If you are like 68% of grandparents, you live too far away for regular interactions with your grandchildren. No reading bedtime stories or soothing little tears. No ticklefests or hands-on projects. These casual yet meaningful activities just aren't an option.
Video visiting helps. But according to Kerry Byrne of The Long-Distance Grandparent, you can count on only about a minute of video engagement for every year of your grandchild's age.

Here are some tips for building an online relationship:

• Coordinate with the parents. Can you make life easier for them? Try reading stories over Zoom while the kids eat breakfast and the parents pack lunches.
• Plan for topics or activities. Find out from the parents what's of interest lately. Are dinosaurs a hit these days? Send dino stickers. Roar together and pretend to be T Rex.
• Be SILLY. Don't be afraid to make funny faces or do the unexpected. Remember, if you were with them in person, you'd likely be more of your playful self. Express that online: Three jumping jacks and run around the chair when they guess the correct answer in a riddle.
• Enhance your visits with props. Send them something in the mail that they can do with you the next time you video call. A tambourine. Heart-shaped Valentine's glasses. Or popcorn you can "share." (Who can catch the most popcorns with their mouth?)
• Use photos and video. Send photos of you doing silly things. Make a video of a children's activity song, like the hokey-pokey. Ask your grandchildren to sing and dance with you. Put it on YouTube so the parents can play it whenever they need a break.

See how this "gran" used Zoom and simple props to record the "Itsy Bitsy Spider" on YouTube. Now her two-year-old granddaughter frequently asks to watch "Gran videos." With this repeated exposure, Gran is a known figure and immediately recognized during FaceTime chats, even though they have met in person only three times in her granddaughter's short life. Relax and have fun. You don’t have to be polished. (This isn’t PBS!) And if you still feel self-conscious, set the videos so they are only visible by those you send the link to.

Interactive apps that might be of interest. The "Longevity Explorers," a grassroots group of tech-savvy seniors, recommends these apps for their high interactivity. The parents will need to download a version too in order for these to work.

• Readeo. (ages 2–5) With the BookChat feature, a video of each of you appears side by side above an e-book. You can read, point to images on the page, and you or your grandchild can "turn" the page.
• Caribu. (ages 4–12) This app has a library of e-books, plus puzzles and games, mazes, and sharable "paint and draw" activities.
• Playingcards.io. (age 8+) A virtual shared "tabletop" allows you to play games such as Hearts, Go Fish, and Crazy 8s. Or rummy and canasta for older kids. There are board games too, such as checkers and chess, backgammon, and cribbage.
  

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A vast majority of older adults (77%) say they want to remain in their own homes as they age. Of course! Home is comfortable: We know where everything is—in the house, and also in the neighborhood and town. Friends, doctors, grocery store. We know how to get around quickly and easily. Plus, the emotional benefits of memories, identity, and history are baked into the walls of a home.

But for many, the concept of staying put is based on how things are now and doesn't factor in the changes that are bound to come: The need for help with shopping and meal preparation, housekeeping and repairs, yardwork, and transportation. And in the very last chapters of life, assistance with personal care such as bathing, dressing, and continence issues.
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There is also the possibility of dementia (33% for persons 85 and older), which may prompt a need for help earlier than imagined. And with that, the fact of care providers coming in and out of the house.

If you plan on aging in place, it may be necessary to

• remodel your home. Very few houses are built to meet the needs of an older adult. You may need better lighting, or a bathroom downstairs. Plus, the house will continue to age and have maintenance issues.
• arrange for transportation. Most of us outlive our ability to drive by seven to ten years. Is your current home conveniently located in terms of public transportation, ride sharing, or other options? If not, you may find yourself more homebound than you want to be.
• budget for assistance. Maybe you plan to rely on your kids or friends when the time comes that you need help. Despite good intentions, they may not be available. And if you are partnered, what happens if your spouse passes before you do? How will you accomplish the things they used to handle? Paying for help gets expensive quickly, and more so as we face increasing shortages of professional caregivers.
• recognize change is inevitable. Many of the reasons you want to stay where you are, are out of your control. Friends will die or move to be closer to their kids. Doctors will retire. Stores will close. In that context, does staying put hold the same appeal?
  
