NOCSC Meeting Tomorrow

Good Morning Friends and Members of the North Orange County Senior Collaborative

This is a reminder that our next All Member General Meeting will be on Tuesday, 19 November 2019 from 8:30 – 10:00 a.m. / St. Jude Community Srvs. Bldg., 130 W. Bastanchury Road, Fullerton  92835.  We’ve got important topics to cover including Fall Elections for 2020 NOCSC Board Members ~ please see the attached NOCSC Board Member Nomination Form.  All current Board Members are planning to return if re-elected (Dan York, Chair; Mark McKibbin, Vice Chair; Karyl Dupée, Secretary; Linda Armas, Board Member; Marilyn Fedorow, Board Member; Stephen Huber, Board Member; and Kyle Vanderheide, Board Member).  Nominations remain open for all positions and self-nominations are accepted as well.

This monthly we will be tackling the difficult and often sticky dilemma around Family Dynamics ~ including resistant patients, family members, problems with finances, legal issues, medical and behavioral health complications, etc. in the hopes of shedding some light and information on best practices in these situations.  Have a good rest of your week and please let me know if you are interested in participating as a NOCSC Board Member in 2020-2021!


Tuesday 20 August 2019  8:30-10:00 a.m.

St. Jude Community Services Bldg.

130 W. Bastanchury Road, Fullerton







                    WHAT YOU’LL LEARN FROM:


CalFresh –  Brana Vlasic and Martha Robledo

Find out just what CalFresh is, who qualifies and how to receive CalFresh

  • Become trained on how to pre-screen your clients
  • Discover how to sign clients/participants/patients, etc., up for CalFresh, and
  • Learn how to become a potential CalFresh partners

ReConnect –  Christine Tran

  • How it decreases the severity of mental health symptoms

  • How it  improves overall quality of life and well-being

  • How it increases social functioning and participation in meaningful activities

  • How you can sign your patient / client up for the program

Does Long-Term Care Insurance Cover Assisted Living?

Every long-term care insurance plan and facility is different. Pay close attention to the details.

By David Levine, ContributorJuly 29, 2019, at 1:26 p.m.

This article is based on reporting that features expert sources including Kelly ShortColleen DennisRachel ReevesJulie Westermann

U.S. News & World Report

Long-Term Care Insurance for Assisted Living

SUPPOSE YOUR ELDERLY mother is struggling with day-to-day activities like laundry, cleaning and cooking. But she’s not truly ill and doesn’t need a high level of daily health care. She’s not ready to move into a nursing home, but you worry about her walking up and down stairs or carrying a bag of groceries. An assisted living facility may be the place for her.


What Is Assisted Living?

Assisted living is a type of housing that seniors move into when they are fairly healthy but need a bit of extra help, says Colleen Dennis, case management team manager with Genworth Insurance. “They typically provide room and board, meals and some level of nursing oversight. It is more advanced than independent living but less comprehensive than a nursing home,” she says, which provides skilled nursing services 24 hours a day, seven days a week.

Assisted living is a great intermediate step on the continuum of elderly care. But, like all health care, it’s expensive. According to Genworth’s 2018 Cost of Care Survey, the national median monthly cost of care in an assisted living facility is $4,000. Who pays? Usually, you do.

“Assisted living is primarily paid for by individuals’ private or personal funds, such as long-term care insurance or personal assets. Medicare does not cover long-term supports and services,” says Rachel Reeves, director of communications for the National Center for Assisted Living.

Medicaid may cover some costs, but the rules vary by state. “How the program is set up in each state determines how residents can use Medicaid to help pay for LTC in home- and community-based settings, such as assisted living communities,” Reeves says. About 1 in 6 assisted living residents relies on Medicaid to cover their costs, many of whom must spend down their personal assets first to qualify for Medicaid coverage, she adds.

That’s where long-term care insurance comes in. Most LTC insurance policies cover expenses at an accredited assisted living facility. “Everything is policy-dependent, but most assisted living facilities are private pay and can be reimbursed by LTC,” Dennis says.

Check Your Policy Carefully

LTC insurance premiums vary widely depending on where you live and how much coverage you want; the average is about $2,700 a year, according to AARP. Whatever you decide to purchase, you need to check the details of your policy carefully. “In general, long-term care insurance is flexible along the continuum of care. It can pay for assisted living, a nursing home or adult day care,” says Kelly Short, editor at However, she adds, some LTC policies are designated as facilities-only, meaning they won’t cover in-home assisted living services.

