Having a Point of View versus Standing Up for Something You Believe In

Guest video blog in Long Term Living Magazine.

Another Reason to Love Rachel Ray - Olive Oil and Alzheimer's

E.V.O.O. (you Rachel Ray fans know that) extra virgin olive oil might help prevent Alzheimer's disease according to a study that will appear in the Oct 15 edition of the journal Toxicology and Applied Pharmacology.

Specifically, the compound oleocanthal in extra-virgin olive oil has been found to alter the structure of certain toxic proteins associated with Alzheimer's. Researchers say the discovery could lead to successful treatments against the disease.

Beta-amyloid oligomers, or ADDLs, disrupt nerve cell function, which is one of the first processes associated with Alzheimer's, according to researchers at Monell Chemical Senses Center. By exposing ADDLs to oleocanthal, researchers were able to increase the size of the ADDLs, stopping them from binding to the synapses of the hippocampus, the memory-control center of the brain that is often first affected by Alzheimer's disease.

Researchers also discovered that, once the ADDLs had been enlarged by the oleocanthal, they became a better target for antibodies, the immune system's natural defense mechanism.

Experts caution that clinical trials must support the laboratory results but for my money you get a two for one - olive oil helps your heart and now maybe your brain. Readers - start your cooking!

Is Genesis Speaking for the Whole Nursing Home Industry in Opposing Reform?

The Center for Medicare Advocacy contends that Genesis Healthcare has been lobbying residents against HR 3200, the reform bill dubbed "America's Affordable Health Choices Act." If you remember Humana got in some hot water with the Department of Health and Human Services over their stand on reform.

The Center's leaders say that Genesis vice president Laurence Lane told some of the chain's residents that the bill would cut nursing home payments by $2 billion, and that such cuts would directly impact care quality and staffing levels. He's urged seniors in various facilities run by Genesis to write letters and make calls opposing the bill.

Make no mistake. Genesis is a for profit entity. Formation Capital and JER Partners completed the acquisition of Genesis for $69.35 in cash for each share of Genesis common stock.

And all this on the heels of news that for-profit nursing homes provide poorer quality of care than not-for-profit homes.

Who to believe? Hard to say. I know where I'm leaning. But check out a much more complete article here.

Special Focus Facilities - add more to the list says GAO

The government’s Special Focus Facility (SFF) program should add 450 nursing homes according to a new report from the Government Accountability Office (GOA).

The GAO wants to include 580 of the poorest performing facilities nationwide-a more than four-fold increase over the 136 facilities currently singled out by the program.

It gets better. To arrive at their conclusions, researchers included data from the controversial five-star rating system for the first time.

They found that poorest performing nursing homes were more likely to have for-profit status and were a part of a chain. They also had more beds and residents, and had an average of almost 24% fewer registered nurse hours per resident day.

The GAO made a similar recommendation two years ago but officials said the resources to implement the changes were not available.

Senators Kohl and Grassley reintroduced their Nursing Home Transparency and Improvement Act in March. Among other more restrictive actions for providers, it calls for more information to be made public about nursing home ownership and business structures. Sen. Max Baucus included their proposal in his recently released Senate healthcare reform bill.

I’ll comment more on this in an upcoming v-log.

Intergenerational Programs – Kindergarten in the Nursing Home

Loneliness, helplessness and boredom – these are just three of the things that plague elders especially residents of long term care facilities. Lack of education about aging, interacting with elders, learning from elders – these are just three of the things that plague society.

So what better way to start to bridge the two than through inter-generational programs. I have written about these before. And have even mentioned some of the organizations I have worked with that are embracing intergenerational programming. For example, one of the places I have entertained at for years, Shady Lane Nursing Center in Clarkesboro, NJ recently built a whole new facility and included a day care center for children in an adjoining building. While there are separate buildings and programs there are interactions among the children and elders that take place too.

Thanks to McKnight’s I learned about a nursing home that has taken this one step further. Windsor Place in Coffeyville Kansas and the local school district opened a kindergarten class on site in August of 2008.

The following from their website:

The elders each day gather around in anticipation of the children’s arrival. The children arrive with smiles, eager to expand their education.

