Compass & Clock Spring/Summer 2018 Publication

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Navigating life today to remain independent tomorrow
&C MPASS CL CK
Are You as Good a
Driver as You Think? 40
Medicare's Role:
Admitted vs
Observation 36
Fighting an
Opponent You
Cannot See 22
Fighting an
Opponent You
Cannot See 22
Medicare's Role:
Admitted vs
Observation 36
Are You as Good a
Driver as You Think? 40
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• Elder Law
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By Carol Fisher for Compass and Clock
When you embarked upon young adulthood, you were undoubtedly eager to de-
clare your independence and reach the milestones that validated your “grown-up”
status. It was a great source of pride to earn your own income, and in turn, the free-
dom to pursue the activities you loved. Your future plans may have included moving
ahead in your career, and perhaps meeting your true love. Looking past that, you
may have aspired to marriage, children, and a home.
In the dash to autonomy, no matter your vision for the relatively near future, you
may not have appreciated the genuine need to pre-plan for the distant future. Life
became hectic. You may have seldom considered who, what, where, and how you’d
be in the fall and winter of your life. Had it crossed your mind, it was easy to dis-
miss, because middle age and retirement were decades away!
Friend, time has passed and middle age or retirement is upon you. It doesn’t matter
if you’ve followed a traditional or unconventional path. If you’ve postponed prepa-
rations for this time in your life, you’ll need dependable guidance to achieve secu-
rity and peace of mind.
Perhaps you feel confident that you’re already solidly prepared. That’s great! None-
theless, you will encounter unanticipated life events. There are solutions. That’s why
we are so proud to present Compass and Clock as your comprehensive guide to:
• Financial Planning
• Legal Guidance
• Health Care
• Housing Choices
• Leisure Pursuits
• Family Support
Don’t wait until you’re overwhelmed by illness and uncertainty. Hold on to that
independence you seized as a young adult by taking advantage of the vast services
Compass and Clock has to offer; from complex legal advice, to simple recommenda-
tions for remaining healthy and active, or enjoying a night on the town.
We’ve forged a community of compassionate professionals dedicated to your fiscal
and physical health, and that of your family. We realize it’s entirely possible you’re
making decisions for others. You may be responsible for your aged parents or a
disabled adult child, at the expense of deferring crucial arrangements to safeguard
your own future.
To that end, this guide provides references to educational tools and resources to
empower you and your family to strengthen your lives as you age. Our program is
intended to help you maintain or improve your quality of life, at any stage, regard-
less of your financial status. And should you need advice and assistance for end of
life care, our participants can provide that as well.
The Compass and Clock Westsound program is comprised of your neighbors. It has
evolved over the course of several years as a labor of love in the spirit of fellowship.
We are grateful for the support of our participants, for without them Compass and
Clock would not exist. This collection of knowledgeable and myriad resources is
designed to help you navigate your journey through middle age, retirement, and se-
nior years. Welcome to a community conceived to guide you into your best future.
WELCOME TO COMPASS AND CLOCK
Richard C. Tizzano, JD
Consultant/Advisor
Elder Law Attorney and Principal
of Sherrard McGonagle Tizzano &
Lind PS.
Specializes in Elder Law & Estate
Planning, Personal Healthcare Crisis
Management, Strategic Health
Cost Risk Mitigation, Sustainability
of Care, Guardianships, and
Adoptions.
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California State Bar Assocation
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For Christ
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Chamber
Past President, Kitsap Community
Foundation
Community educational instructor/
speaker on estate planning & elder
care issue
Published Best Selling Author:
Accidental Safari, a guide for
navigating the challenges that come
with aging. Available on www.
Amazon.com
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Cover Shot
FINANCIAL PLANNING
4 Elder Abuse and Neglect
5 Retirement by the Numbers
6 Veterans Aid and Attendance
9 The One Conversation You Should be Having
11 Baby Boomer Brain Game
12 A Plan to Help the Disabled Help Themselves
14 3 Ways to Finance Your Retirement Home
HEALTH CARE
16 50 Percent of Seniors are Diabetic
18 Medical Marijuana
20 How TCM Can Make a Lasting Difference To Your Health
22 Fighting an Opponent You Can't See
24 Physical Therapy Provides an Effective Treatment Option
for Incontinence.
26 Ringing in Your Ears May Indicate Hearing Loss
28 Help Prevent Senior Falls
HOUSING CHOICES
30 7 Factors to Consider When Choosing a Home to Retire In
32 The Laws of Less
34 Taking the Scary Out of Long-Term Care
36 The Accidental Safari Begins
LEGAL GUIDANCE
38 Elder Orphans
40 Are You as Good a Driver as You Think
LEISURE PURSUITS
42 Sunday Driving
44 Tell Me a Story
46 The Benefits of Intergenerational Programming for Seniors
48 Enjoy Premier Live Entertainment in the Westsound
FAMILY SUPPORT
50 You are not Alone
52 Dave and Molly
54 Who are the Carers?
55 RESOURCE DIRECTORY
Table of Contents
We are a group of compassionate,
experienced professionals
dedicated to your well-being
and safety. Our goal is to share
knowledge, tools & resources to
educate & empower you, and help
you strengthen your quality of life
as you age.
12
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Navigating life today to remain independent tomorrow
&C MPASS CL CK

4 Spring/Summer 2018
I
f your childhood involved anticipating the next
adventures of Spider-man, the Hulk, Doctor Strange,
and any number of other comic book characters,
you likely recognize the name Stan Lee. Lee, a fixture
in the pages of comic books since he was still in his
teens and a prolific writer as well as an editor is now in
his mid-90s and still in the spotlight but not for his work.
Recently a reporter from the "Hollywood Reporter"
published an investigative article suggesting that Lee,
now worth tens of millions, is the victim of elder abuse.
Although, it is worth noting that Lee vociferously claims
differently, several people have insinuated that Lee is
physically and financially abused by one of his two children
and by numerous other hangers on. Unlike Lee, another
long-time celebrity, Mickey Rooney, spent the last few
years of his life speaking out about elder abuse and went
so far as to testify before Congress about elder abuse.
Who are the abused: Unfortunately, elders do not have
to have multimillion-dollar estates. Perhaps it is the fact
that the senior population makes up such a significant
portion of the population or perhaps because many of
them experienced a boom during their life on the main
stage, as they have become frail an epidemic of fraud and
abuse has bloomed in their path. Elder abuse exists in
every sphere of American life. You are not safe if you are
poor, rich, white, black, male, or female. You do not have
to suffer from diminished mental acuity nor poor physical
health. You simply have to have the misfortune of needing
someone else.
The National Council on Aging estimates that at least 1
in 10 Americans over the age of 60 experience abuse.
Abuse can happen anywhere. It can happen while you
live at home, in a retirement community or with a family
member. Every year, hundreds of thousands of adults
60 and over experience abuse, neglect, or financial
exploitation from family members, medical care providers,
and caregivers. Some estimate that as many as 5 million
elders experience abuse each year. It occurs most often
with people who have diminished mental or physical
capacity and who need help with basic life needs such
as bathing, dressing and taking medicine but is also
associated with social isolation.
The Cost of Abuse: People experiencing abuse have a 300
percent higher risk of death than those who have not been
mistreated. It costs older Americans $36.5 billion each year
and that number is likely underreported.
What can be done: Most states have laws specific to
vulnerable populations including for those whose main
vulnerability is their age. If you believe someone is in
immediate, life-threatening danger call 911. For other
types of abuse, contact Adult Protective Services, Long
Term Care Ombudsman program, or the police. (see
directory listings)
Preventing elder abuse: The simplest method for staying
safe as you age is to take care of your health so you
won’t fall prey to abusers but other steps to take include:
planning for your future by getting powers of attorney
and wills drawn up before you need them, staying active
and connected in the community , knowing your rights in
your community and with any caregivers, having your own
phone, protecting yourself from scammers and taking care
of your own mail and bills.
Elder Abuse and
Neglect:
What to Look For
and How to Get
Help
Stan Lee, comic book writer and editoris at the center of a controversy
about elder abuse. Photo: Gage Skidmore

