South Jersey Senior Fall 2011

FALL

2011

Five Real estate tax BeneFits SeniorS Should Be Taking advanTage of in new JerSey

BeaT Back Pain W itHOUt sURgeRy

nurSing reSidenT righTS and Family RespOnsiBilities

ToP 5 ThingS tO lOOk FOR WHen CHOOsing a financial adviSor

UnderstAnding sLeep disorders

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President/editorseth Auerbach856-240-5001

[email protected]

Ceo/CreAtive direCtorMichelle Helfrich

856-912-9930 [email protected]

Advertising [email protected]

Advertising [email protected]

ProduCtionseth Auerbach

Contributing Writers

dana e. bookbinder, esq.

scott J. Ciocco, esq.

Janie de leon-Male, M.s.s., l.s.

laura l. ergood, esq.

esther greenberg

bonnie Joffe

Nancy Keiluhn

Mary Kate Kennedy

steven Kirshner, Md

Celisse lundy

Katherine nuyens

AJ rastogi, Md

Michele M. Schreck

Kieran slevin, Md

donna sobel

Paul J. tully

liz Worthington, rn

ProPerty taxes Got you Down? ...................................... 3

Know where imPortant Documents are before you neeD them ............................................... 4

beat bacK Pain without surGery ..................................... 5

Gamma Knife-brain surGery without an incision ............................................................................. 6

nursinG resiDent riGhts anD family resPonsibilities ............................................... 7

massaGe can be a natural solution to many ailments .............................................................. 10

Don’t Get hurt shovelinG snow: tiPs to avoiD inJury ........................................................... 11

what is your outlet? hobbies for healinG, health & haPPiness .................. 12

what you shoulD Know about osteoPorosis ......... 14

why Downsize? who will helP with this transition? .................................................................. 18

DePression anD the other aDult ................................. 19

who will inherit my worlDly Possessions? .............. 20

naviGatinG throuGh the DreaDeD meDicare “Donut hole” ...................................................................... 21

toP 5 thinGs to looK for when choosinG a financial aDvisor ........................................................... 23

we choose to love or fear every Day ........................ 24

acute inPatient rehabilitation – when it comes to restorinG inDePenDence ............. 25

home infusion theraPy – shorteninG the time frame between hosPital to home .............. 26

six reasons to choose an inDePenDent livinG facility DurinG this economy ........................... 28

unDerstanDinG sleeP DisorDers ................................... 30

one more huG ..................................................................... 35

Fall 2011

(continued on page 13)

then apply for a reimburse-ment of the difference between the amount of property taxes they paid for the base year over the amount they paid in future years. residents applying for the 2010 reimbursement must have total income for both 2009 and 2010 that is $70,000 or less and meet other requirements. Complete eligibility require-ments and the necessary forms can be found at www.state.nj.us/treasury/taxation/prntfrez.sht-ml. the filing deadline for 2010 applications has been extended to october 31, 2011.

Homestead Abatement

seniors age 65 or older may be eligible for a 2010 new Jersey homestead benefit. the applica-tion for this benefit is typically sent to you in the mail or elec-tronically. generally, to qualify

Real estate taxes have become one of the greatest bur-dens for seniors in new Jersey today. even seniors who have long paid off their homes find themselves buried with rising costs in a time of declining ben-efits. if you are a senior and own a home in new Jersey, these are five items you should consider if you are looking at reducing your state property tax burden.

Senior Freeze

the senior Freeze program is a program that effectively freezes eligible seniors’ real estate taxes (or eligible trailer park rental payments) at their current lev-els. in order to take advantage of this program, eligible seniors must file a form to establish a “base year” against which future real estate tax increases will be measured. eligible seniors may

Property Taxes Got You Down? Five Real Estate Tax Benefits Seniors Should Be

Taking Advantage of in New Jersey By Scott J. Ciocco, Esq.

you must have owned and occu-pied a home in new Jersey that was your principal residence on october 1, 2010 and have new Jersey gross income for 2010 of $150,000 or less before exemp-tions and deductions (includes single or combined married or civil union, but excludes income that is not subject to new Jersey gross income tax such as social security), and the home must have been subject to and paid local property taxes in 2010. if you did not receive a 2010 Homestead benefit Applica-tion Packet, or if you have any questions about the program, you should call the division at 1-888-238-1233. the deadline for filing is october 31, 2011.

Annual Property Tax Deduction for Senior Citizens

new Jersey offers an annual property tax deduction of up to $250 for homeowners age 65 or older who meet certain income and residency requirements. in order to be eligible for this bene-fit, annual income (including any spouse/civil union partner com-bined) may not exceed $10,000 after a permitted exclusion of social security and certain other benefits. the forms for claim-ing this benefit can be found at www.state.nj.us/treasury/taxa-tion/pdf/other_forms/lpt/ptd.pdf.

Five Year Property Tax Abatement

Many seniors are often faced with the decision or prospect of moving in with a relative or inviting a relative to move in with them. if you or a loved one

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your parents’ specific health histories.

2. Birth dates. often medical records and insurance infor-mation are cataloged accord-ing to birth date. this can improve communication in an emergency or a crisis.

3. list of allergies. this is especially important if one of your parents is allergic to medication — penicillin, for example.

4. advance directives. An advance directive is a legal document that outlines a person’s decisions about his or her health care, such as whether or not resuscitation efforts should be made and the use of life-support ma-chines.

In august of 2008, my father was rushed to the emergency room for displaying stroke-like symptoms. i shudder at the thought of receiving another emergency phone call. but, one can never be too prepared for a medical emergency.

According to the Mayo Clinic’s website, below — in order of im-portance — is a list of 10 things you should know about your par-ents:

1. Names of their doctors. if you don’t know anything else, this is probably the most important piece of informa-tion. Why? Chances are good that your parents’ doctors can provide much of the rest of the information needed as well as more details about

5. Major medical problems. this includes such conditions as diabetes or heart disease.

6. list of medications and supplements. it’s especially important that a doctor know if your parent uses blood thinners. it’s also important for your doctor to know if your parents take any vitamin or herbal supplements that might interact with medica-tions given in an emergency situation.

7. Religious beliefs. this is particularly important in case blood transfusions are needed.

8. Insurance information. Know the name of your par-ents’ health insurance provid-er and their policy numbers.

9. Prior surgeries and major medical procedures. list past medical procedures including implanted medical devices such as pacemakers.

10. lifestyle information. do your parents drink alcohol or use tobacco?

in addition to having access to the information above, my very good friend and colleague, Jerold e. rothkoff, reminded me that knowing our parents’ medical information is only one piece of the puzzle.

sometimes, our parents’ fre-quent hospitalizations will force us to think about alternative living arrangements, especially if our loved ones are unsafe to live alone in their own home.

Know where important documents are before

you need themBy Janie De Leon-Male, M.S.S., LS


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if you’ve ever suffered a bout of back pain, you know that relief can’t come quickly

enough. if you haven’t, well, unfortunately, chances are you will. virtua Pain & spine specialists AJ rastogi, Md & Kieran slevin, Md, are on the

front lines of treating pain, and in particular back

pain, everyday. Accord-ing to dr. rastogi,

“eighty percent of all men and women will ex-perience at least

one episode of significant back pain

in their lives.”

recent research confirms the widespread trouble caused by chronic pain. in late June 2011, the institute of Medicine pub-lished a report on chronic pain in America. the report brief begins with a startling revelation:

“Chronic pain affects an estimated 116 million American adults — more than the total affected by heart disease, cancer, and dia-betes combined. Pain also costs the nation up to $635 billion each year in medical treatment and lost productivity.”

“the findings of this report are all over the internet right now. they’re even being talked

about in Congress,” says dr. slevin. “this gives you an idea of how significant the issue is.”

Prevention, Prevention, Prevention

the old saying goes that an ounce of prevention is worth a pound of cure; dr. rastogi couldn’t agree more. “our goal should be to optimize back care on our own, with or without medical intervention,” he says. in the fight against back pain, “preventative care is hugely important.”

the following are a few tips for reducing risk factors and pro-moting a healthy back:

Lift with care

there is a right way and a wrong way to lift a heavy object. Wheth-er it’s a child, a grocery bag, or a piece of furniture, dr. slevin’s advice is the same: “Keep your back straight, and bend at your knees. When you lean forward to lift, you put the intervertebral discs in a very compromised position.”

Quit smoking

“it’s still not fully understood why, but nicotine has been shown to block some of the small blood vessels present in the lower back,” says dr. slevin. “this means smoking is a risk

Beat Back Pain WITHOUT Surgery


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gamma Knife® radiosurgery is surgery done without an incision or “knife”. it is a minimally inva-sive procedure which is done to treat benign and malignant brain tumors, vascular abnormalities, functional disorders, and ocular disorders. the Perfexion™, the latest gamma Knife model, is a safer, more comfortable model which provides superior treat-ment over other models. this

radiosurgery medical instru-ment uses 192 precisely target-ed beams of gamma radiation to painlessly treat the specific area with minimal effect on the surrounding healthy brain tissue. only diseased tissue of the brain and skull are targeted and treated, rather than the whole brain. the Perfexion gamma Knife machine uses radioactive cobalt-60 as gamma rays.

