By Meredith Kimple

From our first trips to the dentist as children, we are drilled with reminders to brush our teeth, floss daily, and stay away from candy (to our dismay). Oral health is a component of our wellbeing that we maintain largely out of habit, and is so entrenched in our routine that we often give little thought to it. All of the careful brushing, polishing, flossing, and swishing is done to preserve the beauty and utility of our teeth.

But recent studies suggest there may be a more pressing reason to take care of our smiles.

There is evidence that a positive correlation exists between poor oral health and a greater degree of cognitive decline in the elderly. In one study, the presence of gum disease corresponded to a six-fold increase in the speed of cognitive decline among participants. The theory is that the bacteria generated by gum disease and poor oral hygiene triggers the body’s inflammation system; in defending against foreign bacteria, inflammatory molecules also target the human body. Previous studies have suggested that such attacks on the body, and on the brain, lead to an increased rate of cognitive decline in individuals with dementia and Alzheimer’s.

Generally, tooth loss and gum disease become more prevalent as we age, so even greater care must be taken when performing oral hygiene-related tasks. This can be difficult for our older loved ones for a number of reasons, but for those who have dementia or Alzheimer’s, maintaining oral health may be neglected entirely. If the theories that link gum disease with cognitive decline are, in fact, accurate, then this creates a dangerous cycle. If those with dementia and Alzheimer’s neglect their oral health, gum disease is all the more likely, and if the bacteria leads to inflammation, they may suffer more rapid cognitive decline. This decline may make taking care of their teeth even more difficult for them, leading to further instances of gum disease and tooth loss.

And the cycle repeats.

While medical professionals do see the potential in future studies of this correlation, at the moment there is not enough consistent evidence to suggest the veracity of these theories. However, we know that the bacteria produced by oral infections can enter the bloodstream and cause harm to the body, especially to the cardiovascular system. When a loved one is diagnosed with Alzheimer’s or dementia, preserving their oral health may not be our first concern. But maintaining it can have positive effects on their overall wellbeing.

Whether you are the primary caregiver or you utilize at-home assistance, here are some ways to help keep your loved one’s gums and teeth healthy:

• Brush teeth at least twice a day. This may be difficult depending on what stage of the disease your loved one is in, but anything is better than nothing. Using an electric toothbrush may make things easier and remove plaque and food particles more effectively. If using toothpaste is too challenging, use a wet toothbrush rather than stopping altogether.
• Floss daily if possible. Plaque and food build-up between teeth can be hard to reach with a toothbrush and can lead to gum disease. Try using a flossing tool rather than string; this will make it easier for your loved one to do it on their own or for you to do it for them without being too invasive.
• Use mouthwash regularly. Make sure they do not swallow it, and if there is a danger that they might, even swishing and rinsing their mouths with water can be beneficial for cleaning out food particles.
• Make regular dental appointments. Take your loved one to the dentist often, and discuss any concerns you have about their dental health. Their dentist will be able to spot any early signs of gum disease, and can devise a treatment plan with you.

Pay close attention for these signs of gum disease, and make an appointment immediately if you notice any of the symptoms.

It may be that gum disease and tooth loss have no bearing on cognitive decline, but for our loved ones who have dementia or Alzheimer’s, maintaining oral health is vital. If they begin to lose teeth, chewing can become even more difficult, and dentures may add to their discomfort. The bacteria produced by gum disease can trigger the body’s inflammation system and can have a negative impact on their cardiovascular health.

The earlier we take preventative measures to maintain our oral health, the better for our overall health. For our older loved ones, caring for their teeth may become more difficult for a variety of reasons, and they may neglect their typical oral routine. Suddenly forgetting to brush their teeth may be an early indicator that they are experiencing cognitive decline, and so it is of the utmost importance that we take these changes in our loved ones seriously.

I confess.  Coffee is not just a drink.  It’s an experience.

There’s so much more to coffee than just merely drinking it.  Just ask a coffee drinker.  As for me, it has nothing to do with taste, but has become about ritual (the daily routine of standing in front of the coffee maker watching the brew, shifting from bare foot to bare foot as it drips,  taking in the aroma, wrapping my hands around the warm cup, then padding off to the porch to sip.)  For each of us, there is some unique set of reasons that the “act of coffee” resonates at our core and keeps us going back for more.

