GRAY MATTERS
Notes, News & Musings on Elder Care
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Join your Life Care Team for this very special program on
Thursday, September 15, 2011 from 4:00 to 5:00 PM
4931 Homberg Drive; Knoxville, TN 37919
Join your Life Care Team at the Elder Law Practice of
Monica Franklin, CELA
for this special educational program on Thursday, August 11, 2011
from 4-5:30 pm at 4931 Homberg Drive in Knoxville.
RSVP 865-588-3700
Join us for a Special Presentation: Getting the Most from Your Doctor Visits – Good Healthcare for older adults is an essential and often a complex matter. We are all familiar with the frustrations of long waits and short visits at the doctor’s office. Physicians face similar frustrations with the demands and constraints of the medical practice sometimes in conflict with the needs of patients. In an environment where the patient may feel pretty helpless, there are effective strategies to help you to improve the quality and the substance of your doctor visits. Join us to learn practical tools and techniques to take charge in improving your own healthcare and your satisfaction as a healthcare consumer.
THURSDAY JULY 15 from 4-5 pm; 4931 HOMBERG DRIVE, KNOXVILLE, TN 37919
RSVP 865-588-3700
Call the Director of Nurses!
Entrusting your fragile, dependent loved one to strangers upon whom she will depend for the most basic and intimate necessities of life, most likely for the rest of her life, is a difficult process. There are oodles of layers and dynamics of all kinds which complicate our best intentions to be effective advocates: Guilt? Sadness? Helplessness? And oh so, so many more issues.
Nobody likes to complain, and some folks are downright intimidated by the process. Fears of retaliation, even when entirely unfounded are powerful drivers of inaction… “I don’t want to make waves or upset anybody…it might come back on Momma.”
“I hate to bother them…it’s such a little thing…” Instead of the direct communication route, some families will step in and take care of issues or needs themselves with nary a whimper. The intent is to be understanding/ forgiving/ helpful because staff [always] seems so overworked. Or a more irritated and righteous “Never Mind, I’ll do it myself!” approach may be adopted. There’s also pouting, sarcasm and silent suffering or just plain wimping out. Befriending staff, offering tips, or bringing goodies in hopes that this will curry special favor and result in more or better attention for loved ones will not succeed.
Complaining to the CNA’s, other families, or your neighbors and friends about the terrible care is yet another ineffective approach to addressing care concerns.
So where does the rubber meet the road? The Director of Nurses.
Nursing Home Administrators are of course very interested in your concerns. But to address those issues, they’re gonna call the DON! So start there. Yes, these are very busy people indeed. Worried about bothering them with what might be a kinda petty complaint? Don’t! There is really no such thing. My experience has been that folks tend to save up the little stuff. While the intent is to overlook/ “understand” and/ or forgive, in truth those items are stored. Then, when enough of these “little things” occur, and /or add a big thing or a different thing happens later, that first lil ol’ thing is marched out too. This usually takes place in the wake of a now massive wave of unhappiness.
Unfortunately, the lil-now big-thing is past history, and evidence and accountability may be inaccessible. This is extremely frustrating to all those highly motivated to address the problems.
It is great to bring goodies. Don’t expect a thank you note, and don’t expect better care. Show respect to care providers –but remember: you aren’t a hostage. As in any relationship, finding the good and blowing on those coals will help to warm the room, and encourage better care from the staff.
You may also contact the facility Ombudsman. Information on how to do this is provided on admission and posted prominently in all facilities. However, the Ombudsman is gonna say: “Have your spoken to the DON?”
Here’s the thing: We have a limited number of nursing homes in our community. While some are fancier than others, the rules and regulations and expectations for care are exactly the same for them all. And whether fancy or plain, they all face the same challenges as healthcare providers to a fragile, vulnerable population with very complex needs.
When care does not meet expectations reporting those problems must be as prompt as possible. Remember how the Sheriff always liked it best when the trail was warm? This enables more effective fact-finding and accountability.
I like putting my concerns in writing. This documentation formalizes your expectations for accountability and provides a tidy way to keep track.
Ultimately, ”success” takes a spirit of being on the same side. Remember: It is in everyone’s best interest that the nursing home staff succeeds. This means timely, direct, respectful communication. Start with the Director of Nurses.
A book we have found to be really helpful that we provide to our Life Care Plan clients is called 20 Common Nursing Home Problems and How to Resolve Them, by Eric Carlson, Esq., available through the National Senior Citizens Law Center. Mr. Carlson recommends: “Be the Squeaky Wheel!”
Kumbayah!
