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Government cannot fix healthcare

Mon, 11 Jul 2011 16:32:00 +0000

This article by Mike Hassinger helps to highlight the unbashed ignorance of this administrations inability to appropriately address access to healthcare. Their lack of understanding in staggering and their quickness to mandate through powerplay without due consideration of the unintended consequences again highlights how the personal grab for political power is at the heart of these so called reforms.
The only hope is that states and other private for profit and non-profits work together to create cross lines co-ops that are market driven and use technology, performance based pay models that are really new healthcare models. Do we really believe that government with all it's success with Medicare can reform. To that they would have to start with themselves and I don't see that happening anytime soon.

Medicaid Math and Naked Numbers

July 11, 2011 10:06 am

by Mike Hassinger · 10 comments

Can someone help a liberal arts major out? My math skills are not the best. I can’t count to 21 unless I’m naked, so please, feel free to check these numbers. You can even use decimal points if you’d like. The AJC reports this morning that “In fiscal year 2011, [Georgia] paid roughly $1.7 billion for Medicaid and PeachCare…” and in the same article, “Medicaid and PeachCare for Kids currently provide health care to roughly 1.7 million low-income Georgians.”

So, $1.7 billion divided 1.7 million people is what, $1,000 per low-income person, right? And the feds kick in about $5 billion more, which is, umm, $2,900 or so for each low-income person, right? Let’s call it $4,000 per poor person. (When counting naked, you should always round up.)

Now let’s add 600,000 more poor people when Obamacare expands Medicaid eligibility to people under 65 who earn $30,000 per year. (That’s about 133% of the poverty level for a family of four.)

“…officials say the 600,000-plus people expected to join [Medicaid] under the federal health care overhaul starting in 2014 could cost the state an additional $2.1 billion by the end of this decade.”

So these 600,000 soon-to-be-eligible low-income people will cost Georgia taxpayers 3.5 times as much as the currently eligible 1.7 million low-income people are costing Georgia taxpayers now? Let me put my shoes back on.

Medicaid is currently $180 million short, and as State Sen. Renee Unterman notes: “We can’t afford who we have on Medicaid right now.”

Even a non-math major can see that the cost curve is being bent in the wrong direction. I thought the intent of Obamacare was to make quality healthcare affordable and accessible for everyone. That noble goal brings to mind the sign in auto repair shop that read: “Our service- Good. Fast. Cheap. Pick any two.” That’s the reality with healthcare. You can give it to everyone, or make it the best in the world, or make it cheaper. Pick one.

"Changing the Climate of Healthcare"www.southerncrossmediation.com

The power of the healthcare consumer

Fri, 29 Apr 2011 20:19:00 +0000

The power to decide.....That's what it comes down to. Who has the power? The consumer. How does that effect personal health outcomes? Here is an excerpt from the Georgia Public Policy Foundation to highlight the power of the consumer.
- National health care: The Heartland Institute's Benjamin Domenech defends consumer-driven health care in a letter to Paul Krugman: "The United Kingdom, under CMS director Donald Berwick's beloved National Health Service (he openly confesses 'I am a romantic about the NHS') in which consumer power is extremely limited by law, has created a cancer mortality rate more than 38 percent higher than America's. For example, according to Lancet Oncology's CONCORD study, in the U.K., women with breast cancer have a 46 percent mortality rate, compared with only 25 percent in the U.S., and while only 19 percent of men in the U.S. who get prostate cancer die of it, in the U.K. it kills 57 percent." Read the entire letter here: http://tinyurl.com/3bhky8e.
So let's break this down into bite size pieces.
The US Breast Cancer mortality in our mother's, sisters and friends remains at a high 25% across the board so of 100 women with breast cancer 25 of them will die here in the US. In the UK the mortality rate of our mothers, sisters and friends across the pond is a staggering 46%. So of 100 women diagnosed with breast cancer 46 of them will die. That is just short of 1/2 and that is a 100% increase over the US statistical death rate. The men in the US who are diagnosed with prostrate cancer one of the most treatable and slow progressing cancers has a death rate of 19% or 19 out of 100. The UK death rate is again a staggering 57%. or 200% greater than the United States. These statistics alone bear the burden of proof as to why nationalized health care is not only just a bad Idea but bad for your health. Obama Care provides the fundamental structure that strips the consumer of the very decision making power that makes our health care system the most sought after in the world.
I believe the position of the liberal base is founded on the premise that ALL should have access to healthcare regardless of ability to pay and I, as a compassionate conservative, agree whole heartedly. The downfall of the liberal base is the expectation that Government is the only answer and they are seemingly unwilling to entertain other market options for a shared governance. Why not ONLY government.. you ask even in after reading the above excerpt? Let me explain.
First, the inherent power that our free market grant's is wretched away from the consumer base and it affects the "haves" and the "have nots" equally by altering our ability to choose what will and won't happen to our person. My statement goes directly to the heart of the liberal platitude that the single corpus of power is money and that the most valued applied freedom is using that money to leverage and attain services. Though this privilege is an aspect of a strong and free society it is not it's pinnacle. Liberalism's obsession with other people's money is at fanatical levels and is really a reflection of the self aggrandizing role as the long awaited progressive messiah.
The personal choice exercised with free will is the single most powerful tool a person can wield on their own behalf. There are huge implications for all in abdicating our free will in trade for what is being put forward as a better social engineering for society. Such as accountability. With the government making resource choices and healthcare policy that limits an individuals ability to choose how does that meet the goal of better social engineering? The liberal base chooses to lay down this right under the guise of self sacrifice and in the name of giving this as gift of free will to those that they see as not having the ability to do that for themselves giving them a personal sense of moral superiority and a god like feeling. And they wield it powerfully...not rightly but powerfully.
Second, and the most significant, with abdication is that the government becomes stronger, bigger and more powerful than the people it serves creating the exact power imbalance the liberal base despises between the private industry and consumer base. This is the more disturbing spin on the part of the liberal base that by some magical transformation (aka self aggrandizement) BIG government is truly different than the evil private corporations that just want to keep or steal our money at any cost and enslave their non-unionized workers. Clearly because government is run by hallowed saints rather than the greedy private industry sinners. The really big revelation here is that there is no difference. As this administration is empowered by a minority self-aggrandized leadership to collect power by taking over private markets, using it's influence in a chilling unprecedented move to affect markets and economies for it's own political survival and intervene in our personal healthcare it is heralded as altruistic by the liberal base because it serves to affirm a personal theology regardless of wishes of the majority. There is the power imbalance. Not only do they negate the dialogue of the other group but they are unfairly punitive and outright hostile. This is the evidence that power is used in equally corrupt ways wether private or government to secure one's power base.
The gift and responsibility of free will creates the implicit demand that we first be responsible for our own health and wellness and second keep our leadership accountable to us since we are who they serve and committ to learning how to develop further what has proven to work through consumer driven healthcare. That means creating the ability to purchase insurance across state lines, improvement in claim management, reworking medicare reimbursement and stop paying top dollar for the most invasive of treatments and increase health and wellness reimbursement and granting Nurse Practitioners equal reimbursement in primary care and finally get the state's too grant independent practice to Nurse Practitioner's which would create immediate access across class lines throughout the country.
Who had the power? The consumer. Who is making a grab for the power? The government.... Don't abdicate your free will at the empty promises of a few who have self-selected to exempt themselves from what they are trying to sell you as the best they can offer. For them It really isn't about you....it's always about them.

The Coming Age of the Patient Navigator

Wed, 27 Apr 2011 17:57:00 +0000

The Coming Age of the Patient Navigator

This article though timely in bringing this role into the limelight simply highlights the role of the professional care manager. As health care has become increasingly siloed in response to reimbursement, regulation and an aging population gaps in the process have repeatedly been cited as causes for readmissions and poor treatment implementation at home. Most times this is due to lack of education, coaching, and realistic expectations. Care management services begin implemented from healthcare delivery organizations such as doctor's offices are the key to integrating wellness care, illness treatment and reducing readmissions and poor therapeutic compliance. The components that are all working together to decrease risk and increase wellness are complex. A basic knowledge of the health care continuum is needed, along with the ability to educate on health and wellness topics with a high degree of proficiency, the ability to facilitate difficult dialogue without judgement or imposing your personal sense of right and wrong, the ability to anticipate needs physical and emotional and identify appropriate resources and support services that are beyond our scope.

An area of specialty is in Palliative Care. This role is an advanced role and is integrated with skills of dialogue, listening and in helping others find their narrative of life and death and discerning the values they most cherish in making end of life decisions. This is could be considered at the level of Ethical consultation which requires a significant knowledge base as well as skilled facilitation for a multiple party dialogue on the implications of decisions and what is there meaning on an individual, family and societal level. Very rewarding role and very relationship based role. These are the most rewarding. To empower and individual and a family to work through to a peaceful and dignified death excerciing free will all the way to the last breath.

