A few weeks ago, feeling very good about walking for my health and wellness, I set out on my regular path with my trusty little white dog: Blanche. What began as an ordinary walk quickly turned stressful. A neighbor’s dog became reactive and difficult to control, and in the chaos that followed, the dog got loose from a harness; the owner fell while trying to help, and poor Blanche ended up in surgery.
In the hours after the event, I learned the woman had rescued the dog only two days prior. Neither she nor her neighbor, who was helping her walk the dog for the first time, were strong enough to control the dog. Both had health issues and were older adults, so keeping a young, larger dog on the porch ended up being harder than they thought.
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2022 - 2
LETTER FROM THE EDITOR
Well, it’s official: fall is here. I had my first pumpkin-spiced latte just ture dipped low enough to merit a fleece.
June has a way of inviting us outdoors just before we settle in for a season of oppressive humidity and sweltering heat. It offers a few more weeks of that blissful time when we dine al fresco and enjoy evening walks. It’s a month that encourages us to slow down just enough to notice what is growing—not only around us, but within us as well.
editor@outreachnc.com
, OutreachNC |
In this issue, we’re exploring several themes that, at first glance, may seem unrelated. Yet each one reflects an important aspect of living well as we age: connection, choice, resilience, and care.
Our feature article examines pet ownership and the importance of finding the right fit as we age. The companionship of a beloved pet can bring joy, purpose, routine, and comfort. At the same time, choosing a pet requires consideration of our lifestyle, health, mobility, finances, and support systems. The right match is key to long-term success.
In Mental Health Matters, we explore the difference between loneliness and solitude. While both involve being alone, the experience—and impact—is quite different. Learning to cultivate meaningful connection while also embracing restorative solitude is an important skill at every stage of life.
Amy Phariss, Editor-in-Chief
Don’t worry. It was decaf.
October is a gentle month. There are constant reminders of change. we are lucky, toward each other. We have lingering conversations over the flames flicker. Smoke dances around us in a circle. We zip our jackets
This month’s Ask the Expert tackles a challenge many of us struggle with: navigating insurance approvals and denials within today’s healthcare system. Understanding how these processes work can help all of us (and caregivers) advocate more effectively and access the care we need.
In this month’s feature, we’re starting an important conversation: care community for ourselves or a loved one? Fox Hollow Senior Robin Hutchings offers inside perspective for making this decision.
In Ask the Expert, Amy Natt answers a reader’s question regarding away without any estate planning. Without a will or access to important
And because June brings an abundance of fresh produce, On the Menu includes a few simple seasonal recipes featuring fruits and vegetables at their peak. I’ve tried the corn salad, and I can attest: it’s fresh, full of flavor and a hit even with teenagers. Could there be a better endorsement?
Physical therapist Dr. Sara Morrison of Total Body Therapy and Wellness potential diagnostic tools used in physical therapy to help diagnose these tools differ from what other doctor’s offices may offer.
Of course, June also brings Father’s Day—a time to celebrate the fathers, grandfathers, mentors, and father figures who have shaped our lives.
I’m going to agree with Nathaniel Hawthorne this month, who wrote:
George Herbert’s words ring true:
I cannot endure to waste anything so precious as autumnal sunshine spent almost all the daylight hours in the open air.
One father is more than a hundred
schoolmasters.
Here’s to enjoying the October sunshine, falling leaves and daylight
Thank you to all the men in our lives who teach us, guide us and walk alongside us.
Jennifer Tyner, AOS Care Management, Lead Care Manager | jennifert@aoscaremanagement.com
Q: My doctor says I need a procedure, but my insurance company keeps delaying or denying approval. Why does this happen, and what can I do? I feel stuck between my doctor and my insurance provider.
A: This is an important question, and I’m glad you asked and brought up an issue many Americans have faced or are dealing with now.
For many Americans, health insurance is supposed to provide reassurance during difficult medical situations. More and more, however, patients and families say they’re caught in a stressful and confusing system of delays and denied claims. This happens while people are trying to get the care they need for medical conditions they’re living with right now.
Recently, national news outlets have highlighted growing public concern over insurance denials and the emotional toll they can take on patients. One story featured a man suffering from severe chronic back pain whose physician recommended surgery, only for the procedure to be repeatedly denied by his insurance company while additional treatments were required first.
