5 Signs of Elder Abuse

5 Red Flags That Could Signal Neglect, Mistreatment, or Abuse

Have you ever worried whether an elderly person is really all right?

Sometimes it’s a loved one we’re worried about — we’re concerned about whether she’s being treated well by her caregiver, friends, or family members. Sometimes it’s just a worry about a senior we know casually — someone we see around the neighborhood, at church or synagogue, or at local gatherings. We wonder whether we should worry; we wonder whether we should say something.

The fact is, far too many of our elders are not all right. The Senate Special Committee on Aging says there are as many as 5 million victims every year, while the National Center on Elder Abuse cites recent studies that estimate that up to 3 to 5 percent of the elderly population in the U.S. have suffered abuse.

Unfortunately, this type of appears to be on the rise, according to Elizabeth Loewy, former chief of the Elder Abuse Unit in the Manhattan District Attorney’s Office, where she oversaw thousands of elder abuse cases. Despite the prevalence of the problem, Loewy says it remains signicantly underreported.

That may be partly because neglect, mistreatment and abuse aren’t always easy to spot. Some signs are obvious, some not so much. The New York City Elder Abuse Center defines elder abuse as an act that causes harm or distress to an individual 60 years or older. It happens most often in relationships based on trust. And it can be intentional or unintentional. Elders with cognitive impairment are particularly vulnerable, both because dementia behaviors can be extremely frustrating to caregivers, and because elders with dementia can lose the ability to recognize abuse and defend themselves.

Here are five signs to look for:

1. Signs of Physical Abuse

  • Bruises
  • Broken bones
  • Burns
  • Abrasions
  • Pressure marks
  • Hearing odd explanations for injuries — “Oh, she ran into a wall.”

Common signs of physical abuse against an elderly person include unexplained signs of injury such as those listed above, says Anne Sansevero, a registered nurse and member of the board of directors of the Aging Life Care Association.

“Be alert for a history of broken bones, sprains, or dislocations and sudden hair or tooth loss especially if the injuries are unexplained or explanations do not ‘fit’ with the findings,” she says.

Sansevero also advises looking out for behavioral indicators on the part of the elderly person’s primary caregivers. Not allowing you to visit with the elderly person alone, inconsistent explanations for injuries or taking the elder to multiple medical facilities for treatment can all be red flags that abuse is occurring.

2. Signs of Neglect

  • Dirty clothes
  • Soiled diapers
  • Bedsores
  • Unusual weight loss
  • A home that’s unusually messy — especially if it wasn’t before
  • Lack of needed medical aids, such as hearing aid, cane, glasses

If the elder is disabled, especially cognitively disabled, and needs help taking medication or getting dressed, it can be considered neglect if their caregiver is not providing assistance. Alternatively, passive neglect occurs when the abuse is unintentional, often as the result of an overburdened or untrained caregiver.

3. Signs of Verbal or Emotional Abuse

  • Withdrawal and apathy
  • Unusual behavior, such as biting or rocking
  • Nervous or fearful behavior, especially around the caregiver
  • Strained or tense relationship between caregiver and elder
  • Caregiver who is snapping or yelling at the elder
  • Forced isolation by the family member/caregiver

Emotional abuse is one of the most difficult problems to spot, since the victim may be unable to convey what’s happening because of illness, dementia, or fear of being neglected. “The elderly person is unable to fight back,” says Dr. Irene Deitch, professor emeritus of psychology at the College of Staten Island, part of the City University of New York.

Emotional abuse can range from a simple verbal insult to an aggressive verbal attack. It can also include threats of physical harm or isolation.

Deitch says verbal attacks include a caregiver or family member yelling or cursing at the person, or using phrases such as, “I can’t wait till you die and I have my life back again.”

Often in cases of emotional abuse, Deitch adds, a spouse or adult child will isolate the senior, not allowing calls or visitors, so no one else gets a sense of what’s happening in the house.

4. Signs of Sexual Abuse

  • Bruises around the breasts
  • Bruises around the genital area
  • Evidence of venereal disease
  • Vaginal or rectal bleeding
  • Difficulty walking or standing
  • Depressed or withdrawn behavior
  • Flirtation or touchiness by the caregiver

We don’t even want to think about it, but it happens. Attackers look for vulnerable people to victimize. Seniors can be perceived as easy to overpower. They may also be less likely to report abuse because of their dependency on others for care.

5. Signs of Financial Exploitation

  • Bills not being paid
  • Money disappearing and unaccounted for
  • Caregiver taking money for a purchase that doesn’t arrive
  • Unusual purchases that your loved one didn’t used to make
  • Increased use of credit cards
  • More frequent withdrawls of cash
  • Adding someone new to bank accounts or credit cards

Financial exploitation of elders is all too common. Older adults may be particularly vulnerable to this type of abuse for a number of reasons, says Loewy, who now serves as general counsel and senior vice president for industry relations at EverSafe, a financial monitoring service for older adults.