"Changing the Climate of Healthcare"www.southerncrossmediation.com

Alzheimer's New Guidelines: New York Times Repost

Mon, 25 Apr 2011 16:44:00 +0000

Guidelines Allow Earlier Definition of Alzheimer’s

For the first time in 27 years, the definition of Alzheimer’s disease is being recast in new medical guidelines that reflect fast-mounting evidence that it begins ravaging the brain years before the symptoms of dementia.

Stages of Alzheimer’s Disease(April 19, 2011)

Readers' Comments

"The mental anguish of living with a diagnosis would most certainly be as debilitating as the disease itself; especially if it was wrong. Sometimes, ignorance is bliss."

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The guidelines, to be issued Tuesday by the National Institute on Aging and the Alzheimer’s Association, divide the disease into three stages: a phase when dementia has developed, a middle phase in which mild problems emerge but daily functions can still be performed, and the most recently discovered phase, in which no symptoms are evident but changes are brewing in the brain.

“We’re redefining Alzheimer’s disease and looking at this in a different way than had ever been done,” said Creighton Phelps, director of the National Institute on Aging’s Alzheimer’s Disease Centers Program. “I think we’re going to start to identify it earlier and earlier.”

The drive to diagnose Alzheimer’s before it has progressed into profound dementia is also reflected in a bill introduced in Congress this month, which would create specific Medicarecost codes for Alzheimer’s diagnosis, including steps involving discussions between the patient’s doctor and caregivers, a recognition that keeping family members well-informed can result in better planning and care.

“Early diagnosis is really the key to this,” said Representative Edward J. Markey, Democrat of Massachusetts and a sponsor of the bill. “Oftentimes family members notice the symptoms in their loved ones, but it’s only years later that they get diagnosed or understand what resources are available.”

The most striking addition to the guidelines concerns methods that assess brain changes involved in Alzheimer’s, including brain scans and tests of cerebral spinal fluid. Such methods measure what are called biomarkers, physiological indicators that someone is likely to develop dementia eventually, just as cholesterol and blood pressure are biomarkers of impending heart disease.

For now, the guidelines specify that Alzheimer’s biomarkers — including abnormal levels of the proteins amyloid and tau, and shrinkage of certain brain areas — should not yet be put into widespread use, but used only with patients enrolled in clinical trials.

That is because scientists cannot yet standardize the results of the tests, or know “what measure is truly abnormal and what measure is not,” said Marilyn Albert, director of theJohns Hopkins Alzheimer’s Disease Research Center, and a leader of one working group that developed the new guidelines.

As many as a third of people with amyloid plaques in their brains, for example, have not developed Alzheimer’s symptoms by the time they die. The guidelines also urge caution because there is currently no drug known to halt or significantly delay the onset of symptoms, so people told they are likely to get Alzheimer’s have no effective medication to take.

“We don’t have enough information about what to tell people,” said Dr. Steven DeKosky, dean of the University of Virginia medical school, who participated in one of the working groups. “Until you can tell a clinician, ‘If you do this test you have X amount of reliability and to do that will make a difference in the life of your patient’ — until then, it remains in the lab.”

But the guidelines reflect a sense in the medical community that the moment when science will have more specific knowledge about biomarkers is not that far off. They are intended to encourage more research so that drugs can be developed to attack early brain changes and to identify people who might benefit from such drugs when they become available.

The goal, said William Thies, chief medical and scientific officer for the Alzheimer’s Association, is “extending the range of our ability to investigate this disease and eventually find the treatment that is going to be so necessary to avoid the epidemic of Alzheimer’s disease that we see facing us over the next 40 years.”

In the short term, the biggest impact is likely to be seen with people who fall into the middle phase, those with mild cognitive impairment linked to Alzheimer’s. Experts say there are at least as many people experiencing this phase as the 5.4 million people estimated to have Alzheimer’s dementia. And they expect others to now ask their doctors if they are showing signs of mild impairment, which include experiencing some difficulty or inefficiency with memory, attention or other mental faculties, while still being able to function independently.

Dr. Albert said that if patients with symptoms of mild cognitive impairment wanted to “increase the certainty” of the diagnosis by getting a brain scan or spinal fluid test, they should obtain such tests in a research trial so they have a better chance of getting accurate results.

The guidelines also clarify diagnosis criteria for people with dementia symptoms, distinguishing Alzheimer’s from other dementias, including vascular, fronto-temporal and Lewy body. And they note that the earliest symptom of Alzheimer’s dementia is not always memory loss, but could be mood changes or problems with language, spatial perception or reasoning.

Dr. Pierre Tariot, director of the Banner Alzheimer’s Institute in Phoenix, who was not involved in drafting the guidelines, called them “a step in the right direction” that he hoped would not be “misconstrued” as a sign that biomarker tests are further along than they are. He added, “The notion that Alzheimer’s disease is a continuum that has an extensive pre-symptomatic phase is a very important message to get out.”

Dr. Phelps said it would hardly be the last word from the medical community on Alzheimer’s.

“We’re not drawing a line and saying this is it,” Dr. Phelps said. “What we’re saying is this is the best of our knowledge and we’re not going to wait 27 years to revisit these again.”

Geriatric Care Management is about closing the Gaps especially with planning for the end of life

Mon, 11 Apr 2011 13:30:00 +0000

After a long Blogging Hiatus during which I have done a great deal of personal work in hopes of honing my work into the right places that I am called. It seems that I am called to do one thing regardless of the venue of business and that is close the gap of knowledge. That is through patient advocacy, Geriatric care management, ombudsman, medical navigation and community education too name a few. So to honor that call I am reposting an excerpt with links that is part of my newsletter that I receive from the American Geriatrics Society.

"None of us likes to think about being incapacitated and unable to make our own healthcare decisions. Yet, making your healthcare wishes known is one of the most important conversations you can have with your family, friends, and healthcare providers. In particular, conversations with your doctor or other healthcare providers - known as advance care planning - can help them to guide your family or other caregivers about your wishes if you are unable to do so yourself."

The American Geriatrics Society has released a statement on the importance of advance care planning. The statement highlights why geriatrics healthcare professionals believe these are such important conversations to have with your family, friends and care providers.

The AGS Foundation for Health in Aging has the following resources for you to learn more about advance care planning:

As Americans age HIV increases in our Elders

Tue, 02 Nov 2010 15:44:00 +0000

I wanted to share this with my community so that we quite the myth that HIV/AIDS is lessening because of whatever reason we choose to believe but that in fact the highest

risk group is now 50 and over these are our family, friends and community members that need support and encouragement to care for themselves and to be cared for. Outside of the relational implications are the implications for how they will enter into the elder years and how will our current institutional models respond to this population. We might know how we think they should respond but that is not enough. Be deliberate about these conversations. If you or your loved one is living with HIV/AIDS and you are considering entering into an Elder Care Community of any level ask what provisions they have for patient safety and discuss a potential plan of care and what resources their system can offer. Discuss what you would like and what the current needs are and what provisions you already have in place and how that can integrate into a preexisting community.

It takes immense courage to live with HIV/AIDS, It takes immense courage to age in our current society with the stigma we have place on aging. These my friends are some of the bravest people you will ever know.

Highlighting HIV Issues Among Older Americans

By Gregorio Millett, M.P.H., Senior Policy Advisor, Office of National AIDS Policy (Cross-posted from the Office of National AIDS Policy Blog)

Over 1 million Americans are living with HIV and the number is growing. Advances in medication have not only increased the lifespan for people living with HIV, but also the quality of our lives. Despite this good news, it has also brought new challenges that were not anticipated back when being diagnosed with HIV carried a prognosis of a much shorter lifespan. One of the most surprising aspects of the domestic HIV epidemic is the number of people aging with HIV. Earlier this year, New York City’s Department of Health and Mental Hygiene reported that 75% people living with HIV in the city were 40 years old or older and 37% were 50 years of age and older. This phenomenon is not just taking place in New York City—similar demographic trends are being observed nationally. According to experts at Yale Medical school, is estimated that 50% of people living with HIV in the US will be 50 years old or more by 2017. Moreover, 31% of new HIV infections in the United States each year occur among those between the ages of 40 and 49 and 7% of new infections occur among those 50 years old and older.

This week the White House Office of National AIDS Policy convened a meeting on HIV and aging to discuss these demographic trends. The purpose of the meeting was to raise awareness about people who are aging with HIV or contracting HIV as seniors (>50 years of age); to explore unique clinical manifestations of HIV infection among older adults; to discuss existing services for seniors living with HIV and highlight successes as well as gaps; and to discuss targeted strategies for Federal and non-Federal stakeholders to realize the vision of the President’s National HIV/AIDS Strategy. The meeting was part of a series of discussions that have been convened at the White House over the past year, including meetings that have focused on women, youth, Latinos and other populations.

The White House HIV and aging meeting agenda included an epidemiological and clinical overview of older Americans (age 50 or older) by Dr. Amy Justice of Yale School of Medicine. Dr. Justice discussed findings from various research studies and the complications of managing a chronic infection and the commorbid conditions related to the aging process. This was followed by a panel discussion of people of various demographic backgrounds who are aging with HIV, and complemented by a video clip from ABC’s popular television series Brothers & Sisters where executive producer David Marshall Grant and actor Ron Rifkin discussed the storyline behind a major character on the show who is a senior and diagnosed with HIV.

