Victor Acquista MD is author of “Pathways To Health: An Integral Guidebook” and a co-founder of The Collaborative for Community Health in Palmer, MA. For more information on Acquista’s book, visit http://pathstohealth.info/

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HYMAN G. DARLING

When does generosity disqualify you in your time of need?
It is common for people to want to make gifts and transfers to various charities during their lifetime. These gifts could consist of stock, cash, life insurance, etc. As people become older, they sometimes find that they don’t need as much financial wealth to live on, and they are willing to make either an outright gift or a planned gift, such as a gift annuity or a charitable trust.
When this happens, consideration must first be given to the potential need for Medicaid down the road, as Medicaid requires a look back period of up to 5-years in order to qualify. This means that any gift that was made within the last 5-years may be looked at by Medicaid with a question of whether it was made as part of a lifetime giving plan or if this was a single gift intended to spend down assets to qualify for Medicaid.
In many jurisdictions, the gifting of funds to charity may be regarded as disqualifying transfers, but if there have been significant gifts over years, the Medicaid authority should review the gift and determine that it is not intended as a spend down strategy, but rather was given as part of a deliberate lifetime giving strategy, even through incapacity.
A similar strategy is when a person has a history of giving a weekly or monthly gift to a charity. Most Medicaid offices have agreed that such gifting to charity is not construed to be a disqualifying transfer, and therefore, that person would qualify for Medicaid and not be forced to ask the charity to return the gifted assets, which could be devastating to a charity that believed the gifts were without restrictions or strings.
In many cases, as long as the person making the gift is not pending placement in a long-term facility, the gift will probably not be challenged. When in doubt, however; a request can be made of the physician attending the donor that at the time of the prior gifts to determine that the donor was competent, of sound mind, and not disabled to the extent that they may have required institutionalized care in the near future.
Often the agent serving under a power of attorney for a donor has the authority to maintain a gift giving program to family as well as charities. The donor’s intentions were well thought out, and these gifts should be respected by all governmental agencies. Certainly, they are construed to be gifts for income tax purposes, however; the IRS could challenge a gift if there was no authority within a power of attorney to allow transfers and gifts to be made.
A questionable gift may be one where a person has pledged to make it, but has not yet complied with its fulfillment. In this case, the pledge may be construed to be a contract, and the power of attorney may be acting within his or her authority to complete the payment of the pledge even if the power of attorney document itself does not allow for gifts to be made. This gift may merely be a completion of the contractual terms in fulfilling the obligation of the donor to the charity.
In such a questionable situation such as this, where a charity is aware that the principal has become incapacitated to the extent that they are unable to make their own legal and financial decisions, the charity should review the status of the gift. The charity may wish to verify that the current situation is one where either the principal has sufficient funds to pay for their own medical expenses for 5-years, or their life expectancy is short enough that there will be sufficient funds to pay for the donor’s care for the balance of their lifetime. If not, the charity may be asked to return gifts, so they should not place the funds in an irrevocable endowment fund or use them for permanent expenditures.
If this does happen though, the applicant for medical assistance through Medicaid would ask for a hardship waiver, since the gift would be difficult or impossible to be refunded. In such situations where the donor may not be 100 percent competent, the charity should check with the donor’s accountant and attorney before the gift has been irrevocably allocated to a specific fund.
Gift giving can be a risky venture for people who may need Medicaid coverage within a few years. No one wants to be in a position to ask recipients to return their gifts, and no one wants to be denied the medical care they need. When in doubt, it’s smart to check with a qualified estate planning attorney who can advise you of the best strategies to suit your situation.
Attorney Hyman G. Darling is chairman of Bacon Wilson, PC’s Estate Planning and Elder Law Departments, and he is recognized as the area’s preeminent estate planner. His areas of expertise include all areas of estate planning, probate, and elder law. He is a frequent lecturer on various estate planning and elder law topics at local and national levels, and he hosts a popular estate planning blog at http://bwlaw.blogs.com/estate_planning_bits/

