Age-related macular degeneration (AMD) causes deterioration of the macula, the part of the eye that provides sharp, clear, straight-ahead vision. As many as 11 million people in the United States have some form of AMD, and that number is expected to increase to nearly 22 million by 2050, according to the BrightFocus Foundation, a nonprofit that supports research to end AMD, glaucoma and Alzheimer’s disease.
AMD can be passed from generation to generation, according to Dr. Steve Charles, a clinical professor of ophthalmology at the University of Tennessee and founder of the Charles Retina Institute.
“If you are the sweet daughter that brings her 85-year-old (mother) to my office for macular degeneration treatment, you need to get looked at,” Charles says, adding that there are nine genes responsible for the condition.
It’s not uncommon for those with macular degeneration to notice blurring of their central vision early on or to have difficulty reading. Some may see a dark spot or distortions such as straight lines that seem wavy, says Dr. David Boyer, a clinical professor of ophthalmology at the University of Southern California’s Keck School of Medicine in Los Angeles. To give an idea of what it’s like to have AMD, this video made available by the National Eye Institute shows how a grocery trip may appear.
Also, a person with AMD might experience contrast sensitivity, with difficulty distinguishing, for example, dark gray letters on a light gray background. “I have patients who come in who are 20/20 who tell me they can’t drive at night,” Boyer says.
Over time, some people may have difficulty recognizing faces. Eventually, without intervention, those with severe AMD may lose their central vision entirely, although they may still be able to see peripherally.
Possible Preventative Measures
Fortunately, genetics don’t tell the whole story. Environment also plays a role. For example, smoking increases your risk of getting macular degeneration almost sevenfold, while a healthy diet and regular exercise can help reduce this risk, Boyer says.
Eating fruits and green, leafy vegetables that have high levels of antioxidant vitamins — such as kale, spinach, broccoli and squash — may help to reduce the risk for AMD.
Boyer says research has shown that vitamins, such as the “AREDS 2” formulation, which includes vitamin C, vitamin E, zinc oxide, cupic oxide, lutein and zeaxanthin, have been shown to reduce progression by 25 percent and lower visual loss by 20 percent over a five-year period.
Still, Boyer does not initially recommend these supplements for people whose eyes don’t yet show any changes. “We have to be very careful because we don’t know what high doses of any of these (vitamins) over a 30-year period will do,” he says. “However, when patients show changes, then I would recommend the vitamins.”
Different Types of Macular Degeneration
There are two forms of AMD — wet and dry. About 90 percent of those with AMD have the dry form, and it progresses to the wet form in about 10 percent of patients, according to the American Macular Degeneration Foundation.
With dry AMD, lipid deposits called drusen are the hallmark. Drusen, found underneath the eye’s “retinal pigment epithelium,” a pigmented layer of cells next to the retina, can compromise the eye’s ability to metabolize waste products and lead to damage in the eye’s rods and cones. Rods help us see in low-light conditions; cones allow us to see color.
With wet macular degeneration, abnormal blood vessels leak blood and fluid into the macula causing blurred vision or blind spots. It’s possible for patients to have both dry and wet AMD.
“You can start with dry and it converts to wet,” Boyer says, adding that one eye may develop wet AMD while the other remains at the dry stage. “In those situations, the risk of developing wet AMD in the other eye is about 12 percent a year,” he says.
A 'Miracle' Treatment for Wet AMD
The most common treatment for wet AMD is anti-VEGF therapy. Charles explains that, “Every time nature wants to grow a blood vessel, it uses a molecule in the eye called VEGF (vascular endothelial growth factors).” Anti-VEGF medications act as a sponge to soak up VEGF in the AMD-affected area of the eye, Charles says.
You could call these medications “miracle drugs,” Charles says, because they have no ocular or systemic side effects. “Not a single patient got an allergic reaction and nobody required higher doses over time,” he says. The medications go by the names of Lucentis and Avastin, both made by Genentech and Eylea, made by Regeneron Pharmaceuticals.
Currently, Lucentis and Eylea are FDA-approved for macular degeneration treatment. Avastin was initially FDA-approved as a cancer agent, but is used by 70 percent of practitioners for treating wet AMD, Charles says. Avastin costs about $50 per injection versus about $1,850 per injection for Eylea and Lucentis. While these well-accepted treatments are covered by Medicare and other insurance, many plans will not allow patients to use anything by Avastin, Boyer notes.
Treatment with these drugs can go on indefinitely. Some of Boyer's patients are still maintaining their vision after being on the drugs for more than a decade. The sooner patients start on the treatments the better, since 70 percent of patients on these drugs are able to maintain the vision they had when they started, Boyer says.
Audre Slater, 88, who has battled macular degeneration for more than 20 years, is one such patient. She’s been able to maintain the vision in one of her eyes since Boyer started her on anti-VEGF medication. Unfortunately, prior to going to Boyer for treatment, she had already lost vision in her other eye.
For Slater, the effects of the anti-VEGF drugs have been profound for the vision in her working eye. “Since I went to Dr. Boyer with this forever ago, I just get a shot in my eye every two and a half months … and he keeps me seeing perfectly,” she says, adding that she’s still able to read.
Emerging Treatments for Dry AMD
Unfortunately, for dry macular degeneration, there are no such treatments. Many studies have proven unfruitful for the most part, Boyer says.
One treatment that has shown some promise in FDA trials involves injections of a drug called APL-2, made by Apellis Pharmaceuticals, to slow “geographic atrophy.” In this type of dry AMD, cells in the retina waste away and die.
Currently in research trials, APL-2 has shown to reduce the rate of geographic atrophy by 20 percent. But the tradeoff was an 8 percent increase in the wet form of the condition, Charles observes, adding that while this is not a magic bullet, it may make sense to try it together with an anti-VEGF agent.
The use of stem cells is also being looked at for dry AMD. But it is strictly in the experimental stage and Charles stresses the need for caution. Scam stem cell clinics have popped up in places likes Florida and Mexico. Charles says they use the wrong type of cells, obtained through liposuction, that couldn’t possibly help and could even cause blindness.
Treatments continue to evolve. With any form of macular degeneration, those affected should visit a qualified practitioner as soon as possible to learn how they can ultimately best preserve their vision.


