Whether you are seeking a winter holiday getaway, or just a winter respite, here are five destinations, from across the country, offering unique adventures.  
Charleston, South CarolinaCharleston, South Carolina 
For palmetto trees and pink and red camellias abloom in winter amid balmy weather, you can't top Charleston for a gracious Southern Christmas, even if you didn't know the poinsettia was introduced to the U.S. by a Charlestonian. The first U.S. Ambassador to Mexico, Joel Roberts Poinsett, an amateur botanist, found the red-leafed flower growing wild in Taxco in 1828. He brought it back to his greenhouses, and sent a cutting to a Philadelphia botanist, who named it after him and helped popularize the plant nationwide.
Founded in 1670, Charleston boasts a beautiful, walkable historic district with a wealth of well-preserved 18th and 19th-century Federal- and Georgian-style townhouses in brick or soft pastels, exquisite mansions with large porches to catch ocean breezes on The Battery and charming alleys like cobblestoned Longitude Lane. Shops for antiques, jewelry, clothing and local crafts like woven sweetgrass baskets abound, as do terrific restaurants for Lowcountry foods like she-crab soup and shrimp and grits.
Charleston boasts a beautiful, walkable historic district with a wealth of well-preserved 18th and 19th-century townhouses
A stay in the city's inns in historic houses is an ideal way to savor the history of this jewel box of the South, named the #1 favorite U.S. city for 11 straight years by Travel + Leisure; perhaps an 18th century inn with lacy teal-colored wrought-iron balconies or an 1880s mansion decked with crystal chandeliers and marble fireplaces. Tours year-round range from house and garden tours, horse-and-carriage, food, Gullah history (African Americans who have the best-preserved African cultural and language traditions in the nation), Jewish history (dating back to 1695) and crabbing. 
A packed calendar of holiday tours and events includes candlelight house and walking tours, gospel, jazz and Gullah concerts and shows galore,
Getting there: Charleston is 12 miles from Charleston Airport.
Leavenworth, WashingtonLeavenworth, Washington State
You'll feel you're inside a snow globe in this adorable Bavarian-style town nestled in the stunning Cascade Mountains (just pretend they're the Alps). Over 500,000 lights adorn  Leavenworth from Thanksgiving through February, edging quaint half-timbered buildings with carved wooden balconies and muraled facades and illuminating huge trees in the village plaza in colors like red, purple and white. 
You'll feel you're inside a snow globe in this adorable Bavarian-style town nestled in the stunning Cascade Mountains (just pretend they're the Alps).
Lighting ceremonies, accompanied by a choir singing Christmas carols, take place in the plaza on the first three weekends of December. Enjoy a sleigh ride through the snow-blanketed town, drink hot mulled wine or cider at over 20 tasting rooms in this town of 2,300. Thanks to "fire tables" in front of tasting rooms and restaurants like Rhein Haus, you can sit outdoors and sip, feeling fairly toasty.
You can also see gingerbread houses on display and the Nutcracker Museum's global collection of over 7,000 nutcrackers, take guided winter nature walks, and eat bratwurst and schnitzel in the many German restaurants, followed by dessert at the bakery, The Gingerbread Factory.
At a reindeer farm under a mile from this town of 2,300, you (and delighted grandkids) can meet and feed the herd, and hear a talk about the animals that have (besides helping Santa) helped people in northern Scandinavia survive for centuries. (Reservations required – book far in advance.) 
A spectacular log home whose massive fireplace is built from river stone – and whose picture windows have views of Icicle Ridge – is the wine tasting room at Icicle Ridge Winery, four miles from Leavenworth. Guided snowshoe walks, followed by a meal and wine, leave from the winery, its founders' 5,000-square-foot former home, in January.  
Getting there: Leavenworth is a 2 ½ hour drive from Seattle, or 3 ½ hours from Seattle-Tacoma Airport by bus to Peshastin, a town a 5-minute taxi away.
Santa Fe, New MexicoSanta Fe, New Mexico 
For a high desert winter vacation spiced with a Mexican and Native American accent and lots of culture, Santa Fe is ideal. The tradition of walking Canyon Road at night on Christmas Eve past hundreds of little paper bags illuminated by votive candles filled with sand on streets and ledges, inhaling the scent of smoky pinon-scented bonfires, where people gather to sing carols and chatting with locals is simply magical. 
If you want a dish with both red and green chile sauce, ask for "Christmas" style. 
Called the Farolito Walk ("farol" is Spanish for lantern or lighthouse), it's inspired by the Mexican custom of symbolically guiding the Holy Family on their journey before the birth of Jesus. But you'll also see farolitos in front of homes, churches and businesses — not just on this sloping street where over 80 galleries show contemporary, traditional, Western and Native American art and sculpture, as well as shops and restaurants, in a mere half-mile. Some Native American pueblos perform ornately-costumed dances in late December.   
Adobe architecture everywhere, in a pinkish-beige that's either authentic or painted concrete, and New Mexican food  are other distinctive features of this city at the foot of the snow-draped Sangre de Cristo mountains. Green and red chile peppers are staples in basically everything, from chicken enchiladas and chile stew to chile rellenos. If you want a dish with both red and green chile sauce, ask for "Christmas" style. 
You can find splendid shopping  for Native American jewelry and pottery, locally-made art, textiles, Kokopelli figurines (a humpbacked flute playing deity and symbol of joy and fertility, seen in petroglyphs all over the Southwest) and "dream catchers" (circle-shaped talismans with feathers that prevent bad dreams and evil spirits from disturbing your sleep), both Native American traditions, from artisan sidewalk vendors in front of the Palace of the Governors, museum gift shops and local shops. 
At a year-round Christmas store, you can buy unusual handmade tree ornaments and figurines in clay, metal, wood, paper and glass plus tin Mexican Nativity scenes. 
Museums include the wonderful Museum of International Folk Art – which contains over 100,000 objects from over 100 countries, from costumes to handicrafts; the New Mexico History Museum – which covers 400 years of history, from indigenous, Spanish colonization to 20 joining the U.S. and the Georgia O'Keeffe Museum (the Wisconsin-born artist lived for 40 years northwest of Santa Fe in Abiquiu).
Getting there: Santa Fe is an hour's drive north from Albuquerque, or 1 ½ hours by train from Albuquerque or its airport to Santa Fe's Railroad District.
New Orleans, LouisianaNew Orleans, Louisiana 
A spirit of perpetual festivity pervades New Orleans, but let's count the reasons to visit during the holiday season. Free concerts in St. Louis Cathedral, from gospel, jazz, Christmas favorites to classical music. Carol-singing by candlelight in Jackson Square Park, in front of the historic church. Reveillon dinners, special four-course menus at many restaurants, derived from the Creole custom of having a big feast after Midnight Mass on Christmas Eve (the word derives from the French word for "waken"). House tours in the French Quarter and Garden District, beautifully decorated for the holidays. Bonfires on the Mississippi River levees on Christmas Eve, some creative in their design, a Cajun custom to light the way for Papa Noel, whose sleigh, legend says, is pulled by eight alligators. (Most are about 30 miles north in St. James Parish, but Gray Line narrated bus tours leave from New Orleans.)  
If you're around New Year's Eve, watch the giant fleur-de-lis drop in Jackson Square and watch fireworks over the river. 
Hotel deals up to 25% off are offered during the holidays. In City Park, Celebration in the Oaks means over one million colored lights drape live oak trees dripping with Spanish moss on 25 acres, shaped like dinosaurs, palm trees, fleur-de-lis and a menorah with dreidel. You can walk, drive or bike it, but advance online ticket purchases are required. A free outdoor light and technology festival in Ernest Morial Convention Center park, LUNA Fete, offers large-scale projection mapping on facades and light installations. (Attendees are encouraged to wear lights.) 
If you're around New Year's Eve, watch the giant fleur-de-lis drop in Jackson Square and watch fireworks over the river. January 6 marks the start of Mardi Gras season. That means both the solemn torchlit St. Joan of Arc procession on horses and in medieval-style costume, and time to eat King Cake, a rich coffee/cinnamon cake topped with purple, green and yellow icing, the colors of Carnival.   
Getting there: New Orleans is 15 miles from New Orleans Airport.
Cambria, California Cambria, California 
A small coastal town off scenic Highway 1 halfway between San Francisco and Los Angeles, Cambria holds a European-style Christmas Market from Thanksgiving until December 23 that may well be the most spectacular you'll ever see (but no snow). Two million lights adorn paths, rainbow-colored tunnels, tree ornaments a group can comfortably fit inside, animal shapes and nativity scenes. 
 No, you're not dreaming: those are zebras you see on the bus ride uphill from the visitor center, descendants from Hearst's private zoo.
Vendor stalls sell hand-made gifts both locally-made and imported from Germany. Foods from wood-fired pizza, pot pies to German specialties plus wine, beer and hot mulled wine are served. It's held at Cambria Pines Lodge, a rustic lodge on 34 acres built in 1927 that's up a 250-step wooden staircase (or a short drive) from Cambria's East Village, a charming district of independently-owned shops like Cinnabar, which sells fair-trade crafts from around the world, and Ephraim Pottery and restaurants like Linn's, famed for olallieberry pie. 
In this town of under 7,000, the Market is such a big deal, they start building structures in summer. Tickets are $15-$35 (depending on the night), and overnight hotel packages are offered by Cambria Pines and its two sister inns.
A peaceful place to stroll and admire sunset on the Pacific Ocean, is Moonstone Beach Drive, a two-mile stretch of shoreline with a boardwalk. Bonus: Hearst Castle, the hilltop mansion of media mogul William Randolph Hearst, is just six miles away. Tours include art tours (art treasures from all over Europe are here, from a 15-century Spanish ceiling to 150 Greek vases) and holiday twilight tours. No, you're not dreaming: those are zebras you see on the bus ride uphill from the visitor center, descendants from Hearst's private zoo.
Getting there: Cambria is a 4 hour drive south of San Francisco or north of Los Angeles, or a 45-minute drive from San Luis Obispo Airport or AMTRAK's San Luis Obispo stop.


