Envisioning More Livable Cities

Livable Communities
Envisioning More Livable Cities
By Mac McLean

Talent is a city in Southern Oregon that’s home to 6,500 residents (Courtesy Talent Chamber of Commerce)

The city of Talent has spent nearly 30 years turning its downtown into a thriving community where people can get the amenities and services they need regardless of their age.

t’s a transformation that AARP Oregon hopes to make in other parts of the state through its Livable Communities program.

“It’s kind of fun to be on the front side of this effort,” said Talent Mayor Darby Ayers-Flood, reflecting on the work the city of 6,500 people has accomplished.

Last summer, AARP Oregon kicked off the most recent phase of this initiative by holding 13 public forums to find out what residents like about their communities as well as how to improve them.

Last summer, AARP Oregon kicked off the most recent phase of this initiative by holding 13 public forums to find out what residents like about their communities as well as how to improve them.

The organization recently compiled its findings into a report that it hopes will help state and local officials prepare for a future in which 1 out of 5 Oregonians will be 65 or older by 2025.

In 1991, the Talent City Council formed an urban-renewal agency to improve downtown by building parks, burying power lines, installing light posts and providing grants to business owners to update building facades.

The agency also added bike lanes, sidewalks and bus stops to the area’s key roads.

Ayers-Flood, mayor since 2015, said these early investments—particularly those involving the city transportation infrastructure—drew a steady flow of pedestrian and vehicle traffic to the area. That brought new businesses, homes and residents.

The resulting development boosted the city’s tax revenue and helped pay down bonds used to fund the initial improvements.

The investment in transportation also improved access to services for older adults in nearby housing complexes.

Seeking community feedback

Bandana Shrestha, AARP Oregon’s community engagement director, said transportation issues were one of the most common concerns people mentioned at last summer’s forums.

Some people worried they might have to move if they could no longer drive, Shrestha said. Others continued driving because they didn’t have another way to get around.

“We heard from people who had to make very difficult choices,” she said.

  Shrestha added that Oregonians were anxious, too, about access to health care facilities and finding other homes or apartments so they could downsize.

These concerns were magnified in areas where housing prices were increasing and threatened to push people out of the neighborhoods they love.

Shrestha said many thought their voices weren’t being heard and wanted local leaders—who would steer any major community redevelopment effort—to better listen to their concerns.

Ayers-Flood said elected officials must do everything they can to involve their constituents.

The Talent Urban Renewal Agency is governed by a group of residents who make it a point to get as much community feedback as possible.

Even now, the mayor is looking for residents to join a steering committee that will help guide efforts to improve transportation and affordability in other sections of the city.

“We face the same problems that other cities do,” she said.

Learn more about the AARP Livable Communities initiative at   aarp.org/livable

This article was originally published in the AARP Bulletin on April 29, 2019

Vision Zero’s vision: No traffic deaths

Livable Communities

Vision Zero’s vision: No traffic deaths

By Mac McLean

Rob Zalo started working with the Vision Zero initiative after a family was killed while crossing a busy street in Springfield.

SPRINGFIELD, OREGON — Moments of tragedy can motivate people to work toward goals that seem out of reach.

Rob Zako’s call to action came in February 2015, when a pickup truck driver killed three young children and severely injured their mother while they were crossing a highway outside downtown Springfield.

“Lots of people cross the street at that intersection every day,” said Zako, executive director of Better Eugene-Springfield Transit—commonly known as BEST—a nonprofit dedicated to improving Lane County’s transit services.

Zako began aggressively urging local communities to adopt a Vision Zero action plan to reduce pedestrian deaths.

With help from AARP Oregon and the Eugene Springfield Safe Routes to School Program, Zako persuaded the Eugene City Council last November to adopt such a plan.

These plans commit local officials to work toward eliminating traffic fatalities and severe traffic injuries through the “Four E’s” of Vision Zero’s comprehensive approach: education, enforcement, engineering and emergency response.

Seventeen cities, including Portland, Los Angeles, San Francisco and Seattle, have adopted a Vision Zero action plan, according to the network’s website. More than a dozen others are considering one.

“When cities adopt Vision Zero, they make significant changes in how they do business,” said Bandana Shrestha, AARP Oregon community engagement director and a member of Portland’s Vision Zero Task Force.

Older adults make up a disproportionate share of Oregon’s traffic victims. Between 2004 and 2013, people who were 65 or older made up 13.6 percent of the state’s population and 22 percent of its traffic fatalities. People who were 75 or older made up 6.4 percent of the population and 12.5 percent of its deaths.

The fatal accident that motivated Zako occurred when a driver “unwittingly ran a red light” at the intersection of Main and 54th streets, according to law enforcement officials. His vehicle struck Cortney Hudson-Crawford and her three children—ages 4 to 8—while they were in the middle of a crosswalk. The driver wasn’t drinking, according to news reports, nor did he have a history of reckless driving or other serious traffic infractions.

“Our understanding is that the driver got distracted,” Zako said. The traffic light at that intersection was working properly, he added, and the crosswalk was clearly marked.

Steps toward safety

But that doesn’t mean similar crashes are unavoidable, Zako said. He suggested that communities could run massive public education campaigns that identify the busiest pedestrian intersections and encourage drivers to slow down at those locations.

Localities could also lower speed limits around those intersections and ensure there is sufficient enforcement, he said. Other traffic engineering features such as roadway medians would make drivers feel that they were boxed in and encourage them to be cautious.

And finally, cities could increase the number of available paramedics and ambulances so that if there were a wreck, victims could receive medical care as quickly as possible, he said. That might keep a serious traffic accident from becoming a fatal one.

Under the Vision Zero program, a city must conduct a comprehensive study to identify its most dangerous roads and what resources could be used to improve their safety.

Both Portland and Eugene are now making their way through this part of the process.

Shrestha said AARP Oregon is holding its own “NeighborWalks” in Portland and sponsoring walks in Eugene to get more residents walking and thinking about pedestrian safety and what transportation options are available.

AARP also plans to hold pedestrian audits, in which people look at traffic hot spots and gather information, including how long the traffic and walk lights remain on so people can cross, whether drivers slow down or stop for pedestrians, and the condition of sidewalks and curbs. The information will be shared with the Portland task force.

“We want to educate Oregonians about ways they can be safer,” Shrestha said.

This article was originally published in the AARP Bulletin on July 1, 2016

Scam jams help you avoid the swindler


Scam jams help you avoid the swindler

By Mac McLean

Bill Hamilton’s mother was scammed by an unscrupulous contractor 20 years ago.This prompted his involvement in AARP’s fraud prevention efforts.. (Courtesy AARP Oregon)

Bill Hamilton joined the fight against fraud a few years ago because an unscrupulous building contractor scammed his 83-year-old mother-in-law out of about $10,000.“I wanted to help prevent this type of thing,” said Hamilton, 70, of Portland, a retired software manager who has volunteered with AARP Oregon’s Scam Jam program for nearly three years.

Since October 2013, AARP has worked with the Oregon Department of Justice and other agencies to hold Scam Jam sessions across the state, where people learn about local fraud schemes and ways they can avoid being ripped off.

“We bring all the experts in a community together at one time,” said Joyce DeMonnin, who organizes these events as the communications director for AARP Oregon. She said each session typically attracts 300 to 1,000 people.

DeMonnin said it’s important to warn older people about scams because many are retired and living off savings, and may never be able to replace the money lost to a swindler.

The AARP Fraud Watch Network ( aarp.org/fraudwatchnetwork ; 877-908-3360 toll-free) is another way to keep up to date on the latest types of fraud, with email alerts about scams in the state.

For Hamilton, he knew something was wrong about 10 years ago when his mother-in-law talked about some work she was having done to her roof and driveway. This bothered him because the roof was in excellent condition and her driveway didn’t need to be replaced.

Yet, when a building contractor  showed up one afternoon, he told her that both projects needed to be done right away. He offered to do the work for $20,000, and she gave him the go-ahead.

“By the time we found out about it, half the driveway was done,” said Hamilton, who managed to stop the contractor from working on the roof but had to eat the cost of the driveway replacement.

Hamilton learned that his mother-in-law had fallen victim to a classic construction fraud scam. According to the Oregon Construction Contractors Board, this common scam involves contractors who show up unsolicited, claiming work is needed on a home and can be done for a very low price.

Bogus IRS calls

In another scam, a person “from the IRS” calls, trying to collect a bogus tax debt over the phone. But government agencies always send letters in such cases. Other callers offer to begin or renew a magazine subscription at an inflated price.

The state Department of Justice received 2,818 written complaints about those two telephone scams in 2015, said Ellen Klem, the department’s director of consumer outreach and education.

Klem said this total fails to represent the true number of victims because it counts only those cases that were reported to her office.