A specialized team that consists of a neurosurgeon, a radiation oncologist, a radiation physicist and a neurosurgery nurse are involved with the patient’s care and gamma Knife planning to ensure individualized treatment. All members of the team, experts in their field, are highly trained and experienced with gamma Knife treatment. this team also works closely in consultation with neurologists, neuro-oncolo-gists and primary care physicians depending on the diagnosis. this procedure involves a brief stay in an outpatient procedure area and the patient is treated in one session. usually, the patient can resume normal activities within 24-48 hours. there is mild seda-tion given, thus eliminating the risks, dangers, side effects, or adverse reactions of general anesthesia. there is no inci-sion to the brain which also eliminates the risks of surgical complications such as infection or bleeding in the brain.

the pre-treatment protocol in-cludes no eating or drinking after midnight, washing of the head and hair and avoiding all hair products. some medica-tions may be taken the morning of the gamma Knife procedure with a sip of water. the patient is required to change into a hospital gown upon arrival to the gamma Knife suite and asked to remove

Gamma Knife-Brain Surgery WITHOUT an Incision

By Liz Worthington, RN

(continued on page 16)6

the decision to place a loved one in a nursing facility is often fraught with apprehension and guilt. Families may feel as if they are abandoning their loved one, and their fears may be intensi-fied by stories of neglect in such facilities from our past genera-tion. Fortunately, in 1987, Con-gress passed the nursing Home reform Act as part of the omni-bus budget reconciliation Act of 1987, which sets standards for the dispensation of care and services to nursing home residents. the law applies to nursing homes (or portions of such homes) that participate in Medicare or Medicaid.

the nursing Home reform Act establishes three basic catego-ries of facility responsibilities: 1) quality of life; 2) quality of care; and 3) record keeping. the Act mandates that nursing homes

treat each resident “in such a manner and in such an environment as will promote maintenance or enhancement of the quality of life for each resident.” Moreover, the facilities must make reasonable accommo-dations to meet their residents’ individual needs and preferences. specifically, the Act requires that facilities must not allow their residents’ abilities to conduct the activities of daily living (eat-ing, bathing, dressing, toileting, dressing, and ambulating) to decline. residents must be able to attain or maintain their high-est practicable level of physical, mental, or psychosocial well-be-ing, and they should not develop pressure sores or new disabili-ties unless such conditions are unavoidable.

nursing facilities are required by the Act to periodically assess

each resident’s needs. this includes a comprehensive assess-ment prepared within two weeks of admission and a long range interdisciplinary care plan. the statute also requires the facility to maintain extensive records on the residents’ condition.

the Act specifies that each resident be given the right to:

1. be free from interference, coercion, discrimination, and reprisal for exercising rights

2. Access records

3. be fully informed in an understandable manner of his or her health status

4. be notified of these rights

5. if Medicaid eligible, be informed in writing of the items and services included in the Medicaid state plan

Nursing Resident Rights and Family Responsibilities

By Dana E. Bookbinder, Esq.


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24-36 hours after the injury, and then follow up with heat in the days that follow. A few words of caution: never put ice or a hot pack directly on the skin (al-ways use a barrier, such as a soft towel) and apply at intervals of 20 minutes on, 20 minutes off to give the skin a chance to recover.

toPicaL agents

Analgesic creams applied directly to the skin are another option for pain relief. “the camphor and menthol in products like bengay and the capsaicin (hot pepper derivative) in other over-the-counter creams present strong alternatives in treating back pain,” says dr. slevin. because they’re available at your drug-store without a prescription, they’re often a good starting point for self-care at home.

Braces

“there are some very high-end braces avail-able now, usually covered by insurance, that can be extremely effective in treat-ing back pain,” says dr. slevin. “one of my patients, an active, working woman who i’ve been treating for years and who recently tried a new, stiff brace, reported a 70 percent decrease in her pain thanks to that brace.” For patients concerned about their appearance while wearing a brace, dr. rastogi assures that “the newer braces being made are low profile, very comfortable, and do a great job of correcting posture and body mechanics.”

factor for low back pain in and of itself.”

maintain a heaLthy weight

Weight control is key in the man-agement of chronic pain. excess weight lends itself to additional stress on the back, as well as the hips and knees.

BuiLd a strong core

Patients should maintain a strong core by engaging in a sensible exercise regime. “Make sure your abdominal muscles are strong,” says dr. rastogi. “A cou-ple of sessions with a trainer to ensure proper form and intensity are a good investment of both time and resources.” He warns against pushing too hard or too fast in the gym, however; this can backfire and induce the injuries you’re working to avoid. As with any new exercise routine, it’s always a good idea to check in with your doctor first.

soLving Back Pain without surgery

even when you do everything right, an accident or a chronic issue can introduce back pain. the good news is there’s a lot you can do to treat back pain without invasive surgery.

Here are some tried-and-true methods drs. slevin & rastogi have employed on their patients:

ice/heat

An oft-prescribed and oft-over-looked method of treating pain, properly applied ice and heat can work wonders on an in-jured back. use ice for the first

despite the challenges we all face when it comes to maintain-ing healthy, pain-free backs, drs. rastogi & slevin are excit-ed about what the future holds. “Know that treating pain doesn’t have to mean surgery. there are advances being made in all facets of the spectrum, from the conservative modalities to the minimally invasive to the more sophisticated surgical proce-dures,” they say. “in 10 years of practice, we’ve seen revolu-tionary new approaches to pain treatment take hold. We’re able to help people get and stay more active, and that’s a beautiful thing.”

(continued from page 5)

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eldeRly Massage offers numerous benefits to senior citizens, which can greatly help to improve their health and well being. Just as with any other age group, massage has proven to be physically beneficial to the elderly.

Massage has shown to improve circulation of both blood and lymph, stimulate the nervous system, soften tight muscles, and enhance function of the diges-tive and respiratory processes. Administering touch can also increase appetites, decrease the need for pain medications, calm agitated states, promote restful sleep, and decrease post-surgical recovery.

but beyond the physical, mas-sage has a more emotional ben-efit -- to sweep loneliness away.

What Is Elderly Massage?Massage for elderly citizens is simply that, massage for the elderly, but it’s application is certainly different to massage for the younger population and the massage therapist needs to be knowledgeable of the physio-logical changes that occur in the ageing body. Massage techniques are different, pressure applied is certainly different and there must be great sensitivity shown to the receivers’ feedback to ensure the massage is comfort-able as well as effective.

A natural trend when we age is to become less active and this reduction in physical activity contributes to the reduction of the quality of life experienced by many of our senior citizens.

Many studies have shown that elderly massage therapy can be of significant benefit in manag-ing the effects of aging such as arthritis and a host of other physical ailments.

Although there is a general awareness of massage for elderly citizens, there is a poor under-standing of its direct benefits.

Benefits of Elderly Massage:• Massage for elderly citizens

helps to increase their range of motion.

• Also promotes natural joint lubrication, which is extremely important for arthritis sufferers.

• According to the touch research institute, elderly massage is very useful in the treatment of Alzheimer’s pa-tients. it has shown to facilitate relaxation and communication.

• boosts natural energy levels and mental awareness.

• Can also greatly improve posture by reducing muscle tension. this has the added benefit of assisting seniors with a higher quality of rest, and helps them to sleep deep-er and longer which can have a significant effect on their general health and well being.

• Can also have a profound calm-ing effect which in turn helps them to deal with medical interventions they may need to experience in dealing with various conditions.

• Helps to increase strength and muscle coordination.

• it can greatly assist in arthritic pain management.

Massage can be a

natural solution

to many

ailmentsBy Esther Greenberg


With winter time right around the corner it would be prudent to prepare yourself for the pos-sibility of snow removal with some tips on how to prevent musculoskeletal injuries while shoveling. shoveling snow can be very stressful on the low back and cardiovascular system especially if someone is not in the best condition or does not have proper technique with lifting.

Tips for snow shoveling• stretch first: Walk in place then

stretch your back, legs, and shoulders to get the muscles prepared for activity

• do not fill up the snow shovel to maximal capacity. take smaller loads and always bend at the knees not at the back.

• When moving snow, attempt to push it to the furthest point before you have to lift it. the spine does not do well with twisting motions coupled with forward bending. When you go to lift the snow, bend at the knees and keep the back straight as possible.

• try not to lift and twist. instead, try stepping in the direction you are shoveling the snow.

• use a snow shovel that has an offset handle that allows you to stand up straight while pushing and lifting the snow out of the way.

• take frequent breaks to rest and stretch.

• drink plenty of fluids.

• if possible, get a head start by clearing snow multiple times during a heavy snowstorm. it is easier to remove 2-3 inches of snow at a time rather than 6 inches at once.

• stretch your back, legs, and shoulders when you are fin-ished.