Loewy says it may be that financial exploiters are simply following the money, and seniors tend to have a higher net worth than younger adults. And some older adults are at greater risk of exploitation due to cognitive impairment.

Financial exploitation can also happen when a professional caregiver takes advantage of the elder. Both family caregivers and paid caregivers are in a unique position to perpetrate this crime, Loewy notes. This is why background checks are especially important when hiring a professional caregiver.

What to Do if You Suspect Elder Abuse

The National Center on Elder Abuse (NCEA) recommends calling 911 immediately if you believe an elderly friend, relative, or neighbor is in immediate, life-threatening danger.

If the danger is not immediate but you suspect that abuse has occurred or is occurring, relay your concerns to the local adult protective services agency, long-term care ombudsman, or police.

To find the right helpline, hotline, or elder abuse resources in your local area, visit the NCEA webite.

 

This article was written by Judy Speicher on March 8, 2017 and can be found here.


Baby Boomers: Aging and the Future of the Healthcare System

blog_BabyBoomers_200x200As of 2014, 3 million baby boomers will reach retirement age every year for the next twenty years, and more than 71 million Americans will be 65 or older by 2029.1 This number will place a huge demand on the healthcare system in this country. In addition, every day this year 11,000 baby boomers become eligible for Medicare.2 They will begin switching from commercial healthcare plans to Medicare, which will put pressure on the government program. This switch will affect a hospital’s revenue mix because reimbursement by the government is usually lower than that of commercial plans. By 2029, 20% of Americans will be Medicare eligible, and the number of those able to pay into Medicare will drop to 57%.1

Medical Professionals (Baby Boomers) Retiring

With life-expectancy higher for baby boomers than previous generations, the need for more medical and nursing facilities will rise, as will the demand for doctors and nurses and other members of multidisciplinary teams. However, a majority of doctors are baby boomers and have retired or are planning to retire soon. Baby boomer patients already outnumber doctors and other medical staff available to treat them. Howard Bedlin of the National Council on Aging (NCOA) stated that the US will need 1.6 million new care providers by 2020 to meet the needs of baby boomers.1

The Price of Poor Lifestyle Choices

A study conducted by Jama Internal Medicine revealed that the baby boomer generation may have a higher life-expectancy than previous generations, but they have a higher incidence of chronic disease, disability, and poor lifestyle choices.3 These findings strengthen the prediction that healthcare costs will rise — and continue to rise — and there will be a dire need for healthcare professionals, especially those specializing in geriatric care. Chronically ill patients will place a strain on the already taxed Medicare program, and will drive up hospital costs as patients are admitted more often due to chronic conditions. Consequently, hospitals may be forced to take on the financial burden. 1

Getting Older is Costly

Getting older comes with a slew of problems and needs, regardless of chronic illness and poor lifestyle habits. Aging increases the need for more direct care and assistance, whether in the comfort of one’s home, a practitioner’s office, a nursing or skilled nursing facility or a hospital. It is estimated that 25% of healthcare expenditures will increase by 2030 as a result of the natural aging process.4 This rise will cause insurance companies and Medicare to look for ways to cut costs that in turn will lead to more cost pressure being put on providers.5

With the baby boomers representing 1/3 of the US population, the healthcare system is going to be hit with new challenges. Hospitals and other healthcare facilities, already facing increased budget pressure, will be facing even greater financial challenges. Now is the time to find ways to increase your facility’s efficiency and save money. Contact us for more information on SEC3URE. By effectively managing people, premises, and protocols, IntelliCentrics helps facilities overcome complex challenges including the burden to reduce HAIs, decreasing budgets, and the increasing number of regulatory requirements.

 

This article was written by Tracey Hups in June 2015 and can be found here.


House Calls Improve Care, Lower Costs

Although demand for the service is building, the number of family physicians making house calls is shrinking. In a 2010 AAFP survey, 19 percent of Academy members said they made at least one house call a week. By 2013, the number had fallen to 13 percent, and only 3 percent of respondents reported making more than two house calls a week.

With a rapidly growing elderly population, will that trend ever reverse to meet demand? By 2030, the number of Americans age 65 and older will account for 20 percent of the U.S. population. And by 2038, the nation’s elderly population is expected to double to 72 million — or roughly the current population of California, Florida and Illinois combined. Two-thirds of the people in this age group have multiple chronic conditions and likely would need regular health care visits, which they may have difficulty accessing.

The number of house calls to Medicare beneficiaries more than doubled from 2000 and 2006, despite the fact that the number of physicians making house calls declined during the same period.

In my rural community, there are few resources for assisted living, so house calls could be the difference between an elderly or disabled patient staying in his or her home or moving to a nursing home. A 30-minute house call also can save a patient’s spouse or adult children from taking half a day off work to get a patient to my office.

