Another great medical office, Dr. Aaron Hertel from Hertel and Brown, Erie, PA

Submitted by Andrea Reynolds for her dad, Wesley Reynolds.

My 89 year old Dad’s DPT (Doctor of Physical Therapy (Aaron Hertel) is willing to put in
a handicap parking spot at his front door so Dad can get in and out of the van more
easily. See the photo of the front door at Frontier Place: http://www.hertelandbrown.com/
Most of their patients are young athletes. We already have the Handicap Placard, just not
the place to park.

Hertel and Brown, Frontier Place, 1337 West 6th Street, Erie, PA 16505

Andrea Reynolds, THE CRISIS CLINIC
I champion for justice if you’ve been
cheated, mistreated, or swindled. Retain
me to restore your money, property, reputation.
http://www.AndreaReynolds.com/crisisbrainstorm

Winner of Best Office Story: Dr. William Lyons of Long Beach, California

Medical Office Winner: William Lyons, M.D., 4301 Atlantic Ave., Long Beach, California

From Randa, his patient:

I have several specialty doctors like many others. Thus, evaluating and determining impressive offices is an activity to engage in while waiting. The details of my impressive office begin before I get there. I know the parking will be simple and with no parking fee. The office is on the ground floor. This adds up to saved time and money. I know before arriving that I can treat myself to reading a book or writing notes while waiting. (and rarely is the wait long). It is a treat because the waiting room is comfortable, windows to see the outdoors, and NO TV blaring. Maybe there will be soft music playing and always an abundance of RECENT, quality periodicals to tempt me over the book I brought. The receptionist is like a welcoming friend. She takes the time for short conversation and always alerts me and the other patients if the doctor is delayed and how long it might be. It is a restful place.

The office is impressive because of the doctor. An internist with specialty in oncology and hematology with two offices. I see him in his internal medicine office. I can best describe him as “superb family doctor type” with specialties: asks about my family, knows my interests, refreshes himself on details of my chart, listens to me, answers all questions, and even more importantly teaches me on the recent medical/medication advances. Have you ever had the doctor assist you in taking off your jacket and hanging it up? Have you ever had the doctor jot down a reminder to himself to provide you with a resource for an interest of yours not related to exam? Have you ever had the doctor go over every details of your lab reports? Have you ever had the doctor alert you to some basic safety issues to protect you? Have you ever had a perceptive doctor who seemed to know you had other things on your mind and ask you about it? William Lyons, M.D., 4301 Atlantic Ave., Long Beach provides me with an IMPRESSIVE doctor’s office.

Both Randa and Dr. Lyon’s office will be getting a cake from BakeAWish.com http://tinyurl.com/rylvyz

Long Term Care Insurance, An article from Lauren Gershen’s Newsletter

Here Lauren’s interview at https://kindethics.com/2010/01/interview-with-long-term-care-insurance-expert-on-nov-27th-11am-pacific/?preview=true&preview_id=1478&preview_nonce=7efffc855d

In the years following World War II, there were many babies born which created what has come to be called the Baby Boom. Comprised of persons born between 1946 and 1964, “baby boomers” are one of the largest segments of our society.

With the oldest boomer quickly approaching retirement age, it’s time that boomers asked themselves some important questions: How are you preparing for retirement? Is it possible that you could outlive your retirement savings? Have you faced the possibility that you may need long term care at some point, either in your home, in assisted care, or in a nursing home?