This Age to Age classroom is organized where children are partnered at various points throughout the day with the elders to read, exercise and learn valuable lessons that only the elders can provide. The children are also involved in activities at the school so that interaction with other children occurs and prepares them for next school year, when they will attend Community Elementary.

Windsor Place is trying to unbecome a nursing home because nobody wants to go to a nursing home. We are employees in the home of the community seniors. We believe that “Good enough is never good enough, if better is possible!”

For more, visit Windsor Place online and also read McKnight’s editor’s blog on the topic.

Preventing Chronic Conditions Adds Healthy Years

Chronic conditions affect up to 90% of seniors. A new study suggests something that should be somewhat obvious - preventing chronic conditions could both save significant amounts of money and add healthy years to the lives of the elderly. Duh!

Chronic conditions include diabetes, high blood pressure and obesity. Researchers followed adults aged 51 to 52 years and evaluated their projected medical costs into old age based on preventing chronic conditions. Preventing diabetes would save $34,483; preventing high blood pressure would save $13,702; preventing obesity would save $7,168 according to the report.

These preventive measures add time to a person's life. Preventing obesity would add 0.85 years, preventing high blood pressure would add 2.05 years, preventing diabetes would add 3.17 years and quitting smoking would add 3.44 years. Factoring in the added longevity, researchers say preventing these chronic conditions would be associated with little or no additional lifetime medical spending.

See the American Journal of Public Health.

Emergency Alert Pendant Poses Hazard

The Philips Lifeline Personal Help Button Necklaces pose a possible hazard according to the FDA. There have been at least six reports of serious injury or death associated with the emergency alert pendants.

The emergency alert pendant is designed not to break away when tugged; yet because of its durability it poses a hazard if it becomes tangled around another object.

Between 1998 and 2009, there have been four deaths and two serious injuries associated with the device.

Philips Lifeline has alerted its 750,000 customers to the potential risk. The agency recommends individuals consult with their physician to determine which style of emergency alert button is appropriate for their use.

Simple Test For Stroke Better Than MRI

According to Dr. David E. Newman-Toker of the Johns Hopkins University School of Medicine, a simple, one-minute eye movement exam worked better than magnetic resonance imaging to distinguish new strokes.

People experiencing a stroke have eye-movement alterations that correlate with stroke-damage to various brain areas -- and these are distinct from eye-movement alterations seen with ear diseases.

The findings, published in the journal Stroke, found the quick, extremely low-cost exam caught more strokes than MRI.

Is Medicare Advantage an Advantage?

It would appear the Medicare Advantage programs, Medicare HMOs if you will, actually provide better care. Health plan industry trade group America's Health Insurance Plans has released a study concluding that Medicare Advantage plans may be doing a better job of controlling costs and preventing harm to patients.

AHIP looked at hospital admissions in California and Nevada. This risk-adjusted data concluded that Medicare Advantage enrollees had significantly lower inpatient days per patient, lower readmission rates and lower rates of avoidable hospital admissions.

Researchers concluded that for a group of 13 potentially-avoidable admissions, risk-adjusted Medicare Advantage patients had 6 percent lower rates of avoidable admissions in both states.

As someone who used to work for a Medicare Advantage affiliated physician organization, I am not endorsing enrolling in these programs over traditional Medicare. I will say that my experience in this industry was from a unique vantage point. I worked for a physician organization that aggressively managed the health care of patients. That included having our own medical director, physicians ownership and patient advocates making sure that patients took advantage of all that the health plan had to offer. Of course we were doing right by the patient and it had an economic benefit as well. The government paid us so much to take care of each member. If we did it for less we kept more. So it made economic sense and good patient sense.

Maybe a public run option would look at Medicare Advantage as a program to possibly emulate.

Physical Activity Good At Any Age

In my Meaning of Life keynote I talk about eight things that I have learned from seniors about living an active, full, quality life. I use my 88-year-old mother's schedule to show particularly how her ability to keep active and busy has contributed to her quality of life, still living independently in FL. Now another study comes along and shows just how dramatic physical activity is especially among our eldest.