Unfortunately, his experience is not uncommon.
MANY PEOPLE TODAY SAY THEY FEEL OVERWHELMED BY THE AMOUNT OF PAPERWORK, PHONE CALLS, APPEALS, AND WAITING IT TAKES TO GET APPROVAL FOR TREATMENT.
For patients already coping with pain, illness, or uncertainty, this is emotionally exhausting and adds to the overwhelm they already feel.
One of the most common reasons for reimbursement delays is a process called prior authorization. This means a healthcare provider must receive approval from the insurance company before certain medications, procedures, tests, or therapies will be covered.
Insurance companies state that prior authorization helps manage healthcare costs and ensures treatments are medically appropriate. But critics argue that the process can create unnecessary delays and prevent patients from receiving timely care.
Claims can be denied for many reasons. Some of the most common are:
• Missing documentation
• Administrative or coding errors
• Out-of-network provider issues
• Treatments considered “not medically necessary”
• Lack of prior authorization approval
In some cases, denied claims are eventually overturned through appeals. However, navigating the appeals process can be confusing and time-consuming, especially for older adults or someone already managing serious health conditions.
WHAT MANY PATIENTS SAY IS MOST FRUSTRATING IS THE FEELING THAT HEALTHCARE DECISIONS ARE BEING INFLUENCED MORE BY ADMINISTRATIVE SYSTEMS THAN BY THE RECOMMENDATIONS OF THEIR DOCTORS.
Families facing chronic illness, cancer treatment, surgeries, or ongoing medical care often describe the process as emotionally draining. Delays in treatment may worsen symptoms, increase anxiety, and leave people feeling angry, helpless and confused.
Healthcare providers also feel the strain. Many physicians report spending significant time completing insurance paperwork and prior authorizations instead of focusing directly on patient care.
For older adults and caregivers, these challenges can be especially difficult. Coordinating communication between doctors, specialists, pharmacies, and insurance companies often becomes a full-time responsibility during periods of illness or recovery. More than one client has said it “feels like a part-time job” just to keep up with appointments, prescriptions and billing.
The question becomes: what can you do when this happens, and can anything make it better, easier or less
confusing? The truth is – there are steps you can take to help the system along faster and without quite as many phone trees.
Here are several important steps patients and caregivers can take:
Keep detailed records of all medical visits, recommendations, and insurance communications.
Ask providers whether prior authorization is required before scheduling procedures or tests.
Request written explanations for denied claims.
Appeal denials when appropriate—many are eventually reversed.
Ask to speak directly with a case manager or patient advocate through the insurance company.
Seek assistance from hospital social workers, patient advocacy organizations, or family members when navigating complex cases.
Patients should also remember that persistence matters.
MANY APPROVALS HAPPEN ONLY AFTER ADDITIONAL DOCUMENTATION OR APPEALS ARE SUBMITTED.
But they often do happen. It’s easy to feel like the first pushback is the final answer, but that’s not always the case. It’s important to follow up, which isn’t easy but really does help.
The growing conversation around insurance denials reflects a larger question within healthcare today: how do we balance cost management with compassionate, timely patient care?
Most experts agree that greater transparency, clearer communication, and simplified authorization processes could help reduce stress for patients and families. At its core, healthcare should support healing and wellbeing—not create additional barriers during already difficult times.
Behind every denied claim is a real person, like you, trying to receive the care they need. It’s not easy, and it’s certainly not without frustration, but using the tips above might help make it a little more manageable.
Growing Older Together:
PETS, AGING, AND SAFETY
continued from page 1
What struck me most was not blame or fault. The woman clearly cared deeply for her dog and was doing her best in a frightening moment. When I walked Blanche home, the dog’s owner came looking for me, tearful and apologetic. She was trying to do the right thing, by adopting the dog, by taking it on a walk, by finding me to apologize.
But this experience highlights something many of us don’t like to think about: as we age, our physical abilities, balance, strength, reaction time, and health needs can change — sometimes gradually, sometimes unexpectedly. Yet our love for animals often remains as strong as ever.
For many older adults, pets are far more than companions. They provide routine, purpose, comfort, and emotional connection. A dog may encourage daily walks and time outdoors. A cat curled up nearby can ease loneliness after the loss of a spouse or if we feel isolated or alone.
