A Christmas Letter from Ellin Ostler, resident at Vista del Monte

Merry Christmas. I have decided to send you a Christmas letter about "Service" this year instead of a card. Service has brought a lot of joy into my life and I hope it will for you. Below are words I wrote in the 1980s as I was pondering on the meaning of service. They still represent my beliefs today.

"Service given freely with no expectation of something in return is one of the greatest sources of true joy and happiness. However, service which is not given freely and unconditionally will bring resentment and unhappiness."

I have hired, trained, and supervised hundreds of employees during my life. During their training, I told them a story about how I learned to make a seemingly boring job fun. The story goes like this:

I had a part-time job as an usher at the BYU Marriot Center where the BYU basketball team play their games. I was assigned, the VIP entrance each year. Most of the people had season tickets and sat in the same seat each year. It was a boring job because everyone knew where his or her seats were and I did not have anything to do.

One year, I decided I was going to do something different. As people came to my entrance, I stood right in front of them as they came in, looked into their eyes, gave them a big smile, and said, "Hi, how are you tonight?" They were shocked and surprised. I am sure they thought I was a little weird. I continued to do it each game during the basketball season;

To my surprise, after a few games, many of the people tried to beat me to the punch by saying "Hi," and wishing me well first. After a few games, they began to treat me as if I was one of their good friends. Some of them even brought me food to eat during the game.

Sometimes, I would see these people downtown away from the Center, and they would come up to me and wanted to know how I was doing. They often had to remind me where I had met them. I was shocked about how something as simple as a smile and saying hi could make such a difference in my relationship with people. I learned from this experience that I could make a boring job fun just by smiling and saying hi. I also learned that it is impossible for me to give more than I receive when I freely give of myself.

I had another experience when I was working at UCSB. I supervised a group of students who were responsible for the student union building when it was open. The only time we could all meet for a weekly staff meeting was at 7:00am. Most of the students at UCSB stay up late and are not use to going to a meeting so early in the morning. I decided to show my appreciation to them by bringing them something to eat. At first, they were very appreciative of my gesture.
These students also worked with the student union catering manager. The manager decided to show his appreciation by fixing them a breakfast for .the meeting.

Before long, the students started to complain when they didn't get what they expected. What started out to be gift of appreciation turned out to be an obligation for me and the catering manager. We decided to stop giving them food because it had become an expectation. The students were disappointed, but I think they learned an important lesson about being grateful. I experienced the joy of giving until it became an obligation.

I have decided to experience the joy of giving as often as possible by freely giving of my time and talents. I have also decided that when giving becomes an obligation or an expectation, I will find another way to give. I hope you experience the joy of giving this Christmas.

May you have a Merry Christmas and a Happy New Year.

-Ellin Ostler, Vista del Monte resident

Vista del Monte Retirement Community in Santa Barbara’s Hidden Valley serves seniors from all walks of life in Southern California.

Sunny View and Summer House Residents Make Connections Through Memory Bridge

Gennie Waters has a special moment with her friend Maxine.

Sunny View resident Gennie Waters remembers her longtime friend Maxine as a talkative, vibrant, funny person. But in the past several years, dementia has compromised Maxine’s ability to express those qualities, as she would have in the past. However, Gennie is still able to connect with her friend, a resident of Summer House, Sunny View’s memory care neighborhood, but in a different way using techniques she learned from Memory Bridge, an empathetic form of communication.

 “I am a Bridge!” Gennie exclaims, who learned how to “be with” Maxine and how vital being together is to her and Maxine’s lives, regardless of cognitive capacities.

“We may not communicate in the same way but our time together is just as special to me as always,” Gennie said. “Some days when I visit, Maxine does not recognize me and that’s OK. Other days I can see her light up as soon as she sees me. That’s the special part. At first, I thought I was helping her but then I realized she was helping me learn patience. This has changed my life.”

 Memory Bridge training at Sunny View is funded by resident Jean Eckert through Sunny View Foundation and spearheaded by Sunny View Chaplain Pastor Carol Been. About 15 staff members, residents, family members and volunteers participated in the initial training that teaches non-verbal ways of empathic communication, or ways of “being with” people with cognitive impairment. The techniques are meant to combat emotional isolation that often affects those with Alzheimer’s and other dementias.

