The Wise Guide Spring/Summer 2019 by Jonnie Bradley

SPRING / SUMMER 2019

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Self-Advocacy A Vital Skill! Colon Cancer is No Joke! Certification Matters!

Spring / Summer 2019

Features About the Cover................................................................... 5 Summer’s Coming to the Scotchman Peaks..................... 6 Achieving Optimal Health................................................. 8 Self-Advocacy is a Vital Skill!.............................................. 10 70th Anniversary for Bonner General Health!............... 12 Time to Put Excess Cash to Work?.................................. 14 Having a Procedure? Certification Matters!.................... 16 Medicare and Your 100 Days!.......................................... 18

10 Self-Advocacy is a Vital Skill!

Every 40 Seconds.............................................................. 22 A Different Approach with the Impulse®........................ 24 Getting the Right Care After Hospital Discharge........... 26 Post-Surgical Healing, the Missing Piece........................ 28 Protect & Grow Your Wealth............................................ 30 Medicaid Covers Dental Care in WA............................... 33 Letter to Ellen................................................................... 34 Screening for Colon Cancer Saves Lives.......................... 36 Back on Her Feet.............................................................. 38 PEER-ing into the Future................................................. 40 Tax Guidance for Veterans............................................... 42 Home Improvement Help for Veterans.......................... 43 Veterans Resources......................................................44-46 Idaho Property Tax Benefit for Veterans.......................... 47 The Journey to Oz............................................................ 48

Having a Procedure? Certification Matters!

Crossword and Sudoku.................................................... 50 Do You Remember?......................................................... 52 Alzheimer Association Support Groups......................... 54 6 Tips for Approaching Alzheimer’s................................ 55 Exercise is Essential (for Parkinson’s)............................. 56 Parkinson’s Support Groups............................................ 58 Living with Restless Leg Syndrome................................. 59

Descriptive Advertisers’ Directory........60-65 Run It By Tamara.............................................................. 67 Living Safely in North Idaho........................................... 68 Senior Centers Are NOT for “Old” People..................... 70 In Pain? Try Laser Treatment!.......................................... 72 What is Congestive Heart Failure?.................................. 74

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Medications and Aging.................................................... 76

Protect and Grow Your Wealth

Tips for Talking About Hospice Care.............................. 78

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The Wise Guide Spring/Summer 2019 Office: 208-263-5654 Email: info@thewiseguideonline.com www.TheWiseGuideOnline.com

ADVOCATE! Don’t you want to have a say in what treatments you receive, how you spend your money, or live your life?

Jonnie Bradley Editor The Wise Guide

Then, speak up! That doctor puts his or her pants on one leg at a time, just like the rest of us. And, just like the rest of us, they are focused on their goals, which may or may not take into consideration anyone else’s individual wants and needs. That doesn’t make them insensitive, it means...

...they need to hear from you, or they will make assumptions, like we all do. When you are seeking any kind of service, don’t you want the best you can get? And, when it involves your health, it’s even more important to know HOW to evaluate that service. There are several articles in this edition (and in our archive online at www.thewiseguideonline.com) that provide the information and tools to do a little investigating before you sign up for the procedure or service. USE THEM! Our contributors all offer assistance and are more than willing to answer any questions you have. Do NOT be afraid to just give them a call. They wouldn’t be in this magazine if they did not have a desire to help, it’s a prerequisite! Tell them you have a question from something in The Wise Guide and they will make an effort to answer you.

Wise Guide | Spring/Summer 2019

Donna Brosh Graphic Designer The Wise Guide

About the Cover Artwork:“Coyote and Moon” by Connie Spurgeon

About the Artist “I was born in California and moved to Northern Idaho when I was 8 years old.. I won my first award at age 6 for my rendition of a trout. Horses have always been my driving passion so it was easy to mix these two passions together; I like to paint horses and the cowboys and cowgirls around them. Horses are like breathing to me… living without them in my life is an impossibility.” Connie uses mostly water mediums and her subject matter

includes wildlife, animals, people and abstracts. She has had the good fortune to paint with some of the best artists in the U.S. Connie recently completed Equine Threads, a series of 15 horses inspired by the equine connection to textiles, people and places. A few are represented here. Equine Threads is on display all year at the Kroc Center in Coeur d’Alene, changing monthly. Pendleton Art and Frame is hosting her work through May. Contact Connie directly at 208-610-6225, cssadlepal@gmail.com and on Facebook to purchase original works and prints.

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. The Wise Guide, LLC is not responsible for the contents of any websites referenced within this guide. No part of this guide 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.

“Tapestry Horse”

“Peaceful Ones’ Horse”

Thoroughbreds originated in England by crossing native mares with stallions of the Arabian Peninsula from Turkoman & Barb breedings in the 17th/18th centuries.

The Appaloosa was developed by the Nez Perce. This rendition is a tribute to Chief Joseph, and the black leopard “Star Spangled Horse” The American Quarter Horse is the paw prints make this horse largest breed registry in the world highly prized. with over 350,000 members. ‘Old Glory’ and the horse are proudly carried by cowboys and cowgirls around rodeo arenas everywhere.

“Drinker’s of the Wind Horse”

Bred to be a war horse by the Bedouins, with early documentation in 711 BC in Spain, the Arabian is the foundation of nearly all other light breeds.

“American Quilt Horse”

Tennessee Walkers originally descended from the French Pacer, later crossed with Spanish mustangs to create a smooth running walk to cover distances quickly and comfortably.

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Summer’s Coming to the Scotchman Peaks Volunteers show what’s in their hearts

he rugged Scotchman Peaks greet many visitors each summer. Volunteers help make them welcome, safe and more aware of the place and the animals that live there. Hundreds of hikers and sportsmen enter the Scotchmans each year. Volunteers like Howard and Connie Shay make incredible efforts to maintain trails and see that trail users of all sorts know about wildlife etiquette and leave no trace. “We’re goat ambassadors and also work hard to keep the trails free to roam,” said Connie. “We love volunteering in the Scotchman Peaks. It’s an incredible opportunity.” The season for hands-on trail work and trail ambassadors is coming fast. In late April, Friends of Scotchman Peaks volunteer trail crew begins year 10 of working on trails all through the Peaks, from Little Spar Lake Trail on the east side of the Peaks around to East Fork Creek Trail in Lightning Creek. In June, Trail Ambassadors begin their fourth season of educating hikers about wildlife in general and mountain goats in particular on the popular Scotchman Peak Trail. The volunteer-led summer hike season begins soon, as well. Volunteers are vital to saving the gifts of the wild and free Scotchmans for the future. The wild back yard in the Peaks has awesome trails. If each person who hikes in the Scotchmans puts in one day a year on maintenance, they will be the best in the country.

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“It’s important to save this incredibly wild place,” Howard Shay reminds us, “so my children and grandchildren can enjoy this rugged area as we do.” The 2019 volunteer trail projects include work days in three ranger districts. In Montana, the Scotchmans’ ice-sculpted ridges and deep, green valleys lie in the Cabinet and Three Rivers District on the Kootenai National Forest. In Idaho, namesake Scotchman Peak is in the Sandpoint Ranger District of the Idaho Panhandle National Forests. Trail work is highly satisfying. Walking back along “the line” after a day of moving dirt with hand tools is a reward as highly valued and well-deserved as that cold adult beverage and bag of salty snacks waiting at the trailhead. Trail volunteers not only build tread, but also life-long friendships based on the comradeship of common goals and hard work. Marla Groot Nibbelink began working as a trail crew volunteer in 2016. “It’s so much fun, and you meet such cool people,” She said. “It’s also incredibly satisfying work — it beats the gym any day.” Volunteers in the Scotchmans often sign up for multiple days. The Scotchman Peaks “Allstars” are regulars on the crew. Long-time volunteer Phil Degens, who recently turned 80, got a custom hard hat for his birthday emblazoned with his name and “Senior Crew Member.”

Trail Ambassadors on Scotchman Peak Trail #65 are charged with teaching the hiking public about many aspects of wilderness travel, as well as the concept of Wilderness, with a capital “W.” The Scotchman Peaks are proposed for addition to the National Wilderness Preservation System. The Peaks are owned by the American public and managed by the Forest Service. In the latest Forest Plans for the Kootenai and Panhandle National Forests, much of the Scotchman Peaks are listed as “recommended Wilderness.” Ambassadors inform other hikers on the proper way to respond to wildlife encounters, Leave No Trace Principles and other trails and hikes in the Scotchman Peaks. They also haul tools and help in keeping trail #65 safe and open. Ambassador volunteers love their job, as well. Dr. Mark Cochran and Mary Franzel are both multi-day ambassadors each year, greeting visitors with a smile and friendly, informative hints and clues about mountain goats, lightning storms and even local places to get a good sandwich. “I love to hike,” says Franzel, who often treads trail #65 with her miniature dachshund, Zipper. “Begin an ambassador is a great reason to climb my favorite mountain time and again.” Outdoor education extends beyond the realm of the ambassadors. Volunteer hike leaders and educators take many groups of all ages out into the wild Scotchmans each summer. Some hikes are pure fun. Others feature experts on birds, plants and animals teaching hikers in habitat ranging from old-growth rain forests to alpine white-bark pine groves. Summer is coming to the Scotchmans, and volunteers will be there to greet it and the visitors who come to enjoy the season and an awesome set of mountains and valleys. Learn more at www.scotchmanpeaks.org/volunteer

A volunteer trail crew in the Scotchman Peaks pauses at the end of a day of building trail at Spar Lake in Montana. Cold adult beverages, salty snacks and a dog treat or two wait back at the trailhead. Photo on previous page: An incredible view of Lake Pend Oreille is the background as über Trail Ambassador Dr. Mark Cochran greets a hiker on Scotchman Peak Trail #65.

Volunteers in the Scotchmans lead hikes that are pure fun, as well as some full of “teachable moments,” like this one with outdoor education specialist Brian Baxter and youth from Project ASCENT, a Thompson Falls-based summer program.

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Achieving Optimal Health

proper weight training program. Cardiovascular is the third component of health. Walking, biking or running, are all good forms of exercise to keep the cardiovascular system in peak performance. Using the formula of 220 minus age, times .7 is an easy way to track target heart rate while performing cardiovascular exercise. Diet is too large of a topic to cover in this article on optimal health, however avoiding foods with little or no nutrition value such as solid fats (shortening, ice cream), and added sugars (soda, energy drinks, processed foods) is a good way to stay at targeted, optimal body weight. Good balanced foods such as vegetables, fruits, lean meat, grains and beans are important to maintain the best nutritional value for a healthy system. Antioxidants such as blueberries and most purple fruits also assist in fighting cancer, oxidation of cells (aging) and in balancing the gastrointestinal tract. Supplements such as vitamins, minerals and other metabolites, are also sometimes needed to assist in maintaining optimal health. Over the past 2-3 decades, this has become a major industry and these products have been refined. Toxins, including but not limited to the ones we ingest, are part of our lives. Forming new habits that limit or eliminate them is a good start. Smoking is a good example of a toxin ingested into the lungs that is damaging to the lungs and circulatory system. Alcohol, if used in moderation, is generally safe. Certain red wines in moderation have been proven to help our heart health.

Body Mechanics and ergonomics are essential to normal aging and maintaining a healthy neuromuscular system. Proper body mechanics, or how we use our body to move or manipulate objects, is very important to avoid spine and/or muscle injury. These basic principles are commonly taught in most companies today as a part of orientation and ongoing work competencies. Ergonomics involves posture while in a static position such as sitting, or a position we are frequently in while performing our jobs. As a physical therapist, one of the many things I do is observe human movement. In conclusion, maintain flexibility and strength, a sensible diet and supplement routine, moderation with alcohol, avoid any toxins, have regular wellness and dental check-ups, and use good body mechanics/ergonomics. These are several simple things you can do to keep your body healthy and running at optimal levels. If you have any questions about the topics Iâ&#x20AC;&#x2122;ve covered or want a consultation, I can be reached at 509-447-9308. ___________________________________________________________________

Dr. Michael Zeimantz holds a BS in Biology w/minor in Psychology from Washington State University, a BS in Physical Therapy from Northwestern University and a PhD in Physical Therapy from the University of New England. He has over 100 hours of continuing education in manual therapy. His clinical specialties are ergonomics/bio-mechanics and manual/sport orthopedic therapy. For 32 years, Dr. Zeimantz has been a licensed Physical Therapist in Washington, Idaho, Oregon & Alaska and has been with Newport Hospital & Health Services for 20 years.

Simple Things You Can Do by Dr. Michael Zeimantz, PT, DPT, CEAS Newport Hospital

Healthâ&#x20AC;? has a different meaning for each â&#x20AC;&#x153;Optimal individual. We are all unique and may require specific,

individualized guidelines to remain healthy and injury free throughout adulthood. Each of the following components are pertinent for us to stay healthy and live independent lifestyles as we navigate our way through each decade of life. Physical activity and maintaining appropriate flexibility, a proper, well balanced, and healthy diet along with supplements to fill gaps, help our systems to remain in an optimal state of physical performance. Regular health and dental wellness checks are also very important to avoid certain risk factors. Getting good quality restorative sleep cycles are important for both physical and mental health. Last, but not least, is staying safe, using good body mechanics and ergonomic principles while we work and play.

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Exercise has several parts that play an important role in maintaining our physical well-being. Three of the most important pieces to proper fitness are flexibility, strength and cardiovascular performance. Among the many experts in the fitness arena, Physical Therapists have a very unique level of expertise, and education giving us knowledge and understanding of the human body as it pertains to keeping the body at peak performance levels. Physical Therapists graduating in the past 15-20 years have a doctorate and 7-8 years of college. With over 3000 hours of anatomy and physiology, we are uniquely qualified to treat everything from sprain/strains to neurological problems. Flexibility is first on my list of importance in remaining healthy. Flexibility allows us to move with both quality and quantity as we perform activities throughout a normal day. It only takes a few minutes a day to maintain our flexibility and it has a lifetime of benefits. Without it we do not age well and it limits optimal movement which can lead to risk factors such as poor balance and falls. Strength is also important as we go through adulthood, and despite the fact that we lose muscle mass at a rate of 3-5% per decade, one can maintain or even build mass with a

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Self-Advocacy is a Vital Skill! by Amy Bartoo, Account Executive North Idaho Home Health

s I walked away from the doctor’s office, I didn’t feel as if I’d really had all of my questions answered and wasn’t sure that I was any wiser about my options than before I walked in. Does this sound familiar to you? It was 1993 and my husband and I were trying to get pregnant. My husband had undergone a reversal and because of my age, I knew that there was potential for me to have difficulty conceiving. Many couples struggle with what should be a seemingly normal occurrence to have a baby and since we had “two strikes” working against us, I thought I should seek the help of an obstetrician who had experience working with couples like us. It seemed like a good idea to interview two or three obstetricians to see who might make a good fit for us since it may be a long and delicate process. Being an organized and busy person, I choose three doctors and set up back to back appointments with each of them on a Tuesday. My intention was to sit across the doctor’s desk and have a discussion about their philosophy on fertility, infertility, how to best approach infertility issues, various popular drugs or procedures to assist in improving ones odds of becoming pregnant and then to get a sense of what this

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or that doctor may be like to work with at the very critical moment of delivery. Holy cow, how naive can a person be? Three pap smears later and completely deflated about my ability to communicate my intentions, I never did have a single “over the desk” conversation with one of those doctors. What had happened? Were my expectations that far off? Where did I go wrong? Did I not advocate for myself properly, or enough? As I look back at 26 years later, I realize that I may have been expecting an outcome that the medical model of those days could not provide. Perhaps those doctors’ offices had no “code” enabling them to bill my insurance for a “discussion” and therefore had to perform an examination in order to be enumerated for their time. But why wasn’t I more outspoken with my expectations? Fast forward to 2019 and we have physicians’ offices and clinics with talented clinicians who are more versed in patient advocacy and communication. But, as patients, we are sometimes fearful to ask questions because we don’t want to appear as if we are challenging our doctor. If you feel that your physician isn’t taking your concerns to heart or providing you with adequate information, who else will ask for clarification if it isn’t YOU? This is why self-advocacy is a vital skill for us to master in navigating the medical system. It is unfortunate that our current medical model allows for such limited “face” time with our doctor. They allocate 15 minutes per patient visit because they must allow for 3040 minutes of documentation time to satisfy the insurance company requirements. This creates instances where it seems that our physician isn’t concerned about our issues or how we

feel about a proposed treatment or plan. It is easy to feel as if our physician is treating the disease and not the person. We must remember that physicians are expected to repair or cure, generally through directly treating the cause or symptoms of the illness or disease. They are not counselors and they can’t be expected to read your mind to know what you don’t understand. You have to TELL THEM if you aren’t clear on something or need more information. Additionally, once you feel that you do understand, it is UP TO YOU to tell the physician what you do or don’t want to be done. In the words of April Wallace, LPN for North Idaho Home Health, “What does it mean to advocate? For yourself, it means to speak up about your desires and wishes. It really is ok to ask for a second opinion or choose a different direction than one your physician is suggesting. Do what is best for you! If I hadn’t advocated for myself, I would not have a cochlear implant now to address hearing impairment. My original doctor said it was not an option. I had to fight to get it.” By making a concerted effort to advocate for oneself, you are given a measure of control in an often very “out of control” period of our lives. This also provides you with a sense of calm and thus less stress. Each person, if given the opportunity, will choose to fight for their own way, and it should be their own way. Find your voice during those important moments. Fighting illness and disease is a personal battle than no one else will ever fight the exact same way; no one else will ever feel the same thing. If you were advocating for a friend or family member who

is unable to represent themselves, wouldn’t you take the risk to enforce their wishes because you know they couldn’t on their own? Advocate for yourself just as heartily as you would for someone else. Your doctor will most likely appreciate your assertive and respectful communication which will enable them to respond similarly and address your health more quickly.

