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Question of Month

2013 Brings a 25% pay cut for doctors. How will that affect the frailest seniors and the Assisted Living Care settings they live in?

2013 Brings a 25% pay cut for doctors.  How will that affect the frailest seniors and the Assisted Living Care settings they live in?  Tweets, fb posts Do you know how much Medicare pays your doctor on your behalf? How will the 25% Doctor Pay cut affect care for the Frailest Seniors including those living in an Assisted Living Institutions or Assisted Senior Care Settings? How do you think the 25% pay cut doctors are getting will affect care in Senior Living Settings like Assisted Living, Residential Care Homes, Home Care, or Hospice Care? New Medicare fee schedule for 2013 99215 complex office visit, Medicare fee scheduled amount, for participating doctors 2012 $144.67 2013 $108.43 How do you think Doctors Feel?  Questions to ask yourself. Do you think doctors will be thinking about doing more, providing more continuity of care, building stronger relationships, take extra time to listen and assist in navigating the increasingly complex health care system or might they react differently? How have doctors reacted for the last Decade?  I have observed they have quit  private patient centered practice and taken jobs as institutional, or hospital controlled employees.  Is that what you observed? Do you think Assisted Living, and any care home will have an easier time getting medications, refills, follow up for you, and the patients they offer protective supervision for? Did you know that all doctors get paid exactly same for a 99215 or complex office visit?  That is right, if they spend one hour, or two hours and if they make lots of extra phone calls, if they answer the phone at night for you, they get the exact same pay from Medicare as the clinic doctor you do not know, have little hope of ever seeing again, and who might have not investigated your full story as completely as someone who you have an longer term relationship with. Health Care is more of a unknown "Service" or "Product" than other services or products.  Did you know that based on the Medicare CPT Code payment system all doctors are “the same”?  The CPT code system pays all doctors exactly the same for a 99215 no matter what they do, or how much extra they do. The terms of “% “are very misleading.  For Example, Medicaid  as primary coverage (Not Medicare) pays 100% of a doctor visit,  but they only pay 10 dollars for that doctor visit.  100% of $10 = $10.   For advertising purposes 100% sounds much better.  Likewise, what a doctor is doing, or could do, are largely unknown to most.  How many feel confident they know what one doctor does compared to another doctor and how that is cost effective for their private pay dollars?  Indeed, patients and now many doctors may have widely varied descriptions of what they could do and why it is cost effective for a senior and their family to spend private funds on that. 25% pay cut or new price for complex visit and all follow up until the next visit - $108 dollars. What is a CPT code?  See link to a cms Medicare Description of a complex office visit code. http://www.cms.gov/medicare-coverage-database/staticpages/cpt-hcpcs-code-range.aspx?DocType=LCD&DocID=32001&ver=12&Group=1&RangeStart=99201&RangeEnd=99215 Relative Value of a Doctor’s Visit vs. Women’s Hair Stylist Visit, and DVD or Blue Ray Player purchased from Best Buy. Doctors 99215 office visit.  One might ask what does a visit mean?  The following are just a few very general, things you may not think that are part of providing this service to you. Keeping/storing your records for a  5-7 year period and being responsible to retrieve them in a timely manor. Once they are “your Patient” even for one visit, the doctor is responsible to answer phone calls from patients, families,  Assisted Living, Residential Care Homes, Nursing Homes, and other care settings regarding their care including refill of medications.  Recall, the doctor only gets his 108 dollars if you visit him,  if you do not visit him and he refills medications on the phone then that is “included” in the 108 dollar visit he got on the last visit. Do you know that it is not required for Doctors to have Malpractice insurance and that 20-30% of out patient doctors may not have it?   How does that affect you or the care they are providing to you?  Doctor,  Hair Stylist, DVD Player Hair Stylist Visit  How much does a women’s haircut and style cost?  $50 -100.  