Here are some facts to consider:
• 60% of Americans who reach age 65 are expected to need LTC services at some point, while 40% of those receiving LTC services now are ages 18 to 64, says OPM [Office of Personnel Management].
”A federal case for LTC”
Employee Benefit News, 02/01/03
• The national average cost of a year in a nursing home is $57,700.
Nursing Home Cost of Care Survey
Conducted by Evans Research, an independent research firm, 7/31/03
• Many of the Baby Boomers over age 55 mistakenly believe they are adequately covered for long-term care expenses through their workplace benefits packages. However, their health plans may only cover very limited long-term care expenses. As a result, many Boomers unknowingly face the risk of having their accumulated assets depleted by long-term health expenses that follow an unexpected event in their lives.
”Conning’s Industry Insight: Long Term Care Insurance.”
Issue #4, June 2002

Sobering facts, to be sure. And yet, many of us stubbornly cling to the belief that we will never need long term care. Above all, this shows how vital it is that we become better educated.

First, it’s important to understand what long term care is. Long term care provided under a tax qualified policy is defined by federal law as care for a person who requires assistance with at least two of six activities of daily living – bathing, continence, dressing, feeding, toileting, transferring – for a condition that is expected to last at least 90 days; or care for a person who has severe cognitive impairment, such as Alzheimer’s disease.

It’s important to recognize that includes many types of situations that can result in the need for long term care at any age, not just limited to senior citizens.

Next, it’s time to seriously examine some difficult questions.
Who will provide the long term care we may need? Many of us think our spouses or other loved ones will care for us, regardless of the level of care we need or the level of skill our families have in health care delivery. But, depending how events unfold, that may be impractical or even impossible.
Who will pay for the long term care we may need? Many people believe they can self-fund their long term care needs. But even the most effective savers should calculate how long their assets might last if drawn upon to pay the costs of long term care.
Others believe the government will pay for the long term care they may need. But today, Medicare will only pay some of the expenses for up to 100 days in a skilled nursing home if you qualify at all, and will only pay for certain types of skilled care in your own home. And what will happen to Medicare benefits when baby boomers begin turning 65 in 10 years is an open question.

Long term care insurance can help you provide for yourself.
It is critical that baby boomers understand that the cost of a long term care insurance policy today can be quite affordable, especially when compared to the cost of long term care. But each year the purchase is delayed, the higher the rates generally become.

Compare the cost of long term care insurance premiums paid over even 10 or 12 years to as little as one year in a nursing home, and you’ll see how valuable long term care insurance protection can be in terms of dollars and cents.

Finally, there’s the knowledge that, if you need long term care, with long term care insurance you will have choices about where you receive care, that you will have coverage to help pay for that care, and that the responsibility for providing care may not fall to your family. These choices can also help preserve your financial independence and your dignity, and those are priceless.

Lauren V. Gershen CLTC
Planning For Quality of Life
Long Term Care Planning & Insurance Specialist
LGershen@aol.com
(760) 777-9061 Office
(760) 777-9062 Fax

Visiting hours – When to follow the rules and when to break them

There are no visiting hours at nursing homes. You are allowed to visit your loved one at any time of the day or night. Don’t let them tell you that you are not allowed. In fact, I encourage you to stop by either very early or very late to check on how your loved one is being treated by the night nurses.

There are visiting hours at hospitals to make sure that the patients have enough quiet time to heal. Sleep and rest are crucial for the person that is recovering from an illness or surgery. There also needs to be time that the nurses and other staff can get their work done without you being in the way.

In general, I respect visiting hours. But I know that there are times when visiting hours should be respectfully broken. When someone is dying, there should be open visiting as you will want to spend every precious last moment with your loved one before they die. Or, you may want to ask if you can be of help keeping the patient calm when the person is afraid or is sundowning so the nurses have time to care for all of their patients on the floor. Or perhaps you can help when the person needs to be in restraints. It is great if you can sit with the person to keep them relaxed or distracted and reduce the need for restraints. There may be cultural reasons as well to stay after hours as many people feel safer when someone from their culture/family is present.

If you are going to be there after visiting hours, then you have to be there to help, not to get in the way. If you are constantly bothering the nurses and making it hard for them to take care of the many different patients they have to see that night, then you are being a problem. And the nurse has the right to ask you to leave. Visiting a patient is not a right but a privilege. If you are impeding in the healing process of your loved one or other patients, then the hospital can ask you to leave.

