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  • Avoiding Frauds and Scams: New Learning

    Avoiding Frauds and Scams: New Learning

     

    Scams and Frauds Are on the Rise

    Two years ago, the Council on Successful Aging offered a forum on how to avoid being taken in by scams and frauds. Pine Knoll Shores Police Chief Ryan Thompson and Financial Advisor Cheryl Mansfield from Edward Jones shared examples of scams and offered tips on how to avoid becoming a victim. Unfortunately, even in this short time span, the array and sophistication of these activities has increased.

    Very often intended victims are older people who may be more trusting or less familiar with technology. Scammers may contact you via email, text, phone (landlines and cell phones), U.S. mail and can even show up at your door. Scammers not only credibly misrepresent themselves and their business, they may also add the threat of loss or use fear tactics to induce compliance.

    Types of Scams

    Scams and frauds take a variety of forms (e.g., investment and imposter scams, online shopping issues) facilitated by digital tools that make it easier than ever to target victims. Recently released Federal Trade Commission (FTC) data show that consumers reported losing more than $10 billion to fraud in 2023.

    These numbers suggest that a lot of the fraud prevention advice being publicized may not be working. Michelle Singletary, an award-winning, long-time Washington Post personal finance columnist and author, has interviewed scores of victims and Doug Shadel, a fraud prevention expert who has spent much of his career studying scammers, summarized their insights and concluded that the current advice may be outdated. They shared their thinking in a December 2024 article appearing in the Carteret News Times newspaper.

    Scammers Are Credible Actors

    We easily believe in them; they can make the implausible seem plausible. They appear transparent, polite, respectful and have a lot of charisma. They may pretend to work for a respected agency—e.g., the IRS or Social Security. They may present themselves as authority figures—e.g., a sheriff or a known company executive. Their promises of strong financial benefits are difficult to dismiss.

    Alternatively, when threats of arrest or demands of payment in cash, gift cards, wire transfer or cryptocurrency raise anxieties or fears, we often quickly comply. Scammers who require you to transfer funds out of your bank/accounts “for your protection” can be alarming. If you find yourself in such a situation, it can be very difficult to think clearly and respond objectively.

    Most often we are told to resist the promises made by scammers by remembering: If it’s too good to be true, it probably is. While this is still a true statement, it’s effective only if one remembers it when they are approached. Build your resistance by considering the ideas listed below and adding them to your response set.

    What Can You Do?

    Stay alert…and be suspicious.

    • Scammers may try to rush you into a situation. Hang up.
    • Focus on an action that can be taken rather than try to remember a statement, e.g., ask for a return phone number of the company/person being represented. Reduce anxieties by reminding yourself to breathe.
    • Don’t believe anyone who urges you to move your money to “protect it.” Apply the same advice if someone tells you to buy gold, gift cards or cryptocurrency to protect your assets. Again, hang up or focus on an action.
    • Be aware that some scammers take time to build a relationship over several low-key, non-confrontational conversations to gain your trust. No matter how honorable someone may sound, resist sharing any personal financial information.
    • Educate yourself. Becoming familiar with different, often-used approaches by scammers and fraudsters will help reduce your anxieties should you actually be contacted. Rather than try to remember that you shouldn’t believe promises of extraordinary returns, build a base of understanding of how legitimate financial advisors operate. Review news stories, videos, and scam buster on YouTube to help build a knowledge base.
    • Receive consumer alerts about scams from the Federal Trade Commission and AARP Watchdog Alerts. Talk about these issues with friends and family. Help them be prepared. The FTC will send you alerts and updates to start these conversations in your preferred language and without charge.
    • The FTC wants to hear about scams in any language, even if you didn’t lose money: ReportFraud.ftc.gov (English speakers); ReporteFraude.ftc.gov (Spanish speakers); all other languages call 877-382-4357, press 3 and ask for an interpreter in your preferred language.

    The best protection against being scammed is to be prepared.

    Further Reading

    As Nationwide Fraud Losses Top $10 Billion in 2023, FTC Steps Up Efforts to Protect the Public | Federal Trade Commission, February 9, 2024.

  • When Great Trees Fall: Funeral Pre-Planning in an Age-Friendly Community

    When Great Trees Fall: Funeral Pre-Planning in an Age-Friendly Community

    We all have different ways of acknowledging that we will one day leave this mortal life. Though the when and the how is often unknown, it is possible to prepare for the inevitability. Preparation helps ensure peace of mind and minimize the emotional challenges that are typically associated with decision making at the time of loss.

    Your Pine Knoll Shores Council on Successful Aging recently hosted a forum regarding end-of-life arrangements at the A.C. Hall Municipal Building. Mr. Steve Odom, an owner and the General Manager of Munden Funeral Home, provided a thorough review of the steps required in planning for your farewell.

    The Importance of End-of-Life Pre-Planning

    Mr. Odom stressed the importance of pre-planning. Begin with a written review of your life and these legal documents:

    • Last Will and Testament.
    • General Power of Attorney.
    • Health Care Power of Attorney (directs your representative to aid or make decisions regarding your health care).

    Have an honest conversation with your chosen representative so your final wishes will be honored.

    Financial and Legal Considerations

    Pre-planning should review the financial implications of your choices, but it does not mean you must pre-pay for services in advance.

    Biographical Information to Gather

    Another key step is assembling biographical information for death certificates, obituaries/announcements, and the orderly transfer or closing of assets:

    • Full name, date and place of birth.
    • Education and employment history.
    • Family members and religious affiliation.
    • Military service.
    • Other pertinent details you want conveyed.

