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Question of Month

Assisted Living, Nursing Home, Home Care-If they only knew the value of continuity of care!

Choosing any care setting, Assisted Living or Nursing Home is difficult not because of the physical plant but because the care is delegated, there is not one responsible person or team and the care team changes every time the care needs change.  Indeed, the hospitalist does not talk to the pcp, the pcp never or rarely meets the caregivers, and the family is in the middle quite confused. We are very biased because Tender Loving Care Senior Residence, Costa Brava are the standards of care based on Continuity of Care and Complete Care. While Great Authors like Paula Span write great articles it is clear to me she has never visited http://Tlcsr.com All that she writes is true for the industry. This great article is not exception. Assisted Living or a Nursing Home hits many good points. But in fact the most important fix is continuity of care and knowing the entire care team. Doctor, administrator, and care team throughout this difficult family journey. Assisted Living or a Nursing Home. http://newoldage.blogs.nytimes.com/2011/06/10/assisted-living-or-a-nursing-home/ Another Great NYT post by Paula Span. Two great example to follow as standard of care and continuity of care. Tender Loving Care Senior Residence - http://tlcsr.com   Tender Loving Care Senior Residence, Costa Brava - http://costabrava.tlcsr.com Value continuity of care to get the best care and the most cost effective care. Dr Shawn McGivney

Hospital and Nursing Home InActivity VS Exercise in Assisted Living

Hospital and Nursing Home Inactivity Vs Assisted Living Is Nursing Home rehabbing the best exercise after the hospital or is Assisted Living with structured care and doing daily exercise a comparable choice?  This NYT article raises a good question about activity in the hospital and by extension Nursing Home Rehab where you are on your feet 43 minutes a day.  They go on to point out that if you are allowed to walk more, provided an setting or support system that encourages twice or more a day activity that is better than less activity.  We add in questioning the definition of the phrase "rehab" since we believe that confuses many who would walk more, do more, if they were allowed to be in a setting that encouraged ambulation.  For example being on your feet more, walking to meals, doing day to day tasks that most people would do in a more supervised Assisted Living or structured care setting might give one more activity than in many hospitals or other nursing home type settings. Trapped in the Hospital Paula Span Nursing Home Rehab vs Assisted Living that has adequate staff and continuity of care to do assisted activity with seniors A nursing home, which is the most common form of senior rehab, might only have them on their feet for 43 minutes a day.  While the senior gets “rehab” from a licensed physical therapist  they don’t get a lot of walking and ambulation for the remaining 23 hrs a day.  If walking and ambulation are rehab then one might get more “rehab” or exercise in an Assisted Living or Residential Care home that focus on continuity of care and activity. Just because the hospitalist doctor, who generally does not know you, and might have less  interest in your condition months later since he does not expect to see you,  suggests “rehab”, meaning nursing home rehab  don’t assume you will get a lot of exercise.   In fact, the system delegates your rehab to just the time you are in rehab which is not very long.  The staff do their jobs but the floor staff like the senior  to rest, and not get up, since they don’t have time to supervise that. If you knew your doctor, your doctor participated in the care both in the hospital and after the hospital he might feel differently about your expected functional decline in nursing home rehab.  Now the NYT is confirming this view. We caution that all Assisted Living Homes may not have adequate staff or systems set up to allow or encourage mobility but note that if your setting favors continuity of care and senior independence it might be a good alternative to Nursing Home Rehab.  All of these are speculative and each needs to discuss this with their doctor and health care team. Free or paid by Medicare nursing home rehab  is not always the best care, most care, or most exercise. We bring this point up since many hear that nursing home rehab is free or covered by Medicare for 100 days.  They want to use up this free resource.  At first glance saving a few bucks is a good ideas but when you consider that many my decline further and  not regain their previous community mobility with extended nursing home or hospital  stays and the inactivity that accompanies them. All nursing homes are not the same. Some staff will get you up and walk with you but practically it is hit or miss. Also management will direct staff to stay on task and walking with residents takes time, time that staff could be doing something else. Also walking with residents is risky for the institution in that the patient might fall so they want to be extra safe.  Of course the senior wants to take that risk since to live a full life requires walking.  If they fall it wont be the first or last time and that is ok.  Aging and life are risky. Example of a Assisted Living Care Option that probably does offer more exercise and supervision than many hospital and rehab settings. At http://tlcsr.com we have a negotiated risk agreement with falls and encourage people to walk knowing that our encouraging then will encourage them to do more and when they do more they might not ask for help and fall.  That is an acceptable risk the patient and family agree to which is the negotiated risk agreement.  That should become a model for care. Read this and share your comments. Help us spread the word.  Click for Free Ways to help.  Click for The Best, Most Cost Effective, Assisted Living and Senior Care Alternatives. Tender Loving Care Senior Residence TLCSR, Costa Brava Dr Shawn McGivney

Aging is By Choice! Find out how.

