind of feeling the pressures put on by this whole Covid situation that we're in right now.   Cynthia- It's mortifying actually, I mean I've been a caregiver from my mother. She had dementia and to be able for me (to serve as a caregiver) I was able to get out, I continued working, I continued date night with my husband, I these little things that gave me breathing room from being a caregiver were so helpful to me. I truly advocate for that. But right now the movie theaters closed, you know you know the restaurants are closed, you can't go or do anything away and so I can see how it just becomes crazy scary for the person who's being abused.   Q - Can victims of family abuse disregard the orders? Our governor has said we need to stay at home. Can they say I need to get away if they need to seek some kind of refuge? And then where can they go?  A – Yeah, safety is always number one and I know it is a little bit of a dilemma considering Covid, and exposures, and limiting that, but whenever that safety risk is right there and you're living it on a daily basis, I really think there are that's why we have a central and critical providers and that is our law enforcement. That is our caseworkers through adult Protective Services, who are still on the front lines and seeing these circumstances in the community, to address them and prevent them. And so with that being said, safety is always number one, especially in physical abuse situations and any other mistreatments. We want to ensure that, you know, those paths to getting refuge and getting access to safety is there. And the means of doing that is getting connected with our law enforcement. And we as a silver key as a nonprofit that serves older adults, we have an accountability where we are mandated reporters and so we really have to be on the lookout, have a keen eye and be really observant within our interactions with people who are reaching out for support, to notice any sort of things out of the ordinary that may be indicators of any abuse going on. And also make sure that our staff here are equipped with the answers and the resources to give those victims if they are experiencing that abuse. So, Law Enforcement and Adult Protective Services are key entities in finding a pathway to safety.  Q - So they can get away through contacting Adult Protective Services, they can call them, their phone numbers are readily available, they can also call Silver Key?  A - I, yeah, I see us as really being a holistic support and we are seeing a lot of individuals who, interestingly enough, really kind of bypassing some of their emotional needs, but more so focused on, you know how are they gonna get their next meal? And so we're seeing a lot of food insecure, a lot of food insecurity come out, and so we you know our Silver Line is receiving near, I think in March received 3,700 phone calls, just from individuals in the community who are looking to get connected. Whether it be for Meals on Wheels, or getting commodities, grocery items or those sort of things. So we're having to be really nimble programmatically to able to address that level of need and being able to make sure that people are getting access to food. And while doing so, we're being subtle in our efforts of gaining an idea of the additional supports that they're in need (of) during that initial phone call. So if they need to get connected to a case manager they are able to very easily, and through that they are able to be assessed, their situation be assessed, and really kind of see how we could set that person up for success, especially in the midst of all of this. But even further beyond that, and also you know, what we've also taken into consideration is with all the modifications going on throughout programs, not only internally at Silver Key, but externally. It's really calling out a big risk factor, which is social isolation again. These studies out there on social isolation and it being a risk factor for people who become mistreated, there's a lot of evidence on it. And so, with that being said, a lot of our programs internally really focus on the social piece. So for example we have congregate meal sites, we have 14 different congregate meal sites (that are) kind of spread around the community where it encourages seniors to come out have a meal, grab a bite with their buddy, and with that it's an opportunity to get out and be connected. And in light of the current public health crisis, we've modified it where we're preparing those meals for the week, dropping off once, and they're able to just go in and pick up, and there is no opportunity to sit around at a table and have that contact with their friends, family, neighbors, whoever.  And you know for our food pantry, we're one of the largest food pantries in southern Colorado given the amount of people who come through our door. For a typical basis you would see our lobby for our food pantry just jam packed. It's vibrant, people are talking, people are drinking coffee, and really just again using it as a way of just connecting with others and just fully enjoying the experience in the environment. But we've switched our program to a pick-up only model, where we're minimizing the amount of crowding in the lobby, and it's really just grab and go sort of thing, and so again we're minimizing that exposure, and (it's) for everyone's safety. But at the same time, we're effecting social isolation, where we're essentially putting them in a position where they are socially isolated and so we're very cognizant of that I could say. In fact, we are really relying on volunteers right now, to help us a scale our existing Calls Of Reassurance program. And so, with our Calls Of Reassurance program, we're relying on volunteers to help us scale. We currently have outreach efforts going on to those clients, to our internal clients who are being effected. For example, for the pantry, we have near 2,500 people enrolled in that program. In our connections cafe we have upwards of thousands, upwards of 1,000 clients engaging in that program regularly, and so we're outreaching specifically to these individuals who are feeling the consequences of those modifications at the programs, and engaging, connecting. So we're checking in on that, seeing how they're doing, seeing if they need any additional supports right now, whether it be access to food or even transportation to their medical appointments, those sort of things. but we're also offering The Calls Of Reassurance program, which is done by mainly volunteers and they're really checking in, having lighthearted conversations, one to three times a week. And they're also, a lot of the time, actually the basis of this program, the inception of it, was really targeted to prevent social isolation, especially among people who lack a social support system, and also our concern for their own well-being. So we've actually had people express that, you know if I were to fall, or if anything were to happen to me in my home, no one would know. And so they really look to us to be that check in with them, and we have protocols in place to respond appropriately in the situations where they're not answering their phone and that's (not) kind of the ordinary to how they normally would respond to our calls.  Q - Are you looking for some short-term volunteers that would help with those calls?  A - Yes. Yes. Again, in order to scale, we're talking a good amount of clients, in fact our program steadily had near 30 people or so in it, and we've seen that increase by 100% just over this last week and a half. so a lot of people are seeing them value in it, and are really looking at it as a means of keeping connected, which is really essential in this, in this, again this uncertain time.  Q - There's a lot of folks that aren't working so much right now, for lots of reasons some of which are extraverts, that are looking for things to do that might be useful. So is there a phone number where people can call to offer their time?  A - Absolutely. We have a centralized call system here in Silver Key called the Silver Line and that is 719-884-2300. And it's really kind of the entry point to access any one of our services, whether you're a client and wanting to get connected to a program, or even a volunteer who is looking to give back or donate some of your time and talent, there's a really simple way of just getting into our system.  Cynthia - And that program where they make friendly phone calls, again what is that called?  Dayton- Silver Key Calls of Reassurance.   Cynthia - I think that would be really good for some of us who feeI, I don't want to say totally isolated, but we have time on our hands and we would like to give back even if it's short term.  Dayton - Absolutely   Cynthia - So that would be helpful.  Dayton - And within that program we're privileged to have, we are a behavior health provider. And so we have behavioral health providers on staff who have been very helpful in making sure that those volunteers who are making those phone calls are equipped with the needed resources should any circumstances come up, whether it be any sort of expression on thoughts of suicide, suicidal ideations, or even mistreatment. So, how to really pick up on those things and have those resources at hand to be able to give that path to that person. And also the volunteers are versed on how to get that person connected back in (to) any of the internal programs at Silver Key as well. So they, they know how, if a person mentions that they haven't had food in two days and they can't get to the grocery store for another 3,  how does Silver Key, how does the volunteer, respond to that situation? And we have some pretty solid mechanisms in place to be able to respond appropriately and make sure that that person doesn't go hungry.  Cynthia - Right so there's a lot of support within silver key for those volunteers who are trying to help others. I think that's essential.  Dayton - Absolutely   Cynthia - Food is important, it's one of those basic needs. I need it, you need it, we all need it.   Q - So if a person is being mistreated, and that's really the technical term for abuse, if they're being mistreated and they decide it's time to go, it's “I'm outta here” kind of thing. What should they bring with them?  A - It's a great question. They definitely will need their identification a lot of the time to navigate any governmental program, (and) proof of income, Social Security award letters is important. I would also recommend if any sort of advanced planning has been done, any key documents that have been put in place, to kind of keep copies of those with you. Of course, medicine lists, all those essentials that would be hard to produce without having to take a trip somewhere or have to wait seven business days to get it again. So really kind of just having that list of documents such as that handy would be really good. You've mentioned where can they go? With that in mind, our community has a program called the Emergency Shelter Network Program, and it was a foundational piece to the Pikes Peak Elder Abuse Coalition. And it is a means of finding or having shelter for abused or mistreated older adults to go to. You know, we have community partners, some skilled nursing facilities, some assisted living, who will take those individuals in. There is kind of a path to that,  in where some have gone through the emergency department, some are working directly with the caseworker, with an adult Protective Services caseworker and those are the two primary entry points to gain access to that program, and then be placed into one of those facilities as a means of shelter. We have a pretty unique program in and of itself here in our community, where we're the Pikes Peak Elder Abuse Coalition, and that subcommittee specifically, is involved with a national entity, and they help keep benchmarking and standards for that program, and also help out with the data tracking and these pieces, so that we were informed on the usage of that program in our community. So I think we're lucky here in Colorado Springs to have such an innovative program, and it really speaks to the collaborative nature of our community, especially when you have care facilities involved and willing to, you know, say they have a bed for an individual who has been, whether it be physically abused or these other pieces that really call for them to be removed from that environment.  Q - Do you have a contact where they would call adult Protective Services, basically on themselves, in order to get hooked up with this possible space to stay temporarily?  A - Yeah, so there there's some nuance involved in terms of navigating Medicaid long term care, Medicaid and these other pieces, but generally speaking, the emergency department or the Adult Protective Services caseworkers are the people in tune with the criteria for people to access that program. So the adult Protective Services, they have its own process right to get to the point of being assigned an adult caseworker in their system, and then from there, it would be up to the caseworker to really kind of do that that checking out the criteria (for) that individual.  Cynthia - We need that for people. 'Cause right now it's hard find a space, somewhere to go, we have a lot of older people. I think we were talking the other day, who are older, they feel like they have nowhere to go, and maybe as an advocate for women, the income for a woman who spouse is still alive, specially that older population, their income, their Social Security check, may not be enough to survive.  Dayton - Yeah it's something we see too often, in terms of the financial constraints among a lot of our clients. So Silver Key serves around 7,000 clients a year, and among those, the income is close to $1,200 per month on average among those clients, and so (the) options, you kind of juxtapose that with our current housing market in our community, so even finding an apartment makes it very, very challenging. Whenever you have a fixed income the likelihood of employment, and the chances of employment, is challenged, and then on top of that, again the competitive housing market that calls for you, you know, to even to be considered, your income having to be two to three times the amount of the rent in itself. It really limits so many options for so many people. and so from there you're looking at not many options to go, to go anywhere. And then the hotel situation, there are few if any resources that are there to assist people (to) kind of continuously stay within a hotel, and so hotel vouchers and these sort of things are hard to come by. And subsidized housing and housing vouchers are hard to come by, and so it's a little disheartening. However, there are many smart people, kind of behind the scenes right now that I'm aware of, who are aware of this issue and kind of working on solutions on housing, specifically for seniors, because of those financial constraints, mobility constraints, accessibility considerations, those sort of pieces.  Cynthia - Well we have a new program here in the Springs, that's not really gotten off the ground level yet, the shared housing program. I'm hoping to interview her, hint hint if she's listening, pretty soon here about that program, but I think that would be a useful tool for folks. You know if I owned a home a little bit of income for me with an independent roommate. I think that would be nice. So that is one that I know of. I'm sure there's lots of them  Cynthia - Thank you for joining us today everyone. This was part one of our topic, elder abuse and how it's increasing during their COVID-19 pandemic. With us today was Dayton Romero from Silver Key senior services, a local nonprofit here helping elderly. He is the chair of the domestic violence program here in Colorado Springs. We have more questions for Dayton and we will be having a Part 2 where he comes back in about 2 weeks. So please join us then. Thank you all for joining us and please be safe, don't be sorry. Thanks.  

Aging with Altitude's host, Cynthia Margiotta, an older adult herself and BSW, shares her observations and insights during the age of COVID19.  She describes the chilling neighborhood drive, contemplates physical vs. social distancing, shares how friends with dementia can be supported and finally a multitude of ideas on how to stay busy, engaged and hopeful as we all find ourselves writing a new chapter in our lives. Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country.  We talk about both the everyday and novel needs and approaches to age with altitude whether you're in Ft. Lauderdale, Florida or Leadville, Colorado.  The Pikes Peak Area Agency on Aging is the producer.  Learn more at Pikes Peak Area Agency on Aging. Transcript:   Episode Nine: COVID-19, A Personal Response  SUMMARY  Aging with Altitude's host, Cynthia Margiotta, an older adult herself and BSW, shares her observations and insights during the age of COVID19.  She describes the chilling neighborhood drive, contemplates physical vs. social distancing, shares how friends with dementia can be supported and finally a multitude of ideas on how to stay busy, engaged and hopeful as we all find ourselves writing a new chapter in our lives.    This is Studio 809, the Pikes Peak regions own podcast hub.    Cynthia Margiotta:   This is Aging with Altitude, welcome to all! Brought to you by the Pikes Peak Area Council of Government's Area Agency on Aging. We strive to provide answers, assistance, and advocacy to our elders. Thank you for joining us today.     Our topic today is not so much about the Coronavirus as it is about us in the age of the Coronavirus. I am your host Cynthia Margiotta. I'm a geriatric social worker, and a volunteer with the Pikes Peak Area Council of Government's Area Agency on Aging. I am going to be interviewing me.I don't know how that will work. But we'll see.     So our three topics today, actually four, are our drive around, I did a drive around. And then a little bit about physical distancing, as opposed to social distancing. Number three is activities for folks with dementia, and then a whole list of straight up activities. So if you can grab a pen and paper, and then when we get to that you can write down the ones that interest you and you had forgotten about them.     The Drive Around    So first off, the drive around. I went out into Colorado Springs and drove around a bit. What I got to see was very interesting. First off, during rush hour traffic, there was very little driving very few cars out there. I saw a lot of cops giving people tickets because they were speeding too much. But, you know, not a lot of people on the road. Then over at downtown Colorado Springs and Manitou I went over there as well. I saw a few people out, it was mostly the homeless people, and a few people that were actually on their way to or from work in their businesses.     As far as the businesses were concerned, the ones that were open, were mostly the ones that had food that you could take out or drive up, like the Burger King, McDonald's, or the coffee shops. I grabbed some food from them, which was great. And then the restaurants, they had sort of car delivery situations, which helps them to stay alive. I am worried about the other businesses out there who can't do those things.   Then there was the people who were in their businesses that the business was locked, the building they couldn't get into. And so they have to do it remotely. And then there were some folks inside their business. But what I've noticed is they're not having as many people come into the business, they're doing more of that remote work with them, either through the computer, or on the phone, or just talking to them about "let's set this up for later."     Then there's the doctors offices, and they're conducting a lot of their appointments over the phone. They have this almost like zoom thing going on. I talked to one of the doctors the other day. And he's interviewing and talking with people over the phone. And you can see him. So that's kind of cool.     That's just my observations. You might have others. But I thought those of us that are staying home might be interested in hearing about that. So I think that's a good idea.     Physical Distancing, Not Social Distancing    Then, the second thing is talking about some of physical distancing. And there's a difference between physical distancing and socially distancing. We need to stay socially connected to people we love. How can we do that? Physical distancing, you know, there today, they were saying six, seven feet away from each other is important. I get that. I understand that. But the social distancing, we need to find ways to stay connected to people. So some of my list might be helpful, that some of these things you can do with your friends. But I just want to encourage you to think about the things that might work easily. For instance, talking on the phone with friends, using the computer to send out emails or perhaps connect with Skype and zoom. Both of those have free components so that we can use them. Then, you know, with your loved ones, we can't be close to them, so seeing them through the window even might have been helpful, I don't know. But that's important to stay socially connected and then stay physically apart.     I noticed that when I went to some businesses of people I knew some of them had the masks on, they didn't want to see anybody, they didn't want to get close to anybody whereas others open their doors and said, I need a hug. And so we hugged. So there's differences in that.         Activities for Individuals with Dementia     The second thing I want to talk about is activities for dementia and working with dementia. Six out of ten people that have dementia, and this includes Alzheimers, they become wanders. So we need to find ways to keep them busy, keep them happy. What I say to people is just for a minute, you just want them happy for this minute. So finding things to do. So when I get to my list and share it with you, I want you to think about if you have a person with dementia, I want you to think about the possibility of simplifying those activities.     What I mean by that, and I will use my own mom as an example. Let me explain. I grew up in a house with seven people and we would sit down at the dining room table and all seven of us would play Solitaire together. I know that sounds hard, but somebody would put an ace out on the middle of the table. And everybody who had a two with throw their two on there as fast as possible. First one got to put their two on there, got to keep it there. So, it was a little bit crazy. I'll be honest, I don't think I ever won, I'm not fast enough. But when my mom with her dementia came to live with us, she loved playing solitaire. So she would play Solitaire for hours, she loved her Solitaire. But as her dementia, or Alzheimer's, progressed it got harder and harder for her. So after a little while, we had to take away the aces, the kings, the queens, and the jacks because those didn't make sense to her anymore. She didn't understand what they were, they didn't have numbers attached. So we took them away and she played Solitaire with the two through 10. Simple, easy for her. Then, as things progressed some more, it was hard to understand the concept of the reds and the blacks and putting that together. So we took the black cards away. So she had the hearts in the diamonds. And she would play with those. After a while that even got confusing, so we took the diamonds away. Those diamonds were out of the picture. And she had her hearts, two through 10 she played. We call it Solitaire, what it really was is that she would take the little deck of cards, and she would hold them a one card at a time, until she got to the 10. When there were no more cards, she pick it up and start over again. That's what I call simplifying. Don't try and make them remember, don't try and make them do things that are out of their concept anymore. Make it easy, make it fun for them, that's what I think is important. You don't need to be distanced from them. They won't understand that.     COVID Activities List     So then I want to talk about some activities. I have a list here a mile long. A lot of these are things I've had for years and I've shared with older people, and younger people. Some of these are from a program out in Washington State. It's called PEARLS, program encouraging rewarding active lives for seniors. So I want to give a shout out to them as well.   So I wrote them down and I have this list. So you might hear my papers. Oh, I forgot to mention, I am at home. So please excuse me if my dogs start barking. They might just do that. So here's my list. I hope you have paper and pencil to write down the ideas that I come up with that might help you and maybe new ideas. So here we go. Ready?   listen to music  buy household gadgets over the internet  lay out there in the sun on a warm day  laugh  think about past travels  organize those photos from those past trips  listen to others who are talking to you  read magazines or newspapers  pick up those old hobbies you haven't done in ages like stamp collecting or coin collecting or model building  spend an evening over the internet with friends  plan a day's activity for down the road when this is over  meet new people in internet land, like your sister's best friend for instance  remember some beautiful scenery  eat something you love  practice yoga or practice Tai Chi  ride your stationary bike  repair things around the house that you've been putting off forever  work on the car or on the bike  remembering the words and deeds of loving people  spend time with the people in the house  plan out which place and research where do you want to start volunteering when all of this is over  do you want to get time to have a quiet evening  go internet antique shopping  care for your household plants. My plants have never had so much attention in their lives, they're loving it.   doodle  share a favorite recipe with someone  start an avocado tree or any water routing house plant, I've started three and I'm hoping that all three of them take off and I'm going to give two away  Skype a friend or family member and visit over coffee on the Skype land or over a drink after five  sing a song loud and happy  arrange some flowers  rearrange a room in your house  practice your religion or practice spirituality  go on that diet you've been planning to either to gain weight or to lose weight  acknowledge your good points  find a bargain for something you were going to buy on the internet  paint  do something spontaneous  work on some textiles  embroidery, needlepoint, weaving knitting, macrame, I made a two-day macrame a three tier plant hanger the other day, it took me two days to make it but I feel like I accomplished something.   go to bed early  take a nap  drive someone to the grocery store  sing with a group on the zoom  play that instrument that you haven't taken out of the closet months  do some arts and crafts  make some cards for birthdays  listen to those CDs  plan a party for when all this is over  cook  go for a hike  remember to physical distance  write poetry  write a book  write stories  write articles.   So go out to dinner, well not really out but get some food and bring it in.  work on a project  discuss a book that you've read with someone   do your gardening and beat them to the punch you can plant your little seeds in the house   let's see... drink coffee and read the newspaper  kiss somebody in your house  daydream   listen to music   refinish that piece of furniture that's been sitting in the closet for a while  watch TV. What do they call that now? That's right, "binge watching". There you go, do some binge watching, you know that show from the 60s that you loved. Find it and binge watch it.   Make a list of tasks you want to do  ride your bike  walk around the house  go to a park and walk around there  complete a task that's on your list of things to do  teach something  call your grandchild or call somebody you love. I talked to my sister the other day, and I was telling her "this is how you macrame". She didn't remember as well as I did, I think.   Play with your pets or brush your pets.   Travel, like in your mind. Where do you want to go?   Read fiction  enjoy the time alone   write in your diary  write in your journal  clean the house  read nonfiction  write letters  write postcards  surf the internet  write some emails  dance to a wild crazy song that you love.   meditate  have lunch with a friend over the internet.   think about happy moments.   splurge on something maybe from Amazon or one of them.   play cards.   Solve riddles.   Have a political discussion with somebody. Either someone who agrees with you. Or somebody from the other side might learn something.   I play guitar.   Looking at your beautiful photos that have been in that box in the closet for months.   do crossword puzzles  if you have a pool table, play that   dress up or dress down.   I'm in my sweats.   reflect on how you've improved  talk on the phone.   think about spiritual or religious things like candles.   listen to the radio.   say I love you to someone   think about your good qualities  buy books online or get books from the library online.   It's important to do that.   cuddle  tell jokes  make a contribution to a charitable cause.     meet someone new on the internet   Like your sister's best friend, maybe.   think about something good in the future.  complete a difficult task  take a long hot shower or a long hot bath  have a frank and open conversation with somebody  work at your paid job   wear some comfortable clothes  calm or brush your hair.   solve some personal issues.   You never know. Taking it up.   watch some wild animals on televsion   put together a bag of things you never use any more to take the ark or the thrift shop when things open up again then you can give them away   landscape or do yard work or prep for that.   listen to the sounds of nature  open your mail   watch the weather.   Enjoy the sunrise or enjoy the sunset.   help someone with grocery shopping for some of your neighbors   talk about your children or grandchildren  admiring a beautiful flower or a beautiful plant  reminisce and talk about old times   enjoy the peace and quiet   visit with friends on the other side of the fence, if you know what I mean.   say your prayers  do some favors for people  watch people  complete a project or maybe a task.  smile at people   enjoy the company of the people in your home  have a drink with people on internet that you know, or a cup of coffee  I like the cup of coffee idea best.   feel proud of your family or friends   give a gift on internet, you can order something and have it sent to someone else  look at the stars or look at the moon.   read about the different care options for your plants, I've looked that up and I'm doing a little different now. I think it's going to be happier. Right?  get a manicure from yourself or a pedicure, or give one to somebody in your house.  try a new recipe  get involved in a social cause   bake a favorite treat, I think that's a good one too  Anyway, that's my list of wonderful ideas. If you think of others, more power to you. I'd love to hear about them. I'm always looking for good ideas. I want to thank you all for your time. And please remember physical distancing, not social distancing. Good luck with all of you. Stay well, stay healthy, and do what makes you happy. And I hope you have a great day. And thank you. Thank you very much for spending a little time with me. This is Cynthia. I'm with Pikes Peak Area Council of Government's Area Agency on Aging and I hope you have a wonderful day. Take care, bye. 

