Kansas Senior Press Service
Releases from February 2011
Exposed to Agent Orange in Korea? File your claim
Kansas Senior Press Service
Veterans exposed to herbicides while serving along the demilitarized zone (DMZ) in Korea will have an easier path to health care and benefits under a Department of Veterans Affairs (VA) regulation that will expand the dates when illnesses caused by herbicide exposure can be presumed to be related to Agent Orange.
Under the final regulation, VA will presume herbicide exposure for any veteran who served between April 1, 1968, and Aug. 31, 1971, in a unit determined by VA and the Department of Defense to have operated in an area in or near the Korean DMZ in which herbicides were applied. This extends the applicable dates by more than two years.
In practical terms, eligible veterans who have illnesses presumed to be associated with herbicide exposure do not have to prove an association between their illness and their military service.
To learn about veterans’ diseases associated with Agent Orange exposure, visit www.publichealth.va.gov/exposures/agentorange/diseases.asp. To learn about birth defects in children of Vietnam-era veterans, visit www.publichealth.va.gov/exposures/agentorange/birth_defects.asp.
The VA encourages veterans with covered service in Korea who have medical conditions that may be related to Agent Orange to submit their applications for access to VA health care and compensation as soon as possible.
Visit www.vba.va.gov/bln/21/AO/claimherbicide.htm to learn how to file a claim for presumptive conditions related to herbicide exposure, as well as what evidence is needed by VA to make a decision about disability compensation or survivor benefits.
For additional information about Agent Orange and VA services for veterans exposed to the chemical, visit www.publichealth.va.gov/exposures/agentorange.
The regulation is available on the Office of the Federal Register Web site, www.ofr.gov.
Starting to 'parent' your mom or dad? Here's some Caregiving Counsel
By Edward T. Schulte
Kansas Senior Press Service
Editor’s Note: Johnson County Human Services, and its Area Agency on Aging, receive many calls from members of the baby boom generation who are helping to care for their elderly parents. Many times these loving, compassionate boomers are at the end of their ropes — exhausted, frustrated, and confused.
In three installments, we will share some of the most common questions we receive. Ed Schulte, an aging information specialist with the Johnson County Area Agency on Aging, will provide his experienced and wise answers.Is there any overall advice you give to adult children who see themselves becoming care givers to their elderly or ailing parents?
Take good care of yourself and take regular breaks from caregiving!
Get educated on caregiving options, but keep your own health and attitude in shape. Find ways to maintain or improve your physical, mental, and emotional health. Attend a support group or have lunch with a friend, and work to develop a positive perspective on life and a sense of humor. Empathy, emotional intelligence, and coping skills can go a long way in a caregiving role.
Don’t try to do it all yourself. Ask for help from family, friends, and agencies. See “50 Things Every Caregiver Should Know,” a pamphlet from JourneyWorks Publishing, www.journeyworks.com, 800-775-1998, for more ideas.
Give your parents some slack. What you see as stubborn resistance to your ideas may just be your parents’ way of taking a while to adjust to the changes and challenges of aging. They have spent most of their lives being independent and in charge. They are from a different generation, and are facing challenges and losses related to health, living conditions, and perhaps economics.
Know what issues are critical to their health and safety, and don’t spend a lot of time sweating the small stuff — those personal quirks, persnickety needs, and occasional emotional expressions.
Supportive is better than confrontational when it comes to conversations. Sometimes the best you can do is just being there, rather than sounding off as the expert on all matters related to health and lifestyles. You may be right, but more often it is better to be kind.
What’s the most common question you get from adult children of aging parents who are struggling with illnesses or showing signs that they need help?
The most common questions are: How can I help my parents be safer or stronger? How can I get a break? How do I find and pay for care at home or in a facility?
The answers to all these questions are usually found through a personal health care system and through social services and the Area Agency on Aging (AAA) serving the area where your parents live.
Primary care physicians authorize plans of care, services, and medical supplies covered by Medicare, and also can advise regarding any specialty care that’s needed.
Social workers at a hospital, home health agency, nursing home, or rehabilitation facility advise and assist seniors and their families and help with the transition to other services, which might include in-home services provided through the AAA or private-pay resources.
Most AAAs have services such as information and assistance to discuss local resources and options, case management to help coordinate care needs, Meals on Wheels, housekeeping to help with routine cleaning and laundry, respite to give caregivers a break, and personal attendant care to help with bathing and other personal care.
A wide variety of options exist for care, often involving some economic choices or transition to safer environments, and often the decisions are new, challenging, and time-consuming. Payer sources include Medicare, Medicaid, VA benefits, long-term care insurance, state-supported sliding-scale fee services (where the cost is shared by seniors and the state, based on the senior’s income), Older Americans Act donation-based services, and private pay.
Some persons who own their own home consider a reverse mortgage to get a lump-sum payment or monthly payments out of the value of their home while still living in it. These funds often are used for in-home care or adapting a home for easier at-home care.
All these options involve counseling, research, and careful consideration. To locate the AAA nearest your parents, call the National Eldercare Locator line at 800-677-1116 or visit www.eldercare.gov.
What signs should adult children look for when determining whether their parents are safe to live alone at home?
