The Wise Guide Fall 2017 Winter 2018 - Northernmost Idaho

FALL 2017 / WINTER 2018

A N I N S I G H T F U L A P P R O A C H T O H E A LT H

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FREE

Am I Addicted?

Youth Transition Services Immunizations for Adults Kinetisense The Future is Here!

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Wise Guide | Fall 2017 / Winter 2018

Features

Health Centers Benefit Idaho Communities.................... 4 Wishes for Winter Wellness............................................... 6 BGH Gets Time Sensitive Emergency Designations......... 8 About the Cover................................................................... 9 Nourishing Homemade Gingerbread Latté........................11 Am I Addicted?................................................................. 12 Start Talking Now!........................................................... 14 Kinetisense – The Future is Here!.................................... 16 Mental Health Stigma...................................................... 19 Freedom from Addiction................................................. 20 Transition Services, Much to Consider........................... 22 Peer Support Specialists – A Rapidly Growing Field...... 24 Deep Tissue Laser Therapy Works!.................................. 26 Massage Therapy Treats Specific Disorders..................... 28 How to Support Your Immune System........................... 30 Immunizations for Adults............................................... 32 Understanding Long-Term Acute Care............................ 34 Planning for Medicaid Long-Term Care Benefits........... 36 Need a Ramp for Accessibility?....................................... 39 Crossword and Sudoku...............................................40-41 Key Factors for Senior Independent Living..................... 42 The Right Care, at the Right Time................................... 45 Is It Time for Home Care?............................................... 46 Five Reasons to Start Estate Planning TODAY!............... 48 The Area Agency on Aging & What You Need to Know......50 Transitioning Your Loved One to Long-Term Care........ 52 Claims 101........................................................................ 55 Veterans Pages.............................................................56-61 Good Grief?...................................................................... 62 Alzheimer’s Association Support Groups....................... 64 Hard to Heal Wounds...................................................... 73 Diabetes Self Care, An Alternative Approach................. 74 A Stray or Not a Stray? – That Is the Question............... 76 What Are Overdentures?.................................................. 78

Fall 2017 / Winter 2018

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Am I Addicted?

Making sense of the opioid crisis

Kinetisense - The Future is Here!

Predict future injuries and more...

Immunizations for Adults There are vaccines for adults, too!

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Directory Agencies, Free Referral Services & Volunteer Opportunities......................................... 66 Chiropractic & Massage Therapy..................................... 66 Counseling....................................................................... 67 Dental............................................................................... 67 Education & Recreation................................................... 67 Financial & Asset Management....................................... 68 Gifts & Shopping.............................................................. 68 Hearing & Vision.............................................................. 68 Hospice............................................................................. 68 Hospitals & Medical Care................................................ 69 Independent & Assisted Living, Adult Day Care............ 70 In-Home Health & Personal Care................................... 70 Insurance.......................................................................... 71 Legal.................................................................................. 71 Nutrition........................................................................... 72 Personal Emergency Systems........................................... 72 Pharmacies, Medical Equipment & Supplies.................. 72 Rehabilitation & Skilled Nursing.................................... 72 Veterinary & Animal Care................................................ 72

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Health Centers Benefit Idaho Communities

by Olivia Luther Morlen, Director of Community Relations Kaniksu Health Services

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t was a beautiful summer day when Teresa came to Kaniksu Health Services with her two kids in tow. It was nearing the start of a new school year and her kids, ages 7 and 9 needed check-ups and updated immunizations. With limited income from her full-time job, Teresa is always hesitant to spend money on herself, including preventive healthcare. After her kids’ exams, Teresa learned that she could get a much-needed check-up and the sliding fee payment option made it possible for her to pay on her own. Like many Idahoans, Teresa does not have health insurance and does not qualify for coverage through the Medicaid program.

Teresa’s story plays out every day at health centers across our great state. Non-profit health centers just like Kaniksu and Heritage Health meet the healthcare needs of hard working members of our North Idaho communities. Right now, over 170,000 Idahoans receive primary healthcare at one of the state’s non-profit community health centers. These centers are locally operated healthcare systems offering comprehensive primary and preventive care related to family medicine, internal medicine and pediatrics. Health centers support all aspects of a healthy life by providing high quality and affordable services to everyone. For those who are unnsured or underinsured, a sliding-fee payment scale encourages access and allows a patient to take greater responsibility for their health.

Idahoans are struggling

However, not perfect, the Affordable Care Act (ACA) has improved access to healthcare for Idahoans. The most notable success is the state insurance market-place, Your Health Idaho. Recognized as one of the most successful in the nation, Idaho’s state run (not federal) provides a program to improve and build upon. Unfortunately, the picture is not rosy for everyone in the Gem State: • 13% of Idahoans are uninsured (U.S. Census); • 92% of Idaho’s Medicaid enrollees are low-income children, seniors, people with disabilities and low-income pregnant women (Idaho Dept. of Health & Welfare); • Idaho’s Medicaid eligibility criteria is among the most restrictive in the nation; • Adults without dependent children are not eligible for Medicaid in Idaho; • An estimated 78,000 Idahoans are in the “coverage gap;” • Idaho is one of 19 states that have not expanded

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Wise Guide | Fall 2017 / Winter 2018

Medicaid, leaving those estimated 78,000 Idahoans in the “coverage gap.” These are our family, friends and neighbors who do not qualify for traditional Medicaid and earn too little to qualify for assistance through the insurance marketplace.

• Idahoans in the “coverage gap” are working. The top ten occupations include restaurant/food service, construction, childcare, animal production, landscaping, hotel industry, crop production, business support services (including call centers), entertainment/recreation and personal care support.

What is a health center?

America’s Health Centers owe their existence to a remarkable turn of events in U.S. history, and to a number of determined community health and civil rights activists who fought more than 50 years ago to improve the lives of Americans living in deep poverty and in desperate need of health care. Since then, health centers have been, and continue to be, innovators of public health and act as a safety net for those without health insurance or for those who are underinsured.

In Idaho, community health centers provide healthcare to over 170,000 people. This means that one in ten Idahoans is served by a health center, including 44,000 children and over 5,400 veterans. Federal tax dollars help sustain health centers and this investment enables these centers to fulfill their missions of providing healthcare to Idahoans who may not otherwise have access to care.

Health centers in Idaho – and across the nation – enjoy longstanding bipartisan support from presidential administrations and Members of Congress. Policy makers recognize that health centers save Idaho’s healthcare system in costs from preventable hospitalizations and avoidable emergency room visits from patients. Health centers also contribute significant cost savings for the American taxpayer, saving an average of $2,371, or 24 percent, in total spending per Medicaid patient when compared to other providers, according to a recent study. But health centers are much more than just another health care program. They are problem-solvers that look beyond medical charts not only to prevent illness but also address the factors that actually cause poor health, such as homelessness, lack of nutrition, stress or unemployment.

What healthcare services are available?

Idaho’s non-profit health centers provide patientcentered, integrated care that is convenient and comprehensive. Patients can receive medical, dental and behavioral healthcare through a team-based approach.

Medical care includes family medicine, internal medicine and pediatrics, with a focus on chronic disease management.

Patients may also access dental care (exams, cleanings, fillings, extractions, minor surgery) and behavioral healthcare (prevention, screening and treatment of common mental health disorders). Health centers provide pharmacy services either on-site or through a partnership to ensure low cost

medications for all patients regard-less of income or insurance status. Additionally, health centers conduct outreach to community residents who lack access to health care and other critical services that contribute to health and well-being (help with insurance enrollment and access to community services).

What’s next?

As Congress prepares to reconvene, healthcare reform is one of the many serious policy discussions in the mix.

Though the future of healthcare reform is unknown, Idaho’s health centers will continue to provide high quality medical, dental and behavioral healthcare for Idahoans across the state. By doing so, we hope to provide an example of what is working in our healthcare system.

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Olivia Luther Morlen has a strong mix of both for-profit and non-profit management skills. She received her BA in Art History and Public Relations from SDSU and an MPhil in Art History from the University of Glasgow, Scotland. Originally from Southern California, Olivia has been living in Sandpoint since 2011. She works as both the Director of Community Relations for Kaniksu Health Services and Executive Director of the Bonner County History Museum and believes that a community centered organization is better positioned to remain relevant and vibrant.

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Locations

Providers

Services

Objective

You can afford quality healthcare.

Medical · Dental · Behavioral Health · Pediatrics · VA

(208) 263-7101

Sliding fee for uninsured We also take Medicaid, Medicare & most insurance www.kaniksuhealthservices.org

Bonners Ferry· Ponderay · Priest River · Sandpoint Pediatrics · Sandpoint VA Wise Guide | www.TheWiseGuideOnline.com

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Wishes for Winter Wellness

by Christina Kettenring, Wellness Manager, Winter Ridge Natural Foods

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or most of us, the typical week can be pretty hectic. From busy work schedules, school and sports activities for those with kids, spending time with family and friends, not to mention making time to exercise and eat well — life can seem like one long to-do list. With these busy schedules, catching a cold or even worse, the flu, can really throw us off track and be a real setback.

There is a lot we can do to preserve our health and maintain those on-the-go lifestyles. It is important to give ourselves the time we need to slow down and treat our bodies right, to get the proper nutrition and rest we need. By eating a wide array of anti-oxidant rich foods and boosting our resistance with a few Super-hero herbs and getting the rest and relaxation we need, we can make it through cold and flu season healthy.

Sleep is a big deal for me. Any time I have become sick I know the root cause is inadequate sleep. It happens easily enough, a night or two of restless sleep or I’m ripping myself off on the amount of sleep I’m getting. Throw in some overwhelming stress and some poor food choices and it amounts to a recipe for illness. Getting adequate sleep is vital to a properly functioning immune system. If you get less than 6 hours of sleep a night you are going to be more at risk for contracting the flu. Personally, I’d rather make the time now to sleep than lay in bed for days miserable with the flu!

Stress reduction enhances immune function. When we experience stress, our bodies increase our output of neuroendocrine hormones which have detrimental effects on immune function.

When this happens there is a reduction in the production of antibodies and the activity of NK (natural killer) cells. Not only does this make us susceptible to colds and flu, but it delays wound healing and impairs responses to vaccinations.

Eating well is one of the main ingredients in preventing illness and there are certain foods that go a long way in maintaining good health. Vitamins and minerals required for a fully functioning immune system include zinc, vitamin A and C and selenium.

• Zinc helps the body produce white blood cells and encourages healing. Good food choices would be red kidney beans, green peas and dark meat chicken.

• Vitamin C also helps the body produce white blood cells and defends against pathogens and microorganisms.

Food choices include citrus fruits, broccoli and red pepper.

• Selenium offers antioxidant activity and food choices include brazil nuts and lean meats like turkey and chicken.

• Vitamin A acts as a barrier against harmful bacteria and helps defend against free radicals that can damage cells and weaken the immune system. Eating foods rich in beta-carotene such as carrots, sweet potatoes, pumpkins and cantaloupe is a great way to get that extra vitamin A.

Sugar can be devastating to your immune system because it causes inflammation which creates the perfect environment for pathogens like the flu virus to thrive in. Sugar disrupts the balance of gut flora and since the majority of the immune system is in the GI tract, it is really important to maintain a healthy gastrointestinal system during cold and flu season!

Probiotics are beneficial bacteria vital to helping the body manage illness. Probiotics regulate harmful bacteria in the intestine and colon. Good food sources of these probiotics are kombucha, kefir, sauerkraut, miso or anything fermented.

Taking a daily probiotic can benefit, ensuring that good bacterias exist in the right proportions.

Exercise is still a great idea! Especially as we age, exercise helps moderate reductions in immune function. Higher amounts of physical activity also support a reduction in upper respiratory infections.

Local * Natural * Delicious

Deli * Salad Bar * Bulk * Bakery Fresh Meat * Seafood * Dairy Grocery * Organic Produce Espresso * Supplements * Wine Kombucha * Health and Beauty 703 W Lake Street at Boyer St. www.WinterRidgeFoods.com 208-265-8135 Offer good at Winter Ridge through 2/28/2018.

Herbs have always worked well for me and my family. Some of my favorites are Andrographis, Astragalus, Berberine, Echinacea, Goldenseal and Elderberry. Medicinal mushrooms are potent immune boosters as well.

• Andographis has long been favored in Chinese medicine and has been used to treat colds, fevers, bronchitis, diarrhea and liver disorders. It is included in some of our most popular wellness formulas here at Winter Ridge and I think of it as one of the “Big Guns!’ in treating colds and such.

• Astragalus acts as a tonic to protect the immune system.

It promotes healing and provides energy to combat fatigue and prolonged stress. It helps reduce cold symptoms once one does get sick.

• Berberine is a plant alkaloid with a history of use in Ayuverda (traditional Indian Medicine). Chinese Medicine and American Indian Herbalists. Berberine is a potent microcrobial and helps get rid of bacterial infections.

• Echinacea and Goldenseal are the most famous of the class of immune system herbs. Echinacea fights inflammation and bacterial and viral infection. It is supportive of both the immune system and the lymphatic system. Goldenseal Fights infection and inflammation and cleanses the body, it increases the effectiveness of insulin and strengthens the immune system.

• Elderberry combats free radicals and inflammation. It relieves coughs and congestion, builds the blood and cleanses the system and it is very effective against flu viruses.

• Medicinal Mushrooms such as Reishi, Cordyceps, Maitake and Shiitake are just a few of the mushrooms that support our natural immunity. We as humans share more DNA with mushrooms than we do with plants and because of this connection, we can easily utilize compounds from beneficial mushrooms for total body support. Definitely worth taking a look at and considering for your winter wellness toolkit.

Another very important component to winter health is good ol’ vitamin D. It has some very big jobs in the body such as contributing to bone strength, heart health and cancer protection. Vitamin D plays a hugely important role in your immune system and can even be a determining factor in whether you develop an autoimmune disease.

And I’m going to squeeze one more in, Bee Propolis.

Propolis is a resinous substance collected from various plants from bees. Bees use propolis, together with beeswax, in the construction of hives. As a supplement, it is an excellent aid against bacterial infections. Bee Propolis is believed to stimulate phagocytosis, the process by which some white blood cells destroy bacteria. Propolis fights inflammation and stimulates the immune system.

Let’s face it, when it comes right down to it, nothing is more important than your health. We invite you to come to Winter Ridge Natural Foods, ask questions and learn about the healthful products we offer. Making the right choices can determine how long you will live and how well. “I wish you all the healthiest of winters!” —Christina Kettenring

$10 Off when you spend $50 or more

703 Lake Street Sandpoint, ID 83864 208-265-8135

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Christina Kettenring has been with Winter Ridge Natural Foods since 2010 and is the Wellness Manager. She is passionate about herbal remedies and alternative medicines. She loves spending time chatting with customers about healthy lifestyles and especially loves showing first time visitors around the store.

(The author does not directly or indirectly dispense medical advice or prescribe the use of herbs as a form of treatment for sickness without medical approval. It is not the intent of the author to diagnose or prescribe. In the event you use this information without your doctor’s approval, you are prescribing for yourself, which is your constitutional right, but the publisher and author assume no responsibility.)

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Bonner General Health First in Northern Idaho to Receive Time Sensitive Emergency Designations

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onner General Health is the first hospital in northern Idaho and the second Critical Access Hospital in Idaho to receive all three Time Sensitive Emergency (TSE) Designations.

Bonner General Health Chief Executive Officer, Sheryl Rickard said, “These TSE designations represent our commitment to providing our community with outstanding care at the most critical times. This designation is the result of Bonner General Health’s unwavering dedication to providing high quality, compassionate care.”

Bonner General Health (BGH) was designated a Level IV Trauma Center on February 14th, 2017. On September 12th, Idaho Time Sensitive Emergencies Council designated BGH a Level III Stroke Center, and a Level II STEMI Center on the same day, based upon the recommendations of an onsite survey team. The TSE Council is an organization selected by the Idaho Legislature to develop a statewide system of care to address the top three causes of death in Idaho (trauma, stroke, and heart attack). In order to receive these designations BGH was surveyed in all three areas.

The survey team conducted an extensive survey of the services at Bonner General Health, data and past performance in the areas of stroke and (STEMI) “heart attack care,” equipment, education programs, emergency team response, and the ability to work with pre-hospital care providers to activate emergency teams at the hospital and reduce the length of time to reach treatment for patients experiencing “heart attack” or stroke symptoms or suffering a traumatic injury. The surveyors were extremely impressed by the care provided at Bonner General Health by physicians and hospital staff and the commitment that is demonstrated by the entire organization to provide high quality care to the community.

They were also impressed with the effective collaboration with Emergency Medical Services since pre-hospital care is critical to improving patient outcomes.

The Time Sensitive Emergency (TSE) system is modeled on evidence-based care that addresses public education and prevention, 911 access, response coordination, prehospital response, transport, hospital emergency/acute care, rehabilitation and quality improvement. The TSE program has demonstrated improved patient outcomes, lowered costs, reduced preventable deaths and improved quality of life. It helps get the patient to the right place in the right time to the right care. In the state of Idaho, this system has three components: Stroke, STEMI or “heart attack,” and Trauma systems of care. These are all considered “Time Sensitive Emergencies” in which the faster a patient experiencing any of these conditions receives care, the better health outcome they will achieve, including the reduction of mortality rates associated with these health emergencies. Bonner General Health is the first hospital in northern Idaho and the second Critical Access Hospital in the state to achieve all three Time Sensitive Emergency designations.

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BGH Staff with Telestroke Robot Left to Right: Denis Simko, Emergency Department Nurse, Dr. Ken Gramyk, Medical Director for Stroke and STEMI, Sheryl Rickard, CEO, Misty Robertson, CNO, Colleen Lock, Emergency Department Nurse

Women’s Health Care Cynthia Dalsing, MSN, ARNP Tabitha Barron, MSN, ARNP Advanced Nurse Practitioners Annual Exams & Pap Smears Well Woman Gynecology Birth Control Services Menopause Management Most Insurance Plans Accepted Now Open Fridays!

208.263.1299

1215 Michigan Street, Suite C Sandpoint, Idaho

About the Cover Cover Artwork:

“Hanging in There” by David Gressard

About the Artist

Dave Gressard’s awardwinning art is the result of his appreciation and fascination for animals and the environment which surrounds them.

Dave finds inspiration in the small things, whether it’s an American Kestrel hovering over a country road or an Anna’s Hummingbird basking on a mossy branch in the morning sunlight, each are opportunities to capture the world’s natural beauty. Whenever Dave is spending time in the outdoors, you can be sure he will be drawn to a twisted branch or some small annual flowers that he will dutifully preserve and bring home to use as reference in his work. The simplest things can become the final detail to complete a painting. His studio is full of items that have been, or will be part of one of his paintings.

Dave’s appreciation for the natural

Snowy Owl

Hummingbird

world around him is founded in his belief that it all is a testimony to the God who created it. Through his art Dave seeks to show his respect and enhance the viewer’s appreciation for the beautifully created world.

Dave graduated from the University of Idaho with a directed studies degree

Fall Gathering

Vantage Point

emphasizing art and biology. He is an avid bird watcher and enjoys getting into the back country of the West with his two sons whenever possible.

Every day has the potential for new ideas and inspiration.

Dave is a permanent resident of the Northwest and has his studio at his home in Moscow, Idaho where he lives with his wife Mary. They have three children: Margaret, Stephen, and Scott.

His work can be viewed and purchased on his website: DaveGressard.com

Peregrine

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The Wise Guide Fall 2017 / Winter 2018 Office: 208-263-5654 Email: info@thewiseguideonline.com www.TheWiseGuideOnline.com

Your Social Security Card will no longer have your social security number on it!

The Centers for Medicare & Medicaid Services (CMS) is readying a fraud prevention initiative that removes Social Security numbers from Medicare cards to help combat identity theft, and safeguard taxpayer dollars.

The new cards will use a unique, randomly-assigned number called a Medicare Beneficiary Identifier (MBI), to replace the Social Security-based Health Insurance Claim Number (HICN) currently used on the Medicare card.

Jonnie Bradley Editor The Wise Guide

Patty Jo Carter Marketing Director The Wise Guide

CMS will begin mailing new cards in April 2018 and will meet the congressional deadline for replacing all Medicare cards by April 2019.

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Copyright Š2018, All Rights Reserved.

Idaho Elder Directory Alzheimer’s Resource Directory Just call 800 584-9916

during normal business hours View/download from our Website retirementpublishing.com > Idaho Publications

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Wise Guide | Fall 2017 / Winter 2018

Although every precaution has been taken in the publication of this guide, the publisher and authors assume no responsibility for errors or omissions. This guide is not intended to be legal or medical advice or to endorse any product or service. It is meant to serve as an information resource guide and not as a substitute for professional assistance. The Wise Guide, LLC is not responsible for the contents of any websites referenced within this directory, nor does it endorse any specific products or services referenced. No part of this directory may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by an information storage and retrieval system without the express written permission of the publisher, The Wise Guide, LLC.

Nourishing Homemade Gingerbread Latté

by Kelsey Steffen, Full of Days

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ith chilly days and snow right around the corner, we’re all craving those nostalgic flavors of Fall. I’m talking pumpkin spice, apple pie and, of course, gingerbread.

Certainly I’m not the only one who likes to snuggle up next to the fire with a warm drink in hand. But I don’t want to have to run out and spend a small fortune to get my favorite fall flavored latte.

The unfortunate truth is, after those overpriced lattes, my tummy isn’t thrilled and I’m often left with some *ahem* digestive discomfort. More than likely caused by the large amounts of sugar, unnecessary chemical additives and pasteurized milk.

I knew there had to be a way to enjoy the delicious flavors of fall, not have to leave the house, and keep some pennies in the bank account. And there is! In fact, this drink will actually nourish your body!

The following recipe is amazing with a coffee base, but if you’re avoiding caffeine, there’s a perfect replacement. When I was pregnant with my fourth child, I eliminated caffeine and found out about Dandy Blend. This delicious coffee alternative is what saved my sanity during those chilly months of winter when I wanted to sip something hot and creamy.

So I experimented with my favorite flavors and came up with some incredible lattes.

By adding heart-healthy fat with coconut oil, and protein with collagen peptides, not only was this drink incredibly satisfying, but it left me feeling full and nourished from the inside out. It’s also dairy free, refined sugar free and (if using Dandy Blend) caffeine free!

• We use either Great Lakes or Vital Proteins brands of collagen peptides (hydrolysate) which is made from 100% grass-fed cows, contains the healthiest form of powdered protein and is full of essential amino acids.

Collagen is beneficial for hair, skin, nail, bone, cartilage and joint health. Because it’s among the healthiest forms of powdered protein (containing 9 grams of protein per tablespoon), it’s a great alternative to protein powders.

But the best part about the brands mentioned, they’re absolutely tasteless and dissolve completely in hot or cold beverages and can even be used in baking.

This recipe will assuredly keep you from dropping $5 dollars on a drink, and you can rest easy knowing your belly is filled with something sweet, delicious and good for you!

Ingredients

2 oz. Hot Water or Coffee

1 Tbs Dandy Blend (if not using coffee)

1 Tbs Coconut Oil

1 tsp Maple Syrup*

1 tsp Molasses

1/2 tsp Ground Cinnamon

Pinch of Ground Ginger

Dash of Nutmeg

1 Tbs Collagen Peptides (optional) * Can sub ¼-½ dropper of liquid stevia (our favorite is SweetLeaf’s Vanilla Creme) instead of maple syrup.

Directions 1. Add all ingredients, except nutmeg, to your blender

(or use an immersion blender).

2. Blend on medium-low until coconut oil emulsifies

(you’ll see the color change from black coffee to tan).

3. Bring the speed up to medium-high for about 10 seconds to create a nice foam.

4. Pour into your favorite mug, add a dash of nutmeg for garnish.

Inhale, exhale and savor every last healthy drop!

For more recipes visit everydayfull.com or follow us on facebook@FullofDays” __________________________________________________________________

After Kelsey and her husband became parents, they began looking at food differently. Studying the teachings of Weston A. Price, they do their best to maintain a traditional diet. There are many “ingredients” to a life Full of Days: nutrition, traditional diet, DIY recipes, essential oils, homemaking, reviews, tips and tricks, moneysaving strategies and everyday life. Kelsey is a regular contributor to Mother Earth News (Web & Print), and Delicious Obsessions.

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Am I Addicted?