In the early days after my mom’s stroke, my brothers and I took turns sleeping on the floor beside my mother’s hospital bed. My mom was a difficult patient. She would scream out for help, she was afraid of hospitals and she was also very obese. I was able to help comfort my mom so she didn’t bother the nurses as much and I was also able to help the nurse turn her when needed. Nowadays, I wouldn’t advise helping to move a patient. As family members, we haven’t been trained in how to lift appropriately and may put ourselves at risk of injuries. I made sure that I didn’t get in the nurses way and tried to help in anyway possible.

If you are going to be there after hours, be polite, be appreciative, be helpful and be respectful of the healthcare staff. They are allowing you a privilege to be there after hours so make sure you say thank you.

Have a kind and respectful day.

Healthcare Quality and Efficiency Report – For those who are interested in real numbers and information about global healthcare issues

A new, “Healthcare Quality and Efficiency Report” has been released. This report contains information for those of you who are interested in real numbers and information about global healthcare issues. This is not a political piece of information but a factual reference guide discussing how healthcare is measured and the financial issues that healthcare is facing. You may want to forward this to your local and national politicians, insurance company, your healthcare providers and/or your local hospitals.

http://www.soa.org/research/health/research-quality-report.aspx

Executive Summary:

Healthcare quality and efficiency play an important role for both the overall economy and healthcare consumers. Affordable healthcare is crucial to the financial stability of many workers and retirees, making quality and efficiency of programs particularly relevant during periods of economic challenges. Moreover, quality and efficiency are likely to occupy a prominent position in any healthcare system reform effort. This is particularly true given the fundamental issues in the United States, such as the decentralized nature of the healthcare system, often poorly-aligned payment structures and the complexity of roles assumed by service providers.

In light of the current overlap of political, economic, and other environmental factors, the healthcare industry is changing rapidly. As a result, the Society of Actuaries Health Section and Solucia Consulting have co-sponsored this research project. This report reviews and inventories the wide range of quality and efficiency measures currently available for hospitals and physicians.

Choices: Senior Living Options’ Telesummit – Registration Open

Do you have an aging parent?

Are you a caregiver of an elderly person?

Are you thinking ahead to your own later years?

Four experts will be joining Dale Carter to discuss 4 varieties of senior living options.

Mark Hager, Jill Gilbert, Lisa Sneddon and Eleanor Feldman Barbera.

By the end of this Telesummit, you’ll walk away with a clear comparison and understanding of the following major senior living options.

• Aging in Place
• Continuing Care Retirement Community (CCRC)
• Assisted Living
• Nursing Home

Check your knowledge of Senior living options. Answer True or False.

1. You need to focus on selecting the one right Senior living option for your parent or yourself for the rest of their/your life.
2. “Aging in Place” is just about home modifications.
3. Continuing Care Retirement Communities are just for the wealthy.
4. Nursing homes are places of institutional care where physical needs are met. You should not expect much more.

All 4 statements are false. While these experts will dispel common myths and provide detailed information, they will provide so much more.

The four experts will share their positive vision of aging and how we can partner with our aging parents and families in making the right decision at this point in time in our parent’s life, as well as preparing for the future.

For dates/times… and to reserve your spot for this telesummit go to, http://www.transitionagingparents.com/choicesseniorlivingoptions/

Monday, November 2, 2009 8 pm Eastern
Tuesday, November 3, 2009 8 pm Eastern
Wednesday, November 4, 2009 8 pm Eastern
Thursday, November 5, 2009 8 pm Eastern

Although each session will feature Q&A at the end, feel free to email Dale questions in advance to dale.carter@transitionagingparents.com

Advance Directives Part 3 – Now that you have filled it out, what should you do next?

Now that you have filled it out, what should you do next?