Life is a risk for everyone, and we all should take measures to reduce risks. There are risks posed by activities we engage in and risks posed by the environments in which we live. Can your parents get out of bed and a chair and take care of their bathing, dressing, and toileting? Can they hear and see what they need to hear and see? Are they having cognitive issues due to medications, health problems, dementia, or mental health?
Think of the parents’ normal activities of daily living and the risk factors associated with everyday life. These are the points of concern to address. What will they do in case of an emergency, fire, tornado, or ice storm? What fall-prevention measures are in place? Who is checking on them every day? Are basic needs for food, clothing, and shelter being met?
Signs that more care at home or care in a facility may be needed include multiple falls, needing assistance with toileting, wandering and getting lost, leaving a stove on, not eating properly, taking medications improperly, and anything that might pose a serious and ongoing threat to their health and wellness.
Most people spend their entire lives at home, but at some point need a little help or a lot. If costs are associated with the level of care needed, then cost may become a driving factor for considering alternatives. If you cannot afford the level of care needed for your parents to be safe at home, you may need to locate Medicaid-subsidized care in an assisted living or nursing facility.
Most caregivers feel better if they call their AAA to discuss options for in-home care and then try getting as much in-home care as they can afford before moving on to other options. Bear in mind that the choice is up to your parents as long as they are capable of making their own decisions. Some elders look forward to assisted living for the health care and social aspects a facility can offer. Parents often know when the time is right for a nursing home. It is helpful to talk in a non-threatening, supportive way about all these options.
To be continued.
Do this forever!
By Nancy Julien Kopp
Kansas Senior Press Service
Medical issues crop up when we least expect it. Life goes along quite nicely, and all of a sudden someone you love is hit with startling test results, a heart attack, or maybe a stroke. Your head whirls with all the new information tossed out by doctors, nurses, nutritionists, and friends. Phrases fly through the air and you’re meant to catch them.
“You’ll need to watch your diet.” “Exercise is key.” “Watch your carbs.” “Think low-fat and low-cholesterol.” “Eat more fish.” There is no end to the advice.
If you have a medical issue, your first thought is that you want to do whatever you can to correct it and prevent it from becoming worse. So you agree to go on the diet and add more exercise to your daily routine.
“How long will I need to be on this diet?” you might ask your doctor. Her answer is like a slap in the face with a wet dishcloth. “This is not a short-term diet. You need to make a lifestyle change. It’s a forever program.”
Forever is a very long time. We’ve had three instances of long-term medical issues in our family. My husband had a heart attack seven years ago. Two years ago, I learned I was pre-diabetic. And just recently, our 14-year-old granddaughter’s blood test during an annual physical showed high cholesterol. None of us can afford to ignore the advice of health care professionals, so we’re all making life changes.
Ken’s heart attack involved a helicopter ride to a bigger hospital for a procedure to insert a stent in an artery with a 99 percent blockage.
“You’re lucky to be alive,” the cardiologist told him the next day. And then he went into the diet discussion, which boiled down to “Think low-fat, think low-cholesterol, and eat small portions at all times.” It sounded like good advice for all of us, but hearing it and doing it are two different worlds.
Ken’s cardiac rehab director stated over and over that this can’t be for the 12 weeks of rehab; it has to be a complete lifestyle change. Forever! So we set about doing the things she advised.
I attended a cardiac nutrition class and learned how to cut fat and cholesterol from our diet. I learned many tips about turning family favorites into heart-healthy dishes. I worked on the diet and Ken worked on the exercise, and little by little we made changes that will be — forever! We slip back into old ways now and then, but we get right back on the program again.
It shocked me when my glucose numbers were in the pre-diabetes range during routine blood work for my annual physical. I’d put on 20 pounds over two years for no apparent reason, so my doctor added the glucose test to the standard blood test. I thought I’d been eating quite well since we’d been on Ken’s cardiac diet, but there was more to come. Now I had to watch sugar and carbohydrates, too.
It took me a week to come to terms with this new issue. I did some research and learned which foods I should avoid and which ones I needed to be sure to eat. I worked at the diet and added daily exercise for six months, and the next blood test showed a distinct drop in the glucose number. The elation I felt didn’t last long, as it dawned on me that I needed to keep on with my new life of diet and exercise. Forever!
Our granddaughter is slim and trim and has been active with dance and cheerleading. It was startling to her parents and to us that her blood test showed high cholesterol. As we discussed it over the phone, we had to admit that her eating habits may have added to the problem. She doesn’t like cereal or fruit. She eats white rice, white pasta, white bread. No whole grains, so the amount of fiber she gets is minimal. Like most kids, she leans toward processed goodies like doughnuts, cookies, and crackers that are loaded with trans fats. Add in the trans fats that are rampant in fast-food menus and it’s a recipe for disaster. Her family is in for some big life changes. Forever!
It’s not easy to make these changes even when you know it’s good for you. And the results of these changes aren’t always immediate. The benefits may come a long time from now, particularly in our granddaughter’s case. She needs to watch her diet now so she isn’t having problems 20, 30, or 40 years down the road. My husband and I are both benefiting now, and we’ll continue to do so.