5www.compassandclock.com/
Financial Planning
I
t's been nearly a decade since the first Baby Boomers
reached retirement age and halfway through
the process experts learned a few lessons about
retirement. Boomers, in case you haven't heard,
are retiring. The number being bandied about since
prior to the time that first Boomer picked up his or her
gold watch or whatever replaced the gold watch is 10,000
a day. To put that a bit more into perspective, 4 million
Boomers will retire each year for 19 years.
The recession delayed retirement for many by wiping out
savings and impacting the value of housing but there are
other more complicated reasons that Boomers felt their
wallets constrict to the point of gasping.
There were already storm clouds suggesting that Boomer
retirement wasn't going to be all about trips to Europe
and rounds of golf. The Boomers were the first generation
to rely mainly on their own talents for planning and
saving rather than being able to look to a pension and it
shows. While more seniors than ever before are collecting
Social Security benefits (an increase from 69 percent to
84 percent), Social Security wages as anyone on Social
Security can attest is not a way to increase your earning
potential. Yet, roughly 50 percent of seniors have income
in addition to their Social Security benefits as compared
to 54 percent in 1962 according to a 2017 Investopedia
article.
In addition, low interest rates, since 2008, while generally
good for new home buyers and companies looking to
expand, are not useful for those using traditional methods
of beefing up savings while sticking to a conservative
investment strategy (such as those approaching retirement
might use) nor was the general lack of growth in income
since the '80s.
Of course there was also as mentioned before, the
recession. For many people, it wasn't simply the recession-
-it was The Recession--as in something that compared
to The Depression. The recession hit and many younger
generations struggled for several years to get a job...any
job. The result was a lot of couch surfing at mom and
dad's. While you can say that that particular situation
has improved since the economy has improved, the
Boomers are still acting as the bank. In 2013, 27 percent
of Boomers were supporting their parents and 5 percent
were supporting their children creating the wonderful
term 'sandwich generation'. Things have improved. In the
last five years, Boomers reduced their support for both
their children and their parents but now 9 percent support
grandchildren which were not in the picture at all five
years ago.
Whether or not Baby Boomers are likely to be in financial
crisis after retirement will depend largely on Baby
Boomers themselves. There is only so much that reducing
discretionary spending and working longer can accomplish.
At some point, Boomers will need to look to expert help to
improve their financial futures. But by many estimations,
Boomers have too low of savings, spent too little time
planning, and have too little understanding of the risks
they face as they age.
According to an IRI Boomer Expectation Report, “The
evidence is clear...those who have sought and obtained
help are better prepared for retirement, both by their own
assessments and by empirical measurements."
Photo by Mohammad Danish from Pexels
91%of Boomers who work with financial
professionals have savings, versus only 41
percent of those who do not.
75%of Boomers who work with financial
professionals have saved more than $100,000,
versus only 49 percent of those who do not.
52%of Boomers have not taken any action
regarding their defined contribution plans.
40%of Boomers believe that selecting investment
and insurance products, creating a financial
plan for retirement, and planning for health care and
long-term care require the help of a financial professional.
Compiled from IRI Boomer Expectation Report
Retirement by the Numbers

W
hen I sit down with a family to discuss
their need for assisted living, I always ask
them if they or a spouse served in the
military.
Often the answer is yes.
I immediately become excited because I am about to share
a wonderful secret with them--one that can make the extra
care they need possible and lift a financial burden from
their shoulders.
This well-kept secret is the Veterans Aid and Attendance
benefit.
According to data from the department of Veterans Affairs
(VA), of the country’s nearly 22 million veterans, fewer
than 122,000 veterans and 124,000 surviving spouses
receive Aid and Attendance.
Combined, that’s less than 1.2 percent.
Much of the $6 billion dollars budgeted for pension ben-
efits each year goes uncollected by those who served their
country. This money could make life so much easier for
veterans and their surviving spouses by helping to cover
the cost of senior and assisted living care.
Congress established the Aid and Attendance Pension in
1952 to provide financial assistance to wartime veterans
and their surviving spouses who lack the funds to pay for
the care they require for routine activities of daily living,
such as medication management, dressing, mobility, meal
preparation, bathing and more.
Relatives or professional staff can provide the care at
home, in an independent living facility, assisted living facil-
ity or a nursing home,
By accessing this pension, veterans can increase the funds
available to pay for care or move into the type of commu-
nity able to provide the services they need.
Veterans Aid and Attendance:
The Well-Kept SecretBy Nancy Krieg

The federal government pays this monthly pension directly
into the veteran’s or surviving spouse’s bank account and it
is completely tax free.
How Much Can Veterans Receive Every Month?
According to the American Veterans Care Connection
(AVCC), a pair of married veterans can receive Aid and At-
tendance benefits of up to $2,903 per month; a married
veteran up to $2169 per month; a single veteran could
receive up to $1,830 per month; and a surviving spouse, up
to $1,176 per month. One of the best parts of the Aid and
Attendance benefit is that the care and medical expenses
don’t need to be service related.
Eligibility Requirements
Military history: Veterans must have served 90 days active
duty with one day during a period of war; general or medi-
cal discharge is required.
Medical needs: The veteran or spouse must have physical
or mental conditions that require the assistance of another
individual on a regular basis.
Income considerations: If care expenses exceed income,
the maximum benefit will be awarded. Most individuals
receiving senior care meet this qualification.
Net worth: Assets can be no more than $80,000, however,
since allowable net worth is based on individual circum-
stances and this amount is calculated by deducting all
recurring medical expenses and costs of care from total
income, applicants with widely varying income levels may
qualify.
Surviving spouse: A spouse must have been married to the
veteran until death in order to qualify.
Preparing Your Aid And Attendance Application
Even when someone meets all the qualification require-
ments, the Aid and Attendance application must still be
completed properly. Any mistakes made at this stage could
prevent him or her from receiving benefits in a timely
manner. While you might expect a phone call to the VA
office would provide callers with accurate assistance, sadly,
it is often the opposite. According to the department’s
own data, people who call them are more likely than not
to receive incorrect information. To ensure their applica-
tions are prepared correctly, I encourage my families to
seek assistance from private companies that charge no fee
for guiding people through the process, such as Veterans
Financial (www.VeteransFinancial.com). Another resource
that my families have used with great success is Aaron
Steele (www.americanabp.com). These organizations help
with collection and completion of required documents to
help prevent a denial. All of this is helpful in shortening the
process time from application to approval.
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I work with families every day who are going through the
emotional transition to senior care, and part of my job is to
help them find the best solutions for their family. As they
enter the phase of their lives when they need extra help or
nursing care, affordability can become a concern. My first
question is not do you have any savings or did you invest
in long-term care insurance, but are you or your spouse a
veteran.
Aid and Attendance benefits can be the key factor that
enables a veteran or spouse to afford extra care or senior
living.
Whether you are a family member, a caregiver, a medical
professional or a concerned community member, find out
whether the seniors you know are veterans or surviving
spouses, and then help them get the benefits they de-
serve.
This benefit changes lives. It has become my passion to
make sure that those seniors eligible for this benefit get
the assistance they deserve.
Nancy Krieg is the community relations manager for Sinclair
Place, an assisted living community located in Sequim. She
works with families helping them to find solutions for their loved
ones when home is no longer an option. She can be reached at
(360)558-3250.
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Eligible Wartime Periods
The VA uses the following wartime periods to determine eligibility for VA Pension benefits:
•Mexican Border Period (May 9, 1916 – April 5, 1917)
•World War I (April 6, 1917 – Nov. 11, 1918)
•World War II (Dec. 7, 1941 – Dec. 31, 1946)
•Korean conflict (June 27, 1950 – Jan. 31, 1955)
•Vietnam (Feb. 28, 1961 – May 7, 1975 in the Republic of Vietnam; otherwise Aug. 5, 1964 – May 7, 1975)
•Gulf War (Aug. 2, 1990 – through a future date)
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NOTES
The riskiest financial
move is doing nothing.
Your wealth plan should keep up with the changing
circumstances of your life, as well as with the
cycles in the financial markets. A new career, a
new grandchild, a new business, a significant shift
in your portfolio—any of these events could
necessitate a fresh look at your strategy.
As Morgan Stanley Financial Advisors, we can
work with you to develop a plan and then
help you manage your investments and assets
through life’s changes. Call today to arrange an
appointment. We’ll work together to plan for
what may come.
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MAR014 CRC1988327 01/18 CS 9148636 01/18
L to R: Diane Boileau, Registered Associate;
Tiffany Timar, Senior Registered Associate;
Doug Berger; Jason Berger; Jan Morris
The Casacade Group at
Morgan Stanley
Doug Berger
Senior Vice President
Financial Advisor
Jason Berger
Associate Vice President
Financial Advisor
Jan Morris
Financial Advisor
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Silverdale, WA 98383
360-613-0212
https://fa.morganstanley.com/
thecascadegroup
thecascadegroup@morganstanley.com
Compile a list of uncomfortable hot button topics, and
no doubt health and money would be near the top of the
list. Combine the two and it’s suddenly clear why so many
people fail to lay the groundwork for financial planning
in the event of incapacity. After all, who wants to address
the difficult realities of old age or debilitating illness,
particularly as it relates to finances?
But as the oldest members of the outsized Baby Boomer
generation begin turning 70 years old, a large percentage
of the population will now be faced with these issues.
As hard as it is to swallow, old age can rob one of hard-
won independence. And at some point in time, we’ll all be
faced with the reality that we’re unable or unfit to make
important calls about finances and medical care.
Too often, though, these topics go unaddressed. In a
survey conducted by The Family Caregiver Alliance, 81% of
respondents said they think about incapacity issues, but
only 33% had acted on them. So what prevents many of us
from preparing for outcomes that, intellectually, we know
we’re all going to face?
Facing the Fear of Planning
“It’s painful for people to confront the limits of their own
mortality,” says Thomas Mierswa, an Executive Director in
Morgan Stanley’s Legal and Compliance division. For the
most part, we recoil at the thought of ceding control to the
debilitating forces of old age, so we choose not to plan for
it.
Another reason for delay is what’s has been dubbed “the
positivity effect.”
“People begin to enjoy their retirement—their ‘Golden
Years’—and they want everything to be perfect. They don’t
want to recognize unpleasantness,” Mierswa explains.
“They’re enjoying themselves, but as they’re faced with
The One Conversation
You Should be Having

