Meetings

October 16, 2024. Following a continental breakfast, the Plenary session began at 10:00 am with words of welcome by Barbara Trought who announced the unexpected death of our ORANJ President, Maggie Heineman. Barbara asked the assembly to observe a moment of silence in honor of Maggie, and then she explained that in following the guideline in the by-laws, she has been appointed to serve as ORANJ president to complete Maggie’s term in office.

Barbara introduced  Edward Batten, President of the Seabrook Village Residents Association, who brought greetings.

Barbara introduced Jennifer McNamara, Executive Director of the Seabrook Village, who gave words of welcome to everyone.

Barbara introduced all the members of the ORANJ Executive Committee, including the Regional Vice Presidents, asking each one to stand to be recognized.

Rick Ober was introduced to give the Legislative report.

There was a brief period for an “Open Mike” when several members from the assembly made comments or asked questions.

The Keynote speaker was Nancy Baker, Vice President for Marketing Intelligence with Erickson Senior Living, whose topic was “The Future of CCRCs”.

After a break for lunch in the Princeton Dining Room, there were two presentations:

(a)  Dawn LeBoerf, Clinic Coordinator at Stonebridge at Montgomery, talked about the dangers of seniors to fall and how to prevent them.

(b)  Neal Groinik, Seabrook Resident Association Safety Committee Chair, discussed the safety procedures with Lithium batteries.

2:35 pm Adjournment

Respectfully Submitted,

Paul Basham, Secretary

By Maggie Heineman

ORANJ is indebted to Julie Gelb, and Muriel Touretsky who, along with the staff and volunteers at Monroe Village, hosted a lovely event for the 120 residents from 23 residents associations who attended the Monroe Village plenary.

Katherine Pearson, Professor of Law at Penn State spoke on “Central Concerns of Residents in Continuing Care Communities.’ Please visit Dr. Pearson’ blog post of October 26, 2023, which describes in some detail her visits to the ORANJ Plenary and at the meeting of the Washington State Continuing Care Association.  It is titled “Organized, Thoughtful, Collaborative Advocacy: The Maturing of Resident Organizations in Senior Living,” The post describe the similarities and differences between the two state organizations and the legislative work being done by ORANJ and LeadingAge/NJDE.  Dr. Pearson includes thanks to Barbara Trought, Ron Whalin, and Rick Ober in the post.

Since 2023 is an odd-numbered year, elections were held at the business meeting. Bios of current executive committee members are available on the Leadership page of this website.

By Maggie Heineman

On October 19, ORANJ had its first post-Covid meeting at Fellowship Village.

More than 100 residents from New Jersey CCRCs were helped by more than two dozen extremely efficient Fellowship Village volunteers and provided with a delicious lunch by Fellow Senior Living.  Once again FSL proved to be an excellent venue for our meeting.

The morning speaker, Dan Seeger, taught us about Decision Making Pathologies, using examples of bad decisions with which we were familiar such as the NASA tragedies, New Coke, and the Bay of Pigs invasion.  Good intentions can still lead to bad decisions. Dan listed the causes of decision-making pathologies and concluded by asserting that “We owe it to our organizations and our organizational colleagues to be quite conscientious about avoiding decision-making pathologies. For, as Aristotle wisely said: ‘We are what we repeatedly do. Excellence is not an act, but a habit.’”

The National Continuing Care Residents Association (NaCCRA) has provided several documents to help CCRCs address governance anomalies and financial issues.  These, as well as the text of Dan’s talk, are provided at the top of the ORANJ Publications page at oranjccrc.org/publications/.

In the afternoon we learned about “Covid-19 Side Effects: New Scam.”

Plenary packet documents which are available online include: Legislative Committee Report, Communications Committee Report (with a colorful map showing location of CCRCs in our five regions), Dan Seeger Bio, Afternoon Speakers’ Bios, 2022 Occupancy Report, the ORANJ Trifold Brochure, and the August 2022 issue of our newsletter.

by Ron Whalin. On October 16, Fellowship Village hosted its first plenary meeting in their new Cultural Arts Center. Over 22 volunteers and 150 attendees met in this wonderful space. As President of ORANJ and resident of Fellowship Village it was my role to guide many staff and residents in planning the logistics of the event. The programs and panels explaining palliative and hospice care were administered by Barbara Grutter, Vice President for the Central Region.

After welcoming remarks from Fellowship Senior Living Southeast Region Vice President Gary Baldwin presented me with a plaque. Thank You! A brief business meeting culminated in election of the 2019-20 slate of ORANJ officers who are listed in the sidebar on the first page of this newsletter.

The morning presentation, “Thoughtful Life Conversations – Exploring Palliative Care” by Vikranta Sharma, MD, included an active Q&A session led by Rosemary Gorman, APRN. (Both palliative care and hospice care provide comfort. But palliative care can begin at diagnosis, and at the same time as treatment. Hospice care begins after treatment of the disease is stopped and the person is not expected to survive the illness.)

Lunch provided an opportunity to meet visitors from the many participating CCRCs. Exchange of ideas over good food is always a highlight of a plenary. Fabulous desserts helped make this especially sweet.

After lunch, the Fellowship Village chorus entertained by singing “Shenandoah” and “Good News.” Following the concert, the program continued with a panel discussion on Hospice Care. The panel members were Alaina Nemes and Geralyn Kienilen of Fellowship Garden State Hospice and Residents Lou Lorio of Fellowship Village and Barbara Grutter of Applewood. They discussed the ways palliative and hospice care affected them and their families. The panel was moderated by Rosemary Gorman.

New President Ralph Hemecker thanked Fellowship Village for holding the meeting and announced that the next plenary meeting will be held at The Oaks of Denville on April 15, 2020.

The morning program speaker, Ann Mackay, past president of NaCCRA, talked about the CCRC Lifestyle: Now and in the Future. Her talk featured workforce challenges: payment reform and new service models; partnerships and consolidation; technology; consumer expectations and roles for residents.  Her comprehensive speech gave us much to think about. The entire keynote address is available here.

Robin Bacon Hoffman and Linda Rose, joined together to tell us about Ethical Decision Making in Aging Services. They gave many examples of ethical choice conundrums and suggestions for making some decisions easier for residents, families, and outside caregivers. They stressed that end of life planning can help choices to be right for you and comfortable for your loved ones. They suggested that we seriously consider completing these tasks now.