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Quinoa (pronounced keen-wah) is an ancient whole grain that has been making its way back into the mainstream over the last few years. The name quinoa translates to “mother grain”. This is very fitting as it is the only grain that contains all nine essential amino acids, therefore is considered a complete protein. Quinoa has a high nutrient profile and is higher in calcium, phosphorus, magnesium, potassium, iron, copper, manganese, and zinc than wheat, barley, or corn.
From a culinary standpoint, quinoa has an earthy, nutty flavor with a slightly crunchy texture and it does not take long to cook (about 15 minutes). This grain will definitely add a little more excitement to any meal. It may also be a nice change from your standard side dish of potatoes, pasta or rice.
Enjoy this delicious recipe from www.oaquinoa.com
Balsamic Quinoa Salad
Prep time: 10 minutes
Cook time: 15 minutes
Author: O. A. Quinoa
Recipe type: Appetizer
Cuisine: Quinoa
Serves: 4
Ingredients
· ½ cup Balsamic Vinegar
· ¼ Extra Virgin Olive
· 2 T Dijon mustard
· 6 cloves of garlic, minced
· 2 shallots, minced
· Salt, pepper and cayenne pepper, to taste
· 1 ½ cups quinoa
· Bouillon cube
· 5 Sun Dried Tomatoes (Not in oil)
· 1 red pepper, chopped
· 4 oz blue cheese
· 1 can black beans or 1½ cups cooked, rinsed and drained
Instructions
1. Make dressing by combining vinegar, mustard, garlic, shallots and olive oil. Season to taste.
2. Add quinoa to three cups of boiling water. Boil for 10 minutes.
3. Rinse with cool water and place in a fine mesh colander. Boil water and place quinoa and sun dried tomatoes in the colander over the water. Cover with a kitchen towel and lid. Steam for 10 minutes. Allow to cool.
4. Cook red pepper in a small skillet until tender.
5. Combine pepper and remaining ingredients with quinoa. Add dressing and toss. Enjoy!

Allison Walker RD,LDN, is the Clinical Nutrition Manager at Noble Hospital.

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SPRINGFIELD – For Westfield nurse Roberta Belanger, RN, the decision to become a nurse was a perfect match for her personality.
“They used to give you these tests that would match your personality to whatever kind of job they thought would be good for you, and nursing happened to be one of the jobs that cross matched with me. So, I thought that I would give it a try, and I’ve never looked back,” Belanger said.
Belanger, an endoscopy nurse at Baystate Medical Center, went on to attend the former Baystate School of Nursing after graduating from high school. A nurse for 23 years, Belanger first brought her caregiving talents to patients in critical care for 10 years before moving to endoscopy.
Endoscopy is the practice of looking into people’s throats, intestines, stomach and lungs using an instrument called an endoscope – a long, thin tube with a tiny camera attached to the end. One of the more common procedures many people are familiar with is a colonoscopy, a procedure to look at the large intestine, which tends to frighten many who are faced with taking it.
“Many people are anxious when they come to us for a procedure because of what they might have heard from a friend about the test, and it’s our job to make them feel more at ease, “said Belanger.
National Nurses Week, May 6-12, focuses attention on the nation’s largest health care profession and the many ways America’s 3.1 million registered nurses like Belanger work to save lives and to improve the health of millions of patients. This year’s theme is “Delivering Quality and Innovation in Patient Care.”
“I like talking with my patients and teaching them. People often have to go through a lot to get better and to stay healthy, and it can be scary for them. Nurses are there to help them through it all,” said Belanger about her role as a nurse.
Sponsored by the American Nurses Association, National Nurses Week is devoted to highlighting the many ways in which registered nurses are working to improve health care. Often described as an art and a science, nursing embraces dedicated people with varied interests, strengths and passions because of the many opportunities the profession offers from working in hospitals to school-based clinics to long-term care facilities, as well as many other areas. And, nurses have many roles from staff nurse to educator to nurse practitioner and nurse researcher.
Ask the Whip City nurse what she most enjoys about nursing, and she’ll tell you it’s the impact she can make on the lives of her patients.
“My favorite part about being an endoscopy nurse is that you can genuinely see that you are making a difference. Patients are coming in for screenings afraid of the procedure and what doctors might find. But, once they walk through the door, we try to put them at ease by telling them that it’s going to be an easy process, that they are going to be very comfortable, and that they are going to do well. In the end, it’s a good feeling to know that they trusted you and that everything went fine,” Belanger said.
National Nurses Week begins on May 6, also known as RN Recognition Day, and ends on May 12, the birthday of Florence Nightingale, founder of nursing as a modern profession. During the special week, registered nurses throughout the country and at Baystate Health will be honored in several ways, including displays of research conducted by Baystate nurses, a nursing gala and awards ceremony, and various educational activities.
Baystate Medical Center has been re-designated for the second time as a Magnet hospital for excellence in nursing services – a distinction that places the hospital’s nursing staff among the finest in the nation. Nationally, only about 6.9% of all health care organizations carry Magnet designations.
For more information on Baystate Medical Center, visit baystatehealth.org/bmc.