Ken and I have had time to adapt to our new life, but our granddaughter is at square one. She’s an intelligent girl who has tremendous determination, so I think she’ll do well as soon as she gets her mind made up to work at this new problem.
In carrying out a life change, forever is a long time — but so very worth it. We only have one life, and it’s up to us to live it in the best way possible. The medical world gives us the knowledge and the tools we need, and then it’s up to us.
A few tips for lifetime diet changes
- Eat low-fat.
- Eat low-cholesterol.
- Eat small portions.
- Substitute canola oil for butter in baking.
- Consider sugar substitutes.
- Add fish.
- Add whole-grain foods.
- Avoid trans fats.
- Cut red-meat consumption.
- Add fiber.
Elder law: Competency and executing legal documents
By Alexandra R. English
Kansas Senior Press Service
In my day-to-day practice of law, I frequently find myself having to determine whether my clients possess sufficient mental capacity to sign the documents I have drafted for them.
“Competency,” in this sense, refers to one’s ability to understand the consequences of signing a legal document. If, in talking with my clients, it is obvious that their mental capacity is lacking, I cannot proceed with the execution of their documents. These meetings and conversations can be difficult.
I hope this article will present a picture of what an attorney looks for in determining client competency and why it is so important for clients to handle their affairs before they lose their mental faculties.
♦
The first step in finding an attorney to draft a document is for the client to make the initial contact. With elder adults, it is not unusual for a relative to contact an attorney on the client’s behalf, asking, for example, for certain estate-planning documents to be drafted. It is a red flag to an attorney if the relative dominates the conversation, tells the attorney exactly what the client wants, and then downplays the importance of a meeting with the attorney and client.
At this point the attorney suspects that either the client is not competent but wants to get the document drafted and executed or the relative is trying to have the client sign something that benefits the relative against the client’s wishes. Regardless of the motive, the attorney must be extremely cautious.
The attorney should always meet and talk with the client before a document is executed. If there is any question as to competency, the attorney should meet with the client alone, asking a series of questions to determine whether the client understands the document and whether the document will meet the client’s wishes. The client should be able to express this verbally.
I have had to ask relatives to leave the room. As soon as the relatives leave, it becomes clear whether the client is competent. On one occasion, when I asked a client’s sister to leave the room, it quickly became apparent that my client was not competent to sign a power of attorney. She told me she did not need a power of attorney because a deceased relative, who was an angel, was going to make her decisions for her if she became incompetent. Clearly, this client lacked sufficient mental capacity to sign the document I had prepared, so I politely ended the meeting.
It is possible for people to phase in and out of competency. For example, at the first meeting with the attorney the client might be perfectly clear about his or her wishes. Two weeks later, the intent may seem fuzzy and the client might appear confused.
Many factors could cause this confusion, including medications, skipped medications, the time of day, or even whether the client has eaten recently. If the confusion is temporary and caused by one of these factors, the appointment with the attorney should be rescheduled to find another time when the client will be fresh and capable of signing the documents. If, however, the diminished capacity is permanent, the attorney must not allow the execution of the documents.
What is the lesson here? It is imperative that you have all important estate-planning documents drafted sooner, rather than later. You never know what might happen to cause you to have diminished capacity.
You could be dealing with a slow-progressing disease like Alzheimer’s, when it is difficult to draw a line between competency and incompetency. You should always get your affairs in order soon after a diagnosis like this.
You could also suffer from a life-changing event like a stroke or a terrible car accident. One day you could be perfectly fine and the next day you might be in a coma. You want your affairs in order so loved ones are saved the trouble and expense of trying to guess at your wishes.
What are the consequences of not having important documents signed and executed before you become incompetent? It depends on the type of document. If you do not have a power of attorney (which selects an agent to make decisions for you when you are no longer able to do so), a guardianship case may need to be filed in probate court. There, if a judge determines that you are not competent, the judge will appoint a guardian to make decisions for you. This can be expensive, lengthy, and stressful. Your relatives will be required to hire an attorney, and a guardian ad litem would be hired to protect your interests. And of course there are also those filing fees with the court.
If you neglect to execute a last will and testament and you have not made other legal arrangements to distribute your property, you will die “intestate.” Then a probate case will be opened and your property will be distributed according to statute, rather than your wishes.
If you neglect to execute a living will, your end-of-life decisions may not be carried out. Your life may be prolonged and your quality of life may suffer.
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As you can see, if you do not take steps to have appropriate documents drafted and executed while you are competent, there may be severe, unintended consequences. Attorneys are bound by an ethical duty to ensure that only those who are competent are executing legal documents. So get your affairs in order now.
Alexandra English is an elder law attorney with Kansas Legal Services, Inc.
Humor: The day fate started happening to me
By Ross Murphy
Kansas Senior Press Service
An e-mail letter to my daughters:
I am always amazed at how often we cheat death. I have, maybe 300 times, one of which you shared with me, when we went through the ice in the frozen Susquehanna River. Some I had on my own, recognizing those whirring wings of fate and shaking my head in wonder at my escape as they passed overhead. So one has to be careful.
Each morning when I awake, I feel for my pulse. If it is there, I get up and make coffee. If not, my plan is to just take the day off and rest, hoping that tomorrow things will be better.
