Sometimes it happens suddenly or seemingly overnight. We are all going about our business and then we get sick or have an accident.

Our health and independence – what we once took for granted – can be taken away from us in a heart beat. Illness and/or aging seem to sneak up on most of us when we are busy living life. It doesn’t make it any easier when we see it coming, such as when we or a loved is diagnosed with a serious health condition that doesn’t have a cure.

November is National Family Caregiver Month and this year’s theme is “Family Caregivers – Now More Than Ever!”

Each year, more and more Americans are caring for a loved one with a disability, chronic condition, or the frailties of old age.

There are as many as 90 million family care providers in the United States today, and it’s not just the elderly who need caregiving – the number of parents caring for children with special needs is increasing, too, due to the rise in cases of many childhood conditions.

We are all members of an aging society. Whether an older person becomes confused or physically frail, or an otherwise healthy disabled person begins to face health issues that are associated with aging, there is a common theme: How do I keep doing what I want to do and how I want to do it, for as long as I am able?

Those needing assistance need to be part of the decision-making process. When this isn’t completely possible, it is critical that family members and friends take the time to understand and discuss a person’s expectations for care and support so their choices and wishes can be respected and honored.

This conversation also serves to help determine what is needed in a care provider, and helps care providers know what is to be expected.

Know community resources

The Area Agency on Aging of Lake and Mendocino counties provides guidance and support for older adults and care providers striving to maintain healthy and independent lives in Lake and Mendocino Counties.

Its Information and Assistance Program helps seniors and care providers locate the best resources for their unique situations.

Be a knowledgeable care provider – attend a care provider training

The In-Home Supportive Services Public Authority offers care provider training courses throughout the year in Lake County for those caring for In-Home Supportive Services recipients.

The feedback on these classes is always positive. Folks walk away from the training with increased confidence as well as relief, knowing that they will be of better service to the person who needs their help.

Use the registry to find help

A list of available care providers can be mailed, emailed or faxed upon request to In-Home Supportive Services recipients.

Screen your care providers

Although care providers on the registry have been screened and have completed required training, it is important to do a thorough interview.

Asking the following questions can help select the right care provider:

• What experience do you have as a care provider?
• Do you have any specialized training?
• Do you have any physical limitations?
• Would you be willing to take me to appointments? If he/she is going to be providing transportation, ask to see his/her driver license and auto insurance.
• Would you cook according to my needs?
• Do you have any problems with the days or hours that I need you?
• If you don’t smoke, do you mind being around someone who smokes?
• Do you use drugs or alcohol?

If you have special needs, ask the applicant how they would handle your specific needs.

If you have animals, ask if they have any allergies to them.

Ask if they have gone through the provider enrollment process, including being fingerprinted.

Give them a chance to ask you questions about the job and the services that you need.

Pace yourself – family caregiver support program

Family care providers need a break now and then as well as those receiving care from family care providers.

The Family Caregiver Support Program offers respite grants to unpaid care providers to allow them to get a break from their regular caregiving responsibilities.

So remember to acknowledge and celebrate someone you know who is caring for a loved one to reinforce this year’s theme: “Family Caregivers, Now More Than Ever!”

For information about In-Home Supportive Services and the Public Authority Registry, please call 707-995-4680.

For information about the Area Agency on Aging’s Information & Assistance and Family Caregiver Support Programs, call 707-262-4517.

Todd Metcalf is the Adult Services Program manager at Department of Social Services serving Lake County, Calif.

As you probably know, Sutter Lakeside Hospital became a Critical Access Hospital (CAH) back in 2008. What you may not know is why – or what that designation means.

In 2007 and 2008, we were struggling financially and we were considering several options: We could reduce services, we could close programs or we could consider becoming a Critical Access Hospital.

Under the direction of our volunteer board of directors, and with the blessing of our medical staff, we decided to apply for Critical Access Hospital status.

The federal CAH program is designed to provide additional financial support for small rural hospitals.

This option is offered to small rural hospitals of 25 beds or fewer to ensure that critical health care services remain available locally.

Our Critical Access designation allows us to receive significantly higher reimbursement from Medicare for inpatient and outpatient procedures as compared to non-Critical Access hospitals.

Since 2008, Sutter Lakeside Hospital has received more than $16 million in additional Medicare reimbursement due to our critical access status.

Some of you may remember when Lakeside Community Hospital had more than 50 beds. On average, we had between 27 and 30 patients in beds each night since the inception of the hospital in the mid-1940s.

We decided that a 25 bed-count required by the CAH guidelines would be manageable – and we were right.