Elder fraud and abuse happens and is under-reported.  What can be done to help?  This podcast has two focuses first, learn about  the signs of abuse and strategies to avoid fraud and abuse.  Second, learn about the concept and practice of Elder Shelter.  Our guest is Colorado Springs Police Detective Chuck Szatkowski who is a member of the Colorado Springs Elder Abuse Coalition and the national Spring Alliance focused on creating elder shelter support.  Detective Chuck describes what mistreatment looks like so we can better know if a person is a victim and how to report it.  Detective Chuck also talks about the concept and services of Elder Shelter.  Colorado Springs has one of the best support systems in the nation to provide elder shelter to adults who have been victims of fraud and abuse.  This model is based on collaborations across organizations and for profit entities and is a member of Spring Alliance, a network of regional elder abuse shelters and similar service models. Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country.  We talk about both the everyday and novel needs and approaches to age with altitude whether you're in Ft. Lauderdale, Florida or Leadville, Colorado.  The Pikes Peak Area Agency on Aging is the producer.  Learn more at Pikes Peak Area Agency on Aging. Transcript: Elder fraud and abuse happens and is under-reported.  What can be done to help?  This podcast has two focuses first, learn about the signs of abuse and strategies to avoid fraud and abuse.  Second, learn about the concept and practice of Elder Shelter.  Our guest is Colorado Springs Police Detective Chuck Szatkowski who is a member of the Colorado Springs Elder Abuse Coalition and the national Spring Alliance focused on creating elder shelter support.  Detective Chuck describes what mistreatment looks like so we can better know if a person is a victim and how to report it.  Detective Chuck also talks about the concept and services of Elder Shelter.  Colorado Springs has one of the best support systems in the nation to provide elder shelter to adults who have been victims of fraud and abuse.  This model is based on collaborations across organizations and for-profit entities and is a member of Spring Alliance, a network of regional elder abuse shelters and similar service models.    Cynthia Margiata with Detective Chuck Szatkowski, Springs Alliance and Elder Shelter  Q – What is elder fraud and abuse?  A – Mistreatment is Physical Abuse, Sexual Abuse, Caretake Neglect and financial exploitation. Nationally only 1 in 19 or 1 in 24 cases are ever reported. One of the national problems is that we have different definitions of what constitutes an at-risk or vulnerable adult and different definitions of what constitutes mistreatment or abuse.  Cynthia – That makes it hard to work together  Chuck – Right, no sort of national standard    Q – What is the Elder Shelter Model?  A – It's a program in El Paso County where we have 9 skilled nursing facilities and 5 assisted living facilities so when we have a victim of mistreatment who requires either skilled or assisted living, when we arrest the perpetrator we have these facilities who have agreed that if the person is appropriate and they have a bed they will take the person in on an emergency basis and the adult protective services will work to expedite Medicaid funding to get the persons stay at the facility taken care of. We just recently joined the Springs alliance with a national association of 25 Elder Shelter programs across the united states. Every model is different based on the community and what we do is we help other communities try to set up elder shelter programs and they can look at the various models to see what works best for them. In El Paso County we are really fortunate that this has all been done on a handshake at this point. Christy Swanson from Sava Senior care has really been the guide to this, the go-getter that has kept this program going. But she has been doing this part time on the side of a full-time job as an administrator.   Cynthia – Is she volunteering her time?  Chuck – Her company has been very supportive. Which we really appreciate, but we are at the point now, last year we served 71, this year we have served 82. The program is large enough that we really need a full-time coordinator so we are looking at grant funding opportunities to have a ft coordinator and it looks like that coordinator will be housed in silver key senior services  Cynthia – Nice. So, you are looking at space for them already  Chuck – We are looking into a space, and a computer database so rather than calling around to see who has a bed. The participating communities can put in their availability – is there bed is it male or female so we can go down the list as we need a bed and find an appropriate placement for a person  Cynthia – Are you taking applications?  Chuck – We have to get the funding first. We are looking at applying in January 2020 for a GOCO grant.   Cynthia – I hope you get it, we need it.    Q – What are some signs of elder fraud or abuse?  A – For the mistreatment part, the physical or sexual abuse, you would look for injuries that aren't consistent with how they are being described, or an increase in emergency room or doctors' visits. These are typically the signs you would see of physical abuse. For caretaker neglect you would see a decline in their physical wellbeing. Maybe they start to be dehydrated, malnourished, or you notice they used to be really clean and wear clothes properly, and now their appearance is changing. Those can all be signs of mistreatment, either physical or caretaker neglect.   Now it's hard sometimes to see the difference between neglect or the disease process. The important thing is to work with law enforcement, and we will work with Adult Protective Services. To determine treatment, it may be just self-neglect, but adult protective services can help connect them with resources in the community. Our goal is least restrictive, we want to keep people in their home for as long as possible    Q – What do we do in EPC that is different than other areas?  A – In El Paso County we really have a long history of collaboration with our community partners. We work closely with Adult Protective Services; The Resource Exchange, which is our community center board which coordinates services for people with intellectual developmental disabilities; and the Area Agency on Aging, especially the Ombudsman Program.  In connection with Adult Protective Services we have a civil criminal investigator, paid for half by the police department and half by the Department of Human Services. She is a retired police officer. She has been to the social workers academy, so she is also social worker. She has access to both databases. The law says we have to notify Adult Protective Services within 24 hours of every report of mistreatment of an at-risk adult. We staff those calls every morning with Adult Protective Services to decide if it's theirs, ours, or of both of ours.  If it's both we coordinate closely with the assigned caseworker. We do share information freely between us. We do joint interviews not only with suspects and witnesses but also with victims. Primarily with victims so we don't retraumatize them and so they don't have to go over the same story over and over and relive the experience. And that's unique, other jurisdictions don't have that close collaboration with community partners  Cynthia – I think that would help someone who is a victim to not have to talk about it many many times  Chuck – That's our goal. We're victim centered. Sometimes it may not be in their best interest to pursue criminal charges, but we make that decision  Cynthia – I like that term victim centered, thank you.    Q – So, are older adults more susceptible to certain kinds of fraud then?  A – There are a number of factors that make a person more susceptible as they get older. Some of that is that they become more dependent on other people as we become more frail. That results in isolation which makes it easier to exploit or mistreat someone and it's not detected. A prior history of trauma, like domestic violence or something like that, also makes a person more susceptible to mistreatment.  Sometimes the economic factors can make it, but we see it occur across all income levels. We have it from the 700 social security check to the million-dollar home. The biggest problem is the isolation as we get older and aren't as mobile and then we get isolated from the community and that creates an opportunity for people to mistreat and exploit us.  Cynthia - I have seen a lot of that on the phone. Where people are calling on the phone and asking for money and lonely people seem to be more susceptible.   Chuck – We seem to think about the phone scams as the mistreatment, but unfortunately 90% of offender oroffenders are spouses or family members.  The stranger crimes the fraud does occur over the telephone. The oldest of the old, the 80s seem to be the more trusting generation where things were done upon a handshake, so they trust when somebody calls them. But the government isn't going to call you to tell you they are going to arrest you or that you owe taxes they aren't going to ask you to go to Walmart to get gift cards to pay a bond because you missed jury duty. The key is if you don't recognize the number don't answer it. If its important they will leave a message. The federal government isn't going to call you about your taxes, your Medicare. The sheriff's office or the police department aren't going to call you about an arrest warrant. The thing is to be cautious; you know the old story about if its too good to be true it is. We get the scams where the secret shopper or you won the lottery. Its illegal to participate in a foreign lottery number one, and how would you have won the lottery if you didn't enter the lottery. A legitimate sweepstakes isn't going to make you pay taxes or anything up front. They will take that out of your winnings.   Cynthia – The one I got the other day was they were going to cancel my social security card  Chuck – I've got over a dozen of those calls about my social security being compromised. The thing is its just a computer randomly dialing numbers. So, you say how do they know I'm older, well it's just the luck of the draw you answer the phone and your older. The thing is if you answer the phone you get on a list that says this is a good phone number because it's just a computer randomly dialing numbers. They sell that list to other scammers. And If you talk to them you go on another list, that I call the sucker list, and they sell that to other scammers too, because now people recognize that you are vulnerable. I remember when my grandfather would talk about during the great depression how the hobos would make a little symbol on the fence or back of a house where someone was willing to give them food and stuff.  And this is similar. This is organized crime that is doing this scam and its organized crime from outside the united states. So, it's very difficult for us to investigate and almost impossible for us to prosecute.   Cynthia – sounds horrible and very difficult for our seniors and sounds like our young people are having this problem too.   Chuck – Yep. Some younger people are falling for it too. The thing is don't answer the phone if you don't know the number, get caller ID    Q – How many cases have you dealt with in this area?  A – In 2017 and 2018 my unit averaged 296 cases a year. My unit handles the physical assaults, the sexual assaults, the caretake neglect. The financial crimes go to the financial crimes' unit. And we don't have the stats on how many of those financial crimes because many of the times they are mislabeled. So, we aren't sure if the victim's elderly or how they are being targeted. So, we average close to 300 reports in my unit that we investigate a year.   Cynthia - That's a lot – painful.     Q - So which ones would you say are the most common ones you deal with?  A – The most common ones are intertwined, there is usually some sort of financial exploitation coupled with caretaker neglect. I have had people tell me they don't want to spend their inheritance to take care of mom and dad. Its not their inheritance until mom or dad are gone. So those are the most common ones we see is the caretaker neglect coupled with the financial exploitation. We do, because we have a large number of skilled nursing facilities and assisted living facilities in this community, and we also have a very good program for our intellectual developmentally disabled citizens. So do get a lot of reports of incidents of what we call resident on resident assaults or participant or participant assault that we have to investigate. But usually does not result in criminal charges because the suspect doesn't have the mental state capable of being charged with a crime knowingly or recklessly. But we do have to investigate those cases and establish whether they have the capability to understand right from wrong    Q - How many convictions have there been?   A – We don't track convictions. When we make an arrest and file that with the DA office its pretty much out of our hands. We need probable cause to arrest the DA needs beyond a reasonable doubt which is a very high standard. We try to build our cases to beyond a reasonable doubt but many a times they will look at it and for various reasons they will decide it's not prosecutable because they wont be able to reach their burden of proof to a jury. That why we don't track our conviction rates.   Cynthia - So is it sometimes also that maybe the victim doesn't want to testify.   Chuck – That's a big problem, its just like in domestic violence, the victims recant they want the mistreatment to stop but they don't want the offender to be punished and go to jail. So recanting is a big issue. We can prosecute those cases without their participation we try to build an evidence-based case like you do in a domestic violence case where you don't have to rely on the victim's testimony. But many times, when you get into the areas of exploitation the consent part is a big issue. Did they consent to this? You know, did they make poor choices and let people use their money the way it shouldn't be and now they are in this position where they can't afford their care.  Cynthia – maybe writing a check to their daughter that is misused not for their care  Chuck – Or undue influence. The daughter may say that if you don't give me this money, you're not going to see your grandkids or I'll put you in a nursing home, that type of thing. Those undue influences do occur. The big challenge to prove in court.     Q - What are some tips you can share to help an older adult prevent themselves from becoming a victim of abuse or fraud?  A - Number one get your advance directives in place now – not only your financial powers of attorney but your medical powers of attorney, your living will. Make sure that people understand what your desires are so that when you get to the point you no longer have the capacity to make that decision. Be sure that when you create a power of attorney you don't your rights to ask for an accounting of what's going on with your funds. Be sure you have that accounting or someone who can ask the accounting because a family member can ask for an accounting too. You want to have some oversight because money does strange things to people. You may think its someone you can trust and then once they get access to the money, they start using it for their own benefit and not yours. As far as the way to avoid defrauds is don't answer the phone if you don't know the number. If somebody calls, don't ask them for the number if they say they are from social security or the local sheriff's office, hang up and find the number yourself and call to verify. Again, we're not going to call you to tell you that your wanted. We are going to show up at your door. You get the grandma scams where they get the calls that this is some grandchild and they've been in a car accident or they've been arrested. My mother got that and first thing she did is hang up and call my brother to see where his son Justin was who was sitting right beside him in Cincinnati, he wasn't in jail in Canada  Cynthia - Good for her  Chuck - Take a few seconds to breath, think it out. Don't jump in and assume they are legitimate  Cynthia - Smart move – your mom is a smart lady    Q - When people are removed from their home with their family members. What happens from there? You mentioned that they might go to an assisted living or a nursing home, but what happens?  A - First off, we don't remove people from their homes. With consenting adults, you know it's not like children, the law gives me the authority as a police officer to remove a child if I think it's in an unsafe environment, I don't have that with an adult. Adults are free to make choices. If there is a situation where they are dependent on their caretaker and we have arrested their caretaker and they need medical assistance, we will offer, and they have to consent, to go to one of our shelter facilities. A person can still deny it. We will work real closely with Adult Protective Services. Again, least restrictive is our goal. If its possible to keep them in their home and bring some in-home care in, then adult protective services will try to set them up. I want to emphasize that we don't have the right to take away somebody's civil rights as an adult. There is a process we have to go to through the probate court and it's a lengthy process to protect people's civil rights.     Q – I found the online reporting form. It's a 4 page form for reporting and I think it's a great form and its very easy. I think I would have an easy time, so if people want to report I want them to see that. So, what's the best number and site for reporting  A – If you are a mandated reporter the law says you have to call law enforcement. But the best number here is 719 444-7000, which is the non-emergency reporting number to the police and fire dispatch. Give the call taker as much detail as you can about what you think is going on; what makes the person at-risk, are they elderly, disability, and as much information as possible about the perpetrator so we can do a check the welfare. But if you think someone is being physically abused or financially exploited, please provide those specific details. At a ‘check the welfare' call an officer will go to the house, knock on the door, many times a victim won't disclose what is going on. If the officer doesn't know to ask about physical abuse or exploitation and they see the person and the person says they are well that is all that is going to happen. We are going to leave and we're not going to get any in-depth investigation, so you need to leave as much detail as possible with the call taker. If its caretaker neglect you can call the Adult Protective Services intake line at 719-444-5755 and make a referral for self-neglect because self-neglect is not criminal so we can go out and check on somebody, but we don't put resources in place. It's important to understand too, that once Adult Protective Services gets involved, if the person has capacity they have to consent to APS help, so we can't force them to change their lifestyle.  Cynthia - Can't make them go  Chuck - No  Cynthia -They can stay with their abuser if they want  Chuck - Or in a dangerous, you know a hoarder situation  Cynthia - And a hoarder likes their stuff.     Q - We have a few more minutes, is there anything we didn't talk about?  A - I think we covered the general topic. The important thing is to watch out. It takes a community. Many elders get isolated, so don't hesitate to reach out if you see changes or you have concerns. Please call Adult Protective Services or please call law enforcement so we can get involved early and see what we can do to help the individual   Cynthia - Thank you so much and thank you for being with me. Thank you Chuck, I tried to practice your last name, multiple times over the weekend, I think my husband thinks I am going crazy. But thank you for being here and part of aging with altitude.  Cynthia - Our podcast is part of how we are trying to share important information with people in our community. 