The morning speaker was Katherine Pearson, J.D., Professor of Elder-law at Penn State University. She addressed what she called “The Big Three”; (1) lack of transparency on cost and funding issues, (2) the need for effective resident voices in governance such as residents serving on the board, and (3) the excessively paternalistic attitudes by some management. She spoke of the pressure that tax-exempt CCRCs are facing to make payments to state and local authorities in lieu of taxes. 

The afternoon speaker was James McCracken, President and CEO of LeadingAge New Jersey. He spoke on topics affecting older adults in New Jersey as the legislative season draws to a close. He mentioned the challenges that management of CCRCs face such as delayed medicaid payments by the state, the proposed minimums in CNA staffing and possible changes in the minimum wage. 

Seven officers (President, Five regional VPs, and a Secretary Treasurer) were elected for two-year terms.  Their bios can be accessed from the Leaders Page.  James McCracken spoke briefly to announce the name change of his office which is now reflected in the website for the  New Jersey Long Term Care Ombudsman. 

Marsha Greenberg of Leading Age, who talked on “Big Year, Big Issues,” reviewed the past 10 months and called for action on current issues.  Greenberg’s Power Point Slides.

Basil Pflumm, president of the National Continuing Care Residents Association (NaCCRA) spoke on the “Vision, Challenges, Opportunities, and Pathways” of the national organization, which has individual, association, and state memberships.  Pflumm’s Power Point Slides.  

tbd

The meeting was held at Meadow Lakes on a beautiful autumn day. President Ron Whalin conducted the meeting and was re-elected to a two-year term which would end at the fall plenary in 1917. Reports on the plenary speakers were written by Ellen Handler in the Winter 2016 ORANJ Tree.

After the business meeting, Michael Pierce, Generations on Line (GoL) Director of Technology, made the morning presentation, titled “Tapping into Your Inner Dick Tracy.” GoL is a national nonprofit organization which seeks to reconnect generations by closing the digital divide among the elderly. Older adults have not traditionally been major consumers of electronic tools, such as iPads, laptops, and smart phones. As he explained, to bring older adults into the electronic age, they need motivation, access, skills and confidence.

He usually begins training sessions by asking attendees what they wish to accomplish, e.g. find a job, watch a show, or shop, in order to make recommendations for selecting a device. To develop skills and confidence, his company produces very simple (and colorful) instructions. They supply these tutorials (for PCs and tablets) to CCRCs without charge. To cover costs the company receives grant money from multiple sources. During the presentation Mr. Pierce asked the audience about their use of new technology and the response was quite good. There was a brisk Q&A session. He also announced free availability of training software.

At no cost, ORANJ CCRC facilities can access the tablet tutorial, which teaches older adults how to use a tablet from the first touch to learning about Gmail, apps, Skype/Facetime, photos and more. The tutorial is available in both Apple and Android versions. Along with the software, sites also receive a free coaches’ guide and training aides (emailed pdfs). To sign up for this no cost program go to: generationsonline.org/sipandswipe/ and click on “sign up now” at the bottom of the page (note “buy the app” is for individual users, not facilities). Each location should name a person responsible for communication with Generations on Line and coordinating training sessions for new learners. If interested in learning more about GoL’s free PC training tutorial visit generationsonline.org.

The afternoon speaker was Barbara Gay, LeadingAge Vice President of Public Policy Communications, Washington, DC, who spoke on changes in Medicare brought on by the Affordable Care Act (ACA).

As she pointed out, the Act had several objectives, to improve the quality of medical care, improve access and lower costs. One result has been the expansion of preventive services for Medicare beneficiaries, narrowing the “donut hole” in drug benefits, and raising premiums for well-to-do beneficiaries to pay for these expansions. To rein in unnecessary tests, the Act has encouraged the development of Accountable Care Organizations to coordinate medical care more efficiently, letting them share in any savings that result.

She mentioned that residents of CCRCs now have the right to return to their home CCRCs for post-acute care even if the CCRC is not part of the provider network. She also described new provisions to eliminate some long standing irritants. The annual cap on physical therapy treatments has been eliminated because it was found to be a poor method to control costs. Benefits for post-hospital services such as rehab centers had been unavailable for recipients whose hospital stay was defined as “for observation.” Today, a patient who is discharged after three days of hospitalization, for whatever purpose, is entitled to full post-hospital benefits.

The meeting was conducted by President Ron Whalin. During the business meeting Ron paid tribute to the late Nettie Lowenstein who had served ORANJ as chair of the Health Care Committee for many years. Reports of the plenary addresses were written by Ellen Handler in the Summer 2015 ORANJ Tree.

New Jersey State Senator Robert Singer, our morning speaker, gave an impassioned speech on how New Jersey can become more prosperous and keep up with our successful neighbors by using our resources more wisely. At present, New Jersey, with the second oldest population in the US, second only to Florida, is losing population. Basically, we don’t run the state’s economy very well, as demonstrated in the numerous snafus that attended rebuilding after Sandy. One casualty of our lack of planning is our tourism industry. Utah lures NJ tourists to visit their parks and ski slopes but we don’t advertise in Utah even though we may have more to offer.

We have lost our excellent incubator program despite the wealth of pharmaceutical companies in NJ who need drug research. We also lost our Science and Technology Commission with its potential for bringing wealth to our state. He reminded us that old folks have wealth and we need to keep them happy in NJ. That means, for instance, reclaiming our cities, which offer public transport and neighborhood shopping to meet the needs of the elderly. We should also look for ways to conserve resources such as sharing academic programs between groups of colleges and we should look for ways to make medical care cheaper by restricting a few of the multitude of choices we currently enjoy. As Senator Singer emphasized, the problem is not in the lack of possible solutions but our lack of imagination and commitment to taking steps that will solve NJ’s problems.

Stacey Judge, our afternoon speaker, spoke about the Springpoint wellness program called LivWell, where she is the director. She emphasized the importance of improving all seven aspects of wellness: social, emotional, spiritual, environmental, occupational, intellectual, and physical. The program is not just for residents, but for staff as well, and even the surrounding community. One of the rapidly developing sectors of the wellness program is the dietary. Initially, dietary services were popular among the ill who depended on dietary services as much as on medications, eg. the diabetics and those with celiac disease. Today, they are teaching dining staff to include “heart healthy” and “sugar free” items among the choices available to everyone. They are also standardizing the food symbols so that a heart symbol next to an offering at one dining room will mean the same in a different location. “It is crucially important to be able to demonstrate that a program is effective…especially if the CCRC is applying for outside grants.” Granting agencies require verification of results. Therefore, she strongly suggested that CCRCs develop baseline statistics on their populations to measure effectiveness. She suggested that new residents might be given a battery of wellness tests along with physical and financial fitness tests. Stacey urged CCRC staff to explore granting sources and obtain outside funding to explore exciting new directions in wellness programming for the “silver tsunami” that is rapidly approaching.