The Basics About Age-Related Macular Degeneration

Maxine Lipner

Social distancing and stay-at-home orders due to the coronavirus (COVID-19) crisis have led many health care providers to conduct visits with patients through telemedicine — providing medical and mental health care using the internet and telecommunications technology. People who never wanted to try telemedicine before are suddenly getting a crash course in how it works.
Even those who may not have grown up with computers, tablets or smartphones are acclimating and giving this form of health care a try, says Dr. Michelle Lin, associate director of telehealth for the Mt. Sinai Health System in New York City.
“We have seen a dramatic increase in the proportion of patients using our telehealth services here at Mt. Sinai who are older and who have some chronic medical conditions,” Lin says.
More People Embracing the Technology
Before the crisis began, only about 10% of U.S. residents had used telemedicine, according to a July 2019 J.D. Power survey. Now, volume, at least at Mt. Sinai’s site, is 10 times higher than usual, she says.
"We have seen a dramatic increase in the proportion of patients using our telehealth services here at Mt. Sinai who are older and who have some chronic medical conditions."
While some Mt. Sinai patients using telehealth have COVID-19-type symptoms and are seeking guidance on whether they need go to the hospital, others are using it to avoid coming in contact with anyone who might be contagious. “We know the risk to older folks is higher when they do get infected, so I think it’s beneficial to both patients and providers to keep patients at home who are well enough,” Lin says.


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Medicare Allows More People 65+ to Use Telehealth
What’s more, the Centers for Medicare & Medicaid Services (CMS) has recognized the current need and recently changed Medicare telemedicine rules to accommodate patients, says Dr. Sirisha Mohan, clinical assistant professor at the Keck School of Medicine at the University of Southern California (USC). Mohan also is the department lead for telehealth at USC.
“Prior to all of this COVID pandemic, telemedicine was limited in terms of use because Medicare had more stringent guidelines on when telemedicine could be used for patients older than 65,” Mohan says. Medicare limited its use to rural patients, and they had to go to designated clinics or hospitals for their visits.
But, as of March 17, 2020, the rules changed, allowing more Medicare beneficiaries to receive medical advice from their doctors without going to a clinic or hospital. "CMS is expanding this benefit on a temporary and emergency basis," according to the agency's announcement.
Medicare announced these specifics about its telemedicine changes:
Medicare co-pays and deductibles still apply to telemedicine visits, but health care providers will be allowed to waive or reduce these costs.Clinicians must use an interactive, real-time audio and video telecommunications system. Medicare will waive penalties for potential violations of federal health care privacy laws if clinicians make good-faith efforts to serve patients.Hospitals and a range of health care providers can use telemedicine, including doctors, nurse practitioners, mental health professionals and nutrition professionals.Nursing home residents also can consult health care professionals via telemedicine.Many health care providers also offer “e-visits,” in which patients use a secured part of their health care provider’s website to fill in a questionnaire about their symptoms. Then, a doctor or other provider gets back to them with a treatment plan and, if needed, a prescription. E-visits work for non-serious medical issues in which in-person tests are unnecessary.
Novices Give Telemedicine a Try
As someone who is at increased risk for COVID-19, Barton Colin, 69, is one USC patient who has embraced the technology. With several chronic conditions, including chronic obstructive pulmonary disease (COPD) and chronic pain from a spinal issue, Colin was relieved that he could skip the difficult and risky trip to the doctor’s office.
“You watch on TV and there are six different categories (for COVID-19 risk) — five of them have me pinned right on as very vulnerable,” Colin says.
So, when his COPD lung condition flared up and he found himself gasping for breath, he decided to try telemedicine instead of risking an office visit. Making the virtual visit happen was as simple as clicking a link he received in an email from his clinic. Using his smartphone, he was able to see a tiny picture of the doctor on his screen and the practitioner was able to see him as well. It was a different doctor than he usually sees because his usual practitioner was off that day.
After looking over Colin’s chart, the doctor was up to speed and ready to help, prescribing Colin antibiotics. The medication helped at first, but two weeks later, he needed to reach out once more and was able to speak with the same doctor, who prescribed some additional medication.
Colin found the whole process very easy. “It was like calling up a friend and talking to him,” he says.
Likewise, Paul Fraser, 37, another patient at USC, found using telemedicine pretty straightforward. He opted to give the virtual approach a try, rather than the in-person follow-up visit he would have needed for the undiagnosed intestinal issues he was having.
"It was like calling up a friend and talking to him."
With COVID-19 on the rise, and serious diagnoses already ruled out, Fraser felt it would be easier to use telemedicine for his follow-up exam. The technology was simple to use on his laptop, he says. After clicking the link that was emailed to him, he first spoke with a customer service rep, who then directed him into a virtual waiting room. After a couple of minutes, Fraser's primary-care doctor showed up on the screen and the follow-up visit began.
Lin describes using the Mt. Sinai platform as very similar to a regular doctor’s visit.
“The first time you register, you have to enter a little bit more information to help us get to know you,” she says, adding that this includes standard information, such as your date of birth. Once patients input this information, they then fill out a quick questionnaire and enter a virtual waiting room, which alerts the doctors that they are there. “Then we open our video and you open yours,” Lin says, adding that the visit proceeds much as it would in the doctor’s office.
Telemedicine for Mental Health
Many people are now using telemedicine for mental health as well as physical health, moving forward with psychiatric follow-up appointments or psychotherapy sessions.
These days, Lauren Saletan, a licensed clinical social worker and psychotherapist in Nyack, N.Y., is conducting most of her therapy sessions virtually.
“I would say eighty percent or maybe eighty five percent have moved to online,” she says.
Saletan had to persuade several clients who had never used the video-chat app she uses before. Taking part in such a session just requires clicking on a link. Saletan encourages her clients to give it try, assuring them that it will be a lot like an office visit, and she’s found her clients agree. “Everyone has said, ‘Wow, it’s really like we’re together,’” she says.
In fact, she says it’s easy to forget it’s not an actual office visit. “I have been a therapist for over twenty-seven years and when we’re engaged and we know each other, it’s like we’re in the office,” she says. “As long as we’re connecting, it doesn’t matter whether it’s over a screen or in the office, is what I have found.”
Even after the pandemic subsides, Saletan believes some of her clients may wish to continue with telemedicine. “Some people may prefer it moving forward, because they’re working and life is busy. So, that will be a wait-and-see,” she says.