Talking about death does not make it happen.  So what stops us from exploring the options for best living towards the end of life?  Kent Mathews with the Family Caregiver program with the Pikes Peak Area Agency on Aging (PPAAA) has supported hundreds of individuals and families over his years as an MSW, Chaplain and staff with the PPAAA.  He understands and knows the deep fear and loneliness that can come as people age and bodies change.  He shares his insight and professional knowledge in supportive ways that empowers the individual and the family to live the lives they want. Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country.  We talk about both the everyday and novel needs and approaches to age with altitude whether you're in Ft. Lauderdale, Florida or Leadville, Colorado.  The Pikes Peak Area Agency on Aging is the producer.  Learn more at Pikes Peak Area Agency on Aging. Transcript: Talking about death does not make it happen.  So, what stops us from exploring the options for best living towards the end of life?  Kent Mathews with the Family Caregiver program with the Pikes Peak Area Agency on Aging (PPAAA) has supported hundreds of individuals and families over his years as an MSW, Chaplain and staff with the PPAAA.  He understands and knows the deep fear and loneliness that can come as people age and bodies change.  He shares his insight and professional knowledge in supportive ways that empowers the individual and the family to live the lives they want.    Michaela Nichols – I am here with Kent Mathews, Care Manager in the Family Caregiver Support Center at Pikes Peak AAA. He has over 27 years of experience as a social worker and has worked in hospice care as well  Michaela - End of life issues can often be hard to talk about. Many people hope that they will be able to make their own decisions or that a loved one will be able to make their decision near the end of their life, but they lose that ability. So being unprepared can put loved ones in uncomfortable positions.  Q – Kent, can you talk a little bit about what barriers individuals experience when beginning to make end of life plans?  A – The most common barrier I hear coming from caregivers, but also when I was doing hospice work, coming even from hospice patients, when it comes to advance directives (is that) they would say, well I'll execute them or I'll fill them out when I need them. Not knowing that they probably wouldn't be able to execute them when they needed them, because they would be in a physical state where they were unresponsive and couldn't speak or they couldn't even begin to fill out those documents. So, I think that's one barrier. Another one is we don't like to talk about or think about our end of life. We don't like to think about our deaths. We live in a very death averse society. Generations ago, when we were still a very rural society and we weren't as urbanized as we are now and still a lot of people living on farms and out in nature and what not we were still very in touch with the cycle of creation – birth, life, death, all of that. And now we are really, really, removed from that and that's a huge barrier as well. I think another barrier that comes to mind is people don't have an easy place to go to get good information about what's really going on with their physical condition. I recently ran across a statistic that said if (a doctor is) asked to do a treatment and a doctor knew the treatment wouldn't do any good, 40 percent of the doctors said they would still recommend the treatment. Which is, in my estimation, just rather appalling that they would even do that. A lot of the time people rely on their doctors to give them that information to tell them what's really going on. But most doctors aren't equipped to do that, they don't have the skills to do that. They may have the knowledge, but they don't know how to communicate them in a way that is comfortable for them and therefore makes their patients comfortable. So, everyone is kind of walking around in the dark. The medicines that we take, a lot of the medicines for chronic illnesses, cover up the symptoms which then creates the illusion that I am not as sick as I really am. Which is another barrier. Why would I want to execute that? Because I feel fine, I may be taking 8-15 different medications, but I am not going to die. So why would I want to execute those things? So those are some of the barriers I have been encountering in my career.   Q - In the confusion around what end of life care is, can you talk about the differences between non-medical and medical decisions that they (caregivers and their family members) need to think about?  A – I get phone calls from caregivers they're wanting to know where they can go to hire a nurse. And then talking with them on the phone, they're looking for someone to come out to the house to help mom or dad or a family member with like maybe bathing or dressing or maybe making sure they are taking their medications you really don't need a nurse to do that.  In the homecare industry there are different levels of skill that health care worker, a home care worker has. In CO when they require homecare agencies to be licensed, they established a two-tier system. There is a Class A and a Class B license. The Class B license is the nonmedical and the Class A license is the medical or what is often called the skilled. The two differences between these two licenses, there are a number of them, but two major differences. The A license, or the skilled license, is that home care agency has what is know in the health care world as skilled positions. So, you have a nurse, an RN or an LPN, maybe an NP. You also have skilled positions like the therapist, the occupational therapist the speech therapist, the speech therapist, the physical therapist, or what's called the OTSTST's. Those are all skilled positions. CNA‘s are considered a skilled, semi-skilled positions. And the class A's have CNA's.  The class B's have what are called personal care workers and homemaker companions.  So, when you're looking at home care agencies and you're looking for what kind of care; if you're needing somebody to come out and help mom and dad with maybe some light housekeeping, or some bathing or dressing kind of thing. You don't need a nurse to do that. You don't even need a CNA, you can use like maybe a homemaker companion who could do the light housekeeping the light meal preparation. If you wanted them to help with bathing or dressing you would have to have a personal care worker because that person can legally touch your family member and provide that hands-on physical care. And going back through all those levels. The least amount that you are going to pay for per hour is a homemaker companion. In the Colorado Springs area that is probably running $18, $19 dollars an hour right now. The next higher level would be a personal care worker, that's going to run in the low $20 dollars per hour. Then you're going to a CAN, that's going to run in the mid to upper $20's. And when you get to a registered nurse you are looking at $30 or more per hour for that kind of thing. So, if you choose between somebody who has the same skills (you are needing) a personal care worker who you could pay like maybe around middle twenties or so, or an RN you are paying thirty or higher you are saving money to go with the personal care worker. That's some of the difference between medical and non-medical.  Q - What are some of the misconceptions around these different types of decisions that people will have to make?  A – Some misconceptions, I'll just start and go into it, because I did 15 years of hospice social work. One of the huge misconceptions about hospice care is that you have to be bedbound. Now there is nothing in the rules or regs by Medicare, which licenses and oversees the hospices, there is nothing in the Medicare rules and regs that says you have to be bedbound. But most people have the misconception that ‘if my family member is up and walking around and able to do stuff than they aren't sick enough to be on hospice care'. And in reality, what qualifies a person for hospice care is not what they are doing or not doing. It is, do they meet the specific medical criteria for specific conditions or disease to qualify. Oftentimes people can meet those conditions and still qualify for hospice care but can still be able to do a lot of being able to take care of themselves. I have had hospice patience in my career that were going on two week cruises and going on vacation to Disney Land or Disney World or Las Vegas or traveling 8 or 9 hours across country to go visit family members for 7-5 days and they were the ones doing the driving. But they were still on hospice care. It's not qualifying for hospice care, it's not about what you can or cannot do, it's do you meet the medical criteria. Another misconception is that people think their doctor has to say they are ready for hospice care. I teach a concept called Hospice 101; and basically, after listening to a caregiver tell me what's going on with their family member physically, what kind of chronic illnesses they have, (that) kind of a thing, oftentimes I will say have you thought about hospice care. They will say “but the doctor hasn't said dad is ready for it”. Most doctors, unless they have done time as a hospice medical director, do not know all of the specific medical criteria that go into qualifying a person for hospice care. And doctors, like all of us social workers, healthcare professionals, even people on the street, we all have our misconceptions (and) misunderstandings about hospice care. If doctors have those misunderstandings and misconceptions, they may not be willing to recommend someone for hospice care.   I had, years ago when I was in AZ, I was working for a hospice who also had a homecare. The hospice was having difficulty getting people from their home care over to the hospice side. For a lot of difference reasons, some of them the misconceptions we have talked about. I remember this one, the daughter was taking care of mom. The first time I went out to visit her as the home care social worker, mom was living in her own apartment and mom had cancer and we talked about everything.  Mom said I'm not ready for hospice, I am still doing treatment I said that's okay. And then maybe 3, 4 months later I was asked to go back out, again as home health, but this time mom had moved into daughters' house.  Daughter greeted me at the door and when we were walking down the hall, we walked by moms' room. mom was laying in bed. Her bed was elevated at a 45-degree angle, moms jaw was relaxed so it was dropped her mouth was open, her eyes were rolled back in her head and she was doing what we call chain breathing. Really rapid and in succession. So, when I sat down with the daughter, I said I think your mom is starting to enter what we call in hospice the active dying process. Before I could stop her, her daughter picked up the phone and called the oncologist. The oncologist was screaming at the daughter and demanded who told her mom was dying and she said a hospice social worker here, and he said put him on the phone. I held the phone about two feet away from my ear and I heard the oncologist perfectly because he was yelling that loudly into the phone. And he was accusing me of practicing medicine. He was saying that how did I know that she was dying only doctors knew that kind of stuff. He said if she stops her treatments now, she will die. Because she needs to finish her chemo treatments in order to stay alive and all of that kind of stuff. I hung up the phone. Had a conversation with the daughter. We figured out a way to go to another doctor to get an order which then allowed our hospice to send out one of the hospice nurses to do the evaluation. Long story short, mom died the next day.   We got her into hospice care that night, she died the next day. Sometimes, all of us have our misconceptions and this oncologist evidently had his own misconceptions about what hospice was, I am not going to even speculate what those were. This happened twenty years ago, and I still have a vivid memory of it. So, when it comes to this whole, end of life issues, because we have a lot of barriers, we aren't talking about it anymore. It's not an easy conversation when I talk to caregivers sometimes, they you know talk about well, I'm thinking dad is really sicker than what he really is. Then they begin to apologize. Because they think that by talking about death and that's another misconception that if you talk about death its going to happen. We can talk about death all we want but that doesn't mean it's going to happen. That's how deep our fears go as human being when it comes to death and dying, we believe that when we invite it in its going to kill us.   Michaela – That's a really powerful story. And it shows that people rely on their doctors as well and they're not always the specialist in end of life issues.   Kent – Right   Q – Along the line of medical care, you were talking about hospice care. Can you talk a little about the difference between palliative care and hospice care?  A – I am going to try to give as good of a verbal picture as possible. The picture is, draw a circle about the size of a quarter and draw another circle that is about the size of a small plastic lid on a container. And that small circle needs to be inside that larger circle. So, you've got a small circle inside a big circle. So, palliative care is the big circle, hospice care is the small circle. So, if that's said, all hospice care is palliative care, but not all palliative care is hospice care. There's a difference. The biggest difference between palliative care and hospice care (is that) in palliative you can continue treatment for whatever your hospice diagnosis may be. So, let's say its Chronic Obstructive Pulmonary disease or COPD, which means your lungs aren't working well and its difficult to breath and its going to lead to your death. If you are on palliative care, any treatment you were doing for the COPD you can continue. On hospice care, any treatment that was “to cure” the COPD, you can't do. I think a better example than COPD might be like cancer. On palliative care you can continue to get your oncology, your radiation (treatment) for the cancer. On hospice care you cannot do the oncology, you cannot do the radiation, you have to stop those. So that's the biggest difference. Another difference between palliative care and hospice care is the support level. Hospice care, when people are in hospice care the support they get is really well defined because Medicare pays for the hospice care and Medicare says that hospice care is provided by a team and the team consists of a registered nurse, a CNA, a social worker, a chaplain and a volunteer. Medicare says in those policies that the only person that the hospice patient has to see is the nurse and the nurse has to visit them at least every two weeks. Most people while they are on hospice care take the full team; the nurse, the CNA, the social worker, the chaplain and they even ask for a volunteer. On palliative care its not as well regulated. I have had conversations with professionals in the community who are involved with palliative care programs and the palliative care program is struggling to figure out a way to properly bill Medicare. Under hospice care there are very specific billing codes you use. Under palliative care there is not. You can get reimbursed by Medicare for palliative care. But it's not easy to do as a provider. The other is, because it's not regulated by Medicare like hospice care is, you can have a palliative care program where it consists of a registered nurse or a nurse practitioner going out and visiting the patients once every three or four weeks to check on things like their pain level or their medications and maybe make some adjustments in the medications or whatnot. But that's it, a nursing visit once every three- or four-weeks kind of a thing. There are some palliative care programs where they will allow a CNA to go out to help with maybe some of the physical care. I know of maybe one, possibly two palliative care programs in our community where they offer the full team. A nurse, CNA, maybe pull a social work from the hospice side a chaplain would be from the hospice side. No volunteer, but those 4 people. To be honest, they are really losing money from palliative care because Medicare doesn't reimburse well for palliative care. I have had conversations with professionals in the community that they have said, and I basically said, until Medicare decides to regulate and oversee palliative care like they do hospice care, palliative care is not ever going to really catch on and take off. Hospice care was suffering from the same thing back in the early 70's and whatnot. When hospice care came over, all of the organizations that were doing hospice care were nonprofits and the professionals were volunteering their time. Or, if it was a very organized nonprofit, they raised the money so they could pay at least the nurses, maybe the doctors, but the rest of the team were volunteers. And it wasn't until Medicare came up with the Hospice Medicare benefit, which is under Medicare Part A, that hospice really began to take off and flourish. My point is the same is going to happen with palliative care. It's going to struggle, but when Medicare decides to regulate it and license it like they have hospice care, it's going to take off. But those are some of the major differences. You can be on palliative care, but not on hospice care. You can be on hospice care, but that also means you're getting palliative care and there's restrictions either way.  The other thing, the other similarity or the other similarities, between hospice and palliative care is that it's provided wherever you are at. So, if you're at home, if you're a care facility, an assisted or nursing facility, palliative healthcare can go there. Hospice care can go there. When I was doing hospice work in Arizona, I had one patient who, when the Hospice care started, he was living under a bridge. And the other hospice patient that I remember, he was living in three large cardboard boxes in the middle of the dry riverbed of the Salt River. So, for hospice care, that's another misconception, people often think their hospice care is a place. It's not, it's a type of care, and hospice care will go wherever you are at.  Q - End of life issues are so hard to talk about. America has a fear of talking about it. How would you recommend someone going about talking about it for themselves, talking to their children, or loved ones or a child talking to their parents, about what they want?  A. So, I'll start with the easier one first. So, it's an adult child talking to their parent about what they want. The adult child needs to be thinking about what they know mom and dad have said to them. So why is the adult child coming over to take care of them? It's because mom and dad want to stay in their home for as long as possible. Okay, what mom and dad don't understand is that they have to put some certain things into place to absolutely guarantee that. So, a good starting point would be to say “so dad, I know that you really want to stay in the house and I've been coming over to help you stay in the house, but to really guarantee that you stay here until you die, which is what you told me, we need to be talking about some things. Like powers of attorney, like a medical power of attorney, a financial power of attorney. Because yes, I know you don't want me in control of your money, because you've told me that, but without that power of attorney if something happens to you, I can't access your money to pay the bills. I can't tell doctors what to do, because I don't have the authority. And that's what the purpose for those powers of attorney are. When you name me as the agent, then that means that if you can't tell anybody, I have the authority to step in and tell the bank how to pay a bill or to contact your life insurance, your long term care insurance company, to get your long term care insurance policy started. Without that power of attorney, you don't get the care in the home, because I can't talk to the long-term care insurance company. They will not talk to me. And if you really don't want to go to the hospital and the paramedics show up, I've got to have a medical power of attorney where you've named me as the agent, because if you can't respond and they can't get anything out of you then I should have the authorities say no he wants to stay here. No, he doesn't want to go to the hospital.  No, that's not a guarantee but I now have the authority to do that. Without that, guess what dad? You're going to the hospital, and you're going to be someplace where you don't want to be. So, by the way when you execute those documents usually there's a place where you can say when I sign the document it means it takes effect immediately. Now, that doesn't mean I'm going to step in and overrule you 'cause I love you. I'm gonna let you continue to make your own decisions, but it means it's in effect already. There's another line that will say it goes into effect when I'm incapacitated, and one or two other doctors say I'm incapacitated and can't make my own decisions. So that one is would be a good one if you're not comfortable with having that authority take place right away. You can check off on that one, which then means that it doesn't go into effect until you're incapacitated. But either way, those two types of documents help me to help you. Because we live in a society where we value the rights of the individual so much, that without those documents, I can't do anything, even if your safety is being jeopardized. Without those documents I can't do anything.” So, that would be one way to have that conversation.   Along with the powers of attorney, there are things like advanced directives, those are usually like what are called DNR's, like do not resuscitate, and that usually covers the two major areas of breathing and heart function. So, like if your heart stops, and you've signed a do not resuscitate, that means you don't want anybody to do anything to get your heart started again or you don't want anybody to do anything to get you breathing again. In Colorado we have what's called the MOST form which stands for Medical Orders Scope of Treatment. Other states have similar programs, but there, the acronym is like POLST and I'm not sure what that stands for. But I can only speak about Colorado. So, Colorado with the MOST form (medical order scope of treatment), it is like an advanced directive on steroids. On an advanced directive, it's where you list everything that you do or do not want done to keep you alive or not keep you alive. The MOST form has the same thing, but at the bottom it has a place for your doctor to sign. What your doctors' signature does, is it makes it a medical order. Why is that important? It's important, and I saw that, I saw this happen in my Hospice career both in Colorado and Arizona. So, a person would sign an advance directive and something would happen at the home, and they would be transported to the hospital, and the paramedics would be doing everything against the advance directive, and ER would be doing everything against the advance directive, because the advanced directive that they were working from, even though it was legally signed and notarized by the patient and by a notary or lawyer, didn't function in the hospital world or the medical world because it wasn't a medical order. The MOST form takes that takes care of that problem, so you have everything that you do or do not want done, you have it on this MOST form signed by doctors, so now if something happens and you find yourself going to hospital for an emergency, to the emergency room or for whatever, you produce that and they have to back off because it's medical order signed by a Doc.  Michaela - Thank you so much Kent for joining me on this episode of Aging with Altitude for those interested in learning more about what the Pikes Peak Area Agency on Aging offers you can go to ppacg.org or call 719-471-2096           