5 Idyllic Towns for a Winter Vacation

Sharon McDonnell

We took a bold leap of faith a decade ago by leaving the U.S. to retire in Ecuador. The move happily exceeded all expectations, but during the long months of COVID restrictions in 2020, we re-examined our priorities and agreed it was time to reimagine our retirement once again.
Instead of "go big or go home," we decided to go big by leaving home.
Edd and Cynthia Staton in PatagoniaOur plan was to put all our belongings in storage and travel the world full-time. The big challenge was that we would be doing it on a Social Security budget.
Since this new adventure began almost two years ago, we've traveled from 20 airports to 25 cities in 10 countries. Along the way we've learned numerous "insider tips" to stretch our dollars, euros and pesos, and we're happy to share those tips with you.
Favorable Currency Exchange
A limited budget instantly gets bigger when you visit places with exchange rates that favor your country's currency. Especially ones where prices are cheaper to start with.
Exchanging crisp $100 bills and paying cash in pesos translates to every transaction being 50% off regular price.
When we were in Cancun, Mexico, where one Mexican peso equals about 5 U.S. cents, a platter of fried fish and a beer at our favorite seafood shack costs $6.50. Because Colombia's peso is currently taking such a beating versus the dollar, we recently spent almost two months in that country. The most expensive entree at an upscale restaurant in Medellín was less than $7.50.
To escape winter in the States and take advantage of a unique money-saving opportunity for American travelers, we are currently in Buenos Aires, Argentina.
As a hedge against runaway inflation approaching 100%, Argentineans spend in Argentine pesos and save in U.S. dollars. A government policy to bolster the peso by limiting the peso-dollar exchange rate has created an underground "blue market" for dollars that offers almost double the official rate.
Exchanging crisp $100 bills and paying cash in pesos translates to every transaction being 50% off regular price. That buys a lot more delicious beef and Malbec!
Airbnb Secrets
Traveling full-time on our modest budget has required a lot of creativity when it comes to lodging. For visits of two weeks or less, we most often stay in private rooms with shared common areas.
This economical option is exclusively offered through Airbnb. Typically, the property is a condo or townhouse set up specifically for this purpose. It's cheaper than renting an entire unit but still provides the benefit of a kitchen and dining space.
Traveling full-time on our modest budget has required a lot of creativity when it comes to lodging.
Whichever website you use for accommodations, it's important to take advantage of filters to refine your search. Scrolling through properties that don't suit your needs is a huge waste of time. Set the maximum amount you want to pay, then select anything from a washer to a barbeque grill.
Be sure to read recent reviews by fellow travelers. Before booking, message the host and ask about something. Anything. The speed and tone of the response will give you valuable clues about what to expect once you are there. If the place has an empty calendar, don't be shy about requesting a better price.
Flight Discounts
Did you know that flight discounts are sometimes available for the over 65 crowd? Websites OneTravel and CheapoAir list a "Senior" option right on the Traveler dropdown menu. So does United Airlines.
It's a little trickier with American Airlines. Its home page has no passenger age breakdown, so choose "Advanced/Multi-city search" and whaddayaknow, Senior (65+) is one of the choices. Delta claims to have senior discounts, but you must call their 800 number to inquire.
Two caveats for all this: 1) discounts are available only on select flights, and 2) there's no guarantee that what's called a "senior rate" will be any cheaper than the lowest published fare. Still, it's worth a few extra minutes to potentially get substantial savings on one of the most expensive parts of your travel budget.
Other Money-Saving Ideas
Here's a roundup of other ideas that help us travel more and spend less.
Take advantage of shoulder season. There's everything to love about those glorious months between low and high season. The crowds are gone, the weather's fabulous and costs are lower.
Free admissions. Top attractions around the world often offer free admission on certain days and times. The Prado Museum in Madrid (€15 general admission) is free each evening from 6 to 8 p.m. Binge on almost every museum in Paris the first Sunday of the month without spending a cent.
Eat like a local. In many countries we've explored, locals eat their biggest meal at midday, followed by a pastry and coffee in the late afternoon. That routine suits both our schedule and budget.
We look for busy neighborhood restaurants offering economical daily specials at lunch. How do Europeans eat dinner so late? After a busy day exploring, we are ready to head back home for a glass of wine and maybe a cheese plate or salad before an early bedtime.
Travel for free. Miles and points from strategic use of credit card sign-up bonuses fund much of our travel expenses. We flew nonstop from JFK to Buenos Aires for 20,000 miles and $5.60 each. Almost all of our Airbnb stays during a two-and-a-half-month European adventure were paid for with points we accumulated in only six months through everyday spending on our Social Security budget.
So put that debit card away. Choosing and using the right credit cards for your daily purchases are like jet fuel to accelerate your future travel plans.
Up, Up and Away
Want to travel more but feel like you just don't have the money? Hopefully, these tips we've passed along will get you off the sofa and onto a plane headed to one of your dream destinations.
Rather than feeling restricted by what you perceive to be a lack of funds, we encourage you to instead ask yourself, "How can I make this happen with what I've got?"
Get creative. Be open to possibilities. And above all, believe that what you want is possible. When intention teams up with action, the sky's the limit!


