2019 Florida Conference on Aging 1

Board of Trustees 2

Advancing Primary Care Innovation in Medicaid Managed Care

2

President’s Message 3

Thank you FCOA Exhibitors 4

Florida Conference on Aging 5

Thank you FCOA Sponsors 6

FCOA Advocacy Initiative 7

Florida Conference on Aging 8

AgeW

ise

A u g u s t / S e p t e m b e r 2 0 1 9 V o l u m e 6 0 , I s s u e 4

Guardianship 101 9

$6.4 Million for Hurricane Michael Disaster Case Management Programs/A Practical Guide for Expanding the Inclusion of LGBT Older Adults

10

Welcome New Members 11

Resources & Reports 12

Member Spotlight & Member News 13

Grant Opportunities 14

Link to Calendar 15

2019 Florida Conference on Aging was Amazing! The annual Florida Conference on Aging brought together over 540 attendees, sponsors, exhibitors, volunteers and ad-vocates for 3 amazing days of education, networking and fun! The Opening Session, co-sponsored by WellCare/Staywell and Metz Culinary Management, addressed the topic of liva-ble communities. FCOA was delighted to have Rodney Har-rell, Director of AARP’s Livability Thought Leadership (photo left) discuss the Livability Index and ways to make your com-munity more livable. View the presentation here.

The panel discussion on Livable Communities with Department of Elder Affairs Sec-retary Richard Prudom; AARP State President Jeff Johnson; AARP Associate State Director Laura Cantwell and Rodney Harrell included some interactive polling ques-tions where attendees became part of the presentation! Attendees selected Hous-ing and Transportation as MOST CRITICAL domains for the future of their commu-nities. As Florida continues to grow, by nearly 900 people a day, new models and innovation will be the key to Flori-da’s success.

PHOTO RIGHT: From left to right Charlie Robinson, President, FCOA (podium); Rodney Harrell, Jeff John-son, Richard Prudom and Laura Cantwell.

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Christine Cauffield, PhD, President CEO, LSF Health Systems (904) 900-1075

Terri Barton, President-Elect CEO, Aging True (904) 807-1200

Andrea Busada, Treasurer Director, Broward County’s Elderly and Veterans Service Division (954) 357-6622

Karen Deigl, Secretary CEO, Senior Resource Association (772) 569-0760

Charlie Robinson, Immediate Past President Attorney, Special Needs Lawyers, PA (727) 443-7898

District Representatives

John Clark, District I CEO, Council on Aging of West Florida (850) 432-1475

Sheila Salyer, District II Manager, Tallahassee Senior Services (850) 891-4001

VACANT, District III

Janice Ancrum, District IV Executive Director, Nassau County Council on Aging (904) 261-0701

David Karpan, District V VP Strategic Accounts, GA Foods (727) 573-2211

Rosalyn Roker, PhD, District VI (813) 974-3232

Marsha Lorenz, District VII CEO, Seniors First, Inc. (407) 615-8961

Erin McLeod, District VIII President & CEO, Friendship Centers (941) 955-2122

Pamela Wiener, PhD, District IX Director of Guardianship, Alpert Jewish Family and Children’s Services (561) 684-1991

Katrina Davenport, District X Program Officer, City of Miramar (954) 889-2702

Horacio Soberon-Ferrer, PhD, District XI Vice President for Finance and CFO, Flori-da Community Care (305) 262-1292

Trustees At Large

John Barger, Tampa President, National Medicaid Segments, Humana (813) 679-3231

Laura Cantwell, St. Petersburg Associate State Director of Advocacy, AARP Florida (727) 592-8020

Luisa Charbonneau, Overland Park (502) 417-5596

Kathy Feeny, Jacksonville President, Florida Blue/GuideWell (904) 905-4343

Denise Gammonley, PhD, Orlando Associate Professor, School of Social Work, UCF (407) 823-2215

James Huysman, PsyD, LCSW, Davie VP, Provider Relations, WellMed Medical Management of Florida (305) 303-4000

Marianne Lorini, Ft. Myers President & CEO, Area Agency on Aging for Southwest Florida (239) 652-6900

Carlos Martinez, Miami President & CEO, United Home Care (305) 716-0764

Elizabeth Miller, Tampa State President, WellCare of Florida (813) 206-1123

Andrew Molosky, Temple Terrace President/CEO, Chapters Health System (813) 871-8077