The meeting was conducted by interim president Ron Whalin, Vice President of the NE region. At the business meeting preceding the keynote address Whalin was elected to serve as president for the remaining year of the 2-year term which would expire at the fall meeting in 2015.

In his presentation: “Services of the New Jersey Ombudsman” James W. McCracken explained the work of his office He credited ORANJ for help in passage of the Bill of Human Rights for Independent Living Residents. IL-Bill-of-Rights.htm. He spoke in some detail about the work of his office and how it differed from that in other states. He also mentioned that on July 1, 2014 New Jersey converted to Managed Medicaid (one of 23 states to do so). A new 2-page electronic publication, ORANJ Leaf. was created in order to give a more detailed summary of McCracken’s Talk. ORANJ Leaf Issue #1

Dan Seeger gave a 10-minute talk, “Overview of NaCCRA and National Bill of Rights for CCRC Residents” which led to a 2-page write-up about NaCCRA. ORANJ Leaf Issue #2.

In the afternoon, Keith Grady, Executive Director of Applewood, spoke on “Latest Trends in CCRCs.” Mr. Grady emphasized the need for the evolution a new model for CCRCs. Using the analogy of the change in grocery stores over the decades — from A&P to Whole Foods to Fresh Direct, Grady posits that there must be a similar evolution in the model for CCRCs to a model he calls an “Engaged Living Community.” Competition from active adult senior housing, and the aging of CCRC residents, makes it necessary to reposition CCRCs to attract younger people, those in their mid-70s, into CCRCs. At Applewood there was a master plan survey which was sent to all residents, had a 65% return, and is being sent to future residents. The survey is proprietary, but during the Q&A Grady said he would make it available. Repositioning of CCRCs would involve changes in facilities, technology, and a wellness program that provides for all the dimensions of wellness (physical, mental, emotional, social, spiritual, and vocational). In order to defer the transition from independent apartments to assisted living, Grady advocates a fourth level of care, intermediate between independent and assisted living which he termed “Cooperative Living.” This level of care would be unlicensed, yet offer services such as private duty aides, and some assistance with activities of daily living, bereavement, and cognitive issues. Although he emphasized that his ideas are preliminary and there are many issues that would need to be addressed, he was emphatic that the model for the industry would have to evolve.

— Maggie Heineman

The meeting was conducted by Acting President Regina Tetens, NE Regional VP.

The report below is from the minutes by the Margery Patterson.

The morning speaker was Michelle Kent, President and CEO of Leading Age of New Jersey. The presentation was “Toto, we’re not in Kansas anymore. The Changing Face of CCRCs.” There are 149 facilities serving senior in New Jersey but not all of them are CCRCs. Included in this number are assisted living, home and community based programs, and others. There is a rising occupancy rate; home and community based programs, and others. There is an upturn in development; 80% not-for-profit and 90% occupancy across the United States. Future consumers are willing to leave the U.S., ages 55- 64. They are tech savvy, outliving expectations and providing financial support. 77% of boomers would consider a CCRC. However, seniors are aging in place and home bias needs to be overcome. Many innovative ideas are being tried. E.G., clubs for non-residents, among others. The Affordable Care Act (ACA) has an impact on CCRCs.

Following lunch break, Gene Wachspress introduced Donna Giovannetti, Chief, Mercer County, Division of Consumer Affairs who spoke on scams. She stressed the need to get contracts for purchases. Gold should be weighed in front of the purchaser. You need written receipts and must be aware of “Bait and Switch” scam. Ask for rain check or another product if equal or greater value for the sale price if they don’t have the item advertized. Seniors are frequently scanned by telephone marketers. Ask for a New Jersey registration number. Solicitors must be registered in New Jersey. The “Do Not Call” list isn’t working as well as originally. Credit cards need to know ahead oftime when there will be unusual activity on the card, as, for example, when traveling. Protecting identity is important. Watch what goes out in the garbage, e.g.,bills, statements, etc. Grandparent scam has social networking sites.

The meeting was conducted by outgoing president Ellen Handler. Because there was no nominee for the 2-year presidential term ending in 2015, regional Vice Presidents will serve rotating terms as interim presidents. Interim President David Hibberson wrote the following account of the Fall 2013 plenary for the Winter 2014 issue of The ORANJ Tree.

“ORANJ has had a very successful year, ending in our plenary meeting on October 16, 2013. Medford Leas was an excellent host and attendance was close to capacity. The meeting occurred just after the Bill of Rights, S2502, had been passed in both houses of the legislature and was waiting only for the governor’s signature. The article on the next page describes the process which led to this successful conclusion.

“Dr. Elaine Fultz, former professional staff member of the US House of Representatives, provided an excellent overview of Social Security, its successes, problems, and prospects. Her most important conclusions were as follows: ? Benefits are modest. Yet they are most beneficiaries’ main source of income. ? Benefits will replace a smaller share of earnings in the future than they do today. ? Revenue increases or benefit cuts will be needed to balance Social Security. ? Lawmakers have many options to raise revenues and improve adequacy. ? Research shows that Americans value Social Security and are willing to pay for it.

“The other speaker, Beth Sparling, Executive Director of Crane’s Mill Retirement Community, spoke on essential inputs for collaborative discussions. She particularly emphasized the need for trust, respect, commitment, willingness to share information and follow-up. In essence, she pointed out that collaborative discussions require transparency and, in turn, strengthen transparency in management-resident relationships. Beginning on January 1, 2014, Helen Vukasin will begin her term as Acting President of ORANJ.”

—David Hibberson

The meeting was conducted by President Ellen Handler who wrote the following account of the plenary meeting for the Summer Issue of The ORANJ Tree.