• stop if signs and symptoms of a heart attack are present. these may include left chest pain, left shoulder pain, fatigue, dizzi-ness, sweating, nausea, and/or shortness of breath. if you experience any symptoms of a heart attack seek medical help immediately.

if you have any questions about proper stretching and lifting techniques, please feel free to call us at 856-424-0993.

reference: www.apta.org/media/ releases. Accessed: 8/15/2011.

this article was provided by: Peter Caldiero, dPt specialized Physical therapy, llC, 1919 greentree road, suite b, Cherry Hill, nJ 08003. www.specializedphysicaltherapy.com

voted Courier Post best of south Jersey 2011

Don’t get hurt shoveling snow:

Peter Caldiero, dPt

Tips to Avoid injury

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dealing with the realities of breast cancer can be pretty unnerving for even the most optimistic individual. Many women, who are used to feeling a sense of control in their lives, find the uncertainty of a diagno-sis frustrating and frightening. it’s important both mentally and physically to find ways to take back some control, and one great way to do this is to find a hobby you love.

As children, most of us knew how to let go -- watching clouds, riding our bikes or playing make-believe. As we got older and took on adult responsibilities, that “permission slip” to just relax and feel happy-go-lucky may have gotten lost. now’s the time to find it again.

Whether you are in the midst of treatment, learning how to navi-gate in your new normal once treatment is done – or a long

term survivor just trying to stay healthy – there is no shortage of possible diversions.

go it alone, or get together

A hobby can be something you do alone, like creating jewelry, or something you do with a group like community theater. it can be a quiet activity like painting, or physically challenging like mountain biking.

think you’ve already exhaust-ed ideas for a possible hobby? think again! if you roll your eyes when someone mentions knitting, or fall asleep when a friend talks about their stamp collection, there is hope for you yet. Perhaps you’ll find your niche by getting interested in astrology. or maybe you would enjoy collecting vintage clothing. one woman likes to take cut-outs from vintage clothing and sew them onto jeans so she can

what is your outlet? hobbies for healing, health & happiness

create a look that is uniquely her own.

ballroom or modern dance not your cup of tea? try reaching a little further from your own “normal” How about learning how to belly dance instead? one woman collects holiday themed underwear! stranger still is another who decided she would highlight all words in everything she ever reads that end in ‘tion’ (remember, we told you there is a hobby for everyone)!

Activism can light your spark

Many survivors decide to become involved in the fight to fund breast cancer research and support. sometimes this can lead to a brand-new, never-tapped hobby or desire lurking in your heart.

breast cancer survivor lillie shockney discovered a unique hobby many women may not have considered. “i began doing fundraising/awareness events with a female motorcycle club called leather & lace back in 2001,” says shockney. “i had never been on a bike before. As time went by and i did more and more of these events with them, my interest in biking became a desired passion. While doing a breast cancer awareness event at a Harley-davidson dealership, i decided to sit on a few bikes and at the end of the day when my husband returned to pick me up, i said, ‘guess what? We are about to own a motorcycle!’ i got a 2005 Harley-davidson ultra Classic touring bike!”


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are considering adding on to or improving a house to accom-modate such an arrangement, many municipalities, under the 5-Year Abatement and exemp-tion law, have adopted an ordinance providing for a property tax abatement and/or exemption for improvements to an existing dwelling. in order to take advantage of this abate-ment, you must call your asses-sor’s office and obtain Form e/A-1 (PdF 112K). Most impor-tantly, this form must be filed within 30 days of completion of the improvement.

Tax Appeal

if your income or other eligibility requirements preclude you from taking advantage of one the pro-grams discussed in this article, or even if you are eligible for one or more of these programs and are looking for ways to further reduce your real estate tax bur-den, you should consider a real estate tax appeal. generally, real estate tax appeals must be filed on or before April 1st or within

45 days of the mailing of your assessment notice. individuals may represent themselves and the necessary forms can be found on the web at www.state.


nj.us/treasury/taxation/pdf/oth-er_forms/lpt/petappl.pdf. A word of caution, in order to prevail in a real estate tax appeal your house must be assessed improperly. the amount of taxes you pay or your income levels do not mat-ter. information on calculating the ratio of your assessed home value can be found on the web at www.state.nj.us/treasury/taxa-tion/pdf/lpt/ptappeal.pdf.

this information is provided as general information and should not be relied upon as legal advice.

scott J. Ciocco is a partner in the real estate department for Astor Weiss Kaplan & Mandel, llP

scott J. Ciocco, esquire Astor Weiss Kaplan & Mandel, llP. 4 Kings Highway east Haddonfield, new Jersey 08033 856.795.1113 phone 856.795.7413 fax

osteoporosis, the loss of bone mass, is part of the normal, natural aging process. Women lose an average of 8% of their bone mass every 10 years. one of the most common affects of osteoporosis is a fracture. specifically, a fracture of the spine. thus, an osteoporotic compression fracture.

these compression fractures usually occur in the mid or upper back called the thoracic spine. the bone collapses into itself becoming more narrow. this can be an extremely painful condition. When several of these fractures occur next to each oth-er they cause the upper body to bend forward. this is called a kyphotic deformity or kyphosis. People with this type of fracture lose height, sometimes several inches. in severe conditions this can be noticed by friends and family looking like a “hunch-back”.

Historically, treatment for these fractures has included: limiting activity, bracing, bed rest and narcotic pain medication. Com-plications of these fractures and this treatment, especially in the elderly population, can include: bed sores, blood clots in the legs, pneumonia, progressive weak-ness and possibly even death.

Kyphoplasty is a relatively new, minimally invasive procedure de-veloped to treat these fractures. Kyphoplasty, the reduction and stabilization of these fractures using bone cement, has been a huge advance in the treatment of osteoporotic compression frac-tures. this has added another tool which i use to treat my patients. this is a quick surgical procedure with minimal risks. the procedure is performed in the operating room with an X-ray machine through a tiny incision.

the Kyphoplasty procedure can reduce the pain and increase the

stability of this type of fracture quickly and safely. not every per-son with a painful osteoporotic compression fracture will be a candidate for this procedure.

this procedure can significantly reduce the complications of untreated, or under-treated, osteoporotic compression frac-tures. Many factors are taken into consideration when evalu-ating a patient with one of these fractures. the safest most appropriate treatment will be recommended and performed. since i have been performing this procedure, many patients have enjoyed a significant in-crease in their quality of life.steven b Kirshner Md Kirshner spine institute 525 route 73 south suite 302 Marlton, nJ 08053 1-856-267-5629

What you should know

about Osteoporosis

BY Steven B KIrshner MD

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all jewelry, eyeglasses, dentures, wigs, or hair pieces. A mild seda-tive is prescribed to take before leaving home and again on arrival to the suite. An iv (intra-venous) line is required for this procedure.

before the procedure, local anes-thesia is given (similar to how a dentist numbs the mouth before a procedure) and a lightweight box-shaped frame is attached to the patient’s head with four pins. this frame is required to hold the head still during the gamma Knife procedure, allows for target planning, and serves as a reference point in determining precisely where radiation beams will converge in the brain. there may be slight feeling of pressure when the frame is applied which usually goes away in a few min-utes. With the frame in place, the patient is able to move their head while waiting for treatment to begin. the frame remains on the head until the completion of the gamma Knife procedure.

After the frame is positioned and placed on the patient’s head, im-aging studies are required for planning and treatment. A Ct (computed tomography) or Mri (magnetic resonance imaging) of the brain is performed with the frame in place. After imaging studies are complete, the medi-cal team plans the treatment according to protocol, research and guidelines. treatment plan-ning can take one to two hours and the patient’s family is wel-comed to stay with the patient during this time.

once treatment planning is com-pleted, the patient is moved into the treatment room and then positioned into the couch of the gamma Knife machine. the patient is made comfortable with support pillows and blankets and secured to the machine via the head frame and guiding device. After a correct comfortable position is obtained, the treat-ment team leaves the treatment room and goes to an adjoining room with video monitoring. the patient is monitored during the entire procedure through video and an intercom. Patients are encouraged to bring their own ipod or Cd so that music can be played during their treat-ment. treatment time varies per individual depending on diag-nosis and can be from 60 to 120 minutes. treatment time begins when the doors of the gamma Knife unit open and the couch slides into position with the patient’s head just inside the doors. the gamma Knife machine has 192 holes through which the radiation treatment is delivered.

When the treatment is complet-ed, the frame is removed. Antibi-otic ointment is then applied to the pin sites and the patient will be required to wear a gauze head dressing home for a few hours. A light meal is given and once flu-ids are tolerated by mouth, the iv line is removed. the patient must have someone stay with them for 24 hours and must be driven home from the procedure.