•50-70% of Aging is by choice after Age 30! While many will question that it is true. First, we need to explain after age 30.  Early in life genetic diseases express themselves and those people often die or are identified.  But after age 30 much more of aging is by the choices we make. After age 30 we do choose environmental things like what we eat but also we choose how we spend out time and other resources.  We might choose to smoke or to exercise which are common choices we all would know.  But consider the value of choosing to invest in your family and friends as an enormous emotional health benefit.  People who go to church also have a large health advantage over those who do not.  Trying to speculate on why is difficult is it being part of a group, relating and not working all the time, but what ever it is it is positive. Common Prevention and Screening. There are preventative things people know like breast cancer screening and checking for prostate cancer.  These have low value since most people know them already.  This is not new information. Some other less commonly considered choices are the choice to have health insurance or not.  We all indirectly choose to have insurance or not.  When you choose your job you also are choosing insurance.  We choose our doctor or don't spend a lot of time on who and how well we know our doctor.   As it turns out having insurance is not having a doctor you know, trust, and are confident in developing a long term health and wellness plan with .  That is a choice.  In many cases if you can't find a doctor with any unique ideas to share that is a cost effective health decision to forgo having a trusted doctor.  If the doctor is going to tell you smoking is bad why would any one pay for that?    That is reasonable for a person not to pay extra for that doctor or any doctor who does what all other doctors do.  If you could find a doctor with new ideas that would be worth considering. Unique, Less commonly considered ,choices For example would you pay extra to find out smoking is bad for you? On the other hand, if you did smoke and someone said you already know smoking is bad for you but I can suggest a few tests that will reduce your risk of death and disability to less than that of a non smoker that would be new.  Can you guess what those cost effective, easy to get, tests are?  Ask your doctor.  I must also add that if you did those cost effective, silver bullet, screening and simple interventions in a non smoker that would be better than the smoker who did those.  Just wanted to be fair. Emotional health matters.  Did you know most medical studies that doctors quote specifically exclude emotional health.  That is what they control for.  Ask your doctor if he knows why studies don't translate to real life and to name some big limitations on how to use studies when building a treatment plan.  Emotional and financial considerations, time, practical implementation and life considerations all come to my mind.  See if your doctor recites those too.  They get a control group to eliminate those pesky feelings and social variables which they cant quantify, define, or study.  However, we all know we make all decisions based on feeling, emotion, and social variables.  That is what advertising is.  Doctors studies miss all of that.  What you need in a doctor is a person who helps you interpret studies from your view point and balance the "medical" part of the study with your wellbeing choice.  If you cant work with the doctor openly that value as your agent and guide is reduced. The choice we are describing are general.  The choice not to have a doctor.    Again doctors rarely deal or include things that matter a lot to you.  Finance, social and cosmetic things that are cost effective.  If they could help decide on those that would have value.  What is the most cost effective cosmetic thing you can buy?  Are all cosmetic things equally cost effective? Safe, immediately beneficial?    It is up to you and not you and your doctor to choose how to spend you time and money.  I believe it is better to make those choices with a person like a doctor who is in the position to know what they cost, and the degree and immediacy of the benefits and plan to implement the treatments are. How is an executive physical different from your physical?  The cost effective variable is the stress test.  The president of the united states needs it, the air plain pilot needs it, but any other 50 yr old man does not need it?  why?  It has to do with how we value our own lives. How much do you value your life?  Did you know a life insurance company pays for your stress test.  Why?  To help you? No they value your life more than you do?  If you wanted to live it might be worth paying for the stress test at 200 dollars a year to reduce the most common cause of death and the 2nd most common cause of disability. We concede. These are only choices if your doctor or someone offers them to you in a cost effective, practical way.  Again these are new ideas so we admit it is not really by choice since you need the doctor to descried the cost effective aging plan for you or with you. Comment and share your ideas with us. Two examples of continuity in Care and team work in choosing any health care or Assisted Living / care products TLCSR or TLCSR2 Help us spread the word Dr Shawn McGivney

Laughter is good Medicine. Find Assisted Living that makes you Laugh!