Part of the reason that 25 beds continues to work for us is that medicine is changing and evolving.

Procedures, such as hysterectomies, that once required a week-long inpatient stay, can now be done safely and effectively as outpatient procedures.

Major abdominal surgeries are being replaced with laparoscopic procedures using video technology, which greatly reduces procedure recovery times.

In addition, hospitals continue to work with our community partners to get patients home sooner with the care they need, whether that is homecare, equipment to help care for patients at home (like walkers and hospital beds), support from hospice, or placement in skilled nursing facilities.

As medicine continues to evolve, the move to more outpatient and home-based care will gain momentum.

This is an exciting time to be a part of health care and witness the change in how we deliver care to the people who need it.

I hear comments from the community about the use of helicopter transfers from our Emergency Department.

The overwhelming reason why we transfer patients out of the area is so that the patient may receive a higher level of care.

This means that the patient being seen in our Emergency Department has a medical condition that needs treatment by a specialist, such as an open heart surgeon, a stroke specialist for brain surgeries or the patient requires a procedure like microscopic hand surgery.

Lake County’s population of 65,000 residents is too small for those high-level specialists to make a living.

For example, a cardiac open heart program needs to do about 300 to 500 procedures a year to ensure the staff and providers working in the program maintain their skills.

The old adage “practice makes perfect” is as true in medicine as it is anywhere else. To do 300 open heart procedures a year requires a population base of about 400,000 people – or six times the number of residents in Lake County.

We have been pleased with the results of becoming a Critical Access Hospital. With the transition to CAH status, we have been able to continue offering our community excellent medical care close to home, and that’s crucial to all of us who live and work in Lake County.

If you have any questions about our CAH status, please write to me at This email address is being protected from spambots. You need JavaScript enabled to view it. .

Siri Nelson is chief administrative officer of Sutter Lakeside Hospital in Lakeport, Calif.

Each year at this time I receive phone calls and emails inquiring about the unsolved murder of Barbara LaForge.

Sorting through gallery inventory recently led me to unwrap an unfamiliar box. Carefully placed inside this cardboard box was a beautifully framed memento which belonged to Barbara LaForge.

Never forgetting how proud she was of her whippet show dog, Carmen, a flood of emotions ran through me. That's because Carmen was the only eyewitness to Barbara's murder, which occurred on Tuesday, Oct. 8, 2002.

My mind immediately flashed back to the dreadful day 11 years ago when I learned my friend was murdered in our place of business.

I gazed upon the picture showing Carmen's first blue ribbon. Barbara, who was so proud of the win, was standing with the judge. There were various articles depicting this very happy time in Barbara's life so beautifully placed in this shadow box.

The questions I had suppressed once again filled my thoughts from so many years ago.

I found myself staring at Barbara's photo, uttering under my own breath, “Barbara, what happened to you? Who did this to you? Why?”

I had to ask, because I don't know who did it, or why.

Never forgetting that fall morning – but sometimes wanting to erase it all from my mind – memories flooded my mind.

They included the phone call I received from Mike Stafford, a business owner next door who found her lifeless body after my phone calls to locate her failed.

It was shocking, something no human could ever forget – that call that no one ever wants to receive.

The very distressed and shaking voice repeating over and over, “I think she's dead,” was the beginning of a nightmare that has haunted me, her family, friends and community for all too many years.

Unsolved murders are not easy. They are troublesome; dealing with them can take bites out of your life that can never be regained.

The not knowing is the worst; the bewilderment leaves you in a place called limbo. It's a place you cannot breath in, a place that swallows you up.

Life changes. You look at everyone, every possibility and every probability in a different light.

Murder has its own deeper level of denial and shock. The event is unbelievable, unexpected, tragic and a crime, all at once.

The fear and anger you experience and the psychological effects can take years to work through. But I discovered that sometimes anger is not a bad thing as it allowed me to persevere.

It has helped me to move forward and to create a memorial fund in Barbara's memory. And it also has helped me as I seek to heal.

Today I can say that the path I traveled led me to help victims of domestic violence by raising awareness and also money for the Freedom House domestic violence shelter in Kelseyville.

Although I do not believe Barbara was a victim of domestic violence, she was a victim of the ultimate violence – murder.

Lake Family Resource Center was named “Charity of Choice” by the Corvettes of Lake County for several years now, donating $9,000 in Barbara LaForge's memory.

These generous donations assisted in building rooms, a play yard for children, gutters for the shelter building and helping keep the Rape Crisis Center stable.