Heather Howard, Director of the State Health Reform Assistance Network at the Woodrow Wilson School of Princeton University, spoke about the implementation of the Affordable Care Act (ACA), also known as Obamacare. She emphasized that implementation was a work in process and that some programs were not even scheduled for implementation until 2014 and beyond. For instance, both the states and the federal government are scrambling to establish required health insurance exchanges to offer a marketplace for insurance policies and premiums so that everyone will be covered before the penalties for non-coverage begin. Altogether, the ACA has expanded coverage to 32 million new insureds, especially among the nonelderly and children. However, the new provisions still leave too many without coverage. She reported that we are making more headway among children, where the rates of uninsured is finally declining, but not among non-elderly adults, where the percentage of uninsured is still rising. This group consists largely of families without dependent children, whose family income is below the federal poverty level. These uninsured are costly to all of us because they enter the system when they are sicker. They also put pressure on other parts of the welfare system since many report skimping on basic necessities and depleting their savings to cover medical expenses.

Ray Guarino, Director of Sales and Marketing at Cedar Crest, talked about achieving high occupancy through effective marketing. As he pointed out, occupancy is the single biggest issue for any CCRC, and the successful CCRC will consider marketing an investment rather than an expense. Marketing, he says, has to be more proactive and engaging. It requires a deep knowledge of what a CCRC has to offer and of the anxieties facing a prospective resident. This requires considerable knowledge of the real estate market and the local economy. He sees marketing as a lengthy and multi-faceted process. Most new prospects require multiple contacts over a period of up to five years before the move-in occurs. His job is to persuade people to move sooner rather than later and to recognize that the CCRC provides solutions for people seeking to maintain their independence. And, finally, he must make certain that his staff never rests because occupancy of 94%-96%, which he achieves today, can fall fast if they lose momentum.

—Ellen Handler

The meeting was conducted by President Ellen Handler. The meeting report which follows was written Gene Lanigan for the January 2013 issue of The ORANJ Tree.

“Twenty-three ORANJ CCRCs were represented at the October 17 Fall Plenary Meeting held at Monroe Village. They were treated to a comprehensive review of the Supreme Court decision resulting in the passage of the Affordable Care Act (ACA), aka Obamacare. The speaker was Stephen Maag, Vice President of Leading Age, who provided a bottom-line assurance that the ACA was here to stay. He also outlined the emergence of Accountable Care Organizations (ACO), which will be dedicated to cost containment, facilities increase and patient satisfaction. Bundling, which spreads payment across provider types for a single episode of care, is scheduled for Jan.1, 2013 implementation. It will discourage excessive and unnecessary care, encourage coordination with providers and improve quality — hopefully. Mr. Maag briefly covered the new Medicare Hospital Readmission Program, aimed at provider payment reduction. Lastly, he discussed the consequences of the “fiscal cliff” sequestration and the deficit ceiling issues in the lame duck session and the likelihood that the can will receive another kick down the road. He concluded by noting the substantial number of unknowns that lie ahead, with a variety of proposals all aimed at reducing Medicare/Medicaid costs, most in their formative stage. It is unclear which will survive and in what form.

The next speakers were both from AtlantiCare: Francis Blee, Director of Government Relations and Senior Services, and Judith Henninger, RN. Mr. Blee reviewed the daunting challenges confronting AtlantiCare as ACO implementation gets underway. He noted that four pages of the new law have been exploded into 735 pages of regulation and called the current state of things “chaotic.” Special Care Centers (SCC) will provide a new approach to managing complex medical conditions such as diabetes and cardiovascular disease using a team approach with goals of 40% fewer ER visits and an overall cost reduction of 10-25%. PACE, the Program of All Inclusive Care for the Elderly, will provide Medicare/Medicaid enrollees with comprehensive long term care at home rather than in a nursing home. Four PACE locations are now up and running in New Jersey. Ms. Henninger addressed the wellness aspect of nursing care, stressing the need for program planning, continuing assessment of the program and an open attitude toward change as the need arises. Health and wellness services were listed next with a brief mention of health risk assessment (HRA), the popular screening tool often the first step in an individual health program. The need for an annual health screening was covered, along with proper nutrition, physical exercise and the importance of balance between mind, body, spirit and soul.”

The meeting was conducted by President Ellen Handler. The following meeting report by Gene Lanigan was written for the summer issue of The ORANJ Tree.

“Speakers at the Spring Plenary ORANJ meeting on a balmy April 18 at Crane’s Mill in West Caldwell, NJ, were greeted by a full house. Two speakers were on the program: Crystal Edwards, an attorney with Schenk, Price and King, and Dr. Sudhansu Chokroverty, Co-Director of Neurology at the JFK Medical Center, Edison, NJ. Ms. Edwards began by noting the significance of a living will and the power of attorney with its provisions for gifting. She then dealt with the need for planning for costs of long-term care. On average this can reach $10K per month. Medicare, with its limited coverage for nursing care, is not the answer and private insurance tends to fall short of gold-plated coverage. Insurance premiums have increased sharply and several insurers, including Met Life and Prudential, are withdrawing from the long-term care insurance business. Two other ways to address the problem are Medicaid and the VA. Both require asset depletion in order to qualify and are subject to a five year “look-back” review. Long-term care planning in a five year term context is a must. To be eligible for Medicaid, one has to be practically reduced to penury and work through a labyrinthine application routine that clearly points up the need for someone as skilled as Ms. Edwards to assist in the process.

“Dr. Chokroverty made a presentation on “Sleep and the Elderly,” a complex subject with many facets. He began with a description of the changing structure of sleep from childhood to old age. He distinguished between transient, often event-specific sleep problems and those that are chronic and can pose significant health issues that require medical treatment. The latter include sleep apnea and restless leg syndrome. He discussed the importance of the circadian rhythm, the 24-hour internal clock of all living things which can be disturbed by jet lag, or shift work or simply aging. He emphasized the need for regularity, such as maintaining fixed bedtime and waking hours for those with sleeping problems. He also pointed out that sleep medications tend to lose their effectiveness with prolonged use and should be taken only with medical supervision.”

The meeting was conducted by outgoing president Dan Hartley. Ellen Handler was elected president to the 2-year term ending in 2013. The meeting report which follows was written by Gene Lanigan for the Winter 2012 issue of The ORANJ Tree.

“One hundred thirteen CCRC residents braved inclement weather to attend the annual fall meeting of ORANJ on October 19 at Meadow Lakes in Hightstown. Two speakers were on the program: Somesh Nigam, PhD, a Johnson & Johnson VP, and Dr. David Barile of the University Medical Center in Princeton.

