I find the Mafia fascinating and have therefore seen all the classics: "Goodfellas," "The Godfather" and "The Godfather II" (the less said about version "tre," the better). "Donnie Brasco," while not a classic, is probably the most realistic, with "A Bronx Tale" being the most underrated.
"While I'm not an I.T. genius, it can't be that difficult for the IRS to build a website that allows taxpayers to file their taxes directly, efficiently and without charge."My fascination may very well have to do with being a nearby native New Yorker, with a personal "connection" to La Cosa Nostra.
My run in with the Mafia occurred back in the '70s. I was about 10 years old and remember watching our garbage cans being quickly and ably emptied into the back of a garbage truck by numerous members of Long Island's "waste management" industry. My father causally mentioned to me that it was all run by the Mafia.
Why Doing My Taxes Reminds Me of Garbage
He wasn't at all bothered by it, possibly because that was just the way it was back then, though more likely due to the efficiency of the operation, as he specifically mentioned that the company that removed our garbage three times a week did a very good job.
Tax forms like W-2s, 1099s and K-1s are standardized, so why can't TurboTax allow me to enter them on an identically looking screen? 
Last spring I ran into a very similar situation, except that instead of having my garbage removed, I was doing my taxes, and instead of dealing with the Gambinos, I was dealing with TurboTax.
Much like Long Island municipal governments contracting out waste removal instead of using civil servants, the U.S. government contracts out tax preparation to the tax preparation Mafia. It's all the same, with the likes of Block, TurboTax, Liberty Tax, TaxAct, and Hewitt replacing the Five Families.
And much like my father's indifference, it wouldn't be an issue if TurboTax just did a better job. How could they improve?
1. Have Online Forms Match Paper Versions
Data entry is so incredibly laborious — you'd think it was a union shop, with a heavy dose of no-show jobs. Tax forms like W-2s, 1099s and K-1s are standardized, so why can't TurboTax allow me to enter them on an identically looking screen? Instead, I need to enter them on multiple screens, scrolling down on every single one of them.
Each Form K-1, for my master limited partnerships, requires over 50 mouse clicks and more than 20 screens, with many of them asking unanswerable questions like "Enter the dollar amount of the adjusted gain or loss reported on box 17, Code B of your K-1. . . ."
It's as if TurboTax studied how to make data entry as cumbersome and lengthy as possible, possibly in cahoots with the leadership of the orthopedic surgeons' union.
2. Make Calculations Transparent
The amount owed changes and you have no idea why. I've always been bothered that TurboTax doesn't provide at least a modicum of tax analysis, and instead just changes the refund amount like the reels on a Mafia controlled Las Vegas slot machine whenever you enter another number.
Prior to the personal computer, you had only two options when filing your taxes. You either took your shoebox full of receipts, W-2s and 1099s to your accountant or you got out your pencil, calculator and IRS instructions and got to it.
Note that I said pencil. You knew mistakes would be made, but that when it was all said and done you would be thoroughly familiar with each and every number. Now you have to accept TurboTax's verdict with only the most cursory accounting of how it was rendered.
3. Fix Oversights and Errors Immediately
Just prior to filing my return, TurboTax runs an "Error Check" which always finds errors like missing state names, addresses, numbers, etc. Why don't they just ask me to enter the information in the first place and not let me hit the "Continue" button until all the required information is entered?
4. Show Forms Before They're Filed
Except for a bastardized 1040, it won't let me see any form before I file, which makes it impossible to understand how, say, my foreign tax credit is computed or if all of my deductions are allowed.
After you click the "File" button you can then print out your return and then review your forms. If you find an issue you can then trick the system into letting you make corrections before you click the "File" Button again. Risciacqua e ripeti.
5. Make It Easy to Check Entries as You Go
Want to review all the numbers you entered for accuracy and completeness? Well, you either need to print out your forms after you "File" or go back and review every single data entry screen, one . . . by . . . one. Like youz was enterin' dem from scratch.
6. Speed Up the Electronic Filing Process
To makes filing easier and a little less stressful this year, for the first time I decided to e-file my federal and state taxes. Both were submitted (I'm ashamed to admit) on April 18, with the Fed going smoothly enough with an email from the IRS arriving 37 minutes later confirming acceptance.
Unfortunately, my state return took a further 26 hours to be "Accepted." Let's just say those hours were not as stress-free as I would have liked.
I'm certainly not blaming TurboTax for this 26-hour delay, but when I subsequently determined that this is not unusual, I thought, why couldn't they have provided a modicum of warning and explanation.
Why Do We Tolerate This?
You would think that TurboTax would realize that after their customers finish their taxes, and make an ever increasing annual payment, they want it all to just be finito. A feeling that customers must have after making a final payment to their loan shark.
While I'm not an I.T. genius, it can't be that difficult for the IRS to build a website that allows taxpayers to file their taxes directly, efficiently and without charge. Then why do I still need to use a middleman? While some may blame the deep state, I'm pretty sure TurboTax wise guys, I mean lobbyists, are to blame.
I'm hopeful that in the very near future Amazon will get into the tax preparation business. While I'd rather not risk having my taxes done in a Chinese factory with no emergency exits, at least I know they will provide me with a first-class website that is efficient, businesslike and organized, as I'd expect nothing less from Don Bezos.


TurboTax?? Fuhgeddaboudit!!