The first time I saw this lil’ bit o’terrorism was years ago in the admissions office of a nursing home. Yes, really. Ugh!
Inclined to consider meaning and motivation, my efforts to understand and somehow articulate the significance of this “message” in that setting made my head hurt then, as it does now.
But this is what I really want to share: For the most part, neither you nor your kids will “choose” your nursing home. Your nursing home will more likely be choosing you. Now I encourage you to continue to try to discover some reasonable motivation to be nice to your kids, but in this one regard, they mostly won’t get much of a say.
“We cannot meet your needs” may be the admission director’s response to families with loved ones who have a history of “behavioral issues,” such as agitation, combativeness, or just peaceful exit seeking. Those with complex, major wounds and those with some forms of Methicillin-resistant Staphylococcus Aureus (MRSA) or Vancomycin-Resistant Enterococci (VRE) have needs that some facilities are unable to adequately address. Ventilator or dialysis patients, those undergoing chemotherapy treatment for cancer, and even organ transplant, AIDs patients, and others needing expensive drugs may have difficulty finding placement.
Another patient category having trouble finding placement? Surprise, surprise: those who are not in need of skilled care. Waiting lists for admission to intermediate/ long term residential care in the nursing home often either extend beyond most folks’ life expectancies or just don’t exist. Some Medicare Advantage Plans are also not accepted at some skilled care facilities.
Most folks think that when the time comes, they will just mosey on over to their chosen facilities and sign up. Think again. And tell your kids to behave on the tour! Rowdy family members can jinx an admission as well.
So what to do? When care in the nursing home –either short or long term- is going to be necessary, your New Best Friend is your hospital discharge planner! Request an introduction as soon as possible after admission to the hospital when you know –or even suspect- that additional care will likely be needed at discharge. These folks really know the long term care “lay of the land” and are able to guide families in accessing the best available care. And remember, they too may hit many a dead end before finding the right placement. Breathe deeply.
Heartening news from the Center for MedicareAdvocacy:
WASHINGTON — Two federal courts have ruled that the Obama administration is using overly strict standards to determine whether older Americans are entitled to Medicare coverage of skilled nursing home care and home health care.
Medicare will pay for those services if they are needed to maintain a person’s ability to perform routine activities of daily living or to prevent deterioration of the person’s condition, the courts said. Medicare beneficiaries do not have to prove that their condition will improve, as the government sometimes contends, the courts said.
The rulings are potentially significant for many people with chronic conditions and disabilities like multiple sclerosis, Alzheimer’s disease and broken hips. Skilled care may be reasonable and necessary and covered by Medicare even if the person’s condition is stable and unlikely to improve, the courts said.
This is MOMENTOUS! Or at least it should be. Where are the fireworks and the brass bands? Since this is a clarification of the rules rather than a rule change, it is immediately effective. I am wondering if anyone is noticing any ripples in referrals and treatment plans?
Go to www.medicareadvocacy.org for the entire NY Times article, more information about Medicare coverage, dealing with barriers to access, and even denial appeal kits.
Caveat Emptor [Buyer Beware]… ‘Tis the season for open enrollment which runs from November 15th through December 31st, 2010.
Those that are Medicare eligible have been receiving tons of mail for weeks and many may feel a bit confused regarding the actual task at hand. Making the “RIGHT” decision about healthcare insurance seems more important than ever, so the pressure is on.
And here come the “ADVANTAGE” plans: with fliers, letters, booklets, television and newspaper ads, seminars and telephone calls all proclaiming that their
Products are somehow superior to your original Medicare and a Medigap policy.
Yes, it may look like a good deal-and oh! There are perks! Health club memberships…and you always got your money’s worth out of your health club memberships, didn’t you? Maybe a little vision or dental benefit. When young and healthy, these policies may even be a great deal, and quite satisfactory for many. That’s mostly because it is unlikely that you will need skilled nursing care right off the bat.
Under original Medicare skilled nursing care in a qualifying facility is covered for the first 20 days at 100%, and the next 80 days at 80%. That’s one of the places that the Medigap coverage is important; the other being the 20% not covered under Part A for hospital care [and more], and the 50% of Part B for outpatient care [and more]. In contrast to having up to 100 days of skilled care and rehabilitation following an illness, injury or surgery, one plan being marketed as “sooo great” covers only seven (7) days of skilled care. For the subsequent [up to] 93 days a $100/ day co pay is needed. Whoa! You could be billed much as $9300 out of pocket if you were ill or injured and needed all 100 days of coverage for your care and rehabilitation.