DeMonnin said that many scam victims are too embarrassed to step forward and make a report. “If someone has scammed you, you’re not foolish,” she said. “You’re the victim of a crime and that person is a criminal.”

DeMonnin said it’s also important for victims to provide a first-person account of how the scammer operated. This information can be shared  through Scam Jam sessions and the Fraud Watch Network to help keep other people from falling into the same trap.

“Prevention is the best medicine,” DeMonnin said.

AARP Oregon, the state Department of Justice, and the Department of Consumer and Business Services are planning a series of Scam Jams. Call 877-926-8300 toll-free to register. Each event runs from 10 a.m. to noon:

  • May 18: Hermiston Conference Center, Hermiston
  • May 19: Pendleton Convention Center East Rooms, Pendleton
  • June 2: Beaverton City Library-Main, Beaverton
  • June 3: Four Points by Sheraton Portland East, Gresham

On Sept. 29 in Portland, Frank Abagnale, an AARP Fraud Watch Network ambassador, will share his expertise on how to avoid scams. The event, at 7 p.m., is free. Go to  aarp.org/or  for details and registration.

This article was originally published in The AARP Bulletin on May 1, 2016


Have no fear, tax help is here

Senior finances

Have no fear, tax help is here

By Mac McLean

Kathy Goeddel and other Tax Aide volunteers work to make sure seniors and low-income families get the largest refunds they are due. (Courtesy AARP Oregon)

Kathy Goeddel has 32 years of experience helping taxpayers save a chunk of money when they file their returns. Best of all, her service is free.

Goeddel, a retired information systems director from Portland, listed two common tax breaks that people sometimes miss: the earned income tax credit and the retirement saver’s credit.

There are also tax credits or deductions to help people get back some of the money they spent for child care, health insurance, getting an education or finding a job.

Goeddel, 60, knows this because she spends a couple of months each year as an IRS-certified volunteer tax preparer for the AARP Foundation Tax-Aide program.

Created in 1968, it’s a national effort aimed at helping low- to moderate-income people 50 and older file their tax returns so they don’t miss a single deduction or credit.

The service is free and available to anyone, regardless of age. Unless you fall within one of a few categories—if you farm or own rental property, for example—a volunteer can help you.

Last year, Tax-Aide volunteers helped more than 83,000 Oregonians with their returns. In the process, state taxpayers received more than $50 million in refunds. Goeddel said the refunds some people get can make a real difference in their lives, and that’s why she spends so much time on the program.

“You help people find money they weren’t expecting,” said Goeddel, who joined Tax-Aide in 1984 and is now a district coordinator supervising 11 of the program’s sites in northern Portland.

State coordinator Bill Ensign also joined Tax-Aide in 1984. His first assignment was working alone in the basement of a building in Beaverton that was later demolished to make room for new businesses.

“We were doing returns on carbon paper with a pencil and a pen,” said Ensign, 74, who lives in Beaverton. A retired federal employee, he has managed Oregon’s Tax-Aide operation since 2010. Back in the 1980s, it took him an hour to help a single client—and that was only if he didn’t make a mistake.

An army of 1,300

Goeddel also looks back on this time with a certain fondness. She recalls once filling out three separate returns by hand—one for the state, one for the IRS and one for the client—only to start over from scratch when the person she was helping remembered leaving a W-2 at home.

Goeddel’s work became easier in the mid-1990s when she downloaded a tax preparation software package to her personal computer and carried it with her to the Tax-Aide site.

Today, Oregon’s Tax-Aide program has mobilized 1,300 volunteers who work at around 140 tax preparation locations across the state. All preparers have received updated training. Some sites will do only about 100 returns during tax season, Ensign said, while others are geared up to handle thousands.

Sharon Looney, 62, of Eugene, said the six sites she supervised as the district coordinator for northern Lane County handled about 3,000 tax returns during the 2015 tax season. All those returns kept her working seven days a week.

“In terms of my hobbies, I’d have to say it’s probably number one,” said Looney, who acknowledges she may have done too much during the 2015 season. “I’ve got to cut back.”

Ensign also likes preparing taxes, partly because it’s a great way to keep one’s mind sharp, he said. But not every volunteer necessarily feels the same way.

“I don’t really like doing taxes,” Goeddel said. “But I really like being able to help people who could use a little extra help. There’s something about that that makes it fun.”

People who want help filling out their tax returns for 2015 can find a Tax-Aide site at aarp.org/findtaxhelp or by calling 888-227-7669 toll-free. It’s a good idea to call ahead to make an appointment.

Make sure you know what to bring to your session by checking aarp.org/taxdocs.

This article was originally published in The AARP Bulletin on March 1, 2016


Managing meds can prevent drug interactions

Health care

Managing meds can prevent drug interactions

By Mac McLean

Courtesy photo

Jane Mitchell takes four different prescription drugs each day.

She takes one for blood pressure, one for cholesterol and one for osteoporosis. Then she takes another pill to treat heartburn the latter medication causes.

This four-drug combination is safe on its own. But throw in some grapefruit juice, too much alcohol or the wrong antibiotic, and a negative drug interaction could cause Mitchell, 71, to feel dizzy and fall, damage her kidneys or cause severe pain.

These and other potentially fatal combinations of prescriptions, over-the-counter medications, food and dietary supplements are part of a major public health problem sending thousands of seniors to emergency rooms each year, according to a 2012 study published in the New England Journal of Medicine.

“Luckily, I’ve never had any trouble with that,” said Mitchell, who knew grapefruit juice would be a problem with her cholesterol medication because she used to work in health care.

Still, the retired physical therapist wishes there was a broad-based alert system that would raise a red flag if she got a prescription that might put her at risk for any of these issues.

Nearly 29.8 million people 65 or older are taking more than three prescription drugs each day, according to a recent report from the Centers for Disease Control and Prevention. That figure includes 17.5 million seniors who are taking five medications each day.

There is a system in place to prevent a negative drug interaction if a person uses one pharmacist consistently. Some pharmacies work with insurance companies to learn about all the medications a person is taking, but that’s limited by information available from available insurance and pharmacy records.

Knowing the dangers of negative drug interactions, however, falls heaviest on a patient.

“Ask questions and reach out for help,” said Michael Taday, the director of pharmacy professional practice and clinical operations with Humana, Oregon’s largest Medicare Prescription Drug Plan provider, serving nearly a fourth of the state’s Part D enrollees. Taday urged seniors to be proactive in their medication management. “Don’t assume your pharmacist and your physician knows what the other is doing.”

The risks

According to the AARP/HealthLine drug interaction checker, Mitchell’s blood pressure medication, lisinopril, could cause her to feel dizzy if she drinks too much alcohol while taking it.

Her cholesterol medication, simvastatin, can cause severe muscle aches and fatigue if it’s mixed with more than a quart of grapefruit juice each day. It also can damage her kidneys and cause her muscle tissue to break down if mixed with a macrolide antibiotic like clarithromycin or erythromycin.

Negative drug interactions and other incidents and injuries stemming using medication as prescribed sends 77,853 seniors to the emergency room each year, according to the NEJM study. A third of these patients suffered symptoms so severe they stayed in the hospital for more than a day.

“It’s definitely something you worry about and something you see,” said Rob Uetrecht, staff pharmacist at the St. Charles Health System’s community pharmacy.

These problems often happen with seniors because a person’s metabolism, liver and kidney function slows down considerably as they age, Uetrecht said. This means it takes longer for a medication to clear their system, and a normal dose of medication could push them over the edge to overdose territory.

Seniors are also more likely to take more than one prescription drug or a combination of prescription drugs, over-the-counter medications and dietary supplements, studies show.

Any one of these medications could cause a negative drug interaction if a new prescription comes on board, he said. This problem is only made worse by the fact many seniors do not tell their doctors about every medication they take because they forget one or might not think it’s important at the time.

For instance, forgeting to tell you doctor you take Sudafed during allergy season could lead to nervousness, irritability, difficulty sleeping, increased blood pressure and seizures if he gives you a prescription for Welbutrin.

“When we fill prescriptions for patients,” he said, “we have to watch for all kinds of different things.”

The system

Federal law takes a stab at preventing adverse drug reactions by requiring pharmacists to put detailed information about a medication’s proper dosage, potential interactions and other side effects with every prescription they fill.

They must also put brightly colored labels on a drug’s bottle that warn about any interactions it has with alcohol, aspirin, acetaminophen or another commonly-used OTC medication. Those same warning labels let people know to stop taking a medication if they become pregnant, talk to their doctor before they take any other forms of medications and seek immediate medical attention if certain side effects should arise.

There is a lot of information available about a patient’s drugs,” Taday said. This information is also featured on websites managed by AARP, the National Institutes of Health and private companies such as Drugsite Trust.