What type of risks and long term commitment does she assume with her one hair cut visit? Does she keep records? What are the overhead costs to a Hair Stylist visit and how do those compare to to the overhead costs of a Doctor's visit? DVD Player at Best BuyHow much do you pay for a DVD Player at Best Buy?  50-100?  How much service do you really expect if it breaks?  What type of customer service do you practically expect to get when it breaks or does not work?  A basic policy of bring it back within 30 days and we will refund your money and that is it? How do you determine what services, amount of personal attention is important to you?  Questions you might ask. What “assistance” do you get from any care setting?  What is “Assistance”? Does it include medically related care?  Does the management have any medical care experience; do they “need” any medical care experience?  What do you need and want and how do you define Assistance, Assisted Living, and Assisted Senior Living? The examples above are intended to show us that health care is a service, and like all services it depends highly on the individual people providing it.  We need to meet all of the people involved: management, owner, administrator, caregivers, medication technicians, and doctors if there is a house doctor to know what we are getting.  While we will still may not know it all,  by meeting the individuals in the team, we are much better able to decide on the value for our private care dollars. Impact on Senior Care and All Senior Care Settings. How does all of this affect Senior Care, and most importantly,  Care for seniors who are really sick, have multiple chronic diseases, and are likely to need assistance.  This will further reduce continuity of care by further pushing doctors out of medicine.  Some doctors who are unable to do anything else will just accept the new roll as a salaried employee/ doctor or the institution.  We believe that all people who get a salary will start to behave more like employees than old fashioned doctors.  The respected role of “Doctor” is changing and it is up to both doctors and patients to reevaluate what type of care they want and in what type of care setting they get it. Do residents and families choose a Big, Institutions with hundreds of residents or do they choose smaller care settings where you know the owner, administrator, staff and they all know you are another choice.  Finally, do not under estimate knowing and working with one doctor  when you are older, and  have many care needs and health concerns.   Continuity of the Care is the care.  In all cases, the care team including the doctor,  in each setting big or small, will determine the value you are getting for this very expensive item of Senior Care.  Senior care costs more than a new car every year and is a product most do not know as well as a car. Is this the fix?  Is it fixed? or do we need to value people, doctors, and continuity of care? Then this news Alert, Medscape Medical News Fiscal-Cliff Deal 'In Sight,' Said to Include 1-Year Doc Fix http://www.medscape.com/viewarticle/776955?src=nl_newsalert They may be pushing the Medicare cut back one year.  Now Doctors can just expect that cut next year.  They have one more year to plan their escape from Medicare.  Or Doctors, Patients, and Society can embrace Continuity of Care especially for the frail Elderly and those living in an Assisted Care Setting. One must wonder how these constant changes and proposed "fixes" to the payment system without addressing the care system are suppose to help care and caring?  It is unclear that any one has changed their relative value for Continuity of Care which we believe is essential to get and provide High Quality Care.    But only time will tell if it helps continuity of care and care or not. Health Care is about Continuity of Care and relationships.  Be cautious not to apply the six sigma standard of assessing business efficiency, and quality control when looking for health care services. By Shawn McGivney MD, RFA Thanks for reading this post .  If you liked this post please help us by sharing the message of Care, Caring, and Continuity of Care by likeing, friending, and following our works on Facebook     (tlcsr.kerrymcgivney), Twitter ( TLCSRLasVegas), Youtube (TLCSRLV),  Joining our Email List and this Blog, and sending this to any sons, daughters, or seniors you know. Here are links to make it easy! Like Our FaceBook Page: Friend Us On FaceBook: Follow us on Twitter: Like our videos on Youtube: Join our Free Blog and Email List: Contact: Shawn McGivney MD, RFA [email protected] www.tlcsr.com www.tlcsr.com/blog/