Laughter is good Medicine even when you need Assisted Living Care.  Laughter  might be better medicine than most pills for treating emotional health, wellbeing and sense of belonging.  We need to laugh with other people so look for Assisted Living Care Settings that Make you Laugh. COMMEDY QUESTION Let me “make your day” Laughing is great medicine.  If not watch youtubes videos Find Assisted Living places that make you laugh. Happy-Assisted-Living Youtube Comedy Week Link Test Yourself.  Learning and being involved in day to day chores, life, and TV can be good medicine too.  Look for care Assisted Living Care settings that offer Family Style care where you are involved in care and not hotel style Assisted Living Care Where you are less involved in your own dare. Can you see what is not right with the quote “make your day” and the Arnold video I attached.  Laugh and get the answers at TLCSR - blog     ANSWER: #Clint Eastwood Said “go ahead and make my day” not the #gubernator, #terminator, Arnold schwarzenegger Help us spread the word.  Click for Free Ways to help. Check out these Family Style Assisted Living Alternatives to Live, Laugh, and participate in Life at. TLCSR  Or TLCSR, COSTA BRAVA Dr Shawn McGivney

Three Best Ways to Save Lives. Doctors are the Human Element!

Three Best ways to save lives!  Doctors are just a distant third!! But doctors are the Human Element and the Factor you need to use your individual Health and life resources! Doctors are third line of life savers to 1) Public Health and sewers and  2) Research and antibiotics.  While Doctors are a  distant 3) over all to society’s life saving they are number one for each individual.If Your Doctor” were  your, friend, and trusted doctor  they could advocate and guide you to stay well and use your social, financial and insurance resources wisely.If Your Doctor is a trusted friend, then the doctor is the Best, Most Cost Effective choice to guide you how to use your money to remain Healthy, Wealthy, and Happy. Bill Gates 2.0 is doing 1 and 2 COST EFFECTIVELY!  Making sewers and using already proven research through vaccines. Bill Gates 2.0  CBS 60 Minutes Video Link! Bill Gates with his own money and the money Warren Buffet donated to the Bill Gates charity is putting it all together to make the world a better place.  He unlike governments is smart enough to put his money to the most cost effective uses.  By making a toilet that runs without water and that can be deployed as he called it for the lowest 2 billion people, those who live in India, China, and Africa on less than $2. / day he will help to drastically reduce disease, famine, and hunger for the world.  On the research front Bill Gates and his foundation are  developing a vaccine Ice chest  that holds vaccines for up to 50 days on one load of ice.  That keeps vaccines usable in hot places with no electricity.  Then gates  pays for vaccines which save millions of people.  He is using  things that are already well known, proven, and no risk but all benefit to help billions of people.  That is smart.   Donate to Bill and Melinda.        Why I will donate to the Bill and Melinda Gates Foundation.  Bill is not just throwing money at the advertisers who legally take 80% of the moneys donated in most charity.  He is personally active in this.  He uses not only his money but his time.  That is the type of leader I want supervising any project. We all can help for free!  Share, click, make suggestions. I hope you can all make this viral and it gets back to Bill but here are some added ideas to help Bill’s Cause.   Please everyone add your ideas to help out.  Ideas, comments  and shares might be more powerful than money. Don’t forget Doctors.  My suggestions and 2/3 of Aging is Good! Doctors are the best resource any individual can use to remain healthy, wealthy and happy.  2/3 of Aging is good!  That is right for most people two thirds of aging gets better with age.   The three big parts of aging are Financial, Socially and Health.  Financially most are better off as they age.  They have forced saving as Social Security, some small pension, and still Seniors are the biggest group of home owners.  Many have a small pension.  Socially, most people are more aware of who they are, what to expect out of life, and are more patient and tolerant.  Bill Gates reflected on his own growth and maturity in the 60 minute piece How to use doctors to help the lowest 2 billion and help all people in the individual and global health care crisis. You cant practically develop your own sewer system or research new medicines but you can choose the best personal doctor you can.  Choosing your doctor in not choosing your insurance.  When you choose your insurance they give you a doctor.  Don’t be confused by the statement you can choose any doctor there is always and implied in our network or that we influence, etc.  Instead look for and value a doctor who is part of your social community.  Take the time to know that doctor and you and the social community might have to pay something that the insurance does not pay to keep that trusted, socially aware doctor, your doctor, as your independent voice.  When you don’t have insurance that doctor can still help you.  That doctor can go with you to what ever insurance you do have and be your second opinion.  