Short says that LTC insurance could cover 100% of your assisted living expenses, but that insurance is expensive in and of itself. “A general rule of thumb is that your insurance premium shouldn’t exceed 5% of your monthly income,” Short says.

A typical monthly insurance benefit is between $2,000 and $10,000. That median monthly assisted living cost of about $4,000 varies depending on amenities and location. And there are often additional fees for related services, such as physical therapy, laundry help, meals, dog walking and more.

There’s no federal definition for what constitutes assisted living – and laws and regulations vary significantly from state to state. “Generally, to be eligible for insurance benefits, a person needs to require help in at least two major activities of daily living such as bathing, dressing and eating,” Short says.

Make Sure Your Assisted Living Facility Is Approved by Your Insurance

As a general rule, assisted living facilities accept private LTC insurance payments, but insurance companies don’t always approve of the facilities themselves. “The trouble comes in the other direction: Despite state licenses, an insurance company denies payment because an assisted living agency or facility doesn’t meet its standards,” Short warns. The company could deny coverage because it feels the center is too small or doesn’t have adequate staffing.

Whether there is a connection between state licensing and regulations and the insurance coverage depends on the policy requirements. “If the policy has assisted living facility benefits and requires a license, and the facility is licensed appropriately, then we can approve the facility,” says Julie Westermann, a Genworth Insurance spokesperson. Other insurers may have different rules, however.

Some states – but not all – require licensed assisted living centers to have registered nurses on staff 24/7. States also differ in the amount of education required of facility directors; “maybe the person needs a degree in health care administration, for example, or maybe nobody’s asking,” Short says. Regulations about training for other workers also vary, as do laws about facility cleanliness, meal preparation, organized social activities for residents and much more.

In addition, some states have different levels of licensure for assisted living facilities. One important advanced license to look for involves memory care or dementia care. “This sort of license lets an assisted living center keep caring for a resident even if he or she loses a good deal of independence,” Short says. “Choosing an assisted living center with an advanced license can help a person avoid the stress and expense of relocating again. It can also help couples maintain residence together.” The laws governing assisted living are numerous and they change often, she says, so it is wise to search online for state-specific information.

To find a covered facility, policyholders or their power of attorney can call their insurance company to request a provider inquiry, Westermann says. At Genworth, for example, it “will review up to three providers at a time. If, after those three have been reviewed and the insured or POA isn’t interested in any of those or the facilities wouldn’t be covered under their policy, then the policyholder can open up another inquiry of up to three providers,” she says.

You can appeal denied claims, but appealing can be a hassle. To ensure that payments will go through, Short advises working with a private LTC insurance representative beforehand and then with a consumer advocate at the facility. Most insurers will provide this service free of charge. “And for policyholders shopping for long-term care providers, such as ALFs, it’s important that they call their insurance carrier before deciding on an assisted living facility to make sure the provider meets the requirements of the policyholder’s policy,” Westermann says. Short agrees: “If there is any question about coverage for your condition under a LTC policy, be sure to make these inquiries before making any major moves.”

The goal of assisted living, Dennis says, is to keep the individual healthy and functional in that environment for as long as possible. “Assisted living facilities do a nice job of offering a wide range of services and can accommodate someone with functional needs for quite a while,” she says. “My biggest advice is to review your policy before moving into the facility. Compare the initial plan of care and evaluation with the policy, and call your insurance carrier prior to moving in to discuss that plan.”


Good Afternoon Friends and Members of NOCSC ~ This is your opportunity to learn more about all of the amazing new adaptive / assistive devices that are available for your clients and patients!  So many remarkable devices and new technology is out there to assist our clients and patients ~ be prepared to be amazed!  If you choose to park in the parking structure please bring your parking ticket in to be validated ~ if you’re new to our office, the attached map may be helpful.

Tuesday / 18 June 2019 / 8:30-10:00 a.m.

St. Jude Community Services Bldg.