Michael J. Flack

Most of us have likely experienced some version of an 'a-ha' moment about our age, but Carl Honoré has a rather unique story to tell about his: it occurred on a train, following a ball hockey game in London where he – the oldest member of his team – had scored the game-winning goal to advance them to the semifinals. More on that below.
Carl HonoréA broadcaster, international speaker and writer, Honoré, 56, is the author of "In Praise of Slow" and "The Slow Fix" where he takes on what he calls "the cult of speed" society.
His most recent book, "Bolder: Making the Most of Our Longer Lives" focuses on a different kind of cult – what Honoré refers to as the "cult of youth." In a 2019 TED talk, Honoré breaks down the stereotypes on what it means to grow older in the world today: the myths that later life is depressing; creativity belongs to the young; older people are less productive and can't learn new things.
"Most aging stereotypes are flat-out wrong," he says to the audience. "Ageism is not invincible. The cult of youth is not a permanent or inevitable part of being human."
Next Avenue talked to Carl Honoré from his home in London about how the numbers in our age should never become a "straitjacket" and how he believes aging is a lot like a video game.
This interview has been edited for length and clarity.
An Unexpected Revelation About His Age 
I played ball hockey (a game similar to ice hockey played on land) for the Great Britain National Masters team, the London Jets. We were at a national tournament, up in the north of England, and locked in a zero-zero tie in the quarterfinals with the team we had annihilated the year before. We just couldn't get the goal we needed and I could feel the nerves and the indignation coursing with my teammates. Then out of nowhere, I scored the goal that got us in the semifinals.
"Suddenly this thing that I had loved doing and was playing well, suddenly my age took on this terrible power to define and limit me."
It wasn't just any goal; it was one of those highlight reel/goal of the month type. I will be dining out on this goal for a very long time (laughs). I was floating on air, I felt like a superstar. One of the organizers sidled up to me and he said, 'Great goal. Congratulations. Semifinals.' But then he said, 'Guess what? I've been flicking through player profiles here, and it turns out that you're the oldest player at the tournament.' I knew I was one of the oldest but suddenly, to be the oldest, I don't know. It rocked me to my core. In the blink of an eye, I went from goal scorer to granddad.
All of these questions began crowding in. I was thinking, do I look out of place here? Are people laughing at me behind my back? Suddenly this thing that I had loved doing and was playing well, suddenly my age took on this terrible power to define and limit me. I came away from that tournament thinking, how can that be? This makes no sense. I scored this incredible goal. I'm having fun. Why should the numbers on my birth certificate become a straitjacket in this way?
Making Sense of a New Perspective 
We were all on a train and we were in high spirits. But I remember at one moment just sitting, looking out the window by myself and thinking, wow. It was a real lightning bolt moment, and I knew I would come back to this topic. That was where "Bolder" came from.
"It's not like everything gets better as you get older, just as it's not as though everything gets worse as you get older."
For my own writing, I need to unwind some kind of philosophical dilemma or make sense of it … like doctor, heal thyself. I'm always trying to fix something in my own way of being in the world as well.
A Lens on the Cult of Youth 
What I realized when I began picking this [issue] apart was that not only was I not alone in feeling hampered and hamstrung by my age, but that I myself was a card-carrying member of the cult of youth. I realized that I just either pushed away the idea of aging or found it vaguely abhorrent. It was something that I had put on a shelf.
This moment at the hockey tournament forced me to confront my own ageism, but also to anchor it in a bigger rethink about, how do I fit in? You realize you are not alone. So, the first thing I did was I began putting together a laundry list of all the things that I thought, or that we commonly think, are bad about aging.
The cult of youth view is that aging is a chamber of horrors. That after a certain age, it's all downhill, everything gets worse once you get past whatever, 30, 35, wherever we're drawing the line these days. Which of course is just patently untrue. 
Taking a Nuanced Look at Aging 
One of the most common stereotypes, of course, is that later life is depressing. You think of the words that we trot out, crotchety, grumpy, cranky, old. When in fact the U-shaped happiness curve tells a very different story.
Rather than this binary idea of you start here, you go down, or that somehow you go up, it is much more complex and nuanced than that. It's not like everything gets better as you get older, just as it's not as though everything gets worse as you get older. It's much more tangled and messier and interesting than that.
Aging as a Video Game 
I think of aging now as a bit like a video game. I'm not a gamer myself, but I know that the way gamers think about the game is that you're at a level. So, I'm currently at level 56 (my age). The way you approach the game of life, the game in this metaphor, is I'm level 56, I'm going to make the most of level 56. I'm going to have all the adventures one can have at this level. I'm going to gather all the treasure, all the weapons, woo all the maidens, whatever it is. I'm going to get all that, and then I'm going to move up to level 57. What's waiting for me at level 57? It's something to look forward to. Now, occasionally I'll look back and think, man, I had a great time at level 29, but I don't want to go back to level 29. I'm at 56, I'm looking forward to 57. So, that's one of the ways I think about reframing aging.
"Now, occasionally I'll look back and think, man, I had a great time at level 29, but I don't want to go back to level 29. I'm at 56, I'm looking forward to 57."
Moving the Dial on Aging 
I've been on the front lines of traveling around, talking, thinking, listening about aging for more than four years. ("Bolder" was released in 2019). I would say that the dial has made a quantitative leap in the last 10 months, the last year. With social media, the posts people are doing, the coverage in the press, the calling out of ageism in the workplace, companies taking steps forward to make their workforce friendly and welcoming to all ages. Recently several top CEOs in France signed a declaration with 10-step pledges to take down ageism. That would've been unthinkable two years ago, let alone 10. I think that we've made a great leap forward. There's a long, long way to go.
I was just in central London, standing on the platform at one of the tube stations. Right behind me, there was a massive poster saying, "Are you Ageist?" It's a big national campaign run by the Center for Ageing Better.
You certainly wouldn't have seen that when I brought "Bolder" out. I was having to explain to people what ageism was. Now it's a given. People know what it is. They're being asked to contemplate whether they're guilty of it. That's a big leap forward by any yardstick.
Ageism in the Working World 
There's a feeling that the tectonic plates are shifting and the conversation is moving in a direction that's going to be better for everyone at every age. But there are still some dinosaurs in the way and there's a lot of inertia in the system. There are pinch points, and people feel that. I still meet a lot of people at events, or people write to me saying, 'Yeah. Totally get all this, it's important. I see changes coming, but I just had to pull the cord and get out and become an entrepreneur so I could create my own age-friendly space to build my own company without having to grapple with all these other hang-ups from people in the corporate world.'
What's Lost When Older Adults Leave the Workplace 
I think institutional memory [is one loss]. There are two things here. One is general, whether you call it crystallized intelligence or wisdom. But also a certain kind of nuance and understanding how the world slots together, how the organization you work for fits into the bigger picture ... you lose that. That walks out the door when you freeze out a 54-year-old and make him or her feel unwelcome because they're the wrong side of 50.
There's also just the kind of institutional knowledge of the company that I think goes even deeper. I think that's why you're starting to see more and more companies devising schemes and programs to bring people back, and even to bring them back on looser terms. Maybe not on a full-time contract because that person who left probably doesn't want to come back full-time anyway. But once they come back in the door, they can just lay out a smorgasbord of all this experience and understanding that they've built up over the years that's just so potent and powerful for a company. You need that sweep, you need that scope, you need that diversity of lens.


Carl Honoré: We Can All Age Boldly

Julie Pfitzinger

As I write this, ominous, silent claxons are sounding for yet another local "air quality" alert this summer. That means lung-stinging ozone and dangerous levels of particulate matter — combined with heat and wildfire smoke from Canada — make it unsafe for folks with cardiac and respiratory issues to spend time outside.
When retirees consider ideal places to retire, their lists include things like: sunshine, cultural amenities and access to health care. While these factors are important, few consider local air quality.I love being outdoors, but this caution is more pronounced as wildfire smoke from Quebec blanketed the skies of the Eastern U.S. The crimson sunsets are breathtaking, although the air quality is dangerous. Where can I move to get away from this ill wind when I retire?
When retirees start shopping for an ideal retirement locale, their lists include the usual staples: sunshine, cultural amenities and access to health care. While these factors are important, few consider local air quality.
Yet climate change and the addition of millions more vehicles can degrade air quality, shortening lives and aggravating existing respiratory and coronary conditions. Although much progress has been made in improving the air we breathe since the passage of the Clean Air Act in 1970, air quality in some metropolitan areas has declined to such an extent that it regularly imperils public health.
Millions Breathe Dirty Air
According to the American Lung Association's latest "State of the Air" report, "nearly 36% of Americans — almost 120 million people — still live in places with failing grades for unhealthy levels of ozone or particle pollution." While this is nearly 18 million fewer people breathing unhealthy air compared to last year's report, it still sounds a siren for those who shouldn't be exposed to specific pollutants.
We used to take clean air for granted throughout most of North America. But in an era of global warming and pollution from multiple sources and wildfires, air  has become a prime health concern, especially for older adults and people with respiratory and heart conditions.
What should concern people living in or moving to a place with consistently dirty air? Ozone, public health officials warn, is one of the greatest threats to those with chronic obstructive pulmonary disease (COPD), which makes it harder to breathe and can lead to death.
Small Particles, Big Trouble
Pulmonologist Dr. Meredith McCormack, an associate professor of medicine at Johns Hopkins University, says particles that are two-and-one-half microns or less in width (known as "PM 2.5") can "go beyond the lungs and enter the bloodstream," which poses a risk for heart attacks and strokes.
"Nearly 36% of Americans — almost 120 million people — still live in places with failing grades for unhealthy levels of . . . pollution."
McCormack notes that both ozone and fine particulates are linked to "strong evidence that they are harmful to health" for those suffering from a wide range of ailments, from asthma to diabetes.
The worst metropolitan areas for air pollution typically have abundant highways, industry and low winds. The regions with the most polluted air are Los Angeles, San Diego and the San Joaquin Valley in California as well as Phoenix, Denver and Houston.
All told, California cities occupy more than half of the slots on the "worst-25 cities" list for ozone, according to the Lung Association. Bakersfield, California, was among the three worst areas for ozone and year-round and short-term particle pollution.
Clean-Air Communities
Do you want to relocate to locales with the cleanest air? You'll have to log some miles. The cleanest cities were in Hawaii; Cheyenne, Wyoming; and Wilmington, North Carolina, on the year-round particle pollution scale. Albany, New York; Asheville, North Carolina; and Bangor, Maine, scored the best on ozone.
When considering moves to more out-of-the-way places, of course, don't forget other key factors such as health care access, transportation and amenities.
According to ALA spokesperson Katherine Pruitt, the best way to use the association's ratings is to "check grades by county and city and look at the trend line and changes over time." Some metro areas have improved while others have gotten worse. When considering relocation, also consider factors you may not see in air ratings or on a map.
"Transportation is a major source of air pollution in metro areas," Pruitt adds, "including truck depots." Areas with heavy industry and big polluters like refineries will also impact local air quality.
Climate Change Effects
Generally speaking, climate scientists predict that cities in hot, humid or torrid climates will experience the worst air conditions as the planet continues to warm. Drought, wildfires and extreme heat and humidity are powerful contributing factors. Internationally, cities in South Asia are suffering the most, especially from increased ozone levels, reports a recent "State of Global Air" study.
"The health burden of ozone-attributable COPD is rising in countries with aging populations."
"The health burden of ozone-attributable COPD is rising in countries with aging populations," according to the State of Global Air Initiative. "The growth and aging of populations accounts for much of the increase in COPD-related deaths in countries across Asia." Yet poor air quality impacts nearly every population suffering from a wide range of conditions from asthma to emphysema.
If your doctor tells you that clean air is a priority for your health, you have plenty of desirable retirement locales to choose from on the Lung Association's "Cleanest Cities" report card. Keep in mind that these ratings change every year and few, if any, places are immune from the effects of climate change and dirty air. Some local conditions may improve while others decline.
In some places, data may be incomplete. For example, I tried to find particulate pollution ratings on my home county and the ALA said it wasn't reported. Not all locales have monitoring stations.
How to get real-time air quality information
A number of apps provide timely local air quality information. The Lung Association recommends AirNow, which is available online and via a phone app. Powered by U.S. Environmental Protection Agency air-quality data, the free service gives overall air quality ratings that are searchable by ZIP code, city and state. It also provides information in Spanish. A "recent trends" graphic shows air quality over the past few days.
Don't look at the Air Quality Index numbers, however, without some context. You need to know the range of the scale — none of them top out at 100. Then you need to know what the numbers mean. Don't be flummoxed if there's no rating for the area you are researching. Not every locale has air quality monitors or full data on all major pollutants.
On one recent day, for example, the EPA's AirNow app posted a "108" rating for my town, meaning the air was unhealthy. The was largely due to ozone, which is particularly dangerous for "people with lung disease such as asthma, children and teens, older adults, and people who are routinely active outdoors for six or more hours a day." It offered the following tips to reduce your exposure:
Choose less-strenuous activities (like walking instead of running) so you don’t breathe as hard.Shorten the amount of time you are active outdoors.Be active outdoors when air quality is better.Invest in a high-quality indoor air filtering system.In any case, do your homework when considering relocation or outdoor activities. It won't take much time, but it can certainly make a difference in terms of quality of life.