Although it is coded differently than a traditional house call, I also visit my patients who are in nursing homes so they don’t have to be loaded into a van, transported across town, unloaded and reloaded. Coming to the patient, in these instances, is easier for everyone.

And it isn’t just an age issue. I’ve made house calls on patients recovering from major surgeries, car wrecks and other issues — including terminal illness — that would make it challenging for them to come to me.

Interestingly, as reimbursement for house calls has improved, the number of patients treated at home has increased dramatically even though the number of physicians making house calls has declined. Part of the explanation for this phenomenon is practices that specialize in house calls.

It’s an intriguing business model with lower overhead. It also holds potential to lower health care costs by catching relatively small problems before they become crises and keeping patients with chronic conditions and mobility issues out of the ER. A pilot program created by the Patient Protection and Affordable Care Act is documenting how providing house calls can lower Medicare costs, and Medicare will share savings with participating practices.

A study published last year in The Journal of the American Geriatrics Society compared the Medicare costs and outcomes of more than 700 patients enrolled in a house call program to a control group of more than 2,100 Medicare patients. Patients in the house call group had 17 percent lower health care costs during a two-year period. They also had 9 percent fewer hospitalizations, 20 percent fewer emergency department visits, 23 percent fewer visits to subspecialists and 27 percent fewer stays in skilled nursing facilities.

Obviously, house calls are a service that not all family practices can provide. But for those who can, it is a way to improve care and outcomes and potentially increase revenue. It’s also worth noting that if primary care physicians won’t make house calls, other health care professionals are willing to fill that void.

Beth Loney Oller, M.D., practices full-scope family medicine in Stockton, Kan.


7 Ways Millennials Are Changing the Healthcare Industry

As the largest generation in the United States, and one whose purchasing power continues to grow, Millennials are having a major and increasing influence on just about every industry out there. Healthcare is no exception.

The mindsets, influencers and habits of Millennials don’t align with traditional models of healthcare delivery—and healthcare brands must either adapt or be left behind.

Here are some of the most game-changing ways Millennials interact with healthcare brands.

1. THEY WANT CARE FAST

Millennials have been called the “drive-through generation” because they want healthcare delivered more quickly and efficiently. While older generations see primary care physicians as their first line of defense against non-critical health concerns, Millennials see them as a last resort. Instead, as many as 34% prefer retail clinics and 24% prefer acute care clinics.1

2. THEY DO THEIR HOMEWORK

The Affordable Care Act, the rising costs of healthcare and the increased number of self-help resources available have encouraged this generation to take control of their healthcare. They do that in part by turning to the internet. For non-urgent health concerns, Millennials often search online to gather information before seeing a doctor. They’re also twice as likely as other generations to act on health advice they find through the internet, including social media.2

3. THEY TRUST BUT AVOID DOCTORS

Despite the abundance of healthcare information at their fingertips, Millennials still consider physicians their most trusted resources for healthcare information. So why do they avoid the doctor? Reasons include long wait times for or at appointments, fear of bad news, a general lack of convenience and, not least of all, fear of big bills.3 In fact, as many as 54% of Millennials have delayed or avoided medical treatment due to costs.1

4. THEY WANT UPFRONT ESTIMATES

With out-of-pocket costs on the rise, 41% of Millennials say they request and receive estimates before undergoing medical treatment. That’s compared to only 18% of seniors and only 21% of baby boomers.1

5. THEY LISTEN TO OTHER PATIENTS

Word of mouth is especially important to Millennials. That includes, of course, what’s said online. In the past year, 23% of Millennials say they’ve looked at online reviews for healthcare providers or hospitals, compared to 15% of non-Millennials. These consumers are also twice as likely as non-Millennials to have participated in online communities in the past year, and they’re more trusting of the information they find there. Likewise, Millennials are increasingly comfortable sharing their own symptoms and treatment experiences through patient networks.3

6. THEY’RE LEADING HEALTH-TECH TRENDS

It’s no surprise that people of all ages are using technology to manage their health, from simply searching for health information online to using mobile apps and more. The difference is that Millennials are early adopters, so when you see them forming new tech habits, you can expect others to catch up. Recently, Millennials have spearheaded the use of wearable sensors in conjunction with health apps.3

7. THEY VIEW HEALTH HOLISTICALLY

Compared to older generations, Millennials take a broader view of what affects their health and wellness. Whereas older generations are more likely to consider regular exams important to their health, Millennials are more likely to focus on day-to-day health maintenance choices that they believe will pay off long-term.3

WHAT THIS MEANS TO YOU

To become preferred by Millennials, healthcare brands must start thinking of patients more like retail consumers. This will mean evolving both your care delivery model itself and the way you communicate with consumers. It will mean prioritizing convenience and transparency, embracing consumer technology and finding other, creative ways to deliver value on a day-to-day basis.

It will also mean recognizing that conversations about healthcare are all around us, 24/7. Healthcare brands cannot control these conversations—but they can learn to participate in ways that show leadership, build trust and encourage ongoing brand utilization.