Alexis Nguyen, Tampa CEO, Assisting Hands (813) 868-6782

Peggy Pettit, Stuart Executive Vice President, VITAS Healthcare (305) 350-6060

Recognizing the importance of primary care, state Medi-caid agencies are looking to support advanced primary care models. States are ask-ing not only if an individual

has a relationship with a primary care provider, but also whether that patient and provider is ade-quately supported by a multidisciplinary care team, and how that team addresses the diverse needs of patients — including behavioral health and social needs. But, defining how managed care organi-zations can best support primary care innovation can be challenging. This toolkit is designed to help states leverage their managed care purchasing authority to advance primary care innovation. Based on the experience of states participating in CHCS’ Advancing Prima-ry Care Innovation in Medicaid Managed Care — a national learning collaborative made possible by The Commonwealth Fund — the toolkit outlines design considerations and shares sample con-tract and procurement language within four areas: (1) addressing social needs; (2) integrating be-havioral health; (3) enhancing team-based care; and (4) using technology. The toolkit also compares how three leading states — New York, Ohio, and Oregon — are advanc-ing high-quality primary care in key domains and how they are leveraging managed care and specif-ic payment methods to reimburse for patient-centered medical homes. VIEW THE TOOLKIT »

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President’s Column

Greetings to all of our FCOA members! I am so honored to serve as your new President of FCOA and certainly have big shoes to fill. Our former President, Charlie Robinson, led us with great pas-sion and wit. We thank him for his outstanding leadership these past two years and he has prom-ised to continue to serve and advise us as I begin my new role. Our FCOA Board of Trustees is comprised of the top State leaders in the aging field. It is a privilege to serve with such dedicated colleagues, who share their time and expertise to insure our senior Floridians enjoy healthy and productive lives. We work closely with our State legislators, and advo-cate for policies and funding needs for our seniors. I couldn’t work with a more dedicated and experienced management team, led by Margaret Lynn Duggar, whom we all admire for her countless accomplishments in the aging field. I hope you all had the pleasure to meet Margaret Lynn at our annual conference this year. And what a successful conference it was, thanks to your continued support of FCOA! Top leaders in the Aging field shared their wisdom and expertise during our 3 day event. With 4 plenary ses-sions, 50 workshops, 1 intensives and 8 different tracks to choose from, the opportunities for learn-ing were unparalleled. The ballroom was full of 63 exhibitors, who showcased their innovative tech-nology, products and services that strengthen our ability to serve Florida’s seniors. More than 500 professionals in aging enjoyed networking and exchanging ideas with like-minded colleagues. Our deep appreciation for our sponsors who enabled the tremendous success of our conference. Your support enables the Florida Conference on Aging to be the largest multidisciplinary aging con-ference in Florida! You allow us to educate, advocate and innovate! I want to hear from you and welcome your ideas, comments for future FCOA growth and any feed-back you’d like to share. Together, we can continue to make Florida the BEST state for seniors to

thrive!

- Christine Cauffield, PhD

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Thank you to all of our exhibitors who shared valuable information about their products and services with at-tendees.

AAG American Advisors Group NMLS 9392

AARP Florida

Accessible Solutions

ADT Health

Aetna Better Health of Florida

AGED, Inc.

Aging Life Care Association of Florida

Amada Senior Care

Assisting Hands Home Care

Calmoseptine

CSI Caregiver Services

Centers for Medicare & Medicaid Services

Chapters Health System

Chef Minute Meals

Clarity Products, LLC

ClearCaptions, LLC

Consumer Financial Protection Bureau

Critical Signal Technologies

Diana Food Group

FAAST (no show)

Florida Blue (did not use the booth)

Florida Commission for the Transportation Disad-vantaged

Florida Community Care

Florida PACE Providers Association

Florida Policy Exchange Center on Aging, USF

Florida Power & Light

Florida Sports Foundation

Florida State Alliance of YMCAs

Florida Telecommunications Relay, Inc.

Food With Care

GA Foods

G.E.O Healthcare

Golden Gourmet Meals

Guardian Medical Monitoring

Gulfside Healthcare Services

Home Modifications – Pest Control – Chore Services

LSF Health Systems

Metz Culinary Management

Molina Healthcare

Mom's Meals

MySeniorCenter

National Association of Nutrition & Aging Services Programs

National Association of Social Workers – Florida Chapter

National Committee to Preserve Social Security and Medicare

Neighborly Care Network, Inc.