Some time ago, one or maybe both of you, because you are incurable worry-warts, sent me a Web site called “How to recognize you are about to have a stroke,” or something close to it. I don’t remember, but thank goodness I did memorize the six things that tip a person off.
So, yesterday I stayed up especially late before I went to bed, and when I woke up, there was light, or it seemed like light, entering the windows of the room. It was especially bright from one direction, so I looked at the clock and it said — well, really it didn’t say anything, I had to look at the hands, and it told me — I mean, actually it didn’t tell me anything, I had to read the dials — I mean the hands — while the clock stayed perfectly silent, neither saying nor telling me anything, the lazy coward. I had to do it on my own.
Anyway, I was confused. I didn’t know what time it was; the hands were pointing at 11:30. Now you begin to understand my confusion, because both of these hands are just about the same length, so even though you look at it carefully, you still have to call time-and-temperature, but if you are confused, as I was, you don’t remember the number. I also couldn’t get my bearings, and I couldn’t find the telephone directory, even though I went all through the house, even the garage and the barn. No, we haven’t installed a phone in the barn.
Your mother always tells me that when I can’t find something, I should just stop and think about where it was when I saw it last. The only time I remembered looking at the phone directory was one night when I was at a downtown bar having a beer, and I thought I had better call home because it was getting kind of late, but I couldn’t remember our phone number. (Maybe it was the three beers.)
But I couldn’t go back to that bar to look for the directory, because I also couldn’t remember the name of the bar or where it was. It might even have been in Chicago. Anyway, that phone directory experience was about 11 years ago, so even if I could find that directory, the number for time-and-temperature might have changed. Come to think of it, I seemed to remember that Jimmy Carter was president then, so it might have been more years than that.
I recall that the first (1.) sign that you are about to get ready to have a stroke pretty soon is that you are confused about where you are or what time it is or maybe you are dreaming, because you actually haven’t awakened yet. So I was having the first symptoms exactly. I thought, Whoa, settle down and let’s think about this. I wanted my rational mind to take control, and sure enough, after about half an hour it did, and what it told me was, Chill out! My mind said, This is how you always wake up, so you are not having a stroke. Maybe a hangover. Boy, it’s true, I just hadn’t realized it had been 11 years. Was Carter president before Nixon or after? Was Jerry Ford actually president, or did I just dream it?
I was starting to relax, but then I thought of the second (2.) sign, which is that you suddenly have a bad taste in your mouth like you have a piece of aluminum wrapping from a Hershey’s Kiss stuck in one of your teeth, or maybe like you went to the zoo and got kissed by a camel. Yes, that was it! I had gone to the zoo! I just didn’t remember the name of the camel. I looked at the clock again. Eleven-thirty still. The hands hadn’t moved.
This was sign number three (3.) Everything seems to slow down to a crawl, until time stops completely. Why had time stood still? Then I remembered. One day the clock fell off the night stand and pulled the plug out from the receptacle. I had looked at the plug: one of the prongs had broken off. That’s why the hands stayed in the same position — 11:30 or 5:55, we didn’t care, as long as it was correct four times a day, which is more accurate than most clocks. I started thinking about when that prong was broken off. It was 11 years ago! Everything was coming together. Now there was no doubt, I was about to have a stroke!
As I waited, I became quite philosophical about my impending stroke. I was thinking, Why do we have time? Who needs it? Why don’t we pass a law that on a certain day, like next Tuesday, everyone has to line up around the nearest landfill and throw away their clocks? Then we won’t get any older. It is amazing how the certain knowledge that one is going to have a stroke clarifies one’s thinking. I was pleased with myself.
Then I was overcome by a feeling of (4.) dread! Stop, everybody! Don’t throw away your clocks! If we don’t have time, everything will happen at once!
What was symptom five (5.)? A terrific headache. By this time, I was lying on my back on the bed. Actually, my head was hanging backward from the edge of the bed, trying to ward off convulsions. I noticed a distinct unpleasant aroma. Another sign! I had noticed it just seconds before my head started to ache. I rolled over and looked right at my old tennis shoes. I threw them out the window, then took five aspirin. Symptom (5.) was ebbing rapidly.
Oy, symptom six (6.) You get numb, first in your fingers and toes, then your ears, then your brain. No, no, no! Now I recalled that this is not a stroke symptom; it is a reaction to reading People Magazine or watching television and oil spills and Barry O’Bama, who was actually born in Ireland, you know.
Anyway, I just thought I would give you a heads-up about my impending stroke. Hold on, someone’s at the front door.
It was your mother, all excited. When we went to the garage sale at Our Lady of Sorrows and Bring Some Money, I bought a lottery ticket, first prize $50. Your mom had just come from the mailbox — and we (I mean, I) had a check for $50!
The symptoms were right!
I had had a stroke of luck!
Ross Murphy lives in Shawnee.
Grandparents as parents: Childhood obesity
By Shirley Carson
Kansas Senior Press Service
As March begins, we long for warmer days and greener grass. This is the month in which we celebrate St. Patrick’s Day, and traditionally we eat a meal of corned beef and cabbage. And at our house, we always make shamrock-shaped sugar cookies with that yummy almond-flavored frosting we all love so much.
