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Inspired Aging: Happiness increases with age


It may seem like a paradox, but older adults are happier than younger adults. You may question this statement—after all, how can we be happier when our bones are weakening, our eyesight and other senses are declining, our friends are narrowing and we constantly lose our keys?

Any age has its own set of issues, and it is how we deal with those issues that reveals the key to happiness.
Older adults have a lead on the younger generations because they’ve had more practice dealing with problems. They use the wisdom they have gained through the years to work through solutions.

Scientists have found that older adults regulate their emotions much better also. They don’t focus on the negative as much as they do on the positive. Based on their life experiences, they tend to know what situations may provide an unpleasant outcome, so they try to avoid such situations.

In addition, research shows that when older adults do have negative emotions, they don’t linger on them. Happiness experts teach us to “live in the moment,” and that is exactly what older adults do.

As we age, we realize that the clock is winding down, and the focus becomes more on the now. We know life is short in our younger years, but it is only around our 70s that we appreciate that time is truly of the essence.
As I interview older adults, I try to gauge their level of happiness. When I ask them to look back at their lives and tell me about their successes or regrets, almost all have told me that they are very satisfied with their lives and have few if any regrets. The glass is definitely half full.

Those who have aged gracefully and are happy say they lived life to the fullest and did not take happiness for granted. As one told me, “Happiness is a choice. Each day, you get up make a choice to be happy.”
This is advice to which I truly subscribe. No matter what life brings to our doorstep, I believe God has given us free will as to how we deal with our issues.

We are responsible for our attitudes and reactions. I recently heard the story on the news about a blind 67-year-old woman who lives in a senior residence. She had a recent stroke that has made her disabled and in need of daily assistance.

The incredible part to her story is that she made a choice to not feel sorry for herself. She said she is glad to be alive and has an “attitude of gratitude.” She makes a conscious choice each day to count her blessings.
Older adults who are happy have learned how to control their reactions and attitudes to situations. They value the depth of experiences; they evaluate life on the small miracles rather than negativity; they accept things they can’t change and make peace with the past.

Now if only we could practice all this in our younger years and we can, if we choose. Let’s learn from our experienced elders and take advantage of each day so as we look back, we find little to regret. Let’s make a choice let’s be happy.

Neda McGuire is a local gerontologist and owner of Comfort Keepers, a home-care organization in Fredericksburg. She can be reached at or 540/370-0008.

To learn about seven steps that can help you be happier, visit and type “choosing to be happy” into the search box at the top of the page. The steps discussed in the WebMD story include:

Participating in meaningful activities.

Fostering close friendships.

Cultivating gratitude by listing a few things each day that you’re grateful for.

If, on the flip side, you find yourself feeling chronically sad and struggling with feelings of hopelessness, it may be wise to consult with your doctor or a mental health professional, as depression is common in the elderly and can stem from a variety of causes, including certain medications. Signs of depression can include fatigue, a loss of interest in pleasurable activities, social withdrawal and sleep problems.

—Janet Marshall

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Legal Ease: Who is eligible for Medicaid benefits?


Last month, I covered the basics of Medicaid and explained how Medicaid is different from Medicare.

I also gave readers the six tests that must be met in order for a person in Virginia to become eligible for Medicaid long-term-care assistance. As promised, in the next two months I will go into further detail regarding the last two tests: resource eligibility and asset transfer evaluation.

There are resource eligibility rules in place that must be met in order to qualify for Medicaid in Virginia.

When the applicant applies for Medicaid assistance via the Medicaid application, he or she must report all money on hand, stocks, bonds, annuities, life insurance policies, trusts and real property, among other assets owned by the applicant. A Virginia applicant for Medicaid assistance cannot have more than $2,000 in countable assets in his or her name.

So what are countable assets? All assets are considered countable assets except for those that fall under the exclusion rule.

Excluded assets include personal items such as jewelry, furniture, collectibles, one automobile, the applicant’s personal residence, commercial property, prepaid burial arrangements or a burial savings account, term life insurance policies, a life estate in real property, special needs trusts and any assets that are considered excluded for another reason.

In addition, if the applicant owns a personal residence, this residence will become a countable resource after six months of institutionalization unless the resident’s spouse or other dependent relatives such as a disabled child lives in the residence as well.

The biggest misconception I hear from folks is in regard to the applicant’s personal residence.
Here is the rule: If an unmarried applicant who owns his or her own home applies for Medicaid long-term assistance, the home will not be considered a countable resource until the applicant has been in a nursing home continuously for six months.

After the six months lapses, the home may at that time become a countable resource requiring that the home be put on the real estate market for sale at the tax-assessed value. This is generally the case where the single applicant has no (or few) liquid assets and needs to sell the home in order to pay for long-term nursing-home care.

If the liquid assets are few to none, the applicant will usually be approved for Medicaid pending the sale of the home.

So what if the applicant is married or has a dependent adult in the home? This is where the confusion begins.
A married applicant (whose spouse resides in the home) or applicant who has a dependent adult in the home will have the home excluded as a countable asset even after the six-month period.

For our purposes, I am going to focus on the scenario where the Medicaid applicant has a spouse who remains in the residence. The spouse is referred to in Medicaid lingo as the “community spouse.”