Making Sense of the Opioid Crisis in America

by Dr. Scott Magnuson, Pain Management of North Idaho

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pioid medications offer an important tool in the treatment of some chronic pain issues, but one doesn’t need to look far into the news to realize that these medications are being abused and are responsible for an ever increasing number of adverse consequences, including death.

It is important to understand that this article addresses opioid use in chronic, non-terminal, non-cancer pain. Patients with pain from terminal diseases including cancer are not the focus of this article.

Opioids are drugs that act within the central nervous system on cells to block the sensation of pain. Unfortunately, they also bind to other receptors in our central nervous system that account for their bad side effects, like decreasing our drive to take a breath and stimulating centers in our brain that are associated with addictive behaviors.

Examples of opioids include morphine, hydrocodone (Vicodin), codeine, oxycodone (Percocet, OxyContin), oxymorphone (Opana), suboxone, Butrans and methadone.

Illicit opioids include heroin and illegally produced fentanyl.

The United States has seen a staggering increase in the number of opioid related deaths over the last 35 years. In 1980, the number of drug overdose deaths per year was about 7000. In 2016, an estimated 60,000 people died from drug overdoses, with most of those involving some type of opioid.

In a bit of good news, opioid prescriptions in the United States have started to level off, reversing a steady upward trend over the last 30 years.

Why has this happened? You can go back to the early 1980s when a number of medical articles started to promote the use of opioid medications for non-cancer pain.

Long-standing fears among doctors on prescribing pain medications began to be relaxed. This was not unnoticed by pharmaceutical companies who began aggressive marketing campaigns to encourage doctors to treat their patients’ pain with opioids. The result was a steady increase in prescriptions for opioid pain medications, putting people who are prone to addiction at risk.

People who previously had no history of addiction found themselves losing control of their pain medications

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and suffering devastating consequences including loss of their job, divorce, homelessness and isolation. Recently, the pendulum has started to swing the other way, with physicians being reluctant to prescribe opioid pain medications. This sometimes Draconian approach to conservative prescribing has made it difficult for some patients who truly benefit from these medications to find appropriate care.

The other consequence with more conservative prescribing habits is the decreased supply of prescription medications on the streets with a population of addicts looking for an alternative. With a decrease in prices of heroin and the alarming increase in illegally made fentanyl, a very potent opioid, many people are turning to these dangerous alternatives to fuel their addiction. The CDC, state medical boards and medical societies are launching educational initiatives to help provide guidance to physicians on responsible prescribing of these medications.

If you are on pain medications like these, what should you know? First you should understand that these types of medications are just one tool that can be used to treat chronic pain, and they may not be the best tool at that. Studies show that long term use of opioid medications at best can give about 30% improvement in pain (about the same as placebo) and improvement in function is not clear.

Also, be aware that most people who are on these types of medications for a long time will likely become tolerant to them meaning that the medication tends to lose effectiveness over time. This can sometimes be addressed by changing to a different medication in the same class, but sometimes it requires taking a holiday from using the medication. Increasing the medication to account for tolerance is generally going to be unsuccessful because it just leads to further worsening of the tolerance.

Addiction, while a risk on these medications, is generally low for most people. If you have a history of addictive behavior to any substance, a family history of the same, significant psychological disorders, or are young, your risk is going to be much higher. Your healthcare provider is going to be more cautious using these medications for someone with this history and will likely require you to have closer follow up.

Opioid medications can be an important tool in the fight against chronic pain. Even though they have been used for pain for literally thousands of years, we still are learning how to effectively use these powerful medications.

Responsible prescribing by physicians and responsible stewardship by our patients is key to successful use of this class of pain medications.

Having realistic expectations of how much relief these types of medications can give for chronic pain is an important step towards successful pain care. There are other treatments including non-opioid medications, interventional pain management, physical treatments, cognitive behavioral therapy, and spiritual practices that have been shown to be successful. If your healthcare provider suggests these types of treatments as part of your chronic pain management plan, be open to them. ___________________________________________________________________

Dr. Magnuson is a Board Certified Anesthesiologist with Added Qualifications in Pain Management. He is a graduate of Creighton University School of Medicine, University of Missouri Kansas City Anesthesiology Residency and completed his fellowship in Pain Management at the University of California San Diego.

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Start Talking Now!

Preventing Youth Substance Use—

You are the #1 influence!

by Carrie McKinley, Coordinator Panther Country Coalition

T

he key reason kids give for not using alcohol, marijuana, or other drugs is that they don’t want to disappoint their parents (Monitoring the Future survey). Parents can truly make a difference by talking to their teens about the risks of underage use. It is not uncommon for teens to act like they are not listening to you but in fact they are! Even though they may walk around with headphones on 24/7 do not assume they are actually listening to music at high volumes and not listening to you or that what you say is not being taken to heart, because many times it is. Kids are listening and paying attention. They also want to be happy, make you proud and live long healthy lives. One way to help them is by talking early (by 6th grade) and often about the real life risks of underage substance use.

What are the risks of underage use of alcohol, marijuana, and other drugs?

Early use of alcohol, marijuana, and other drugs puts teens at greater risk for addiction and other health problems, failing in school, and limited career choices by arrests and lack of education. These substances can impair areas of the brain that control motor coordination, impulse control, memory, learning and judgment. Because the teen brain is still developing, it is more vulnerable than an adult’s brain to the effects of alcohol, marijuana, and other drugs according to the National Institute on Drug Abuse (NIDA).

The Centers for Disease Control and Prevention (CDC) reports underage substance use is associated with the top three causes of teen deaths: accidents (including traffic fatalities and drowning), homicide, and suicide. Over eighteenhundred college students die each year as a result of underage drinking according to the National Institute on Alcohol Abuse and Alcoholism.

Teens who drink and use other drugs are more likely to engage in risky behaviors like sex. Such behavior can result in pregnancy, AIDS, and other sexually transmitted diseases (CDC).

Kids who drink before age 15 are 4 times more likely to develop alcohol problems as adults (2013 National Survey on Drug Use and Health).

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How can I prevent my child from using alcohol or marijuana?

You have the greatest influence on your children’s decisions about alcohol and other drugs. Research consistently shows that kids who learn a lot about the risks of alcohol and other drugs at home are 50% less likely to use, yet many parents find it difficult to talk about this.

In fact, in Pend Oreille County only one half of the parents (51%) had talked to their 10th graders about not using alcohol and marijuana according to the WA state 2016 Healthy Youth Survey.

Local youth substance use is increasing as noted in the 2016 Pend Oreille County Healthy Youth Survey. 21% of 10th graders reported using marijuana in the past 30 days where as in 2014 it was only 12%. Alcohol trends are similar. In October of 2016, 26% of Pend Oreille County 10th graders report current use of alcohol and that is up from 18% in 2014.

Parents are needed now as much as ever to help their teens make healthier choices.

Tips for parents • Don’t accept use as a rite of passage to adulthood • Set clear rules against using alcohol, marijuana, and other drugs • Help your children deal with peer pressure and stress • Be a good role model - show kids you don’t need a drink to relax or celebrate • Talk with them early and often about the ways alcohol and marijuana can harm them, ask questions and be a good listener • Stay involved in their lives • Know who their friends are, and where they are going

Create close bonds with your children

Children are less likely to drink, use marijuana or other drugs when their parents are involved in their lives and when they feel close to their parents. Family conflict and lack of bonding increase the risk of drinking and marijuana use.

To increase family bonding: • Give kids at least 15 minutes of one-on-one time every day • Do fun things together • Give positive feedback about the healthy choices your child makes • Eat as a family five times per week

Set clear boundaries for your children Set clear rules early and talk about the rules often.

To set boundaries: • Help your child practice ways to say no to drugs • Use fair and consistent discipline any time your rules are broken • Help your kids have positive relationships with friends

Monitor your child’s interactions

Always know what your kids are doing. Help them plan safe and fun activities.

To monitor your child, ask these five questions when she or he spends time with friends: • Where are you going?

• What will you be doing?

• Who will be with you?

• When will you be home?

• Will there be alcohol, marijuana or other drugs?

An excellent multi-lingual online resource for parent-child communication is StartTalkingNow.org, sponsored by the Washington Healthy Youth Coalition.

The Panther Country Coalition is a local resource in Cusick, WA with a mission to prevent and reduce youth substance use. We offer evidenced-based parenting programs, Sport Prevention and Wellness, a health promotion program that highlights the positive image benefits of an active lifestyle to reduce the use of alcohol, tobacco and drug use by high school students, free trainings, and leadership opportunities for students involved in our youth coalition. Please contact us today for more information at 509-447-6419 or visit our website at www.PantherCountryCoalition.com. __________________________________________________________________

Carrie McKinley, CPP, is a Certified Prevention Professional with over 5 years of substance abuse prevention experience working with local youth and community coalitions. She received her Bachelor’s degree in Social Services from Whitworth University.

Carrie is currently employed by Pend Oreille County Counseling Services as the Prevention Specialist and Community Coordinator for the Panther Country Coalition.

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Kinetisense - The Future is Here!

by Amanda Thome, PT DPT, Idaho Pain Clinic

I

magine a device that could predict future injury susceptibility in less than five minutes. Or a device that could near instantaneously provide you with threedimensional postural analysis or balance and concussion screening The Kinetisense system offers this and more.

The world of technology is constantly evolving to provide clinicians and patients better tools for tracking outcomes and even predicting future injury or sources of pain. Clinics that incorporate these groundbreaking technologies often report higher patient satisfaction, success and retention. Idaho Pain Clinic in Sandpoint values the idea of combining the knowledge and skills of their clinicians with cutting edge technology to provide a new standard of care for the patients and clients they serve.

The Kinetisense system is a markerless motion sensor device that uses Microsoft Kinect technology to instantaneously detect the client’s body using thousands of data points. The Kinetisense system provides threedimensional posture analysis and is used as a pre-season concussion screening tool and as one aspect of determining safe return to sport or activity after concussion.

The Kinetisense is also used for testing and tracking balance in the geriatric population and it accurately measures a client’s range of motion at the shoulder, neck, spine, elbow, hips, and knees. The device tracks the client’s improvements in all aspects, whether it be balance, range of motion, or posture.

The system also allows therapists to video record their patients completing tasks such as sit-to-stands, lunges, squats, dead lifts and nearly any functional movement. The recording of these movements provides accurate measurements at all the major joints as well as rotational information that may be occurring at the joints as the participant completes their movement. This allows the therapists to pinpoint exact moments during a movement where the patient went from being in alignment to falling out of alignment, and thus compromising their joints or muscular structures. Often the therapists at Idaho Pain Clinic Physical Therapy capture the patient’s range of motion pre-treatment and, after a single therapy session, re-assess the motion allowing the patient immediate feedback on gains made in therapy that day.

Beginning October 2017, the Kinetisense system will offer an additional feature that will be instrumental in preventing the development of future injuries or pain. The newest feature called KAMS (Kinetisense Advanced Movement Screen) will be the most advanced functional movement screen on the market. Within three to five minutes the therapists at Idaho Pain Clinic will be able to use KAMS to analyze over twentyfive joints and joint axis in all three planes of movement.

The KAMS system will detect and report over 250 neuromuscular compensatory patterns of seven research based movements. The report generated by KAMS will provide a functional score, a vestibular score, a lower extremity power score, and a joint susceptibility to injury score. The institution of KAMS will remove subjectivity and lack of efficiency that is currently a problem for functional movement screens traditionally offered by therapists and trainers. To top it off, the KAMS system will also provide corrective strategies to the clients. For example, if the KAMS detects the client’s right knee is highly susceptible to future injury, it will suggest exercises and strategies to limit the chance of future harm to that joint.

The future of rehabilitation and recovery is emerging to embrace technologies that not only track a patient’s success during their time in therapy, but even more importantly will predict likelihood for future injuries. Cutting edge technology such as the Kinetisense may be what changes healthcare and the lives of thousands as it helps in the detection of susceptible joints that have yet to experience detriment. This early detection can help keep patients active, healthy, pain and injury free.

Idaho Pain Clinic Physical Therapy has consistently sought out and implemented the most state of the art and Continued on Page 18

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Kinetisense - The Future is Here Continued from Page 16

_____________________________________________________

proven technologies offered in the industry. From offering the only AlterG anti-gravity treadmill system and Anodyne infrared light therapy in Sandpoint to now the addition of Kinetisense into their practice.

The team at Idaho Pain Clinic believes a full Kinetisense and KAMS evaluation should become a standard routine assessment that all people, young and old alike have completed at least yearly in order to track present health performance and address any postural abnormalities or joints susceptible to future injury. Kinetisense and KAMS evaluations are available through the Physical Therapy department at Idaho Pain Clinic. Call 208-263-9757 today to schedule an appointment or schedule an appointment online at idahopainclinic.com/pt. ___________________________________________________________________

Amanda Thome graduated from Columbia University with her Doctorate in Physical Therapy in 2010. It is her belief that each patient presentation and treatment interventions should be unique and tailored to that individual. Amanda uses clinical skills she gained working for nationally top-ranked rehabilitation facilities and the skills she continues to develop through rigerous continuing education training. Amanda has a strong background in manual therapy and the treatment of acute and chronic pain conditions including neuropathy pain, post surgical rehabilitation, balance and vestibular disorders as well as those with neurological conditions. Amanda is one of only two ImPACT concussion trained physical therapists in Idaho.

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Mental Health Stigma

by Annabelle Payne, Director Pend Oreille County Counseling Services

G

oogle the most popular Presidents in the United States history and odds are that Abraham Lincoln will be in the number one spot or within the top three. Honest Abe was a Civil War hero, who “saved the Union,” authored the Gettysburg Address, issued the Emancipation Proclamation that freed all slaves, and…was a person who suffered chronic and pervasive depression. A condition at times so acute, that his friends and neighbors would form suicide watches over him.

So why was he allowed to be in a position of authority, making decisions on a daily basis about important military and national policy? Does this question seem disrespectful, or offensive? Possibly, yet everyday in current society are examples of attitudes that convey disparagement of character, devaluation of abilities and a marginalization of persons with mental illness. Prejudices that view such individuals as incompetent, irresponsible, and violent.

An intelligent, creative and caring person is too often reduced to a diagnostic label and unfortunately these biases may also be a barrier in seeking help for conditions that are very treatable. Citing concerns they will be viewed as inadequate or defective which may in turn, lead to rejection from family and friends, loss of employment, insurance, gun rights, bullying or persecution; less than half of the adults in the U.S. who need services and treatment get the help they need. This is concerning considering the need.

The Centers for Disease Control report about 25% of all U.S. adults have a mental illness with almost 50% likely to develop a mental illness in their lifetime. Other National surveys estimated 1 in 5 children experienced a serious mental illness and by 2030, projections are that at least 15 million older adults will suffer a mental illness.

Why care about the stigmatization of mental health? Data shows the needs have risen to a Public Health level but it is also personal – this could be your parent, your child, your friend…it may at some point, be you.

It is important to be informed and talk openly about mental health to dispel myths and prejudices.

It is also important to see more than the illness, to recognize the strengths, gifts and other qualities that are a more accurate characterization of the person.

Lincoln’s contribution to society was significant and a testimony of the human spirit in prevailing against adversity.

It could even be said that Depression played a significant role in developing Lincoln’s humility, conviction, discerning insight and wisdom. A history without Lincoln would indeed be a poorer history. _____________________________________

Annabelle Payne is the Director of Pend Oreille County Counseling Services. Pend Oreille County Counseling Services provides outpatient substance use disorder and mental health treatment, to include case management supports for inpatient treatment. Counseling Services also partners with Newport Hospital and Health Services for medicationassisted treatment. Call 509.447.5651 pendoreilleco.org/your-government/ counseling-services

Freedom from Addiction by Dr. Michael Whiting

A

ddiction treatment meets science. We now know exactly how opioid addiction alters the chemistry of the brain and why the brain of the addict keeps pulling them back into addiction. Science has shown us a way to break the cycle of addiction. With the intelligent use of medication, combined with intensive outpatient counseling, we can help you to finally break free from the substances that bind you. Our treatment can bring you to the point of true freedom from addiction. When you complete our treatment you will be drug AND medication free. It will not happen overnight, but if you sincerely want to be free, we can show you the way.

Medication for opioid addiction is not about “trading one addiction for another.” It is about breaking the destructive cycle of relapse and regret, and finally giving you a real chance at leaving your addiction in the rear view mirror. Opioids alter the brain in ways that make it impossible for most opioid addicts to remain abstinent. Our medication changes this – you can become stable on medication so that you can benefit from treatment, and then you can get off the medication and be truly free. There is no detox. There is no withdrawal.

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In addition to addiction treatment, we recognize the inherent and prevalent process of mental health disorders and addiction. Often, depressive disorders are associated with addiction; people want to use something to feel better, alleviate interfering negative psychiatric symptoms, and begin using illicit substances instead of being under a doctor’s care and treatment. Before you know it, you are addicted to the substance you are using, and most often in these situations, you don’t know who to turn to that can help treat both your mental health and addiction effectively.

There are interventions that assist with managing both addiction and the symptoms of mental illness, more often referred to as co-occurring disorders. Effective intervention promotes healthy and strategic skills, and the thinking that combat those negative behavior traits, and restore functioning and healthy coping skills back into your life. Opioid use and addiction is prevalent amongst those who attempt to treat their own symptoms, which frequently leads them to dependency and addiction.

Our counselors have years of experience in the treatment

Rathdrum Counseling Center, LLC and Restored Horizons have

of opioid addiction and mental health conditions, both severe and persistent diagnosis, trauma related issues, and every day stressors that may lead to a more debilitating condition and ongoing use of opioids. They know that treatment succeeds best when there is compassion and understanding. And just as importantly, they know how the medication alters traditional treatment.

Our counselors work closely with the physician to optimize your treatment program so that you have a real chance at success with taking this first step in your recovery. Let us help you find the future you have been longing for – a future free from that which binds you. Don’t wait a day longer. Give us a call at 208-687-0538 to schedule your confidential intake — and start your future today!

joined forces to provide Medication Assisted Treatment (M.A.T.) and comprehensive outpatient Mental Health & Substance Use and Addiction services under one roof. Under the direction of Dr. Michael Whiting, and with a team of professional substance use disorder, addiction treatment specialists, and mental health practitioners, we have opened our Kimo Court location for those specifically with addictions to Opioids.

The mission and vision is to be a ‘one-stop clinic’ that meets the needs of those who seek Mental Health & Substance Use Treatment services. Staff are licensed Social Workers, CADC (Certified Alcohol & Drug Counselors), Licensed Clinical Professional Counselors, Physicians, and bachelor level practitioners. M.A.T. medication includes the use of Suboxone, a medication that has proven results of assisting recovery and wellness without residual withdraw and detox. For the M.A.T program we accept private pay, Idaho Medicaid, and most insurances. For the outpatient treatment services we accept BPA, private pay, and most insurances.

Call 208-687-0538 now or visit our website at www.RathdrumCounseling.com for more information!

_________________________________________

Rathdrum Counseling Center, LLC, has been serving Kootenai, Bonner, Boundary, and Shoshone Counties for the past 10 years. We provide services to anyone who enters our door, regardless of their ability to pay. Our highly experienced and dedicated professional team have year of experience treating individuals, couples, and families during times of crisis, or simply to share life changes and challenges. We are partners in your journey to wellness. We utilize the most effective methods to assist you in learning new ways to think and approach those life challenges, so you may build your own resilience tools and walk thru life with confidence and resolve. We partner with the courts, probation and parole, child protection, and other community systems to collaborate and provide you with a network of support and access so you may never feel that there is no answer to any struggles you may face. Come join us!

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Proven results for recovery and wellness without residual withdrawal and detox.

Rathdrum Counseling Center & Restored Horizons have joined forces, providing comprehensive mental health and addiction services under one roof!

Utilizing the most effective methods, we assist you in learning new ways to approach life’s challenges, so you can build your own resilience tools and walk through life with confidence and resolve.

We are your partners in your journey to wellness.

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208-687-0538 • rathdrumcounselingcenter.com

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Youth Transition Services, Much to Consider

Vicki Leeper, Marketing Specialist, Disability Action Center NW

L

ife is full of transitions, and one of the more remarkable ones occur when we get ready to leave high school and go out in the world as young adults. Ideally everyone during these transition years acquires knowledge and skills to maximize their independence and self-sufficiency in their communities. From a federal perspective it is defined as: “our national policy of ensuring equality of opportunity, full participation, independent living, and economic selfsufficiency for individuals with disabilities.”

But when a student has a disability, it is critical that they plan ahead and learn to identify themselves with pride as individuals and members of the very accomplished disability community. This process may involve accessing educational and employment opportunities including career and technical education, obtaining employment related services and supports, finding stable housing, acquiring health insurance coverage, transitioning from pediatric to adult health care, acquiring daily living skills, financial aid and other services to assist in future planning and development towards adulthood.

Local Centers for Independent Living (CIL) are able to provide these services to youth with disabilities. Through a

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peer mentoring session, students can get the assistance they need to set goals that are important to them and pursue that move to independence; whether it’s getting their license to drive, finding a way to continue their education, or choosing between independent housing or a group home. It is always personally defined by the individual – not the agency.

Developing these youth-driven and strength based transition plans requires significant time from families and their local CIL. But research shows that increased youth engagement leads to positive outcomes.

Sometimes they just need help to be aware of their options and be able to make informed choices. Other things to think about are civil rights, community life, emergency preparedness, available assistive technology, and access to health care. The Affordable Care Act expanded access for youth with disabilities.

This is critical as most have a pre-existing condition, frequently change or hold only part-time jobs. And expansion of access to Medicaid can help youth transition to adulthood with chronic health care needs.

What’s available here & now? Association of Programs for Rural Independent Living (APRIL) is hosting their conference in Spokane, October 20-23. This conference sponsors youth every year to help them understand the voting process and how to advocate and be a voice in their local community. Their overall experience will develop skills in housing, transportation, education, healthcare, and employment. They also learn about diversity and disability disclosure, all while expanding social skills and networks.

Career Mentoring Day is another opportunity for transitioning youth with disabilities to test-drive their dream

job. Held November 9th in Moscow, Idaho. This full day includes an orientation breakfast, and an opportunity to job shadow the career of their choice. No one makes these decisions for them, their choices are only limited to what businesses are in the area (for instance, being an astronaut would be a tough career choice to fill). The afternoon is rounded out with workshops covering resume building, mock interviews and guest speakers. Not only does this event help the students, but it also helps dispel fears about hiring people with disabilities in the local business community.

Independent living involves so much – making choices about how and where we live in the community. It involves everything from setting an alarm clock to get out of bed, to self-care, to getting to work and back home again, to what to eat for dinner. Lots to think about and get ready for. And these successful young men and women with disabilities serve as role models for the future in helping youth realize their ability, right, and obligation to pursue meaningful employment and contribute to society.

Disability Action Center NW

Helping youth with disabilities transition to independent adult lives!

___________________________________________________________________

Vicki Leeper was hired by the Board of Directors several years ago. The Marketing Specialist for all three offices, she uses her experience to get the word out about DAC and all they do. She finds making our information accessible to our consumers and the community through outreach, the website and social media very rewarding. An expert in planning and marketing events, Vicki helps promote the independent living philosophy of DAC and related local organizations throughout Idaho.

800.854.9500 – DACNW.ORG

Tools for Life Fair 2018 Held in Moscow!

March 5-6, 2018 Join us at the 13th Annual Tools for Life: Secondary Transition and Technology Fair.

The Tools for Life Fair travels around the state between Northern Idaho, Boise, and Idaho Falls to make the Fair more accessible to students and families across Idaho.

In 2018, the Tools for Life Fair will be in Northern Idaho at the Best Western Plus University Inn Hotel in Moscow, ID. Tools for Life Fairs are for students with disabilities and anyone who offers support as they transition from high school to college or work. The event includes presentations about secondary transition and assistive technology. Idaho Educators, Post Secondary Educators, therapists, counselors, service providers, job developers, and other rehabilitation specialists, and especially secondary students with disabilities and their families are encouraged to attend.

An Exhibitor Hall will be open both days to allow higher education institutions, state agencies, and vendors the opportunity to promote their organizations, present resources, and demonstrate their newest products.

Registration is free for K12 educators/staff. Registration is $10 per student. Hotel rooms, food stipends, and transportation are available for students who wish to attend! The conference fills up quickly so please register early!