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Amy Bartoo is a Coeur d’Alene native. In 1991, she became the Executive Director of Idaho Drug Free Youth and worked as a Prevention Specialist, being recognized as the 2010 recipient of the Governor’s Volunteer of the Year award for inspiring teens to resist drugs and alcohol. Upon retirement from IDFY in 2011, Amy joined the team at North Idaho Home Health as a marketing Account Executive. She has a 22-yearold son, Trey, four gorgeous grandchildren and a three year old Great Dane, Digby.

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70th Anniversary for Bonner General Health!

by Sheryl Rickard, CEO Bonner General Health

019 is a landmark year for Bonner General Health. Seventy years ago, the first patients were seen at Bonner General Hospital. Since that time, many of our community leaders have been involved in the success of the medical community. We celebrate their vision and commitment to ensuring that Sandpoint has a hospital that provides quality, personalized healthcare. As a community hospital, we feel a deep sense of pride and commitment to all those who place their trust in our care. As we celebrate our 70th Anniversary, we thank our founders for their vision and our community for their support. The best part of Bonner General Health is our people. The number of staff and physicians we have continues to grow. Our staff and physicians are committed to providing excellent, compassionate care. We currently employ 450 staff members: 55% hold clinical positions and 45% are non-clinical or support positions. We currently have 62 physicians on the BGH Medical Staff. In 2018, we added nine providers to the Active Medical Staff. The newest members are Mark Hawn, DDS; Joe Wassif, PhD Psychologist; Bryan Berkey, MD Radiologist; Bruce Thomas, MD and Jeff Barton, DO Hospitalists; James Lathrop, NP at Bonner General Immediate Care Clinic; Hannah Raynor, MD Family Practice; Hans Hurt, MD Emergency Medicine, and Gregory Pennock, MD Cardiologist. In 2019, we hired Dr. Susan Anderson and opened an ENT (Ears, Nose, Throat) Clinic, and added Natasha Splaine-Talbott, Psychiatric Mental Health Nurse Practitioner to Bonner General Behavioral Health. We are so fortunate that these providers chose to join the other skilled providers in Sandpoint. We are blessed to have a large group of volunteers who provide hours of their time and talent to make a difference for our patients, visitors and staff. We have over 100 volunteers including the Auxiliary who volunteer in most departments of the hospital, Hospice volunteers, Chaplains, Healing Garden “angels” and the BGH Hospital and Foundation Board members. We couldn’t provide the care that we do without

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this committed group of individuals. We are extremely proud of all of the programs we provide and the continued growth that we experience. Many of our departments have grown considerably due largely to the passion of our team. They are constantly exploring new programs which improve the health of the members of our community. We are preparing to engage in another Community Health Needs Assessment (CHNA) survey to determine the areas we should focus on in the next three years. In 2016, the CHNA focus areas were Obesity, Child Abuse & Neglect, Mental Health and Suicide. We have identified critical community partners who have worked with us to make a difference in those areas. One of the most successful programs is CAST (Coping & Support Training) that we offer in the community to school aged children to give them the support and tools they need to maintain healthy relationships. We are working closely with Lake Pend Oreille School District, and hope to be able to expand this program to reach more children. We received the Qualis Award for Excellence in Health Care and the Yellowstone Insurance Risk Management Gold Award for the last three years based on quality programs that we have designed and implemented. These programs include our Tele-Stroke Program, Code Stork Program and Antibiotic Stewardship Program. We are extremely proud of these awards and more importantly, we are proud of the improved care that we provide our community because of these programs. ___________________________________________________________________

Sheryl Rickard is the Chief Executive Officer of Bonner General Health in Sandpoint, Idaho. Sheryl went to work for Bonner General in 1986 as the Accounting Supervisor. She was promoted to Chief Financial Officer in 1988, Chief Operating Officer in 2003, and Chief Executive Officer in 2004.

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But if you have taken care of all these needs and you still have excess cash, you may want to consider putting this cash to work, possibly by investing in short-term fixed-income vehicles now being issued at higher interest rates. And keep in mind that regardless of where interest rates are going, bonds and other fixed-income investments can offer some key benefits to investors. In addition to providing a source of regular income, these types of investments can help reduce the effects of volatility on your portfolio. While bonds can, and will, fluctuate in value, they typically can provide more stability to your portfolio and tend to behave differently than stocks over time. After years of historical lows, shorter-term rates now have risen to levels that are more attractive to investors. Take the time to review your situation, perhaps with the help of a financial professional, to determine if taking advantage of these rates may be appropriate for you. This article was written by Edward Jones for use by your local

Time to Put Excess Cash to Work? by Ken Wood, Financial Advisor, Edward Jones

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ou’ll always want to base your investment decisions on your own needs and goals. But there may be times when you might consider adjusting your portfolio because of risks and opportunities. Now may be one of those times. Here’s some background: In recent months, the Federal Reserve has raised short-term interest rates several times, and given its generally favorable outlook on the economy, it has indicated it may continue bumping up interest rates gradually over the next year or so. The Fed doesn’t control long-term interest rates, but these rates often follow the lead of shortterm movements. However, longer-term rates haven’t yet risen as much as shorter-term ones, which means the difference between short- and long-term rates is relatively small, historically speaking. This doesn’t mean you should make drastic changes to your portfolio. You still need to stick with the asset allocation that’s suitable for your situation, which typically involves owning a certain percentage of growth-oriented vehicles, such as stocks, and a certain percentage of fixed-income securities, such as bonds. However, if you do have space in the fixedincome part of your portfolio, you may find the higher interest rates offered by short-term bonds and certificates of deposit (CDs) to be attractive. To take advantage of this opportunity, though, you will need to have the cash available to invest.

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Some people hold too much in cash, waiting for interest rates to rise, or as protection against the risk of a market decline. But holding excess cash involves its own risk – the risk of not investing. So, if you have your cash needs covered, you may want to consider investing any excess cash.

To determine if you are holding excess cash, you’ll need to review your entire cash situation. For example, do you have enough cash, or cash equivalents, to create an emergency fund of three to six months’ worth of living expenses? To determine if you are holding excess cash, you’ll need to review your entire cash situation. For example, do you have enough cash, or cash equivalents, to create an emergency fund of three to six months’ worth of living expenses? This fund can be vital in helping you pay for things like a major car repair or an unexpected medical bill without dipping in to your longterm investments. And, of course, you need enough liquidity to provide for your lifestyle, including your regular spending needs – your mortgage, utilities, groceries and so on. Also, you may want to set aside enough cash for a goal you want to reach in the next year or so, such as a vacation.

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Having a Procedure? Certification Matters! Dr. Scott Magnuson North Idaho Pain Center & Pain Management of North Idaho

s the owner of North Idaho Pain Center, an ambulatory surgery center (ASC), I am often asked about the differences between a hospital and an ASC. More procedures are being done in an ASC than in the past and because of this, it is important to understand this difference. Let me start by saying they each have their own advantages, and both provide excellent, safe care. Surgery cases that are extensive, have a greater risk for complications, and on people who have significant health problems, should be done in a hospital where the appropriate resources are available to help support the procedure. Less risky procedures on otherwise healthy people may be appropriate for an ASC. Low risk procedures include things like same-day pain management procedures, colonoscopies, and many eye surgeries. Both hospitals and ASCs are held to high standards of care. The Center for Medicare and Medicaid Services (CMS) has regulatory oversight of hospitals and ASCs. CMS publishes standards of care that need to be met at 100% compliance by these facilities in order to be certified. The Joint Commission and American Association for Accreditation of Ambulatory Surgery Centers (AAAASF) are examples of independent, not-for-profit organizations who certify that a hospital or ASC meets — and maintains — the highest quality standards. Certification by the CMS and AAAASF address standards through a rigorous interview process that was developed by health care experts in their field. This includes review of the ASC’s policies and procedures, such as patient safety, infection control,

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employee safety, HIPAA compliance, patients’ rights, records review, on-site inspections and observation of procedures. This is an ongoing process and not just a one-time inspection. Most ASCs, like North Idaho Pain Center, have certification from both CMS and an independent organization like AAAASF. Dual accreditation is the Gold Standard of care. It is important to note that office-based procedure areas do not have to undergo this type of inspection and certification, though some offices have. Certification provides a level of confidence for the patient to know that the procedure is being done in the safest environment.

One significant advantage for ASCs is cost effectiveness. With insurance deductibles skyrocketing and patients shouldering more of a financial responsibility, the same procedure is often 17-50% less when performed at an ASC vs. a hospital. Also, while both hospitals and ASCs can boast low infection rates, ASCs will often have a lower infection rate. One significant advantage for ASCs is cost effectiveness. With insurance deductibles skyrocketing and patients shouldering more of a financial responsibility, the same procedure is often 17-50% less when performed at an ASC vs.

a hospital. Also, while both hospitals and ASCs can boast low infection rates, ASCs will often have a lower infection rate. However, this is not an equal comparison because hospitals care for a greater range of sickness in patients, and perform more complex procedures. In short, ASCs provide excellent, safe and cost-effective care for certain same day procedures in otherwise healthy people. Make sure that if you are going to have any same day procedure in an ASC that they are CMS certified and have been independently certified by an organization such as AAAASF to ensure that they are meeting the highest quality standards. While facilities are required to prominently display their accreditation certificate in a public area, the best way to know if a facility is actively AAAASF accredited is to contact AAAASF headquarters in Illinois directly by calling: 888-545-5222 For CMS certification visit: https://healthandwelfare. idaho.gov/Medical/LicensingCertification/FacilityStandards/ ASCSurveyResults/tabid/1642/Default.aspx ___________________________________________________________________

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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THEGOODLIFE C O M P A S S I O N AT E S K I L L E D N U R S I N G PERSONALIZED SHORT-TERM THERAPY C O M F O R TA B L E A S S I S T E D L I V I N G

Medicare and Your 100 Days

hen patients are admitted to a skilled nursing facility (SNF) they are often under the assumption that traditional Medicare will automatically pay for 100 days of care. While Medicare beneficiaries do have up to 100 days of skilled nursing benefits, there are criteria that must be met in order to utilize this benefit.

Medicare covered services in a SNF include, but are not limited to:

Who is eligible for Medicare?

• • • •

• Anyone with Medicare Part A with days remaining in their benefit period. • A patient must have a minimum stay of at least 3 consecutive midnights in a hospital. This does not count an observation period. An inpatient stay begins on the day you are admitted to a hospital. • The patient requires daily skilled care given by skilled nursing or therapy staff. • Skilled nursing and/or skilled rehabilitation services are those services, furnished pursuant to physician orders, that:

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• • • •

Room rate Meals Skilled nursing care Physical, occupational, and speech-language services (if needed to meet your health goals) Social services Medications Medical supplies and equipment used in the facility Dietary services

Experience quality living with our premier continuum-of-care services. No matter where you are in life, we are here to meet your needs.

Your costs associated with a Medicare skilled nursing stay: • Days 1 – 20: $0 for each benefit period • Days 21 – 100: For calendar year 2017, the co-pay is $164.50 per day. Many people have a supplemental Continued on Page 20

208.265.9299

1125 N. Division Street LifeCareCenterOfSandpoint.com

208.263.1524

1123 North Division Street TheBridgeAtSandpoint.com Wise Guide | www.TheWiseGuideOnline.com

128739

by Tiffany Goin, Executive Director, Life Care of Lewiston

• Require the skills of qualified technical or professional health personnel such as registered nurses, licensed practical (vocational) nurses, physical therapists, occupational therapists, and speech-language pathologists or audiologists; and • Must be provided directly by or under the general supervision of these skilled nursing or skilled rehabilitation personnel to assure the safety of the patient and to achieve the medically desired result.

Medicare and Your 100 Days! Continued from Page 18

____________________________________ insurance plan that will cover some, if not all, of the co-pay. • Days 100+: You are typically responsible for all costs.

What if your Medicare coverage stops or you are discharged from the facility prior to using all 100 days? This depends on how long your break in SNF care lasts. Less than 30 days: You don’t need a new 3-day inpatient hospital stay to qualify for coverage, but you do need to meet all other coverage requirements. Your current benefit period would continue where it left off when you were discharged from the facility. The maximum coverage is still 100 days. At least 30 but less than 60 days: Medicare won’t cover additional SNF care unless you have a new 3-day qualifying inpatient hospital stay, and you meet all other coverage requirements. The reason for the new hospital stay does not have to be the same as the previous stay. Since the break in your SNF stay was less than 60 days your current benefit period would continue. At least 60 days: Medicare won’t cover additional SNF care unless you have a new 3-day qualifying hospital stay, and all other coverage requirements are met. Since your break in skilled care lasted for at least 60 days in a row, this would end your current benefit period. This means that the maximum

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coverage available would be up to 100 days of SNF benefits in your new benefit period. Medicare uses a period of time called a benefit period to keep track of how many days of SNF benefits you use, and how many are still available. A benefit period begins on the day you start getting inpatient hospital or SNF care. You can get up to 100 days of SNF coverage in a benefit period. Once you use those 100 days, your current benefit period must end before you can renew your SNF benefits. There’s no limit to the number of benefit periods you can have. However, once a benefit period ends, you must have another 3-day qualifying hospital stay and meet the Medicare requirements before you can get up to another 100 days of SNF benefits. Clear as mud? If you have more questions about Medicare, you have several resources available to you. You can go online to medicare.gov or contact the the Senior Health Insurance Benefits Advisors (SHIBA) at 800-247-4422, or go online to SHIBA at shiba.idaho.gov As a skilled nursing facility (SNF) we deal with Medicare on a daily basis and can easily and promptly answer your questions. Just give us a call at 208-798-8500. We are here to help! ___________________________________________________________________

Tiffany Goin is a licensed nursing home administrator with over 14 years experience in long term care. She is currently the Executive Director at Life Care Center of Lewiston. Tiffany resides in Clarkston, WA with her husband, Darrin, and daughter, Macie.

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Every 40 Seconds… by Heidi Frazier, Director of Marketing & Business Development Rehabilitation Hospital of the Northwest & North Idaho Acute Care Hospital

Stroke is the fifth-leading cause of death in the United States, responsible for about one out of every 20 deaths. As many as 80% of strokes may be preventable. But if someone is suffering a stroke, one of the most important factors is time. Knowing the signs of stroke, and what to do in that situation, could save a person’s life.

ay marks National Stroke Awareness Month, and this year the National Stroke Association is turning the spotlight on the 10 modifiable risk factors that account for 90% of strokes globally. Hypertension remains the single most important modifiable risk factor, accounting for nearly 48% of strokes. With eight in 10 people experiencing their first stroke having hypertension, getting your blood pressure checked is an important first step in controlling your stroke risk. Research has shown that unhealthy behaviors such as physical inactivity, poor diet, and smoking have an adverse effect on health and increase your stroke risk. For example, smokers have an increased risk of stroke, up to two to four times, compared to a nonsmoker or those that have quit for longer than 10 years. Here are the top ten modifiable risk factors that account for stroke: • Hypertension • Smoking • Physical inactivity • Heart causes • Lipids (blood fats) • Alcohol intake • Poor diet • Stress • Obesity • Diabetes Talk to your doctor to learn ways to help modify your risk factors.

HERE’S HOW TO SPOT A STROKE: Every 40 seconds, someone in the United States suffers a stroke. Every four minutes, someone dies.

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All you need to remember is F-A-S-T.

F: Face Drooping Look at the person’s face. Does one side droop? Do they feel numbness on one side of their face? Action item: Ask the person to smile. Is their smile lopsided or uneven?

A: Arm Weakness Does the person feel numbness or weakness in one arm? Action item: Ask the person to raise both arms above their head. Are they able to lift both arms? Does one arm drift downward?

S: Speech Difficulty Is the person making sense when they speak? Are their words slurred? Action item: Ask the person to say a simple sentence, like “The sky is blue.” Can you understand what they say?

T: Time to Call 9-1-1 If any of these symptoms are present, call 9-1-1 immediately. Tell the operator you think someone is having a stroke. Do this even if these symptoms disappear. Time is critical, so it is important to get them to the hospital right away. Be sure to note the time when the symptoms appeared.

Action item: Call 9-1-1! _____________________________________________________ Rehabilitation Hospital of the Northwest is a 30-bed, freestanding rehabilitation hospital that provides specialized rehabilitative services to patients recovering from or living with disabilities caused by injuries, illnesses, or chronic medical conditions. The hospital is the first hospital in Idaho to earn certification by The Joint Commission in Stroke Rehabilitation. For more information, call 208-262-8700 and visit RHN.ernesthealth.com.