Travel More, Spend Less

Edd and Cynthia Staton

When we moved to our very rural small lake home in the Ozark Mountains nearly 15 years ago, we thought our expenses would be much less. There is a well, so we would no longer be paying a water bill. We were very happy to ditch the high real estate taxes of our suburban home for a property the state actually paid us to develop with a Homestead Credit, which is a property tax credit. 
Finally, the home is smaller, so surely it would cost less to heat and cool.
We were very surprised to learn that living in the country actually doesn't save much, if anything, in any area of the budget.
"I've lived in the country all my life and there are lots of hidden costs people who live in the cities and suburbs don't understand," says Tammy Sons, 52, who lives and owns various businesses around Altamont, Tenn. "There are a few things cheaper like the cost of rent or the price of homes, but wages are generally lower, too."
The 5 Hidden Costs of Living in the Country
We discovered hidden expenses we weren't expecting. Here are some areas where we were surprised.
1. Gasoline and Car Maintenance
It is logical you're going to be paying more for gasoline because towns are typically farther away. If you only have a couple of routes in and out, and one road shuts down or you have to take a longer route due to bad weather, it adds more to your budget. A bridge on one of two routes to my town recently shut down; it's especially hard now that gasoline prices are up. 
"I've lived in the country all my life and there are lots of hidden costs people who live in the cities and suburbs don't understand." 
I live on a dirt road in rocky terrain and even with care, I'm lucky to get two years out of a set of tires. Sons points to the problem of mice, rats and other pests that may nest under your car hood or chew your wires. 
There may be bigger problems with wildlife as well. "If you live in an area with bears, they will sometimes also break into your homes and cars, causing lots of damage," says Sons.
Cost analysis: According to Car and Driver, many new tires will get 30,000 to 80,000 miles, or 3–5 years. My car is at 23,000 miles at two years old and my service shop is recommending new tires. My car only gets two trips to my town per tank of gas. Recently, it cost $35 to fill the tank. (And gas prices are also rising.) 
2. Wells and Septic Systems
"I think the most surprising thing to most people who move to the country is the cost of maintaining the well and septic system," says David North, a real estate broker and owner of Realtrua in Redmond, Wash. "Most people understand wells need to be maintained, but it's an abstract idea until the well pump goes out and can cost thousands to replace." 
Many rural homes also have septic systems, which if not maintained, could overflow. "The septic has to be pumped and the costs of that can be high," says North. "The systems also require repairs sometimes. Accounting for the amortization of those costs is guess work."
Cost analysis: When my well suddenly quit pumping, I was afraid it might be the 15-year-old well pump. According to This Old House, it costs between $900 and $2500 to replace a well pump. I was relieved that it was only a wire that needed replaced and it cost $100. The Environmental Protection Agency recommends having a professional inspect the septic system every three years and having it cleaned at least every five years. Home Advisor says it costs an average of $408 to inspect and clean the septic tank. Additives to help your septic system cost about $10 per month.
3. Heating and Other Utility Costs
Even if your home is a small one, like my cabin is, it may not cost less to heat. When we first moved here, we only had a wood stove for heat, which may have saved money because we were harvesting downed trees from our own property. However that's questionable, given the cost to buy and maintain a wood splitter and chainsaw. 
When we ran out of downed trees and had to buy wood from others, it was pretty costly. I now have electric heat, but I believe I pay rates (for heat) as high, if not higher, from my rural electric company. At least I do not heat with propane. Experts are estimating that will cost up to 47% more this year than in 2021. Access to rural internet is also likely a higher cost and provides much slower speeds than what is found in the city. If you work from home, this could limit your job opportunities.
Cost analysis: I pay $150 to have my stovepipe on my wood stove cleaned and inspected each year. If you heat with propane, as many rural people do, expect to pay more this year.
4. Insurance and Fire Dues 
Sons says, surprisingly, insurance rates tend to be higher in the country. 
"If there are no fire hydrants within a half-mile radius, or a volunteer fire station within that distance, you're likely going to be paying more," she says, adding that while insurance companies typically offer small discounts for living in a low crime area, the premium they charge for the fire hazard is more. 
"If there are no fire hydrants within a half-mile radius, or a  volunteer fire station within that distance, you're likely going to be paying more." 
I also pay dues to my volunteer fire department; they have doubled in the past 15 years.
Cost Analysis: Fire dues for my volunteer fire department have risen from $25 to $50 per year. Homeowners insurance can be up to 43% more for rural homes, depending on how far the nearest fire station is located. 
5. The Costs of Health Care
The benefits of good health care, as the ad says, are "priceless." However, many small rural hospitals don't offer some services, and provide inadequate services in other areas. 
The small rural hospital system in my town doesn't have an endocrinologist, which I need, nor a rheumatologist, which my aunt (who is also my neighbor) needs, so we have to drive an hour to a larger health care system in a bigger town. 
Our rural hospital doesn't provide trauma services, so extra air ambulance insurance is needed in case we have to be airlifted to a larger hospital. A study conducted by the University of Minnesota School of Public Health suggests people living in rural areas pay more for health insurance.
Cost Analysis: Georgetown University's Health Policy Institute published a report saying health insurance costs are only slightly higher for rural residents, but a larger proportion of rural residents pay out-of-pocket for their costs. 
Despite the hidden (and sometimes higher) costs of living in the country, I am not complaining. This is where I want to be, where I feel at home now. However, when making the decision to move, people should investigate these as well as the other costs, of living rural.