Registration Opens October 15th, 2017 at: http://idahoat.org/services/tools-life For more information: 800-432-8324

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Peer Support Specialists - A Rapidly Growing Field replicate. Peers offer hope and encouragement by sharing their experiences and knowledge. They create opportunities for recovering individuals to live satisfying and meaningful lives.

by Treva Rawlings, Executive Director, Rawlings Community Counseling

I

n all areas of life, no matter your background, relationships are crucial to well-being. We call friends in hard times, visit family members when they aren’t feeling well, and often seek support groups with other individuals who have experienced similar challenges like chronic disease or loss of a loved one. In the same way that we reach out to someone who we think will understand, peer support specialists, referred to as “Peers,” can provide that understanding during a time when many feel alienated and hopeless.

Peer support specialists are people with lived experience who use their familiarity with recovery from mental health, psychological trauma, or substance use disorders to support others in recovery. Because of their real world understanding, peers have expertise that professional training cannot

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Roles of Peer Support Specialists

Peer supporters are more than just people who have been there. There are many tasks performed by peer support specialists that may include assisting their peers in articulating their goals for recovery, learning and practicing new skills, helping them monitor their progress, supporting them in their treatment, modeling effective coping techniques and self-help strategies based on the specialist’s own recovery experience, and supporting them in advocating for themselves to obtain effective services.

Peers support individuals with creating peer-centered recovery plans. This plan is instrumental for individuals in the process of their recovery. Components often include support groups and individual therapy, basic health care maintenance, stable housing, improvements in family life and personal relationships as well as community connections. The plan may also include education goals, vocational development, and employment.

Peer support specialists go beyond “treatment as usual” using unique training and skills to support recovery as part of a multidisciplinary team with other professionals such as therapists, social workers, and psychiatrists. They are seen in a variety of

Private Insurance, Sliding Fee Scale and Private Pay

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settings including hospitals, drop-in centers, community-based recovery centers, VA clinics, crisis centers, prisons, and community mental health centers. They work in a variety of roles including case management, wellness coaching, education, and as active participants in a full range of clinical settings.

Evidence Based Practice

Peer support is considered a best practice by the Substance Abuse and Mental Health Services Administration (SAMHSA).

Established in the public mental health system and moving into the private sector, the research shows that peers improve treatment outcomes. Peer support services have been shown to: • Reduce symptoms and hospitalizations • Increase social support and participation in the community • Decrease lengths of hospital stays and costs of services • Improve well-being, self-esteem, and social functioning • Encourage more thorough and longer-lasting recoveries

core competencies, clinical theories as stages of change, motivational interviewing, and co-occurring disorders.

Trainings are now being rolled out in communities across Idaho. If a person’s goal is to become a Certified Peer Support Specialist (CPSS) in Idaho, it is important to be familiar with the requirements for certification (e.g. lived experience with recovery of a mental health disorder or substance use disorder, adherence to Idaho rules and standards, and certification qualifications) before attending training.

Please see the Empower Idaho/OCAFA website for training opportunities and facts regarding becoming a peer support in Idaho: http://www.empoweridaho.org/peer-support/.

Trainings will be also held in Coeur d’Alene. For more information: idahopeersupport.com.

For local information regarding Peer Support Services or to express interest in becoming a Peer Support Specialist you may contact Treva Rawlings with Rawlings Community Counseling located in Bonners Ferry, Idaho at 208-267-0900. _________________________________________________________________

Certification

Funding for peer recovery programs comes from a combination of federal and state agencies as well as local and national charities and grant programs. When peer support specialists work in publicly funded services, they are required to meet government and state certification requirements.

Certified Peer Support Specialists (CPSSs) are critical in the Idaho mental health service system. Training includes courses on the ethics of a recovery coach, recovery coaching

Treva Rawlings holds a Bachelor of Science in Education, majoring in K-12 Physical Education. Treva is also a Licensed Clinical Professional Counselor and Executive Director of Rawlings Community Counseling. She has been a practicing licensed therapist since 2009 working with individuals of all ages and their families during tough times, including those with mental health and cooccurring mental health and substance use disorders. Treva is an approved Recovery Peer Support Specialist Trainer and will be holding future trainings for volunteers and staff.

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Deep Tissue Laser Therapy Works!

by Dr. Daniel L. Moore, Moore Chiropractic

S

ince running an article on the use of LightForce Laser, Photobiostimulation in the previous edition of The Wise Guide: LightForce Laser, Photobiostimulation Relieves Pain & Enables Healing, I have had many new patients come to me with a variety of needs. I wanted to share their experiences with readers, and encourage you to read the previous article to understand how photobiostimulation works, and consider this form of treatment for your own acute or chronic condition. The article is also posted on my website danmooredc.com or you may obtain a printed copy from my office.

Whether you are seeking faster healing, or relief from chronic pain, this non-invasive form of therapy can help you. It helped me when nothing else worked for a nerve injury causing excruciating pain in my leg. It is because of my own experiences that I have brought this treatment option to my patients.

Story at-a-glance

Infrared laser therapy treatment helps reduce pain, reduce inflammation, and enhance tissue healing, both in hard and soft tissues, including muscles, ligaments, or even bones.

It increases oxygenation of tissues and allows injured or damaged cells to absorb photos of light, which speeds healing. Class 4 laser therapy can be effectively combined with a number of other treatment modalities.

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Laser therapy can be helpful for acute injuries, such as strains, sprains, and shoulder injuries; repetitive-use injuries, such as carpal tunnel syndrome; traumatic injuries, and chronic issues such as frozen shoulder and arthritis.

One of the greatest benefits I’ve found is that Class IV laser therapy allows the body to heal without the use of prescription drugs. These patients whose testimonials follow, were treated using photobistimulation via the LightForce Class IV Laser.

A typical treatment session can take anywhere from 5 to 20 minutes, dependent upon your injury or condition. The majority of conditions require 6 to 12 treatments over a twoto four-week period of time.

Here are just a few examples: “I’m suffering from plantar fasciitis and the laser treatment helped with inflammation and my pain level. It has given me a new outlook for staying active and working in a whole new light!“ —Sharon C.

Plantar fasciitis is a common cause of heel pain. It involves inflammation of a thick band of tissue that runs across the bottom of the foot connecting the heel bone to the toes (plantar fascia). It seems that there is little agreement as to who may develop it, nor the best treatment, however there is one thing that does help and that is laser therapy, but not just any laser therapy. The deep tissue laser reaches into the location of the pain and works there.

“Deep tissue laser therapy has been very effective at alleviating the pain and swelling from a broken ankle. I’m getting back on my feel much faster than expected.” —Cynthia D.

It takes at least 6 weeks for a broken ankle to heal, sometimes longer, depending upon the severity and location of the breakage. Class IV laser therapy allows my patients to return to the activities they love while maintaining their healthy lifestyle. Recovery from injuries is much faster, often avoiding surgery altogether.

“I sustained a deep cut on my finger while on a construction job and had a laser treatment right away. After the treatment, I had almost no pain, and my finger healed phenomenally fast.”

—Forest D.

Laser therapy generates a photochemical response in damaged tissue by a process called photobiomodulation. This process stimulates healing on a cellular level by enabling cells to more rapidly produce energy (ATP).

“I came into the office bent over with a painful limp and walked out like a normal human being. Dr.Moore actually hears me, knows what is causing my pain and takes time to fix it.”

—Judy M.

Deep tissue laser therapy is a non-invasive use of laser energy that promotes healing of damaged or dysfunctional tissue. This form of therapy helps your body use its own natural healing power by activating a positive cellular response, increasing microcirculation to reduce inflammation. For those suffering from chronic, nagging pain, inflammation and lack of mobility, Class IV laser therapy offers fast, healing relief.

“I am diabetic and haven’t had any feeling in my feet for years, although my legs feel like they are on fire sometimes. With just the first treatment, I felt tingling in my lower legs and feet, and walking isn’t as painful.” —Charles B.

In general, diabetic neuropathy is thought to be the result of chronic nerve damage caused by high blood sugars. Similar to how an electric wire is surrounded by insulation, our nerves are surrounded by a covering of cells called Schwann cells.

Water is drawn into these cells causing nerve swelling and damage resulting in pain. Unless the process is stopped and reversed, both the Schwann cells and the nerves they surround will die. The application of photobiostimulation that the Class IV laser delivers to these cells prevents or reverses the biochemical processes that cause this damage.

My own personal experience: “I traveled to Boise seeking Class IV laser therapy. It was recommended to me by a neurologist after medication and treatment failed to address nerve injury and a terrible radiating pain in my left leg. It worked so well that I wanted to share it with my patients.”­—Dr. Daniel Moore, D.C.

The LightForce Class IV Laser was developed by leading laser scientists and engineers and we are proud to offer one of the very few Class IV LightForce Lasers in North Idaho.

I have treated hundreds of patients with such great results that I have many health care practitioners stop in to see what deep laser therapy can do for their patients. We encourage those who have tried other forms of treatment without success to try the technology

We have already seen many of our patients benefit from this treatment with as few as two treatments. We are so confident that this exciting new treatment can help you that your first treatment is on us. Contact our office at (208) 2672506 to schedule your complimentary first treatment and start your road to a pain-free life today.

Visit danmooredc.com to see a short video on how the Class IV Laser works. __________________________________________________________________

Daniel L. Moore D.C. has been in private practice for more than 30 years. His career began in Los Angeles, California in 1984. While working with Olympic athletes under Dr. John Thie, he mastered cutting-edge techniques like kinetic taping and Kinesiology.

A past board member of Boundary Community Hospital and Vice President of Boundary Community Ambulance, Dr. Moore currently works with several athletic teams at Bonners Ferry High School and is often seen on the sidelines during football, baseball and track events.

Dr. Moore’s advanced rehabilitation and athletic training has served Bonners Ferry and surrounding communities in North Idaho and Western Montana for over 20 years. He has continually led his field in the application of ground-breaking technologies including the LightForce Class IV Laser used in the treatment of nerve-related pain.

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27

Massage Therapy Treats Specific Disorders

by Jan Rudeen, Lifestyle Massage Therapy

L

et’s make a clear distinction from the beginning - there is a significant difference between getting a nice relaxing massage, and Massage Therapy. It’s not “just a massage,” but rather having an expert therapist listen to what you are experiencing in your health, with the purpose of addressing the needs of your body, whether it be coping with tension, experiencing the aches and pains of various syndromes, sleep disorders, post surgery stiffness, mental and physical stress.

An experienced therapist can relate to the aches and pains of aging. Unless you’ve lived a fairly sheltered life, your body has probably been through some trauma, such as a car accident, a fall, an injury at work - or at play! Or you may have poor circulation, TMJ (tension and pain in the jaw), inflammation, struggle with built up water retention in the cells interfering with weight loss.

The techniques used by a highly trained and knowledgable Massage Therapist should be tailored to the needs of the client. Everyone is unique, and so are their needs.

“One size” does NOT fit all. While a traditional massage is relaxing, and sought by many, therapeutic massage has a much more lasting, and very often curative benefit.

Following are just two disorders that respond remarkably well to Massage Therapy.

TMJ, Inflammation of the Jaw

TMJ or TMD Syndrome is an umbrella term covering acute or chronic inflammation of temporomandibular joint which connects the mandible to the skull. This disorder and resultant dysfunction can result in significant pain and impairment. There are a variety of treatment approaches because this disorder crosses over into dentistry and neurology. The symptoms typically involve more than one of the numerous TMJ components: nerves, muscles, tendons, ligaments, bones, connective tissue, and the teeth.

Ear pain and tinnitus (ringing of the ears) are associated with the swelling of near-by tissues and may result from temporomandibular joint disorders.

Symptoms associated with TMJ disorders may be: • Biting or chewing difficulty or discomfort • Clicking, popping, or grating sound when opening or closing the mouth

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• Dull, aching pain in the face • Earache (particularly in the morning) • Headache (particularly in the morning) • Hearing loss • Migraine • Jaw Pain or tenderness of the jaw • Reduced ability to open or close the mouth • Tinnitus • Neck and shoulder pain

Disorders of the teeth can contribute to TMJ dysfunction.

Impaired tooth mobility such as braces and other dental appliances and tooth loss can be caused by destruction of the supporting bone and by heavy forces being placed on teeth.

The movement of the teeth affects how they contact one another when the mouth closes, and the overall relationship between the teeth, muscles, and joints can be altered.

One of the major contributors of TMJ is stress. Patients of TMJ often experience pain such as migraines or headaches, and consider this pain TMJ-related. There is some evidence for this in that more than 50% of people who use biofeedback to reduced nighttime clenching experience a significant reduction in migraines and headaches as well as a reduction in direct TMJ pain. TMJ can also cause the following: cervical pain, migraines, myofascial pain, fibromyalgia and stress.

Myofascial Release is a therapeutic massage technique that can be a very effective way of treating TMJ and its related symptoms.

Fibromyalgia, a Complex Syndrome

Fibromyalgia is a group of signs and symptoms that include chronic pain in muscles, tendons, ligaments and other soft tissues. Fibromyalgia syndrome (FMS) is frequently seen in combination with chronic fatigue syndrome, irritable

bowel syndrome, migraine headaches, sleep disorders, and several other chronic conditions.

FMS affects 2% to 3% of the U. S. population. Women account for 85% to 90% of diagnoses, but that number may be misleading because men may be less likely to seek medical intervention for its symptoms. Fibromyalgia has been seen in all ages and economic groups, but its incidences seem to increase with age. It is different from most other muscle problems because it is a complicated combination of a sleep problems, neuroendocrine imbalances, and emotional state. FMS may eventually be reclassified as a central nervous system disorder, but because muscle pain is among its most obvious symptoms, it continues to be discussed as a musculoskeletal disorder.

Fibromyalgia patients eventually develop tender points that are distributed all over the body but tend to concentrate around the neck, shoulders, and low back.

Signs and Symptoms: • Widespread pain in shifting locations that is extremely difficult to pin down. The intensity of pain may vary widely ranging from a deep ache to burning and tingling.

• Tender points. Nine predictable pairs of these are distributed among all quadrants of the body. When FMS is triggered by a specific trauma, additional tender points may develop in the area around the injury.

• Stiffness after rest.

• Poor stamina.

• Sensitivity amplification and low pain tolerance. All kinds of sensation become more intense and likely to cause pain. This includes light and sound, and is true especially of cold, texture, and pressure.

Diagnosis: No objective diagnostic test has been developed for FMS. It is typically diagnosed after ruling out other diseases with similar symptoms, including Lyme disease, multiple sclerosis, rheumatoid arthritis, lupus, and several others. FMS is particularly challenging because most people who meet the diagnostic criteria for this problem may also have a host of other disorders. Such a close correlation exists between FMS, irritable bowel syndrome, and chronic fatigue syndrome that many experts believe these may all be different manifestations of a single problem. People with FMS may have migraine headaches, temporomandibular joint disorder (TMJ), and restless leg syndrome.

Complications: While FMS is not a life-threatening disease, it certainly threatens quality of life. The pain it causes is

“invisible” pain; that is, no recognizable outward signs of a problem are perceptible. Nothing shows up on imaging tests, no signs of this disorder are readily visible. No blood test reveals specific markers for this problem. A person with this syndrome may be discounted as a faker or malingerer by doctors, employers, even friends and family. By the time a patient has reached a definitive diagnosis, the experience with the medical community has often been frustrating and overwhelmingly negative.

Chiropractic Care: Chiropractic care has been found to play a significant role in treating people with this condition for more than a decade now. Once a Fibromyalgia patient’s spine is properly aligned, the pain and other symptoms of FMS will be greatly reduced together with the other difficulties such as fatigue, weakness and difficulty with sleeping.

Massage: Gentle massage is very appropriate for clients with FMS. Massage reduces reported levels of pain, anxiety and depression. Massage may be best used to relax the client and aid with toxic flushing, a little with each session. A client who can be pain free, even for an interval of time after each massage, will feel more able to take control of her/his own healing process, which is the most important step toward recovery.

Whether you are experiencing one of these conditions, or another, please call me at 208-290-7281 and schedule a free consultation where we will discuss therapeutic options and techniques to address your individual needs. ___________________________________________________________________

Janice Rudeen, Licensed Massage Therapist, holds a degree in Speech Pathology from the University of Washington, with advanced courses in medical sciences, anatomy and pathology, and has worked in the University of Washington Medical Center. Janice also holds a Masters of Education in Curriculum and Instruction with certification in teaching, reading, and administration in both Washington and Idaho. She has designed reading curriculum in Washington and worked with Data Recognition Corporation to design and test items for reading and language arts for the Idaho Standard Achievement Test. Jan later completed a Massage Technology Degree in Northern Idaho, focusing on anatomy, physiology, nutrition, hydro-therapy and ethics. She works closely with her clients addressing neck, back, spine, shoulder, arm, foot and a variety of other medical issues, serving ages from 1 - 100 throughout the region with offices in Bonners Ferry and Sandpoint. janrudeen.massagetherapy.com

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29

How to Support Your Immune System Against Colds and Flu

by Scott Porter, Pharm.D. and Director, Center for Functional Nutrition

C

old and flu season is upon us. There are many ways that you can support your immune system during this time. This includes the flu shot, probiotics, effective herbal supplements, healthy food, and even a good night’s sleep.

The flu shot is very popular, especially with those that are more at risk of complications after an infection. The ideal candidates for a flu shot are individuals that have compromised immune systems, heart disease, or diabetes. Getting a flu vaccine is best done before the flu begins spreading in the community.

The Centers for Disease Control and Prevention (CDC) does recommend the flu shot for healthcare workers with direct patient contact, pregnant women, caregivers of children younger than 6 months, children, and adults under 24. The CDC also recommends that everyone 6 months of age and older should get a flu vaccine every season.

A flu shot contains an agent called an antigen that elicits an immune response in your body. This antigen is incubated in fertilized hen’s eggs after they get inoculated with this year’s predicted version of the flu virus.

Upon vaccination, your body will create it’s own antibodies against these strains of the virus. This is what protects you later.

It takes about two weeks after your are vaccinated to create these antibodies. Since the exact flu strains that will be going around aren’t known before hand, it is an educated guess as to which

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strains to be used. The success of the vaccine depends upon matching the ones that we end up getting with the ones injected into the eggs.

You will need a flu vaccine every year. Not only do the viruses change each season, your body’s ability to fight the flu off after a vaccine can weaken over time.

Some physicians will advise pregnant women and infants to opt for a single dose mercury-free vaccine which comes in a pre-filled syringe. Other individuals simply choose not to get the flu shot at all out of a concern for the use of a preservative called thimerosal. Thimerosal contains mercury.

If you are generally healthy and want to avoid the flu vaccine, you could focus on boosting your immune system.

Improving the quality of your lifestyle will help, including more pleasure, relaxation, eating fresh and nutrient-dense foods, and staying well hydrated. Make sure you limit processed foods.

Getting sick in the first place can often be avoided by taking care of the way we eat, keeping in good shape, sleeping well every night, and taking a few nutritional supplements. Probiotics can be very helpful at supporting the immune system. This is important during seasonal colds and flu, as well for those with allergies. Probiotics directly support a healthy gut.

It’s been said that 70 to 80 percent of our immune cells are located in the gut. This protective environment identifies and attacks a variety of threats, including viruses, bacteria, and parasites, while distinguishing them from our own tissue.

Supporting your immune response can not only reduce duration and severity of colds and flus, it can lower the incidence of developing these in the first place. Getting enough sleep is one of the most effective ways to support our immune system. Some

disease fighting substances are released or created only when you sleep. Repairing and growing new tissue happens at this time.

Even short sleep deprivation causes undue stress on the body.

During times of prolonged stress, our bodies produce too much cortisol which creates chronic inflammation. This can lower signals that are critical to immune cell response. Short term inflammation is one of our first immune responses in order to create a barrier against the spread of infection and promote the clearing of pathogens. This is helpful. But long term inflammation is destructive.

Be careful what you eat. Avoid sugars and flour, especially when you are starting to feel sick. A clean diet that is rich in nutrients, minerals and antioxidants, like Vitamin C, is essential.

You can also support yourself by taking a multivitamin. I suggest you pick one that has a recommended dosage of at least three capsules a day, ideally six.

Increasing dosages of other nutrients can also be supportive.

Vitamin D3 has antimicrobial properties that help fight against pathogens. Vitamin C is a well know antioxidant and must be taken as the body does not produce it. This vitamin produces beneficial effects on virtually all of your immune system’s cells.

Fish oil is another source of D and is shown to enhance the function of immune cells.

Vitamin A has a profound effect on your immune system, particular the surface of your digestive track and leads to immune tolerance across the gut lining. This is a key to being able to consume a wide range of foods and not react adversely. Zinc Citrate is an important component of the enzymes involved in tissue repair and may reduce the duration of a cold by 50%.

Probiotics support a healthy gut flora. This is a major defense against invaders and integral to the immune system. I consider probiotics foundational to optimal health. It is important to get an effective one though. Probiotics with more than 15 strains will reduce the potency per strain. Typically, I like to find one that has between 6 and 12 strains. But when I’m not feeling well I’ll even take one with just 3 strains in order to increase the benefit. Make sure you ask if potency of your chosen probiotic is at expiration or manufacture date as this make a big difference in quality.

Beta glucans, like those extracted from mushrooms, are considered immune modulators. These activate without overstimulating your system. Mushrooms, such as maitake, shitake, and reishi have been highly effective for me when battling an infection.

Natural herbs can have broad spectrum effects against viruses and bacteria. Some of these immune boosters include astragalus, echinacea, green tea extract, elderberry, andrographis, and goldenseal. Olive leaf is another great one and I use a spray of this to reach directly to my throat.

You can support your body and be prepared to fend off an attack, whether you choose a flu shot, probiotics, mushrooms, or a good night’s sleep. Stop by Sandpoint Super Drug and talk anytime. ___________________________________________________________________

Scott Porter, Pharm. D., is a functional medicine pharmacist and is the director of the Center for Functional Nutrition at Sandpoint Super Drug. He emphasizes integrating diet, exercise, and nutrition with science-based medicine for optimal health and well-being.

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31

Immunizations for Adults

by Geoff Jones, MD Newport Hospital and Health Services

W

hile most of the current media buzz surrounding immunizations has to do with the childhood variety, it is important to remember that there are also vaccines that are intended for adults, too. These are surprisingly effective, and can help keep adults healthier. They are especially important, though, for people with chronic diseases such as diabetes and COPD (emphysema).

There are many adult vaccines available, but the most common ones given in the U.S. are influenza, Tetanus/ Diptheria/Pertussis, Pneumococcal vaccines, and Varicella.

Less common adult vaccines that may be given in special situations and foreign travel include HPV, MMR (Measles), Hepatitis A &B, Hemophilus Influenze B (HIB), Yellow

fever, Typhoid, Rabies, Japanese Encephalitis, Anthrax, and Meningococcal vaccines.

The most common adult immunization given in the U.S. is influenza. The “flu” vaccine is made new each fall, and consists of the 3 strains that were the most common strains of the virus at the end of the last flu season. The flu virus is notorious for mutating and changing during the course of the season, and so it will often change prior to the fall release of the new vaccine – because of this, some years the vaccine is less effective than others. However, every year studies show that receiving the vaccine decreases a person’s chance of getting the flu as well as being hospitalized with complication of influenza. It may not be perfect – but better than nothing!

The next most common adult vaccine is TDaP. This stands for Tetanus, Diphtheria and acellular Pertussis (whooping cough). Adults should get a tetanus/diphtheria booster every 10 years (or every 5 years if they are exposed to a high risk wound like a dirty nail from a horse pen), with at least one

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of those boosters containing Pertussis. Furthermore, it is recommended that all pregnant women receive a booster shot of TDaP every pregnancy at about 28 weeks to help protect their newborn. In addition, many parents are now insisting that any one (like grandparents!) that will be around their child should have a pertussis booster. We have a lot of pertussis in our region, and this vaccine is our best defense against that potentially fatal disease.

Next is the Pneumococcal vaccines. These two vaccines – PCV13 and PPS 23, or Prevnar and Pneumovax, are given in combination several months apart. They are designed for adults over 65 or those with a compromised immune systems at a younger age. They target Strep Pneumonia, the bacteria that is the most common cause of death from pneumonia in the U.S. In people between 60 and 80 years of age, receiving these vaccines decreases a person’s risk of dying from pneumonia by over 10% – but it is most effective in people with chronic conditions who need this protection the most.