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Dr. Victor Acquista

Much is written about obesity and health, but many people are unaware of the extent of the detrimental health effects of being overweight or obese. Annually in the United States, obesity related conditions cost over 150 billion dollars and contribute to an estimated 300,000 premature deaths. According to the National Health and Nutrition Examination Survey (NHANES) 2009–2010, almost 70 percent of Americans are overweight or obese.
What is the difference between being overweight and being obese? These conditions are defined by a simple calculation using height and weight to determine your body mass index or BMI. Overweight is defined as a BMI greater than 25 and obesity is defined as a BMI greater than 30. There are many BMI calculators readily available on line. The National Heart Lung and Blood Institute has a calculator at–http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm. You can also ask your health care provider to calculate this for you. There are also mobile apps you can download.
Here are some specific health conditions associated with obesity:
• Heart Disease—Included here is both atherosclerosis, i.e. the buildup of fatty deposits that clog your arteries and lead to heart attacks, as well as heart failure.
• Stroke—Strokes occur when the blood flow to a portion of the brain is interrupted leading to damage to that portion of brain tissue. The risk of having a stroke rises as BMI increases.
• High Blood Pressure—The heart functions as a pump. Being overweight or obese often contributes to elevating the pressure which the heart must pump against. This can contribute to many deleterious health consequences such as heart attacks, strokes, and other diseases of atherosclerosis such as abdominal aortic aneurysms, peripheral vascular disease and chronic kidney disease.
• Diabetes—Being overweight can lead to type 2 diabetes. We used to consider this as adult onset diabetes, but it is now commonly occurring in children related to an epidemic of childhood obesity. In addition to heart disease, stroke, and kidney disease, diabetes is a major cause of blindness.
There is a significant causal relationship between being overweight and the development of the metabolic syndrome. This develops due to insulin resistance (insulin is the primary way the body controls blood sugar). The insulin resistance contributes to high blood pressure, elevated cholesterol, as well as elevation in certain inflammatory markers and clotting factors. In the U.S. approximately one third of overweight or obese individuals exhibit the metabolic syndrome.
• Cancer—Having a BMI greater than 25 increases the risk for colon, breast, endometrial (the lining of the uterus), and gallbladder cancers. It also increases the risk for prostate cancer in men.
• Osteoarthritis—This is also referred to as degenerative joint disease. Because the hips, knees, and lower back bear the major mechanical stressors of being overweight, these joints are prone to more damage as weight increases. This can lead to pain as well as joint damage.
• Sleep Apnea—This is a condition of upper airway obstruction which leads to brief periods when breathing stops. It is frequently associated with snoring. There are many adverse health consequences related to sleep apnea including sudden death, heart failure, and increased accidents related to drowsiness. Obesity Hypoventilation Syndrome (OHS) is a related condition.
• Restrictive Lung Disease—Additional weight in the chest and abdomen can impede the respiratory muscles that move air in and out of the lungs. This can contribute to respiratory failure.
• Gallstones—These are primarily accumulations of a cholesterol related substance which can lead to acute blockage in the biliary system, surgical emergencies, pain, and altered digestion. Being overweight may also contribute to impaired gallbladder function independent of whether stones are present. Fatty liver is yet another medical condition associated with being overweight.
• Reproductive issues—Obesity can cause menstrual problems and infertility in women.
• Psychosocial issues—Being overweight can contribute to a host of psychosocial problems including: bias, adverse judgments about a person’s character and/or self-discipline, job discrimination, poor self-esteem, depression, lower income, and fewer romantic relationships.
This is a longer list than many people realize. The potential adverse health effects of being overweight or obese are admittedly a big problem. It’s a good idea to calculate your BMI and make plans to slim down if you are over a BMI of 25. Your health may depend on it.
Be Healthy!
Victor Acquista MD is author of “Pathways To Health: An Integral Guidebook” and a co-founder of The Collaborative for Community Health in Palmer, MA. For more information on Acquista’s book, visit http://pathstohealth.info/