The 5 Hidden Costs of Living in the Country

Kerri Fivecoat-Campbell

Frog Eye Salad isn't nearly as savory as it sounds. Nor does it contain peepers extracted from the jumpy amphibian, either. It's a coconut and pineapple-laden sweet take on chilled pasta salad.
Author Christina Ward's latest book, "Holy Food: How Cults, Communes, and Religious Movements Influenced What We Eat — An American History," provides the recipe and breaks down the more profound history of the creamy dish. 
In her latest book, "Holy Food: How Cults, Communes, and Religious Movements Influenced What We Eat — An American History," author Christina Ward breaks down the ways food and spirituality have intersected and shaped our culture.Where the recipes are like dessert — a rich and indulgent complement to the main dish – the historical facts this book serves up is a hearty feast.
"I'm definitely one of those weird 'why?' people. I always want to know why." 
As it turns out, the Frog Eye Salad hails from the Church of the Latter-Day Saints (LDS), which dates back to the early 1800s. Most of the Mormon community follows the LDS tenets, and some of their practices — predominately polygamy — have recently netted them a place in mainstream media in TV programs like "Sister Wives."
In Ward's book, she amply informs readers about various religious groups and their beliefs, highlighting their respective food evolutions. With the Mormons, for example, their oral tradition of sharing recipes established very basic iterations of everyday dishes; eventually, missionaries brought back cooking traits from the regions they visited on their treks to spread their gospel.
Fascinations With Food 
The way food and spiritual quests intersect is only one of Ward's food-related fascinations.
An author, editor, and VP of Feral House Publishing, Ward has penned other food books including "American Advertising Cookbooks: How Corporations Taught Us to Love Bananas, Spam, and Jell-O;" "Preservation: The Art and Science of Canning, Fermentation and Dehydration;" and the recent "Happy Days: The Official Cookbook." The latter is about the iconic TV show, a perfect task for a food expert from Milwaukee, where the show was set.
Ward is a go-to expert on food for platforms from news stations to blogs; she even got to ride around in the Wienermobile with the former "Top Chef" host Padma Lakshmi on her breakout TV show, "Taste the Nation." Ward does what you do when you've got a ton of eats or a platter of information before you: she digs in.
Ward's 'Why' 
From an early age, an interest in food and an all-consuming curiosity has been a part of Ward's makeup. "I'm definitely one of those weird 'why?' people," she says. "I always want to know why. Growing up in a mixed household — my dad was kind of agnostic, and my mom was Catholic — I went to Catholic schools, and that gave me an early awareness of the different ways people do things. And our church was an Italian and Irish Catholic church, so it was very food-oriented. I made an early connection between religion and food."
Christina WardShe also cooked at an early age for siblings — not uncommon for young Gen-Xers – and spent summers helping on her grandparents' farm; she says those experiences helped build her food-knowledge foundation.
Media played its part, too, in an aspect of her book. "Growing up in the 70s and 80s, there was a cult awareness — all of those after school specials that showed how cults would snatch you off the sidewalk, which led to realizing there was a lot more to that topic, but that was my evolution of interest (in cults)," Ward says. "That interest has been there since childhood. Then, later, putting together some other connections, like Kellogg's and Little Debbie's roots in the Seventh Day Adventist Church. All of those things made me want to dig through it all and unpack it."
Compiling it all, telling one big story, added excitement to Ward's interest. "It's how my brain works. If I were talking to you in person, I'd corner you and say, 'Wait, let me tell you about this weird thing,' so this is my way of telling everyone, and they can read it on their timeline," she says. "I also collect cookbooks, and I was aware some of the groups (in the book) had been publishing cookbooks. So, I wanted to tell that bigger story — that was really the impetus."
Another component that often threads through these movements and groups is using food and diet as a means of control, which the book thoroughly examines. 
"If you look at some of the dogma of these groups, some of it is very radical — they would like to impose their dogma and belief systems on everyone because they think it's best," Ward notes. "That's the challenge with any religiously informed diet morality — the arrogance that comes with it – that their way of thinking is better than everybody else's and that they're doing you a favor by imposing it on you."
"In a city like Milwaukee ... you can safely guess that we have an incredibly dynamic food culture."
"Holy Food" took Ward five years of "active research and writing." She says that one of the most interesting parts of the deep dive was finding a through-line of connectivity. 
"Not just of the food, of the religions, of the new religious movements and how connected they are to each other. Not just modern connections: some things link back to the 1700s. How connected all the beliefs are and how all the actual people are was a revelation and surprise to me," she explains. 
Folklore and Holiday Food Magic in Milwaukee 
Ward was born in Milwaukee in the late 1960s and talks about the city with a familiarity that travels well beyond being a resident. She attributes the mix of choice eats to its diverse human blend. 
"I've said this to people, food writers, and even Padma Lakshmi, but I firmly believe we become 'American' through our stomachs," Ward says. "In a city like Milwaukee, with a long history of European settlement and immigration that welcomes migrants and refugees, you can safely guess that we have an incredibly dynamic food culture."
When the winter holidays roll around, Krampusnacht on St. Nicholas Eve night (Dec. 5) is a big deal. Courtesy of movies and an inherent intrigue, the folklore figure Krampus has been growing a vast U.S. following, especially over the last decade. For Milwaukee folks, it's been prevalent for well over 100 years.
"Krampus and St. Nick came to Milwaukee with the thousands of Germans seeking refuge from persecution during the 1848 German Confederation Crisis. St. Nicholas Day is celebrated on December 6, and Krampusnacht on St. Nicholas Eve night of December 5," Ward says.
"In the legend, St. Nick brings treats to good children on the morning of his day, while the American version of Santa makes him do the work of keeping a 'naughty or nice' list. St. Nick outsources the finding (and punishing) of the 'naughty' on the evening of December 5 to a more sinister Krampus," Ward explains. "Rough stuff, but in Milwaukee, we love Krampus and St. Nick because no one is ever so naughty to be snatched by Krampus!"
On the morning of December 6, kids of all ages will find a stocking or shoe filled with treats. And in Milwaukee, there are rules. "According to the Milwaukee St. Nicholas tradition, the stocking must contain the following items: an orange, a handful of walnuts, pecans and hazelnuts, pieces of chocolate and a small present," Ward adds. "The celebration of St. Nick has been severed from both the religious and ethnic roots to become a people's holiday enjoyed all."
Carrying on Traditions, Honoring Memories 
Ward, who grew up enjoying Christmas Eve by gathering with family and friends to share a meal and open presents, recalls that though many holiday dishes exemplify the holiday's religious roots, her dad eschewed those foods in favor of his favorite — pizza.
"Dad's best friend from childhood was the second-generation owner of Maria's Pizza. Dad and Ronnie were close, and their 'gang' hung out at the pizza parlor," Ward says. In 1967, her dad even donned a Santa suit for the place. 
As it happens, the friends found less time to hang out as they got older, but they found a way to connect.
"Dad would toss the pizzas in the oven, and we kids were in awe that while every other kid we knew had to sit still and eat their vegetables, we got to eat Maria's."
"On December 23, after his shift at the factory ended, my dad would go to Maria's and spend the waning hours visiting Ronnie, reminiscing and catching up. Then, in the pre-dawn morning, Ronnie would make two or three 'par-bake' pizzas for Dad to take home," Ward says. "In addition to the other plans of the day, Dad would toss the pizzas in the oven, and we kids were in awe that while every other kid we knew had to sit still and eat their vegetables, we got to eat Maria's."Ward's father passed away in 1999. "He was 54 years old, the same age I am now. As I went to the house to bring order to the chaos that follows an unexpected and tragic death, I noticed the pizzas were in the fridge. We were no longer children, but we would always be his kids."
And for Ward's family, the tradition continued. "For 24 years after Dad's death, we have made the trip to Maria's Pizza on December 23 to pick up the par-bakes," she says. 
While Maria's Pizza just closed after 65 years, Ward's family pizza tradition continues, growing to include new people and accommodate new dietary restrictions. 
'Holy Food' Recipe: 
Hog Farm Granola Breakfast (Road Hog Crispies)
Recipe note: Hog Farm Granola was famously served at Woodstock in August 1969 to the nearly half-million hungry attendees. The recipe can be scaled up to serve a larger-than-expected crowd.

Ingredients:
½ cup millet
½ cup cracked wheat
½ cup buckwheat groats
½ cup wheat germ
½ cup sunflower seeds (without shells)
¼ cup sesame seeds
2 Tbsp. cornmeal
2 cups raw (or rolled) oats
1 cup rye flakes
1 cup dried fruits and/or nuts (Use your favorites or whatever you have on hand. This recipe is very forgiving. You can add either ½ cup each of dried fruit and nuts OR 1 cup of each.)
3 Tbsp. soybean oil (can substitute canola or vegetable oil)
1 cup honey

Steps:
1. Preheat oven to 250°F.
2. Over medium heat, boil the millet in a double boiler for 30 minutes. Stir occasionally to prevent sticking.
3. In a large bowl, mix all the dry ingredients. Add in the cooked millet and mix thoroughly.
4. Over low heat, cook while mixing the soybean oil and honey together until small bubbles appear. Remove from heat and set aside.
5. Spread the cereal in a parchment-lined baking pan. Pour the honey-soybean oil syrup over the grain mix. Toast in oven until lightly browned, approximately 30 minutes. Stir once or twice to ensure even browning. Remove from oven and cool.

To serve: Pour into bowl and eat plain or with milk.
Store leftovers in refrigerator in a covered container.
Vegetarian. Can be made vegan if honey is substituted with maple or sorghum syrup. Makes 10 to 20 servings, depending on serving size.