Those of us who are parenting our grandchildren need to be aware of what our grandchildren are eating, however — every day, not just on holidays. We must make sure they eat a diet rich in fruits and vegetables so a cookie or cupcake won’t be a problem for them as a special treat on holidays or birthdays.
Childhood obesity is the condition in which excess body fat negatively affects a child’s health or well-being. It is on the rise in the United States and is reaching epidemic proportions.
Obesity in early childhood can lead to adult obesity. First Lady Michelle Obama started the Let’s Move Campaign on Jan. 6 to combat childhood obesity, and the government has intervened to make school lunches more healthful and lower in calories.
Children become overweight and obese for a variety of reasons. The most common causes are genetic factors, lack of physical activity, and poor eating patterns — or a combination of the three. Only rarely is being overweight caused by a medical condition such as a hormonal problem.
If your grandchild is diagnosed with childhood obesity or even receives a warning that she is at risk, it can be devastating. This is especially true for the grandma who has taken on the parenting role. But there are many ways to reduce or prevent obesity in your grandchild. In doing so, you’ll lower her risk of serious health consequences.
The first thing to do is to improve your grandchild’s eating habits. This is important for any child, but especially for the overweight child. Your grandchild does not need a crash diet. He needs an improved way of eating that he can sustain for years to come. Discuss his needs with the doctor or nutritionist. Generally, he will need a diet low in fat and empty calories but rich in fruits, vegetables, low-fat dairy, lean meats, and whole grains. Eliminate the empty calories found in juice and soda. Low-fat milk and water are much better beverage choices. It will particularly help your grandchild if the whole family can eat in the same healthful manner. Limit sweet treats, giving fresh or frozen fruit as desserts.
You should also increase your grandchild’s physical activity — and here again, it will work better if the whole family gets more active together. People of all ages, from preschoolers to senior adults, should be active for 60 minutes every day. Don’t panic! Short bursts of 10 to 20 minutes of activity several times a day are OK. Find some activities that you can do with your grandchildren, such as walking, biking, and swimming. My grandkids’ favorite was swimming, and we purchased season swim memberships every year. As your family becomes more active, be sure to limit sedentary activities such as TV and video games.
Children who are overweight often have low self-esteem, and the two conditions can combine to form a hard-to-stop cycle. So, as you help your grandchild make physical changes through diet and exercise, be sure to build her emotional and psychological health, as well. Perhaps it would be beneficial to seek help with this from a family therapist.
My best wishes to all of you and your precious grandchildren for a healthy and happy St. Patrick’s Day!
Shirley Carson, RN, is a retired nurse and great-grandmother. Since raising her three oldest grandchildren, her desire is to encourage others who are parenting their grandchildren. She lives in Olathe.
Home front: Furnace size matters
By Don Carter
Kansas Senior Press Service
Sooner or later, you will replace a furnace — and when you do, the issue of size must be a consideration. It may seem odd, but a furnace with excess capacity is not the one you want. Here is some background:
About 35 million homes in this country heat with forced-air natural gas, and many older furnaces are so inefficient that 30 percent of their fuel energy goes up the flue instead of heating the house. Fuel produces fire and fire produces heat, but not all that heat gets to where you want it.
Furnaces are rated by the amount of fuel energy consumed when they’re running, called “input BTU.” Furnaces of the same input BTU can produce vastly different output, though, depending on their efficiency. Furnaces manufactured after 1992 are required to turn at least 78 percent of their fuel into heat, but efficiency was a price-driven variable before then.
Say it’s time to replace your furnace and you live in an older home. The old furnace is probably oversized, to as much as four times its ideal capacity. That’s because contractors used bigger furnaces to offset heat loss in the days before tight windows, weather-stripping, and heavy insulation.
As you consider the replacement furnace, beware of bidders who will check your existing nameplate (the unit’s label, stating the BTU-per-hour input) and then propose to sell you one just like it or, even worse, one that’s larger.
For illustrative purposes, say the old furnace has a 40,000 BTU nameplate and is 78 percent efficient. An Internet search shows that major brand furnaces now are typically 95 percent efficient, so for openers you could downsize to 33,000 BTU on efficiency alone. And if you have upgraded your home’s windows, siding, doors, or insulation, the home’s heat losses are now well below what the old furnace was sized for. If you buy in kind, you will have a greatly supersized furnace, and that creates a problem because the furnace will get your home to its designated temperature right away, then turn off before the heat is uniformly distributed. This is called “short cycling”; it is inefficient and it will reduce the furnace life. Moisture accumulates in the heat exchanger, and running in short bursts doesn’t get the insides hot enough to vaporize the water.
Another problem with short cycling is humidification. Many of us use a furnace-mount humidifier to keep the house from drying out, but in a short cycle it doesn’t run long enough to do the job. And finally, a furnace circulates air to overcome cold spots around the edges of the house, under windows, and near doors. In a short cycle the furnace blower isn’t on long enough to fully displace the air there.
To get a furnace with ideal capacity, require all bidders to calculate the optimum size, then compare their numbers. We are told that some utility companies provide this service at little or no charge, but regardless of who does it, calculations should be based on “Manual J, Residential Load Calculation,” published by the Air Conditioning Contractors of America.