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Disasters are upsetting experiences for everyone involved. Children, senior citizens, people with disabilities and people for whom English is not their first language are especially at risk and are likely to need extra care and help. But everyone, even the people that others look up to for guidance and assistance, is entitled to their feelings and deserves support throughout the recovery process.
Emotional Responses to Disasters
When we experience a disaster or other stressful life event, we can have a variety of reactions, all of which can be common responses to difficult situations.
These reactions can include:

Feeling physically and mentally drained
Having difficulty making decisions or staying focused on topics
Becoming easily frustrated on a more frequent basis
Arguing more with family and friends
Feeling tired, sad, numb, lonely or worried
Experiencing changes in appetite or sleep patterns

Most of these reactions are temporary and will go away over time. Try to accept whatever reactions you may have. Look for ways to take one step at a time and focus on taking care of your disaster-related needs and those of your family.
Keep a particularly close eye on the children in your family. When disaster strikes, a child’s view of the world as a safe and predictable place is temporarily lost. Children of different ages react in different ways to trauma, but how parents and other adults react following any traumatic event can help children recover more quickly and more completely. Your local Red Cross can give you information about helping children cope with disaster and trauma.
Recovery Is Not a Race
Getting ourselves and our lives back in a routine that is comfortable for us takes time.

Take care of your safety. Find a safe place to stay and make sure your physical health needs and those of your family are addressed. Seek medical attention if necessary.
Limit your exposure to the sights and sounds of disaster, especially on television, the radio and in the newspapers.
Eat healthy. During times of stress, it is important that you maintain a balanced diet and drink plenty of water.
Get some rest. With so much to do, it may be difficult to have enough time to rest or get adequate sleep. Giving your body and mind a break can boost your ability to cope with the stress you may be experiencing.
Stay connected with family and friends. Giving and getting support is one of the most important things you can do. Try to do something as a family that you have all enjoyed in the past.
Be patient with yourself and with those around you. Recognize that everyone is stressed and may need some time to put their feelings and thoughts in order. That includes you!
Set priorities. Tackle tasks in small steps.
Gather information about assistance and resources that will help you and your family members meet your disaster-related needs.
Stay positive. Remind yourself of how you’ve successfully gotten through difficult times in the past. Reach out when you need support, and help others when they need it.
When the Challenges Are Ongoing
Many people have experience coping with stressful life events and typically feel better after a few days. Others find that their stress does not go away as quickly as they would like and it influences their relationships with their family, friends and others.
If you find yourself or a loved one experiencing some of the feelings and reactions listed below for two weeks or longer, this may be a sign that you need to reach out for additional assistance.

Crying spells or bursts of anger
Difficulty eating
Difficulty sleeping
Losing interest in things
Increased physical symptoms sucha as headaches or stomachaches
Fatigue
Feeling guilty, helpless or hopeless
Avoiding family and friends

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Jennifer Giffune, R.D., L.D.N. Is a freelance author, professional speaker and nutrition counselor. She currently is providing nutrition counseling services for Hampden County Physician Associates at their offices in Westfield, Southwick, Feeding Hills and West Springfield. If you would like to schedule a counseling session with Jennifer, please call (413) 786-1500.

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Neil Roache, of Westfield, checks out the “Light it up Blue” light display at the Home Depot store on East Main Street in Westfield yesterday. Home Depot has partnered for the third year to shine a light on autism during Autism Awareness Month in April and World Autism Awareness Day on Tuesday. The special blue light bulb can be purchased for $1.99 with $1.00 from each sale benefiting the Autism Speaks program. Home Depot will donate up to $150,000 as part of the special promotion. For more information on the program log into www.lightupblue.org (Photo by chief photographer Frederick Gore)