*Sources: 1.) 2015, March 25. “Survey: 5 Millennial Trends Altering the Delivery of Healthcare.” HIT Consultant. / 2.) “Millennials and Healthcare: What Is Your Engagement Strategy on Social Media.” Referral MD. / 3.) 2015. “Healthcare Without Borders: How Millennials Are Reshaping Health and Wellness.” Communispace Health. / 4.) 2012. “Healthcare Consumers: The New Reality.” Smith & Jones.

You can find this article on the HFA website or by clicking here.


Why You Need A Primary Care Physician

You’re young, you’re healthy, and you’re very, very busy. Do you really need a primary care physician? The short answer is, “Yes, you do.”

If you’re satisfied with that response, you probably already have one. But maybe you–or your best friend or your kid brother–are not yet convinced. I can practically hear your voice rising two octaves in protest: You’re perfectly healthy and you always have been with the exception of that broken arm in third grade, the surgery on your wisdom teeth, and the occasional cold.

So, why should you get yourself a primary care physician? Is it because you need lots of tests and blood labs and all that jazz to make sure you don’t have a hidden cancer? No. You can breathe a sigh of relief – that is not the reason.

Put simply, having a primary care physician will keep you healthier as you age. Studies in numerous medical journals have confirmed this, including one in International Journal of Health Serviceswhich revealed that states with more primary care physicians per capita have better health outcomes, including fewer deaths from cancer, heart disease, or stroke. A separate study in the same journal suggests that an ample supply of primary care physicians is associated with a longer life span–if you add more primary care physicians to a community, the result is fewer premature deaths.

How is it that a primary care physician could have such a big impact on your health, you ask? The key is what’s known in the medical community as “continuity of care.” Continuity of care means that you establish a relationship with a health care provider and you enhance that relationship year after year. This provider gets to know you and your health goals, and helps you manage your overall progress. Continuity provides tangible benefits that have been proven to add up to better health. Here are just a few:

  • Someone to Watch Over You

In the short term, continuity of care dramatically increases the likelihood that you’ll receive a correct diagnosis and appropriate treatment. “The best diagnostic test available to a doctor is the test of time,” says One Medical Group physician Andrew Diamond. “Your primary care physician gains valuable information from tracking a problem over time –whether for a week, two weeks, or a month–and can make treatment decisions accordingly.” Think of the other extreme: If you go to the ER with a problem, the providers don’t expect they’ll ever see you again, so they’re likely to order extra tests and treatments to cover all the possible bases at once.

Over the long term, a provider who knows your health history, your habits, and your personality can more easily recognize signs that indicate a potential change in your health. For example, if you complain of fatigue to a doctor who doesn’t know you, you might not be taken seriously – but your primary care doctor will be able to see that you aren’t your usual self. On the flip side, that same provider will be able to reassure you when you’re not sick–they’ll know that the mole you’re worried about on your back isn’t a problem because it hasn’t changed in the six years they’ve observed it.

  • One Point Person

If you need to see a specialist, a skillful primary care physician will refer you to someone they know and with whom they have a collaborative relationship. If you have concerns about getting different suggestions from different specialists, your primary care physician can help you sort through and prioritize which suggestions to act on first. “This is the concept that’s known as the ‘medical home,’” says Richard Madden, MD, a family physician who serves on the board of directors of the American Academy of Family Physicians. “Your primary care physician has a working relationship with their referrals and keeps track of your care with them.”

  • Save Time Down the Line

Setting up a relationship with a consistent provider can help you get care more quickly should you get sick in the future–whether it’s a pesky sinus infection or something more serious. “When you’ve established care and set up that relationship, it’s much easier for us to help you down the line,” says One Medical Family and Nurse Practitioner Meg Scott. “We know your history, we know more about you, we can even help you resolve things over the phone or via email sometimes.”

  • Prevent Future Illness

And finally, if you come in for regular physicals instead of only coming in when you’re sick, your primary provider can help educate you about your health and prevent chronic illnesses down the line. “When we do a physical, we do a lot of routine, basic checks. But coming in regularly can be very valuable to your long-term health,” says Scott. She says she covers a lot of ground in a yearly physical, dispensing information tailored to the unique needs and goals of each patient. The range of topics may include education about high blood pressure, weight loss, STD prevention, alcohol and tobacco use, or stress and anxiety. “It’s proactive and preventive at the same time,” she says.

The Problem with Self Referrals

Still not convinced you need a point person to help you manage your health? Think it saves you time to go directly to a specialist when you sense something is wrong? Think again. When you refer yourself to a specialist without seeing a primary care physician first, says Madden, “You’ve already identified a certain part of your body as the source of the problem and chosen a specialist based on that.” Sometimes the problem is fairly obvious: You’re having a skin problem, so you go to a dermatologist. But what happens when you have chest pain? You might decide that you need to see a cardiologist, who will evaluate your problem through a cardiologist’s lens, looking for cardiac explanations and ordering tests of your cardiac function.

