Addressing the realities of a terminal illness requires a great deal of sensitivity and compassion. It is an emotional issue that takes a toll on the recipient and their loved ones. Fortunately, hospice care providers have specialists who can help you with discussing the issues and options. They can be of great service in developing a plan that prioritizes comfort, dignity and quality. Even better, most hospice services are paid for through Medicare.

There are several very good providers of hospice services in Marin County. They each generally employ a team of doctors, clinicians, caregivers and counselors. To tap into their services a person must first meet certain criteria. Medicare A coverage will include everything that you usually receive, which includes:

• Items and services for pain relief and symptom management
• Medical services
• Nursing services
• Social services
• Prescription drugs
• Pain management
• Durable medical equipment
• Health aides
• Homemaker services
• Spiritual and grief counseling
• Additional services

Please note that last item. There are a host of other services, including such items as massages, that are covered, but generally not known. Be sure to ask the provider you select for a full list of additional available services.

Depending on the individual’s needs and circumstances, the services can be provided at their home, in an assisted living setting, at a skilled nursing provider or even a specialty hospice center. Recipients generally fall into one of four categories: routine home care, respite, continuous or general in-patient.

• Routine home care is the most common. A person may choose this level of care when they do not require continuous hospice care. Usually, this means they are not in crisis — they are stable and can control their symptoms.
• Respite hospice care takes place in an approved in-patient setting. Hospice care professionals provide care so that the primary caregiver(s) can rest.  Typically, respite care is on a short-term basis for up to 5 days.
• Continuous hospice care focuses mainly on nursing care, though a person also may receive homemaker services, hospice aid, or both. A recipient may receive continuous hospice care in their home. Someone may require continuous hospice care if their pain or symptoms become uncontrollable.
• General inpatient hospice care occurs in an in-patient center, such as a hospital or nursing facility. This level of care focuses on pain control and symptom management that is unmanageable in home settings.

Most of us will only access hospice care once or twice in our lives. So, unfortunately for many, they put off having these difficult discussions and end up missing out on many opportunities and services. Those who have been through the process and/or advise others generally suggest you have these discussions well before a need arises.  In that way, if you ever need it, you can make informed decisions and take full advantage of the Medicare provisions.

Simply stated, the primary objective of hospice care is to help individuals spend their remaining time in a peaceful environment and to help maintain quality of life. By acknowledging the difficult realities of death, you can reframe the conversation to what can be done to give a loved one what they deserve, a good ending.

Although this blog is only a high-level overview of the complex subject of hospice care, our hope is that this may serve as a conversation starter. Grappling with an impending loss is deeply emotional. Working with a hospice agency to alleviate some of that burden can help you create opportunities for meaningful memories during the most challenging moments.

Thinking about our social lives, and how they influence health outcomes, is getting new attention. In February, researchers at Massachusetts General Hospital and UCSF published a 10-item “social frailty index”. They found a strong corollary between social frailty and physical frailty which often leads to an increased risk. So, what does this mean, and what can you do to decrease our social frailty?

Well, to start, it is important to recognize that the implications for health care are real and you can take action. Oak Street Health, a chain of primary care centers in 21 states, is trying to increase awareness in its clinics.  At least three times a year they ask about loneliness and social isolation, barriers to transportation, food insecurity, financial strain, housing quality and safety, access to broadband services and utility services.  According to Linda Waite at the University of Chicago and Director of the National Social Life, Health, and Aging Project, that is great, However, they miss a crucial question: whether their relationships with other people are positive or negative.

If you want to think about your own social situation, consider the following five questions developed by researchers in Japan:

1. Do you go out less frequently compared with last year?

2. Do you sometimes visit your friends?

3. Do you feel you are helpful to friends or family?

4. Do you live alone?

5. Do you talk to someone every day?

If you find your responses unsatisfactory, it might be time to spice up your social interactions by making some changes.

Fortunately, we are in an area that offers lots of opportunities. You might take a class at the Community Center, plan a weekly outing with a friend, attend a worship service, volunteer, or simply plop yourself down with a cup of coffee at the Depot and strike up some conversations.  You could consider joining Marin Villages and getting regular help going to appointments and shopping.  It might also be a good option to change your living situation to one that offers more immediate interactions with others through an ADU or joining a broader living community.