Well… not to worry.
Advantage Plan benefits, already much reduced compared to original Medicare, are also vigorously managed. Your healthcare provider must persuasively argue on a daily to weekly basis to justify your continued care. The chances of receiving all 100 days-or even that entire first 20 days- are not great.
In spite of frail health- physically, emotionally, and cognitively- criteria for continued care are rigorous. There is less and less tolerance for the seemingly inevitable run of “bad days,” slow progress, and “plateaus” in progress. The provision of physical, occupational, and speech therapy “to maintain functioning and prevent further decline” is rare, although it is a documented Medicare benefit. Thus, lengths of stay in Medicare-funded skilled care are often much more limited than patients and families anticipate.
Another reason to hang on to your original Medicare? Your doctor, favorite hospital, skilled nursing facility or other provider may not accept your particular Advantage Plan. For example, providers in the Summit Medical Group, right here in K-Town, will be accepting only Humana Advantage Plans after January 1. Many unsuspecting older patients will find themselves without access to their longstanding, trusted primary care docs unless they make the change to Humana.
(Summit will continue to accept original Medicare and your Medigap policy.)
If these Plans aren’t advantageous why not just return to original Medicare? That can be done. However, once past your initial option to purchase a Medicare supplemental or “Medigap” Plan, your ability to access this very valuable secondary coverage becomes increasingly expensive and downright unaffordable for many. Medical underwriting may even deem you ineligible due to advancing age and increased health issues. However, if income assets are ample, doing without the supplemental may be an option.
So what if you have an Advantage Plan?
All is certainly not lost. Even though it’s not the best thing, it’s also not the worst thing.
During open enrollment sign up for the bestest/ mostest of it you can have: the most precious metal or gemstone offered by your carrier. Also, families must be prepared to advocate for their loved one’s needs. Whether original Medicare or an Advantage Plan, it is important to speak up if you believe you or your loved one is being discharged prematurely from any service covered under your plan. We have found that appeals are indeed considered, and sometimes successful in gaining more time for needed care.
Once again Science—via controlled empirical study…has affirmed an experiential truth: a grateful heart is a happier heart.
I love that researchers are more engaged in the pursuit of Happiness. It seems like a no-brainer, and yet traditional – ol’- timey- psychiatry long excavated for demons that rule individual and collective angst from deep within the wounded unconscious. And now we “prove” that there is a positive relationship between happiness and gratitude. Punitive superego: move over. We can actually get there from here!
They found that grateful people report higher levels of positive emotions, life satisfaction, vitality, and optimism and lower levels of depression and stress. Grateful people do not deny or ignore the negative aspects of life. Gratitude appears to enhance pleasant feeling states more than it diminishes unpleasant emotions.
The researchers also note that those strongly disposed toward gratitude have the capacity to be empathic and to understand the point of view of others. People in the social networks of those that are grateful are rated as more generous and more helpful by others (McCullough, Emmons, & Tsang, 2002).
There is huge value in “practicing” gratitude in concrete ways, thus becoming more mindful about blessings. Keeping a gratitude journal on an at least weekly basis taking just a few minutes to list those things for which one is grateful had a significant impact upon study participants. They reported more regular exercise, fewer physical symptoms, feeling better about their lives overall, and were more optimistic in the following week compared with those who recorded problems and stresses, or neutral life events (Emmons & McCullough, 2003).
A related benefit was observed in the realm of personal goal attainment: Participants who kept gratitude lists were more likely to have made progress toward important personal goals. Gratitude also translated into decreased envy and materialism!
I think most profound and important is a major Kumbayah factor:the finding that grateful people are more likely to acknowledge a belief in the interconnectedness of all life and a commitment to and responsibility to others (McCullough et. al., 2002). (!)
The happy fruits of gratitude are borne through mindfulness: becoming conscious and attentive to the blessings in your life. This Thanksgiving begin the lucrative practice of creating a list of blessings for which you are grateful. Then at least weekly take a little time to focus on the abundance in your life by continuing to journal simple lists. And breathe deeply. And celebrate.
“Both abundance and lack exist simultaneously in our lives, as parallel realities. It is always our conscious choice which secret garden we will tend… when we choose not to focus on what is missing from our lives but are grateful for the abundance that’s present — love, health, family, friends, work, the joys of nature and personal pursuits that bring us pleasure — the wasteland of illusion falls away and we experience Heaven on earth.” –Sarah Ban Breathnach
Happy Thanksgiving from Monica, Judy, Susie, Trish, Gwen, Gabe, Brooke and Scout!