The spouse of a married applicant is permitted to keep one-half of the couple’s combined assets up to $113,640, which is referred to as the Community Spouse Resource Allowance, or CSRA. The minimum CSRA is $22,728.

These figures are calculated using the “snapshot date.” The snapshot date is the first day of the month of institutionalization of the nursing-home spouse. Once the institutionalized spouse qualifies for Medicaid, the community spouse’s resources are no longer considered available to the institutionalized spouse.

The community spouse will not have to use his or her own income to support the institutionalized spouse once Medicaid is approved.

Further, in some circumstances the community spouse may be entitled to some of the income earned by the institutionalized spouse.

The Department of Social Services will compute this amount, which is known as the Minimum Monthly Maintenance Needs Allowance (MMMNA). This allowance amount ranges from a minimum of $1,838.75 per month to a maximum of $2,841 per month.

Next month I will tackle the Medicaid asset transfer rule (commonly known as the “look-back” rule) and penalty for transferring assets.

Elizabeth McMaster is an elder-law attorney in Fredericksburg. Email her at

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New Horizons: Go easy on yourself in challenging times


Self-help books are full of good advice. Even if we know much of this advice already, sometimes an inspiring book helps us along our way. But what happens when the self-help books and the common suggestions for wellness seem ridiculously inadequate?

What if we have been hit by a real, unexpected crisis and we can’t even think about tomorrow because we can’t even imagine getting through today?

Many of my friends and I are facing more serious difficulties as we have gotten older. It seems the older you get, the more loss, transitions and other challenges you’re bound to face.

Recently, someone asked me a most provocative question: “What do counselors do when things get really bad? What do you do when all the good advice—like get regular exercise, eat your vegetables and keep a gratitude journal—just seems pathetically unrealistic?”

I brought this question to my group of mental health professionals at Riverside Counseling, and it sparked an interesting conversation. Everyone had experienced times where it was hard to hold it together and, unfortunately for us, counselors are not exempt from this intense human suffering.

Our collective difficulties included the death of friends and loved ones, divorce, illnesses, surgeries and the sometimes daunting responsibility of parenting several young babies at once.

Any of these things could send someone into a tailspin, and if you have a couple of them lumped together, you may feel an overwhelming impact. So what can you do?

First and foremost, everyone agreed that in these times, we need a good therapist. We believe in therapy, so when we need it for ourselves or our kids, it seems natural to reach out for help. Our training doesn’t mean we don’t need some help to cross our own personal hurdles. Just because we know, for example, the stages of grief, doesn’t make it any easier for us to get through them.

Our discussion focused on those especially tough times when you might feel like you can’t even get out of bed. During these times, we agreed, you might have to take just a single step at a time. You put your feet on the floor, you shower, you get dressed and try eating something, even if it’s just an orange.

When you’re in that difficult place, you give yourself permission to do, within reason, what you need to do to get through the day. You might drink a whole pot of coffee because you didn’t get any sleep the night before. You might need a sleep aid for the first time ever.

You just manage one task at a time and try as much as possible to keep your ordinary routine in place. You try to accept that life, at the moment, is just crappy, and your goal is to get through it in the best way you can.

It isn’t pretty. You give yourself permission to slack off on some things for a while. Maybe you skip doing the laundry or cleaning the house and let yourself watch reruns of mindless TV, all the while remembering that this is part of a process of healing and you’re not sinking into this state forever.

You are giving yourself permission to be broken down for a while, without losing sight of the “you” that will eventually pull it back together.

As one therapist said, “When I resisted the painful feelings, it just made it worse. When I finally just let the emotion flow through me, I might have a good cry or feel some intense anger, but then I’d feel a little better afterwards.”


You can also reach out to people who support you and can help you get through day to day, or even hour to hour. If people offer help, you say “yes.” Don’t try to do it on your own—let others help you. You might need to be there for them one day.

Another good idea we talked about is to pay attention to your thinking. Here, counselors may have a little better preparation. If we are thinking “I’ll never be happy again,” we know that we’re projecting our current feeling into the future but, of course, we really don’t know what the future will bring.

So, finding positive thoughts to hang onto is critical. You might say, “I have felt this way before and I got past it then, so I can get past it now.” Or you might do a positive reframe. “This will really help me have greater compassion for other people in this position.”

Other advice for navigating the losses that seem to be an inevitable part of getting older:

Ask yourself what you can control, because so much of your life may feel outside of your control. Take charge of those things you can do, even if it seems like pathetically little. Take charge of your recovery, no matter how long it takes, but don’t make rash decisions. You are in no state of mind to make major lifelong decisions. Tell yourself that these are good ideas that you can think about later when you are feeling better.

Remember that it is not going to last forever. In this emotionally wounded state, it is normal to feel physical pain, but with time your mind and body have the capacity to heal.

Finally, take wisdom from anywhere you can find it. When I was in my 30s, a close friend died suddenly and without any warning. The pain was so acute, I could hardly face it. I was an overwhelmed mother of young children and thinking of this tragedy was almost unbearable.

One day shortly after, as I was driving, I was reminded of her. I could do nothing more than pull my minivan over and burst into tears. My children were with me and my then-5-year-old asked: “What’s wrong mommy?”

Struggling to put it into age-appropriate language, I said: “I’m just hurting. Do you ever get hurt and it just makes you want to cry?”