Papa

Personal Response Corporation

Philips Lifeline

Private Care Association of Florida

Safe Mobility for Life

Senior Nannies/Senior Advantages

Southern Gerontological Society

Sunshine Heatlh

Surterra Wellness

Therap Services

UnitedHealthcare Community Plan

U.S. Securities and Exchange Commission

UF Department of Aging & Geriatric Research

Valley Services, Inc.

Veterans Home Care, LLC

VITAS Healthcare

Staywell a WellCare Company

WellMed

WellSky

Day two of the Florida Conference on Aging started with an amazing plenary session co-sponsored by Humana and Uber Health. Andrea Busada (RIGHT), Presi-dent, Florida Association of Ag-ing Services Providers and FCOA Trustee, facilitated an amazing session. The session kicked off with Bob Blancato (TOP LEFT) with his now infamous 10 in 10 presen-tation that provides attendees with information about what is happening in Washington D.C. The session then turned to the topic of civil discourse. FCOA was pleased that Kyle Reese (BELOW LEFT) and Nancy Broner (BELOW RIGHT) of OneJax were at the conference representing the National Institute for Civil Discourse. This session was interactive and contained a lot of great infor-mation about how we can engage in civil conversations are difficult or divisive topics. Take a look at their presentation here! The Quality Senior Living Awards Luncheon, Co-Sponsored by Flor-ida Power & Light, AARP Florida and Florida Community Care, speaker was Sister Madonna Buder (BOTTOM LEFT). She brought her inspirational message about staying present and engaged, as well as some wonderful stories about being a tri-athlete in her eighth decade. Watch her in a Nike video here.

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Thank you Florida Conference on Aging Sponsors!

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FCOA Advocacy Initiative 2020

The Florida Council on Aging Board of Trustees voted to continue the Advocacy Initiative. This will be the12th year FCOA will take an active role in advocating on behalf of General Revenue funded home and community based programs. These programs are an important component of the long-term care continuum. In mid September the Florida Department of Elder Affairs submitted their Legislative Budget Re-quest to the Governor. The Florida Council on Aging fully supports their request to serve people on the waitlist for services. Here is the 2020 request:

Alzheimer’s Diseases Initiative (ADI) - $3.6 million to serve an additional 308 people

Community Care for the Elderly (CCE) - $6 million to serve an additional 712 people

Home Care for the Elderly (HCE) - $1 million to serve an additional 242 people

Local Service Programs (LSP) – Recommend continuation funding $2,472/person The General Revenue Programs waitlist of above programs, as of 8/27/19, is 64,441. The pro-posed increase of $10.6 million will serve an additional 1,262 (2%) frail older adults from the waitlist.

LEFT: Dr. Jamie Huysman, VP of

Provider Relations and Government

Affairs, WellMed Medical Manage-

ment and FCOA Trustee, announced

at the annual conference a $25,000

gift from the WellMed Foundation and

Dr. Rapier to support the 2020 FCOA

Advocacy Initiative.

RIGHT: Dr. Horacio Soberon-Ferrer,

Vice President for Finance and CFO

for Florida Community Care, and

FCOA Trustee, announced at the an-

nual conference a $5,000 gift from

Florida Community Care and Nestor

Plana to support the 2020 FCOA Ad-

vocacy Initiative.

