Articles Posted in Home Care

caregiver-300x200Pick up that phone. Dash off a text or an email. Issue a dinner invitation or make a date for a casual lunch. Or just drop by to see that friend or loved one who struggles with the burdens of caring for someone in poor physical or mental health.

Why now? Why not? Paula Spann deserves credit for her latest New York Times column highlighting the “unbearable” loneliness and isolation that caregivers confront as, other experts estimate,  43.5 million Americans provide $470 billion in tough, unstinting, and unpaid work for loved ones.

Even as they do so, however, they often must abandon their own careers and chunks of their own lives, watching with sadness as their social contacts and intellectual interests narrow, especially as their worlds become consumed with washing, feeding, entertaining, and keeping safe a spouse, grandparent, uncle, aunt, or other loved one. Their woes can be especially great if they’re caring for loved ones with the increasingly common and hugely demanding conditions of dementia and Alzheimer’s.

Dr. Bruce Leff explains why geriatric healthcare is best practiced out of the hospital

It wasn’t that long ago — see those classic black-and-white movies — when hospitals commonly cared for many different kinds of patients in large open wards. Young volunteers, women known as “candy stripers,” could be seen rolling carts down the aisles between the many rows of beds, selling cigarettes. Families might pop in for a visit, carrying for their sick kin a chicken dinner on a plate covered by a white napkin.

With the huge changes that the Affordable Care Act has brought to hospitals and American health care, and with the shifts that are yet to come if Obamacare gets repealed and replaced, it’s easy to forget how significantly and rapidly medical services continue to transform.

The events of recent days ─in Texas, Louisiana, and Minnesota─ have been so tragic that it’s easy to despair. Here are four health-related people stories worth reading to remind us of humanity’s enduring better side:

  • In the horrors of Syrian combat, medical Samaritans strive to maintain some kind of care

syriaFirst, let’s stipulate that there’s almost as much barbarous conduct as can be imagined in this recent New Yorker report about the struggle to maintain medical care in combat-ravaged Syria. President Assad’s predation on his own people has become an international abomination, including his forces unleashing snipers to maim emergency medical personnel, and their dropping barrel bombs, laden with lacerating shrapnel, on hospitals or known care-giving sites (February, 2016, photo of a bombed hospital from Doctors Without Borders/Medicins san Frontieres).

Flag_of_South_Dakota.svgSevere diabetics, the blind, and the mentally ill all too often get sent to sterile and restrictive group or nursing homes by South Dakota officials who can’t seem to find other care options because they discriminate against thousands of the disabled, the federal government says.

The Justice Department is investigating the state under federal laws affirmed by the U.S. Supreme Court. As the New York Times reports, the feds aim to protect the disabled from needless confinement in highly regimented group or nursing homes because:

[A] 1999 Supreme Court decision, Olmstead v. L.C. [held] that, unless a nursing home is medically necessary, people have a right under the Americans With Disabilities Act to receive care without being segregated from society. Advocates for the disabled have compared that ruling to Brown v. Board of Education, which declared racial segregation in schools unconstitutional.

An elderly couple wait to cross the road
With the United States getting grayer by the day and a national crisis looming in dementia- and senior-care, new information from one of the larger, longer running, and more significant health studies has offered a glimmer of optimism. Experts say dementia risks are showing a  decline─by as much as 20 percent. They’re uncertain exactly why. But increased education and individuals’ improved overall health, especially their cardiovascular wellness, may be helping.

An elderly couple wait to cross the road (Photo by Garry Knight/ Creative Commons)

The surprising dementia trend emerges from the legendary Framingham Heart Study, which has monitored and detailed the health of thousands of Americans for decades. Framingham research led to greatly improved heart and lung care with information on such issues as high blood pressure, high blood cholesterol, smoking, obesity, diabetes, and physical inactivity.

Americans are legend for their discomfort in discussing death. That makes conversations about end-of-life care a big challenge, even though the medical attention paid to the dying can drive up health care costs.  A quarter of traditional Medicare spending for health care is for services provided to program beneficiaries in their last year of life—a proportion that has remained steady for decades. But new studies shed interesting light on the end-of-life experiences of patients with cancer, as well as how physicians themselves spend their last days. And it is worth watching how California grapples with the tough issues tied to doctors’ roles in assisting the dying in ending their lives.

Let’s look first at the provocative, published findings of an oncologist and a radiation oncologist about aggressive care for those with late-stage cancer. The researchers compared U.S. patients with patients in other countries. They focused on cancer because, “in developed countries, it is the second leading cause of death and the most expensive per patient.” The researchers found that just under a quarter of Americans with cancer die in hospitals — a lower rate than occurs in Canada, England, Norway, the Netherlands, Belgium, Germany, and six other industrialized nations they studied. Further, as they wrote in a New York Times Op-Ed:

America was not the most expensive country in which to die. On average, $21,840 was spent on the last six months of hospital-related care for dying cancer patients in Canada and $19,783 in Norway. In the United States, the bill was $18,500 per patient. (That figure does not include physician costs, which are part of hospital spending in other nations. Including them brings America’s costs up by about 10 percent, leaving us still below Canada and about equal with Norway.)

Letters to the editor in the New York Times come with the provocative headline: “Can There Be Good Mental Asylums?” As the father of a 25-year-old son with severe autism, I think about this a lot.

Our son Brendan now lives in a group home which we helped set up in Silver Spring, Maryland. It seems to work for him, although for a parent, eternal vigilance is required. Brendan is out and about in the community every day: at his day program sheltered workshop, and with his “one-on-one” at weekend activities like Special Olympics, trips to museums, dinner at our house, and all sorts of good fun. That’s the ideal for any human being.

But look around you. Huddled in the doorway of an office building, sitting in a prison cell — lots of mentally disabled people have no real home.

Most patients would prefer to receive care at home instead of in an institution. But home health service, according to some professional observers, is the victim of misinformation.

Writing on KevinMD.com, Dr. Michael Fleming, former president of the American Academy of Family Physicians and chief medical officer of a home health and hospice service, says “Most primary care physicians have yet to adequately recognize, understand and appreciate the role that health care brought directly to the home can play.”

Fleming has identified six major myths about health care at home that he hopes to dispel.

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