1. Well, the first thing you have to do is sit down with your first choice and your alternate decision makers and discuss what you would want if you were injured, disabled or dying. Remember that this form goes into affect when you are too mentally disabled, unconscious or sedated to speak for yourself.

2. Then, you have to give all of your decision makers a copy of your advance directive. You also need to give copies to all of your doctors and your local hospital. You should keep a copy at home either by your bedside, taped to the inside of your medicine cabinet or on your refrigerator. You can also keep one in your car or in your purse. People won’t know what you want if they can’t find your instructions. Doctors get frustrated when the family says, “The patient has an advance directive, but we don’t know where it is.”

3. The next time you go to your doctor, bring him a copy and discuss what you have written with him. Ask him if he would be willing to respect your choices. This is where you can really get into trouble. Some doctors won’t follow what people have written in their advance directives, so you better know right now if he is one of those doctors. Also, some doctors are too afraid to talk about death. If you don’t think your doctor would not respect your wishes or if they are too uncomfortable talking about dying, then find yourself another doctor. I am serious about this. Doctors go against people’s instructions and prolong the suffering and dying of patients in every hospital. If you find yourself in this situation, with the doctor refusing to follow the advance directive, then the bioethics committee at your hospital should be able to help you. If you are the loved one and you are unwilling to follow what is written in the advance directive, then you shouldn’t be the decision maker. Have the doctors use one of the alternates.

How to get an advance directive and other resources.

1. The easiest way to get a free advance directive is to go to the front desk of any hospital. Just tell them you need one or more for your family and they should give them to you free.

2. You can go online to caringinfo.org for a free, state specific form. These are also free.

3. If you need one in a particular language, then do a google search with your state and language and see what comes up. Only a few languages are available, I am sorry to say.

4. Your doctor’s office should have one for you, but unfortunately, many doctors don’t keep them in their office.

5. You can also order one from Five Wishes. This is a very good document for explaining what you would want in certain situations. The document costs $5 each and can be ordered in bulk (25 copies or more are $1 each) at 888-5-WISHES or www.agingwithdignity.org. These forms are valid in 40 states including: Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, The District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska,
New Jersey, New Mexico, New York, North Carolina, North Dakota, Oklahoma Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Vermont, Virginia, Washington, West Virginia, Wisconsin and Wyoming.

Quick Version for How To Fill Out Your Form:

Whom should you pick?
1. Pick someone who will understand what the doctor is saying.
2. Pick someone who knows you well and has listened to you tell them what you want.
3. Pick someone who won’t fall apart in a crisis.
4. Pick someone who will do what you have asked, even if it difficult to do.
5. Write down who you don’t want to be your decision maker.
6. You can pick two or three people to work together as your decision makers.
7. Your spouse may not be your best choice and you may want to choose someone else.

What would you want?
1. This form goes into effect when your brain isn’t working anymore, not just when you are dying.
2. Don’t be too specific about the particular treatments you want or don’t want because you don’t know what the medical situation will be when you need this form.
3. Write out a “Meaningful Recovery Statement” describing what kind of life you would want, if you were disabled and couldn’t think anymore.
4. Tell the doctors what they should do if you were going to live in a terrible condition as well as if you were dying.
5. Write down anything else you want them to know about where or how you want to die, organ donation preferences or autopsy instructions.

Have a kind and respectful day.

Advance Directives Part 2 – What would you want if you were unable to speak for yourself?

Next let’s look at how to tell the doctor what you would want, if you were unable to speak for yourself.

What would you want?

1. The first thing is to remember that this form goes into affect when you are too mentally disabled, unconscious or sedated to speak for yourself. This form will be used when you are injured, sick and/or when you are dying. Too many people, including doctors, think of this form as only a dying form. For some people, this form will be used for years when they have become mentally ill or disabled.