Is it good for me, or what?  Over the years,  I have tended to exercise my confirmation bias in a single direction and zone right in on all the studies and research declaring the reasons coffee is good for me, knowing full well that with each affirmation,  stories of research would follow to convince me that I was indeed a bit delusional.  It’s been an emotional roller coaster.

So what’s a coffee drinker to do when it’s #NationalCoffeeDay?  Well, first it’s important to get the facts straight.  My plan is not to bore you with all the citations here.  Know that the bottom line is that the research is conflicting. . .  that coffee increases health risks for some conditions  and improves outlook for others. . .

I know!  Shocking!

Here’s a bit of good coffee news from this year.  Take heart in this small take-away from  June of this year:   the WHO declared that coffee would no longer be listed on it’s database of carcinogens!   Yessss!

Just don’t drink it hot. . . !

Study: Elderly’s Family Caregivers Need Help, Too

By Rachel Bluth

Republished from Kaiser Health News.

Elderly Americans’ well-being is at risk unless the U.S. does much more to help millions of family caregivers who sacrifice their own health, finances and personal lives to look out for loved ones, reported a study released Tuesday.

Nearly 18 million people care for a relative who is 65 or older and needs help, yet “the need to recognize and support caregivers is among the most significant challenges” facing the nation’s swelling elderly population, their families and society, according to the report from the National Academies of Science, Engineering, and Medicine. Describing family caregiving as “a critical issue of public policy,” a committee of experts in health care and aging said the next presidential administration in 2017 should direct a national strategy to develop ways to support caregivers, including economically.

According to the report, people who help elderly family members with three or more personal tasks a day devote 253 hours a month to caregiving — almost the equivalent of two full-time jobs.

Five years is the median duration that family members care for older adults with high needs, the report said.

For some Americans who accept that responsibility, that can mean taking a less demanding job, foregoing promotions or dropping out of the workforce.

Lost wages and benefits average $303,880 over the lifetimes of people 50 and older who stop working to care for a parent, according to a study cited in the report. That’s not all: A lower earnings history also means reduced Social Security payments for caregivers when they become eligible.

A possible fix for that problem, proposed by researchers in 2009, is to provide caregivers with a Social Security credit for a defined level of deemed wages during a specified time period, the report said.

Leave programs do exist for some workers shouldering caregiving duties, but many lack such job protections.

The federal Family and Medical Leave Act doesn’t cover 40 percent of the workforce. It allows eligible employees to take 12 weeks of unpaid time off to care for certain family members, but the law only applies to those who work federal, state and local governments and private companies with more than 50 employees. But ineligible family relationships for leave include sons- and daughters-in-law, stepchildren, grandchildren, siblings, nieces and nephews. Many workers can’t afford to give up their incomes for 12 weeks.

In 2011, 17 percent of caregivers didn’t take leave because they feared losing their jobs, according to a national survey cited in the report.

The report recommends that family caregivers receive status as a protected class under existing job discrimination laws and that employers get guidance and training on ways to support workers caring for family members.

Beyond the economic costs of caregiving, the report notes that the social and physical toll of caregiving should get more attention than it does.

“If their needs are not recognized and addressed, family caregivers risk burnout from the prolonged distress and physical demands of caregiving, and the nation will bear the costs,” the report said.

Instead of delivering “patient-centered” care, health care providers should adopt “family-centered” models that include checking with caregivers to ensure they are healthy and capable of filling the role. The report also recommended wellness visits, counseling sessions and better training for caregivers who must understand increasingly complicated medical instructions.

Dealing with feeding and drainage tubes, catheters and other complicated medical devices causes stress, and the study’s authors noted that caregivers report “learning by trial and error and fearing that they will make a life-threatening mistake.”

The study was funded by 13 private foundations, the Department of Veterans Affairs, and an anonymous donor that requested the National Academies undertake the research in 2014.

KHN’s coverage of late life and geriatric care is supported by The John A. Hartford Foundation. KHN’s coverage of aging and long-term care issues is supported by The SCAN Foundation.

by Meredith Kimple

It’s estimated that Alzheimer’s disease affects about one in ten seniors over the age of 65, and 1 in 3 seniors over the age of 85. With those statistics in mind, the prevalence of Alzheimer’s can make developing the disease seem an inevitability. However, recent research suggests that certain dietary changes may significantly lower a person’s risk of developing the disorder.