Insurance companies that provide Medicare prescription drug coverage must also talk to certain members about the medications they are taking and help them come up with a long-term medication management plan. The criteria for these conversations vary widely from prescription plan to prescription plan, Taday said, explaining they tend to focus on how many drugs the member is taking, how many chronic conditions he or she has and how much money the person might spend on drugs each year.

Finally, pharmacists who work with Humana insurance companies pool their prescription and claim information into a database that can track an individual patient’s drug use over time. These programs throw up a red flag when the pharmacist fills a prescription that may have a negative interaction with something the patient is taking or has taken in the past, Uetrecht said. He shares this information with the patient’s physician so a medication regimen or dosage can be changed if need be.

“We’re constantly sending notes to doctors,” Uetrecht said. “First and foremost, my thought is, ‘Am I doing harm to the patient by letting him have the medication?’”

But these systems also have holes.

Pharmacies only have records about prescriptions they fill, and insurance companies only have records if there’s a claim, Taday said. This means some medications may fall through the cracks if a patient uses more than one pharmacy, pays for a prescription out of pocket or takes an over-the-counter medication or a supplement that does not require a claim.

That’s why it’s important for patients to talk to their doctors and pharmacists about every medication they take, he said, or make sure they have a caregiver or a friend who can do so in their place.

“A patient who stays engaged with their medication management is critical,” 

This article was originally published in The Bulletin on Oct. 23, 2015

Piping a hero’s farewell

Veteran's issues

Piping a hero’s farewell

By Mac McLean

Mark McIntire of Military Honors by the Pipes prepares to play Amazing Grace Friday, September 4, 2015, during a funeral for a WWII veteran in Prineville. (Courtesy Jarod Opperman / The Bulletin)

The first few bagpipe notes of “Amazing Grace” echoed across a hilltop at Prineville’s Juniper Haven Cemetery, bringing a somber silence to Phillip T. Quinn’s graveside service earlier this month.

Master Piper Mark McIntire, Military Honors by the Pipes director of piping, played his instrument to honor the World War II veteran being laid to rest.

“The highlanders believed we summoned the light (when we played the bagpipe ),” said McIntire, who has almost 20 years of bagpipe experience. “That light would come down, and it would take you to heaven.”

The bagpipers’ group founded in 2013 is a Prineville-based nonprofit that honors veterans by playing one of the world’s oldest instruments at their gravesides. The organization’s pipers played at 51 services in 2013, the year they incorporated as a 501(c)(3) nonprofit, and 84 services by the end of 2014. So far this year, its pipers have graced 300 services.

The growing demand is affirmation for the organization’s founders; however, it’s been hard to keep up. McIntire and the group’s founder, John Pierson, hope a recent $1,500 grant will help.

“We get calls to do this every day,” Pierson said, explaining the challenge for him and his six bagpipe players. “There are more than 1,000 military funerals in Oregon every month.”

The pipes

Scottish historians claim the bagpipe — a rather loud instrument that produces sound when someone squeezes a bag of air through wooden pipes called chanters and drones — is one of the world’s oldest instruments and traces its roots back to ancient Egypt and the Assyrian Empire.

Bronze statues show Roman centurions playing bagpipes during their 400-year occupation and conquest of England. Written records show instances where Scottish and Irish troops used bagpipes instead of a horn before running against British troops on the battlefield in the mid-16th century.

“It’s a Scottish tradition,” said Jeffrey Mann, president of the Western United States Pipe Band Association. “When you bring someone into the world, the bagpipes are used to celebrate the event. … When someone leaves the world, the bagpipes celebrate that as well.”

Immigrants from Scotland and Ireland brought these piping traditions with them when they traveled across the Atlantic Ocean to settle this country in waves during the 17th and 18th centuries, Mann said.

These people often took jobs as police officers, firefighters or soldiers when they arrived, he said, which is why bagpipe melodies such as “Amazing Grace,” “Danny Boy,” “Flowers of the Forest” and “Going Home” are so common at funerals that honor these professions.

McIntire, whose ancestors boast an 800-year history with bagpipes, said the instrument is also popular at funerals because it carries a very somber, emotional tone that sweeps across the audience like a flood whenever its melodies are played.

“That’s what gets the healing process started,” said Pierson, who started playing the bagpipe and launched his organization as a way to honor both the people who served his country and the family members they left at home.

The honors

Pierson served as an Air Force reserve during the Vietnam War. His pararescue unit, most of whom were deployed to recover pilots after their planes had been shot down, lost 10 men in the line of duty. Pierson never went to Vietnam, he stayed in the United States, but those deaths haunted him.

“When I got out, I had this nagging sense of guilt I was not honoring those men,” Pierson said. Those feelings are the reason he started studying the bagpipe in 2003. He felt called to play at military funerals as a way to honor those who served, including his fellow soldiers.

In 2012, Pierson’s effort and desire came to fruition when military officials identified some remains belonging to a soldier from his unit who had been killed during the war. “His family asked me to play,” he said.

As Pierson played the bagpipe, the fallen pararescueman’s body was finally laid to rest during a special internment held at Arlington National Cemetery, 40 years after his helicopter was shot down in Vietnam.

The explosive growth Pierson’s organization has seen over the past four years is due to extra pipers who volunteer their time . The recent grant from the Oregon Community Foundation will help these pipers travel and make up for some of the money they spend on gas, food and lodging when they travel from their home to the veterans’ gravesides.

Military Honors by the Pipes has also expanded its reach by building relationships with veterans’ groups like the Prineville Area Band of Brothers, cemetery directors and funeral home providers who call the organization when they plan a service for a veteran.

Pierson is especially fond of this network because it makes arrangements easier for veterans’ family members — a group of people he feels deserve as much recognition as the veterans themselves.

“It was all taken care of in a matter of two weeks,” said Quinn’s son Patrick, who planned his father’s ceremony from his home in Santa Fe, New Mexico.

Patrick Quinn’s father wanted to be buried in Prineville because he was born there and his parents are buried at Juniper Haven Cemetery. When Patrick Quinn called the Whispering Winds Funeral Home, the organizers told him they would set up the funeral with pipers and a full honor guard organized by Prineville Area Band of Brothers.

“It was tremendous,” said Patrick Quinn, who was blown away by the amount of recognition his father received some 70 years after his service as a pharmacist’s mate in World War II. He said the bagpipe music McIntire provided that afternoon “was just the icing on the cake.”

This article was originally published in The Bulletin on Sept. 25, 2015


Planning death: Choices and dialogue at the end of life

Death and dying, Health care

Planning death: Choices and dialogue at the end of life

By Mac McLean

Milton Buehner braved floodwaters in Houston to see an oncologist at one of the country’s leading cancer centers in May so he could learn more about his diagnosis of a rare form of renal cancer.

The 75-year-old Bend man also learned he had less than six months to live.

When Buehner reflects on his trip to the University of Texas’ M.D. Anderson Cancer Center, it’s not the weather, his diagnosis or the confusion of landing in a strange city under water that stands out.

It was a simple question his doctor asked after delivering the bad news. “He asked me: ‘What do you want to do now?’

“I wasn’t ready for that question,” Buehner said as he looked back on how his doctor invited him to decide how they’d proceed with his future medical care. Buehner never thought he’d have choices while facing such a grave diagnosis. He was accustomed to doctors telling him what to do rather than giving him options.

A century ago, doctors could tell their patients what was wrong but do little to stop it. Now they can often keep their patients alive for years regardless of injury, disease or future health prospects.

Extending life comes with a sacrifice, however, because the quality of those years often will be severely diminished.

Over the past 20 years, more patients and their family members have been seeking tools that give them the ability to limit their medical treatments, preserve their quality of life and take control of their fates.

Health care providers say baby boomers — a generation of more than 76.4 million Americans who were born between 1946 and 1964 — played a vital role in moving this change forward by bringing their desire for choices and self-determination, along with their legendary activist spirit, to the doctor’s office.

“They want dialogue instead of direction,” said Eric Alexander, president and chief executive officer of Bend’s Partners in Care Home Health and Hospice. “They’re looking for resources, and they’re willing to explore a lot of things the previous generation may never have thought about.”

One tool in this boomer-fueled push for choices is the use of Physician Orders for Life Sustaining Treatments (POLST), which lets people who have a life-limiting condition dictate what medical treatments their doctors can use to keep them alive.

Created in Oregon about 25 years ago, POLST and its related programs have since been adopted in more than 30 states and could become a national phenomenon if a bill seeking to create a Medicare-funded end-of-life planning service for terminally ill seniors moves forward in Congress this fall.

That push was also echoed by the fact that, in the wake of Brittany Maynard’s death nine months ago, elected officials in more than 20 states and the District of Columbia sponsored bills seeking to create a “death with dignity” or aid-in-dying statute like the one Oregon adopted in 1997. These laws give patients the ability to get a lethal dose of medication from a physician, which they can use to take their own lives if they choose not to die naturally through limited medical treatments or a hospice program.