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A Different Approach with the Impulse®

by Adam Mills D.C., Axis Spine Center

would like to give you a better understanding of chiropractic care and discuss a technique that you may not have heard of before. Chiropractic is a health care profession that focuses on disorders of the musculoskeletal system and the nervous system. Chiropractic care takes a hands-on approach to the restoration of normal joint motion allowing for proper movement of the spine which allows the body to efficiently start the healing process of injured tissue. Tissue can be injured through a traumatic event or repetitive stress over time. Restoration of joint motion can be done using various manual adjustment techniques or with the aid of a device such as a table or a hand-held tool. Often patients are afraid to seek chiropractic care because they are worried about the popping or cracking that is so commonly associated with chiropractic. So, what if I told you that there was a different approach? A gentler approach that does not involve any popping or cracking. An approach that is painless and can be used on patients of any age with a wide array of spine conditions. The Impulse® Adjusting Instrument is the only FDA approved, UL Certified and ISO Class II medical adjusting instrument on the market today. It is a hand-held device that relies on speed rather than force. It delivers an adjustment 100 times faster than a manual adjustment. This allows the practitioner to deliver an adjustment before the patient’s muscles tighten up and resist the adjustment, which is common if the patient is in pain or nervous about treatment. The versatility of the Impulse® is amazing. The stylus is the only part of the device that touches the skin. The shape of the stylus allows the adjustment to be a

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very controlled force applied in a specific line of drive to the vertebra or joint of interest. This allows for the restoration of proper movement and/or normalizes the function of an individual vertebra or joint. With three different force settings and different shaped styluses the Impulse® can be adapted to adjust any part of the spine or to any extremity, like the knee, wrist, or shoulder for example. The settings on the Impulse® vary to apply the correct amount of force to the area being treated. The lowest setting is 100 newtons or approximately 17 pounds of pressure. The next setting is 200 newtons which is 34 pounds and the highest is 400 newtons for 67 pounds of pressure. Another benefit is the same amount of force will be consistently applied with each adjustment. This is beneficial when treating patients who are in severe pain, have a diagnosis of osteoporosis or have had previous spinal surgery. It allows for customized and efficacious care of patients who may not otherwise seek chiropractic care. During a typical visit my patients can expect counseling related to their specific diagnosis and a discussion of modalities of care. Patients who have been under chiropractic care in the past, often have a preference on how they are adjusted. This is wonderful, and the use of a detailed history and examination will aid in determining which adjustment approach is best for a faster recovery and to provide the highest quality of care possible. If you find that you are in pain, getting frequent headaches, or unable to get down on the floor and play with your grandchildren, then you may benefit from a comprehensive chiropractic examination and treatment. Give us a call at Axis Spine Center in Post Falls, Idaho.

Services Offered Include:

Jessica Jameson, MD Interventional Pain Physician

Leigh Stevens, MD Interventional Pain Physician

Roland Kent, MD Spine Surgeon

Daniel Blizzard, MD Spine Surgeon

• Minimally Invasive Surgery • Motion Preservation • Revision Spine Care • Deformity Correction • Complex Spinal Trauma Care • Sacroiliac (SI) Joint Care • Spine Injections • Joint Injections • Botox for Migraines • Medical Weight Loss • Cancer Pain Treatment • Vertebral Augmentation • Platelet Rich Plasma • Stem Cell Therapy • Spinal Cord Stimulation

Adam Mills, DC Chiropractor

__________________________________________________________________

Dr. Adam Mills is board certified by the National Board of Chiropractic Examiners. Specializing in acute severe low back and neck pain, migraines and soft tissue injury as well as rehabilitation. Dr. Mills completed his bachelor’s degree at Colorado State University in Pueblo, CO and completed his chiropractic training at Parker University in Dallas, TX where he graduated in December of 2013. Dr. Mills utilizes chiropractic both for preventative care as well as to address acute injuries and chronic pain. This non-invasive approach gives patients another tool to regain and maintain their health.

Axis Spine Center is the region’s ONLY comprehensive spine center. We are owned 1641 E. Polson Avenue and operated by board-certified and fellowship Suite 101 trained spine physicians. We are committed Post Falls, ID 83854 to improving each patient’s quality of life by (p) 208-457-4208 increasing daily functioning and empowering axisspinecenter.com patients to achieve their goals. Wise Guide | www.TheWiseGuideOnline.com

Getting the Right Care After Hospital Discharge

the first 21 days paid at 100%). Be sure to ask about your level of medical coverage prior to admission, the hospital discharge planner and the skilled nursing centers staff should be able to answer your questions.

Investigate the Facility & Their “Star” Rating

by Maryruth Butler, M.B.A., N.H.A., R.C.A., Q.C.P. Executive Director, Mountain Valley of Cascadia

hen you no longer need the level of care provided in the hospital, the hospital will begin the process to discharge you to a level of “post acute care” (after hospital care), which may include a skilled nursing facility. Skilled nursing facilities (SNFs) provide short-term rehabilitation, long-term care, and in some cases, the most extensive care available including wounds and/or IV therapy. Most individuals hope that they can go directly home from the hospital after an illness or surgery. Even if you and your physician had planned for you to return home, your recovery may be slower than expected, or there may have been unexpected complications. As a result you may need post acute care at a skilled nursing rehabilitation facility. In this case, when the hospital starts the discharge planning process, included should be discussion with the patient and/or their

representative to ensure the selection of facility is patient driven — not hospital driven. If your surgery is planned, this gives you the opportunity to prepare ahead with your doctors and family members. If your hospital stay is unexpected, you and your family should discuss discharge planning with your doctor and the hospital’s social service staff, who help coordinate discharge planning, ensuring that the next level of care is the right choice for you. Too often, choosing a facility can be a source of stress for families. You may have simply been given a list of facilities and asked to choose one — or worse yet, only given the name of the facility they chose for you— rather than giving you an opportunity to express your preferences. Choosing a facility that is right for you will include some research on your part, to ensure you go to a place that provides the highest quality of care, and is located where you would like to be.

THINGS TO CONSIDER Quality & Convenience

Finally, use the tools available to help you navigate through the selection process for a SNF. Visit Medicare.gov to review “Your Guide to Choosing a Nursing Home or Other Long-Term Care” — a document and checklist that is prepared by the Centers for Medicare & Medicaid Services (CMS). CMS and individual states oversee the quality of skilled nursing centers; this information can be found and reviewed on Medicare’s Nursing Home Compare (Medicare.gov), which allows consumers to compare information about skilled nursing centers. Reviewing health inspection results, level of staffing, and quality measures data are three important ways to measure a skilled nursing home’s quality. This information will give you a “snap shot” of the care individual skilled nursing centers are able to provide. SNF’s will often refer to their star rating, which consists of a nursing home rating from health inspections, nursing staffing, and quality measures. These three ratings are combined to calculate an overall rating — 5 STAR being the highest. SNFs vary in the quality and scope of care they provide to their patients and residents. The goal of a skilled nursing facility is to get you back

home as quickly and safely as possible. If you take time to research your options and make an informed decision you will reduce the amount of stress and anxiety associated with entering the post-acute care environment as well as reduce your risk of re-hospitalization. If you live in the Silver Valley, be assured that you have the ONLY facility in all of North Idaho to have the 5-star rating for 10 years in a row! And, we are right here in Kellogg, close to home near family and friends where you will receive the highest quality of care in a facility of your choice — the first step to a successful recovery. ___________________________________________________________________

Maryruth Butler’s healthcare passion led her to be the Executive Director at Mountain Valley of Cascadia, a 68-bed Skilled Nursing and Rehabilitation Facility located in her hometown of Kellogg, Idaho, and a 2016 recipient of the Malcolm Baldrige National Quality Award. She attributes using the Baldrige Framework for shifting her professional approach and creating a culture of performance excellence. She guides her workforce to continuously improve, encourages innovation, and is dedicated to providing the highest quality care for residents. She received her Master of Business Administration in Health Care Administration from Jones International University, is a QAPI Certified Professional, 2017 recipient of the American Health Care Association’s National Mary K. Ousley Champion of Quality Award, 2019 national recipient of the Baldrige Foundation Award for Leadership Excellence, and enjoys sharing her quality journey.

First, is there a skilled nursing rehabilitation center close to your home so family and friends can visit you often? This may also support your ability to continue to have your primary care physician involved in your care along with other specialty physicians. Ask if transportation is provided for follow up physician appointments to help minimize the burden on your family. Most SNF’s do provide transportation to physician visits while also allowing families to be very involved. Tour the center to make certain that they can provide the level of care you require through therapy and nursing staff. When researching facilities that are near to you, or those suggested by friends or the hospital, find out more about them, this will enable you to make an informed decision before informing the hospital staff where you would like to receive post-acute care. The quality of care you receive at the facility you choose plays the biggest role in getting you back to your home.

Financial Arrangements Second, finances must be considered prior to discharge to a SNF. Medicare Part A covers skilled care provided in a SNF under certain conditions for a limited time. Skilled care is nursing and therapy care that can only be safely and effectively performed by, or under the supervision of, professionals or technical personnel. Medicare covers certain daily skilled care on a short-term basis (up to 100 days in a benefit period

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Post-Surgical Healing, the Missing Piece

by Jan Rudeen, Lifestyle Massage Therapy

ou’ve just had hip, knee or shoulder surgery and perhaps had physical therapy, either at a recovery facility, and sometimes continued at home for a period of time. At some point, the therapist “releases you” and you’re usually expected to continue with some form of home exercises on your own. Sound familiar? There’s more! Or, there should be more… Several things happen as a result of surgery and the healing process. The first thing most people don’t think about is adhesion.The body is trying to “stitch” itself back together. The process of that knitting of tendons, muscles and skin results in adhesions that very likely will interfere with flexibility. That is what scarring on the skin is about, it’s adhesion of the skin to the tissues below the surface. Just as it can be greatly reduced on the skin from massage, so can it be reduced where it is occurring below “skin deep.” The result of adhesion is weak, tight or atrophied muscles because vital oxygen and nutrients are not reaching all the tissues and vital organs to improve circulation —which is the key to proper healing. This also counteracts “inappropriate” adhesions. Let’s talk about swelling. The body sends healing fluids to the point of injury and/or the tissues damaged during, or as a result of, the surgery. The body is focused on the point of injury, not the delivery of healing to the entire muscle group involved in healing that joint. And it’s the entire muscle that needs to stretch and retain its tone. Massage increases

circulation, helps reduce pressure from the swelling, and “spreads” those healing fluids around the injury/incision for broader healing of ALL the muscles and tendons involved for proper function of that joint. Would you like to reduce the swelling, pain and general discomfort you’re experiencing? Massage stimulates the brain to release endorphins which are amino acids that work as the body’s natural painkiller, lessening the need for pain meds. In short, let me help reduce your pain and swelling, avoid inappropriate adhesion, scarring and loss of flexibility, and shorten the recovery time while we’re at it! Haven’t had the surgery yet? Come for a pre-surgical therapeutic massage to help ease the discomfort of that soon-to-be replaced joint while you’re waiting. I’m here to help you. Call 208-290-7281 today to schedule an appointment in Sandpoint or Bonners Ferry. ___________________________________________________________________

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. 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

10% off your first 3 sessions! Techniques are tailored to the clients’ needs Call today to schedule your appointment in Bonners Ferry or Sandpoint!

208-290-7281 28

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Jan Rudeen

Licensed Massage Therapist janrudeen.massagetherapy.com

A good massage therapist is your therapist for life! Wise Guide | www.TheWiseGuideOnline.com

You’ve Worked Hard to Protect & Grow Your Wealth – Let’s Keep It That Way • Estate Planning (Wills and Trusts) • Asset Protection • Medicaid and VA Benefits Planning • Probate and Estate Administration • Gun Trusts

Protecting Your Retirement Assets from Creditor Claims Against You and Your Children or bankruptcy filing and POOF! Your life long, hard earned savings could be gone.

by: Jeffery Crandall, J.D., AEP, Certified Estate Planning Law Specialist

o you have IRAs or other retirement accounts that you plan to leave to your loved ones? If so, proceed with caution. You worked hard to save those retirement dollars and your beneficiaries’ creditors shouldn’t be able take them after you’re gone. However, recent changes in the law could allow creditors to do exactly that. Although your retirement accounts are generally protected from creditor claims when you’re alive, the U.S. Supreme Court recently held that those same retirement accounts lose federal protection once they are inherited by your family. Your beneficiaries’ creditors have the power to seize those IRA accounts and take them as their own. This means one lawsuit

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• Business Entities (Corporations, LLCs) • Purchase, Merger, or Sale of a Business • Business Succession Planning • General Business Counsel • Real Estate and Business Transactions

NEED A SPEAKER FOR YOUR GROUP OR ORGANIZATION?

Give us a call!

How Can Inherited IRAs Be Protected? Enter: the Standalone Retirement Trust

Fortunately, retirement account protection still exists but only if you take action. A special trust, called a “Standalone Retirement Trust” (SRT), is designed specifically for retirement assets and can protect inherited assets from your beneficiaries’ creditors. A properly drafted SRT: • Protects the inherited retirement accounts from creditors as well as predators and lawsuits • Ensures that inherited retirement accounts remain in your bloodline and out of the hands of a in-laws or former inlaws • Allows for experienced investment management and oversight of the assets by a professional trustee • Prevents the beneficiary from gambling away the inherited retirement account or blowing it all on exotic vacations, expensive jewelry, designer shoes, and fast cars Continued on Page 32

Jeff Crandall

Ryan Crandall

We offer complimentary consultations for Estate Planning and most other matters. So don’t sit through a seminar with a bunch of strangers ... get personalized information from an experienced estate planning attorney in your own, private consultation. To learn about protecting your wealth and loved ones with a Will or Trust....

Call Today to Schedule your No-Obligation, Complimentary Consultation!

8596 Wayne Drive, Suite B, Hayden, ID | 208.772.7111 Wise Guide | www.TheWiseGuideOnline.com crandalllawgroup.com

Protecting Your Retirement Assets

• Enables proper planning for a special needs beneficiary • Permits you to name minor beneficiaries such as grandchildren without the need for a court-supervised guardianship • Facilitates generation-skipping transfer tax planning to ensure that estate taxes are minimized or even eliminated at each generation of your family

You have beneficiaries who receive assistance. If one of your beneficiaries receives, or may qualify for, a need-based governmental assistance program, it’s important to know that inheriting from an IRA may cause them to lose those benefits. An SRT can avoid disqualification. You are remarried with children from a previous marriage. If you are remarried and have children from a previous marriage, your spouse could intentionally (or even unintentionally) disinherit your children. You can avoid this by naming the spouse as a lifetime beneficiary of the trust and then having assets pass onto your children after his or her death.

Is the Standalone Retirement Trust Right for You?

The Bottom Line on Protecting Inherited IRAs

Continued from Page 30

Here are some important factors to consider in deciding whether your family can benefit from an SRT. You have substantial combined retirement plans. Spouses can use an SRT to shield one or the other from creditors. You believe your beneficiary may be “less than frugal” with the funds. Anyone concerned about how their beneficiary will spend the inheritance should absolutely consider an SRT, since they allow you to provide oversight and instruction on how much they receive – and when. You recognize the incredible power of tax-deferred growth. Tax-deferred growth, permitted solely under qualified retirement plans, dramatically increases the growth potential of those accounts. An SRT can ensure your family enjoys the incredible benefits of this super-charged investment, providing them with the resources they’ll need for retirement in the face of uncertainty over the survival of social security and private and public employment benefit plans. You are concerned about lawsuits, divorce, or other possible legal actions. If your beneficiary is part of a lawsuit, may file for divorce or bankruptcy, or is involved in any type of legal action, an SRT can protect the assets they inherit from those creditors.

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Unfortunately, the Supreme Court decision has made outright beneficiary designations for IRAs and other retirement accounts a risky business. However, we are here to help you decide whether an SRT is a good fit for you and to answer your questions about protecting your retirement accounts. Let us show you how an SRT can help you protect your assets as well as provide powerful tax-deferred growth. NOW is the best time to act. At the Crandall Law Group, we offer complimentary consultations to review your existing estate plan, or if you don’t currently have a plan in place, to assist you in developing a plan that addresses retirement plan preservation as well as all of the other important estate planning considerations necessary and relevant to you and your family.

Medicaid Covers Dental Care in Washington State! T

hat sounds great, except very few providers, and none in Pend Oreille County accept Medicaid — BUT the Camas Center Clinic does! If you need dental services and are on Medicaid, we are here for you. From comprehensive exams to preventive cleanings, the Camas Center Clinic provides excellence in dental care. Care for the whole patient and the whole community. Under the guidance of the Kalispel Tribe of Indians vision of a healthy community, the Camas Center Clinic Dentistry program offers: • Comprehensive Exams and Preventative Cleaning • Restorative Care (Fillings) • Crowns & Bridges • Dentures – Full and Partial • Root Canals (Endodontic) • Gum Treatment (Periodontal) • Oral Surgery (Limited) • Fluoride Varnish and Sealants We accept Medicaid, Managed Care Organizations and most Major Insurances.

Call 509-447-7111 for appointment availability or insurance questions. The Camas Center Clinic gladly accepts new Medicaid patients of all ages, and the public is always welcome too! NEED TRANSPORTATION? Call Kalispel Tribal Transit at 509-447-7247 Find us on Facebook www.facebook.com/KalispelTribalTransit Kaltran provides medical transportation services throughout Pend Oreille County to the Camas Center Clinic. If your appointments are Medical-eligible and you have a current Medicaid Card, you may be eligible to use Kaltran services to get to your appointment at no cost to you. Routes to the Kalispel Reservation, Spokane, Ione, and Cusick since 2009. All buses are wheelchair accessible. Call Kaltran at 509-447-7247 Monday – Thursday 7am – 5pm to schedule your ride. All rides must be scheduled 24 hours in advance; call Thursday for appointment on Friday, Saturday or Monday.

_________________________________________________________________

Jeff Crandall is a business and estate planning attorney with over 29 years of experience in business, tax, estate planning, elder law and business succession planning. He is licensed in Idaho, Washington and California and has been practicing in the Coeur d’Alene area for over 20 years. Jeff loves helping people solve problems and, whenever possible, helping them to avoid problems in the first place.