“After stating the premise that health care information technology will drive pharmaceutical/medical R&D, Dr. Nigam listed the present stark facts of life: Health care expend-itures represent 18% of our GDP, with chronic illness as the principal contributor, and bringing a single new drug to market costs $1 billion and, with more rigorous clinical trials, takes 10 years. The call for further innovation is clear. One possible answer lies in health care informatics, which could provide efficiencies and savings of $80 billion annually.

“The second speaker, Dr. Barile, Director of Acute Care for the Ederly at the University Medical Center in Princeton, is also founder and director of NJ Goals of Care, which has the mission of aligning patients’ goals and hopes for care with available therapies and treatments. He pointed out that evolution of medical decision-making here has come at a price: medical specialization and a shift away from the palliative role of the doctor at the bedside. Dr. Barile delineated the differences between problembased and goal-based care, noting that elders’ goals may change from cure and longevity to more comfort and improved quality of life in the time remaining. He suggested that plans for treatment be initiated by asking the patient, “What are your goals for the future?”

The meeting was conducted by President Dan Hartley. The report of the plenary was written by Ellen Handler for the Summer 2011 issue of The ORANJ Tree.

On April 20, 2011, about 150 residents and guests gathered in Denville, NJ, at the Franciscan Oaks Retirement Community to hear two outstanding speakers and to enjoy a delicious lunch. It was a remarkable gathering. Both speakers commented on the high quality of the audience and on their thoughtful comments and questions. In the morning, James McCracken, the recently appointed New Jersey Ombudsman for the Institutionalized Elderly, described the many interconnected functions of his office. They not only investigate reported cases of abuse, neglect, and financial exploitation but also serve as advocate for the elderly who live in long-term care facilities in NJ, with the exception of those in independent living, who are under the authority of the NJ Department of Community Affairs. The ombudsman’s current initiatives are designed to help institutions to prevent problems. In the Volunteer Advocate program 180 trained citizens spend 4 hours per week in buildings that house the elderly, such as nursing sections of CCRCs. (See next article.) A Regional Ethics program helps providers to make appropriate decisions in end-of-life care situations. The ombudsman is encouraging passage of legislation that would help physicians draft rules for orders such as Do Not Resuscitate and Do Not Hospitalize. He warned his audience about unlicensed providers who claim to “provide assisted services” because these often drain financial resources of patients without providing the services they need. The hotline number for the Office of the Ombudsman for the Institutionalized Elderly is 1-877-582-6995.

In the afternoon, Katherine Pearson, Professor of Law at Pennsylvania State University, spoke about the need for a National Bill of Rights for residents in CCRCs. (The rights of nursing home residents are codified in both state and federal statutes which could serve as templates for CCRCs.) She emphasized that residents need to have a voice in the direction of their CCRCs and to have comparable information on other communities. A study based on IRS forms 990 could be a valuable tool, as well as the profiles from Leading Age (formerly AAHSA) and other actuarial studies. She commended ORANJ as a national leader and especially noted its many helpful surveys such as the recent transparency study, which she hoped would be widely adopted. She summarized that there is “a harmony between resident rights and sound management.” She hoped that more CCRCs will recognize that guaranteeing resident rights is good marketing strategy.

The meeting was conducted by President Dan Hartley. The meeting report was written by Ellen Handler for the Winter 2011 issue of The ORANJ Tree.

“On October 20, 2010, more than 100 residents and guests attended the 43rd semiannual meeting in the beautiful dining room/auditorium of Harrogate in Lakewood. As morning speaker, Michele K. Guhl, President and CEO of NJAHSA (NJ Association of Homes and Services for the Aging), described its main functions as advocacy for bills, policies and regulations affecting these services, and as providers of educational programs for their staffs.

“Senator Robert W. Singer, currently representing the 30th District in NJ, and serving his 23rd year in the Legislature, was the afternoon speaker. He touched briefly on a variety of issues that require serious scrutiny, such as our vastly expanded pension system and the enormous outlay for educational programs along with its disparities and deficiencies. Closer to home, he discussed his concern about a looming deficit in physicians, especially general practitioners, and the spiraling costs of medications, fueled in part by advertising.”

The 40th plenary meeting of ORANJ, which was held at Applewood Estates in their beautiful new dining room and performing arts center, attracted 150 CCRC residents and guests.The Meeting was conducted by president Dan Hartley. The meeting report was written by Ellen Handler for the Summer 2010 issue of The ORANJ Tree.

“The morning speaker, Deborah Breslin, Director of the NJ State Health Insurance Assistance Program (SHIP), covered the main provisions of the current Medicare program and described recent changes and those on the horizon. Medicare costs and out-of-pocket expenses are expected to rise mainly because the aging baby boomer generation is about the become Medicare eligible and will put pressure on existing facilities and services. In NJ, private insurance plans, often called Medicare Advantage, are disappearing. Preventive services, including annual physicals, and HIV screening will be expanded and the dreaded “doughnut hole” in prescription drug plans will gradually disappear. Hospice provisions will be added to all plans and “At Home Recovery” to some. Ms. Breslin urged her listeners to educate themselves about choices and options by using medicare.gov or phoning 800-635-4227. The website is open 24/7 and she strongly suggested calling before 10 AM and after 4 PM. For technical information, use cms.hhs.gov. In addition, the SHIP program has over 300 counselors statewide, who are trained to give unbiased information. Call 800-792-8820 for an appointment.

“In the afternoon, Keith Robertson, Senior VP of Ziegler Capital Markets, made a presentation on the CCRC industry with a focus on CCRCs with financial problems. The most serious problems concern lower than projected occupancy levels and working capital. Options for communities that run into serious problems are 1. “Expense Management,” meaning controlling costs such as management salaries; 2. Acquire or affiliate with other organizations to benefit from economies of scale; 3. Restructure debt; and, as last resort; 4. File for bankruptcy. He reported that, on the whole, CCRCs in NJ have done well, especially the more mature communities. As for residents, he urged them to protect themselves by reviewing their CCRCs’ financial information before they enter a CCRC and, after entry, by reviewing audits annually and asking questions of management. If bankruptcy does occur, the residents, as unsecured creditors, have little leverage except to threaten to leave or to file a class action suit. In general, state attorneys general give high priority to residents’ welfare if a bankruptcy occurs.”

On October 21, 2009, the Fall plenary meeting, conducted by President Dan Hartley, was held at Cedar Crest Village in Pompton Plains, NJ. The meeting attracted a record attendance, which was commented upon by all the speakers. A brief business meeting included reports from all the standing committees and concluded with unanimous approval of the slate of candidates, put forward by Wink Livengood, Chair of the Nominating Committee.