Financial Planning
the onset of physical and mental limitations they begin to
feel it all slipping away, and they don’t want to address it.
It holds true whether facing one’s own incapacity or that of
a parent.”
Indeed, for today’s Boomers, denial applies not only to
themselves but to their parents as well. “They tend to
think they have all the time in the world,” says Mierswa,
“and they think it will never happen to them, and they will
never be like their parents.”
It’s a Matter of Planning—and Paperwork
Preparing for incapacity boils down to having the right
documents in place that address the need to handle
future financial and medical matters if your ability to do so
deteriorates.
More simply, it’s about identifying people you trust—while
you are still able—who can make decisions for you.
According to Rocco Procopio, Head of Field Compliance
for Morgan Stanley’s Wealth Management business, one
tool your advisor can use is an Account Disclosure and
Authorized Person Form, through which a client identifies
a person or persons who may be contacted if the client
displays certain behavior that indicates decreased capacity
for making important decisions.
The Account Disclosure and Authorized Person Form
authorizes a Financial Advisor to discuss your account with
someone you trust. The disclosure form does not authorize
that person to act on your behalf, though. That requires
designating a Power of Attorney, which gives your advisor
greater ability to work with an authorized person who can
take action on your account.
Without these documents in place, your Financial
Advisor—upon identifying diminished capacity—may
be unable to act in the event of a severe market event
or account-threatening situation. Instead, the Financial
Advisor will have to wait for the court system to establish
legal authority to act on a client’s behalf. Needless to say,
such a scenario is less than ideal: “Once we’ve learned
there is incapacity, we have to act cautiously—and
oftentimes quickly,” Procopio warns.
Take These Steps, Too
Procopio recommends identifying people that you trust to
know about your assets and other personal information.
And he stresses that planning for incapacity is not entirely
about financial assets; it’s about planning for an entire
estate, as well as for healthcare concerns.
It’s equally important to identify someone who knows
where all of your vital documentation is located—
insurance policies, bank account information, military
records, and so on—so that it’s easily accessible in a pinch.
Also, once you have identified the key individuals who
will manage your assets, make health care decisions
and administer documentation, make sure to share this
information with key family members. In many cases,
family members are hurt or surprised by the choice of a
key individual. Sharing this information early helps avoid
potential conflicts.
Finally, make sure to have all of your other documents in
place, including:
• A standard will
• A Revocable Living Trust which is a legal entity created to
hold ownership of an individual’s assets
• A Medical Power of Attorney for health care decisions
• A Living Will to state your wishes for end-of-life medical
care
• A HIPAA Authorization so a loved one can view your
medical records
• A “Durable” Power of Attorney to allow your chosen
representative to act in your place for medical care and
finances
This material has been prepared for informational purposes
only. It does not provide individually tailored investment advice.
It has been prepared without regard to the individual financial
circumstances and objectives of persons who receive it. Morgan
Stanley Smith Barney LLC (“Morgan Stanley”) recommends
that investors independently evaluate particular investments
and strategies, and encourages investors to seek the advice of
a Morgan Stanley Financial Advisor. The appropriateness of a
particular investment or strategy will depend on an investor’s
individual circumstances and objectives.
Morgan Stanley, its affiliates and Morgan Stanley Financial
Advisors and Private Wealth Advisors do not provide tax or
legal advice. Clients should consult their tax advisor for matters
involving taxation and tax planning and their attorney for matters
involving trust and estate planning and other legal matters.
© 2016 Morgan Stanley Smith Barney LLC. Member SIPC. All
rights reserved.
CRC 1554344 (7/16)
The Cascade Group, Morgan Stanley
Jan Morris, Douglas Berger, and Jason Berger
2011 NW Myhre Rd, Silverdale / 360-613-0212
https://fa.morganstanley.com/thecascadegroup/index.htm

(360) 337-5700 (800) 562-6418
www.agingkitsap.com
• Preserve and promote choice
in how individuals and
families receive long term
services and supports
• Support families in caring for
loved ones while increasing
the well-being of caregivers
• Delay or avoid the need for
more intensive Medicaid-
funded long-term services and
supports (LTSS) when possible
Aging & Long Term Care
Promoting the well-being of older adults and
assisting them in maintaining their independence.
9857 Silverdale Way NW
Silverdale
Care for Yourself...
...Care for a Loved One
• Support group options
• Resources & education
• Case manager support
• Caregiver lending library
• Caregiver respite options
• Counseling
https://spf.kitsapgov.com/hs/Pages/Aging-Landing.aspx
Presently, the early retirement age is
A) 59
B) 62
C) 65
D) 67
Which of the following statements is false?
A) The baby boomers have married later than their
parents.
B) There has been an increase in earning power
among men in the baby boomer generation.
C) The baby boomers have waited longer to have chil-
dren than their parents did.
D) The baby boomers have had fewer children than
their parents.
Which of the following social changes has contrib-
uted to the impending depletion of the trust fund that
pays Social Security?
A) the aging of the baby boom generation
B) the significant slowdown in population growth
after 1960
C) the fact that people are living longer in old age
D) All of these
When Social Security was enacted in 1935, the age
of eligibility for benefits (the normal retirement age)
was set at
A) 60
B) 62
C) 65
D) 67
Baby Boomers were born between
A.) 1946 - 1964
B.) 1944 - 1962
C.) 1945 - 1965
D.) 1943 - 1966
Baby Boomers remember phones that were
A.) Digital
B.) There were no phones
C.) Attached to the wall
D.) None of the above
At 1 a.m. or later, what was playing on your TV?
A.) Only News & Weather Shows
B.) Music Videos
C.) Reruns
D.) The National Anthem
How much was minimum wage in 1950?
A.) $0.75 per hour
B.) $1.75 per hour
C.) $2.50 per hour
D.) $5.00 per hour








Baby Boomer Brain Game
1.)B2.)B3.)D4.)C5.)A6.)C.7.)D.8.)A.
Answers

Financial Planning
D
isabled individuals are frequently dependent
on public benefits. Medicaid exists to help
with health care expenses while Supplemental
Social Security benefits help with other costs
of living such as housing, food, support, and
transportation, among other things. The average income
provided from Supplemental Social Security benefits is
less than $800 per month. To qualify for these benefits,
recipients cannot own personal assets in excess of $2,000.
This means that these individuals will not have a savings
account or emergency fund greater than $2,000.
Congress passed the “Achieving a Better Life Experience
Act”, known as ABLE, to ensure that disabled individuals
can enjoy a better life. The ABLE Act effectively changed
the $2,000 limit for many disabled persons by creating
the ABLE account (a tax advantaged savings account
for individuals with disabilities also called a 529A plan).
An ABLE account can receive deposits of up to $14,000
annually.
Access to the benefits of an ABLE account is available to
disabled persons of any age whose disability began prior
to their 26th
birthday. Until the passage of the ABLE act,
and the creation of ABLE accounts, all funds accepted by,
or used for, the disabled person would have to be reported
as income and would reduce the monthly Supplemental
Social Security payment. They would also jeopardize the
disabled person’s eligibility for Medicaid benefits. Now,
under the ABLE account, payments made for the benefit
of the disabled person do not count as income to the
beneficiary.
Under the Act, a qualified disabled individual is limited to
one ABLE account. Contributions into the account and its
subsequent investment growth are allowed to increase the
total asset balance of the account, but if the balance of the
account exceeds $100,000, distributions from the account
will be considered income and would, therefore, affect the
disabled person’s eligibility for future Supplemental Social
Security payments and Medicaid. The maximum lifetime
contribution that can be made to an ABLE account during
the lifetime of the qualified disabled person is $500,000.
Any residual balance remaining in the ABLE account at the
death of the disabled person is subject to the Medicaid
payback provisions which require that any residual assets
will be used to reimburse the Medicaid program for the
cost of services provided to the disabled person during
their lifetime.
The ABLE account is similar to the 529 Education Savings
account, and each state can establish and monitor its
own ABLE/529A program. Washington State is currently
in development of the ABLE program, but residents need
not wait. Many states that have developed 529A plans
invite nonresidents to invest in their plans. You may
contact a local investment advisor or search the internet
for the ABLE plan in the state you are interested in. Ohio
has established a popular plan. Other states offering open
national enrollment are Tennessee and Nebraska. Florida
offers accounts for Florida residents only.
Until the establishment of the ABLE account, the primary
means for establishing a fund for the benefit of a disabled
person was through an Irrevocable Special Needs Trust
or a Pooled Trust Account. The ABLE account will meet
a different need. While Special Needs Trusts and Pooled
Trusts are created for the benefit of the disabled person,
they are controlled by a Trustee and used to purchase
goods and services for the disabled person. These Trusts
are more costly to create, but they can hold larger assets.
In contrast, the ABLE account is owned and controlled by
the disabled person for the benefit of the disabled person.
A major benefit of the ABLE account is that use of the
funds for the benefit of the disabled person does not count
as income to him/her for purposes of qualifying for Social
Security or Medicaid benefits, and like a 529 Education
Plan account, the ABLE/529A account’s assets grow tax
free.
Written by Richard C. Tizzano, a Poulsbo, WA attorney. Richard
specializes in the field of Estate Planning, Elder Law and Long
Term Care Crisis Management, Strategic Care Cost Risk Mitiga-
tion and Sustainability. 360-779-5551 / www.westsoundlegal.
com
A Plan to Help the
Disabled Help Themselves
By Richard C. Tizzano