Artwork from my gallery was raffled and Wine and Chocolate art auctions brought the total to $14,500. And that's became my recipe for making sweet lemonade out of a tragic event.

My hopes sometimes fade for a conclusion to this cold case, yet discouragement or weariness will not dictate silence or forgetfulness.

I have been assured that the Lakeport Police detective assigned to investigate the murder is continuing his work to bring this case to a conclusion, and I believe this case will one day be solved.

That glimmer of hope sustains me through the passing years and I hope all who knew Barbara will continue to pray for a resolution and never forget Barbara's warmth and love for others.

Gail Salituri formerly owned the Inspirations Gallery, which shared space with Barbara LaForge's Wildwood Frame Shop in downtown Lakeport. She lives in Kelseyville, Calif.

Some people may not realize it, but there are actually two ways to get Medicare benefits.

The best-known way is Original Medicare. With Original Medicare, you can choose any doctor, hospital, or other healthcare provider you want, as long as they accept Medicare. When you receive medical services or goods, Medicare pays the provider directly.

The other way is Medicare Advantage, which is a form of managed care, like an HMO or PPO. Medicare Advantage is provided by private insurance companies approved by Medicare. If you’re in Medicare Advantage, you generally must go to doctors and other providers in the company’s network.

If you go outside the network, you may have to pay more.

On the other hand, Medicare Advantage companies may offer some coverage – such as dental, hearing, vision, and wellness programs – that Original Medicare doesn’t.

Most people with Original Medicare pay a monthly premium. If you’re in Medicare Advantage, you sometimes pay an additional monthly premium to the private insurance company that covers you.

With Original Medicare, you must pay deductibles, co-pays, and coinsurance.

To cover these “gaps” in Medicare, some people buy a type of supplemental insurance called Medigap. If you have a Medigap policy, Medicare pays its share of the covered costs, and then your Medigap policy pays its share.

Medigap policies also are sold through private companies. All plans offer the same basic benefits but some offer additional benefits. The costs vary between insurance companies – and often cost is the only difference between policies. Some Medigap policies also offer benefits that Original Medicare doesn’t, such as medical care when you travel outside the United States.

Original Medicare generally doesn’t cover prescription drugs. If you want drug coverage, you can get it through Medicare Part D. Part D policies are sold through private companies approved by Medicare. You have to pay an additional monthly premium for Part D.

About 75 percent of Medicare beneficiaries choose Original Medicare, with the rest getting coverage through Medicare Advantage.

Medicare Advantage companies must cover all of the services that Original Medicare covers, except hospice care and some care in qualifying clinical research studies. (Original Medicare covers hospice and qualifying clinical research care even if you’re in a Medicare Advantage plan.)

In all types of Medicare Advantage plans, you’re covered for emergency and urgent care. Most Medicare Advantage plans also include prescription drug coverage.

But the plans can charge different out-of-pocket amounts and they have different rules for how you get service.

For example, you may need a referral to see a specialist. And you may need to stay in their provider network, unless you’re willing to pay more to go outside the network.

You should always check with the plan before you get a service to find out whether it’s covered and what your costs may be. If the plan decides to stop participating in Medicare, you’ll have to join another Medicare health plan or return to Original Medicare.

How can you decide whether Original Medicare or Medicare Advantage is better for you?

There’s a more detailed explanation of the differences between Original Medicare and Medicare Advantage in the “Medicare & You” handbook. An updated version of “Medicare & You” is mailed to all Medicare beneficiaries every fall.

You can also find “Medicare & You” on our Web site, www.Medicare.gov .

If you have any questions, you can always call Medicare’s toll-free number, 1-800-MEDICARE (1-800-633-4227).

David Sayen is Medicare’s regional administrator for Arizona, California, Hawaii, Nevada, and the Pacific Territories.

Lake County residents are a diverse group to be sure. There is little we seem to have in common and less upon which we are likely to agree, except for one thing.

To a person, Lake County residents are justifiably proud of the beauty of the land around us. Biologists tell us of the diverse habitats and the abundant wildlife they support; geologists tell us of the complex and fascinating geological wonders under our feet; and botanists tell us how our land is able to produce such bounteous and wondrous agriculture.

But we need only our eyes to confirm that which raw data and studies can only hint at – we are blessed to call this county home.

For nearly 20 years, the Lake County Land Trust has had as its mission to identify and preserve the most important places in the county.

This motivated the protection of Rodman Ranch and Slough (now the Rodman Preserve) on the north end of Clear Lake and the preservation of the Black Forest on the slopes of Mt. Konocti.