How are “Care” and “Caring” different in Assisted Living and Senior Care Settings?

How are "Care" and "Caring" different?   Care in Assisted Living might be just the physical act of giving a shower and caring might be something more emotional and personal, that is shared between the two people while that service is provided.  We believe continuity of care and a professional relationship are the main factor that determine how care is appreciated, felt, and perceived by both care givers and residents in all care settings including Assisted Living, Residential Care Homes, Dementia Care, Alzheimer's Care, Memory Care, Hospice and Home Care.  The care setting does allow or impede how the care is provided.  For example A La Cart Care vs Live in more Family Style care will affect the continuity of care.  However, in the end even the care system can be over come by the individuals providing that direct care and direct patient management and protective supervision. Big, Institution, Nursing Home, or Assisted Living Facility VS Small, Single Family Home    Home VS  Institutional Hall ways ? The physical setting does matter.  A small, private room with a kitchenette is not a home no matter how you phrase it.  A single family home is well known to most seniors and offers all the comforts they are use to.  While a hotel is a flashy place for vacations it is not what a person in need of Assistance really wants or needs.  If a Senior were well enough to dress up in a suit or dress and go out on the town they would not need an Assisted Senior Living Setting.  In fact, people prefer care in a single family home that has many of the senior modifications they need to accommodate their care needs.  Do not just accept the old phrase "home is everywhere you are"  In fact, when you are older you want a home to be steady and not changing and in many case Assisted Living Facilities will force you to change your "home" at least one more time after you move in.  Most are priced out or the level of care increases and they are asked to move to a more or real Assisted Senior Care setting.  Recall a recent post where they said about 1/3 can remain in Assisted Living until they die.  While that sounds good, 2/3 are forced to move again!!  That is more common outcome statistically.  Conversely, family style of care and hands on management all will improve  the quality and intimacy of the care one does receive.  In any care setting Assisted Living, Residential care, Home Care , Nursing Home, Hospice Care, meet the entire care team and especially the management since their interest in direct care, relationship building will most likely be reflected in the importance care givers place on that, personal aspect of the care they offer you.                                                                                                                       Assembly Line Care VS Family Style, Live in, Continuity of Care models of care VS Assembly line, A La Cart Care On a highly scheduled Basis VS Individualized, Family Style,  Live in Care, Like Mom provides her kids. Are "Care" vs "caring" the same thing?  What is the difference?  Is care provided in an assembly line style, that does the physical care tasks, the same as Family Style, more live in care, where the staff live and work with the senior day in and day out the same?  Is the "caring" that comes with the care different depending on the style or system in which the care is provided?   Care and Caring  require the senior and caregiver know each other and have continuity of care and a professional relationship.  Which do you want?  Which system of care  Assembly line, like you see in a Big Facility, Nursing Home, or Institution, or a more family-style, live in care system provides a Higher Quality of care?  Everyone says we offer High Quality of Care but it is up to each senior and their family to meet the entire care giving team before they make their choice of a senior care setting. The choice of a Big,Less personal Institution or Facility over a small, single family home and a choice between  more assembly line care or a more live in, continuous style of care, complete with the most continuity of care you can get,  is often difficult since many times, especially in the Big Institution or Facility you never meet the direct care staff and management  that you are hiring.   You often times meet the sales lady but may not really meet the people you are hiring the care team from the administration down to the care givers.   Many people see the nice sofa and then Assume the care.  They assume the name "Assisted" Living Facility means you get the type of Assistance most of us would want.  In fact, that often times is a bad assumption.    The choices of the type of physical building ( Big, studio room, or Institution) VS ( smaller, single family home with a private room)  and the system of care ( Assembly line Vs Live in, Family Like)  do affect  how the care is perceived after they sign up. Delegated Care Management VS more hands on Care and interaction of management with all staff, residents and families. Another major factor in  distinguishing Care, Caring, and Continuity of Care is that Care in any setting is heavily influenced by the management.  If the management knows you, the senior and the family, it is much harder for them to skimp on the care and caring.  When care is impersonal it is easier to decide to make more money and provide less care, hire fewer staff, and maximize the Institutional Bottom line.  Everyone has a bottom line, but if the management, owner, and caregivers all know you the client you are likely to get the best over all value including caring and continuity of care. Assisted Living, Home Care, Hospice Care, Dementia Care By Kerry Mcgivney Thanks for reading this post .  If you liked this post please help us by sharing the message of Care, Caring, and Continuity of Care by liking, friending, and following our works on Facebook     (tlcsr.kerrymcgivney), Twitter ( TLCSRLasVegas), Youtube (TLCSRLV),  Joining our Email List and this Blog, and sending this to any sons, daughters, or seniors you know. Here are links to make it easy! Like Our FaceBook Page: Friend Us On FaceBook: Follow us on Twitter: Like our videos on Youtube: Join our Free Blog and Email List: Contact: Shawn McGivney MD, RFA [email protected] www.tlcsr.com www.tlcsr.com/blog/

Assisted Living Fire News Article.