Financial Planning
14
S
tatistically, housing is the single most significant
retirement expense. This makes choosing where
to live one of the most important decisions
Americans make in retirement. What’s more, as
a lifetime recurring bill it dramatically influences
what retirees spend in other areas of their lives.
Most people feel that they will or should downsize their
home in retirement. However, many people in retirement
— in fact about 50 percent according to a recent study—
buy the same size house or larger.
When the house you can afford to buy in your desired
location causes you to downsize your expectations when
downsizing is not in your plans, financing becomes an
important and deciding factor.
Let me give you an example. Jim and Mary are both 70 and
have $200,000 in equity from the sale of their previous
home. The home they want to buy costs $400,000. So how
do they buy that $400,000 home with only $200,000 from
the sale of their previous home? They have three options.
The first option is to pay cash for the new home. They
can purchase the home outright by pulling the $200,000
difference out of their investment accounts to come up
with the full $400,000. However, they may pay taxes on the
cash coming out of the IRA as well as lose the future gains
and income from that money. On the positive side, they
will have no house payments. However, now all of that
cash is tied up in equity for the rest of their lives.
The second option is to pay 20 percent down on the
new home. That uses $80,000 of the sale price from
their previous home but now Jim and Mary have monthly
payments of principal and interest. Those costs add up to
over $580,000 in total payments over a 30-year retirement.
In this scenario, Jim and Mary build equity but doing so
greatly reduces their retirement cash flow.
The third option is a new type of reverse mortgage
insured by the Federal Housing Administration (FHA). It
is called a Home Equity Conversion Mortgage or HECM. An
HECM for Purchase, commonly called an H4P, was made
available in 2009.
The H4P is available to anyone over the age of 62 or to
couples if at least one buyer is over 62. It requires basic
credit in addition to income qualifications that are less
stringent than qualifying for a traditional mortgage.
Homebuyers need to come up with a down payment that
falls between 25 percent and 60 percent of the home’s
purchase price depending on the homebuyer’s age. The
older you are, the smaller the required down payment.
The greatest benefit to this plan is that homebuyers can
leverage their available money to buy a higher value home
and yet never pay a mortgage payment again. Under H4P,
homebuyers only pay property taxes and home insurance.
Back to Jim and Mary. The couple could use the $200,000
as their down payment at closing and the HECM loan
would fund the other $200,000. They would have no
mortgage payments for the rest of the time they lived in
the home. When Jim and Mary move out of the house
or they pass away, the proceeds of the sale of the home
would pay off the HECM mortgage balance, and any equity
left would go to Jim and Mary or their heirs.
Very important note: FHA and HUD insure The HECM
and the FHA MIP fund any shortfall in equity and Jim and
Mary’s heirs would owe nothing. This provision eliminates
all the risk of real estate price fluctuations and life
longevity.
Revisiting Jim and Mary’s options, they can:
Use the $200,000 from the proceeds of their home sale,
and buy a smaller, cheaper house in a less expensive
locale; or
Pay $400,000 cash using the $200,000 from the sale of
their home and another $200,000 from their retirement
fund and tie up all their cash in equity; or
Finance 80 percent, making mortgage payments every
month resulting in paying $660,000 over the rest of their
retirement; or
Pay $200,000 cash in a one-time down payment, finance
the balance of a $400,000 home with a HECM for Purchase
loan and never make a mortgage payment again, only pay
property taxes and insurance as long as they live in the
home.
So if you were Jim and Mary, what would be your choice?
By Joan Qvigstad, Senior Reverse Mortgage Planner
Fairway Mortgage
3 Ways to Finance Your
Retirement Home

Health Care
C
heck out this shocking number…100 million
Americans. That’s the number the Centers for
Disease Control and Prevention estimates either
have diabetes or prediabetes. If you’ve driven
down a highway, you’ve likely read a billboard
for prediabetes. The most telling part of that sign comes
from the words “Guy-stuck-in-traffic” or sometimes “Guy-
waiting-for-the-bus,” or something similar. The reason?
A large number of diabetics and prediabetics don’t know
they have the disease. If you are over the age of 65, the
likelihood that you have diabetes of one form or the other,
whether you are aware you have it or not, is nearly 50
percent.
So, what is diabetes?
Whether you eat fast food, chef created food miracles,
or something in between, your body turns the food you
eat into glucose. Glucose is a type of sugar that your body
uses to create energy. In a healthy body, that glucose
would cause the pancreas to release insulin. Insulin makes
it possible to convert that glucose into energy. However,
several things can go wrong with that system.
The most severe form of diabetes is called Type 1 Diabetes
and usually occurs in young people. Type 1 Diabetes is a
type of autoimmune disorder in which the body’s immune
system attacks the pancreas as if it were a foreign body.
• Food, friends and fun for those aged 60+ years
• Community dining meal sites serving healthy and
delicious hot meals Monday to Friday at 12pm
• Nutritious, well-balanced meals delivered to
medically-homebound individuals
• Senior Farmers Market Nutrition Program—
seasonal fresh produce program for income-
qualified seniors (June-October)
• Dietary counseling and nutrition education services
• Volunteer opportunities available
Serving
“more than a
meal”
since 1973
360-377-8511/888-877-8511
www.MealsOnWheelsKitsap.org
50 Percent of Seniors Are Diabetic:
Are You One of Them?

Health Care
Remember from up in the previous paragraph that insulin
converts glucose into energy. In Type 1 Diabetes, there
is no insulin. The sugar does not get converted. Instead,
it builds up in the body and can eventually starve the
cells depending on the glucose. Left untreated Type 1
can damage eyes, kidneys, nerves and the heart and
potentially lead to death. A small number of diabetics have
Type 1. Nearly everyone has Type 2.
Type 2 Diabetes is usually associated with older adults;
i.e., those over the age of 35. Unfortunately, a growing
number of American youth develop diabetes well before
adulthood. People with Type 2 Diabetes produce some
of their own insulin but it’s usually not enough and
sometimes the insulin acting as a key to open cells and
allow glucose to enter fails.
Prediabetes doesn’t have symptoms. But, without medical
intervention, prediabetes often becomes diabetes.
That’s why knowing whether you are diabetic or not is so
important. Diabetes and prediabetes requires a medical
diagnosis. Lab tests or imaging is always required.
You might be moving from prediabetes to diabetes if
you have increased thirst, frequent urination, fatigue, or
blurred vision.
Prediabetes is a chronic disease that can last for years
or be a lifetime disease. The bad news is that without
intervention, prediabetes is likely to become diabetes
within 10 years. The good news is that it isn’t inevitable.
A diagnosis of prediabetes can be turned around with
lifestyle changes, weight loss, and medications.
Back to those billboards. While many people know they
have diabetes, about 24 percent of those with diabetes
don’t know they have it or they don’t report it. There
are risk factors associated with it so if you are obese,
sedentary, smoke, or have high blood pressure, high
cholesterol or high blood glucose you may be aware
that you have diabetes or that you could have diabetes.
However, for many people that don’t have diabetes but
have those high risk factors it is really a matter of they
don’t have diabetes yet.
Don’t be complacent. The reason why there is such a focus
on diabetes is that people with diabetes have increased
risk of stroke, heart attack, amputation, and now scientists
link it with Alzheimer’s disease and dementia. If the secret
to avoiding some of the most insidious and heartbreaking
diseases is early detection, exercise and lifestyle changes,
then don’t you want to be in on the cure?
Improving the Lives of People
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Health Care
B
eginning in the 1990s, physicians were
encouraged to view pain as the "fifth vital
sign." As a result, they began using opioid
medications to treat pain, causing opioid use
to dramatically increase. The results were so
extreme that medical groups began requesting that the
Joint Commission re-examine pain and scrap assessments
relying on patient’s satisfaction with their own pain. It’s
not that pain receded for patients, it’s that owing to drug
manufacturers and doctors expanded use of opioids,
Americans had a far more serious problem.
Chronic pain, by definition pain that lasts for months
or even years, impairs the sufferer’s ability to function
normally. Because pain is so subjective, each person feels
a unique level of pain even in those situations of similar
conditions and levels of pain. That makes pain difficult
enough to treat but according to a 2015 report by the
National Institute of Health (NIH), more than 25 million
Americans suffer pain on a daily basis. While numbers
vary greatly, researchers estimate that 39 million US adults
experience pain on a regular basis. Those two numbers
fueled a national trend for prescription painkiller abuse
and added to an epidemic of death by painkiller and a
corresponding rise in heroin overdose. Americans with a
pain category of 3 or 4 were more likely to have a worse
health status, use more health care and suffer from more
disability according to the "Journal of Pain", a medical
journal published by the American Pain Society.
This trend has been on the national conscience for long
enough that Americans are looking for other options. A
2017 Pew Research Study found that 76 percent of the
public says that prescription drug abuse is an extremely
or very serious public health problem in America.
Complementary treatments such as acupuncture and
yoga and natural products such as cannabis, which offer
sufferers a more holistic means for controlling pain and
reducing the risk of getting addicted to painkillers are
meriting more consideration.
As an increasing number of Americans view legalizing
marijuana for recreational use, 29 states – plus the District
of Columbia, Guam and Puerto Rico – have legalized the
drug for medical purposes. That national trend towards
legalizing medical marijuana has allowed cannabis use to
leap to new levels as sufferers look to medical marijuana to
treat pain, nausea (especially from cancer treatments) and
the side effects of medical treatments as well as diseases
such as ALS, Crohn’s disease, epilepsy, MS and terminal
illness.
Medical marijuana comes in several form: oil, pill,
vaporized liquid, nasal spray, dried leaves and buds and
the plant and is used to treat disease or relieve symptoms.
Some medical marijuana provides relief with the effects
associated with recreational marijuana but many do not.
The problem at least for the short term is that for many,
the use of marijuana is associated with “getting high”
whether that’s the case or not. As a result, few studies
exist to back claims that important medical use really does
exist. Still, there are some studies beginning to do just that.
A 2011 University of California San Francisco (UCSF) study
Medical
Marijuana:
On the Frontlines
for Battling
Prescription Drug
Abuse and Pain

