In a recent discussion hosted by Steve Gurney of the Positive Aging Community, Lisa Pahl, a licensed clinical social worker and co-creator of The Death Deck, shared insights into her innovative tool designed to spark meaningful conversations about end-of-life decisions. With 18 years of experience in hospice care and eight years in emergency medicine, Pahl identified a critical gap in how families approach death and dying. Too often, the absence of prior discussions leads to conflict and distress when making healthcare decisions during a medical crisis. The Death Deck, created in 2018, aims to bridge this gap by encouraging open dialogue in a lighthearted yet profound way. Pahl, who became the sole CEO of The Death Deck after buying out her business partner in 2025, continues to expand its reach.What is The Death Deck?The Death Deck is a card game designed to make end-of-life conversations more approachable. By incorporating humor and multiple-choice questions, it helps individuals and families discuss sensitive topics without the heaviness that often accompanies them. Pahl explained that the deck was born out of her desire to reduce chaos and uncertainty at the end of life by empowering people to share their preferences well before a crisis. In 2023, Pahl and her team expanded their offerings with the EOL (End of Life) Deck, a professional tool tailored for hospice and palliative care settings. This deck adopts a softer tone with less humor, focusing on detailed end-of-life preferences.A third deck, the Dementia Deck, is set to launch on September 1st in collaboration with Compassion and Choices. This deck, inspired by their Dementia Values and Priorities Tool, helps individuals articulate care preferences for different stages of dementia, addressing a condition many fear more than death itself.Why These Conversations MatterPahl emphasized that discussing end-of-life wishes is like exercising a muscle—it requires practice to become comfortable. Many avoid these conversations due to fear, believing that talking about death might somehow hasten it. The Death Deck’s cards prompt reflection on personal and family attitudes toward death. For example, one card asks, “Growing up, my family dealt with death by: A) talking openly, sharing feelings, stories, and dark humor; B) in a no-nonsense sort of way—shit happens, you move on; or C) keeping it all bottled up and avoiding any discussion.” Pahl shared that her upbringing leaned toward options A and B, with humor often used to cope, while Gurney noted that his family leaned toward avoidance, but his professional work has shifted his perspective, encouraging more open dialogue.How The Death Deck is UsedThe Death Deck serves as a versatile tool for both families and professionals. For families, it provides a structured yet approachable way to discuss end-of-life wishes, often using humor to ease tension. Professionals, particularly in hospice and palliative care, find the cards useful for initiating conversations without making patients or families feel overly vulnerable. As Pahl noted, “It feels a little less vulnerable when I am reading something off a card than if I’m just staring into your eyes asking how you feel about visitors as you’re declining.”A Tool for Living WellUltimately, The Death Deck is not just about preparing for death—it’s about living more intentionally. As Pahl and Gurney discussed, reflecting on end-of-life preferences often prompts people to prioritize relationships and values in the present. For those interested in exploring this tool, The Death Deck and its companion decks are available at thedeathdeck.com, where additional resources and a blog provide further support for end-of-life planning. As Pahl’s work demonstrates, embracing these conversations can transform fear into empowerment, ensuring that both life and death are approached with clarity and connection.