In the September 14 Archives of Internal Medicine, researchers studied seniors born in 1920 and 1921 and found that those who exercised more than four hours per week and performed vigorous activities, such as swimming or jogging twice a week, significantly reduced their likelihood of dying over the course of the study.

The more active members were more likely to live independently and retain their ability to perform activities of daily living. The benefits were especially noticeable for those who remained active well into their 80s. They reduced their risk of dying between age 85 and 88 by 17% compared to the more sedentary.

As the new season of The Biggest Loser debuted last week, it is important to note that these physical activity habits start (or don't) when we are much younger. Yes it is never too old to exercise but the later you start the longer road you have to go of it. And caregivers listen up, you have to make time for you. Caregivers often end up suffering more than those who they are caring for. A woman on The Biggest Loser was a caregiver to her mother who died at 48 and was more than 300 pounds. The daughter is almost 500 pounds and she spent all that time taking care of her mother and ignoring herself.

The keys to life are fairly simple. It is the discipline that we need.

On this World Alzheimer's Day, let's pay close attention to what we can do it our own lives to ward this disease off, how we can help caregiver's with their burden, help those afflicted lead the best life possible and advocate for increased funding around this disease.

Having a Point of View versus Standing Up for Something You Believe In

I had an engaging conversation with Kellyann Curnayn, author of A Good Day in Hell: The Flatlining of Nurses Across America. She is a dedicated, practicing nurse. She told me that nurses do not get paid to take care of patients. They get paid to fill out paperwork. Kellyann has a point of view and Kellyann also stands up for something she believes in. Her employers may not agree with what she writes but she works everyday to make healthcare better for patients and for nurses.

I then found this wonderful quote from Winston Churchill. It reads: You have enemies? Good. That means youve stood up for something.

Having a point of view and acting on that point of view are two different things.

If the patient and the resident experience starts with the employee experience, it will only start when leaders SHOW us how. Having a point of view is OK. Acting on it is what counts.

New leadership methods could propel patient-/person-centered care

Read our guest blog in Hospital Impact.

World's oldest person dies in Los Angeles at 115

A nice tribute to a long quality life.

Medpedia - New Resource for Alzheimer's Disease

The Medpedia Project is a long-term, worldwide project to evolve a new model for sharing and advancing knowledge about health, medicine and the body among medical professionals and the general public.

The Alzheimer's Disease Community has article pages, discussion boards, Q&A, links to related Communities of Interest on Medpedia, links to medical/health Groups on Medpedia, and a section for "Related News & Analysis" where related blogs appear!

A Clinical Trial feature in the Communities of Interest makes information on that topic readily available.

Check it out. This could be yet another valuable resource for you in the future.

Cutting Medicare to nursing homes is poor healthcare policy

Here is a guest blog from McKnight's that again shows how nursing homes are being ignored in the health care reform debate. My opinion has been clear and consistent. Aging in place is great. BUT...this country is ranked 37th in the World Health Organization and the latest study on obesity shows we are getting fatter as a nation. And the statistics on chronic conditions we suffer is alarming. So will we need nursing homes? Yes. Will we put up with them as they are now? No. But if we put them out of existence we will put a huge burden on society not just in the near future but for decades to come. So let's not ignore the elephant in the room. There are three times as many nursing homes as hospitals. These are for many places to live. So when will we truly make them home? Cutting funding and ignoring this industry in health care reform is just the wrong thing to do.

Self - Responsibility: How to Reduce Healthcare Costs for the Elderly

This is a guest blog from Adrienne Carlson, who regularly writes on the topic of nurse practitioner schools . Adrienne welcomes your comments and questions at her email address: adrienne.carlson83@yahoo.com

One of the things I "preach" about often is the need for self-responsibility. Part of the reason we have a health care crisis is because we do not take care of ourselves. We are ranked 37th on the World Health Organization and the latest study on obesity in this country is pointing in the wrong direction. So Adrienne's advice is sound. Take a read.