  

And none of this addresses the key disadvantage of aging in place: Isolation and its companions, depression and anxiety. Twenty percent of older adults speak with three or fewer people over the course of a week. Technology and video chatting can help. But again, you must be proactive to avoid the very real hazards of loneliness.

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Especially for older adults living alone, the ability to summon help in the event of an emergency—such as a fall—is a very real concern. With a cell phone in your purse or pocket, it's easy to feel well set. Think again. The bathroom is where most falls occur. Do you take your cell phone in when you are using the toilet? Or taking a shower? And what if you hit your head and are unconscious? With a brain bleed, minutes count!

But who wants to wear one of those telltale pendants? Fortunately, with the advent of smartwatches, there are stylish options that do not carry such stigma.

Look for a smartwatch with some or all of these features.

• Fall detection. Think of it as vertical GPS. The watch is programmed to detect an unnatural descent to the ground.
• Simple one-button emergency alert. In a situation such as this, you don't want to have to flip through screens to get to the call function.
• Voice activation. Like Siri or Alexa, no buttons are required to call for help.
• Sophistication of the response. This is probably the most important factor. An automatic call to 911 can be daunting and feel inappropriate. Some smartwatches can be programmed to call a friend or relative. If they don't answer, then 911. Most useful is a call to a 24/7 professional service where a trained responder can talk with you about whatever is going on and make decisions with you. This doesn't have to be fall related. Perhaps your car died and you're stranded somewhere. Although superior, a more nuanced human response does come with a monthly fee.
• Battery life. You don't want to fall and realize your battery is dead. Most batteries last for at least 18 hours. The more extra functions in the watch, the shorter the battery life.
• Waterproof or water resistant. Ideally, wearable in the shower.
• Large readout. You may not have your glasses on. Or you may have arthritis or other issues that make fine motor movements difficult (aka, "fat finger syndrome").
• Tech features that match your needs. From steps per day to reading your heart rate, hours of sleep, texting, and even video chatting, there are a plethora of extras available. And, these watches also tell the time!
• Aesthetics. While smartwatches are less cumbersome than traditional pendants, many women feel they are still bulky. The fewer the features, the trimmer the watch. Bottom line is, will you wear it consistently? If not, save yourself the expense.
  
  

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Three out of five (61%) of adults over 60 feel they have more stuff than they need. And yet many of us find it emotionally painful to cull our belongings.
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While the physical labor of "right-sizing" is daunting, perhaps more powerful—and surprising—is the emotional challenge. For instance, you may feel that letting go of grandmother's wedding dress is like putting her in the trash. Or that if you discard your high school debate trophy, it's like that part of you has died. Or that giving away the fabric you bought to make a quilt "one day" is like abandoning your inner artist. It's human nature to imbue belongings with meaning, and it's those heartstrings that give us pause.

Some tips to help you let go

Recognize that some belongings need "safe passage." You want to find a place or person who will cherish and appreciate them. This will take time. But if you are persistent and start well before a deadline—six months or more before a move, for instance—you have a greater chance of placing them in good homes.

Build momentum. If you cull strategically and make it a routine, it gets easier over time. Start with large items, maybe a mattress or golf clubs you no longer use. Large items are an easy first win. Next, turn to items currently gathering dust in the basement, attic, or storage. These are often a quick release. Turn to the clothes closet after that. The comfort of your existing clothes may help you let go of those garments you no longer wear. Files are the next. They take time to go through. Consider bulk shredding rather than doing it yourself. (The IRS says you do not need to keep records any longer than three years.) Photos, old letters, and journals are the last. If you don't recognize the people, it may be time to let them go. As for that letter from your high school sweetheart, maybe save it in a box labeled "throw away." Some things are too precious to let go of during your lifetime, but perhaps too private for others to find.