Steve Gurney of the Positive Aging Community recently sat down with Tom Najjar, Co Founder & President, and Heather Najjar, Co Founder & Chief Clinical Officer of CarePlus Home Health, to reflect on the organization’s three decades of service, its deep roots in the community, and its vision for the future.A Personal Start Focused on QualityCarePlus Home Health was founded in 1995 when Tom Najjar was caring for his father during end-of-life. The experience inspired him to launch CarePlus not only as a business but as a mission to provide quality, compassionate care. From the start, Tom emphasized quality over growth: “We wanted to have a good reputation and rely on referrals rather than advertising. We built a reputation we’re proud of and made many partnerships within the community.”Leadership with Clinical StrengthHeather Najjar, a doctorally-prepared nurse practitioner with 32 years of experience, helms the clinical side of CarePlus. She leads a robust team, all registered nurses, ensuring education and professional development are continual priorities. “Our clinical leadership team is especially strong,” Heather shared, highlighting ongoing training and opportunities for caregivers to develop their skills.Flexible, Community-Based CareCarePlus stands out for its adaptable approach to home care. The organization has established close partnerships with a variety of residential settings, including independent and assisted living communities, and offers what it calls "flex care." This allows clients to receive services starting at just 30 minutes and up to full 24/7 care, making professional support accessible and affordable even for those who might only need occasional help.Heather noted the unique value CarePlus brings to independent living communities that lack in-house healthcare: “We fill the gap where there’s either no care or not enough care, providing everything from hands-on support to light housekeeping and transportation.”Commitment to Excellence in TrainingA key differentiator is CarePlus’s investment in professional training. All caregivers undergo an annual two-day skills event as well as in-person orientation and return demonstrations for new employees. The clinical team regularly refreshes caregiver skills and provides remediation when needed. Tom credits much of the company’s reputation and client satisfaction to this strong foundation of education and support: “The strength is the clinical team, making sure our caregivers are up to speed on what they need to know and do.”A Culture of Collaboration and Giving BackTom and Heather emphasized the importance of collaboration—both within their team and across the wider caregiving community. Tom reflected, “I don’t look at competitors as competitors. We refer to and rely on each other for services and information. It makes us all stronger.” This collaborative ethos extends to supporting other agencies and building a network of trusted providers.Looking Back and AheadWith staff members who have remained part of the CarePlus team for decades, Tom and Heather are proud of the supportive community they’ve built, not only among clients and families but also within their own organization. As Heather summed up: “I love the focus on training and a career path for our caregivers. It's a wonderful mission.”As CarePlus enters its fourth decade, the Najjars’ commitment remains unwavering: delivering personalized, quality care while supporting caregivers and the entire community. Their story showcases what’s possible when compassion, professionalism, and community engagement come together in service of others.

Wound care is a vital aspect of healthcare, particularly for people with chronic or complex wounds, such as diabetic foot ulcers, pressure ulcers, venous leg ulcers, and post-surgical wounds. In the United States, these wounds affect about 6.5 million individuals, with annual costs exceeding $25 billion. They commonly arise from diabetes, poor circulation, or immobility, and if left untreated, can result in infections, amputations, and reduced quality of life. Recently, mobile wound care has emerged as an innovative solution that brings specialized treatment to patients’ homes or care facilities. This article synthesizes the essentials of wound care, highlights the benefits of mobile wound care, and shares insights from a Positive Aging Community discussion with Ashley Harris (Advanced Mobile Wound Care of Virginia) and Andre Atkins (Alternate Solutions Home Health).

Watch the episodeWhat is Wound Care?Wound care comprises medical interventions to promote healing and avoid complications in wounds that don't heal naturally. It involves cleaning, debridement (removing dead tissue), dressing changes, infection prevention, and advanced therapies like biologic grafts or negative pressure wound therapy.Benefits of Mobile Wound Care1. Accessibility and ConvenienceMobile wound care overcomes logistical obstacles—patients no longer need to arrange transportation or travel long distances. Providers deliver care wherever the patient resides, ensuring consistent treatment for those with mobility or scheduling challenges.2. Advanced Technologies and ExpertiseMobile providers use advanced tools like biological placental grafts and ultra-mist debridement systems, increasing comfort and healing rates. These certified specialists focus only on wound management for high-level care.3. Improved Compliance and HealingPain, transportation, or dissatisfaction can lead to missed appointments and slow healing. Mobile care ensures regular visits, cutting down cancellations and enhancing adherence. Consistent care can reduce hospitalization rates and risk of reinfection.4. Personalized, Collaborative CareTreatment plans are tailored in collaboration with physicians, home health agencies, and caregivers. Providers like Harris emphasize close work with home health teams to ensure continuous care between visits.5. Patient Choice and EmpowermentPatients can request mobile wound care, especially when traditional options are inaccessible or ineffective, giving them more control over their healing journey.6. Support for Care FacilitiesMobile wound care reduces administrative burdens for care facilities by providing on-site expertise, letting staff focus on daily caregiving while residents receive specialized treatment.While mobile wound care offers notable advantages, some cases may still require hospital-based interventions. Availability can vary by location, and the post-pandemic loss of experienced clinicians has made these specialized teams even more valuable. Mobile wound care teams combine advanced skills with patient education, supporting effective wound management between visits.Overall, mobile wound care is a major advancement for patients with chronic or complex wounds who face barriers to traditional care. By delivering specialized, evidence-based treatments at home or facility, providers like Advanced Mobile Wound Care of Virginia and Alternate Solutions Home Health are improving healing, reducing complications, and elevating quality of life. As highlighted by Harris and Atkins, the combination of advanced technology, expertise, and patient-centered care makes mobile wound care a transformative option for those in need. To learn more, individuals can contact providers or consult their home health agency about available options, as mobile wound care continues to grow as a compassionate, effective solution.