You Can Still See a Doctor, Through Telemedicine

It can be the bane of existence for those at midlife: the need to have reading glasses at the ready, particularly in darkened conditions like a dimly lit restaurant with a menu that lists dishes in type too small to decipher.
“Usually at around (age) 43 to 45, patients start noticing that they need to hold things farther out and they need more light,” says Dr. Daniel Durrie, clinical professor of ophthalmology at the University of Kansas Medical Center, and founder of Durrie Vision in Overland Park, Kan.
At the heart of this universal condition, known as presbyopia, is the lens in the eye. Our lenses naturally stiffen as we age, making it more difficult for them to change shape to focus on things close up. The stiffening is caused by “disulfide bonds” building up in the lens.
While the lens is still crystal clear at this point, the initial problem is getting it to focus for reading, Durrie says. This is known as stage 1 of dysfunctional lens syndrome. During stage 2, the lens begins turning yellow and gets a little bit hazy. By stage 3, the disulfide bonds build up so much, they block the light rays and cause a cataract, Durrie says.
Fortunately, for those in the early stages of presbyopia, there are a variety of options that can help minimize or even do away with the need for reading glasses. They include: corneal inlay devices; refractive surgery in one eye to help with reading and eye drop options now being tested in clinical trials that promise to temporarily enhance close-up work.
Pinhole Device Sharpens Vision
For patients with good distance vision who are frustrated by the idea of dependence on glasses for reading, a corneal inlay device in one eye may help provide near vision. Likewise, for those whose distance vision isn’t on par, it’s also possible to have that corrected first using refractive surgery, and then receive the inlay for near vision.
Currently, there is only one Food and Drug Administration (FDA)-approved corneal inlay: the Kamra (CorneaGen) inlay. This opaque, donut-shaped device is placed in the eye in front of the pupil, narrowing the pupil and producing a pinhole effect.
“What the Kamra does is it changes the optics of the cornea so that it’s like narrowing down the F-stop (aperature) in a camera,” Durrie says. “Any photographer would say, ‘Oh, that increases your depth-of-focus, so it gives you a better range.’”
The Kamra inlay is primarily for those whose lenses are just beginning to stiffen but are still clear, making it basically an option for people age 45 to 55. If the lens is already getting hazy, the Kamra inlay will only cut down further on the light, Durrie warned.
The Kamra inlay is placed in just one eye at a LASIK (laser-assisted in situ keratomileusis) surgery center in a 10- to 15-minute outpatient procedure. Unfortunately, neither Medicare nor private insurance cover this or other presbyopia procedures. Getting the inlay implanted in the eye costs around $2,000.
The 'Blended Vision' Technique
Another option for some patients may be “blended vision,” in which one eye is tweaked to allow for reading while the other is corrected for distance. In true monovision, one eye is fully corrected to see best for things near and the other completely for distance. With blended vision, there is less difference between the eyes, so the two prescriptions meld comfortably together. Durrie likens it to stereo music.
“In stereo music, everybody knows that the speakers are not playing the same song, but it sounds great,” he says.
The blended-vision correction, also known as mini-monovision, can be made with a laser procedure such as LASIK or PRK (photorefractive keratectomy), or with a technique known as SMILE (small incision lenticule extraction), says Dr. Richard L. Lindstrom, adjunct professor emeritus at the University of Minnesota in Minneapolis.
With LASIK and PRK, an excimer laser is used to reshape the cornea to let people read more easily. With SMILE, a femtosecond laser cuts a sliver of tissue beneath the surface, which is then removed through a tiny incision.
In some cases, this blended vision in which one eye is left slightly nearsighted, can provide patients with enough reading vision to make them happy, Lindstrom says. In other cases, however, this procedure may just be the first stage before implanting the Kamra inlay.
Lindstrom finds that the blended vision approach may work for patients up to about age 60. Even after this, it may be enough to give people good intermediate and distance vision and let them see their computer screen or their car’s dashboard.
Blended vision also is not covered by insurance. When done with LASIK, this runs about $1,950 per eye.
Eye Drops Being Tested
One non-surgical approach being tested in clinical trials is eye drops. There are two types of drops currently winding through the FDA regulatory process. Their availability is still several years out, and it's too soon to tell what they will cost, but these could be a great option for people who want a less invasive solution.
“The first set of drops just make your pupils small,” Lindstrom says, adding that the drops employ the same principle of pinhole optics as the Kamra inlay to increase the patient’s depth of focus. The idea is to put the drops in both eyes to allow for better reading during a four-to-eight-hour period, he says.
Another type of eye drop aims to counteract the process that stiffens the lens, allowing it to be more flexible again. One clinical trial including 75 patients showed measurable improvement in near vision with this type of eye drop. Lindstrom expects those results could translate into about a five-year reduction in age for the eyes. So, if someone is 50, it will restore the eyes back to the way they were at, say, 45. However, it would actually take about 400 patients to confirm this, he noted.
“That would be very attractive; it would be like a fountain of youth for your eyes,” he says. Ultimately, in the end, all of these options can functionally help to turn back time.