It’s not even official yet, but the proposed health care reforms have already managed to get people up in arms against it, especially for the way it “treats” senior citizens. While the news about “death panels” is grossly exaggerated, there are issues that need to be discussed in terms of end-of-life decisions. However, this is a process that starts not when you’re 60 or above, but right from the time you hit 30 and before you make the downhill slide on the other side of 40. Now most people do not consider 40 to be an age that can be called “old” by any means, but it is the time when both men and women realize that they are not as youthful as they were and go through a sort of midlife crisis.

If you take care of yourself by eating sensibly and exercising regularly (you’re your mind and your body) when you’re young, you can go a long way in keeping illness at bay as you become older and more prone to the infirmities that affect the elderly. And once you’re there among the senior citizens, here’s what you can do to protect your sanity and your health and keep your health care costs to a minimum:

· Remain active: It’s a fact that people who are active remain healthy for a longer period of time. When you stop working or doing even simple tasks around the house, your muscles atrophy and become useless. So assume responsibility at least for your own needs – cook, do some laundry, clean your room, take a walk or raise a pet. In short, have something active to do each day when you wake up.

· Socialize: When you meet people on a regular basis and stay in touch with the outside world, you don’t fall prey to mental illnesses like dementia and Alzheimer’s disease. So go out, enjoy a drink or a game of cards with friends, visit your grandkids, or join a club.

· Monitor your health: Be responsible for your own health. If you have a medical condition, take your medicines correctly and regularly and follow your doctor’s instructions to the letter. Keep your medical appointments as scheduled so that your doctor can see for themselves how you’re doing and change your medication accordingly. When you are aware of your limitations and live within them, there’s no reason why old age has to be lonely or expensive.

Editors Note:

I would add that there are certainly older people who independently can not proactively undertake some of the suggestions above without help. There is a duty I believe that we all have to assist our elderly who can not take care of themselves. Through us we can help them find purpose, get their health on track and lead productive lives whether they are 65 or 105! Thanks Adrienne.

No Rest Even When Your Dead - Identity Theft

Came across this and just shook my head. I mean come on people. Where is the moral compass in this country?

Identity prowlers comb obituaries. They forward the deceased's mail which contains an overabundance of personal information, from credit card accounts to bank accounts, which they in turn use.

They literally take on your identity; they take your name becoming you; and they get drivers licenses as you, but with their picture. They will use their newly acquired identity to get loans, open bank accounts and take out mortgages.

Once a loved one passes away, you may want hire a lawyer to help you identify any financial, credit card, insurance and/or loan companies the deceased might have had accounts open with or had done business with.

Joint accounts should also have the deceased's name removed. Provide all the above institutions with a copy of the death certificate, request the accounts to be closed and that an official letter confirming this action be mailed to you. The major credit reporting agencies (i.e. TransUnion, Experian, and Equifax) should also be notified.

If an identity thief tries to use the deceased's credit, the agencies will realize there is a ‘deceased alert’ and will tell the company that the person is dead and cannot be issued credit.

The FTC website http://www.ftc.gov provides consumers many tools, tips, and breaking news.

I mean really. Caregivers already exhausted from caring for a loved one still can not rest after their loved ones death.

Guest Blog in Long-Term Living Magazine - Leadership Must Change if Person / Patient Centered to take Root

Our post from yesterday is now featured in Long Term Living Magazine's blog entries. Leadership must change their ways or the experience for patients and residents and staff will not change. Interestingly today I had a wonderful conversation with Kellyann Curnayn. She is a nurse in Orlando and the author of A Good Day in Hell: The Flatlining of Nurses Across America. Her contention is that people at the front lines of health care must serve as role models so nurses whether in nursing homes or hospitals must step up and put the patient first. She contends and I agree that health care workers are not necessarily paid to take care of patients/residents but are paid to document. She also said that nurses exhibit behaviors of an oppressed population. The lateral violence – nurse to nurse – that happens every day in health care is actually scary and many times centered around having to, pardon my French, cover your ass, that is make sure all the i’s are dotted and t’s are crossed so that the regulatory bodies and payers are happy. It may somewhat contribute to quality of care but whether it contributes to quality of life is questionable.

Leadership Must Change if Person / Patient Centered to take Root

I have been blogging a lot lately about why patient centered care and person centered care have not taken firm root. Readers of the blogs came back to one systemic issue - leadership. A couple of recent Harvard articles might hold the answer to the leadership question. The article, Are You Ready to Manage in an Irrational World? is a primer for the second entitled Leadership in a (Permanent) Crisis.