The phrase "I'm not ready yet" is a common refrain in elder care, as Steve Gurney, founder of the Positive Aging Community, shared in a 2025 webinar. Heard daily for 35 years, it reflects hesitation to plan for aging, from housing to legal prep. A community-driven discussion, sparked by surveys and a concise PowerPoint, unpacked this sentiment's roots, risks, and solutions.What It MeansGurney’s slides listed key triggers: aversion to age-segregated living, affordability fears, emotional downsizing burdens, resistance to strangers in the home, and denial of health decline. Participants added depth via chat: Pam said, “We don’t see ourselves as old. I’m frozen at age 53.” Dixie noted, “Folks aren’t ready to face mortality.” These reflect self-perception and fear, often tied to ageism—prejudice against one’s future self.Why We HesitateEmotional attachment to homes, financial uncertainty, and independence fears drive delays. Gurney highlighted longevity concerns: with people living past 90, costs loom large. Health denial—“I’m fine now”—blocks planning for scenarios like dementia. Attendees like Wally feared becoming a burden, while Joe said it’s easier to imagine death than incapacitation.Risks of DelayProcrastination limits options, as Gurney’s slide warned. Health crises or emergencies force rushed choices, reducing control. Early planning ensures choice in living arrangements and access to benefits like social programs or peace of mind. Phyllis shared her mother’s 19-year dementia journey, showing aging in place is possible but tough without prep.Helping OthersTo counter “I’m not ready yet,” Gurney advised empathy: “I get it—I don’t want to leave my home either.” Encourage open talks about fears, share stories of regretful delays, and suggest gradual steps like adult daycare “test drives.” Legal prep—wills, trusts, advance directives, HIPAA forms—was urged by attendees like Florence.Moving Forward“I’m not ready yet” is human but surmountable. The webinar’s breakout rooms fostered candid chats, reinforcing community as key. Planning now—whether for housing, care, or documents—offers control and dignity. As Gurney’s platform, positiveaging.com, provides resources, the message is clear: readiness shapes a purposeful future.

Engaging discussion features Steve Gurney from the Positive Aging Community and bestselling author Jane Heller, focusing on her book "You'd Better Not Die or I'll Kill You: A Caregiver's Survival Guide to Keeping You in Good Health and Good Spirits." Jane shares her journey from a book publicist to a successful author, highlighting her personal experiences as a caregiver for her husband, Michael, who has Crohn's Disease, and her mother, who had dementia. The conversation delves into the challenges and strategies of caregiving, including the importance of humor, maintaining personal health, and building a supportive community. Jane emphasizes the necessity of having an advanced directive and shares insights on dealing with medical professionals and the emotional toll of caregiving. The discussion also touches on the unexpected friendships and personal growth that can arise from caregiving experiences. Jane's candid reflections offer valuable advice and encouragement for those navigating the complexities of caregiving.

More information: https://janeheller.com/

Book on Amazon: You'd Better Not Die or I'll Kill You: A Caregiver's Survival Guide to Keeping You in Good Health and Good Spirits

Recording Link: https://www.retirementlivingsourcebook.com/videos/you%E2%80%99d-better-not-die-or-i%E2%80%99ll-kill-you-a-caregiver%E2%80%99s-survival-guide-to-keeping-you-in-good-health-and-good-spirits

Howard Gleckman, a senior fellow at the Urban Institute and Forbes columnist, provided a comprehensive overview of recent public policy changes affecting older adults. Drawing from his expertise in aging and tax policy—stemmed from personal caregiving experiences—Gleckman analyzed the implications of the Trump administration's "big beautiful bill" and related executive actions as of August 2025. The focus was on Medicaid and Medicare reforms, which could reshape long-term care, costs, and access for millions of seniors and people with disabilities.

Medicaid, which supports about 7.2 million seniors and 4.8 million younger disabled individuals (dual eligibles), faces a $1 trillion reduction in federal spending over the next decade. Key changes include:

• Work Requirements and Paperwork: Starting potentially in December 2026, states must impose work mandates, though older adults and those with disabilities are exempt. Family caregivers' status remains unclear, risking benefit loss for those quitting jobs to provide care. Recertification is now required at least twice yearly, increasing administrative burdens and potentially deterring eligible recipients.
• Funding Reductions: Limits on state provider taxes (e.g., on nursing homes) will cut federal contributions by about $120 billion starting in 2028. Expansion states under the Affordable Care Act lose extra funding from January 2026, forcing tough choices: cut benefits, limit eligibility, or raise taxes. Gleckman warned that optional home and community-based services (HCBS) are most vulnerable, as nursing home care remains mandatory. While the bill allows states to expand HCBS for less needy individuals without lengthening waitlists, funding cuts make this unlikely.
• Staffing and Workforce Impacts: The bill repeals Biden-era minimum staffing rules for nursing homes until 2034. Combined with mass deportations, this exacerbates shortages of direct care workers, driving up costs for facilities and families.