Breathe Easy in Retirement

John F. Wasik

I stayed up after midnight several times in 1977 to watch Dr. Wayne Dyer on "The Tonight Show with Johnny Carson." He was relegated to the last slot on the show because an author wasn't expected to be a big attraction, but it became apparent that this self-help author could mesmerize an audience. His book, "Erroneous Zones," was sustaining its place on the New York Times Bestsellers list with its message about self-actualization.
Dr. Wayne Dyer in 2015I owned a copy given to me by Wayne with the inscription "Linda, I love you - really I do - You are something special - Wayne W. Dyer 3-1-76." My story with Wayne dates to when he was on the cusp of fame and at a defining moment in his life that I played a role in shaping.
A New Role as Counselor
How I met Wayne is an embarrassing story that he chided me about for years. My first job out of college was as a community counselor at the Education Assistance Center, known as EAC, in Port Washington, New York. It was 1974 and there was funding available for drug intervention because middle-class youth had discovered illicit drugs. I had no counseling experience, but my employer told me not to worry because I would receive in-service training. A group of counselors from EAC was sent to a workshop led by a professor at St. John's University in New York, Dr. Wayne W. Dyer.
My big secret was that I probably shouldn't have been a community counselor, but the salary was $7,000 a year, so there weren't many applicants.
Despite the reassurance from my employer that I shouldn't worry, I did. The workshop had about twenty counselors from all over the county. My big secret was that I probably shouldn't have been a community counselor, but the salary was $7,000 a year, so there weren't many applicants. 
Wayne went around the room asking each person what they hoped to gain from the workshop, and all had insightful thoughts. When Wayne focused on me, I burst into tears that indicated: "Fragile. Handle with Care." Being a master teacher, he turned my meltdown into an object lesson.
After the in-service training, Wayne invited me to join a group he was forming to teach individuals his self-actualization counseling approach. He led the group for over a year. During that time, I suggested that there was space available at the EAC in the evenings where he could offer a class.
The class outgrew the space, so we moved it to a school auditorium. I found the space, advertised in the paper, distributed flyers and collected money at the door.
Early Days of Fame 
People flocked to the events to hear him and to feel his magnetism. This was before cell phones and emails, so each event required planning by telephone calls and personal contact, with ample opportunity for personal interaction with a positive and energetic Wayne.
When Wayne published "Erroneous Zones" he bounded up the double flight of stairs at EAC to give me my inscribed copy. Before he left, he asked if I would leave EAC to promote the book as I had done with the speaking engagements, but I was not so adventurous to abandon a job, no matter how paltry the pay, for such uncertainty.
Wayne gave me empowerment and a cure for a lifetime of fear-based crying, freeing myself from that erroneous zone.
I never imagined that "Erroneous Zones" would be the first of 21 bestsellers and the beginning of his motivational speaking career. Wayne's teachings became more spiritual later in his life, attributing the unlimited power which he encouraged people to access as deriving from a divine universe.
Wayne gave me empowerment and a cure for a lifetime of fear-based crying, freeing myself from that erroneous zone. Without that gift, I would not have had the tools to take on the career I eventually chose in law. Wayne and I kept in touch for thirty years by letters and holiday cards that I sent, often replied to with books and cassettes.
In one letter in 1984, he fondly recalled "You gave me the original room that launched my speaking career" signed "I love you" and closing with "P.S. Don't you dare cry." I only saw Wayne when he was in New York for speaking engagements. I found valuable lessons in his evolving spirituality.
We lost contact ten years prior to his untimely death in August 2015 at 75 of a heart attack, but his legacy came back into my life in a powerful way after he passed.
When I reached a milestone in my life having established a career in law and ushering a son and daughter into adulthood, I wrote a reflection on my journey from clueless hippie to wife, mother and career woman. There was little interest in the book, which at the time had the awful title "Forty Years of Menstruation." In all fairness to myself, "Menopause the Musical" was playing off-Broadway, so my title wasn't so outrageous in that context.
I abandoned the book sometime around 2005, but twelve years later, I heard Wayne Dyer's words: don't let the music die inside you. It inspired me to revise and publish my book, this time with a better title, "Forty Years of PMS." The extra twelve years made it a more mature reflection with an understanding that the challenges and learning continue as long as we live and breathe.
One chapter in my book was about the peak years I spent in Wayne's orbit from 1974 to 1976 and his influence was mentioned in other sections. Without being able to share this with Wayne, I wanted to connect with his family to tell them about my book, those years, and how my life was changed by him.
Unexpected Influence 
After stating the intention to meet his family, synchronicities happened. In 2018, a catalog arrived at my house that I would normally toss out, but instead, I flipped through it. There was a weekend seminar given by an author of spiritual works, Karen Noe, along with Wayne's daughters, Saje and Serena. I went and made their acquaintances, although the daughters appeared virtually because both were pregnant.
He went as far as to call me an angel on his path, moving him towards this divinely appointed mission.
Saje and Serena then invited me to participate in a six-session virtual course in June 2019 about lessons they learned from their father and his continuing presence in their lives in spirit, which Serena later told me motivated she and her sister to write these lessons down in their book, "The Knowing." 
During the course, Saje and Serena frequently referenced Wayne's memoir, "I Can See Clearly Now." In it, he viewed his life from a spiritual perspective, revealing how every incident, painful or pleasant, led him on his spiritual path. I decided to read it while taking the course.
When I reached Chapter 28, covering the time when I interacted with Wayne in Port Washington, he wrote in detail about the speaking engagements. He realized that people wanted to hear his message, and that he could earn money from speaking, which empowered him to leave a secure job as a college professor for his great adventure. He went as far as to call me an angel on his path, moving him towards this divinely appointed mission.
I was stunned to discover that the person who had a significant influence on my life, and the lives of hundreds of thousands of people worldwide, considered me, the crying counselor, to be one of the people who shaped his life. 