If You Hate Reading Glasses, Here Are Other Options

(This article appeared previously on Kaiser Health News.)
During Anne Soloviev’s semiannual visit to Braun Dermatology & Skin Cancer Center in Washington, D.C., in January, the physician assistant diagnosed fungus in two of her toenails. Soloviev is vigilant about getting skin checks, since she is at heightened risk for skin cancer, but she hadn’t complained about her toenails or even noticed a problem.
The assistant noted some unusual discoloration where the nail meets the skin. “They took a toenail clipping and said, yeah, you have a fungus,” Soloviev, 77, recalled.
So the physician assistant called a prescription into a specialty pharmacy with mail-order services (My Express Care Pharmacy), which would send medication to Soloviev’s Capitol Hill home.
It seemed like an easy fix to an inconsequential health issue. “I did not ask how much it cost — it never crossed my mind, ever,” said Soloviev, a former French teacher, who still works part-time.
Then the bill came: $1,496.09 for Kerydin, a topical medication originally produced by Anacor Pharmaceuticals and now a product of Sandoz, a Novartis division.
An Unwelcome Surprise
Soloviev is covered by Medicare, Parts A and B, and has supplemental insurance through her late husband’s government health benefits that covers prescription drugs. She also has a health reimbursement account (HRA), which contains almost $1,500 pretax dollars each year to pay for uncovered medical expenses. She typically uses that pot of money to cover co-pays for the other medicines she takes regularly.
The initial Kerydin prescription arrived by overnight mail, and an automatic refill came a few weeks later. Soloviev began swabbing it on the two toenails, as directed, having been told it would take about 11 months to treat the fungus.
She thought little of it.
But when Soloviev went to her local CVS to pick up another medication — a statin that is usually paid for by her HRA — she discovered her HRA reserve was empty.
Unbeknownst to her, Kerydin, which it turned out costs nearly $1,500 per monthly refill, had wiped out her entire reimbursement account.
The price tag is difficult to rationalize, experts said.
“Reality check — this is $1,500 for a medicine to treat [it],” said Wendy Epstein, an associate law professor at DePaul University, who researches health care law. “That’s quite a chunk of change.”
Leslie Pott, Sandoz’s vice president of communications, explained that Kerydin is patent-protected and priced “at parity” with its one market competitor, Jublia. She also pointed out that to secure a place on an insurer’s list of approved drugs — its formulary — the drugmaker often had to offer substantial discounts to insurers and various middlemen. “We have no visibility into the extent to which these discounts are passed onto patients or payers,” she wrote in an email.
Other Options Were Available
There are many prescription treatment options for toenail fungus — both older medicines in pill form and newer topical treatments such as Kerydin, said Dr. Shari Lipner, an assistant professor at Weill Cornell Medicine and director of its nail unit. The patient in this case would have been a candidate for “quite a few” of them, she said.
Patients are likely to pay less for the pills, for which a course of treatment lasts three months, compared with the newer topical treatments, noted Lipner, adding that the pills also seem to have greater efficacy.
In its application for Food and Drug Administration approval granted in 2014, Anacor Pharmaceuticals highlighted that a yearlong treatment of Kerydin completely cured toe fungus in 6.5 percent of patients for one trial and 9.1 percent of patients in another.
Over-the-counter treatments are also available, but there’s not much data on them, Lipner said.
Cost ‘Isn’t a Factor’ for Physicians
Xavier Davis, Braun Dermatology & Skin Cancer Center’s practice manager, said a drug’s price tag simply isn’t a factor when prescribers recommend a course of treatment.
“When our providers are treating patients, we’re not treating them based on what the cost’s going to be. We look for what’s the best care for the patient,” Davis said. “If the patient calls and says that’s too expensive, then we’ll look for alternatives.”
Dr. Kavita Patel, a nonresident fellow at the Brookings Institution and a practicing physician, said this process contributes to the problem. “My sister’s a dermatologist, and she’ll do the same thing — she’ll prescribe and she doesn’t know. You’re getting at many layers of how [messed] up the system is, starting with the doctor doesn’t know.”
And patients often don’t see the actual price. Or they see it too late, when they’re at the pharmacy counter picking up medicines they have been told they need or in a roundabout way discover unexpected payouts.
HRA Account Drained
In January, Soloviev’s insurance plan was billed the full price of Kerydin. Of that, $1,439.57 came from her HRA. The difference, $56.52, was covered by a patient-assistance program from the drug manufacturer, explained Jonathan Lee, a pharmacist for My Express Care.
In February, when Soloviev’s prescription was refilled, her plan was again billed the full drug price. But she didn’t know about that either. A manufacturer coupon was applied to cover what remained of her insurer’s $2,000 annual deductible and the $60 co-pay. Her insurance then kicked in to pay the difference.
Such patient-assistance programs and coupons are meant to insulate patients from cost sharing, so they don’t feel a pinch from a drug’s price. But in this case, the drugmaker’s patient-assistance program apparently took effect only once Soloviev’s HRA has been wiped out, allowing the manufacturer to maximize revenue from both patient and insurer.
Epstein said it took her “15 minutes to figure out what was going on” here. And, unlike the average patient, she studies this issue for a living.
Lee, the pharmacist, said even he didn’t realize that money could be withdrawn directly from a patient’s HRA without her knowledge, and he’s been in the business for the better part of a decade.
No Warning for Patients
None of that is consolation for Soloviev, who said: “I just find it is outrageous for a fungal medicine to cost $1,400, to be prescribed for 11 months, and for neither the PA [physician assistant] nor the pharmacy to warn you,” Soloviev said.
Resolution: Though Soloviev has told My Express Care not to renew the prescription, her HRA is depleted. For the rest of the year, she’ll have to pay out-of-pocket costs for any other medications, an expense she hadn’t planned on.
The Takeaway: For even the most informed of patients, getting a new prescription can mean walking through a financial minefield. And Soloviev hit a number of booby traps.
Bottom line, experts say, medical professionals should make the patient aware if they prescribe a high-priced medicine and explain why it’s beneficial.
Patients should play defense and ask their physicians about the cost of every new prescription. They should ask again at the pharmacy — even if that means calling a mail-order pharmacy. Because costs can vary depending on each patient’s coverage, they may need to contact their insurance carrier or the pharmacy benefit manager that handles their medicine claims.
And if the cost is extremely high, they should ask their doctor about generic or over-the-counter alternatives.
“This is an important component of the decision a patient’s going to make,” Epstein said. “If it’s toenail fungus and not life-or-death, it strikes me … an individual might want to have relevant data.”


For Toenail Fungus, A $1,500 Prescription

Shefali Luthra

Judy Marrazzo wasn't looking to launch a part-time, second business at this time last year. For two decades, she kept plenty busy as co-owner of the East Norwich, N.Y., advertising agency named after her husband and business partner, Paul Jann.
But last summer her Villanova University-bound daughter, Maxine, inspired Marrazzo to create goCAMPUSing, a new venture that offers college tours to high-school students. The fledgling firm has quickly blossomed into a successful business as well as a fulfilling personal adventure. "This is the East Coast's premier college tour company," says Marrazzo, 57. “It’s also refreshing to take a concept and bring it to fruition.”
It started when Maxine began looking at colleges and Marrazzo couldn't always take time off from work to accompany her. Thinking other parents might be equally time-pressed, Maxine organized a Girl Scouts community service project that took high-school students on a $225 overnight bus trip to six colleges in Delaware and Pennsylvania — with Marrazzo as chaperone.
As the tour ended, Marrazzo realized she could turn college tours into a part-time business. After developing a marketing and business plan, she opened goCAMPUSing and has joined nearly 300 students on 11 excursions to date. Four more campus trips are planned through August.
The company offers three-day, holiday weekend visits to schools in Mid-Atlantic states, New England or upstate New York for $399 to $499; four-day tours to schools in New Jersey, Pennsylvania and Delaware costing $740 to $815; four-day tours to schools in New England for $789 to $864; five-day trips to Delaware, Washington, D.C., Virginia and North Carolina for $979 to $1,025; and five-day trips to upstate New York colleges for $979 to $1,025. Marrazzo anticipates expanding the business soon, by offering East Coast tours just for guidance counselors.
Early fans of the service include parents like Arun Garg of California's Silicon Valley, whose daughter flew to New York with a friend in February. “She was able to see a maximum number of colleges in a minimum amount of time, which optimized cost,” Garg says.
So far, goCAMPUSing is turning a small profit, says Marrazzo, a welcome development after several years of stagnant revenue at her advertising agency.
But she's discovering other rewards, like the gratification of seeing high-school students accept responsibility for their trip by soaking up information about every school they visit. “If their parents were to come along, the kids would be in the back seat of the car texting while the parents asked all the questions,” she says.
The venture has also experienced a few setbacks.
Marrazzo says goCAMPUSing has been informed it can’t participate in local college fairs; only nonprofit organizations and institutions are allowed. Some families are also put off by the cost of the trips. Marrazzo, however, claims her biggest mistake was underestimating parents’ need for the service.
In fact, if she and her husband ever decide to wind down or sell their advertising agency, Marrazzo plans to continue running goCAMPUSing. “Entrepreneurs don’t ever really retire," she says. "They just do something else.”


