Dr. Solomon Liao from the Center for Excellence on Elder Abuse and Neglect at UCI, “Recognizing the signs of abuse and taking action” on Sept. 21, 10AM pacific,

r. Solomon Liao from the Center for Excellence on Elder Abuse and Neglect at UCI, “Recognizing the signs of abuse and taking action” on Sept. 21, 10AM pacific. blogtalkradio.com/kindethics

Dr. Solomon Liao is an Associate Professor, Medicine School of Medicine and the Director of Geriatric Education at the School of Medicine University of California, Irvine. The Center of Excellence in Elder Abuse and Neglect at the UCI School of Medicine, Program in Geriatrics, funded by the Archstone Foundation.

Locally, the Center of Excellence provides medical, forensic, and victim services to abused and neglected seniors and serves as a “living laboratory” of innovative approaches.
Statewide, the Center of Excellence serves as a central source of technical assistance, best practice information, multidisciplinary training, useful research, and relevant policy issues in California.

The Center of Excellence in Elder Abuse and Neglect serves through:

Direct Services – The Center of Excellence provides medical assessments, forensic evaluations, interdisciplinary case planning, linkages with existing resources, and the identification of available and needed services in Orange County.

Technical Assistance – The Center of Excellence provides statewide technical assistance to elder abuse programs in California. Two types of technical assistance will be offered: case consultation and program development/replication assistance.

Connecting Practice and Policy – To make a sustainable improvement in the field of elder abuse, it is crucial to connect practice and policy. The Center of Excellence uses the knowledge gained through a systematic and sound evaluation process to educate those in a position to make policy decisions.

Conducting Research – Through the faculty of the UCI School of Medicine Program in Geriatrics, the Center of Excellence provides the bridge between direct service and academics. Research at the Center of Excellence is currently funded through the National Institute on Aging, National Institute on Justice, and the California Department of Health and Human Services.

Providing Education – The Center of Excellence guides the UniHealth-funded Elder Abuse Training Institute in identifying California’s most pressing training needs in elder mistreatment. Multidisciplinary experts conduct discipline-specific training seminars for law enforcement, legal, medical, and social service professionals.

To learn more about UC Irvine School of Medicine’s Program in Geriatrics and Dr. Liao’s work, please visit our Geriatric Medicine website http://www.healthcare.uci.edu/seniorhealth/geriatricmedicine/index.asp.

An healthcare insider’s look at the healthcare debate from a money point of view.

Someone recently asked me what I think about the national healthcare debate. I don’t usually talk politics but I have decided to voice my opinion and to give you a healthcare insider’s view of the issue.

Part 1:
I am very angry about the death panel comments. Finally, Medicare was going to pay doctors to spend time listening to and respecting the patient’s end-of-life wishes. (Not telling seniors what to do, but listening and respecting.) These conversations already take place, but the doctor hasn’t been able to get paid for that longer appointment time. If a plumber spends 1 hour or 5 hours at your house, they can charge you appropriately. But the doctor can’t because if there isn’t a billing code for the service, the service can’t be billed. Now the doctors will continue to not be paid to listen to your wishes while they already are sacrificing not going home to their own family on time. This will be one more reason that doctors will leave the practice of medicine. You can only mess with someone so long before they say, “I am out of here.”

The idea of a death panel goes against everything in medicine. The last thing doctors want to do is to kill people. They went into medicine to heal and save. Doctors won’t participate in making sure the prisoner doesn’t feel any pain with lethal injections because doctors won’t agree to be a participant in a death. Doctors are very opposed to physician assisted suicide, even when the patient is in out of control pain and is begging for help with dying. (About 5% of the time, pain can not be managed no matter what medication is used.) These are the types of things that politicians can’t understand. The rules of medicine are deeply embedded in the culture of medicine.