Follow up care may include a Mri or CAt scan and an office appointment in 4 weeks to 6

months, depending on the diag-nosis. it is recommended that the patient follow up with all treating physicians after gamma Knife procedure. A detailed report is sent to the patient’s primary care and/or the referring physician.

diagnosis considered for gamma Knife treatment may include:• Meningiomas• Metastatic Malignant brain

tumors• Pituitary tumors or craniopha-

ryngiomas• trigeminal neuralgia• AvM (Arteriovenous Malfor-

mations)• Acoustic neuromas or vestibu-

lar schwannomas• other malignant tumors such

as glial tumors, chondrosarco-ma, ocular tumors, melanoma, various carcinomas, chordo-mas

• residual tumor beds after cra-niotomy brain surgery

• essential tremor• Parkinson’s tremor or rigidity• Pineal region tumors

the Cooper neurological institute is the region’s only facility dedicated to the diagnosis and treatment of neuro-logical and neurosurgical issues for pediatric and adult patients. the insti-tute is staffed by a multidisciplinary team of physicians who work together to provide optimal, integrated and individualized patient care.

liz Worthington, rn Clinical Practice Manager

H. Warren goldman, Md, Phd Chief, department of neurosurgery director, Cooper neurological institute director, gamma Knife Program


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Pain management in the elderly is predominantly treated through pharmaceutical methods, but thankfully, more people are becoming aware of the benefits of massage therapy.

Massage for elderly citizens is a natural solution to many ail-ments associated with the ageing process, and has proven to be an effective complimentary therapy to assist and improve the efficacy of conventional treatments.

What are conditions that would be inadvisable for massage?

• severe inflammation of a vein

• swelling or edema• Aneurysm• blood Clot

• bruises or skin sensitivities• open sores or wounds• recent heart attack, stroke

or flu by manipulating the body and stimulating the mind, massage provides the perfect balance

Delivering exceptional therapy in the convenience of your home

Physical aND OccuPatiONal thERaPy

701 w. somerDale roaDsomerDale, nj 08083office: 856.504.3150

fax: 856.504.3157

we have an outpatient facility at our location listed above.

(continued from page 10) needed for an individual’s health to thrive.

For more information on massage or to schedule an appointment: Please contact: esther greenberg, Massage therapist and reiki Practitioner at [email protected] or 856-577-7229.

www.therapeuticandmedicalmassagenj.com

such is the circle of life… Many of us get married, start a fam-ily, purchase our first home, outgrow that first home, and then purchase something larger to ac-commodate the growing family. this is typically a 3-4 bdr, 2-2.5 bath in the “burbs” with the pro-verbial picket fence. We gener-ally stay there until our children have grown, leave the nest and who come back only for those occasional visits.

so what are we supposed to do with the extra space and empty bedrooms? baby boomers on a whole are now entering into this new chapter of their life and the 65+ age group have actually far surpassed this phase, but contin-ue to remain in their homes.

one must consider the cost ef-fectiveness of remaining in the larger home. With bigger houses comes higher real estate taxes, utility bills, and not to be un-derestimated, the continuous upkeep. Many baby boomers and seniors are asking the ques-tion… Where would i go? How can i possibly downsize and keep all my “stuff”? Many are

afraid to downsize because they do not know how to accomplish this daunting task.

so now the million dollar question…

When Is the right time to downsize?

Here are a few examples you need to ask yourself:

1) do you or your spouse have difficulty climbing the stairs?

2) is the upkeep of your home becoming more difficult to maintain?

3) Are you spending money on your home for repairs?

4) do you anticipate some larger repairs in the near future that could cost you a boat load of money? i.e., roof, heating/air, painting – just to name a few.

5) is it negatively affecting the lifestyle you have always enjoyed?

6) do you want to simplify your life? Have more time to your-self?

7) do you wish you could be closer to your grandchildren or other close family members?

Consider this… if the negatives are starting to outweigh the posi-tives, it just may be the time to start contemplating a downsiz-ing move. these reasons could be for a variety of reasons; some already mentioned above.

but most importantly, MAKe A PlAn! Making decisions for yourself is by far more satisfying than having them made for you. talk to your children, relatives, a professional or anyone you trust that can give you the advice you need. As we all continue to move thru the aging process, it is im-portant to recognize when we need to seek the help from those that can shield us from potential problems.50andbeyond.com is your online resource to help simplify the tasks of finding the right professionals, resources, products and services that are important to you; whether a baby boomer or senior.

these resources include a comprehen-sive list for all your real estate needs, Financial and legal services, senior services, Health and Wellness Profes-sional, Home services and design and so much more. All are within local reach- right here in the greater southern new Jersey area.

Why Downsize?Who will help with this Transition?By Bonnie Joffe

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television commercials today re-mind us that “depression hurts.” the hurts related to geriatric de-pression can have far-reaching effects and are often misunder-stood. geriatric depression is an illness that can go undiagnosed for very long periods of time, or sometimes it doesn’t get diag-nosed at all. but why does that happen?

to begin to understand this com-plex issue, we must first realize that misdiagnosis of geriatric depression often stems from stereotypes about senior citizens. even ageism, which is the discrimination against older people, can easily cause the prob-lem to be overlooked. Many a senior suffers in silence, assum-ing the despair they feel in life to be the consequence of getting old. it is important to remember that depression is not a natural occurrence of the aging process.

there is a lingering percep-tion that the typical behaviors signaling depression in younger people, such as staying in bed for long periods of time, or not wanting to socialize, are viewed in seniors as just a natural part of getting older. this assumption is not accurate.

A well-recognized spokesper-son for this issue is doris rob-erts, who plays the mother in the sitcom everybody loves ray-mond. now 81 years old, rob-erts went before Congress a few

years ago to seek support for initiatives to abolish the biases and prejudices of ageism. such publicity indicates that the prob-lem needs attention. eliminating stereotypes about seniors will further promote the recognition and routine diagnosis of geriatric depression.

Causes of geriatric depression

depression in seniors has dis-tinctive symptoms and unique causes. no single factor has been associated with depres-sion in later adult years. illness, injury or even mild impairment of memory, or other changes in bodily functions, such as loss of bladder control, may play a role. some studies point to family genetics and others to previous episodes of depres-sion or other mental disorders suffered earlier in life as having possible links.

in seniors, neurological changes in the brain and blood vessels are thought to be significant factors in geriatric depression. Common events such as widowhood, unexpected health or financial challenges, diminished mobility,

or even the loss of a beloved pet can play a noteworthy part in the development and course of geri-atric depression.

symptoms and evaluation

Apathy and poor attention are often mistaken as signs of demen-tia in the older adult. symptoms of depression in later years may include sadness, loss of interest in hygiene or self-care, moodi-ness or heightened frustration with others, anxiety, changes in eating habits, weight gain or loss, fatigue, and many others.

in the comfort of the senior’s home, geriatric depression can be readily identified and treated by specialists in the field of chronic illness and geriatric psychiatry. evaluation can include compo-nents of survey, mental examina-tion and cognitive testing, as well as diagnostic tests to rule out underlying problems. Many medical issues related to chronic illness can be a source that triggers the problem and thus expands the treatment plan.

ManagementQuick fixes do not always exist when treating geriatric depres-

Depression and the Other Adult


by Mary Kate Kennedy

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Most of us have stuff that is important to us and our loved ones. some have more than others but often many people have more valuable possessions than they realize. the ultimate question becomes who will inherit my valuable possessions when i exit this delightful mortal world? After all, most of us want our loved ones to be happy. to answer this question you must be aware that certain property may pass to your loved one in one of three different ways.

WILLS/TRUSTSProperty titled in your own individual name and only your name, will pass to your loved ones according to the terms of your Will or trust. if your Will says that you want all of your worldly possession to be inherited equally by your three children and you own Cds and bonds in your own individual name, then your three children will inherit these assets equally.

JOINT TENANTS WITH RIGHT OF SURVIVORSHIP (WROS)However, you may own a check-ing account jointly (wros) with your daughter who helps you right checks to pay your bills. then only your daughter who is the joint owner of the account will inherit the money in the checking account as a matter of

law, not your other two children. Perhaps, you own your home or a vacation home jointly (wros) with your son and daughter-in-

law. then only your son and daughter-in-law will inherit this home.

BENEFICIARY DESIGNATIONSYou may also own an irA. the irA will be inherited by the beneficiary or beneficiaries you designated on a form provided by the institution holding the irA for you. Maybe you only named your youngest son as the beneficiary. then only your youngest son will inherit the assets of the irA. Maybe you own a life insurance policy or an annuity with a death benefit and you named your other two children as the beneficiaries on this asset. the life insur-ance death benefit may be more valuable than the irA and your

youngest son inherits much less than your other two children.

these are just examples to illus-trate the different ways that your

property may pass upon your mortal exit. in other words, your loved ones may not inherit your valuable prop-erty equally as you had thought based upon the terms of your Will (or trust). this may also lead to an unequal es-tate tax burden among your loved ones in some situations.

in conclusion, make sure you know how all of your property and assets are titled or owned and

who your beneficiary desig- nations are. try to stay current with these important matters. it is easy to sign documents and then forget about them. Yet this could have the unintended conse-quence of leaving one loved one with more than the other ones. if you aren’t sure about these issues, consult with an estate planning attorney.

this information is provided as general information and should not be relied upon as legal advice.

laura l. ergood, esq. the Cherry building 385 n. Kings Highway, suite 208 Cherry Hill, nJ 08034 Phone: 856-266-9525 www.ergoodlaw.com

Who Will Inherit My Worldly Possessions?

by Laura L. Ergood, Esq.