Part-Time Business: Working Mom Finds a Way to Make Extra Money

Amy Zipkin

Retired couples can encourage each other to do new things, go new places and meet new people. Retired single people must make those efforts on their own.
“In a world that seems organized for couples, if you don’t think about how to construct a social life after retirement, you could end up sitting on your couch,” said Carol, 66, a widow in Berkeley, Calif.
We asked single retirees about the challenges of retirement and what advice they have for others to help make the most of this new beginning. They came up with five smart suggestions:
1. Make a List of Goals
Before Carol left her job in 2013 as CEO of a private nonprofit educational research organization, she assessed her situation in the following areas:
financial statusphysical healthintellectual needsspiritual needsrelationshipscommunity“Everyone’s first concern is money, but community is a big thing,” Carol said. “After you leave work — where you’re connected over a common goal — you don’t have a ready-made community. I thought about what resources I did have and what would bring me joy, and I made a list of goals.”
First, Carol moved from Portland, Ore., to be closer to her family. Then, she began building a network of friends. Today she takes photography classes, participates in two photo clubs, works with The League of Women Voters and looks for opportunities for group travel.
“My biggest fear — loneliness — was unfounded,” Carol said. “I’m not lonely.”
2. Know That ‘It’s All OK’
Maxine, who is divorced, had not planned to retire at 62, but when she got an offer to buy the four nursing homes she owned in the Midwest, she took it. That was nine years ago.
“I had pictured retirement as freedom from responsibility, and I looked forward to that,” Maxine said. “But when you’ve been in a position of authority, it’s hard to leave. If you’re not in the game anymore, what is your game?”
Maxine turned to her longtime interests to fill her days. She became certified as a Master Gardener. A past president of the Missouri Mycological Society, she wrote a book on mushrooms for the Missouri Department of Conservation. And she gave public talks about the book.
Out of the limelight now, Maxine’s pace has changed. “I don’t need a lot of projects, but if you’re a go-getter, that’s OK. It’s also OK to spend days at home, reading. It’s all OK,” Maxine said. “It’s tough being retired. You have to choose between fun and fun.”
Maxine said she has eased into a nice rhythm, going to the gym every day, traveling with family and taking walks in the woods. “You have to create a life for yourself, get out and find like-minded people,” she said. “I don't have a need for a partner; my life is full. And if I want popcorn for supper, I can have it.”
3. Regard Challenges as ‘Part of the Fun’
After decades on the job, Laura, 62, wants to watch birds in southwestern Mexico — and she is making that happen.
Laura retired in 2014 from a career in art conservation at several museums and as a consultant. Recently, she moved to Oaxaca. “I love Mexico and have visited over the years, and I wanted to try living here,” Laura said.
Never married, Laura noted the decision to move to Mexico was easy. “I sold my house and car and most of my furniture, and came down here with two suitcases,” Laura said. “There is a nice group of expats and lots to do, but you do have to put yourself out there and get engaged in something in order to meet people.”
Laura volunteers at the local library. She plans to take Spanish classes, do some bird watching in the mountains and travel in Mexico and Central and South America.
So far, her bold move has lived up to her expectations in every way. “I’m learning new customs and a new language,” she said, “and the challenges are part of the fun.”
4. Admit That Time Is Not on Our Side
George, 66, spent his entire career in one place — until the day eight years ago he decided to retire.
“The decision to leave my job as assistant director of a large county library system was a quick one, and I hadn’t thought a lot about retirement,” George said. “When I did think about it, I imagined my life would not change much. I have lived by myself since 1973 and the idea of a lot more time at home was not frightening.”
What has changed is that George does not spend all his time at home in St. Louis, Mo. For eight years, he has enjoyed a long-distance relationship with a man in another city. “Being retired means I am free to travel often, to spend time with Nathan,” he said.
At home, George sings in his church choir, serves on the board member of the St. Louis Chamber Chorus, plays bridge, takes part in a writing group and spends time with family. He also volunteers as part of a special project at The Muny, an outdoor theater nearing its 100th anniversary.
George stays active for two important reasons. “I know people — especially men — who withered away after they left work,” he said. “If leaving your job is going to leave a huge hole in your life, start filling it before you retire.”
Another motivating factor is the passage of time. “I realize every day I am on the downhill slope, well past the halfway mark of my life,” George said. “Now I choose to be happy. There is no point in being regretful about the past.”
5. ‘Find Something You Like to Do’
Jeanette, 59, retired five years ago from teaching middle school. A widow, she spends part of her time substitute teaching and part of her time enjoying old friends and making new friends, especially people who like to walk, hike or bike.
“When all my body parts are working, I want to be outside, be active,” Jeanette said. “I’ve never been a sit-on-the-couch person, so I’ll go to an art exhibit or concert, and if someone else asks me to go somewhere, I go.”
She also devotes time to friends in need. “When I had surgery, so many people looked in on me and now I can do that for others,” she said. “As we age, people have doctor appointments, and someone needs to take them or maybe drop off some lunch.”
Jeanette also recommends volunteering, even once a week. “Read to little kids, work at the food pantry. Do something for somebody else. I was raised this way — this is what people do,” she said.
“Just find something you like to do, and find a way to do it. It’s survival.”
 
 