No matter what you do, keep the list handy and, like the folks at Oak Street, check it 2-3 times a year.  The studies show your heart and your head will thank you, especially if you are brutally honest and get more social!

The #1 fear of seniors is memory loss, or more specifically, dementia.  According to the United States Department of Health and Human Services, dementia affects more than 5 million people in this country. That number is expected to double by 2050 and women are at higher risk of developing dementia than men. but recently there has been some very good news.

A study in The Journal of the Alzheimer’s Association found women, aged 65 or older, were less likely to develop dementia if they did more daily walking and moderate-to-vigorous physical activity. The researchers sampled data from over 1,000 women.  The average participant had 3,216 steps a day in a combination of 276 minutes of light physical activities and 46 minutes of moderate-to-vigorous physical activity.

Researchers found that an additional 1,865 daily steps a day reduced the risk of mild cognitive impairment by 33 percent.  They also determined that an additional 31 minutes per day of moderate-to-vigorous physical activity was associated with a 21 percent reduction.  These are staggering numbers for relatively little extra effort.

According to Steven Nguyen at the University of California San Diego’s School of Public Health and Human Longevity Science, who conducted the study, “The findings for steps per day are particularly noteworthy because steps are recorded by a variety of wearable devices.” Senior author Andrea LaCroix, Ph.D., M.P.H., added “Given that the onset of dementia begins 20 years or more before symptoms show, early intervention (to delay or prevent cognitive decline and dementia among older adults) is essential.”

Fortunately, here in Mill Valley we have a lot of walking paths, hiking trails and new sidewalks.  The additional 1,865 extra steps to reduce your risk equates to a little less than one mile. To achieve the goal you could walk from: the Community Center to Boyle Park, the Tam High Pool to the far end of track and back, the Depot to the Library and back, or the Safeway on Redwood Highway to the In-N-Out Burger and back.

You get the point.  Adding a relatively short walk can significantly reduce your risk of cognitive impairment and there are a lot of easy ways to achieve the number of steps needed.  So please – get up, go for a walk, and take care of #1 today!

May is Older Americans Month, but how did we get here and how should we celebrate it?

The first question is relatively easy.  Older Americans Month was established in 1963 by President John F. Kennedy after meeting with members of the National Council of Senior Citizens.  Every President since has issued a formal proclamation asking the entire nation to pay tribute in some way to older persons in their communities.  Since the 1980s there has also been a theme for each year – the 2023 theme is Aging Unbound.

So, how should you be celebrating if you are a senior? Well, many are truly enjoying living the “unbound” life by throwing themselves into second careers, helping others, discovering new interests, and pursuing dreams.  

If this is for you, you might find reinventing yourself can be fun and rewarding.  Whether you are planning for retirement or simply looking to get involved in new activities, start by thinking about your skills, dreams, and passions.  Thankfully there are many organizations in Mill Valley who really need experienced help today.  

Others are living the “unbound” life by expressing themselves through the arts. If this sounds good to you, you might consider learning to paint or draw, dust off your dancing shoes, or put your musical talent to use, take a class in stand-up comedy or acting, or finally write that story.  Even if you never felt artistic, everyone has the ability to be creative. As a bonus, studies show that the arts can improve brain health and Mill Valley is full of opportunities to explore your artistic side.

Still others want to keep learning by trying a new language or taking a computer class. Maybe you have always wanted to travel and discover other cultures.  Some use their years of experience to serve others by volunteering to meet a range of community needs.

No matter how you choose to celebrate an “unbound” life there are clear benefits.  All of the above help you keep your mind active and maintain good physical health.  Most provide structure and routine, connect you with the community, and prevent isolation.  Some even provide a little income.  Whatever you choose, here’s wishing you the best as we all celebrate everything you can do!  Congratulations for being an older American.

It’s April, a time for enjoying the spring, for thoughts of renewal and planning for the future.  It is also tax time which gets most of us focused on our finances and, especially for those of us 60 and older, a time for being sure we are set financially for whatever may come.  To explore this further we looked to the experience, knowledge and wisdom of some seniors.

While many in Mill Valley are more than comfortable with their retirement plans, others have not thought ahead as much.  Those among us who are renting may not have the comfort of a large asset (a debt free home) to rely on.  A surprising fact we learned recently is that about a third of the residents in Mill Valley are renters.  So, what to do if that describes you, or you simply are not a planner.