Dr. Wayne Dyer and the Crying Counselor

Linda Goor Nanos

Almost 11% of Americans over sixty-five have Alzheimer's. With cases expected to double during my lifetime; I realized the odds of becoming a patient or caregiver were too high to ignore. So, I volunteered at our community program, Adult Day Respite Care, to learn while helping.
Respite Care provides caregivers a rest while the person with Alzheimer's receives care in a safe, supportive environment. Respite care can be provided in-home, in long-term care facilities or in adult day centers.
Respite Care provides caregivers a rest while the person with Alzheimer's receives care in a safe, supportive environment. Respite care can be provided in-home, in long-term care facilities, or in adult day centers. 
In our community program, two volunteers serve meals and assist a staff member with social time, exercise, games, and crafts. Our clients vary from age-related mild cognitive impairment (MCI) to more severe cases. 
While some clients need help finding the right word or have short-term memory problems, one can't produce a complete sentence. 
However, all clients can follow simple directions, feed themselves, communicate well enough to make needs known, interact appropriately, use the restroom without assistance (adult briefs are acceptable) and ambulate independently with canes or walkers. 
Adjusting to My Volunteer Role 
I felt out of place at first. While I have a psychology Ph.D., I possess no preferred volunteer qualifications:
Health care backgroundExperience with older adults or individuals with dementiaExperience as a family or private caregiverMy volunteer partner was perfect − a retired nurse caring for her mother. It appeared I needed to work to become qualified, so I reminded myself that "volunteers are to be friendly, welcoming, patient, kind and calm with participants." 
Patience, never one of my strengths, felt more comfortable.
I could do that while serving coffee, fetching walkers, washing dishes, cleaning and listening. As my comfort level increased, I realized volunteering had unexpected benefits. 
I was surprised I was learning to slow down. I chatted with participants after lunch instead of jumping to clear the dishes. I celebrated wins like an energetic game of beanbag toss or successfully spelling sixty words from the letters in the word "Thanksgiving." Patience, never one of my strengths, felt more comfortable.
One day I remained in the singing circle instead of leaving to prepare tea and water glasses. The louder I sang, the more energetic we became. I realized they didn't want an introverted dishwasher; they wanted interaction and fun. Laughter, smiles, hugs, warmth and connection are more critical than efficiently-served meals.
I began to appreciate the best part of each person. I looked forward to one woman's afternoon ritual as she balanced against her walker to hug and thank us.
Laughter, smiles, hugs, warmth and connection are more critical than efficiently-served meals.
I enjoyed hearing stories from the social worker who'd been a houseparent for teen girls in Philadelphia. 
But, on the other hand, I wondered how much of the world the retired flight attendant had seen, then forgotten.
Some caregivers don't use Adult Day Respite centers because they feel their loved one doesn't yet need the program. For example, one caregiver said her husband wasn't ready for our program but also revealed he tries to use the TV remote as a cell phone (and vice versa).
Benefits to Caregivers
Another caregiver insists her husband didn't belong because he was a retired physician, even though a former doctor attends our program. Acceptance and knowledge are vital to navigating any illness. Caregivers using the program appear less stressed and anxious than those claiming the program isn't a fit.
Some clients would prefer to attend. One woman can't convince her suspicious, anxious mother to venture outside her home's drawn blinds. While respite care programs aren't the solution for everyone, they provide needed socialization and stimulation that homebound people don't get.
I learned about dementia symptoms and ways to ease those symptoms. While energetic and fit, Ann never said anything besides "yes," "no," and "why?" She'd bolt for the door when frustrated with games, crafts or conversations.
Since leaving the facility wasn't an option, my volunteer partner and I took turns occupying Ann with birdwatching or admiring photos in an adjoining room.
Ann became agitated after lunch, so I wondered how I'd keep her busy for three more hours. I pulled out an album by the Mamas and the Papas, and when "California Dreamin'" began, Ann's face brightened as she swayed to the music. We locked eyes, smiled and sang while we slowly rocked.
I was shocked when the full lyrics flowed from her mouth. No longer frustrated, not trying to flee, she was more than content. Ann was joyful.I learned embarrassment and shame could remain intact after words have left. When Ann tried eating soup with a fork, no matter how kind the suggestion that a spoon would work better, she blushed and frowned before switching utensils. We could keep such moments at a minimum.
While respite care programs aren't the solution for everyone, they provide needed socialization and stimulation that homebound people don't get.
Ann was limited to one day per week when the facility decided they couldn't dedicate one volunteer to her care. So, unfortunately, it was not my day. Keeping her occupied was exhausting but rewarding. 
She was willful but bright and full of life. While she couldn't participate, she appeared to understand conversations and often was the first to laugh at a joke. I missed her.
Inspired by Positivity 
Frank took Ann's slot, but I doubted anyone could replace her energy. Yes, Frank was super-kind among a group of gentle people. Yes, he offered compliments and praise amid a sea of compliments. But it was his repeated expression of gratitude that lifted us. I'm a longtime believer in the importance of gratitude, but Frank was an expert.
I heard murmuring while serving soup, but only when seated did I realize the sound came from Frank. Between each spoonful, Frank whispered, "M'm, M'm, M'm. Boy, they make good soup here!" Those who heard him smiled. Every conversation lag was filled with "M'm, M'm, M'm!" His praise was genuine and continuous.
I was entranced. "You certainly are easy to cook for!" He grinned. "Their soup is always delicious!" Of course, Frank was right; the freshly-made soup was wonderful. But he produced compliments when the food wasn't stellar.
Halfway through an unremarkable chicken breast shoved against bland mashed potatoes, Frank leaned back and smiled. "Well, this will keep you full right up until dinner!"
I laughed and complimented his ability to find the positive in any situation. He beamed and returned to his meal.
I never expected to receive a master class in gratitude at the Adult Day Respite center. However, I'd like to know what I'll learn next.


The Unexpected Benefits of Volunteering at an Adult Day Respite Center

Carol Morgan Milberger

Like children on Christmas morning, eager to unwrap gifts, hoping that each leads to the ultimate holiday gift, people roam the house made famous in the movie "A Christmas Story."Released 40 years ago, "A Christmas Story" was low-budget holiday fare that followed the antics of Ralphie, a young boy holding out hope he'd get the ultimate Christmas gift — a Red Ryder BB gun.
The house featured in “A Christmas Story” was listed for sale on e-Bay when Brian Jones purchased it for more than $100,000Touring the house takes you back to your own childhood, whether you were like Ralphie, Flick or even Farkus.
Despite early success at the box office, "A Christmas Story" grew in popularity thanks to cable television. Produced for $3 million, the movie opened strong, bringing in about $2 million the weekend before Thanksgiving 1983. Shelved after a few weeks in the theater, giving way to expected blockbusters, "A Christmas Story" went on to earn approximately $19 million.But it was a marathon broadcast on TNT in 1988 that led to the birth of a cult classic that ranks among the most popular of all holiday movies. Now on TBS, the movie airs on a loop for 24 hours beginning Christmas Eve through Christmas night.That popularity easily explains why 80,000 people annually visit the Cleveland house used in the movie. The late 19th century three-story wood-frame house was perfect for the movie, set in a blue-collar Midwest neighborhood. 
Touring the house takes you back to your own childhood, whether you were like Ralphie, Flick or even Farkus. A 10-minute presentation by a guide covers interesting tidbits about the movie, such as producer/director Bob Clark and producer Rene DuPont hanging out at the Rowley Inn across the street waiting for homeowner to arrive home, so they could discuss renting the house.Then, the real fun begins as the guide lets the group of about 20 people loose to explore the house, starting with the living room. With replica furniture closely matching the movie set, you'll swear you're in the Parkers' house. From the leg lamp in the window to Mrs. Schwartz's screaming over the telephone as Mrs. Parker explains that her son taught Ralphie curse words (we all know it's his Old Man), clips of the movie run through your internal movie screen.
The Parker Family's living room with some of the iconic gifts.On the second floor, a red bar of Lifebuoy sits on a bathroom sink, sight of Ralphie's atonement for cursing. It's also the spot where his dreams are crushed by Little Orphan Annie's secret code that's really an ad for a flavored drink.
Stepping into the bedroom Ralphie shared with little brother Randy, check out the term paper that netted a C-minus, along with the infamous words, "You'll shoot your eye out."
Visitors on the tour easily lose their inhibitions, as some crawl into the space under the kitchen sink to reenact their favorite scene with Randy.For Sarabeth Sydney, 22, it was a dream come true to visit the house. She and her parents traveled from Naples, Florida, just to take the tour. The rest of their vacation in Cleveland was gravy. Sydney donned a pink bunny pajama suit and posed for photos with fellow tourists, even reenacting Ralphie's frown at the landing of the staircase.
Visit the bathroom with its Lifebuoy soap bar, as well as Little Orphan Annie decoderThe "Christmas Story" house and its owner, Brain Jones, seemed a natural fit. Growing up a fan of the movie, Jones jumped at the chance to buy the house.
"It's hilarious," he said. "It's offbeat. It's not your typical Christmas movie. It's not 'It's a Wonderful Life' or 'Miracle on 34th Street.'" There's a leg lamp; there's these hound dogs. The kids are getting beat up. It's basically a series of smaller stories all tied to Christmas, because Christmas is a big deal when you're a kid."
Growing up in a Navy family, Jones wanted to follow in his father's footsteps and become an aviator. Attending the United States Naval Academy in Annapolis, Maryland, he studied engineering with the intent to fly fighter jets. But, his vision veered from 20/20 (required to fly), so he became an intelligence officer during his six-year career after graduation.
A Career in Leg Lamps 
Being an intelligence officer didn't interest him, so Jones sought a career as a civilian. His parents gave him a full-size leg lamp as a gag gift. After learning his parents made the lamp because they couldn't buy it anywhere, Jones decided selling "Christmas Story" leg lamps would be his career.
Business boomed, with 500 leg lamps sold in the first year. It was in his second year — with 2,100 lamps in his inventory – the house became available.
Sarabeth Sydney of Naples, Fla., dresses as Ralphie during her family’s tour of the “Christmas Story” house in ClevelandSince starting tours in 2006, more than 1 million people have seen the house. With its popularity growing, Jones bought a second house to use as a museum and gift shop. Then he bought the house next door — the Bumpuses' house in the movie. 
Today, the gift shop, complete with a checkout counter resembling the leg lamp container, takes up an entire one-level house. Along with leg lamps of all sizes, fans can purchase memorabilia and gifts related to "A Christmas Story" as well as other holiday movies, such as "National Lampoon's Christmas Vacation."
Between the museum and gift shop, you'll find one of the vintage automobiles used as the family vehicle and a firetruck in a garage. You can also reenact your own impression of one of the most iconic scenes in the movie — when Flick was triple-dog dared into sticking his tongue on a frozen flagpole. While much of the movie was filmed inside a soundstage in Canada, the flagpole scene was filmed in temperatures below zero.
With his tongue inside a small slit in PVC piping, a small hand vacuum provided suction to keep actor Scott Schwartz's tongue in the slot. A known prankster, who regularly ordered steak dinners from room service for the director, Schwartz, himself, ended up the victim of a prank. One day, knowing it was Schwartz ordering the food (he later requested he order chicken or fish once in while), Bob Clark wrapped the set for lunch. Everyone left, leaving Schwartz and his tongue at the flagpole.
Prankster Scott Schwartz, aka 'Flick' 
Left alone for only a few minutes, Schwartz still chuckles at the memory.
"Of course, it didn't stop me from pulling more pranks," Schwartz said. The actor, then 14, had his big break in "The Toy," opposite Jackie Gleason and Richard Pryor, but said "A Christmas Story" was his favorite movie.
If you want to partake in the ultimate "Christmas Story" experience, consider spending the night at the Christmas Story Loft ... The Bumpus' house can also be rented for overnight visits. 
"It was fun meeting new people, creating new friends," Schwartz said. "We're still friends to this day."
If you want to partake in the ultimate "Christmas Story" experience, consider spending the night at the Christmas Story Loft. A private third-floor apartment is home to a living room, kitchen, bathroom, queen bed, sleeper sofa and the boys' twin beds. The loft can accommodate up to six people. The house is available an hour after closing, but you need to be out for the day by 9 a.m. before tours start. Stays include tickets for a tour of the house. You may want to purchase bunny PJs for your stay.
The Bumpus' house can also be rented for overnight visits. The entire house can be rented or a suite on the first floor accommodates up to four people, while the second and third floors can host six guests.
A visit to the "A Christmas Story" house may rekindle childhood memories or bring laughter as you stroll through the house reminiscing about the holiday classic.


