Author Archives: Dianne Savastano

Sharing a Personal Experience

“Empathy. The capacity to understand or feel what another person is experiencing from within the other being’s frame of reference, i.e., the capacity to place oneself in another’s position.”
– Wikipedia

In my 25 years as a healthcare professional, I’ve encountered many older adult patients, clients, friends and family who have been diagnosed with shingles. I’m well aware of the basics (you can read more about them here, if you like), but it wasn’t until I, myself, was diagnosed with this virus that I developed a true appreciation for the impact it can have.

It began when I noticed a suspicious rash on my lower abdomen that wrapped around my body, all the way to my lower back. I called my physician right away and scheduled a “same day” sick patient appointment (something I hope your primary care practice offers to its patients as well).

She acted promptly to prescribe treatment with prescription antiviral drugs that can speed healing and reduce the risk of complications. I also saw an Infectious Disease Specialist who prescribed a medication called gabapentin (Neurontin). Despite my reluctance to take this for fear it would make me sleepy – a feeling I don’t like or have time for – I took a very small dose at night because she convinced me it could reduce the risk of post-herpetic neuralgia. Six weeks into this experience, I’m wondering if I should have followed her recommendation that I take a higher dose for a longer period of time. (I never said I was the most compliant patient!!!)

My first emotion was fear

My first emotion upon being diagnosed was tremendous fear. I thought of two clients, both of whom had developed such severe cases of shingles that they required hospitalization and aggressive pain management for months and years. For one, she was never fully pain free again. She’d describe “pings of electricity” in her body, coming and going unexpectedly, that would just stop her in her tracks.

I’d seen it all before, but until now, it was secondhand. Realizing what lay in front of me, I had great concerns about the coming weeks.

What causes shingles? How do we prevent and manage it?

The reason for developing shingles is unclear, but it may be due to lowered immunity to infections as we grow older. Those older than 50 are at risk (I hope you’re surprised to learn that this includes me!), and some experts estimate that half the people 80 and older will develop shingles at some point.

Shingles is caused by the Varicella Zoster virus, the same one that causes chickenpox. The varicella vaccine (Varivax) has become a routine childhood immunization to prevent chickenpox – it is also recommended for adults who’ve never had chickenpox. Though the vaccine doesn’t guarantee you won’t get chickenpox or shingles, it can reduce both your chances of complications and the severity of the disease.

A second vaccine is the “shingles vaccine,” Zostavax. This also doesn’t guarantee you won’t get shingles, however it will likely reduce the course and severity of the disease and reduce your risk of post-herpetic neuralgia. (I found myself wishing I’d had this!)

Zostavax is recommended for adults age 60 and older, whether they’ve already had shingles or not. Most insurance companies use the initial recommendation of “over the age of 60” as to when they will pay for it, so getting it earlier can result in an out-of-pocket expense of between $200.00 and $250.00.

Living with the pain

During the first week, just moving from one position to another and trying to shower and dress caused a lot of pain. I was more fatigued than usual and my patience would wear thin as the day progressed – something my husband was incredibly patient with in the evenings.

By the second week, I was experiencing tremendous stiffness, as a result of limiting my mobility. My physician reassured me that I wasn’t going to harm myself by resuming my normal functional activities (although she did encourage me to get more rest than I usually do.)

So, I resumed life. I took mild over the counter medications to manage the discomfort, practiced my meditation techniques more frequently, and moved on with my work and personal life. I focused on all the good aspects as I did not want to miss a thing, and tried to use the power of distraction to the best of my ability. For me, that worked well – but I consider myself “young and resilient.” For the older people in my life, I developed a much greater appreciation for how resumption of normalcy can take much longer. Having tremendous patience when interacting with such individuals is necessary.

Reflections/Lessons learned

Recommendations for management of shingles include trying to reduce the amount of stress in your life. Oh no, was my mom right again?

My loving mother watches my lifestyle, something that is full of work and fun. But more recently, it’s been complicated by selling our home; moving to a temporary apartment and office because our new home wasn’t ready; travel, including multiple speaking engagements; my husband’s upcoming retirement; and Open Enrollment season for both Medicare and employer-sponsored insurance plans.

And so she asked, “Are you taking good care of yourself?” Maybe I wasn’t. In the past, I’d probably develop a respiratory infection or a GI bug to slow me down. This time, maybe it was shingles.

Conclusion

Everyone’s reaction to life’s challenges is different and as a healthcare professional, I must have empathy for another’s experience. I encourage you to follow my mother’s advice and pay attention to whether you are taking adequate care of yourself, getting enough sleep, eating healthy foods, exercising and maybe practicing mindfulness.