Keep your eye on the prize. If you are downsizing to move, keep in mind the goals and life you imagine with your new digs. Who is the new you? It's easier to let go of the you-from-the-past if you focus on your future self. If you are decluttering on principle, remember that people who have completed the project say they feel so much lighter. It's an accomplishment that leaves them feeling freer to explore new vistas.

Hire a professional to help early on. Especially if you are on a deadline. A person trained in late-life moving can help you honor your feelings and streamline the process.

Looking for help? Give us a call 203-826-9206.

Do you find yourself more easily distracted these days? There is good reason: Concentration is about keeping what's useful top of mind while at the same time suppressing thoughts that distract from your primary objective. As we age, the "executive" center of the brain becomes less able to sort out distractions. It's a filtering process that requires heavy brainpower. Many people worry that lapses in concentration are an early sign of Alzheimer's. Not necessarily. While memory and focus are related, they are not the same thing.

If you are concerned about increasing distractibility

• Make sleep a priority. Lack of sleep is strongly linked to poor concentration. The brain sorts through the day's input when we sleep and decides what to keep and what to toss. Sleep makes room for processing input. Sleep is also when the brain eliminates toxic byproducts of the day's work. Optimal is seven to eight hours of sleep per night.
• Increase oxygen to the brain. Take care of conditions that tend to limit good oxygen supply. High blood pressure, for instance; also, sleep apnea and excess weight. (In addition to contributing to sleep apnea, obesity seems to reduce one's ability to resist distractions.) Aerobic exercise is a great way to get oxygen to the brain.
• Avoid or limit situations that are hard on the brain. Chronic stress, anxiety, and depression all challenge the brain and reduce resources available for concentration. Actively tame the stressors in your life and seek treatment for depression and anxiety. Explore alternatives to medications that fog thinking. Get glasses and wear hearing aids if you have impairments. This frees the brain to focus on concentration rather than on deciphering blurry images or garbled words. Alcohol also impairs thinking and sleep.
• Reduce unnecessary distractions. Treat painful conditions. (Pain is a distraction that's very difficult to ignore.) Turn off alerts on your smartphone. Bury the myth of multitasking. Do just one thing at a time. And for very important situations such as driving, turn off the radio or ask your passenger to stop conversing until traffic complexity has subsided.
• Practice focusing attention. This isn't about beating yourself up to try harder (that doesn't work). Instead, you can use beginning mindfulness strategies. Set aside ten to twenty minutes in a day to just focus on your breathing. When you notice your mind has wandered, no recriminations. Just gently return to focusing on your breath. By learning to monitor your thoughts, you improve your ability to notice when your mind is off task and shorten the time you "spend away."

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Are you tired of long waits to get an appointment? Rushed visits? Not being able to talk to your doctor by phone or communicate via email?
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You aren't alone. Doctors dislike it too. But because most physicians today are employees of a large medical group, they are required to complete 30­–40 patient visits per day. Appointments are set to last no more than 15 minutes. This is necessary to manage a typical patient load of 4,000.

Some primary care doctors are moving away from this business-focused model of medicine.

"Retainer-based," "concierge," or "boutique" medicine prioritizes the doctor–patient relationship. For an annual membership fee (average $1,500 – $2,400) you can join a primary care practice that is dedicated to staying small and intimate (≈150–600 patients). Your annual fee allows the doctor to guarantee

• same-day or next-day appointments
• longer appointments (30 minutes on average)
• phone and email communication, with personal follow-up for lab results

You pay the membership fee out of pocket. It is not covered by Medicare. You must also maintain an original Medicare policy and likely a supplemental policy since the concierge doctor will bill Medicare for office visits. As with traditional medicine, you also still have to pay your insurance premiums, deductibles, and copayments (unless your supplemental plan covers them).

What to look for in a concierge physician

• Is the doctor certified by the American Board of Internal Medicine? (Extra "plus" if also certified as a geriatrician.) Affiliated with a major hospital?
• Do they "accept assignment" from Medicare? If they do, then they cannot charge you more than Medicare allows for a specific service without giving you an "Advance Beneficiary Notice of Noncoverage." If they don't accept assignment, that means they are willing to bill Medicare, but you may owe a balance of up to 15% above what Medicare is willing to pay. (Your supplemental plan will not pay the extra, either.)