Through Ralphie's Eyes: 'A Christmas Story' House Tour

Tim Trudell

Jeff Bentoff is just one person among two million Americans who started birding during the pandemic. It began with Facebook. The Milwaukee, Wisconsin, resident began to notice photographs popping up of colorful birds taken by friends and neighbors.
Bonaventure Island is home to one of the world's largest colonies of northern gannets. Tens of thousands of the dark gray juveniles and mature white adults migrate to the island every year."I realized that there were all of these amazing, colorful birds all around me ... I didn't know they were here, so it really piqued my interest. It made me wonder what am I missing," Bentoff said.
"I want to know what's happening around me in the natural environment. To me, that's really exciting."
Bentoff bought himself a pair of binoculars and decided to join a neighbor on a jaunt to their neighborhood park. A black-throated gray warbler, unusual in the area, had been spotted, and news had spread through the local birders' network. Bentoff knew they were hot on the warbler's trail when they came upon a gathering of people, including several photographers poised with their signature long lenses.
Since then, Bentoff has invested in a camera specifically for birding, downloaded several helpful apps (like the Merlin app that will identify a bird based on a bird call), and connected with several walking groups for birders. 
He compares birding to learning a language or a musical instrument. His goal is to gain more knowledge through practice.
"I want to know what's happening around me in the natural environment. To me, that's really exciting," Bentoff said.
With travel back in full swing, birders like Bentoff have taken to the skies. If considering a birding trip of your own — or visiting a special spot where you can enjoy a variety of activities including birding — the following four destinations are certain to spark your interest.
The Gaspé Peninsula, Quebec 
Those who love the energy of a crowd — of birds, that is — will love the Gaspé Peninsula's Bonaventure Island. One of the largest colonies of northern gannets in the world resides on this uninhabited isle during the summer months. 
Begin your adventure at Percé wharf where you can pick up a ferry to the island. First, however, the captain will encircle another of the area's draws, Percé Rock. Measuring nearly five football fields in length, the rock is an iconic monolith. It rises out of the Gulf of St. Lawrence, just offshore from the charming village of Percé. The ferry ride will give you a chance to see this natural work of art up close and personal.
Next, it is on to nearby Bonaventure Island and a zoomed-out look at the northern gannets. Appearing cigar-shaped in flight, the birds have a long pointy beak on one end and jagged tail on the other. Their pearly white plumage starkly contrasts with the crisp blue of the Northern Atlantic sky and sea as well as the clay-colored cliffs where they nest. 
Their cream-colored heads and blue eyes come into focus, while at the same time, their multitude blends into an alabaster blur.
The ferry ride is a great opportunity to see the birds in action. Starting as high as 100 feet, they circle the waters looking for prey and then divebomb the water at a high rate of speed.  
After arriving at the dock, take the 3.5-mile colony trail for a look at the northern gannet outpost. You will know that you are close when you hear a cacophony of cawing birds. The wooded trail empties out into a wide-open area on the edge of the island, and it is here that tens of thousands of northern gannets nest. 
They are as captivating to watch on land as they are in the air. Their cream-colored heads and blue eyes come into focus, while at the same time, their multitude blends into an alabaster blur. And as entertaining as their fishing technique, the birds engage in what looks like a sort of sword dance, mated pairs facing each other and scraping the edges of their long bills back and forth.
Percé is located just south of the Gaspé Peninsula's tip, an eight-hour drive from Quebec City. If that seems like a long trek, know that the scenery on the way up the peninsula is as lovely as the birds.
Gulf Shores, Alabama 
Alabama's Gulf Coast is the place to set your eyes on a myriad of species rather than a single colony. (Although you do stand a good chance of seeing northern gannets in Gulf Shores during the northern hemisphere's winter months.) To help pinpoint areas ripe for birders, The Alabama Coastal Birding Trail offers six loops of over 200 miles.
In fact, over 170 species of birds winter along the 53 miles of Alabama coastline, according to the Alabama Ornithological Society. Many others pass through the region as they travel the Mississippi Flyway. 
In the spring, the beaches are a good spot to view permanent residents who nest on its sandy shores. This includes snowy plovers, least terns, black skimmers, American oystercatchers and Wilson's plovers.
You may also want to try your luck watching an aviary phenomenon in action on Dauphin Island, aptly named "America's Birdiest City" for three consecutive years by the National Audubon Society. The barrier island is a short ferry ride from the western tip of the Gulf Shores peninsula. 
A brown pelican comes in for a landing at Gulf ShoresCalled a "fallout," birds, like indigo bunting, fall from the sky following a particularly arduous journey from Mexico across the gulf. Adverse weather conditions require great effort from the birds to the point that they fall out of the sky from pure exhaustion.
However, it is the shorebirds that most enthrall Alabama's visitors. To really get a good vantage point of Alabama's finest in their natural habitats, get off the well-trodden birders' path and kayak the waterways instead. 
Wild Native Tours offers half-day kayak trips through Oyster Bay, the Intracoastal Waterway and Bon Secour Bay and River. Not only will you see brown pelicans, blue herons, great egrets, cormorants, ospreys and belted kingfishers, you will learn about their habits and other fun facts from owner and guide Kristian Aboud. In addition to the birds, you also stand a good chance of kayaking alongside a pod of dolphins.
Pinnacles National Park in Central California 
Pinnacles National Park sits quietly in the shadows of Sequoia and Kings Canyon National Parks (145 miles west) and Yosemite National Park (130 miles northwest). All the better for the California Condor that frequents its canyons and the tourists who don't need to fight the crowds when coming to see them.
California condors are the largest land birds in North America with a wingspan of more than nine feet and a weight typically reaching 20 pounds. Their longevity is hefty, too; California condors, an endangered species, live over 60 years. Seeing them in their natural environment is a treat, and Pinnacles offers one of your best bets for doing so.
California condors are the largest land birds in North America with a wingspan of more than nine feet and a weight typically reaching 20 pounds.
If you don't mind a bit of an adventure, getting to Pinnacles is fun, too. The park has two entrances, neither road connected to the other. To reach the western entrance requires a seven-mile drive down a remote, winding road that narrows to one lane. To reach the Visitors' Center or campground, enter from the east. 
Each side of the park offers a hiking trail that will take you past the spires that Pinnacles is named for and to a group of talus caves, one of its finest features (aside from the California condor). Hiking through the caves is a bit like hiking through slot canyons: dark, extremely narrow with some mild climbing required. The caves have formed over time as boulders have fallen from cliffs forming a giant pile of rubble.
If you take the western route out of the park following a day of hiking and searching for California condors, consider a stop at Chalone Wineries for a rest and a glass of their signature Chardonnay while sitting amidst the stark beauty of the Gabilan Mountains. The drive is mere minutes from the park's boundary.
Costa Rica's Oca Peninsula 
A toucan perches on a branch at Corcovado National Park in Costa Rica's Osa PeninsulaIn the southwestern corner of Costa Rica lies the remote Osa Peninsula, once an island in the Pacific. A mere 700 square miles, it houses 2.5% of the world's biodiversity including over 460 species of birds. An array of 16 species of hummingbirds are among them.
However, the scarlet macaw is, by far, the peninsula's biggest showstopper. In fact, the Osa Peninsula is the site of Central America's largest population of this colorful bird. Their loud, distinctive crooning often alerts visitors to their presence long before their bright ruby red feathers come into view. In addition to their namesake color, they also boast canary yellow and bright blue on their wings. 
The bird's size gives them away as well. The largest parrots in the world, the scarlet macaw can measure up to 33 inches from beak to tail. In addition to scarlet macaws, guests stand a good chance of catching sight of cotingas, pelicans, cormorants, boobies, antbirds, Amazon parrots and toucans. 
A great place for a guided hike is Corcovado National Park. Keeping an ear tipped to the treetops, the guides quickly throw down their tripods equipped with high-resolution magnifying lenses when they spot a bird of interest. 
In addition to the birds, you will likely see two and three-toed sloths and spider, capuchin, titi and howler monkeys. Be sure to adjust your gaze to ground level from time to time. You stand a good chance of seeing tapirs, wild peccaries, coati and more.