    Types of Funeral Services

    Funeral services can be simple or more involved and can be customized for the individual and family. Personalization may include:

    • Video tributes.
    • Religious services with after-service receptions and catering options.
    • Fallen Hero Programs for law enforcement officers.
    • Military services for honorably discharged retirees and veterans.

    How Funeral Homes Can Help

    Funeral homes are familiar with pre-planning requirements, including location/type of burial (in- or out-of-state, out of country, or Veteran cemetery), laws on distribution of cremated ashes, and management of organ or anatomical donation.

    Final Thoughts

    While the many decisions can feel overwhelming, discussing your plans with funeral service experts can provide comfort that your wishes are understood and will be honored—and it spares your family difficult decisions at a challenging time.

    Mr. Odom’s presentation was videotaped and can be found on our website.

    Your Pine Knoll Shores Council on Successful Aging will continue to seek out topics and resources to connect you, our residents, with solutions to aging gracefully and successfully in place. Help us help others. Please share this information.

    *Credit is due to Maya Angelou for the title from her poem, “When Great Trees Fall,” as she reminds us: “…when great souls die, after a period, peace blooms …our senses …whisper to us… they existed… we can be better… for they existed.”

  • Final Thoughts: Alternative Living Situations for Seniors (Part 3)

    Final Thoughts: Alternative Living Situations for Seniors (Part 3)

    If you have been following the thread of my recent articles (Part 1 and Part 2), you will have found some support and guidance if you have had to accept the painful reality that your loved one’s physical and/or mental well-being cannot be managed by you alone.

    The decisions related to this realization can be overwhelming and are life-changing. Hopefully, you have gained an overview of some of the options open to you and how to evaluate them. Often, the choices you make define the last of their lives.

    I make this statement to give emphasis to the importance of the evaluative stage of the process. As you read in the previous article, there are many questions to be addressed.

    This article highlights additional considerations that are important to the decision you make; note that this is not an exhaustive list. As mentioned, the stage of the disease of your loved one will dictate the degree these considerations will affect your decisions.

    Transitioning from Home to Facility

    You may experience some resistance to the move from your home to the facility you have chosen. Feelings of fear, betrayal, confusion, and abandonment often dominate. If your loved one has been part of the choice and evaluation of the facility, these feelings may be mitigated. However, be prepared to acknowledge the strength of the attachment your loved one has to you and your home which may make the transition day especially difficult.

    On the departure day, limit the number of people present at this time. Try to surround your loved one with 1-2 individuals she/he is most comfortable with; these friends/family should speak positively and optimistically about the benefits of the new experience. Avoid using words like ‘facility’ and ‘nursing home’; instead, refer to the new location as a “new place” where they can get more help. Messages of love, that you are close by, that their comfort is important to you, that phones and phone numbers are easy to access by them and for them by the staff are recommended. If possible, set a date you can keep for your first visit. Importantly, you must stay calm and positive.

    Plan Ahead

    Some facilities allow you to set up the new room before the patient arrives, so it feels more like home immediately. Bringing personal items from home, such as family photos, favorite blankets, or books, make the room feel familiar. (Re)introduce staff and other patients to provide a sense of connection. On arrival, an orientation to the room setup, individuals who are sharing spaces, and the facility are suggested.

    Schedule the Move

    Find a time of day when the patient is generally more relaxed and less likely to be confused or agitated, such as mid-morning or early afternoon.

    Work Closely with the Facility

    Partner with the staff to ensure the patient receives care that aligns with their personality, preferences, and needs. Share information about the person’s background, preferences, and routines.

    Visit Regularly but Give Time to Adjust

    Initially, frequent visits can provide reassurance and help with the adjustment, but monitor how your loved one reacts. Some may benefit from short visits, while others may need a longer period without too many visits to settle into the new environment. Communicate regularly with the staff to address any concerns early on.

    Lastly, Give the Transition Time

    Adjusting to a new environment can take time. It may take weeks or even months to get comfortable. Be patient and give them space. If needed, don’t hesitate to seek the professional guidance of a geriatric care manager or experienced social worker.

    Alternative Living Situations for Seniors

    Know Your Rights

    I want to underscore the necessity of thoroughly understanding your rights and those of your loved ones under the care of the facility/agency you choose. As mentioned in earlier articles, assisted living and memory care agencies are state-regulated; nursing homes are guided by federal laws. All three types of facilities are private entities functioning as businesses. How they do business can affect the care of the patients in their charge – over time, this can change. Here are four examples:

    Private Pay vs. Medicaid Reimbursement

    If a facility can earn more from private pay than Medicaid reimbursement, it might prefer to accommodate non-Medicaid residents, altering its policies at its discretion.

    Hospitalization and Return Policies

    An assisted living residence (or nursing home) may send a patient to the hospital for a medical issue that cannot be addressed at the facility, then refuse to let them return—even going so far as giving away their room or bed to a new tenant.

    Reasons for Eviction

    A nursing home might cite several “good causes” to evict your loved one. Legal eviction can occur if necessitated by medical reasons or if your loved one’s presence poses a threat to others’ well-being.

    Eviction for Level of Care Changes

    Additionally, eviction is permissible if your loved one no longer requires nursing home care or if they need more care than the facility can offer, such as hospice care.

    Eviction for Non-payment

    And ‘yes,’ failure to pay for care can result in eviction. However, most facilities are required to provide the resident and their family with written notice to proceed with eviction. This discharge notice should afford at least thirty days for the resident or their representatives to resolve the payment issues.

    By law, the notice must also detail the reason for discharge, a summary of the resident’s condition, and a future care plan sufficiently detailed for use by a subsequent facility.