A panel of Federal officials provided information on prevention, care, research, disability, legal and workforce issues related to people aging with HIV; and a final community panel further explored these issues at the local level. A highlight of the meeting included recognizing Dr. Robert Franke, a retired university provost and Unitarian Universalist minister who is living with HIV and who recently won a discrimination lawsuit against a Arkansas nursing home.

The meeting ended with a clear message that older age is not a safety net that protects people from getting HIV and that people are living with HIV for decades. It was also clear that the many issues surrounding HIV among older adults will only increase as our country faces the continuing graying of our nation’s HIV epidemic.

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David Marshall Grant and Ron Rifkin: HIV & Aging -- Clips from Brothers & Sisters

Geriatric Care and the role of one

Fri, 29 Oct 2010 22:31:00 +0000

Working in health care for over 20 years now it still never ceases to take my breath away when I experience a system of such
disproportionate dysfunction through the personal experience of a family. The delivery of care sometimes is so compromised that it is
no longer recognizable as health care but reflects some superficial version of it through a dismissive attitude delivered as a double whammy from the caregiver and the system.

It can be very defeating to an Elder client that has a decreased ability to hear and see and respond as quickly as this fast paced system demands. There is hope though. Here are some tips to
assist you, the family caregiver, and are easy to follow and at most take a little more preparation time with you and the Elder family member working together to make the most of visits.

First create a binder, folder or some time of storage center for medical visits. Divide by month and then for each pending visit take 30 minutes and discuss what needs to be addressed in that visit
and write those questions down. Pay significant attention when the provider gives new treatments or medications and be sure that you can repeat back to the provider the directions and the purpose of the medication and what it is for and when can you expect to see a response. Also ask "What might be some side-effects" that you need to think about such as hypotension or a lowering of blood pressure. This may predispose the elder to falls so getting up and going to the bathroom becomes more risky. A reliable internet source for medications is www.rxlist.com and it has specific consumer information.

Transitioning changes into daily life may be more difficult than previously considered and those difficulties may translate to poor outcomes. You can anticipate that you will need to spend more time on the new treatment changes until integrated into the elder's daily routine.

When things become overwhelming or you are experiencing Care giver stress find a respite for you to take a step back and regain some balance. To do this contact your local Area on Aging for resources. Another good resource is your state Health and Human Services department which will include your Area on Aging along with multiple possibilities for support system development.

For questions Please contact Kim Bunker RN BSN LNC GCM

Groups of providers collaborate to help Consumers

Thu, 14 Oct 2010 13:10:00 +0000

Assited Living Disclosure Tool

This is a another great tool pending for use by both consumer's and Assisted Living Providers.
The exponential growth of our aging populations in the next 5-7 years will be a business boon for non-healthcare providers to start personal care homes.
These smaller assisted living facilities will be needed but what is really needed is oversight on the quality of care and support programming available to clients and the monitoring of conditions and changes in conditions. Nutrition, hydration, behavioral management, hygiene issues, ,skin issues, medication management to name a few of the complex issues that surround senior care.

Southern Cross can provide insight and tools to consumers to ask the right questions and monitor the care provided. We can assist the personal care home owner with creation of the right practices that provide excellence in care management for their clients. Through ongoing education of non-skilled providers such as certified nursing assistant's.

Elder needs are complex and time intensive and worthy of all our attention and professional abilities. An attitude of learning and willingness to integrate with the elder's individual needs.

The future of healthcare is dependant on interdisciplinary providers

Tue, 12 Oct 2010 15:04:00 +0000

Nursing is the backbone of healthcare delivery will be the force that delivers the majority of primary care. How will states and insurers support the development of this group of providers. The need is great and the economic implications are staggering

The IOM Report on the Future of Nursing and the AMA’s Response

October 8th, 2010

By Diana J. Mason. The Institute of Medicine’s (IOM) report on the Future of Nursing released on October 5^th at the National Press Club was developed by an interdisciplinary committee after public hearings around the country and an exhaustive review of the literature on various related themes, such as the evidence on the outcomes of nursing care. Physicians Harvey Fineberg (President of the IOM) and Risa Lavizzo-Mourey (President of the Robert Wood Johnson Foundation) spoke to the importance of the report for improving health and health care in the United States. Risa specifically pointed out that the report was not so much about nursing as it was about how to transform health care. Additionally, committee member and physician Jack Rowe (former head of Aetna) spoke eloquently to the importance of ending interprofessional turf battles by focusing on what patients need.

Organized medicine continues to be stuck on protecting its view of its turf. In a statement issued after the IOM report was released, the American Medical Association (AMA) claimed that only physicians can lead health care teams because they are more educated than nurses. They claim it’s a matter of quality and safety, but they are ignoring the evidence to the contrary that is laid out in the IOM report. To better understand the origins of this turf battle, read Chapter 3 of the IOM report and look at the work of legal scholar Barbara Safriet.

What the AMA doesn’t seem to understand is that the future of health care requires skills that other health care providers have. Especially in primary care, clinicians need to emphasize health promotion, chronic care management, and care coordination. Physicians are highly trained diagnosticians of disease and surgeons, but this is a narrow skill set for primary care. The ideal is to have primary care physicians who can provide that expertise when needed but be on teams that may be headed by them, nurse practitioners, nurse midwives, social workers, or others. For example, for people with chronic mental illness who have developed important relationships with mental health practices, the social worker may be the best person to head the team.

Nurse-managed health centers have demonstrated that nurses can lead primary care centers that are health or medical homes using interprofessional teams that include physicians. We know that nurse practitioners can do 90% of what primary care physicians do with comparable outcomes, plus the health promotion and care coordination.

If we all can keep our eye on the real aim defined by Jack Rowe—focusing on what people need to promote health—the approaches to health care will become clear. Here’s hoping that the AMA achieves an understanding of this essential point soon.

Poverty Grows In Suburbs, But Social Services Don't Keep Up

Thu, 07 Oct 2010 13:50:00 +0000

When private markets are manipulated by Government and those leaders within for their own private wealth building-(Dodd & Frank..... both criminals). There is no difference between them and Enron's Skilling. They fleece others money because they don't have enough
creativity or ability to work hard and make their own. The end result is that legitimate businesses that create jobs and provide income suffer to pay for their mistakes. Business suffers the middle class suffers and thus those they supported through charitable giving below the poverty line stops because they now face the same possibility.

Government cannot and should not ever replace our personal responsibility to care for our families in need. They or government begins to see themselves as a benevolent god and the answer to all. It seems easier to some because it's hands off and it feels good but the real answer is to ask ourselves what each of us can do whether financial, emotional, coaching, volunteering getting in a really understanding their plight through their experience and offering what gifts we can to support their efforts to move out of poverty or improve their situation. Investing in relationship. It's a risky proposition but empowering to a collective nation.

Poverty Grows In Suburbs, But Social Services Don't Keep Up

"Changing the Climate of Healthcare"www.southerncrossmediation.com

Profiling who is most at risk for Elder Abuse

Mon, 04 Oct 2010 15:57:00 +0000

We are beginning to develop our understanding of those elders who are most at risk of Elder abuse and this will help provider community and our communities at large become better and more confident advocates for those elders who are most vulnerable.

Racial Disparity In Psychological Elder Abuse

Main Category: Seniors / Aging
Also Included In: Psychology / Psychiatry
Article Date: 30 Sep 2010 - 0:00 PDT

Current Article Ratings:

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In the first population-based survey to indicate a racial disparity in the psychological abuse of senior citizens, University of Pittsburgh researchers found that African American seniors could be twice as likely to be mistreated than elders of other races. The survey also revealed that African American elders could be up to five times more susceptible to being swindled. Reporting the survey results in The Gerontologist, the researchers urged that health care and social service workers be especially vigilant for the possible mistreatment of African American seniors.

Lead author Scott Beach, assistant director of Pitt's University Center for Social and Urban Research (UCSUR) and director of the center's Survey Research Program, said the study is important to the developing field of elderly abuse research. Beach worked with coauthors Richard Schulz, director of UCSUR and the center's gerontology program; Nicholas Castle, a professor of health policy and management in Pitt's Graduate School of Public Health; and Jules Rosen, a professor of psychiatry in Pitt's School of Medicine.

The Pitt survey is among only a few that focus on race as a specific factor in elder mistreatment, Beach said. In addition, the population-based survey collected information directly from senior citizens through face-to-face and telephone interviews, the most effective way to document unreported abuse, he explained; typically, elder mistreatment data is gathered from complaints filed with Adult Protective Services. In this way, the Pitt study helps fill a noted gap in elder mistreatment research: The National Research Council, in its 2003 report, Elder Mistreatment, described existing elder abuse research as having "a number of weaknesses," including a lack of clear, consistent definitions and an absence of population-based data.