Here is what I am also angry about. The healthcare debate has become a battle of political posturing and propaganda instead of trying to come up with a really great plan. I am angry that the politicians are designing the national healthcare program. Hospitals, doctors, nurses, economic experts, healthcare and public health experts etc. should be designing the government program. It would be like an electrician trying to teach your child in school. They are not trained to do that job and are not qualified. I am also angry with the politicians because they are forgetting or are ignorant to the rules of medicine. They can’t ask the doctors to jump through these new hoops to provide adequate care and still hold them to the malpractice standards in place. You can’t tie someone’s hands and then punish them when they couldn’t do everything they wanted to do.

Here are a few other insider perspectives.

Part 2:
1. We already have 3 large government run programs: Medicare, Medicaid and the Veterans Administrations. While those aren’t perfect, they are already a form of socialized medicine. If someone is against a government run program, then I suggest they turn in their Medicare card and go buy their own insurance. The doctors are already relying on the government (Medicare and Medicaid) to pay their bills because the other insurance companies are paying the doctors less and less after they provide services. The government part of healthcare is keeping hospitals and doctors in business.

2. The biggest problem is that there are too many stakeholders involved. Your employer buys your insurance, the insurance manages your healthcare dollar while taking a big cut for themselves, the doctors and hospitals take whatever they can get and eventually you get service. You are so separated from your healthcare dollars, that you can’t understand the true cost and value of what you are getting. If you buy a Chevy or a Rolls Royce, you understand why it costs what it costs because you are writing the check. But you don’t know what you are getting or what the actual costs are when you get medical care. Would you be willing to pay for the services if it was coming directly out of your pocket?

Next, if the insurance company wasn’t taking their cut, there would be plenty of money to care for even the uninsured. And if you are paying for healthcare, you need to realize that you are already paying for the uninsured. That cost is added to part of the charges the hospitals and doctors are billing your insurance company. Removing the insurance company as a middle man would really reduce your costs.

3. Doctors are fleeing the profession. I know doctors that can’t cover the costs of staying in business. One group of Ear Nose and Throat doctors haven’t been paid a salary for 6 months. They just cover the cost of running their practice and that is it. Would you be willing to work for 6 months without a paycheck? No. But doctors are so devoted to their work that they are enduring terrible hardships. But this won’t last. They can’t do this forever. We are losing the good doctors in record number. This is not a joke. Eventually we will have to recruit foreign doctors to fill our vacancies.

4. We don’t have enough emergency rooms still open. In Los Angeles, a large number of hospitals are still open but are no longer providing emergency services. Because of EMTALA, which mandates that anybody who comes to the emergency room must be treated, it is a tremendous financial burden to these institutions. The only choice they have is to close the ER or they will have to close the hospital. There is no emergency room near me.

5. You can not expect people to keep businesses open when they are losing money. And healthcare is a business that is bankrupt. The time is now to put a new plan in place that is fiscally responsible and can meet the needs of our growing and aging population. I am not the expert but there are experts out there that should be designing this plan for us. Stop the political bickering and get down to creating a viable healthcare system.

See this article for more discussion about our role in the healthcare debate.
https://kindethics.com/2009/09/a-healthcare-insiders-view-of-the-healthcare-debate-from-a-social-point-of-view/

Have a kind and respectful day.

A healthcare insider’s look at the healthcare debate from a social point of view.

5 reasons we will never actually pass a national healthcare plan.

Reason #1.
You, the patient, are offered three medical treatment choices:
Option #1 costs $10,000 and works very well with very few side effects.
Option #2 costs $1000 and will also work very well but will have a few more side effects.
Option #3 costs $300 but only works some of the time with lots of side effects.
Which will you choose?

Most people will say, “I don’t want a chance for more side effects or one that only works some of the time, I want the best, Option #1.” Or people might say, “Well it is okay for someone else to choose the 2nd or 3rd option, but I have a right to good healthcare.” And what they mean by “good” healthcare is really great healthcare. For national healthcare to work, we need people to be willing to accept and to choose the second best choice sometimes which may come with a few more side effects. The system can’t afford the best all of the time. To make this happen, we have to adjust the rules doctors live by which brings me to reason number two.