Health Care
Learning about the
plant with a purpose
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In 2015, more
Washingtonians died
from opioid overdose
than died from car
accidents.
suggests that a combined therapy of cannabis or medical
marijuana with an opiate treatment could reduce opiate
dosages. That's been backed up
by a recent study in the Journal
of American Medical Association
(JAMA) that found that medical
cannabis policies could prevent
opioid harm and lower opioid use
in pain sufferers. JAMA’s study
was confined to Medicare Part D
populations.
Neither JAMA nor other medical
studies recommend patients
self-medicate. Rather they
recommend having an open
discussion with your doctor about whether or not cannabis
might be the right choice for helping control pain. Which
all sounds good in theory, but researchers and physicians
complain that conflicts between state and federal law
prevent all but the thinnest scientific research.
There's a long way to go. Marijuana use remains illegal
under federal law. This often creates conflicts for doctors
looking for other options for their patients. Veterans
Administration doctors, for instance, are not allowed to
subscribe or recommend cannabis as a treatment, even in
states where medical marijuana is legal.
With the federal government
considering marijuana a Schedule 1
drug, lack of research on the benefits
of marijuana or its active ingredients
leaves patients and their physicians
without proper guidance for using
it as a treatment. Despite that
restrictive environment, the Society
for the Study of Addiction published
a report in 2016 that found that
cannabis use among adults 50 years
and older has increased significantly
in the past 50 years, a conclusion that
many both in and out of the medical field smacks of “duh.”
Still, it may very well be that aging hipster or not, Baby
Boomers who are on the whole not strangers to marijuana
may be the kick in the pants needed to allow researchers
something other than anecdotal stories to build upon
when looking for studies to back a prescription of medical
marijuana.

Health Care
F
or many of us, looking toward the future can be
both exciting and nerve-wracking. Our hopes and
dreams tend to assemble around one common
goal: staying healthy. It is no secret that the
earlier we start taking care of ourselves; the more
likely we are to experience success down the road. So how
do we maintain our vibrant selves for years to come? A
typical vision of optimal health might conjure up images
of procedures, pharmaceuticals, and even surgeries.
Traditional Chinese Medicine (TCM) offers an alternative
and effective solution to those options.
Imagine a medicine based upon real physiology derived
through anatomical study; methodically practiced by the
best minds of every generation; and proven to work in
hundreds of millions of case studies. This is the story of
TCM. This 3,000-year old medicine is no longer on the
fringes of modern healthcare; it is an integral part of its
future.
TCM, a complete medical system, diagnoses and treats
systemic diseases using herbs, acupuncture, nutrition, and
exercise. It focuses on the circulatory system. Your blood
and its vessels deliver oxygen and nutrients to the body.
Through the combined use of acupuncture and herbs, TCM
works to open and strengthen the circulatory system and
aids in calming an agitated nervous system.
Acupuncture, the physical therapy side of Chinese
Medicine is used mostly for pain relief. Hundreds of
studies around the world have proven its effectiveness
in eradicating pain. Acupuncture provides the perfect
assistance to your body because it addresses the problem
at its source. Naturally-occurring painkillers called
enkephalins re-awaken the body’s own pain-relieving
abilities. The National Institute of Health supports
acupuncture as one of the best methods of pain relief.
The largest treatment modality of TCM, by far, is herbal
therapy. For many, the use of both herbal therapy and
acupuncture is the best tactic. With over 4000 herbs in the
Chinese pharmacopeia, a typical herbal formula contains
approximately 6 to 30+ herbs.
There are many different ways that TCM can benefit your
long-lasting health, but that does not mean it supersedes
recommendations from your general practitioner (GP). One
interaction between an acupuncturist and a GP happens
when a patient’s condition changes so dramatically that
they are advised to stop taking certain medications.
TCM tackles problems before they lead to long-term
illness. As part of its commitment to outreach, the
Acupuncture & Wellness Center in Poulsbo, led by
clinic director Robert Doane, has sought to inform the
local community about TCM. In addition to one-on-one
treatments with patients, the desire for more widespread
involvement in local businesses has laid the groundwork
for some truly inspiring success stories.
Take the Benik Corporation, a Kitsap County business,
which turned to the clinic in order to help its workforce.
Recent research has shown that the psychological effects
of a stressful workday have a direct impact on our home
life habits. The more stressed we are, the more likely we
are to eat junk food. This causes poor sleep, which then
makes the next morning at work stressful... and on the
cycle goes. It affects both our personal and professional
lives. Benik Corporation President, Tim Baumgartner saw
an opportunity to combat those issues through fostering a
better working environment for everyone in his company.
“Over the course of this past year we have noticed fewer
employee doctors’ visits, reduced time off for illness, and
greater harmony in the workplace,” says Baumgartner after
his employees began treatment with the Acupuncture and
Wellness Center. “With all of this, we have noticed more
production as well.”
Not only are employees happy and healthy, but production
has increased as fewer members of staff are taking time off
to convalesce. Robert Doane’s specially designed Medical
Pulse Diagnosis (MPD) is a diagnostic technique that allows
the practitioner to assess a person’s organ health by the
many different qualities of the pulse. Acupuncturists can
learn far more than just a person’s heart rate using this
unique skill.
TCM takes a drug-free approach to tackling problems at
the root and getting rid of them for good. Robert Doane
and the staff at the Acupuncture & Wellness Center pride
themselves on addressing chronic health complaints by
discovering the real issues underlying visible symptoms
and helping patients experience what it means to have
true health.
Article by Gem Seddon courtesy of Acupuncture & Wellness
Center, Poulsbo, (360) 394-4357 / www.acupuncturewellness.net
How TCM Can Make a Lasting
Difference to Your Health
By Gem Seddon

Health Care
LIVE LIFE
PAIN FREE.By proactively controlling your health, you can be pain-free,
independent and live the life you’ve always dreamed of.
SOME OF THE CONDITIONS WE TREAT:
• Chronic Pain
• High Blood Pressure
• Neuropathy
• Depression
• Diabetes
• Memory Loss
• Fatigue
• Joint Pain
• Fibromyalgia
Call (360) 394.4357 to take the first step.
acupuncturewellness.net
18870 8th Ave NE • Suite 108 • Poulsbo, WA 98370
O
ne of the largest
C
hinese M
edical C
linics in
the U
SA
, right
in
your
backyard.

Health Care
All over the world, some of
the nation’s toughest fighters
train several times each
week.
But they don’t fight each
other; they fight a single
opponent —Parkinson’s
disease.
A
doctor diagnosed Marion County Prosecutor
Scott Newman with Parkinson’s disease at
age 40. (PD). The rapid progression of the
symptoms associated with young onset PD
impaired his ability to do his job. A friend, who
was also an attorney and a former Golden Glove boxer,
offered to teach him to box as a way to keep him moving
and combat his symptoms. At the time, Scott who was
struggling with typing and writing and needed to do both
for his job thought, “what have I got to lose?” They hung
up a heavy bag in Scott’s basement and began boxing
training. Within a few months, Scott began to see some
physical improvements and a reduction of many of his
symptoms. Other people with PD began to take notice and
wanted to do what he was doing.
PD is a progressive, incurable, neurodegenerative
movement disorder, which causes deterioration of
motor skills, balance, speech, and sensory function. The
Parkinson’s Foundation estimates there are more than 1.5
million people in the United States suffering from PD, and
more than 60,000 people receive a diagnosis of PD each
year. Experts predict that the number of people with PD
will double by 2040.
Scott founded Rock Steady Boxing (RSB) to offer classes
to people with PD and hired professional world champion
boxer Kristy Rose Follmar to teach and design the
classes. RSB held its first class in October 2006 for six
boxers. Indianapolis’ RSB was the first gym in the country
dedicated to the fight against PD. Professional boxers
condition for optimal agility, speed, muscular endurance,
accuracy, hand-eye coordination, footwork, and overall
strength to defend against and overcome opponents. At
RSB, PD is the opponent.
The RSB program existed only in Indianapolis until 2012
when Joyce Johnson joined the staff as its first full-time
Executive Director. She led the development of Training
Camp and the replication of RSB in other communities.
Johnson’s mother suffered from Parkinson’s for many
years before she passed away. According to Johnson, “I
have been blessed by an opportunity to work with an
organization that provides hope. I wish my mother could
have experienced the camaraderie and friendships that
characterize the Rock Steady experience.”
RSB’s success and associated publicity created a demand
to replicate the RSB program. The headquarters in
Indianapolis receives calls each week from people all over
the world who want an RSB program in their hometown.
Each month more than 25,000 people participate in
boxing-inspired exercises in RSB programs around the
world. Instructors adapt exercises from boxing drills and
vary them depending upon the individual’s fitness and
progression of symptoms.
Fighting an
Opponent
You Can't
See
MarcMorrison