The team interviewed 903 adults - a statistically large sample - aged 60 and older living in Pennsylvania's Allegheny County about instances of psychological abuse and financial exploitation occurring within the past 6 months and since they had turned 60. The sample contained 210 African Americans, or 23.2 percent of respondents, which is nearly twice the proportion of African Americans living in Allegheny County, Beach said.

Psychological mistreatment included being yelled at or insulted, having personal property destroyed, and receiving threats of injury, stoppage of care, or being sent to a nursing home. Among African Americans, 24.4 percent reported being abused since turning 60 and 16.1 percent reported psychological mistreatment within the past 6 months. Around half as many non-Black seniors reported abuse with 13.2 percent claiming psychological abuse since turning 60 and 7.2 percent saying it happened within the previous half-year. Interestingly, African Americans were usually less upset by aggressive behavior, yet more African Americans reported being "extremely upset" when deliberately insulted or when their belongings were destroyed.

African Americans reported even higher instances of financial exploitation, which was defined as having checks stolen, having money tampered with, and being made to sign documents they did not understand. Only 8.4 percent of non-African American elders reported being cheated since turning 60 and a mere 2.4 percent said it happened within the past 6 months. On the other hand, 23 percent of African Americans claimed that someone meddled with their money since they turned 60 and 12.9 percent said it occurred recently.

Most striking about the team's findings was that the racial disparity in mental abuse or financial exploitation was not explained by additional factors such as education, health, age, or socioeconomic status, Beach said. On average, African Americans in the survey tended to be slightly younger, less educated, and more likely to be single, divorced, or widowed. Nonetheless, non-African Americans of similar means, years, schooling, and marital status were still less likely to report mistreatment or financial deceit, Beach said.

Beach plans to follow up on the survey by including seniors from other parts of the country, interviewing the perpetrators, and developing more standardized definitions of the various types of psychological mistreatment and financial exploitation.

Source:
Morgan Kelly
University of Pittsburgh

Children with Allergies at higher risk for bullying from students and teachers

Tue, 28 Sep 2010 18:30:00 +0000

The following article identifies an at risk group of children for bullying in their school communities. This link to The Association for Conflict Resolution http://www.acrnet.org/Educator.aspx?id=674 identifies several tools that can be implemented in an school setting for conflict management. They are numerous and please call ACR if you have any questions regarding implementing a conflict engagement program in your school.

First study of its kind finds children with food allergies are often victims of bullying

In the first-ever study to assess the social impact of food allergies in children, Mount Sinai researchers have found that approximately 35 percent of children with food allergies, who are over the age of five, were reported to have experienced bullying, teasing, or harassment as a result of their allergies.

Of those experiencing teasing or harassment, 86 percent were reported to have experienced repeated episodes. Classmates were the most common perpetrators, but surprisingly more than 20 percent reported harassment or teasing from teachers and other school staff. The data are reported in the October issue of Annals of Allergy, Asthma & Immunology.

Led by Scott H. Sicherer, MD, Professor of Pediatrics, Jaffe Food Allergy Institute at Mount Sinai School of Medicine, researchers analyzed survey responses from 353 parents or caregivers of children with food allergies and food-allergic individuals. The survey was conducted at meetings of the Food Allergy and Anaphylaxis Network in Tarrytown, New York, Rosemont, Illinois, and Baltimore, Maryland in 2009.

"We know that food allergy in children affects quality of life and causes issues like anxiety, depression, and stress for them and their parents," said Dr. Sicherer. "However, our study is the first to explore teasing, harassment and bullying behaviors aimed at these children. The results are disturbing, as they show that children not only have to struggle with managing their food allergies, but also commonly bear harassment from their peers."

More than 43 percent were reported to have had the allergen waved in their face and 64 percent were reported as having experienced verbal teasing. No allergic reactions resulted from the bullying, but approximately 65 percent reported resulting feelings of depression and embarrassment.

"It was recently estimated that nearly one in 25 children has a food allergy," said Dr. Sicherer. "What is so concerning about these results is the high rate of teasing, harassment and bullying, its impact on these vulnerable children, and the fact that perpetrators include not only other children, but adults as well. Considering the seriousness of food allergy, these unwanted behaviors risk not only adverse emotional outcomes, but physical risks as well. It is clear that efforts to rectify this issue must address a better understanding of food allergies as well as strict no-bullying programs in schools."

A previous study by the National Institute of Child Health and Human Development showed that 17 percent of children in grades 6 through 10 reported being bullied. While this study was not designed to determine prevalence of bullying in children with food allergy, the number of patients bullied in the corresponding age group according to the survey is double that of the prior study. The authors suggest that school programs designed to reduce bullying should include information about the vulnerable population of children with food allergies.

Personal Care Homes: What you need to know in Georgia

Mon, 27 Sep 2010 14:04:00 +0000

The following article is a snapshot into the near future for Georgia. Personal care homes are growing significantly to meet the current and near future demand of elder care needs

You can find the personal care home requirements at the following link on the Georgia Secretary of State Web site
http://rules.sos.state.ga.us/cgi-bin/page.cgi?g=DEPARTMENT_OF_COMMUNITY_HEALTH%2FPERSONAL_CARE_HOMES%2Findex.html&d=1

It is important for the family to know what questions to ask on an ongoing basis. These questions center around fundamental daily needs. Some examples are as follows:
How much food did mom/dad eat for their daily meals? Was it 10%? 30%
How much water are they getting daily? 3 glasses? or more?
How much and what activities did they participate in today?
Did they get a bath today and if so were they assisted and how did their skin look on the back and bottom area?
Who is caring for them regularly?
Who is the owner and how often do they visit the facility?
Who do I talk with for concerns and how are they documented?
What is the Policy and procedure you follow when there is a fall?

Personal care homes can be the answer to many of our elder's needs if they are properly monitored by the family and the private industry through self- regulation.
I suggest the Georgia personal care Home industry proactively develop a third party private group that functions like a surveying body that strives to build excellence much like the Magnet Program has done for the Hospital industry by providing excellence in care through having and developing skilled caregivers.

Deaths in adult homes hidden and ignored

The deaths of hundreds of seniors at adult family homes may have been the result of neglect or abuse, but were never investigated.

By Michael J. Berens

Seattle Times staff reporter

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COURTESY OF JAMES RUDOLPH / JAMES RUDOLPH

A home's mistreatment proves deadly Neglect at an adult family home is blamed for the 2008 death of 87-year-old Jean Rudolph, a retired nursing educator who had Alzheimer's disease and heart problems. Infection from severe bedsores, which developed during her stay at the home, spread to her vital organs.

Seniors for Sale | Suspicious Deaths

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Seniors for Sale | Examining deaths

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Listen to reporter Mike Berens discuss the series on NPR's 'All Things Considered'

About the Seniors for Sale series

Earlier findings:

Explosive growth of adult homes, fueled by profiteers and a lack of careful state regulation, has left thousands of people vulnerable to harm.

DSHS excused reports of abuse and neglect, even when it knew that violators lied to its investigators or contributed to preventable deaths.

The state saved hundreds of millions of dollars relocating the poorest residents to adult homes. In hundreds of cases, medically fragile adults were placed in the hands of caregivers who were inadequately trained to keep them safe.

Changes so far:

Home owners must publicly post inspection reports and violations.

DSHS will publish online all enforcement actions against adult homes.

Real estate officials agreed to ban listings that offered elderly residents for sale as part of an adult home purchase.

Parts 1-3 of the series: seattletimes.com/seniorsforsale

How we identified the 236 deaths

The Times identified 236 suspicious deaths first by using addresses of adult family homes and matching them to those found in state databases of death certificates.

This showed that at least 4,703 residents died in state- licensed adult homes from 2003 through 2008. Most died from natural causes.

We next screened cases by primary and contributing causes of death that indicated possible neglect, such as internal bleeding from falls, choking and other causes termed "accidental."

We also screened for deaths involving quality-of-care factors, such as late-stage pressure sores — those with open wounds and infections.

None of the 236 suspicious deaths led to an autopsy or investigation by law enforcement.

Because physicians typically sign death certificates for the elderly without a physical examination, signs of recent neglect — such as internal bleeding or pressure sores — can be overlooked. The cause of death often is a best guess, based on medical history.

As a result, the number of questionable deaths almost certainly is higher than 236.

Some fell to the floor and bled to death internally. Others choked on food and suffocated. Still others languished for weeks as bedsores burrowed to the bone, ultimately killing them.

In neighborhoods throughout Seattle and across the state, hundreds have died prematurely, many in avoidable misery, while living at state-licensed adult family homes.

A Seattle Times investigation has uncovered at least 236 deaths that indicate neglect or abuse in these homes but were not reported to the state or investigated.

Dozens of suspicious deaths occurred in adult homes with long histories of violations, including some whose owners employed caregivers with little training or forged credentials.

In the first accounting of such deaths, The Times identified these cases by analyzing death certificates of 4,703 Washington residents who died at adult homes from 2003 through 2008.

Adult homes are a less-regulated, less-expensive elder-care option than nursing homes, and are touted as providing personalized care in cozy, neighborhood settings.