“Oh yes, mommy” she said, “like if I cut my finger, then I put a Band–Aid on it, and take really, really good care of it. Then I have to wait and wait and after a whole lot of time it finally feels better.”

So I took her advice. I let myself face the pain, and I tried to take better care of myself. I did have to give it time, but then—even though I really missed my friend— the pain subsided, and I recovered.

Sometimes, you just have to cling to the basics: Eat, sleep and breathe.

Dr. Delise Dickard is a life coach, psychotherapist and director of Riverside Counseling. She welcomes reader feedback. For contact information, visit

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Fit After 50: Don’t let aches stop you from exercising


I over-yoga-ed last week. Back hurt. Knee hurt. Wrist hurt. Instead of feeling energized the way I usually do from yoga, I just felt tired.

So I took a couple of days off, took a couple of ibuprofen and took long, hot showers. And I went to bed early. And that pretty much fixed me. Except that even after I got my yoga back on, I kept fretting about that knee and wrist. I worried that maybe it wasn’t just the aches and pains I sometimes get—more often as I get older. Maybe it was something worse, something chronic.

Arthritis? Carpal tunnel? Something that might require treatment, or an extended break from yoga? A symptom of my decline?

This seems to be how it works for many of us as we age: Not only do we realize we’re more likely to get hurt, and need more time for recovery, but it’s easier to fret that that our aches and pains from exercise might signal something deeply wrong.

For some people over 50, this fear can trigger a vicious cycle. First comes worry, then a reluctance to exercise, as if it’s possible to save up whatever physical abilities they have left. And then comes a lot more TV watching. The longer they sit, the less confident they become in their ability to be active—and the less able they are when they try.

Anyone who has ever lost balance and fallen will attest to what a debilitating loop it is. You don’t want to walk because you’re afraid you might fall again and hurt yourself worse than before. But because you’re not walking, muscles atrophy, balance gets shaky, and you actually are at greater risk of falling—to say nothing of the significantly higher mortality rate for people who are sedentary.

Knowing all this, when my wrist and knees acted up, I knew not to let my aches and worries sideline me for long. So my response was twofold: Because I had no sharp or throbbing pain, and since I had taken a few days off and rested, I challenged myself and my class with a fairly intense workout the next time I taught power yoga.

But I babied myself some, too, with modifications for my creaky wrist and knee. I didn’t want to lose out on the benefits of regular stretching and breath work, or the aerobic aspects of my yoga. But I also wanted to make sure I allowed any inflammation to heal.

What I didn’t do was stop—at least not for very long.

Like most people, when I was younger and took a break from exercise, I didn’t have much problem picking it back up again. A few sore days, maybe, some fatigue along the way, but no big deal.

Now, though, pushing 60, it’s pretty much ‘Use it or lose it.’

Yet it’s still possible to get at least some of your physical abilities back, even if it’s been a long time since you exercised.
Researchers have long known the benefits of regular yoga practice for people who suffer back pain and arthritis, for example. And a new study from the American Heart Association indicates that stroke victims—the people most likely to sit down in a chair in front of a TV and never get up again—can improve their balance and mobility through yoga.

Even elderly stroke survivors, some as old as 90, with significant paralysis, improved with yoga.

Balance and mobility got better for those who did several weeks of yoga for the study. The stroke survivors also felt less afraid of falling, more confident physically and said they were enjoying a better quality of life.

You don’t have to wait until you’ve had a stroke to start yoga or some other similar exercise regimen, of course. But it sure is nice knowing it’s there if you do.

As for me, my knee is better, and I’m still taking it a little easy on my wrist. But I’m not about to stop challenging myself—though as I get older, I’ll probably do a few more Advilasanas than I used to.

Steve Watkins, a novelist and professor emeritus at the University of Mary Washington, teaches power yoga at the Stafford YMCA and power and family yoga at Read All Over Books in Fredericksburg. His website is





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Choose your salad dressings wisely


Eating salads can keep skin smoother and help prevent wrinkling. Salads also can protect your sight. But using the wrong salad dressing could make you miss out on the benefits.

We’ve known for years that dark green and bright orange salad veggies such as romaine lettuces, spinach and carrots are packed with natural chemicals called carotenoids, such as beta-carotene, lutein and zeaxanthin. Your eyes use these natural chemicals to prevent age-related damage and blindness.

Red veggies such as tomatoes contain another carotenoid, lycopene, which acts as a mild natural sunscreen. Beyond protecting skin and eyes, carotenoids in foods also seem to reduce risks of cancer and heart disease.

But what you might not know is that the kind of salad dressing you use can affect how you absorb these benefits.


Fat-free salad dressings are useless when it comes to absorbing the valuable carotenoids from your salad veggies. Carotenoids dissolve only in fat, so they’re easier to digest if your salad dressing contains some fat.

In fact, you might not absorb any carotenoids at all if you eat a salad with fat-free dressing, according to research at Iowa State University.

But not all fats are created equal. It seems that monounsaturated fats such as those found in canola oil, olive oil and avocados are better than creamy dressings. That’s according to new research at Purdue University and Ohio State University.