Health Care
Putting the Needs of our Patients First
Dr. Mark Hoffman, Dr. Teresa Andersen, Dr. Brad Andersen, Dr. Charles Power
Providing the Best Quality Care
• Members-Only Relational
Primary Care (RPC) Practice
• Membership $150 Annually
• Most Insurances Accepted
• New Patients Welcome
• Founded in 2009, Independently
Owned Practice
• All 4 Physicians are local
community members
Hours of Operation:
Monday - Friday, 7:30 am - 5:00 pm
22180 Olympic College Way NW, Suite 201, Poulsbo
www.soundfamilyhealth.com
360-394-3500
RSB clients attest to, and academic institutions such as
University of Indianapolis and Purdue University, report
and document, improved quality of life – both physically
and cognitively – among RSB boxers. Their research
demonstrates that forced, intense exercise may actually be
neuroprotective, slowing the progression of the disease.
Discovery of a cure may be many years away but in the last
ten years, ample evidence exists that those participating
in the RSB program experience systematic improvement.
National Parkinson’s organizations, such as the Michael
J. Fox Foundation or National Institute of Neurological
Disorders, have invested hundreds of millions of dollars in
research to find a cause and a cure, but to date they have
been unsuccessful. It may be years before scientists find a
cure and years more before the FDA approves treatment.
People with PD need help today to maintain their quality
of life, independence, and dignity, while they wait for a
cure.
As of this writing, RSB has trained more than 1,500
coaches and established 550 affiliates in 50 states and
Puerto Rico. There are also 28 affiliate locations in
eight countries – Canada, Italy, Japan, Norway, Sweden,
Australia, Scotland, and the Netherlands.
To bring a Rock Steady program to your community, there
is a required 2-day “Training Camp” held in Indianapolis
that prepares coaches to establish RSB programs in their
home communities. Visit the Rock Steady website, www.
rocksteadyboxing.org, and click on the “Become an
Affiliate” tab, or call 317-205-9198.
Rock Steady Boxing (RSB), a 501(c) 3 nonprofit organization
founded in Indianapolis in 2006, gives people with Parkinson’s
disease (PD) hope by improving their quality of life through a
non-contact, boxing-inspired fitness curriculum. RSB’s mission is
to empower people to “fight back” against Parkinson’s disease.
The organizations big, bold vision is to provide an opportunity
for people all over the world, who are diagnosed with PD,
to participate in an RSB program in their own community.
They dream of the day when the neurologist says, “You have
Parkinson’s disease,” and follows it with, “and there’s an RSB
program in our community where you can fight back.”
To see a Rock Steady Boxing program in action, visit the Tom
Taylor YMCA Rock Steady Boxing South Sound, 10550 Harbor Hill
Drive Gig Harbor, WA 98332, 253-678-0927, http://southsound.
rsbaffiliate.
Rock Steady Boxing, Inc.
7440 N Shadeland Ave., Suite 202, Indianapolis, IN 46250
317.205.9198
www.rocksteadyboxing.org

Health Care
M
any women find the subject of
incontinence tough to broach with
their healthcare provider. Some feel
embarrassed. Others hesitate because
they believe that surgery is their only
option. To cope, they typically resign themselves to
wearing pads and limiting their activities.
“I think it’s hard for them to bring up because it’s a private
matter,” said Dr. Anita Alvestad-McIntyre, an obstetrician-
gynecologist with Kitsap OBGYN, PLLC. “As practitioners,
we try to bring this problem to light.”
Dr. Alvestad-McIntyre says the procedures addressing
incontinence or pelvic prolapse are high risk, and
frequently fail. The recurrence rate for prolapse and
incontinence is also high after those procedures, which
is why she often suggests conservative therapy to her
patients — including physical therapy.
“Physical therapy is very effective, especially if I can catch
women at an early stage,” she said. “It’s conservative
therapy for the long term to try to avoid surgery or having
to use other devices.”
Like many women with pelvic floor weakness, Melanie
Herr, 68, stopped doing many of the activities she once
enjoyed. After diagnosis, her doctor referred her to Kitsap
Physical Therapy where her treatment included stretches
to improve the function of the pelvic muscles, deep
breathing to engage the abdominal muscles, and other
techniques.
“I haven’t had to wear a pad for weeks and weeks,” Herr
said following her treatment.
Herr is so excited about her success that she now talks to
other women about it, telling them they don’t have to live
with it.
“I never thought I would discuss my bladder or pelvic floor
issues with anyone.”
Taking a holistic approach
The exact cause of incontinence may be difficult to
pinpoint because many factors can be involved. One myth
is that it is a natural occurrence for women due to giving
birth or menopause.
Weakness in the pelvic floor, poor nutrition and
dehydration, low estrogen, and even anxiety and
depression can all play a role. When patients receive
referrals to Kitsap Physical Therapy, a therapist considers
those factors before implementing a treatment plan.
Treatment plans can include stretching and other exercises,
along with strategies such as dietary change to eliminate
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Health Care
For more info visit www.KitsapPT.com or call today for your FREE consultation
Pelvic Floor Dysfunction (PFD) can be a socially embarrassing condition, causing withdrawal
from community situations and reducing your quality of life.
Bainbridge Island
(206) 842-6288
Bremerton
(360) 792-1015
Kingston
(360) 297-7050
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locations to
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• Can you only hold your bladder for 2-4 hours between emptying?
• Do you get up in the middle of the night to urinate?
• Do you leak when you cough, jump, or get out of a chair?
If you answered YES to any of these questions, ask your insurance* or
primary care provider if you can schedule with a pelvic health specialist.
*Some insurances do not require a referral from your primary care provider.
Physical Therapy is often the first line of treatment before surgery and
medication, and is effective in helping you become the boss of your
bladder.
Are You Afraid to Sneeze or Fear
"having an accident?"
irritants like caffeine and recommendations for estrogen
replacement.
KPT physical therapist Kara Bermensolo knows the problem
first hand. She suffered from incontinence as a competitive
gymnast when she was young - due to stress, poor diet,
and performance anxiety.
Now, Bermensolo specializes in treating women who have
pelvic floor dysfunction resulting in incontinence and other
problems.
She says women who undergo physical therapy need to be
patient because results take weeks, and even months.
“To change 20 years of habits in six weeks is a challenge,”
Dr. Alvestad-McIntyre says most of her patients who try
physical therapy are happy with the results.
“With physical therapy, they get a much better
understanding of how their body works,” she said. “They
can take better care of themselves in the long run.”
Kitsap Physical Therapy treats an array of pelvic health
issues such as:
• Pelvic Pain
• Incontinence (urinary and fecal)
• Constipation
• Pelvic Organ Prolapse
• Sexual Dysfunction (desire, tissue pain, vaginal dryness,
orgasm)
In cases where all other medical causes have been ruled
out and pharmacological management, general PT or
surgical management have been exhausted or proved
ineffective, a referral to a pelvic health specialist would be
a next conservative option for evaluation and treatment.
A pelvic health specialist can do a screening to determine
whether pelvic physical therapy is needed or not.
Symptoms include:
• SI Joint (hip pain)
• Sciatic pain
• Coccydynia (tail bone pain)
• Lower Back Pain (50% of women with incontinence or
low back pain have a pelvic floor dysfunction)
• Organ Pain (pelvic floor dysfunction can often feel like
organ pain)
Specialists are available at KPT’s offices in Port Orchard,
Bremerton, Silverdale, Poulsbo, and on Bainbridge Island.
For more information, visit kitsappt.com.
Written by: Kara Stadshaug, PT, DPT, CLT, PHC - Kitsap Physical
Therapy and Dr. Alvestad-McIntyre is board-certified in OB/GYN

Health Care
H
mmmm. Buzzzz. I awoke one morning and
thought a mosquito was in the room only
to discover that instead it was an incessant,
irritating noise that continues to occupy my
head ever since that first detection. While my
audiogram indicates that my hearing lies within normal
range, it certainly isn’t what it used to be and the gradual
deterioration of hearing that comes with the aging process
has left me with constant sounds in my head.
Tinnitus, commonly called ringing the in ears, is a condition
characterized by ringing, humming, buzzing, or other
noises that appear to be originating in the ear or head.
Not normally a dangerous or serious problem, tinnitus is
usually a symptom of some other underlying condition
with the most common cause being hearing loss. While
tinnitus can be extremely irritating, it rarely progresses
into a serious problem, but research has linked it to
other issues such as fatigue, stress, high blood pressure,
depression, and anxiety.
The most common cause of tinnitus has been identified as
damage to the inner ear. Tiny, delicate hairs in the inner
ear move in relation to the pressure of sound waves. This
triggers the hair cells to release an electrical signal through
a nerve from the ear to the brain and the brain interprets
these signals as sound. While hearing loss is the most
common cause of tinnitus, other common causes may
include repeated exposure to loud noise, side effects from
certain medications such as antibiotics, chemotherapy
drugs, diuretics, and aspirin taken in high doses.
Twelve million Americans have tinnitus and one million
experience it so severely it interferes with their daily
activities. The condition can have a serious effect on a
person’s quality of life, particularly in the period after the
person is initially affected.
Coping with these unsettling noises can be debilitating,
leading to anxiety and depression, loss of interest in work,
leisure activities, and relationships. Many individuals
report that tinnitus disturbs their sleep and even interferes
with their concentration. Unfortunately, other’s lack
of understanding of a condition that is not visible can
increase a person’s isolation.
Ringing in Your Ears May
Indicate Hearing Loss
Mkedzie