How Religious Groups and Cults Shaped American Eating

Amy Young

Nearly a decade ago Jane Burdette glanced up from a cross-stitch project and noticed the door frame suddenly looked crooked. "I called my primary doctor who referred me to an ophthalmologist who saw me immediately. She contacted the retina specialist who saw me the same day, diagnosed the problem, and gave me the first injection in the left eye," she said. Her diagnosis: wet age-related macular degeneration (AMD) in her left eye, and dry AMD in her right.
The onset of age-related macular degeneration often begins so slowly that many people may not notice symptoms until the disease progresses or affects both eyes."I would have been alarmed if I had known this was the beginning of a long journey."
Upon diagnosis, Burdette, now in her 70s, says, "I was numb because this happened so fast. I was anxious about getting a shot in my eye. I assumed this would be fixed quickly and I would go on my merry way. I would have been alarmed if I had known this was the beginning of a long journey."
She received injections every 4 weeks (ranibizumab, [Lucentis, Genentech]) until late 2022, when she transitioned to a therapy that extends her treatment to every 14 weeks (faricimab-svoa [Vabysmo, Genentech]). She also takes vitamins made for people diagnosed with moderate to advanced AMD. Now in her tenth year of receiving eye injections, Burdette's wet AMD is now stable and some of her vision has improved. 
Sight-Threatening Condition 
The diagnosis of AMD affects the center of the retina (the macula), which is responsible for central vision. In a healthy eye, the macula captures detailed information from the center of the visual field, and then a person can read, drive a car, recognize faces, perceive color and contrast, and see fine details, according to the American Macular Degeneration Foundation.
The onset of AMD often begins so slowly that many people may not notice symptoms until the disease progresses or affects both eyes. Initial vision changes can include difficulty seeing in the center of vision needed for reading, cooking or driving; trouble seeing in dim light; and straight lines, like light poles, start to appear blurry, crooked or even missing. Fading and/or changes in the appearance of colors, and difficulty recognizing familiar faces are other signs, according to Prevent Blindness.
Types of AMD
The common forms of AMD are non-neovascular ("dry" or atrophic) and neovascular ("wet" or exudative). Macular degeneration starts as dry AMD progresses slowly over several years. It is classified in 3 stages: early, intermediate and late.
An estimated 1 in 10 Americans aged 50 and older have the early form of AMD
Approximately 85% to 90% of the cases of macular degeneration are the "dry" type, while 10% to 15% are the "wet" type, in which abnormal blood vessels grow in the back of the eye and damage the macula. This less common late form of AMD, also called advanced neovascular AMD, usually results in faster vision loss.
An estimated 1 in 10 Americans aged 50 and older have the early form of AMD and approximately 1 out of every 100 Americans ages 50 and older have the late form, according to a study in JAMA Ophthalmology. Overall, it impacts more than 1 million people in the United States and 5 million people worldwide.
What You Can Do 
"While we don't specifically have a guideline stating that there is a mandatory requirement for screening from the American Academy of Ophthalmology or the American Society of Retinal Specialists, I recommend patients, particularly those over 65 years of age, get a comprehensive eye exam, which can catch treatable diseases like glaucoma, macular degeneration and diabetic retinopathy at early stages," explains Yasha S. Modi, MD, an ophthalmologist and vitreoretinal surgeon with NYU Langone Health in New York. "Part of that exam is something called a macular optical coherence tomography (OCT) scan, which is an imaging test that's very sensitive at identifying even early stages of macular degeneration."
In addition, lifestyle changes — such as good nutrition and not smoking — can help keep eyes healthy. 
"Eating high amounts of leafy green vegetables and low amounts of saturated animal fats is correlated with a lower probability of macular degeneration and less severe stages of macular degeneration. Although we can't prove causality, we tend to recommend diets that are very high in leafy green vegetables and low in saturated animal fats, which is not only beneficial for macular degeneration but can also help with blood sugar and blood pressure control. Overall, this is a very good lifestyle diet," says Modi.
"One of the largest modifiable risk factors is to quit smoking." 
"One of the largest modifiable risk factors is to quit smoking. People who smoke are more likely to get macular degeneration or to have their condition progress and worsen. Unfortunately, smoking is highly addictive, so it's beneficial to reach out for help and to use resources available to help quit," he adds.
Treatments for Advance Dry Macular Degeneration 
In 2023, the new treatments — pegcetacoplan injection (Syfovre, Apellis Pharmaceuticals, Inc.) and avacincaptad pegol intravitreal solution (Izervay, Astellas Pharma Inc.) — were approved by the FDA to treat geographic atrophy (GA) caused by macular degeneration. GA, the progressive, irreversible, advanced form of dry AMD, is when atrophic lesions form in the outer retina.
"It's important to realize these are not global treatments for all macular degeneration, but rather only for a small population of patients with advanced atrophic macular degeneration," explain Modi.
The treatments, which are given either monthly or every other month in the form of an injection into the eye, slow the progression of macular degeneration, specifically GA. 
"We don't know what happens if individuals miss visits, or if they stop these treatments. Additionally, even if you are receiving treatment, it's critical to realize the disease is progressing, albeit at a slower rate. The goal of this treatment is to slow GA before it progresses to the very center of the retina (the fovea)," he says.
"If all goes well, the goal is that over years of receiving these treatments they will still have the ability to see with the center of their retina, because the progression has been reduced." 
The pegcetacoplan injection was approved for use for GA with or without subfoveal involvement, with a dosing schedule of every 25 to 60 days. Clinical studies showed that the treatment reduced the rate of GA lesion growth and demonstrated increasing treatment effects over time, with the greatest benefit (up to 36% reduction in lesion growth with monthly treatment) occurring between months 18 to 24 months. Later in 2023, avacincaptad pegol gained approval. Phase 3 clinical studies showed it provided a statistically significant reduction in the rate of GA progression at 12-months.
Modi has used these newer treatments. "Individuals who have extrafoveal (outside of the center of the retina) GA that has progressively gotten worse over time are the perfect patients for treatment. For these patients, the writing is on the wall that eventually the center of the retina will become compromised. Treatment can slow the progression to the fovea that will then ultimately render them with very limited central vision," he explains. 
Gauging the real-world impact of treatment can be challenging because there is no measurable output to know the medication is working. "Patients do not see better when they get these injections. If all goes well, the goal is that over years of receiving these treatments they will still have the ability to see with the center of their retina, because the progression has been reduced," he says.
Treatments for Wet AMD
Wet AMD can come on suddenly and insidiously. "That's why we ask all patients to use either an Amsler grid or some form of home monitoring device to be able to detect vision changes at the earliest stages, because the sooner we identify the conversion from dry to wet AMD and start treatment, the better the long-term vision is likely to be," Modi says.
Anti-VEGF agents are used to treat the abnormal blood vessels leaking, growing and bleeding under the retina in wet AMD. Treatments, such as bevacizumab (Avastin, Genentech), ranibizumab, aflibercept (Eylea, Regeneron Pharmaceuticals) and faricimab-svoa, are available to slow the condition's progress and preserve existing vision.
"It's much more important that patients receive consistent anti-VEGF therapy rather than any particular type of anti-VEGF therapy. Oftentimes, patients will miss visits, but the more consistently you receive the injection, the more likely you are to maintain your vision. Your doctor will set out a plan to start the injections typically every 4 weeks and then extend that by some interval based on the response," Modi says.
"Some medications, like faricimab (Vabysmo) or aflibercept 8 mg (Eylea HD), can potentially last longer in the eye relative to other medications and the interval may be extended further relative to first generation anti-VEGF medications. That can lower the number of visits and injections that somebody may ultimately have, and that's huge when it comes to patient satisfaction as well as for the caregivers who don't have to bring them to the office as frequently," he adds.
Less frequently, photodynamic therapy (PDT) is used to treat abnormal blood vessel growth from wet AMD. The drug verteporfin (Visudyne, Bausch + Lomb) is injected into the arm and moves throughout the body to the blood vessels of the eyes. Then focused laser light is directed on the eye's abnormal blood vessels to activate the drug and cause them to close. PDT may improve vision and slow the rate of vision loss. Re-treatments are sometimes needed to treat the blood vessels that reopen over time.
Quality of Life 
Treatment has improved Burdette's quality of life and lets her remain active with her community's Historic Preservation Committee. "If I lost the ability to do this work, it would be a great loss for me," she says.
Burdette also encourages others to keep up with their regular eye appointments. "I tell my family and friends to find a good ophthalmologist, one who keeps up with the latest research on AMD, and ask about this disease and treatment options now, before you are diagnosed with it," she says.
Modi points out that probably everyone is touched in some way by a family member or friend who has macular degeneration. "As we are fortunate enough to live longer and longer, this is going to become something that is more prevalent in our society. It's incumbent on everybody over 50 years of age to educate themselves on the warning signs of macular degeneration."