One final thought: Always install a carbon monoxide detector near your furnace and near a vent. Even a properly installed furnace can introduce carbon monoxide into your home.
Select information was obtained from the U.S. Department of Energy.
Don Carter is a licensed structural engineer and managing general partner of Foundation Engineering Specialists LLC, a company specializing in residential design and assessments: don@fdnengineering.com.
Hospice: Providing a team of support at the end of life
By Jerry L. Old
Kansas Senior Press Service
When most people hear the word “hospice,” they think of death. However, hospice is about life! It’s about living the best quality of life that you can live for as long as you can live it.
A recent medical study proved that people receiving hospice care live longer than similar patients on aggressive therapies — an average of 29 days longer. Patients can have quantity and quality.
The concept of hospice began in England and migrated to the United States in 1974. In 1982, Medicare began paying for hospice services (100 percent, with no out-of-pocket deductible or co-pays from the patient). There are now more than 4,500 hospice programs in the United States.
Hospice is not a place; it’s a philosophy. A recent Gallup poll showed that 90 percent of Americans want to stay at home to die, if possible. For those people, that becomes the goal of hospice.
Hospice is good medical care, but a “cure” is not the goal. There comes a time in everyone’s life when a cure is not achievable. At that point, our hopes need to change — perhaps to achieve peace or reconciliation with family or friends or to live long enough to experience a special event. Perhaps the goal becomes pain control, a dignified death, or staying in control of one’s life.
Hospice services are intended for persons with terminal illnesses, with a life expectancy of six months or less if the disease runs its normal course. However, life expectancy is hard to determine, even by physicians trained in hospice. As long as the patient meets Medicare guidelines, hospice benefits continue indefinitely. Some people may live for two days while receiving hospice care; some may live two years. The average amount of time on hospice is 29 days.
The most common comment I hear from families is, “I wish I had known about hospice sooner!”
End-of-life care is very individualized and requires a team approach — coordinated services by a physician, nurse, home health aide, social worker, chaplain, and volunteers. As needs vary, a patient may use all these disciplines, or one more than the others.
Medicare and most private insurance companies cover the cost of all medications related to the terminal diagnosis, nursing visits at least every two weeks, physician supervision, home health aide visits, medical equipment (oxygen, hospital beds), social worker and chaplain visits, and volunteer services. Also available are respite care (relief for the caregiver), general in-patient treatment, and crisis intervention. Families are given bereavement support for at least 13 months after the loved one dies.
All hospices are paid the same Medicare amount, whether they are for-profit or non-profit organizations.
How can people choose the hospice that is right for them? Here are some questions patients and families should ask when deciding on a hospice organization:
How frequent are nursing visits? Medicare requires a visit every two weeks, but each company has its own standard.
What is the nursing case load? Does each nurse care for 10 patients or 30 patients? The answer makes a big difference in how much time can be spent with each patient.
When emergencies occur on weekends or at night, does a hospice nurse answer the phone or do patients and families get a recording or the dreaded “press one, press two” machine?
Does the hospice have a local medical director?
Does the hospice spend money on such things as wound care programs? Does it support education for employees and the community?
Dying is part of the life cycle. It is a time of reflection and tremendous mental, emotional, and spiritual growth. But 70 percent of Americans still die without the support that hospice can offer.
To locate hospice options in the Kansas City area, check your phone directory yellow pages or the Johnson County Senior Directory, available by calling 913-715-8999 or online at http://hsa.jocogov.org and see Senior Directory under Quick Links.
Jerry Old, MD, is chief medical officer for Hospice Care of Kansas/Midwest. He formerly taught medical students and residents, and is now associate professor at the University of Kansas School of Medicine–Wichita. He is a nationally recognized author and presenter on end-of-life care and hospice.
The Ides of March: A remembrance
By Fred Farris
Kansas Senior Press Service
We slogged through a light snow in early March 1945. We were the 86th Infantry Division on the road to Germany’s Rhine River.
In front of us, other American divisions had just captured the city of Cologne, which fronted on our side of the Rhine. As we trudged into Cologne, the bombed-out remains of an automobile factory appeared. Steel hulks of car and truck bodies, axles, fenders, and other car parts lay on the ground, twisted like skeletons, mutilated by bombing and abandoned in the pockmarked parking lot.
On the fence, a sign read “Ford-Werke. Home of a German-Built Ford.” I remembered reading news of Henry Ford receiving a German Eagle award medal in 1938.
Glad to end our long march over cold, damp ground, we billeted ourselves in German homes. I can still remember a few phrases from the small GI Phrase-Book of Useful German. One was, “Clear away the debris out of this street and be quick about it.” Another asked, “Which way to the train station?”
The German Wehrmacht (army) had re-formed behind the wide Rhine barrier to defend the “Heart of the Fatherland.” German infantry and panzer tank divisions intended to drive the invaders back into the river as we struggled to cross the swift water barrier, now swollen by spring runoff from the mountains. The Germans had a solid defensive position because they had blown up all the Rhine bridges for 400 miles up and down stream.