 According to the training course, one of the biggest mistakes people can make is to stop communicating with those diagnosed with Alzheimer’s or dementia because of the erroneous belief that they are “gone.” This counter productive approach to communicating with people with Alzheimer’s and dementia not only negatively impacts the individual living with memory loss by making them feel lonely and depressed, but it also deprives those who have stopped communicating from learning valuable lessons from these individuals, like the importance of presence and patience.

 Chia-Liang Li visits his Memory Bridge “buddy” at Summer House at least once a week. “We are both Chinese and both Christian so we have that in common,” Chia-Liang said. “I just don’t want her to be lonely. I do the best I can to let her know I care about her and her son appreciates that.”

“A one-on-one approach is the focus,” said Sunny View Volunteer Coordinator Julia Earley, who participated in the training and visits her buddy Marie, regularly. “We learn to be in the moment and let our buddies guide us during our visit. Sometimes a simple touch is all that’s necessary to get a positive response.”
With additional funding from the Sunny View Foundation, Sunny View hopes to expand training to more volunteers.

Just What the Doctor Ordered

Pioneering physician, veteran, family man, detective novel enthusiast, 60-year Santa Barbara resident and amateur astronomer all describe Vista del Monte resident Dr. Dean Vogel.

“I have a full life -- a somewhat exciting life -- and I’m looking forward to experiencing new things at Vista del Monte,” Dr. Vogel said.

Dr. Vogel was born in a small town in Indiana but moved to southern California when his brother received a basketball scholarship to play at USC. After graduating from medical school, he was an associate member of the Mayo Clinic before coming to Santa Barbara. He was instrumental in bringing coronary care to southern California in 1968 when the field was in its infancy.

Although the retired internist likes to keep up to date on the latest medical news, he spends most of his time enjoying the simple pleasures of life with his wife Mary at Vista del Monte.

“The last few years I’ve been the cook in the family so I’m glad I don’t have to do that anymore,” Dr. Vogel said with a smile. “The food here is excellent. And whenever we go to dinner here we end up sitting with someone with a PhD, or someone who performed on the New York stage or someone with an interesting hobby or story. The people here are just fantastic!”

He describes his wife Mary as a crossword puzzle expert. They both appreciate the newly landscaped grounds. “I don’t think there is another retirement community in the area that has such a wonderful garden as we have here.”

When Dr. Vogel wants some quiet time, he listens to detective novels using books on tape or gazes at the stars from his balcony through his telescope – lifelong hobbies that he has plenty of time to savor.

 “Living at a continuing care community was important to us at this time of life.” Dr. Vogel added. “We looked at several communities but Vista del Monte is by far the best choice for us.”

All in the Family at Wesley Palms

Employees enjoy working with family members


Francisco Murillo remembers the day in 1977 when he applied for a housekeeping position at Wesley Palms. The then 24-year-old got a ride from his dad to the retirement community high atop Mt. Soledad in Pacific Beach.

“That was the first time my dad told me the story of how he helped build Wesley Palms in the late 1950s and early 1960s,” Francisco said. “He was a pipefitter back then and was hired to use his expertise for Wesley Palms.”



Housekeeper Francisco Murillo has worked at Wesley Palms for more than 40 years. .

Wesley Palms opened in 1962 when Francisco was about nine years old. “Obviously I knew my dad went to work every day but I didn’t know exactly where,” Francisco said. “When he told me the story I was very surprised. I thought … I have a chance to work at a place my dad help built. How about that! Thinking back, I wish I could have visited my dad here when he was building this place.”

Francisco’s sister has photos of their dad at work at Wesley Palms. The iconic façade of main building is pretty much the same on the outside but of course, the new patio homes have replaced the original cottages. “That’s a huge change from the original cottages that my dad built. Back then, Wesley Palms was probably considered a new concept with its large open spaces and cottages. Now, the new patio homes at Wesley Palms are unique.” Francisco is now Wesley’s longest standing employee at more than 40 years.

Francisco isn’t the only employee with family ties at Wesley. Husband and wife, Laura and Juan Vargas have been working together for more than 13 years. Laura is the housekeeping supervisor and Juan is in the maintenance department. Laura began at the community first and then Juan joined her two years later.