But The Times also found that adult-home deaths indicating neglect occur at strikingly higher rates than comparable deaths at nursing homes:

• Pressure-sore deaths in adult homes occur at a rate more than 3.5 times higher.

• The rate of deaths from falls is four times higher.

• For choking deaths, the rate is 15 times higher.

Adult family homes are regulated by Washington's Department of Social and Health Services (DSHS), which licenses home owners to rent out spare bedrooms and provide long-term care for up to six seniors.

This housing option, which has boomed since the 1990s into a patchwork of 2,984 privately owned homes today, has earned the state a national reputation as an innovator in providing community-care choices for the elderly. Dozens of states plan to emulate Washington's program.

There is a dark side to that business boom. DSHS, for example, doesn't track how many residents die in the homes each year or question the circumstances.

The industry has expanded so swiftly and with so little oversight that it has attracted profiteers who, until The Times exposed the practice earlier this year, freely marketed homes and the residents as good investments.

Kathy Leitch, DSHS' head of aging and disability services, said that most adult homes provide safe care and represent an important option and first choice for many seniors.

Cindi Laws, executive director of the Washington State Residential Care Council of Adult Family Homes, said only a small fraction are problem homes.

None of the 236 deaths came to the attention of DSHS, records show. When such cases do get reported to the agency, Leitch said, it investigates them and routinely refers evidence of possible crimes to law enforcement.

But in dozens of cases, DSHS ignored or excused reports of suspicious deaths, including statements from witnesses, The Times has found.

By law, all caregivers are required to report suspected abuse of the elderly to DSHS. However, King County Medical Examiner Dr. Richard Harruff said he's learned, well after the fact, of elderly deaths that his office would have chosen to investigate. "Getting people to report seems to be a problem," he said.

Pain meds withheld after broken hip

Retired dairy farmer Clarence Yesland, 84, had struggled with Parkinson's disease and dementia for a decade until he became too frail to live at his Kirkland home. His wife, Marie, 82, moved him in 2004 to Houghton Lakeview adult home, also in Kirkland.

The five-bedroom home, blocks from Lake Washington, was licensed to owner Patricia Goodwill. She billed $3,500 a month for room and care.

"We thought the home was excellent," said Yesland's stepson, Gary Gelow, 67, of Kirkland.

What family members didn't know until much later was that the home, while Yesland lived there, had been cited for more than a dozen serious violations during DSHS' inspections.

One resident had not received enough fluids and was dangerously dehydrated. Caregivers considered another resident too active, so he was forced to consume anxiety medications prescribed for a different person.

Three staffers had convictions for felonies — assault, drug possession and child abuse — which by law should have disqualified them from working with vulnerable adults.

In January 2008, Yesland's family was told Clarence had fallen in the kitchen. The family would later learn that his primary caregiver, a woman they trusted named Effie Dutton, may have delayed getting any care for him for two days or more, worried about losing her job.

"We never did get a good explanation about how he fell," Gelow said.

After finally being taken to the hospital, Yesland was found to have a broken hip. But he was too weak to endure major surgery, his dementia was much worse, and he was unable to communicate coherently.

Yesland was given a narcotic to dull the pain from his hip. But Dutton told members of his family that the drug would hasten his death, Gelow recalled.

At the time, he was unnerved by Yesland's rapid decline from being active to spending all his time curled in a ball in bed.

"She said that these medications put people into vegetative states and they die more quickly," he said.

Dutton said that, as a favor to the family, she would not give Yesland the narcotics but falsify his medical record to show that she had, Gelow said. Trusting her, he agreed to the plan because he wanted his stepfather to live longer. Yesland died a month after breaking his hip.

A short time later, DSHS received a five-page, typewritten letter that described widespread abuse and neglect inside the Houghton Lakeview home. The letter was signed by Dutton's husband, Robert.

He and his wife had lived in the basement of the home for two years. Dutton wrote that his wife had pocketed prescription drugs from Yesland and several other residents. She told him that she had fabricated medical files to cover up the thefts and sold the pills to a caregiver with a drug problem at a different adult home owned by Goodwill, he wrote.

As proof, he later provided empty vials of the residents' medications, which he said he found in his wife's dresser.

Dutton also wrote that his wife had confided to him that Yesland was not promptly treated after falling, and that internal bleeding may have contributed to his death.

Dutton, who is now divorced, said he finally came forward because he couldn't live with the guilt and that it "made me sick to think of all the residents dying."

Gelow recently reviewed DSHS records and Robert Dutton's letter, provided by a Times reporter. Gelow said he was "stunned" to learn that Effie Dutton had been cited for using a forged nursing assistant license. DSHS considered it a minor violation because adult homes are not required to have licensed caregivers.

Gelow believes that Effie Dutton likely diverted the drugs, resulting in unnecessary pain for his stepfather, who, with his dementia, could not communicate at the end of his life.

Gelow said he feels guilty. "Now I realize how I was duped," he said.

DSHS failed to investigate Robert Dutton's accusations about drug thefts and sales, records show. Nor did DSHS, or any agency, look into Yesland's death.

Screams, stench and deadly infection

Dutton dropped another bombshell in his letter to DSHS: An elderly woman died from neglect just months after Yesland's death.

In May 2008, Dutton wrote, he received a panicked phone call for help from his wife. She had a medical emergency at the home with a female resident, but was afraid to alert 911.

The woman was Jean Rudolph, 87, a retired nursing educator who had Alzheimer's disease and heart problems. She had moved there six years earlier from her nearby home.

When Robert Dutton arrived, he learned that Rudolph had seven pressure sores, some so deep that muscles and bone were exposed.

"So we stripped Jean naked and the smell and her clothes were so bad, I opened the window and started gagging. Effie was gagging too," he wrote. "Jean's diaper was totally full of urine and poop and it looked like she hadn't been changed for at least 24 hours.

"When we stripped her down, I looked at the sores and they were very red, inflamed and very infected. Jean was screaming loudly when Effie touched her sores and was fighting but I kept talking to her and trying to distract her."

The Rudolph family had been told nothing about her pressure sores for 22 days, DSHS records show. Rudolph's son, James, said when Dutton finally called him about his mother's condition, he immediately went to the home and transferred her to the emergency room. It was too late — infection from the bedsores had spread to her vital organs.

Jean Rudolph died in June 2008 at her son's Bellevue home under hospice care.

"I think there's really a lot of guilt," said James Rudolph, 56, a Bellevue architect. "You kind of feel like: My God, how did this happen?"

The family contacted DSHS repeatedly about what happened to Jean at the adult home. DSHS eventually sent an investigator, who determined that Effie Dutton, instead of monitoring residents, often trolled the Web on her laptop computer, conducting a relationship with a man overseas via chat rooms and e-mails.

Dutton and Goodwill, the owner, were each charged with one felony count of criminal mistreatment for failure to provide proper care to Rudolph. Dutton, who remarried and was charged as Effie Tutor, pleaded guilty last month and awaits sentencing. Goodwill's case is pending. Both declined to comment.

DSHS now requires adult homes to publicly post copies of violations. The agency made this change in February, shortly after The Times' investigation showed how families were kept in the dark about a home's violation history. In addition, DSHS now lists violations for adult homes on its website.

Bedsores can be more than painful

The Times identified at least 29 adult-home deaths that were linked to advanced pressure sores.

In 2008 alone, three retirees in Puget Sound-area adult homes died from complications of advanced pressure sores: a Lynnwood hairdresser, 93, who had multiple sclerosis; an Everett homemaker, 93, with heart disease; and an Issaquah homemaker, 91, who had severe dementia.

None of the cases was reported to DSHS.

Asked about this recently, DSHS' Leitch said she is concerned that many cases of "elder abuse and neglect are not reported."

Pressure sores, also called bedsores, commonly plague seniors who are bedridden or rely on a wheelchair to get around.

Researchers disagree over how the sores develop — above or below the skin — and even how quickly they advance. Constant pressure against the skin, especially along bony areas, may reduce blood supply and kill tissue.

Sores have four classifications: a reddened area of the skin (Stage 1); a large blister (Stage 2); an open wound (Stage 3); and finally, a gaping wound with exposed muscle, tendon or bone (Stage 4).

Most medical professionals believe that Stage 3 or 4 pressure sores are likely signs of neglect.

If detected early, the sores are treatable with ointments or powders. But constant vigilance is needed. To avoid prolonged pressure that can develop sores, doctors sometimes require at-risk seniors to be shifted every one to two hours, particularly at night, which requires a well-staffed home with diligent caregivers.

Staffing, safety loosely regulated

Health-care research conclusively links higher staffing to lower fatality rates. It's a simple formula: More caregivers equals better care.

With nursing homes, the federal government has stepped in and mandated minimum levels of staffing, including a requirement of 24-hour care overseen by a registered nurse.

But Washington's adult homes are not regulated by federal law. And Washington law, so far, hasn't required adult homes to follow the dozens of safety standards required of nursing homes.

For example, an adult-home owner or sole staffer is not required to be awake at night when overseeing as many as six residents. Owners and staffers aren't even required to have a minimum health-care license, such as that of a nursing assistant.