Research continues to show that pet ownership can support emotional wellbeing, reduce stress, and encourage social interaction and activity. Owning and engaging with pets helps both our mental and physical health. In many ways, pets help keep us engaged with life and are part of the overall recipe for a higher quality of life.
At the same time, healthy pet ownership is not only about affection — it is also about compatibility. The right pet can enrich daily life immeasurably. The wrong match, however, can create stress, injury risk, financial strain, or challenges that become increasingly difficult to manage over time.
As conversations about healthy aging continue to evolve, exploring pet ownership from multiple angles is key to ensuring we find the best fits for everyone: ourselves, our pets and our communities.
THE POWERFUL BENEFITS OF PETS AS WE AGE
For many people, pets become especially meaningful in older adulthood. Retirement, the loss of loved ones, children leaving home, health challenges, or changes in social circles can create loneliness and isolation. A pet often provides steady companionship during times of transition.
Animals bring structure to the day. Dogs need walks, feeding schedules, grooming, and play. Cats seek attention and routine. Even small daily interactions — filling a food bowl, tossing a toy, sitting quietly with a pet nearby — can create a sense of purpose and rhythm to the day.
For older adults living alone, pets may also increase feelings of security and connection. Dog owners, in particular, tend to spend more time outdoors and often interact more with neighbors and community members during walks or trips to parks and pet stores. There can also be emotional and physiological benefits. Studies have linked healthy pet ownership with lower stress levels, improved mood, and decreased feelings of loneliness. Some older adults report that caring for an animal helps them maintain motivation, routine, and emotional resilience during difficult periods of life.
Pets can even help support grief recovery. Following the death of a spouse or partner, the quiet companionship of an animal may ease feelings of emptiness and provide comfort during emotionally difficult days.
For many, the bond between human and animal becomes deeply significant. Pets offer affection without judgment. They do not care about aging bodies, changing careers, physical limitations, or life circumstances. They simply offer presence.
LOVE & SAFETY TOGETHER
Yet loving animals and safely caring for them are not always the same thing.
As we age, changes in health and mobility can shift our ability to manage certain types of pets — particularly large, energetic, or physically demanding animals. A dog that pulls on a leash, jumps on visitors, reacts aggressively toward other animals, or requires significant exercise can unintentionally create dangerous situations for an owner with balance issues, arthritis, chronic pain, vision impairment, or
slower reaction times. And small dogs can be just as challenging as larger dogs. Blanche, for example, is 10 pounds and a ball of energy. At 50, I struggle sometimes to keep up with her needs for walks, ball throwing, retrieving, swimming and rides in the car! I’ve also literally tripped over her twice now.
Falls are one of the leading causes of injury among older adults, and pets can sometimes increase these risks. Even a friendly dog can accidentally pull someone off balance or create a tripping hazard underfoot. For me, while cooking, I tripped over Blanche and caught myself on the counter. Not only does she like to be with me, she really likes being with me when food is involved.
And it’s not just the animal itself that can be physically demanding. Carrying heavy food bags, lifting pets into vehicles, cleaning litter boxes, or managing veterinary appointments can also become more physically taxing over time.
Financial obligations matter, too. Veterinary costs have risen significantly in recent years, and unexpected emergencies can place tremendous strain on individuals living on fixed incomes. The total bill for Blanche’s surgery was $2,500. We gladly paid it, but the expense was certainly unexpected.
Grooming, boarding, medications, special diets, and mobility-related pet care needs may become difficult to sustain, and we don’t always know when an issue will arise. Pets, like people, change. Diets change. Medical needs change. Dogs and cats lose eyesight, develop dementia and experience anxiety, just like humans.
None of this means older adults should avoid pet ownership. Instead, it means that choosing a pet should involve thoughtful honesty about lifestyle, physical abilities, support systems, finances, and long-term planning – as it does for any age.
Sometimes we make decisions based on the pet we wish we could manage rather than the pet that truly fits our current season of life. Thinking this through helps us make the choice that we can sustain over the long term, within the lifestyle we have now.
CHOOSING THE RIGHT COMPANION
One of the kindest things we can do — for ourselves and our animals — is choose a pet whose temperament, size, and needs realistically match our lifestyle.