Lastly is the Shingles vaccine. Shingles is an extremely painful rash that is caused by the re-activation of the chicken pox virus (varicella) the individual had as a child. The pain of shingles cannot be overstated, and can linger for years after the rash resolves. The vaccine is about 70% effective in preventing shingles, and can be given to anyone over the age of 60.

While there is a lot of controversy surrounding vaccines, the simple fact is that they are our best defense against many potentially fatal or life altering diseases. They are not perfect, and not indicated for everyone – so please talk to your doctor about whether or not these vaccines can help keep you healthy. ___________________________________________________________________

Dr. Geoff Jones graduated from University of Washington School of Medicine in 1996, completed his residency at Family Medicine Spokane in 1999, and has practiced in Newport (Washington) since 2003. He is a Clinical Instructor for the University of Washington School of Medicine Department of Family Medicine, and is on faculty for Family Medicine Spokane.

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33

Understanding Long-Term Acute Care

by Heidi Frazier, Director of Marketing & Business Development Northern Idaho Advanced Care Hospital

L

ong-term acute care. The term may sound a bit confusing at first, but it’s important to know what it is before you need it, according to Una Alderman, Chief Executive Officer of Northern Idaho Advanced Care Hospital.

“Most people who need inpatient healthcare services for serious injuries or illnesses are admitted to an ‘acute care’ hospital for a relatively short amount of time,” Alderman says.

“But when someone is recovering from a medically complex condition, he or she may be referred to a long-term acute care hospital (LTACH) for continued care beyond the original hospital stay. This type of hospital is also certified as an acute care hospital, but specializes in long-term and critical care services.”

When patients are referred to a long-term acute care hospital like Northern Idaho Advanced Care Hospital, they usually have one or more serious conditions that require critical care services. These conditions can include respiratory failure, cardiovascular disease, trauma, infectious diseases, complex wound healing, and more.

“At a long-term acute hospital, medical services are tailored to the complex needs of each patient, and a personalized plan of care is created by an interdisciplinary team for each individual,” says Dr. Kevin Strait, Medical Director of Northern Idaho Advanced Care Hospital. “The medical team can provide services such as 24-hour nursing care, ventilator weaning, respiratory care, pain management, wound care, and physical, occupational and speech therapies, among other medical services. Being provided with this comprehensive, specialized care can be significant to a patient’s recovery process.”

Confirming this is a study published in Medical Care, a journal of the Medical Care Section of the American Public Health Association. The study shows that in most cases, medically complex and critically ill patients have better results at a long-term acute care hospital compared with similar patients in other settings. In particular, the research found lower death rates among most non-ventilator patients with multiple organ failure, and those who had spent three or more days in an acute-care hospital’s intensive care unit (ICU) prior to going to a long-term acute care hospital.

“I think the study reflects that long-term acute care hospitals are well equipped to handle medically complex conditions,” Dr. Strait says. “Through use of specialized equipment and training of staff, those of us in long-term acute care settings can offer a patient continued high-quality long-term or critical care needed so he or she can eventually be discharged either to home, a skilled nursing facility, or to an inpatient rehabilitation hospital to meet further medical needs.”

Dr. Strait suggests when looking for long-term acute care for you or a loved one, to be sure to discuss options with your physician or healthcare provider.

“Do research on facilities in your area and ask for recommendations,” he says. “I always suggest touring the hospital as well. This is a good way to get a sense of the care provided. It gives you the opportunity to observe the attitude of the staff, type of equipment, and the cleanliness of the facility.

It’ll also give you a chance to ask any questions you have.”

Other items that can be reviewed with the staff include: • healthcare specialists who will be involved in your care, • therapy programs offered, • nurse-to-patient ratio, • comfortableness with private rooms and baths, • nursing station locations, • certifications and credentials of the staff, • hospital accreditations and recognitions, • patients’ results, • level of involvement of family with patient care, • and general information such as visitation hours or overnight policy.

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Wise Guide | Fall 2017 / Winter 2018

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In addition to choosing an appropriate facility, Strait also suggests that family members educate themselves on what to expect when a love one is in critical care.

“For a critical care patient, the road to recovery may be a long and overwhelming experience for not only him or her, but for family members as well,” he says.

“So knowing what to expect can provide some ease of mind and help everyone deal with the situation better.”

Dr. Strait shares the following to help prepare for when a loved one is in critical care: 1. Remember that you have an experienced team on your side. The hospital staff that’s caring for your loved one is highly skilled and prepared to treat the sickest – and most medically complex – patients.

From the physicians and nurses to the respiratory therapists and dietitians – they all are specially trained to care for your loved one.

2. The tubes and equipment in a critical care unit can be intimidating. But, they all have a role and purpose in providing your loved one with the intensive healthcare that he or she needs. The healthcare team will be able to explain the role of any equipment to help you better understand what it happening.

3. Information overload can – and most likely will – occur. Everything will be new to you from the equipment and noises to the procedures and health professionals. Take a deep breath. Once you get your bearings, think of how you can best keep track of information. Write in a notebook. Keep notes on your phone. Jot down items like key information, questions you want to ask, purpose of treatments, and names of hospital personnel.

4. Expect peaks and valleys. Critical care can be a bumpy ride. Some days will be better than others. As much as possible, try to be patient and keep perspective.

5. Talk to your loved one. Communicating with your loved one is important for not only him or her, but for your entire family. Often patients can hear while in critical care. Speak calmly and clearly, and make short, positive statements. Hold your loved one’s hand or touch him or her gently if a member of the healthcare team says it’s OK. 6. Take care of yourself. It may be a long road to recovery, so be sure to take time for you. Sleep, eat, and shower.

Don’t be afraid to leave the room for a bit. The healthcare team will be there 24/7 to provide care. ___________________________________________________________

Northern Idaho Advanced Care Hospital is a 40-bed, freestanding facility providing long-term acute care and critical care services for patients recovering from serious illnesses, illnesses or chronic medical conditions. It is the first hospital in Idaho to earn The Joint Commission’s national certification in Respiratory Failure. For more information, call 208-262-2800 and visit NIACH.ernesthealth.com.

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35

Planning for Medicaid Long-Term Care Benefits

by Ryan J. Crandall, J.D., Crandall Law Group

M

edicaid is a government program that pays medical costs, including long-term care costs for nursing home care. Not to be confused with Medi-care, which is available to all seniors and does not cover long-term care, Medi-caid has strict financial and eligibility requirements. The rules are complex and change frequently, requiring great care when planning and applying for benefits.

Basic Eligibility Requirements

In most states, including Idaho and Washington, an individual applying for Medicaid long term care may only own $2,000 in total countable assets. Certain assets such as a residence or a vehicle may not be “countable” for eligibility purposes, but Medicaid may be able to place a lien on these assets after the recipient dies. If the individual is married, the healthy spouse may be able to keep up to $120,900 in countable assets. But any excess countable assets would need to be spent before the individual would qualify; this is often referred to as a Medicaid “spend down.”

Gifts, “Look-Back” Periods, and Penalty Periods

To preserve assets and avoid having to go through a Medicaid spend down, individuals will often give away assets such as homes or bank accounts to their children or family members. As might be expected, Medicaid regulates these types of gifting strategies. Medicaid will look back five years from the date of application (the “look-back period”) for any uncompensated transfers or gifts. Gifts made during this period will result in a period of ineligibility for the applicant (“the penalty period”), the length of which is calculated based on the value of the gift. Note: There are exceptions for gifts of certain assets to individuals such as a disabled child or caretaker child who lived in the applicant’s home for at least two years.

When to Plan for Medicaid

Most people start planning for Medicaid only when they think they need benefits. Because of the five-year look-back period, that’s a big mistake. The best time to plan for Medicaid is at least five years before you anticipate having to go into a nursing home or assisted living facility. However, if an unexpected illness arises, there are usually better options than doing a complete Medicaid spend-down, and it still may be possible to preserve a significant portion of your assets using more advanced planning strategies not discussed in this article.

Using Irrevocable Trusts

As mentioned earlier, individuals planning for Medicaid benefits will often make gifts to family members. Gifts can either be made directly to individuals as “outright” gifts, or they can be made to an irrevocable trust for their benefit. There are usually significant advantages to using an irrevocable trust rather than outright gifts. Some advantages of irrevocable trusts include: Asset Protection for Beneficiaries – Using a trust, it is possible to insulate the gifted assets from creditors of the beneficiary. For instance, if a child is sued, files for bankruptcy, or goes through a divorce, assets held in trust can be fully protected from the child’s creditors or ex-spouse.

Preserving the Exclusion of Capital Gains on the Sale of the Home – For homeowners, Section 121 of the Tax Code excludes up to $250,000 of capital gains from being taxed when the taxpayer’s principal residence is sold. This valuable tax benefit may be forfeited if the home is gifted outright.

Preserving Tax Basis “Step Up” – Tax “basis” refers to the owner’s original value in an appreciating asset and is used to calculate capital gains tax owed when the asset is Continued on Page 38

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Wise Guide | Fall 2017 / Winter 2018

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Planning for Medicaid Long-Term Care Benefits Continued from Page 36

____________________________________ sold. When an asset passes at the owner’s death, the recipient gets a “step up” in tax basis to the current fair market value. Gifts made during the owner’s lifetime, however, do not receive a step up. For example, if Dad purchased property for $20,000 and the property was worth $100,000 when he died and left it to Son, Son’s new tax basis is “stepped up” to $100,000, and $80,000 of taxable gains are eliminated. Conversely, if Dad gifted the property to Son during his lifetime, Son keeps the original tax basis of $20,000 and could owe a hefty tax when the property is sold. Carefully drafted irrevocable trusts can preserve the “step up” at the owner’s death, even though the asset was gifted to the trust during the owner’s lifetime.

Determining Lifetime, Death, and Successor Beneficiaries – Trusts make it possible to name both lifetime beneficiaries and beneficiaries entitled to receive assets at your death. You can also differentiate between beneficiaries of income generated by trust assets and beneficiaries of the principal amount.

Finally, you can name successor beneficiaries to any beneficiary who predeceases you or dies before the trust is used up. This can be very important for those who want assets to remain in the family.

Incentivizing Use of Trust Assets – With an irrevocable trust you can place limits and incentives on how assets are to be used. For instance, you may specify that funds can only be used for specific purposes such as education, health, or living expenses, or for special occasions such as graduation, marriage, or the purchase of a home. Trusts can also provide important incentives and protections for individuals struggling with addiction.

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care environment for adults with disabilities and seniors who are receiving care at home. Open weekdays, the program provides a safe, caring environment where participants can spend all or part of their day while their usual caregiver is unavailable or attending to other duties. Staff are specially trained in caring for the mental and medical needs of participants while providing activities that engage their interest and help reduce social isolation.

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(208) 625-5354 or visit kh.org

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Wise Guide | Fall 2017 / Winter 2018

Protecting Beneficiaries with Disabilities or Special Needs – Giving an outright bequest to individuals receiving means-based government assistance such as Medicaid or SSI can cause them to lose these benefits and can be disastrous. With a trust it is possible retain shares in a “Supplemental Needs Trust,” which is designed to give beneficiaries use of their funds without interfering with their government assistance.

The use of irrevocable trusts can result in significant tax savings and asset preservation for beneficiaries and can give individuals greater control and flexibility in planning for long term care.

Every person’s situation is different, and trusts are one of many Medicaid planning strategies that may be available to you.

The use of irrevocable trusts can result in significant tax savings and asset preservation for beneficiaries and can give individuals greater control and flexibility in planning for long term care.

Every person’s situation is different, and trusts are one of many Medicaid planning strategies that may be available to you.

When considering Medicaid planning, it is important to work with professionals who have experience in this complex area of the law.

Crandall Law Group offers free initial consultations for our Medicaid planning. ____________________________________________

Ryan Crandall is an attorney and estate planner with a passion for helping individuals and families prepare for the future. Ryan believes that one of a lawyer’s primary roles is to be an educator and counselor. At Crandall Law Group, he works hard to discover his clients’ goals and explain, in easy to understand terms, the strategies that can be used to accomplish their objectives.

Need a Ramp for Accessibility?

T

he Disability Action Center (DAC NW) in Moscow & Post Falls can help! A variety of access ramps have been purchased and are available throughout northern Idaho at no cost to the recipients. For some of these recipients, it means everything to be able to stay in their own home. Other ramps have been used to make public events accessible.

For the Lloyd Home Dedication held on April 30th in Moscow, a ramp was set up so everyone could have access to see the home. “It worked wonderfully!” said a Palouse Habitat for Humanity Representative, “We had several individuals attend who had limited mobility, another who was in a wheelchair, and a family with children in strollers -- and they all made good use of the ramp.”

Another ramp was installed at a home in Clarkston, Washington. The resident there is a chair user but steps to the front door prevented him from living there. Volunteers delivered and set up a new ramp that he will be able to use indefinitely.

In September 2016, Disability Action Center NW received a $17,500.00 grant from the Christopher & Dana Reeve Foundation for providing access to ramps. This grant provided funds to purchase a variety of modular aluminum ramp systems that are designed to address different needs. These are deployed to community members on a short- or long-term loan basis, with volunteer labor from community service organizations. The grant also paid for transportation costs and for a new trailer to move the ramps to different locations. “We ran into road blocks with our volunteers finding the use of a large enough pickup to move the ramps when needed,” said program manager Mellowdee Brooks of DAC NW. “Now it’s as easy as loading the sections on the low deck of the trailer, hooking up and off they go.”

The Christopher & Dana Reeve foundation have been supporting this program since September 2016. Some of these ramps are still waiting for a new assignment. People who need a ramp and can’t afford it can contact the Disability Action Center at 208-883-0523 to find out more. To learn about DAC, visit our website at dacnw.org

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Crossword Bears Across

Down 1 Bear back scratchers 2 Summation 3 French romance 4 Big bear 5 Perfume brand by Dana 6 Decorative pitchers 7 Chinese dynasty 8 Historic period 9 Rite of passage 10 Bump off

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12 Gossips 14 Juicer 15 Lennon’s Yoko 18 ___ room 23 New Rochelle college 25 Query 26 In the cellar 28 Klutz’s cry 30 Diner’s card 31 Bonanza finds 32 Cozy retreat 33 Lump of mush 34 Scowl 35 Light beige 37 “What was ___ think?�

38 Irene of “Fame�

41 Pool division 44 Trans-Siberian Railroad city 47 Troop grp.

48 Good name for a bear 51 Tristan’s love 53 Alleviated 55 Campers, for short

Wise Guide | Fall 2017 / Winter 2018

56 Locales 58 Lists 59 Roast host 60 Cold spot for bears 61 Kyat part 62 Common Market letters 63 Picnic staple 65 Ages and ages 68 Painter’s medium 69 Roll of dough

Copyright Š2017 PuzzleJunction.com

1 La-la lead-in 4 Telecom giant 7 Rancher’s concern 11 Sleep acronym 12 Sticking point?

13 Operatic passage 16 Author Umberto 17 Bear’s down time 19 ___ de Cologne 20 Sky-blue 21 Golden rule word 22 Squirt 24 La ___ opera house 27 Capital on a fjord 29 Bear’s snack 33 Secluded valley 36 Cry of encouragement to foxhounds 39 Bard’s “before�

40 Type of anesthetic 42 Bake sale org.

43 Subdues, with “down�

45 “Days of ___ Lives�

46 Soak up 49 Necessary 50 Kodiak bears, among others 52 Bellicose deity 54 Scorches 57 Sharpshooter name 61 Coin in CancĂşn 64 Opinions 66 Cousin of an ostrich 67 Bears like it here 70 Half an antiaircraft gun?

71 Bears of Maine like it here 72 Chisholm Trail town 73 Modern (Prefix) 74 Fuse together 75 Compass dir.

76 Ringgit part

Sudoku

How to Play Sudoku To solve the Sudoku puzzle, each row, column and box must contain the numbers 1 to 9.

Crossword and Sodoku answers on page 63.

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Key Factors for Senior Independent Living

by Peggy Fairfield, LSW, Kootenai Health Lifeline

M

ost of us would like to remain in our homes as long as possible. The information from this article is beneficial to healthcare professionals and to caregivers.

The following content courtesy of Independent Living (July 7, 2015). There are four key areas in which you can encourage safe senior independence, lower fall risk, and help seniors maintain their abilities to remain in their own homes.

1. Assess the Costs of Care

Help seniors understand the true costs of aging in place versus assisted living or nursing home care. Coverage provided by Medicare and long-term care insurance is limited, and depends on the service and amount of time it’s needed. One advantage to receiving services at home even when paid out of pocket is often far less expensive than moving to a long-term care facility.

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The daily cost for a semi-private nursing home bed in 2016 was $6,844 per month, according to Genworth 2016 Annual Cost of Care Study: Costs Continue to Rise, Particularly for Services in Home. Assisted living facilities cost roughly $3,628.

By contrast, the cost hiring a homemaker or in-home health aide for 44 hours weekly was $3,813 and $3,861, respectively.

Home health nurses and therapists are typically more expensive, but for seniors who only need part-time assistance, this option could be less costly in the long run. These potential savings free up more money to spend on other aspects of independent senior living.

2. Support Physical Health

The greatest challenge to maintaining senior independence is declining physical health. Healthcare providers can have a direct and significant impact on preserving older Americans’ wellbeing, by: • Identifying physical issues that interfere with independent living.

• Focusing specifically on prevention and management of the most common chronic diseases, keeping in mind that seniors frequently live with comorbidities.

• Helping seniors be safer at home and on the go by exploring technological options such as home monitoring, medical alert systems and automated medication dispensing.

Heart Disease

The leading cause of death in the US, heart disease takes the lives of 614,348 Americans every year, according to the U.S. Centers for Disease Control and Prevention (CDC).

Inform recovering cardiac patients that a slow change in lifestyle choices has a higher chance for success. Eating a healthy diet, quitting smoking, finding a safe and enjoyable place to walk, learning to control stress, and properly managing medications are all important. In most cases, these goals are realistic, especially if instituted gradually. Also be sure patients are aware of medication side effects such as dizziness, which may increase their risk for falls.

Organizations such as the American Heart Association offer a wealth of useful information to reduce the impact of heart disease on senior independence, including diet plans, recipes, and exercise instructions. Government agencies such as the CDC and the National Heart, Lung, and Blood Institute also offer useful insights.

Cancer

Cancer and its side effects may negatively impact your senior patient’s comfort, safety, and independence. Fatigue is the most common and persistent side effect of cancer treatment. It’s experienced by about a third of survivors, especially those who receiving chemotherapy. The American Cancer Society’s 2016-2017 Cancer and Survivorship Facts & Figures explains the impact: “Compared with fatigue experienced by healthy individuals, cancer-related fatigue is more severe, more distressing, and less likely to be relieved with rest.”

Other side effects of chemotherapy, such as poor balance, visual changes, confusion, and trouble walking, may increase the risk for falls and fall-related injuries.

Help cancer patients with medications and/or activity recommendations to reduce these impacts. The American Cancer Society’s Stay Healthy section features information on how to live better with the effects of the disease.

Lower Respiratory Diseases

Chronic obstructive pulmonary disease (COPD) can become severe enough to make walking and other movement a major challenge. When the lungs are unable to provide the brain and organs with an adequate oxygen supply, the result can be weakness, dizziness, and confusion – all things that increase a senior’s fall risk. Tubes and tanks for oxygen support may also become tripping hazards. These factors may adversely impact seniors’ ability to age in place.

Introduce your patients to resources from the American Lung Association for advice on living safely with COPD. Your patient’s local United Way or Department on Aging also provides assistance and referral network resources. Through these and other organizations, your patients can find help with such needs as transportation, food assistance, senior companions, and much more so that they can continue living as independently as possible.

Stroke

Because a stroke significantly effects balance and gait, it has a huge impact on senior independent living. Once a stroke survivor is home, how well s/he manages depends Continued on Page 44

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Key Factors for Senior Independent Living Continued from Page 43

______________________________________________________ on the residual damage and the patient’s motivation, environmental conditions, and social support.

The United Way is an excellent resource, while the American Stroke Association, National Stroke Association, and the National Institute of Neurological Disorders and Stroke are the go-to resources for stroke patients, caregivers, and healthcare professionals alike.

Diabetes

Diabetes influences senior independence in many ways, including: • Poor eyesight that increases fall risk.

• Neuropathy from damaged vessels that leaves the feet oversensitive or with minimal sensation and makes safe walking difficult.

• Sore gums and loss of appetite that can cause unsafe weight loss and increased fatigue.

Diabetes symptoms are manageable but require selfdiscipline and significant lifestyle changes. The American Diabetes Association recommends that patients eat a healthy diet as advised by their primary healthcare provider, stay as active as possible, maintain strict blood glucose monitoring, keep up with good oral healthcare and routine trips to the dentist, and exercise good foot care.

3. Focus on Mental & Cognitive Health

Mental health concerns — primarily mood disorders, anxiety, and cognitive impairment — affect approximately 20% of the 55+ population, according to the CDC. These conditions can reduce a senior’s ability to age in place for many reasons, including the increased risk of falls.

The CDC estimates that most older adults are in good mental health – only about 15% report any mental health illness. The incidence of depression, however, rises with age and loss of independence: 11.5% of older hospital patients and 13.5% of people needing home healthcare are depressed.

The National Alliance on Mental Illness and CDC offer useful resources for patients and professionals.

Sometimes overlooked, substance abuse among older adults is a real and growing problem. According to the Center for Behavioral Health Statistics and Quality, more than 1 million 65+ people had a substance abuse disorder in 2014, the most recent year available. That includes 978,000 abusing alcohol and 161,000 abusing illicit drugs. And those numbers are on the rise, expected to reach 5.7 million by 2020. Consult the Substance Abuse and Mental Health Services Administration for education materials and links to support groups in your area.

Cognitive issues related to Alzheimer’s disease and dementia make senior independent living difficult. These patients are prone to falling and to becoming disoriented, lost and confused – so they require assistance and supervision.

Home monitoring and medical alert systems with fall detection can help patients age in place safely. The Alzheimer’s Association is a valuable resource for patients and caregivers.

4. Address Fall Risk and Prevention

Any patients you believe may be at risk for falls can benefit from tips to prevent slips, trips and falls at home and on the go, including: • Removing loose rugs, electrical cords, and clutter.

• Maintaining adequate lighting.

• Installing grab bars, ramps, and other safety equipment.

• Wearing shoes with sturdy soles.

• Understanding how medications and conditions can make falls more likely.

• Using a personal emergency alert device - Lifeline.

Developing creative ways to help your patients age in place safely benefits their health and wellbeing, and makes you a valuable partner for them and their caregivers. That’s the best way to honor and ensure senior independent living. _________________________________________________________________

Peggy Fairfield, obtained her Master of Social Work degree from University of Montana in 1978. She has been with Kootenai Health for 30 years, working on the acute care floors 5 years and running the Lifeline outreach program for 19 years serving Boundary and Kootenai counties. Peggy has been a member of the Kootenai County Board of Community Guardians since 1989, Chair since 1998.

She is a Charter Member of CareNet, a networking organization of professionals providing services to seniors and their families.

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3372 East Jenalan Ave • Post Falls ID 83854 • 208.262.8700

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RHN.ERNESTHEALTH.COM

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The Right Care, at the Right Time

by Darryl Heisey, Idaho State Veterans Service Officer

I

f you want to learn something about VA benefits, what you read in this article may change your life or the life of someone you know. Are you a Marine? Did you serve at Camp Lejeune? Do you have one of the following conditions: Kidney Cancer? Liver Cancer? Non-Hodgkin’s Lymphoma?

Adult Leukemia? Multiple Myeloma? Parkinson’s Disease?

Aplastic Anemia and other myelodysplastic syndromes?

Bladder cancer? These conditions are considered presumptive for 30 days of total service at Camp Lejeune, North Carolina or MCAS New River North Carolina. Veterans who served from August 1, 1953 to December 31, 1987 are considered to have been exposed to contaminated water at Camp Lejeune or MCAS New River. The new presumptive conditions where written into law on March 14, 2017. IF one of your loved ones passed away from one of the eight conditions, the surviving dependent family members may be eligible for Veteran Affairs Benefits. If you have or had one of these conditions listed and you meet the criteria of 30 days cumulative time at Camp Lejeune or MCAS New River, you need to contact your nearest Veteran Service Officer for more details and help with filing service connected disability claims.