Scientists compared salad dressings with three types of fat: canola oil, which has monounsaturated fat; soybean oil, which has more polyunsaturated fat; and a buttery dressing, which has saturated fat. Volunteer salad-eaters absorbed the most carotenoids for the least calories with the canola oil dressing, rich in monounsaturated fats.

That’s important to know, because a lot of bottled salad dressings contain soybean oil or cream, rather than more effective monounsaturated fats.

Here’s how you can get more of the good fats:

Choose the best dressings. Pick those made with olive oil, safflower oil or canola oil, which are some of the richest sources of monounsaturated fat. Each teaspoon of these oils provides about 3 grams of monounsaturated fat and only 10 calories. Recipes for easy homemade dressings appear below, for Citrus–Honey Dressing and Ginger–Cashew Dressing.

Crunch on nuts. Top your salad with some nuts. Macadamia nuts, hazelnuts and pecans have the most monounsaturated fat. But you can also get significant amounts from almonds, cashews, Brazil nuts, peanuts and pistachios. An ounce of nuts, about ¼ cup, has 7–17 grams of monounsaturated fat and roughly 200 calories.

Sprinkle on some seeds. Seeds add flavor and monounsaturated fat too. Try sunflower seeds, pumpkin seeds or sesame seeds. An ounce, or ¼ cup, has 140 to 200 calories, depending on the seed, and 4 to 8 grams of monounsaturated fat.

Add avocado. Slice an avocado for your salad. Half an avocado has 125 calories and 7 grams of monounsaturated fat. Avocados are deliciously creamy, too.

Make a chocolate fruit salad. Fruit salad can also benefit from a monounsaturated fats—watermelon, cantaloupe, and peaches are all rich in carotenoids. Consider adding sliced almonds to fruit salad or top with a few semisweet chocolate chips, which also contain some monounsaturated fat.

Remember, adding the right dressing can help you get the most flavor and nutrients from your salad.


Citrus–Honey Dressing

Makes 4 servings.

The clean, tangy taste of this dressing complements any salad. And with just three ingredients, and it’s simple to whip up.


  • 1/4 cup fresh-squeezed lime or lemon juice (about 1 large lemon’s worth)
  • 1 tablespoon honey
  • 1/4 cup olive oil


  • Whisk all ingredients together. Serve immediately. Refrigerate any leftovers and use within the week.
  • Note that olive oil may congeal in the refrigerator—simply shake or whisk to remix the dressing before serving.

Nutrition facts per 2 tablespoons: 139 calories, 14 g fat, 2 g saturated fat, 9.8 g monounsaturated fat, no trans fat, no cholesterol, 1 mg sodium, 6 g carbohydrate, no fiber.


Ginger–Cashew Dressing (Adapted from Moosewood Cookbook by Mollie Katzen)

Makes 4 servings.

This Asian-style dressing is great on coleslaw or on tossed salad topped with mandarin oranges. You can make a Ginger-Peanut variation easily as well.


  • 1/2 cup toasted cashews (or 1/3 cup smooth peanut butter)
  • 1/4 cup water
  • 2 teaspoons minced fresh ginger (or 1/2 teaspoon powdered ginger)
  • 1 teaspoon soy sauce
  • 1 teaspoon honey
  • 2 teaspoons cider vinegar
  • pinch cayenne, to taste


  • If using cashews, puree everything together in blender. Or, if using peanut butter, simply whisk all ingredients together.
  • You may add extra water if you enjoy a thinner dressing.
  • When it is as smooth as you like it, serve or transfer to tightly lidded container and refrigerate.

Nutrition facts per 2 tablespoon serving Cashew–Ginger Dressing: 106 calories, 8 g fat, 2 g saturated fat, 5 g monounsaturated fat, no trans fat, no cholesterol, 87 mg sodium, 7 g carbohydrate, 1 g fiber, 3 g protein

Nutrition facts per 2 tablespoons Peanut–Ginger Dressing: 127 calories, 11 g fat, 2 g saturated fat, 5 g monounsaturated fat, no trans fat, no cholesterol, 119 mg sodium, 5 g carbohydrate, 1 g fiber, 5 g protein.

Jennifer Motl is a registered dietitian. Formerly of Fredericksburg, she now lives in Wisconsin. Jennifer Motl welcomes reader questions via her website,, or by email at

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Bright Eating: Cherries can ease pain, help you sleep


Here’s another reason to enjoy summer cherry season: Tart cherries may ease arthritis pain, help athletes recover faster and lead to deeper sleep.

First, the news on sleep, since sleep difficulties affect a quarter of Americans. A study of older adults suggested that those who drank cherry juice daily were able to fall asleep about 17 minutes faster than those who did not drink the juice.

Another study found less daytime napping among those who drank cherry juice.  And a small British study suggested that drinking tart cherry juice concentrate helped volunteers sleep longer and more deeply because it increased levels of melatonin, a natural sleep hormone.

University of Rochester Medical Center scientists said tart cherry juice was just as useful a sleep aid as two other natural remedies, melatonin and the herb valerian. (However, none of the natural remedies were as strong as sleeping pills or cognitive–behavioral counseling.)

So if you have insomnia, consider seeing your doctor, as well as drinking cherry juice.


If you have arthritis, eating more cherries may help ease your pain. Though not a substitute for a doctor’s care, tart cherry juice eased osteoarthritis pain by 20 percent for most men and women in a study at Baylor Research Institute.