Here are three shifts I see taking place:

1. From Play Caller to Context Provider
The new leadership calls for people to help paint a picture and create a context .
2. From Check Lists to Collaboration
New leadership style must embrace staff empowerment, collaboration and shared problem solving.
3. From I Have to Do It to I Want to Do It
Fundamental shifts come from self-driven authentic change by empowered people. When you are passionate about something, where you have come to a belief for yourself, when you understand the bigger picture, change happens faster. You change because you want to change.

Are you one of the new leaders? Whether you are running a hospital or a nursing home or a marketing department, you can step forward. Create context. Paint the picture. Remember the ultimate reason for why you do what you do. Then step out of the way and empower people to figure things out collaboratively.

Active Twitter User Celebrates 104th Birthday

OK I can't get my 88-year-old mom to look at a computer and here we have dear Ivy Bean in England on Facebook and Twitter with more than 45,000 followers. Read the CNN article here.

Then go and read my friend Laura Bramly's blog about the larger implications and what we could possibly learn about care homes that foster a culture that really listens to residents and embraces what they have to offer. Thanks Laura.

Look to your leaders, not healthcare reform, to change long-term care

Read the guest blog in McKnight's Long Term Care News and Assisted Living.

Disciplined Nurses Database is a Dirty Little Secret

Any wonder patient and resident experience suffers in our health care facilities; word comes of another hidden resource that might be able to help but has not been shared.

The Healthcare Integrity and Protection Data Bank was created 22 years ago to help hospitals and nursing homes perform background checks on potential new hires. More than 102,000 names of disciplined nurses, nurse aides, pharmacists and pharmacy aides are in the database. NPR has reported that inefficiency and bureaucracy in the Department of Health and Human Services have held up the opening of the database for the last two decades.

The regulation to fully implement the law that would allow the facilities access to the database was never fully completed. The regulation to allow access to the database was completed toward the end of the Bush Administration, but White House officials froze the program. The program is under review again by the Department of Health and Human Services, and officials say they hope to have the program fully implemented by the end of the year.

Let’s keep them honest and put some pressure on DHHS to do just that.

Medicare Cuts to Nursing Homes

Nearly half of voters view Medicare cuts to nursing homes as the least acceptable way to pay for healthcare reform, according to a recently released poll conducted by The American Health Care Association.

The poll also found that 66% of voters would be less likely to re-elect an official who voted in favor of Medicare cuts to nursing homes. A total of 78% of voters over the age of 65 feel that nursing home care for seniors would be worse if Medicare cuts were made. The poll posed the following question, among others: “If Congress cut $32 billion in Medicare payments to nursing homes to care for seniors, do you think the quality of care seniors receive in nursing homes would get better, stay about the same or get worse?”

The saddest part about all of this is that long term care is being ignored in the reform discussions. With so much emphasis on aging in place it is almost as if people want to will assisted and nursing care out of existence. But look at the facts. We are 37th in the World Health Organization and plagued with chronic conditions in a nation that is growing fatter. If people don't think we will need this type of care then they are frankly delusional.

Remember that might you or I in that facility one day. So speak up on behalf of many of our elderly that can not. Long term care needs to be reformed. Taking money away from it will not help that at all.

Obesity associated with Brain Degeneration among Older People

New research from University of California, Los Angeles reveals that older obese people have brains that appear 16 years older than their peers who are of a healthy weight.

Researchers examined the brains of 94 individuals aged 70-79. Overweight seniors had roughly 4% less brain tissue, and their brains aged prematurely by eight years. Meanwhile, obese seniors has 8% brain matter loss, which researchers called "severe brain degeneration." These brains looked 16 years older than those of thinner individuals. Much of the brain loss was found in the frontal and temporal lobes, which control planning and memory. Other areas of brain matter loss included the hippocampus, which is associated with long-term memory, and the basil ganglia, which helps control movement.

The World Health Organization estimates a combined 1.3 billion people worldwide are either overweight or obese.

No lecture needed here.