So far, there are only 12,000 concierge physicians nationwide, but the number is growing quickly!

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If you have trouble participating in conversation in a noisy room or tend to want the TV volume turned up, you might want to investigate a new category of device called an enhanced "hearable."

Up until now, there have been few options short of a hearing aid for people with only mild hearing loss. The best have been "personal sound amplification devices" that fit in the ear like a hearing aid. While reasonably affordable and easily purchased online, they have the disadvantage of amplifying all sounds, even the ones you don't want to hear.

Modern hearing aids can distinguish between a conversation close by and the noisy chatter in a crowded room. The technology is expensive—in the four figures—and requires testing and fitting by an audiologist. Plus, many people feel a stigma attached to hearing aids.

Enter the "hearable," a sophisticated amplification system that wirelessly connects to a mobile device. The hearables were invented for talking on your smartphone and streaming your favorite podcast. In the development of its very trendy "AirPods," Apple stumbled onto the realization that it was very easy to add an enhancement that adjusts for different listening situations. Other developers have since come out with wireless earbuds and improved hearing apps for both Android and iOS (Apple) devices. The result: No stigma. Less cost than a hearing aid. No need for an audiologist.

Features to consider

• Ability to emphasize certain sound frequencies (high pitch or low)
• Ability to block background noise. (This may be called "directionality," setting the device to focus on sounds in the direction you are facing.)
• Ability to highlight speech over other sounds
• Time between recharges. All sound amplification devices require energy, usually in the form of a rechargeable battery. How long does a full battery last? Also, how quickly does the battery recharge?

The disadvantages. Hearables are not considered medical devices, so there is no FDA testing or oversight. They are not appropriate for moderate to severe hearing loss. They are designed for short-term use only, not for all-day wear (they need recharging after a few hours). They are visibly prominent. Someone seeing them in your ears during a conversation may assume that you are listening to music or are otherwise multitasking.

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Are you enjoying a love you never thought you'd feel again? It's hard to be happy, though, if your children rain on your romance. Are they being selfish? Not necessarily. An in-depth study of "adult stepfamilies" revealed how disruptive it is when a parent gets involved with a new partner later in life.

The family tree changes! Even for adult children who are married with kids of their own, a deep—almost primal—sense of self is challenged when a parent brings in a new member. It brings up existential issues.

• Fear of abandonment. A common response is "I always thought my mom/dad would be there for me, even if nobody else was. But now...?" A child may worry they are no longer a priority. While you know the special place your children will always have in your heart, they may be wondering if they still have that backstop.
• Loyalty and favoritism. In truth, it's likely that drop-by visits, cherished family holiday traditions, or time with grandchildren will need some adjusting. Your kids weren't asking for a change. Now they must redefine something as bedrock as "family." Even though they may have had to choose between their spouse and family of origin on certain matters, they may doubt where they fit given your new commitments.
• Finances. Sad to say, concern about inheritance can put the kibosh on any joy your children might feel for your happiness. There's some human nature in that. (Do stepsiblings get a share of the family home?) But your kids may also be worried about your financial security. What if it doesn't work out? Does a person who was in your life for a short period of time get 50% of your nest egg? Where might that leave you?

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Reassurance. As you all strive to maintain the bonds of the original family while also making room for new connections, roles and expectations must come to a new balance.

• Make it a point to spend time with your kids separate from your spouse.
• Ask about traditions that are important to them and try to preserve those.
• Perhaps mention your own emotional journey in coming to terms with the partners they chose. You might describe how you came to understand that their natural need for daily companionship changed their availability and level of engagement with you, but not their love for you.
• As for financial reassurance, your money is yours. With assets accumulated over many decades, however, it's sound advice to get paperwork in place that ensures those assets are protected and later distributed as you would wish.