    Eviction Rights and Protections

    While evictions are relatively rare, knowing your patient’s rights when joining a community can serve as a shield against eviction. These rights extend beyond medical care and include privacy, financial, and access rights. It is strongly recommended that you completely understand your patient rights in writing and in a language you understand before moving in to prevent unexpected evictions.

    These Are Just a Few Examples

    These are just a few examples of the rights and protections you can expect and the questions you should ask.

    Understand Upfront Costs

    Be sure you know what you will be paying upfront. An inability to afford unexpected costs is one of the most common reasons for evictions. Most states require new residents to receive a disclosure of all possible fees. File this document in case you need it at a later date.

    Clarify the Eviction Policy

    Be clear on the eviction policy before moving in. What exactly will it take for the facility to say you must leave? What are the steps of that process? Specifics are important – a policy that is ambiguous is more likely to be used unfairly and the more likely you are to be surprised by an eviction. In particular, get a clear definition of ‘endangering behavior.’

    Review the Admissions Agreement

    Carefully review the admissions agreement and have an expert, like an elder law attorney, review it as well. Any promises made by management should be put into writing.

    Ask About Hospital Visit and Bed Hold Policies

    Ask how many days will your loved one’s bed be held if a hospital visit is required? Again, get this information in writing.

    Information Sources for this Article

    Information for this article comes largely from Clinical Tools, Inc. (an NC company) with funding from the National Institute on Aging (grant #R44AG026227).

    The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Aging or the National Institutes of Health. The site is currently managed by American Aging Care, LLC. AgingCare.com connects families who are caring for aging parents, spouses, or other elderly loved ones with the information and support they need to make informed caregiving decisions.

    DementiaCareCentral is a resource center for dementia caregivers.

    Centers for Medicare & Medicaid Services: CMS is the federal agency that provides health coverage to more than 160 million through Medicare, Medicaid, the Children’s Health Insurance Program, and the Health Insurance Marketplace. CMS works in partnership with the entire health care community to improve quality, equity, and outcomes in the health care system.

  • When Plans Change: Alternative Living Situations for Seniors (Part 2)

    When Plans Change: Alternative Living Situations for Seniors (Part 2)

    Alternative living situations for seniors

    Last month’s Part 1 on this topic provided an overview of alternative living options when our limitations or those of our loved one negatively impact on our ability to care for ourselves or them.

    Once you have identified the type of facility (assisted living, memory care or nursing home) that best meets your needs, narrow the list of acceptable facilities within type to two or three.

    The next step is to vet each of these acceptable alternatives.

    Importance of visiting care facilities

    The importance of visiting each facility you are considering cannot be overstated.

    Preparation for the onsite visit involves online and phone research to identify key features of each facility.

    What you learn can help differentiate facilities and set the stage for your visit.

    Involving Seniors in the Decision Process

    Several reputable sources and organizations (e.g., Centers for Medicare and Medicaid Services and American Geriatrics Society) recommend that the potential patient, to the extent possible, be involved in this assessment process.

    The need for involving older adults in their care decisions helps to ensure that choices are aligned with their values and preferences and helps to build trust.

    Key Questions for Vetting Facilities

    I have enhanced a list of questions/concerns prepared by the care.com clearinghouse that you should ask yourself and your family, as well as the professionals and residents in each facility. It isn’t an exhaustive list.

    Logging truthful answers to these questions in a systematic fashion by date and source based on your experiences should identify your best options. I hope you find it useful.

    Neighborhood and Facility Research

    Before you visit, get a feel for the neighborhood you are considering.

    Determine if the neighborhood is generally safe or if the facility is in a high crime area.

    Trulia.com and NeighborhoodScout.com have tools to help you evaluate neighborhood environments and safety rates.

    Local police precincts canalso be helpful.

    Checking Reviews and Feedback

    What are others saying about this provider in reviews?

    Can you find any information about the provider through the Better Business Bureau or your local Area Agency on Aging?

    Read both positive and negative reviews by these bureaus as well as reviews from the community.

    Online Research for Additional Information

    Check the websites and Facebook pages of each facility for reviews.

    Often there is a compilation of comments from those with experience with the facility, its services (including the availability of religious services), and personnel.

    Note responses or explanations that address specific issues raised: and also note if nothing is explained.

    Gathering Materials for Your Visit

    Gather online materials from the facilities you are interested in visiting, such as:

    • A sample admission contract.
    • Copies of the Resident Bill of Rights.
    • The most recent survey results from state regulatory inspectors.
    • A recent list of weekly activities and events.
    • Menu of meals and snacks.
    • Visiting hours.
    • Rules allowing overnight guests (e.g., a family member from out of town).

    These documents will be helpful in generating specific questions for your tour.

    Compare what is described with what people are saying in their reviews.

    First Impressions Matter

    On the way in, take notes on your initial impressions of the neighborhood, parking options, whether the grounds are clean and well kept, etc.

    Do you feel safe getting out of your car?

    Facility Design and Layout

    Upon arrival, be aware that assisted living and nursing home care designs will vary.

    Assisted living environments typically offer a more homey feeling with a variety of amenities throughout the facility, as many residents are ambulatory.

    Nursing homes may be more hospital-like, with the need to have amenities surrounding the patient.

    You may have to adjust your expectations based on the level of care needed.

    That said, hallways should be easy to navigate, with hand rails and plenty of room for wheelchairs, and patient comfort and security needs should be a priority in both.

    Observing the Facility’s Sound Atmosphere

    Use your senses. What sounds do you hear throughout the facility? Pay attention to:

    • Resident activity. Do you hear residents chatting and laughing, or are there sounds of yelling and distress?
    • Staff communication. Is staff interaction respectful and welcoming?
    • Noise levels. Excessive noise can be a red flag. A balance of quiet and activity is ideal.
    • Announcements and alarms. Frequent alarms can be stressful.
    • Music and entertainment. Pleasant sounds enhance the environment.