In August 2017 President Trump signed the VA Choice and Quality Employment Act of 2017. The VA has been authorized $2.1 billion for the Veterans Choice Program (VCP). What changes? This will allow VA Medical Facilities to maximize referral to local VCP participants in the community where veterans reside. Keep in mind that eligibility for Choice Program has not changed. Choice First may be referred if requested care is not offered at the local Veteran Administration Medical Center (VAMC) or, if the VAMC can’t see the veteran for specific care, and is over 30 days from a preferred date, or 40 miles driving distance from the closest VA health care facility; these facilities include Community Outpatient Clinics (CBOCs).

The veterans Choice Program WILL NOT pay for emergency visits. The Choice Program requires approval from the VA Health clinic/hospital after all attempts to receive needed care cannot be met; once that has been established the veteran can call the Choice Line at (866) 606-8198. The North Idaho and Eastern Washington Choice number is (509) 484-7969. Choice falls under Triwest the website for Triwest is www.triwest.com. To reach the VA Care in the Community or Choice Program Troubleshooters call (509) 434-7969. IF you have a VCP billing issue call 877-881-7618.

Services NOT covered under the Choice Program: Nursing home care; hospice; long term acute hospital; homemaker and home health aide services; chronic dialysis treatments; dental care; pediatric services; durable medical equipment including eyeglasses and hearing aids; orthotics and prosthetics; non-urgent/non-emergent medications; compensation and pension examinations and EMERGENCY ROOM care.

Co-pays: Under the Choice Program veterans are required to make a co-pay in the same manner they would for care or treatment from the VA health clinics/hospitals.

IF the veteran has approval for the Choice Program, be sure that the local provider submits bills to the following address: WPS-VAPC3 PO Box 7926 Madison, WI 53707-7926.

Your local County and State Veteran Service Officers are able to assist you and steer you in the right direction when you have questions about VCP. Keep in mind you must be enrolled in VA medical care in order to qualify for this program. Call your local VA clinic or your County or State Service officer and they can help you with your enrollment process into the VA healthcare program. Please contact Darryl Heisey at 208-446-1096 if you would like to learn more about your earned VA benefits. __________________________________________________________________

Darryl Heisey is the State Veterans Service Officer, Idaho Division of Veteran Services, Post Falls. Darryl served in the U.S. Army as 56M40H Chaplain Assistant Supervisor from 1982-2002. Army Duty Assignments: Fort Polk, LA, 588th Engineer Battalion, 5th Infantry Division (Mechanized); Fort Richardson, AK, 1st Brigade, 6th Infantry Division (LIGHT); Fort Carson, CO, 4th Infantry Division, Mechanized; Fort Monmouth, NJ, United States Army Chaplain Center and School; Fort Jackson, SC & Schofield Barracks, HI, 25th Infantry Division (LIGHT); Fort Huachuca, AZ, United States Signal Command. Darryl holds a B.S. degree in Human Resource Management from Madison University.

A past board member of Boundary Community Hospital and Vice President of Boundary Community Ambulance, Dr. Moore currently works with several athletic teams at Bonners Ferry High School and is often seen on the sidelines during football, baseball and track events.

Dr. Moore’s advanced rehabilitation and athletic training has served Bonners Ferry and surrounding communities in North Idaho and Western Montana for over 20 years. He has continually led his field in the application of ground-breaking technologies including the LightForce Class IV Laser used in the treatment of nerve-related pain.

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Is It Time for Home Care?

by Cindy Barnett, Director Addus HomeCare, Coeur d’Alene

E

very family must face the question at some point: What’s the best way to care for our elderly relatives?

There are many factors to consider, of course, such as your loved one’s health needs, available financial resources, and where the various family members live. There are many options for care as well, including nursing homes, assistedliving facilities, and adult family homes.

When possible, however, many families are considering in-home care.

According to AARP, 82 percent of people say that they would prefer to stay in their homes as long as possible. This comes as no surprise. Home is obviously the most familiar

and comfortable place to be, especially when a person isn’t feeling their best. And being in one’s home offers more freedom, independence and dignity than a community living situation allows.

Studies by the National Association for Home Care & Hospice have confirmed that in many cases home care is a cost-effective service that reinforces and supplements care provided by family and friends, while also allowing people to take an active role in their own care, which promotes healing and faster recovery.

Ten Questions To Help Decide

So, how do you know when it’s time for home care for your loved one? Here are 10 questions that could help you decide.

1. Has there been a recent emotional or medical crisis?

2. Are pills left over or being used too quickly?

3. Does your loved one require assistance walking?

4. Is he or she becoming more forgetful?

5. Are there signs of burnt pans on the stove or scorch marks on pot holders, dish towels, etc.?

6. Is his or her hearing or vision affecting their ability to function?

7. Is he or she unable to run errands or travel to appointments alone?

8. Is routine house cleaning being ignored?

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and reporting Changes in Condition – anything that is noticeably different in their behavior, appearance or living situation, from one visit to the next. This can help prevent problems that could affect their ability to stay in their home.

Addus HomeCare is focused on one goal: keeping our clients healthy and independent at home. We are here to help residents throughout all of Northern Idaho.

Call us at the Lewiston Branch: 208-746-8881 and the Coeur d’Alene Branch: 208-667-2309. ____________________________________________________________

Cindy Barnett is the Director of Addus Homecare in Coeur d’Alene; providing quality In-Home Care to those in need.

Cindy has a degree in Psychology and a minor in health promotions from Weber State University. Over the last 30 years she has worked with a range of age groups; many who suffer with depression. Her passion is to help others live a better quality of life.

9. Have social activities become less

frequent or stopped altogether?

10. Have there been recent falls?

If the answer to any of these is “yes”, it may be time to consider in-home care.

Addus Has All the Home Care Services You Need

Agencies such as Addus HomeCare provide in-home support, including personal care and other assistance with “Activities of Daily Living.” These typically include:

• Personal Care (bathing, dressing and grooming)

• Meal Planning and Preparation

• Household Chores (light housekeeping and laundry) • Medication Reminders • Transportation (appointments, shopping and errands)

In addition to providing companionship and support, professional home care aides will also advocate for your loved one by observing

Two locations serving all of Northern Idaho Lewiston Branch

Coeur d’Alene Branch

Latah, Clearwater, Nez Perce & Lewis Counties

Kootenai, Shoshone, Benewah, Bonner & Boundary Counties

208.746.8881

208.667.2309

www.addus.com

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Five Reasons to Start Estate Planning

. . . TODAY

by Denise Stewart, Attorney at Law, ELTC Law Group

I

f you need to ask when you should start writing your will and other documents, most estate planning experts will tell you the same thing: you should have started yesterday! It doesn’t matter if you’re a young newlywed with no children, a middle-aged divorcee, or a senior citizen with a huge family—a solid estate plan is absolutely essential to your future. There are several important reasons why youngsters and old folks alike should start planning A-S-A-P.

1) Remember that anything can happen No one wants to believe they will die unexpectedly. When you hear about a young person suddenly passing away after an accident or a rare illness, it may seem very removed from your life—a news story rather than a harsh reality. The fact is, tragedy can strike when you least expect it. If such a thing should happen to you, what would you leave behind for your family and friends? An estate plan gives you control in the face of unexpected situations.

2) Don’t leave unfinished business When a person passes away without an estate plan, they leave behind a host of unfulfilled goals. Have you thought about your estate planning goals, financial or otherwise?

Maybe you want to name a guardian for your children, specify medical treatments according to your beliefs, or give instructions for your burial. Maybe you just want to make sure your assets and property are passed on to your loved ones in a very specific way. Without an estate plan, your wishes may never be known.

3) Prevent family feuds It’s safe to assume that when you pass away, you don’t want your family fighting over your assets. It’s not the legacy most people want to leave behind. Unfortunately, you can’t assume that they will resolve everything amongst themselves in a fair and appropriate way. The earlier you start estate planning, the more time you’ll have to make sure your assets and property are distributed according to your wishes.

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4) Account for life events Most estate planning experts can’t emphasize enough the importance of starting right away, but that doesn’t mean it’s a one-time event. Estate planning, like life, is an ongoing process. Your goals and priorities will change in light of marriage, divorce, death, birth, adoption, and so on. For example, if you divorced and started seeing someone new, you may want certain assets to go to your current partner instead of your ex-spouse. If you start estate planning early, you won’t have to play so much catchup—you’ll have a solid foundation to make updates and improvements as your life changes.

5) Protect your children and surviving family Perhaps the biggest reason to start estate planning is to protect your children and your family. It’s not pleasant to think about where your children will go if you should pass away before they turn 18. In case it does happen, you can control where they end up by naming a guardian, and you can safeguard their interests from a financial standpoint with a variety of estate planning tools. When you use the right methods, you can also help your family save money on taxes and other costs, maximizing the assets and property you leave behind for their benefit.

It’s time to get started! A knowledgeable lawyer can help make your estate plan as strong as it can possibly be. Contact the estate planning attorneys at Estate & Long-Term Care Group for personalized guidance. We can advise you on the best legal strategies, save you money, and leave you with peace of mind about the future.

Understanding the Dangers of DIY Estate Planning

The “do-it-yourself” approach has been cropping up all over social media in recent years, usually presented as hobbies and money-saving hacks. The fun side of DIY may look like hand-knitted scarves, homemade soaps, and upcycled clothing, but the other side is riddled with botched plumbing jobs and

sketchy electrical work. In other words, there are some things you should never DIY—and estate planning is one of them.

The first thing to understand about DIY estate planning is that, on a simpler level, it’s similar to those home improvement jobs you should never tackle without a professional. For example, a DIY roof repair may seem like a cheap alternative to your local contractor, but it comes with a caveat. If you don’t do the job exactly right, you risk

The first thing to understand about DIY estate planning is that, on a simpler level, it’s similar to those home improvement jobs you should never tackle without a professional. compromising your roof, letting in leaks, and eventually paying for a whole host of other repairs you never expected to need. Because estate planning is not quite so simple, the leaks can be difficult to catch—and the damage can cost your family much more than you ever planned to pay for a good attorney.

You may have heard of online DIY legal services. They provide you with blank legal forms that you can use to create a quick will or other estate planning document. These forms are supposed to be cheap and easy to use, but in reality, they are not. It’s all too easy for a layperson to make a mistake. You might end up misreading the instructions or using the wrong legal terms, causing repercussions you never intended—or you might simply create a document that’s invalid or ineffective.

Because estate planning documents typically kick in after your death, you may not even know the extent of your mistakes

until it’s too late. Instead, your family and friends will be stuck with the consequences.

Aside from the potential for mistakes, DIY legal forms are one-size-fits-all documents. They don’t take your personal needs, or your unique situation, into account. You may have specific healthcare wishes, children with special needs, or an estate large enough to owe federal estate taxes. An attorney can leverage many different estate planning strategies to accommodate your needs and maximize what you leave behind for your loved ones. You may pay a smaller one-time fee with DIY, but there’s no replacement for the value you get from qualified legal counsel.

Many DIY legal websites are barred from providing legal advice and no website is a member of the Attorney Bar Associations. That’s because their services are really no substitute for those of a knowledgeable attorney. The lawyers at Estate & Long-Term Care Group can create an estate plan that’s perfectly tailored to your circumstances, your wishes, and your goals. Call us to get dedicated support throughout the estate planning process. We will take care to minimize your legal risks, save your loved ones from future stress and expense, and protect the legacy you leave behind. __________________________________________________________________

Denise Stewart graduated cum laude from Western Washington University with degrees in Anthropology and French. She graduated from Seattle University School of Law and was admitted to practice law in Washington State in 1999. Since being admitted to practice, Denise has a thriving practice in estate planning, business and elder law. She serves both Idaho and Washington clients with offices in Newport, WA, Bonners Ferry & Sandpoint, ID.

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The Area Agency on Aging and What You Need to Know…

T

he Area Agency on Aging of North Idaho (AAANI) is the go-to place that provides information and resources to older adults age 60 year or older, individuals with disabilities and vulnerable adults 18 years and older. AAANI, located in Coeur d’Alene, serves the five northern counties of Idaho: Benewah, Bonner, Boundary, Kootenai and Shoshone, and is the designated local Aging and Disability Resource Center for northern Idaho.

The AAANI Mission is to work in partnership with older adults, families, and the community to provide information and services that maximize independence and quality of life.

Our focus is to help older individuals remain in their homes safely and independently.

AAANI Services and Referrals • Information and Assistance (I&A) provides

- Trained staff to assess an individual’s needs, determine appropriate available services, and make referrals for assistance.

- Counseling to provide information and options to assist families and seniors make informed choices in planning for current and long-term care needs.

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• Adult Protective Services (APS) investigates reported cases of abuse, neglect or exploitation of vulnerable adults and determines when a report should be made. Definitions of reportable cases: - Abuse: Intentional or negligent infliction of physical pain, injury, or mental injury.

- Neglect and self-neglect: Failure of a caregiver to provide food, clothing, shelter, or medical care reasonably necessary to sustain life and health of a vulnerable adult, or the failure of a vulnerable adult to provide those services for him/herself.

- Exploitation: An action which may include, but is not limited to, the misuse of a vulnerable adult’s funds, property, or resources by another person for profit or advantage.

• Ombudsman Program advocates for residents of long-term care facilities with a focus on resident rights, quality of care, and quality of life.

- Ombudsmen investigate, mediate and help resolve complaints registered on behalf of residents having issues with nursing homes, residential care homes and assisted living homes.

- Assistant Ombudsmen are an adjunct to the

Together we can help you find solutions to issues facing aging adults!      



Aging & Disability Resource Center Resource Information & Referrals Family Caregiver Support Programs Long Term Care Ombudsman Adult Protection Services Care Transitions from Hospital to Home

    

In-Home Support Services Community Support Services Long Term Options Counseling Volunteer Opportunities Medicare Fraud Education Medicare “Extra Help”

Call us to learn about available resources in your community!

2120 N Lakewood Dr, Ste B ٠ Coeur d’Alene, ID 83814

208-667-3179 • 800-786-5536 www.aaani.org PROUDLY SERVING BENEWAH, BONNER, BOUNDARY, KOOTENAI, & SHOSHONE COUNTIES

Ombudsman Program. Volunteers receive 40 hours of training to learn how to advocate, investigate, and problem-solve for elders in skilled nursing and assisted living facilities, followed by on-going mentoring and support by Ombudsmen staff.

• In-Home and Community-Based Services. These services provide assistance to help seniors (ages 60+) remain living independently in their own homes. In-home services have eligibility requirements. There is no charge for these services except for homemaker, which may incur a co-pay based on a sliding fee scale. Providers of the meal programs request, but do not require, a suggested donation, as our funding does not cover the cost of the meals. For more information on these services call AAANI at 208-667-3179 or 800-786-5536.

- Home Delivered Meals provide up to 7 meals per week for home bound seniors who are unable to prepare a nutritious meal for themselves.

- Homemaker Service provides light housekeeping, including changing bedding, laundry assistance, and cleaning bathrooms, floors, dusting, etc. for individuals who are unable to complete these tasks themselves.

- Family Caregiver Respite offers a break for unpaid caregivers providing 24/7 care of a loved one with professional in-home caregivers or adult day care services.

- Congregate Meals are hot, healthy meals provided in a group setting, usually at a senior center.

- Legal Assistance for seniors is available through Idaho Legal Aid.

- Transportation. AAANI currently contracts for senior transportation with City Links/Ring-a-Ride in Kootenai Co., Silver Express in Shoshone Co., and SPOT bus in Bonner and Boundary Counties.

• Retired and Senior Volunteer Programs (RSVP).

Provides a variety of opportunities for individuals age 55 and older to participate in the life of their community’s volunteer service. RSVP volunteers enhance and strengthen all levels of North Idaho communities, as well as improve their personal well-being.

Funding

The Area Agency on Aging of North Idaho receives both federal funding through the Administration of Community Living (Older Americans Act) and state funding from the Idaho Legislature (State Senior Services). These funds are distributed through the Idaho Commission on Aging (ICOA) to the six Area Agencies on Aging located throughout the state.

AAANI operates under North Idaho College.

Donations

The number of elders asking for help exceeds available resources and donations can make a positive difference.

Contact the AAANI office to learn about giving a gift in perpetuity to the Aging Services of North Idaho Endowment 208-667-3179 / 800-786-5536.

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Transitioning Your Loved One to Long-Term Care

M

by Melodie Phillips, LSW, Director of Social Services Life Care Center of Sandpoint

aking the decision for long term care for your loved one can be a very difficult one. Especially, if they have always been very independent at home and able to care for themselves. When a loved one is struggling to care for themselves and is in need of 24 hour care, long term care is an option. The transition to long term care at a skilled nursing home can be overwhelming for families and their loved ones.

Change can be difficult regardless of age, however the older we become, change can seem even more daunting.

Deciding if your loved one does need long term care should start with their primary care physician. This topic can be very sensitive and may cause tension and upset feelings within a family. Your loved one may even feel betrayed, angry or hurt when the decision has been agreed upon to move into a facility. For family members, feeling guilty could also be associated with this decision. Scheduling tours at long term facilities and meeting with admission personal is a good first step in this process.

Having the discussion about finances is also very important. For many families discussing and learning about Medicaid may come up during this time. Many facilities can assist with Medicaid applications and can explain Medicaid qualifications. Before deciding on a facility, families and their loved one should have an understanding of their finances, insurance and other benefits that they may have, or be eligible for and what is affordable for them.

Once the decision has been made for long term care, the transition is usually easier to manage when families know what to expect and how to help a loved one feel at home in their new environment. Preparing for this move can be physically taxing and take an emotional toll on everyone. The first week in a long term care facility may be a little confusing for both families and their loved one. Trying to get used to a new routine and schedule can seem overwhelming. A loved one may even make negative comments or become very emotional about the idea of living in a “nursing home.”

During this transition, having regular conversations, reassuring and validating a loved one’s feelings will be important during this time. They may express desires to “go home.” Acknowledge their feelings and listen to their concerns, just listening can be a powerful solution. For families, hearing your loved one’s feelings and comments may be difficult and tug at your heartstrings and may even have family members second guessing their decisions. Families will need to have reassurance and validation about their decisions as well. Friends, other family members and even staff at the Continued on Page 54

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Transitioning Your Loved One to Long Term Care Continued from Page 52

______________________________________________________ long term care facility can be a great sounding board and of support during this difficult time.

Also, during the first week or so, the facility may schedule a care conference or care planning meetings with staff for families and their loved one. During these meetings, families

It is important for families to remember, that they are their loved one’s biggest advocates and when they have questions or concerns to discuss, with the appropriate staff, it should be right away. and their loved one, can address any concerns or questions about medications, rehab therapy or dietary preferences. It is an excellent opportunity to interact with facility staff who are directly involved in your loved one’s everyday care. It is important for families to get to know these care providers. The more families become familiar with care providers and their loved one’s routines, the more families will be comfortable with their decision with long term care.

It is important for families to remember, that they are their loved one’s biggest advocates and when they have

questions or concerns to discuss, with the appropriate staff, it should be right away. Do not let concerns continue without being addressed. It is easier to address the concerns when they first occur instead of letting them fester. Families, should feel comfortable with visiting and calling the facility to check on their loved ones. Families are welcome to visit as often as they can and bring in personal belongings in order to make their loved one feel at home.

The first couple of weeks of long term care may be a roller coaster of emotions. Some days may be tougher than others but it is important to remember it will get easier. With time, loved ones and families will have a better understanding of the routines of their environment and staff, and become content with the decisions they made and the care being given. Keeping a positive outlook on your loved one’s new home will help them feel more comfortable as well. It is difficult to make changes, but the love and support of family and friends can help make the transition to long term care a little easier. __________________________________________________________________

Melodie Phillips, LSW is currently the Director of Social Services for Life Care Centers of America in Sandpoint. Melodie is a licensed Social Worker in the state of Idaho. She has worked with families for the past 24 years, starting as a basketball coach while studying for her degree. Melodie has experience working with families in a wide range of different aspects in their lives. She enjoys assisting and advocating for families during their times of need.

B U S H N E L L L AW Wills / Estates Adoption / Guardianship Property Law Personal Injury Contract Law Free half hour consultation Tom takes the time to get to know you, to understand your unique situation and provide the most cost-effective and practical solutions for you. Tom’s specialty is solving problems without the expense of a larger law firm.

Free seminars start at 6:30 pm every 3rd Friday.

Call to reserve a seat!

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Thomas A. Bushnell Attorney at Law, P.A. 6430 Kootenai Street Bonners Ferry, ID 208-267-9321 boundarycountylaw.com

Claims 101

by Bryan Hult, Bonner County Veterans Service Officer

R

ecently a veteran said, “Claims should be simple!” Sometimes they are. Other times a claim to the Veterans Administration (VA) is not only difficult, but is often intimidating!

I enjoy helping veterans make disability claims to the VA. As a Veterans Service Officer (VSO), I’m an “advocate of veterans to the VA.” I believe the VA “intends” to make the process simple, but that is not always the case. Fortunately there is hope!

Every claim for disability compensation is based on three things: a current chronic condition, a situation or event during a veteran’s military service and a link between the service and the current condition.

The first factor is a current chronic condition. Let’s say you have a condition, such as Diabetes Mellitus type II, or Peripheral Neuropathy of the lower extremities (numbness in the feet or sometimes tingling). The best way to ensure verification of the condition is to have your doctor make a written diagnosis. While the condition is very real to the veteran, the VA works off objective evidence, not subjective claims. Hence, you need a written diagnosis from an expert in the medical field, such as an Endocrinologist, or Neurologist, in the above examples. So, the first requirement is a current condition that is chronic (persistent) rather than acute (sudden or short duration).

The second factor required for every claim is that there must be a situation or event during military service that “triggered” or aggravated a health condition. Exposure to Agent Orange, acoustical trauma (noise exposure) from combat as an infantryman, or Traumatic Brain Injury (TBI) from an Improvised Explosive Device (IED) are all examples of situations that “trigger” chronic conditions either immediately or manifested later in life. These triggers can be verified by orders or noted on the DD 214, Military Occupation Specialty (MOS) and deployment on the battlefield, or written in service medical records (SMRs) substantiating treatment for a concussion, in the above examples.

There must be situation that occurred while on active duty.

The third factor is a link between the two above items.

The link can be established in a number of ways. For example, Diabetes Mellitus type II (DM2) is “presumed” to have come from exposure to Agent Orange. DM2 is one of over twenty presumptive conditions related to Agent Orange. The link for noise exposure is confirmed by a good write up in the claim,

the military occupational specialty and military conditions that cause acoustical trauma. The link for TBI is the note in military records that records the IED (or otherwise) event and the accurate diagnosis of the brain concussion by a qualified medical person. Without a good link, the claim will be denied.

This link is just as important, if not more, than the other two factors. Let me explain.

I provide a six page handout on the “Nexus Letter.” The word “nexus” can mean many things in different contexts. In this context it means the “link” between the military trigger and the current chronic condition. The handout explains how there must be irrefutable evidence for a disability claim.

A nexus letter must be brief, written by a medical expert (e.g. oncologist for cancer related conditions) and the doctor must have reviewed all available and pertinent service medical records.

The doctor does not have to use absolutes or that the “trigger” caused the current condition. He/She must, however, record his/her opinion of whether the condition is “more likely than not” (probability greater than 50%) or “at least as likely as not” (probability of 50%).

This is a broad brush summary of the three essential ingredients for making a claim and the possible need for a Nexus Letter. There are many exceptions to a simple claim that can make the process frustrating, but there is hope. Give me a call and I’ll be happy to walk through the details of your claim. __________________________________________________________________

Bryan Hult is the Bonner County Veterans Services Officer. He enlisted in the infantry, graduated from Officer Candidate School and Jump School from Fort Benning, Georgia and Flight School from Fort Rucker, Alabama. He then flew helicopters at Fort Hood, Texas. His military education included the Army War College in Carlisle, PA. After seminary, he served at every level of the Army chaplaincy in the Indiana National Guard and retired in 2010 as the Assistant Chief of Chaplains.