Is your family raining on your romance? Give us a call.
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There is no single test that can determine if a person has Alzheimer's disease. But a combination of several different tests can identify if memory and thinking problems are due to one of the many conditions that result in symptoms of dementia.
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By process of elimination, doctors can determine what may be the root cause of thinking problems. Some conditions are treatable. Others are not.

Advantages to getting tested early. If changes in memory and thinking are getting in the way of doing what you need or want to do in your life, ask your doctor for a checkup. Even if the source of your problem is not curable, getting a diagnosis as soon as possible has benefits. You can make lifestyle changes that might help slow disease progression and take advantage of medications that can lessen troublesome symptoms. You also become eligible to participate in clinical trials, which puts you in line for cutting-edge treatment. And knowing sooner rather than later gives you time to prioritize what you want to do in the near future, and to complete paperwork and make plans with your family about your wishes for later in the disease.

The components of a full evaluation. To get a complete picture of your brain's health, figure on visits with several different specialists, each providing a unique perspective.

• Medical history and physical exam. Your primary doctor will check your heart, hearing, vision, and medications, as well as do a quick memory screening. Expect to discuss your symptoms, your medical history, and your family's. Also, your lifestyle habits such as exercise and alcohol and recreational drug use.
• Lab tests. Typically, this involves blood work and a urinalysis. Bladder and kidney problems can point to conditions other than Alzheimer's that trigger memory issues. Lab work will assess thyroid, liver, and kidney function and screen for infections anywhere in the body. Genetic tests may be offered, but they are controversial at this stage because they provide nothing conclusive. Just probabilities.
• Brain imaging. A neurologist may order a CT scan, MRI, or PET scan to look for structural changes in the brain. Perhaps you have had a small stroke or several mini-strokes. There may be bleeding, a tumor, or excess fluid in the brain.
• Tests of your thinking and mental health. Dementia and depression each cause fuzzy thinking and memory loss. Testing by a neuropsychologist can zero in on the distinction, which is key to finding the correct treatment. The exams are mostly question-and-answer tests or puzzles. They assess arithmetic, memory, concentration, language, problem solving, and spatial recognition skills.
  
  

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From October 15 to December 7 each year, Medicare enrollees have the option to change their insurance plans. For prescription drug coverage, which is only offered by private insurance companies, it pays to shop around. Even if you have been happy with your current plan, drug prices and premiums change from one year to the next. It's a good idea to compare. There could be hundreds of dollars at stake.

The federal government makes Medicare prescription plan rules, so some things are the same no matter the company. For instance, the point at which the initial coverage stops and the coverage gap begins—sometimes called the "donut hole"—is up to $4430 in 2022. But how soon you get to that number depends on drug pricing, which varies from one insurance company to the next.
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Here are some factors to consider:

• The price of your medicines. To compare plans, you must research the prices in each plan's "formulary" for each of your prescriptions. A plan that charges $200 for a month's worth of pills will land you in the coverage gap sooner than a plan that charges $100.
• The cost of the deductible. This is what you must pay before insurance kicks in. Some policies have a $0 deductible. Others go to the 2022 Medicare maximum: $480.
• The cost of copays. Typically, once the deductible is met, you need to pay a set fee per prescription or a percentage of the price of each drug. This is called the "copay." It varies widely from one company to another, as does the price or percentage that is required in the coverage gap.
• The price of the monthly premium. The lower the premium, the higher the copays.
• Customer service. Each plan has a Medicare star rating based on customer satisfaction and other performance factors. These are updated yearly. A rating of fewer than four stars probably indicates slow service, which could cost money or cause health problems.
• Other services tied to the drug plan. If you have a Medicare Advantage plan, prescriptions may be bundled with your coverage for doctors and hospitals. A plan that might be better for medicines may not include the doctors you have been seeing. You may need to choose which is more important.

Get help comparing plans. Go to Medicare.gov for an online comparison tool. Or use free telephone assistance at 1-800-MEDICARE. There, you can get help weighing the costs and benefits so you can select the best coverage for your money.

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