Well, according to some residents at The Redwoods, they believe they are comfortable living within their means.  They have found that between their pensions, social security and possibly some savings, they can live just fine in our city.  Medicare covers most of their health and medical needs.  The resources available through Mill Valley Villages, Marin County and the transit support systems helps them remain active, independent contributors to the community.

We have all seen the recent reports of inflation and that is a concern, but the people we talked to put it in context.  They have seen lots of ups and downs.  They feel certain they will weather the latest economic cycle and feel fortunate to enjoy the lifestyle that Mill Valley offers.  They praised the affordable classes offered through the Recreation Department and noted that for so much of year they can enjoy hikes, walks and rolls in nature for free.

Plus there pointed out all manner of discounts offered to seniors if you just ask.  There are discounts at retail stores, but also for entertainment and other services.  While acknowledging that Mill Valley has a reputation as a high-income area they are adamant that it is affordable as well.  So, if you have a sound plan they say, “good for you.”  If you don’t, their advice is to try not to worry too much.  Mill Valley is a great place to live, even on a budget.

Ask people what they like about living in Mill Valley and you are likely to hear about the small town feel as well as being so close to San Francisco, the Bay and the ocean.  You are also apt to hear about living among the trees and being nestled at the foot of Mount Tamalpais.  Guess what? It turns out those are good for you, especially if you are older.

A recent study from Harvard University noted that living near bodies of water, parks or other green spaces helps older adults avoid first-time hospitalizations for Alzheimer’s disease and Parkinson’s disease.  The researchers analyzed data regarding about sixty-two million Medicare recipients.  When they focused on those living in ZIP codes with close proximity to natural environments or vegetation, like ours, they found a variety of clear health benefits.

Recent studies of seniors living in Japan had similar findings.  In those, they found several health benefits to seniors who regularly participated in “forest bathing.”  To be clear, this meant taking walks in heavily wooded areas, not “actual” bathing.  They found that it reduced stress, increased life satisfaction, and improved overall health and happiness.

Researchers further found there are benefits when seniors talk about their experiences in the woods with others.  The simple act of recalling their times in nature helped reduce blood pressure, improve moods and decrease the chance of several common illnesses.

It is a beautiful time of year to be outside.  Spring has sprung, the rains are gone and now you have even more reason to get outside for a hike in the woods, a stroll along the waterside or both.  Plus, you will get added benefit from talking about it with friends and family afterward.  So what are you waiting for? Get out there and enjoy our backyard.  If anybody asks why, you can now confidently assert that science shows it is good for your body and your mind!

When you spring forward this month, it is a good time to re-energize your exercise plans too.  In fact, regular physical activity is one of the most important things you can do for yourself.  Being active has been shown to improve brain health, help manage weight, reduce the risk of disease, strengthen bones and muscles, and improve one’s ability to do everyday activities.

The CDC recommends that adults age 65 and older get at least 150 minutes of moderately intense activity (such as brisk walking), or 75 minutes of vigorous activity (such as hiking, jogging, or running) each week.

Studies show that regular physical activity can help keep your thinking, learning, and judgment skills sharp.  It can also reduce your risk of depression and anxiety and help you sleep better.  While individuals vary greatly in how much activity they need for maintaining their weight, the CDC recommendation is a good general guide.

Meeting the recommendations can also lower your risk for heart disease and strokes, as well as lower your blood pressure, improve your cholesterol levels and reduce your risk of developing type 2 diabetes.  It can even lower your risk for developing cancer of the bladder, breast, colon, endometrium, esophagus, kidney, lungs and stomach.  If you mix it up by doing a variety of activities, it will decrease you risk of falls and hip fractures.

It is estimated that over 100,000 deaths in the US, per year, could be prevented if seniors increased their moderate-to-vigorous physical activity by a relatively small amount. Even 10 minutes more a day would make a difference.  For adults 65 and older, the risk of premature death leveled off at about 6,000 to 8,000 steps per day.  Again, this can be achieved with a brisk walk or even marching around your couch during a favorite program.

Do you need more reasons?  Well regular physical activity can help people manage existing chronic conditions and disabilities too.  It will help reduce pain and improve function, mood, and quality of life; helps control blood sugar levels; lowers the risk of nerve damage; and supports your ability to complete activities of daily living.