The MIND diet*, created by nutritional epidemiologist Martha Clare Morris, combines the DASH and Mediterranean diets for an eating plan that promotes better brain health and may decrease one’s chance of developing Alzheimer’s. From 2004 until 2013, Dr. Morris studied the eating habits of over 900 participants aged 58 to 98 in order to determine the efficacy of the MIND diet in Alzheimer’s prevention.

The results of the study show a positive correlation between adherence to the MIND diet and a decreased risk of developing Alzheimer’s. Participants who followed the diet moderately saw their Alzheimer’s risk decrease by about 35%, while those who followed it strictly had a decrease of 53%!

The MIND diet is composed of 10 food groups that promote brain health:

1. Whole grains (3 servings a day) Substitute whole wheat breads for white, choose brown rice or quinoa in place of white rice, and have oatmeal or a whole-wheat cereal in the morning.

2. Leafy green vegetables (at least 1 serving a day)  Spinach, kale, collards, broccoli and cabbage are fine choices. The MIND diet suggests meals be made up primarily of vegetables.

3. Other vegetables (at least 1 serving a day)  Carrots, peas, peppers, tomatoes, radishes, sweet potatoes, beets and more.

4. Nuts (at least 1 serving a day)  Nuts are recommended for daily snacks and provide essential healthy fats that can improve brain function.

5. Beans (1 serving every other day)  Beans can be added to soups, stews and salads, so they are very versatile and easy to work into your current diet.

6. Berries (at least 2 servings a week)  Add berries to your morning cereal or oatmeal, or eat them as is for a healthy snack or dessert. Eating a variety of berries can help with brain function.

7. Poultry (at least 2 servings a week)  Chicken and turkey are excellent choices when you want to have a meat-based dish for lunch or dinner. While the MIND diet places greater emphasis on vegetables, poultry is a brain-healthy option for getting in your recommended protein.

8. Fish (at least 1 serving a week)  Fish is another good source of protein while following the MIND diet.

9. Olive oil  Instead of using butter, cook your food with olive oil. Food tastes just as good without the additional fat.

10. Wine (1 glass a day)  Wine lovers rejoice! A glass of wine once a day can be great for your brain health.

The MIND diet asks that you keep the following 5 food groups to a minimum when planning your meals:

1. Red meat:   Beef, sausage, steak and burgers are fine on occasion, but try to substitute them with chicken or turkey alternatives whenever you can.

2. Butter and margarine: (less than a tablespoon a day)  Use a vegetable-based butter substitute on breads, and use olive oil for cooking.

3. Cheese: (less than 1 serving a week)  This is perhaps one of the most difficult foods to limit, but do your best to avoid cheese. There are dairy-free cheese substitutes available if you really miss it.

4. Sweets and pastries: (less than 1 serving a week)  Try to limit your sugar intake and treat yourself to a favorite dessert only once a week.

5. Fried or fast food: (less than 1 serving a week)   Eliminate fried or fast foods from your diet. Baked dishes can be more flavorful and are much better for you.

The MIND diet may seem too restrictive at first glance, and if that’s the case, try easing into it slowly. Instead of taking away, add in. Eat more leafy greens, vegetables and whole grains. Snack on nuts and berries instead of chips or pretzels. Once you start making changes you may feel more comfortable substituting and restricting foods in the unhealthy categories. Whatever you can do in the moment is worth it for your health. Though the MIND diet is geared toward brain health and Alzheimer’s prevention, it may also improve cardiovascular function, lower blood pressure, and lead to weight loss.

While the MIND diet has not been named a foolproof tool for Alzheimer’s prevention, the results of Dr. Morris’s study indicate that dedicated adherence to such an eating plan may significantly lower one’s risk. The study took into account other factors that contribute to the development of Alzheimer’s, but found that what we eat seems to have the greatest impact on our mental health. Though the nutritional specifics of the MIND diet need further development as research continues, the current dietary suggestions it offers have proven effective for those participants who followed them the longest.

The prevalence and mystery of Alzheimer’s disease can make us feel powerless to prevent it. While there is still so much that doctors and health professionals have yet to determine about the disease, the MIND diet offers us the opportunity to minimize our risk and take control of our bodies in the present moment. Eating well is a choice that gives us some of that power back, and in making that choice, we are allowed some say in the functioning of our minds.

*Before trying a new diet, it’s always best to discuss any changes in your diet with your health care provider to make sure that it is right for you.