But what if those tests are inconclusive? Will you seek out a different cardiologist who will repeat the same tests, hoping for an answer this time? What if your chest pain isn’t caused by a cardiac problem? What if it’s coming from your gastrointestinal system, or from your lungs? Will you take yourself to a gastroenterologist, or a pulmonologist, and go through all the specialized tests they recommend, too?

All those visits take time, delaying your diagnosis. And all that testing can be dangerous. “There can be harm in overtesting,” says Madden. “There can be complications or pain, and lots of costs that could have been avoided.” Diamond agrees, “Many tests involve radiation, toxins, or invasive procedures that carry significant risks. Tests can give ‘false positive’ results, prompting treatment for an illness that you don’t have. And tests can detect miscellaneous irregularities unrelated to your complaint – leaving you stuck with even more testing to prove those are benign.”

In contrast, when you go to a primary care physician whose goal is to consider the whole of the person, says Madden, “You avoid a narrow approach to your problem and the unnecessary tests that go with that.”

The Big Picture

The point Madden makes is key: Everyone should have a provider who can step back and look at the “big picture” of their health–especially during times when a diagnosis is needed. This is what primary care physicians are trained to do. In medical terms this approach is called a “a broad differential diagnosis.” As Diamond explains it, “Any set of symptoms can have a lot of possible explanations. A primary care physician has to have an open mind, listen carefully, and consider all the possibilities.”

What to Look For

What should you look for in a primary care provider? Along with feeling a sense of safety, rapport, and trust, Madden recommends finding a practitioner who conveys a sense of thoroughness and a depth of knowledge. He also recommends finding a provider who values your input and opinion. “You want to feel like you’re involved in the process of decision-making.” For example, if your doctor recommends tests she might then ask, ‘How do you feel about that? Is this what you’re looking for? Does it seem reasonable? Is it affordable?’ Meg Scott agrees. “It’s not a one-directional relationship, it’s bi-directional,” she says. “The goal of each visit should be to have a level playing field, where you can voice your concerns openly and you walk out the door feeling like you were really listened to and you’ve got a plan that’s going to work for you.”

One:Life is published by One Medical Group, an innovative primary care practice with offices in BostonChicagoLos AngelesNew YorkPhoenix, the San Francisco Bay Area, and Washington, DC. This article can be found here.


House Call Advantages

While Uncommon, House Calls Can Be Appealing to Doctors, Patients and the Health Care System.

A doctor on a house call writes a prescription for a sick woman.

House calls can make for a more personalized experience for the patient – and even the doctor.

When Simon Jacobsen’s aging mother needed to see a doctor, she first had to descend the stairs – a journey that once left her with a broken neck. After that, Jacobsen and his father carried her down themselves, but their method was hardly graceful.

“We were just a couple of gorillas doing the best we could,” says Jacobsen, a 49-year-old who lives in the District of Columbia. Meanwhile, the care his mom received was fragmented, time-consuming and physically and emotionally exhausting for the entire family.

“It just got to a point where we realized we couldn’t move this person, but we also believed that she didn’t belong in a nursing home,” Jacobsen says.

“You call him, he’s there in 30 minutes,” says Simon Jacobsen of Dr. Ernest Brown.

“You call him, he’s there in 30 minutes,” says Simon Jacobsen of Dr. Ernest Brown.

So Jacobsen’s father called Dr. Ernest Brown, a 47-year-old family physician in the District of Columbia who runs a house call-only independent practice. Until Jacobsen’s mom’s death about five years later, Brown served as her primary provider, coordinating with other doctors for more specialized care, driving her to the hospital himself and eventually setting up a type of in-house hospice care. Some weeks, he visited every day.

“I think this is care that everybody deserves,” Jacobsen says.

For Brown – who’s tough to miss in blue scrubs with “House Call Doctor” embroidered on the back and a classic black medical bag in his hand – one of the most rewarding aspects of his job is being a part of the community. “I feel like I belong,” he says between calls last week, while sipping a cappuccino at a local Turkish restaurant – whose staff he treats.

Brown cares for many hotel guests, including visiting heads of state and tourists, as well as low-income, elderly people whom he sees pro bono. He also treats airline employees, hotel concierges and a wide circle of friends – nearly all within a few mile radius of his apartment. “I really don’t have to go but a few blocks to do what I do – provide care,” he says.

Dr. Ernest Brown follows up with a hotel guest whom he treated for a kidney stone.

Dr. Ernest Brown follows up with a hotel guest whom he treated for a kidney stone.

Brown is a rarity among an already small cohort of doctors. Only 13 percent of family physicians surveyed made regular house calls in 2013, and only 3 percent made more than two per week, according to the American Academy of Family Physicians. Even fewer run practices like Brown’s that are exclusively house calls, says AAFP’s president, Dr. Robert Wergin, a family physician in Milford, Nebraska, who goes on a couple house calls each month.