    Assessing the Facility’s Cleanliness Through Smell

    What smells do you notice throughout the facility?

    • Common areas. Should smell clean and fresh.
    • Dining areas. Should smell appetizing, not like garbage or chemicals.
    • Laundry areas. Is laundry done consistently?
    • Pet areas. If allowed, are they well-maintained and odor-free?

    Evaluating Staff and Tour Guide Interaction

    Do you like your tour guide? Are they listening? Do you feel pressured? Do they include your loved one in the conversation? Can you speak with other staff?

    • Personality. Are staff friendly and professional?
    • Expertise. What training do they have? What’s the turnover rate?
    • Staff ratio. Are there enough staff for the number of residents?
    • Background checks. Are they performed before hiring?
    • Physician rounds. How often do doctors visit?
    • Emergency preparedness. What’s the facility’s plan?

    Note: Tour Guide’s Limitations. They may not know all the answers, but they can refer you to someone who does.

    Note: Regulatory Compliance. Nursing homes are governed federally and by the state; assisted living is state-regulated. Ask for staff-to-resident ratios and regulatory details.

    Observing Subtle Signs and Unspoken Issues

    Be aware of what isn’t said:

    • Resident activities. Are staff engaging residents meaningfully?
    • Activities director. Can you speak with them or see the schedule?
    • Personal items. Are they visible in rooms?
    • Signs of abuse or mistreatment. Look for warning signs.
    • Staff behavior. How do they treat residents?
    • Response to requests. Is staff responsive?
    • Understaffing concerns. Do staff seem overworked?
    • Social isolation. Are some residents isolated?
    • Food quality and cleanliness. Are meals clean and nutritious?
    • Bedsores. Ask how they prevent and manage them.

    Final Thoughts

    Finding a facility doesn’t guarantee a permanent placement. Evictions can happen — more on that in a separate article.

  • When Plans Change: Alternative Living Situations for Seniors (Part 1)

    When Plans Change: Alternative Living Situations for Seniors (Part 1)

    One of the most difficult decisions we may need to make as we age—among the many that we have to make as we face the limitations of our life—is how to provide care for ourselves and our loved ones.

    How well we care for ourselves and others depends on our strengths. As we age, our ability to do this well may be challenged. While most prefer to stay in their own home for as long as they can, there may come a time when it’s no longer safe or comfortable to do so.

    You may need to find alternative living places for yourself and/or for those you are responsible for. Options you never considered before may be the ones we have to evaluate now.

    This article is an overview of choices and an evaluative guide to help you make the decision of a residency that best meets those in need. There are no verifiably ‘right answers,’ rather factors to consider when making your choices.

    Part I of this topic provides an overview of the types of facilities that operate; Part II (next month) provides a checklist of questions to ask as you sort through your options. I hope you find it useful.

    Understanding the Level of Care Required

    To begin, talk with your physician, nurse practitioner, or physician’s assistant; it is critical to understand the level of care required. This diagnosis and its anticipated progression will determine what to look for in a facility, how much the recommended care will cost, and how you will fund your choice.

    Be aware that health conditions will likely change over time and the solution that is viable today may need to change with it.

    Successful living and care arrangements can be found within each option. Knowing how these options differ and the cost implications of each can help you make a good decision.

    Comparing Aging Care Facility Provider Options

    Here’s what you can expect from assisted living vs. nursing home vs. memory care facilities.

    Assisted Living

    Assisted living facilities provide a supportive environment with a focus on independence, offering less intensive care compared to nursing homes and memory care.

    • Services Offered: Preparing meals, recreational activities, transportation, help with medication, and assistance with activities of daily living.
    • Level of Care: Does not offer round-the-clock care.
    • Rules and Regulations: Governed by individual states; laws vary by location. There are no comprehensive federal regulations.
    • Living Arrangements: Shared and private rooms are available, with facilities ranging in size from small with as few as five beds to large with several hundred beds. Common areas provide opportunities for socialization, and safety/security measures are emphasized.

    Nursing Home

    Nursing homes offer comprehensive medical and personal care, providing more extensive support and 24-hour nursing care than assisted living or memory care.

    • Services Offered: Continuous medical care, rehabilitation services (including physical, occupational, and speech therapy), medication management, meals, social and recreational activities, assistance with daily living activities, and palliative and hospice care.
    • Level of Care: Provides 24-hour nursing care, suitable for both short-term and long-term care.
    • Rules and Regulations: Regulated by the federal government with consistent laws across states. Nursing homes are certified to provide services to people with Medicare and Medicaid. They are highly regulated in terms of licensing, certification, inspections, staffing, resident rights, and health and safety standards.
    • Living Arrangements: Offers shared and private rooms with common areas. Emphasis is placed on safety and security measures.

    Memory Care

    Memory care facilities specialize in providing structured, safe environments tailored to individuals with memory impairments, offering more specialized care than assisted living and more focused supervision than nursing homes.

    • Services Offered: Assistance with bathing, dressing, eating, and other activities. Care plans are individualized to meet the specific cognitive and physical needs of each resident.
    • Level of Care: Continuous supervision and security are provided, with staff specially trained to handle the unique challenges of dementia and Alzheimer’s.
    • Rules and Regulations: Memory care facilities are generally licensed by state health departments or aging services departments, with additional federal laws on safety and well being. States have specific licensing requirements, including staff qualifications, training, facility standards, and care protocols.
    • Living Arrangements: Shared and private rooms with common areas designed to minimize confusion. Emphasis is placed on safety and security measures.