Reason #2.
Doctors must give informed consent which means people have to be given enough meaningful information so they can make a good decision regarding what treatment to choose. This information would include being told about the first, second and third best options. Who is going to say, “No, doctor, really it is fine with me. Give me second best option.” We are starting to see this problem for certain hospitals that statistically provide second rate care and therefore may eventually need to disclose to patients, “You may be better off going somewhere else.” So if doctors need to tell the whole truth, the system will break down. Informed consent will have to be limited to those treatments allowed under the national health plan.

Reason #3.
The other problem doctors will have is that they will still be held legally liable for providing good healthcare. If you don’t get better or you get extra side effects, you will sue the doctor. Why is this doctor’s fault when the system says he has to give you option #2 or #3? Our malpractice system will have to change to protect doctors who are only following the rules set up by the national healthcare system.

Reason #4.
National healthcare will mean a more equal distribution of medical resources. What that really means is that many of us will have to accept a little less for everyone else to receive a little more. Now, you may say you want this but how many people really act in an unselfish way? I know lots of people who say they care about the poor and underprivileged, but I don’t see them sending a poor family half of their paycheck. We want the government to take care of everyone while we still get everything we want. But we can’t get everything we want with national healthcare. It just isn’t possible. But, everyone could get reasonably good care.

So, we are part of the problem. We are selfish. Our selfishness is a deeply imbedded societal belief about what our obligations are to others. This country was built on individualism and watching out for your own best interest. We are not a country which cares more about others above ourselves. And those of you who just said in your mind, “Well I care.” Then do something significant to prove me wrong.

Reason #5.
The last reason things won’t change is that our politicians are not interested in voting for national healthcare. Right now they are receiving a substantial amount of money from insurance companies and pharmaceutical companies. Why would they want to stop getting all this money? They don’t. And you wouldn’t either if you were in their place. Politicians talk a good story but when it comes to action, nothing gets done. How many politicians said they are for national healthcare during their campaigns? Most, but still nothing will happen. It is about money.

But we, as individuals have power. If the politician gets voted out of office they will lose their financial kickbacks. So, we have to tell them that if they want to stay in office, they have to give us national healthcare. And if they don’t vote it in this time, we must vote them out of office. We are not helpless. If we truly care, and I hope we do, we need to speak up, speak out and vote responsibly. Contact all of your local and national politicians to vote for national healthcare. And contact them over and over again. They won’t take us seriously unless we get serious about caring for all Americans.

For a look at the money issues in the healthcare debate, go to https://kindethics.com/2009/09/an-healthcare-insiders-look-at-the-healtcare-debate-from-a-money-point-of-view/

Have a kind and respectful day.

Rescheduled: Date TBD, Interview with Peter Lichtenburg Ph.D. on blogtalkradio.com/kindethic

Peter A. Lichtenberg, Ph.D., is the Director of the IOG and Professor of Psychology, Psychiatry and Behavioral Neuroscience & Physical Medicine & Rehabilitation at Wayne State University. Dr. Lichtenberg received his Ph.D. in Clinical Psychology at Purdue University, where he also minored in aging. Dr. Lichtenberg will be discussing dementia, Alzheimer’s and the work of the Institute of Gerentology at Wayne State University, including the work of the Healthier Black Elders Center.

www.iog.wayne.edu — blog
www.dementiacoalition.org
http://www.mcuaaar.wayne.edu/events.php — Healthier Black Elders Center

Director of the IOG since 1999, Lichtenberg has led this research and education unit to record levels of funding (annual totals for the past 8 years are a 300-400% increase from previous highs), to an expansion of research focus by recruiting faculty in the area of cognitive neuroscience, and the leadership of several highly successful training and mentoring grants (See below for details on the Predoctoral and Postdoctoral Training and on the Michigan Center for Urban African American Aging Research). Dr. Lichtenberg also created the first IOG-funded development Board of Visitors which in its first 4 ½ years raised over $2.25 Million dollars.