“We both started in housekeeping but then after a few years Juan encouraged me to apply for the director’s position,” Laura said. “If I got the job, he knew he would have to transfer to another department since family members can’t supervise each other. He was sad at first that we would not be working closely together anymore but he soon found new energy on the maintenance team. He’s one of that department’s top employees now.”



Husband and wife Juan and Laura Vargas love working together at Wesley Palms.

 

“We take our first break together every day and then we don’t see each other until we get home,” Juan said. “Sometimes we like to swap stories around the dinner table about how our day has gone or we tell a funny story a resident told us.”

And then there is Muhannad Sofi and his 17-year-old daughter Delan Sofi-Haji. Muhannad has been dining room manager for 21 years and last year Delan joined the team as a receptionist. “I told Delan that Wesley is great place to work and left it up to her if she wanted to apply for a job here,” Muhannad said. 

“I kind of grew up here,” Delan said. ”My dad would tell me stories about how nice the residents are and how much fun he has doing his job so I decided to apply. Now I have my own stories to tell about our incredible residents.”

Wesley Palms’ staff are not the only ones who have family connections. Many residents are second generation. Longtime resident Bob Crabb’s mother lived at Wesley Palms in the 1970s as did resident Holly Steere’s parents and Becky Graber has the privilege of currently living at Wesley Palms with her mother.

“I’m not surprised we have both second generation residents and staff here,” said Executive Director Ben Geske. “Word gets out that Wesley is a great place to work and live. We’re a family here.”

 

Can Bundled Medical Payments Save You Money?

The promising idea aims to prevent unexpected bills after a surgery 

Credit: Adobe Stock

By Richard Eisenberg, via Next Avenue

Two of the most upsetting things for patients are the high cost of health care and the surprise — sometimes indecipherable, sometimes nonstop — hospital bills. But something known as “bundled medical payments” might relieve both of those and possibly provide you with better health care.

With bundled medical payments, patients are told before the medical procedure exactly what the whole shebang will cost, and pay a flat fee up front. Think of it as prix fixe health care.

With a bundled payment, you wouldn’t get one bill from the surgeon, one from the anesthesiologist, one from the hospital, one for physical therapy and so on, the way you normally do now. Instead, you get a total fee and hospitals and doctors are incentivized to keep costs down, so they can ensure profits. 

How Bundled Payments Could Help Patients and Hospitals

Bundled payments are “a powerful tool for the health care system,” Shawn Bishop, vice president for the Controlling Health Costs Program at The Commonwealth Fund, a nonprofit health research group, said at a recent webinar on the topic. They’re being tested to “improve the cost of health care and the quality of health care,” she told me in an interview.

“It’s a significant departure from the legacy model of health care,” said P. Marshall Maran, CEO and president of Muve Health, a joint replacement company that works with health systems to bundle payments before hip or knee replacement surgery. “We have a 50-year-plus run of a business model and tech and infrastructure with large insurance companies set up for a fee-for-service model, so unwiring that will take time.” 

Hip and Knee Replacement Surgery

So far, hospitals and doctors are mostly experimenting with bundled medical payments for hip and knee replacements — because those surgeries are typically straightforward. (An average joint replacement costs $26,000, but some cases exceed $125,000, according to The New York Times.) The results for patients charged through bundled payments have been promising, especially for people over 65 who are on Medicare.

“The bundled-payment trend is very smart and very good for health-care consumers,” said Leor Catalan, CEO and co-founder of Robin, a new platform that lets consumers know the cost of health care in advance.

Medicare began testing bundled payments in 2012, on a voluntary basis. Then it began making bundled payments mandatory for hip and knee replacements in 67 markets; President Trump has since scaled back the number to 34, but added new, voluntary bundles for some inpatient and outpatient episodes of care.

So far, hundreds of hospitals and thousands of health providers have made millions of bundled payments. Here’s a U.S. map showing places where Medicare has bundled payment arrangements. 

What the Bundled Payment Studies Show

When The Commonwealth Fund, along with researchers from Harvard University and the University of Pennsylvania, studied the outcomes of some bundled payment surgeries, they found “costs generally are lower and contained, and quality is either stable or a little bit better” than similar procedures billed the traditional way, said Bishop.