More Treatment Options for People with Macular Degeneration

Lisa B. Samalonis

(This article originally appeared on Simplywise.com.)
In 2019, 64 million Americans were estimated to have received Social Security benefits, and for more than half of beneficiaries age 65 or older, Social Security represented over 50% of their income. Nonetheless, a recent SimplyWise survey found that less than one in eight Americans aged 60 to 70 considered themselves “very knowledgeable” on the topic.
Worse, only one out of 300 people asked knew the correct answer to all five of the following questions below.
These questions are fundamental, and confusion leads to some people missing out on Social Security income they desperately need. Whether you’re single, divorced or married and looking to maximize your retirement income, familiarizing yourself with the Social Security claiming rules is paramount to a relaxed retirement.
Question 1: Claiming at which age maximizes your monthly earned Social Security benefit?
Correct answer: 70.
While non-disabled people can begin collecting their Social Security benefits at 62, the monthly benefit amount will increase for every month they wait until turning 70. After that, the benefit does not increase.
Waiting past your Full Retirement Age will earn you delayed Social Security retirement credits and result in an increased benefit amount.
How many got it right: 42%.
Most common wrong answer: 35% of people believe that you earn the maximum monthly benefit at Full Retirement Age. Full retirement age — typically 66 or 67 — entitles you to 100% of your Primary Insurance Account or PIA, which is the amount you’ve earned based on your working record. But waiting past your Full Retirement Age will earn you delayed Social Security retirement credits and result in an increased benefit amount.
Question 2: For non-disabled people, what is the earliest age you can receive survivors benefits?
Correct answer: 60.
How many got it right: 9%.
Most common wrong answer: 21% of people surveyed believe that the age is 62. In the case of earned benefits and spousal benefits, this is correct, but the age drops for survivor benefits. Similar to earned and spousal benefits, waiting past the earliest age can increase the monthly benefit amount.
Question 3: Does your spouse need to be receiving Social Security benefits for you to qualify for spousal benefits?
Correct answer: If you intend to collect Social Security benefits based on your current spouse’s earnings record, your husband or wife must already be collecting his or her Social Security earned benefits. When it comes to collecting spousal benefits on an ex-spouse’s record, however, this is not necessary.
How many got it right: 20%.
Question 4: Can divorced spouses receive survivor benefits?
Correct answer: Yes. The criteria differ slightly from those of married spouses — for example, the marriage must have lasted for at least 10 years and there are rules around remarriage — but divorced spouses can collect survivor benefits in relation to a deceased ex-spouse.
How many got it right: 38%.
Question 5: Can divorced spouses receive spousal benefits?
Correct answer: Yes. As is the case for survivor benefits, some differences do exist for divorced spouses, but they are eligible for spousal benefits.
How many got it right: 67%.
The Bottom Line
Increasingly, online Social Security blogs and free calculators are emerging to help people avoid costly mistakes. Hopefully, with better education around the topic, Americans can maximize what they’ve earned.


Only 1 in 300 People in Their Sixties Know These Social Security Rules

Retirees have long been a frequent target of cybercriminals, but the amount of money those digital fraudsters fleeced from older adults skyrocketed in 2022 amid the growth of poorly understood cryptocurrencies and hyped concern about the economy.
While tech support scams continue to be the most common type of fraud, investment frauds raked in the most money by far — roughly $990 millionWhile tech support scams continue to be the most common type of fraud, with 17,810 victims, investment frauds raked in the most money by far — roughly $990 million, or more than four times as much as 2021, according to the most recent FBI Elder Fraud Report.
Education and awareness are the most effective defenses against fraud. If you can spot a con, you can avoid it
The soaring sum of money lost came even as data from the bureau's Internet Crime Complaint Center (IC3) showed that the number of investment-fraud victims aged 60 and over declined by 4.4%, to 88,262 in 2022 from 92,371 a year earlier.
So Many Hustles
"Senior individuals often fall victim to these scams due to a lack of digital literacy," explains Taylor Kovar, a CFA and founder of Kovar Wealth in Lufkin, Texas. "Scammers take advantage of their unfamiliarity with technology and their often-trusting nature." Cryptocurrency and other types of newer payment methods also helped scammers to commit elder fraud.
When looking at the full menagerie of scams — including those involving tech support, non-payment, personal data breach and confidence/romance — total losses by victims aged 60 and over soared to $3.1 billion in 2022 from $1.7 billion in 2021.
Unfortunately, that's not the only statistic that skyrocketed last year. The average loss per victim increased to $35,101 from $18,246, and the number of victims losing more than $100,000 rose to 5,456 from 3,133.
Finding Flimflams
To be clear, people in every age group are susceptible to fraud. However, the $3.1 billion reported by those over 60 years of age is close to or more than double the $1.8 billion reported by those in the 50 to 59 age group or the $1.5 billion reported by those in the 40 to 49 age group.
Education and awareness are the most effective defenses against fraud, Kovar says. If you can spot a con, you can avoid it. To help you recognize frauds, here are common scams.
Investment Fraud
Investment fraud scams tend to be online and are presented as low-risk opportunities promising guaranteed returns. This includes Ponzi schemes, pyramid schemes, real-estate swindles and advance-fee fraud. Cryptocurrency is commonly involved. Victims are often talked into draining their savings, tapping into the equity in their home or accessing their retirement accounts.
Tech Support Scams
Tech support scams claimed 17,810 victims in 2022, a year-over-year increase of 147%. It was, by far, the most common swindle committed against victims over 60 and resulted in losses totaling more than $587.8 million. In addition, government-impersonation flimflams claimed 3,425 victims — almost twice as many as a year earlier — and resulted in losses of $136.5 million. These two schemes involve call centers, which disproportionately target older adults.
Lottery/Sweepstakes/Inheritance Fraud
Schemes involving lotteries, sweepstakes or inheritance stung 2,388 victims. Total losses exceeded $69.8 million. In this kind of fraud, con men may contact victims by email, phone call, social media or U.S. mail, but the scam remains the same. Victims are told they won a contest, lottery or sweepstakes (even though they never signed up or submitted any type of information). After calling in to claim the prize, they are informed that they need to pay taxes and fees. This scenario plays out for several months (but can even be years), as the scammers keep making up new types of fees, while promising victims they are just one step away from claiming their prize.
With inheritance scams, it's the same process, but involves an unknown relative who died and purportedly left the victim a large sum of money.
A closely related crime is the grandparent scam, in which grifters pretend to be a member of the victim's family who is in trouble and needs money sent to them immediately.
Confidence/Romance Scams
Confidence and romance scams claimed 7,166 victims and resulted in losses exceeding $419 million. This online crime involves a scammer pretending to fall in love or have other types of strong feelings for victims in order to gain their trust — and eventually their money. The scammers will usually claim to either be in the military or live outside of the U.S., and ask for money to be sent overseas. This cover also provides them with a convenient excuse to avoid meeting the victim in person.
A closely related crime is the grandparent scam, in which grifters pretend to be a member of the victim's family who is in trouble and needs money sent to them immediately. The FBI reports that close to 400 victims lost 3.8 million in 2022 as a result of this scam.
Extortion Scams
Extortion scams claimed more than $15.5 million from 4,285 victims in 2022. Victims are coerced to turn over funds or else face physical or financial harm or public embarrassment by the release of sensitive information. Sextortion accounted for almost half of the extortion scams. Victims, who were tricked into thinking they were in actual relationships with the scammers, shared intimate photos or information; the material is then used against them.
Non-Payment/Non-Delivery Scams
The second-most-reported elder fraud are non-payment/non-delivery scams, in which victims sell something of value to someone they met on social media but never receive payment or pay up front for something that never arrives. Criminals using this scam stole $51.5 million from 7,985 victims.
The Internet Crime Complaint Center classifies cryptocurrency as a descriptor, not a type of fraud, because IC3 considers it a tool sometimes used to commit fraud. The center said about 10,000 people asserted they had lost a combined $1 billion on a variety of cryptocurrencies, such as Bitcoin, Ethereum, Litecoin and Ripple.
Avoid Becoming a Victim
This isn't an exhaustive list of elder fraud scams. There are also data breaches, identity theft, credit card fraud — the list goes on. However, there are ways to avoid elder abuse.
"It's important to know that unsolicited tech support calls or emails are almost always scams," Kovar says. "No reputable company will ever ask for remote access to your computer or ask for payments via gift cards or wire transfers."
Regarding the alarming increase in confidence/romance scams, Kovar says, "It's crucial to remain skeptical of anyone you meet online who quickly professes love and then needs financial assistance."
"No reputable company will ever ask for remote access to your computer or ask for payments via gift cards or wire transfers."
He adds that there is no such thing as love at first sight online. "And it certainly doesn't carry a price tag," he cautions, "so when in doubt, take the advice of your heart, but take your wallet out of the conversation."
The Consumer Financial Protection Bureau recommends that retirees choose a trusted contact person who can help them protect their money. This person, who could be an adult relative or close friend, would be listed on your banking account as an emergency contact.
If the bank cannot contact you to confirm that a large withdrawal from your account is not a scam-related transaction, it would be authorized to ask your trusted contact person to talk with you about the withdrawal.
Sometimes, two heads are better than one, and someone who has not been in contact with the scammer can provide a different perspective.