Hopefully, I’ll do a better job of this for myself in the future. I certainly encourage you to do the same!

Recommended Reading: The Mistrust of Science

I just loved this article!: The Mistrust of Science. During a commencement speech at the California Institute of Technology this year, Atul Gawande described the educational credentials the graduates received (regardless of discipline) and encouraged them to remember what real truth-seeking looks like.

As Gawande says, it is the effort not of a single person but of a group of people – the bigger the better – pursuing ideas with curiosity, inquisitiveness, openness and discipline. As scientists, in other words.

This is a wonderful article about being an organ donor, even at an older age.

A Tale of Two Brothers – Both Trying to Do Their Best for Their Mom

Last month, I met with two brothers/sons (Ted and Ray), trying so very hard to do all the right things to care for their mom, Grace. Thirty years ago, and just after her husband passed, Grace made clear her desire to “LIVE AT HOME FOREVER.”

As she aged, Grace hired an Accessibility Contractor to make accommodations that would make her home safer and more accessible, just in case her mobility and dexterity changed. At the time of our meeting, Grace was living exclusively on the first floor, but maintained that the larger house, with the extra bedrooms upstairs, was necessary so that the family could continue to gather “at home.”

One son, Ted, lives close by and took on the day-to-day responsibilities of frequently visiting his mom, organizing private help to assist Grace as needed, and responding quickly to her multiple, daily phone calls.

The other son, Ray, lives 1,000 miles away. He took on financial responsibilities, such as bill paying and checkbook reconciliation, and did all he could from a distance.

Before long, however, Ray recognized that Ted was doing much more than he, often at the expense of his own family’s needs, and reached out for some help from Healthassist. He wanted to know what they might do differently to improve the situation.

Assistance with physical care

It was following a fall at home resulting in a broken hip, and a long recovery in both the hospital and a skilled nursing facility, that Ted and Ray orchestrated their mom’s return home. They hired a private homecare company to provide daily assistance.

They were astute enough to know that they couldn’t physically care for their mom with their lack of knowledge and experience and, more important, knew that her boundaries and sense of dignity would be violated if they tried.

They described how numerous home health aides and certified nursing assistants flowed through the household. When I probed, they didn’t seem to know who was in charge and how decisions were made about who would be there, or when. Worst of all, their mom was not happy. She resented these “strangers” in her home and she regularly “fired” them.

Ted and Ray were now questioning whether their decision to take mom home was the right one and if an alternative living environment was necessary. Both were worried about the potential of going against Grace’s wishes to remain in her own home.

Home healthcare providers need to be managed as you would any employee

After listening to their story and appreciating how distraught they were, I found myself stating the following:

“The success of your plan to care for your mom, thus honoring her wish to remain at home, will be a direct result of the quality of the caregivers you hire. The way to ensure that quality is to invest in those caregivers and to manage them as if they were your own employees.”

They were surprised!

Both Ted and Ray are successful businessmen and manage large teams of individuals in their respective fields. They understand that hiring the right people, utilizing a comprehensive job description, outlining specific expectations, continuously providing feedback and coaching, are all critical to the success of their employees.

But they hadn’t applied those same principals to the “work environment” they’d set up in Grace’s home. They thought that once they hired the home healthcare company, they’d done their job. They’d invested a lot financially and now needed to invest more of themselves in the process.

The responsibility of care partners/family members

The good news is that these two brothers were incredibly motivated to do the right thing, reflecting that Grace and their dad had raised them well! So, here’s what they did, and it’s what I encourage any person hiring care to be delivered to a loved one at home to do:

  • Invest in the relationship with the homecare company. Know the person with whom you are contracting, the person who will be responsible for placing caregivers in the home, and the person managing them while they’re there. Meet with the management team regularly to outline expectations and to provide direct feedback. Know that you have a lot of choice when hiring these companies, so if your specific needs are not being met, begin to investigate alternatives.
  • Require that you, and your loved one, interview all caregivers. Make it clear as well that you will make the final determination as to whether the direct caregiver is not only qualified, but the right fit.
  • Insist that a consistent schedule with a regular team be established. Then make sure that all involved in the care of your loved one share knowledge and experiences according to pre-set guidelines. Communication methods may include daily texting or emails, writing in a communication book in the home, regular phone calls, meetings, etc. Whatever works best for you to monitor the situation.
  • Develop standard documents, up front, that can be used to communicate information, train future caregivers, and hold caregivers accountable. Some examples are:
    • A specific job description for caregivers. This may be an enhancement of the one the homecare company uses.
    • A “typical” daily schedule for your loved one, including what time they get up, what they generally do hour by hour, and how they like to do it.
    • A “caregiver responsibilities” schedule that follows your loved one’s schedule. Include very specific things like the way they prefer to shower, dress, eat, where they like to sit, etc. This document requires tremendous specificity and although tedious to create, will be instrumental in the caregiver being able to anticipate your loved one’s needs.
  • Spend time with the direct caregiving team members, both individually and as a group. Get to know each other as people. Caring for an older adult is incredibly hard work and takes tremendous skill, proficiency and patience. Learn from them as they learn from you.