Most of these bills have failed or stalled in their respective states’ legislative process. California’s Death with Dignity Statute, which passed a vote in the state Senate, was postponed until next year so its sponsors could rally more support for it in the state Assembly. But advocates for these programs take solace in the fact only five states considered a death-with-dignity or aid-in-dying statute the previous year.

They see the nearly fivefold increase in the number of proposed statutes between this year and last year as a sign their movement is nearing a tipping point and promise to continue their push during the next legislative session.

“The baby boomers are really changing how we look at death,” said Kat West, national political director for Compassion & Choices, a nonprofit seeking to improve end-of-life choices. “They’re fiercely independent, they’re used to making decisions by themselves and they want choices throughout the health care system.”

Generations and medicine

Baby boomers were born during an 18-year period of economic prosperity that stretched from the end of World War II to the mid-1960s. They are perhaps best known for a strong sense of entitlement, self-identity and an activist spirit that fueled the civil rights movement, Vietnam War protests and just about every other social change the country has experienced in the past 50 years, including the opportunity for more end-of-life choices.

While members of the Greatest Generation are best known for their service in World War II, they could also be known for coming of age when 26 to 27 percent of the country’s children died before reaching their fifth birthday, and the country’s leading causes of death were tuberculosis, pneumonia, influenza and abdominal conditions like diarrhea, enteritis and ulceration of the intestines.

But during the time the oldest baby boomers were coming of age, the medical community was benefiting from a series of breakthroughs that greatly increased what doctors could do to keep their patients alive, including:

  • Discovery of penicillin and development of the first noninvasive “iron lung” respirators in the late 1920s.
  • Invention of the first dialysis machine and use of plastic catheters as an alternative to metal needles in intravenous therapy in the mid-1940s.
  • Development of the first alternating current defibrillator machine in the late 1950s.
  • Widespread adoption of CPR as a technique keeping people alive after their hearts stop beating in the mid-1960s.

Dr. Susan Tolle, founder of the Oregon Health & Science University Center for Ethics in Health Care, said each of these advances had a profound effect on what caused people to die and how quickly they died. Quick killers such as infection, communicable diseases or complications during childbirth were replaced by slow-moving, chronic conditions such as heart disease, cerebrovascular disease and cancer, which could be treated through repeated visits to the emergency room, stays in the intensive care unit and an ongoing cycle of treatment, remission and relapse before they finally claimed their victims’ lives.

But these new life-sustaining technologies also come with a catch, said Dr. David Grube, a retired physician from Philomath, Oregon, who is the national medical director for Compassion & Choices. Grube said that while the advances can extend the length of a person’s life, they may have a negative impact on the quality of that person’s life and what he or she is capable of doing without assistance.

“Your survival is not: Have a heart attack and get back to normal. It’s: Have a heart attack and get back to 95 percent of where you were before,” Grube said. “Your quality of life (after going to the intensive care unit) is not what it was before. Your experience in life is not what it was before.”

Setting limits

Buehner thought about his quality of life and what he’d been able to accomplish when he considered his M.D. Anderson Cancer Center doctor’s question about what should happen next. He had raised a family, started a business and wanted to make sure both pieces of his legacy would be preserved and continue to function without his presence.

“I’ve been blessed more than anyone I can imagine,” Buehner said. “I’ve had a pretty good life. I’ve left something behind where I can say it was all worth it.”

He also thought about the legacy he wanted to leave behind when he died and chose to spend his final days in a hospice program as a way to face his fate rather than endure a series of complicated medical treatments that would lessen his quality of life and only delay the inevitable.

“I wanted to face death and show people that you can leave behind a legacy while you are living and you can leave behind a legacy when you’re dying,” said Buehner, who held a massive celebration of life in early June so he could say goodbye to his friends and family before he got too sick.

In mid-July, nearly two months after receiving his diagnosis, Buehner said he was doing better after some swelling subsided. The swelling had been caused by a gamma knife procedure at Eugene’s PeaceHealth Sacred Heart Medical Center to remove tumors just before his trip to Houston.

Recent studies have shown that between 10 and 30 percent of the population want their doctors to do whatever it takes to keep them or their loved ones alive, hoping for an unforeseen recovery. It’s a medical treatment decision Tolle said is perfectly valid and one the medical community is well equipped to honor. But she said a growing number of residents like Buehner would rather enjoy their final days than take measures that could infringe on their quality of life.

“Very few people say, ‘If I had a choice, I’d want to die in the hospital,’” she said. Many have lived through a situation where they watched a close friend or a loved one die “a technological death that involved a lot of machines.”

But for decades, many of these people were missing something they needed to make their wishes known and make sure their doctors followed through: a voice.

“The generations before the boomers were more honoring of what their doctors said and had fewer questions,” Tolle said. “They were more passive in their relationship with doctors; they had less of a sense of personal empowerment and autonomy than the new generation.”

Because they lacked a strong voice, Tolle said, it’s likely many members of the older generations decided not to step forward when doctors prescribed a series of advanced medical treatments they or their loved ones might not have wanted. That started to change when boomers entered the end-of-life discussion and started using their sense of identity, their activist nature and their willingness to question authority to honor their loved ones’ end-of-life wishes and, by extension, be sure their own wishes were followed.

“Not everyone is willing to stand up and say, ‘I want my medical treatments to be stopped,’” Tolle said, explaining that in many cases it can be difficult for people to confront their doctors when faced with death. But the boomers “will look a doctor in the eye and say, ‘Mom wouldn’t want this,’ because Mom’s talked to them and said, ‘I don’t want a death like Uncle Henry had (in the intensive care unit).’”

Tolle also sees the boomers’ push to control the end-of-life decision-making process as part of a much broader series of changes that generation has triggered in the field of medicine, starting with a demand that men be allowed in both the labor and delivery rooms during childbirth.

”It’s been interesting to watch,” she said. The boomers “believe, and, rightfully so, that health care decisions should be made with the family and with the values of the patient taking primacy. … Increasingly this movement with the boomers (and end-of-life care) is taking that process back; it’s saying we can plan things ahead of time and we can be more focused in this process when it comes to getting what we want.”

Tolle and other Oregon physicians developed the state’s POLST program to allow people diagnosed with a life-limiting condition to dictate how they eventually wanted to die.

The program’s current two-page form has sections where people can decide whether they’d like to be given CPR if their heart stops and whether they’d like to be given a feeding tube if they cannot eat. It also lets people specify whether they’d like their end-of-life care to be comfort measures that can be provided at home, limited additional interventions that can be provided in a hospital or full treatment measures that can be provided only in an intensive care unit.

“The form doesn’t have an agenda,” said Dr. Stephen Kornfeld, a semi-retired oncologist with St. Charles Health System who played a role in making sure the POLST program had an early success in Central Oregon. “It allows patients to have their say and speak their minds. … It’s a wonderful way to start the conversation (about someone’s wishes for end-of-life care).”

Kornfeld said these conversations are critical because the “default position in modern medicine” is for physicians to do everything they can to keep a patient alive unless he or she explicitly directs them to do otherwise. He said this default position means doctors may end up providing unwanted and, in some cases, unnecessary end-of-life care that infringes on their patient’s right of self-determination, simply because the person being treated did not make his or her wishes known. That treatment can also be costly for Medicare and other health insurance plans.

“Maybe the default position should be nobody gets aggressive care unless they want it,” he said, explaining physicians should play a more active role in encouraging their patients to think about and record their end-of-life wishes, as Buehner’s doctor in Houston did.

Rippling forward

Eight weeks ago, Tolle held a news conference in Portland where she announced a new collaboration between OHSU and the California-based health care technology firm Vynca, which developed a fully electronic version of POLST. It allows doctors and their patients to fill out the program’s form on a computer and automatically store it in a six-year-old database that already includes more than 250,000 POLST records.

ePOLST, the formal name for this new option, is available to health care providers through Vynca’s website (demo.vynca.org). It comes complete with video clips that show what’s involved with each life-sustaining procedure discussed on the form and is designed to cut down on the 18 percent error rate that OHSU has seen in the past with its paper-based forms, which will still be available to patients who want them.

The June 15 announcement came less than a year after a study published in the Journal of the American Geriatrics Society found only 6.4 percent of the people who requested “comfort measures” on their POLST forms died in a hospital, and nine months after the Institute of Medicine cited the journal’s findings as one of the reasons every state in the union should adopt POLST or a similar program.

“(POLST has) really taken hold because it works so well,” said Tolle. “The whole combination of planning, empowerment and honoring (a patient’s wishes) works better in this state than any other part of the country.”