Health Care
Dr. Robin Fiscus
Doctor of Audiology (360) 373-2571
www.simplyhearaudiology.com
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According to the National Institute on Deafness and Other
Communication Disorders (NID-CD), tinnitus affects almost
12 percent of men and 10 percent of women aged 65 to 74
years of age.
One in ten of these are significantly troubled by the
persistent sounds in their head.
With time, the great majority of people do learn to live
with tinnitus, and have a good quality of life in spite
of it. If the tinnitus is caused by a hearing loss, hearing
aids provide relief from these irritating and sometimes
debilitating noises.
If you suffer from the effect of tinnitus the first steps
towards remediation is getting a comprehensive hearing
evaluation. If the buzz you hear is in your head call an
audiologist today. What do you have to lose, but perhaps
your hearing!
Article Written by Dr. Robin Fiscus, AuD, Doctor of Audiology
Simply Hear, 2635 Wheaton Way, Bremerton
(360) 373-2571
www.simplyhearaudiology.com
Mention this article and you will receive a complimentary
hearing screening

Housing Choices
M
inimize the risk of senior hospitalization
by reducing the risk of falls and accidents.
According to the Centers for Disease
Control and Prevention (CDC), one of
three older adults over age 65 falls each
year, but less than half will bring their accident to the
attention of a healthcare provider. Falls are the leading
cause of fatal injury and the most common cause of
nonfatal trauma-related hospital admissions among older
Americans.
“A fall is a warning sign as it is considered a symptom
of another issue,” said Dr. Carolyn Clevenger of Emory
University, president-elect of the Gerontological Advanced
Practice Nurses Association (GAPNA).
As people age they experience natural aging affects,
such as stiff joints, poor eyesight, and decreased muscle
strength along with poor balance. Natural aging along
with chronic conditions, such as cataracts, arthritis and
Parkinson’s disease, can increase their risk of falling.
Environmental changes that can limit exposure to fall risks
include:
• Removing clutter from pathways.
• Arranging furniture to make rooms easy to navigate.
• Removing or securing throw rugs.
• Encouraging the use of assistive devices to retrieve items
from high shelves.
• Using a cane when walking on uneven surfaces.
• Wearing shoes with non-slip soles.
• Avoiding walking in stocking feet on wood floors.
• Replacing traditional shoe laces with elastic ones that
won’t come untied.
• Organizing the house so items used most frequently are
at waist level in order to minimize the need to bend or
climb.
• Applying high-contrast colored tape to top and bottom
of stairs and thresholds.
• Improving the lighting in the home particularly to stair-
ways.
• Using a night light and/or leaving a light on in the bath-
room to reduce the risk of falls in the dark.
• Installing and using handrails.
• Keeping one hand free when walking to provide an op-
tion for grabbing onto a sturdy object to stop a fall.
• Minimizing distractions and remaining focused while
walking.
• Allowing plenty of time for activities and tasks.
According to the CDC, older adults can stay independent
and reduce their chances of falling if they:
Exercise regularly. One potential problem for older adults
is inactivity. Lack of exercise can lead to weak legs and this
Help Prevent Senior Falls
Juanedc

Housing Choices
increases the chances of falling. It is important that the
exercises focus on increasing leg strength and improving
balance, and that they get more challenging over time. Tai
Chi programs are especially good.
Ask their doctor or pharmacist to review their medicines—
both prescription and over-the-counter—to identify
medicines that may cause side effects or interactions such
as dizziness or drowsiness.
Have their eyes checked by an eye doctor at least once a
year and update their eyeglasses to maximize their vision.
Consider getting a pair with single vision distance lenses
for some activities such as walking outside.
To help assess the potential for falls, check out the videos
titled "Prevent Senior Falls: Assessment and Balance
Exercises", available at: https://www.caregiverstress.com/
senior-safety/prevent-hospitalizations/assessment-and-
balance-video/ which will help caregivers gauge an older
adult’s potential risk for falls and provide examples of
exercises that could help to build balance.
Article submitted by:
Brian Jackson, Owner
Home Instead Senior Care
(306)681-2511
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We are a professionally managed Community providing
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Housing Choices
A
s more and more baby boomers enter
retirement age, the question of whether or
not to sell their homes and move will become
a hot topic. In today’s housing market climate,
with low available inventory in the starter and
trade-up home categories, it makes sense to evaluate your
home’s ability to adapt to your needs in retirement.
According to the National Association of Exclusive Buyers
Agents (NAEBA), there are 7 factors that you should
consider when choosing your retirement home.
1. Affordability
“It may be easy enough to purchase your home today
but think long-term about your monthly costs. Account
for property taxes, insurance, HOA fees, utilities – all
the things that will be due whether or not you have a
mortgage on the property.”
Would moving to a complex with homeowner association
fees actually be cheaper than having to hire all the
contractors you would need to maintain your home,
lawn, etc.? Would your taxes go down significantly if you
relocated? What is your monthly income going to be like in
retirement?
2. Equity
“If you have equity in your current home, you may be able
to apply it to the purchase of your next home. Maintaining
a healthy amount of home equity gives you a source of
emergency funds to tap, via a home equity loan or reverse
mortgage.”
The equity you have in your current home may be enough
to purchase your retirement home with little to no
mortgage. Homeowners in the US gained an average of
over $14,000 in equity last year.
3. Maintenance
“As we age, our tolerance for cleaning gutters, raking
leaves and shoveling snow can go right out the window. A
condominium with low-maintenance needs can be a literal
lifesaver, if your health or physical abilities decline.”
As we mentioned earlier, would a condo with an HOA fee
be worth the added peace of mind of not having to do the
maintenance work yourself?
4. Security
“Elderly homeowners can be targets for scams or break-
ins. Living in a home with security features, such as a
manned gate house, resident-only access and a security
system can bring peace of mind.”
As scary as that thought may be, any additional security
7 Factors to Consider When
Choosing a Home to Retire In
Teri Tennyson
KITSAP SENIORS REAL ESTATE
(360) 440-6211
www.kitsapseniorsrealestate.com
“It’s about more than selling a house”
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teri@teritennyson.com  9226 Bayshore Dr. NW, #140 Silverdale, WA 98383

Housing Choices
Olympic Medical Physicians provides high-quality medical care across a range of specialties, including:
Cardiology • Family Medicine • Gastroenterology • General Surgery
Internal Medicine • Oncology • Orthopaedic Surgery • Neurology • Pediatrics
Pulmonary Medicine • Sleep Medicine • Urology • Women’s Health
Olympic Medical Physicians is a division of Olympic Medical Center. Visit olympicmedical.org for details.
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You get the gist.
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and an extra set of eyes looking out for you always adds to
peace of mind.
5. Pets
“Renting won’t do if the dog can’t come too! The
companionship of pets can provide emotional and physical
benefits.”
Evaluate all of your options when it comes to bringing
your ‘furever’ friend with you to a new home. Will there
be necessary additional deposits if you are renting or in a
condo? Is the backyard fenced in? How far are you from
your favorite veterinarian?
6. Mobility
“No one wants to picture themselves in a wheelchair or a
walker, but the home layout must be able to accommodate
limited mobility.”
Sixty is the new 40, right? People are living longer and
are more active in retirement, but that doesn’t mean that
down the road you won’t need your home to be more
accessible. Installing handrails and making sure your
hallways and doorways are wide enough may be a good
reason to look for a home that was built to accommodate
these needs.
7. Convenience
“Is the new home close to the golf course, or to shopping
and dining? Do you have amenities within easy walking
distance? This can add to home value!”
How close are you to your children and grandchildren?
Would relocating to a new area make visits with family
easier or more frequent? Beyond being close to your
favorite stores and restaurants, there are a lot of factors to
consider.
Bottom Line
When it comes to your forever home, evaluating your
current house for its ability to adapt with you as you age
can be the first step to guaranteeing your comfort in
retirement. If after considering all these factors you find
yourself curious about your options, let’s get together to
evaluate your ability to sell your house in today’s market
and get you into your dream retirement home!
“Article sourced with permission from
KeepingCurrentMatters.com”.
Article Submitted by:
Teri Tennyson, SRES, Kitsap Seniors Real Estate
360-440-6211
www.kitsapseniorsrealestate.com