Unfortunately, the scheduled morning speaker, Mr. Rick Grindrod, President and CEO of the Erickson Retirement Communities, had to cancel his commitment. In his place, Mr. Peter Desh of the NJ Department of Community Affairs in Trenton made a brief presentation, describing his department’s responsibilities. He also said that he and his staff were open at any time to questions and comments about CCRCs although, at present, ORANJ had no statutory authority to advise the governor on issues relating to CCRCs.

In the afternoon, Mr. Doug Pace, Chairman of the Long-Term Care Solution Campaign for the American Association of Homes and Services for the Aging (AAHSA) described the urgent need for a legislative solution to meet the long term care expenses for the 10 million Americans including six million over 65 who need help. Only 4% of the long term care expenses are covered by private insurance and 20% by Medicaid, leaving 52% paid by ourselves.

AAHSA’s solution is a broad based National Insurance Trust financed by premiums from an all-inclusive risk pool. The program would be actuarially sound because it would be prefunded by baby boomers long before they would need the coverage. The program would not cover all services but would provide a certain amount of cash (for example, $75 a day for up to one year) to a person age 21 or older, with qualifying disabilities (2 or more ADLs), after a five year vesting period. Premiums would rise if the claimant desired coverage for more than one year. Additional insurance benefits could be purchased to cover full costs of long term care.

In order to succeed, the program would require everyone’s participation in order to achieve a sufficiently large risk pool. The emphasis on cash benefits would widen the choices among services and permit payment to a neighbor or relative as a care giver.

AAHSA found that with the above parameters, we can create a national insurance trust that would pay a benefit of about $27,000 per year to each adult who needs assistance with two or more ADLs for about the cost of a large cup of coffee a day.

—Ellen Handler

The meeting was conducted by President Gary Baldwin. The primary speaker at The Fountains at Cedar Parke on April 15 was Stephen Maag, JD., Director, Assisted Living and Continuing Care for the American Association of Homes and Services for the Aging (AAHSA). His presentation consisted of two parts, 1. current issues relating to fair housing and transfers versus aging in place, and 2. social accountability among not-for-profit providers.

He made the point that “Fair Housing” provisions apply only to those in a protected class, i.e. according to race color, disability etc. Age is NOT a disability per se. Discrimination may be permissible if not in a protected class, i.e. among smokers, persons with weapons. Recent amendments added a prohibition against discriminating against families which includes an exception allowing senior communities to restrict residents to persons above a specified age. An important issue is older adults with disabled children who ask to keep their children with them.

In order to qualify for protected status as disabled, a person must have a physical or mental impairment that substantially limits one or more major life activity. If a disability exists, there is a duty by the provider of service to “reasonably accommodate” that disability. Grab bars, for instance, are a reasonable accommodation but the provider does not need to accommodate if he can’t afford the change or if it fundamentally alters the nature of his program.

Another significant controversy for CCRCs is a right to aging in place versus a CCRC’s contractual right to transfer a resident to a higher level of care such as Assisted Living. This is especially important in cases where the resident can afford to live safely in their dwelling, i.e. with a private duty aide, and the transfer is seen as discriminatory. Restrictions on private duty aides have been termed acceptable, e.g. appropriate certification, criminal background check and also when a CCRC requires that an aide may not be an employee of the facility.

Regarding the use of mobility aids such as walkers, wheelchairs, motorized carts, the courts have generally considered restrictions discriminatory. For instance, they have disallowed competency testing, damage deposits, restricting or limiting access to common areas. However, they have allowed limiting mobility aids to those who have a medical need so that residents cannot use them simply for convenience. Finally, he pointed out that new rules were being considered regarding service animals. Seeing-eye dogs in the case of blind residents are clearly allowable but the situation is more controversial for “emotional support” animals.

Mr. Maag’s second topic, social accountability, is particularly important because of 1,850 CCRCs in the US about 82% are not-for-profits. They receive tax exemptions on the assumption that they serve a community or governmental need in return. These exemptions are increasingly being challenged in the courts especially as communities with budget deficits look to increase their revenue streams. He emphasized that creating an internal climate of social accountability has to come from the top down and from the inside out. The Board, senior leadership, and residents have to recognize the importance of this mission. It is helpful if the organization add up what they gain by tax exemption, e.g. sales tax on purchases of supplies, equipment, food, tax exempt bonds for financing, charitable deductions for donations or endowments. Against this sum, the board, leadership and residents have to calculate the cost of their “giving back.” This would include any charity care given residents so that they could remain at the CCRC even after they had used up their funds. It also includes, for example, making space available for community organizations to meet at the facility, release time for staff to take part in community services, community work by residents, and after-school or day care programs for children. The CCRC needs to publicize the “give backs” as widely as possible including the results in annual reports, web sites, volunteer recognition events, etc. If possible, the total value of the contributions should come close to the value of the exemptions the CCRC has been granted.

In the afternoon, Charles Graziano, aide to Congressman Adler of the third Congressional District of Southern NJ, spoke briefly of items concerning seniors that are under discussion in the Financial Services and Veteran Affairs Committees. He emphasized the Congressman’s concern that bailout funds go to the middle class and that they prevent government waste. He also hopes to find ways to reduce health care costs, to provide health services to the uninsured and to include preventative measures. He is also concerned that Medicare does not provide for long term care and for better managed care.

—Ellen Handler

There were about 125 people attending the meeting, which was conducted by president Gary Baldwin. In welcoming the audience, James Wells, the CEO of Arbor Glen commented on a number of positive changes that he had noted. These included the greater empowerment of residents along with greater involvement of residents in governance of their CCRC. He also said that “the ears of management are more open.”

The morning speaker was Carol Ann Campbell, Medical Staff Writer at the Star Ledger since 1998. She has received awards for her articles including those on medical mistakes, iatrogenic (hospital based) infections, and treatment at the end of life. She noted that end-of-life issues are especially troublesome in NJ, in part because of the heavy marketing by pharmaceutical companies, who are very prominent in NJ, and intense public relations efforts by hospitals. As a result, we spend more during the last six months of life than any other state. In searching for information on outcomes she found that people in NJ are more likely to die in intensive care, to have more tests and to see more specialists and yet do not live longer or feel better than people in other states. When she studied the lives on real people, she found that New Jerseyans are more likely to die alone with heavy bruises from testing and treatment. In addition, NJ has a greater percentage of people receiving nursing care in hospitals, rather than in nursing homes, an unnecessary expense. Because doctors spend little time talking to patients or their families, they do not have sufficient information to write effective “Living Wills.” Without the necessary information, many patients’ families suffer needlessly about whether to “pull the plug” at the end of life. She called it a “conductorless train” where no one is looking at the big picture.