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America’s Wars

Department of Veterans Affairs American Revolution (1775-1783)

217,000 4,435 6,188

War of 1812 (1812-1815) Total U.S. Servicemembers Battle Deaths Non-mortal Woundings

286,730 2,260 4,505

Indian Wars (approx. 1817-1898) Total U.S. Servicemembers (VA estimate) Battle Deaths (VA estimate)

106,000 1,000

Mexican War (1846-1848) Total U.S. Servicemembers Battle Deaths Other Deaths (In Theater) Non-mortal Woundings

78,718 1,733 11,550 4,152

Civil War (1861-1865) 2,213,363 140,414 224,097 281,881 1,050,000 74,524 59,297 Unknown

Spanish-American War (1898-1902) Total U.S. Servicemembers (Worldwide) Battle Deaths Other Deaths in Service (Non-Theater) Non-mortal Woundings

306,760 385 2,061 1,662

World War I (1917-1918) Total U.S. Servicemembers (Worldwide) Battle Deaths Other Deaths in Service (Non-Theater) Non-mortal Woundings

World War II (1941 –1945)

Total U.S. Servicemembers (Worldwide) Battle Deaths Other Deaths in Service (Non-Theater) Non-mortal Woundings Living Veterans 5

4,734,991 53,402 63,114 204,002 16,112,566 291,557 113,842 670,846 1,711,000

______________________________________

NOTES: 1. Exact number is unknown. Posted figure is the median of estimated range from 184,000 – 250,000.

2. Exact number is unknown. Posted figure is median of estimated range from 600,000 – 1,500,000.

3. Death figures are based on incomplete returns.

4. Does not include 26,000 to 31,000 who died in Union prisons.

5. Estimate based upon new population projection methodology.

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May 2017

Korean War (1950-1953)

Total U.S. Servicemembers1 Battle Deaths Non-mortal Woundings

Total U.S. Servicemembers (Union) Battle Deaths (Union) Other Deaths (In Theater) (Union) Non-mortal Woundings (Union) Total Servicemembers (Conf.) 2 Battle Deaths (Confederate) 3 Other Deaths (In Theater) (Confederate) 3, 4 Non-mortal Woundings (Confederate)

Office of Public Affairs Washington, DC 20420 (202) 461-7600

Wise Guide | Fall 2017 / Winter 2018

Total U.S. Servicemembers (Worldwide) Total Serving (In Theater) Battle Deaths Other Deaths (In Theater) Other Deaths in Service (Non-Theater) Non-mortal Woundings Living Veterans

5,720,000 1,789,000 33,739 2,835 17,672 103,284 2,275,000

Vietnam War (1964-1975)

Total U.S. Servicemembers (Worldwide) 6 Deployed to Southeast Asia 7 Battle Deaths 8 Other Deaths (In Theater) 8 Other Deaths in Service (Non-Theater) 8 Non-mortal Woundings 9 Living Veterans 5, 10

8,744,000 3,403,000 47,434 10,786 32,000 153,303 7,391,000

Desert Shield/Desert Storm (1990-1991) Total U.S. Servicemembers (Worldwide) Deployed to Gulf Battle Deaths Other Deaths (In Theater) Other Deaths in Service (Non-Theater) Non-mortal Woundings Living Veterans 5, 10

2,322,000 694,550 148 235 1,565 467 2,244,583

America’s Wars Total (1775 -1991) U.S. Military Service during Wartime Battle Deaths Other Deaths (In Theater) Other Deaths in Service (Non-Theater) Non-mortal Woundings Living War Veterans11 Living Veterans (Periods of War & Peace)

41,892,128 651,031 308,800 230,254 1,430,290 16,962,000 23,234,000

Global War on Terror (Oct 2001 - ) The Global War on Terror (GWOT), including Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), are ongoing conflicts. For the most current GWOT statistics visit the following Department of Defense Website: https://www.dmdc.osd.mil/dcas/pages/casualties.xhtml

________________________________________________________ 6. Covers the period 8/5/64 - 1/27/73 (date of cease fire) 7. Department of Defense estimate 8. Covers period 11/1/55 – 5/15/75 9. Excludes 150,341 not requiring hospital care 10. Defense Manpower Data Center (DMDC) estimate, as of 4/09, does not include those still on active duty and may include veterans who served in Iraq and Afghanistan.

11. Total will be more than sum of conflicts due to no “end date” established for Persian Gulf War. Source: Department of Defense (DOD), except living veterans, which are VA estimates as of Sep 2010.

Senior Living Community

Winter Camp for Military Connected Youth Alice in Wonderland theme this year at the FREE Snow Bash Camp in Cascade, Idaho. Statewide Transportation Provided (see below)

The Idaho National Guard offers this FREE winter camp for military connected youth, ages 10-18 yrs.

Held for 3 days from January 12-15, 2018.

There is a “fee” of $35 to hold a spot, fully refunded upon arrival. All included food, lodging & activities (snow sledding/tubing, arts & crafts, resiliency, dance). It’s a great winter fun camp!

Call 208-282-4387 OR 208-272-8397 for registration forms and information. Seeking Youth 10-18 yrs., Adult Chaperones & Teen Counselors Transportation is provided from: Gowen Field, Idaho Falls Armory, Lewiston Armory, Pocatello Armory, Post Falls Armory, Twin Falls Armory.

208.665.1600 www.bestlandcda.com

606 E. Best Ave. • Coeur d’Alene, Idaho G.I. Java Vet Center 1203 N. 4th Street Coeur d’Alene has a lot going on!

Kung Fu San Soo

FREE training for veterans, taught by Master Steve McConnell Mondays & Wednesdays at 1800 Chess Club - Wednesdays 1500 to 1700 (public welcome) Drawing Class - Fridays 1400-1600 (public welcome)

1st Annual Veteran’s Day 2017 Celebration Party

Organized by the Kootenai County Veterans Council Honoring all who served. Held at the American Legion Post 143, 1138 E. Poleline Ave., Post Falls, ID Cocktail party, live music, heavy hors d’oeuvres, cash bar from 6:00 -10:00 PM Cocktail attire encouraged. Everyone is welcome!

Call 208-773-9054 to get tickets - $25 per person

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This page brought to you by:

These Veterans Service Officers are here for you:

“Our commitment to caring extends to all our veterans and their families.”

NORTH IDAHO Idaho State VSO

Darryl Heisey 208-446-1092/1094 120 E. Railroad Ave., Post Falls M-F 8:30 AM - 5:00 PM email: Darryl.Heisey@veterans.idaho.gov

Bonner County Bryan Hult 208-255-5291 1500 Hwy 2, Ste. 122, Sandpoint M-TH 8-5 (call/email for appointment) email: bhult@bonnercountyid.gov

MONTANA

Montana State VSO National Guard Armory • 406-755-3795 2989 Hwy. 93 North, Kalispell Appts. M & F, walk-ins welcome Wed., Tues. is outreach, Thurs. closed.

Carolyn Collins email: carolcollins@mt.gov

Ryan Keeler, 406-755-3795 email: rkeeler@mt.gov

Boundary County John Tucker 208-267-8611 6635 Lincoln St., Bonners Ferry Thursdays 9:00 AM - 1:00 PM email: jtucker@bonnercountyid.gov

Bryan T. Zipp email: bzipp@mt.gov

Kootenai County Scott A. Thorsness, Director 208-446-1090/1092 120 E. Railroad Ave., Post Falls M-F 8:30 AM - 5:00 PM email: sthorsness@kcgov.us

Shoshone County Susan Hendrixson • 208-752-3331 700 Bank St., Suite 120, Wallace M-Thurs. 9:00 AM - 5:00 PM email: commsec@co.shoshone.id.us

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Idaho Department of Labor - Veterans Reps.

Benewah/Kootenai/Shoshone Counties

Robert Shoeman 208-457-8789 Ext. 3993 600 N. Thornton St., Post Falls email: robert.shoeman@labor.idaho.gov

Bonner/Boundary Counties

Tyler Anderson 208-265-0193 Ext. 4079 613 Ridley Village Road, Ste. C, Sandpoint email: tyler.anderson@labor.idaho.gov

This page brought to you by:

READ THIS!

Veteran Service Officers (VSO’s) are trained, certified and accredited ADVOCATES FOR YOU! They are NOT VA employees. Assistance is FREE. Contact them BEFORE you call the VA. It will save you a lot of grief.

“If you are a Veteran....Thank you!

If you are not a Veteran...Thank one!

NORTH CENTRAL IDAHO Idaho State VSO

Bob Cooper 208-750-3690 821 21st Ave., Lewiston M-F 8:00 AM - 5:00 PM email: bob.cooper@veterans.idaho.gov

Idaho State VSO

Joseph Riener 208-750-3690 821 21st Ave., Lewiston M-F 8:00 AM - 4:30 PM email: joseph.riener@veterans.idaho.gov

Nez Perce County

Please call the Idaho State VSO offices in Lewiston: 208-750-3690

Nez Perce Tribe Veteran Benefit Specialist

Mary S. Taylor 208-621-4738 271 B Street, Lapwai M-F 8:00 AM - 4:30 PM email: mtaylor@nezperce.org

Idaho Department of Labor - Veterans Reps.

Clearwater County

Eric D. Fleming 208-476-7378 330 Michigan Ave., Orofino M-TH 9:00 AM - 2:00 PM email: vsoclearwater@gmail.com

Moscow

Dave Darrow 208-882-7571 Ext. 3743 Veteran Services Representative 530 S. Asbury St., Ste 1, Moscow email: dave.darrow@labor.idaho.gov

Idaho County

Camden Schacher 208-983-0239 320 W. Main Rm 29 M-F 8:30 AM - 5:00 PM (appointments) Grangeville (Courthouse) email: cschacher@idahocounty.org

Latah County

June Beyer 208-883-7209 220 E. 5th St., Moscow M-F 8:30 AM -12 noon, 1:00 - 4:30 PM email: jbeyer@latah.id.org

Lewis County

Michelle A. Lyons 208-937-9248 510 Oak St. Room #1, Nezperce M-F 9:00 AM -12 noon, 1:00 - 5 PM Wednesdays & Fridays Drop-ins email: mlyons@lewiscountyid.org

Lewiston

Don Erickson Disabled Veterans Outreach Program (DVOP) Phone: (208) 799-5000 Ext. 3526 1158 Idaho St., Lewiston email: donald.erickson@labor.idaho.gov

NOTE: The Department of Motor Vehicles now offers a Veteran Designator on Idaho State Drivers Licenses. The veteran must provide proof of an Honorable discharge from the Armed Forces.

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This page brought to you by:

We Salute Our Veterans . . .

RESOURCES

If you are a veteran or partner of a veteran, these organizations are here to help with free assistance. Call any of them and they can connect you with the services you are seeking.

“Let us never forget their sacrifices.”

Need to talk to someone NOW?

Combat Call Center/Crisis Line - 1-877-927-8987 Veterans Crisis Line: 1-800-273-8255 Press 1 Confidential Online Chat: VeteransCrisisLine.net

VA Outreach Centers

Spokane Vet Center 509-444-8387 Kalispell Vet Center 406-257-7308 or 877-927-8387 Missoula Vet Center 406-721-4918 Walla Walla Vet Center - 509-526-8387 Spokane Mobile Vet Center - they come to your area!

Call your local VFW for schedule.

CBOC’s and Rural Health Clinics Colville Rural Health Clinic 509-684-3701 1200 E. Columbia, Colville, WA Coeur d’Alene CBOC 208-665-1700 915 W. Emma Ave., Coeur d’Alene Grangeville Outpatient Clinic 208-983-4671 711 EW. North Street., Grangeville Kalispell CBOC 406-758-2700 Three Mile Professional Bldg.

31 Three Mile Dr., Ste. 102, Kalispell, MT Lewiston CBOC 208-746-7784 1630 23rd Ave., Bldg. 2, Lewiston Libby Veterans Clinic 406-293-8711 211 E. 2nd Street, Libby, MT Missoula CBOC 406-493-3700 2687 Palmer St., Ste. C, Missoula, MT Sandpoint Veterans’ Clinic 208-263-0450 420 N. 2nd Ave., Ste. 200, Sandpoint

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Online Resources va.gov/homeless Each VA medical center has a homeless coordinator and programs that help veterans establish or maintain safe, stable housing. Call VA’s National Call Center for Homeless Veterans 1-877-424-3838, 24/7. oefoif.va.gov Toll-free line and website that provide information about health care, dental care, education and other benefits for OEF/OIF/OND veterans. 1-877-222-8387 ptsd.va.gov VA’s center of excellence for research and education on the prevention, understanding and treatment of PTSD. 1-802-296-6300 caregiver.va.gov Provides support for caregivers of veterans and information about services that may be available to them. 1-855260-3274

This page brought to you by:

“For their valiant courage in defending the cause of freedom, we honor our Veterans.”

VA MEDICAL CENTERS & TRANSPORTATION Walla Walla VA Medical Center 888-687-8863 77 Wainwright Dr., Walla Walla, WA DAV Van Schedule: Thursdays: 6:00AM departs State Veterans Home 821 21st Ave., Lewiston Picks up: Clarkston, Pomeroy, Dayton,Waitsburg & Dixie, WA APPOINTMENTS FOR RIDES MUST BE MADE 72 HRS. IN ADVANCE Call DAV Transportation Office Walla Walla VA Med. Ctr.: 888-687-8863 x22529 Spokane VA Medical Center 800-325-7940 4815 N. Assembly St., Spokane, WA DAV Van Schedules: Wednesdays & Fridays: 6:00 AM departs State Veterans Home, 821 21st Ave., Lewiston Wednesdays - Picks up: Genesee, Moscow, Viola, Potlatch, Tensed, Plummer & Worley Fridays - Picks up: Uniontown, Colton, Pullman, Colfax, Steptoe, Rosalia & Spangle, WA Noxon & Libby DAV Van Schedules: Mondays, Wednesdays and Fridays - (Noxon Van) Picks up: Noxon, Bull River Junction, Clark Fork, Hope, Sandpoint, LaClede, Priest River, Newport, Diamond Lake, Chattaroy, Spokane VA. Tuesdays and Thursdays - (Libby Van) Picks up: Libby, Bonners Ferry, Sandpoint, LaClede, Priest River, Newport, Diamond Lake, Chattaroy, Spokane VA. APPOINTMENTS FOR RIDES MUST BE MADE 72 HRS. IN ADVANCE. Call DAV Transportation Office at the Spokane VA Med. Ctr. 800-325-7940

Veterans Transportation Services - for FREE transportation to VA Medical Centers, Outpatient Clinics (CBOC’s) & authorized VA appointments 509-434-7527

VAMC Mobile Health Clinic

Days & Locations: Moscow - Fairgrounds - Last Monday Pullman - WSU Alumni Center - Last Tuesday Osburn - VFW Post - Last Wednesday & Thursday To be seen by the mobile health clinic, a veteran must call the Mann-Grandstaff (Spokane) VAMC and ask for an appointment. 1-800-325-7940 or 1-509-434-7000 The VAMC tries to schedule all of these appointments for the last week of each month.

The VAMC Bus

GOVERNOR’S VETERANS AFFAIRS ADVISORY COMMITTEE TOWN HALL MEETING

Washington Veterans are invited to attend a Governor’s Veterans Affairs Advisory Committee Town Hall Meeting. Meet area leaders and providers to learn about local veterans services and benefits, and hear about veterans issues being debated in the Washington State Legislature.

Information will be available on transition, employment, education, housing, benefits (compensation, pension & military funeral honors) counseling, financial assistance and support services.

A free Continental breakfast is provided. Held November 16, 2017 from 9:00 AM - 12:00 PM at the Lincoln Center, 1316 N. Lincoln St., Spokane

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Good Grief ?

by Jan Noyes, Volunteer Ombudsman

L

oss and grief happen to everyone throughout their lives. We all know about it and have experienced it. It’s a part of life.

Grief doesn’t save itself for old age although many people experience loss and grief as a part of growing old.

What is grief?

Grief is intense sorrow or unhappiness over a loss. Loss and grief are a natural part of living. Grief can be the result of any kind of loss, a loved one, financial security, the breakup of a relationship, a debilitating illness, a child leaving home, a cherished pet, a loss of trust.

The loss of a parent, child, or mate can be devastating, knocking us off our feet, changing our view of life, even challenging our belief in a loving God. We all know at some point we may experience the loss of a loved one, but we can never fully prepare for the grief.

Grief doesn’t always follow a set pattern, but the emotions in the image are common among those who grieve the loss of a loved one.

How it feels Grief hurts. Death is so...final. That sounds strange but, in the flash of a moment, everything changes. The feelings hit us emotionally and physically.

All of us, at some time in our lives, will experience some sort of grief. Knowing that others know what grief feels like doesn’t erase the pain, but it does mean we are not alone in our experience. Billions of people have known the feelings and survived to live full, satisfying lives.

From survive to thrive Suffering isn’t a good thing, but grieving isn’t a bad thing.

It’s natural and healthy to grieve. Blocking or stuffing feelings doesn’t mean they’ve gone away. What we think we’re hiding will show up in the body and in the body of our affairs if we don’t deal with it.

Strange as it sounds, good can come out of grief. Loss can be devastating but we can emerge wiser, more resilient, and more compassionate.

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Common characteristics The journey through grief is winding. It can be like riding a roller-coaster. The path isn’t exact, but these are some of the common characteristics of grieving a devastating loss.

• Disbelief and shock • Crying • Physical symptoms • Denial • Questioning • Sadness • Anxiety, lack of concentration, and forgetfulness • Idealizing the loved one • Preoccupation with thinking about the loved one • Guilt and regret • Exhaustion • Acceptance and peace • A new perspective on life

How long does it take?

Grieving takes however long it takes and there’s no right or wrong way to grieve. One day the grieving person may be feeling a new interest in life and the next crying at the loss. There’s no set pattern, although there are similarities.

Following are some common misconceptions about grieving.

Common myths about grieving:

•

• •

•

• •

• All people grieve alike • Grief has a time limit • Crying doesn’t help • Painful thoughts should be avoided • It’s helpful to keep a stiff upper lip • Grief should be private • Once grief is over, it’s done with • Anger has no place in grieving • Staying busy makes grieving end sooner • The intensity of grieving is equal to the love for the

one who died • While grieving, only sick people have physical symptoms

Take advantage of simple pleasures, such as walks, music or other activities that have felt peaceful in the past Get ample rest, relaxation, and mild exercise Find something to look forward to, such as coffee with a friend Write a letter to the one who died. Share memories, changes, challenges, and good things happening.

Answer the letter Keep connected to your spiritual practice Join a support group

How does a grieving person know they’re healing?

Being there for a grieving person Acknowledge the loss. Be a good listener, patient, and non-judgmental. Offer your company, assistance, and support, respecting that the grieving person may need time alone.

Friends and family sometimes don’t know what to do when someone they’re close to or work with is grieving. Some people feel so uncomfortable around grief that they avoid the grieving person altogether. Some have unrealistic ideas about how the grieving person should be handling the loss.

Things the grieving person can do • Keep a daily journal to help work through feelings • Rely on trusted people for support. Talk to others that

have been though the grieving process

• When new clarity brings positive change • When decisions get easier • When mood swings even out • When a sense of humor returns • When planning for the future becomes easier Countless people have gone through grief, some of it unbelievably difficult, and have emerged stronger and clearer about the important things in life. Working through grief can open up new and meaningful purpose. __________________________________________________________________

Jan Noyes holds a degree in education and has used her teaching skills in public schools, adult education , workshops and seminars for church and civic groups, and corporations. Jan has been an ombudsman with the Area Agency on Aging for ten years, recruiting and training new ombudsmen. Jan also acts as an ombudsman, visiting facilities and advocating for their resident rights, quality of care and quality of life.

Crossword and Sudoku Answers 7 5 ( ( 6 * / 2 %

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Puzzles on pages 40-41

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Alzheimer’s Association Support Groups Why struggle alone? Attendees share their knowledge and experience of what works and what doesn’t in caring for themselves and loved ones. Groups are facilitated by professionals and are confidential. Come — learn — and get solutions.

IDAHO PANHANDLE

TELEPHONE

Kootenai Health Medical Center, Coeur d’Alene Main Building - Main Floor Classrooms 3rd Saturday @ 1:30 - 3:30 PM Facilitators: Arlene Sleigh 208-772-2542, Connie Clark, CSA 208-769-9560

ONLINE

Sandpoint Senior Center, Sandpoint 820 Main Street 1st & 3rd Thursdays @ 1:00 - 2:00 PM Facilitators: Jan Griffitts 208-290-1973 & Liz Price 208-263-7889 (Free respite care at DayBreak Center next door with advanced reservation - 208-265-8127) Orofino & Cottonwood Areas: Sister Barbara will help form a group in Cottonwood or Orofino - call her at: 208-962-3251

EARLY STAGE SOCIAL ENGAGEMENT for people with dementia & their family.

Please contact Coeur d’Alene branch office to register 208-666-2996 x8314

NORTHWEST MONTANA Immanuel Lutheran Church, Kalispell Buffalo Hill Terrace, 40 Claremont Street 3rd Monday @ 3:00 PM Call 406-849-6207 for information Presbyterian Church of Polson 301 4th Ave. East 2nd Wednesday @ 1:30 PM Facilitator: Arlene 406-849-6207

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24/7 HELPLINE: 800-272-3900

ALZConnected.org An online social networking community for people with Alzheimer’s, their caregivers and others affected by the disease.

ALZ.org for more valuable resources!

POWERFUL TOOLS FOR CAREGIVERS CLASSES

Classes provide a practical approach to dealing with caregiver stress, prioritization, challenging family communication and planning. In the six weekly classes, caregivers develop a wealth of self-care tools to: reduce personal stress; change negative self-talk; communicate their needs to family members and healthcare or service providers; communicate more effectively in challenging situations; recognize the messages in their emotions, deal with difficult feelings; and make tough caregiving decisions. Class participants also received a copy the The Caregiver Helpbook, developed specifically for the class. Classes are offered in Coeur d’Alene & Regionally.

If you are interested, please call 208-666-2996 x8314 for the schedule.

MEMORY CAFÉ Living with memory issues…You are not alone!

This is a new offering by volunteers and the Alzheimer’s Association. People with the memory loss are welcome to come and feel comfortable in a casual gathering to provide socialization, interaction and fellowship.

Socialization creates confidence and a sense of belonging and well-being. Open to ALL stages of the disease. If the person can physically go out and drink coffee, then they are welcome, but of course, they should be accompanied by their family member/ friend. It is designed to provide a lovely afternoon in the company of others with whom they can identify.

This is not a support group, it is purely an opportunity for those with dementia and their caregiver to enjoy companionship.

Longboard Coffee Company 5417 Government Way, Coeur d’Alene 2nd & 4th Mondays at 1:00 PM Kokanee Coffee Company 509 N. 5th Avenue, Sandpoint 2nd & 4th Tuesdays from 2:00 - 3:30 PM

EASTERN WASHINGTON: SPOKANE NORTH Church of the Nazarene 9004 N. Country Homes Blvd.

Last Thursdays of each month @ 6:30 - 8:00 PM Facilitators: Gene Engelbrecht 509-842-6034, Dawn Keig, PhD 509-808-4076 Whitworth Presbyterian Church 312 N. Hawthorne Road 2nd Mondays @ 1:00 - 2:30 PM Facilitator: Christine Ambrose, RN 509-456-0456 x8313 Providence Adult Day Health 6018 N. Astor St. (not affiliated with Alzheimer’s Assn.)

1:00 - 2:30 PM 2nd Mondays - Designed for All Caregivers 3rd Mondays - Male Caregivers Only 4th Mondays - Female Caregivers Only Facilitators: Oscar Haunt, MSW & Hannah Teachman Adult daycare available at no charge if pre-arranged 509-590-3965

SPOKANE SOUTH First Presbyterian Church 318 S. Cedar Street 3rd Tuesdays @1:30 - 3:00 PM Facilitator: Beth Priest 509-590-3965

SPOKANE VALLEY Good Samaritan Village 17121 E. 8th Avnue 1st & 3rd Tuesdays @ 1:00 - 2:30 PM Facilitators: Kathleen Burzynski 509-924-6161, Patricia Garcia 509-789-4377

EARLY STAGE SUPPORT GROUP

Meets monthly at the Spokane Alzheimer’s Association office in the afternoons. This group is for people with dementia and their care partners. This is a closed group and there is a screening process for admission. For more information, please call the chapter office at 509-4560456 x8314

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Directory Listings Agencies, Free Referral Services & Volunteer Opportunities AARP Idaho.................................................................... 208-855-4004 3080 E. Gentry Way, Ste. 100, Meridian facebook.com/AARPIdaho AARP Idaho is a nonprofit, nonpartisan organization, with a membership of more than 175,000 in Idaho that serves as a voice and an advocate to protect consumers and improve the lives of Idahoans age 50 and over.