State ownership rules are so loose that some adult-home owners are business investors who have no prior health-care experience, buying and leasing adult homes like fast-food franchises.

Washington legislators have tried but failed to fix some of these problems. The adult-home industry has opposed additional staffing requirements as unnecessary and too costly.

Lawmakers have been reluctant to impose tougher measures on what they often perceive as mom-and-pop enterprises.

A sharp rise in accidental deaths

For nearly a decade, Washington's rate of accidental deaths in adult homes and nursing facilities remained the same, about one out of 50 deaths. But the accidental-death rate for adult homes jumped 50 percent in 2007, and again the following year.

Adult-home residents now die from accidents at twice the rate of those in nursing homes, a Times analysis of death certificates shows. A key reason centers on the declining number of caregivers at homes. During this economic recession, scores of owners have cut staff and services to stay afloat, adult-home industry officials said.

State records reveal a pattern of problems during night shifts at adult homes. For example, in November 2007, a Seattle adult-home resident, 77, was found dead in his room. A catheter had dislodged from his arm and he slowly bled to death unnoticed during the night, according to DSHS, which received a complaint about the incident.

In another case, at a Kent adult home last year, a caregiver discovered an unconscious woman sitting in her wheelchair in the kitchen. The 61-year-old woman had accidentally taken too many prescription drugs. The caregiver wheeled her to her room. Not strong enough to lift her, the caregiver rolled the comatose woman onto the bed, face down. She was found dead in the morning.

In health care, these kinds of deaths are called "failure to rescue," meaning the deaths would have been avoided if a caretaker had noticed the problem and taken the correct action.

Choking to death on food falls into this category. The elderly often have trouble swallowing, a condition caused by dozens of medical maladies that interfere with this seemingly simple task.

Caregivers are required to properly prepare food, such as cutting hot dogs into small pieces, and then to monitor residents' mealtimes. But many homes employ just one caregiver during the day, making it difficult when overseeing six residents, the maximum allowed per home.

The Times identified seven adult-home residents who choked on food and suffocated from 2003 through 2008. In contrast, nursing homes, which have many more residents statewide — about 17,000, to adult homes' estimated 11,000 — had only one choking death.

The Times identified 128 adult-home residents who died from injuries related to falls but whose cases were never investigated. Among those who died, all from head injuries, were a retired seafood distributor, 94, of Darrington; a former Spokane medical tech, 94; and a retired Renton teacher, 88.

Not all accidental deaths can be prevented. But such deaths, at the very least, should spark a review of care at the homes, said Seattle police Detective Suzanne Moore, who specializes in investigating deaths of the elderly.

Strong resistance to fatality reviews

In 2006, King County prosecutors, the medical examiner and Seattle police came up with a plan to review adult-home fatalities. They believed that some were likely caused by neglect but had not been reported as suspicious deaths, said Harruff, the medical examiner. A Seattle police detective planned to visit each Seattle adult home when it had a death.

But the idea faced instant opposition. Families were apprehensive about privacy. Owners feared unnecessary disruption. Physicians worried about second-guessing from medically unsophisticated police officers.

"There was just huge push-back," said Detective Moore, part of the review team. "There were those who didn't want the police responding to every death."

Today, Harruff is trying again. He's collaborating with researchers at the University of Washington, which obtained a federal grant to examine deaths in all long-term-care settings, and they plan to publish their findings next year.

Autopsies, which are reserved for unexpected, violent, suspicious or unnatural deaths, are performed in about 10 percent of the state's 46,000 annual deaths. For adult-home deaths, which typically are not unexpected, the autopsy rate is just 1 percent, a Times analysis shows.

Barring an autopsy, the cause of death listed on a death certificate often represents a best guess, based on medical history. Frequently, the dead are not examined by physicians. So when doctors sign death certificates, they may be unaware of recent injuries, such as pressure sores or hemorrhages from falls.

As a result, the number of suspicious deaths at adult homes is almost certainly higher than the 236 identified by The Times.

In the case of Clarence Yesland, the physician who signed the death certificate had last examined him weeks earlier. Yesland's body was transferred directly from the adult home to a funeral home, then cremated.

Gelow said he and his mother are upset that DSHS kept them in the dark and then failed to pursue evidence of neglect.

"The state closed this case and never asked me or my mother a single question," Gelow said. "It makes you wonder how many times they've done this."

Michael J. Berens: mberens@seattletimes.com or 206-464-2288. Seattle Times researchers David Turim and Gene Balk contributed to this report.

The Boomer's Rock the BARN

Sat, 25 Sep 2010 15:45:00 +0000

There is a new Sheriff in radio town. The Boomer generation is taking the internet broadcasting wave by storm with music, issues and content relevant to this generation!

Baby Boomer Radio Network Launched

A new multi-platform “Baby Boomer” radio network set to launch to incorporate both Internet and AM/FM programming focusing on the most important issues confronting the baby boomer and older adult demographic.
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Boomer Authority™ Radio Network (BARN) will officially launch with a live broadcast from the exhibit floor of the AARP National Convention in Orlando FL on September 30, 2010.

BARN is a multi-platform radio portal incorporating both Internet and terrestrial radio programming focusing on the most important issues confronting the baby boomers and older adults.

The inaugural broadcast, hosted by Adriane Berg, BARN’s Chief Executive Producer, will include interviews with Peter Greenberg, Rob Reiner and Jodi Olshevski.

The creation of BARN represents a watershed moment in the growth of Boomer Authority™ Association. Boomer Authority™ continues to develop a global ecosystem of websites, blogs, social networks, and talk radio programming published and produced by professionals in 23 countries that serve the 50+ demographic.
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BARN is presently populating the network with new channels and talk show hosts. Unique to BARN is its ability to link to any radio program notwithstanding their current platform ─ Blog Talk Radio, Voice America, Web Talk Radio, and AM/FM programs, including international channels. The host does not need to change his/her current platform provider to be heard on BARN.

“Our value proposition for existing hosts is simple: link to BARN, syndicate your show, and expand your listener base,” said Martin Diano, BARN’s cofounder and CEO of Boomer Authority™ Association.

For those many experts who desire to enter the world of talk radio, BARN provides a complete 8-week tutorial through its Radio Results division, developed and led by Berg, a 20-year talk show veteran. “So many experts have tried internet radio and failed because they misunderstand radio itself and the power of communication both as a business game changer, a means of generating income and a powerful platform to attract and guide listeners. Radio Results offers interview training and Boomer Authority™ ready-made access to thousands of targeted listeners.

Berg, when asked to summarize BARN’s mission, said: “Our goal is to provide high-value, inspiring, and educational radio programming that 50+ boomers and seniors can put to practicable use in their daily lives, and that will further the spirit of successful aging and foster aging advocacy worldwide.”
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About Boomer Authority Radio Network (BARN)
BARN is a multi-platform radio network incorporating original programming and talk show syndication. Existing talk show hosts can link to BARN, syndicate their show and extend their listenership without having to change their network provider. To have your show linked to BARN, click here.

About Boomer Authority™ Association
Boomer Authority™ is a professional association comprising 1400+ professionals from 23 countries who specialize in offering products or services to the 50+ demographic. Membership in Boomer Authority™ Association is free to qualified professionals. To view its activities, browse the membership list and to join, click here.

retest

Sat, 25 Sep 2010 15:40:00 +0000

retest

Brave New Health-Care World

Sat, 24 Apr 2010 13:20:00 +0000

"Changing the Climate of Healthcare"www.southerncrossmediation.com

Flickr

Tue, 12 Jan 2010 17:35:00 +0000

This is a test post from , a fancy photo sharing thing.

Small Business Seeking influence on HCR

Tue, 12 Jan 2010 16:00:00 +0000

Colorado NFIB to seek changes in health-reform measure

Monday, January 11, 2010, 9:15pm MST | Modified: Monday, January 11, 2010, 9:18pm

Denver Business Journal

Colorado's division of the National Federation of Independent Business plans to ask members of the state's congressional delegation to remove provisions from the health-reform legislation before Congress that the group says unfairly target the construction industry.

Tony Gagliardi, Colorado state director for the nationwide small-business organization, said he will join with representatives of the Associated Builders and Contractors, Independent Electrical Contractors, Associated General Contractors and the Colorado Association of Home Builders on Wednesday at a state Capitol news conference to call for changes in the legislation.

NFIB objects to provisions inserted into the Senate version of the bill that would require construction companies with more than five employee and a payroll over $250,000 to provide health coverage to workers or face penalties.

The bill originally exempted any business with fewer than 50 workers from the mandatory-coverage provision. The narrower exemption for the construction industry was inserted at the behest of labor unions representing construction workers, the New York Times reported Jan. 3.

"This narrowly focused provision is an unprecedented assault on the construction industry, and all the men and women who, every day, make the bold decision to strike out on their own by starting a business," Gagliardi said in a statement.