In one study published in the Journal of the American Medical Association in 2017, joint-replacement surgery payment bundles for 3,942 Medicare patients saved taxpayers $5,577 or roughly 21 percent per joint replacement care episode.

Dr. Amol Navathe, assistant professor, health policy and medicine at the University of Pennsylvania, noted during the bundled-payment webinar that research he and colleagues did found a four percentage point improvement in cost (roughly $500 to $1,000 per joint replacement episode) by bundling hip and knee replacements.

“There was no effect on increasing or worsening quality,” he added. Nor was there a significant increase in the number of surgeries performed. And patient satisfaction neither worsened nor improved with bundled payments.

One caveat: the data was based largely on the experience over one year. “What we know is that change is hard and takes time,” Navathe said. 

The Future of Bundled Payments

Surgeons who’ve tried a bundled payment system are “warmly embracing it,” said Maran, “because it allows them to control the care and decide how dollars are being spent.” Many hospitals, Maran added, “understand that this is the future.”

Medicare, Bishop said, wants to test and broaden bundled payments as much as possible to help save the system as much money as possible.

“We’re still in the early innings” of bundled care in America, said Maran. But other countries, such as The Netherlands, have been using bundled payments more aggressively, said Bishop, including for maternity care. And these countries often make bundled payment estimates for health procedures and recuperation for as long as a year; bundled payments in the U.S. are generally restricted to a 30-to-90 day period of care.

Odds are, you’ll be increasingly likely to see bundled medical payments offered by hospitals for knee and hip surgeries where you live. But don’t count on them for many other types of medical maladies soon, if ever.

“The thing about medical conditions like lung and heart conditions is that it’s harder to set up a set of services for them,” said Bishop. “It’s harder to manage a condition than a surgical procedure.” In other words: their medical treatments vary too much to set a fixed price, because situations of patients can be so different.

Added Catalan: “The types of services you can create bundles around are very limited. So this trend will grow, but it has a ceiling on it.”

McKesson and ORC International forecast bundled payments to account for 17 percent of payments by 2021. Already, some large employers are negotiating bundle pricing, according to a NEJM Catalyst article. 

2 Potential Concerns

There are two potential, disconcerting, unintended consequences for bundled payments, though.

First, people who are sicker than typical patients getting these procedures (so-called “higher acuity patients”) may be turned down because the hospitals might lose money on them. As Dr. David Blumenthal and David Squires wrote in a Commonwealth Fund article: “The otherwise healthy patient needing a knee replacement may prove more profitable than a knee replacement patient with complicating problems such as heart, lung or kidney disease.”

Second, hospitals might assign less-experienced and possibly less-talented doctors to the bundled payment surgeries to keep costs down and under the bundle price.

Health researchers and the government will need to keep an eye on both of those possibilities.

As of now, there’s no easy way to find out whether you can get bundled payments for your next hospitalization. And health providers aren’t yet advertising they offer them. So, if you’d like to bundle up, the best thing to do is ask your doctor or a hospital representative whether that’s possible.

© Next Avenue - 2018. All rights reserved.

Finding Creative Opportunities After Retiring

Investing time into developing your 'second act' can pay off

By Patricia Corrigan, Next Avenue

Ann Nessa presenting one of her shawls

Tone deaf? Turned off by a blank canvas? Two left feet?The arts enhance the lives of older adults, but even if you have no desire to sing, play an instrument, paint a picture or take up the tango, many other options for expressing creativity exist.

That was evident at a recent pop-up art show at a home in my neighborhood, where colorful lithograph prints, origami-inspired leather purses and wallets, handmade kimono jackets and abstract art crafted from recycled materials were on display.

Whether you’re interested in exploring a new area of endeavor or want to reinvigorate a passion from the past, finding the right path can be part of the process.

Four people who did just that include a doctor-turned-sculptor, a former astronautics and aeronautics engineer with a sweet job in a chocolate shop, a veteran of the corporate world who reinvented herself as a photographer and a retired buyer at a manufacturing firm who knits gorgeous scarves she calls “neck art.”