Driving is often the key to independence with many older adults and family members struggling to make the best decisions around this ability and resource.  Terry Cassidy, Occupational Therapist, certified Driver Rehabilitation Specialist for Fitness to Drive and owner of Health Promotion Partners shares this discussion with Maile Gray, Executive Director of Drive Smart as they talk about signs that driving may be at risk, the evaluation processes they use and most importantly how to transition out of driving and yet keep on living. Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country.  We talk about both the everyday and novel needs and approaches to age with altitude whether you're in Ft. Lauderdale, Florida or Leadville, Colorado.  The Pikes Peak Area Agency on Aging is the producer.  Learn more at Pikes Peak Area Agency on Aging. Transcript:  Today's episode is about transit and independence. My name is Michaela Nichols and I'm here with Terry Cassidy and Maile Grey. Terry is a licensed occupational therapist and a certified driver rehabilitation specialist at Health Promotion Partners. Miley is the Executive Director of Drive Smart Colorado.   Q - Can you both give a short introduction about what you do?  A – Sure. I'm the director like you said of a small community traffic safety education program. We're a non-profit and we've been around since the 1980s. We have a series of programs, kind of from birth on up through you know teenage years, working with communities and we have a very, very, robust program geared toward the older driver. Our entire focus, our mission for the nonprofit, is to reduce crashes. Thus, reducing injuries and fatalities. So, our work with the older driver, is to focus on making sure that they drive as long as they can safely do so. So, we have some little tips we give presentations, we partner with Terry, and basically have a good time with the aging population.  Michaela - Thank you   Terry - I'm Terry and I'm the owner and operator of Health Promotion Partners. Our main program is the Fitness to Drive Program. And so, through that problem, we do driver evaluations. I really see our role as helping individuals and helping families to make decisions around driving. So, certainly when we're talking about older drivers, really looking at skills related to driving, really helping people make decisions. Do they need to cut back, do they need to change some things, or maybe they need to find alternatives to driving in order to get around in the community?  Q - As people age, they can begin to experience decreased ability to safely drive. Can you talk about some of the signs that people may be losing the ability to drive safely?  Terry - Sure. You know there are definitely warning signs, and there's a list of them available, there are some good lists, we can give you some resources for those. but one piece I would like to mention, is it's not to me that ability or losing the ability drive, isn't related directly to age. so, there are factors like are physiologically that tend to be more common as people get older, but certainly when I'm looking at someone's ability to drive it's really about function more so then the date they were born. but in terms of the driving ability things that are commonly changing with age would be things like vision. the amount of light someone needs to have good vision. also, that reaction time, making quick decisions in the moment. sometimes some physical changes, neck range of motion can really impact safe driving in terms of being aware of what's going on around your vehicle. and even moving hand and foot movements can be issues there. I think in terms of warning signs that a family member would notice, or maybe someone drivers themselves, and things we ask families to keep an eye out for would be dents or scratches on car that there's maybe not an explanation for. certainly, somebody getting lost in a familiar environment is a warning sign the third should be a little more investigation done. and you know one that we mention a lot is if there's people in your life who are not wanting to ride with you. so that might be your child sometimes it could be a very good friend who is trying to help you out there so listening to people around you sometimes and   Maile - to tag on a little bit to Terry, oftentimes the family members don't necessarily notice the changes in mom or dad driving because say you go to visit them it's pretty typical for the younger, the adult child the adult family member, to actually take over the driving while they're visiting or such. and so sometimes you might say well yeah my mom or dad is just doing great, well when was last time you actually let them drive? you know so that might be something to keep in mind that periodically, you as a family member, let that person drive you around a little bit. and then you might have a better understanding of where they're at when it comes to their ability to safely drive. and like Terry said, I think I think most people can drive from their house to the grocery store, or their House or to the doctor's office, in the perfect world. but we don't live in a perfect world, and there are people out there who are who do things like run stop signs and run stoplights and are very distracted these days and for that reaction time to really be keen you know to be able to really slam on their brakes, or to be able to really maneuver out-of-the-way of somebody else. might not be your driving, but to be able to protect yourself and people in your car. That's kind of a tricky situation.  Q - Can you talk about the process of assessing someone's driving and the steps that you take?  Terry - Sure, so as you mentioned in the beginning my background is as an occupational therapist so really my evaluation all comes from that standpoint. but we're really looking at the skills related to driving. so, some of those warning signs or factors that I mentioned earlier we do a really thorough evaluation of vision. so not just the eye chart, but an interesting vision piece is contrast sensitivity, and something that's not measured very often, and that is a visual skill that does tend to decrease with age. There is actually more evidence linking contrast sensitivity to crashes than acuity. so it's just kind of interesting.  Maile - Can you explain Terry what contrast sensitivity is?  Terry - I can try, yes. so, I explain contrast sensitivity as really being able to tell foreground from background. so, I think of somebody driving, around here, I think of seeing a deer at dawn. like you're going down the street, if your vision is crisp and you're awake, you'll notice it- but it would be easy to drive by and not even notice that there was a deer on the side of the road, or somebody in a dark sweatshirt in the evening. so really pertains to low light conditions and so that's just one piece of what I could look at. So, what I would look at but a lot of times somebody would decrease contrast sensitivity in my recommendation might be that may not drive at night, for example.  Maile - so, it does not necessarily mean you can't drive at all it just means you might need to self-limit or have some serious suggestions made to you about where you should drive and when you should drive  Terry - so aside from vision. I would look at strength and range of motion. some of those things I talked about. movement, being able to check your blind spots, or turning your head. and then I do have some equipment that looks at brake reaction time. so really just testing that motor speed of going from gas pedal to brake pedal, based on what that person is seeing the red or green lights there. I always do some sort of cognitive assessment. so, it's just a screening, but really looking at memory. working memory and cognition to some extent as part of it. really because it's driving involves so much brain work. We just, it's such an overlearned task we don't realize that we're working so hard when we're driving, but really there's a lot to it  Q - Can you talk about some of the small adjustments that can be made to help assist with safer driving?  Terry - yeah, I'm going to let Maile talk about car fit for little bit here  Maile - So, car fit. I actually was taught car fit by Terry, but she's been real busy doing all of our other things. For the most part I kind of have done a lot of car fit trainings and events in our community. Car fit is an international program that was developed in 2006 by AAA, the American Occupational Therapy Association, and AARP. So those folks got together and thought, can't we just do something that helps seniors, or really anybody, make sure that they fit in their car properly. That they can do things simply, like eliminate the blind spot, which really helps in the range of motion for your neck. If you eliminate blind spots out of your sideview mirrors, you don't have to careen your neck so far in order to see a car coming up on your side. That does a couple things, in these days of extreme distracted driving, the longer you take your eyes away from the windshield and from what's in front of you, even to look behind you to see who's coming up on the side of you, could mean the difference of a crash or not. So, the less time that you take your eyes away from the road the better. So, we have little tips. You know, simple, simple, things that all, and i really want to stress this, is really for all ages. When people buy a car these days, they're taught about Bluetooth, they're taught about the little blinking lights for, you know in the side view mirrors, they're taught about all the info-tainment section, on maps. They're taught about all this stuff. But they're not reviewed on how they should sit, how far away should you sit from your steering wheel, which is really not just your steering wheel but it's where the airbag deploys. So, we remind people that they want to keep that 10-inch zone between their chest and the steering wheel, airbag deployment zone. You don't ever want to sit real close to the steering wheel, like you see a lot of people driving, sometimes more the older person. because perhaps they've shrunk a little bit, they're not quite as tall as they once were, so they are sitting closer to the steering wheel to see things. So, you know, those are very simple to show them and remind them how you tilt your steering wheel so that it's tilted down toward your chest and not your face, because you don't want the airbag coming up at your face. Most people do not realize that their seat belt up by their shoulder actually can slide up and down to accommodate a taller person or shorter person, so that you make sure that that seat belt is riding across your collarbone and not like across your neck or down low on your shoulder. You really need that seat belt to be sitting across your collarbone, and then the lap portion to be low on your hips below your tummy. Those little reminders can actually make the difference between life and death, or at least severe injury. So, this is a 12-point check, this car fit event, a 12-point little checklist that we go through. And I am telling you every single person that gets out of there has some kind ‘ah-ha!' moment that they didn't realize. And so, anything that we can do for them, the more we can educate the public on how to make sure that their car actually fits them properly. We don't look at their driving. We don't evaluate their driving at all. We only wanna see how they sit in their driver seat, and it can even be used for the passenger as well, some of these little tips. So, it's just really important to remember that, when you get in the car, make sure your steering wheel is not tilted up towards your face, make sure your sideview mirrors and your rearview mirror are all adjusted properly. Make sure that that you're just ready to go, that it fits you and not your spouse who is 6 foot four and you're 4 foot 11. You're not seeing things the same way, but oftentimes people don't make those personal adjustments every time they get in the car. So, these are all just super simple and it's a very, very, enjoyable free service. And you can find a car fit technician by going to car-fit.org and you can find a technician in your area.  Terry - and if I could just add to that, car fit is really fun and great program. as I said it's not an evaluation of driving, it's really, I think of it as how well someone is using the safety features of their vehicle. For a lot of individuals, safety features have changed quite a bit since they started driving so there's..  Maile – Well there ARE safety features  Terry -..to me,  I would say along the lines of small adjustments. In terms of helping your driving ability, to me, really goes along with healthy habits for life. Things like exercise, getting your eyes checked, taking your medications, walking keeping your brain active. You know, the kind of things that I think are good for our bodies and our brains throughout our lives. Those things are going to impact your driving as well.  Maile - To tag on to that. I was chatting with a woman one day at the Senior Center, and so she was a little bit elderly, but she's just walking along, and she just did a car fit with me. I said ‘well you did great', she said ‘I learned so much' and she goes ‘you know, I didn't drive for two years because I couldn't move my neck and everything, now I've been taking an exercise class and I'm back in the driver seat'. She goes, it made all the difference for her to get physically active again. So like Terry said, it is really important to maintain that physical fitness, along with everything else, your hearing, your eyes and what not because that is just going to help maintain your health as long as possible so that you can remain as active as possible.  Q - Driving is often seen as a way to stay independent. how would you help convince someone who may no longer be a safe driver to stop driving or limit their driving?  Maile - I do have this conversation with individuals that I see, I wish..  Terry - Its terribly difficult  Maile - ..that I didn't ever have to have this conversation, because nobody wants to.  Often, I'm coming at it from the perspective of, I want to keep somebody, when I look at independence. I'm looking at, are you able to do the things you want to do in your community? So often, we think independence has to mean alone, like I got there by myself. But to me it's very independent if you were able to do the things you need to do. If you're able to get to church, if you're able to get groceries, if you're able to socialize with your friends. And if we can emphasize more on the outcome in that perspective and less on that, (more on) things like did you independently schedule your ride with Silver Key or with Envida or with… you know there's a lot of ways to be independent and not drive yourself, but that's a shift in thinking  Terry - In our community, you know we're fortunate to live in a city of pretty good size. We're a substantial sized city, we're not as big as, you know, Los Angeles or even Denver, but we have over a half a million people living in this community. We're fortunate that we have some programs out there. Transportation options for people. and it depends on your own ability, your own mobility, but you can take the bus, you could ride a cab, or a ride sharing program like Lyft or Uber. But there are, in the Colorado Springs Pikes Peak Area Council of Governments region. There are many open public transportation options that are pretty cost efficient and don't cost a lot of money, and you can find those by the mobility coordinating committee page on the Area Agency for Aging website. But, besides that, they often also rely on family members or friends. But it is the most difficult, probably, conversation that anybody has with a family member, for sure. Because I think that people do associate loss of driving, which they've been doing almost all their lives, with… well it can be very depressing to people. Our goal is to not let those people get to that point of depression by helping suggest other (options like) Silver Key or some of our other programs in our area. Now it is a little more tricky if you live in rural communities, where there are not as many options. And that's a very serious problem and there could be some innovative ridesharing. You know, if you're older and retired and you still have a car, perhaps you can offer your services to help drive somebody to their doctor's appointment, or to get their hair done. Something as simple as getting your hair done is one of the most important things that a lot of women do, and a lot of these transportation options take them to medical appointments, but not necessarily these other social engagements that are part of keeping you a whole person. So, we want to be able to suggest some other options to them so that they can maintain that feeling of being who they have been without driving. It's really a tough it's a tough situation.  Maile - And I will add a little bit here just my belief that as a society where we're going to have to shift to having this conversation more often. Honestly, because people are living longer if you look at generations, in the past it was not as big of a topic as it is now. And the research (shows that) men will outlive their ability to drive by 6 years, women by 10 years. And I often share that with clients, just to know that they're not alone in this, and they're not really being singled out by their family for some reason. This is something that as a society we need to find solutions to. And I think if we get closer to that, then it may not be as difficult of a transition. Because ‘Oh my neighbor down the hall says this service' and ‘my neighbor here', you know as more people are doing it my hope is that it's normalized.  Terry -absolutely  Q - It sounds like you already talked about alternate transportation options, but what do you see in the future of transportation in this area and the surrounding area?  Terry - I think the new buzzword is like autonomous vehicles right and that would just be amazing. Just dial up an autonomous car and they come and pick you up, and off you go to wherever you want (and) whenever you want. That is a ways off. The way people talk about it these days, is they really think this is going to happen within the next five years (for) that type of independence. They are testing them for sure, but when you think of an autonomous car, they do operate on a lot of things, for sure technology, but even as simple as infrastructure the road condition. If we think right now about the roads that we drive on, and the potholes, and the broken lines, because oftentimes they guide themselves on lines and on guardrails and what not. And there's just still a lot of that that needs to be fixed, so that's gonna take a little while. But I think at some point we will be, that will be a reality. I'm not exactly positive when that's going to happen, when it does it's going to be amazing. So that's one thing that we hear a lot about these days, ‘oh autonomous cars, driverless vehicles', it's just going to be a little while. In the meanwhile, we need to do these other things that we've been talking about.   Maile - And I think too, finding ways, I think really turned courage community members to be involved in these discussions. With vehicles, or things along those lines, there's a lot of different ways it could look. And so, there's an ideal way, where there's coordination so that there's not just duplication of services (where you would have) 10 cars on the road for every one car you have right now (and) half of them are empty. You know there's a lot of pieces to that, but I think if it can be coordinated with public input. And I think a really important piece is to look at all the stakeholder. So, is there access for somebody in a wheelchair into an autonomous vehicle or a bus system, whatever that is. Is it appropriate for people, maybe who have low vision or even? So, looking at aging and disability and whatever the future for transit in this area is, I think is an important piece and then really looking at collaboration so there is not duplication.  Terry - And you know (as) we are here talking, we're sitting in the Area Agency on Aging, but honestly the services that like, for example I'm the chair of the mobility coordinating committee through this organization. And a lot of that deals with the disabled. So, it's not you know, we're talking about ability for everyone to be able to get where they want to go, when they want to get there, safely. Not just the older folk, who sometimes are also a little bit disabled in various ways, but it could be someone who's young but has some type of disability, who has a difficult time navigating this situation too. We want everyone to be able to get wherever they want to go safely and efficiently.  Q - Do you have anything else you'd like to share   Maile - If you have any questions about driver evaluation services, I'd be happy to talk to you/ go ahead and give us a call health promotion partners number 719-231-6657 or website is www.healthpromotion partners.com   Terry - and Drive Smart Colorado can be found up at 719-444-7534 and our website is drivesmartcolorado.com, even though we're a non-profit, I don't even know if .org was around when we started, we've been around so long. But it is drive smartcolorado.com. I do want to guide people to the older driver page on that website because it has a lot of good information. It also has a copy that you can download of the Colorado's guide for aging drivers and their families. This is about a 60 page guide, that is we can also send hard copies if you want, but it talks about everything from how to drive a roundabout, what did some of the bike lanes mean and how do you navigate them, because that's confusing to a lot of people. It also talks about Colorado's laws on how you get, how you renew your driver's license and that sort of thing. It also goes through some tips on car fit (like) how to make your mirror adjustments. We also have a planning table. Let's say you want to reduce your driving amount of time, so maybe each week you sit down and you write ‘OK Sunday I'm going to go to the grocery store into church and Monday I'm gonna do this' I mean it's a planning table to kind of help you guide your decisions in your week of driving as well. So, there's a lot of good information in there, so it's Colorado's guide for aging drivers and their families   Michaela - thank you so much Terry and Maile for joining me on this episode of aging with altitude for those interested in learning more about what the Pikes Peak Area Agency on Aging offers you can go to ppacg.org or call 719-471-2096. Thank you.  

Is depression a normal part of aging?  What are the risk factors, treatments and hope for the future for older adults?  Dr. Sheri Gibson, private psychotherapist and consultant, University of Colorado Colorado Springs instructor and faculty affiliate, holds a Clinical Psychology PhD with an emphasis in geropsychology from the University of Colorado Colorado Springs.  Dr. Gibson shares her years of experience and insight to better understand how mental health becomes an issue for older adults and how to find and receive support that can make the 3rd Chapter of one's life a time to look forward to.  Resources to tap into Drsherigibson.com, UCCS Aging Center, National Suicide Prevention Lifeline 1-800-273-8255. Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country.  We talk about both the everyday and novel needs and approaches to age with altitude whether you're in Ft. Lauderdale, Florida or Leadville, Colorado.  The Pikes Peak Area Agency on Aging is the producer.  Learn more at Pikes Peak Area Agency on Aging. Transcript: Cynthia Margiotta: Hello and thank you for listening to Aging with Altitude, a podcast series sponsored by the Pikes Peak Area Agency on Aging that aims to highlight issues and resources that affect older adults in our community.  My name is Cynthia Margiotta and I'm here with Dr. Sheri Gibson who received her PhD in clinical psychology with an emphasis in geropsychology from the University of Colorado, Colorado Springs.  She's an instructor for the Psychology Department at UCCS and a faculty affiliate with the UCCS Gerontology Center. Dr Gibson serves on the editorial board for the Journal of Elder Abuse and Neglect, is chair of the Colorado Coalition for Elder Rights and Abuse Prevention, a member of the research committee for the National Adult Protective Services Association, and board member for the Colorado Culture Change Coalition.  In addition to being an advocate for elder justice, Dr Gibson has a private psychotherapy and consultation practice which includes provision of capacity evaluations, expert testimony, consultation and training.   Thank you so much for being here Doctor.   Dr. Sheri Gibson: You're so welcome. Thanks for having me, Cynthia.  Cynthia: Today's podcast theme is on mental health and aging.  My first question, is depression a normal part of aging?   Dr. Sheri Gibson: There is a wide belief that it is normal, but it's not correct.  You know our society has believed for a long time that, as we age it is certainly inherent in our aging process is the theme of loss.  That there are losses both at the individual level, where we lose friends in our personal circle as we age, and also losses in terms of our physical functioning, chronic health problems, maybe even loss to our home where we may need to downsize and possibly move to a different part of the country to be closer to our children or maybe move from our large home into a smaller place.  I think society has often believed that as those losses occur it would be reasonable to make the jump that depression would also accompany those losses. But, what we do know is that a lot of people, as they age, have developed coping mechanisms throughout their lifetime. Many older adults, by the time they reach that part of their life, which is what I like to call the third chapter of life, that they have learned to tolerate losses throughout their life and they have they have developed effective coping strategies. So, what we do find is that depression is not a part of normal aging process. That's a myth that really needs to be debunked in our society so that we don't associate older people with depression.  Cynthia: How common is depression in the senior population?  Dr. Sheri Gibson: Well, it's really interesting, it's less common among older adults compared to younger persons. However, the age of onset of depression is really important. Research has shown that the first onset of most mental health disorders occurs in childhood or adolescence, and a much smaller percentage of disorders have an onset in later life. Among older adults with mental disorders, it's clinically relevant for us to discern when a disorder began. For example, an older adult who may have suffered from lifelong depression would likely have a lengthier and more complicated treatment than an adult who developed or experienced depression in later life.   Cynthia: Regarding depression, what are the risk factors?  Dr. Sheri Gibson: The risk factors are multifaceted and they are influenced by cohort, socioeconomic status, culture, and gender.  At the individual level, for example a person's ability to initiate treatment or even to understand if they are experiencing depression, may be directly impacted by the mood disorder itself. It can also be further influenced by whether or not there's presence of cognitive impairment for example, or multiple chronic health disorders. Some of the risk factors that we look at are those multiple chronic health conditions such as vascular problems, diabetes mellitus, and then there are certain acute stressors of health.  Stressors such as stroke, which has been associated with depression. So we want to look at that when we look at depression as practitioners. When I say practitioners, I also mean primary care physicians.  We tend to take a biopsychosocial approach so that we look at one of the biological risk factors, so that would be those at health conditions that I discussed. We look at the psychological risk factors, one risk factor is if the person has had lifelong depression that does increase their risk for having a depressive episode later on. We also look at psycho-socially what's going on for the individual. Have they had any changes? For example, has there been a death of somebody they are grieving? Is their home situation distressed by family discord, for example? Or, are they isolated from people?  I would add one more circle to that Venn diagram, if you will, and that would be spirituality. Understanding a person's spiritual relationship, whether or not they are part of a faith community or if they're not. How does spirituality and religion impact a person for them to make meaning of these certain stressors in their life?   Cynthia: Many of our older population was so involved with their churches, this created an issue for them not be able to go anymore and to not be connected to that community. So you know that also brings up the question of what is the difference between a situational depression and regular depression?  Dr. Sheri Gibson: That's a really good question, Cynthia! Depression, as a mental health disorder, is kind of broken down into two categories. We have depression that is kind of a general diagnosis and then we have Major Depressive Disorder. Since you asked the question about depression, what we want to know as clinicians is what might be causing the depression. Oftentimes it may be situational and what that means is the person may be dealing with a chronic stressor or an acute stressor in their life and if that stressor was remedied then their mood functioning would return back to normal. Situational depression is kind of used among lay people to describe the feeling of “hey I'm just going through something right now this is situational.” However, from a clinical standpoint, we use that term to really think about is there something that, if it were resolved for the person, that they would be functioning in a normal capacity?  The important thing is to point out around situational kinds of stressors is that there's never a timeline for that situation to remedy. So the person may come in to say (I'm talking about caregivers), “I'm caring for a person who is chronically ill...” this may be wife, this may be a parent, and may even be an adult child, “... I know that if I could either get resources in or when the person does die or have to be moved into higher level of care then I will begin to feel better.” The problem is that we never have a timeline for that, and if we let depression as a disorder progress without being treated and hope that it will remedy once the situation remedies, we are often very remiss. It can lead to worse things for an older adult such as isolation or it could lead to thoughts of suicide, for example.  It could lead to early mortality because depression has been related to early mortality. It can also lead to cognitive impairment if the person is older and is functioning. Without being treated for their depression, or not being diagnosed, that can have real deleterious effects on their overall wellbeing in their course of their life.  Cynthia: Wow, so what kind what types of treatments are the most successful for older adults?  Dr. Sheri Gibson: What the literature tells us, and what clinical research has shown, is that really the best treatment or the treatment with the most effective outcomes, is a combination of medication and mental health treatment like counseling, for example. Older adults need to talk to their primary care physicians, or if they're seeing a psychiatrist to talk, about their mood. They can be put on a fairly safe low-dose anti-depressant.  There are some cautions with that depending on the person's health problems. If they have multiple chronic health problems that they're being treated for, it may be ill-advised that they take a medication. In that case, psychotherapy alone or counseling alone, can be very beneficial.   