Still, the historic practice of seeing patients in their homes may be making a comeback, says Dr. Justin Davis, a primary and urgent care doctor in San Francisco who typically sees a few house call patients every day in addition to treating people in his private practice.

“When I first started [making house calls] 10 years ago, it was even more unheard of,” he says. “Now, there’s a paucity of it in actual practice, but there’s a lot of talk about it. It’s becoming more in people’s consciousness.”

A Personalized Experience

The concept of a doctor coming to a patient rather than a patient going to a doctor is hardly revolutionary. In 1930, about 40 percent of doctor-patient interactions were through house calls, but by 1980, the rate was down to 1 percent, according to a Clinics in Geriatric Medicine article. “It used to be the norm, and the norm was decency,” Jacobsen says. “[Dr. Brown’s care] is an act of incredible decency that seems so foreign to so many people now because they’re just not used to it.”

From a patient’s perspective, summoning a doctor to your house has plenty of appeal: No waiting rooms, traffic or skipped work. No dragging a sick and tired body out of bed to see a doctor whose prescription is to go back to bed. No feeling like a number.

Patients are looking for “a personalized experience,” Davis says. “They want to feel like they’re with somebody who knows about them, or at least cares about them, and can give them time and really listen to them.”

 

This article can be found here.


The Truth About Grief and Loss

Lauren was frightened. She considered herself to be a resilient, “no-nonsense” woman. Since the death of her dad, however, she had fallen apart, and feared that she wouldn’t be able to put herself back together.As Lauren moved through the grieving process she began to understand that her reactions were normal. In the course of her therapy we addressed a number of commonly asked questions about grief and loss:

  • What is loss? When we speak of grieving and loss we often think of death. However, there are many other kinds of loss, including divorce, illness or loss of a job. What is particularly surprising is that any change — even positive change — involves loss. Getting promoted or married are changes that we think of as positive, but these changes also involve elements of loss.
  • What is grief? Grief is the inevitable process we experience as the result of a loss. Grief involves a series of stages including denial or disbelief, fear, anger, depression, and finally acceptance. These stages may overlap, or come in a different order. During this process we may experience myriad emotions, such as confusion, sadness, fear, guilt or hopelessness. These feelings will vary in intensity according to the size or extent of a given loss.
  • How can I best heal after a loss? There is no one right way to grieve. Everyone’s experience of grief is unique. In the words of author Anne Morrow Lindberg, ” … suffering … no matter how multiplied, is always individual.” There are some general guidelines, however, that will allow you to mend more quickly and completely:
    • Remember that no matter how much pain you may feel, you will survive your loss.
    • Emotional ups and downs are a normal part of any grieving process. Here’s the paradox: In order to get past the difficult feelings, you must experience them.
    • Don’t try to speed up or avoid the process. If you do, you will not heal properly. Your grieving will have been incomplete, and your energy to deal with the present will remain bound to the past.
    • Care for yourself as if you are caring for a dear friend. Rest, eat well (even if you aren’t hungry), and exercise (even if you don’t want to). Avoid other changes and don’t make big decisions unless you absolutely must.
    • Ask those you love and trust for support. You don’t have to face this alone.
    • Write about your loss. Journaling will bring your unexpressed emotions to the surface, thereby encouraging the grieving process to move along.
    • Create your own ritual. Most cultures have ceremonies to mark death. A ritual marking any loss helps us to acknowledge that the loss is real. It is a way to honor the loss, and to separate the past from the present. When faced with any kind of a loss, feel free to create any kind of ceremony that holds meaning for you.
  • There are actually gifts in loss? When a painful loss first occurs it is impossible to imagine that anything good could come from it. With time and perspective, however, you may be able to see something positive. You may be able to appreciate good times more than ever before. Or you may have an increased respect for your own strength and resilience. Most important, you can better empathize with others as a result of your own experience.

Loss is an inevitable part of everyday life. Understanding how to better cope with small losses prepares us to effectively grieve for major ones.

 

grief and loss

 

This article, The Truth About Grief and Loss, was written by Maud Purcell, LCSW, CEAP and can be found at http://psychcentral.com/lib/the-truth-about-grief-and-loss/


Disruptive Innovators: Physician House Calls Making a Return

The return of doctors to homes provides a better model for caring for the frail elderly.
It wasn’t so long ago when it was common for a physician to visit patients in their homes. New technologies and a changing healthcare system placed physicians firmly in their offices, forcing patients to go to them. But the adage of everything old becomes new again is proving true. Physician house calls are making a comeback and disrupting today’s healthcare system.