Credit: Compliments of Susan Emmerson

 A longtime ear, nose and throat surgeon in Illinois, Susan Emmerson took early retirement, earned two fine art degrees and now works as an artist in Boston. Clients make appointments at her studio or view her work at the Kingston Gallery.

What do they see?

“People tell me they see vague body organs, interesting shapes and shadows — and some say they enjoy the colors,” said Emmerson, 60. “I started drawing what I was most familiar with — the inside of the body. Now I draw on Tyvek®, heat it and sculpt 3-D globular objects.”

Emmerson has long been interested in both art and science. “I knew I couldn’t do both at the same time — you have to throw yourself into both careers — but it was always in the back of my mind that I would retire early from my practice and go to art school,” she said. Emmerson left medicine in 2004 and completed her undergraduate and graduate degrees in art in 2012.

“If people want to retire to write or be an artist, I encourage them to find a way to do it,” Emmerson said. “Yes, it takes time. But you may as well be doing something you love to do, because time is going to go by anyway.”

‘Being Creative Is a Form of Relaxation for Me’

Astronautics and aeronautics engineer, ski racer, information systems technician,

Compliments of Doug Cale

consultant, house flipper, marathon runner, homebuilder, proud grandfather and owner and head chocolatier at Birmingham Chocolate in Birmingham, Mich, near Detroit. That sums up much of Doug Cale’s life to date.

“I’m a risk taker,” said Cale. “I like to take chances, and I’m not big on the word ‘retirement.’” Cale, 71, left his “first collection of careers” in 2002. One day, while working on a house he hoped to flip, he met with three friends who also had left the corporate world. One was making chocolate, which interested Cale.

“I’ve been in the chocolate world now for 10 years,” he said. “I’m not trained in the pastry arts, but I come up with ideas for new recipes. I’m always asking why we can’t try this or work on that.”

One of the dark chocolate truffles at Cale’s shop is flavored with Jamaican rum. A white chocolate truffle has hints of blood orange. A specialty bar, made for a pie company, combines a streusel crumble with berries.

Cale also finds job satisfaction developing marketing strategies, exploring new partnerships and experimenting with his business model.

“For me, life is all about engagement,“ he said, “Coming up with new ways to do things day in and day out, what I get out of this job is the creativity. And being creative is a form of relaxation for me.”

Credit: Compliments of Pete Rosos

‘Photography Is My Second Act’
“Originally, photography for me was a way of hiding, but now it’s about making connections, meeting new people and hearing their stories,” said Carol Thomas. “Photography has opened my eyes and my heart to the beauty of the world.”

Thomas, 71, lives in Berkeley, Calif. She got her first camera at age 12 and has considered herself serious about photography since the 1970s. But only recently has she started identifying herself as a photographer.

In 2012, Thomas retired as the CEO of Education Northwest in Portland, Ore., one of 10 federally funded regional education labs. Her list of retirement goals included improving her photography skills. “I looked for local resources, started reading more photography blogs and enrolled in a class,” she said.

Since then, Thomas has joined two local photography clubs and she is an affiliate of Pro Bono Photo, a group of volunteer photographers that works with nonprofits. This year, Thomas was invited to join Berkeley Fine Art Photographers and her work has been included in exhibits at galleries.

“Photography is my second act,” Thomas said. “I wasn’t very good at first, because it was a hard switch from being so analytical and literal in my old job to being more creative and abstract. Now, it’s cool to think of myself as a photographer!”
‘Making Shawls Brings Me Lots of Joy’

Ann Nessa never goes out without wearing one of her shawls — wardrobe accessories she calls “neck art.” Nessa knits them from colorful yarns, including silk, merino, linen, angora and even bison. Many of the yarns are hand-dyed, and they come from all over the world.

“I look for unique yarns, and I want no distraction from the design. I want the yarn to do the talking,” said Nessa, 75. “Some of the shawls are big and some are small, and I wear them with dresses or jeans.”

When Nessa retired in 2009, she was already a knitter. When she noticed new and different shawl patterns available, she decided to make shawls. Each one takes a couple of weeks to finish, depending on how often Nessa sits down to knit. How many has she made? She admits to “hundreds,” each one unique. “Making shawls brings me lots of joy.”