Alzheimer’s Association Inland NW Chapter N. Idaho Office....................................................208-666-2996 x8314 24-Hour Help line.......................................................... 800-272-3900 alz.org * P.J.Christo, RN; email: pj.christo@alz.org We connect families to needed programs, products and services, provide Dementia Information, Local Support Groups, State and Federal Advocacy, educational programs, workshops and lectures for caregivers, families and the general public.

Area Agency on Aging of North Idaho.......................... 208-667-3179 Toll Free......................................................................... 800-786-5536 2120 Lakewood Dr., Ste. B, CdA • aaani.org AAANI is a grant funded agency providing services for seniors including information on in-home and community services, senior center meals, home delivered meals, homemaker, respite for family caregivers, legal assistance, adult protection, long term care ombudsman, long term care options counseling, hospital to home care transition, and volunteer opportunities.

Panther Country Coalition............................................ 509-447-6419 panthercountrycoalition.com starttalkingnow.org The Coalition is a collaborative effort between Pend Oreille County, The Cusick School District, Kalispel Tribe and WA State Division of Social & Health Services, implementing the “Start Talking Now” campaign in and near the communities of Cusick, Usk, Kalispel and Newport to help parents realize they are the most powerful influence in helping their children stay drug and alcohol free.

Retirement Publishing................................................... 800-584-9916 retirementpublishing.com Keeping Idaho seniors informed of their options with our FREE publications: Idaho Elder Directory, North Idaho Retirement, Assisted Living in Idaho, Alzheimer’s Resource Directory. Call toll free during regular business hours for your FREE copy or visit our web site.

SHIBA (Senior Health Insurance Benefits Advisors).... 800-247-4422 2005 Ironwood Pkwy, Ste. 143, Coeur d’Alene doi.idaho.gov/shiba/shibahealth.aspx SHIBA is a division of the Department of Insurance. SHIBA counselors offer free education and assistance about Medicare benefits, plan choices and billing. SHIBA counseling is done by phone, email, or at community partner locations throughout Idaho.

Chiropractic & Massage Therapy

Compassionate Care Referral Service............................ 208-660-9982 compassionatecarereferral.com I can refer you to the best fit for your Assisted Living, Senior, and Disabled Care Services. Through mutual discussion and needs assessment, I will create for you a customized short list of possible solutions.

Camas Center Clinic........................................................509-447-7111 1821 W. LeClerc Rd. #1, Cusick, WA kalispeltribe.com/camas-center-clinic The Camas Center Clinic offers comprehensive healthcare including: medical, dental, chiropractic, physical therapy and massage therapy.

The clinic is open to the general public and accepts most major commercial and public insurance carriers. Ride Monday-Thursday round-trip from Newport to Clinic. Suggested donation $1.Call 800776-9026 for more info.

Disability Action Center NW (DAC) 330 5th St., Lewiston..................................................... 208-746-9033 505 N. Main St., Moscow............................................... 208-883-0523 3726 E. Mullan, Post Falls............................................. 208-664-9896 dacnw.org DAC NW is a local Center for Independent Living which offers a variety of services from peer-to-peer independent living support, medical equipment exchange, help with self-advocacy, and access to assistive technology.

Lifestyle Massage Therapy.............................................. 208-290-7281 200 Main St., Ste 211, Sandpoint 6843 Main St., Bonners Ferry JanRudeen.MassageTherapy.com An experienced and skilled therapist can relate to your specific needs and becomes your therapist for life. Various techniques are used to address trauma from a fall, car accident, surgery; posture, stress-related pain, TMJ, headache, sleep disorders. I provide care for ages 1 to 100.

Let me help you.

“I may be disabled, but I can try to do anything” Multiple Sclerosis Advocate Meeting Monthly Call or email for more details: beth@mswobbles.com

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Moore Chiropractic 6843 Main St., Bonners Ferry........................................ 208-267-2506 315 E. Missoula Ave, Ste. 4, Troy, MT ............................ 406-295-5252 danmooredc.com Providing gentle, effective, quality care that’s affordable for everyone.

Dr. Daniel Moore has over 25 years experience utilizing the latest techniques and chiropractic physiotherapy technologies ensuring the fastest recovery time possible. Come see why over 4,000 patients have trusted Dr. Moore with their health!

Rathdrum Counseling Center, LLC............................... 208-687-0538 14954 Coeur d’Alene St., Rathdrum rathdrumcounseling.com Rathdrum Counseling Center is a full outpatient substance use disorder and mental health treatment clinic. We focus on client strengths, needs, abilities, and strive to encourage least restrictive interventions that are culturally sensitive, cost effective and within your own community.

Counseling Heritage Health Mental Health..................................... 208-769-4222 2025 W. Park Pl., Ste B, Coeur d’Alene Family Support Services..................................................208-620-5210 2201 Ironwood Pl., Ste.100, Coeur d’Alene myheritagehealth.org We offer and provide excellent, affordable mental health services to individuals and families with unique situations and needs. A collaborative integrated care model with Family Support Services ,helps clients discover and strive to reach their full potential through care coordination with medical providers.

Kaniksu Health Services................................................. 208-263-7101 Behavioral Health 6615 Comanche St., Bonners Ferry 30410 Hwy 200, Ponderay 6509 Hwy 2, Ste. 101, Priest River 420 N. 2nd Ave., Ste. 100, Sandpoint kaniksuhealthservices.org Kaniksu Health Services is a nonprofit community health center which plays a vital role in Idaho’s safety net by providing medical, dental, behavioral health and VA services to the residents of Bonner & Boundary Counties.

Life Choices Pregnancy Center...................................... 208-263-7621 502 N. 2nd Ave., Sandpoint lifechoicespc.org Offering free & confidential pregnancy testing, ultrasound imaging, options education and parenting/life skills for women and men facing unplanned pregnancy, assistance for women struggling with past abortion or miscarriage, and guidance for young ladies who are wrestling with sexual integrity.

Pend Oreille County Counseling Services .................... 509-447-5651 After Hours Crisis Services: 866-847-8540 105 S. Garden Ave., Newport, WA pendoreilleco.org/your-government/counseling-services Outreach Offices: Cutter Theater in Metalline Falls & Selkirk School District. Providing quality integrated behavioral healthcare (mental health and chemical dependency), and supportive services for adults, adolescents, children and families of Pend Oreille County. We promote the values of consumer driven recovery, resiliency and selfdetermination, working collaboratively to provide outpatient, crisis, prevention and psycho education services.

Rawlings Community Counseling................................. 208-267-0900 6807 Cody St., Bonners Ferry rawlingscommunitycounseling.com Mental health counseling for children, adolescents, adults, couples and families. Offering addiction treatment, case management, and EMDR Therapy for trauma treatment. We accept most insurance, Medicaid and a sliding fee scale is available.

Dental Heritage Health Dental Care......................................... 208-620-5250 Appointments in both locations 1090 W. Park Pl., Coeur d’Alene 413 Pine Street, Wallace myheritagehealth.org Our patients benefit from our skilled, caring staff, advanced technology, and modern dental treatments. Whether you are bringing your family in for a regular check up or are in need of restorative dental care, you can trust us to keep your smile looking its best!

Kaniksu Health Services................................................. 208-263-7101 6615 Comanche St., Bonners Ferry 30410 Hwy 200, Ponderay kaniksuhealthservices.org Kaniksu Health Services is a nonprofit community health center which plays a vital role in Idaho’s safety net by providing medical, dental, behavioral health and VA services to the residents of Bonner & Boundary Counties.

Tom Davies, D.D.S., PLLC............................................. 208-263-8514 103 W. Superior, Sandpoint daviesfamilydds@gmail.com We provide dental services to the entire family. Among the services we offer are: Mini Denture Implants, Fillings, Bridges, Root Canals, Veneers, Whitening, Extractions, Dentures/partials, Suction Cup Relines, Dental Cleanings, Laser Assisted Periodontal Therapy, Nightguards/Mouthguards, Sealants. Call today for an appointment.

See our ad for specials!

Education & Recreation North Idaho College........................................... 877-404-4536 x1705 Bonners Ferry: 791 Main St. .......................................... 208-267-3878 Silver Valley: 323 Main St. Kellogg................................ 208-783-1254 Sandpoint: 102 S. Euclid................................................ 208-263-4594 Parker Career & Technical Education Facility............... 208-769-3448 7064 W. Lancaster Rd., Rathdrum • nic.edu North Idaho College is committed to bringing educational opportunities to the communities we serve. Our outreach locations offer admissions and advising assistance, financial aid and career counseling, credit and non-credit classes, testing and tutoring services, and a welcoming and supportive staff.

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Directory Listings

5% DI

S

Your North Idaho Recumbent Dealer

M COUNT Wiseention !

Guid e

Home of the comfortable, affordable, reliable and fun way to bicycle!

Gary Dagastine Call or email for appointment gary@nwrecumbentcycles.com

208-818-5491 NorthWest Recumbent Cycles.........................................208-818-5491 Gary@NWrecumbentcycles.com We specialize in getting anyone riding cycles, especially those with special needs. We build custom bikes and trikes for those with almost any disability. Come on out to Post Falls and play on many models of the most stable and comfortable bikes and trikes in the world. Call for appointments.

Financial & Asset Management Caring Transitions Inland Northwest............................. 208-449-2711 1869 E. Seltice Way, #289 Post Falls www.caringtransitionsinlandnw.com We understand that any downsizing or de-cluttering project can be overwhelming. As the nation’s largest professional resource for downsizing, de-cluttering and household liquidation, your Caring Transitions team provides a total solution for sorting, organizing, donations, shipments, packing, Estate Sale and Online Auction.

Panhandle Accounting, LLC.......................................... 208-290-6716 panhandleaccounting.com A professional and experienced accounting firm providing bookkeeping set up, payroll processing, bank reconciliations, tax return preparation and filing, and consultation services for small businesses. Helping business owners concentrate on their customers while taking care of the bookkeeping & “back office” details.

Gifts & Shopping Hospice of North Idaho Thrift Stores 1823 N. 4th St, Coeur d’Alene....................................... 208-667-5128 503 E. Seltice Way #5, Post Falls.................................... 208-773-5076 honi.org Shop our huge selection of high quality, gently used items from furniture, books, electronics, craft sup-plies, kitchenware, linens, clothing, shoes, accessories, and much more. All proceeds go to Hospice of North Idaho, the community’s non-profit hospice.

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Panhandle Animal Shelter Thrift Store ............................................ 208-263-0706 870 Kootenai Cutoff Rd., Ponderay PAS.org Open seven days a week offering lowcost, quality items - a wide selection of clothing for the whole family, housewares, art, furniture, movies, books, athletic equipment and more. 100% of the proceeds benefit the animal shelter! Make a positive difference, donate your gently used items, seven days a week.

Quilter’s Guild???

Hearing & Vision

Audiology Research Associates 700 Ironwood Dr., Ste. 220, Cd’A ....................................................................................... 208-765-4961 123 S. 3rd Ave., Ste. 9, Sandpoint.................................. 208-255-4389 hearingtricities.com Serving North Idaho for over 20 years. We help you hear better!

Hearing evaluations for adults and children. We sell the most advanced digital hearing aids available and each hearing aid comes with 3 to 5 years free batteries.

Hearing Center of Deer Park......................................... 509 276-8859 708 S. Main St., Deer Park, WA eargeek.com The HEARING CENTER is committed to providing outstanding customer service and superior products. We offer complete audiometric hearing evaluations, consultations, full service repair & custom hearing protection. We specialize in Workman’s Comp and WA Labor & Industry claims.

Idaho Commission for the Blind & Visually Impaired ....................................................................................... 208-769-1419 229 E. Locust Ave., Coeur d’Alene • icbvi.idaho.gov ICBVI is a state agency that provides free independent living training and offers adaptive aids, such as magnifiers and talking devices, to help individuals who are struggling with vision loss to be more independent in their homes and the community.

Lilac Blind....................................................................... 509-328-9116 1212 N. Howard St., Spokane • ilacblind.org Lilac Services for the Blind provides individualized training in alternative techniques and strategies, adaptive aids and optical devices, and continuing support to help individuals maintain independence and safety at home and in their communities. Serving Eastern and North Central Washington.

Hospice Auburn Crest Hospice 1221 W. Ironwood Dr. Coeur d’Alene............................. 208-665-8111 6371 Kootenai St.,Bonners Ferry................................... 208-267-0579 auburncrest.com We admit quickly upon doctor’s orders, equipment delivered within 4 hours. We listen to our patients, loved ones and caregivers to develop a care plan with the wishes of the patient first, allowing patients to live out their lives with trust, dignity, comfort and compassion.

Bonner Community Hospice..........................................208-265-1179 A service of Bonner General Health 520 N. 3rd. Ave., Sandpoint • bonnergeneral.org Caring for terminally ill patients and their families in Bonner and Boundary counties. Services include pain management, specialized nursing care, bathing and personal care, chaplaincy, supportive counseling, medical supplies and equipment. Covered by Medicare, Medicaid and most private insurance.

Hospice of North Idaho................................................. 208-772-7994 9493 N. Government Way, Hayden • honi.org We provide end-of-life care to anyone in our community regardless of their ability to pay. We are a non-profit hospice serving the seriously ill and those touched by loss since 1981.

Hospitals & Medical Care Bonner General Health.................................................. 208-263-1441 520 N. 3rd Ave., Sandpoint Bonner General Immediate Care................................... 208-265-3751 400 Schweitzer Plaza Rd., Ponderay • bonnergeneral.org Your community hospital providing quality, compassionate care in a comfortable, healing environment. We provide a full range of healthcare services, including home health, hospice, physical, occupational and speech therapy, radiology, laboratory, surgery, and emergency services.

Camas Center Clinic........................................................509-447-7111 1821 W. LeClerc Rd. #1, Cusick, WA kalispeltribe.com/camas-center-clinic The Camas Center Clinic offers comprehensive healthcare including: medical, dental, chiropractic, physical therapy and massage therapy.

The clinic is open to the general public and accepts most major commercial and public insurance carriers. Ride Monday-Thursday round-trip from Newport to Clinic. Suggested donation $1.Call 800776-9026 for more info.

Heritage Health Medical Centers 1090 N. Park Pl.,Coeur d’Alene...................................... 208-292-0292 117 Terrill Loop, Mullan................................................ 208-783-1267 925 E. Poston Ave., Post Falls.........................................208-618-0787 14775 N. Kimo Ct., Ste.B, Rathdrum............................. 208-687-5627 Mountain Health Care, 740 McKinley, Kellogg............. 208-783-1267 myheritagehealth.org Our Primary Care Providers (PCPs) have a broad set of skills and are able to diagnose and treat most conditions and ailments: Chronic Disease Management, Diagnostic Services, Express Care/walk-ins, Minor Outpatient Surgery, Routine Medical Care, Women’s Health, Wellness Care—at affordable prices.

Idaho Pain Clinic........................................................... 208-263-9757 11 E. H St., Ste. F, Deer Park, WA 714 W. Pine Street, Newport ,WA 1327 Superior St., Ste. 101 Sandpoint, ID 229 S. 7th St., Ste. 401, St. Maries, ID idahopainclinic.com Idaho Pain Clinic is a leader in non-operative orthopedics, pain management research, diagnostic procedures and techniques, and effective treatment. Our physicians are board certified and fellowship trained in pain management and offer the most advanced treatment options available in the U.S.

Kaniksu Health Services................................................. 208-263-7101 Medical, Pediatrics 6615 Comanche St., Bonners Ferry 30410 Hwy 200, Ponderay 6509 Hwy 2, Ste. 101, Priest River 420 N. 2nd Ave., Ste. 100, Sandpoint VA Clinic......................................................................... 208-263-0450 420 N. 2nd Ave., Ste. 200, Sandpoint kaniksuhealthservices.org Kaniksu Health Services is a nonprofit community health center which plays a vital role in Idaho’s safety net by providing medical, dental, behavioral health and VA services to the residents of Bonner & Boundary Counties.

Kootenai Urgent Care Coeur d’Alene.................................................................. 208-667-9110 700 Ironwood Drive, Ste 170E Hayden, 566 W. Prairie Avenue...................................... 208-772-9110 Post Falls......................................................................... 208-777-9110 1300 E. Mullan Ave., Ste 600 kootenaiurgentcare.com Kootenai Urgent Care of Coeur d’Alene, Post Falls and Hayden specializes in cost effective medical care for minor accidents, injuries or illnesses, including: sprains, minor fractures, sports injuries, infections, burns, and illnesses. Save your spot in line at kootenaiurgentcare.com.

Newport Hospital & Health Services............................. 509-447-2441 714 W. Pine St., Newport, WA • phd1.org We provide 24-hour care when you need it! Two primary care clinics offer same day/walk-in appointments. Other services: Emergency; General Surgery; Obstetrics; Anesthesia; Diagnostic Imaging; Laboratory; Physical, Speech, & Occupational Therapy; Acute Care; Swing Bed; Long Term Care; Assisted Living.

North Idaho Advanced Care Hospital........................... 208-262-2800 600 N. Cecil, Post Falls niach.ernesthealth.com We hold a Joint Commission “Gold Seal of Approval” and 5th in the nation rating for care of diseases associated with respiratory failure (COPD, pneumonia, cystic fibrosis, etc.). Our 40-bed facility provides long-term acute care and critical care services for patients recovering from serious illnesses or injuries.

Pain Management of North Idaho................................. 208-765-4807 1686 W. Riverstone Dr., Coeur d’Alene cdapain.com Pain Management of North Idaho is Coeur d’Alene’s only comprehensive Pain Management Center where patients have access to two fellowship-trained interventional pain physicians and a multidisciplinary team.

Rehabilitation Hospital of the Northwest 3372 E. Jenalan Ave., Post Falls..................................... 208-262-8700 rhn.ernesthealth.com We provide intensive physical rehabilitation services to patients recovering from strokes, brain, spinal cord and orthopedic injuries and other impairments as a result of injuries or illness. Also treated are cerebral palsy, ALS (Lou Gehrig’s Disease) multiple sclerosis & Parkinson’s disease.

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Directory Listings Women’s Health Care.................................................... 208-263-1299 1215 Michigan St., Ste.C, Sandpoint Our advanced nurse-practitioners provide personalized, comprehensive care to women of all ages, and enjoy educating and empowering patients about their health care needs. We encourage our patients to take an active role in their overall health with recommended health screenings.

Independent & Assisted Living, Memory Care, Adult Day Care Bestland Senior Living Community.............................. 208-665-1600 606 E. Best Ave., Coeur d’Alene • bestlandcda.com Bestland Senior Living offers 3 home-cooked meals per day, weekly housekeeping with linens, transportation, all utilities, wi-fi, and cable TV at one low rate. We are a smaller community offering residents a warm and loving atmosphere where they truly feel at home!

Boundary Community Restorium................................. 208-267-2453 6619 Kaniksu St., Bonners Ferry boundarycountyid.us Our facility accommodates 52 residents with 24-hour care, homecooked meals, help with shopping, medications, and bathing, rides to appointments. All inclusive rates. Medicaid accepted. We offer an array of activities for our residents and adult daycare is available.

Brookdale at Coeur d’Alene........................................... 208-667-6490 205 E. Anton Ave., Coeur d’Alene • brookdale.com We offer newly remodeled, all inclusive, independent and assisted living; studios, deluxe studios, one and two bedroom apartment and stand-alone cottages. We pride ourselves on a full, active, life enrichment program, delicious meals presented restaurant style, housekeeping, transportation to appointments, shopping and other excursions.

Harmony House Assisted Living................................... 208-704-2502 Four Homes in Hayden, ID harmonyhousealf.com Providing a safe, comfortable home for those with Mental Illness, Traumatic Brain Injury or Developmental Disability. A family atmosphere, quality care, structured activities and positive counseling help residents develop life skills to reach their fullest potential in a community setting.

The Lodge Assisted Living............................................. 208-457-3403 52 N. Cedar St., Post Falls 58 N. Cedar St., Post Falls 3989 N. Player Dr., Coeur d’Alene • lodgeliving.net We provide the most dignified environment for aging members of our community. Our highly trained staff and loving environment is perfect for you or your loved one with additional care needs. Our communities are custom built and locally owned offering comfort, security, convenience to our family of residents.

River Mountain Village Assisted Living......................... 509-447-2903 608 W. Second Ave., Newport, WA • phd1.org A beautiful 42 unit studio & one-bedroom apartment community for an active, independent lifestyle. En-joy the cozy fireplace, a stroll along a lovely landscaped walking path, and a variety of daily activities to meet the individual needs of our residents.

Rose Terrace Country Homes........................................ 208-623-6154 5672 W. Rhode Island, Spirit Lake Rose Terrace Cottages.................................................... 208-665-0580 632 N. 21st St., Coeur d’Alene • roseterrace.org Our quaint, home-style facilities offer a compassionate, caring environment with well trained staff 24/7. Nurses available 7 days a week, wonderful meals and fun activities. Private and semi-private rooms. Medicaid accepted.

In-Home Health & Personal Care

Kootenai Health Senior Care Program.......................... 208-625-5353 521 W. Emma St., Coeur d’Alene kh.org/seniorcare A community based program to meet the social needs of seniors and respite needs of their caregivers. Activities address the special interests of participants, provided in a safe, loving environment by caring professionals. Private pay & funding sources available through Area Agency on Aging, VA or Medicaid.

Addus Health Care......................................................... 208-667-2309 850 W. Ironwood Dr., Ste. 101, Coeur d’Alene addus.com Since 1979 we have been providing quality in-home care; companionship, light housekeeping, meal preparation; transportation to appointments, bathing assistance, medication reminders. Our costeffective services are designed to improve health and well-being and make your choice easier to remain independent at home.

The Bridge Assisted Living............................................. 208-263-1524 1123 N. Division Ave., Sandpoint CenturyPA.com Adjusting to the transition of a new home is made easier with the intimate and compassionate environment at The Bridge. Assisted care is developed on an individualized basis. It’s the right place for home!

Advanced Care Northwest, LLC .................................... 208-263-3225 Serving All of North Idaho advancedcarenorthwest.com Promoting safe and independent living, we are committed to providing compassionate and enjoyable personal care services to Seniors, Children, and Individuals with intellectual and developmental disABILITIES. Accepting BlueCross/TrueBlue, Medicaid/Medicare, Veteran, and most Private Insurance carriers.

Call today for a FREE in-home consultation!

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August

Insurance

Home Health • Bath Aide • Meal Prep • Housekeeping • Transportation • Med Reminders

Customize your own plan today!

Let the Sun Shine!

Medicaid Accepted

www.AugustHH.com

208-664-0858

Serving North Idaho since 1994

August Home Health, Inc ............................................. 208-664-0858 Toll free.......................................................................1-800-664-0838 2005 Ironwood Pkwy #227, Coeur d’Alene • augusthh.com New clients call Lynn our Supervising Nurse to schedule a visit! A Medicaid and Veteran approved Agency we hire and screen local caregivers (even family members) to provide assistance for Seniors struggling with tasks or the disabled of any age. If you are selecting an Agency to provide care, or know someone who needs help give us a ring. There is no obligation. We simply love what we do!

Bonner General Health Home Health Services .............208-265-1007 520 N. 3rd Ave., Sandpoint • bonnergeneral.org Providing skilled, intermittent care in the home. Services include skilled nursing care; physical, occupational and speech-language therapies; medical social services and certified home health aid services. Covered by Medicare, Medicaid and most private insurance.

Boundary Personal Care................................................ 208-267-5070 6821 Main Street, Bonners Ferry Dawn Pownall is all about her hometown. A Medicaid and Veteran approved Agency we hire and screen local caregivers (even family members) to provide assistance for Seniors struggling with tasks or the disabled of any age. If you are selecting an Agency to provide care, or know someone who needs help give us a ring. There is no obligation.

We simply love what we do!

North Idaho Home Health............................................ 208-667-7494 850 W. Kathleen, Coeur d’Alene • amy.bartoo@LHCgroup.com We provide skilled nursing, physical therapy, occupational therapy, speech therapy and medical social work. Proud to serve Kootenai County since 1979. Jayco Certified. 4.5 Star rating.

Boundary Personal Care (a division of August Home Health)

• Bath Aide • Meal Prep • Housekeeping • Transportation • Med Reminders

Customize your own plan today!

Let the Sun Shine!