Assisted Living Fire-News Article. This is a good example of an small personal Assisted Living Home in North Carolina.  Notice the picture of the single family residence.  However, many Big, Less Personal, Facilities, Hotels, or Institution also describe their Assisted Living Services as being Home Like.  The confusion and multiple definitions of the phrase Assisted Living require each senior and family to be cautious when assuming what the phase actually means. Seeing is believing. Compare an Assisted Living Facility, or big institution with a small, personal, Home. We encourage all to follow Our Golden Rule-Meet the ENTIRE care giving staff from the Administrator, Owner, down to the Direct Care Providers. The more continuity of care the better, more caring, and less impersonal and assembly line the care is likely to be. Health Care, Assisted Living are services and require a relationship among the resident and persons providing that service to begin to expect caring to go with the physical care. Join us for the more on the discussion.      What would these people do in case of emergency? The staff matter.  When you need something remember that is whey you need the skills.  Do not get the cheapest, least skilled people, you need skilled people as well as caring day to day providers especially when new, unique or emergent issues arise. By Kerry Mcgivney Thanks for reading this post .  If you liked this post please help us by sharing the message of Care, Caring, and Continuity of Care by likeing, friending, and following our works on Facebook     (tlcsr.kerrymcgivney), Twitter ( TLCSRLasVegas), Youtube (TLCSRLV),  Joining our Email List and this Blog, and sending this to any sons, daughters, or seniors you know. Here are links to make it easy! Like Our FaceBook Page: Friend Us On FaceBook: Follow us on Twitter: Like our videos on Youtube: Join our Free Blog and Email List: Contact: Shawn McGivney MD, RFA [email protected] www.tlcsr.com www.tlcsr.com/blog/