There is another myth out there that older adults do not benefit from therapy and I just want to say that is completely untrue and that older adults benefit just as well, if not better compared to their younger counterparts. They are more willing to dive into some very important meaningful issues of their life. One thing that we know, as practitioners, is that sometimes treatment can last or take a little longer with older adults than with their younger counterparts. That's just because of our own aging process, we have slower processing speeds in our thinking. So, we may need to take a longer time to integrate the information that we're learning in therapy and then applying that. So sometimes the course may take a little bit longer with older adults. Psychotherapy with older adults is very successful and the highest outcomes are when you can combine a very low dose and short-term medication.   Cynthia: This is using Erickson's nine tasks, saying that we're looking at our past and go into some of that to help ourselves heal?  Dr. Sheri Gibson: That's right, so we're resolving going back kind of doing a life review, is what we call that. A life review is reflecting on what's been important to me and how can I make meaning of some of the things that were hurtful in my past? What do I want to do with this chapter of my life? I always ask, whether or not the person actually talks about it. The forefront of older adults is kind of resolving this stage of development, if you will. Going back to Erikson's stages of development, is that people are thinking of their own mortality and that time is limited. So thought of “how do I want to spend this time and what is meaningful to me? How do I want a good death?” for example. Even planning our deaths because time is limited and we're thinking about that more as we approach old age.  Cynthia: And it's perfectly OK to be thinking about those things.   Dr. Sheri Gibson: Absolutely, it's so healing to be thinking about that.  Cynthia: It's a normal part of our lives.  Dr. Sheri Gibson: Correct!   Cynthia: Nobody gets out of this alive, that what I say. It a horrible joke, right? But it is true.  Dr. Sheri Gibson: That is true!   Cynthia: So, why might older adults avoid pursuing the treatment that would be helpful, especially when they're struggling emotionally so much?  Dr. Sheri Gibson: I think that, again this is very multifaceted as I mentioned before, we see differences with older adults who are probably seventy-five and older. There may have been a little bit of stigma associated with mental health. Those who grew up with mental health problems of that cohort kept those things under wraps and they didn't talk about it. It may be an individualized kind of mantra that you just pull yourself up by your bootstraps and you don't talk about it. That it is nobody else's business and only your business and so you handle it on my own. Sometimes that problem gets so big that the person can't handle it on their own. We also know that certain personality types are less open to receiving help. Another barrier might be a socioeconomic status that's a huge barrier for access to mental health resources. If a person isn't able to drive and doesn't have a social circle of people who can take them to appointments. Or, if they are segregated in their community by virtue of their culture, their race, their socioeconomic status, they will have less information about services available to them and less access nearby. So, it really is multifaceted.   I think that this community in Colorado Springs has done a really good job of doing our best to reach out to people and let them know. We have to shift the way we think about provision of mental health services and going to the people rather than waiting for them to come to us. We know that all of those things can be a barrier to them seeking help.   Cynthia: So, like being isolated for whatever reason affects all of that.  Dr. Sheri Gibson: Correct. When we think about isolation, I think about social isolation and geographical isolation. We're missing a big population of people in rural parts of our state, for example.   Cynthia: Another issue, changing topics, if it were, I don't want to say too much because suicide is also related to depression. Another issue for older adults suicide, can you speak to that for a bit?  Dr. Sheri Gibson: Yeah, you bet. Well, I think it's important to note that older adults complete about 20% of all suicides. They also have the highest rate of suicide completion, compared to any other age group which is a startling statistic. Older adults tend to use more lethal forms of on completing suicide. Some major risk factors occur in later life. One of the highest of demographics of persons who complete suicide are older white males. So, aside from being an older white male, other risk factors include depression hopelessness, substance abuse, a previous suicide attempt, and widowhood, a major late life transition like physical illness, social isolation, family discord, financial strain and stressful life event. Institutionalizations, interestingly enough (I'm really referring to nursing homes), may also be a predictor of suicide although residents of nursing homes tend to use more subtle forms of self-termination to complete their suicide such as starvation. In those cases, they may not be officially labeled as suicide in nursing homes.  Unfortunately, the majority of older adults who do complete suicide were experiencing their first episode of depression, meaning that it could be readily treated.   Another more staggering and if not more alarming statistic is that 75% of those persons were actually seen in their physician's offices within a month prior to their suicide. This really puts on our radar on the importance of screening in primary care offices. Physicians and their nurses need to be much more diligent in asking about whether or not a person is feeling suicidal or wanting to end their life. Knowing that people have been seen by their physicians, I think really gives us an opportunity to do something different in our primary care offices. It's certainly an issue.   I would also say that persons who are showing signs of suicide, that we have an opportunity as friends and family and neighbors to look for certain signs. Maybe some of the signs that we would look for is if the person stopped participating in activities that they used to enjoy. For example, are they isolating from their social or familiar circles, including their faith circles? Do they make off-handed comments about ending their life or wanting to die? It's not uncommon that some older adults will say things like “I'm just tired and I'm waiting to die” or “I'm waiting for God to take me” or “it's time I should be going” … and it shouldn't stop us from asking further. “Are you wanting to end your life prematurely,” that's the way I would ask that. However, it's also not always the case that their meaning to end their life, they're just tired and they're just waiting and that's also a normal response for some people towards the end of life.  I can't stress it enough, just the simple question of asking a person “are you okay” and leaving the question open. Asking “are you okay” or making an observation like “it seems that you're feeling down or you're having the blues” or “is there anything that I can do” or “tell me about your managing these days”... Oftentimes, there's another myth that we dance around these questions with older adults and we don't want to be seem like intruders and ask those questions. But I will tell you, in my clinical practice over the years, whenever I've asked the question more than likely the person is so willing to share. Often people don't ask them those questions and they don't want to burden others and they don't want to bring it out. So, it is our I think responsibility as friends and as family members to ask that question.   Cynthia: They're thinking about these things so why can't we talk to them? They may feel isolated by that conversation and think “my children don't want to hear about this” or “my friends don't want to hear about this.” But really, we need to get involved in where they're at.  Dr. Sheri Gibson: That's right.  Cynthia: It helps us to grow.  Dr. Sheri Gibson: Absolutely, and it gives us an opportunity to hear where we might be helpful to that person if we know that there are barriers to them getting the help. We have an opportunity to maybe bridge those barriers or just destroy the barriers altogether, but we don't know that if we can't ask the question.  Cynthia: Thank you.  Dr. Sheri Gibson: You're welcome.  Cynthia: According to the CDC, in 2013, the highest suicide rate was nearly the 20% among forty-five to sixty-four year-olds.  The second highest rate, very closely related was 18.6% (his is a few years ago) occurred in people eighty-five years and older, why?  Dr. Sheri Gibson: I think there's a couple things here. If we know that typically the highest risk factor is older men, and you think about how women tend to outlive men, also think about the gender roles of this cohort of seventy-five to eighty-five year-olds. There were gender roles in heterosexual relationships. That's what we know most about that cohort. Gender roles were that women were kind of a social outlet for the family and the men were the workers of the family. So, I think that we see this occurring when the woman of the couple has died first and so the man is left without a social network. Also, at the age of eighty, so many friends and close people have also deceased at that point.   We also see a high percentage of older veterans who complete suicide because they're not afraid to use a firearm and most of them have firearms, so they use a more lethal means of ending their lives.  So, I think it gets to cohort and that isolation piece. When we think about eighty-five year-olds living at home, they likely more isolated than people who are living in an assisted living facility or a community for older adults.   Cynthia: Even an introvert needs community.  Dr. Sheri Gibson: Absolutely, whatever that community means. You know, I think that this brings up another topic of engagement. Understanding that engagement is different across people. So, if we always think that we want our older adults “to be more engaged” and I use that in quotations because what does that mean? What was engagement like for that person throughout their life?  I worked with a caregiver once whose eighty-five year-old father was moving to the area. He had been living on the East Coast and was moving here. She had this vision for his aging that was not aligned with his vision. She wanted him to move into a retirement community and she had these visions of him playing bingo and shuffleboard and going to movies. When he got here it was just not his vision; in fact, his vision was to purchase a motorhome and he wanted to travel the country at eighty-five. She just really couldn't see it happening so we worked together. First of all, were there any reasons that he was making a poor decision? For example, was there cognitive impairment? He was more than happy to do testing to ease his daughter's concerns and it turned out he was fine cognitively and he could make this trip. He could make the decision get a motor home. What really threw her over the edge of was that he was on match.com and he had arranged blind dates along his travels.  So I think as adult children, when we step into the care of our parents and when they allow us to step in, we need to have an understanding of what is engagement for that person. Community is important but community can look like all different kinds of things. So really understanding that and not imposing our own values and preferences on the people that we love so they can live these final years in the way that they've always wanted to.   Cynthia: My husband and I have talked about these things. He wants to go hang out in the library and I want to do more volunteerism. I want to be around community. We're all different.  Dr. Sheri Gibson: We're all different. We have to recognize and respect those differences.   Cynthia: So, can you tell me where can people go for help with suicide and depression in El Paso County as well as where can they go nationally?  Dr. Sheri Gibson: Well, that's a great question and I'm glad that we're providing our audience with some tools. So, if you if you or somebody that you care about appears to be showing signs of depression, or if they are making some comments about life not being worth living anymore, you really need to find a mental health professional with whom that person can talk. There are several resources immediately in our area in Colorado Springs. The first I would recommend is the UCCS Aging Center, they are located on North Nevada in the Lane building. They're associated with the University and they are staffed with psychologists. They are a premier training clinic for future geropsychologists like myself. They offer mental health treatment under an array of mental health disorders. In addition to that, they offer free caregiving classes for caregivers and individual counseling for caregivers which is really important. We recognize at the Aging Center that people age in context and they age in a community and system, whether that be their community as a system or their family system. So, we believe in treating the whole family when we can. I say we because I actually see people there for them one day a week.  We also provide a cognitive testing. We know that cognitive impairment can impact one's mood and vice-versa. So we want to make sure that we are being diligent and getting people all the information. We have a neuropsychological clinic where we do very in-depth neuro psych testing where we can actually give people diagnosis. We also have a lighter version of that, which we call the memory clinic, where we can do a smaller version of testing to track people across time. We believe that cognitive testing should be a part of any whole-body testing, just as you would get a mammogram or colonoscopy. You should also, after the age of sixty-five, have cognitive screening done. So they do that there as well.   In addition to that, there are several psychotherapists in town who specialize in older adults, me being one of those people. You can access my services online, my website is doctorsherrigibson.com spelled “Dr SheriGibson.com” you can read about the services that I offer and I also have a contact page so you can send me an email. If I can't help that individual, I have a list of referrals in the community that I'm willing to share. The Aging Center is also really good resource.   At the national level, particularly around suicide, I definitely want to give the National Suicide Prevention Lifeline that's available 24 hours a day to anybody. That number is 1-800-273-8255. I definitely want to provide that to our listeners.   Then there was one question that you and I explored prior to this that I wanted to address. You and I were having a conversation before we went on the podcast and one question that you asked me is “what does the future hold for mental health issues for our seniors?” So, if you don't mind and if we have time, I can address this somehow.  Cynthia: I missed that question, sure!  Dr. Sheri Gibson: Mental health services for older adults will continue to evolve. The way that we see it, as practitioners, are really a function of three elements. The things that we think are coming down the pipeline is the changing characteristics of older adults in future cohorts. The developments in our basic understanding of processes that affect geriatric mental health and the alterations in our public policy that will affect the provision of mental health services to older adults. Today's older adults represent as a really unique intersection, if you will, between individual and historical time. Stigma has always been considered, or was historically considered to be a real barrier for mental health treatment. Tomorrow's older adults may arrive into later life with a different perspective and different patterns of mental health and disorders. Some have suggested that today's younger and middle-aged adults have higher rates of depression when compared to the current older adults at a comperable points in their lives. Thus, they're bringing higher rates of mental health problems into later life. Additionally, the older adults of the future may arrive in later life with increased experiences and expectations around mental health services and mental health treatment. I think we can't say enough about the emergence of technology in this regard. Technology can be a means of opening access to mental health care and that's a growing area of study and implementation.   So getting back to my earlier comment around provision of services to rural parts of the state or rural parts of our country, using telehealth mechanisms can do that for people. There are inherent challenges in that and we recognize that as a field. At the same time we have to embrace technology now.   We now know that this cohort of older adults, the baby boomers for example, are very tech savvy. So, they are more than willing to engage with technology as a way of helping themselves or getting help. I think that that is where the future is going to be. Putting on our legislative's minds about the importance of mental health and allowing that to continue to be covered through Medicare and Medicaid so that people are really getting the benefit of that. So that we're allowing people to live into their later lives in the best quality possible.   Cynthia: Whatever that means for that individual.   Dr. Sheri Gibson: That's correct, yes. I think we can't say enough about joy and fun and pleasure is really important as we age.   Cynthia: Yes, in a different way than what I think young people do.  Dr. Sheri Gibson: I would imagine for you and me sitting here, what I thought was enjoyable at 20 is certainly different as I approach 50.   Cynthia: Wait until you're my age, gal! It's a whole different story.   Dr. Sheri Gibson: Well, thank you so much, that's all we have time for today. Thank you doctor Gibson. I appreciate you're time and willingness to be with us today.   Cynthia: It's been a pleasure.      

Dr. Rusky, Board Certified Family Physician and certified in hospice and palliative care, has practiced in both urban and rural settings.  Today, he discusses the differences between home health care, palliative care and hospice.  He answers what resources palliative care provides in addition to the many services a person might already be receiving.  He mentions palcarenetwork.com, a resource to help select a palcare provider and assist with long term planning.  Ultimately, it is about whole-person care, ensuring mind, body and spirit are receiving the supports needed to help a person live with advanced disease or complex illness.  Tune in now for answers to questions you did not know you had about differing care and aging with altitude. Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country.  We talk about both the everyday and novel needs and approaches to age with altitude whether you're in Ft. Lauderdale, Florida or Leadville, Colorado.  The Pikes Peak Area Agency on Aging is the producer.  Learn more at Pikes Peak Area Agency on Aging. Transcript: Audio  00:00  You're listening to Studio 809. This is what community sounds like.    Cynthia Margiotta:  00:15  Hello, and thank you for listening to Aging with Altitude, a podcast series sponsored by the Pikes Peak Area Council of Governments Area Agency on Aging that aims to highlight issues and resources that affect our older adults in our community. My name is Cynthia Margiotta and I'm here with Dr. Chris Ruskey. Dr. Ruskey is a board certified family physician, and is also certified in hospice and palliative medicine in the U.S, and by the Royal Society of Medicine of New Zealand and Australia. He has provided care in rural and urban settings in the U.S. and abroad, including a small group practice, assisted living, nursing facilities, and hospitals. He has served as medical advisor to home health and skilled rehabilitation services. For the past 16 years, Dr. Ruskey has dedicated his professional time to the fields of palliative medicine and hospice, serving as medical director for both community-based and hospital-based services. He has volunteered faculty for the education of medical students, nurse practitioners, and family medicine residents. In addition, Dr. Ruskey is involved in several community collaboratives to improve transitions in care and community understanding and best practices in the application of palliative care for our community. Today's podcast theme is supportive and palliative care. What is it? And how could it benefit me and my loved ones and my parents? Thank you, Dr. Ruskey, for being a part of this podcast. Now I have a few questions for you, if you don't mind, sir.     Dr. Ruskey:  02:03  No, that would be wonderful. Thank you for that introduction and for allowing me to participate in the podcast.    Cynthia Margiotta:  02:10   So, what is supportive and palliative care?     Dr. Ruskey:  02:13  Supportive and palliative care is whole person care, which is generally focused on symptom management such as pain, nausea, not sleeping well, or perhaps poor appetite. This may include care planning, such as advanced care planning, attention to mood, anxiety, depression, shoring up a person's supports and resources or addressing spiritual concerns. This whole person approach to care has been shown to improve a person's quality of life and function and they do better with whatever treatments they're receiving to treat their underlying disease. So for example, if the person is being treated for cancer, in order to best tolerate the treatment and benefit from the treatment of their cancer, they do better when their symptoms are well controlled like when they have good appetite, when they're not suffering from pain, when they're able to maximize their function. And you can see similar benefits for people who may be suffering from conditions such as heart failure, heart disease, neurologic disorders, and we can talk more about that later.     Cynthia Margiotta:  03:21  What are the differences between palliative care, home health, medical home health and hospice?     Dr. Ruskey:  03:28  I'm glad you asked Cynthia, people get very confused about these different services and how to best utilize them. Home health care generally focuses on short term goals, often for a specific medical issue, such as for a person returning home after surgery from a broken hip. And it uses skilled interventions to maximize independence. This would be things such as physical therapy, occupational therapy, nursing, CNAs, and social workers. It requires that a person be homebound and the idea is to try to help get that person rehabilitated from whatever event led to their decline in health. Supportive and palliative care is ideally suited for patients with complex illness, such as advanced disease, multiple hospitalizations, that type of thing. It's a whole person approach to care, meaning it addresses mind, body, and spirit alongside the patient's regular care team. We visit people in a clinic, in a hospital, or in home settings. And this care could be provided at the same time as home health care. Hospice is kind of like palliative care, it's a whole person approach to care. It provides an entire range of palliative care type services 24 hours a day, seven days a week. This includes a prescriber, usually a physician or nurse pactitioner, nursing care, social worker, chaplain, CNA, and sometimes a volunteer, and bereavement services. Hospice requires a limited life expectancy, usually less than six months. In order to get hospice care, a primary attending can continue providing care. Or you may have a prescriber from the hospice who helps provide most of the care or direct most of the care. Hospice care can usually not be provided at the same time as home health care.     Cynthia Margiotta:  05:39  So, home health care is generally designed to help get folks through an acute illness. Palliative care and hospice sounds similar in that they both take a whole person approach to care. Please clarify how to do these two services and how they differ, specifically.     Dr. Ruskey:  05:59  Yeah, you bet. This is confusing for a lot of people because, as you mentioned, palliative care and hospice both take a whole person approach to care. They both address mind, body and spirit but they do vary. I wish this was a video so I could diagram this out. But if you think of this as a picture, and you draw a big circle and that circle encompasses this whole person approach to care, again, mind, body, spirit. Palliative care is the big circle. And within that circle is a smaller circle, which would be hospice care. And hospice care is very specialized, it's a very specialized type of palliative care. It's  specifically designed to address the needs of people who appear to be in their last six months of life or so. Whereas palliative care, generally, could be for anybody who has a need in any one of these areas. Again, it could be a physical problems such as pain, and emotional difficulties, such as depression or anxiety, spiritual issues, such as wondering, you know, why is this happening to me, why now? Or maybe they need some additional supports to help them get through a difficult illness or time in their lives. In any case, palliative care can address all of those, but not necessarily for folks with limited life expectancy.    Cynthia Margiotta:  07:35  Do they have to have a doctor referral to get into palliative care then?    Dr. Ruskey:  07:40  Ideally, yes. We'll talk a little bit more about this later in our session. Ideally, palliative care is coordinated alongside a person's regular providers, be that a primary care provider or a specialist such as an oncologist (a cancer doctor) or a heart doctor. So ideally, the referral to palliative care comes from a person's regular care provider, and then there's close coordination of care between different services. We'll talk a little bit more about that later.    Cynthia Margiotta:  08:16  Alright, so supportive and palliative care works alongside other medical providers to help manage symptoms, emotional difficulties, spiritual challenges, and shores up the supports a person needs to help best manage their medical issues. Who qualifies for palliative care?     Dr. Ruskey:  08:37  Well, first of all, a person should have a palliative need. And again, that could be in any of those areas that we mentioned earlier. It could be a physical problem, pain, nausea, not sleeping well, it   could be an emotional difficulty, or spiritual distress, but some palliative need typically related to an underlying disease process, such as cancer, lung disease, heart disease, and the like. As resources dictate, programs may focus their efforts and resources on those with the greatest need. So in other words, most programs have a limited number of providers and resources so they can't take care of everybody who has a palliative need. And we'll talk about the difference between generalist palliative care and what I call specialist palliative care. But certainly, in the realm of specialist palliative and supportive care, anyone who's been in and out of the hospital several times within the past few months to the to a year, or perhaps a person who is suffering from cancer or heart condition that causes symptoms, which are difficult to manage. Those people would be ideally suited to be cared for by a palliative care service. Let's say that somebody has a troubling symptom, but they are otherwise doing okay, they haven't been in and out of the hospital, they don't have an illness that's necessarily going to advance rapidly over time. It may be that as a onetime consultation with a palliative care provider or palliative care team could help give some advice or direction to the regular providers. And then routine follow ups with a palliative care team might not be necessary. So for some people, palliative care will get involved and will follow over a long period of time with routine visits. And in other cases, it may just be a onetime consultation.    