For some older adults, a smaller dog with a calm temperament may be an ideal fit. Others may thrive with a cat, particularly if mobility is limited or frequent walking is difficult. Senior dogs can also make wonderful companions. Many older rescue animals are already house-trained, calmer, and less physically demanding than puppies or adolescent dogs.
Energy level matters more than breed popularity. A highly active working breed may require extensive exercise and training, while a lower-energy companion breed may fit comfortably into a quieter lifestyle. And the needs of the animal matter, too. What lifestyle does this pet need for it to thrive? Often, we’re not sure or we haven’t really considered the pet’s point of view. But some animals are meant to be active more hours of the day than others. Thinking this through is key for everyone’s happiness.
It’s also worth considering the pet’s long-term needs. Puppies, while adorable, require significant patience, consistency, physical stamina, and training (Blanche). Some older adults may enjoy that challenge, while others may find the demands exhausting or overwhelming after the initial excitement wears off.
Fostering can be another meaningful option. Foster programs allow individuals to experience companionship without the long-term commitment of permanent adoption. In some cases, fostering helps older adults determine what type of pet best fits their home and abilities before making a larger commitment.
The goal isn’t perfection. It’s thoughtful compatibility through awareness and acceptance. We’re aware of our needs, the animal’s needs and our capacity to meet them.
THE IMPORTANCE OF PLANNING AHEAD
One aspect of pet ownership often overlooked is emergency planning. Emergency planning is a huge part of any aspect of aging, and pets are no exception.
• What happens to the pet if the owner is hospitalized unexpectedly?
• Who can help if surgery, illness, or injury temporarily limits mobility?
• Is there a trusted friend, family member, or neighbor who can assist with walks, transportation, or temporary care?
These questions may feel uncomfortable, but they are incredibly important.
Many older adults are highly independent and prefer not to rely on others for assistance. However, planning ahead can prevent both human and animal crises during emergencies.
A written pet care plan can be helpful. This might include:
; feeding instructions
; veterinary information
; medication schedules
; emergency contacts
; temporary caregiving arrangements
Some families even include pets in broader aging and estate planning conversations.
These preparations are not signs of weakness or pessimism. They’re acts of responsibility and care.
AGING WELL WITH PETS
One of the most meaningful aspects of healthy aging is learning to thoughtfully adapt to changing realities while continuing to pursue joy, purpose, and connection. For many people, pets are an important part of that equation.
The goal is not to discourage animal companionship. In fact, pets may become increasingly valuable as we age. Rather, the goal is to approach pet ownership with honesty, flexibility, and compassion — both toward ourselves and toward the animals we love.
Sometimes that means transitioning from large dogs to smaller breeds. Sometimes it means choosing an older rescue animal instead of a puppy. Sometimes it means accepting help from family members, dog walkers, or neighbors. And sometimes it means recognizing when a pet’s needs no longer align with our physical abilities.
There can be grief in those realizations. But there can also be wisdom.
Responsible pet ownership is ultimately rooted in care — not only in affection, but in creating an environment where both human and animal can thrive safely together.
The incident I experienced during that neighborhood walk stays with me because it revealed how quickly a joyful relationship can become physically overwhelming when circumstances change. It also reminds me of something else: the woman involved was clearly trying to do the right thing. Her efforts came from care and concern, not neglect. That distinction matters.
As our population ages, these conversations deserve more openness and less judgment. Aging doesn’t diminish someone’s capacity for love, companionship, or meaningful connection with animals. But it may require more intentional decisions about which type of pet ownership is safest and healthiest.
Choosing a pet that matches our season of life is not “giving something up.” It’s making a thoughtful choice that protects both the owner and the animal while preserving the joy that companionship can bring. And that is something worth protecting at every age.
Questions to Ask Before Adopting a Pet
Choosing a pet is about more than affection — it is about finding the right fit for your lifestyle, health, energy level, and support system. Asking a few thoughtful questions before adopting can help ensure a safe, rewarding relationship for both you and your future companion.
Can I safely walk or physically manage this animal every day?
Could I maintain control if the pet became startled or reactive?
Does this pet’s energy level realistically fit my lifestyle?