2. The next thing to decide is what you would want in certain medical situations. Should you be specific or vague about the specific medical treatments you would want? I would encourage you to be vague. You won’t know the exact medical situation you might find yourself in and you may have guessed wrong when you wrote down don’t do this or don’t do that. Here is an example: A patient might write on his or her advance directive that they never want to be put on a ventilator. How will this statement be interpreted by your doctors? The doctor will not put you on the ventilator because if he does, then it is considered assault and battery to give someone medical treatments against his will. This recently happened to an elderly gentleman. The gentleman wrote that he didn’t want to be hooked up to a ventilator, but what he meant was, he didn’t want to live on a ventilator. This became a problem when he needed to be hooked up to a ventilator for 4 days in order to recover from an infection. He didn’t need it forever, just for a few short days. But because he was too specific, the doctor couldn’t save him. So be careful when you request certain medical choices. Make sure that what you have written would work in all situations.

3. So, now that I just scared you, you are probably worried about what to write in this section. I have a solution. It is called a “Meaningful Recovery Statement.” You need to explain to the doctor, “What kind of life would you want to live if your mind no longer worked well or if it didn’t work at all?” Now for some people, any condition is okay as it is God’s will to determine how we live and when we die. But for others, you can’t think of anything worse than living in a nursing home, wearing diapers, having other people feed you and not being able to recognize your loved ones. But how will your doctors know what you want if you don’t tell them? Doctors know how to practice medicine. But what they don’t know is what would make for a “meaningful recovery” for you. So you have to tell them.

Here is my “Meaningful Recovery Statement”:
“I value a full life more than a long life. If I have lost the ability to interact with others and have no reasonable chance of regaining this ability or if my suffering is intense and irreversible, even though I have no terminal illness, I do not want to have my life prolonged. I would not then ask to be subjected to surgery or to resuscitation procedures, to intensive care services, or to other life-prolonging measures, including the administration of antibiotics, blood products or artificial nutrition and hydration. I also believe that the financial and emotional burden on my family should be considered in making these types of decisions.”

Because I have written this in my advance directive, the doctors will know what is important to me. Of course this doesn’t have to be your statement. Write one that is meaningful to you and attach it to or write it on your advance directive.

One more thing, please address the issue of terminal versus non-terminal situations. If you are terminal, then it is important your doctors know where and how you would want to die. If you are only severely disabled, but not going to die soon, then you need to let them know what kind of life would be tolerable for you. The best way to be protected is to write it down.

We have just gone over the main sections. Of course you can write down anything else you want the doctor to know about you. You might want to tell them where or how you would want to die, if you would like to donate your organs or if you are for or against an autopsy. This is your form, so write down whatever works for you.

Have a kind and respectful day.

Interview with author, B. Lynn Goodwin, “You Want Me to Do What? Journaling for Caregivers” on Nov. 16th 10AM pacific, on BlogTalkRadio.com/kindethics

Interview with author, B. Lynn Goodwin, “You Want Me to Do What? Journaling for Caregivers” on Nov. 16th 10AM pacific, on BlogTalkRadio.com/kindethics. Call in to listen live at (347) 945-5152 or listen online at blogtalkradio.com/kindethics

B. Lynn Goodwin is a teacher, editor, freelance writer, former caregiver, and the author of You Want Me To Do What? – Journaling for Caregivers (Tate Publishing). She is published in Voices of Caregivers; Hip Mama; the Oakland Tribune; the Contra Costa Times; the Danville Weekly; Staying Sane When You’re Dieting; Small Press Review; Dramatics Magazine; Career, We Care, Caregiving, and Self-Care NCDA Monograph; 24/7—a caregiving anthology (forthcoming); Families of Loved Ones Magazine (forthcoming); Kaleidoscope (forthcoming) and numerous e-zines. She facilitates journaling workshops for caregivers and publishes Writer Advice, www.writeradvice.com. You can reach her at Lgood67334@comcast.net.

In addition, Lynn cared for her mother for six years while she struggled with undiagnosed Alzheimer’s. During this time my outlet was my journal. Whether I wrote three sentences or three pages, journaling eased my frustrations and fears.