But Daniel Gardner, a lobbyist for the International Brotherhood of Electrical Workers, is quoted by the Times as saying that the special provision for the construction industry "is necessary because construction is an extremely competitive, low-bid industry. Very few small non-union construction employers provide health insurance. It’s one way they gain an advantage over union contractors."

Congress is at work reconciling differences in the House and Senate health reform bills, which were approved late last year, before a final vote on the package, possibly by the end of January.

The national NFIB last fall opposed both the House and Senate versions of the health-reform bill.

denvernews@bizjournals.com

Traumatic Brain Injury New Horizons

Mon, 11 Jan 2010 21:15:00 +0000

"Changing the Climate of Healthcare"
www.southerncrossmediation.com

Low Vision Requires Asssistive Devices, PDF Resource

Mon, 21 Dec 2009 02:20:00 +0000

This is a portion Blog Post is from Aging and Disability in America, Barry D. Weiss, MD College of Medicine, University of Arizona December 19, 2009

This provider fact sheet will review several of the most commonly used devices for individuals with visual impairment that cannot be successfully managed with medical or surgical therapies (summary in Table 2).

Download Document

HealthBlawg: Patient control over patient data in electronic health records: A work in progress

Thu, 17 Dec 2009 15:03:00 +0000

HealthBlawg: Patient control over patient data in electronic health records: A work in progress

"Changing the Climate of Healthcare"

Insights from a patient on how to be your own advocate

Sat, 21 Nov 2009 14:15:00 +0000

This is fantastic insight from an patient who learned to advocate on his own behalf and sets his own criteria for you to consider when to bring on your own patient advocate.
Southern Cross Mediation and Legal Nurse Consultings' model develops the model of patient advocacy throughout the care continuum from prevention of hospitalization to medical navigation while in acute settings to adult and Geriatric care management in the community and skilled facilities.

November 20, 2009, 12:25 pm

The Old Man: How to Be a Patient

By HILDING LINDQUIST

I have become an experienced — and resourceful — hospital patient. And I want to share my newfound knowledge with others who are faced with being hospitalized for the first time, and have yet to acquire a working set of skills for navigating the vagaries of hospitalization.

On the Local

Hilding Lindquist writes about aging, ageism and end of life issues, all of which he believes are better understood by experience.

First of all, getting out of bed and walking is one of the most important things I can do. I learned where the pantry was with a microwave, refrigerator and drawer full of tea bags and sweeteners, and that patients were free to use it.

Whenever the mood arose, I would unplug the cord to my continuous IV pump — it then ran on its battery backup — and walk down the hall for a cup of tea.

Nurses and their assistants usually have more to do than they can get to immediately. The best staff will keep you informed, ask you for your cooperation when something is delayed and respond quickly when necessary. I train my nurses to keep me informed of my care — I press the call button when I don’t know what is going on, or I think a procedure or pill is late.

I kept careful track of the medications I was taking, and when they were supposed to be given. This was a consistent issue with each nurse, and there was almost always a different nurse on the day or the night shift, or both.

I take a medication orally — a phosphorous binder — that radically affects all other meds I take orally. The rule is that my other oral meds must be taken at least one hour before or three hours after I take the binder. And I take the binder with my meals. So, if there is a medicine that I have to take with food, then I have to have a partial meal that does not require a phosphorous binder, again within the one hour before, three hours after rule.

One tip for a successful hospitalization: try to keep active.

Believe me, I had to track my schedule for taking my medications. If a patient is in anyway unable to function on this level of clarity, it’s time for a patient advocate.

A pause, here, to establish some street cred. I have done enough time recently in hospital garb to know what I’m talking about. In early spring of 2008, I was hospitalized for more than two weeks at The University Hospital of the University of Medicine and Dentistry of New Jersey for peritonitis. Then in May of this year, I had 10 inches of small intestine removed at St. Barnabas Medical Center with less than a week hospitalization, followed up immediately by another short week at Beth Israel for suspected internal bleeding.

Then in June I had my left carotid artery cleaned out — just like the TV ads — again at St. Barnabas, and stayed overnight. Which brings us up to the time of this writing, following five trips to the E.R. at St. Barnabas over a span of three weeks.

I’m being frank with the issues surrounding my medical care at St. Barnabas, and it may seem at times that the negatives outweigh the positives, but they do not. I choose St. Barnabas as my hospital because I get superior care there, and I’m discussing the problems to assist in making it an even better place for patients, and to give other patients an example of actively participating in their care. If they cannot, then I strongly suggest they get a personal patient advocate.

One of the most troublesome — if not THE most troublesome — procedure for patients is “the stick.” This is when the nurse or specialized technician sticks you with a needle to draw blood for lab tests or to insert an I.V. I have developed my own protocols for this.

My left arm has relatively good veins and my right arm has relatively poor ones. Plus, my upper left arm has the fistula for my hemodialysis needles; two large ones inserted on Tuesdays, Thursdays and Saturdays, one in the artery, the other in the vein. So my left arm cannot be used for anything else — no drawing blood, no IV’s, not even blood pressure. All they can do is check my pulse by hand in my left arm.

They put a band around the left wrist with a “limb alert” sticker. They also put an “allergy” sticker on the same band to remind everyone that I am allergic to some medicines. Occasionally someone will forget to check the wristband and start to do something with my left arm; usually it’s taking my blood pressure. I have to remind them not to use that arm.

So they have to use the right arm and they can tell right away it will be difficult to stick me there. I never let anyone try to stick me three times without success. The person has to have a few years under their belt in sticking before I let them try twice. The conversation usually goes like this:

Staff: This will be a little difficult.

Me: I know. (The staff person attempts to find the vein with the needle and fails.)

Staff: Sorry.

The staff person probes a little, causing some pain and discomfort, and fails again. However, after having been stuck three times a week for over a year-and-a-half with much larger hemodialysis needles, I can handle it.

Staff: Sorry, I’ll have to try again.

Me: How long have you been doing this?

Staff: A couple of years.

Me: Do you think we can find someone with a little more experience to stick me?

Or:

Me: How long have you been doing this?

Staff: 10-plus years.

Me: Go ahead, but if you don’t get it this time, I want someone else with experience.

You can wait until after they try the second time before you assert your right to someone else. I think it makes them less nervous.

You see, nobody can do anything to me without my permission. That’s the patient’s ace in the hole.

Once at a hospital late at night when there was too much noise to sleep coming from my roommate’s guests — it was a special rules floor — I took my stuff and went out into the hall, telling the staff I wasn’t going back in my room, and to please move me to another floor. They moved me relatively rapidly, in less than half an hour.

And there once was a nurse so bad in communicating that I refused to let him care for me. He kept saying he was sorry and that he was very busy. I replied that he was then too busy to have me as a patient.

Another procedure that may be troublesome is taking the patient’s vital signs — blood pressure, pulse, and temperature. This doesn’t hurt, that’s not the problem. The problem is that they wake you up if you are sleeping, and when the schedule for vital signs mingles with the schedule for taking meds mingles with the schedule for drawing blood … well, it’s hard to get a full night’s sleep.

I couldn’t ever change it, though sometimes it would change all by itself when more urgent matters imposed themselves on the routine. Learning to adapt to what was the “normal” schedule for me was key to having a good hospitalization.

If anything happened to me outside of what was the normal schedule, I immediately asked about it. In doing this I learned that my best nurses were my strongest and best allies in managing my hospitalization.

For example, I got a new doctor for a separate aspect of my health care while I was hospitalized. He came in and talked with me in a general way, saying he was going to run some tests. He didn’t tell me any specifics about any treatments he would be ordering, and I didn’t ask because I thought we would be waiting for the results of the tests.

That evening a technician came in and wanted to administer a treatment that involved a drug to which I had recently learned I was allergic. Of course I refused the treatment. The next day when I talked to the doctor, his whole defense was based on my not having listed the drug as an allergy on my chart. He couldn’t grasp the concept that I wanted to be informed of the specifics of a treatment before it was even ordered, as long as there was time — especially with a new doctor.

In dealing with the technician over refusing the treatment, my nurse sided with me. The nurse immediately understood the situation and what was troubling me in not having an advance discussion of what was going to be done to me. I typically don’t have this problem with my doctors, and when I do he or she is no longer one of my doctors.

Then in my third hospitalization of this recent series, I found out St. Barnabas has free WiFi.

I had my friends bring my laptop, and from then on it was almost like being at a spa — except for the blood draw sticks, being awakened for checking of my vitals, and having a continuous I.V. on a pole with wheels to drag around. I could tweet with abandon, and work on future posts. And enjoy the food–truly, it wasn’t bad for cafeteria fare.

The Elements of Eldercare Decision making

Fri, 20 Nov 2009 14:22:00 +0000

This is an interesting look at the personal, social and professional elements that go into family care/Elder care decision making. A complex path for many leading to restructuring of family roles and possibly jobs. For a consultation please visit www.southerncrossmediation.com

Elders Happier With Long-Term In-Home Care From Family Versus Professionals

November 18, 2009 — Most families, at some point, will struggle with a decision about how best to provide long-term care for an elderly parent. A new study co-authored by University of Virginia economics professor Steven Stern suggests that you shouldn't assume a home-care professional can better care for your parent than you can.