What are the expected monthly costs for food, grooming, medications, and veterinary care?
Do I have friends, family members, or neighbors who could help if I became sick or injured?
What would happen to the pet if I were hospitalized unexpectedly?
Am I prepared for the long-term commitment this pet requires?
Would an older or lower-energy pet better fit my current stage of life?
Have I considered fostering before committing to permanent adoption?
Does this pet help support my wellbeing — or create ongoing stress and physical strain?
PET CARE PLAN
Important Information in Case of Illness, Injury, or Emergency
PET INFORMATION
Pet’s Name:
Breed/Type:
DOB/Age:
Microchip Information:
Veterinarian Name & Phone:
Medications/Special Needs:
DAILY CARE INSTRUCTIONS
Feeding Schedule:
Walking/Exercise Needs:
Favorite Toys/Comfort Items:
Behavior Notes or Triggers:
EMERGENCY CONTACTS
Primary Contact:
Phone Number:
Secondary Contact:
Phone Number:
IMPORTANT INFORMATION
Where Food/Supplies Are Kept:
Leash/Carrier Location:
Medication Instructions:
IN CASE OF HOSPITALIZATION OR EMERGENCY
; Temporary care arrangements have been discussed.
; Emergency contacts have house key/access instructions.
; Veterinary records are accessible.
; Financial arrangements for emergency care are considered.
FINAL NOTES
ON THE MENU: Summer Savoring
PEACH, CORN & TOMATO SUMMER SALAD
Sweet peaches, fresh corn, and ripe tomatoes come together in this bright, seasonal summer salad. It pairs beautifully with grilled chicken, fish, or crusty bread and is simple enough for a light lunch on a warm evening.
Ingredients
3 ears fresh corn, cooked and kernels removed
2 ripe peaches, sliced thin
2 large tomatoes, chopped or sliced
1 cup sugar snap peas or fresh peas
1/4 small red onion, very thinly sliced
1/4 cup fresh basil, torn
2 tablespoons olive oil
1 tablespoon balsamic vinegar or fresh lemon juice
Salt and black pepper to taste
Optional: crumbled feta or goat cheese
Instructions
1. Lightly grill or sauté the corn for extra flavor. Allow to cool before assembling salad.
2. In a large serving bowl, combine corn, peaches, tomatoes, peas, and red onion.
3. Drizzle with olive oil and balsamic vinegar or lemon juice.
4. Add basil and gently toss.
5. Season with salt and pepper.
6. Top with feta or goat cheese if desired and serve chilled or at room temperature.
Serving Tip
For extra protein, add grilled chicken, shrimp, or white beans. This salad is best eaten fresh and makes an excellent addition to picnics, cookouts, or light summer dinners. It can keep for a day or two, but the vibrancy isn’t quite as…vibrant.
EASY PLUM CRISP
This simple plum crisp is warm, comforting, and perfect for showcasing ripe summer plums without any complicated baking skills or obscure ingredients. The fruit becomes soft and jammy, and the crisp topping adds just the right amount of sweetness and crunch.
Ingredients
Filling
5–6 ripe plums, sliced
2 tablespoons brown sugar
1 tablespoon flour
1 teaspoon vanilla extract
1/2 teaspoon cinnamon
Small squeeze of lemon juice
Crisp Topping
3/4 cup old-fashioned oats
1/2 cup flour
1/3 cup brown sugar
1/2 teaspoon cinnamon
Pinch of salt
5 tablespoons cold butter, cut into small pieces
Instructions
1. Preheat oven to 375°F.
2. Lightly grease a small baking dish or pie plate.
3. In a bowl, toss sliced plums with brown sugar, flour, vanilla, cinnamon, and lemon juice. Spread into baking dish.
4. In another bowl, combine oats, flour, brown sugar, cinnamon, and salt. Cut in butter with a fork or fingers until crumbly.
5. Sprinkle topping evenly over plums.
6. Bake for 35–40 minutes, until fruit is bubbling and topping is golden brown.
7. Allow to cool slightly before serving.
Serving Tip
Serve warm on its own or with a scoop of vanilla ice cream or vanilla Greek yogurt.
Plums are rich in antioxidants and naturally sweet with a balance of tartness that makes them ideal for simple summer desserts. Look for fruit that feels slightly soft and fragrant for the best flavor.