Our Emotional Goblins are animated by sneaky yet powerful irrational beliefs that drive anxiety, frustration, and unhappiness. Albert Ellis’s List of the 12 Most Common such ideas reveals familiar themes… for most of us, anyway! Routing these goblins is first and foremost about recognizing their presence – and appreciating fully their deep, abiding, whacko irrationality. To do so means to acknowledge the consequences of a goblin relationship: The dull thud in the pit of your stomach, the shallow breath, the persistent, audible bang of your beating heart, the purging sigh, the gnaw -or the yank of cruel voices that sap energy and optimism. These physical flags, and the horrid feelings associated are evidence in need of reckoning.
Liberation from the grip of a goblin is a matter of reviewing all evidence to “support” the irrational belief and then disputing the idea with rational thought.
Sometimes we can get kinda’ comfy with our goblins- becoming worry warts and drama junkies, needy nellies and brittle, catastrophic, moody people. Argh! Familiar isn’t the same as functional. The very happy news is that we can change. Think differently. Feel differently. Behave differently.
Like replacing bad habits with good ones, your irrational thoughts must be replaced with more rational ones. For each of the obvious Irrational Ideas listed here, there are corresponding Rational Beliefs. The first two of these are provided:
1. It is not possible for everyone to love and approve of us; indeed, we cannot be assured that any one particular person will continue to like us. What one person likes another hates. When we try too hard to please everyone, we lose our identity; we are not self-directed, secure or interesting. It is better to cultivate our own values, social skills, and compatible friendships, rather than worry about pleasing everyone.
2. No one can be perfect. We all have weaknesses and faults. Perfectionism creates anxiety and guarantees failure. Perfectionist needs may motivate us but they may take away the joy of living and alienate people if we demand they be perfect too. We (and others) can only expect us to do what we can (as of this time) and learn in the process.
3. I hope you will review all 12!
Go to http://www.stressgroup.com/12IrrationalBeliefs.html
Hit not your forehead with the heel of your hand or sob long to the tune of “what was I thinking?” No need to dwell on having overlooked the obvious. Embrace an economy of motion argument: it truly takes every bit as much energy to entertain emotional goblins (much more, really) as it does to have positive, affirming rational beliefs.
Then of course there’s the added attraction of kumbayah and world peace.
Banishing Your Emotional Goblins…
Remember all the scary stuff we believed in as children?
Boogabooga!
Even more disturbing and more enduring than the pod people, the troll under the bridge or the wicked witch of the west are the irrational ideas we have unconsciously accepted as truths. Uttered by the “goblins” in our heads, this evil self -talk is capable of twisting feelings about ourselves and others.
Dr. Albert Ellis, creator of Rational Emotive Behavior Therapy, was among the first to recognize that we continuously have this lil’ dialogue going on with ourselves that drives bad feelings, and results in dysfunctional and self defeating behavior. He found that we tend to believe that events, i.e. “what happens” to us cause our unhappy feelings: anger, depression, anxiety and such. In actuality, it is NOT the event, but rather what we THINK about the event that causes the feeling or “emotional outcome.” Consider Dr. Ellis’s list of
The 10 Most Common Irrational Beliefs:
1. The idea that you must – yes, must – have love or approval from all the significant people in your life.
2. The idea that you absolutely must be thoroughly competent, adequate, and achieving.
3. The idea that people absolutely must not act obnoxiously and unfairly, and that when they do, you should blame and damn them, and see them as bad, wicked, or rotten individuals.
4. The idea that you have to see things as being awful, terrible, horrible, and catastrophic when you are seriously frustrated or treated unfairly.
5. The idea that you must be miserable when you have pressures and difficult experiences; and that you have little ability to control, and cannot change your disturbed feelings.
6. The idea that if something is dangerous or fearsome, you must obsess about it and frantically try to escape from it.
7. The idea that you can easily avoid facing many difficulties and self-responsibilities and still lead a highly fulfilling existence.
8. The idea that you’re past remains all-important and that because something once strongly influences your life, it has to keep determining your feelings and behavior today.
9. The idea that people and things absolutely must be better than they are and that it is awful and horrible if you cannot change life’s grim facts to suit you.
10. The idea that you can achieve maximum human happiness by inertia and inaction or by passively and uncommittedly “enjoying yourself.”
Which of these malevolent goblins are you nurturing? And what are the emotional outcomes for you?
To change the way you feel, you need only to recognize and challenge your goblins and replace them with positive, affirming ideas and beliefs.
More on “how” to come…
Trick or Treat?
You get to choose!
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