Investment Fraud Soars

Terri Williams

How do you envision life in your later years? Most of us imagine ourselves aging happily and healthy in our own homes. The reality is the experience of aging falls along a spectrum.
Seven out of 10 of us who turn 65 will at some point need long-term care services. While most of us will get that care at home – most often from family caregivers – some will require a level of medical care that makes moving into a nursing home the right option.
A nursing home is a communal living facility providing 24-hour on-site services such as nursing care, physical therapy and assistance with everyday activities like bathing, eating or walking. Importantly, nursing homes are not all alike.
Many nursing homes are beautiful, safe environments that help people thrive, no matter their physical and mental condition. Others desperately need radical changes, which my organization and many others are calling for right now.
Not everyone who moves into a nursing home does so for the same reason. Here are five common questions and answers that will help you and your family better understand nursing home care:
When is a nursing home stay needed and for how long?
You may need a nursing home after a hospital stay for an acute condition — like a joint replacement or recovering from a stroke. The most common reason for living in a nursing home, however, is dementia, affecting more than 50-70% of all nursing home residents.
The length of time you stay in a nursing home depends on how much care you need and for how long. For example:
Short-term stay (up to 100 days): for physical, occupational or speech therapy following an in-patient hospital stay (like for a hip replacement or small stroke) or after an out-patient procedureLong-term stay (100 days and beyond): for disabled, chronically ill and older individuals who do not require hospital-level care but need more support than is possible in their own homesWhat may start as a short-term stay can unexpectedly turn into a long-term stay in a nursing home, especially if your condition is not improving.
Who cares for me in a nursing home?
A variety of professionals care for nursing home residents: registered and licensed practical nurses; physical, speech and occupational therapists and social workers. Certified nursing assistants (CNAs) handle much of the day-to-day patient care such as helping with bathing, getting in and out of bed and delivering medications. Often, CNAs do not receive livable wages, full-time benefits or adequate training for their incredibly difficult and highly skilled work. These issues have been exacerbated by COVID-19 and you should ask any nursing home you are considering about their staffing policies.
What will it cost?
A short-term rehabilitation stay in a nursing home can be covered for up to 100 days by Medicare following hospitalization. But be aware: if Medicare classifies you as being on "observation status" (meaning the hospital has not admitted you as an in-patient but just as "observational"), that could disqualify you from Medicare coverage for that post-hospital nursing home stay. The Center for Medicare Advocacy has a helpful resource on nursing home coverage.
Intermediate- to long-term stays are typically paid for by private insurance or out-of-pocket by the patient or family members. Nursing home stays can cost on average $255 per day for a shared room or $290 per day for a private room.
How have nursing homes changed?
Many of today's nursing homes were designed 50 years ago to meet the needs of a past era. They often reflect how care was delivered. But nursing homes are beginning to adapt to the contemporary needs of patients and deliver high-quality care with a supportive and fair workplace for staff
Green House senior living is one example of innovative nursing home care where the number of residents in each of its small homes is restricted to a maximum of 12 and dedicated staff are assigned exclusively to each home, which proved incredibly important during the pandemic.
How do I choose a nursing home?
Choosing a nursing home can seem daunting at first but there are several checklists that can help you make your decision, including ones from the National Institute on Aging and Medicare.
You may want to consider reviewing nursing home safety ratings before you make your decision as well. Medicare's Nursing Home Compare online tool features a database of nursing home ratings based on health inspections, staffing levels and certain measures of the quality of resident care. The tool has limitations and not all nursing homes accurately report their data. Another tool, Nursing Home Inspect, allows you to compare nursing homes based on citations and penalties related to safety deficiencies.
As you consider your options, it's important to ask how nursing homes have adapted during COVID-19 and what new policies they have in place to safeguard and ensure the highest quality of life for staff and residents.