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January 30, 2019 Dear Ellen, I am writing this letter to pass on a very special gift called a Butterfly Coin that was given to me. But first, you need some background… About 16 years ago, around the same time you started your talk show, I was going through a very hard time. I was a single parent of four beautiful children and struggled every day to make ends meet. Lucky for all of us, I met a wonderful man who was also a single parent of four. We became a very large family in a blink of an eye. The financial stress of raising eight children often became too much for us. We always found a way to manage. There were times, especially in the beginning, that we had to ask for help. Needing assistance from the state and from local non-profits was very humbling. I often felt broken. As a mother, you learn quickly that personal pride isn’t important when it comes to your children’s wellbeing. One time while at a community action agency I saw some unemployed men organizing to shovel snowy driveways for the elderly and I wanted to help. Unfortunately, with all my kids in tow, there was just no way. Later that evening, my daughter asked if we could make something in the kitchen. We spent the next afternoon baking 20 dozen muffins for all the men shoveling and the elderly they were helping. For the first time in so long, I finally felt the joy of giving. From that moment on, I have always found ways of paying it forward to others in need. Now, three years later, I work for Valley Vista Vista Care in Sandpoint, a wonderful non-profit Skilled Nursing Home in beautiful, Sandpoint Idaho. We have up to 73 residents who rely on our care team for 24-hour care to meet their needs. I work as the Assistant Dietary Manager, a job I would never have imagined doing, but I truly love what I do! I get the creative privilege of having “fun with food” for our residents. Sometimes it means making colored pasta that looks like clown hair for Halloween, or figuring out how to make a pureed candy bar for a lady who wants a chocolate bar but cannot safely eat one…we figure out how to make it happen! Recently at Valley Vista Care Sandpoint, Sheila a coworker of mine, gifted me with a beautiful Blue Butterfly Coin to recognize a kind deed I participated in. I helped pull together a special anniversary dinner for a resident with terminal pancreatic cancer. It was his and his bride’s 15th wedding anniversary and probably his last celebration of it here on this earth. Determined to make his last days as incredible as possible, we quickly planned a dinner hosted at our facility. It was complete with a private meal, sparkling cider in champagne glasses, 12 red roses + 1 white rose and gifts for his wife! It was beautiful and they LOVED the thoughtfulness behind it! A memorable day indeed! Sheila recently initiated a staff appreciation program called “Operation Butterfly Effect” using these beautiful coins. She got the idea after a talking to a good friend, Bruce Pedersen, who gifted her a coin while visiting a family member in our facility. He shared the concept of The Butterfly Effect: The scientific theory that a single occurrence, no matter how small, can change the course of the universe forever. The concept is simple, the effects are profound! Perfectly aligning with what we stand for at Valley Vista. Bruce Pederson and his friend Ron Hornbaker

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had taken this concept and co-founded Butterflycoins.org. Each Butterfly Coin inspires and tracks the butterfly effect of kindness. By carrying one of the solid brass coins in your pocket or purse, you’re reminded to look for opportunities to help a friend or stranger, to pass the coin along with a kind deed and encouragement to pay it forward to someone else. Each coin has a unique tracking code and dedicated story page, where the recipient posts a brief story about how they received the coin, and you can watch the legacy of kindness unfold countless times into the future, forever. Every day I see the Nurses and Nursing Assistant’s going above and beyond the call of duty to calm or redirect a confused resident. They are always laughing and telling stories, discussing football games, what’s going on in their family’s lives, playing games, doing crafts, or just reading a magazine. We have staff that buy Christmas and birthday presents for residents who don’t have other family besides us. Our Administrative Staff and Therapy Department are always going out of their way to find community resources for residents who may be able to go home. I have seen them spend their own days off hauling and splitting firewood for a resident’s wife or driving to a family member’s home to carry in a special chair. Honestly, I could spend days telling stories about these awesome people. Most importantly, we share much love and have a lot of fun! Our staff, residents and their family members have become like family; celebrating in the good times and supporting each other in the difficult times. Now the REAL reason I am writing you! As one of the first employees to be given a coin, I wanted to do something very special with it to launch it into the world on behalf of ALL of our team, residents and family at Valley Vista Care. I am sending it to you to recognize you for going above and beyond to help so many, including me. At the heart of it, you have become an inspiration to me through your positivity and encouraged me to do good and help others. —Do Good & Fly On, my friend! Christy C.

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Colon Cancer is No Joke!

test.” Said Dr. Peter Purrington, Chief Medical Officer for Heritage Health. “There is new information that the fecal immunochemical test (FIT) performed annually can be as effective as colonoscopy for patients at average risk for colon cancer.” The FIT test can be performed in the comfort of the home and returned to the physician’s office for processing. Cologuard is another non-invasive test that can be performed at home. While the FIT test must be performed annually, Cologuard can be completed every three years if the test is negative. If either test is positive, a colonoscopy would need to be performed to confirm or exclude a diagnosis of colon cancer. “Colonoscopies are still the best screening test, but it does come with some risk and there is some inconvenience from the preparation,” said Purrington. “If a colonoscopy is negative, the test can be repeated once every 10 years. If precancers or colon polyps are found, colonoscopy should be repeated every three to five years.”

Screening for Colorectal Cancer Saves Lives by Marc Stewart, Multimedia Specialist, Heritage Health

he mere mention of a colonoscopy can make people cringe uncomfortably or produce a bevy of bad jokes. Valley Vista Care of Sandpoint has one of the only nonacute care options for long term living for someone with a TBI. A secure setting is available with trained staff who are prepared to deal with the myriad of behavioral challenges possible for those who are unable to function safely in a less controlled setting. This special unit for men is known affectionately as “The Lodge.” There is also a secure women’s unit referred to as “The Cottage,” but most of the TBI residents are male. But colorectal cancer is no laughing matter. According to the American Cancer Society, colorectal cancer kills more than 50,000 people annually. Many of those deaths could have been prevented.

Wise Guide | Spring/Summer 2019

“Colon cancer screening absolutely reduces morbidity and death from colon cancer,” said Heritage Health’s Dr. Peter Purrington. “After being diagnosed with colorectal cancer, approximately one in three will die from their disease. These deaths are largely preventable with proper screening.” Patients without a personal or family history of colon cancer or colon polyps are at average risk for colon cancer, and screening should begin at age 50. Patients with firstdegree relatives who had colon cancer or polyps are at increased risk and should be screened more frequently, usually starting 10 years before the family member’s age at diagnosis. Dr. Peter Purrington, “While colonoscopy is still Chief Medical Officer the best test, it is not the only for Heritage Health

According to the US Centers for Disease Control and Prevention (CDC), most insurance plans and Medicare help pay for colorectal cancer screening for people who are 50 years old or older. Colorectal cancer screening tests may be covered by your health insurance policy without a deductible or co-pay. Also, according to the CDC, 16,000 US lives were saved thanks to colon cancer screenings between 2003 and 2007. Despite this, current colon cancer screening rates remain low. As of the beginning of March, over 3,000 eligible residents of Kootenai Country have not taken advantage of this lifesaving test for this year. Ask your healthcare provider about your risk for colon cancer and what screening test is best for you. Colon cancer is preventable, and colon cancer screening can save your life. __________________________________________________________________ Marc

Stewart, Multimedia Specialist with Heritage Health has worked in journalism, marketing, and communications for 20-plus years. He joined Heritage Health in February 2018 after working 2 ½ years at the Coeur d’Alene Press as the marketing writer. Previously he worked at STCU, Lewis-Clark State College, the Coeur d’Alene Press a couple of times as a reporter, and the Coeur d’Alene Tribe.

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Back On Her Feet

5% DI

by Marc Stewart, Multimedia Specialist, Heritage Health

Your North Idaho Recumbent Dealer

wo years ago, alcoholism finally knocked Amy off her children, didn’t have health insurance and she couldn’t afford feet. The Coeur d’Alene resident suffered from alcoholic to go to the doctor. neuropathy, a painful nerve condition in her feet and she was “Maryellen died prematurely because she was unable unable to walk. After a brief stint in to access health care,” said a local rehabilitation hospital, Amy Linda Johann, a Heritage Health could walk again. However, she still board member. “The Maryellen needed ongoing medical care and Scholarship Fund fills the gap for long-term counseling. people who have nothing. Lidwin “I had nothing,” said Amy, who would say, ‘It’s unacceptable for lives in Coeur d’Alene. “I didn’t have people to not get the care they any insurance. I didn’t have any need because they don’t have the income. But I heard about Heritage resources to pay for the visit.’ The Health and how they could help me. Dirne Foundation furthers our I am so glad I found them.” mission at Heritage Health.” Last year, Amy was one of 81 Heritage Health served patients whose Heritage Health 28,320 patients last year in services were covered by the Maryellen Kootenai, Shoshone, and Benewah Scholarship Fund, a program run by Counties. “Providing high quality, the Dirne Foundation. The Maryellen affordable healthcare from the heart Scholarship Fund paid out about is our passion,” said CEO Mike $24,500 for those patient expenses in Baker. “Heritage Health exists for 2018. the sole purpose of delivering a In addition, Heritage Health health care experience that provides donated or heavily discounted hope, inspires change and extends another $2 million in services to the lives for our patients and our Amy, who suffered nerve damage from alcoholic 4,775 patients without insurance or community. Our amazing care neuropathy, said Heritage Health played a limited income. teams deliver world- class health key role in her recovery. Amy, 46, believes Heritage Health care utilizing a patient- directed, and the Maryellen Scholarship Fund community-focused approach.” helped her immensely. She has hopes and dreams for the To make a donation to the Maryellen Scholarship Fund, future and is charting each step of the way. “I love my doctor,” visit www.myheritagehealth.org ___________________________________________________________________ she said. “She helped me a lot and I feel so much better. I am in recovery. I have my own place and I have a job. I’ve always Marc Stewart, Multimedia Specialist with Heritage Health has been an independent person and I am able to support myself worked in journalism, marketing, and communications for 20-plus without any help from my family.” years. He joined Heritage Health in February 2018 after working Her success story would have made Lidwin Dirne smile. 2 ½ years at the Coeur d’Alene Press as the marketing writer. Lidwin Dirne was inspired to launch a volunteer clinic in Previously he worked at STCU, Lewis-Clark State College, the 1985 after one of her neighbors, Maryellen, passed away from Coeur d’Alene Press a couple of times as a reporter, and the Coeur health issues. Maryellen, who was a single mother of four d’Alene Tribe.

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

May is

Pend Oreille County Counseling Services is hosting the 13th Annual Community Forum on Thursday, May 16th. This year it will be held at the Pend Oreille Counseling Services Building at 105 S. Garden Avenue in Coeur’d Alene, from 5-7 pm. Light dinner will be served. Please RSVP at 208447-5651. Please join us to learn about our agency and mental health awareness. We welcome community feedback. Children are welcome. Rusty Mae Squires, Peer Certified Support Partner will serve as Facilitator.

“Heritage Health exists for the sole purpose of delivering a health care experience that provides hope, inspires change and extends the lives for our patients and our community. Our amazing care teams deliver world- class health care utilizing a patient- directed, community-focused approach.”

Wise Guide | Spring/Summer 2019

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PEER-ing into the Future

PEER SPECIALISTS WANTED!

Interested in becoming a peer support specialist?

“Keep your face to the sunshine and you cannot see a shadow.” —Helen Keller

There is a growing demand for Certified Peer Specialists. The main requirements are shared experience, to be well grounded in your own recovery, and completion of a State approved Peer Specialist training course for certification. Requirements can take up to a year or more to complete. The Certified Peer Specialist training covers core competencies identified by SAMHSA and The Health Care Authority of Washington https://www.hca.wa.gov/billers-providers-partners/behavioral-health-recovery/peer-support.

Training is 100% FREE. Currently, 2 trainings are scheduled in Washington State: by Donna M. Anderson, CPC Pend Oreille County Counseling Services

ave you ever heard the familiar saying by Haruki Murakami, “Pain is inevitable. Suffering is optional”? This saying implies that we cannot avoid the pain that life brings, however we can control how we respond. I encourage you to look deeper into that saying, to apply it to the situations that arise, seemly to overwhelm us and cast a shadow of doubt that not only will we suffer, but we will suffer alone. There are options and you are NOT alone. According to the National Alliance on Mental Health, 43.8 million Americans experience a mental health challenge in a given year with 9.8 million experiencing a serious mental health challenge “that substantially interferes with or limits one or more major life activities.” Research shows that the mind in crisis is not able to function at its optimum best. Stress, death, loss of any kind, divorce, abuse, neglect, crime victimization, financial crisis, overwhelming debt, physical health issues, legal battles, poverty, domestic violence and parenting dilemmas are just a few situations that may cast a shadow on our lives. Pend Oreille County Counseling offers hope in many forms to help those who are working toward recovery and mental health wellness, including peer specialists. A Certified Peer Specialist can help you navigate the many complex challenges you may face. Their lived experiences provide a unique perspective and understanding. You are not alone. A Peer Specialist can be right beside you, helping you fill out forms, understand confusing terminology, coordinate appointments and advocate for your needs.

Wise Guide | Spring/Summer 2019

The greatest benefits of peer support are in the area of integrated health. Integrated health is focused on comprehensive care for both an individual’s physical and mental needs. This “whole person” approach is paramount to achieving optimal wellness and recovery. The Substance Abuse Mental Health Administration (SAMHSA) definition of recovery is: “Recovery is a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.” And, the Washington State Division of Behavioral Health and Recovery supports peer recovery in this statement: “The belief that recovery is possible for all who experience psychiatric, traumatic, or substance use challenges is fundamental to the practice of peer support.” Together, these guiding principles are the foundation of the services we provide at Pend Oreille County Counseling. The likelihood of long-term recovery is increased with effective support. Peer support has been demonstrated through

May 13-17th - Moses Lake & June 10-14th - Spokane —Informational meetings will be taking place in Pend Oreille County in 2019. If you would like more information to become a Peer Support Specialist or would like to attend a meeting, please contact Donna Anderson or Brittney Stemarie at 509-447-5651.

research and practical application to be highly effective. In addition to the SAMHSA Working Definition and Guiding Principles of Recovery, the following core values have been ratified by peer supporters across the country as the core ethical guidelines for peer support practice: 1. Peer support is voluntary 2. Peer supporters are hopeful 3. Peer supporters are open minded 4. Peer supporters are empathetic 5. Peer supporters are respectful 6. Peer supporters facilitate change 7. Peer supporters are honest and direct 8. Peer support is mutual and reciprocal 9. Peer support is equally shared power 10. Peer support is strengths-focused 11. Peer support is transparent 12. Peer support is person-driven Peer support can be you. There is a growing demand for Certified Peer Specialist. No one should ever be alone. ___________________________________________________________________

Donna Anderson, CPC is a Colorado native and has lived in the Pacific Northwest for 12 years. She taught school at House of the Lord Christian Academy, Oldtown, ID and was a Case Manager for Youth Emergency Services (YES). She is the Chair of the Panther Country Coalition for Youth Drug Prevention and the Parent Peer Counselor for the WISE Team of Pend Oreille County.

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Tax Guidance for Lump Sum Disability Payments

by Bryan Hult, Bonner County Veterans Service Office

o one wants peace more than a soldier. General Douglas MacArthur wrote, “The soldier above all others prays for peace, for it is the soldier who must suffer and bear the deepest wounds and scars of war.” Yet because there are wars and rumors of war, we need those soldiers, sailors, airmen, marines and coast guard personnel, who volunteer to serve their county. They must be ready to go into combat as their Commander in Chief directs and suffer and bear the deepest wounds – the protected will never fully understand. Because of that choice, sacrifice and noble ambition,

Wise Guide | Spring/Summer 2019

many do carry the scars of war. Fortunately, in the United States, there is support that government-elected officials have approved to assist combat veterans. One of those benefits is the Tax Fairness Act Claim of 2016. This Tax Fairness Act was initiated to assist veterans who received a lump sum disability severance payment at some point after January 17, 1991. Unfortunately, that lump sum was included on W2, Wage and Tax Statement, as taxable income and had to be filed with the 1040 series of IRS forms. This lump sum was later determined to be non-taxable. The Department of Defense and IRS were directed to inform 130,000 veterans (letters 6060-A and 6060-D) in July 2018. What does this mean for you? If you received a lump sum severance payment, and you filed it as taxable income, you may have a refund coming. The lump sum was taxable, unless the disability was a result of a combat-related injury or you received notification from the Department of Veterans Affairs that you were awarded for a combat service connected disability. So if you were taxed on a non-taxable payment, the Tax Fairness Act authorizes you to file a claim or refund for the tax year in which the lump sum disability payment was made What do you need to do? You’ll have to file a 1040X, Amended U.S. Individual Income Tax Return, for the tax year the lump sum payment was made. There are instructions on the July 2018 notice mailed by the Department of Defense. Additionally, the date to apply is the later of: • 1 year from the date of the Department of Defense letter (July 2019), • 3 years after the due date for filing the original return for the year of the disability severance lump sum payment, or • 2 years after the tax was paid for the year the lump sum payment was made. But I didn’t receive a letter from the Department of Defense! If your lump sum payment was made after January 17, 1991, you can still file a claim as long as you attach the necessary documentation to your Form 1040X. There is a helpful site with “FAQs” (Frequently Asked Questions,) which may further clarify questions you might have: https://www.irs.gov/individuals/military/filing-amendedreturns-for-combat-injured-disabled-veterans. You don’t have to have the original tax form, but you do need the information from that original tax form to complete the 1040X form. There is also helpful information at the following link: https://www. dfas.mil/dsp_irs. If you have further questions, consult your tax preparer and/or contact the IRS toll-free at 833-558-5245, ext. 378. If you know of someone to whom this might apply, please let them know!