130 W. Bastanchury Road, Fullerton
















Dear Friends and Members of NOCSC:
Just a reminder that we’ve got a full agenda tomorrow morning (Tuesday, 21 May 2019 / St. Jude Community Srvs. Bldg., 130 W. Bastanchury Road, Fullerton / Conference Room on the left) with a special segment on “Low-Income Resources” by Brooke Weitzman, Elder Law Attorney, and Beatriz Nunez, Council on Aging, and an opportunity for you to add to our growing list of resources, and a Special Election to fill one vacant Board seat.  Please feel free to park in the parking structure and I’ll be happy to validate your parking ticket.  I look forward to seeing and hearing from you in the morning!

Should Seniors Be Driving?

How to navigate the conversation.

By Anthony Cirillo, Contributor
U.S. News & World Report

PRINCE PHILIP, WHO’S 97, was recently involved in a car crash that injured two women and prompted a debate on older drivers in Britain. Two days after the accident, he was photographed driving a Land Rover and not wearing a seatbelt. Of course, that reignited a debate about seniors and driving.

An Emotionally Charged Issue

What if I told you that tomorrow, just for a day, you would all of a sudden not have a car available? What if I said a week? You can start to see how your independence would be affected.

A car represents different things to people: a way to get to places for some; status and identity for others; freedom and spontaneity. What it represents also says a lot about how you approach the situation.

Just because you’re older doesn’t mean you have to stop driving. We see so many distracted driving accidents from much younger people on phones or texting, and that’s not representative of how seniors drive.

Spotting Problems

If you’re geographically close by, the best thing is to observe directly. In other words, go for a ride-along. Buckle up!

Distinguish between serious signs of trouble and those that are less so. For example, confusing the gas with the brake is serious. Riding the brake is perhaps less serious. If a problem is serious, take immediate action. If it’s less so, observe over time, take notes and look for a consistent pattern. These facts will help when having a conversation.

Things to look for:

  • Struggling to change lanes.
  • Problems turning, particularly with left turns.
  • Driving too slow or too fast.
  • Reaction time.
  • Other drivers honking.
  • Hitting curbs.
  • Following signals.
  • Scrapes on cars.

Often, older adults will start self-correcting, not driving at night, in bad weather and on freeways. My mom started going places by making all right hand turns. Praise these behaviors, but also take them as a sign that things might be changing.

A Patient’s Guide to Arthritis

Know the basics on symptoms, diagnosis and treatment to help as you battle the disease.

By Elaine K. Howley, Contributor

A Patient’s Guide to Arthritis

Arthritis is such a common problem, particularly for older people, that most of us have probably come across an older person with creaky, swollen joints or knobby, gnarled fingers at some point. But this disease of aging can cause significant pain and can severely limit how some people interact with the world. The Centers for Disease Control and Prevention reports that “arthritis affects 54.4 million U.S. adults, about 1 in 4. It is a major cause of work disability in the United States and one of the most common chronic conditions in the nation.”

But what is it exactly? Arthritis can actually refer to a wide range of diseases and conditions, and they’re not all the same thing. “Arthritis is a very global term,” says Dr. Esther Lipstein-Kresch, chief of rheumatology at ProHEALTH Care in New York. But the term “implies that there’s some inflammation involving a joint.” That inflammation could be the result of any of “over 100 different types of inflammatory conditions that can affect the joints. As a result, we have so many different rheumatic conditions, but they all ultimately have arthritis in common, which is inflammation of the joint and the erosion of cartilage and sometimes the erosion of bone depending on the actual arthritic disorder.”

Types of Arthritis

Although there are more than 100 different rheumatic conditions that can cause arthritis, The Arthritis Foundation reports that the most common types include:


Osteoarthrosis is the most common form of arthritis and the one most of us probably think of first when we hear the term arthritis. Dr. David Pugliese, a rheumatologist at Geisinger in Danville, Pennsylvania says that “osteoarthrosis is essentially a wear-and-tear phenomenon” that gets worse over time. “It’s a structural problem. Every joint is made of two bones that come together with an interface of cartilage and fluid that makes a cushion and keeps (the joint) free of infection. With osteoarthritis, over time that cartilage wears away. When the cartilage wears away, the bones start to bang on each other and start to create pain from the direct contact.” This loss of lubrication in the joint makes movement more difficult “and it’s a progressive problem.”

Osteoarthritis tends to get worse with activity, so Pugliese says most osteoarthritis patients will usually feel fairly good upon waking but often develop more pain and stiffness as the day progresses and they move their joints more.