The program and its record of success may gain even more national attention in the coming months if Congress takes up a bill sponsored by Sens. Mark Warner, D-Va., and Johnny Isakson, R-Ga., that would extend Medicare to cover services that enable seriously ill people to discuss their end-of-life options and chart a course forward.

“It’s about making sure that your doctors, your hospital and your family know about what choices you have made about your care,” Warner wrote in a June 10 news release about his legislation, the Care Planning Act of 2015 (Senate Bill 1549). “If a patient prefers to explore every possible treatment option, that choice will be respected. And if an individual prefers a different approach after informed consultations with his or her health care team, family and others, those choices should be documented and honored, too.”

The legislation would:

  • Develop a public information campaign that stresses the importance of end-of-life care planning.
  • Create a website that teaches people about advance directives, portable treatment orders like POLST, palliative care services and hospice services.
  • Help health care providers determine whether their patients have an end-of-life care directive in place and make sure that information stays with them.
  • Set up a program to test whether people who filled out one of these forms received the care they wanted.

Nearly a month after Warner and Isakson announced their legislation, officials with the Centers for Medicare and Medicaid Services announced they had created a set of two billing codes doctors could use to signal whenever they had a 30-minute conversation with a patient and his or her loved one about filling out a basic advance directive form and other advance care planning services.

The agency also announced July 8 it was holding a special two-month comment period where it would seek input from the medical community and members of the general public about:

Whether doctors should be paid for having these advance care planning conversations with their patients and how much they should be paid.

Whether the Medicare program should offer doctors and physicians an incentive for having these conversations.
Whether the advance care planning conversations, if requested, should be included as part of each patient’s annual medical exam.

Warner called the proposed physician reimbursement plan an “important first step” in a news release his office sent out after CMS’ announcement. He said he still planned to move forward with his legislation because it covered several other topics — particularly patient education, special planning procedures for people with a serious or advanced illness and portability that would ensure people’s wishes were honored regardless of what state they were in — that he thought were missing from CMS’ proposal.

“Moving forward, the Care Planning Act provides a strong, bipartisan foundation for Congress as we consider how to further empower patients to make informed choices about their own care,” Warner said. “It’s not about limiting any patient’s choices, but expanding them by making sure that people have the opportunity to make their wishes known and can trust that they will be honored.”

His legislation does not, however, provide any federal money to death-with-dignity or aid-in-dying programs that let patients get a lethal dose of medications from their doctors. Funding for these services is explicitly prohibited by the Assisted Suicide Funding Restriction Act of 1997, a federal law Congress adopted in direct opposition to Oregon’s Death with Dignity Act. It was crafted soon after a November 1996 poll conducted by Wirthlin Worldwide found 87 percent of Americans were against any government money going toward these programs.

But Grube and West, with Compassion & Choices, said public attitudes regarding these initiatives changed dramatically following Maynard’s death in November 2014. They cited a pair of recent surveys that found 54 percent of doctors (Medscape, December 2014) and 74 percent of the population as a whole (Harris Polling, November 2014) support a terminally ill patient’s ability to end his or her own life.

“Death with Dignity is at a turning point,” West said.

She said Maynard’s story played a pivotal role for the aid-in-dying/death-with-dignity movement because millennials could see the 29-year-old brain cancer patient as being a friend or a sibling, and boomers could see her as being one of their children. It also involved a woman who moved from California to Oregon so she could increase the choices she had in her end-of-life planning, she said, noting this idea of having choices when a person dies is at the heart of the movement.

“Getting a life-ending prescription does not obligate a person to use it,” she said, citing a February report that found only 60.6 percent of the people who received one of these prescriptions from a physician used it to end their lives. “They have a choice. … They have a greater control over the circumstances of their death.”

This article was originally published in The Bulletin on Aug. 10,, 2015

Reverse mortgages on the rise in Deschutes County

Retirement planning

Reverse mortgages on the rise in Deschutes County

By Mac McLean

Courtesy photo

Frances and Ken Byrum faced a difficult choice last year when they lost a supplemental insurance plan that paid most of their medical bills.

The couple, respectively 69 and 81, could pay the plan’s premiums by taking money out of an individual retirement account and draining their retirement savings faster than they had planned.

They could also sell the house they’d shared for more than 14 years and move to a smaller place that was easier and cheaper for them to maintain.

Or, the Byrums could borrow against their home’s equity with a reverse mortgage and use its proceeds to wipe out some existing debt and create a small financial cushion that could help the couple the next time they needed some extra cash.

“It was a big decision on our part,” Frances Byrum said. “There’s times I think we regret (getting the loan), but at that time we really didn’t have a choice.”

According to records obtained by The Bulletin, 62 Deschutes County homeowners, including the Byrums, took out a reverse mortgage on their homes in 2014. This represents a 59 percent increase from the total number of reverse mortgages the county’s homeowners took out in 2013, and comes after a few years of slight decreases in the county’s total reverse mortgage volume since 2010.

Meanwhile, the state’s overall reverse mortgage volume fell sharply over this 5-year-period and is now less than half of what it was in 2010.

Reverse mortgage lenders and housing counselors say the county’s increase is likely due to an improving real estate market that allows homeowners to have more equity in their homes they can borrow upon to get these loans. It could also be a sign the county’s homeowners are seeing reverse mortgages as more than just a “loan of last resort” that can help retirees who are caught unprepared for a major expense and have no other way to get funds.

“When you really understand how this product works, it can be an unbelievable financial planning tool,” said Larry Melton, the reverse mortgage manager with Director’s Mortgage, which is one of the 28 lenders that issued a reverse mortgage in Deschutes County last year.

The loans

Technically known as home equity conversion mortgages, reverse mortgages are a 50-year-old financial product insured and regulated by the Federal Housing Administration that lets people who are 62 or older get a loan based exclusively on the amount of equity they have in their homes.

People can borrow an amount equal to between 52 percent and 75 percent of their home’s assessed value, depending on their age and other factors — the maximum allowed is $625,000 — and can get this money in the form of a single lump sum payment, a series of regular monthly payments that last for a period of time, a line of credit they can use whenever they need it or any combination of these three.

Unlike a traditional mortgage where borrowers must make monthly payments, the balance of a reverse mortgage and any taxes or fees it has accrued comes due only when the last surviving borrower dies, sells their home or leaves it for a period of more than 12 months. The total amount due is usually deducted from the home’s sale price but can also be paid back with cash if the borrower or survivors don’t want to sell the house.

Borrowers do not need to make any payments on the loan as long as they live in the house, though they must stay current on their home’s tax and insurance payments to avoid going into default on the loan and losing their home through foreclosure.

Since September 2010, the Federal Housing Administration has required prospective reverse mortgage borrowers to complete a two-hour counseling session as part of their application process. The session includes a 10-question quiz to make sure they understand the product, and prospective borrowers are presented with a list of alternatives that may solve their financial situation without forcing them to borrow against the equity of their home.

“We have to discuss all of the options that are available to them,” said Shelley Nelson, default intervention manager with NeighborImpact’s HomeSource program. Her organization runs one of only five FHA-certified home equity conversion mortgage counseling programs in the state of Oregon and the only one that is located east of the Cascades.

Nelson said those options typically include selling the home and moving into a smaller place or with their children, friends or other family members. Prospective borrowers may also qualify for Medicaid, Veteran’s Aid and Attendance or another government program that can help retirees pay their long-term care or medical bills, she said, explaining the primary focus of a counseling session is to make sure the borrower knows all of the risks and responsibilities associated with a reverse mortgage before they take out a loan.

“At the end of the day, it’s a really good solution for some people but not for others,” she said, explaining people typically move ahead with their plans to get a reverse mortgage after they’ve finished one of these counseling sessions.

The borrowers

The Byrums thought about getting a reverse mortgage so they could wipe out some debt when Frances Byrum became eligible for one of these loans about seven years ago. But they instead refinanced their home with a traditional mortgage worth $85,000 in 2009 that cost about $750 a month.

Frances Byrum said she and her husband didn’t have any problems making this monthly payment until her former employer started phasing out the supplemental insurance coverage it gave retirees a couple years ago.

“It just put more expenses on us,” she said, explaining the company started making its retirees pay part of the premiums for this insurance coverage before it canceled the program entirely last year. “We were just kind of floating along and couldn’t handle the extra expense.”

The Byrums borrowed enough through their reverse mortgage to pay off what they owed on their 5-year-old loan and put another $10,000 into a savings account they could use in case of an emergency.

Frances Byrum said this was a huge boost for their financial situation, and keeping their house made it possible for the couple to take in her daughter and grandson when the two of them needed a place to live.

“Where would we be if we hadn’t done it?” she said.

Nelson said most of the people she sees through her counseling service have an existing mortgage on their house and can keep up with its payments until an unforeseen expense, or in some cases the death of a spouse, pushes them over the edge financially.