Cynthia Margiotta:  10:39  What are the most common medical conditions where palliative care might help address some of these aspects of a person's life? Who is faced with illness?     Dr. Ruskey  10:49  Yeah, so we talked about a few of these, including cancer, congestive heart failure, COPD. Other conditions that come to mind would be neurologic disorders, such as folks who have suffered from a stroke, Parkinson's disease, or ALS, which is also called Lou Gehrig's disease. It could be a person who suffers from diabetes and the complications of diabetes, which can be lots of different things including pain, digestive problems, kidney failure, could be somebody who suffers from renal disease, kidney disease, liver disease, or blood disorders such as sickle cell disease. Virtually any condition that impacts multiple areas of a person's life causes discomfort causes difficulties, emotionally, with you know, issues such as depression or anxiety, may disrupt normal relationships or work may cause increased need for additional services. And again, may ultimately lead to some feelings of you know, why me why now, what is the meaning of this, which are existential type concerns, any illness that that can affect all those different areas, is amenable to treatment by the specialized services provided by a palliative care service?    Cynthia Margiotta:  12:21  Where would I visit with supportive and palliative care provider? In a clinic hospital home nursing facility?     12:30  The answer is yes. Yes. So years ago, oh say 1020 years ago, it would have been difficult to find a palliative care provider in all these different settings. But the reality is there is more and more evidence that people benefit from these services across the spectrum of where they may live. There are clinics that have palliative care providers in them. Certainly not all do. But some specialized clinics such as oncology services, sometimes will have palliative care providers. Hospitals have palliative care providers, and palliative care providers oftentimes are willing to and able to visit patients in their home, whether that's a single family home, a nursing facility or an assisted living facility.    13:25  So, what specific types of treatment might a person receive in palliative care?    13:32  You bet. So yeah, our listeners are probably wondering, what does palliative care have to add to the type of care that I'm already receiving? So, in the first place, palliative care providers are taught and and have experience with careful listening and care planning around a client's goals, values, and preferences, and will include family or other supports as desired by the client. Secondly, it is a team approach to care. It's typically an interdisciplinary team, which means the different members of the team, which may include physicians, nurses, nurse practitioners, counselors and chaplains, who all make up part of an ideal palliative care service, work together, put their heads together and all their experience together to help provide the best care for any one individual. That doesn't often happen in other systems of care. Special therapies include a skilled use of symptom management tool. These would be for issues such as pain, nausea, shortness of breath, etc. and palliative care providers are trained and have experience in utilizing lots of different medications or treatments, routes of administration that may not be commonly known or utilized in routine medical care. That can include regular medicines that a person might take by mouth, but also topical medicines, medicines that can be applied to the skin If a person's having difficulty swallowing, or if they have a localized problem. If that's oftentimes amenable to topical medications, it could include injections, and other interventions. Also, because there's a focus on a whole person, people who are involved in palliative care will use techniques such as cognitive behavioral therapy to help people understand and best way to manage difficulties that they're having using guided imagery and life review. All of these elements help to enhance these various aspects of the whole person that we mentioned before. And lastly, and most importantly, palliative care providers are taught and emphasize in any plan of care that they develop coordination of care with other health care providers. And as you and I both know, that often just doesn't happen in the regular system of care.    Cynthia Margiotta:  16:17  Unfortunately… So how often are palliative care visits? How often do they visit with a person?    Dr. Ruskey:  16:25  So that is determined by an individual's need. So visits could be multiple times a week, or they might be once a month, best practices would dictate that there's timely follow up with particularly challenging circumstances, or after significant medication adjustments. Now that follow up might just be a phone call a day or two after prescribing a new medication to see how a person's getting along. But it might also involve a follow up visit if there's some complicated symptoms and a face-to-face visit is required. It depends on the program. And this would be one thing that I would encourage folks to think about if they are looking to console the palliative care service provider is to find out what the availability of that service is to have some flexibility in their visits depending on the needs of the patient.    Cynthia Margiotta:  17:19  Can a person get palliative care and home health care at the same time?    Dr. Ruskey:  17:24  Yes, as I mentioned before, a person can be getting what we would consider routine care that includes a regular physician office visits, being in and out of the hospital occasionally, home care services, those are all considered part of routine care, and palliative care can be provided right alongside those other providers, and oftentimes will help enhance that regular care and maybe even add to it because of the unique ability and interest in palliative care in helping to coordinate care.    Cynthia Margiotta:  18:03  What are the barriers to supportive and palliative care then?    Dr. Ruskey:  18:07  Yeah, good question. So probably the main barrier is that it's oftentimes unknown to clients or families. It might be something that they've heard of, but oftentimes, they don't exactly understand what it is or how it might be helpful to them. There are also misunderstandings around who is eligible and how to access the service. And that's not just from a consumer's perspective, even amongst healthcare professionals. Oftentimes, people don't understand what palliative care is, and how it can best be integrated with regular care to provide the best care for patients and families. One other thing I'd like to mention is, there are multiple providers with very different programs. In other words, there are in the Colorado Springs, you know, El Paso and Teller County area, for example, somewhere around 10 to 15 different providers who provide some form of palliative care. But those services can vary from a nurse who does visits and tries to incorporate some of the elements that we described in the services that they may help with, to what I would call a full spectrum palliative care service that includes a physician, nurse practitioner, nurse, chaplain, social worker, all coordinating care around a patient's needs. So programs can vary considerably. And that's another difference between home health or hospice, which have pretty prescribed benefits that they're expected to deliver to patients. Some families, palliative care can vary quite a bit. And it makes it a little challenging for folks to know which program to select.    Cynthia Margiotta:  20:07  So they should ask: "are you offering these services?" If that's what they want.     Dr. Ruskey:  20:15  Absolutely. And I have some tips to, you know, help folks out as they try to navigate that with that we can talk about in a little bit.    Cynthia Margiotta:  20:24  Is palliative care accepted by the medical community as a valuable part of care?    Dr. Ruskey:  20:31  Yeah, you bet. So, great question. And the answer to that is yes with the caveat being that sometimes these other providers don't exactly understand how it works. But I can give you several examples where palliative care has been definitively shown to be helpful in providing care. And that includes hospitals, integrated health care systems, oncology services, and also for the treatment of folks with COPD and congestive heart failure. Hospitals, for example, larger hospitals require that a palliative care service be available to patients and families. That's become a regulatory benchmark for hospitals for the past three to five years. Integrated health care systems, these would be HMOs, such as Kaiser, or the Gundersen clinic is a great example in Iowa. Integrated health care systems have long recognized that when we address people's health in a holistic manner, again, taking into consideration their values, their preferences, their goals, and crafting care around them in this multidisciplinary way, that people do better, and it costs less money, and they get the care that they want. So it's a win win win, that integrated health care systems have recognized for a long time. Again, oncology, there's some interesting examples of where they'll do a study. There was one study in particular, back in 2011, folks who were suffering from lung cancer, and not only did they do better symptom wise, and so they had less pain, they felt more in control during their oncology treatment, but they actually lived a little longer. Those who received palliative care services. And again, you can imagine if you're feeling better, you're eating better. People are listening to you, you feel a little more empowered, you're going to do better. So and there are similar examples for other conditions.    Cynthia Margiotta:  23:02  And that's what's important, to do better and feel better. How does a person sign up for palliative care?    Dr. Ruskey:  23:10  First of all, I would approach your regular providers for advice on whether they think palliative care would be beneficial to you, and which program they might refer you to. And if you are on the same page as your provider, then they can write a referral to palliative care services. Alternatively, you could find supportive and palliative care services online, ask friends, family, other resources, such as the Area Agency on Aging, and see if they have some suggestions, or can at least give you a list of services that you can get involved with. If you contact a palliative care service, they can also work with you to get in touch with your provider, either your primary care provider or whatever providers are most involved in helping take care of you, and coordinate and make sure that the provider also thinks it's a good idea to get you involved.    Cynthia Margiotta:  24:16  How do I select between the different supportive and palliative care providers available to me in El Paso County and Teller County?    Dr. Ruskey:  24:24  Yeah, I'm glad you asked. And I'd like to put a plug in for a group that has developed a website called the palcarenetwork.com. You can get online and just punch in palcarenetwork.com and there are many resources there for patients and families related to palliative care and advanced illness in general. So they'll find resources there for advanced care planning, description of what palliative care is and how it might benefit them. There's a outline of some of the questions some of the things to look for in a palliative care service. Some of the things that are mentioned on the website include asking about what services are available, or their staff from multiple disciplines who would be involved in your care if you want. Our team members board certified in palliative care? Does the team regularly meet to review challenging situations? How often do they meet? Does a palliative care board certified physician or nurse practitioner routinely attend these meetings? How does the service ensure seamless coordination of care with your regular health care providers? Does the service participate in community wide efforts to enhance care through the care continuum? In other words, are they involved making sure that services generally are better coordinated in the community? In the course of your care (this is maybe most important)  is the service truly centered on you as a whole person helping guide you and empowering you in a way that makes that takes into account your values, preferences and goals?    Cynthia Margiotta:  26:14  Thank you so much. Dr. Ruskey. It sounds like it's bringing it all together with our healthcare.    Dr. Ruskey:  26:20  Yeah, I think ideally it is and in in the world that we live in, where care is often disjointed and it seems like patients and families get tossed in the machine, it's nice to know that there are services and service providers such as they may find with palliative care.    Cynthia Margiotta:  26:41  And that's all we have time for today. Thank you so much for being here. Dr. Ruskey with the Aging with Altitude podcast series. Have a great day, everybody!    Audio  26:55  Before we go, I just want to give a nod to our good friends at Stargazers Theater and Event Center. That's a warm and welcome place for concerts, screenings, and community events. Check out the schedule at stargazerstheater.com 

"Permaculture (the word, coined by Bill Mollison, is a portmanteau of permanent agriculture and permanent culture) is the conscious design and maintenance of agriculturally productive ecosystems which have the diversity, stability, and resilience of natural ecosystems."  The concept of building a productive ecosystem includes how people interact with their environment and each other.  Melissa Marts, Program Development Administrator for the Pikes Peak Area Agency on Aging, explains some of the permaculture principles and applies them to reframe aging.  Melissa is a certified permaculture designer and has been practicing design for over 10 years.  One principle states to integrate rather than segregate another to use edge and value the marginal.  These principles speak to valuing our older adults (and younger too).   Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country.  We talk about both the everyday and novel needs and approaches to age with altitude whether you're in Ft. Lauderdale, Florida or Leadville, Colorado.  The Pikes Peak Area Agency on Aging is the producer.  Learn more at Pikes Peak Area Agency on Aging. Transcript: This is Peak Community. The Studio 809 podcast collaborative.   Cynthia Margiotta:   Hello and thank you for listening to Aging with Altitude, a podcast series elevating the issues that matter. This series is produced by the Pikes Peak Area Council of Governments Area Agency on Aging. Today we have Melissa Marts, who works for Area Agency on Aging as the Program Development Administrator for almost a year. Welcome to Area Agency on Aging.   Melissa Marts:   Thank you.   Cynthia Margiotta:   Today she is going to talk about permaculture. She is a graduate of the permaculture design class and took that class 11 years ago.    Melissa Marts:   I did, yeah. It's hard to believe it's been 11 years. Permaculture is a huge part of my life and so much so that I have a fabulous certificate in my office that people ask me about it so I'm always excited to be able to share about why I love permaculture and why it is a part of my life, and how I think it matters to age in place.   Cynthia Margiotta:   Nice. Who started permaculture and why?   Melissa Marts:   Great question. It's two gentlemen who started permaculture, and it was started in the 70s and it came out of Australia. The founder, his name is Bill Mollison. You can check him out online, learn a lot of great information about him. He was a wildlife biologist and so throughout his career he had really had lots of opportunities to observe and interact with nature and see how different species would thrive, others might not thrive. He looked at flora and fauna. He looked super intensely with the eyes of a scientist, and a biologist. Through that he started to realize that there were lots of principles that were happening in nature that if he applied those in his personal life, he would probably have a better existence, just kind of in his own life. The person who joined him on the quest with permaculture was one of his students named David Holmgren. The two guys got together and came up with this kind of way of existing in our world called permaculture. The term comes from the word permanent culture, kind of put together. Realizing that even though permaculture is an evolution in and of itself, the concept is that we're looking at creating a really solid foundation to grow and build from and looking at culture and creating something that really matters, and can be sustainable going forward.     Cynthia Margiotta:   Great, and so then why did you decide to get involved?  Melissa Marts:   My husband and I are really big gardeners. We grow a lot of food. The whole reason that we bought the house that we live in, in the old North End, is because the house was small and the yard was large.  So without even realizing it we were kind of taking permaculture principles to heart back when we were in our early 20s and looking for a place to live and settle down.  It was important to us to have a space that we felt we could interact with and be a part of it, and you know grow the right types of plants and food on our little piece of land, integrate water into our landscape, integrate sun, and just kind of have a space and utilize as much of our landscape as we could. We didn't even know that were living and breathing permaculture. One of the things that my husband does that I just love is when it snows, he goes out. He doesn't just scrape the snow off the sidewalk and have it go haphazardly wherever. He creates little snow berms to kind of melt very strategically throughout our property so that we make sure that we utilized that snow as it melts, and that water and that's a permaculture thing. We didn't even know it, and so we were just kind of living and breathing permaculture. A person that I know in our community, her name is Becky Elder, and she owns Blue Planet Earthscapes. She is the perme goddess here in our community, and actually pretty much our whole entire state. She and I met through you know local food and gardening and she told me about thing called permaculture. I said I have got to take part in this. At the time I was actually working for Care and Share Food Bank and so it just was really a great kind of overlap of you know, how do we live in our landscape and do it in a way that's respectful? How do we grow more food? How do we feed people? How do we not produce waste? How do we utilize waste in a different way? So being at this regional food bank, it was just a perfect time to take the course. It was a nine month course and so I kind of laugh about it. It's kind of like you know cultivating a new family and starting over with a 9 month birthing process of this idea, these principles and cultures, and eventually you know, out they come and you just kind of look at the world in a different way as a result of permaculture. So that's why I got involved.   Cynthia Margiotta:   You mentioned principles. What are the principles of permaculture?   Melissa Marts:   Yeah, so there are actually 12 of them. I'm actually only going to mention 6, but I'm going to encourage listeners to check out permacultureprinciples.com on the Internet. You can see all 12 of them on the Internet there. You could also look at Blue Planet  Earthscapes, our local leader here in Colorado Springs in the Pikes Peak region. She also mentions all 12 of them, but for the sake of time and interest I'm going to talk about six of them. These are kind of the ones that rise to the top for me. I think also mean a lot for the aging sector as well.    The first one is called observe and interact. That's kind of what my husband and I were doing, but we didn't really realize it. When we bought our property, well it's not really a piece of property. It's a little lot in the downtown Colorado Springs area, but it is a larger lot than most which is what we were looking for. When we first moved in, we just kind of took some time and sat in our yard and sat in our house and said what do we like? What works? What doesn't work? How are we going to you know, make this our permanent place? So we just observed and interacted with our landscape in a way that was just kind of very natural for us. I think for some other people too, it's really natural, but for others it might not be. You might have the tendency to just kind of jump in and want to tear things up. You saw a picture in a magazine, and you want it to look just like that. With permaculture, you know, we kind of shy away from that and really want to say, you know, where does the sun come up in the yard? Where does the wind blow through? At Care and Share the wind was a huge problem. Care and Share Food Bank is located on the east side of Colorado Springs. The wind out there is fierce, so when we were looking at building gardens at the food bank we had to really spend a lot of time observing and interacting. And of course from an aging perspective, it's super important and just fine to sit back, slow down, observe what's happening in your space in your world, and then you know, slowly kind of take steps to interact. So I love that principle.    Another principle is about catching and storing energy. Again as people grow older what do we want to have more of? We want to have more energy to do things so it's kind of fun to think about this principle. You know, from the perspective on aging of how can we interact in our landscape and actually catch more energy, store more energy, feel more vibrant, to be able to get involved in life. Which is one of the things about permaculture that's super important. It's not necessarily just about how do we interact and grow food, how do we create a garden or those kinds of things. It's actually also about how do we create a community and economy together. So catching and storing energy can also be about, you know, interacting with other people, creating community. It's not just about ecosystems or wildlife biologists or any of that. What Bill Mollison and David Holmgren did was create this way of life that is much bigger than just gardening. With catching and storing energy kind of garden perspective, is you do want to be able to plant your landscape so that you can catch energy, store energy, utilized it. So my husband's example with the snow berms is really important because instead of just letting that water melt off haphazardly, he would really direct it to go to certain places and really controlled it. So it's about catching and storing that energy. So kind of a fun piece.    Then a third really important principle is about obtaining a yield. So whatever you do in permaculture, growing food, making friends, whatever it is. You want to obtain some type of yield because you want to be able to be giving back and producing and creating. So obtaining a yield is really important.    I'm saving the best for last so I'm going to talk about another one here which is, and I think again really applies to aging creatively, use and respond to change. When you look at the landscape, when you look at a community, you know change is there all the time, but so often we're frustrated by it. It drives us crazy. It makes us angry. Permaculture really encourages you to look at change in a positive light. Use it for your benefit and respond to it. Don't be so you know, stuck in the mud so to speak, but be able embrace, get in with the flow. Be part of that change and embrace that change. I don't have a really good example of that right now, but I may come back to it before the talk is over.      Another principle is use small and slow solutions. Again, it kind of goes back to that beginning principle that I mentioned about observing and interacting. We don't have to go in and change things overnight. We don't have to go in and drastically address things. There are times where that does need to happen. You know, timing wise right now in our country we of course, are facing hurricanes and so there are times where a hurricane is going to come in and devastate the landscape, and how do we respond to that? Afterwards there are going to be some immediate fast things that people have to do in order to recover from that hurricane, but yet it's also OK to take a step back and say let's really look at some smaller solutions, some slower things that we might be able to implement. Be patient with what we might do. I think that's also important with aging you know, to go ahead and take a deep breath, take a step back. It's OK to think about small solutions and slower solutions and to take time and be at peace with things.    The last of my six principles that I'm bringing up, which is my favorite, is using the edge and valuing the marginal. So from an ecology or landscape perspective, what Bill Mollison and David Holmgren would observe in nature was those places where the natural landscape was making a change. You might be in a water estuary and so you might have the ocean water coming in, and you might have river water coming out, and when you look at those places there's an edge that's happening. It's kind of the margin. It's the edge and they said the greatest biodiversity in nature happens at these edges. Whether you're in an ocean, whether you're in the mountains in the different tundra, you know when you look at the flora and fauna that are in those places, you'll see the highest level of biodiversity in those areas. From a landscaping perspective, you want to create edge. You want to create biodiversity. You want to have different types of changes in your garden that value that edge and the margins. But also in culture.  I feel like we want to value the edge and we want to value the marginal. When we you know, want to have everything homogeneous, when we want to shut certain aspects of the world out and just be in our own space, we're not creating biodiversity. We're not creating growth. We're not creating evolution and so for me, of the 12 principles, that one is one that is with me pretty much every single day. So here is this permaculture way of being. I took the class 11 years ago, it is with me every single day of my life. I think about it, and even with this new job that I have that I've been in for almost a year, many of the permaculture principles rise to the top here supporting a new community around aging. It's really been wonderful.   Cynthia Margiotta:   Wonderful, and I'm especially interested in some of the more direct things that some of our aging community can do. Some of the simple specifics maybe?   Melissa Marts:   I really think that with permaculture, the great part about it is encouraging people to get out of whatever space they are in. So if a person is used to being inside, in their home, we really want to encourage people to get outside and get engaged in the environment outside. That may be hard for folks, but the good news about permaculture is it's about slow small solutions. You don't have to go out and do a huge change today you know start out small. Start out by just heading out and maybe getting a flowerpot that you can grow some flowers on your front porch, and you know, just enjoy being outside on your front stoop and watching some flowers grow. Just really, really simple changes even in your inside environment. There's ways to integrate permaculture ideas in inside your home. It could be introducing plants into your house just so that you get that biodiversity inside your home. One of the things that is really beneficial for folks from a visual perspective, is to have the different types of textures that plants bring, to be able to look at and focus and pay attention to with plants. Even just bringing some plants into their home could be a slow, small change, can benefit vision. As well as just kind of circulating the air in the house a little bit better.   