How to Retire Single Without Being Isolated

Patricia Corrigan

Liz Kozlowski and her staff at Brookdale Senior Living’s Westlake Village, outside of Cleveland, knew that resident Ed Petrigac and his wife Yvonne had started an auto parts business. But it wasn’t until they read his life story that they realized he also had a love of cars. That knowledge helped the staff provide better, more patient-centered care for Petrigac, a Korean War veteran who lived in the facility’s memory-care unit.
Ed PetrigacAnd, based on a recent independent study conducted through a grant for my firm, MemoryWell, familiarizing professional caregivers with residents’ life stories can be impactful for the people with dementia in long-term care — and their families.
Considering that the median cost of a private room in a nursing home is now roughly $100,000 a year, according to Genworth Financial, person-centered care has become essential to ensure your loved one gets the best long-term care for the money. Families want to be assured their loved ones in memory-care communities are known and treated like the person they know and love.
A Trip to the National Car Show
In Petrigac’s case, Brookdale’s staff read the story of his life that had been provided for them digitally by a professional writer. In it, they learned that Petrigac and his son, Mark, had spent three years fixing up a 1965 GTO when Mark was in high school. The revelation led to a trip with Westlake staffers to the National Car Show in Cleveland, followed by pizza — an enjoyable outing for Petrigac, who by that point spent most of his time in Westlake's memory care wing.
In surveys administered three and six months after the stories were written and shared, 83% and 90% of care workers respectively reported the life stories benefited them in their work.
“He had a great day,” recalls Kozlowski, Clare Bridge programs manager at Westlake Village, which piloted a life story telling platform last year as part of a grant from the International Women’s Media Foundation, funded by Howard Buffett for women journalists doing innovative work. In the study, writers turned their news-gathering talents on Westlake’s residents to help staff more readily know their residents.
“We learned about certain quirks or things people really enjoyed,” Kozlowski says.
The staff assumed one prim-and-proper resident had been exaggerating when she described being a pilot previously. They were surprised to read in her story that she really had been one, for many years.
What the Study of Residents With Dementia Revealed
The study offered preliminary substantiation that a digitally shared narrative approach can assist in providing person-centered care for people with dementia, replacing handwritten questionnaires that are sometimes illegible and can be hard to access by staff.
Person-centered care was developed in the late 1980s by U.K. social psychologist Tom Kitwood and has become the standard of care for people with dementia. The Alzheimer's Association endorsed it as the foundation of its 2018 Dementia Care Practice Recommendations. Until recently, little research had been done in the U.S about the usefulness of life story telling for caregiving. But U.K. and Canadian studies have shown that it builds empathy for paid caregivers and family caregivers and can also help reduce depression and improve quality of life.
In the Westlake study, about half of the facility’s residents (16 people) had their stories told by MemoryWell. Then, the Gilster Group, an independent research group in Ohio, studied the impact of those stories on many of the 25 front-line staff workers over six months.
In surveys administered three and six months after the stories were written and shared, 83% and 90% of care workers respectively reported the life stories benefited them in their work.
The researchers found that, over the course of the study, paid caregivers increasingly accessed the digital platform hosting the stories and allowing families to add photos, music and movies and staff to search them. The proportion of staff who reported referring to the stories “frequently” jumped from 9% to 31% between three and six months and those who reported referring to the stories “periodically” increased from 18% to 38%.
The Key for Caregivers: Getting to Know You
Maxine H. and her nieceFeedback from the care staff also showed the appeal of a life story telling platform that lets them add new details over time. So, for example, being able to update the residents’ changing food preferences such as from chocolate ice cream to vanilla. “People change and you need to know who they are now,” one West Lake caregiver told researchers.
Getting to know the details of someone’s life sometimes improved staff’s engagement with the person, too.
For example, the caregivers initially only knew that Maxine H. had worked for a railroad company. But they learned in her story that she also had loved spending her downtime in Cleveland’s Tower City District. So, as part of a Westlake activity that lets residents explore local towns virtually, when Maxine is present, the staff makes sure to “visit” that district.
The stories “give me a sense of comfort knowing I am providing the best personal care I can based off the resident’s needs,” one Westlake staffer told researchers.
Answering More Questions About Person-Centered Care
Can a better understanding of residents’ histories, likes and dislikes reduce the overreliance of psychotropic medications in long-term care facilities for people with dementia who become agitated or aggressive? And, can tools for understanding and relating to difficult residents help professional caregivers find more job satisfaction, so they’ll stay in their jobs longer?
To help answer these and other questions, MemoryWell has applied for a small business innovation research grant from the National Institute on Aging to conduct some of the first U.S.-based research on a much larger scale.


Getting a Parent With Dementia the Best Long-Term Care for the Money

Jay Newton-Small

(Advances in science and public health are increasing longevity and enhancing the quality of life for people around the world. In a series of interviews with the Milken Institute Center for the Future of Aging, 14 visionaries will be revealing exciting trends and insights regarding healthy longevity, sharing their vision for a better future. The Longevity Innovators interviews highlight new discoveries in biomedical and psychosocial science, as well as strategies to promote prevention and wellness for older adults. This is the first in the series.)
Renowned neurosurgeon Dr. Keith Black (chair of the department of neurosurgery and director of the Maxine Dunitz Neurosurgical Institute at Cedars-Sinai Medical Center in Los Angeles) has pioneered advances in our understanding and treatment of brain cancers and complex neurological conditions. Black is also a research scientist studying targeted drug delivery, cancer stem cells and Alzheimer's detection through retinal imaging, among many other areas. In an interview with the Milken Institute Center for the Future of Aging, Black talks about the importance of developing a test for early onset Alzheimer’s and his goal to inspire the next generation.
Dr. Keith BlackWhat is the most important thing that people should know about improving brain health? 
People need to know how important lifestyle is to sustain health. Lifestyle, diet, exercise, moderating stress, making sure you get a good eight hours of sleep when you can, making sure you keep your brain engaged particularly in novel activities — all of these matter. You have to remember the brain is a living organism very much like a muscle — the more you use it, the stronger it becomes.
We need to treat our brains better. For example, try to avoid excessive alcohol and make sure that you screen yourself for diseases like diabetes and hypertension that can be devastating to the brain.
What will be the benefits of having a reliable test for early onset Alzheimer’s?
I think there’s a huge misconception that if you get Alzheimer’s or if you’re going to get Alzheimer’s, there’s nothing that you can do about it. And I think the science shows that that perception is incorrect.
We know two things now that address your question. The first is that Alzheimer’s starts about two decades before a person develops symptoms. During that period of 20 years, you’re losing brain cells, and you’re losing brain connectivity. If you can detect the disease at the very start, particularly before you lose enough brain cells to become symptomatic, we may have the ability to stop the process or at least slow it down and prevent an individual from becoming symptomatic.
If people are developing Alzheimer’s in their 50s and 60s, they are going to become symptomatic in their 70s and 80s. If you can slow the overall process and have people become symptomatic in their late 90s or 100s, you have the ability to essentially prevent the disease from being symptomatic in most of our lifetimes. That’s really the major reason to move towards early detection, because preventing brain loss is a lot easier than restoring brain cells once they’ve died.
The other reason people should be interested is that even though we don’t have a pill that can stop the progression, we know that Alzheimer’s also has a lifestyle component. The scientific evidence shows that lifestyle habits such as a Mediterranean diet, exercise, sleep, meditation and other types of mindfulness modify stress levels. We’re seeing that potentially even micronutrients like the omega-3 fish oils may be very important in slowing the progression of Alzheimer’s disease.
What’s your take on Pfizer ending research to find new drugs aimed at treating Alzheimer's and Parkinson’s diseases? How do you think it will impact ongoing research?
I think a lot of the trials that have failed for Alzheimer’s disease, including the Pfizer trial, could’ve been better designed and better developed. I think we have a lot to learn from the failure of those trials.
For example, how do we get the drugs into the brain more effectively? How can we better select the right population of patients to treat? I think addressing those potential reasons for the failures of those drugs will lead to successful therapies and hopefully successful approvals.