However, 50 miles upstream another armored division forged onward. Four men in a reconnaissance half-track — we called them “recons” — scouted ahead. They looked down from a hill above the small city of Remagen and couldn’t believe their eyes. A railroad bridge was still standing. German demolition squads were climbing under the iron structure, strapping dynamite to the girders, but the old Ludendorff Bridge was intact. Wreckage lay on the tracks and gaping holes had been blown in the roadbed, but the bridge stood. Through some mix-up in the war’s shifting confusion, the final order to blow it had been delayed.
The brave men of the 27th Armored Infantry Battalion led their platoons across the bridge under fire. One was killed and two wounded before our assault troops reached cover in a railroad tunnel on the other side. Within three days and nights, about 5,000 troops and dozens of tanks and armored half-tracks charged across the bridge in spite of incoming rifle fire and mortars plus strafing by Luftwaffe airplanes. The German army mounted a desperate effort to block the breech of this crucial barrier.
I crossed the Rhine there several nights later, but I didn’t go over the famous bridge itself. My troops, now transferred to trucks with canvas coverings, crossed on a new pontoon bridge hastily completed about 40 yards downstream from the bridge, which, weakened by age, mortar attacks, and bombings, fell into the river.
Unfortunately, seven of our American engineers plummeted with it into the rushing water. Two of them drowned; the rest were fished out by other engineers on the pontoon bridge being hastily built downstream in anticipation of a collapse.
Two nights later, my group of motorized troops drove across the new pontoon bridge. My canvas-topped truck had 13 guys jammed in among metal ammunition boxes and reels of wire for setting up field telephones. It was March 15, 1945, the Ides of March, and it was midnight. Our truck was tight between a Sherman tank and an armored half-track on a narrow strip of precariously floating pontoons. Its metal strip roadbed had no side rails but did have three-inch gaps in the wet iron plates.
Through those gaps we saw rushing water. The slippery, narrow slabs challenged all drivers as the chain-linked pontoons undulated up and down, heaving and creaking. A torturous cry came as metal scraped against metal, an ominous omen. To heighten the tension, the swift current plunged against and under the pontoons, seeming to lift the up-river side of the pontoons at a dangerous angle. The dark night showed its teeth in a flash of lightning. Peering out the open back of our truck into black rain, I could barely see the front of a Sherman tank just three feet behind us, its metal caterpillar tracks grinding out an anguished clanking as it lurched forward and halted, again and again. Its giant engine screamed a spasmodic zoom. It was too close. I could have jumped onto it.
We jerked forward, then stopped, over and over, and so did that tank behind us. Our whole chain of vehicles lurched along like drunken snails. It also seemed that we were wobbling side-to-side. Even so, I was glad not to have to march over that treacherous bridge and glad to be out of the driving rain.
As time stumbled on, we all tried to think about other things. I thought of Julius Caesar on the Ides of March, the day he ignored a warning and was killed. I thought of Caesar crossing the Rubicon, the river beyond which he could not turn back. Not that we could turn back; we just sat tight, swept along by the current of war.
When our truck finally moved off those perilous pontoons and onto solid ground, we didn’t mind admitting we had been afraid. We joined other armored and infantry divisions to force a giant pincer movement around the large Ruhr area, the industrial heart of Germany. It was officially named the Battle of the Ruhr Pocket, although some called it the “Rose Pocket” in remembrance of Gen. Maurice Rose, the only American general killed in combat in World War II.
The capture of the bridge at Remagen became famous. Books and Hollywood movies depicted the assault on the bridge as a heroic thrust into Hitler’s heartland. But I’ll always remember it as the Ides of March.
Fred Farris lives in Leawood. He served in the 86th Infantry Division of the Army from January 1943 to August 1945.
Taxpayer check-off makes it easy to help Meals on Wheels
By Gordon L. Davis
Kansas Senior Press Service
The 2010 individual income tax form again allows for donations to the Senior Citizen Meals on Wheels Contribution Program. If you donate to the fund, 100 percent of your contribution will go to local programs serving in-home meals to home-bound seniors and people with disabilities.
The check-off program is an efficient, convenient way to make a difference in the lives of Kansas seniors. Each year this program helps to fund meals for vulnerable seniors throughout the state, and makes a significant difference in their lives, their health, and their ability to remain independent in their own homes.
The Senior Citizen Meals on Wheels Contribution Program is a fund that the Kansas Legislature created in 2002, allowing taxpayers to make a donation to support home-delivered meals. The program is a channel for people who want to support food programs for seniors but perhaps can’t participate in ways such as meal delivery.
The intent of the fund is to supplement nutrition services for the elderly and people with disabilities in the community, making it possible for them to live independently in their homes as long as possible. The personal contact with meal volunteers is helpful to the seniors’ well-being, and the delivery process is a way to learn of clients’ changing needs or of emergencies.
If you will receive a state refund this year, indicate on line 37 (Senior Citizen Meals on Wheels Contribution Program) of the tax form the amount you wish to donate. You may contribute $1 or more, a portion of your refund, or all of your refund to the Meals on Wheels fund.
If you owe state taxes, indicate the amount you wish to donate in the designated space and write a check for the tax balance plus the amount contributed to Meals on Wheels.
Information about filing your Kansas individual income tax return electronically is available through the Kansas Department of Revenue (KDOR) at www.webtax.org.