So as you make plans for day light savings time, check your fire alarms and start thinking about spring cleaning, please consider adding a few steps to your Spring!

March is named after the Roman god of war, but maybe it should have been named after Bacchus, the Roman god of pleasure.  We talked to some elders to find out what they like best about March and they had a lot to share and it seems there is something for everyone.

Some of you are party animals will celebrate Mardi Gras and Fat Tuesday on the 1^st or St. Patrick’s Day on the 17^th.  Others prefer the great outdoors and can be found celebrating in the garden on March 12^th (plant a flower day) or howling at the moon on the 15^th (the Ides of March).  While others love the 20^th, the first day of spring.  In case you miss those days, no worries, you can still celebrate on the 30^th (take a walk day).

March is Women’s History Month and you might find women walking particularly tall, sharing stories of our nation’s relatively unsung heroes.  March is also Red Cross month, a perfect opportunity to organize a blood drive or make a donation.  March even includes a chance to celebrate those that provide essential assistance, as the 3^rd is caregiver appreciation day.

For sports fans it’s a great month.  Basketball fans rejoice on March 12^th, the beginning of March Madness, the NCAA’s annual men’s college basketball tournament.  Spring skiers enjoy the best of both worlds, deep snowpack and warmer temperatures. Plus March is the lull right after the football season has completed and just before hopes are refreshed by the optimism only spring training can bring to baseball fans.

Daylight saving time starts Sunday, March 12, and while getting up earlier might not be what you celebrate, certainly everyone can take advantage of a little extra daylight stretching into the evenings.  It makes it a great time to enjoy long and casual dinners outside.  In fact, you might use it as an excuse to celebrate March 14^th, otherwise known as Pi or Pie day.

As you can see, there is a lot of wisdom we can take from our discussion with elders on how to enjoy March.  One last day they pointed out, and we can all use, is March 22^nd (as young as you feel day).  A day and month for all of us in Mill Valley to forget about age and just have fun.  Here’s hoping you can enjoy this wonder-filled month!

Hopefully love, for you, is an everyday affair, but Valentine’s Day offers a chance to express it more formally.  It is a day to show your partner, best friend, pet, sibling, parent, grand-parent and others just how much you cherish them.  A thoughtful gift is a good idea but sometimes telling someone how you feel, in person or in a card, is what really touches them.  It can be difficult to find the right words.  So we asked a few seniors for some quotes they feel are particularly effective in hopes they might help you.

Several cited famous sayings that focused on another person.  From Hermann Hesse there is, “If I know what love is, it is because of you.”  Katharine Hepburn, known for her relationship with Spencer Tracy, once said, “Love has nothing to do with what you are expecting to get, only with what you are expecting to give – which is everything.”  Writer F. Scott Fitzgerald wrote, “I love her and that’s the beginning and end of everything.”

Some preferred a different tack – like Lucille Ball’s inward focused, “Love yourself first and everything else falls into line” or Eva Gabor’s “Love is a game that two can plan and both win.”  Former President Barack Obama talked about love and hardship, stating, “If you work through the tough times, the respect and love you feel deepens.” Tolstoy wrote about being realistic scribing, “When you love someone, you love the whole person just as he or she is, and not as you would like them to be.” Many other liked quotes focused on acts and preferred Saint Ignatius saying, “Love is shown more in deeds than in words.”

Some seniors focused on the lighter side and like cartoonist Charles Shultz saying, “All you need is love, but a little chocolate now and then doesn’t hurt” or Dr. Love, Leo Buscaglia’s, “A life lived in love will never be dull.”  Mill Valley’s own Joan Baez is famous for her quote that, “That’s all nonviolence is – organized love.”  Perhaps all the above quotes were summarized by Henry Miller when he penned, “The only thing we never get enough of is love; and the only thing we never give enough of is love.”

We could all use more love, especially after nearly three years of a pandemic in which we all had to separate ourselves somewhat for those we care most about.  So whether you are enjoying it with a special partner, envisioning it with a potential soul mate, reminiscing about a love long gone, looking inward or just looking for some fun, here’s hoping you found in the quotes something that will help you express your love to those most important to you.  Happy Valentine’s Month!