Big Changes in Home Care in 2013

This article from Syracuse, New York, give us  the ideas of much bigger cost containment changes to come They note that at of Jan 2013 Medicaid will no longer pay per hour for Home Care aides.  That means that the company will have to decide how many hours you need and the government will be off the hook for that decision.  Recent years have seen the government cut Medicaid Home Care from two 12 hr shifts if "needed" 10-20 yrs ago.  Then 10 ys ago it was the same "needy" senior could get one person who lived in for 24 hours.  Subsequent, changes have continued to reduce the number of hours they felt the same level of need "needed".  Recently 3-5 yrs ago, they cut the hours they paid for from 4-8 to 2-4 hours.  They do this in many ways one was by combining the tasks they expected the aid to do in a treatment or visit period.  For example they use to list you can get 1 hr for a shower, 1 hr for personal care, and time for other things then they just combined that to a global time estimate or everything in 2 hrs.  Of course the seniors needs are not changing.  What is changing is All Insurance companies needs to provide less and pass the risk of being sued to someone else.  Discrimination?  or Just Financial, Efficient, Cost Cutting? Of course, those who needed a friend will most likely get less care.  Enough and need depend on the view point defining them! WHY ARE THE GOVERNMENT AND INSTITUTIONS GIVING AWAY THE RESPONSIBILITY FOR DIRECT CARE: Could it be to pass the risk of law suits to someone else? When you sue the new "health care company" they can go bankrupt and the senior is holding the bag.  When you sue the government the bad publicity means you get a settlement since they are not going bankrupt.  I guess this is good risk management for the government.  The same idea applies to Medicare Advantage Plans".  Hospitals who clearly affect the practice style of Doctors including limiting privileges to Hospitalists and saying Doctors are not representatives of the Hospital are similar ways to get paid for participating in care but to pass responsibility for the care off to "your Doctor" or someone else.  Your Doctor, just not them or the Doctors they allow into their Institution.  If you cant stay at home, Medicaid pay for Nursing home.  Hello, Nursing Home for many. We need your help.  Comment on your experiences in home care as a provider, or consumer, or frail person.  Please help me fill in the many details and variations on the above idea. In sum, Medicaid will pay for less home care over all.  You will have to go to an Skilled Nursing Facility (SNF), or Nursing Home.  Since Medicaid pays for just small amounts of home care or Nursing Home care in general.  In the private pay setting you can get the full range of care from the high value very low cost care to high value but higher service care.  You have to look and follow our Golden Rule.  Meet all the care providers and managers in each setting.  Be sure to meet the owner and administrator since care is a hands on service and a management team who does not know you, their care giving staff, is likely to be less sensitive to your needs since they have no idea who you are.  That lack of a relationship makes it much easier to cut and reduce staffing and to lower the definition of what one "needs". Cost Effective, Private pay, Choices for Senior Care DO EXIST!!   The range of private pay Senior Care is wide.  Low end Residential Care Homes let you live in, provide some care, meals, etc for as little as 1, 000 / mo.  Higher end, care settings with lots of staff, better physical plants can charge up to 3500 -4000 for a more fixed price plan.  Assisted Living Facilities or institutions tend to charge the most and provide the lowest amount of care.  They start at 2, 000 / mo for the room and meals and then add small amounts of care for 1000 and up.  When you combined the many A La Cart charges Assisted Living Facilities cost the most and provide a lower value.  We suggest visiting many care settings before you decide how to spend your private pay senior care dollars. Medicaid and other insurance will most likely continue to try to provide less and reduce the long term commitment  they have for your care by passing that responsibly on to someone else.  While you might feel entitled to care and continuity of care for the decades of taxes you have paid and insurance premiums, only time will tell what you actually will get in terms of direct care.  One common method of paying for less is to encourage people to go to Hospice Care.  Hospice does very little of the direct care even if they claim to help the "help" is 2 hrs twice a week leaving the majority of care 164 hrs / wk ( 24hrs/day @ 7days 168 hrs per week) to someone else or the staff of the care setting.  Make no mistake the Care Setting does the work not the doctor, not hospice, etc! Reading this blog and blogging will help others to become more informed about Senior Care and How to pay for it. By Shawn McGivney MD, RFA   Thanks for reading this post .  If you liked this post please help us by sharing the message of Care, Caring, and Continuity of Care by likeing, friending, and following our works on Facebook     (tlcsr.kerrymcgivney), Twitter ( TLCSRLasVegas), Youtube (TLCSRLV),  Joining our Email List and this Blog, and sending this to any sons, daughters, or seniors you know.Here are links to make it easy! Like Our FaceBook Page: Friend Us On FaceBook: Follow us on Twitter: Like our videos on Youtube: Join our Free Blog and Email List: Contact: Shawn McGivney MD, RFA [email protected] www.tlcsr.com www.tlcsr.com/blog/