I Didn’t Know That Either!

(More Home Improvement Help for Veterans!) by Bryan Hult, Bonner County Veterans Service Officer

knew there was medical, compensation and pension benefits available from the VA. But what I didn’t know was how much potential help could be available adapting a home to a veteran’s medical needs! I also didn’t know that there are people in the VA that help the veteran assess and determine what is needed so he/she can get the adaptation mission completed! Hooah! So last issue of The Wise Guide, I described the VA help that the HISA (Home Improvement) Grant can provide. I described what it could provide and what it couldn’t as well as the step by step process of making it happen. The amount was $2000 for non-service connected veterans and $6800 for service-connected veterans. Now, I’d like to describe two other grants that seem even better than the HISA Grant and how they can change your living conditions! You might even say that they can change your life! They are the SAH and SHA Grants. First, let’s march through the SAH Grant. This is the Specially Adapted Housing (SAH) grant which helps veterans with barrier-free living, like making sure your home is wheelchair accessible. Currently, the maximum grant amount is $85,645.00! Yes, you read that right! AND, it can be used for the purpose of constructing or modifying a home to meet adaptive needs. Now, this is not for any veteran, but those who are really dealing with these issues: a) loss, or loss of use, of both legs; b) blindness in both eyes, plus loss, or loss of use, of one leg; c) loss, or loss of use, of one leg and loss, or loss of use, of one arm affecting balance and the ability to move without aide; d) loss, or loss of use, of both arms at or above the elbows; e) a severe burn injury. I’m glad the VA is compassionate about helping our vets! Second is the SHA Grant. This stands for the Special Housing Adaptation (SHA) grant, used to increase your mobility throughout your residence. The current maximum amount is $17,130, which can be adjusted each year, so you’ll have to check the va.gov site each year. Eligibility is limited to veterans with blindness in both eyes with 10/200 visual acuity or less in the better eye with use of a corrective lens, or anatomical loss or loss of use of both hands or arms below the elbow, or a severe burn injury. The purpose of these grants is to adapt the home for the disability-specific needs. They cannot be used for roof repair, etc. You’re not going to believe this, but there is also a “Temporary Residence Assistance Grant,” which is a

temporary SAH/SHA grant to adapt a family member’s home where the veteran is living waiting for his/her home to be adapted. The amount available for the SAH grant is $37,597 and the SHA grant is $6713. Check this out on www.benefits.va.gov/homeloans/adaptedhousing.asp. Most of us young people (middle age is from 70-85 years) have pretty good health, so we’re not thinking of needing these kinds of improvements. But, then, all of a sudden, even in our youth, the health goes out the window and we can’t even make it into the old bathroom facilities. These grants can make a huuuuuge difference! How can you get your hands on that help? Glad you asked! The first step would be to contact your VA social worker. Every veteran is assigned a VA social worker and you can contact your veteran service officer for his/her phone number. Based on the social worker’s feedback, fill out the VA form 26-4555 “Application in Acquiring Specially Adapted Housing or Special Home Adaptation Grant.” The social worker, or VSO can help you with that. You can also contact a Specially Adapted Housing staff member via email at sahinfo.vbaco@va.gov or by phone at 877-827-3702. Maybe you won’t need this help, but you know of a veteran who does. Pass this information on or have him/her give me a call at 208-255-5291 I’m glad to help! ___________________________________________________________________

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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These Veterans Service Officers are here for you:

EVENTS

NORTH IDAHO

Veterans Stand Downs

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

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

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

Ryan Keeler

Bryan T. Zipp

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

Justin Offerman 208-263-7544 Ext. 3713 613 Ridley Village Road, Ste. C Sandpoint email: justin.offerman@labor.idaho.gov

READ THIS!

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. 44

Wise Guide | Spring/Summer 2019

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.

The Vietnam Veterans Memorial Wall will be

Coeur d’Alene, ID - May 11th Kootenai County Fairgrounds, 8-1 Kalispell, MT - June 8th, Evergreen Fire Hall, 9-3 Newport, WA - July 27th, Newport High School, 8-4 Wenatchee, WA - September 14th, at the Armory on 5th St., 8-3 Helena, MT - August 24th, L&C County Fairgrounds, Starts at 8:00 AM with a Walk/Run in Recognition of Gold Star Families Moses Lake, WA - September 28th Grant County Fairgrounds, 9-2 Libby, MT - October 5-6th in the Armory, 9-3 Kennewick, WA - November 8th, City of Kennewick Event Center, 9-3

Military Appreciation Day Celebration May 18th, Spirit Lake City Park - Patriotic Parade at 11:30, Music noon-6 PM Dancing, Family Fun & Games, Beer Garden & Foot Veterans Service Booths Auction/Raffles/Games Benefitting Spirit Lake Troop Support sending military care packages. Info: Roy Racy VFW Post 1473 / Carla Street 208-661-0953

Salute to Service Resource Fair Saturday May 19, 2019 1 pm – 6 pm River Park Square Shopping Center 808 W. Main Ave., Spokane, WA 99201 The event starts in conjunction w/ The Cruisin’ the Falls Car Show and before the Armed Forces Torchlight Parade. In collaboration with The Spokane Veteran Center. Featuring the Washington State Fallen Heroes Banners to bring honor and remembrance to fallen military service members with ties to Washington and N. Idaho who were willing to sacrifice their all. Charity@thefamilyguide.org | 509.928.9664 www.thefamilyguide.org | facebook: nwfamilyfunfair

in Medical Lake, WA from June 13-16, 2019. Available for viewing 24/7. If you visit during the annual Founders Day event you can enjoy the festivities of the weekend: BBQ Fireworks, Parade, Kids Zone, 5K Tri/Duathlon, Street Dance, Vendor Fair. Info: www.medicallake.org/fd

Peaceful Warriors - a FREE Ranch Retreat for Women Veterans

September 26-29th, 2019 - Wolf Springs Ranch, St. Maries, ID Women veterans, active duty, reservist or retired connecting and working with horses, sharing meals, traditional crafts, massage, campfire circles, journaling, preparing and eating fresh farmstyle food, communing with nature and fellow women veterans. www. lifeskillsranchprogram.org Deadline to sign up September 1st.

The War Within

by Krystle Shapiro, MSHN, LMT. A holistic approach to preventing veteran suicide. A well-researched, five-part, easy to implement program outlined in this book, will help reduce the incidence of depression, hopelessness, fatigue and suicidal ideation. liferichpublishing.com paperback 978-1-4897-1900-3, or e-book 978-1-4897-1899-0

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Idaho Initiates a Property Tax Benefit for Veterans

by Scott A. Thorsness, Director, Kootenai County Veteran Services

Monthly Hiring Event

every 2nd Wednesday from 10 - Noon at the Idaho Department of Labor, Kootenai Office, 600 N. Thornton in Post Falls . Job seekers meet with multiple employers with current job openings. Full/part time, seasonal, temporary, Entry level skilled trades & professional level positions available. Bring your resume! For more info: labor.idaho.gov

Wise Guide | Spring/Summer 2019

es, as of 1 January 2019, the State of Idaho is instituting a helpful tax break for our Veterans that have an evaluation 100% Service Connection for disabilities incurred in the military. This had been in the works for quite some time, and finally as of 1 July 2018, was approved and applied to our Idaho State Tax laws, starting for the calendar year of 2019. What it the benefit? It can mean a savings of $1,320 on your annual property taxes. What are the qualifying factors to be able to apply for this tax break? — First, a Veteran must be recognized as 100% serviceconnected disabled by the US Department of Veteran Affairs (VA) as of 1 January 2019. — Second, one must have owned and lived in the home, to include a mobile home, in Idaho before 15 April 2019. — Third, the property must have a current “Home-Owner’s Exemption”. Those are the basic eligibility requirements to qualify for the Property Tax Reduction. There are some additional factors that are case-by-case specific such as: • Benefit is for the home and “up to” one acre of land • A surviving spouse can use this benefit • The benefit isn’t transferrable to a new property after the death of the qualifying veteran • You could still qualify even if you are living in a care facility or nursing home and still own your home. Let’s look at an issue and definitions that have caused confusion with this new benefit. A veteran that is considered 100% VA disabled due to Total Disability Individual Unemployability (TDIU) will not qualify. Yes, the VA may recognize veterans on an even basis pertaining to federal benefits, whether 100% serviceconnected or 100% TDIU, but the state does not in respect to this State tax benefit.

Things to remember: • This benefit is not automatically renewed. One must submit a new application every year. • If approved, your benefit will be evident on the property tax bill for December 2019 • The applicant must obtain a current letter from the VA showing the 100% service-connected disability rating as of 1 January 2019, or as of 1 January for each following year. There are a couple options to obtain this letter. Call the VA at 1-800-827-1000, or, print off a current benefit letter from “eBenefits.va.gov”.

HOW, WHEN, & WHERE TO APPLY HOW: Obtain the current VA letter showing the veteran’s 100% service-connected disability rating. WHEN: The application must be submitted between January 1st through April 15th of each tax year. WHERE: Visit your local County Assessor’s Office. They will assist you with the application process. For more information, you will want to contact your local County Assessor’s Office, or call the Idaho State Tax Commission toll-free at (800) 334-7756, ext. 2. You can also receive more information on the following website: https://tax.idaho.gov/i-2053.cfm

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47 47

The Journey to Oz by the Auburn Crest Hospice Team

f you’re able, click on this link as you experience this article https://youtu.be/ JSMujZR7M8w and perhaps you might remember where you were when your world went from black and white to color; when you longed for the familiar small town feeling again; when you held that tiny dog in your arms and felt companionship; when the hourglass seemed plenty big and then it seemed to start going way too fast; and perhaps you’ll remember an unusual encounter with friends who walked through a chapter of life with you. These moments can let you peer through a peep hole within the land of “OZ” into a place called “Assisted Living.” It’s also where hundreds of North Idahoans are serving thousands of residents who now call those communities “home.” Auburn Crest Hospice team members come together with Assisted Living caregivers to serve a new cluster of friends walking the journey along their “yellow brick road” of life. The

overwhelming challenges along the way are offset by friends, family and professionals who keep focused on 4 letters within the word HOSPICE: “H O P E”. Some hope for pain relief, some for stress and anxiety to be eased. Some hope for one more taste of their favorite meal, others for restoration among strained family relationships. Some hope for another hug, a good night’s rest, for forgiveness, some for their eternal home. The goals of Auburn Crest Hospice’s team are to help patients and their families chose to live every moment while the sands of time are still moving. For over 10 years now, serving in North Idaho’s Assisted Living environment, Auburn Crest Hospice team members have witnessed the likes of the tenderhearted tin man, the compassionately thinking scarecrow, and the courageous lion joining “Dorothys” along their journeys. There are many “tin men” in North Idaho community like Christina who tenderheartedly manicured Jewel’s nails

Wise Guide | Spring/Summer 2019

in her favorite lavender hue so she’d look beautiful when her family saw her for their last time. Others like Beverly held hands with Jean while relaxing to a musical performance. Bob’s acoustic guitar music filled the hallways so Mary and her housemates could help her reach life’s finish line, singing. Others experienced pure miraculous joy when compassionately, Adam placed his instrument on a deaf resident’s lap and she exclaimed, “We’re making music together!” Whitney lovingly and beautifully styled Lucille’s hair brightening her huge contagious smile as she joined in a sing-a-long with all her house friends. Heartfelt hopes were renewed! As though the uncertain journey to Oz was being re-walked, genuine friends like Ray Bolger’s scarecrow provided careful planning and perfect timing for special moments to unfold. As dressing room aides of old had done, Todd and Brandia arranged Mary’s make-up, hair, and flowers so she could relive opera singing once again while caregiver Lauren and her colleagues gathered Mary’s friends to join her in the musician’s audience. While Melinda helped steady the spoon, Patsy savored a third helping of same day homemade maple nut ice cream. Orval was able to buy Valentines gifts and candy for all the ladies in his house. Erica and Nelanie delighted in eating BBQ bacon wrapped bratwurst and grilled smores with Mark and his house mates as summertime camping moments were relived. Leola brought her pen and took notes on a fun Auburn Crest geography presentation to share with her great granddaughter. Magical memories were thoughtfully recreated AND created anew! And who can travel through the uncertain and unknown path of hospice without those who could come alongside with courage to en courage? Dave led hundreds of chapel services for John and Irvina, Lloyd and Grace, Sylvia and Bill, Dale and Shirley so they could continue to sing and smile, cry and hug as they were encouraged “to run their race with endurance.” Pat read favorite Scriptures to Marilyn as the light in her

eyes slowly dimmed. For a living room full of residents, Dave spontaneously sang “What a Wonderful World” with “Satchmo” flair as Andy Rising provided golden cello accompaniment. Beth and Audrey customized Italian Sodas for residents during a music performance. Cultivating laughter and hope, nurturing with nostalgia and wisdom; refreshing with song and inspiration, these serve as courage catalysts within the walls of Assisted Living to enliven the souls within those walls to remember that there is a “Somewhere Over the Rainbow!” If indeed, “Home is Where the Heart Is” then the Tin Man’s wish for a heart was granted so he could be by Dorothy’s side during her journey through Oz to Kansas just like hundreds of caregivers’ hearts have been in North Idaho for loved ones’ journeys. If indeed, as JFK eluded to in “Profiles in Courage” that courage expounds in everyday people, then some brave lions have been present many times as North Idaho’s “Dorothys” have made it “home.” If indeed, the scarecrow’s loyal friendship and tenacity was complemented by his clinical thinking as Dorothy neared her journey’s end, then in like manner, these loving and tender skilled professionals have helped these loved ones click their heels “One More Time” so that they might know undoubtedly that there is “No

Place like Home” and when they get to their home they may look into all the faces around them and perhaps they’ll say, “And you were there, and you were there, and you were there!” as they “wake up where the clouds are far behind them.” Auburn Crest Hospice’s team of

CNAs, Doctors, Nurses, Social Workers, Chaplains, and support staff truly focus on helping patients and their families to choose to LIVE every moment and many Assisted Living communities in our Northern Idaho have teamed up with us to bring black and white into full color!

You Have a Choice! Auburn Crest Hospice has earned a reputation of doing more than is expected. Our compassionate team’s commitment to helping our patients live every moment is seen in every aspect of what we do. When choosing a hospice, choose to live every moment with Auburn Crest.

208-267-0579

6541 Main Street Bonners Ferry, ID 83805 www.AuburnCrestHospice.com

208-665-8111

1221 W. Ironwood Dr., Suite 102 Coeur d’Alene, ID 83815 www.AuburnCrestHospice.com

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Crossword Branching Out Across

3 Linden tree 4 Snoop 5 Flowering trees 6 Itsy-bitsy bits 7 Bullfight bull 8 Witnessed 9 ___ Cruces, N.M. 10 Quaking tree 11 Poseidonâ&#x20AC;&#x2122;s mother 12 Small change 13 Presidential inits. 21 Health org. 22 Computer insert 27 Cry out for 29 Psychic power 30 Seed coverings 31 Unadulterated 32 Fir with red-brown bark 33 Hindu princess 34 March date 35 Paul Bunyanâ&#x20AC;&#x2122;s ox

Wise Guide | Spring/Summer 2019

1 Rainbows 5 Caresses 9 Tough, durable conifer 14 Aerial maneuver 15 Plains tribe 16 Deciduous timber trees whose wood is used for baseball bats 17 Obligation 18 Sweat source 19 All tuckered out 20 Compass pt. 21 Small bushy tree native to Asia and North Africa 23 Have a bite 24 Early touring car 25 More, in Madrid 26 Vacation spot 28 Within earshot 30 Church niche 32 Hindu title 35 Fiddle sticks 37 Christmas evergreen 39 Scoundrel 40 Take as oneâ&#x20AC;&#x2122;s own 42 Make known 43 Pilotless plane 45 Life story 46 Hair curler 49 Elevator man 50 Cricket wicket 51 Schools of thought 52 â&#x20AC;&#x153;Paradise Lost,â&#x20AC;? e.g. 54 Our sun 55 Summertime in Colo. 56 Store posting (Abbr.) 59 Beaverâ&#x20AC;&#x2122;s work 61 Canadian capital 64 Lulu 65 Carpet slippers 67 Buckeyeâ&#x20AC;&#x2122;s home 68 â&#x20AC;&#x153;See you later!â&#x20AC;? 69 Orchard tree 70 Nevada city 71 â&#x20AC;&#x153;Iâ&#x20AC;&#x2122;m ___ your tricks!â&#x20AC;? 72 Electrical pioneer Nikola 73 Gave the once-over 74 Maple dropping Down 1 Birch relative 2 Awaken

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 66

36 Norse war god 38 Tree with branchless trunk 41 Threesome 44 King of France 47 Capital on a fjord 48 Giant sequoia 53 Educ. group 54 Common sense? 55 Pine Tree State 57 Rodeo rope 58 Parody 59 Hoodwink 60 Mont Blanc locale 62 Raced 63 He and she 65 Yoga class need 66 Mermaidâ&#x20AC;&#x2122;s home 68 USMC rank

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Do You Remember?

by Tina Mouser, Executive Director The Renaissance Assisted Living

ave you ever walked into a room and wondered, “What did I come in here to do?” Memory loss happens to us all from time to time. However, memory loss that affects our activities of daily living is an entirely different matter and can be traumatic. Different diagnoses and prognoses can be associated with memory loss. A person experiencing the effects of memory loss will develop increasing needs for assistance with everyday tasks. Think about it, you’ve probably known someone who has experienced memory loss of some sort. Do you remember?