She contrasted the situation in NJ with that of Utah where minimal end of life treatment is the norm. In that state, nurses try to get patients out of the ICU (intensive care unit) as quickly as possible and to encourage effective communication with physicians. As she pointed out, for many patients it is more important to have a conversation than just another round of chemo. Because most people die from chronic illnesses, we are wasting money with futile treatment. In many cases, a hospice program that offers palliative (comfort) care is more appropriate and much less costly.

A major culprit in the current medical climate is the specialization of medicine. We are moving constantly to more specialized, more hospital based care when studies have shown that less care can lead to better outcomes. For example at the Mayo Clinic, medical care is low cost and ranks high in patient satisfaction. To illustrate her points, Ms. Campbell described patient care in Utah, where end of life treatment is minimal. “Slow Medicine” is commonly practiced, where patients are maintained at home as long as possible. Along with hospice, patients receive “high touch” care which can provide more comfort than high-tech testing and interventions. She described one patient who told his hospice care givers, “All I want is two Texas wieners and a bubble bath.” Hospice provided both and he died, contented, within a week.

The afternoon session was devoted to energy issues and was given by John Shure, President of NJ Policy Perspectives. He described the challenges and goals of the energy master plan of NJ. The four challenges are that (1) the growth in supply of electricity is less than demand, (2) energy prices are rising, (3) global warming is increasing, and (4) NJ has less control over supply and demand. The five goals are (1) to maximize conservation and efficiency, (2) to reduce peak hour demand by 20%, (3) to obtain 22.5% of electricity from renewable energy sources (we have 2% today), (4) to develop power plants with higher carbon energy effectiveness, and (5) to invest in clean technology.

To meet these goals we need another nuclear power plant to create electricity at reasonable cost. We also need to dramatically reduce consumption and one of the best way to achieve this is to change the current building codes. In addition, we need to build offshore power generators with wind farms. We don’t need to build them where they irritate inhabitants. We can build plants 20 miles off shore that will yield enough power to supply thousands of homes. We can also encourage the construction of solar panels on rooftops. NJ does not have to rely on natural gas from Texas. No one is happy with the status quo and a master plan may help. We are already a leader in harvesting wind and solar power and both political parties believe that nuclear energy must be part of the solution for NJ.

—Ellen Handler

The meeting was conducted by President Gary Baldwin. After a brief business meeting, the morning was devoted to a presentation by Solomon Randall, Founder and Executive Director of NJ Sustainable State Institute, a Rutgers University think tank devoted to strategies to enhance sustainability in NJ. “Sustainability” or “Sustainable Development” means protecting the resources and systems that support us today so that they will be available to future generations.

Mr Randall pointed out that we have finite resources, i.e. air and water and that we need to live within these limits. Our consumption of these resources, can be defined as our “ecological footprint.” Thus, Princeton’s ecological footprint requires an area 61 times the size of Princeton itself. The footprint reflects not only the number of acres needed to sustain a person but also by the number of acres lost by the trash generated by each of us. Therefore, we lose 4,000 acres of open space daily in part because each person produces 90,000 pounds of trash in his lifetime.

Even though the US has not signed the Kyoto Protocol, many of the cities, have designed their own plans to deal with global warming. Among the strategies are efforts to decrease pollution by encouraging people to move more closely together and to increase the amount of open space . With higher population density public transportation becomes economically viable and pollution due to car travel decreases. Another set of strategies is the adoption of green building practices, which may be expensive in the near term.

He emphasized that it will be important to engage all sectors of society to bring about environmentally friendly changes in practice, including the public and private sector, the schools etc. But if we neglect such efforts we can expect catastrophic results from global warming. As an example, he pointed out that if the average high temperatures in NJ were to rise 15 degrees we could expect significantly less rain and the earth will become too warm to soak in whatever rain there is. To avoid such a disaster, NJ must mandate energy efficient practices, increase the amount of biomass used for fuel, and levy a carbon tax. He suggested as a target for NJ that 22% of our energy needs will be satisfied from renewable sources by 2021.

To help communities measure their effectiveness in combating global warming, his institute has developed a set of measurable goals, indicators, and actions. However, he pointed out that one of the problems with design of energy policy is that actions that lead to desired outcomes can also have unintended negative consequences. For instance, Brazil gets 50% of its fuel from biofuels but this decreases the food supply available to the population.

The afternoon presentation was made by Fred Profeta, a former mayor of Maplewood, NJ, and currently Deputy Mayor of Maplewood for the Environment. As he put it, “For me, the environment is the number one issue.” But he was optimistic that American ingenuity that is able to put a man on the moon will also be able to tamp down the “doomsday scenario” of the environmental movement.

He pointed out that Maplewood is known as a “green” community and has made great strides in that direction. It has been expensive but it has earned Maplewood a significant dividend. According to the realtors, residential properties in Maplewood have maintained their value despite the drop elsewhere.

He described the new police station as the first public green building in NJ. It has solar panels on the roof which, together with its tinted windows, reduces electricity consumption by 20%. The building also has sensors which turn on the light and respond to motion and to an increase in the amount of CO2 when additional people enter the room. The savings from these strategies more than pay for the extra investments.

In addition, Mr Profeta has persuaded the community to commit to hybrid cars and he hopes that the entire municipal fleet will be green by 2015. Also, the community has instituted jitney service for commuters during rush hours, which, they calculate, will take 300 cars off the roads.

Mr. Profeta pointed out that we cannot yet evaluate all the effects of global warming. For instance, what will happen to our local trees and plants that cannot migrate north when local temperatures rise? What will happen to the ski industry in VT and NH when the snow disappears?

On the other hand, we can try to buy local products to reduce emissions from trucks that transport goods, and could benefit local producers. We can encourage the use of fluorescent light bulbs instead of incandescents, build bike paths and place racks where they will provide an incentive to use bicycles instead of automobiles. We can also plant trees, a good CO2 sink and forbid the destruction of trees above a certain height unless they are deceased.