By Meredith Kimple

We all understand the importance of exercise when it comes to maintaining our health, but engaging in beneficial physical activity can become more daunting and difficult as we age. Alternative, gentler forms of exercise, like dancing or swimming, can still be taxing on an older body. Many physical activities hurt more than they help, and instead of building or maintaining a senior’s endurance, they exhaust, strain, and weaken their bodies.

Tai Chi, an ancient Chinese exercise that evolved from martial arts, may offer us a method by which balance and strength can be fortified without fatigue.

Over last few decades the popularity of mind-body exercises like Tai Chi and yoga has increased dramatically, and among a variety of age groups. These physical activities are not about raising heart rate, breaking a sweat, or meeting specific time goals; while you will improve your flexibility and balance by participating in these exercises, the aim is to look inward and get in tune with your own body.

Tai Chi in particular is an excellent option for seniors who, for any number of reasons, find exercising difficult. There are many different types of Tai Chi, but most are performed by moving slowly through a series of poses while engaging in deep breathing. Spatial perception becomes impaired with age, making it more difficult for seniors to keep their balance while moving and increasing their anxiety about falling. Tai Chi as a practice emphasizes the individual in relation to the space around them, which fosters greater awareness of one’s body and movements in day-to-day life. Beyond merely strengthening their physical stability, participating in Tai Chi can help restore confidence in their bodies, thereby assuaging their fear of falling.

Research has shown that Tai Chi, though movement-oriented, is also gentle on the joints. In fact, the motions employed in Tai Chi are similar to physician-prescribed exercises to help manage arthritis. The poses are made through fluid, purposeful movements that are not physically taxing on the body and which are meant to relax the participant. When performing Tai Chi the muscles are not tense, and throughout the exercise deep, even breathing is used to focus the body and mind.

There is evidence that Tai Chi reduces stress levels and blood pressure, improves strength, and can make recovery from falls and cardiovascular events easier. But more importantly, it seems to offer a safe, rewarding way for seniors to become reacquainted with their physicality. Aging is an emotionally difficult and physically draining process that we all undergo, and the change in our abilities can be very disheartening. Suddenly running up a flight of stairs is no longer possible. Stepping off the curb becomes a nasty fall. Our backs refuse to let us engage in our preferred physical activity. We are forced to be more cautious in order to navigate a less accessible world.

Practicing Tai Chi can help seniors feel more at home in bodies that are constantly changing. It can restore confidence and inspire self-love. Yes, we won’t always be able to run five miles or hike a mountain trail or bike across town. But our bodies are still amazing, still valid, and still capable of remarkable feats of strength. We just have to approach them differently, and Tai Chi is a wonderful way to foster a deeper awareness of your own body.

Many senior centers offer Tai Chi classes, and while there are YouTube videos and DVDs available for practicing in your own home, you should learn the basics with a certified instructor. This way you can be sure that you are performing the movements correctly and not straining your body. If you or a senior loved one are unable to stand, Tai Chi has been and can be adapted to a sitting position. If you have a pre-existing medical condition you should consult with your physician to make sure that you are well enough to engage in Tai Chi exercises.

If you’re interested in Tai Chi and want to know what it looks like in practice, this video shows a certified instructor leading classes!

With a bigger spotlight, the stigma surrounding men and mental health has eased, but there is still quite a void of understanding to be filled.  Men often will manifest depression in slightly different ways than women.  Depression in men can be exhibited not just by “down” feelings, but also by irritability and anger.   In this informative 5 minute Youtube video from the Harvard Health Minute Library, hear Dr. William Miller, Assistant Professor of Psychiatry at Harvard Medical School speak about men and depression.

Two Bodies, One Person  by Alan Millikan

Couples.  Do you know a couple that seems to be one person?   One starts the sentence, the other finishes it.   One cooks, one cleans.   One drives, one navigates.   One loses stuff, the other finds it.   One is the life of the party and the other one brings the chips.

As couples grow older together, the “one person” phenomenon seems to become less of a precious nuance and more of a necessity.   One can see, one can’t.   One drives the car and the other is furious and frustrated that they have lost their license.   One can hear, the other needs aids.   One fills the pill boxes and the other one takes them when reminded.  One can reach … and tie …  the shoe laces and the other has arthritis.