Filing your Kansas individual income tax return electronically is typically more accurate and faster to process than paper filing, and costs less. Submitting your information electronically is safe. If you choose direct deposit for your refund, you can expect a refund in as few as five days.
If you plan to file electronically but would like a paper form and instructions to start with, consider using the sample forms contained in the instruction booklets on the KDOR Web site. This will reduce costs in providing forms to you that will not be filed.
For sample forms and instructions for the K-40 (Kansas Individual Income Tax or Food Sales Tax Refund), visit www.ksrevenue.org (click on “Forms and Publications”).
If you use paper to file your Kansas return, you may obtain a KDOR-printed scannable form by e-mailing KDOR at forms@kdor.state.ks.us or calling 785-296-4937. Allow two weeks for delivery. If your paper form is complete and accurate when mailed, allow 12 to 16 weeks for processing.
For more information about the Senior Citizen Meals on Wheels Contribution Program, call Aging Information at the Johnson County Area Agency on Aging, 913-715-8861.
Phantom power: Electricity you pay for, without benefit
By Ron Trecker
Kansas Senior Press Service
The latest KCP&L rate increase for Kansas customers took effect Dec. 1, 2010. The average residential rate will increase 4.5 percent, or about $50 per year. The increase is to pay for delays and cost overruns for the Iatan 2 power plant. KCP&L rates have now gone up 30 percent in the past five years.—Source: The Kansas City Star, 11/22/10
As I read this article in The Star, I realized that my standard of living had just taken a hit. As a retiree, I did not get a Social Security cost-of-living increase last year or this year, and Congress defeated the $250 payment to seniors. My next thought was, I didn’t work 30 years only to have KCP&L reduce my standard of living. To me, the rate increase was a call for me to find ways to lower my electricity use.
Most of us think that when we turn an electronic device off, it stops drawing power. Unfortunately, that’s often not true. Most devices, instead of switching off, revert to a standby mode that continues to use power while the device waits for you to switch it on again. For example, when you grab your TV’s remote control and press “on,” the television must be getting some power already to enable it to receive that “on” signal and respond to it. It’s standing by, waiting for you to turn it on with the remote. That’s how the term “standby power” originated.
Other examples are the digital clock display on your microwave oven or the power adapter for your laptop computer. All of these devices consume power without offering any features in return. If the adapter is warm to the touch, it’s using power.
This wasted power — also called phantom power or vampire power — is bad for your wallet and for the environment. Studies conducted by the Lawrence Berkeley National Laboratory estimate that standby power consumption in the United States accounts for 5 percent of all residential power consumption. This means that Americans spend more than $3.5 billion annually on phantom power, and the average U.S. family spends $270 each year for energy that is of absolutely no benefit. It also means that standby power is responsible for 27 tons of needless carbon dioxide discharged into the atmosphere yearly by power plants producing the power to meet this unnecessary demand.
Phantom power is used when electronic devices that you keep plugged in quietly drain electricity, all day, all night, every day, even when they’re off. Just about everything that requires being plugged in draws phantom power. Almost any device with an external power supply, remote control, or continuous display (including an LED display), or that charges batteries, will draw continuous phantom power.
If you have a DVD player, do you leave it plugged in all the time? If you do, you are paying almost $9 a year more on your electric bill. I would bet that most of you have a computer. If it’s a desktop model and you leave it plugged in, you are paying an extra $34 a year for power that gives you absolutely no benefit. If you purchased an X-box or a Wii for your grandchild last Christmas and you leave either one plugged into the wall receptacle, you are paying an extra $25 annually in electricity. The cost of phantom power usage for these electronic toys adds new meaning to the adage “you must pay to play.”
Do you own a large-screen television, and do you leave it plugged in? Congratulations! You have just won the Vampire Power Award! Plasma screen television sets can cost you an unnecessary $160 a year even when they are turned off.
So what does this mean when mitigating the recent KCP&L rate increase? It means you can save money simply by unplugging your electrical devices while you’re not using them. Use a switchable power strip for clusters of computer or video products; that way you can switch everything completely off with one action.
Before you shop, go to the Department of Energy’s Energy Star Web site (www.energystar.gov) and identify products with lower standby power requirements.
Below are a few of the most common phantom power user devices and the expected amount of power they waste each year.
For further reading
Lebot, Benoit; Alan Meier; and Alain Anglade. 2000. “Global Implications of Standby Power Use,” in the Proceedings of ACEEE Summer Study on Energy Efficiency in Buildings. Asilomar (Calif.): American Council for An Energy Efficient Economy
(Washington, D.C.). Also published as Lawrence Berkeley National Laboratory
Report No. LBNL-46019: June, 2000.
Device Potential Annual Savings1
DVD Player $14
Answering machine $20
Microwave oven3 $27
Cable modem $35
CD player $45
Inkjet printer $47
Set-top box, digital cable on, TV off $221
1 Department of Energy Standby Power, Lawrence Berkeley Laboratory, using $0.11 per KWH.
2 When a 1,000-W microwave is off with the door closed, it draws 3 W. With the door open, it draws 26 W. When cooking, it draws 1,433 W.
Ron Trecker is a retired professional engineer who worked with Boeing, Jacobs Engineering, and GM. He lives in Lenexa.
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