    Cost Considerations

    The choice of a type of facility cannot be made primarily on cost, and any report of average costs can be misleading. Though there is a good deal of overlap of services, each type of facility (assisted living, nursing home, memory care) reflects a different model of care and offers different levels of care.

    That said, there are many additional factors that influence costs, including, but not limited to:

    • The part of the country the individual lives in.
    • Private vs. shared room accommodations.
    • Special needs that must be met.
    • If the services are governed by state regulations, federal regulations, or some combination of both.

    Typically, assisted living costs less because seniors receive less care and less support is required. Nursing homes typically cost more due to the constant skilled care provided. Memory care options tend to fall in the middle of this price continuum.

    Generally, within each type of facility:

    • Level I care refers to basic care.
    • Level II is enhanced care/longer-term care, which can add up to $2K per month.
    • Level III care is specialized care and can add an additional $2–$3K per month.

    Quality of Care

    To identify the quality of care provided, you must visit the facility—not just once, but a couple of times across days and times.

    While a paper view of options can help initiate a review of your choices, nothing can communicate the quality of care to be expected better than a visit and conversations with the staff you would be typically interacting with and the individuals that reside there.

    Locating Resources

    The task is challenging. The approaches listed below can help identify available options in this area. That said, there are relatively few facilities in our area. I suggest that you network through as many as possible and isolate the ones that come closest to filling your need. Depending on your time frame, you may need to search beyond this geographic area for an appropriate choice.

    Local and Governmental Agencies

    • The Pine Knoll Shores Council on Successful Aging maintains a list of options for the Morehead City area. We can be reached through our website: PKS Council on Aging, by email [email protected], and phone 252-726-1986.
    • In Carteret County, the Leon Mann, Jr. Enrichment Center maintains a source book of agencies in the county. The Center is located at 3820 Galantis Dr., Morehead City, NC 28557, phone: 252-247-2626. They are open Monday through Friday from 8 am to 5 pm.
    • The Eastern Carolina Council (ECC) is a multi-county, local government, planning, and development organization ([email protected], phone: 252-638-3185). The ECC (specifically the ECC’s Area Agency on Aging Department) is a conduit between local governments in our region and state/federal partners.

    Online Clearinghouses

    Clearinghouses for patients and families can be found online. The value in using the clearinghouses is that they try to maintain the most current lists and easily allow comparisons across options.

    Here are some tips if you use this approach:

    • Searching Online: If you are searching for local assisted living facilities, enter prompts in your browser for assisted living facilities in the Carteret County area to reach these sites. If memory care options are not listed with the assisted living contacts, you can confirm the availability of this type of care when you call. As assisted living options are governed by each state, you must enter your zip code and answer several questions to obtain the list.
    • Clearinghouses: Be aware that many clearinghouses for assisted living options are compensated by the referrals they generate. Providing them with personal information is a catch-22: your personal needs guide the choice of options but also can invite a variety of follow-up phone calls.
    • Nursing Home Search: If you’re exploring nursing homes, Medicare offers a searchable website called Nursing Home Compare, where you can find and analyze nursing home options in your area.
    • Review Local Options: If you are familiar with the names of local options across resident types by name/reputation, a thorough review of their websites should provide enough information to generate a list of questions that can be addressed with a phone call and in-person visit.

    Final Considerations

    If your search leads you to an acceptable choice, but your need is not immediate, consider putting your name on a waiting list as options are limited.

    The importance of visiting each facility you are considering cannot be overstated. Part II provides a checklist of questions and factors to consider as you sort through your options. These are questions you should ask yourself and your family, as well as the professionals and residents in each facility. I hope you find it useful.

  • Estate Planning: Some Actionable Items

    Estate Planning: Some Actionable Items

    I believe it is fair to say that many of us have experienced the loss of close relatives and friends who, for perhaps many reasons, never got around to making a will. And the subsequent fallout from this lack of planning may have created complications for those remaining relatives and friends who hadn’t a clue as to the person’s final wishes.

    Estate planning forum

    On Thursday, April 25, 2024, our Council hosted a forum at PKS Town Hall to provide us with an overview of the estate planning process. Guiding us through the questions to be asked, and decisions to be made in creating a detailed plan, we were pleased to welcome Andrew Foster, Attorney from the Law Firm of Harvell and Collins, P.A.

    Mr. Foster began by listing the various documents necessary for a properly executed estate plan. These documents, with brief definitions, include:

    Last Will & Testament (LW&T)

    This is your declaration as to where your assets will go when you die. The LW&T identifies an Executor, a trusted person to whom you confer a fiduciary responsibility to carry out your decisions.

    Durable General Power of Attorney

    This establishes an Agent, a person you designate to act for you in managing your financial and other personal affairs in the event you become unable to do so.

    Health Care Power of Attorney

    This establishes a Health Care Agent, a person you designate to make health care decisions for you in the event you become unable to do so.

    Health Insurance Portability and Accountability Act (HIPAA) Release

    This item designates a person or persons who have your permission to access your health care records.

    Declaration of Advanced Directives for a Natural Death (Living Will)

    Perhaps one of the most thought-provoking of these documents. This provides your health care providers with directions about prolonging your life in the event you experience a terminal and incurable condition, a persistent vegetative state or advanced dementia.

    How to set up these documents

    As these are considered legal documents, it is prudent to seek advice from legal counsel. Establishing a relationship with an attorney who specializes in the practice of estate planning can serve as an invaluable resource in guiding your decisions.