She said reverse mortgages help people in these situations because they give the borrower a chance to wipe out what’s left on the standard mortgage.

The rise

When the real estate market tanked after the housing crash in 2008, people simply didn’t have enough equity — the appraised value of a house minus its mortgage debt — to qualify for a reverse mortgage. That, though, is changing, Nelson said.

According to a report from the Beacon Appraisal Group, the median price for a home in Bend climbed by more than 73 percent from $186,000 in January 2012 to $322,000 in January 2015 (the median price has since dipped slightly). The median sale price for a home in Oregon climbed by only 22 percent during that time, which is a sign people may still not see a huge increase in the amount of equity in their homes statewide and one of the reasons reverse mortgage volume is low statewide.

Frances Byrum said she saw a 20 percent increase in the value of her southeast Bend home between the time she got her traditional mortgage in 2009 and her reverse mortgage in 2014.

Melton, with Director’s Mortgage, said the improving housing market is probably the biggest reason there was an uptick in the county’s reverse mortgage volume last year. He said borrowers are also learning more about how the product works and that its uses aren’t limited to homeowners who have fallen on hard times.

“There’s lots of scenarios where a person might use it,” he said, explaining he gets a lot of referrals from attorneys, accountants and financial planners who think a reverse mortgage might be a good fit for their clients.

Melton said he’s helped people get a reverse mortgage so they can pay for a vacation, buy a new car or give their grandchildren some extra money so they can go to college. Some of his clients live off the interest they get from a trust and would rather borrow against their home’s equity than reduce the trust’s principal and the amount of income they get each year.

Mike Dawson falls into this second category of reverse mortgage borrowers. Three years ago, Dawson and his wife, Tina Jiang, bought a three-story house off Cooley Road they planned to renovate and sell to raise a substantial amount of money for their retirements. But they ran out of money before they could finish the project and turned to a reverse mortgage because given their circumstances, it was the only loan that they could get.

“We’re retired,” said Dawson, who couldn’t find a bank in Oregon that would give him a no-documentation loan. “We have no income outside of Social Security but we have plenty of equity in our home.”

This article was originally published in The Bulletin on Oct. 23, 2015

Living the Alzheimer’s Story

Living the Alzheimer’s Story
By Mac McLean

Julianne Moore’s Oscar-winning role in “Still Alice:” rings true for a Bend woman with early-onset Alzheimer’s disease.

Christine H. Jones grabbed a copy of “Still Alice” from her coffee table and started to read a passage she had marked in its 19th chapter.

“‘I’m honored to have this opportunity to talk with you today, to hopefully shed some insight into what it’s like to have dementia,’’ she read. “‘Soon, although I’ll know what it is like I’ll be unable to express it to you. And too soon after that, I’ll no longer even know that I have dementia.’’

Written by Lisa Genova in 2007, “Still Alice’ is a New York Times bestselling book that tells the fictional story of Alice Howland, a Harvard University professor and mother of three adult children who was diagnosed with Alzheimer’s when she was 50.

It has received a lot of praise from people in the Alzheimer’s community because it paints a well-researched picture of what it is like to have Alzheimer’s — particularly when the disease strikes someone at such a young age, a rare condition known as early or younger onset Alzheimer’s. It was at the time an unprecedented first-person manner that describes what the person was experiencing as their symptoms progress.


The book was recently adapted into a movie starring Julianne Moore, who was nominated for an Oscar for her portrayal of the book’s title character.

“(This story) tells you what (having Alzheimer’s) is like from the inside out,’ said Jones, 70, who loves the book because she went through a similar set of experiences as the book’s title character when she started showing signs of Alzheimer’s in her late 50s. “If I could write my story this would be it.’

The disease

Believed to be the third-leading cause of death in the United States after heart disease and cancer, Alzheimer’s disease is a degenerative neurological condition that occurs when plaques and tangles form in a person’s brain and blocks their cells’ ability to communicate with one another. The damage caused by the condition makes a person forget things and interferes with the ability to concentrate, plan and organize certain tasks. It continues until patients can no longer control their muscles, hold their heads up, swallow or smile.

According to the Alzheimer’s Association, most of the 5 million Americans who currently have Alzheimer’s started showing signs of the disease when they were in their late 60s, 70s or 80s. But in rare cases like Jones’ and Howland’s the disease can also strike people in their 50s or 60s.

“We don’t usually think of Alzheimer’s as something that happens to people in their 50s and 60s,’ said Sarah Holland, field services director for the Alzheimer’s Association’s Oregon Chapter. She said this happens with only 4 percent, or 200,000 of the 5 million, people who have the disease.

Jones knew exactly what would happen when she was diagnosed with Alzheimer’s disease because she worked as a critical care nurse in West Texas and taught at the University of Texas El Paso’s nursing school. She also cared for her aunt and her father, both of whom died of Alzheimer’s, and believes her grandfather may have died from the disease as well, though he was never formally diagnosed.

When the last of her family members in West Texas died, Jones said, she moved to Central Oregon in the late 1990s so she could be closer to a cousin who lived in the area. Jones, who has lived alone since her family members in Texas died, took a job working as a nursing director at an assisted living facility in Redmond. She said it was a couple years after making this transition — a time when she was in her late 50s — that the signs of her condition started to show themselves.

“I saw what was happening to me,’ she said. “I felt it and I knew it wasn’t right.’

The loss

Jones said she has lost all concept of time and cannot remember the exact circumstances that led her to suspect she might have had Alzheimer’s disease. Though, she does remember one evening when she couldn’t balance her checkbook because she forgot how to subtract numbers in her head.

“I’ve lost the ability to subtract and I’ve just recently lost the ability to multiply,’ said Jones, who managed her family members’ finances when they were older and often worked with institution-sized budgets during her career. “I don’t know how to do the numbers any more.”

Over the years, Jones said she also lost her ability to read music, which is tragic to her because she sang in her church’s choir since she was a child. She also can’t remember what she read in a book or saw on TV the day after it happened, doesn’t use the stove in her apartment because she’s afraid she’ll leave a burner on, and doesn’t write anything by hand because she can’t remember how to make letters.

“My immediate memory is what seems to be going first,’ said Jones, who keeps a sign on the front door of her cottage at the Aspen Ridge Retirement Community that reminds her to turn off her fireplace and lock the patio door whenever she leaves the house.

But even with her condition, Jones is able to maintain some level of independence because she has figured out how to ride the city’s bus system and uses it to get around town. She has a friend who takes her to church on Sundays and another one who comes by her house every week to help organize her medications, organize her belongings and lay out her clothes so she always has something to wear.

Jones also has an 11-year-old cat, Elsie Kate, who keeps her company, friends she can call or visit at church and at the retirement community and a pair of dry erase boards in her bedroom where someone has written little messages that remind her “God is holding my life,’ “You are loved,’ and “It’s okay to visit the sadness’ along with the fact she needs to shower, brush her teeth and change her clothes every morning.

“While my journey has been difficult,’ Jones wrote in a typed letter that she delivered to the Bulletin, “I, also, am upheld by daily reminders of the many blessings that I have.’

The movie

Because the disease’s early stages affect a person’s ability to remember things and their ability to communicate or express themselves, Holland with the Alzheimer’s Association said it is extremely difficult to find a first-person account that describes what a person experiences when their symptoms start showing up and how they manage to come to terms with their condition.

“The voice of Alzheimer’s disease as it’s being experienced is not necessarily a perspective that’s out there,’ she said, explaining one of the reasons that Genova’s book is so important to her organization and the people its trying to help.

She said Genova, who worked as a neuroscientist before she started writing full-time, also spent a considerable amount of time with people who have the Alzheimer’s disease so she could write an accurate description what the fictional Alice Howland may have experienced as her symptoms progressed.

Genova also worked with the Alzheimer’s Association to craft a five-page discussion guide that comes at the end of her book. Shew has become a key advocate for people with the disease who talks about the issue on daytime television shows, news broadcasts and at events like the Oregon chapter’s 2012 McGinty Conference on Alzheimer’s, where she delivered the keynote address and met with the conference’s attendees.

Holland said she bought a several copies of “Still Alice’ after Genova’s appearance three years ago so she can give it to people who are dealing with a new diagnoses of Alzheimer’s disease, or suspect they may have it, and have questions about what their future might hold.

She is looking forward to seeing the movie version of “Still Alice’ because Moore put a lot of research into her portrayal of Alice Howland and spent time shadowing a member of the association’s advisory council who developed Alzheimer’s at an early age.

“Julianne Moore is great and I’m excited to see what she does,’ Holland said. “Our hope is definitely that (her role in this movie) increases the awareness around Alzheimer’s disease. … Any time you raise awareness you’re going to get people involved.’