For Nessa, knitting is not a solitary art. Before she moved recently from Whitehall, Mich., to Buffalo, N.Y., Nessa was a longtime member of Pints and Purls, a knitting club that met at a craft microbrewery. In her new city, Nessa has learned about one knitting group, but hasn’t ruled out starting another.

“I’ll go to a library and see what groups they have, or maybe I’ll settle in at a coffee shop and start knitting,” she said. “Other knitters will come right over to talk. Who knows what might get started?”

Patricia Corrigan is a journalist and the author of numerous books, including a guide to San Francisco that expresses her great joy in her adopted city. Visit her blog here.

 

The Best Way to Improve Brain Health

By The Milken Institute Center for the Future of Aging from Next Avenue

Credit: Adobe Stock

(Advances in science and public health are increasing longevity and enhancing the quality of life for people around the world. In a series of interviews with the Milken Institute Center for the Future of Aging, 14 visionaries will be revealing exciting trends and insights regarding healthy longevity, sharing their vision for a better future. The Longevity Innovators interviews highlight new discoveries in biomedical and psychosocial science, as well as strategies to promote prevention and wellness for older adults. This is the first in the series.)
Renowned neurosurgeon Dr. Keith Black (chair of the department of neurosurgery and director of the Maxine Dunitz Neurosurgical Institute at Cedars-Sinai Medical Center in Los Angeles) has pioneered advances in our understanding and treatment of brain cancers and complex neurological conditions. Black is also a research scientist studying targeted drug delivery, cancer stem cells and Alzheimer’s detection through retinal imaging, among many other areas. In an interview with the Milken Institute Center for the Future of Aging, Black talks about the importance of developing a test for early onset Alzheimer’s and his goal to inspire the next generation.

Dr. Keith Black

What is the most important thing that people should know about improving brain health?

People need to know how important lifestyle is to sustain health. Lifestyle, diet, exercise, moderating stress, making sure you get a good eight hours of sleep when you can, making sure you keep your brain engaged particularly in novel activities — all of these matter. You have to remember the brain is a living organism very much like a muscle — the more you use it, the stronger it becomes.

We need to treat our brains better. For example, try to avoid excessive alcohol and make sure that you screen yourself for diseases like diabetes and hypertension that can be devastating to the brain.

What will be the benefits of having a reliable test for early onset Alzheimer’s?

I think there’s a huge misconception that if you get Alzheimer’s or if you’re going to get Alzheimer’s, there’s nothing that you can do about it. And I think the science shows that that perception is incorrect.

We know two things now that address your question. The first is that Alzheimer’s starts about two decades before a person develops symptoms. During that period of 20 years, you’re losing brain cells, and you’re losing brain connectivity. If you can detect the disease at the very start, particularly before you lose enough brain cells to become symptomatic, we may have the ability to stop the process or at least slow it down and prevent an individual from becoming symptomatic.

If people are developing Alzheimer’s in their 50s and 60s, they are going to become symptomatic in their 70s and 80s. If you can slow the overall process and have people become symptomatic in their late 90s or 100s, you have the ability to essentially prevent the disease from being symptomatic in most of our lifetimes. That’s really the major reason to move towards early detection, because preventing brain loss is a lot easier than restoring brain cells once they’ve died.

The other reason people should be interested is that even though we don’t have a pill that can stop the progression, we know that Alzheimer’s also has a lifestyle component. The scientific evidence shows that lifestyle habits such as a Mediterranean diet, exercise, sleep, meditation and other types of mindfulness modify stress levels. We’re seeing that potentially even micronutrients like the omega-3 fish oils may be very important in slowing the progression of Alzheimer’s disease.

What’s your take on Pfizer ending research to find new drugs aimed at treating Alzheimer’s and Parkinson’s diseases? How do you think it will impact ongoing research?

I think a lot of the trials that have failed for Alzheimer’s disease, including the Pfizer trial, could’ve been better designed and better developed. I think we have a lot to learn from the failure of those trials.

For example, how do we get the drugs into the brain more effectively? How can we better select the right population of patients to treat? I think addressing those potential reasons for the failures of those drugs will lead to successful therapies and hopefully successful approvals.
By The Milken Institute Center for the Future of Aging

The Milken Institute Center for the Future of Aging aims to improve lives and strengthen societies by promoting healthy, productive and purposeful aging.