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When i mention the word “donut hole” to my seven year old daugh-ter, her face lights up, because that means it’s a tasty treat com-ing her way. but say that same word to a Medicare beneficiary and the reaction will be, well, let’s just say less than favorable.

the “donut Hole”, or “Cover-age gap” as it is called, is when a Part d Medicare beneficiary’s initial prescription drug benefit limit has been met. it is at that time the beneficiary’s prescrip-tion drug benefit changes. the benefit now becomes a discount off the costs of name brand and generic prescription medica-tion. once the maximum out of pocket amount is met, the bene-ficiary’s Part d prescription drug benefit then pays the majority of the costs. let me explain.

in 2012, the Coverage gap will be reached after the initial cov-erage amount of $2,930 including your deductible and copayments is paid. You then receive a 50% discount off the cost of name brand medications and a 14% discount off the cost of gener-ics until the total out of pocket maximum of $4,700 is met. Cata-strophic coverage then kicks in. You would then pay the greater of $2.60 for generics and $6.50 for brand name medications or 5% of the cost of the drug for the remainder of the benefit year.

this Coverage gap starts again annually. Your total goes back to zero when your new benefit period begins, usually the first of the year.

Here are some useful tips to help you save money while in the cov-

erage gap, and could delay or possibly Avoid your falling into the donut Hole altogether:

1) sHoP Around! every phar-macy does not charge the same price for your particu-lar medication. For exam-ple, Plavix in Cvs may not cost the same at Walgreens. simply call around to differ-ent pharmacies and ask them what their retail price is for that medication. Check with your health plan. Chanc-es are your Part d carrier participates with all the big Pharmacy chains and maybe even your local pharmacy. the big warehouse chains like Costco or bJ’s have phar-macies in them and carry many medications at whole-sale prices. You don’t even need to be a member to use their pharmacy! lower retail costs mean saving more money while in the coverage gap later.

2) take advantage of the $4 deal for generic medications offered at such pharmacies found in Walmart and target. if you pay this amount out of pocket, without using your Part d prescription drug card, the total cost of this generic drug is not calculated towards the coverage gap amount.

Navigating through the Dreaded “Donut Hole”By Celisse Lundy


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for which the resident may not be charged

6. Protection of his or her personal funds

7. Free choice in selecting a physician

8. Privacy in accommodations, medical treatment, commu-nications, personal care, and visits

Certainly, nursing home resi-dents have the right to be free from any physical or chemical restraints that are not neces-sary to treat the resident’s medi-cal symptoms. they may only be used to ensure the resident’s physical safety or the safety of other residents and only upon a physician’s written order that specifies the duration and circumstances under which they may be used.

residents may not be invol-untarily transferred or dis-charged from their nursing facility unless:

1. the facility cannot meet the resident’s needs

2. the resident no longer needs the facility’s services

3. the health or safety of the resident or other residents is jeopardized

4. the resident refuses to pay for the facility

5. the facility is shutting down

in cases of an involuntary transfer, the facility generally must give thirty days no-

tice in writing, documenting the reason for the transfer, notice of the opportunity to appeal the transfer; and contact information for the state long term care ombudsman for the institutionalized elderly. Facili-ties may not discharge a resident because he or she is waiting for a Medicaid application to be processed.

these safeguards have certainly brought nursing facilities a long way from the abusive conditions of the past; yet, merely relying on the current statutes to protect a relative’s dignity and care is not enough. Families must still re-

main proactive in participating in their relative’s care plan and in monitoring their relative’s well-being. even though a nurs-ing home resident is entitled to his medical records, under the Health insurance Portability and Accountability Act of 1996, his relatives may not. therefore, it is necessary to explicitly autho-rize relatives to access medical records. this authority is usually granted in a Health Care Power of Attorney, which can be part of a living will. Although residents are entitled to their financial independence, if a resident is incompetent, he must have a

power of attorney naming another individual to access his accounts and pay bills. remember, once an indi-vidual loses the mental capacity to conduct these basic estate planning docu-ments, a guardianship is the only option. Planning early and remaining vigilant still proves to be the most effective means to achieving positive results when a loved one enters a facility.

dana e. bookbinder practices elder law with begley law group, P.C., in Moorestown, Princeton, and stone Harbor, new Jersey. Call 800-533-7227. visit: www.begleylawgroup.com.


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other loved ones be financially taken care of if something were to happen to me? these are all questions we as Americans have

pondered, but may have never gotten around to. A finan-cial advisor helps answer these ques-tions-- plus so much

more. not only will you be able to properly manage your financ-es, but you’ll have the advice of a professional to lead you down a sound path of life. However,

we understand that choosing an advisor can be the most difficult part – after all who doesn’t want the most reputable in the busi-ness handling their finances? that’s why we’ve come up with the top five attributes you should require when making the deci-sion on who will be managing your money.

1. First and foremost – Creden-tials & experience. not all finan-cial advisors are created equal. Although we often overlook all these titles and letters following the names of professionals, this is a crucial key in your search for

the best. CFP® (Certified Finan-cial Planner), CFA (Chartered Financial Analyst), CiC (Char-tered investment Counselor), and ChFC (Chartered Financial Consultant) are all abbrevia-tions for the type of education a financial planner can receive. For example, when choosing an advisor, you should look for the CFP certification which is a good indicator of an advisor’s knowl-edge and experience. to become licensed with this certification, one must master certain areas of study including general Prin-ciples, insurance, investments, tax, retirement, and estate Planning. Although these things are important, the advisor’s experience in the industry is probably even more essential. Knowledgeable advisors have been in their business for a while


How much money will i have when i retire? Will i have enough to live out the rest of my life stress-free? When is it time to start sav-

ing? if i’m already retired, is it too late to start investing? How will health care costs affect my nest egg? Will my spouse and

TOp 5 THINgs TO LOOk FOR WHeN CHOOsINg A FINANCIAL AdvIsOR

By Paul J. Tully

How will health care costs affect my nest egg?

If I’m already retired, is it too late to start investing?

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Mike dooley, au-thor of notes from the universe, states: “Whether its praise, love, criticism, money, time, sorrow, laughter, care, or plea-sure… the more you give, the more you will receive.” We are powerful beings and we have an oppor-tunity to create our life filled with love or fear. What we give out to others comes back to us, so let’s make it good! What do you give to yourself and others?

international author and speaker, Wayne dyer, knows the impor-tance of feeling good. He shared his message for callers on his cell phone. “Hello, this is Wayne dyer and i choose to feel good today. if your message does not make me feel good, you have the wrong number.” What we focus on expands in our life. look for what makes you feel good. nega-tivity and fear pull us down.

We live in a world of fear when our inner critic bombards us with negative messages that make us feel inferior, not good enough. Most of the negative messages we heard and accepted about ourselves date back to our early childhood. our negative thought patterns came from authority

figures or others who played a major role in our lives. Young and vulnerable, we made the decision to accept negative and restrictive messages as our truth. big mistake, right?! one of my favorite quotes is from eleanor roosevelt. she states, “no one can make you feel inferior with-out your permission.” that puts the responsibility back on us. We get to choose how we feel.

We cannot change unpleasant-ness of the past, but we can consciously make the decision to focus on the present. We are here now; the past is over. We need to be compassionate enough with ourselves and others to let go of any past mistakes, errors in judg-ment. that’s forgiveness. For-giveness does not mean we con-done an experience or situation. rather, forgiveness means i want to let go of the energy of it. nega-

tive energy just pulls us down and we give the past too much power over us. Forgiv-ing self and others lets

us move forward with more love and energy.

in the past i was self criti-cal, often berating myself

when i thought i could have said or done something more appropriately. to counteract that critical part of me, i have learned the importance of praising myself. i chose the word sweet-ie, as an endearing name for myself. now i speak sweetly to myself assuring myself i am good enough. i challenge you to think of an endearing name and use it on yourself. it will make you smile! smiling actually changes us physiologically, so smiling makes us healthier.

gratitude also shifts our ener-gy in a positive way and invites more goodness, more love into our lives. it sends out a powerful message to the universe that we want to attract more of the same. i am taking the time to gratefully write the good i have noted dur-ing the day. What i have noticed is that during the day i remind my-self that particular experiences deserve to be noted in my book. it’s fun to focus on the positive.


We

Choose to love or Fear every d

ay

by Katherine nuyens

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When defining Acute inpatient rehabilitation, it’s not only about the number of therapy hours in a day. it’s about the individual, the complexity of their needs, and intensely addressing their physical, social, and emotional well-being. in doing so, a multidisciplinary team addresses every obstacle by developing a comprehensive treatment plan based on achiev-able goals toward successful out-comes and a smooth transition back to community living.

the benefit of such a comprehen-sive team approach is that the patient is given the opportunity and support to progress to their maximum level of functional independence with an improved quality of life prior to returning home.