TOGETHER, WE CAN END ALZHEIMER’S.

COEUR D’ALENE - 9/28 SPOKANE - 10/5 JOIN THE FIGHT: alz.org/walk Thank you to The Wise Guide for being a 2019 Media Sponsor!

Wise Guide | Spring/Summer 2019

Activities of daily living can become difficult to perform as we age, but for an individual with memory loss accomplishing those tasks may become impossible without help. They may not re-member the simplest things such as putting on clean clothes, taking their medication appropriate-ly, or even eating. Caring for a person with memory loss can become all-consuming, but it doesn’t have to be, there is assistance. Memory Care and Assisted Living communities focus on the specific needs of those with memory deficits. According to the Alzheimer’s Association, every 65 seconds someone in the United States de-velops Alzheimer’s, and by the year 2050 the estimated number of people with Alzheimer’s will be nearing 14 million. We cannot ignore these facts! Now is the time to learn about Memory Care and the communities available. When you are dealing with memory loss, take the initial step to seek out a doctor who can make an accurate diagnosis, determine the level of cognition, and provide treatment for you or your loved one’s specific needs. Knowledge is the key to making the best decisions throughout this process, especially when selecting the type of community that will fit the needs for each person involved. Memory Care or Assisted Living communities differ. There are options to consider regarding the types of communities you may select to care for your loved one, or even for your own future needs. You want to be assured that the memory care community or assisted living community chosen is the best fit, and that they will help you during this time of transition. The Renaissance at Coeur d’Alene is a memory care community intentionally designed to care for individuals with memory deficits. Specialized and on-going training is provided to the staff for patients with Alzheimer’s disease and the many other types of dementia or memory issues that can occur. They focus on meeting the individual “in their reality” while providing a safe en-vironment that is both comforting and as structured as possible. In both Memory Care and Assisted Living communities individual needs are carefully assessed to assure that a care plan is tailored to the needs of each individual. The basic activities of daily living will be addressed and assisted with as needed. Assistance with medications, bathing, toi-leting, laundry, social activities for emotional well-being and meals

will be provided in most long term care communities. Often a memory care community will have a mixed population due to the fact that individuals decline cognitively at different rates and degrees. Aging is inevitable. We are all getting older each day so be prepared, if not for yourself then for a loved one or a friend. Staying actively engaged and socializing helps one’s mind. If you do not remember why you walked into that room, go back to what you were initially doing and the thought usually returns. Do you remember?

________________________________________________________ Tina Mouser, Executive Director of The Renaissance at Coeur d’Alene, has been providing healthcare services for over twenty years. Tina holds a Bachelor’s Degree in Social Work from Lewis Clark State College and is a Licensed Social Worker and Licensed Assisted Living Facility Administrator. Caring for the aged has been her focus for many years and she is an active community participant advocating for the dignity and respect for those she serves.

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Alzheimer’s Association Support Groups

6 Tips for Approaching Alzheimer’s

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. TELEPHONE

24/7 HELPLINE: 800-272-3900

ONLINE 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! IDAHO PANHANDLE

• 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 208-660-2030 • St. George’s Parish Hall 2004 N. Lucas St., Post Falls 1st Wednesdays @ 2-2:30 PM Facilitators: Rosemary McDougall, RN 208-699-6060 & Ene Gaines 208-970-8471 • 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)

MEMORY CAFÉ

Who: Persons diagnosed with Alzheimer’s or related Dementia and care partners. What: A casual and FREE gathering to provide socialization, interaction and fellowship, creating a sense of belonging, well-being and confidence. • Kroc Center Café 1765 W. Golf Course Rd., Coeur d’Alene 2nd & 4th Mondays at 1:00 PM • Connie’s Café 323 Cedar Street, Sandpoint 2nd Wednesdays 10:00 AM • Skyway Café at Felts Field 6105 E. Rutter Ave., Spokane 1st & 3rd Mondays from 10:00 -11:30 AM

EARLY STAGE SOCIAL ENGAGEMENT for people with dementia & their family. Please contact Coeur d’Alene branch office to register 208-666-2996

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EASTERN WA: 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 Facilitators: Christine Ambrose, RN & Paul Dionne 509-290-1816

DEER PARK

• St. Mary’s Presentation Catholic Church 602 E. 6th St., Deer park 2nd Wednesdays @ 1:00 - 2:30 PM Facilitator: Paul J. Dionne 509-290-1816

SPOKANE SOUTH

• First Presbyterian Church 318 S. Cedar Street 3rd Tuesdays @1:30 - 3:00 PM Facilitators: Beth Priest 509-590-3965 & Norma Juarez 509-389-5458

SPOKANE VALLEY

• Spokane Valley Senior Center Center Place, Room 235 2426 N. Discovery 2nd Thursdays from 1:00-2:30 PM Facilitator: Erika Grant 509-904-82

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

by P.J. Christo, MS, RN, Outreach Coordinator Alzheimer’s Association, Coeur d’Alene

f you notice any warning signs of Alzheimer’s in yourself or someone you know, don’t ignore them. Early detection makes a world of difference, and so does the way you approach the conversation with a family member or a friend. If you notice a pattern of memory loss or behavioral issues that are affecting one’s ability to function, its essential to talk about it so they can be evaluated. The Alzheimer’s Association offers these tips: 1. Have the conversation as early as possible. Ideally, its best to talk about the Alzheimer’s warning signs with a family member or friend before they even occur, so that you can understand how someone would want you to approach them about it. However, many people aren’t planning for Alzheimer’s before it happens. If you’re noticing signs of dementia, start a conversation as soon as possible, while mental functioning is at its highest and before a crisis occurs. 2. Think about who’s best suited to initiate the conversation. There might be a certain family member, friend or trusted advisor who holds sway. Consider asking this person to step in and plan around how to have the most supportive and productive conversation. 3. Practice conversation starters. The following phrases can help broach the conversation: “Would you want me to say something if I ever noticed any changes in your behavior that worried me?”“I’ve noticed a few changes in your behavior lately, and I wanted to see if you’ve noticed these changes as well?” “Lately I’ve been considering my own long-term care plans, and I

wanted to see if you’ve done any advance planning you can share with me?” 4. Offer your support and companionship. Seeing a doctor to discuss observed warning signs of Alzheimer’s may create anxiety. Let your family member or friend know that you’re willing to accompany them to the appointment and any follow-up assessments. Offer your continuous support throughout the diagnosis process. 5. Anticipate gaps in self-awareness. It can be the case that someone showing the warning signs of Alzheimer’s is unable to recognize those signs in themselves. Be prepared to navigate confusion, denial and withdrawal, as people may not want to accept that their mental functioning is declining. 6. Recognize the conversation may not go as planned. Despite your best intentions, a family member may not be open to discussing memory or cognitive concerns. They may get angry, upset, and defensive or simply refuse to talk about it. Unless its a crisis situation, don’t force the conversation. Take a step back, regroup and revisit the subject in a week or two. If they still refuse to get help, consult their physician or the Alzheimer’s Association for strategies that may help. If you have any questions or concerns, please do not hesitate to contact the Alzheimer’s Association’s free 24/7 helpline any time, day or night: 1-800-272-3900. You may also contact the local Chapter in Coeur d’Alene for assistance at: 208-666-2996. ___________________________________________________________________

PJ Christo received a BA Education and BS Nursing from Southern Illinois University, and a MS in Physiology from the University of Arizona. PJ worked many years as an RN in hospitals, a Charge Nurse in Neurology at Letterman Army Medical Center, and ICU at the VA San Francisco. In 1997 she became employed by the Alzheimer’s Association and coordinates support groups, answers the helpline, presents educational programs, does care consultations and assists with fundraising for Alzheimer’s disease.

Caring for someone with Alzheimer’s or dementia?

You're not alone. We're here to help.

24/7 Helpline

1.800.272.3900 alzwa.org Wise Guide | www.TheWiseGuideOnline.com

Exercise is Essential!

Exercise, along with physical therapy, being on the right medication and regular visits to their doctor, allows most of my patients be able to live longer and more active lives with Parkinson’s disease than ever before!

Research is Ongoing If you are interested in participating, call Inland Northwest Research at 509-960-2818 and go to inwresearch.com/research-studies. To learn more about Dr. Aldred’s Neurological & Primary Care, Testing and Treatments go to selkirkneurology.com ______________________________________________ Dr. Aldred, co-founder of Selkirk Neurology in Spokane, is a board-certified neurologist and Fellow of the American Academy of Neurology (FAAN). He completed neurology residency at Oregon Health & Science University (OHSU), serving as neurology chief resident. He then completed an additional two-year clinical research fellowship in Parkinson’s disease and movement disorders at the Parkinson’s Disease Research, Educational, and Clinical Center (PADRECC), a collaborative program between the Portland VA and OHSU. Dr. Aldred also completed formal training in clinical research through the Human Investigators Program (HIP) at OHSU focused on design and execution of clinical trials. Dr. Aldred provides diagnosis and treatment for all neurological conditions, with a special interest in Parkinson’s disease and other movement disorders. He conducts clinical trials for a variety of neurological disorders through funding sponsored by the National Institutes of Health (NIH), Patient Centered Outcomes Research Initiative (PCORI), as well as other sources. These research activities are conducted through Inland Northwest Research, a collaboration between providers and trained staff currently integrated into the Selkirk Neurology clinic.

by Jason Aldred, MD, Fellow of the American Academy of Neurology Selkirk Neurology exercise, exercise!” These are the words I start “Exercise, every discussion with when talking to my patients

about treatment of Parkinson’s disease (PD). Sometimes I am met with surprise, relief, or often more questions about this ready-made treatment option. So what is there to know about exercise and Parkinson’s disease? Well, first of all, we must understand PD is a neurodegenerative disorder that involves the slow death of nerve cells within the brain that make the chemical dopamine. This chemical is important for many things done by the brain. For PD to occur, loss of those nerve cells that make dopamine, prevent normal movement. The results of nerve cell death in PD are slow movement, muscle stiffness, and tremor, usually on one side of the body more than the other. Low speech, decreased facial expression, tremor and slower thinking may also occur. It is crucial that a person experiencing these symptoms be seen by their doctor. They are usually referred to a general neurologist, or even a Parkinson’s neurologist like myself to have the diagnosis confirmed. Life changes from then on. The first thing I am asked by my patients when given a confirmed diagnosis is, “What can I do?” After a discussion about physical or speech therapy, and considering if any medication for PD is needed, we then move on to discussing exercise. This is often the most inspiring part of being a doctor and working with PD patients; helping them learn to live a longer more active life with the disease. Exercise has been shown, in many carefully tested research studies, to definitively improve the slowness, stiffness, and tremor associated with Parkinson’s disease. We do not yet fully understand how this happens, but we do know exercise results in increased dopamine in the brain, which improves the PD symptoms. Another thing that makes exercise so helpful for PD is that it seems to reduce inflammation thus protecting nearby dopamine nerve cells that are at risk for death from spreading PD inside the brain. There is no single exercise that has been shown to be the best. In fact nearly every carefully tested type of exercise — walking, running, boxing, dancing, Nintendo, Wii — has been

Wise Guide | Spring/Summer 2019

shown to improve movement problems associated with PD while the person continues the exercise. The benefits decrease fairly quickly after exercise is discontinued so this is why it is important to exercise often and at least moderate in intensity. I generally recommend a person with PD exercise on a daily basis for 30 minutes per day. More people seem to successfully add “exercise as medicine” to their regimen when they involve a spouse, family member, or close friend to make the activity more enjoyable. I cannot state the number of times I have seen a diagnosis of PD go from a black cloud hanging over my patient to an empowering challenge that allows them to change habits and take some control over this neurodegenerative disease. I can almost always tell which of the patients in my clinic have performed regular exercise of moderate intensity for 3-4 days per week, and even more profoundly, those who exercise 7 days a week.

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Want to start a Parkinson’s support group in your community? Contact NW Parkinson’s Social Services Manager, Sarah Winter, MSW, LICSW at 206.946.6517 or sarah@nwpf.org COEUR D’ALENE Lake City Center, 1916 N Lakewood Dive 1st Friday of the month at 1 - 2:30 pm Contact: Beth Hatcher 208.635.5243 Email: cdapsg@hotmail.com Women with Parkinson’s Affinity Apartments, 3594 N. Cederblom Street 3rd Friday at 1 pm A casual get-together. Free to people with Parkinson’s and their caregivers.

SANDPOINT Bonner General Health, Annex Conference Room, 520 N 3rd Ave. 2nd Mondays at 2 - 3:30 pm Contact: A.C. Woolnough 208.265.3325 Email: acwooly@gmail.com

SPOKANE DBS Connect Support Group - “Bionic Brain Club” For prospective or current DBS patients and families who want to learn more about DBS! Parkinson’s Resource Center, 1420 E Sprague Ave., Ste 103 3rd Thursdays at 5:30 - 7 pm Dinner sponsored by Medtronic Contact: Halle Goodwin, MSOL 509.443.3361 Email: halle@nwpf.org

Caregiver Support Group #1 Parkinson’s Resource Center | 1420 E Sprague Ave, Ste 103 4th Wednesdays at 2 - 3:30 pm Contact: Halle Goodwin, MSOL - 509.443.3361 Email: halle@nwpf.org Women Affected by PD Support Group Riverview Retirement, Dining Room, 1801 E Upriver Drive 1st Thursdays at 1 - 2:30 pm Bring your lunch and join this group of remarkable women living well with Parkinson’s. Contact: Sally Sullivan 509.499.5113 Email: 22sullys@gmail.com Parkinson’s Support Group Touchmark on South Hill, 2929 S Waterford Drive 3rd Wednesdays at 2:30 - 4 pm Contact: Lori McCormick 509.321.8130 Email: lori.mccormick@touchmark.com Parkinson’s Connect Location Varies Last Tuesdays at 5:30 - 8 pm For those under 55 yrs. and newly diagnosed at any age, family, and friends! Share experiences, ask questions of peers in a relaxed, unstructured fun social setting. Anyone with a Parkinson’s-like disorder is welcome. Contact: Halle Goodwin, MSOL - 509.443.3361 Email: halle@nwpf.org

Living With Restless Leg Syndrome, From Someone Who Is

by John P. Smith, LC Valley Parkinson’s Resource Center, Clarkston WA

ome of you may be asking, “What is Restless Leg Syndrome?” Or you may have never heard of it! Let me explain: Restless Leg Syndrome (RLS) is also called WillisEkbom Disease. It causes unpleasant or uncomfortable sensations in the legs and arms with an irresistible urge to move them. Symptoms commonly occur in the late afternoon or evening hours and are often more severe at night. When I’m resting such as sitting or lying in bed trying to fall asleep, or when I’m sitting for long periods of time such as taking a trip in a car or plane, or watching a movie. Symptoms can increase severely at night when trying to fall asleep. Moving my legs or getting up and walking typically relieves the discomfort, but only for a short period of time, and often recurs once trying to sit or sleep again. RLS is classified as a sleep disorder. However it is best characterized as a neurological sensory disorder because the symptoms are produced by the brain, common with people who have Parkinson’s Disease (PD). There is no cure! RLS is one of several disorders that interferes with sleep, causing exhaustion, and daytime sleepiness. As most of us are aware, interference with sleep strongly effects mood, concentration, memory, productivity, all of which can ultimately lead to depression and anxiety. RLS is estimated to affect 7 to 10 percent of the U.S. population. And for reasons yet to be determined, tends to affect

mostly women. The cause of RLS is unknown, however, like many disorders, RLS has a genetic factor. RLS indicates low levels of iron in the brain, which can also be a factor of Parkinson’s Disease. Considerable evidence suggests that RLS is related to one of the sections of the brain (called the Basal Ganglia) that uses Dopamine needed to produce muscle movement. So the relationship between PD and RLS is real and I have both. This is not to say that if you have RLS you have PD. It is common for a person with Parkinson’s Disease (PD) to have Restless Leg Syndrome (RLS), but not people with RLS to have PD. RLS appears to be related to or accompanied by the following factors: end stage of renal disease and hemodialysis, iron deficiency, use of alcohol, nicotine, caffeine, pregnancy, neuropathy (nerve damage), certain medications aggravate RLS, and sleep apnea can all trigger RLS. The relationship between RLS and PD are similar, but not exact. Children with RLS are most likely to be misdiagnosed by dismissing it as “growing pains.” Iron supplements seem to be the most effective treatment for RLS, but is not a cure. Lifestyle changes, dietary adjustments, exercise and establishing regular sleep patterns play a part in managing RLS. The Restless Legs Syndrome Foundation at www.rls.org helps provide support, education, and research for better treatments and a cure for RLS.

UPCOMING EVENTS YOU WILL WANT TO ATTEND! Check www.NWPF.org for details Follow us on Facebook! @NW Parkinson’s Foundation

HOPE® Alternative Medicine Forum August 8th – at the Spokane Southside Senior Center, 3151 E. 27th Ave., Spokane

Wise Guide | Spring/Summer 2019

2019 Walks for Parkinson’s: Coeur d’Alene, Spokane, and Kalispell Walks are being planned & teams are being organized. Check the website www. NWPF.org for the dates!

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Directory Listings Agencies & Free Referral Services

Chiropractic & Massage Therapy

Alzheimer’s Association N. Idaho Office.................................................... 208-666-2996 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.

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 800-776-9026 for more info.