Flock to These 4 Feather-Friendly Destinations

Jenny Wisniewski

Americans gave nursing homes a D+ for quality of care in a recent Gallup/West Health poll and most said they'd be uncomfortable being admitted into one or admitting a loved one. One reason could be the severe understaffing problems facing the 1.2 million residents in the nation's 15,000 nursing homes.
The proposed rules would provide nursing home residents with a minimum number of hours of care per day and ensure that an RN would be on site 24 hours a day, seven days a week.The lack of registered nurses (RNs), licensed practical nurses (LPNs) and certified nursing assistants (CNAs) in many nursing homes recently led the Biden administration to propose national minimum staffing requirements.
Improving Safety and Care
The goal, said U.S. Health and Human Services Secretary Xavier Becerra, is to "improve resident safety and promote high-quality care so residents and their families can have peace of mind." About one-fifth of all COVID-19 deaths in the United States during the pandemic were at nursing homes.
Currently, 38 states have minimum staffing standards at nursing homes, but many of those standards are low or over 20 years old. Studies have shown that higher nursing-home staffing has been associated with better patient care and health outcomes.
"This is a step in the right direction. I wish it had been a bigger step, but the administration deserves a ton of credit for going down this path."
The new rules would provide nursing home residents with a minimum number of hours of care per day. They would also ensure that an RN would be on site 24 hours a day, seven days a week. The administration says 22% of nursing homes would need to hire RNs to meet that requirement. Today, nursing homes must have at least one RN for a minimum of eight straight hours a day and an RN, LPN or LVN (a Licensed Vocational Nurse) on duty 24 hours per day.
The Long-Term Care Community Coalition (LTCCC) , a nonprofit organization seeking to improve the quality of care in nursing homes and assisted living centers, has favored a 24/7 RN requirement for years.
Jasmine Travers, an NYU nursing college assistant professor and co-chair of the staffing committee at Moving Forward, a coalition working to improve nursing-home care, said: "I'm excited the president will be requiring 24 hours-a-day staffing for RNs."
Will the Standards Happen?
Exactly how much the proposals would improve resident safety and promote high-quality care — or even ever take effect — is an open question.
The trade group representing primarily for-profit nursing homes, The American Health Care Association, calls the minimum standards "unfathomable."
"Staffing ratios are a key lever to help nursing homes offer high-quality, age-friendly care to residents."
Katie Smith Sloan, president and CEO of LeadingAge (an association of nonprofit aging services providers, including nursing homes), said her group is "disappointed" the president moved forward with the proposals "despite clear evidence against them." She says the cost of implementing the staffing mandate "will cripple nursing homes."
Others, however, applaud the administration's efforts.
"This is a step in the right direction," said Harvard health care policy professor David Grabowski, a noted nursing home analyst. "I wish it had been a bigger step, but the administration deserves a ton of credit for going down this path."
Terry Fulmer, president of the John A. Hartford Foundation, a philanthropy that seeks to improve care for older adults, said: "staffing ratios are a key lever to help nursing homes offer high-quality, age-friendly care to residents."
What Consumer Advocates Say
Some long-term care consumer advocates think the proposals don't go nearly far enough.
Leaders of both the LTCCC and the National Consumer Voice for Quality Long-Term Care said they're generally disappointed by what the administration has proposed.
LTCCC Executive Director Richard Mollot said: "The basic staffing standard, outside of the 24/7 RN [proposal], is abysmal. It's well below what every study has shown to be necessary."
He chastises nursing home leaders who say they can't afford the proposed minimum standards. "Nursing homes aren't warehouses," Mollot said. "There's absolutely no excuse to ever allow nursing homes to take in residents when they clearly don't have the staff and the ability to care for them."
Sam Brooks, director of public policy at National Consumer Voice for Quality Long-Term Care, said: "This rule was designed to bring up poor performers to average, and we disagree that average is the mark of quality in the nursing home sector."
A History of Staffing Proposals
Proposals for minimum staffing standards at nursing home aren't new, though the U.S. government has never adopted any.
"There's absolutely no excuse to ever allow nursing homes to take in residents when they clearly don't have the staff and the ability to care for them."
The National Academy of Medicine (formerly the Institute of Medicine) called for minimum staffing standards in 1986, and the 1987 Nursing Home Reform Act gave the U.S. government authority to create staffing standards. In 2001, a Centers for Medicare and Medicaid Services (CMS) study said each nursing home resident needed at least 4.1 hours of direct care a day to avoid being at risk of harm.
By contrast, the Biden administration proposals would require 3 hours of care per day — 33 minutes from an RN and 2 hours and 27 minutes from a CNA, who helps residents with tasks of daily living, like eating, bathing and going to the bathroom. Moving Forward calls CNAs the "often underappreciated and undercompensated core of the nursing home workforce."
Grabowski said he thinks there could be real benefits increasing the proposed minimum staffing standard to at least 3½ hours of care per day.
According to the Biden administration, to meet its proposed hours-per-day standards, 36% of nursing homes would need to hire RNs; 68% would have to hire nurse aides.
What the Biden Proposals Miss
There's no specific requirement, however, for LPNs, who provide hands-on patient care and handle administrative tasks like monitoring vital signs, changing bandages and inserting catheters.
That LPN omission concerns some nursing home analysts.
"I worry a little bit with putting in a requirement for RNs and one for CNAs, but ignoring LPNs," said Grabowski. "Are you going to see LPNs shift to almost zero in a lot of nursing homes and see the facilities staff up to the minimum for RNs and fill up the remaining staff slots with CNAs?"
That's what happened in Ohio and California after those states adopted Biden administration nursing home standards. A 2015 study Grabowski helped to write found that the overall quality of care rose, but since those states didn't specify minimum number of hours for RNs, LPNs and CNAs, "we saw a shift away from higher-cost professional staff and toward certified nurse aides."
Slow Rollout and Exemptions
The Biden administration's staffing proposals have a long rollout period before they would take effect — three years for most nursing homes; five years for those in rural areas. "It will really be about seven years, since you have to figure on [time needed for] enforcement," said Brooks.
Rural nursing homes would be allowed three years to make sure they have RNs onsite 24/7, a year longer than others.
Lisa Harootunian, associate director of the health program at the Bipartisan Policy Center, thinks that timetable will give nursing homes the time they need to meet the staffing requirements.
"You don't waive regulations on an airplane or on a bus. We're talking about safety here. If you can't provide high-quality care, why are you in business?"
The proposals would also let nursing homes apply for hardship exemptions. "There will be nursing homes that despite their best efforts will not be able to meet the minimum staffing requirements and will have to apply for the waivers," said Travers.
Critics worry the waivers will amount to a giant loophole, allowing many nursing homes to escape the new rules.
"We oppose all waivers," said Brooks, of the National Consumer Voice for Quality Long-Term Care: "This is a matter of human dignity. You don't waive regulations on an airplane or on a bus. We're talking about safety here. If you can't provide high-quality care, why are you in business?"
To avoid an avalanche of waiver exemption applications, Grabowski said, the U.S. government could give some nursing homes extra money to put toward staff.
Staffing Shortages at Nursing Homes
Nursing home trade groups say meeting the staffing proposals isn't possible given the shortage of nurses and nurse aides and high turnover rates. The median among nursing home assistants in nursing homes is nearly 100%, according to the Paraprofessional Healthcare Institute, or PHI.
"There simply aren't enough people to hire. Nursing homes are being forced to reduce admissions or even close when they can't fill their employee rosters."
"The shortage of workers, not only in nursing homes, but also home- and community-based settings, is a major issue that needs to be tackled right now," said Harootunian. "This shortage was exacerbated in the past few years through the COVID-19 pandemic."
Said Smith Sloan: "There simply aren't enough people to hire. Nursing homes are being forced to reduce admissions or even close when they can't fill their employee rosters."
Over half of nursing homes in 2022 limited new patient admissions, citing staffing shortages, and the U.S. has at least 600 fewer nursing homes now than six years ago, according to a Wall Street Journal analysis.
Low Pay Hampers Hiring
But consumer advocates say hiring problems are due to low wages and working conditions and a lack of training. According to CMS, registered nurses make $37 an hour, on average, LPNs earn $28 an hour and aides frequently start at $17 an hour, which is close to the $15 minimum wage.
"Over time, we haven't paid nursing homes, and financed nursing home care, in a way to encourage strong staffing models."
Travers acknowledged "challenges" attracting RNs to nursing homes, noting the need to pay them "a more appropriate wage to be competitive." Grabowski noted that during the pandemic, many nursing home RNs, LPNs and CNAs left for jobs at places like WalMart, Amazon and McDonald's.
To improve recruitment and training, the Biden proposals would invest over $75 million in scholarships and tuition reimbursement.
Harootunian wants Congress and the administration to improve recruitment and retention of nursing home workers – including immigration reform — so the facilities can meet the proposed requirements.
Is Medicaid Reimbursement Too Low?
Nursing home representatives also say Medicaid, the federal/state program that's the primary payer for 62% of nursing home residents, doesn't reimburse facilities enough to pay higher wages.
Critics say that nursing homes' lack of financial transparency means no one knows whether the facilities can afford to pay higher wages.
The Biden proposal would require state Medicaid agencies to report the percent of payments for Medicaid-covered services spent on compensation. "We see that as a nice first step into transparency," said Brooks.
What Happens Next
CMS is accepting comments about its proposals until Nov. 6 and will decide on a final rule after.
"We're going to fight as much as we can to get the proposals to a place that's safe for residents. This is a once-in-a-lifetime opportunity for nursing home residents," said Brooks, whose group will offer comments to make the proposed standards tougher. "We're not going to give up."
With critics fighting the staffing mandates and consumer advocates pushing to strengthen them, independent analysts expect the proposals will likely take effect, and pretty much as is.
"I don't think they're going to get tougher," said Harootunian.
The Root Problem for Nursing Homes
Grabowski maintains that although staffing is "a huge problem" at nursing homes, it's not the root problem.
"Over time, we haven't paid nursing homes, and financed nursing home care, in a way to encourage strong staffing models," he said. "And we haven't always held nursing homes' feet to the fire. We haven't held them accountable to taxpayers."
Grabowski hopes the Biden administration's staffing proposals are "a starting point, but not a finishing line."