The Best Way to Improve Brain Health

https://vimeo.com/119877101
Filmmaker Maxine Davis recalls the moment when she first learned about an opportunity that would impact her life both personally, and later professionally. The year was 1965, and while in the family car, Davis heard a woman on a Minneapolis radio station talking about the chance for young women to attend an Outward Bound School course in the Boundary Waters Canoe Area (BWCA) near Ely, Minn.
“I was going into my senior year in high school and I thought this just sounded very cool,” Davis said.
That summer, Davis became part of the first group of 24 young women (plus four female instructors) to attend a 28-day survival school at Outward Bound.
The group’s experience, and their 2012 reunion 47 years later when the women were in their 60s, is the subject of Women Outward Bound  an award-winning documentary by Davis airing on more than 270 PBS stations around the country this month.
Originally founded in Wales in 1939 to encourage “physical fitness, enterprise, tenacity and compassion” among young men, Outward Bound launched in the United States in 1962. To date, more than 7 million young women and men worldwide have participated in Outward Bound programs.
In the summer of 1965, the young women, ranging from age 15 to 23, were from all over the country. None of them knew each other. According to Davis, their expectations of what was ahead varied. Some thought they were attending a traditional summer camp; a few others from Colorado, whose brothers had experienced Outward Bound, were told by their siblings, “There’s no way you can do this."
Into the Wilderness
The young women first had 10 days of survival training at what was called Home Place, where they learned skills including orienteering (or navigation), canoeing, portaging (carrying watercraft or cargo over land), building a campfire, cooking and first aid. Then, they were sent out in two brigades of 12 members each, along with two instructors, into the primitive BWCA.
“There were no campsites set up, there were miles and miles of trails; all that’s there are trees and water,” said Davis. It was when the young women entered the wilderness that the hard work and the now-classic Outward Bound need for cooperation began in earnest.
“You have to remember, this was before Title IX, so most of us had never been part of a team before. We had to work together and learn together,” Davis  said.
When asked if there was squabbling among the campers — many were teenagers, after all — Davis said there simply wasn’t time for disagreements.
“There was a lot of complaining and commiserating — ‘I’m wet, I’m cold, I can’t go on’ — but of course, we had to keep going. We all had jobs to do,” said Davis. “I know that I cried a lot and I felt sorry for myself.”
A Level Playing Field
Cathy Crowson thought she was going to camp “to ride horses and make S’mores” and didn’t realize the nature of Outward Bound.
“My mom entered me into a contest and I won,” said Crowson, who was 15 at the time. “I didn’t know what I was in for, but I didn’t want the other girls to know that. I learned to keep my cool and just figure it out. That's something I've come back to many times in my life."
One of the things Crowson found most valuable was that the experience “stripped away all the junior high/early high school behavior. No one cared about clothes, no one looked good,” she said. “It didn’t matter if someone was wearing a madras shirt — we were all up to our necks in mud.”
Asked whether they felt a profound sense of accomplishment on the last day, Davis said matter-of-factly, “We just wanted to go to town to get ice cream.  We went to the nearest restaurant and ordered malts.”
"And I was anxious to get home to my boyfriend,” said Crowson.
A Time for Reconnecting
The sense of pride in their accomplishment would arrive later in life when the women reflected on their Outward Bound experience, as a group and then on film, after Davis first conceived of the idea for a reunion.
“I wanted to get everyone together, I wanted to see where they were in their lives,” said Davis, founder of Every Life is a Story, an award-winning production company focused on video biographies and short films.
Even with the advent of online research, tracking down her fellow students proved challenging. Many had married and had different last names. Providentially, Davis learned that a former Outward Bound instructor had saved all their application forms which contained information about schools and the like.  If not for that, the documents would have likely been destroyed in a 1967 fire at Home Place.
One by one, Davis made calls. “Everybody went berserk,” she said. “All of them told me how significant the experience had been in their lives.”
However, it was a conversation with one of the former Outward Bounders named Rosie that truly set the project in motion.
“I told her that I was thinking about putting together a reunion,” said Davis. “She told me, ‘Well, you better hurry, because I will be dead in a month.’  She had cancer.”
Davis packed her video camera and headed to Little Rock, Ark., to meet up with Rosie and film their conversation. Featured in the documentary, the woman, who died not long after their meeting, told Davis how she’d always been taught that "girls don’t camp, but I learned different.”
Davis realized the story of the 1965 Outward Bound experience was one that needed to be told.
Director Maxine Davis in the middle is also one of the young women who went on the historic 1965 Outward Bound trip.Reunited at Outward Bound
In 2012, Davis invited the women to gather at her Minneapolis home before they traveled together to what is now called the Voyageur Outward Bound School, where they spent four days.
“The Outward Bound board was very generous and paid for those who initially said the trip was an expense they couldn’t afford,” said Davis, who raised funds separately for the film.
Wanting to be a full participant in the reunion, Davis hired Nick Clausen, a young outdoor filmmaker, to document the trip.
“He knows how to be a fly on the wall,” said Davis, who praised Clausen for capturing compelling footage of their activities, as well as conversations with the women about the impact of the original experience.
Clausen’s work, along with promotional film Davis obtained from the 1965 girls’ program, was used to create the hour-long Women Outward Bound, which Davis co-produced and wrote with filmmaker Melody Gilbert.
Since its debut at the Minneapolis-St. Paul International Film Festival in 2016, Women Outward Bound has won several awards including Best Feature Documentary at the Chagrin Documentary Film Festival, Best Film from the Milwaukee Women’s Film Festival and Best Feature at the Maine Outdoor Film Festival.
Making an Impact
Lynn Cox was an instructor for Davis’ brigade and only a few years older than the students at the time. She and her husband, both teachers, worked at Outward Bound during the summer for several years. For Cox, seeing the women again was particularly gratifying.
“There was a very honest sharing of life’s journeys. There were the commonalities we talked about around aging gracefully,” said Cox. “Many of them have been through some tough times, but they risked self-disclosure and had the courage to talk about their experiences.”
Davis is glad the film has become part of a broader conversation about equality. “I think it’s a seed to talk about what’s happening now, and why what we accomplished is still important,” she said.
At a screening of the documentary several months ago, Cox recalled being struck by a comment made by a middle-school girl during the Q and A session.
“She raised her hand and said, ‘I didn’t know that women weren’t allowed to do those things," said Cox.