Osteoarthrosis is also essentially unavoidable if you live long enough – it’s just part of the natural aging process. “Everybody gets some osteoarthritis,” Pugliese says, although some people may develop more severe cases or be more prone to pain from it sooner than other people. Why exactly isn’t entirely clear. “There are some genetic determinants – different people have different amounts of it, but everyone is going to get some of it because it’s a function of this wear and tear.”

Naturally, osteoarthritis tends to impact older adults more. People who lead active lifestyles or engage in a lot of manual labor, such as construction workers, may experience the effects of wear on joints sooner than their more sedentary counterparts. If you’ve suffered a trauma to a joint, such as a bone fracture or other injury, that can also increase your chances of developing arthritis in a specific joint.

Rheumatoid Arthritis

Unlike osteoarthritis, rheumatoid arthritis is an autoimmune disorder that can affect more than just the joints. “Rheumatoid arthritis doesn’t start out as a structural problem,” Pugliese says. Rather, “it’s an immunologic problem,” meaning that the immune system goes a little haywire and begins attacking the body’s own tissue. This leads to swelling and inflammation that can cause significant pain. “When people get rheumatoid arthritis, what essentially happens is their immune system becomes activated and treats their joints as if they have infections.” Over time, that overactive immune response can lead to destruction of the tissues in the joint, which can lead to pain and a loss of mobility.

Psoriatic Arthritis

Psoriatic arthritis is an inflammatory immune disorder that’s often associated with the common skin disease psoriasis. Lipstein-Kresch says that not every person who has psoriatic arthritis also has psoriasis, but having psoriasis puts you at greater risk for developing this condition that can cause significant pain in the joints and other immune responses throughout the body. People with psoriatic arthritis will often experience swelling of the fingers or toes, and sometimes certain bones can fuse to one another, making movement of the joint difficult or impossible.


Gout is a type of arthritis that’s caused by a buildup of uric acid crystals in the joints, most often the joint at the base of the big toe. It can come on suddenly with severe pain and swelling and the joint may feel hot to the touch or tender. Gout tends to impact older people more, and those whose diets contain items that can elevate the levels of uric acid in the body, such as alcohol, sugar and meat. Certain medications and genetics may also play a role in whether you’re more prone to attacks of gout.

What Causes Arthritis?

With osteoarthritis, the simple cause is wear and tear on joints over time. As we age, our bodies lose some of the fluid that sits between the bones of the joints. As that fluid dissipates, the joint has less cushioning, creating pain and inflammation from the friction of bone-on-bone movement.

With inflammatory arthritis conditions like rheumatoid arthritis or psoriatic arthritis, the cause is a problem with the immune system. Because the immune system begins to treat cells in the joints as though they were foreign invaders to the body, an inflammatory response is triggered that can lead to significant pain, deformity and disability.

Arthritis Symptoms

Symptoms of osteoarthrosis include:

  • Pain, stiffness or swelling of the joints that gets worse with use.
  • Deformity of the joints over time (bony growths in fingers or toes are common).
  • Decreased range of motion.
  • Difficulty walking or muscle weakness.

Osteoarthritis symptoms commonly occur in finger joints, the wrists, knees and hips, but most any joint can develop arthritis, especially if the joint has sustained a trauma or injury in the past.

Symptoms of rheumatoid arthritis can include:

  • Swelling, pain or redness in one or more joints throughout the body (although symptoms usually are symmetrical).
  • Fatigue.
  • Joint stiffness and pain in the morning that takes a while to loosen up.
  • Fever.
  • Numbness or tingling in the extremities.
  • Decreased range of motion.

If you experience any of these symptoms, be sure to see your doctor. Pugliese says that if you have rheumatoid arthritis, starting on the right treatment as soon as possible is important to improving your outcome. “As soon as the question pops into a primary care doctor‘s mind, ‘Is this inflammatory?’ Then we (rheumatologists) want to see the patient.” He says the American College of Rheumatology has set guidelines aiming to have every patient with rheumatoid arthritis “started on disease-modifying therapy within three months. That’s a pretty lofty goal when you think about the time it takes for someone to present to primary care and for that referral to go through and get the appointment. But we know that as soon as there’s inflammation, the process that causes the damage has started.” Starting the appropriate course of medications as early as possible can slow that progression and significantly delay the development of more severe symptoms and complications.