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. 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. Northwest Parkinson’s Foundation.....................509-443-3361 1420 E. Sprague Ave., Ste. 103, Spokane nwpf.org We help people with Parkinson’s and their loved ones experience improvement in physical symptoms, reduction in anxiety and a clear path forward on the journey with Parkinson’s.We bridge that gap between diagnosis and cure, with the best evidence-based programming available at no or low cost. Senior Medicare Patrol................................208-667-3179 x232 Toll Free...................................................... 800-786-5536 x232 2120 Lakewood Dr., Ste. B, CdA • aaani.org We work to prevent Medicare Fraud. Volunteers like you are trained and provide community outreach to educate and inform consumers on how to prevent, detect and report Medicare fraud and abuse. Want to help? Come join us! SHIBA (Senior Health Insurance Benefits Advisors) ............................................................................. 800-247-4422 2005 Ironwood Pkwy, Ste. 143, Coeur d’Alene doi.idaho.gov/shiba SHIBA is a division of the Dept. 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 partners locations throughout Idaho.

Wise Guide | Spring/Summer 2019

Lifestyle Massage Therapy....................................208-290-7281 Offices in Sandpoint & 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. Marker Chiropractic Associates........................... 208-946-3990 204 E. Superior St., Ste 3, Sandpoint markerchiropractic.com Where the Pain stops and the healing begins. We focus on the source of your problems not the symptoms. Why suffer with pain in the low back, neck, joints, headaches, or numbness and tingling? Our goal is to keep you active and pain free. Moore Chiropractic 6843 Main St., Bonners Ferry.............................. 208-267-2506 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!

Counseling Bonner General Behavioral Health......................208-265-1090 Pinegrove Bldg., 606 N. Third Ave., Ste. 102 Sandpoint bonnergeneral.org/behavioral-health/ Bonner General Behavioral Health offers outpatient mental health services from our licensed psychologist, Dr. Joe Wassif, and psychiatric services for adults, provided by our boardcertified psychiatrist Dr. Terry Johnson. Community Cancer Services................................208-255-2301 1205 Highway 2, STE 101-B Sandpoint communitycancerservices.com Serving anyone in Bonner and Boundary counties who have been diagnosed with cancer. CCS provides financial and emotional support to patients, families and caregivers affected by cancer.

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 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.

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.

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.

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 self-determination, working collaboratively to provide outpatient, crisis, prevention and psycho education services.

Dental Camas Center Dental Clinic..................................509-447-7111 1821 W. LeClerc Rd. #1, Cusick, WA kalispeltribe.com/camas-center-clinic The Camas Center Dental Clinic offers comprehensive dental healthcare for all ages. 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 800-776-9026 for more info. Heritage Health Dental Care............................... 208-620-5250 1090 W. Park Pl., Coeur d’Alene 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!

Financial Planning & Legal

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. Edward Jones........................................................208-255-2613 Ken Wood, Financial Advisor 477100 Hwy 95, Ste.B, Sandpoint ken.wood@edwardjones.com At Edward Jones, we focus on serving the financial needs of individual investors of all ages and financial means. We have built our business by treating our clients as we would want to be treated, a simple idea that still makes sense in today’s complex marketplace.

Hearing 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.

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Directory Listings 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 General Health 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 2290 W. Prairie Ave., Coeur d’Alene • 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 & Pain Managment Axis Spine Center................................................. 208-457-4208 1641 E. Polston Ave., Ste 101, Post Falls axisspinecenter.com The region’s ONLY comprehensive spine center, owned and operated by board-certified and fellowship trained spine physicians. Dr. Kent and Dr. Jameson are committed to improving each patient’s quality of life by increasing daily functioning and empowering their patients to achieve their goals. Bonner General Health........................................208-263-1441 520 N. 3rd Ave., Sandpoint Bonner General Immediate Care........................ 208-263-0649 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 800-776-9026 for more info.

Wise Guide | Spring/Summer 2019

Heritage Health Medical Centers 1090 N. Park Pl.,Coeur d’Alene........................... 208-292-0292 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.

Selkirk Neurology................................................ 509-473-0885 610 S. Sherman, Ste. 201, Spokane WA selkirkneurology.com Providing in-clinic diagnostic, neurophysiological and laboratory testing to devise the best possible care plan for continued care and for health issues related to your neurological and preventative care diagnosis. We also conduct clinical trial research studies for neurological disorders.

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.

Boundary Community Restorium.................. 208-267-2453 6619 Kaniksu St., Bonners Ferry • boundarycountyid.us Our facility accommodates 52 residents with 24-hour care, home-cooked 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.

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.

Independent & Assisted Living, Memory Care, Adult Day Care

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! 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. The Renaissance Assisted Living, A Radiant Senior Living Community ................ 208-2664-6116 2772 W. Avanté Loop, Coeur d’Alene assistedlivingcda.com The Renaissance is a one-of-a-kind assisted living community offering excellent resident to care staff ratios 24/7 for personal care and specialized memory care services, in Coeur d’Alene. Our gorgeous French-chateau atmosphere is simply a complement to our dedication to quality-of-life. 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 Personal Care AAging Better In-Home Care Offices in CDA/Post Falls, Sandpoint, Kellogg & Spokane TOLL FREE: Idaho.............................................. 866-464-2344 Washington...........................................................844-814-8080 aagingbetter.com One of the Inland Northwest’s largest and most trusted providers of quality, affordable in-home healthcare services for seniors, veterans and the disabled of all ages. Locally owned and operated, serving all of North Idaho and Spokane Metro Area counties of Spokane, Stevens, Pend Oreille and Ferry! 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! 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!

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Directory Listings

August

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.”

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

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.

Home Health Customize your own plan today!

Let the Sun Shine!

Medicaid Accepted

www.AugustHH.com

208-664-0858

Serving North Idaho since 1994

Boundary Personal Care.......................................208-267-5070 6821 Main Street, Bonners Ferry Lisa Medeiros 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!

In-Home, In-Patient & Out-Patient Skilled

Boundary Personal Care (a division of August Home Health)

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

Customize your own plan today!

208-267-5070 Medicaid Accepted

Let the Sun Shine! Serving North Idaho since 1994

www.AugustHH.com

Nursing & Rehabilitation 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 speechlanguage therapies; medical social services and certified home health aid services. Covered by Medicare, Medicaid and most private insurance. 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

Wise Guide | Spring/Summer 2019

Recreation & Shopping Friends of the Scotchman Peaks Wilderness.......208-290-1281 P.O. Box 2061, Sandpoint, ID 83864 scotchmanpeaks.org The FSPW mission statement is: To protect the Scotchman Peaks for future generations through Wilderness designation, ongoing stewardship and education.

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.

Kalispel Park 370 Qlispe River Wy, Cusick, WA kalispelcasino.com Nestled along the Pend Oreille River at the foot of the Selkirk Mountains, Kalispel Casino & Market, opening this fall, located just north of Cusick, Washington, on Highway 20 (part of the International Selkirk Loop). RV Resort opening next spring/ summer. Offering locals and travelers a destination to enjoy Kalispel Hospitality at the heart of nature.

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.

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.

Valley Vista Care...................................................208-265-4514 220 S. Division, Sandpoint • valleyvista.org Offering in-patient and out-patient & in-home skilled nursing. We provide Physical, Occupational, Speech, Restorative & Aquatic Therapies for Short Term Rehab, Long Term Care & Hospice Care. Specialized care for Behavior/Dementia,TBI and Difficult to Place Residents. Secure Behavior Units.

Hospice of North Idaho Thrift Stores • honi.org 1823 N. 4th St, Coeur d’Alene..............................208-667-5128 503 E. Seltice Way #5, Post Falls..........................208-773-5076 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.

Insurance

Transportation

Spears Insurance, Inc........................................... 208-265-2026 300 Bonner Mall Way, Ste. 48, Ponderay 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!

Kaltran - Kalispel Tribal Transit ......................... 509-447-7247 72 Camas Flat Rd., Cusick, WA facebook.com/KalispelTribalTransit Routes to Kalispel Reservation, Newport, Ione, Cusick & Spokane. Wheelchair accessible buses run Monday-Thursday 7am-5pm. Call Thursday for appointments on Friday, Saturday or Monday. Suggested donation $1, Medicaid Card - free.

Real Estate Consulting

Bonners Ferry Veterinary Clinic.......................... 208-267-7502 24-Hour Emergency Available 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.

Rob Orth, Associate Broker..................................208-290-8189 Realm Partners LLC 215 Cedar St., Sandpoint If you or a family member in Bonner or Kootenai Counties are considering a home sale and would like a free in-home decision-making consultation, with absolutely no obligation, please call me. I’ve helped many seniors with the options they are weighing. Recreation & Shopping

Veterinary & Animal Care

Bonners Ferry Veterinary Clinic

Complete Veterinary Services for Small & Large Animals

208-267-7502

24-HOUR EMERGENCY

Roland H. Hall, DVM Chad A. Burt, DVM Jill Lang, DVM

8:30-5:00 Mon-Fri 8:30-1:00 Sat In-Office & Farm Calls

6657 MAIN STREET • BONNERS FERRY

“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

208-818-2150 Wise Guide | www.TheWiseGuideOnline.com

Run It By Tamara

Confused About In-Home Care? Home HEALTH CARE

PERSONAL Home Care

by Tamara Jacobson, Compassionate Care Referral Services

â&#x20AC;˘ Doctorâ&#x20AC;&#x2122;s order required

â&#x20AC;˘ No doctorâ&#x20AC;&#x2122;s order required usually

â&#x20AC;˘ Some private insurance

â&#x20AC;˘ Medicaid

â&#x20AC;˘ Some private insurance (insurance assessment is required) â&#x20AC;˘ Long term care insurance â&#x20AC;˘ Medicaid (must qualify first and a nurse is sent to provide assessment)

â&#x20AC;˘ Short term for medical recovery wound treatment, medication administration and/or infusions, therapies.

â&#x20AC;˘ Term is longer - can be lifetime. Assistance with laundry, meals, housekeeping, medication prep, transportation.

â&#x20AC;˘ Performed by nurses, physical, occupational and speech therapists, CNAs

â&#x20AC;˘ Performed by CNAs or caregivers

â&#x20AC;˘ Medicare (60 days) â&#x20AC;˘ Medicare HMOâ&#x20AC;&#x2122;s

Any Pie Contest September 11th Judging at 2:30

Panel of Judges - Great Prizes! 1st 2nd & 3rd Place Winners

Make ANY pie and bring it to Life Care in Sandpoint for the judging on the 11th. Andâ&#x20AC;Śenjoy eating some fabulous pie when the judging is over!

Crossword and Sudoku Answers Puzzles on pages 50-51

$ / ' ( 5

5 2 8 6 (

% $ % (

2 ' , 1

& 2 7 7 2 1 : 2 2 '

' $ 0 8 / $ 3 3 7 ( 6

6 3 <

3 2 3 $ / 0 $ ( $ 5 6 6 3 7 5 2 , 6 6 2 / 0 2 ( 6 / ( / $

Wise Guide | Spring/Summer 2019

$ 7 2 0 6 3 $ / 0 7 2 5 (

7 2 5 2 $ 5 , / 6 7 + ( <

6 ( ( 1 ' , 3 6 8 & 5 ( 5 ( 0 ' $ : , 2 1 2 ( '

/ $ 5 & $ 6 + ( 6 3 ( 1 ( $ 7 1 1 ( 6 5 ( & $ ' 5 2 1 2 7 , 3 , & 7 + 5 $ 3 , & , $ 2 1 7 / ( $

+ 6 7

, ' ( 6 6 3 2 2 )

This gives the seniors time to â&#x20AC;&#x153;test it outâ&#x20AC;? as well as giving them time to become stronger physically and mentally.

From a daughter who lives out of state: â&#x20AC;&#x153;My mother is caregiver to my father who suffers from dementia and she needs surgery in a week. Is there a way, or place to help both of them?â&#x20AC;?

From a Local Senior: â&#x20AC;&#x153;Is there a way besides a taxi that I can get to my medical appointments and shop too? I am not on the bus route.â&#x20AC;?

Here are a few ways to fulfill some critical needs: 1. Find respite care for Dad while Mom is in the hospital. There are a few Assisted Living Communities equipped to handle memory care. They charge a daily rate. 2. Pick a place where Mom could join him if she needed to recover from surgery. 3. If they are able to transition home upon Momâ&#x20AC;&#x2122;s recovery, put in place some non-medical, inhome help for food preparation, shopping, bathing assistance and housekeeping until Mom is fully up to the tasks. In-Home Personal Care companies provide these services based on an hourly rate. 4. Ask yourself, â&#x20AC;&#x153;Is this the time to transition you parents to Assisted Living or Independent Living in a community that supplies transportation and meals?â&#x20AC;? Note: In Idaho, most Assisted Living or Independent Living communities have a 30-day notice policy for moving out.

â&#x20AC;˘ Comfort THE â&#x20AC;˘ Security PERFECT â&#x20AC;˘ Convenience CHOICE FOR THE HIGHEST Call us STANDARD today: IN ASSISTED LIVING

208-457-3403 www.LodgeLiving.net

Some taxi services do have a senior rate if asked. We have numerous Medical type transport services including a free shuttle to Kootenai Health appointments if planned in advance: 2448 hrs. scheduling for door to door pick up. These medical transport companies are not allowed to stop off for shopping needs. There is a local lady who has started her own business to fulfill the need of running errands or medical appointments. She offers reasonable rates, especially if most errands are

planned together. I am happy to share her contact information with youâ&#x20AC;&#x201D;just call or email me! If you would like to submit a question and â&#x20AC;&#x2DC;Run It By Tamaraâ&#x20AC;&#x2122; regarding senior day-to-day care issues, please email to: CCRS@netscape.com or call 208-660-9982. There is something so encouraging and comforting just sharing our concerns with one another. I look forward to hearing from you! â&#x20AC;&#x201D;Tamara Jacobson ___________________________________ Tamara Jacobson, a Senior Care Consultant and founder of Compassionate Care Referral Services, Inc., www. CompassionateCareReferral.com Tamara formed the company as a way to connect area seniors and services in a personal but professional manner. Straight forward comparisons are discussed to fit the individuality of her clients. Your Only Locally Owned Referral Service

A personal approach to evaluating senior care choices to fit your needs and budget. NO FEES. NO PRESSURE.

Tamara Jacobson Senior Care Consultant

(208) 660-9982

www.CompassionateCareReferral.com

Locally owned and operated

Four Convenient Communities: Welcome to a place â&#x20AC;˘ The Lodge at Riverside Harbor 1 & 2 â&#x20AC;&#x201D;52 & 58 N. Cedar Street, Post Falls, ID youâ&#x20AC;&#x2122;ll truly love to call home. â&#x20AC;˘ The Lodge at Fairway Forest 1 & 2 â&#x20AC;&#x201D;3989 & 3991 N. Player Dr., Coeur dâ&#x20AC;&#x2122;Alene, ID

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Living Safely in North Idaho

by Rob Orth, Associate Real Estate Broker Realm Partners, LLC

market and sold quickly. We had also discussed finding a place to move to and the timing of things to best transition from one home to another. Timing the home sale and new purchase was challenging but ultimately everything worked together. They moved into their new place and were living comfortably, were planning a nice vacation. About two months after the move, without warning, the husband had a severe stroke changing their lives dramatically. Fortunately he is now home and going through rehab.

n the previous edition of The Wise Guide, I discussed the process of reaching the decision point as to if or when it might be the right time to move from your family home. As we age, physical health, proximity to services, style of home and distance from family can all lead to the necessity or consideration of selling a long-time home, or making some changes within the home, for a safer and more practical living environment. I would like to share the story of two families I met last year and the significant impact the decision to move had on their lives.

Wise Guide | Spring/Summer 2019

One older couple decided it was time they moved to a single level home, preferable in an over 55 community. They had lived in their tri-level home for many years. They recognized that it was getting harder to navigate the stairs and to take care of a fairly large property. Both of them still worked part time and they were very active in the community. After getting their home ready to sell, it went on the

After the stroke, we talked about how even more difficult things would have been in the previous multi-level home. Fortunately, prior to moving, they had discussed what their future needs were as they were getting older and had the wisdom to downsize their lives to make things easier. After the stroke, we talked about how even more difficult things would have been in the previous multi-level home. Fortunately, prior to moving, they had discussed what their future needs were as they were getting older and had the wisdom to downsize their lives to make things easier. Now, the husband is able to be home, get in and out of the house easier as it is single level and no care of a large yard. Their thoughtful pre-planning helped them significantly when life threw them a curve ball. The second family I met lived in a rural setting on several acres of land that required a great deal of work. The home was about 45 minutes from Coeur dâ&#x20AC;&#x2122;Alene and the hospital. In our early conversations about potentially moving, we discussed the family needs, challenges they were facing and what might be a better setting for them. This family was a bit younger but the husband was having some health issues that were affecting their ability to care for the home and property. They ultimately decided to sell their home and downsize things, moving closer to the city center. Their home sold quickly and they chose to rent in CdA for a while before choosing where they might like to purchase a home. Last month, the husband had a severe heart attack while at home. He was rushed to the hospital where he received immediate care. He survived, is at home and in full recovery. One of the comments during all of this that really stuck with them was from one of the rescue workers who responded that day. He told them that if they had lived much further away from prompt medical services, he likely would not have survived the event. They were very thankful for their decision to make the move when they did given their concerns at that time and specific family needs.