What happens when this symbiotic, mutual dependency loses one of the “can” sides of the equation?   The visionary has to have cataract surgery.   The driver fails the driver’s test.    The listener gets the flu and can’t go to the doctor’s appointment. The pill box spills and the resident pharmacist is on a three-day golf trip.   The flexible one tears a rotator cuff. . .

Things happen.  Yet for older adults, these normal aging events can send the previously functional couple into a crisis that can spiral out of control quickly.   It can also create anger when the couple who was used to their independence is now is being forced into requiring some kind of help.

Sometimes the uncertainty can lead the couple to try to hide the fact that they are struggling with the change, and say they are “fine”.    Sometimes they can make their way through the short term chaos and come out unscathed.  Sometimes a daughter or son must leave their full-time job for a bit and move in for a week or two.   Sometimes the neighbor makes a call to the church saying they are worried about Bill and Marge.    Sometimes a disaster happens and previously stealthy interdependence is exposed.

Not many couples are going to be so lucky as to live to 93 and die together while scuba diving in Belize.   Something is going to happen to cause one person to hit a road block first.  Just a little advance thinking goes a long way.  Preparing for possibilities is always beneficial.  This preparation doesn’t have to be morbid or depressing.  It is just sensible.  And it makes it a lot easier to do something when you are not forced to by a crisis.

Talk about your existing and potential needs with your family and friends.   If you are retiring or downsizing, think about a universal design home that has zero entry showers, wide doorways, and minimal steps.   If you have known chronic medical conditions, talk to your providers about “what happens when . . . “     Look at care options and life management services.    Share your fears and laugh about reality.

Give yourselves the gift of being prepared for what may come.

American comedian and actor W.C. Fields once said, “The best cure for insomnia is to get a lot of sleep.” If only it was that easy! Many of us have endured nights in which sleep refuses to visit, and some of us have encountered sleeping difficulties for a prolonged period of time.

The adverse effects of insomnia are detrimental to the functioning of all people, but for the elderly, they are especially so. Without sufficient sleep, older adults may:

• Increase their risk for certain diseases, like diabetes or cardiovascular disease
• Have difficulty concentrating, and as a result, endanger their lives or the lives of others via car / domestic accidents
• If clinically depressed, worsen their condition

Why do seniors in particular tend to suffer from insomnia?

As we age, our circadian rhythm (the internal system which regulates our periods of sleepiness and wakefulness) can change, meaning that we tire in the early evening and wake in the early hours of the morning.

However, it’s important that we don’t conflate aging with insomnia; depending on the length of time an older person has had trouble getting an adequate amount of sleep, insomnia can indicate a more serious problem. If an older loved one is experiencing chronic sleep deprivation, make sure to consult a doctor.

Here are some tips that may help improve your or someone you love’s sleep:

1. Move. A sedentary lifestyle requires little energy, and as a result, it may be harder to sleep at night. Aerobic exercise, dancing, or even walking at least three hours before you go to bed can refocus your mind and tire you out for a good night’s sleep.

2. Refrain from drinking. This means no caffeine or alcohol in the evening, and no drinking a large amount of any fluid before bed. Many seniors can’t sleep because a full bladder wakes them up throughout the night; not only is this disruptive to their sleep cycle, but it can be dangerous, as they might fall in transit to or from the bathroom.

3. Get some sun. If a senior spends the majority of their time indoors, make sure his or her rooms are well-lit in the daytime. Try to spend some time outside every day; the sunlight can help regulate your sleep cycle.

4. Relax yourself before trying to sleep. Unwind with a book, listen to music, write in a journal or meditate. Don’t go to bed until you’re ready to fall asleep.

5. Routine. A consistent set of pre-sleep practices can be extremely beneficial. Go to bed at the same time each night if you can, and perform the same hygienic tasks in the same order (brush your teeth then wash your face then comb your hair, etc.). Do something that you only do right before you go to bed, so that when you do it, your body will know it’s time to go to sleep (spray your pillow with a calming scent, turn off the light by your bed, say a prayer or a poem you’ve memorized, etc.).

6. Cold, dark and quiet. Create the ideal sleeping environment by closing the curtains and turning the lights off. Turn a fan on or turn the heat off; it can be hard to fall asleep if you’re sweating under the covers! Turn off the radio and television. Without these distractions, your body and mind can relax.