After a neurologic, traumatic or orthopedic event, a person may be left with various functional limitations, which may prohibit them from returning to their pre-

vious lifestyle. Acute inpatient rehabilitation is oftentimes the best treatment modality towards recovery for those with potential for improvement.

Acute inpatient rehabilitation is generally offered in a hospi-tal setting with the primary goal of providing medical, physical and psychological intervention to help overcome pronounced functional limitations.

under the leadership of a phys-iatrist (rehab doctor), multidis-ciplinary team members evaluate each patient and collaboratively establish individualized treat-ment goals. Family input and training is an integral part of this process. the treatment plan is developed to meet the pa-tient’s distinctive needs. based on the individualized treat-ment plan, the patient’s thera-peutic schedule is determined.

the intensity of the therapy program is personalized so that it is manageable and reasonable, keeping the patient’s needs and ability level foremost in mind.

An Intense Collaborative Approach is a fundamental aspect of Acute Inpatient Rehabilitation.

A comprehensive plan of care with set individual treatment goals are established by part-nering patients and their family with the physiatrist, physical and occupational therapists, speech and language therapists, rehabil-itation nurses, dietitians, and case manager. Additionally, specialty physicians may be asked to provide clinical con-sultations to address specific disease states and conditions that may impact a patient’s rehabilitation progress. such conditions may be diabetes, renal disease, cardiac disease, wound management, and others.

acute inpatient rehabilitation – When it Comes to Restoring independence


By donna sobel

infections that require iv anti-biotics, and malnourishment which involves iv tube feedings.

What is home infusion theraPy?Home infusion therapy is the administration of medications by iv using intravenous and subcu-taneous routes, (into the blood-stream and under the skin), that are performed outside of a formal healthcare environment. Common drug therapies that can be administered in the home include antibiotics, nutrition, cardiac and immune therapies. infusion therapy is also provided for patients treating a wide assortment of chronic and some-times rare diseases for which “specialty” infusion medications are effective.

Benefits of home infusionHome infusion is more cost- effective than an in-patient hospital stay. secondly, it de-creases the length of time in a hospital, which reduces the risk of exposing patients to micro-organisms that can cause addi-tional infection. studies show that patients who return to their homes and families, recover more quickly and the quality of life for both the patient and family or caregiver is increased. elma godoy-Williams, director of Patient and Client services, for Home solutions states, “Working in admissions for a home infusion provider gives me the privilege of witnessing all of the patients and caregivers who give home infusion a chance, and encountering how our clini-

When our loved ones are in the hospital, how often do caregiv-ers or family members hear the question, “When will i be well enough to go home?” the term “home” for an elderly person is more than just a location of residence, it is an emotional safe haven that is consistent, secure and familiar. As a result, when an elderly person is hospital-ized, the separation from “home” can negatively hinder the speed

of their recovery. With the aver-age hospital stay being 6.31 days, having the option to administer iv treatments from home pro-vides an opportunity for a short-ened hospital stay and faster recovery. Home infusion therapy is a solution for easing the cur-ing process for many common ailments that affect the elderly. these conditions include wound infections, bone infections, pneumonia and urinary tract

home infusion theraPy“ SHORTENING THE TIME

FRAME BETWEEN HOSPITAL TO HOME.”


“i refer to the bike as ‘the ther-apist.’ the sense of freedom, the wind on my face, and sitting close to my husband feels wonderful. i return from a ride and feel at peace.”

Move yourself forward

When you focus on doing something you really enjoy, it’s easy to lose track of time. this stress-free place allows your body to find a healthy balance which can be very healing. Alice domar, director of the Mind/body Center for Wom-en’s Health at Harvard Medical school says, “Hobbies provide a calming sense of control, and research suggests this strengthens immunity. You may have little say about what is happening in your world, but when you’re involved with a hobby, you get the satisfaction of spend-ing time doing something you enjoy.”

if you’re ready to look forward with a new hobby (or re-ignite an old one), there are lots of ways

you can get started exploring. Here are some first steps.

1. think back. Ponder your childhood. What did you love to do then? Was it swimming? Coloring? baking cookies with your Mom? Ask yourself if those things could be en-joyed as an adult. (of course they could!)

2. Make a map. sarah ban brethnach’s book, simple Abundance, gives a wonder-ful lesson about creating your “personal treasure map.” You can have fun gluing inspira-tional photos or words onto paper to make a collage. take it out often. something there may speak to you and point the way.

3. Volunteer. if you want to be part of something, get in-volved. Maybe acting is your long-time wish, but you’re not ready to audition just yet. the local theater might need your help in other ways, which will introduce you to its people and processes.

4. grab a friend. First-time jitters can be eased if you take a friend along. try a watercolor class, then go have lunch.

5. explore online. there are “types of hobbies” quizzes online, as well as articles about every topic imaginable. learn all you can. the inter-net is infinite!

Whether it’s yoga, crossword puzzles, indian cooking, playing the guitar, dragon boat racing, juggling, bell ringing, blogging, knotting (yes there are peo-ple who tie knots as a hobby), making and flying kites, or even yodeling – your hobby is about you. if it makes you feel good and takes your mind off your worries – go for it!this article originally published in Amoena life magazine, summer/Fall 2010. excerpt reprinted with permission. www.amoenalife.com.


Although the decision to volun-tarily move from one’s house into an independent living communi-ty is often difficult, even during a good economy, many seniors are using the current state of the economy as a convenient excuse to not even consider current opportunities.

the fact is it is a great time to make a wise choice and move into a Continuing Care retire-ment Community (CCrC). Most seniors plan to wait out the econ-omy until it improves, which may be as long as 2, 3 or more years, before readdressing the option of a move. others state that as long as they are in good health they want to stay in their house as long as possible. Here are six reasons to reconsider: your health, personalized incentives, creative financing, no entry fee contracts, excess inventory and flexibility.

Reason 1: Although the housing market will eventually improve and portfolios will rebound in time, for many seniors, changes in their health may prevent them from qualifying for independent living medically if they postpone the decision much longer. tens of thousands of dollars can often be saved by moving into a CCrC at the independent living stage. once there is an incident or advancement of an existing medical condition, indepen-dent living may no longer be an option.

Reason 2: Many communities are offering creative, personal-ized incentives to prospects- better than those offered over the last several years to attract move-ins. Communities offer-ing such incentives as money off of the entrance Fees or limited free month fees actually off-set potential loss on the sale of one’s house in this real estate market.

Reason 3: Creative incentives, such as promissory notes, are be-ing used to help people who can-not sell their home as quickly as they would like.

Reason 4: new contract options are being introduced at many communities showing increased flexibility to adapt to the current economy. some communities offer a variety of contracts such as lifecare, Fee for service or rental options.

Reason 5: excess inventory is allowing the consumer to have their pick of several choice apartments with spectacular views and amenities. When com-munities have a higher census, apartment choices are limited.

Reason 6: Flexibility is the key to all marketing strategies at this time. discover a community that is willing to work with you. the best communities will offer you several options and assist you as a resource in making this big de-cision. Many CCrC communities offer direct admission into all levels of care offered in addition to independent living, including Assisted living, long-term Care and short- term sub-acute reha-bilitation. A marketing team that understands the economy and your unique situation will strive to find the best arrangement and package to meet the prospective resident’s individual needs.

eventually, the economy will recover and business will return to business as usual. Many of the great available apartments will be gone, incentives will shrink and we all will be a little bit older. the fact remains: it is a great time to make a wise choice.

Michele M. schreck Marketing director, Cadbury at Cherry Hill *Cadbury at Cherry Hill is a not-for- profit, Quaker-based CCrC.

sIx ReAsONs TO CHOOse AN INdepeNdeNT LIvINg FACILITy dURINg THIs eCONOmy

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if so, then understanding our parents’ financial situation will help us determine how we could best pay for their long-term care needs.

on top of knowing the account information and policy numbers of our family member’s bank accounts, irA’s, 401K’s, mutual fund accounts, and life insurance policies, Jerold taught me that it is also critical to record our parent’s computer passwords for these accounts.

in today’s age of the worldwide web, we engage in a great deal of internet commerce. We order office supplies, buy books, pay bills, transfer funds, check ac-count balances, sell things, check email, and need a password to access a laptop or office com-puter. As we complete more and more tasks via our computers, we also need to remember that our parents are savier than we think with reference to managing their lives via the computer, too.