Listen to the UVA Today Radio Show report on this story by Brevy Cannon:

The study, Stern said, found that elder parents are more likely to describe themselves as "happy" when they are receiving informal in-home care from a child or spouse than when they receive formal in-home care from a nurse, home health aide or other home care professional.

Appearing in the November issue of the International Economic Review, the study examined a data set of about 3,500 households with at least one member age 70 or older who participated in the 1993 wave of a nationally representative, longitudinal survey, the Assets and Health Dynamics Among the Oldest Old.

The comprehensive survey, conducted by the University of Michigan, was designed to facilitate study of older Americans. It includes questions on health, family characteristics (including demographic details of one's spouse and/or children), income and wealth, but does not include any direct measure of health quality. Consequently, self-reported "happiness" was used as a proxy, Stern noted.

Of the 3,500 respondents, 22 percent received some sort of in-home care, 90 percent of which was informal, compared to 18 percent formal. Eight percent received both.

Stern speculated why this self-reported happiness was more prevalent among those receiving informal in-home care from a child or spouse: "A big part of looking at happiness isn't the care per se, but the fact that the kid is involved in it."

Many children of elder parents did not share that insight about how Mom's or Dad's happiness during long-term care may hinge more on sharing time with loved ones than the medical proficiency of a relative stranger.

"The kids who are more educated perceive their own care-giving as not particularly high-quality," Stern said. "They think that formal care is going to be more high-quality."

That attitude may reflect belief in the whole concept of professionalism, the notion that a professional, by definition, will be more skilled at a given task than a nonprofessional.

The same bias is shared by more highly educated parents, who also seem to prefer formal care compared to their less-educated peers, and not just because they can better afford it. They see it as more effective, Stern noted. So, in more educated (and more professional) families, both parents and children are better able to pay for formal care, and may be more inclined to view the formal care as higher quality.

Such assumptions have huge financial implications as Baby Boomers gray and swell the ranks of those needing long-term care. Billions of dollars are at stake, both for society and for family nest eggs, in decisions about whether in-home elder care will be provided informally or formally, notes the study, "Formal Home Health Care, Informal Care, and Family Decision Making."

Stern's three co-authors are all former students: David Byrne, now with the Federal Reserve Board; Michelle Goeree, who holds joint appointments at the University of Southern California and the University of Zurich in Switzerland; and Bridget Hiedemann of the University of Seattle.

There are variations among those children who provide care to their parents, Stern said.

The average child of an elder parent (over 70) does not want to be a caregiver because the task is seen as burdensome. Among those who do choose to give informal care, the primary motivation is a sense of filial obligation and expectation, Stern said.

Daughters tend to provide higher-quality care and experience less burden and more sense of obligation than sons. As adult children age, he added, they feel less burdened by providing care, but provide lower-quality care.

Mothers are less burdensome to care for than fathers, but care for fathers is more effective than care for mothers (as measured by self-reported happiness).

The study also finds that higher opportunity costs (i.e. giving up a higher salary, more time, etc.) decrease the likelihood that a child will provide care, Stern said, which translates into the only significant racial difference in care-giving. Increased prevalence of informal care among African Americans correlates largely with lower average wages and opportunity costs.

Mothers are more likely than fathers and unmarried parents are more likely than married
parents to receive informal care from a child or child-in-law.

After examining the various factors that impact long-term care decision-making, the study modeled how adjustments to public programs (primarily Medicare and Medicaid) might influence family choices of informal versus formal care.

The results suggest that marginal state-by-state variations in Medicaid qualification policies or spending have little effect on long-term care decisions, Stern said, because the decisions are driven primarily by other factors: the potential caregiver's feelings of burden and/or obligation, the opportunity costs of informal care-giving, and judgment of the effectiveness of informal versus formal care.

Medicaid subsidy increases large enough to offset those primary decision-drivers would be so expensive as to not be politically feasible, Stern said.

This study builds on earlier research by Stern, who has spent more than 15 years studying the economics of health care and other social services.

Future research, Stern said, will look at several waves of data from the Assets and Health Dynamics Among the Oldest Old surveys to shed light on how changes over time may impact elder care decision-making. Preliminary results suggest that, as a sibling engages in care-giving, his or her care-giving skills improve, but care-giving motivation declines, Stern said. It's not yet clear whether the "learning" effect or the "burnout" effect is more powerful.

Stern also aims to examine how strategic sibling interactions may impact elder care decision-making. Strategic self-interest (or altruism) might be evident in a number of ways, he said, such as siblings comparing salaries, comparing care-giving skills, an inclination to free ride when one sibling is wealthier and more capable of paying for formal care, or even competition among siblings to spend time providing informal care in hopes of a bequest reward.

— By Brevy Cannon

New Logo!

Tue, 03 Nov 2009 13:51:00 +0000

"Changing the Climate of Healthcare" through Adult & Geriatric Care Management services, Medical Navigation, Patient Advocacy and Mediation & Facilitation among all stakeholders.
What are your thoughts on the new logo for Southern Cross? I hope to hear from you.

Results on Pregnancy and H1N1 vaccination Hopeful

Tue, 03 Nov 2009 13:47:00 +0000

FOR IMMEDIATE RELEASE
Monday, November 2, 2009

Contact: NIAID Office of Communications
(301) 402-1663

Initial Results Show Pregnant Women Mount Strong Immune Response to One Dose of 2009 H1N1 Flu Vaccine

Healthy pregnant women mount a robust immune response following just one dose of 2009 H1N1 influenza vaccine, according to initial results from an ongoing clinical trial sponsored by the National Institute of Allergy and Infectious Diseases (NIAID) of the National Institutes of Health.

“For pregnant women, who are among the most vulnerable to serious health problems from 2009 H1N1 infection, these initial results are very reassuring,” says NIAID Director Anthony S. Fauci, M.D. “The immune responses seen in these healthy pregnant women are comparable to those seen in healthy adults at the same time point after a single vaccination, and the vaccine has been well tolerated.”

According to the Centers for Disease Control and Prevention, since the outbreak began last spring, at least 100 pregnant women have been hospitalized in intensive care units in the United States and at the last official count, 28 pregnant women have died.

A preliminary analysis of blood samples taken 21 days post-vaccination from a subgroup of 50 pregnant women participating in the trial shows the following:

In 25 women who received a single 15-microgram dose of the vaccine, the H1N1 flu vaccine elicited an immune response likely to be protective in 92 percent, or 23 of 25, of these women.
In 25 women who received a single 30-microgram dose of the vaccine, the H1N1 flu vaccine elicited an immune response likely to be protective in 96 percent, or 24 of 25, of these women.

The trial began on Sept. 9 and reached its target enrollment of 120 volunteers in mid-October. All participants are between 18 to 39 years old and began the study in their second or third trimester (14 to 34 weeks) of pregnancy.

At entry into the study, the participants were divided at random into two groups: half are receiving two doses of a 15-microgram vaccine and the other half are receiving two doses of a 30-microgram vaccine. The two injections of vaccine are spaced three weeks apart.

Safety is being monitored closely in the trial, by the study investigators and by an independent panel of experts known as a safety monitoring committee. To date, the vaccine appears to be well-tolerated, and no safety concerns related to the vaccine have arisen.

The vaccine used in this clinical trial was manufactured by Sanofi Pasteur in its plant in Swiftwater, Pa., in the same manner as the company’s injectable seasonal influenza vaccine. Like the seasonal flu vaccine, the 2009 H1N1 flu vaccine contains a purified portion of the killed virus and therefore cannot cause infection. The vaccine does not contain the preservative thimerosal or an immune boosting substance known as an adjuvant.

NIAID is conducting this trial through five clinical sites affiliated with its longstanding clinical trials network known as the Vaccine and Treatment Evaluation Units. For additional information about the NIAID trial in healthy pregnant women, see the Sept. 9 NIAID news release http://www3.niaid.nih.gov/news/newsreleases/2009/H1N1pregnanttrials.htm and related Q&A http://www3.niaid.nih.gov/news/QA/H1N1pregnanttrials.htm .

For more information on influenza, including pandemic influenza and avian influenza, visit www.flu.gov. Also see NIAID’s influenza Web portal at http://www3.niaid.nih.gov/topics/Flu/ .

NIAID conducts and supports research—at NIH, throughout the United States, and worldwide—to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at http://www.niaid.nih.gov.

The National Institutes of Health (NIH)—The Nation's Medical Research Agency—includes 27 Institutes and Centers and is a component of the U. S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.

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The Elements of Eldercare Decision making

This is an interesting look at the personal, social and professional elements that go into family care/Elder care decision making. A complex path for many leading to restructuring of family roles and possibly jobs. For a consultation please visit www.southerncrossmediation.com

Elders Happier With Long-Term In-Home Care From Family Versus Professionals

New Logo!

Results on Pregnancy and H1N1 vaccination Hopeful

Initial Results Show Pregnant Women Mount Strong Immune Response to One Dose of 2009 H1N1 Flu Vaccine