Dr. Lichtenberg is the author of five books, including the highly acclaimed Handbook of Dementia (2003, Handbook of Assessment in Clinical Gerontology (Wiley press, 1999) and A Guide to Psychological Practice in Geriatric Long Term Care (Haworth Press 1994). In addition, Dr. Lichtenberg has edited a four volume series for the organization Medical Psychotherapy, and has published over 125 peer reviewed scientific articles. His particular areas of research include mental health in long term care, geriatric depression, geriatric psychology and
medical rehabilitation and the early detection and management of Alzheimer’s Disease.

Dr. Lichtenberg has been awarded many distinctions including the 1996 Early Career Award in Rehabilitation Psychology, Fellowship in the Gerontological Society of America and the American Psychological Association, the Outstanding Contribution Award for Psychologists in Long Term Care, and both the 2001 Distinguished Faculty Award and Outstanding Mentor Award at Wayne State University. In 2002, he was the first educator to be given the Alzheimer’s Advocate Award. In 2004, on behalf of the IOG, he accepted community honors from the Area Agency on Aging 1C and Wayne County. In 2006 he was awarded the Harry Kelly Award for outstanding leadership in Gerontology

Dr. Lichtenberg is a leader in many national and community organizations in Detroit and the State of Michigan including chair of the http://www.dementiacoalition.org/>Michigan Dementia Coalition, past-chair of the Central City Aging Services Consortium, and Board member for the Area Agency on Aging 1-B Advisory Board. Nationally, Dr. Lichtenberg was the Chair of the
Behavioral and Social Sciences Section of the Gerontological Society of America (2007), Chair of the APA Committee on Aging (2008) and a member of the APA Presidential Task Force on Integrated Care for an Aging Population.

The Institute of Gerontology at Wayne State University brings together science and service to advance the cause of aging research. Its multidisciplinary faculty, post-doctoral fellows, and pre-doctoral trainees focus on the social and behavioral aspects of lifespan health and cognitive development. Dedicated to promoting successful aging, the Institute of Gerontology is where research and outreach combine to make life better in Detroit and beyond.

Improving Bedside Manner While Managing Your Time

Your bedside manner will affect the medical outcome of the patient. Here are some easy tips you can do in your office. The first thing you want to do is to briefly review the chart before you walk in the room. Usually physicians will start looking at the chart once they’ve entered the room and will be so busy reading the chart, that they missed the opportunity for a warm greeting and good eye contact. So while you’re in the hallway, before you open the door, do two things. Review the chart quickly and check in with yourself. You want to check in with yourself that you’re ready to go in and be present with this particular patient. Even if your mind has been thinking about other patients in the office or the hospital, or if you’re thinking about your kid’s soccer game, stop and redirect your focus. Then when you walk in the room, the patient will feel like you are there for them and that you are paying attention. As you walk, greet the patient warmly and use culturally appropriate nonverbal skills. Don’t assume that the patient hasn’t minded waiting for you, they do mind. Apologize if you are late.

Please don’t sit behind a desk. The desk can be cold and distancing. The patient will feel more comfortable if you sit with them in the exam room. If you can, please talk to patients with their clothes on as patients can be very uncomfortable sitting in a small gown or with just a drape covering them up. If you’re using electronic medical records and are just now getting used to doing the patient interview in front of a computer screen, please remember to look up from the screen and to make sure you stay connected to the patient. I know the new technology takes some getting used to, but you can’t afford to have the patient feel like you don’t care. You also want to make sure that you don’t make the patient a third-party patient. This is when you talk to their caregiver and ignore the patient. Even if the patient doesn’t have full capacity, keep them included in the conversation.