Jones is also excited to see the film because she thinks that it well describes what it is like to have Alzheimer’s in a way most people with the disease can no longer express. She feels this way about Genova’s book, which a friend gave her about six or seven years ago, even though it paints a depressing picture of the future that lies ahead.

“I know what’s going to happen,’ Jones said as she glossed over passages where Alice Howland doesn’t recognize the person’s she’s become, makes plans to commit suicide and forgets her children’s’ names. “There isn’t a cure. I will die of Alzheimer’s or an Alzheimer’s related condition.”

This article was originally published in the Bend Bulletin on Jan. 13, 2015

Drug Theft Affects Care


Drug Theft Affects Care

By Mac McLean

Courtesy photo

When he was confronted by police and his supervisors with some questionable medication records about nine months ago, Cole Elf, 28, of Bend, admitted he stole 40 prescription painkillers from a handful of residents at the Touchmark at Mt. Bachelor Village retirement community, according to a police report.

“Since November (2012), Elf estimated he has accessed the narcotics cabinet in the locked medication room approximately 15 times to retrieve hydrocodone and a couple Oxycontin pills,” Officer Whitney Wiles with the Bend Police Department wrote in a report chronicling an interview she had with Elf and Touchmark’s administrators on Dec. 11, 2012.

Elf was arrested and charged with unlawful possession of oxycodone and a schedule II controlled substance, both of which are felonies, as well as unlawful possession of hydrocodone and third-degree theft, which are misdemeanors.

Elf declined to comment for this story when contacted by The Bulletin. According to Wiles’ report, he had been working at Touchmark since 2010 and was known “as a good employee.”

“He told me he never took any of the pills when he was working,” she continued as she described her interview with Elf. “But when he got home he took (the pills) so he could sleep.”

According to records obtained by The Bulletin, the Oregon Aging and People with Disabilities Division has investigated 29 cases of medication theft that have taken place at 17 long-term care facilities in Crook, Deschutes and Jefferson counties since 2009.

With 15.8 cases of medication theft per 1,000 beds/units in a long-term care facility, these three counties — which make up the division’s District 10 region — have the second-highest medication theft rate in the state, according to the division’s data. District 14, which includes Grant, Harney and Malheur counties, has the state’s highest medication theft rate with 16.2 theft cases per 1,000 beds/units in a long-term care facility.

In each of Central Oregon’s medication theft cases, investigators suspect the thefts were committed by a facility employee who, as part of his or her job duties, was given access to a locked cabinet, cart or room where the medicines needed by dozens of elderly residents were kept.

These staff members, some of whom had been working at their facilities for years, most often stole strong narcotic painkillers like hydrocodone and oxycodone.

Local law enforcement officers, working with the state’s investigators, identified and arrested five medication theft suspects and charged them with a variety of felonies and misdemeanors, depending on the number and type of pills stolen.

The state agency also cited the suspected thieves with abuse — an administrative red flag that according to one expert can wreck a person’s career — even if there wasn’t enough evidence to bring them to trial. In cases where a suspect couldn’t be identified, it administered this sanction against the facility itself for allowing such a theft to happen.

“In our legal definition, it is elder abuse to steal anything from a person living in a nursing home,” said Paul Greenman, legal counsel for the Oregon Health Care Association, a trade organization with almost 600 long-term care facilities as members. “This is a prohibited activity and there is a clear penalty for it.”

Local law enforcement officers say these thefts aren’t as common as other examples of drug diversion — the act of taking a legitimate drug such as a painkiller and putting it to an illegitimate use — that they’ve seen in our community.

According to a report by the Mayo Clinic, this problem has been seen with increasing frequency in health care facilities across the country, yet its full scope is still relatively unknown.

But while medication theft from long-term care facilities may not be as common as obtaining drugs through stolen prescription pads or doctor shopping, its consequences can be severe for the people whose drugs were stolen. Residents can experience increased pain or be put at risk of taking an improper medication or going through opioid withdrawal, according to reports.

“Certainly it has a detrimental impact on the resident,” Greenman said. “If a caregiver steals a resident’s medication, then he or she may not be able to get it when they need it.”


Located on the banks of the Deschutes River in southwest Bend, Touchmark is a sprawling 25-acre community where more than 260 people ages 55 and older live in an array of well-appointed apartments and cottages.

It also features a 75-unit residential care facility known as Terrace Lodge, where a team of nurses and other health care workers provide 24-hour care to people who cannot live alone.

Since 2009, the Oregon Adult Protective Services program — a state agency that investigates any allegation of theft or abuse in Oregon’s long-term care facilities — responded to five alleged medication thefts at this facility, more than any other place in the region.

Scott Neil, the facility’s resident care manager, declined to comment for this story about the thefts that have happened at his facility or the steps it took to correct them. Investigators also recorded a series of steps Touchmark’s managers took during the past three years that made it easier for them to not only discover medication theft but to identify and prosecute the alleged thief as well.

The facility’s problems started in September 2010 when staff discovered a bubble pack of prescription painkillers — each of which contains about 30 pills — was missing from a medication cart. This prompted a full audit of Touchmark’s medication room that found 12 other bubble packs, or a total of 360 pills, had been stolen between June and September of that year.

When Touchmark’s administrators called APS investigator Michelle Smith to report the crime, she noted they had already taken considerable steps to beef up their policies regarding how often the medication is counted and how each dose of medicine is handed out.

Smith noted these steps made it possible for Touchmark’s administrators to immediately detect the theft of two more bubble packs on Oct. 22, 2010. These enhanced counting and logbook procedures also helped catch Elf when he stole medication from the facility two years later.

During the winter of 2010, Touchmark’s administrators also implemented a policy that required a weekly audit of the medications kept in its medication room.

A Touchmark employee performing one of these audits in January 2011 noticed some pills contained in a bottle of narcotic painkillers one of its residents hardly used had been replaced with an over-the-counter drug and that another patient’s bottle of cough syrup with codeine had been diluted with an unknown substance.

Because of this discovery, the facility’s staff members were able to prevent these tainted medications — the byproduct of medication theft — from going to residents and potentially causing an allergic reaction or another negative side effect.

But while these new procedures helped Touchmark discover the theft of its medications almost immediately after they had been taken, they didn’t make it any easier for Smith or local law enforcement investigators to identify a suspect.

The facility’s final step — installing a security camera in its medication room and hallways — did.

When a staff member discovered someone replaced hydrocodone pills that belonged to two residents with an over-the-counter drug during an April 2011 audit, Touchmark’s administrators watched the camera’s footage and saw Touchmark worker Shirley Postma, 63, of Bend, make the switch, according to Smith’s report.

They gave a copy of this video to Officer Troy Wiles with the Bend Police Department, who then had all he needed to bring a case against the suspected employee.

“I informed Postma there was solid evidence she had, in fact, taken medication that did not belong to her,” Troy Wiles wrote in his report. “I told her I knew what had happened, but was curious as to why it happened.”

The report said Postma took a total of 101 pills from Touchmark’s residents, including the two bubble packs that went missing on Oct. 22, 2010, and admitted she had about 10 pills in her purse at the time of her interview.

She was arrested and later charged with three counts each of second-degree theft and unlawful possession of a schedule III controlled substance, and two counts of recklessly endangering another human being, all misdemeanors.

Postma could not be reached to comment for this story. According to Wiles’ report, she had been working at the facility since 2009 and took the medications for her personal use.

“Postma said she suffers from back pain … she has taken about two tablets a day of the stolen medication,” Wiles wrote. “She said she could not afford medication of her own.”

According to the U.S. Bureau of Labor Statistics, the average personal care aide working with the elderly or disabled at home or in a specialized care facility in Central Oregon earns $10.20 an hour. A 30-day supply of 120 hydrocodone 5/325 (5mg hydrocodone, 325 mg acetaminophen) pills costs about $67.

“Medication aides receive very little training and they are paid poorly,” said Andrew Mendenhall, the outpatient director of the Hazelden Addiction Treatment Center in Beaverton, which has a program specializing in treating health care professionals. “They may steal medication because they have addiction issues or because they can make some extra money selling it on the street.”

Mendenhall said these jobs may also not include health insurance, and that causes even more problems — it could keep people who have a legitimate reason to take pain medication from getting help.

“The absence of health care may prevent people from getting what they need,” Mendenhall said, including both medication for pain and treatment services if they develop an addiction to the medication.

A new camera wasn’t needed to solve Touchmark’s fifth medication theft case. According to one of Smith’s reports, the facility’s enhanced record-keeping procedures were enough to suggest after a December 2012 audit that Elf was giving a considerable amount of painkillers to patients who normally didn’t ask for them at night.

None of these residents remembered asking for the extra drugs, and the facility’s key card records — which list any time one of Touchmark’s 100-plus employees enter a resident’s room — show that Elf never entered their rooms when he said he did.