    Estate planning checklist

    Preparing an Estate Planning Checklist is a good place to start your conversation with counsel, and should at least include:

    • An inventory of your assets, including home and land, cash, stocks, bonds, etc. with type of ownership (individual or joint).
    • An inventory of all life insurance policies, IRAs and annuities held, and include beneficiary designation forms filed.
    • A listing of debts and liabilities.
    • A list of your heirs, such as your spouse, children, parents, other relatives, friends, charitable organizations.
    • The name of an Executor, the trusted person who will carry out your decisions in a responsible manner.
    • The name of the person who will serve as Executor, Trustee and Guardian if there are minor children.

    While this list is a very objective, matter-of-fact approach to planning for the future disposition of your possessions, it is most important to communicate this plan to those who will be your heirs—or not. Conversations concerning your wishes are awkward and can be very emotional, but they are crucial to a well-executed estate distribution.

    Final thoughts

    Mr. Foster provided examples of successful estate plans, and some that weren’t so successful. His presentation was videotaped and can be found on our pkscouncilonsuccessfulaging.com/ website. I encourage you to view it. The information he shared can help in guiding your declarations.

    Your Pine Knoll Shores Council on Successful Aging will continue to identify topics and resources to connect you, our residents, with solutions to aging gracefully in place. Please share your experiences and ideas with us.

  • Estate Planning Checklist: What You Need to Know

    Estate Planning Checklist: What You Need to Know

    By Ann Bures, Guest Columnist

    I believe it is fair to say that many of us have experienced the loss of close relatives and friends who, for perhaps many reasons, never got around to making a will.

    The subsequent fallout from this lack of planning may have created complications for those remaining relatives and friends who hadn’t a clue as to the person’s final wishes.

    On Thursday, April 25, our Council hosted a forum at PKS Town Hall to provide us with an overview of the estate planning process.

    Guiding us through the questions to be asked and decisions to be made in creating a detailed plan, we were pleased to welcome Andrew Foster, Attorney from the Law Firm of Harvell and Collins, P.A.

    Essential Estate Planning Documents

    Mr. Foster began by listing the various documents necessary for a properly executed estate plan. These documents, with brief definitions, include:

    • Last Will & Testament (LW&T): This is your declaration as to where your assets will go when you die. The LW&T identifies an Executor, a trusted person to whom you confer a fiduciary responsibility to carry out your decisions.
    • Durable General Power of Attorney: This establishes an Agent, a person you designate to act for you in managing your financial and other personal affairs in the event you become unable to do so.
    • Health Care Power of Attorney: This establishes a Health Care Agent, a person you designate to make health care decisions for you in the event you become unable to do so.
    • Health Insurance Portability and Accountability Act (HIPAA) Release: This item designates a person or persons who have your permission to access your health care records.
    • Declaration of Advanced Directives for a Natural Death (Living Will): Perhaps one of the most thought-provoking of these documents. This provides your health care providers with directions about prolonging your life in the event you experience a terminal and incurable condition, a persistent vegetative state, or advanced dementia.

    As these are considered legal documents, it is prudent to seek advice from legal counsel. Establishing a relationship with an attorney who specializes in the practice of estate planning can serve as an invaluable resource in guiding your decisions.

    Preparing an Estate Planning Checklist

    Preparing an Estate Planning Checklist is a good place to start your conversation with counsel, and should at least include:

    • Inventory of Assets: Including home and land, cash, stocks, bonds, etc., with type of ownership (individual or joint).
    • Inventory of Insurance Policies and Retirement Accounts: Include life insurance policies, IRAs, annuities held, and beneficiary designation forms filed.
    • Listing of Debts and Liabilities: This includes a detailed record of all outstanding financial obligations, such as loans, mortgages, credit card balances, and other liabilities.
    • List of Heirs: Such as your spouse, children, parents, other relatives, friends, charitable organizations.
    • Name of Executor: The trusted person who will carry out your decisions responsibly.
    • Designation of Roles: The person who will serve as Executor, Trustee, and Guardian if there are minor children.

    While this list is a very objective, matter-of-fact approach to planning for the future disposition of your possessions, it is most important to communicate this plan to those who will be your heirs, or not. Conversations concerning your wishes are awkward and can be very emotional, but they are crucial to a well-executed estate distribution.

    Learning from Experience

    Mr. Foster provided examples of successful estate plans and some that weren’t so successful.

    His presentation was videotaped and can be found on our pkscouncilonsuccessfulaging.com/ website. I encourage you to view it. The information he shared can help in guiding your declarations.

    Conclusion

    Your Pine Knoll Shores Council on Successful Aging will continue to identify topics and resources to connect you, our residents, with solutions to aging gracefully in place. Please share your experiences and ideas with us.

  • It Does Take a Village: Navigating Dementia Care

    It Does Take a Village: Navigating Dementia Care

    As we age, many of our conversations turn to reports of our physical well-being as our ailments or disabilities can seriously disrupt our ability to function on our own. The inability to take care of ourselves impacts those around us, which is particularly challenging in the event of a dementia diagnosis.

    When a loved one presents with dementia, you both need to prepare yourselves for the journey forward as best as you can. You will be faced with challenges you may not have imagined, and many decisions will be yours alone.

    As every situation is unique, there is no one answer or set of solutions that will work for everyone. Hopefully, these thoughts can at least begin the discussion.

    Prepare yourself

    If you haven’t done so already, a first step in the process of identifying your options is a frank discussion with a trusted family physician. If he/she confirms the diagnosis of Alzheimer’s, Parkinson’s or dementia, you will need to:

    • Understand the basis of the diagnosis,
    • Know the stage of dementia you are dealing with,
    • Have an idea how rapidly the disease is progressing,
    • Have a complete grasp of what medications are being given, and
    • Know what you can expect in the short and long term.

    A medical diagnosis of dementia is valuable when speaking to support agencies.