7. Think good thoughts. Anxiety and fear can keep us from getting the sleep we need. But if we don’t sleep well, how can we face the challenges the next day brings? As you get into bed, imagine that you’re sliding into a space where your problems and worries are suspended. There is a time to tackle tasks and difficulties, but it’s not during the middle of the night; the things that make you anxious will be there in the morning, so give tomorrow’s you a good start by getting the rest your body needs. Write a story in your head, keep a journal of your anxieties, and take long, deep breaths using your diaphragm. If anxiety regularly impacts your life, it may be beneficial to speak with a psychologist.

8. Keep naps short and regular. It’s normal to burn out mid-afternoon, and if your body needs sleep, don’t feel bad about taking a nap. However, sleeping too much during the day can make you restless at night. To get the most out of your naps, keep them short (no more than 30 minutes) and take them in the afternoon (well before evening). If possible, set a time in your schedule for a daily nap, and then your body will adjust and your sleep at night won’t be affected. 

The real difficulty of insomnia in older adults is that it can occur for a variety of reasons, some of which cannot be remedied via a change in lifestyle and sleeping habits. Pain from pre-existing medical conditions, gastrointestinal and continence issues, sleep apnea and certain medications can cause chronic sleep deprivation.

Depression has also been linked to insomnia in the older adult population. 

If an older loved one is suffering from chronic insomnia, it’s important not to dismiss the condition as normal. Recent studies have shown that insomnia can be a symptom of depression in the elderly; to make matters worse, insomnia can also worsen clinical depression.

It’s difficult for families as seniors age to determine which of their bodily and behavioral changes are “normal.” There are certain ideas that we accept: that seniors will eat less, sleep less or understand less as a product of their age. And while the body undergoes significant transformations in its later years, these assumptions of normalcy may prevent our loved ones from receiving the proper treatment.

Insomnia is one of those issues that is, perhaps, taken for granted in the elderly. But we can’t dismiss this prevalent condition as normal or expected. At worst, being proactive in helping them with their insomnia can mean that the hours they do get sustain them; at best, it can bring to light other, even more serious conditions like depression, and they can get the therapy or treatment they need.

If an older loved one is experiencing chronic insomnia, consult a doctor; there are various medications and treatments that can be prescribed to help seniors get the sleep they need to function at their best.

Contributed by Meredith Kimple

It has been some time since I have had the opportunity to check in here at our blog. Since that time, my Dad declined in a heart-breaking spiral which can be typical in the last stages of Alzheimer’s, and we said good-bye to him on August 22, 2015. Over the last months, we wrestled with the pain of watching Dad lose function and mobility day by day, and toggled between spending our time savoring what we knew to be our final days with him and making frantic attempts to prevent him from slipping away. In that short time, Dad’s care needs began to exceed what even our own Aegis caregivers could safely provide in the home, so we hastily arranged for his transition to a skilled nursing facility nearby. The “paper” transition was smooth, but the Dad transition was not.

At every turn, we tried to handle the demands of our own families and the challenges that came with Dad’s confusion and frustration in his new environment. We experienced the gnawing second-guessing of whether we had done the right thing (there was no other choice, was there?), and the guilt (newness and unfamiliarity had to be the worst possible thing for a person with dementia, didn’t it?), but also gained a small measure of peace that Mom (87) was finally getting a full night’s sleep, and not pushing herself to the brink of a major health crash. Dad was also going to have more access to more comprehensive services that a facility could provide to try to preserve as much of his functioning as possible. Yet, it was still wrenching to see my parents physically separated for the very first time after 64 years of marriage. They had always shared that same bed, and the thought of Dad calling my mom’s name when we weren’t there, even for just a few hours, was devastating.

We are so grateful that Dad’s needs were well-served and he received professional and compassionate care until his death. And I am grateful, too, that our out of town family members bore the news of the advancing changes with understanding. No shaming. No resentment. Just a collective wistfulness and profoundly joyful appreciation for the life of a man who by many would be called a quiet hero. I know it’s what he was and continues to be for me and our family–an example of deep faith and integrity.

For each person, for each family, the path takes it own kind of turn, but it is never easy. On a routine basis we expertly transition families or help families enable their loved ones to age in place with abundant support. Yet because we have had to weather these very storms ourselves, we get it.  We never take for granted that although it might look smooth on the outside, families will still need support to cope with deeply intimate challenges.  It is our promise that we are here to provide it.