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Guardianship 101

By Pamela Wiener, PhD, FCOA Trustee Guardianship is a means to keeping a vulnerable person safe, ful-filled and engaged. This article will concentrate on older adults (and will exclude the guardianship of children). However, what you see here is generally relevant to adults of any age with special needs such as traumatic brain injury, addiction, developmental dis-abilities, etc. which can seriously impair judgement and/or func-tion. Consider this an overview, and I invite you to reach out for further information. Typically an interested party such as a neighbor, relative, or friend will notice that an adult is compromised after significant exploita-tion or behavioral changes have taken place. When concerned that an ‘allegedly incapacitated person (AIP)' can no longer man-age his or her affairs without assistance, the interested party will petition the court for a guardian to be appointed. This must be done with an attorney’s assistance. Sometimes the interested party will report concerns to Adult Protective Services (APS), and APS will do the petition. The attorney will seek family members and will inform them of the petition. Family members are invited to participate in the hearing. If a relative is able to take on the guardianship responsibilities, a professional guardian will not be assigned. It is also possible that an ‘Emergency Temporary Guardianship (ETG)’ may be put in place for 90 days so that the AIP can get treatment while the guardian gets financial, medical and other matters in order. In some cases the AIP can emerge from the ETG with all of his or her rights restored, and the guardian-ship will end. The ETG can also be extended. Concurrent with the guardianship hearing is an incapacity hearing. The law requires three people to evaluate the AIP, formally using metrics such as Saint Louis University Mental Status Examination (SLUMS) tests, medical exams, chart reviews, interviews with medical providers, etc. One of the examin-ing committee, as the evaluators are called, must be a physician, another a licensed clinical professional. The third is a community member with expertise in the area of concern such as dementia, mental illness, addiction, etc. The evaluations of these individuals are considered very seriously by the judge oversee-ing the case. Sometimes the committee members are asked to testify at the hearing. Florida law requires that less restrictive alternatives to guardianship be considered prior to assigning a guardian. Therefore, if there are documents pointing to a trusted person as Power of Attorney even if in-capacity is determined at the hearing, guardianship may not be the end result. If a guardian is assigned, the court will approve a budget and a plan of care. Any expenses outside the budget or activities beyond the submitted plan of care require a judge’s review and a court order. At the incapacity/guardianship hearing, the AIP is represented by an attorney. If he or she does not have the means or wherewithal to engage representation, an attorney is assigned for this purpose and they meet prior to the hearing. The attorney advocates for the AIP’s wishes during the hearing. When the judge determines that the AIP needs a guardian, he or she may delegate a limited number of rights to the guardian, or may assign a plenary guardian.

Continued on page 9

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Vo l u n t e e r F l o r i d a A n n o u n c e s $ 6 . 4 M i l l i o n f o r

H u r r i c a n e M i c h a e l D i s a s t e r C a s e M a n a g e m e n t P r o g r a m s

The funding, provided by the Federal Emergency Management Agency will sup-port a Disaster Case Management Pro-gram that will connect Hurricane Michael survivors with a case manager who can help them achieve recovery. Organizations interested in applying to provide these ser-vices should respond to the request for proposal by October 11, 2019 at 12 pm

(ET).

Strengthen Your State and Local Ag-ing Plan: A Practical Guide for Ex-

panding the Inclusion of LGBT Older Adults

Highlighted throughout this guide is the work of State Units on Aging and Area Agencies on Aging who engage and in-clude the LGBT community in their plan-ning and services. The guide includes an extensive list of tools and re-sources to assist with outreach to LGBT communities, data collection, needs as-sessments, writing LGBT-inclusive plan-ning goals and objectives, and suggest-ed organizational best practices for LGBT-inclusive planning.

Guardianship 101—continued from page 8 The AIP is then called a ward. In my experience wards often maintain the right to determine their friend-ships and the right to vote. Rights that are frequently removed include the ability to contract, to apply for public benefits, to marry, to drive, and to consent to medical treatment. Some wards maintain their right to determine their residence and some do not. A professional guardian is typically assigned when a ward has no family, or when family can not agree on what is needed nor which family member should provide care. We see many families that are es-tranged and haven’t communicated in decades. Professional guardians are also assigned when the court determines that relatives participated in the exploitation the ward. The goal of guardianship is to restore as many rights to the ward as possible. This means finding good treatment and helping the ward navigate the world as much as possible. It means good stewardship of the ward’s assets. Guardians encourage positive relationships with family members and maintain com-munication with the families of their wards. With older adults who have dementia, the expectation of res-toration of rights is unrealistic. We provide those wards with the highest quality of life possible. Professional guardians are randomly assigned to cases off of a wheel, unless there is a compelling rea-son why a specific guardian should be chosen. If a professional is the guardian of a married person and the spouse becomes incapacitated, it is likely that the same guardian will be assigned. Cultural and reli-gious considerations are taken into account. Professional guardians must accept at least 1 pro-bono assignment annually from the wheel. The Public Guardian offices (in most counties) and other not-for-profit corporate guardians (such as my agency, Ferd and Gladys Alpert Jewish Family Service) take on many indigent cases. This is the tip of the iceberg. It is important to note that there are standards of practice, that we have professional certification, and that our role as guardians is guided by statutes. Many professional guard-ians have additional training and expertise in real estate, nursing, social work, and law.