One key part of healthy aging is connection. I think, as a society, we missed how important social and personal connection is….until COVID. During those years, we saw what could happen if we didn’t reach out, spend time together and relate with each other on a personal level. We tried to compensate with virtual meetings and drive-by birthday parties. These helped bridge the gap – but the gap was still there, and we’ve become more aware of how and where loneliness exists.
In my counseling practice, loneliness is one of the core issues clients report. Clients often say, “Sometimes, I feel loneliest when I’m with other people.” Loneliness is also often coupled with anxiety or depression (or both), and people can begin shying away from social interactions altogether.
I regularly hear from clients who want to socialize but are isolated due to health issues. They say, “I’d love to get out, but I’m so tired all the time. And with my immune system compromised, every interaction feels like a threat. I don’t want to get sick on top of being sick.”
There are layers to the issues of loneliness and solitude…community and connection.
LONELINESS VS. SOLITUDE: UNDERSTANDING THE DIFFERENCE
It’s easy to assume that being alone (solitude) and feeling lonely (loneliness) are the same thing—but they’re different, and this difference matters as we age.
One can quietly wear a person down. The other can restore and steady the mind.
WHAT IS LONELINESS?
According to the American Psychological Association, the definition of loneliness is: n. affective and cognitive discomfort or uneasiness from being or perceiving oneself to be alone or otherwise solitary.
Loneliness isn’t about how many people are around you. It’s about how connected and comfortable you feel. Do you feel known by these people? Do they “get” you, know your likes and dislikes, understand your personality and like you even on days when you’re cranky?
When we feel seen, understood and supported, we feel connected. A person can be surrounded by family, attend regular gatherings, and still feel deeply lonely if that connection is missing.
Loneliness might feel like:
• A sense of disconnection or being unseen
• Feeling like others don’t truly understand you
• A quiet emptiness, even during social interactions
• Longing for deeper or more meaningful connection
It’s less about quantity of interaction and more about quality. Loneliness can also be subtle. It doesn’t always announce itself clearly. Sometimes it shows up as irritability, low motivation, or a sense that something just feels “off.”
WHAT IS SOLITUDE?
Defining solitude is a bit trickier. In fact, there’s research trying to do just that.
In “Definitions of Solitude in Everyday Life”, researchers Weinstein, Hansen and Nguyen (2022) write, “To explore the defining characteristics of solitude, we asked adults to explore its meaning from their own perspectives.” They conclude that solitude comes in many forms (physical, public, companionate, total) and can be either positive or negative.
For example, we can choose and even seek out solitude. We might set aside a few minutes each morning for quiet reflection or take ourselves into the woods for a solitary walk, without friends or family. There is something soothing and calming about solitude when people’s lives are busy and distracted.
When solitude is thoughtful, intentional and wanted, it can be quite positive.
For many older adults, solitude becomes more familiar—especially after retirement, children leaving home, or the loss of a spouse or close friends. And while those transitions can be difficult, solitude itself is not the problem. In fact, it can be deeply nourishing.
WHEN SOLITUDE ISN’T A CHOICE, HOWEVER, IT CAN DIP ITS TOE INTO LONELINESS.
And solitude can sometimes lead to loneliness. What begins as time to decompress can slowly become isolation. Seniors are especially vulnerable to this transition because they’re often limited in physical capacity, might have restrictions in driving or have simply outgrown certain social interactions (work, sports, social groups).
PETS,
COMPANIONSHIP, AND THE MIDDLE
GROUND
This is where companionship—especially through pets—can help.
Pets can help bridge the gap between solitude and loneliness. They provide presence, routine, and a sense of being needed. A dog waiting for a walk or a cat settling beside you can soften the edges of an otherwise quiet day.
But pets are not a complete solution. Like all problems and answers, there is usually more than one approach or path toward resolution.
PETS CAN SUPPORT EMOTIONAL WELLBEING, BUT THEY DO NOT REPLACE HUMAN CONNECTION.
As we explored in this month’s feature, they also come with responsibilities that aren't always easy to manage. The healthiest approach is balance—recognizing that connection can come from multiple sources and reaching out when you can, how you can and with the help and support of others, furry friends and everyone in between.