Cherries can ease joint and muscle pain because they contain anti-inflammatory compounds. In fact, the natural anthocyanins from raspberries and sweet cherries work similarly to ibuprofen and naproxen (brand names Advil and Aleve), according to scientists at Michigan State University.

Cherries contain natural versions of COX-1 and COX-2 inhibitors just like the drugs, although in smaller amounts. Cherries also contain several other antioxidants not found in pills.

Cherries also are useful for folks with gout, another type of arthritis. Gout is a disease caused by high levels of uric acid in the blood. The uric acid forms sharp crystals in the joints, causing pain.  When volunteers ate 10 ounces of cherries, their uric acid levels dropped 15 percent.


Tart cherries can help weight-lifters and runners. Lifting weights temporarily damages muscles and causes a temporary weakening before the muscles get stronger. Volunteer weight-lifters who drank 12 ounces of cherry juice daily for over a week lost only 4 percent of their strength, compared with 22 percent losses in folks who didn’t receive cherry juice. Researchers at University of Vermont did that study.

Cherry juice helps runners, too. Drinking 12 ounces of tart cherry juice daily for seven days prior to and during a long-distance race can minimize muscle pain. That’s according to research at Oregon Health and Science University.

Another study found that marathon runners who drank cherry juice recovered their leg strength more quickly. The cherry juice reduced inflammation, according to British researchers.


Not all cherries are the same. It’s easier to find sweet Bing cherries than tart cherries in grocery stores. That’s because tart cherries are so fragile.

Tart cherries, also called sour cherries or pie cherries, are in season now in Virginia, so check your farmers market or local orchard. If you can’t find fresh tart cherries, you can always buy tart cherry juice year round as well as dried cherries and frozen cherries.

A cup of fresh or frozen tart cherries has only 60 calories, less than many other fruits, and cherries are rich in beta-carotene.

You can use dried cherries like raisins: sprinkle dried cherries over your breakfast cereal; try adding them to oatmeal cookie dough or brownie batter, or use them to top salads, along with pecans and cheese.

Fresh or frozen cherries can be added to muffin mixes, used as a topping for ice cream or cheesecake, stirred into yogurt or blended into smoothies.

However you eat them, cherries may ease pain and insomnia.


Serves 4


  • 4 cups water
  • 1 pound fresh or frozen tart cherries,
  • pitted
  • 2 cinnamon sticks and 6 cloves
  • (optional)
  • cup sugar
  • 7 ounces Greek yogurt
  • (whole milk, not nonfat)
  • 1 tablespoon flour


  • Add water, cherries, sugar, and optional cinnamon and cloves to saucepan. Boil for 10 minutes, or until sugar is dissolved and cherries are tender.
  • In a mixing bowl, add yogurt and flour to a cup of the hot cherry liquid and whisk until smooth.
  • Add yogurt mixture to cherry soup pot and simmer for about 5 minutes to thicken.
  • Remove cinnamon sticks and cloves, if used.
  • Cover and chill soup in refrigerator before serving. If juice separates, simply stir soup before serving.

Nutrition facts: Calories 204, Total fat 2.5 grams, Saturated fat 1.8 grams, Trans fat no grams, Cholesterol 6 milligrams, Carbohydrates 41 grams, Fiber 2 grams, Protein 6 grams.

Cook’s note: In Hungary and surrounding countries, tart cherries are sought after for a traditional summertime dish, chilled cherry soup. This luscious, pink appetizer or dessert is traditionally made with sour cream, and you can substitute Greek yogurt to boost the nutrition yet preserve the wonderfully creamy taste. Use whole-milk Greek yogurt, not the nonfat variety, for richer taste. The overall recipe is actually still low in fat.

Recipe adapted from:

Jennifer Motl is a registered dietitian. Formerly of Fredericksburg, she now lives in Wisconsin. Jennifer Motl welcomes reader questions via her website,, or by email at

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New Horizons: Fall in love with your body


Remember line from a famous Stephen Stills song? “If you can’t be with the one you love, love the one you’re with.”

Well, look in the mirror right now. You gotta love the one you’re with—your body, that is. You don’t get another one. I am sorry if I dashed anyone’s dream of waking up one morning to find you’ve suddenly morphed into Jennifer Aniston or Brad Pitt.

In your most raw state, look in the mirror—a full length one if possible—and if you don’t already love yourself, think about how you are going to fall in love with your body.

Even if it doesn’t function very well or look the way you want it to, this body needs you.

It’s loyal. It will be there until the day you die. It can take you to amazing places and help you do amazing things. It needs your attention, your confidence, your kick-butt enthusiasm and your gentle loving care.

Think about this: If you had a brand new Mercedes convertible sitting in your driveway now, you would take care of it. You might put only premium gas in the tank. You might keep it polished. And you would certainly go to the trouble of changing the oil regularly.

But many of us don’t love our bodies even that much, even though we can—and should—learn to love our bodies for the same two reasons we love a shiny new car: functionality and looks.

So how do you fall in love with (or even just accept) the way you look, especially as you age?

If you struggle to adore your own body, try this:

First, stop with the endless comparisons. Unless you are a movie star or a model, then you don’t need to worry about looking like the conventionally beautiful people in the movies or on the magazine covers.