Neil, the resident care manager, called police and arranged for them to talk with Elf when he was supposed to report to work.

“It should be noted that the facility’s uses of resident door and (other) monitoring systems enabled administration to quickly identify a suspect in this matter and stop the diversion,” Smith wrote in a report describing her investigation into Elf’s case.

Big and small

Almost two-thirds of the medication theft cases discovered in The Bulletin’s investigation took place at large long-term care facilities like Touchmark.

Between 2010 and 2011, Smith and other APS staff members investigated three theft cases at the East Cascade Retirement Community — a six-building campus in Madras that features a traditional retirement community, 12 independent living apartments, a 36-unit assisted living facility, a 16-unit memory care facility and a 20-unit nursing facility. It has about 60 employees, facility manager John Wakeman said.

The adult protective services program’s investigators also checked out two theft cases each at the Ashley Manor-Rimrock in Redmond, Emeritus at Cougar Springs in Redmond, the Ochoco Care Center in Prineville and the Summit Assisted Living Facility in southeast Bend.

The Ochoco Village Assisted Living Facility in Prineville and the High Lookee Lodge in Warm Springs were each home to one case of medication theft between 2009 and 2012.

Each of these facilities has been cited for financial abuse or exploitation at least once in the past three years because they failed to prevent thefts. Seven of their employees, including Postma and Elf, were cited for abuse as well.

Amber Darden, 31 of Prineville, is accused of stealing approximately 890 pills from Ashley Manor between September 2011 and April 2012, according to court records and Smith’s investigation report.

She was arrested and later charged with one count of first-degree aggravated theft, tampering with drug records and possession of oxycodone, all of which are felonies, and possession of hydrocodone, a misdemeanor.

Darden could not be reached for comment, but told Smith she “was not proud of her actions,” during a phone call the APS investigator logged in her report. It is not known how long she had been working at the facility at the time of the alleged thefts.

But the prevalence of medication theft cases at these larger facilities doesn’t mean adult foster homes — where a handful of employees provide care to a small group of residents in a setting that resembles a large family home — are immune to the problem.

In some cases, the closeness and intimacy of this setting only makes the crime worse.

“One of our girls left her position (last spring),” said Connie Thornton, owner of the Haven House Adult Foster Home in Terrebonne. “… It was devastating.”

On April 20, 2012, one of Haven House’s four employees counted the number of pills inside a resident’s bottle of narcotic painkillers and noticed eight of them disappeared between the time she left her shift the day before and when she returned to the facility that morning.

According to Smith’s investigation report, the employee confronted the person who worked the overnight shift — a woman the Deschutes County Sheriff’s Office later identified as Mylea West, 31 of Redmond — and called the Sheriff’s Office.

West denied the allegations, saying she may have given the resident one pill without writing it down in the medication log and did not know what happened to the other seven pills.

Deputies arrested West that day and charged her with one count of possession of a schedule II substance, a felony, and one count of third-degree theft, a misdemeanor.

West could not be reached to comment for this story and according to Smith’s report had been working at Haven House for about a month when the alleged theft occurred. She has a trial scheduled for Sept. 26 in Deschutes County Circuit Court.

“Hopefully you can trust your caregivers to administer a resident’s medication properly and not take it for themselves,” Thornton said, expressing her frustration at the alleged theft, which ruined a theft-free record she had running the facility for more than 12 years.

According to one of Smith’s investigation reports, Thornton’s record was besmirched again four months later when one of her staff members noticed someone had replaced a handful of one resident’s anti-anxiety medication with another resident’s high blood pressure pills, a potentially dangerous switch.

“This is a worst-case scenario because you could get multiple doses of a blood pressure medication (if it was not detected),” said Bruce McLellan, with the St. Charles Heart and Lung Center. “There’s a good chance she would become lightheaded (if her blood pressure dropped too low) and could pass out as well.”

McLellan said if this condition lasted for a while, the resident could suffer other problems such as damage to the kidneys, brain, liver and heart. It could also induce a heart attack or a heart failure, he said.

This case yielded no arrests, but Smith noted a relatively new employee suspected of taking the medication was “no longer working at the facility” after the theft occurred.

“We are only going to hire people we know,” Thornton said, explaining she has since changed her policies so that only she and one other employee have a key to the home’s narcotics cabinet.

“We run a pretty tight ship.”

But even people who are trusted can change.

In August 2011, Bend Police Officer Robert Dewitt arrested Ardis Cox, 53, of Bend, and charged her with one count each of possession of a schedule III controlled substance and third-degree theft — both misdemeanors — after she admitted to stealing 40 Vicodin pills from a resident at the Butler Market Adult Foster Home in Bend.

According to Smith’s report, Cox worked at the facility for seven years and was responsible for ordering its medications. She could not be reached to comment for this story, but told police and Smith that she regretted what she had done.

“Cox told me she had just had surgery and was under a lot of stress at work,” Dewitt wrote in his police report. “She told me she took the pills ‘to escape’ and admitted that wasn’t a very good excuse.”

The consequences

On Jan. 6, 2012, Cox pleaded guilty to one count of second-degree theft and in exchange for avoiding jail time, agreed to perform 40 hours of community service work, undergo a drug treatment program and complete 12 months of probation.

Postma got a similar sentence, except it came with 80 hours of community service, when she pleaded guilty to one count of second-degree theft on Sept. 6, 2011.

Elf also avoided jail time, pleading no contest to one count of unlawful possession of a schedule III narcotic on March 26. He was ordered to undergo a drug treatment program and complete 18 months of probation. But his story is not over.

The Deschutes County District Attorney’s office says Elf violated the terms of his probation when he was arrested on suspicion of driving under the influence of intoxicants on June 27. He could get jail time as a result.

Both West and Darden face prison terms if they decide to go to trial.

But there are some cases where a person who is suspected of stealing medication from a long-term care facility does not go through the criminal justice system at all, said Rebecca Fetters, an operations and policy coordinator with the Oregon Department of Health.

“When it comes to our investigative process, our standard of proof is only a ‘preponderance of the evidence,’” she said, explaining this means that only 51 percent of the evidence in a particular case needs to point toward a suspect for them to be considered guilty.

This standard is much lower than the “beyond a reasonable doubt” standard police officers and prosecutors like to reach before bringing someone to trial, she said.

Greenman, with the Oregon Health Care Association, said that in the past this has created a huge problem for facility managers because there was no way of telling whether a potential employee had been involved in a medication theft case unless they were convicted.

He said the state’s background check system only flagged people with convictions — an applicant’s conviction for theft or drug possession serves as a red flag but does not necessarily bar the applicant from getting a job at a long-term care facility — and it was possible that suspected medication thieves could get a job at another facility and steal again.

“Unless law enforcement populates their criminal record with a conviction,” Greenman explained, “there’s no way to tell what happened. … That person can just go down the street, get a job at another facility and you’ll have a reoccurrence.”

Fetters said the 2009 Oregon Legislature worked to prevent this when it approved a piece of legislation that allowed her agency to cite individuals, as well as facilities, with abuse. The legislation passed and state officials said this database has been in effect for about two years.

The state has included these individual abuse citations in its background check system for the past two years, she said, so they now show up as a red flag when someone applies for a job at a long-term care facility.

The penalties are even stronger for certified nursing assistants who commit abuse at nursing homes, said Dave Allm, manager of the Aging and People with Disabilities Division’s nursing facility licensing unit.

These people are immediately added to the state nursing board’s abuse registry, a distinction that bars them from getting a job at a long-term care facility ever again and serves as a red flag whenever another health care facility or office looks up their license to see if it is still current.

For facilities, Allm said, an abuse citation can carry a fine, depending on a number of circumstances including how severely residents were hurt or put at risk because of the incident and whether the facility has a track record of abuse. Most of the time these fines range from $100 to $1,000 per offense, Allm said, but in especially bad cases the division may seek a fine of between $2,500 and $10,000.

Fetters said the division also keeps information about any abuse citation a facility receives on its website and keeps records of every investigation at the agency’s local office for public view. She suggests people check both these sources of information whenever they’re trying to find a facility for loved ones or themselves.

But these penalties pale in comparison to what can happen to victims whose drugs are stolen, said Mendenhall, of the Hazelden addiction clinic in Beaverton.

Mendenhall said on two separate occasions he experienced a case where patients suffered negative consequences because of theft.

In the first case, the patient was in a severe amount of pain before Mendenhall checked the patient’s urine and discovered a lack of painkillers.

His second patient was rushed to the emergency room one night because of severe diarrhea, sweating and a host of other problems. Nobody knew the cause until they checked the patient’s urine and realized the patient was going through opioid withdrawal.

This article was originally published in The Bulletin on Sept. 8, 2013