Conclusion

Ted and Ray have begun applying these principles and I’m pleased to say that the situation has improved considerably. Grace is much more accepting of help from her caregivers and has come to view the team that cares for her as “her new, younger friends.” She’s engaged in learning about their lives, their families and their cultural traditions, and has stated she feels the need to take care of them a little bit, just as she took care of her sons. We couldn’t ask for anything more.

How Will The Election Impact My Healthcare Coverage?

The results of this month’s presidential election have caused concern about how healthcare will change. And while the specifics are still being worked out, changes in our healthcare system are sure to come. Understandably, many people are wondering how the objectives of the new administration will affect health coverage for themselves and their loved ones.

With that in mind, I am happy to share some insights…

The Affordable Care Act and Medicare

Medicare has been in place for a long time (1965). Tweaks are made on an ongoing basis, including enhancements made with the passage of The Patient Protection and Affordable Care Act (ACA). In short, and while nothing is guaranteed, there is no reason to think that future changes to the ACA will affect Medicare coverage in 2017.

With that in mind, remember that Medicare Open Enrollment season began on October 15th and continues through December 7th of this year. Any change you make will become effective on January 1, 2017 and continue through the rest of next year.

As always, Open Enrollment is a time to reassess based on an analysis of the healthcare we’ve accessed in the past year and how we hope to access care in the year ahead. From there, we can make adjustments as needed for the future.

Pre-existing medical conditions are not an issue for 2017 coverage

One concern repeatedly raised is about not being able to access coverage because of pre-existing medical conditions. It has been a great pleasure over these past few years to reassure individuals that they cannot be discriminated against for having pre-existing conditions and therefore will be able to purchase affordable health insurance without being charged exorbitantly high premiums, as may have occurred in the past.

While we do not know if this will continue on indefinitely in the future, we do know that it will not change for 2017.

Children under the age of 26 can remain on their parents’ plan

Another question I’ve received is from young adults under the age of 26 and their parents. They want to know if they can remain insured on their parents’ plan. Here as well, there are no changes to this coming in 2017.

In addition, I make sure to remind them that if a young adult is turning 26, now is the time to purchase a plan, either through a Healthcare Exchange or directly from an insurer. The Exchange will allow young people to identify if they may be eligible for a subsidy to help pay for premiums. In my experience, the subsidies help to make the difference in their decision to enroll. Here’s where a “helicopter parent” can be helpful!

Purchase insurance now if you have not already done so

Many people who have not purchased insurance in the past are wondering if they should now bother, considering changes that have been discussed. My answer is a definite, “Yes!”

Others, fortunate enough to be planning for early retirement, are wondering if they should change their plans to retire. My answer is a definite, “No!”

First, because this is the time of year when those without insurance may purchase for the coming year.

Second, because you can enroll via a Special Enrollment Period if you are coming off an employer sponsored plan.

While we do not know what may lie ahead, it is my feeling that changes that are being considered for the future are less likely to impact those already insured. If legislation is proposed and passed, transition periods will be included and replacements will be offered.

If you remain uncovered, on the other hand, it’s entirely possible that you may be prevented from purchasing in the same way in the future and that premiums may be different for you if have not maintained continuous coverage.

Conclusion

Despite the volatile election season and all the rhetoric about healthcare and The Affordable Care Act, any changes surrounding these things will take time to legislate and enact into law. At this point, changes for 2017 would be virtually impossible to make. Things take time.

And so I continue to advise people when purchasing any form of healthcare plan, that while we can analyze the past and think about what may occur in the future, none of us has the ability to predict what might happen.

The best we can do is mitigate any risk we have now to the best of our ability and fully understand how the healthcare products we select and purchase will be implemented, appreciating where additional cost may be necessary.

Recommended Reading: British Vs. American Health Care

I found this article, which contrasts certain aspects of the US Health Care System with those in the UK, to be very enlightening. I have clients who come from systems in other parts of the world and I’m always intrigued by how we can learn from each other: British Vs. American Health Care, Through One Trainee Doctor’s Eyes.

This article does a nice job of explaining how our current healthcare insurance is organized: Donald Trump is about to face a rude awakening over Obamacare.