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Welcome New Members

July & August

Robin Atkins, Tampa General Hospital, Tampa

Iva Carter, Hillsborough County Government, Tampa

Guy Davis, Orlando

Nicole Dawson, UCF, Orlando

Dr. Christopher Ingersoll, UCF, Orlando

Jay Jackson, Abacus Life, Orlando

Mary Kiefert, PACE Place, Jacksonville

Rachel Langdon, WellCare, Tampa

Kelly McCartney, USF, Tampa

Jennifer O’Brien, USF/St. Petersburg, St. Petersburg

Sheri Stripling, UCF, Orlando

Below: FCOA President Charlie Robinson swears in the 2019-2020

FCOA Board of Trustees

AgeWise - August/September 2019 12

Resources & Reports Dental Care Among Adults Aged 65 and Over, 2017, by Ellen A. Kramarow (Data Brief No. 337, May 2019). In 2017, slightly less than one-third of adults aged 65+ had dental insurance. Overall, approximate-ly two-thirds of adults aged 65+ had a dental visit in the past 12 months. Older adults who were poor (42.7%) or near poor (42.8%) were less likely to have had a dental visit compared with not-poor (74.4%) older adults. Older Women Live Longer, But With More Disabil-ity and Financial Challenges Than Men, “ Women may be living longer but not healthier lives than men,” says Eileen Crimmins of the University of Southern California. Her team examined life expectancy and disability rates in the 40-year period from 1970 to 2010. Their analysis of U.S. vital statistics shows that both men and women saw lifespan increases, but women are spending a larger share of the additional years with a disability than men. Strategies Used by Adults Aged 65 and Over to Reduce Their Prescription Drug Costs, 2016–2017, by Robin A. Cohen and Peter Boersma (NCHS Data Brief No. 335, May 2019). Among adults aged 65+ who were prescribed medication in the past 12 months, 4.8% did not take their medication as pre-scribed to reduce their prescription drug costs, and 17.7% asked their doctor for a lower-cost medication. Women were more likely than men to not take their medication as prescribed. A Look at College Costs across Generations, by Joe Valenti (May 2019, 12p.). Increased student debt levels may threaten retirement security for students and their parents alike. If young workers delay saving for retirement due to their student loan payments, they may need to work two to seven years longer to achieve the same retirement account balances. Policy Options for Improving Dental Coverage for People on Medicare, by Meredith Freed, Lisa Potetz, Gretchen Jacobson, and Tricia Neuman (September 2019, 21p.). Nearly two-thirds of the Medicare popu-lation – 37 million beneficiaries – have no dental cov-erage at all. Cost concerns and lack of dental cover-age contribute to beneficiaries foregoing routine and other dental procedures. Lack of dental care can ex-acerbate chronic medical conditions, such as diabe-tes and cardiovascular disease, contribute to delayed diagnosis of serious medical conditions, and lead to preventable complications that sometimes result in costly emergency room visits

Cognitive Performance in Adults Aged 60 and Over: National Health and Nutrition Examination Survey, 2011–2014, by Debra J. Brody, Ellen A. Kra-marow, Christopher A. Taylor, and Lisa C. McGuire (National Health Statistics Reports No. 126, Septem-ber 2019. This report describes cognitive perfor-mance in the U.S. noninstitutionalized population of older adults. The association of sociodemographic factors and self-reported cognitive and health status with low cognitive performance is also investigated.

Factors influencing adherence to home-based

strength and balance exercises among older

adults with mild cognitive impairment and early

dementia: Promoting Activity, Independence and

Stability in Early Dementia (PrAISED), by Jennie E.

Hancox, Veronika van der Wardt, Kristian Pollock,

Vicky Booth, Kavita Vedhara, and Rowan H. Harwood

A Unified Cost-Sharing Design for Medicare: Effects on Beneficiary and Program Spend-ing, by Bowen Garrett, Anuj Gangopadhyaya, Adele Shartzer, and Diane Arnos (July 2019, 24p.).In this report, we examine a potential reform to

Medicare that would simplify coverage for fee-for-service beneficiaries, streamline cost-sharing obliga-tions under a uniform deductible for Medicare Parts A, B, and D services, and create an out-of-pocket maxi-mum to protect beneficiaries from high financial bur-dens. Medicare spending would increase by $31.2 billion (a 5.7 percent increase) relative to current law in 2020.