One of the main ways to encourage “green” is to develop the tool kits, such as new books in the “Dummies” series, e.g. “Environment for Dummies,” help to establish criteria to measure whether efforts have been successful, and provide incentives to encourage effective strategies. As Mr. Profeta said, “This is our job. Can we do it? Sure but we need everyone to get aboard.”

—Ellen Handler

President Gary Baldwin conducted the meeting which attracted about 120 attendees from 16 members CCRCs. Among the attendees were Joan Duggan, CEO of the NJ Homes and Services for the Aging and Peter Desh of the Department of Community Affairs in Trenton.

The morning speaker was Candy Ashmun, a private consultant on environmental matters including land use and preservation (anjec.org) accompanied by Michelle Byers of the NJ Conservation Foundation (njconservation.org).

Ms. Ashmun spoke about two major environmental issues affecting the state, the country and the world: Climate change, especially that segment caused by human behavior, and land use, especially as it affects water supply. She mentioned that NJ is an old, industrial state that has been blessed with good water. Therefore, the state is famous for its good beer and pharmaceuticals. However, it needs to take concerted action to protect its water supply and this is difficult to achieve because of its fragmented responsibilities. The state has 566 municipalities in 21 counties that have a hand in land use and badly needs regional plans in order to be effective.

She emphasized what the CCRCs and their residents can do, including but not limited to:

• Start their own Environmental Committee at each CCRC.
• Volunteer to serve on the municipality’s Environmental Commission.
• Have their community conduct an energy audit.
• Address energy conservation issues including the use of fluorescent bulbs, which provide as much candle-power, at a far lower wattage, than the incandescent bulbs in use.
• Set up composting facilities so that the mulch that is generated may be used in the spring rather than having to buy it.
• Plant native species of plants and trees.
• Install solar panels for heating water and/or generating power with voltaic cells.

In the afternoon, Linda Rose, Vice President of Health Services for Presbyterian Homes and Services, spoke on “How to talk to Your Doctor.” She pointed out that seniors have many problems in communicating with their doctors. Often they are unable to adequately inform their doctor of their problems or even of the medicines that they are taking. They also have problems in remembering what they are told. She emphasized preparing for a visit with your doctor, writing down questions, taking notes and asking another person to accompany them as an additional pair of ears.

Ms. Rose gave every attendee a pamphlet entitled “A Guide for Older People; Talking with your Doctor.” It contains information and recommendations developed by the Federal Government’s National Institute on Aging of the National Institutes of Health. It also includes work sheets that will help patients to prepare for their visits with their doctor. Anybody who was not present at the meeting can obtain one of the pamphlets from the website, and click on “Health and Aging.”to order copies of “Talking with your Doctor.”

An additional source of help is the websites listed at the back of the pamphlet that provide further information for communicating with busy physicians.

—Ellen Handler

Still looking for information! 

On October 18, 2006, Michael Patterson from AARP addressed the fall meeting of ORANJ (the Organization of Residents Associations of New Jersey) at Stonebridge at Montgomery in Skillman, NJ. The meeting attracted a record turnout of over 100 people from various CCRCs (Continuous Care Retirement Communities) throughout the state. The presentation on brain health is part of a national Staying Sharp initiative, which is a joint project of NRTA: AARP’s Educator Community, (formerly the National Retired Teachers Association): and the Dana Alliance for Brain Initiatives.

The title was “Staying Sharp” but the presentation dealt not only with maintaining brain functioning but also with engaging its potential for growth and development in older people. In the old days, we used to hear about “the feeble brain” of the elderly. There was a widespread belief that we are born with all the neurons (nerve cells) we would ever have and that the number would diminish gradually as we age.

Recent research has overturned the old shibboleths. We now know that brains continue to generate new neurons throughout life, particularly in the hippocampus, which is critical to memory and learning. Further, brains are not “hard wired” at birth, but keep changing by developing new synapses (connections between neurons) as a result of learning and experience. This growth in synapses can be tested empirically. For instance, in a study of British taxi drivers who are required to memorize the map of their territory, research showed that the section of the brain devoted to spatial recognition was significantly larger than that of non taxi driver cohorts.

It also turns out that we must make sure that the brain does not learn “bad” behaviors. For instance, if we walk with our backs bent over, the brain will learn to think of this as normal. Straightening up will help the brain to change its notion of normal. After a stroke when we are left with a defective arm, some physicians recommend putting the “good” arm into a restraining cast to encourage the brain to re-learn how to activate the “bad” arm.

According to Mr. Patterson, there is a growing consensus among neuroscientists that healthy brain behavior requires 1) physical activity, 2) mental activity, 3) cardiovascular health, 4) social engagement, staying involved with people, and 5) self mastery: engaging in successful new activities and especially those that involve many facets of behavior. Shopping, for instance, is such a multi-faceted activity. It requires a) critical thinking – i.e. making choices, b) spatial learning – i.e. where are the desired objects, c) physical activity – i.e. traversing a supermarket or a Walmart, and d) social engagement – at least with the cashier at the check out counter.

The presentation was lively and stimulating. Fortunately, the presentation or a version of it, may be available to any CCRC if requested. For information about brain health and the Staying Sharp program, see the AARP website.

—Ellen Handler

There were 85 delegates representing 19 CCRCs and 6 guests present. Gary Baldwin, President, reviewed the history of ORANJ and paid tribute to the founding members, including Walter Neidhardt of Applewood Estates, Bob Anderson of Medford Leas, and John Cook of Applewood Estates.

The first speaker was Dennis Koza, CEO of Medford Leas. His talk was titled “Improving Communication: Management and the Resident Population.” He described what he called the Five Truths. Koza Speech

The second speaker was Catherine Kelly, RN, Administrator of Renaissance Gardens, Seabrook Village. She described the provisions of the Health Insurance Portability Accountability Act (HIPAA) and how it deals with the transfer of information regarding health care and the rights of persons covered by the act. She responded to many questions from the audience.

The final speaker was Ford Livengood, prosecuting attorney in the Fraud Unit of the Essex County Prosecutor’s Office, on “Identity Theft Protection: Steps to Protect Yourself.” He covered a number of ways in which your identity can be stolen and ways in which you can protect yourself from injury. For instance, he suggested using a shredder for anything which gives your address, social security number, or bank information and also suggested that everyone should check their checkbook(s) frequently for incorrect transactions.

The meeting closed with a plea for volunteers to serve on various committees and for someone to serve as Vice President for the new Southwest Region.

—Ellen Handler