Remember that the conversation should be a dialogue, not a monologue. Leave plenty of time for listening, especially at the beginning of the conversation. If you do want to connect with the patient on a personal level, don’t make the mistake that many doctors do. Doctors will begin to tell the patient about their own hobbies or interests. Don’t tell the patient more about you, instead you want to listen more to discover things about them. You also want to look for moments of caring where you can reach out and give the patient and family the needed reassurance. Don’t just focus on the symptoms the patient is reporting. Make sure you ask the important questions about how their lifestyle or culture may be contributing to their illness.

These are just a few tips I teach doctors when we talk about bedside manners and how to improve medical outcomes.

Have a kind and respectful day.

Viki Kind interviews Allan Hager, “Right at Home” on Sept. 8th, 9AM pacific on blogtalkradio.com/kindethics

Interview with Allen Hager and Right at Home. Right at Home is a national in home care and assistance agency. They provide trained, insured and bonded caregivers for a variety of elder care services. Whether it’s for extra assistance after a stay in the hospital, an aging parent who needs extra help or companionship to remain in their own home, or as a respite for a husband or wife who cares for an ailing spouse, Right at Home can help with home health care needs.

Right at Home’s home care services cater to a variety of in home care needs ranging from companion services to personal care to light skilled nursing.
Companion & Homemaker Services:

• Caring Companionship
• Medication Reminders
• Meal Preparation
• Shopping & Errand Services
• Light Housekeeping
• Laundry Services
• Bathing Assistance
• Family Respite Care
• Recreational Activities
• Personal Hygiene & Dressing Guidance
• Incoming Mail Organization
• Review with Family
• 24-Hour Emergency Response Personal Care Services:

• Bathing
• Walking Assistance
• Posture Positioning
• Continence Care
• Oral Hygiene
• Special Diet/Meal Preparation
• Eating Assistance
• Toileting Assistance

Right at Home care services are highly personalized and flexible. Right at Home caregivers can provide in home care from a little as a few hours a day to 24 hours a day. Whether it’s for extra assistance after a stay in the hospital, or to provide respite to a caregiving spouse, home care may be the solution for you. They’ll do everything they can to make sure you and your loved one are completely satisfied. Furthermore, they take great pride in making sure they fit the right caregiver with the right client.

No regrets. Spend quality time with loved ones today.

It is important to spend time with our loved ones. It is especially important that we spend time with those who have lost their ability to drive. Tell your loved one that you have saved the afternoon for them and you are willing to drive them where they want to go. We lose so much of our freedom as we get older and more dependent. Instead of you choosing the activity or the restaurant, let them be in charge. So, if they want to go to the local hardware store and wander around like they used to when they were young, go with them. If they like to get out in nature, even if they have physical limitations, find a local park that is disability friendly.

And of course bring your attention. If you are busy on your cell phone or distracted, it won’t count as quality time. We have to stop and truly be present with our loved ones. And that means turning down the technology and turning up our caring attitude.

One thing I regret is that I didn’t take the time to take my dad to the places he wanted to go. I took him where he needed to go like the doctor’s office, but then I would run out of time to do the little extras. I wish he was still here so we could just stop for an ice cream or take a drive around the old neighborhood. The time we spend counts and is remembered forever.

Have a kind and respectful day.

Interview with Cristina Chamberlain, “Assistive Technology for the Deaf and Hearing Impaired” on Sept. 2nd, 3PM pacific

Cristina Chamberlain, “Assistive Technology for the Deaf and Hearing Impaired” on Sept. 2nd, 3PM pacific. blogtalkradio.com/kindethics. Call in with your questions about dealing with a new hearing loss or finding the right technology to help those who are already hearing impaired.