    You also need to be honest with yourself and other family members, especially if you are committed to being an at-home caregiver. Currently, there is no cure for dementia.

    Questions to ask a provider

    Many family members choose to take on caregiver responsibilities, particularly in the early stages of the development of symptoms.

    As the disease progresses, however, continue to ask yourself these questions:

    • Do you have the skills and tools to take care of someone in this stage of dementia?
    • What, if any, changes do you need to make your home safe and comfortable (such as space for a hospital bed or grab bars in the bathroom/shower)?
    • As the disease progresses, can you keep up with the demands of care—physically, emotionally, mentally and financially? No two days will be alike. A good day today does not mean it will be a good day tomorrow.
    • Do you have friends/family you can rely on to help?
    • Is there someone who calls regularly to check on you?
    • Are you prepared to make different decisions if in-home care becomes more difficult to deliver?

    Keep your knowledge of resources current. It is o.k. to change your mind as you gain new information and updated experiences. Keep a good record (with dates) of developments to enable you to look back and see a realistic picture of how things are progressing. Keep yourself healthy. (I am reminded of the pilot’s directive to place their oxygen mask on first and then help those nearby.)

    Local resources that can help

    Some have asked for a list of services that can guide a dementia caregiver. I agreed to put one together and summarized what I have found available in Carteret and Craven counties.

    You may not be surprised to know that these types of resources, especially in Carteret County, are limited. Many did not survive the widespread shut down of person-to-person services during COVID and are just now trying to restart/restaff.

    Even though I contacted many of these agencies before listing them to confirm the phone number and that the receptionist could answer some basic questions, I strongly suggest that you do the same. You know your situation in far greater detail, and you are in the best position to determine what will work best for you.

    List of resources

    The list of resources appears on our website at pkscouncilonsuccessfulaging.com/. Please note that the Council on Successful Aging does not endorse any of the providers listed.

    The information included is thought to be reliable, but is not guaranteed to be accurate. It is compiled from provider descriptions of their own services as well as other public data sources and is subject to change without notice. It is organized by type of service; many services are not mutually exclusive.

    I strongly encourage you to explore these services, talk to participants and evaluate the benefit to you and those for whom you are caring.

    The list covers these content areas:

    • Caregiver discussion groups (in person as well as virtual)
    • Patient support groups, including Memory Cafes
    • In-home nonmedical patient care
    • In-home medical patient care
    • Local physician specialists
    • A review of tech tools that can help to preserve a quality of life

    The initial list of resources covers nine pages, and the landscape of services for those with dementia and their caregivers is not easy to navigate. If you do need assistance, consider engaging a patient advocate to help you sort through the options, especially as the disease progresses.

    The most recent forum offered by the Council on Successful Aging showcased the work of the patient advocate. See “Who Will Care for You?” by Ann Bures on our website or in the April 2024 issue of The Shoreline.

    Author’s notes

    This list of resources was compiled to guide you in your search for information and is not intended to be exhaustive. No church groups were included in these selections, though it may be worthwhile to ask if your church offers these types of resources.

    Further, there are no Veterans Administration-specific services listed here. Home Helpers in Morehead City (listed under In Home Nonmedical Patient Care) has a current, strong relationship with the VA and can help you explore these benefits. Call 252-622-4690 for details.

    Be aware that there are numerous online articles on a wide variety of topics related to caregiving and understanding the progression of dementia. One place to start is with carterethealth.org. Just search for the condition you want to learn about.

    Alternatively, an internet search for a specific organization (Dementia Alliance of NC, Alzheimer’s Association, etc.) or for a specific topic (dementia caregiver support in NC, etc.) will yield information that may be useful.

  • Who Will Care for You?

    Who Will Care for You?

    In her 2024 Shoreline inaugural article, Council on Successful Aging (COA) Chair Cindy Schersching challenged us to “Talk to Me” about the issues that matter most. We responded by countering with the above title to this article.

    On Thursday, February 15, our council hosted a forum at the Pine Knoll Shores town hall that challenged us to review our personal healthcare decisions. To help us sift through the myriad of choices we have to make, we engaged a pioneer in the field of patient advocacy, Certified Patient Advocate Marilyn Whitley, MSN, RN to direct the conversation.

    This discussion begins by asking ourselves several questions:

    • What health problems do I have (diabetes, high blood pressure, lung problems, arthritis, or something else), and to what stage has the disease progressed?
    • How am I being medically treated for these conditions at this time (medication, physical or occupational therapy, or some other approach)?
    • How am I responding to the treatment prescribed? Do I feel any better, and, if not, how do I communicate this information and ask the right questions of my healthcare provider to achieve the best relief for me?

    Enter the patient advocate.

    This individual can be a family member, friend or anyone who can “plead on behalf of another” (Webster’s II New College Dictionary).

    The important point is to choose someone with whom you can comfortably and honestly discuss these issues.

    The goal of the exchange is for you to make decisions regarding your plan of care based on your needs and preferences. Once decisions are made, your plan must be communicated to all of those involved.

    Ms. Whitley outlined the various steps that a patient advocate can take to help you understand your health issues and prepare the necessary questions to help you make informed healthcare decisions. The patient advocate plays a critical role in:

    • Communications with your healthcare team (e.g., interpreting medical terminology related to your treatment);
    • Using the Electronic Health Record (EHR) to perform such activities as scheduling appointments, reviewing tests completed and developing questions to guide you in understanding test results as well as medications or treatments that may be prescribed; and
    • Helping you enroll in medical insurance programs such as Medicare, Medicaid and supplemental insurance plans that best meet your financial situation—as well as how to appeal a denial of service.