For 15 years, family physician Brian Mathwich worked in an office-based practice in Colorado, feeling like he wasn’t providing the care that many of his sickest patients really needed. These frail patients had a hard time getting to his office, and some couldn’t leave home at all. Minor problems snowballed into serious ones requiring ER visits and hospitalizations.

doctor home, house calls

Mathwich left office-based practicing and started a house call practice three years ago. He was the sole provider in the beginning, but the demand became so great, his one-man house call practice expanded to six primary care providers and a psychiatrist. In June, Mathwich’s practice was acquired by the Visiting Physicians Association, one of the country’s largest house call companies serving patients in 10 states, and he became the practice’s regional medical director.

Mathwich is not alone in recognizing that the frail elderly population needs a kind of care that is hard to achieve in today’s healthcare system. That’s why returning to physician house calls is the way to go with these patients, says Alex Binder, the chief operating officer of New Jersey-based Visiting Physician Services.

Today’s healthcare system is “industrialized medicine,” Binder said. “It’s everything by algorithm and computer,” which is fine for much of the population, but not everyone.

“What we have found is there’s a segment of the population – primarily the frail and elderly – where those algorithms and that entire model causes more harm than good. It absolutely causes unnecessary expenditures. It’s not cost effective. It’s not in alignment with what the patient and the family probably would prefer for these last few years of life,” Binder said.

“What has worked for their first 82 years will not work for their last three.”

From Binder’s perspective, it only makes sense to extract the frail elderly out of the “industrialized medicine” system and put them in a parallel system based on home health services.

The frail elderly, with multiple, chronic conditions, are better served by house calls, Binder said, because they get the medical access they need when they need it and they don’t have to leave home or utilize more costly resources to get it.

“If their only option is to continue to go back into the industrialized system,” he said, “their last three years of life is going to end up costing Medicare a half a million dollars and the outcome is going to be no different, or possibly worse, than it would have been if they were in this alternate environment.”

The potential for cost savings for a population that is one of the biggest drivers of healthcare costs has caught the attention of policy makers. The Affordable Care Act created the Independence at Home Medicare demonstration project. The IAH, a delivery and payment model that uses primary care teams treating patients in their homes, began in 2012 and continues through 2015.

According to the American Academy of Home Care Physicians, home-based primary care has the potential to save Medicare 20 to 40 percent. And while a house call visit may cost more than a visit to a physician’s office, house calls, by preventing visits to the ER and hospital, save money. The cost of 10 house calls is offset by one prevented $1,500 ER visit, says the AAHCP.

Not everyone is enamored of a return to house calls, though, said Constance Row, AAHCP’s executive director.

“I’ve never heard anybody say it’s a bad idea except the people who are completely wedded to their extensive investments in outpatient buildings of one kind or another and who do not want anything that is going to reduce the dependence on this built up infrastructure that, quite frankly, is not doing what the patients need and also isn’t needed any more,” she said.

When doctors didn’t have much in the way of diagnostic tools, they brought their stethoscope and a few supplies to their patients’ homes in their little black bag. The creation of technological tools that couldn’t be easily transported parked those doctors in offices.

Where once technology chained them, the miniaturization of technology – laptops, smartphones, mobile labs, mobile x-rays – is now setting them free, said Row. “Everything can be brought into the home that used to require an office visit,” she said. And with that technology, doctors can keep many patients out of the ER, out of the hospital and out of nursing homes – saving a bundle of money.

“The idea that you could, in fact, have mobile providers who are providing care at the same level, or in some cases, a higher level, than what’s available in the office is in fact mind-boggling, and for that reason, some people just reject it out of hand,” Row said. “But I will tell you, for the people who need it and for the people who are doing it, it’s something that just needs to happen.”

 

This article was written on July 23, 2013 by Stephanie Bouchard and can be found in full at http://www.healthcarefinancenews.com/news/disruptive-innovators-physician-house-calls-making-return 


No Place Like Home

Mary Wareheim suffers from a long list of health problems. She’s an amputee who uses a wheelchair. She has diabetes, heart disease, high blood pressure and an irregular heartbeat; she takes 11 prescription drugs. At 83, she leaves home infrequently, perhaps twice a year.

Yet she’s been the hospital just once in six years, probably because she’s had excellent medical care and monitoring. Though she’s essentially homebound, doctors come to her, in the Baltimore house she shares with her daughter, son-in-law and a Great Dane named Murphy, through the Johns Hopkins Elder House Call Program.

house call jan“My mother would absolutely make excuses not to go to a doctor,” said her daughter Chris Ricko, 49. “Now she doesn’t have an excuse.”

In an aging society trying not to drown in medical costs, the problem is that a majority of Medicare dollars are spent on a small sliver of very sick patients with multiple chronic diseases and disabilities — like Ms. Wareheim. A simple visit to a Baltimore emergency room, for instance, often tops $2,000; even brief hospitalizations cost tens of thousands of dollars, and too often the medical carousel brings discharged patients back to the hospital within weeks.

House call physicians seem to slow that carousel. The Veterans Administration, for example, maintains a network of more than 160 house call programs. Last year, those programs cut days spent in hospitals by 70 percent among 9,400 elderly patients and reduced total VA and Medicare costs by more than a third, V.A. researchers announced at a conference last month.