We undertook each of these projects confident that you, our fellow residents, would rally to the cause and help us forever to preserve these important Lake County icons. We were correct in our faith in your love of your home.

And now we are embarking on a third equally important project – the Big Valley Wetlands Project.

The aforementioned scientists helped the Land Trust identify the shoreline of Clear Lake from the south of Lakeport to Clear Lake State Park as the highest priority region in the county for protection.

Some of the reasons for that designation are self-evident: it is the last (nearly unbroken) stretch of undeveloped shoreline on the lake, the wetlands of the region provide natural filtration of the Lake’s water, the tules and other shore plants provide habitat for fish, fowl and aquatic mammals.

As always the Land Trust works only with willing landowners. The first of those, George Melo, has come forward.

His 31-acre parcel on Clipper Lane near Kelseyville sits at about the midway point of the shoreline. The Land Trust has identified it as the keystone priority for the entire Big Valley Wetlands project and has negotiated its purchase and an option to raise the necessary funds – $225,000.

The Land Trust has already acquired $45,000 towards this commitment which leaves a balance of $180,000. That is where you come in.

We trust in you and your love of this county to help us raise the balance in increments of varying sizes by March of 2014. We believe in your commitment to Lake County in all its beauty and in your determination to resolve our matters locally.

We are the Lake County Land Trust and, as our name implies, we trust in the land, but we have faith in you.

If you are interested in helping with this project and would like to receive a detailed “Case for Support” document with pictures and documentation, call us at 707-994-2024 or email This email address is being protected from spambots. You need JavaScript enabled to view it. .

Donors of $1,000 to $2,500 will receive permanent recognition on a plaque located at the Rodman Preserve office; $5,000 and up donors will receive plaque recognition plus listing on a donor display board at the Melo property; $10,000 and up donors receive all of the above, plus a donor plaque on a trail sign, bench, or viewing area at the Melo property.

However, more importantly, donors will have the satisfaction of knowing they helped contribute to this important beginning project for the Big Valley Wetlands preservation project.

Michael Friel and Roberta Lyons are members of the Lake County Land Trust, serving Lake County, Calif.

Today a needless and reckless government shutdown continues. There is no reason for us to be in this situation.

Our government is closed because 40 or so radical Tea Party Republicans refuse to vote for any funding bill that doesn’t delay or defund the Affordable Care Act.

This is a fight they’ve lost nearly 50 times in Congress, in a national election and in the United States Supreme Court.

Keeping the government shut down because Democrats want to make sure people can buy affordable health insurance is a thoughtless disregard for responsible governance and the people we serve.

Democrats have compromised. I agreed to support funding measure that included $72 billion in annualized across the board spending cuts to keep the government open.

The Senate passed this legislation multiple times before the government closed, but this wasn’t enough for the Tea Party wing of the House Majority – for them to vote for any measure the Affordable Care Act had to be defunded or delayed.

Their refusal to compromise is hurting our economy and country. It’s putting 800,000 federal employees out of work and delaying paychecks for two million more, cutting off food-safety operations and infectious disease surveillance, stopping important medical research, halting the disbursement of new small business loans, and costing the tax payers $150 million a day.

Now the House Majority is trying to pass piecemeal funding measures to fund things like our national parks and the Department of Veterans Affairs. These bills are nothing more than cynical political ploys designed to lessen the outrage the House Majority is facing for shutting down the government.

By passing these piecemeal measures, the House Majority is choosing which people the government works for and which people it ignores. That’s not the way government works. It’s irresponsible. And while it might be good for politics it’s terrible for our country.

The right thing to do for our nation would be to pass the Senate’s compromise government funding legislation that protects health care reform and reduces spending.

I stand ready to support such a bill. Democrats stand ready to support such a bill. And many responsible members of the Republican Party in the House stand ready to pass such a bill. If it was put on the floor of the House today it would be passed and our government would be open tomorrow.

It’s important for everyone in our nation that the institution of representative government works. Right now this important institution is being held hostage by a small fraction of extremists in the House Majority who are obsessed with sabotaging health care reform.

It’s time for the House Majority to put the interests of our nation ahead of the interest of the Tea Party, pass the Senate’s compromise bill, and reopen our government.

Congressman Mike Thompson is proud to represent California’s 5th Congressional District, which includes all or part of Contra Costa, Lake, Napa, Solano and Sonoma counties. He is a senior member of the House Ways and Means Committee and the House Permanent Select Committee on Intelligence. Rep. Thompson is also a member of the fiscally conservative Blue Dog Coalition and chairs the bipartisan, bicameral Congressional Wine Caucus.