Payroll Tax Is One State’s Bold Solution To Help Seniors Age At Home

Nearly a decade after federal officials discarded a provision in the Affordable Care Act that would have provided Americans with long-term care in-surance benefits, two states — Washington and Hawaii — are experimenting with taxpayer-funded plans to help older residents remain in their homes. Washington state’s ambitious plan, signed into law in May, will employ a new 0.58% payroll tax (or “premium,” as policymakers prefer to call it) to fund a $36,500 benefit for individuals to pay for home health care, as well as other services — from in-stalling grab bars in the shower to respite care for family caregivers.

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Roaming Hills Dental Care

Delivering Dentistry to You

Roaming Hills Dental Care is a completely porta-ble dental practice. We understand that reliable transportation can be a large barrier to receiving

dental care for the elderly and homebound. Our mission is to make dental care more accessible and stress-free for our patients. We are able to complete most dental services in the comfort of your facility or home. Our practice is structured in a way that allows us to spend four to five times longer

with each patient than is typically seen at a traditional office. This allows for more individualized treatment, informative evaluations, thorough explanations, and education on a patient's particular condition. We also create customized treatment plans to help our patients maintain their healthiest

smiles.

We are able to provide most common dental services including, but not limited to, the following: Preventative Care; Cleanings and Exams; Deep Cleanings; Fillings; Complete and Partial Dentures;

Denture Repairs; and Emergency Treatment.

For more information or to schedule an appointment with FCOA member Ashley Baptiste, DMD – Dentist/Founder, please contact us directly:

Phone: (850) 545-5364 Email: info@roaminghillsdentalcare.com

Web: www.roaminghillsdentalcare.com

Member News

The Senior Resource Alliance, which acts as the local Area Agency on Aging of Central Florida, has hired Karla Radka as the next President and CEO. The Senior Resource Alliance manages the El-der Helpline and the Aging and Disability Resource Center.

Dwight Chenette, has joined Your Aging and Disability Resource Center/Area Agency on Ag-ing of the Palm Beach/Treasure Coast as its Chief Executive Officer. Mr. Chenette has concentrat-ed the majority of his career in leadership roles which focused on caring for vulnerable populations and improving access to community services.

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Grant Opportunities Environmental Influences on Aging: Effects of Extreme Weather and Disaster Events on Aging Processes (PAR-19-249, National Insti-tute on Aging, in conjunction with other agencies, application deadlines November 4, 2019; March 9, 2020; July 7, 2020; November 9, 2020; and March 8, 2021). Together with the companion FOA (PAR-19-250) that focuses on how extreme weather and disaster events impact older adults, these FOAs will help to explicate the behavioral, biological, epigenetic, genetic, neurological and socioecological processes that affect the aging process. The ultimate goal is to improve the health and well-being of older adults via increased knowledge about extreme weather and disaster preparedness, response, and re-covery. The Awesome Foundation is a global community advancing the interest of awesome in the uni-verse, $1,000 at a time. Each fully autonomous chapter supports awesome projects through mi-cro-grants, usually given out monthly.

These micro-grants, $1,000 or the local equiva-lent, come out of pockets of the chapter's "trustees" and are given on a no-strings-attached basis to people and groups working on awesome projects. Deadline: Open The Walmart Foundation is accepting appli-cations through its Community Grant Pro-gram. Through the program, grants of up to $5,000 will be awarded to local nonprofit organi-zations in the service area of individual Walmart stores in the areas of hunger relief and healthy eating, health and human services, quality of life, education, community and economic develop-ment, diversity and inclusion, public safety, and environmental sustainability. Applications will be accepted on a rolling basis through December 31, 2019. For complete program guidelines and application instructions, see the Walmart Foun-dation website.

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www.fcoa.org

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The Florida Council on

Aging is committed to

serving Florida’s

diverse aging

interests through

education,

information-sharing

and advocacy.

AgeWise is published six times per year by the Florida Council on Aging for its members. The publication is edited by Margaret Lynn Duggar & Associates. The subscription rate for nonmembers is $65 a year. Foreign

subscriptions are not available. Reprint permission for use by any media type is required in advance, and there may be a fee to reprint. Please contact FCOA for more information on reprints. Advertising space may

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