5 Common Questions About Nursing Home Care

Terry Fulmer, PhD, RN, FAAN

Traditional financial advice like the kind you got from your parents is often true but even experienced investors might rely on maxims that are outdated and no longer serving your financial well-being.
In fact, quite the opposite, as sticking to adages like "cash is king" (money is more valuable than other investments like stocks and bonds) and "all debt is bad" may be financial relics that you can stand to update.
Here are 5 money thoughts that you can ditch to keep a young financial mind:
1. Pay Your Mortgage Off Early 
One rule that may have become obsolete is paying down your mortgage faster than usual. With mortgage interest rates low, there's a good argument that putting that money elsewhere and earning a higher return over time may be a better bet than paying down your mortgage early. "Trying to decide between eliminating debt and investing for the future can be a difficult decision," says Jason Laux, retirement advisor at Synergy Group, a retirement planning firm in White Oak, Penn.
"Saving and investing for retirement is going to offer you a better return over time." 
"But mortgage debt isn't always a bad thing. If you put off saving for retirement in order to pay off your mortgage early, you may end up house rich but cash poor," says Laux. 
Instead, prioritize your personal finances. Use any extra money to max out contributions to your 401(k) or IRA. "Saving and investing for retirement is going to offer you a better return over time," Laux says.
2. Cash is King 
Over the long run, holding significant amounts of cash ensures that you'll suffer significant lost opportunities, explains Robert R. Johnson, professor of finance at Heider College of Business, Creighton University, and the co-author of "The Tools and Techniques of Investment Planning, Strategic Value Investing and Investment Banking for Dummies."
He explains that when it comes to building wealth, you can either sleep well or eat well. If you invest conservatively, you sleep well because of little volatility. But it doesn't allow you to eat well because your account won't grow large enough to keep you well-fed. 
According to data compiled by Ibbotson Associates, large capitalization stocks (think S&P 500) returned 10.3% compounded annually from 1926 through 2020.
Over that same time, long-term government bonds returned 5.5% annually and T-bills returned 3.3% annually. To put it in perspective, $1.00 invested in the S&P 500 at the start of 1926 would have grown to $10,945 (with all dividends reinvested). That same dollar invested in T-bills would have grown to $21.71. "The surest way to build wealth over long-time horizons is to invest in a diversified portfolio of common stocks," says Johnson.
3. You Must Have a Financial Advisor
Twenty years ago, if you had disposable income, you gave it to a financial advisor, who invested your money into safe, boring vehicles earning roughly 7% – 10% per year, explains Stefan von Imhof, CEO of alts.co, one of the world's largest alternative investing communities. "Today, retail investors are increasingly shunning financial advisors, and managing investments themselves."
Imhof explains that a decade ago, 57% of households with $500K+ in net worth and a prime earner under 45-year-old had an investing style considered "mostly self-directed." By 2019, that number has shot up to 70%.
"New generations are self-educating and taking on higher levels of risk to get higher returns," says Imhof. They look to invest in alternatives, which usually aren't an option with mainstream advisors," he says. Today, managing your portfolio on your own or with light guidance from an occasional financial check-up with a professional may be the preferred way to go.
4. Contribute 10-15% Toward Retirement 
"Sure, this advice will work for someone who plans on working until their mid to late 60s," says Ty Jones, a personal finance and retirement blogger who blogs at AskTheSavingsGuy, a Financial Independence Retire Early (FIRE) advocacy blog, "but if you want to retire in your 50s, you'll need to save much more aggressively."
By saving 25% of your income, a 30-year-old with no retirement savings could reach their retirement goal by age 55 instead of age 63, which is what it would be if they were to contribute only 15% per year based on the 4% rule and assuming an 8% return. Bumping up your 10% percent retirement savings to 20 or 25% can ensure both a more robust retirement portfolio and allow for earlier retirement, explains Jones.
5. Stick to the 4% Retirement Rule 
This rule says you can spend 4% of your retirement funds annually and not run out of money. Johnson says, research, most notably by Wade Pfau of The American College of Financial Services, shows that while historically that rule of thumb worked in the United States, the current environment of low bond returns increases the likelihood that retirees may well run out of money if that rule is applied going forward.


5 Money Thoughts That Might Be Aging You

Jennifer Nelson

A 2020 study from Australian researchers finds that vigorous intermittent lifestyle physical activity (VILPA) — exercising in an intense burst for 1 minute, 3-11 times a day — cut study subjects' risk of cardiovascular death by an impressive 65% and death from cancer by 49%.
Exercising in an intense burst for 1 minute, 3-11 times a day — can cut the risk of cardiovascular death by an impressive 65% and death from cancer by 49%.VILPA is thought to be effective in the same way a high-intensity conventional workout can be. Lead study author Emmanuel Stamakakis, professor of physical activity, lifestyle and population health at the University of Sydney's Charles Perkins Centre, and his team found that VILPA done during daily activity can provide the same health benefits as more traditional cardio activities.
"Ideally, getting 150 minutes a week of moderate exercise, or 75 minutes a week of vigorous exercise is recommended."
The researchers asked 25,000 people who said they did not work out to use a wearable device and engage in exercise "micropatterns"— frequent, spaced-out, high-energy movement as opposed to one long session. The results: Eleven VILPA micropatterns a day is all you need to do to gain results, and you can do almost any cardio — even amped-up housework does the trick.
Additional research has previously shown this workout approach to be favorably effective. For example, a French - US study found that spreading outbursts of physical activity throughout the day positively affected mood, appetite and energy levels. 
Also, the study found that moving for three minutes every half hour – which you can achieve by taking some stairs or jumping jacks – helped control participants' blood sugar. 
"Ideally, getting 150 minutes a week of moderate exercise, or 75 minutes a week of vigorous exercise is recommended," says Cindy Sullivan, owner of Cindy Sullivan Fitness in Boston, which trains older adults. "That equals about 30 minutes a day, but it can be broken up in many different ways to be effective."
Do you want to try this time-saving, health-boosting "workout"? We asked two top exercise experts for their advice; here are their five easy tips for getting the most out of VILPA.
1. Get A Physical
No matter how briefly you do it, higher–intensity cardio requires endurance and good health. So you want to make sure before you start any VILPA that it's safe for you to start. 
"You definitely want to speak with your doctor before you do this kind of exercise," says Ron DeAngelo, director of sports performance training at the University of Pittsburgh Medical Center. 
"I would also recommend using a pulse oximeter while doing this exercise, for safety. If you measure 95 or more, your oxygen level is good. You don't want it dropping below 93," he says.
Your doctor may also advise you to monitor your heart rate before, during and after exercise.
2. Vary Your Activity
Making micro-bursts a habit throughout your day should never feel like a chore. Instead, it should be something that invigorates you. The key to making this happen? "Try to make it fun," suggests Sullivan. 
"You can do microbursts while brushing your teeth or taking out the garbage." 
"For example, I have a client who admitted to sitting and watching TV a bit too long. I encouraged her to start including little bursts of exercise during commercials. We make it like a game to see how many chair squats, standing and sitting, she can do in 60 seconds during the commercial."
"Another way to do this could be to sneak in a microburst workout while the water is boiling while you are cooking. You can march in place, raising your knees high with your arms overhead. You can do standing push-ups off your kitchen counter. You can do microbursts while brushing your teeth or taking out the garbage." 
Remind yourself that you are doing good for your body and you will also experience an incredible sense of accomplishment.
3. Watch Your Form
"Even though you might be speeding up your moves, you still want to maintain proper form throughout your movements," Sullivan stresses. 
"This is especially important as we get older to maintain good joint health, posture and alignment, and to prevent overall injuries," she adds. 
Remember to engage your core, not hunch over, and do a few stretches before and after you complete a micro-burst. 
You can consult a trainer at your local gym for tips on a specific form to ensure you are maximizing your results.
4. Focus on Recovery
The period after you stop exercising is just as beneficial as the workout. For example, the physiological changes that exercise causes that are good for your heart occur as you rest. 
Therefore, it's crucial to stop after short activity, drink water, and allow your system to "catch up." 
"Go at a comfortable pace and listen to your body as you go."
"As we get older, recovery is even more important," says DeAngelo. Another critical reason to pause for recovery: you'll rejuvenate, so it will be less stressful on your body when you do your next micro-burst. 
"It's not unusual to be out of breath after intense exercise, but you don't want to be totally out of breath," DeAngelo adds. 
"So, you have to have an excellent recovery period. If you run up and down the stairs to get your laundry in the basement, for example, take breaks. For fit people, the work-to-rest rate is about 10 seconds of going upstairs, then 1 minute of recovery."
5. Don't Overdo
You'll notice some quick and positive changes after following a VIPLA routine. Of course, it's normal to feel a little fatigued at first, but chances are, your energy level will increase as your body gets used to the activity boost. 
Still, this doesn't mean you should push too hard or fast. "Start slow and build up the intensity to avoid injury," notes Sullivan. It's great to set mini-goals – say, increasing the number of micro-bursts you do throughout a couple of weeks. 
However, there are no rules as to how fast you should progress. "I think a good way to think about this is that everyone is different," DeAngelo explains. "An intense 5 minutes for me might be longer for someone else." 
"Go at a comfortable pace, and listen to your body as you go." Be consistent and you'll notice the difference. 


Why Exercising For Just A Minute Could Save Your Life

Lisa Mulcahy

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