Those folks have teams of people—personal trainers and hairdressers—making sure they look that way. What a hassle it must be to be perpetually beautiful. That would take so much work.

Accept your body type. Everyone has a look that is genetically predetermined, and we need to look for the good in what we’ve been given.

If you are shaped like a pear, why live your life wanting to be an hourglass? Why be a short person longing to be tall, or a tall person longing to be shorter?

Try to find the good in what you’ve got. For example, small-breasted women get to sleep on their stomachs, and large-breasted women get cleavage.

Honor what makes you different. One of my daughters has a pretty large birthmark on her arm, and one day when she was about 6, I asked if it bothered her: “Oh, no” she said with surprise, “That is my marker!”

The things that set you apart can be the things you like the most.

If you are older and wiser, you may have learned to appreciate some of these things about yourself already.

But as we age, our bodies change. We have to expect that our bodies will eventually succumb to gravity. Everything will drop a little—our eyebrows, skin, boobs, belly, maybe even our height.

So as we age, our thoughts may shift into wondering how to protect our body’s ability to function as we want it to. This is the use-it-or-lose-it time of life.

For advice on keeping our bodies running well, I turned to an expert, Dr. Barbara Ehman, a physical therapist and part owner of Orthopedic and Sports Physical Therapy Associates in Fredericksburg.

Here’s her advice:

First, know your genetics. If you want to keep things working right, know what you need to watch out for: osteoporosis, heart disease, etc.

Second, find out what is going on in your body physically by going to your primary physician and getting a physical checkup. If something is going wrong, you want to know what it is so that you can try to fix it.

Finally, put effort into improving your body’s functionality. This is like tough love. As the saying goes, “The man at the top of the mountain didn’t just fall there!” So, work for it!

While you work to keep the good parts running smoothly, don’t forget to love the parts that don’t work perfectly. For example, if you are carrying extra pounds around with you, love your body the way it is today—without giving up your hard work and intention toward improvement.

We all know: “You are what you eat.” I just watched “Fat, Sick and Nearly Dead.” This documentary of an Australian businessman who goes on a juice fast really made me think about the connection between what we eat and how our body feels and functions.

If you value your body a little more, it may help you munch on the good stuff more often.
Realize that this is a process. If you have some injuries to work with or battle scars to live with, remember that falling in love takes a little bit of time. You have to forgive mistakes and foibles. When we genuinely love, it has to be warts and all.

I got a great reminder recently about how we can view an aging body through a loving and beautiful lens. It was at a FredCamp graduation ceremony for my daughter.

FredCamp is a great community outreach program where teens and adults work together to improve the living conditions for families not able to do so themselves. For a week of summer break, the teens and adults rise early to do things like build ramps for people in wheelchairs.

At the end of the week, there was a program that started with a slide show. The speaker showed a picture of a pair of hands—his grandmother’s hands. They were wrinkled and gnarled bit from arthritis.

He explained that these hands, spotted with age, have done a lifetime of good deeds. “Those hands are the most beautiful hands I have ever seen,” he said.

Dr. Delise Dickard is a life coach, psychotherapist and director of Riverside Counseling. She welcomes reader feedback. For contact information, visit

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Fit After 50: Strive to maintain ‘functional fitness’


My dad walks in the road. Close to the curb, where the asphalt slopes down to allow rain to run off—but he’s still in the road.

Somebody drove by him on one of his recent pre-dawn walks and called my sister. “Saw your father walking in the street this morning. Everything OK?”

The polite suggestion was that maybe Dad, who is 85, is getting senile and we need to keep closer tabs on him.

Dad had an explanation, though. His right hip has been bothering him, causing his foot to drag—nothing significant, but enough to be an aggravation. He still wanted to go for his daily walks and figured if he moved from the level sidewalk and onto the road, going with traffic, his foot wouldn’t drag since the asphalt would be lower on his right side.

So far it’s working, he said. And he assured my sister he wears light-colored clothing so nobody will run him over.

Dad has an engineer’s mind, and his strategy makes a kind of engineer’s sense, though I still think he should get his hip checked out. But I do admire his tenacity, and I think we can all learn a lot from it. The old Appalachian Trail hiker and one-time marathon runner has slowed down over the years, but he hasn’t stopped moving.

As we age, what matters to most of us isn’t how fast we can run or how far we can swim, but how well we can manage the ordinary tasks each day brings.

Can we carry our groceries? Keep up with a friend on a walk? Toss a ball with our kids?

Considering everything else Dad does, he’s not just a lesson in perseverance, but in maintaining what’s called “functional fitness”—the ability, and the confidence in that ability, to do all these things. calls functional fitness and functional exercise “the latest gym buzzwords,” designed to build a body “capable of doing real-life activities in real-life positions, not just lifting a certain amount of weight in an idealized posture created by a gym machine.”

You can work on functional fitness in a gym, with a trainer, of course. (see the infobox for more details). Or you can work on maintaining functional fitness through daily activity, like my dad does.

Here’s his schedule: His morning walks end in a cool-down stroll through his retirement community. But not just any stroll. Dad stops in front of every house, picks up the newspaper from the yard, and walks it up to the porch.