Janie de leon-Male, M.s.s., ls director of Care Coordination law offices of Jerold e. rothkoff 911 Kings Highway south Cherry Hill, nJ 08034 (856) 616-2923 (856) 616-2991 [email protected] www.rothkofflaw.com offices in Cherry Hill, Center City Philadelphia, and trevose, PA


Most people suffer the occasional “bad night,” when they either have trouble falling asleep or staying asleep. but for those with a sleep disorder, bad nights often – if not always – outweigh the good ones, making it difficult to feel and do your best during the day. More than 40 million Americans suffer from diagnos-able sleep disorders, but the vast majority are undiagnosed and untreated, creating larger, some-times life-threatening health is-sues. it doesn’t have to be this way, however!

sleep disorders are defined as any abnormal or irregular sleep-ing pattern. they include:

• insomnia, the most common sleep problem, marked by dif-ficulty falling and remaining asleep, difficulty returning to sleep, early morning awaken-ings or non-restorative sleep.

• obstructive sleep Apnea (osA), a disorder that results in spells of “breath-holding” that usually last at least 10 seconds, and often occur without a person knowing. A person suffering from osA will, however, notice that they sleep poorly, have low energy or feel drowsy during the day. osA has been linked to high blood pressure, diabetes and heart issues.

• narcolepsy, a neurological dis-order that results in excessive daytime sleepiness (eds);

cataplexy (a sudden loss of voluntary muscle control); dream-like auditory or visual hallucinations; and sleep pa-ralysis (a temporary inability

to move either when falling asleep or just waking up).

• Primary snoring/upper Airway resistance syndrome, marked by loud upper airway breath-ing sounds during sleep, can disturb others nearby and even awaken the snorer.

seeking care through a physi-cian for sleep issues is the first step toward diagnosis and treat-

ment. After a complete physical and medical history, your doctor will determine what tests, if any, need to be conducted. Many times, people are referred to a sleep Center for overnight testing.

sleep studies are a painless way for your physician to determine if you have a sleep disorder. Patients sleep in a private room with hotel-like amenities, while their sleep patterns are moni-tored throughout the night and recorded for study. this is done through lightweight sensors placed on the head, chest and legs to record sleep data.

if you are diagnosed with a sleep disorder, your physician will pre-scribe a treatment plan to meet your specific needs. Many pa-tients with sleep apnea can be successfully treated with CPAP, or Continuous Positive Airway Pressure therapy, while those with narcolepsy may require special medications. if you or someone you know is having an ongoing problem with sleep, talk to your doctor. Your health depends on it!nancy Keiluhn, rrt, rPsgt, is a registered respiratory therapist with the Kennedy sleep Center in stratford and Washington township, nJ. A third Kennedy sleep Center will open this fall on its Cherry Hill campus. to learn more about the sleep Centers, call 800-580-6364 or visit www.kennedyhealth.org.

Understanding Sleep Disordersby nancy Keiluhn, rrt, rPsgt

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Physician oversight is an essential feature of acute inpatient rehabilitation – with accessibility of daily interven-tion.

the Multidisciplinary team’s primary focus is to maximize the individual’s level of inde-pendence through therapeu-tic intervention and leading edge treatment modalities.

Physiatrists are board-certified physicians specially trained in physical medicine and rehabili-tation. the rehabilitation team is under the leadership of the physiatrist who oversees the individualized care plan for each patient.

Rehabilitation Nurses are spe-cially trained to focus on care and education of both patients and families.

Physical Therapists evaluate and treat for strength, range of motion, muscle tone, gait, bal-ance, sensation, coordination, endurance and pain.

Occupational Therapists ad-dress activities of daily living such as hand function, visual/ spacial/perceptual deficits, assis-tive devices, and more.

Speech and Language Pa-thologists focus on expressive and receptive language needs, dysphagia (swallow) screening and follow-up, motor apraxia and dysarthria, memory deficits, cognitive linguistics skills, as-sessment of functional language skills, attention and concentra-tion tasks and more.

Respiratory Therapists evalu-ate, treat and educate patients

with orthopedic injuries, recon-structive surgery (including Joint replacements), Multiple trauma, stroke, brain, or spinal cord in-jury, neuromuscular disorders, Advanced osteoarthritis, neu-rological conditions, and more.

Core therapy programs in-clude Physical and occupa-tional therapy, speech and language therapy (including swallow therapy), and Cogni-tive remediation. specialty programs may include stroke

and brain injury Programs, Amputee / Prosthetic training, spasticity & Pain Management, balance therapy, Wound Care Management, Pulmonary rehab, and Aquatic therapy.

in an acute inpatient rehabilita-tion environment, rehabilitation doesn’t end in the gym. reha-bilitation is incorporated into the patient’s day and the focus is on rehabilitation at all times.

Credentials are Importantnational accreditation programs, such as the Joint Commission, review elements of treatment that research has shown to be ef-fective. these programs are used to inquire quality assurance and quality improvement. For acute inpatient rehabilitation hospi-tals, accreditations and certifica-tions may vary by state. Asking whether a rehabilitation program is accredited will show that their program meets higher treatment standards and regulations, en-suring a well-run and established treatment program. this will be vital when deciding which inpa-tient acute rehabilitation hospi-tal to choose.

whose ability to breath has been compromised.

Clinical Dietitians coordinate medical and nutritional needs through patient assessment.

Recreational Therapists are trained and certified to utilize therapeutic activities to improve awareness and physical abilities.

Neuropsychologists assist with awareness and understanding of deficits, adjustments to disabil-ity, social skills, problem solving, and family issues.

Neuro-Optometrists provide treatment regimen for patients with visual defects resulting from physical disabilities, trau-matic or acquired brain injuries.

Case Managers offer organiza-tion of family support and com-munication, team and commu-nity resource coordination, and insurance carrier interaction.

Acute inpatient rehabilitation addresses the needs of patients



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and are experienced with the markets as they have seen their fluctuation over an extended period of time.

2. Repute – Word of mouth is one of the best ways to choose a

financial advisor. think about it. When a friend or family member recommends a restaurant you’re more likely to try it because you’ve heard good things. the same goes for a certain contrac-tor that’s done fantastic work on your new kitchen or a doctor that made you feel extremely comfortable. that word-on-the-street reputation says a lot. so ask around. see where your friends and family members are getting their financial advice from.

3. alternatives – You’ll want to make sure you have a number of options and extras being offered when you’re deciding on your match. For example, are they providing you with different kinds of investment strategies or offering you tax advice too? Which of your accounts will be handled directly by them? You may want to look for an advisor with a specialty such as retire-ment income or estate planning. You should know ahead of time the specifics on what you’re look-ing for and make sure you will be getting your money’s worth out of their services.

4. transparency – When you’re going for an estimate on your car to find out how much that little check engine light is really going to cost you, helplessly you hope that what your mechanic tells you needs to be fixed is the truth. Well, when your advisor is telling you which investment will

suit you best, you’re defi-nitely bank-ing on their genuineness.

And why do we listen to these people? because we trust their expertise and believe that they’re in it for us. but you can’t just determine one’s integrity by taking a shot in the dark. You need to do your homework and ask some questions upfront. one very important questions to ask is, “How do you make your money?” some advisors charge c o m m i s -sions on each invest-ment pur-chased and sold while others charge an an-nual percentage of the assets they manage. the differences between these styles can be sub-stantial, so determine all of this beforehand so that everyone understands and is on the same page. Make sure you read any written agreements about their services and get in writing that all decisions they will be making will be based upon the benefits they provide you.

5. Communication & Rapport – the relationship you will be developing with your advisor is also a vital part of the process.

You should make sure your ad-visor plans to meet or speak with you fairly often so that the communication line is open and effective. Your portfolio should be revisited frequently for updates and changes you may have made or that your advisor has suggested. see if you will be personally involved with the investment process if you so choose to. Find out how many clients they work with and how many of them are in situations similar to you. Also, establish which advisor you will be work-ing most closely with so you know who will be in constant contact. overall, your advisor should have your best interest at heart and should be setting realistic goals and objectives with you that are ultimately being met.

so there you have it. the top 5 things to shop for when making the big decision. it’s your money and it should be handled with care. don’t settle for anything less than the highest standard of professionalism, the most superb service, and the best people in the business.

Paul J. tully is a Certified Financial Planner with raymond James Financial services, inc. Member FinrA/siPC located at 58 euclid street in Woodbury, nJ. Paul J. tully can be contacted at (856) 845-4005 or [email protected].

How much money will I have when I retire?

Will I have enough to live out the rest of my life stress-free?


32

this could mean a significant savings and could offer you an extra month or two of benefits before reaching the coverage gap!

3) see if you qualify for Medi-care extra Help (800)772-1213 or www.ssa.gov/prescription-help/, or PAAd-new Jersey’s Prescription Assistance for the Aged and disabled (800)792-9745 or www.njpaad.gov. these programs can assist eligible beneficiaries with the coverage gap.

4) Contact the manufacturer of your medication. All drug companies have a prescrip-tion assistance program. if you qualify, they can

offer you your medications at a discount or even Free. Call Partnership for Pre-scription Assistance (PPA) (888) 447-2669 or www.pparx.org/intro.php for more infor-mation. these drug manufac-turer’s programs are available for All ages.

Although it doesn’t look like the donut Hole will ever go away, the good news is that Health Care reform is working to im-prove the discounts every year for Medicare beneficiaries during the coverage gap. good luck, and stay Well!