Las Vegas Reniew Journal Article “Alzheimer’s Rising Storm” 12 10 12

Comments on LVRJ Article "Alzheimer's Rising Storm"  12 10 12, section D,  Dont Despair, There are Many Senior Care Alternatives at many price points. While the author notes a "Rising Storm"  and notes one care choice that costs 5K and a second choice to move out of state there are many high quality, small, personal, and COST EFFECTIVE care choices right here in Las Vegas. People With Alzheimers often Face Leaving Home To Receive care LVRJ Article I would direct Pual Harasim [email protected]  702 387 2908, that there are many less expensive Residential Care Homes that provide high level,  Assistance with Living and Dementia care, Alzheimer's Care, Memory Care, and Hospice Care right here in Las Vegas. There there are many small, cost effective, and currently available residential care homes that are Dementia endorsed and provide live in care, staff ratio of 1/6, and staff with Dementia Training for much less than the 5K dollar it costs at Prestigue Senior Living that George noted to him and he listed in his article. As a more useful community resource would suggest readers check out Residential Care Homes and not the big institutional Memory care units of the Big Assisted Living Institutions.  Residential Care Homes offer care in a real, single family home.  They are not "home like" small studio apartments that tend to isolate seniors in their small room but instead offer  more personal, cost effective care ranging from $2,000-$4, 000. The smaller places also have more hands on management from an Administrator that supervises 10 residents instead of 100 - 150 and owners who are often on site instead of unknown companies ceo's who have no personal knowledge or the residents they serve.  Continuity of care from the top down matters in the care that is provided. There is a wide range of service levels and prices within the list of Residential Care Homes attached.  In that list from HCQC there is a range of homes from the simple to the private senior estate home and with staffing that runs from the minimum required 1/6 and up all for less than the $5,000 dollar price tag quoted in this article. Positive Resources  We agree Finding Good, Caring, Assisted Senior Living and Care is difficult.  We applaud the LVRJ for raising awarness of the issues in senior care but we want to help readers with real, praticle, suggestions.  Here is one.  There are many Residential Care Home Beds that are cost effective, and AVAILABLE right now!! See link to HCQC, (The Bureau of Health Care Quality and Compliance.) This link is to a list of inspection reports for all facilities and shows their grades. http://health.nv.gov/Deficiencies_Qry_AGC.asp The second link is a facility locator you can use to find many places close to home. Try several local zip codes for best results. http://dhhs.nv.gov/Health/hcqc/healthfacilitiesquery/FacilitiesSearch.aspx  ( for easy search list, just type in zip code) As for sending people out of state I cant imagine that unless they have family out of state.  Indeed, at first blush that sounds at least unnecessary.   If they live her, their friends are here, why would they move out of state when there are many vacancies at places on the list of dementia endorsed facilities right here in Las Vegas.  To comment on that and not ask that question seems miss leading. Summary Like anything in life, you have to look a little to find what you want.  This Blog has many ideas that help all Journalists, Writers, Seniors, Family Members, Politicians, Doctors, and everyone to re evaluate what they want and need when it comes to Assisted Living and Assisted Senior Living.    We need your help to fill in the many blanks we have left out.  Comment on our blog  as we have done on the LVRJ article to help the discussion, understanding, and path to solutions grow. Our Golden Rule - Meet the entire care giving team from the top down to the direct care givers and Medication Technicians.  We feel strongly that you have to meet the Administrator and Owner if you want to get the Best Quality of Care and Continuity of Care.  The Staff follow the plan given by the management. If the management focus only on paper work and the billing the staff are likely to do so as well.  If the Administrator and owner know each staff member and care giver by name, meet with them and talk to them weekly it is likely continuity of care for the residents and family will be maximized.  If the Administrator or owner has specialized knowledge and skills beyond getting the most billing possible and having the paper work prevent law suits they need to meet the resident and family to share that knowledge and skill.  Health care, and Senior Care is a Service and to provide that you really do need to meet the person.  of course, Delegated Care happens and does provide a very good, assembly line, approach to care. We believe, that residents and families need to look for and value care and caring more than that.  We hope that discussions like this will give families and Seniors more to evaluate and consider when they make this expensive and life changing decision. The Golden Rule applies in all care Health Care Settings.  Assisted Living, Residential Care Home, Home Care, Hospice, and even Hospital, Nursing Homes.Trust the people you know.  Pets stay with you for life! By Shawn McGivney MD, RFA      Thanks for reading this post .  If you liked this post please help us by sharing the message of Care, Caring, and Continuity of Care by likeing, friending, and following our works on Facebook     (tlcsr.kerrymcgivney), Twitter ( TLCSRLasVegas), Youtube (TLCSRLV),  Joining our Email List and this Blog, and sending this to any sons, daughters, or seniors you know. Here are links to make it easy! Like Our FaceBook Page: Friend Us On FaceBook: Follow us on Twitter: Like our videos on Youtube: Join our Free Blog and Email List: Contact: Shawn McGivney MD, RFA [email protected] www.tlcsr.com www.tlcsr.com/blog/

NYT ARTICLES ON ASSISTED LIVING VS. HOSPICE: WHO IS IN CHARGE?