Gleckman emphasized that states may prioritize institutional care over community-based options, potentially worsening outcomes for older adults preferring to age at home.

Despite campaign promises to protect Medicare, changes aim to curb fraud, boost efficiency, and emphasize prevention—but at the risk of higher costs and reduced access:

• Prior Authorization Expansion: For the first time, traditional fee-for-service Medicare will require prior approval for 17 procedures (e.g., back surgeries, pain injections) in a six-state demo (New Jersey, Ohio, Oklahoma, Texas, Arizona, Washington). CMS plans to use AI for reviews, with human oversight.
• Payment Adjustments: Skilled nursing facilities see a 2.8% payment increase for 2026, deemed insufficient by the industry. Home health agencies face a 6.4% cut ($1 billion+), sparking bipartisan opposition. The Labor Department repealed Obama-era rules, allowing home care workers to earn below federal minimum wage ($7.25/hour) and exempting them from overtime, per state laws.
• Enrollment and Programs: Easier enrollment in Medicare Savings Programs (for low-income beneficiaries) is delayed until 2034. The GUIDE program for dementia care navigation continues but with penalties if it fails to improve outcomes or save money. Value-based care is expanding, rewarding providers for quality over volume.
• Drug Pricing and Hospice: Trump favors "most favored nation" pricing to align U.S. drug costs with foreign markets, potentially supplementing Biden's negotiations. Hospice faces crackdowns on alleged fraud, though details are pending.

Gleckman noted deregulation of nursing homes (e.g., rolling back transparency rules) and potential reductions in Medicare Advantage supplemental benefits like gym memberships due to insurer financial pressures.

An engaging and informative live & interactive session where Aging Life Care Managers® come together to share their knowledge and best practices. 

• Marie Woodard ([email protected])

• Megan Descutner ([email protected])

• Soni Pahade ([email protected])

Summary of the Chat Transcript (see full transcript here):

• The discussion centers around Aging Life Care™ (also known as geriatric care management), its role, certifications, and practical considerations for families and professionals caring for aging adults or those with disabilities. Key themes include:
• Resources Mentioned

• International Commission on Health Care Certification (ICHCC)
  Website: www.ichcc.org
  Provides Certified Geriatric Care Manager (CGCM) credential, though not ALCA-recognized.

• Booklet by Soni Pahade

  • Details and questions for interviewing Aging Life Care Managers (available through Soni—no direct upload provided in chat).

• Retirement Living Sourcebook Article
  Understand Aging Life Care™ – Guides and advocates for families
  Website: www.retirementlivingsourcebook.com (link noted as non-functional in chat).

• Legal Advice:

  • Any qualified estate planning attorney can update wills and POAs, no need to return to the original drafting attorney.

  • The importance of elder law attorneys for legal matters related to aging.

• HandyPro (Ali Soltani contact)
  Website: handyprowdc.com
  Offers free consultation services in VA, MD, and DC area.

Mindy Mitchell’s story, shared in a candid conversation with Steve Gurney of the Positive Aging Community, offers a compelling narrative about solo aging, decision-making, and the importance of listening to one’s heart. As a 73-year-old woman who identifies as a “solo ager,” Mindy’s journey from a life plan continuing care retirement community (CCRC) in Washington State to a vibrant new life in South Florida underscores the value of adaptability, self-awareness, and community in navigating the complexities of aging alone.

Watch video and see full article here https://www.retirementlivingsourcebook.com/videos/real-life-story-navigating-solo-aging-life-plan-communities-ccrc-a-journey-of-self-discovery

In a recent interview with Steve Gurney of the Positive Aging Community, registered nurses Elisabeth Mack and Sherri Mack shared their expertise on plant-based therapy, specifically cannabis and hemp-derived products, for older adults. With decades of nursing experience, both have transitioned from traditional medical settings to pioneering the use of cannabinoids to improve quality of life, particularly for seniors. Their company, Holistic Caring and The Green Nurse, offers education, coaching, and consulting to help individuals navigate this evolving field Bloom Hemp CBD, their sister company, specializes in organic hemp-based CBD formulas tailored to target specific symptoms. They also provide free access to a nurse hotline and personalized care plans to support your wellness journey.