Why are these two stories important? Both of these families didnâ&#x20AC;&#x2122;t know what the future held for them but they did know their living situations needed to change. The families were able to choose a new home and move with control over what was happening. Should a major health event occur in any of our lives, having to add a move into the mix becomes much more of a challenge. Obviously, none of us has a crystal ball but doing some thoughtful planning about our future living situation is wise and can save other family members having to make those decisions for us. This may mean making some in-home changes or moving to a location that makes more sense for your familyâ&#x20AC;&#x2122;s longer term well-being. _________________________________________________________________

Rob Orth is an Idaho Associate Real Estate Broker (AB43313) with Realm Partners, LLC. He is very active in the community serving on the boards of the North Idaho Crisis Center and ElderHelp of North Idaho. He previously worked as a non-profit executive director providing in-home outreach services to seniors and consulting services for collaborative senior housing opportunities. If you or a family member in Bonner or Kootenai Counties are considering a home sale and would like a free in-home decision-making consultation, with absolutely no obligation, please call Rob at 208-290-8189.

215 Cedar St., Sandpoint www.roborth.com Facebook - Living North Idaho License Number AB 43313

Rob Orth

Associate Broker

Office: 208-255-7772 Cell: 208-290-8189

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Senior Centers Are NOT for “Old” People! by Jan Noyes, Associate Ombudsman Area Agency on Aging of North Idaho

ld” is a relative term. It’s true, senior centers are for people 60 and above and you’ll see a lot of gray hair, but that’s where the concept of “old” stops. For those who are active and engaged, or want to be, senior centers offer opportunities for socializing, participating in enjoyable activities, conversation, and laughter. There’s no age limit on any of that! Socialization is important to the quality of life and health for people of all ages. Much of life is spent interacting with others, in school, at work, in church, with family and friends, raising children, and in the community. As we age, life changes may alter how we socialize, decrease how we socialize or, for some people, if they socialize at all.

“

Wise Guide | Spring/Summer 2019

Physical and psychological well-being may depend on how well we make those transitions to new ways of interacting with others. The people who spend time at a senior center are there to continue being actively engaged in life. Consistent social interactions help keep people mentally, physically and emotionally fit. Developing various positive sources of social support…at senior centers for instance… can reduce stress, ward off anxiety and depression, and reduce the risk of some physical health concerns. In other words, socializing is good for you. Senior centers provide opportunities for enjoyment: getting together for conversation, activities, and often a meal. Depending on the center, activities may include cards, games, art classes, dancing, pool, exercise, quilting, computer instruction, and yoga to name just a few. Whatever is offered, there is always the opportunity to have a cup of tea or coffee and interact with others. Keeping a senior center going with all its activities is a big job, and the end result is inspiring. Much of the work is often done by loyal volunteers. Give them a big “Thank You!” when you see them and, if you have some time, offer to help. Volunteering is not only a way to give of yourself to assist

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



Aging & Disability Resource Center  Resource Information & Referrals  Long Term Care Ombudsman  Adult Protection Services



     

Family Caregiver Support Programs In-Home Support Services Community Support Services Long Term Options Counseling Medicare Fraud Education Medicare “Extra Help” Care Transitions from Hospital to Home

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

others, it is a healthful thing to do. Volunteering helps maintain and improve mental and physical health. It is well documented that volunteers have fewer health issues and maintain a sense of purpose and improved quality to their lives. Here are some facts to consider: The percentage of the U.S. population 65+ years of age is expected to increase by nearly 60% during the next four decades according to Work and Retirement Figures, published by the Urban Institute of Washington, D.C. More attention will be focused on the older adults in our society as they age, and how to maintain a healthy and engaging lifestyle. Active senior centers are a big part of that equation. Even though aging may present challenges, most older adults live active, healthy lives. How do they do it? Keeping engaged is key… learning, participating in meaningful activities, interacting with others…all the opportunities that can be offered at senior centers. Some senior centers offer meals. The Area Agency on Aging helps fund many senior centers throughout North Idaho to provide nutritious meals. The funding comes from federal and state grants and is seed money to help towards the cost of the meals. The objective is to provide anyone, aged 60 or older, nutritious meals, regardless of whether they can contribute towards the cost of the meal or not. Senior centers are restricted from charging for meals, but they can ask for a “suggested donation” to help offset the costs.

Senior donations usually are in the range of $4-5, but its up to the person receiving the meal to donate or not, or how much. The senior centers rely on these contributions from participants to help pay for the program. Fund-raising is also a source of money, but is never enough. Donations from individuals and businesses are a blessing and gratefully accepted. At a recent noon meal at a senior center, a group of seniors sharing a table talked about why they spend time there. “Pinochle!” “Line dancing!” “The meals!” Everyone at the table enthusiastically voiced a favorite activity they enjoyed, but when asked what the main thing is that keeps them coming back, everyone agreed that it was mainly the people… spending time with friends, making new friends, and sharing time and interests with others. Sure, the meals are a big attraction, and the activities are fun, but it’s the people that make the centers so special. For information on senior centers near you, contact the Area Agency on Aging of North Idaho at 208-667-3179 or 800-786-5536. ___________________________________________________________________

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.

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“I have chronic lower back pain from years of hard work and the laser calms the inflammation and helps greatly.” —Justus K. “I had laser right after getting a cut on my finger from work which healed my finger phenomenally!”. —Duncan F. “I had a hip replaced 2 years ago which changed my leg length, and my lower back never stopped hurting until I tried laser treatment. I walked in with pain, walked out pain-free.” —Richard W. Call today to schedule your complimentary first treatment: 208-267-2506 ___________________________________________________________________

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. 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. Through his own personal experience with laser therapy, he chose to bring this treatment to his patients.

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In Pain? Try Laser Treatment!

Audiology Research Associates

by Daniel Moore, D.C., Moore Chiropractic

lass IV laser therapy is a non-invasive, highly effective form of treatment for deep tissue healing. It is simply faster than modalities like ultrasound, and is a safe and effective alternative to drugs and surgery. “I traveled to Boise seeking Class IV Laser therapy because 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, I wanted to share it with my patients.”— Dr. Daniel L. Moore, D.C.

Wise Guide | Spring/Summer 2019

Since we began providing the LightForce Class IV Laser, we have had great success helping patients alleviate pain and accelerate recovery from a wide variety of acute and chronic issues such as arthritis, tendonitis, neuropathy and plantar fasciitis. Knee, hip, neck and back pain have also been shown to respond extremely well to treatment.

From our patients…. “I have plantar fasciitis and laser treatment helped with the inflammation and pain level.The laser has helped me stay active and keeps me working!”—Sharon C. “I used to get injections in both feet to treat my acute arthritis. After the first laser treatment, the pain dropped by 50%. Now.I am just getting laser treatment once a week, which seems to work well for me.” —Pete W.

since 1977

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What is Congestive Heart Failure?

by Michael Meza, MD

ailure is such a harsh word and when it comes to your heart, it can be devastating, but it doesn’t have to be. Congestive Heart Failure (CHF) is a very common diagnosis many people live with, but with a better understanding and good self-care, you can avoid the pitfalls and exacerbations, which can otherwise seem like a revolving door to the healthcare world. CHF can be caused by years of high blood pressure, coronary heart disease, valve disease, diabetes, toxins such as alcohol or drugs and even some viruses. CHF comes in many forms and stages, but simply means the heart is not pumping as efficiently as it should. This causes fluid in our body to accumulate in areas it shouldn’t be, most commonly in the form of edema or swelling of the legs, but also in the lungs which makes it much harder to breathe. Symptoms of CHF can include shortness of breath, chronic cough, leg swelling, and difficulty laying flat which also triggers shortness of breath.

Treatment of CHF typically includes medications such as diuretics or water pills. These medications help the kidneys remove excess fluid from the body and decrease the edema and/or help one breathe easier. Other medications include certain blood pressure medicines, which help the heart pump more efficiently. These include Ace Inhibitors and Beta Blockers. One of the most important things you can do to avoid CHF exacerbations is reduce your overall salt intake. Salt comes in many forms, most of which you may not even recognize. It’s much more than the shaker on the table. It sneaks into your diet in the form of preservatives, especially in canned goods, soups, chips and other pro-cessed foods. How do you protect yourself? Read the label on all purchased foods and look for the sodium content. The best way to avoid salt is to cook with fresh unprocessed meats, fish and vegetables. Remember, if you have CHF, utilize a low salt diet, frequently check your weight, blood pressure and pulse and record this information to review with your healthcare provider at each visit. Its imperative to follow your weight very closely as this will tell you how much water weight you have gained or lost during the ongoing treatment phase of the disease process. Anyone diagnosed with CHF may be asked to attend a CHF clinic. This offers educa-ional information to help you take better care of yourself and avoid unnecessary complications and hospitalizations. As with any disease process, the more you learn, the better off you will be. Take charge of your life! ___________________________________________________________________

Dr. Meza graduated medical school from the University of Texas Southwestern in Dallas, Texas in 1993, followed by Family Practice residency at John Peter Smith Hospital in Forth Worth. After graduation he moved to Orofino, Idaho and enjoyed 16 years practicing full spectrum family medicine, providing care in the clinic, hospital, emergency department and Skilled Nursing Facility. He also provided obstetrical care, including cesarean sections, and performed colonoscopies and EGDs for his patients. He and his wife Casey moved to Coeur d’Alene in January 2012 and began focusing on care for the elderly. He enjoys seeing residents of “the greatest generation” in the Post Acute Care facilities, Skilled Nursing facilities, and Assisted Living facilities where they live, and building a health care team to support their needs. He works collaboratively with Kootenai Health through the Community Partners group to insure a smooth transition of care for patients discharged from the hospital to these types of facilities. Dr. Meza has also joined forces with Heritage Health as the Director of the Post Acute Care department. He is excited to participate in the mission Heritage Health has set forth for our communities.

Wise Guide | Spring/Summer 2019

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Medications and Aging —Keep This Close at Hand! They may cause many side effects in older adults, including confusion, drowsiness, blurred vision, difficulty urinating, dry mouth and constipation. Safer medications are available. by Brian Auer, Pharmacy Manager Owl Pharmacies

There are physiological changes that occur as a person ages which can increase the risk of adverse reactions from certain medications. Changes like decreased renal function, decreased hepatic metabolism in the liver, reduced gastrointestinal absorption, and changes in fat/ water distribution can increase the time medications remain in the body. The “Beer’s Criteria for Potentially Inappropriate Medication Use in Older Adults,” often referred to as the “Beer’s List,” has been an important resource for preventing adverse outcomes of medication use in the elderly population since it was first published in the Archives of Internal Medicine in 1991. It serves as a guideline for practitioners and pharmacists of medications to avoid in prescribing decisions. The list of medications has been updated several times, most recently in 2015. The “Beer’s List” is meant to be a guideline and not to override professional judgement. If a person is taking a medication on the list, it does not mean it is inappropriate for them. One person may respond differently to a medication than another, and that is why the panel of experts that review and update the criteria use the phrase “potentially inappropriate.” Never stop taking medications without first checking with your healthcare provider. Following is a summary of the “Beer’s List” medications:

Antihistamines (typically prescribed for allergies, hives and eczema) • Brompheniramine • Chlorpheniramine • Clemastine • Cyproheptadine • Dexbrompheniramine • Dexchlorpheniramine • Diphenhydramine (oral) • Doxylamine • Hydroxyzine • Promethazine • Triprolidine

Wise Guide | Spring/Summer 2019

Antiparkinsonian (prescribed for Parkinson’s disease and other health problems) • Benztropine (oral) • Trihexyphenidyl There are other medications that are usually more effective for Parkinson’s disease and related disorders than these. These drugs should not be used for other conditions, like treating side effects of other medications, for example the movement side effects of antipsychotic medications.

Antispasmodic Medications (prescribed to relieve cramps or spasms) • Belladonna alkaloids • Clidinium-chlordiazepoxide • Dicyclomine • Hyoscyamine • Scopolamine

Nitrofurantoin (an antibacterial drug prescribed for urinary tract infections) This drug may cause side effects that affect the lungs. Safer medications are available.

dangerous side effects. Older patients with kidney problems are at particular risk of side effects.

Spironolactone (at doses higher than 25 milligrams daily). In people with heart failure, higher doses may boost risks of high potassium levels.

Tertiary Tricyclic Antidepressants (alone or in

• Clidinium-chlordiazepoxide • Clonazepam • Diazepam • Flurazepam Older adults are especially sensitive to these medications. These drugs may increase risks of mental decline, delirium, falls, fractures, and car accidents in older adults. Despite these risks, they may be appropriate, in certain cases, for treating seizures, certain sleep disorders, anxiety disorders, withdrawal from benzodiazepine drugs and alcohol, and end-of-life care.

Alpha1 Blockers (drugs for the prostate but also prescribed for high blood pressure) • Doxazosin • Prazosin • Terazosin These drugs can cause a drop in blood pressure and dizziness when you stand up. This can lead to falls. Alternative treatments provide better results with lower risks.

combination) • Amitriptyline • Chlordiazepoxide-amitriptyline • Clomipramine • Doxepin at doses of more than 6 milligrams per day • Imipramine • Perphenazine-amitriptyline Potential side effects include: confusion, drowsiness, blurred vision, difficulty urinating, dry mouth and constipation in older adults. They can also cause a drop in blood pressure and dizziness when you stand up. Safer medications are available.

Estrogens (with or without Progestins) These hormones may increase risks of breast cancer and cancer of the lining of the uterus. They don’t appear to help protect women from heart disease or loss of cognitive (thinking) ability in later life.

Medications, called Alpha Agonists (prescribed

Benzodiazepines

___________________________________________________________________

for high blood pressure) • Clonidine • Guanfacine • Methyldopa These drugs may cause a slow heartbeat and dizziness. They are not recommended for routine treatment of high blood pressure.

Short- and intermediate-acting: • Alprazolam • Estazolam • Lorazepam • Oxazepam • Temazepam • Triazolam Long-acting: • Chlorazepate • Chlordiazepoxide • Chlordiazepoxide-amitriptyline

Digoxin (at doses higher than 0.125 milligrams per day) In older patients with heart failure, higher doses appear to offer no additional benefit and may increase risks of

The complete list with explanations and recommendations can be viewed at a number of online sources including the American Geriatrics Society website: geriatricscareonline.org Brian Auer completed a BS in Pharmacy at Washington State University Cum Laude in1984. His professional profile: Lewis-Clark Pharmacy Association Continuing Education Coordinator 19861991; Idaho State Pharmacy Association Board Member 1991-95 & President 1994-95. Brian was Washington State University Pharmacy School Alumni Board Member 1995-96. Brian has been a Long Term Care Consultant Pharmacist from 1990 to present and Pharmacy Manager of Owl Southway from 1987-2019. He is affiliated with the National Association of Community Pharmacists, American Society of Consultant Pharmacists, Idaho State Pharmacists Association & Lewis-Clark Pharmacists Association.

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Tips for Talking to Your Family About Hospice Care

by Denna Grangaard, Director of Communication Hospice of North Idaho

onathan and Elizabeth’s love story began at a local soda fountain café in 1955. After 60 years, their journey has included a supportive marriage, four children and caring for each other when they each fought cancer. Their love has sustained them, and they have always been able to count on each other. Now, Elizabeth’s final journey in this life is drawing closer. Their children notice the need for additional care for both mother and father. Elizabeth is confined to her recliner in the day and to her bed at night. She struggles with painful episodes, a diminished appetite, and the trips to her doctor’s office have become a nearly insurmountable task for the couple. As Elizabeth’s symptoms progress, the children see their father’s fatigue more clearly. He is anxious and has restless nights. He carries an increased sense of responsibility for care that is beyond his capability. The children see this struggle and want to advocate for Hospice of North Idaho’s support. They are unsure how to bring up this difficult subject. As the community’s trusted, nonprofit for 38 years, Hospice suggests the following guidance to help the family start the conversation. First, recognize the difficulty in the parents accepting this support. Affirm that their situation is unfamiliar, difficult, and that they do not have to do it alone. It is important to convey that the end of life is not an event, but rather a journey. This final journey is unlike any other time in life and it deserves support. Next, convey that accepting hospice is not about giving up, nor is it just for those who are in the final moments of life. Hospice provides care through the progression of symptoms.

Wise Guide | Spring/Summer 2019

As symptoms progress, the level of care also increases. Hospice will walk alongside the family providing education and encouragement, ensuring that the family never feels alone on this journey. Assure them that Hospice of North Idaho offers a full team of specialized support. This team will learn Elizabeth’s goals and wishes for comfort, quality of life and peaceful days. Nurses visit the home regularly, manage medications, and arrange for equipment. Aides assist with personal care. Social workers provide an array of support including emotional and grief support. Additionally, every hospice family can access volunteer resources if they wish. Recognize that the fear of cost may contribute to resistance; however, Hospice of North Idaho provides care to all patients regardless of their financial circumstances. It is also important to know that Medicare and private insurance include a hospice benefit which helps alleviate financial burden. Hospice care is a patient’s right at the end of life. Consider that it never hurts to ask hospice questions. Nurses are staffed around the clock, every day of the year for questions or concerns. Start the conversation with Hospice of North Idaho, 208-772-7994. Once you are ready, you or your primary doctor can refer your loved one to Hospice of North Idaho, and a dedicated team will handle the rest. The end of life journey is unique, it can be difficult, and it is meant to be shared. Hospice strengthens the support so that families can enjoy the months, weeks, and moments to come. Call upon the experience from Hospice of North Idaho to support your family in living fully. _____________________________________________________ Hospice of North Idaho welcomed Denna Grangaard as Director of Communication in 2016. Denna worked 10-years for the State of Idaho with 7 years focused on public involvement and communication and is an Alumni of the University of Idaho. Honored to work alongside the experienced and heart-centered staff at Hospice of North Idaho, her approach is to create awareness, education, and compassion through various media channels to benefit the community.

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