Read the two articles below and comment. Assisted living vs. Hospice:  Who is in Charge? Click on these links for the two articles from the NYT. Assisted Living VS. Hospice:  Who’s in charge? http://newoldage.blogs.nytimes.com/2012/11/16/assisted-living-vs-hospice-whos-in-charge/ Managng the Assisted Living VS. Hospice Dilemma. http://newoldage.blogs.nytimes.com/2012/11/19/managing-the-assisted-living-vs-hospice-dilemma/?pagewanted=print The New York Times is right on the money and we applaud them for discussing this. To be fair we believe you need to add many players to the list of  who is in charge ? We would add Doctors, Your Doctor, and the financial entities that pay for your medical care and control to various degrees "your Doctor"  into the mix. This is precisely the issue, no one, Doctor, Assisted Living, Hospice, Hospice Doctor, the Home Care aide or the office manager who runs the Home Care Company, Family Member, The Government, The Insurance Company -- WANT TO BE RESPONSIBLE FOR THE VERY CHALLENGING AND EXPENSIVE TASK OF PROVIDING CARE TO A SENIOR.  When it comes to being "responsible" few want that job.  That is expected since it is a very difficult and under valued job.  While Medical Care use to have a high Value, much of the value came from relationships, continuity of care on both sides, "provider" and "Senior".  However, we have seen a stead decline in the value both sides places on relationships and continuity of care which has gotten us to the assembly line, less personal, style of care we now see.   Why, How, that is a discussion we are ready to have and need to have as a society. assisted living vs hospice nyt article pdf       The issue is lack of continuity of care.  This is a lack of responsibility by the patient and the provider.  To have a responsible party you have to have a person, family, or patient who is participates and respects that responsibility.  If the Patient jumps to a new insurance company because a stranger, a sales lady, promises them something new they can't expect to build and earn a trusting relationship.  We believe that health care requires that relationship especially as people age or acquire chronic illnesses for any reason.  30% of people on Medicare are less than 65 yrs old.  Accidents do happen, illness is not only for the old and all of us will need health care someday.  We need to value it, invest in a cost effective, humanistic, system of care and the basis of that will undoubtedly be Continuity of Care. The power struggle is between financial entities, corporations trying to get your dollars and delegate the work and responsibility.   While that is a very good business system and works great when building inanimate cars or objects it fails miserably in dealing with people or providing Health Care which by definition has Emotional Health, Feeling, Depression, Satisfaction, and all the human emotions included in the service or product.  If we all were VCR's then we can roll out care down the wide Assisted Living , Nursing Home, or Hospital Hall and go do to door making the patients wait until our assembly line was turned on.  However, in fact the bowl and bladder and entire body and mind work on their own time table making assembly line much less efficient  in providing high quality heath care.  Do not let the sales lady convince you that her best care, care she will not provide, care she has little interest in once she signs you up, will be as compassionate as care you get from someone you have a professional relationship with.  Look for continuity of care. of course the ideal person to be in control is "your Doctor".  They use to have more control but now have had that dissolve.  Families, insurance companies, politicians, have all come between the care providers, Doctors, RN, and Caregivers and the patients.  As those relationships were lost it stands to reason some care and caring went with them.  Now the financial institutions want to be "responsible" for your premium but want to delegate are to unknowing doctors. By Shawn McGivney MD, RFA By Kerry Mcgivney                            Thanks for reading this post .  If you liked this post please help us by sharing the message of Care, Caring, and Continuity of Care by likeing, friending, and following our works on Facebook     (tlcsr.kerrymcgivney), Twitter ( TLCSRLasVegas), Youtube (TLCSRLV),  Joining our Email List and this Blog, and sending this to any sons, daughters, or seniors you know. Here are links to make it easy! Like Our FaceBook Page: Friend Us On FaceBook: Follow us on Twitter: Like our videos on Youtube: Join our Free Blog and Email List: Contact: Shawn McGivney MD, RFA [email protected] www.tlcsr.com www.tlcsr.com/blog/

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