New Nursing Home Staffing Rules: Will They Help?

Richard Eisenberg

One couple trying to get their COVID-19 vaccines put their names on five different lists. One devoted son waited up until 1 a.m., juggling three computer screens to snag an elusive slot for his dad and stepmom. A friend persuaded a patient's longtime pharmacist to make a house call to administer the vaccine. Another couple endured a 5 1/2-hour wait for their second dose. 
They're just a few examples of the tens of thousands of Americans who've been eligible for the COVID-19 vaccine (as part of groups 1B or 1C  per the Centers for Disease Control and Prevention's recommendations), struggled to receive it and finally did. Some states are now moving to Phase 2 of eligibility, which allows all adults to get vaccinated. 
An older adult receives the COVID-19 vaccine in Highland, California, on Jan. 22, 2021.Andy Giambarba spent three late nights refreshing multiple browser windows in hopes of snatching a slot through Walgreens for his 92-year-old father and 86-year-old stepmother. He says his family wasn't trying to "jump the line" — it's just that difficult to get an appointment. While vaccine supply is increasing rapidly, an expected surge in demand from newly eligible people will likely continue to make appointments challenging to get.
But, as the stories and advice below show, it may be possible — through extraordinary perseverance and creativity.
"Don't go crazy trying to get an appointment. It will get easier as more vaccines become available."
Judy Miller, 75, tried to get vaccinated in her home county of Palm Beach, Fla. She called the state's vaccination hotline dozens of times with no luck. "I kept getting a recording saying no appointments were available," she said.
Finally, someone in her high-rise suggested she stay on the phone line after the recording played and after a short wait, "an actual live person came on the phone," Miller said.
She and her partner were ultimately able to schedule appointments at a mass vaccination site in Miami, about an hour's drive and two counties away. "It wasn't too bad, we waited in the car and drove through when it was our turn," Miller explained. 
The first dose took about 3 1/2 hours, including the round-trip drive; the second was closer to a 5 1/2 hour trip, because of a backlog at the site. 
"Still, it was worth every minute," Miller said.
"There's no working federal system for vaccine distribution," said Hana Schank, director of strategy, Public Interest Technology, at the think tank New America.
States have even fewer resources and less tech capacity. Turf battles and siloed systems create additional roadblocks, too. COVID-19 vaccine distribution is "a really complicated thing to solve and there are good, smart people in government working on it, but often bureaucracy gets in the way," Schank said.
Randall Fields, 71, who lives in rural southeast Ohio, signed up with the county health department, two local health clinics, the regional supermarket chain and a regional pharmacy.
The pharmacy chain "only set up appointments on Sunday at 10 a.m., and you had to move fast," he said. Ultimately, Fields and his wife, Barb Klaer, 67, got the coveted appointments at a fairgrounds two counties over.
One of the vaccination scheduling challenges living in such a rural area is broadband access. Fields is fortunate to have high-speed internet, but many of his friends and neighbors don't. "That's a problem, since all of these places want you to make appointments online. You can't call," Fields said.
Even if calling the county or state is an option, it may become an exercise in frustration. 
Donna Myrow had been trying to help her friend Ken, 85, get a vaccine appointment in Los Angeles for weeks. He has underlying health issues and uses a wheelchair. "He was on hold with the county once for over four hours, before he finally gave up," said Myrow. Ken doesn't drive, and his physical limitations make waiting in long lines virtually impossible.
Myrow finally contacted his longtime pharmacist, pleading with him to make a house call when a vaccine shipment became available. Ken has since received his first dose that way; the pharmacist will return to administer the second shot in a few weeks. 
"Ken heard nothing from his city, county or state. He's on his own, and if I hadn't called the pharmacy, he would not get a vaccine," Myrow said.
To get vaccinated, many people are dealing with government bureaucracy for perhaps the first time, Schank pointed out. "We're often not used to having a medical thing we want not be immediately available," she said.
Patience and persistence could eventually pay off, though. "There are good people working on making the process better," Schrank said. "It will get easier as more vaccines become available."
What You Can Do
In the meantime here are some suggestions:
Check out the CDC's national VaccineFinder tool. The website helps people find information about providers who offer select COVID-19 vaccines. VaccineFinder also allows healthcare providers to list their vaccination locations in a centralized, searchable database and to track vaccine availability.Register on as many COVID-19 vaccination lists as possible, as Fields did. Even the acting Maryland Health secretary suggests this approach.Try to get online very early in the morning or late at night like Giambarba. Many sites release appointment slots at odd hours, depending on how much supply is expected for the coming week. It may also be easier to access a busy site at an off hour.Talk to friends, neighbors or other family members about their strategies. After Miller learned about staying on the phone, she has shared the advice with her condo neighbors.Contact your Area Agency on Aging or other local organizations that focus on older adults. Some community groups are stepping up to help people who lack computer savvy or those who are homebound.If you're an eligible Veteran, you can sign up with the VA. You may have an easier time getting an appointment through your local facility, which will also vaccinate designated caregivers. (In Massacusetts, some people trying to game the system have been trying to pay hundreds of dollars to older adults in order to be seen as their "caregivers" and then qualify to tag along to get the vaccines under state rules for caregivers.)Enlist an adult child, grandchild or computer-wise neighbor to help. If your tech skills are not up to filling out pages of online forms, don’t be embarrassed to ask for assistance. A digital native can make quick work of the many screens and information required to confirm your slot.Be flexible about a vaccination location, if necessary. Fields and Miller got their vaccines miles from their homes because they were willing to travel to available sites. My husband drove 160 miles round-trip for his COVID-19 vaccination appointment.Make your second appointment when you get your first dose. Many sites now do that to ensure that those eligible receive both doses within the suggested time frame.Be patient and keep trying. Dr. Anthony Fauci, head of the National Institute for Allergy and Infectious Disease and an adviser to President Biden, predicts that by the summer, anyone who wants a COVID-19 vaccine should be able to get one.