After breakfast, he drives over to his church to pick up and deliver “commodities”—which is what he calls the donated food and clothing church members collect for the homeless shelter and the food bank. He also delivers Meals on Wheels. Most of his deliveries go to people much younger, and considerably less mobile, than he is.

In the late afternoons, he goes swimming and is often the only person in the retirement community pool. After 15 or 20 minutes of slow but steady laps, he’s finally ready to call it a day. Sometimes he parks himself in the hot tub next to the pool for a few minutes afterward. Sometimes he just naps in a deck chair.

On Saturday nights, he walks over early to the community center and sets up the tables for bridge.

Lately he’s been complaining about how tired he gets. He even admitted to feeling “kind of old.” But when I suggested he take a couple of days off from all this activity, he wouldn’t hear of it.

It’s always a good idea to work in some recovery time, especially as we get older, to allow sore muscles a chance to repair themselves. But as Dad knows, it’s a use-it-or-lose-it situation for him and everyone else who’s getting on in years.

Muscles naturally atrophy with age, but they atrophy even faster with sedentary living.

It’s been only a few years since Dad stopped building houses for Habitat for Humanity and participating in church mission construction projects, and he misses the physical challenge and the sense of purpose those things always gave him.

So he’s not about to give up any of the things he can still do—like ushering at his church, riding his bike the mile and a half around a lake near his house, and still occasionally paddling around the lake in his kayak, not so much for the sport but to pick up trash.

What all this adds up to for him, and for the rest of us who commit to seizing opportunities for exercise and physical activity throughout the day, is freedom.

It’s the principal thing most people fight against losing as they age—freedom to live independently, without the need for help, with the ability to live as they please.

Because my Dad’s always moving—bending, lifting, carrying, throwing, swimming, paddling, walking—he has greater strength, flexibility, balance, and range of motion than most of his contemporaries. And he doesn’t need to go to the gym to get training to be functionally fit, either (though he’s spent plenty of time there, too).

He’ll never again run a marathon or hike the AT. And his need for recovery time will increase as fatigue and bum hips continue to bother him. He’ll have more and more days when he feels “kind of old.”

But the freedom a lifetime of exercise and daily physical activity have given him—and can give most of us—will always be worth the aches and pains.

Now if we can just figure out a way to get my Dad to stop walking in the road.


Steve Watkins is an author and retired college professor who teaches yoga at the YMCA in Stafford County and at Read All Over bookstore in Fredericksburg. He can be reached at

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Senior Moments: Navigating Medicare’s maze


Oftentimes I am asked, “Why did they make Medicare so difficult to understand?”

My set answer is, “I don’t know; the government has never asked my opinion in developing these policies.”

I’ve spent my time trying to understand the peculiarities of Medicare, instead of the idiosyncrasies of the government.

Medicare has 4 parts: Part A (hospitalization), Part B (medical), Part C (Medicare Advantage) and Part D (prescription drugs).

Most people 65 or older and those certified disabled through the Social Security Administration for 24 months are entitled to Medicare Part A.

Part A has been paid for through one’s working years via payroll taxes, provided you accumulated at least 40 quarters, or about 10 years, of Medicare covered employment.

Part B has an annual deductible and a monthly premium; 2012 enrollees pay $99.90. Beneficiaries whose modified adjusted gross income is more than $85,000 as an individual or $170,000 as a couple pay as much as $319.70 per month.

Part C, Medicare advantage programs, are a choice, and the premium varies.

Part D, which covers prescription drugs, also is optional, but comes with a penalty if you choose not to participate initially and later decide to. Plans have premiums that vary from $15.10 to $118.70 per month, and there is an annual deductible.

Now that we have the basics of Medicare out of the way, let’s talk about what it covers. Of course your stay in the hospital, your doctor visits and lab work are all covered by Medicare.

It covers rehabilitation in skilled nursing facilities, oftentimes referred to as SNFs. Medicare pays in full for up to 20 days and will pay the majority of your stay up to 100 days, along with your supplemental insurance, as long as you continue to show progress in your therapies.

Therapies covered in skilled care facilities are physical, occupational and speech, and they include coverage of social and psychological services, nursing care, drugs you cannot give yourself and durable medical equipment.

Medicare covers outpatient therapies at a different rate. It can include services mentioned above as skilled care, but you must go to a Medicare-certified provider multiple times per week.

If you’re “homebound,” Medicare will pay for home health agencies. Covered on a limited basis are cardiac rehabilitation, covered at two one-hour sessions for 36 weeks; and pulmonary therapy, which is limited to a maximum of 36 sessions, with no more than two sessions per day.

Medicare provides coverage of some ambulance transports, particularly in emergencies, but certain criteria must be met.

Many items are covered under durable medical equipment, including wheelchairs, scooters, walkers, hospital beds, home oxygen equipment, prosthetics and orthotics.

Medicare coverage includes testing, fitting or training in the use of prosthetics and orthotics. People with diabetes are allowed one free pair of shoes with orthotic innersoles per calendar year. They can also get diabetic supplies (glucose monitors, lancets and testing strips). Foot care to monitor for nerve damage is covered every six months.

Medicare also pays for annual glaucoma screenings.

I just recently learned that Medicare offers outpatient nutrition counseling covered by Part B to people with diabetes or kidney disease who are not on dialysis.