If your doctor suspects that you have any type of arthritic condition, you’ll likely undergo a thorough physical exam. Most cases of osteoarthritis can be diagnosed based on the findings of a physical exam conducted by your doctor. You may also have some X-rays to look at how much space you have between the bones in symptomatic joints.

“There’s no blood test for osteoarthrosis,” Pugliese says, but you may end up having some tests just to rule out an inflammatory arthritic condition such as rheumatoid arthritis or psoriatic arthritis. And it’s important to know that you can have osteoarthritis and another inflammatory arthritis condition such as rheumatoid arthritis at the same time.

With inflammatory arthritic conditions like rheumatoid arthritis, the diagnosis can be a little more challenging in some cases, because autoimmune disorders aren’t always the easiest to pinpoint straight away. But your doctor will likely order certain imaging and blood tests to take a look at what’s going on.

Arthritis Treatment

Currently there aren’t a lot of great drug options for people dealing with osteoarthritis, Pugliese says. “The big challenge with osteoarthritis is that there’s no medication that will stop or reverse the process.” You can take anti-inflammatory medications to help ease some of the symptoms, but the damage has been done and “the big thing is management.” For some patients, surgery, such as a joint replacement, is the best way to cope with an arthritic joint.

For rheumatoid arthritis, the past 15 or 20 years have seen the debut of several new types of medications called biologics that have improved the outlook for many patients with the disease. These drugs target specific molecules that generate inflammation, and the newer drugs are offering some patients a much-improved prognosis. In addition to these newer drugs, many still take the older medications, such as methotrexate, that have long been used to treat rheumatoid arthritis. Some rheumatoid arthritis patients may also take steroids for a time, but Pugliese says many rheumatologists try to wean patients off those as soon as possible, because they can have some difficult side effects if used long-term. In some cases, joint replacement surgery may also be recommended.


Lipstein-Kresch says many patients newly diagnosed with osteoarthritis will ask her whether they should be taking a dietary supplement to help alleviate some of their symptoms. “A lot of people ask about glucosamine (a natural compound found in cartilage) and turmeric (a spice thought to have anti-inflammatory properties) for osteoarthrosis, and the bottom line is that there’s no definitive study that shows that glucosamine is indeed effective for osteoarthrosis. The recommendations are that if you’re already taking it and you think it’s helping, then stick with it. But starting it is probably not something I’d do ordinarily unless I have no other options,” she says. Some people say that adding turmeric to their diets has helped ease some of the symptoms of osteoarthritis. For anyone dealing with this disease, Lipstein-Kresch recommends “eating healthy” and exercising as good ways to help manage the disease.

In addition, if you have osteoarthritis and you’re carrying around a few extra pounds, Pugliese says one of the best things you can do is lose some weight. “Even though we can’t give you a pill to cure it or fix it, there are a lot of things patients can do to make it better and easier on themselves, one of which is weight management.” Dropping just a few pounds can make a difference, because “every pound of weight a person carries translates into 4 or 5 pounds of pressure on the joint. If you extrapolate even a 20-pound weight loss for an obese person, that person may be taking up to 100 pounds of pressure off each of their weight-bearing joints,” which can translate into less pain when moving.

For patients with rheumatoid arthritis, it’s important to keep your doctor apprised of how you’re doing and whether your treatment protocol is helping. Rheumatoid arthritis is a chronic, autoimmune condition that can’t be cured but can be managed. You need to speak up if you’re having difficulties, Pugliese says. “Don’t be afraid to ask for help and tell your doctor if you don’t feel well. A lot of times if you have a 30-year-old, otherwise healthy person, their mindset is, ‘I’m too young to have arthritis. I better just deal with it.’ But we don’t want people letting it go. We would much rather have more people in our office, so we can catch those people before they go on to get damage,” which can occur outside of the joints. Because rheumatoid arthritis is a systemic, autoimmune condition, sometimes the disease can affect the internal organs, such as the heart, kidneys and lungs and it’s important to stay on top of your health as you manage this chronic condition.

No matter which type of arthritis you have, your doctor is likely to recommend that you get plenty of sleep, eat right and get lots of exercise. Pugliese says exercising is important because strengthening the muscles that move the joints can also result in smoother movement and less pain. “The joints are two bolts coming together, but the muscles are what move them. The better the muscles are in shape, the better the arthritis will perform, so we always encourage exercise and strengthening.”