Worth Watching: 'Women Outward Bound'

Julie Pfitzinger

Restoring a forest isn't usually a project people take on when they're in their 60s. But when Southern Oregon's natural beauty hooked San Francisco urbanites Fred Gebhart and Maxine Cass they decided to abandon city life and take on the challenge.
Fred Gebhart and Maxine CassIn 2010, the couple inherited 20 mostly wooded acres from Gebhart's mother. Knowing that the house on the property needed repairs, they went to inspect. When the sun woke them the next morning, it pointed them to a new life direction.
"We groggily got up and looked outside," said Gebhart. "It was early June and we saw a beautiful green meadow. Wildflowers. Oaks were freshly in leaf. Everything was bright and shiny. The sun was coming through a pair of table rocks with a snow-capped Cascade mountain in the background. Our mouths just dropped."
Instantly, they both thought of relocating there. "Can we do this?" he recalled saying. "How would we do this?"
Taking Stock and Making the Move
The couple took stock of their resources and what they'd need to be able to live on the property. With an existing DSL line, Gebhart could continue his work as a medical writer remotely. Cass had already retired from travel writing and photography.
"We couldn't get to some parts of the forest ... We had to bushwhack to get into the back woods."
For both, their age was an obstacle to changing health insurance plans. But the Affordable Care Act opened that door, allowing them to set early 2014 as their move date.
In the meantime, they planned to travel to their land every few weeks and learn all they could about home repair and the plants, animals and weather there.
As they got to know the property, they found they owned a 20-acre tangle of trees, blackberry brambles, 12 to 14 feet tall Scotch Broom shrubs and poison oak running up 100-foot trees.
"We couldn't get to some parts of the forest," said Cass. "You couldn't see what was there. You could sort of see your way through overgrown logging roads and paths previous owners had built but we had to bushwhack to get into the back woods."
Eventually, they realized they had not just one but two forests, one hardwood and the other mixed conifer.
The buildings also showed the effects of delayed maintenance. More than they knew. And more than they knew how to fix. As urban renters for 33 years, "we didn't have a clue," Gebhart said, smiling at the memory. "We were so unprepared we didn't even know what questions to ask."
An Expensive Education
They discovered the house needed a new roof, electrical system and paint inside and out. The septic system was clogged, two wells and a cistern pump had to be replaced, and three outbuildings were not salvageable. Gebhart came home one day and told Cass, "I have two words for you. Wells and septic."
"We have wells?" Cass asked.
"Yes, but nobody knows if it's one, two or three."
"What's a septic?" she asked.
Fond Memories but No Skills
Having lived his early childhood in the Ozarks, Gebhart said he had "fond memories of outhouses" but no knowledge of plumbing. The couple's two years in the Peace Corps in Senegal in the late 1970s offered no help either. They had taught English and French.
"In cities, whether water, sewer and electricity worked or not, it wasn't our problem to repair it," said Gebhart. "We discovered in the country there's no one to call. We got to fix all of that stuff."
"If not for Oregon State [University] Extension and Google we'd have been lost," said Cass. "We sucked up information and went from there."
"Family Forest" Stewardship
Cass and Gebhart are two of the nearly 10 million "family forest" owners in the U.S. According to the Family Forest Research Center, a family forest can be as little as one acre with at least 10% trees owned by an individual, family or unincorporated group.
In fact, family forests make up the largest percentage of American forest land. In total, they cover more acreage than all of the national forests combined.
Brett J. Butler, co-director of the Family Forest Research Center and author of "America's Family Forest Owners," says these individual owners' collective decisions will influence the fate of America's forest ecosystem.
Even so, most family forest owners have no stewardship plan nor have they consulted professional forest managers for advice. Some may not even know help is available.
Asking Experts for Advice
For Gebhart and Cass, assistance came from the Oregon Forestry Department and the local soil and water district. Working with these entities, they developed a 10-year forest stewardship plan.
With an approved, written plan they qualified for a multi-year cost-share grant as well as direct contributions. For example, a forestry crew brought a massive chipper and spent two days cleaning up dead trees, returning the wood's nutrients to the forest rather than hauling them away.
Most of the work, though, is DIY. Propagating and planting native shrubs, caging new plants to protect them from grazing deer, seeding native wildflowers and tree-thinning, limbing and pruning, Cass and Gebhart share the load.
To avoid using fire or chemicals to control weeds, they cut and hand-pull all unwanted plants. "We're legendary weed-pullers," said Cass, concluding a story about clearing an acre of weeds by hand.
A Photographer's Paradise
"It was six years before we could even see the whole twenty acres," said Gebhart. Now you can see all way through to the edges. Flowers grow in the forest where there were none. Trees are trimmed with six to eight feet of clearance for walking under.
"The wildlife here is striking."
Their biggest surprise is the variety of trees, at least 11 where three or four was expected. "People don't believe it," said Cass. But visitors have seen it for themselves. While Gebhart and Cass participate in virtual classes and take field trips to other restoration projects, they also host groups for what they call "walkabouts."
For Cass, their land is a photographer's paradise. "The wildlife here is striking," she said. "We don't have any window coverings − not something you can do in the city. We pay attention to what's going on outside, whether it's animals, what the trees are doing, what the weather's doing."
One day a herd of Roosevelt elk appeared outside her bedroom window. Photographers know you don't shoot through glass, but you don't step in front of elk, either. Cass spent an hour and a half watching and photographing.
With delight at the unexpected, she saw skimmer dragonflies land on their truck bed and battle for territory. "I got great action shots of them coming at each other," she said.
Perspective and Attitude
Gebhart marvels at his new perspective on the natural environment. In an urban setting, he said, you might see birds, rats or squirrels, but few other animals, and their behavior is influenced by "human rhythms."
"In rural areas, it's reversed," he said. There's a "rich variety" of wildlife and "it's not our space. We're much more co-inhabitants. It's a very different outlook to realize we need to fit in with their world instead of ordering it specifically for what we need."  
Not everyone shares the couple's attitude about living in such a remote area. Some think it would be "inconvenient," "daunting" or "overwhelming," said Cass. "I tell people it's an adventure. It's a big pain sometimes to come out in all weather and do what we're doing."
A Decade-Long Adventure
"But it's also a privilege," she added. "I get to see things others don't and photograph and absorb it. Seeing a big leaf maple for the first time, it's whoa! Like a five-year-old kid. It puts you in a positive state of mind and helps you face challenges. You're not pushed down by it. After ten years, it's still an adventure."
Where some see boredom, Gebhart and Cass see opportunity. "Everything is so new, there's always something to learn or discover or figure out," said Gebhart.
Cass has become a Master Gardener, and both completed Master Food Preserver, Land Stewards and Master Woodland Managers programs and the Citizens Fire Academy — all through OSU Extension.
"Who has time to be bored?" Gebhart said. "We've been learning a whole new way of life."


Quitting the City to Restore a Forest

Christina Leimer

The Retirement Gap is a real-life problem for many Americans, but it’s also an opportunity to ask yourself who you are comparing yourself to, what you truly need as you move into whatever retirement looks like for you.

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An inclusive and comprehensive space for caregivers with stories about innovative research and important conversations focused on the heart of caregiving.

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