    Perhaps even more important than being an interface with complicated healthcare and insurance agencies, a patient advocate addresses the many personal and emotional barriers that you can face in managing your healthcare needs at a time when you may be the most vulnerable.

    These may include your own physical illness or physical limitations, family or friends unable or unwilling to assist in your care coordination, transportation limitations, or other stressful situations within your personal life impeding your ability to stay healthy.

    A patient advocate is a valuable resource that you can involve as much as or as little as you need for your situation.

    They are a second pair of eyes and ears working on your behalf.

    There are several avenues available to seek out the support of a certified patient advocate, including, but not limited to, an internet search, word of mouth from a trusted source, or consultation with your primary care provider or hospital discharge planner.

    Once you have completed your search, be sure to gather together any documentation concerning your health issues to provide to the patient advocate in your initial consultation.

    This will assist in developing your contract and a Plan of Action tailored to your individual needs.

    Your Pine Knoll Shores Council on Successful Aging will continue to identify topics and resources to connect you, our residents, with solutions to aging gracefully in place. We invite you to share your experiences.

    Note: A certified patient advocate is an individual who has a commitment to patient and healthcare advocacy and has achieved a professional certification through the Patient Advocate Certification Board.

  • Star Light, Star Bright: Light Pollution in Pine Knoll Shores, NC

    Star Light, Star Bright: Light Pollution in Pine Knoll Shores, NC

    When I walk out of the house at night, I look up at the stars. I’ve done this most of my life. It is still awe inspiring.

    We’ve found ways to connect the stars into recognizable shapes in our minds; we give these shapes names like the Big Dipper and Orion.

    We tell stories about them.

    The stars have led sailors from shore to shore, expanding our awareness and knowledge of our planet, while the shape and glow of the moon lights our surroundings.

    Science and satellites have given us a new understanding about their place in the skies. Whether we romanticize them or just see them as configurations of heat and dust, the moon and stars are part of our environment that we are drawn to.

    Natural light cycles have defined our days and nights as well as the ecosystems surrounding us for all of known history.

    We are especially aware of this beauty surrounding us in Pine Knoll Shores.

    As we become more civilized, and with few alarms raised, artificial light has slowly transformed our nights into brightly lit days.

    While 24-hour days have led to employment opportunities, reduction in crime, more travel opportunities, etc., current lighting practices have negatively impacted human life as well as the environment.

    Artificial light pollution

    Light pollution has not been regarded as an important issue until lately. According to the World Atlas of Night Sky Brightness, more than 80% of the world’s population—and 99% of Americans and Europeans—live under a diffuse glow that scatters back from the sky when light is directed upward or is incompletely shielded from the ground.

    This sky glow can be visible from great distances, disrupting visibility and jeopardizing our health and our ecosystems.

    Light pollution in all of its forms disrupts the natural circadian rhythms of living organisms.

    Exposure to artificial light at night can interfere with the production of melatonin, which can lead to sleep disorders, mood disorders, obesity, diabetes, cardiovascular diseases and some cancers.

    Light pollution affects the behavior and survival of wildlife, especially nocturnal animals that rely on darkness for hunting, foraging, migration, reproduction and communication.

    Artificial light can attract, repel, confuse or blind animals, making them more vulnerable to predators, competitors or human activities.

    Light pollution affects the growth cycle of plants as well as their pollinators. In addition, when used indiscriminately, artificial light wastes money and energy and is believed to contribute to climate change.

    Bring back the dark sky

    There are several organizations working to reduce light pollution. One of these is the U.S.-based International Dark Sky Association (IDA), formed in 1988 to preserve the natural night sky.

    IDA educates the public and certifies parks and other places that have worked to reduce their light emissions.

    It is worth noting that the Carteret County Board of Commissioners endorsed a Dark Skies resolution, and the application, for certification of Cape Lookout National Seashore as an International Dark Sky Park was successfully completed in December 2021.

    It is the first certified Dark Sky Place on the east coast.

    Currently, a resolution is before the Pine Knoll Shores Board of Commissioners asking for guidance and assurances that responsible outdoor lighting practices are in place.

    These include the use of shielded fixtures, low-intensity lighting and efficient technologies that minimize light spill and glare.

    These tools help preserve the integrity of the night sky while ensuring public safety and security.

    The commissioners have asked the Planning Board to look into measures to promote low-intensity lighting, etc. and report on their findings.

    This opens a discussion in the community on light pollution, why we need to reduce it and simple ways to accomplish this.

    This effort is not about telling people they have to turn off all outside lights at night or that all outside lighting must be replaced. This is not about politics. It is about our quality of life.

    This resolution is consistent with our town’s heritage:

    • Alice Hoffman, an early resident and land owner on Bogue Banks, was a conservationist in the way she managed her property that later provided the foundation land for the development of Pine Knoll Shores by her heirs (the Roosevelt Trust).
    • We are a recognized Tree City, respecting the maritime forest and trees growing in residential development spaces as well as a turtle sanctuary with regulations defining areas along ocean-facing nesting habitats for sea turtles;
    • The resolution acknowledges that the detrimental effects of light pollution extend beyond maritime forests and trees and nesting sea turtles to the broader quality of island life by impacting human health, public safety, astronomical observations, energy security and global climate.

    I encourage you to support a light management plan that will reduce light pollution and preserve the integrity of our valued natural ecosystems through advocacy, education and the proper application of lighting principles.

    Let me and/or our town officials know your thoughts.

    While the Dark Sky principles are consistent with our community’s interest and definition, we are not asking for certification.

    Sources: DarkSky.org; Dark Sky International with the Illuminating Engineering Society (9/2023); EarthEclipse.com; Carteret County Board of Commissioners, regular session, Sept. 21, 2020.