But I don’t want to cast the value of house calls in purely financial terms. Think what it takes to get elderly relatives to doctors’ offices and how often they need to go; think how often a family member might have to miss work to accompany someone to those appointments.

“It’s inconvenient, it’s unpleasant, it can even be dangerous,” said Dr. Eric De Jonge, who directs the house call program at Washington Hospital Center in Washington, D.C.

Sometimes, the struggle results in elderly patients who don’t see doctors very often, don’t get the follow-up they need and can’t get prescriptions refilled because a physician hasn’t examined them in months. Medical care that comes to them may be the only kind of medical care they’ll regularly receive.

Physicians who make house calls also find it enormously helpful to see patients in their own environments. “You learn more about the patient in five minutes at home than in five visits to the office,” said Dr. Leff.

Doctors on house calls talk about “the kitchen biopsy” — seeing what’s in the refrigerator, noticing a jumble of pill bottles that suggests hit-or-miss medication use, observing that descent to a basement washing machine involves fall hazards.

These doctors also say they develop deeper relationships with their patients. They know their families, their values and preferences. Dr. Jennifer Hayashi, who directs Johns Hopkins’s program, can spot not only when her patient Mrs. Wareheim might need a higher diuretic dose, but also when her daughter Ms. Ricko is wearing out as a caregiver.

A resident sees Mrs. Wareheim every three months; a nurse comes monthly to draw blood, because Mrs. Wareheim takes the blood thinner Coumadin, which requires regular monitoring. “They’re never rushed,” Ms. Ricko said. “They listen diligently to what my mother has to say. And she’ll never complain, so I tell them my concerns, and they listen to those, too.”

As a thank-you gift for her doctors and nurses, Mrs. Wareheim crochets hat-shaped toilet paper covers. But the doctors’ greater reward, I imagine, is seeing her at home, watching Orioles games and visiting with great-grandchildren and sharing snacks — albeit against the rules — with Murphy.

This article was written by Paula Span on June 30, 2010 and can be found in its entirety at http://newoldage.blogs.nytimes.com/2010/06/30/no-place-like-home/?_r=0

 


How House Calls Benefit Both Patients and Physicians

Physicians used to take care of patients at their homes. Through the 1960s, patients would make a phone call and the doctor would arrive at the doorstep, black bag in hand, eager to serve. This changed in the mid to late-1960s as doctors developed group practices and as medical care expanded to include technology-based studies and specialty referrals, and thus became more hospital-centered. Prior to World War II, 40 percent of patient encounters were in the home. By the mid-sixties, only 4 to 9 percent of patient encounters were house calls.

Physicians

In this new hospital-based environment, patients turned to the emergency room for reliable and immediate medical service. On nights and weekends when their physicians were less accessible, they flooded nearby emergency rooms and expected to receive the quick, individualized service that they had previously received in their own homes. No such luck: as emergency room visits soared, hospitals struggled to find solutions to deal with volume overload, increasing patient dissatisfaction, and poor outcomes. One of the short-term solutions was to divert non-urgent patients to ambulatory clinics; the other, which occurred early on at community hospitals but much later at academic hospitals, was to staff the ER with  adequately trained “emergency physicians” to improve patient flow and provide adequate resident supervision.

In recent article by Paula Span, No Place Like Home, she discusses recent revival of the physician house call. A small but growing group of physicians who provide house calls emerged nearly a decade ago, when Medicare raised reimbursement rates for home visits. Despite this new movement to revive the house call, house calls still only account for under 1 percent of all patient visits.

I went on house calls as a medical student while working with a small-town internal medicine physician. No doubt there are benefits – the opportunity to take care of patients in their own home and to get a sense of their living environment, their support system, and their overall safety provides insight which cannot be gleaned from office or hospital visits.

But the nature of the visits has changed dramatically since the 1960s. A 2006 article in TIME, A Doctor in the House, discusses the ever-expanding contents of the modern-day “black bag,” which can include everything from a Blackberry to an EKG machine to portable lab kits and IV medications, and the list goes on. Maybe someday physicians will add the newest physician gadget, GE’s Vscan, to their white coat pockets.

The house call offers many benefits to patients and physicians; it has the potential to cut costs by eliminating unnecessary ER visits, and it has the potential to help re-establish a more intimate doctor-patient relationship. With the emergence of boutique medicine, it may quickly become the primary method of care among the more affluent members of society. However, regardless of house calls, the uninsured and the homeless will continue to flood emergency rooms, and we will not see much improvement until we establish a more effective way to deliver primary and preventive care to those who need it the most.

 

 

This article, How House Calls Benefit Both Patients and Physicians, was written on September 29, 2010 and can be found in its entirety at

http://www.kevinmd.com/blog/2010/09/house-calls-benefit-patients-physicians.html