Personal Journeys to Plant-Based Medicine

Elisabeth Mack, MBA, BSN, RN, discovered cannabis as medicine after a bicycle accident left her reliant on high doses of ibuprofen and muscle relaxants. Introduced to CBD through a topical massage at her chiropractor’s office, she experienced reduced inflammation and pain after adding CBD extracts to her supplement regimen, prompting her to research cannabis extensively. This led to her book, Cannabis for Health: Become a Coach, and the development of training programs for healthcare professionals, nurses and patients.

Sherri Mack, BSN, RN, widely known as The Green Nurse, experienced a life-altering health crisis in 2012 that left her hospitalized in the ICU and dependent on numerous pharmaceuticals. Her turning point came when a 70-year-old nurse introduced her to cannabis, which enabled her to transition off 18 medications. Motivated to empower others through her experience, Sherri founded The Green Nurse. In 2021, she joined forces with Elisabeth’s Holistic Caring, creating a robust educational platform called Holistic Caring & The Green Nurse. This platform features a free network designed to help individuals adopt, optimize, and maintain holistic approaches to health and wellness using plant medicines.

Cannabis nursing has emerged as a recognized specialty, officially endorsed by the American Nurses Association in 2023. The National Council of State Boards of Nursing now requires nurses to be educated on cannabis as a form of medicine. Key resources, such as Cannabis: A Handbook for Nurses (featuring Chapter 9, "The Cannabis Nurse Experience," co-authored by Sherri) and Elisabeth’s book, offer valuable professional training. Their comprehensive 30-unit health coach program empowers nurses to incorporate cannabis therapy into their practice, broadening access to this specialized care.

Elisabeth and Sherri Mack are transforming how older adults approach plant-based therapy, offering a compassionate, evidence-based alternative to traditional pharmaceuticals. By combining their nursing expertise with personalized coaching, they empower seniors to manage pain, enhance well-being, and live their best lives. For those interested, their resources at Holistic Caring and Bloom Hemp provide a trusted starting point to explore this natural option.

For more information, visit Holistic Caring & The Green Nurse  https://holisticcaring.com/ or contact their free nurse line at 970-404-HOPE(4673) to begin your journey with plant-based therapy.

Interactive discussion with a live audience, featuring thought leader Wendl Kornfeld, provided an insightful and inspiring look into the challenges and solutions of “solo aging”—growing older without immediate family nearby. Hosted by the Positive Aging Community, the session brought together older adults from across the United States for a candid conversation on building support networks, fostering resilience, and finding belonging as we age.

Wendl Kornfeld’s personal story underscores the reality of solo aging. Married for over 40 years but without adult children and with a spouse in declining health, Kornfeld realized over a decade ago the importance of constructing a robust support team. She described how, in 2013, she began organizing small focus groups for older adults in similar circumstances. These meetings, initially held in private homes, evolved into a larger movement now known as "Community as Family." The group started with six attendees at New York’s Temple Emanu-El and now boasts a mailing list of more than 80, providing both practical resources and genuine friendships.

Kornfeld emphasized that community is as vital as resilience in navigating the later stages of life. Drawing from her experience and academic studies in the psychology of aging, she highlighted:

• Mutual Aid Philosophy: Support networks aren’t one-way streets—members both give and receive help. This mutuality is central to lasting, meaningful engagement.

• Practical Steps: Attendees were advised to widen their social circles by forming bonds with neighbors, colleagues, and through local organizations. Volunteering, joining “third places” like libraries and community centers, and taking the initiative to organize meetups are effective ways to foster connection.

• Professional and Legal Preparation: Kornfeld stressed the need for all older adults to have key documents—such as health care proxies and financial power of attorney—prepared. She noted that many of these forms are available for free from local Departments of Health and don’t always require legal assistance.

Participants openly discussed emotional hurdles, financial constraints, physical limitations, and isolation—especially for introverts and those with disabilities. Kornfeld explained that urban, suburban, and rural environments present different opportunities and challenges but encouraged everyone to seek out what’s available in their community, especially through county Departments of Aging.

The discussion was rich with personal stories—of pet owners bonding over dog walks, support groups forming around shared diagnoses, and strangers becoming trusted friends and even health care proxies. Kornfeld championed the idea that if you build it, they will come, encouraging attendees to start small support groups, develop mission statements, and be proactive about community-building.Full recording and more details here