Medicaid Accepted

www.AugustHH.com

208-267-5070

Serving North Idaho since 1994

Humana MarketPoint ....................................................208-215-5817 Christopher “Chris” Murphy, Sales Associate 1300 N. Washington St., STE 3500, Spokane cmurphy16@humana.com Humana is a leading health and well-being company focused on making it easy for people to achieve their best health with clinical excellence through coordinated care. The company’s strategy integrates care delivery, the member experience, and clinical and consumer insights to encourage engagement, behavior change, proactive clinical outreach and wellness for the millions of people Humana serves across the country.

Spears Insurance, Inc......................................................208-610-8096 102 S. Euclid Ave., Ste. 103, Sandpoint 1121 Mullan Ave., Ste. 208, Coeur d’Alene cspears4insurance.com There are many types of benefit plans. Which one is right for you? Let’s first understand the basics of Medicare in plain simple language, and then discuss other factors to finding the right coverage for you. Call me today to schedule your appointment. Serving ALL of NORTH IDAHO!

Legal Bushnell Law, Thomas A. Bushnell, Attorney at Law, P.A. 6430 Kootenai St., Bonners Ferry.................................. 208-267-9321 boundarycountylaw.com Tom is an attorney downtown Bonners Ferry, providing estate planning, probate, real estate, business, adoption and guardianships.

Tom is honest and professional. Providing personalized service, let him find a cost-effective, practical solution for your unique situation.

Free half hour appointment.

Crandall Law Group........................................................208-772-7111 8596 Wayne Dr., Ste. B, Hayden crandalllawgroup.com The Crandall Law Group is a boutique law firm offering highly specialized, top quality legal services to clients in the Inland Northwest region in the areas of estate planning, business, elder law, probates, guardianships, tax and business succession planning. We offer free initial consultations during which we will review your estate, discuss your needs, and explain your planning options.

Coyle & Wytychak Elder Law......................................... 208-765-3595 314 E. Garden Ave., Coeur d’Alene cwelp.com Since 1987, Coyle & Wytychak Elder Law, PLLC has provided the senior and disabled population of North Idaho and their families with individualized service to help them through difficult issues related to Estate Planning, Probates, Trusts, Guardianship, and planning for Long Term Care and Public Benefits.

Estate & Long Term Care (ELTC) Law Group 7177 Main St., STE E, Bonners Ferry, ID........................ 208-263-3585 418 W. 3rd St., Newport, WA......................................... 509-447-3242 102 S. Euclid Ave., Sandpoint, ID.................................. 208-263-3585 ELTCLawGroup.com Elder Estate Planning including Trusts, Wills, Long Term Care Calculations, Health Care Powers of Attorney, Living Wills, Advance Directives, Asset Preservation, Medicaid Planning, Probate and Trust Administration. Serving Idaho and Washington.

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Directory Listings Nutrition Full of Days...............................................................everydayfull.com It’s not about “half-empty” or “half-full;” for us it’s about pulling up a chair and sharing a cup…Welcome to our lives, where Days Become a Life…welcome to Full of Days. Traditional living, real food recipes, DIY, and everyday stories.

Winter Ridge Natural Foods Market.............................. 208-265-8135 703 Lake St., Sandpoint winterridgefoods.com Winter Ridge is Sandpoint’s largest natural foods market. We are here to provide you with the finest quality fresh, natural, organic and whole foods, nutritional products, body care products and health information in a fun, comfortable, clean and safe environment.

Personal Emergency Systems Kootenai Health Lifeline .............................................. 208-625-5020 2003 Kootenai Health Way, Coeur d’Alene pfairfield@kh.org Leader of personal emergency response services - the only non-profit provider in North Idaho. Lifeline provides peace of mind and access to emergency help at the touch of a button.

Project Lifesaver............................................................. 208-446-2250 Kootenai County Sheriff’s Office Radio transmitter-based personal locator system helps bring loved ones home. Works everywhere, reducing rescue time to approx. 30 minutes. Kootenai County families of those who wander (Alzheimer’s, Dementia, Autism, Developmental Disabilities) PLEASE CONTACT US! Also seeking donations to expand this proven national program.

Pharmacies, Medical Equipment & Supplies Medicine Man Pharmacy Bonners Ferry 6452 Main St. (in Super-1).................... 208-267-4021 Sandpoint 624 Larch St. (in Super-1)........................... 208-597-7466 Rathdrum 15837 Westwood Dr. (in Super-1)............... 208-687-5717 Hayden 8093 N. Cornerstone Drive.............................. 208-762-9355 Hayden 240 W. Hayden Ave (in Super-1)....................... 208-772-3311 Coeur d’Alene 305 W. Kathleen (in Super-1)................ 208-765-2268 Coeur d’Alene 1114 Ironwood Drive.............................. 208-666-2502 Post Falls 802 E. Medical Court..................................... 208-773-3566 Post Falls 805 E. Polston Ave. (in Super-1)................... 208-777-7732 medmanpharmacy.com

Complete Veterinary Services for Small & Large Animals Roland H. Hall, DVM 24-HOUR EMERGENCY Chad A. Burt, DVM 208-444-1024

Jill Lang, DVM

8:30 - 5:00 M-F 8:30 - 1:00 Sat.

208-267-7502

6657 MAIN BONNERS FERRY

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At Medicine Man Pharmacy we work to improve your health and the health of our community. You’ll find more than a place to fill your prescriptions: You’ll receive personalized care, answers to your questions and exceptional customer service. Visit our website to find a Medicine Man near you.

Sandpoint Super Drug................................................... 208-263-1408 604 N. 5th Ave., Sandpoint • superdrugsandpoint.com We strive to provide the highest quality home health care equipment, supplies and services, while being competitive on product and pricing.

We offer goods and services unique to our community, with the comfort and independence of our customers in mind. Medicare approved!

Rehabilitation & Skilled Nursing Life Care Centers of North Idaho • LCCA.com 500 W. Aqua Ave., Coeur d’Alene....................................208-762-1122 460 N. Garden Plaza Ct., Post Falls............................... 208-777-0318 1125 N. Division St., Sandpoint.................................... 208-265-9299 Our in-house physician, rehabilitation and nursing teams focus on inpatient and outpatient rehabilitation with 24-hour skilled nursing care to create individualized care plans, taking each resident’s and patient’s needs and goals into account. We focus on physical, occupational and speech therapy and provide advanced treatment options. Stop by for a tour today.”

Newport Hospital Long Term Care & Skilled Nursing........................................................... 509-447-2464 714 W. Pine St., Newport, WA • phd1.org Our Long Term Care offers both long and short term skilled nursing and restorative care. We provide skilled nursing 24 hours a day, coordinating care with local physicians.

Rehabilitation Hospital of the Northwest..................... 208-262-8700 3372 E. Jenalan Ave., Post Falls, ID • rhn.ernesthelath.com We provide intensive physical rehabilitation services to patients recovering from strokes, brain, spinal cord and orthopedic injuries and other impairments as a result of injuries or illness. Also treated are cerebral palsy, ALS (Lou Gehrig’s Disease) multiple sclerosis & Parkinson’s disease.

Veterinary & Animal Care Bonners Ferry Veterinary Clinic..................................... 208-267-7502 Emergency Phone.......................................................... 208-444-1024 6657 Main St., Bonners Ferry Let us help you care for your favorite four-legged friends! Our clinic provides complete veterinary services for healthy pets and for sick or injured animals, including horses and livestock. We provide an on-call emergency service in addition to our regular hours.

Panhandle Animal Shelter • pasidaho.org 870 Kootenai Cut-Off Rd., Ponderay Adoptions, strays, and ferals ............................208-265-PAWS (7297) Helpline for support and resources to keep your family together ....................................................................................... 208-217-4453 Home to Home, www.home-home.org, to find or place a pet without setting a paw inside a shelter.............................................. 208-217-4453 Panhandle Animal Shelter (PAS) is a no-kill shelter providing care to homeless dogs and cats and assistance to owners who require help with their pets. All dogs and cats receive vaccines including rabies, and are spayed or neutered and micro-chipped before being adopted.

Hard to Heal Wounds Provided by Bonner General Health

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ost people experience a wound at some point in their life. Typically, the healing process is simple and requires basic care. In some instances, wounds can be hard to heal and require prolonged treatment and care. Hard to heal wounds can be painful and cause symptoms affecting a patient’s quality of life.

A hard to heal wound is a wound that fails to heal with standard therapy in an orderly and timely manner, this is applicable to both acute and chronic wounds.

The normal healing process has multiple stages, any of which can be interrupted, leaving a wound vulnerable.

Many factors can affect the healing process, including: patient age, wound size, location of the wound, persistent inflammation that can slow down the healing process, access to proper healthcare, and availability of advanced wound care products. Hard to heal wounds can have a wide range of causes, including: arterial or venous ulcers, complications following surgery, congestive heart failure, diabetes, lymphedema, peripheral vascular disease, traumatic injury, and other conditions that can compromise healing.

If a healthcare provider assesses a patient’s wound as hard to heal, the patient can be referred to a wound care specialist for advanced treatment with specialty products. Early identification of a hard to heal wound with the use of advanced wound care products can significantly improve the healing process. At the initial visit the wound care specialist will identify what is causing the wound not to heal, they will develop a treatment plan to care for the wound that involves the patient and possibly their family members or caregiver, and they will begin treatment of the wound. Initially a patient may have scheduled appointments twice a week, and as the healing progresses appointments may be scheduled once weekly, and then on a monthly basis or as needed.

A stable wound environment is necessary before active wound management components can be effective. Advanced wound care dressings are typically

applied to create a moist healing environment to help the wound heal.

Types of advanced wound care dressings include: calcium alginate, collagen, manuka honey gel, hydrocolloids, hydrogels, silicone foam dressings and non-adhesive foam dressings are used for different types of wounds.

Jonathan Fisher, DPM who is Board Certified by the American Board of Podiatric Surgery directs the Wound Care Center at Bonner General Health. It is staffed with nurses and other healthcare providers who provide comprehensive, advanced wound care treatment that improves the quality of life for patients with hard to heal wounds.

They treat pressure ulcers, arterial and venous ulcers, diabetic foot ulcers, minor burns, wounds caused by traumatic injuries, and provide ostomy care and education for colostomy, ileostomy and urostomy patients, and many additional wound care services.

Patient/caregiver education is key in the successful treatment of wounds, and to prevent recurrence. The Wound Care Center staff at BGH address a wide variety factors affecting the patient’s healing process, including diabetes control, smoking cessation, nutrition, infection prevention, side effects of medications, and other topics related to wound healing.

The Wound Care Center at Bonner General Health is open Monday through Friday and offers a wide range of convenient appointment times to accommodate patients’ schedules. Call 208-265-1154 to schedule an appointment.

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Diabetes Self Care, An Alternative Approach

by Wendy Drum, M.A., Special Diabetes Program for Indians, Camas Center Clinic

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ersonalized health care through whole person wellness is the foundation for services provided at the Camas Center Clinic. Our method of care revolves around the understanding that our patients are more than a name or number in a chart, and acknowledging the diversity in the lifestyles of the individuals who utilize our clinic. If they are a mother, a big sister, an athlete, a low income family, all these factors play a major role in the type of health care they desire. At the Camas Center Clinic, we strive to understand the whole person to assist our patients toward total wellness. This ideology has created new programming focusing on diabetes mellitus in the Kalispel Community.

Diabetes is no longer the crisis diagnosis it was 20 years ago. Extensive research, pharmaceutical innovations, and a better understanding of this metabolic disorder has led to better care for all diabetic patients. At the Camas Center Clinic, a program funded though the Indian Health Service known as the Special Diabetes Program for Indians (SDPI) has taken the clinical side of diabetes and combined it with life skill education to help patients achieve diabetic self care. Individuals of all ages are taught to cook, grow vegetable gardens, increase their daily physical activity, learn to understand their medications, and learn to accurately take their glucose levels.

Learning how, what and when to cook has shown to be a major obstacle in diabetic patients at the Camas Center Clinic. A diabetes diagnosis sends most patients into a panic.

Questions quickly arise like, “What do I eat? When do I eat?

How much can I eat?” which in some cases leads to, “I don’t know how to cook!” To address this need, the Kalispel Tribe hired a nutrition educator to be onsite at the Camas Center Clinic. The nutrition educator works closely with all medical staff in helping establish calorie goals, personalized meal planning, and providing general nutrition education. In addition to providing clinic services, the nutrition educator also incorporates life skill classes to help diabetic patients learn to cook, how to shop, and how to read food labels to make the food choices that are right for their families and themselves. These classes are held every other week on the Kalispel Reservation.

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In addition to community cooking classes, the SDPI program also works extensively with the Rural Aging Program to improve the health and quality of life of our community elders. Monthly elder’s luncheons showcasing a variety of healthy food options encourages elders to make healthier food choices, and also introduces new ideas and strategies for leading healthy lives. In addition to monthly luncheons, the nutrition educator attends elders focused clinics and outings to assist with any nutrition needs the elders group may have.

Collaborating with the Rural Aging Specialist also increases community elder participation in the number of annual check-ups, diabetic check-ups and medical interventions.

The gardening program was started by the Washington State University Extension office in Pend Oreille County in the early 2000’s. The nutrition educator, being a former employee of the WSU Extension office, knew of this programming and quickly established a partnership to increase access to fresh fruits and vegetables for Camas Center Clinic patients and the community at large. Utilizing community gardens, including a clinic patient garden, education is provided on how to properly create, plan, grow, maintain, and harvest garden produce. Additionally, garden produce is utilized in cooking classes and to provide free produce to the community. This partnership strengthened the SDPI program by addressing food insecurity and minimal access to fresh produce on the Kalispel Reservation. The gardens provide fresh food, and also low impact physical activity to those involved in classes.

Along with nutrition, physical activity plays a vital role in diabetes self care. Increasing the amount of physical activity in patients has been increasingly effective due to the location of the Camas Center Clinic. Housed in the Camas Center for Community Wellness, patients have access to a full gymnasium, a fully equipped fitness floor that includes specialized equipment for low impact weight bearing exercise, an aquatics center, and free fitness classes. The SDPI program works closely with the health and fitness department in creating new opportunities focused on our patients to help increase physical activity. Currently, the highlight of this partnership is a diabetes prevention kids dance class that involves 4-5 year old students from the Camas Early Learning Center daycare facility. In addition, Native focused physical activities are being planned using culturally relevant physical activity such as the Pow Wow Sweat program developed by the Coeur d’Alene tribe.

New diabetes care programs are being developed every day. The ultimate goal of the SDPI program in the Camas Center Clinic is to empower diabetic patients to take their health into their own hands. Medical care, education, and personal support are the tools we find the most valuable in moving patients toward self care. Providing whole person

wellness in the form of personalized health care is proving successful in many medical centers throughout the United States. Using these tools, we are moving toward a healthier and brighter future for the next seven generations.

While the SDPI program is specifically for Native Americans, the Camas Center Clinic has expanded many of the services to the general public. Diabetic nutrition and primary care physician follow up and monitoring, and the food program and cooking classes are all open to the general public. Won’t you join us in our whole person approach to

diabetic self care? For more information, visit our website at kalispeltribe.com or call 509-447-7111. ___________________________________________________________________

After earning a Master’s degree from the University of Montana, Wendy Drum moved to beautiful Pend Oreille County and began working for Washington State University in 2009. Focusing on nutrition education on the Kalispel Reservation, Wendy’s time at WSU paved the road toward her work in the Camas Center Clinic where she began work with the Special Diabetes Program for Indians in 2016.

You are always welcome ....

Visit the center and spend the day enjoying the facility’s fitness and recreational offerings (four pools, spa, daycare, deli serving delicious and healthy breakfast, lunch & dinner).

Getting there: We are 30 minutes north of Newport. You can drive or you can also get here fo a $1 donation by taking the Rural Resources wheelchair accessible vehicle - round trip from Newport, 6 departures & return trips every Monday through Thursday, except holidays. Call 800-776-9026 for more information. Kaltran, operated by the Kalispel Tribe of Indians is now providing Medicaid transportation services throughout Pend Oreille County to the Camas Center Clinic, Camas Path North and People’s Place. This service is free for current Medicaid patients.

Please call 509-447-7247 for more information or to schedule a ride.

CARE FOR THE WHOLE PATIENT AND THE WHOLE COMMUNITY. Welcome Dr. Rajeev Rajendra NOW ACCEPTING NEW MEDICAL AND DENTAL PATIENTS    

Primary Care & Women’s Health Comprehensive Dental Services Clinical Massage Therapy Service Chiropractic Services

 Physical Therapy — land & aquatic  We accept most public and commercial insurances

APPOINTMENTS: 509-447-7111 K A LI S PE LTR I B E .COM/C LI N I C/M E D I C A L 1 8 2 1 N LEC LE RC R D, STE # 1 • C U S I C K , WA 9 9 119

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A Stray or Not a Stray? – That Is the Question

A

s we all know, cats can be independent creatures, not to mention adventurers. They are not always content to stay within the confines of their yards. Cats don’t care about property lines or staying within them. So when you are out walking and come across an unfamiliar feline on your route, you might assume she is a stray or lost. The Good Samaritan in you might want to scoop her up and rescue her. There’s nothing wrong with those instincts, to help what you perceive to be an animal in need.

However, is she truly in need of your assistance? Maybe she is a neighbor’s indoor cat who has gotten out or maybe she is a new cat to the neighborhood. Before you intercede and rescue, do some detective work.

• Ask neighbors if they know anything about the cat. Did she just arrive or has he been seen around for some time.

• Does she come and go? If yes, then she likely belongs to someone and will find her way home.

• Is anyone feeding her? If so, stop the feeding. If she leaves straight away, she probably has another source of food and a home.

• Check to see if she has a collar and tags.

• Look for “lost cat” signs and look online at area websites or Facebook pages that post lost pets.

Okay, so you followed through with the suggestions above and you believe that the cat is lost. Then it’s best to do the following: • Take the cat (assuming it is friendly and not feral) to a veterinarian clinic or shelter, like PAS, to be scanned for a microchip.

• Put up flyers in your area and at veterinarian clinics.

• Post on Facebook, like Panhandle Animal Shelter’s page, and other local online pet message boards.

Often at PAS we see instances of lost cats that have come home on their own. Their owners had posted information about their missing cats on our Facebook page and/or on our website’s lost and found directory and then later on they let us know that cats came back all by themselves. Take Lola for example. She was missing for six days this summer before she showed up back at

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Lola, the cat who came home on her own. home. Her owners had searched and gotten the word out about their missing feline. They’d done all the right things. As will often happen, the cat found her own way home.

Recent studies show that cats are 13 times more likely to return home by non-shelter means. Also, 60% of healthy, likely owned cats will find their way home on their own, while 30% will be found by their owners in a neighborhood search. Each year stray cats come into Panhandle Animal Shelter (PAS). Many of the cats we receive are healthy, friendly, and likely owned cats.

National statistics show only 2% will be claimed by their owners.

So we encourage people to not be too hasty in bringing in cats unfamiliar to them without doing some checking first.

If no one claims the cat after you’ve gotten the word out and you determine that the cat is most likely a stray that has been abandoned, then call your local animal shelter. If there is a waiting list for entry into the shelter, consider fostering the cat in the meantime, or try to rehome on PAS’s rehoming site, www.pas.home-home.org. Who knows you may discover that a feline friend is for you and decide to keep her. Many a loving relationship has begun that way, even for people who thought they didn’t like cats! Turns out they had been mistaken. They just hadn’t met the right cat.

Okay let’s say you come across a cat that is extremely unfriendly and fearful. Most likely she is feral. A feral cat has had little to no contact with people during its life. Feral cats are

generally fearful of people and are unlikely to ever become pet cats. On the other hand, a stray cat has been socialized to people at some point, but may no longer have much human contact or dependence. It all depends on how long the stray cat has been living independently as to how approachable she will be; temperament can play a role in this, too. Strays can be friendly or aloof. Typically, they can become pets again.

You may think that you can only help lost or stray cats but not the feral ones. Not so. Panhandle Animal Shelter has a Trap-Neuter-Return program (TNR) for Bonner and Boundary counties. Cats are humanely trapped, brought into our shelter for spay/neuter surgeries, and later returned to their outdoor homes. TNR is a proven method in controlling community (feral) cat population growth. Healthy, natural lives can be led by

community cats, and the returned cats will have improved lives. For instance, behaviors and stresses associated with pregnancy and mating, such as fighting will stop. Through a $25,000 grant from PetSmart Charities, PAS will “fix” 800 community or feral cats this year.

So the next time an unfamiliar cat crosses your path, you might look at her differently now that you’ve read this article. The cat you once might have assumed to be lost or a stray might look differently to you. Instead of looking homeless or lost, she might look intriguing and worthy of donning your sleuth cap, for observation and inquires.

Above and top left: Local strays.

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What Are Overdentures?

by Tom Davies, D.D.S. PLLC

T

he first recorded use of dental implants was by ancient Mayans in 600 AD. Since then, dental implants and the technology surrounding this treatment have significantly evolved. Today, dental implant therapy is considered the premiere treatment option for people with missing teeth.

Dental mini implants are small titanium anchors that are permanently placed into your upper and/or lower jaw bone.

Throughout time, the implant integrates with your bone and acts very much like your natural tooth root in your jaw bone.

This integration not only creates a stable foundation to attach dentures to it, it also slows bone loss.

Overdentures are replacement teeth retained by dental implants. What are some of the benefits of overdentures?

1. Overdentures promote better digestion: Poor fitting dentures are often held in by adhesives. Overdentures utilize mini implants, so they are more stable. This allows you to chew food more thoroughly. The hard and chewy foods you love are easier to eat. Because the retention and stability is unmatched with implant-retained overdentures, you’ll no longer need the added cost, mess and hassle of adhesives.

2. Overdentures slow bone loss by stimulating the jaw bone: The mini dental implants stimulate your jaw bone when you eat. This stimulation will slow or even stop the shrinkage process that is natural when teeth are missing.

3. Overdentures help your facial features and structure: The natural process that occurs when you have an unhealthy jaw as a result of missing teeth can cause the distance between your nose and chin to shrink. This shrinking can make your face look “sunken-in” and prematurely aged.

4. Overdentures worn on the upper and lower jaw are more comfortable: When your overdenture is clipped onto the mini dental implants, it fits more securely. This lessens the instances of sores and dislodgement.

5. Overdentures improve the quality of Life: Implantretained overdentures secure your teeth in your mouth and can reduce or eliminate movement, improve the esthetics of your smile, improve chewing functions, improve speech and have a positive impact on your physical and psychological health.

Frequently Asked Questions: 1. How will I know if Overdentures are right for me?

Every patient situation is different; when you consult with your Dentist he/she will be able to determine if overdentures are right for you.

2. How long does the Overdenture treatment take?

Treatment times and methods vary from patient to patient.

Your Dentist will evaluate your general health, oral hygiene habits and anatomic acceptability to determine the right treatment plan for you. Many patients leave the dental office after treatment in full function, recognizing the renewed quality of life the treatment has given them.

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Are Implant Retained Overdentures Right For You?

Only your Dentist can recommend if dental implants are the right choice for you. However, the recent advancements in dental implant technology mean that the chances are there is a treatment option that will work for you. It all starts with your initial in-office consultation with your Dentist. At the initial consultation, your Dentist will help you to understand your current dental condition by: 1. Reviewing your dental and general health history.

2. Listening to why you are unhappy with your teeth.

3. Performing a complete dental examination, including necessary radiographs.

4. Recommending the appropriate treatment option that best fits your scenario.

Once the assessment of your dental health is complete, your Dentist will work with you to develop a plan that fits your needs to deliver the option that is right for you.

Here is a real life story about one of our patients. She went to her water aerobics class, and was enjoying her exercise and time in the pool with her friends and instructor. Her ill-fitting lower denture flew out of her mouth and sunk to the bottom of the pool. This water aerobics class turned into a search and rescue for her denture. Don’t let this happen to you!

Want more information?

You can call our office at 208-263-8514, for a free, exclusive mini-implant consultation with purchase of Panoramic Film. Our address is 103 Superior Street, Sandpoint, ID 83864 _________________________________________________________________

My name is Tom Davies, and I grew up in southern California, attended UCLA, and then USC School of Dentistry. A USC Trojan at heart, I opened a general dentistry practice in North San Diego County and enjoyed all the benefits this career has to offer. I have been brightening smiles for 40 years. My wife and I burned out on the Southern California lifestyle and dense population, and moved to the smaller mountain community of Sandpoint. Our practice is located in Sandpoint on the lower level of the Urgent Care Building on the corner of Superior Street and First street, just as you come over the long bridge. Please stop by for a cup of coffee and meet our staff.

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