Cynthia Margiotta:   Maybe even to the point where they sit out on that front porch, and visit with neighbors walking their dogs.   Melissa Marts:     Exactly. I appreciate the outdoors so much, but I do understand that it's not for everybody. So I want to be respectful, because again, that gets to that principle that for me, I think you know, I want to live every day, which is valuing marginal using the edge. I do want to be appreciative of people who have different lifestyle choices and things they are comfortable doing, but I love the idea of encouraging people to be outside and to take in what our outside environment has to share with us.  And, while they're there, hopefully interacting with some people. It's really important, and huge part of permaculture is building community with others. There are intentional permaculture communities all over the world, where it is a little bit “commune-y.”  People have purchased land and come together, and they work on the 12 different principles as a community of people. Here in El Paso County, we're a little looser than that. We have a community of permaculturists. We don't all live together but we do get together and have potlucks and share ideas and resources with each other. It is a way of life and we do appreciate the community that other people bring. So for a person who finds themselves isolated and alone and getting older and feeling really frustrated, I love that image of them literally going out, sitting in a chair on their front porch or on their front stoop, and you never know who's going to walk by.  And they've got a little plant that they're tending and caring for and all of a sudden that sidewalk that was the edge of their world now has created some biodiversity because some other people have walked by, and they've said hello. I think that's really great, and I think it's fun to think that some of these lessons all came from a wildlife biologist who took his observations and learnings and has created this whole entire way of life.    Cynthia Margiotta:   What an exciting adventure you've been on. I like it a lot, so I have another question. So you do relate this to helping in the aging community, and that's important with little steps that make a huge difference for folks. Sometimes our seniors feel isolated, stay in their homes, get lonely. I think it's a great idea. Another question I have would be, is there something as an individual I can do? You make me think of a few things in my home that I want to do. Is there a little thing you can think of?   Melissa Marts:   I think a nice start would be for people to get on the Internet and take a look at what permaculture means. Check out some of the different websites that are out there. Kind of take a little step out and learn what some of the principles are. See which one resonates with you. It's interesting to see what the different ones are. There's 12 of them. Chances are when a person checks into it they'll find numerous that they're like Oh my gosh, I do this every day. Then to look at the 12 principles together and see where your one principle is fitting in and how you can continue to evolve your life to introduce other principles and other ways of interacting in your world in a way that is very peaceful, sustainable, and just really lovely. As I'm sitting here talking on the podcast, I am using my hands and I'm drawing this circle with my hands because the principles are presented usually in a way that it's kind of like a globe, and they're presented in a circle. Even the principles themselves are in little circles. There's this kind of ongoing symbolism of the circle of life and evolution of change. We're all in this together and again I think that that's just a really great piece to contemplate, it provokes. Especially people who might find themselves alone to realize that they might not have to be so alone. Again back to you know, what things can folks do. One, is getting on the Internet, checking out the different principles. I think taking stock of what the resources are in their life right now. What are some of the things that are giving them energy and feeding them the right kind of good feelings that make them want to get up in the day, get up in the morning, and kind of get out there and kind of taking stock of what those pieces are in their life. I hate to think that it might be a television show that comes on, but that could very well be the reality for some folks. I would love to think that it's more about the view that they take in when they look out their window, their cup of coffee that they're filling themselves up with in the morning. Just taking stock of those things that give them good energy, and be respectful of that, and appreciate that. Then take a few minutes to think about what pieces they might want to change and think a little bit about how they might be able to bring some of those changes into their life. A couple little, independent things there. And to be patient. Change doesn't have to happen overnight. It doesn't have to happen quickly, but just be purposeful and meaningful with the things that they're thinking about and contemplating.    Cynthia Margiotta:   My last question is who should folks contact if they're interested? You mentioned a website. Do you know the specific website that we can give folks?    Melissa Marts:   Yeah so you know, for people who are listening outside of the Pikes Peak region, there is a website called permacultureprinciples.com. Again, permacultureprinciples.com. And it's a great kind of introductory place to look at some information. There's another website permies.com which is a little bit more on the kind of “culty-feeling” a little bit. They have a lot of interactive groups that are talking and sharing information, but it really is a great resource to kind of get a feel for the depth of permaculture. And in your own community chances are there is a permaculture community right where you live. For people to be able to dig a little bit deeper maybe talk to their gardening centers or extension offices and ask them if they know about permaculture because like I mentioned here in the Pikes Peak region, we have a permaculture potluck every month. Folks get together and you don't have to have gone through the permaculture programs to be a part of that, you can just be interested and come and meet some amazing people who are doing really great things. Here in the Pikes Peak region, but also a really great resource all over, is our blueplanetearthscapes.com and that is Becky Elder. She is the woman who teaches the permaculture course here in the Pikes Peak region. She brings people from all over the world to that program to teach and she does a great job. There are other permaculture courses around the country that people could tap into, but here, you know, just to go check out her website and see the kinds of things that she talks about, how she implements permaculture on an everyday basis in her life would be great to check out for sure.    Cynthia Margiotta:   Great. Well, thank you so much. Thank you for meeting with us Melissa. If you have any questions, please contact one of those websites or even go to your gardening center. Thank you very much.   Before we go, just want to give a nod to our good friends at Stargazer's Theater and Events Center. It's a warm and welcome place for concerts, screenings, and community events. Check out the schedule at stargazerstheater.com  

How does a senior service agency get into the work of housing without building its own complex?  Silver Key in Colorado Springs, Colorado spent months doing listening sessions to find out where the gaps were for older adults and housing.  Once they started to pick up on trends they crafted a new position within their organization that supports their case managers and collaborates on a broad community basis to serve older adults in new ways. Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country.  We talk about both the everyday and novel needs and approaches to age with altitude whether you're in Ft. Lauderdale, Florida or Leadville, Colorado.  The Pikes Peak Area Agency on Aging is the producer.  Learn more at Pikes Peak Area Agency on Aging. Transcript: Michaela Nichols:   Hello and thank you for listening to Aging with Altitude, a podcast series about how we rise above the day-to-day issues that surround aging. This series is sponsored by the Pikes Peak Area Agency on Aging. Today's episode is about housing. My name is Michaela Nichols and I'm here with Dayton Romero and Erin McNabb. Mr. Romero is the director of senior assistant programs at Silver Key Senior Services, which is a nonprofit that provides services to the senior community in El Paso County. He's been with Silver Key since July of 2015. Miss McNabb has been with Silver Keys since February, solely working in the housing navigation program. The program was created in March 2019 to help seniors looking for housing in the area.   Can you all explain a little bit about what the housing navigation program does?   Dayton Romero:   Yeah, the housing navigation program came to its fruition whenever we held a focus group as part of the Age Friendly Colorado Springs Initiative. Our case management group specifically was asked to hold this focus group to kind of have a discussion on some of the different things we were observing anecdotally across our clients, and also data wise. What we found is that there was a gap in our community specifically among seniors who were running into challenges. When they were looking for an alternative place whether it be downsizing or their rent at their current place increasing, and so we found that the extent of services offered to these individuals was to provide them a housing list that may be outdated as soon as it prints out from the Internet. And so we found a big need for a dedicated position and role, and a program to be able to provide a comprehensive navigation service for individuals. That ranges from being able to identify their preferences, their barriers and really putting them in a position where they are most likely able to find a place where they'll be able to thrive and be independent.   Erin McNabb:   Part of that is educating people on the changes in the housing market since the last time they were looking at housing; changes and how technology has affected how people search for housing; changes in how landlords are looking for tenants due to the lack of housing in our community as the increased rents and increased barriers. It's definitely a landlord's market versus a renter's market. I spent a lot of time educating people on what barriers landlord's do put in place as eligibility criteria for people to get into properties, also how to search. People often don't understand the best ways to search for housing anymore or they don't have access to the Internet and that's where you have to go. Facebook marketplace and groups are huge places where people are posting available rentals; difference between private landlords and property managers and different expectations, different barriers people put between the two groups. I spent a lot of time educating on how to search and when I do, measure those barriers and preferences that the client themselves has, talk to them about how to mitigate those to make themselves more desirable to potential landlords. A lot of it is education as well as helping them with the search themselves, and helping to identify units that will fit their needs and helping advocate on their behalf.   Michaela Nichols:     Older adults often rely on a fixed income such as Social Security or retirement funds for their living expenses, this can put some seniors, like you said, in challenging situations when their rent is increased or they need to downsize their homes. Can you give us a few examples of situations that arise regularly and explain how you would approach those specific situations?     Erin McNabb:   Some of the biggest barriers I see are of course income in general. Landlords often times are requiring you have two and a half to three times the rent in income. That becomes a large barrier for people who are on fixed incomes especially the people who are on the lower end of the spectrum for fixed incomes because oftentimes rents are above their income in general. That becomes one of the biggest barriers. Other barriers are credit. Landlords are often requiring credit scores of at least 600. And surprisingly, although not to those who are looking, animals are one of the biggest barriers. Most landlords are not allowing animals at all in their units anymore and so animals become one of the biggest barriers we deal with because a lot of people do view animals as part of their family. It's not something they're willing to give up, but landlords aren't accepting them and that becomes a very hard choice for people to make; and also prolongs the process of finding a place. We see those oftentimes all three in one situation and it's that constant search to figure out where can we go and who can we find that might be willing to work with people. That also ends up oftentimes being “we want double or triple deposit but will work with you” and that becomes another problem because who has those funds? So we have to help look elsewhere to see if we can find those funds within the community to help people get in.   Dayton Romero:   And I could add to that Michaela. In the scope of income, in that lens, is a lot of our clients who come through our door seeking assistance around housing are relying on their Social Security income. We've seen a lot prevalently where one single event could really put someone in a downward spiral. Whether it be a medical event, a loss of a spouse or even a car repair could put someone in a position where they're going to be on the street, or they won't have enough to make ends meet to make that rent payment. Those are the situations that will actually come bring the client into our door and we're able to really look at the client holistically and identify what supportive services we could put in place in addition to meeting that imminent need of preventing them from becoming evicted or what other supports can be put in place so that they are able to be self-sufficient and independent. Some other barriers that have come up quite a bit where we've seen have caused problems is transportation. Again, really navigating our housing market here specifically it takes quite a bit of coordination. There's a dignity aspect to things as well so whenever, say you're looking for an apartment online, and you find an apartment that you know is on the 1st floor, it looks like it will meet all your needs and you reach out to the person; you schedule an appointment, but you don't have a vehicle. Or you don't know how to navigate our bus system, or you don't have enough resources to buy a bus pass, and other transportation services you have to wait two weeks out. By the time they are able to get to that place to view and even sign a lease or so on, someone's put it deposit on it. It really is a big barrier in terms of being competitive where things are moving so quickly. Then the third that comes to mind is those who are suffering from mental health ailments or are chronically disabled. These two things kind of compound those already existing barriers like transportation. Those who are having difficulty presenting appropriately in front of property managers. Like Erin said, being presentable and being marketable too as a tenant to property managers on where you have the composure to be able to kind of work through the logistics and come upon an agreement in terms of what your lease will look like and that sort of thing.   Michaela Nichols:   Do you have a success story that you could tell us about?   Erin McNabb:   I actually just got a gentleman. He is going to be moving into his place within the next week or so. He is someone who needed extra support around him and found his place rather quickly. I started working with him less than a month ago. He had the support of neighbors and friends. He had the support of his pastor at his church. All of them came around him to help with the process and I would supply listings to them. They helped him with going and looking at places and talking to people and getting in place. That is what so many of our seniors are lacking, but that was a huge success because he had the support network to help him make progress and make progress quickly. Then we're coming in and helping him with his first month's rent to get him into his place because in his case he does have to pay double deposit. We're going to be helping him with first month rent to make sure that he secures housing. He is someone who has to leave his place because his unit is being sold. His property is being sold and he has nowhere to go. Those are what we usually find is the biggest success stories. People who have those support networks, but we also know that we have a lot of seniors who don't have the support networks. That's very much where I come in. That's very much where we try to wrap around them with our support services, through our case management programs, through our food pantry, through our connection cafes so that they have those support networks and extra resources to be able to navigate this process and have people who can help them along the way.   Dayton Romero:   May I? I love success stories. One recently is, I'll preface it with just kind of the collaboration that goes on in our community that everyone kind of rallying around specific situations. Recently we had a tragedy in our community where over 100 people were displaced, older adults. Silver Key really stepped in as an entity that would be there to support those seniors who were looking for alternative permanent housing placement. We were able to help those clients from the shelter where they were evacuated to, to securing housing. This took multiple people to kind of get that in place, but as I had said the duality of services, with errands services as a housing navigator and locating, identifying those preferences and barriers, doing that real holistic assessment in our case management team. Those two services really put a person in a position where they are able to really thrive. That's our goal is to make sure that they are self-sufficient, and they feel empowered to move forward. Part of that is again, really identifying not only what the resources are needed to move into the place, but also what assistance benefits are they eligible for? What are those other factors that we could really plug in with or get them connected to whenever we do collaborate with other partners in the community? We did have a gentleman who went to the shelter, was displaced as a result of a fire, and used the shelter to its very last day. We were able to help him get into a place. It was crunch time and we got him in there. At the same time, he is secured. He's safe and he is continuing other services that we offer through Silver Key like our transportation, our food pantry. He'll continue to stay engaged with us and so we will be able to continue to support him. Michaela Nichols:   In your experience, I know the programs only been going on for a few months, but have people typically been connected with you and then continue to use other services through Silver Key?   Erin McNabb:   Absolutely. Often times the people that are connected to me, and in many cases they're already clients of Silver Key who have utilized either case management or the food pantry or transportation or any of the other myriad of services that we provide, who have found themselves in a position where they need assistance with navigating finding housing and then are referred to me. They continue to use the other resources even after I have assisted them with finding housing or staying within their current housing. In other cases, it's people that are now referred to us because of the new program with help in locating housing and have never utilized our services before. Through working with me, and you know I do those holistic assessments on their barriers their preferences. I measure their health needs. I measure their nutrition needs. I measure all the social determinants of health. I can connect them to the other resources within Silver Key, and within the community that meet those needs. Oftentimes they may be coming to us for housing, but they're realizing oh wow, Silver Key has all of these other services that are going to help me continue to be stable and continue to be sustainable moving forward. Then they know that if they need additional assistance down the road that they have a case management program at Silver Key that they can come to who can help them navigate their needs as their needs increase.   Dayton Romero:   Well put. I would add is Silver Key's reach is pretty far and wide in our community. We have the privilege to serve near 7,000 clients annually, and that that's across all of our programs. We have near 600 volunteers, and we look to those across the departments to be the eyes and ears to identify these clients who may be struggling or having challenges. Whether it be it just a conversation being had in a bus when they're being transported to their doctor's appointment, that volunteer or that staff driver is equipped to be able to get that person connected to the appropriate place internally at Silver Key so that we are able to help out and get those supports in place. I must add again, to the collaboration piece we're big collaborators, we love our partners and we definitely try to stay within our our expertise, but but one thing that we've noticed, and this is a little bit outside of the question, but just to get it in there. We recently, upon the launch of this program, we really took our time with it, you know. It's young. It's five months right now however, kind of the model that within the framework that we've developed is really innovative in that it addresses some gaps that we've noticed across other providers. Again to that collaborative piece, we've actually sat down with these other partners and really evaluated what they're doing. We kind of picked and chose some different things we could integrate within our framework and concept that will help us be successful whenever we are providing this service. Another cool thing, being a partner with the Area Agency on Aging and getting Older American Act dollars, is that we serve those 60 and over. We do have some real flexibility in terms of the individuals who we are able to serve. It's not a real rigid sort of guideline of hey you have to be this, this and this across our programs. However, we did get on with the city. What I mean is we are now a contractor with the city to be able to assist those who fall on a specific sort of percentage on the federal poverty guideline scale. We're sitting in with the Coordinated Entry efforts which is kind of a mechanism that the community has put together to identify chronically homeless individuals and get them housed through a really rigorous process. A process that really places a lot of importance on quality, I must say. The Pikes Peak Continuum of Care actually administers that and overseas it. They actually do our our point in time survey annually which is a survey, a collective effort amongst the community that gets a hard count amongst the homeless individuals so that we have an idea where we're at in terms of homelessness. What we noticed for a while there is that those who were older adults, 60 and over, were a little underrepresented in terms of providers for them. We've been really kind of keeping our eye and keeping our fingers on the pulse in terms of what are those numbers doing across older adults who are experiencing homelessness. That's why we thought it would be imperative that we get in and sit at this table at the Coordinated Entry so that we are that safety net for older adults who are experiencing homelessness. Erin actually pulled some numbers for us that show a pretty significant increase over the past three years in homelessness amongst older adults 60 and over.     Michaela Nichols:   Do you want to share some of those numbers?   Erin McNabb:   Through the Coordinated Entry meeting administered by the COC, the Continuum of Care, we were recently shown some numbers based on how many people of which age group were on the Coordinated Entry by name list, which is a list of people who have completed a housing assessment. These people are currently homeless or at risk of homelessness, although usually literally homeless or chronically homeless. In the age ranges that we serve, so we're talking 60 and over, in 2017 there were 54 people in July on the by names list from the ages of 60 to 69. In 2018 there were 78 people from the ages of 60 to 69 and in 2019, so this July, there were 83 people on the list. We've seen this small increase from ages 70 to 79. There were eight people on the list in 2017, five people on the list in 2018, and there are now 14 people on the list between the ages of 70 and 79. There is currently one person on the list who is over 80 years old. The biggest jump we've actually seen which has massive implications for where things are going in the future, is the ages 50 to 59. We're talking those younger baby boomers that are about to enter those 60 plus years. In 2017 there were 169 people on the list in July. In 2018 or 172. 2019, there were 240 people, almost a 100 person jump in the ages of 50 to 59. Those are the people that within the next few years are going to be the clients that Silver Key serves. There's this massive jump of people who are now experiencing homelessness due to the increase in rents, hitting that fixed income age range, and all sorts of other life events that happened such as the death of a spouse or disability or whatever it may be in their life that has now put them in a place where their income has lowered. These are all people that are going to be entering our system in need of finding housing, specifically affordable housing. They're going to need help navigating the processes because it becomes more challenging every day.   Michaela Nichols:   Do you see the housing issues in our community worsening or getting better?   Erin McNabb:   I think that the housing issues in our community are, there are city, the county, the state, all of the agencies in our community, the Continuum of Care we're all working very very hard to address the housing shortage because of course you know demand controls the market. Rents are higher because we have more demand than we have housing. Everybody in town who deals with housing, who works with people who are living in poverty, everybody is doing everything they can to create more affordable housing, to provide more funding, to collaborate, to make innovative programs. It is becoming the biggest conversation piece. We're seeing that nationally as well. This the first time in any preliminary presidential race where affordable housing has been a topic of conversation for all of the candidates. Something that's going to be changing overtime and hopefully will get better. We have a lot of people who are very intelligent, very passionate and very innovative working on finding a solution. Colorado itself has just passed legislation. HB 19-1228 doubled funding for state affordable housing tax credit from $5 million to $10 million per year. HB 19-1245 generates $50 million per year for affordable housing starting in fiscal year 2021 to 2022. It'll be 8 million and 10 million in the first and second years, respectively. HB 19-1322 generates $30 million per year for affordable housing for three starting in fiscal year 2020 to 2021. Our legislator or state government has passed these laws to put huge amounts of money into affordable housing that Colorado historically hasn't put into housing. Massive increases in how much funding we're going to receive specifically to build affordable housing because this is well known to be a statewide problem. Like I said it's becoming this massive nationwide problem and not just in big cities but everywhere.   