WESTFIELD – A global recognition of autism will take place Tuesday, which is designated World Autism Awareness Day.
To mark the day – and April as Autism Awareness Month – Autism Speaks is asking everyone to participate in the Light It Up Blue campaign. People are encouraged to purchase special blue light bulbs, available locally at The Home Depot, to light their homes blue. A portion of every blue bulb goes to Autism Speaks, an autism advocacy organization that sponsors autism research and conducts awareness and outreach activities.
Autism spectrum disorder (ASD) and autism are both general terms for a group of complex disorders of brain development. These disorders are characterized, in varying degrees, by difficulties in social interaction, verbal and nonverbal communication and repetitive behaviors. They include autistic disorder, Rett syndrome, childhood disintegrative disorder, pervasive developmental disorder-not otherwise specified (PDD-NOS) and Asperger syndrome. With the May 2013 publication of the new DSM-5 diagnostic manual, these autism subtypes will be merged into one umbrella diagnosis of ASD.
The number of children diagnosed with ASD has grown to one in 88, with one in 54 boys receiving an ASD diagnosis. For families, the diagnosis can be difficult, but advances in training and resources have grown, along with the number of children diagnosed.
Westfield Public Schools Special Education Director Patricia Byrnes said of the 1,000 students in the system with an Individualized Education Plan (IEP), 123 have a diagnosis of ASD. She said there could be others not yet diagnosed, and there are certainly more students entering the schools with ASD. In fact, the Fort Meadow Early Childhood Center is “bubbling over” with students on the spectrum, she said.
Byrnes said receiving a diagnosis at or before preschool age is progress.
“Pediatricians are able to diagnose earlier, so early intervention (EI) is able to give services earlier,” Byrnes said, adding that EI providers, such as the Westfield Infant Toddler Services, are better able to provide data to schools, which results in more comprehensive services for children.
“The earlier we get them, the better chance they have,” said Byrnes.
For most young children on the spectrum, social skills and speech therapy are the top services. Byrnes touted Fort Meadow’s ability to educate the youngest children in the district while providing the services they need, including Applied Behavior Analysis, which is a type of behavior analysis based on the traditional theory of behaviorism to modify human behaviors as part of a learning or treatment process.
Byrnes said the school department created a partnership with Westfield State University to establish programs based on the May Institute approach. The May Institute is one of the largest providers of services and special education for children and adults with autism and other special needs in the U.S.
The program at Juniper Park is for students in kindergarten through grade five and takes place in two classes. Byrnes said the intense program has been “extremely successful.”
There are three autism consultants in the schools, one works with high school and middle school students, while the other two work in the elementary schools and preschool. Training for teachers with students with ASD is ongoing and Byrnes said differential instruction allows teachers to teach typical students and students on the spectrum, both high functioning and more severe.
“We also have autism specialists that support our general education teachers,” Byrnes said.
Byrnes said she has seen the number of students diagnosed with ASD soar in the past decade, which comes at a cost and while much is made of the cost of special education, part of the reason the cost has increased is simply because the diagnoses have increased.
“We try to meet the needs of all students, whether they have a disability or not,” Byrnes said.
Byrnes said there are many myths about autism, including how people “get” it.
“It is brain-based and the experts are finding more and more evidence it is genetic,” she said.
Many people with ASD have language delays, often the first sign of autism noticed by parents. However, people with high-functioning autism often have an incredible vocabulary at a young age. No two people with autism are alike, but there are common characteristics, with varying degrees.
The following “red flags” can be indicators of autism in young children: No big smiles or other warm, joyful expressions by six months or thereafter; No back-and-forth sharing of sounds, smiles or other facial expressions by nine months; No babbling by 12 months; No back-and-forth gestures such as pointing, showing, reaching or waving by 12 months; No words by 16 months; No meaningful, two-word phrases (not including imitating or repeating) by 24 months; Any loss of speech, babbling or social skills at any age.
Those red flags, listed on autismspeaks.org, are indicative of what people classically think of as autism. Some children, however, show different signs, including being highly verbal, engaging in repetitive behaviors and speech, restricted interests, lack of eye contact and one-sided conversations.
Byrnes said one of the biggest keys to success for people with autism is early intervention, and part of that is educating parents on the signs of ASD and how an IEP can help. She said awareness is so important, which is why the Westfield Public Schools is encouraging everyone to wear blue Tuesday and participate in awareness events throughout the month.
For more information on ASD, and the Light It Up Blue campaign, visit autismspeaks.org. Byrnes said she welcomes questions about autism and the programs offered at the schools.

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