Medicare covers hospice care to help manage your pain and symptoms. Hospice care is an all-inclusive type of benefit depending on your condition. For some people, hospice is prescribed at end of life, for others at “failure to thrive.”

Hospice covers nursing care, personal care, skilled care, durable medical equipment, respite for the caregiver, medications for pain relief and symptom control, as well as spiritual and emotional support.

The mental health parity law has forced Medicare to bring the individual’s out-of-pocket expenses for mental health services more in line with those of health care. Unfortunately, they will not be balanced until 2014. This year, the initial outpatient visit will be covered at 80 percent, with subsequent visits covered at 60 percent. They also cover in-hospital and partial hospital stays, as well alcohol and substance-abuse treatments.

The last coverage item to discuss is preventive services. With the Affordable Care Act, most of these services are now covered at 100 percent.

These include screenings for colon cancer, prostate cancer, mammograms, pap smears/pelvic exams, cardiovascular risk reduction, alcohol misuse, depression, sexually transmitted infection and obesity.

Smoking cessation counseling is covered at 100 percent for those who do not have a smoking-related illness and 80 percent for those who do.

Three vaccines are fully covered: flu, pneumonia and hepatitis B.

A history and physical are covered at 100 percent for those who are within the first 12 months of Medicare.

Medicare is a topic that political pundits like to toss around to jolt the other party into a state of fear, yet somehow when all of the benefits are shown together, it makes me proud to be an American.


Free individual insurance counseling is available through the Virginia Insurance Counseling and Assistance Program. Counselors can help you resolve claims or billing problems, file for benefits, and sort through statements and notices.

In the Fredericksburg area, VICAP is based at the Rappahannock Area Agency on Aging, 540/371-3375.

Valerie Hopson–Bell is a geriatric care adviser at ElderCare Connections LLC. She can be reached at 540/419-4387 or

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Legal Ease: Medicaid tests your needs


There are more misconceptions about Medicaid than any other program affecting seniors today.

I get asked questions every week about Medicaid and many of you have a preconceived idea or have heard something that is just not true about the program so I am going to begin this series with the basics—separating the fact from the fiction.

The first step is distinguishing Medicaid from Medicare.

Medicare is a federal health insurance program provided to elderly and certain disabled U.S. citizens/permanent residents.

Medicare consists of four parts: A, B, C, and D and is offered to those who are at least 65 years old, less than 65 years old and disabled, or in end-stage renal failure requiring dialysis or a kidney transplant. In addition, those eligible must be U.S. citizens for 5 contiguous years and must be eligible for Social Security benefits and contributed to the Social Security system for at least 10 years. As most of you are aware, payroll taxes fund the Medicare program.

Medicare Part A pays for hospital stays, some home health care for rehabilitation services, and inpatient rehabilitation services. There is no monthly premium for Part A as these services are covered by payments made through your lifetime payroll taxes.

Medicare Part B covers physician’s services, X-rays, tests, dialysis, and various other items. There is a monthly premium for Part B and an annual deductible.

Part C (or Medicare Advantage Plans) are customized to meet your own medical needs and may be coupled with private insurance.

Medicare Part D covers prescription drugs and requires a monthly premium and annual deductible.
Medicaid is a need-based health and medical services program with oversight provided by the federal government; however, each state administers its own program and eligibility standards.

In Virginia, Medicaid rules and regulations are found in the Virginia Medicaid Manual and eligibility is determined by the local Department of Social Services.

There are no age restrictions for Medicaid, as the program is designed for all U.S. citizens who have little to no income.

For our purposes; however, we will focus on Medicaid for folks who are over the age of 65 and may need long-term care.

Virginia’s Medicaid Manual is more than 2,000 pages and is updated twice a year so I cannot cover everything in the manual, just those sections pertinent to older folks in the community.
In Virginia, in order to be eligible for Medicaid long-term care assistance, six tests must be met.

First, the individual applying must be a Virginia resident at the time the application is filed; however, there is no specific time requirement as a Virginia resident.

Next, the applicant must be part of a covered group (i.e. aged, blind, disabled or otherwise in need medically).

Third, the applicant must meet certain criteria known as average daily living skills (known as “ADLS”).

Fourth, the applicant must meet income standards currently set at three times the maximum Supplemental Security Income rate per month (the maximum SSI monthly rate for 2012 is $698). If the applicant’s income is more than this, he or she may still be eligible if medical expenses exceed this income amount on a monthly basis.

The fifth test is the resource eligibility amount, which is currently set at a $2,000 maximum in countable resources. Several exclusions apply such as a personal vehicle, prepaid burial arrangements, life estate interest in real property, and the applicant’s personal residence if married or otherwise excluded, among several other exclusions.

The final test is the asset-transfer evaluation, and this is where people get in trouble.
Most applicants who apply for Medicaid meet the first four tests without a problem. Tests number five and six above; however, are where the land mines are placed and things get tricky if you do not know the rules.

Next month I will go into detail regarding the last two Medicaid eligibility tests and hopefully clear up the misconceptions out there. I will discuss spousal protections, including the personal residence and the minimum monthly maintenance needs allowance (the MMMNA) and the five-year gifting and transferring “look-back” rule, which comes into play for the sixth test of asset transfer evaluation.

Elizabeth McMaster is an elder-law attorney in Fredericksburg. Email her at

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