Housing Choices
B
ill and Rosy sheepishly open the door to the
spare bedroom they share as an office. “It’s
not always like this,” Rosy tells me without
much conviction. Then adds with a sigh, “Well,
actually it is. I’m so embarrassed.”
Bill squeezes his wife’s hand. “She hasn’t been well and
I just can’t do what I used to.” Bill and Rosy are in their
mid-80s, living in what used to be their dream home. They
no longer feel this is the best choice for them. The office is
hip-deep in boxes accumulated over years, filled with mail,
magazines and financial documents. Yellow and pink sticky
notes dot every surface, silent reminders of unfinished
business.
They want to sell the house and move into a local
retirement community — something we now call “right-
sizing.” It means choosing to live in a space that is a good
fit based on current needs, abilities and limitations. Nice
idea. But if you have lived in a large house for years,
maybe decades, getting from here to there is a daunting
challenge. In fact, the very thought can be paralyzing.
Bill and Rosy stare balefully into the office. Bill explains,
“We keep meaning to get organized and clean it up. We
have two nice desks under all that!
Rosy laughs, “But every time we look at the mess, we
immediately feel tired and decide to take a nap!” She
shuts the door, demonstrating how to magically deal with
the problem. “Would you like some tea?”
That was five years ago. Since then, I have worked with
hundreds of older adults faced with the physical and
emotional challenges of downsizing and relocating.
Regardless of their differences, they have all had one thing
in common. They feel overwhelmed. Moving is ranked
by mental health professionals as one of the top five most
stressful life events. As we get older, the stress is even
greater. We are trying to navigate the waters of a major
life change while simultaneously dealing with declining
health, caring for an ailing spouse, or going it alone.
Here are some of the cardinal truths you’ll need to get
your train chugging down the right track. Trust me, if you
can adjust your thinking as needed, the journey will be
much smoother. Let’s start with how you think about your
stuff. Then we’ll talk about what to do with it.
Truths About Your Stuff:
It’s probably not worth what you think. With our aging
demographic, the market all across the USA is flooded
with used furniture. Thrift stores are simply not able to
accept most of what people are trying to donate. Over-
supply means less value. You may have paid $3,000 for
that Drexel dining set, but a quick peek at Craigslist will tell
you the hard truth. You’ll be lucky to sell it for 15 percent
of that.
Your kids don’t want your stuff. Breathe. It’s not
personal. It’s just that tastes have changed. Values have
changed. Today’s young adults like things mobile and
disposable and practical. So if you are holding on to stuff
because you think you’re going to pass it on, think on a
new track.
Less is more. There is a real cost associated with keeping
stuff. You have to house it, clean it, maintain it, move
it, etc. I would say that in 99 percent of the cases I have
worked on, people felt better, lighter, freer and less
stressed once they were free of the burden of maintaining
so much stuff. If you’re afraid that you’ll regret letting
something go, try putting it into storage for six months. If
you don’t miss it, let it go for good. And then get rid of the
storage unit.
Fabulous. You’ve decided to right-size. Now what? Here
are some truths about right-sizing.
Everything WILL GO into one category or another. Set up
three categories: Keep / Donate or Sell / Throw Away. For
small items, you can set up and label bins or boxes. For
large items, use color-coded sticky notes.
You must be brutal and focused. I recommend the OHIO
rule: Only Handle It Once. As soon as you handle an item,
you must decide which category it goes into. If you pick
it up, then set it aside saying, “I’ll decide later,” you’ve
started down a bad track that loops you right back to the
same overwhelming mess you’re in. If you truly must
delay the decision (let’s say you’re waiting for your son to
tell you if he wants that socket set), then start a “Pending”
bin with a clock on it. Give your children, or whomever
The Laws of Less:
Bite-size Tips to Right-Sizing
By Linda Kaahanui

Housing Choices
you are waiting for, a deadline to respond. If you find it
difficult to stay focused or make decisions, consider hiring
a professional to guide you through the process. They
can help you ask the right questions about each item that
will make the decision clearer and easier. I once arrived
at a house where the adult daughter of my client met me
at the door. “Thank God you’re here!” she exclaimed.
“We’ve been at this for two weeks and have gotten no
where.” A detached, objective professional has a way of
making things go faster. One day later, we were done.
YOU CAN DO IT, one small space at a time. Start with
something well-defined and with little emotional
attachment. Like the coat closet. Once you have FINISHED
that area, you can use the sense of accomplishment and
success to fuel your momentum to the next area. Perhaps
something a bit more challenging this time, like the kitchen
junk drawer. Remember, you are in control, not your stuff.
Don’t forget to celebrate between each success.
Options for the “Donate or Sell” Pile:
Some thrift stores will pick up, but be warned, they are
getting choosier and choosier these days.
Try alternate donees like the local women’s shelter,
homeless shelter, food bank (they often also give away
clothing and household items), libraries, organizations
holding large garage sale fundraisers like schools, churches
and clubs.
Sell it yourself online on venues such as eBay or Craigslist.
If this is outside your experience or comfort zone, ask your
grandkids for help.
Auction houses. Typically they will come and appraise your
pile of “sell” items and offer you a lump price and haul it
away. You won’t get much but hey, it’s gone.
Estate sale. Hire a reputable company to come into your
home once you have moved away and stage a house-wide
sale of all the belongings you have left behind. A well-
run estate sale usually generates considerably more than
a “garage sale” or auction house sale but there are no
guarantees. An average fee is around 40 percent of the
proceeds.
Bill and Rosy were able to carefully choose all their most
treasured possessions, move to a space that met their
needs and enjoy their new life surrounded only by what
was beautiful and meaningful to them.
Linda Kaahanui
Owner, New Season Move Management
360-774-1255
www.NewSeasonMove.com
Serving Jefferson County & surrounding area
253.906.9696
www.homesteadmove.com
It's More Than Moving...
...It's Making It Home
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Need Help Moving?
Down-sizing?
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Serving Jefferson County and Surrounding Area

Housing Choices
Taking the
scary out of
Long-Term
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• Professional
• Of Good Character
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John M. TaylorJohn M. Taylor
Your Personal Realtor®
L
ong-term care refers to hospital, nursing home
or other form of health care that takes place for
a prolonged period. The national average cost for
long-term care is over $15,000 a month. If you
consider that the average cruise for the same
amount of time would cost around $10,000 or less, the
scenery would change, the weather would improve, and
one day you could get off that boat, you can begin to
imagine the horror of long-term care.
So, how do you avoid spending the more than quarter
million dollars on average that most seniors would shell
out if they had to pay for long-term care? The most robust
option is to move into a senior retirement community
that allows your care to progress with your needs. For
instance, you might first move to the community and live
in an apartment or cottage that resembles an apartment
or housing in a mixed residential area. You live normally
and interact with the community as you see fit or as
fits your busy schedule. In such a community, you could
add services as your care needs change. Living in the
community provides an opportunity to develop long-term
relationships with other residents, provides opportunities
for travel, learning and socializing, and can offer security
without any of it impinging on your freedom.
From there we move on to Independent living.
Independent means you mostly don’t need help with
things. You prepare meals, take whatever medicines you
need if any without reminders and generally live life much
as you would if you lived in a mixed residential area with
one exception. All the services you might need, either
short-term or long-term are at your fingertips. Hate to do
laundry and housekeeping, someone can provide those
services. Want dining options for when you don’t wish to
cook, they can do it. It’s a bit like living in a hotel except
the staff know you and your friends are there as well.
In fact, you may already live in one type of independent
community if you live in a Naturally Occurring Retirement
Community (NORC).As the name implies NORCs are
not planned. They may be an apartment complex or

Housing Choices
Aging in Place and Accessibility Support
Enabling people, regardless of their level of ability
or disability, to age with dignity in the most
comfortable environment possible, their own
home.
• Enhancing accessibility
to meet current & future
physical needs
• Increasing safety &
security
• Providing customized
assessments &
modifications
• Ensuring construction
and modifications are
completed with your
health & medical needs
in mind, at the highest
possible level of quality
Building independence, one home at a time
Your Forever Home
Our Objectives:
Dr. Carrie Marcello
OTD, OTR/L, CAPS, ECHM
360-621-3341
Serving Kitsap
County and
Surrounding Areas
www.your-forever-home.com
a neighborhood street that has a significant senior
population and they generally tend to be a cost-effective
aging-in-place model. Thriving NORCs offer seniors a
vibrant lifestyle, supportive services including health
care, education, recreation, and volunteer opportunities.
Some have also added adult day care meals, home safety
improvements, financial advice, and transportation.
Assisted Living options often reside hand-in-hand with
Independent Living options. Perhaps you need help with
a shower or need medication reminders. You may simply
wish to live somewhere where you don’t have to prepare
all your meals or mow your lawn. Individuals who move
to Assisted Living communities often find their health
improves. One significant reason lies in the regular meals
and the dining options available in Assisted Living. Looking
forward to spending a meal with a friend and providing
activities that range from travel to art keeps people
engaged and active longer.
Aging-in-place means remaining where you are. You stay
in your home and allow the services you need to come
to you. You hire companions to provide basic care and
housekeeping and otherwise remain living independently.
It is a great option if you are healthy and have structures
such as transportation and nearby health and recreational
options nearby.
Adult Family Homes provide much of the care that we
associate with nursing homes of old but they allow a level
of independence that simply can’t exist in the more rule-
bound and procedure-oriented nursing home. Generally,
residents have their own room but live in a family style
structure. Help with bathing, toileting and dressing is
readily available while the norm involves family dining,
shared living areas and a small but robust staffing model
that looks more like family and friends.
Some of the horror people experience when they think
of growing older lies in not knowing the options or being
forced to make a choice on the spur of the moment. Yes,
there are expensive and luxurious living options out there
but there are also intimate, friendly, and economic options
available. The number of people who should reside in
nursing homes is actually low. Most people, including
those with severe dementia, do not require the skill
and level of care provided by a nursing home and would
find nursing home life stifling in addition to expensive.
Understanding the level of freedom you want and the
options you have will prevent you from making a costly
and unnecessary choice if you plan early and realistically.

Compass & Clock Spring/Summer 2018 Publication

Compass & Clock Spring/Summer 2018 Publication

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