Pointers on Booking a COVID-19 Vaccination

Liz Seegert

Some call it revenge travel — that is, getting back at COVID-19 by getting away. The pandemic may have kept us confined for two years, but 2022 is shaping up to be a year of travel. With eased restrictions and nine out of ten older Americans fully vaccinated against COVID, 67% of older adults reported an intention to travel, according to the AARP 2022 Travel Trends study, released in March.
Bixby Bridge in Big Sur, Calif.Two months later, the picture has become somewhat more complicated with the number of COVID-19 cases once again on the rise. Still, some travelers may feel a bit less vulnerable than they were last summer knowing that 77% of Americans have received at least one dose of the vaccine and the recently developed Pavlovid pills may help keep severe COVID outcomes at bay. Many others have simply reached their limit on social distancing.
"Some people say I don't care where, I just want to go somewhere."
"I'm really seeing a mix of desires," said Andy Lunt, an advisor at Travel Experts Inc. who specializes in travel for older adults. "On the one hand, the desire to get away — and some people say I don't care where, I just want to go somewhere. Combined with that, though, is a reluctance to venture too far," he added.
Many older adults are booking domestic cruises on the Great Lakes, Mississippi River or New England coastline, Lunt said. National parks are another popular destination. However, he warns that many cruises are booked and parks crowded.
Still, the U.S. is a big place. If you want to get away this summer or fall to view something beautiful, something besides the same four walls of your office or home, here are five scenic destinations that will likely rejuvenate your spirit.
The Stunning Seascape of Monterey County, California
You've probably seen the images in movies: a sports car snaking around a two-lane, winding roadway before crossing the famed Bixby Bridge. On one very-close side, cliffs descend dramatically to the crashing waves of the Pacific. On the other, the Santa Lucia mountains reach up to meet the blue-gray sky — and practically rub shoulders with you on the way.
Scenic Highway 1 is breathtaking on the screen. But it is much, much better in person.
On the drive between Monterey and Big Sur, you will have plenty of opportunities to get out of your car at scenic overlooks to take in the misty majesty of it all. Several state parks, including Point Lobos, Julia Pfeiffer Burns and Pfeiffer Big Sur State Parks, offer the chance to experience the area's natural wonders a little more deeply. Hiking trails for people of all ability levels will lead you to waterfalls, giant redwoods and more scenic overlooks. 
For other spots to enjoy the scenery, view a sunset at dog-friendly Carmel Beach following a fresh catch-of-the-day dinner at one of the many sidewalk cafes on Carmel-by-the-Sea's Ocean Avenue, or shoot a round of golf at Pacific Grove, where the back nine overlooks the Pacific.
"There is no shortage of scenic beauty in Monterey County, and I'd recommend that travelers explore it at their leisure,'' advised Rachel Dinbokowitz, public relations manager of the Monterey County Convention & Visitors Bureau. "The destination is full of incredible scenic drives – from 17-Mile Drive through Pebble Beach to exploring vineyards along River Road and iconic Highway 1 down through Big Sur."
Mountain Vistas in Asheville, North Carolina
While in Asheville you could happily spend your days sitting in an Adirondack chair taking in the splendor of the Blue Ridge Mountains. That is, if the area didn't have so much else to offer. 
The Blue Ridge Parkway near Asheville, North CarolinaGazing at the views while visiting a few of Asheville's sites is a great compromise. And one of those highlights is The Omni Grove Park Inn, perched atop Sunset Mountain. Opened in 1913, this grand hotel features an 18-hole golf course, multiple restaurants, and a 43,000 square foot subterranean spa. 
Even with its modern amenities, it has maintained its rustic, yesteryear charm. The native uncut granite boulders on the original lodge remain, and its walls are adorned with black and white photos of past guests such as Eleanor Roosevelt and F. Scott Fitzgerald. Stay at the lodge to enjoy its many offerings or come for a tour and a moment to relax on its spacious grounds while sipping a glass of wine and taking in the views.
Another must-see is the Biltmore Estate, a French Renaissance 250-room chateau built for George and Edith Vanderbilt. Get a close-up look at the Gilded Age with a tour of the house and its 65 fireplaces, 16th century tapestries and original art masterpieces. The property includes a winery, and on its 8,000-acre backyard is an outdoor adventure center that offers biking, kayaking, archery and much more.
Asheville is also known as a community for artists and art lovers. In its River Arts District, you can visit artisans at work, take a class and shop. And once per month, the district really comes alive with gallery walks, live music, wine tastings and free trolley rides. Additional art festivals abound throughout the summer and fall in the Asheville area.
The Outdoor Paradise of Wisconsin's Northwoods
When poet Mary Oliver wrote of trees "turning their own bodies into pillars of light" and "giving off the rich fragrance of cinnamon and fulfillment," she may have been experiencing the Northwoods of Wisconsin. Its half million acres of box elder, sugar maple and white birch trees blanket five counties in the northern half of the state. The area is also home to 3,200 lakes, streams and rivers.
Wisconsin's NorthwoodsVacationers head to the Northwoods (or "Up North" in Wisconsin parlance) to hike, bike, hunt, fish, camp, canoe, kayak and water ski. Rustic cabins, campsites and lodges are favored spots to hole up for a few days or more.
One popular destination is Vilas County. A great way to experience its woods is on a bike trail, like the Bearskin Trail, a scenic rail trail starting in Minocqua. If hiking is more your thing, options include the Powell Walsh Wildlife Area between Manitowish Waters and Lac du Flambeau and the North Lakeland Discovery Center in Manitowish Waters, which includes a 22-station bird breeding trail. And golfers have seven courses to choose from including Timber Ridge, a public, 18-hole championship golf course.
Be sure to take a break from the activity to visit one of the many supper clubs in the area. The menus are almost certain to include whitefish and walleye, and the bars to stir up a tasty brandy old-fashioned, a Wisconsin specialty.
The Otherworldly Landscape of Southern Utah
Revel in the colors of southern Utah. Plan to see more variations of taupes and terra cottas than you ever imagined possible, all set against a cobalt blue sky. 
Southern Utah boasts of five unique national parks. One of many possible itineraries is taking a drive down the 122-mile Scenic Byway 12. Begin with a stay in the quaint town of Torrey and a visit to Capitol Reef National Park, the least crowded of the five national parks in the state. 
Utah's Bryce Canyon National ParkDriving on, you will begin a climb to 9,000 feet. Stop at an overlook for a view of the firs and aspens, the red rock and the canyonlands in the distance. You may even see a bit of snow. After continuing on, a great place for a stop is Boulder's Anasazi State Park Museum, site of an ancient Puebloan village. 
For the adventurous (and those with a four-wheel drive vehicle) a hike through Peek-a-Boo and Spooky Gulch Slot Canyons in Escalante National Monument are an otherworldly experience. Hiking these narrow, winding canyons are like a trip through a natural funhouse. Be aware that they do require a drive down a 25-mile dirt road and a hike to reach the canyons themselves.
After an overnight stay in the town of Escalante, head to Bryce Canyon National Park, known for its flamingo-colored cliffs and spindly hoodoos, or columns of rock. If you are a morning person, consider viewing the landscape at sunrise. You will never forget the quickly changing warm hues as the sun peeks up over the canyon.
Kentucky's Inland Waterway: Lake Cumberland
Nothing beats listening to the rhythmic ripples of lake water while the setting sun throws its golden glitter upon the waves. Sitting on the deck of a boat or a dock with a beer in hand while doing so isn't bad either.
So why Lake Cumberland? For one thing, its sheer size provides for solitude if you want it. The lake is a reservoir with 1,200 miles of shoreline. 
And it offers a unique stay-and-play option — houseboats. In fact, some refer to it as the houseboat capital of the world. The boats typically come with equipped kitchens, living spaces and bedrooms, and many have hot tubs and slides. A special license is not needed to operate the boats, but training is provided.
Lake Cumberland's waters are typically calm, which makes the lake ideal for kayaking, canoeing, and stand up paddling. Fishermen have good opportunities to catch several varieties of bass including striped bass, bluegill, crappie, rockfish and walleye.
You may never want to leave the lake, but if you are looking for alternative activities in close proximity, there is a little something for everybody. 
History buffs might like the Mill Springs Battlefield National Monument in Nancy, site of a major Civil War victory for the Union Army. Music aficionados may want to head to the Renfro Valley Entertainment Center in Mount Vernon for classic Southern music: country, Southern gospel and mountain bluegrass. For those interested in cars, there is a monthly car show and "car cruise" in Somerset.


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