Christina Chamberlain is the Deaf and Hard of Hearing Services Coordinator at the Three Rivers Center for Independent Living. Christina is part of the Assistive Technology Department. The Three Rivers Center is one of many Centers for Independent Living in the US. Their goal is to help people with disabilities live independently in the community setting of their choice by providing consumer controlled supports and services. Their services include Advocacy, Assistive Technology, Waiver programs, Housing, Deaf and Hard of Hearing services, Nursing Home Transition, Peer Support, Skills Training, Personal Assistance and Transitioning. The website is www.trcil.org

Other resources include:

Harris Communications www.harriscomm.com A good starting point for assistive devices for the Deaf/Hard of Hearing.

ASL Expo www.aslexpo.com

http://en.wikipedia.org/wiki/Deaf_culture A good starting point for information on Deaf Culture
Hearing Loss Association of America http://www.hearingloss.org/

http://www.virtualcil.net/cils/ This site will direct people to a Center for Independent Living near them.

The Pennsylvania Initiative for Assistive Technology (PIAT) http://disabilities.temple.edu/programs/assistive/piat/

PIAT Assistive Technology Lending Library http://disabilities.temple.edu/news/newsletterAT/
Pennsylvania Telecommunications Device Distribution Program (TDDP) http://disabilities.temple.edu/programs/assistive/tddp/

Pennsylvania Assistive Technology Foundation (PATF) www.patf.us

Have a kind and respectful day.

Why wouldn’t my doctor or the nurse listen to me?

Dear Viki,

I was having a terrible allergic reaction to a new medicine and the nurse at the doctor’s office wouldn’t take me seriously. My skin was turning red and was burning and my lips were stinging and swelling. It took me days before anybody took me seriously. I called over and over again for three days. And then when I finally talked to the doctor, she said I should keep taking the medicine because it was important for my heart. Eventually I got an appointment with another doctor and when I stopped the new medicine, all the symptoms went away. What could I have done to get their attention?

I am so sorry this happened to you. First thing, if you are having a terrible reaction to a medication, go to the emergency room. Some allergic reactions can become fatal. Regarding your doctor and the nurse, you have a problem. This is an office that isn’t taking your complaints seriously. Either they didn’t believe you or they didn’t realize it was serious. Either way you are in trouble.

Be thankful you have found out now that this doctor isn’t a good fit for you. This doesn’t mean this is a bad doctor, just not the right doctor for you. For some reason, they wouldn’t believe you and you can’t take the chance that this might happen in the future. This could be dangerous to your health.

Even it wasn’t the doctor who made the mistake, the doctor has a nurse working for her that doesn’t respect what the patient says or doesn’t pass on the messages appropriately. You can not take that risk. What if it is truly life threatening the next time? I highly recommend that you take this as a warning and find a different office. Sometimes in life we get the gift of knowledge. Use this experience to protect yourself and get an doctor’s office that will listen to you.

Have a kind and respectful day.

Sign up for free, “Kindness Reminders” – Remember to connect with your loved ones.

The “Kindness Reminder” is a brief weekly email to remind you to connect with your aging parent or other loved ones. The reminder is full of touching and fun ways to reach out and connect.

A colleague said to me, “I love my grandmother but I keep forgetting to call her.  Can you send me an email once a week to remind me to call her and can you include some ideas of things I can do for her?”  When he asked me to create these reminders for him, I realized I have been doing this type of thing all my life. I used to call my brothers and remind them to call our dad. It wasn’t that they didn’t care; it was just that like all of us, we get caught up in our own lives.

People think I am amazing because I remember to call on birthdays or to call in once a week to check on my elders. I am not amazing, I am organized. I pre-book recurring appointments in my calendar so I it sends me reminders to call, write or show I care. Otherwise, it would slip my mind and weeks would go by before I would make the effort.

These email reminders will give you a number of ways to show that you care. I will also give you ideas on how to thank those who are taking care of your loved one when you are either far away or unable to be there. The more you show appreciation for those who take care of your loved one, the better care they will get.

Just sign up in the box in the upper right section of my blog at KindEthics.com. Thanks for helping me make the world a kinder place. Please let others know about this free service.

Have a kind and respectful day.

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