You can learn more about the book, the workshops and Lynn at http://www.writeradvice.com/ywmtdw.html or in this article that was published in the Danville Weekly on February 27: http://www.danvilleweekly.com/story.php?story_id=5708.

Lynn’s book creates a wonderful opportunity to give voice to the feelings you are experiencing when caregiving. “You want me to do what?” can also be used to start a conversation with the person you are taking care of or with the others who are also doing the caregiving. Healing the caregiver is just as important as healing the patient and journaling can help with the healing process.

Have a kind and respectful day.

Advance Directives Part 1 – Choosing your decision maker

Most doctors just hand the patient this form and say fill it out. But they don’t help you fill it out or explain what the decisions mean. I am going to help you think through the process of filling out your Advance Directive.

There are two main decisions you need to make when you are filling out your Advance Directive. Who you want to make your decisions for you and what you would want. After I help you with these two questions, I will then tell you what to do with your advance directive after you have filled it out. At the end, I have included instructions on how to find a form that would work in your state.

Let’s first talk about who you would want to make decisions for you. In your state, your form might ask you to list your agent, proxy or surrogate decision maker. (These words all mean the same thing, but each state its own legal term.)

Who should you pick?

1. You should pick someone who is medically literate. What does this mean? The person should be able to understand what the doctor is saying, be able to figure out the medical words and be able to understand the medical choices being offered. If the person you thought you were going to pick would be confused by what the doctor would say, then pick someone else.

2. You should pick someone that knows you very well, would know what you would want in a medical crisis and would tell the doctor what you have told them in the past. The person you have chosen will be asked to listen to the medical information and then use your values to make the medical decisions. The person is not supposed to use his or her own values, but to speak as if they were you. If the person you thought you would pick wouldn’t respect your choices or has very different beliefs from yours, then pick someone else. You want someone who will speak as if he or she is speaking with your voice, not his or her own agenda.

3. You should pick someone that won’t fall apart in a crisis. It doesn’t do you any good if the person is hysterical, can’t function or can’t stand to visit you in the hospital. You need to pick someone brave enough and who will be by your side no matter how difficult things get. If the person you thought you would pick doesn’t handle his or her own life very well, then don’t have him or her be in charge of yours.

4. You should pick someone that will do right by you even if it is the most difficult thing they ever had to do. Sometimes doing the right thing is allowing the person you love to have a peaceful death. And your decision maker needs to be able to live with the difficult decisions he or she has to make. In reality, he or she is making the decisions based on what you would want, not what he or she would want. But that doesn’t make it any easier. You have to be able to talk to this person ahead of time about what you would want in different kinds of situations. So, if the person you thought you would pick is too afraid to talk about death and dying, then he or she isn’t the right person for this job. And if he or she would refuse to follow through with what you have requested, then pick someone else.

5. You can write down whom you don’t want to be your decision maker. Depending on what state you live in, the rules vary regarding who is in charge of you when you are unconscious or incapacitated. You need to protect yourself.

6. Doctors won’t tell you this but you can pick two or three people to share in your medical decision making. But be careful that you pick people who can work together, will support each other and who you know won’t make things worse for the healthcare team. I had one lady tell me that she picked her two sons to make her decisions and that these two men had never agreed on anything. She is setting herself up for a nightmare as good decisions won’t get made and the doctor will hate having to deal with her sons. You don’t want your doctor to hate your decision maker. Please pick carefully.

7. Some people don’t pick their spouse because they know that it would be too much for their loved one to go through and that their spouse couldn’t make these most difficult decisions. If you do pick your spouse, then you need to be extremely careful about picking the alternate decision makers. The alternates will make your decisions if you and your spouse are injured in the same accident. The alternate should be just as qualified as your first choice.

I am available to speak at your organization or hospital.

Have a kind and respectful day.

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