Dayton Romero:   Well put, Erin. The collaborations again, that are going on are so inspiring. The philosophy that's been going on at Silver Key over especially this past year, has been housing is health. We recognize that really by the focus group first being that that steppingstone, but we've implemented some measurement tools that we're able to measure where individuals are at across those different social determinants of health. I think that really kind of goes in line with the attention that the topic of housing is getting right now because the impacts that homelessness, or challenges around housing as a whole has on the healthcare system. It does lead to individuals inappropriately using the Emergency Department or frequently calling 911 or using the healthcare system inappropriately, which spends a lot of resources. If we are able to somehow alter that and as Erin said, the brilliant minds behind coming up with solutions from academia, philanthropy and service providers, and seeing those three really put their heads together has been really inspiring. That's happening right here in our community with places like the Quad and different other foundations going on in town and us, and the Continuum of Care and all the stakeholders who are sitting around that table. Can I finish up a thought really quickly as it relates to the healthcare field and the health care system and how it's impacted by housing? Not only does it affect the the hospital system, the emergency department utilization and recidivism and so on, it also impacts long term care facilities so those who are able and essentially can live independently are opting to move to a long term care facility and utilized a long term care Medicaid waiver to just get housing. I think that is definitely something notable because the amount of money that is spent from Medicaid dollars toward long-term care is huge. It's so big especially when we're talking about a skilled nursing facility. We're talking there, I think the last numbers I had seen was somewhere between $7000 and $8000 a month for one single individual. Whenever we get an individual who's running into housing issues and challenges and ops to go to a long-term care facility and utilize long-term care Medicaid, rather than move to a retirement community who has a coordinator, and they could get by with that and with some additional supports with Meals on Wheels and so on. I point this out mainly because Silver Key's goal is to help and empower seniors to maintain their independence and their dignity. Only to where they're able to do that safely. There's this really interesting phenomena going on where individuals are opting for long term care as a means of finding alternative housing.   Michaela Nichols:      Do you have anything else you'd like to share with the audience?   Erin McNabb:   Just that we have great plans for the program. In the future we plan to expand as we see the need. We do have plans to hopefully build affordable housing within our community for seniors. We are also hoping to expand, build a network of landlords who would be willing to accept our clients that do have higher barriers. We have lots of ideas and this is just going to continue to grow and then we know that the need in our community is going to continue to grow as well for help with navigating the systems. We're just really excited to be able to bring a program to this community that fills a need that hasn't been filled in quite this way before and we hope to continue being innovative in doing so.   Dayton Romero:   I have two things, one is with the expansion in mind because we are serving the demographic that has, or we anticipate the most growth. We really rely on the community, not only professionals, but non-professionals. Those who are going into retirement so to the conversation a little bit earlier around volunteers. Those who are familiar with the nonprofit sector will know what I'm talking about is, volunteers are absolutely essential to being able to do work at a scale where we are making giant impact. Right now we we're small but mighty in the housing navigation arena, but we do plan on expanding. Through that we'll really look to volunteers and those in our community to help us serve those who are struggling around housing. Secondly, I just want to say Silver Key, we're an advocate for senior empowerment and we offer a variety of services for seniors to maintain independence, safety and quality of life. Our mission is to serve in partnership with our stakeholders to support quality of life for seniors allowing them the choice of safely aging in place with dignity and independence combined with our vision to make the greater Colorado Springs area the best in the nation to age. Housing security and nutritional health for seniors are fundamental needs and our organization has helped provide for decades, and we plan on continuing to do that and making a bigger splash in the senior community.   Michaela Nichols:   Thank you Erin, and thank you Dayton for being here today. I really enjoyed being able to learn more about the housing navigation program and all that Silver Key has to offer. And then for those interested in learning more about the program, you can visit SilverKey.org or call Silver Key at 719-844-2300.   Before we go, I just wanna give a nod to our good friends at Stargazers Theater and Event Center. It's a warm and welcome place for concerts, screenings and community events. Check out the schedule at stargazerstheater.com  

Older adults in long term care may not realize they have rights from ensuring basic personal dignities are respected to choices that frustrate and challenge providers.   How do we weigh self-determination and safety?  What's best for the individual vs the  group?  Ombudsmen step in and offer insight, direction, education and support for both residents and facilities. Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country.  We talk about both the everyday and novel needs and approaches to age with altitude whether you're in Ft. Lauderdale, Florida or Leadville, Colorado.  The Pikes Peak Area Agency on Aging is the producer.  Learn more at Pikes Peak Area Agency on Aging. Transcript: You're listening to Studio 809. This is what community sounds like.  Michaela Nichols:   Hello, and thank you for listening to Aging with Altitude, a podcast series about how we rise above the day-to-day issues that surround aging. This series is sponsored by the Pikes Peak Area Agency on Aging. Today's episode is "Start with Dessert" about long-term care. My name is Michaela Nichols and I'm here with Scott Bartlett. Scott is currently an ombudsman at the Pikes Peak Area Agency on Aging Ombudsman Program. He has been with the agency and working as an advocate for older adults in the community for fourteen years. He's been nationally recognized for his work in long-term care services and support. So Scott, can you tell us a little bit about what you do in your role as an ombudsman?   Scott Bartlett:  Sure. So what an ombudsman is, we are advocates for residents of long-term care facilities. So when I say long-term care, what that means is state-licensed assisted living and nursing homes. The majority of the residents there are older adults, but there are quite a few young people with mental illness and traumatic brain injuries or disabilities that also reside in long-term care facilities. So what we do is help to increase the quality of life for people in long-term care. We are an intermediary or an advocate when there are problems in care, or rights, or just general. Any areas of conflict, everything from the coffee might be cold to assisting with allegations of abuse and neglect. And so really, just to sum it up in a few words, we are a voice for people that often don't feel like they have a voice. Sometimes this is also for family members. But also we are there to align with the facilities, because we need them to be on board with us and vice versa, to make sure that people have a good quality of life, and they retain their civil rights while in care. And so we do a lot of education and consultation with facilities to help them be better at what they do.  Michaela Nichols:   Can you tell us about some of the most rewarding parts of the position?   Scott Bartlett:  Yes. You know, there are a few cases that come to mind that I think we feel good about. Often, those cases are about either protecting somebody from abuse and neglect or restoring their civil liberties. There was a case where a resident disclosed to us some pretty severe abuse allegations. Ultimately, that place ended up, because of this, having their license suspended and then later terminated because the abuse was substantiated. But the resident that first came forward after she moved out of the home, and was free from this abuse and neglect. Her family took her on kind of a tour of the western states of the United States and sent us postcards and thanked us for allowing the end of her life to be happy and that we had assisted her to be free from this oppressive environment but she was living in. We feel good about those kinds of cases where the resident is satisfied with the results and feels that we help to make their life better. Those are the best cases.   Michaela Nichols:   That's a sweet story. So what are some of the most difficult issues you've had to deal with?  Scott Bartlett:  Difficult issues often are around abuse and neglect is always difficult. You know, personally for the ombudsman, but also professionally, it sometimes becomes frustrating. Other issues might be legal ones around surrogate decision-making. So when I say surrogate decision-making, I'm talking about powers of attorney or guardianship. Often when there's conflict in those areas we see a power of attorney or a guardian exercising their authority in a way that doesn't always promote quality of life. I always talk about how the issues that we see often come down to when we're talking about rights, about what is the proper balance between autonomy and the right to self-determination and safety. Often we see decision-makers with good intent sometimes. It's not always just about power and control, it's about trying to keep the person safe. But there isn't that consideration that not allowing somebody to do, like, have dessert when they're diabetic, that there's harm in that too, by disallowing a person a choice. That's oversimplifying some of the issues that we see. But it's difficult to talk to guardians and powers attorneys and say, "Listen, you, there's dignity in allowing some risk here." And then, you know, there are issues with the power of attorney that are misunderstood. In Colorado, Power of Attorney cannot, well, they have to work alongside the person the power of attorney has sworn. And they're not allowed to override the decisions of the person, they can make decisions alongside them, or make decisions when they can't. But when the individual can't do to whatever reason, but what they're not allowed to do is go against the wishes of the principal, or who the power of attorney is for. So we do a lot of education around there. And sometimes that's difficult. And I think one of the greatest challenges is where, because we're the voice, we have to go with the implied wishes, the stated wishes, the expressed wishes of the person. And sometimes they're asking to assume the risk that, even as an ombudsman office we might be uncomfortable with, but it's not our position to, if we're going to be the voice for the person, then we are not to put our own values and our own thoughts on what the person should do. So there are times that maybe we advocate for things that from the outside look unreasonable. But again, it comes back to we're the voice for the person, we're not a family member, we're not a decision-maker, we're not case management. We might advise the person on if they make this choice, here's the risk. But ultimately, if they want us to advocate for things like leaving the nursing home and returning back to their community home when it's observably unsafe, our mission is to still advocate for that because it is their right.   Michaela Nichols:   So, do you have an example of a time when you had to separate your values from that person and the decisions that you had to make or advocate for them?   Scott Bartlett:  Yeah, I think what I just said often becomes difficult, because we see people that come from community settings and enter long-term care for various reasons. Usually, because there's been something unsafe in the home that has led to a hospitalization, and then ultimately, they end up in assisted living or a long-term care facility. And you often see residents of long term care that are resistant to care, and were resistant to allowing supports in the home to help them be safe and independent in the home, and then they'll want to return back to the very situation that created them going to long term care in the first place. You know, I always feel uncomfortable when advocating for someone to be unsafe. Not always but in some of the cases, I feel uncomfortable about the safety of the person but again, I think the way that balances out in my mind is that we're advocating for their right to assume risk. And the way that I think we try and balance that out is again making sure that that person is getting all the information that they need to make a choice. You know I will be very honest with them that if you don't allow, you know, home health to come in and assist you and help keep you independent as possible that you might come back to long-term care again. But, you know, again, going back to we're the voice. If that person still wishes to deny any help, then that's what we have to do.  Michaela Nichols:   So what are some of the most frequent scenarios that you come across? I don't know if you've already touched on some of them or if you have any other ones?   Scott Bartlett:  Well, big ones are always around things like answering call lights. Many facilities, not all of them in the assisted living world, but most of them in nursing homes, have a system where a button can be pushed when a person needs assistance. Then the staff knows to come to the room and ask what help is needed and then provide that help. We get frequent complaints that call lights aren't answered, or they're not answered on time. You know, we may see call responses being 20 or 30 minutes, sometimes an hour or more. And that's very difficult for a person who might need assistance to the bathroom. And then, because the call light wasn't answered timely, they may soil themselves. And that becomes a dignity issue also. So that's a very common complaint often stems from staffing ratios, maybe there's not enough staff there. Sometimes the call lights are broken. Sometimes residents can't reach the call lights. So they're placed in bed, but the call light may not be within their reach. So call light issues are frequent. Other things are around personal need's money. So residents are afforded some personal need's money to spend on things of their choosing. Often they feel like they need more, or there's an issue accessing those funds. That's another very common one. Also, complaints about dietary. So, dining services, which are sometimes the most difficult to solve, because you're coming from preference many times. You know, someone says, "well, the chicken is too spicy." If you talk to the resident next door, they would say it was just fine. But again, we're the voice. And so we're going to, you know, advocate for that person and say, " Listen, this person says that the chickens too spicy or whatever." Dining complaints can be big, you know, cold food or not enough variety. But yeah, dining complaints, call lights, also medication being timely. Many residents have been on the same medications for years and years and know what medication they're to take, and at what time, and if it's 30 minutes late. They become very anxious, especially when it comes to pain medication. But I would say those are a majority of our complaints. And unfortunately, we do receive a lot of complaints about rights issues or abuse and neglect.  Michaela Nichols:   So I want to go on to a little bit about the editorial that I read about one of your first cases. It was about a facility resident with diabetes who was being denied dessert. And you mentioned it a little bit earlier. Do you want to explain more about that situation and how the person felt and how it went way beyond just getting dessert?   Scott Bartlett:  Yeah. So and that is a good one to talk about because it kind of hits on a couple things I've already touched on. So the situation was I received a call from a gentleman who lived in an assisted living facility. He wanted me to come out and see him and so I did. He told me that the issue was that he wanted chocolate cake, and he was being disallowed. And so I went and talked to the administration, the administration told me that he was diabetic and his daughter was power of attorney and that the power of attorney had instructed the facility not to allow him to have dessert. Now, this gentleman, from what he told me, just having a dessert after dinner was the norm. He wanted to uphold that norm. That was a part of his life that he wanted to maintain. And he told me, you know, "I'm a veteran, I fought the Japanese and the South Pacific, I'm not afraid of a little chocolate cake." And so the issue here, and going back to the administration that I explained, is that it's a power of attorney. She's exercising the power of attorney document in a way that it's not designed to be used for. She's overriding his decision to assume choice and risk. And, you know, going back to that, there's dignity with risk. Taking away the chocolate cake arguably could be more harmful to his social and psychological needs and quality of life than his blood sugar spiking a little bit after dinner. So what I did was I talked to the power of attorney and I talked to the facility about a plan. And that was to get them educated about what the true risk was, for having sweets when he's diabetic. And basically, what the nurse said is that "we'll track it, your blood sugars are probably going to spike, it'd be advisable, maybe to have half a piece of chocolate cake rather than a whole piece." And so, the end result of that was that he got his chocolate cake and because there was a consultation on the medical side, where we could figure out what the true risk was, and then a plan to watch his blood sugar's a little closer. The resident was totally happy with the result, I think that the facility and the power of attorney still had some reservations. Ultimately, you know, this man got his chocolate cake, and he was happy and it increased his quality of life. It was something that continued from his former life. I think what people don't understand is that this wasn't really about chocolate cake. Right? You know, this was about him wanting to maintain the quality of life, some normalcy from his former life. He wanted to exercise his right to risk. And he thought about it, of course, he went with the chocolate cake. And as far as I know, I never heard anything about it again, I don't think he had suffered any harm from having the chocolate cake. So, you know, that's a good one to talk about, it has these elements that we've already brought up.  Michaela Nichols:   So are there any misconceptions that people have when thinking about long-term care that you've come across in your work?  Scott Bartlett:  Yes.  Michaela Nichols:   So, the misconceptions are?  Scott Bartlett:  Well, you know, if you talk to people, and you ask them about long-term care, a lot of them feel that long-term care is a place that you go to die and that life stops. That's not necessarily true. I think, at one time, maybe it was. You know, many years ago. But through regulations and changes of standards of care in the long-term care industry, you're becoming more aware. Patients are their own advocates, and in allowing choice and independence as much as possible, I think we've seen changes there. But misconceptions are, again, that long-term care is a horrible place to be in. Granted, a lot of people that I talked to who are residents of long-term care facilities will say, "I'd rather be at home in my own place." But many of them will say, "you know it's okay. I understand I need this assistance." But, if they're offered these things that we're discussing, if they're offered the lanes of opportunity to make their own choices, such as being involved in their medical care, allowed to have relationships with people including intimate ones, they're allowed to exercise their rights just as they had in the community, they're usually okay. Again, they'd rather be at home. But it's not the place that I think people have in their minds where you don't have any more rights, you're isolated and stuck. And to some degree, that is true in some cases. For the most part, we want long-term care to be seen as part of the community and not that residents are excluded from the community and their rights.   Michaela Nichols:   In your fourteen years in the Springs, have you seen improvements in long-term care in general? I mean, I know you still deal with issues of abuse and neglect and things like that, but do you see more rights for people in long-term care than there were?   Scott Bartlett:  I do. Again, I think fourteen years is not very long in the scope of long-term care, that's just the course of my career. But even in that short time, I've seen a change in attitude about rights and assuming risk. Long-term care is is better informed and educated in promoting the rights of residents. I've seen shifts, they're both systemic, in understanding, but also in individual professionals, who maybe have heard from ombudsman or elsewhere, that these things matter. As far as supporting as much independence as possible, making people feel like they have the right to self-determination. There's a term in the industry that's widely used right now, about person-centeredness. So it used to be that your medical team made decisions for you, and you didn't have a whole lot of say, now, that's all changed towards, we are working for this person to make sure that they are safe, and they receive medical care, but also that their psychological and social needs are met at the same time. Those are just as important and for some individuals, it may be more important than addressing physical needs. So yes, I would say that I have seen an increase, at least in my observation of this region, in my fourteen years, of better understanding of what leads to better satisfaction for people that are living in long-term care.     Michaela Nichols:   So what kind of advice would you give to families and individuals looking into long-term care solutions?   Scott Bartlett:  Well, I deal with those calls frequently to my office. And you know, the first place I normally start is, if it's a family member asking "what does mom or dad want to do?" or an uncle, whatever the relationship is. Do they want to go to long-term care? You know, going back to that issue of who is the decision-maker legally? And, yeah, you know, the risk of addressing only the safety issues and not the social and psychological issues and potential for harm there. So, helping them to decide if long-term care is the right option. Because there's a spectrum of possibilities in between having nothing at home to entering a nursing home. So there are things like home health, you know, what services might be brought into the home. We can get closer to that proper balance of addressing safety and autonomy. And then we'll move into how to pay for long-term care because there's kind of a broad spectrum. I'll just kind of throw out general numbers. It's not exact but say assisted living may cost three to five thousand a month, sometimes more. Nursing homes, you're looking at seven to nine thousand a month. Few of us have that kind of money. It's probably not going to last very long. So talking about how to pay for long-term care, whether that is through private funds, or having to seek Medicaid to help pay for care. And then the next step would be to ask what is the right level of care? Does someone need assisted living versus a nursing home? So a lot of that is determined by how much assistance is needed. And then making choices about what is the right fit for that person? Does facility size matter? Does location matter? Is a person a smoker, because some facilities don't allow smoking at all. And trying to make a match. Going back to if the right fit is found, the better the odds are that the person will be more satisfied with moving into a long-term care facility. And then, we usually try to help them narrow down to three or four facilities to check into, and then they go out and do it.   Michaela Nichols:   Okay, yeah. Do you have anything else you want to share?   Scott Bartlett:  Yeah. So it may be important to understand when to call an ombudsman. So it's appropriate, and I suggest that you call an ombudsman, in a couple different cases. So one is, a lot of people don't understand how to access long-term care. You know, we talked about kind of the scope when family members are considering long-term care and what that looks like in my office. I would encourage people to go out and get information from the ombudsman's office. Also looking at facility performance history. So they're regulated by the state, and they are assessed on a pretty regular basis as to their compliance with regulations. Some are better than others. But it's important for people to understand what that history has been. Most people wouldn't understand where to find that information. So an ombudsman can help with that. So again, in seeking long-term care, and a lot of people don't know how to access the correct information. So it would be advisable to contact an ombudsman on how to do that. Other areas are questions about regulations, say you're a resident in a long-term care facility, or you have a loved one in a long-term care facility, and you are confused about a facility policy or standard of care and want to know if what is happening. Such as is it compliant with regulations. We can answer questions there and help give people the knowledge level to be empowered to solve their own problems sometimes. It is always advisable to contact an ombudsman when a problem persists. Also, when the resident or family member has gone to the administration and feels that they have exhausted all their ability to work the internal grievance policy and they still feel like the problem exists or they weren't heard. Contacting an ombudsman to assist in moving that forward is always advisable. Certainly around issues of abuse and neglect. Most of those probably should go to law enforcement if it's criminal, but it's not out of bounds to contact an ombudsman and discuss the case and get some advisement there. And maybe even, you know, opening a case with the ombudsman office because those are the ones that we really want to be involved in because they can be so detrimental to people. I always say this too; I always get all the bad stuff. But, you know, if people really feel good about the facility, then I would like to hear that too. I don't get a lot of that. I like to know the facilities that are doing well. And so, really, it comes down to if you have questions about long-term care, we're a safe place to come to discuss those and provide some education to help people wrap their head around whatever questions that they have. Hopefully, empower them through gaining more knowledge. But ultimately, we're just here to assist and help improve the lives of people living in long-term care.  Michaela Nichols:   Thank you so much for joining me on this episode of the Aging with Altitude Podcast. I enjoyed being able to learn more about your role as an ombudsman, and I hope the audience did too. For those interested in learning more about the program, you can visit PPAG.org or call 719-471-2096.