Celisse lundy luv 2 run insurance resources (800)894-7120 www.luv2runinsurance.com

(continued from page 21)EVERGREENDENTAL

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sion, and sorting out the root cause can take some time. Also, most of the medications used to treat depression may take six weeks or more for the senior to begin to feel better. sometimes treatment may require trying different medications in order to find the right one that works the best, as the response to differ-ent drugs is individual. often the older adult is taking multiple medications for chronic ill-nesses that may interfere with or impact the effects of anti-de-pressant therapies. successful management of geriatric depres-sion includes both recognizing and addressing the debilitating side-effects and complications from the medications frequently used to treat other health problems.

other treatments like behavioral therapies, complimentary inter-ventions such as tai Chi, yoga or exercise have been found effective alone or in conjunction with medication therapy.

in addition to these treatments, there are still other important components that need to be considered when managing geriatric depression. these in-clude promoting better sleeping habits, increasing or changing daytime activities, improv-ing mobility and safety in the home and more. A wide variety of equipment and supports can be purchased at a local medi-cal supply company like Komfort and Kare in Westmont. items such as air mattresses, lift chairs, mobility aides, bed

canes, and shower or tub supports can greatly increase comfort, safety and indepen-dence for the senior. even small items such as grabbers or other adaptive equipment can make a big difference.

successful treatment and long term management of depression in seniors can also help decrease the stress that often impacts their loved ones.

Conclusiongeriatric depression is not a natural consequence of getting old and does not have to go unnoticed. it is effectively iden-tified after survey, examination and testing; and depending on the cause, many types of treatments are available. treatment and recovery is a process, but successful outcomes bring clarity and quality to lives of the senior and their loved ones. Consult with an individual’s doctor or health care provider to help determine if the possibility of depression exists and what can be done to treat it. seek advice from experts in geriatric care management to provide the resources and services that make a difference in caring for seniors. in doing so, life for the older adult can be lived to its fullest.Mary Kate Kennedy, bs, CMC, Cirs-A, CsA is a nationally-certified geriatric care manager and resource specialist in aging and disability at 1 link 4 se-nior Care, inc. she finds solutions for families with her team of specialists in chronic illness, geriatric psychia-try and addiction. For a free con-sultation, call 856-939-5005 or email [email protected].

the commission on Accredita-tion for rehabilitation Facilities (CArF) is a private, not-for- profit organization that promotes quality rehabilitation services. CArF uses standards and guidelines to determine how organizations are deliver-ing care and how it can improve. the standards are reviewed each year in order to continue improvement with changing conditions and current patient needs.

Patients can be admitted to an Acute inpatient rehabilita-tion hospital from a general acute care hospital, long-term Acute Care Hospital (ltACH), a skilled or sub-acute nursing facility, an Assisted living Facility, home, a physician’s office, or an emergency room. Appropriateness for admission is determined following a complete assessment that can be set up by your physician, social worker, or case manager.

Written by donna sobel, director of business development at Marlton rehabilitation Hospital, a 49-bed acute rehabilitation hospital offering inpatient and comprehensive outpa-tient services. Accredited by the Joint Commission and CArF, Marlton rehabilitation Hospital is the first in nJ to receive CArF accreditation for excellence as an inpatient stroke specialty Program. to learn more about Marlton rehabilitation Hospital please go to their website at www.marltonrehab.com

(continued from page 19) (continued from page 31)

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One More HugOne More Hugof your life, it takes away a little of the “don’t know” and replaces it with opportunity. it creates an opportunity to ask, “How can i make this experience before i die just a little better?” Coming to that place of being able to say “if i am going to die, then i want to change something or, even change myself” is frequently a most difficult, but extremely satisfying journey.

Managing change is what hospice does. it can facilitate “the know-ing” in a way that helps you to take full advantage of opportuni-ty. Knowing can and does foster hope even if the hope is simply for one more hug…either to give one or, receive one. Knowing when you come to that place in your journey where the end is in sight, life is still worth living and change is still very possible, hos-pice can help.

if you would like more information, please contact ligHtHouse HosPiCe at 1-888-HosPiCe.

When it comes right down to it, every one of us feels differently about the end-of-life. some of us live in the presumption that more care is better and that we are entitled to have whatever it is we need and want in order to satisfy that belief and fulfill our wish to delay the end, if at all possible. others of us tend to be somewhat more open to the inevitable want-ing only to be made comfortable after we have been assured that “nothing more can be done”. no matter in which place we find ourselves, thinking about our own death can be a very difficult thing to do.

in reality, every year each one of us unknowingly passes the anniversary of our death…that one day, in the future, when we will die. it really doesn’t matter what day it is. We only hope we will be remembered on that day, and that it is still many anniver-saries away, but...what if it isn’t? How would you choose to live

if you knew your last day was tomorrow or, next week, or next month? Would it make a differ-ence if you knew?

it can be difficult thinking about that day, your last day. it’s difficult to know you are leaving so much behind…your work, your fam-ily, your home, your community, this earth. sometimes, not know-ing seems easier doesn’t it? And, there’s the rub. Most of us would probably change some things, mend some fences or, want to do something special if, indeed, we knew our destinies. Yet, it still seems easier not to know when we are to die because not know-ing means not having to face “certainty”. it’s easier to say, “i don’t know” and, therefore, not be faced by the challenge of wanting or, perhaps, needing to change.

but, in that quiet moment when you do begin to think about the possibility of change…a change in the plan you had for the rest

that’s how we receive more.

it has been said that we are the captains of our own ship. that means we have the power to choose how we perceive and react to things that happen to us. We have the power to cre-ate a good day for ourselves and others around us. love allows us to be in the moment, and in the

face of fear we can make a choice not to react to it. i simply ask myself if i choose faith or fear.

the journey begins by getting in touch with our inner connec-tion. Happiness does not lie out-side of our-selves. it is getting in touch with who and what we are at the core of our being. learn-ing to love all parts of ourselves

expands our capacity to love others with all of their problems and limitations. loving ourselves fully cancels out the fear to love others.

Katherine nuyens, MA, CH, Cbt proudly shares her alternative healing techniques in Marlton. You can visit her at www.empoweringchangeinyou.com. some of her work can be done on the phone. You can call Katherine for a free consultation at (856) 780-5302.


35

cians transform their nervous, anxious energy into confidence and trust. Most patients like receiving iv therapy in the privacy and comfort of their own homes and around their person-al schedules. the treatment is effective and the patient’s happi-ness is rewarding.”

What is a home infusion therapy Provider?An infusion therapy provider is a state-licensed pharmacy that specializes in the provision of infusion therapies to patients in their homes or other alter-nate-sites. the infusion therapy always originates with a pre-scription order from a qualified physician who is overseeing the care of the patient. the goal is to increase the patient’s quality of life by maintaining an active lifestyle, administer treatment within the comfort of the patient’s home and avoid re-hospitaliza-tion.

What is the Process?1. A person from your doctor’s

office or a case manager from the hospital will contact a home infusion provider.

2. Your hospital case manager or home infusion provider will call your insurance company to determine your insurance coverage.

3. the start of your home infu-sion therapy will be coordinat-ed with your doctor.

4. the home infusion provider will contact you to schedule a time for your nurse’s first visit.

5. the home infusion provider’s pharmacists and technicians will prepare all of the neces-sary medication and coordi-nate your delivery.

6. A delivery technician will bring your medication and supplies to your home or preferred location prior to your nurse’s visit.

7. Your nurse will instruct you on the basic techniques for the safe administration of your medication or therapy until you demonstrate comfort.

8. on subsequent visits your nurse will monitor the iv infusion site and evaluate the effectiveness of therapy.

insurance coverage concernsWhen a patient’s physician ap-proves home infusion therapy, the next natural question is, “Will insurance cover my treatment?” it will be important for you to supply accurate records for all of your insurance coverage so

the hospital or therapy provider can quickly determine what your coverage and co-pay charges we will be. Most insurance carriers have both in-network and out-of-network benefits available to allow the patient to select which home infusion company they would like to work with. once you have selected your home infusion provider, they will have an insurance expert on staff to verify your individual home infusion benefits prior to starting therapy.

hoW Do i get signeD uP for home infusion service?the prescription for home infusion therapy is typically generated by your physician. secondary resources for infor-mation and approvals can be generated through your case management specialist or social worker in the hospital. to obtain more information contact the national Home infusion Associa-tion (nHiA), www.nhia.org. or call 1.703.549.3740.

Home solutions is one of the largest independent home infusion providers in the country; serving the northeast and Mid-Atlantic regions. Home solutions has many years of experi-ence in comprehensive patient care and nutrition support management and is known for its reliability, customer service and professional expertise. visit infusionCare.com or call 888.646.6379 for more information.

1 source: American Hospital Association (AHA) Annual survey of Hospitals. Hospital statistics, 2010 edition. Chicago, il


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South Jersey Senior Fall 2011

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