Imagine how hard it would be for another doctor who represents Medicare, Medicaid, or any insurance or ER to say no when they have to defend the reason for no to another doctor, your friend.  It is easy to say no to you, the patient,  since you don’t know the words, vocabulary, meaning of one phrase vs the next.  You wont be able to write down what transpired but another doctror is going to know what they are saying and not saying.  Your doctor will have a higher duty, a social duty, to defend your interests.  Unlike law and need for a friend who is a lawyer, we cant know we will get in trouble with the law  but with medicine we all know we will get old and when we need even a little assistance we will increasingly need the health care system.  Your doctor is your lawyer for the rest of your life.  If you choose wisely the verdict might be very different for you. Your doctor is in the best position to be a gate keeper but one who values your interests first and the specialists second.  That saves money and provides better care. Patch Adams said it best, if you treat the disease you win or lose but if you treat the person you win NO MATTER WHAT THE OUTCOME.  You win even if you die because the person had independence, dignity and remained connected to their social system as an example that life is good even in death.  Being connected, friends, family are more powerful medicine than any pills.  Seniors teach us many things and we need to re evaluate how we value those more social things.  What do you think?  Share comments, like, make this viral. Your doctor needs to be a part of that process from the minute you need even minor assistance. The doctor, feeling like you have a friend with some access, knowledge, and skills and one who will visit and sit with you if that is all he does is invaluable.  Your entire social system benefits from the seniors and that doctors example.  In essence and old fashioned doctor. Continuity of Care the Cure for the individual and Global health care crisis!    We all will need Assisted Living, as we grow  old.  As we approach that time of older age, needing any amount of assistance,  I believe CONTINUITY OF CARE  is the cure to the global and individual health care crisis.  I would love to have the opportunity to speak to Bill and Melinda Gates about why that is true.  What we see now is the lack of leadership of a persons’ care from the doctor. The many sub segmented forces of hospitals, insurance company, Medicare pushing continuity of your chart instead of care, all of which segregate and divide any relationship, sense of duty, that once existed between doctor, patient and the local social community they lived in.  We can change that right now by choosing care settings like Tender Loving Care Senior Residence,  and Tender Loving Care Senior Residence, Costa Brava or doctors you pay a little extra to help them stay in private practice.  Yes, if you want them to be your independent voice, or the voice of you and your social system you might have to pay them something since the insurance does not cover that.  Insurance wants them to work in their office, with their rules, so they pay for the office, insurance and “help out”.  What we all give up is an independent Doctor who is more of “Our Doctor”.  To have duty, sense of commitment both sides need to help the other.  We can get that right now but we need to read about continuity of care and then look for it.  Meet the entire care team you are hiring when you buy senior care, Assisted Living, or Home Care. Don’t forget the value of a doctor in a third world county. The 60 minutes story highlighted a person who was doing public service who was abducted.  Imagine a single doctor who was working other there and helping to do something as simple as triage for many people their practical health care options including to educate on why the society needed to protect the toilets and vaccine cooler.   The doctor would not be able to say bypass for everyone but could have a practical list of care alternatives and facilitate care while helping to protect the most valuable resources of the community.  That to me is a powerful idea.  If the public care agencies could offer a pension like the military we might see more doctors “volunteering” or serving abroad.  Again a small cost to improve the Gates Plan. Cost effectiveness is drastically reduced when the system gets to sub segmented but the doctor can give a good menu of prices, outcome, and plans for those to use their existing resources.  The doctor could give anti biotics to all as a free first lawyer of help and a way to get them to come for more education.  The big benefit over there of empowering the community to protect its vaccine and toilets might help the Gates Foundation buy the local police force of the community they need to further protect their awesome plan.  That works at all levels and the bigger the budget the more you save which is how continuity of care and re organizing and re valuing the role of “your doctor” can save the Individual and Global health care system. Continuity of care the human element that is NEVER INCLUDED IN ANY STUDIES! The doctor is the human element that sewer and research cant provide! The third level of heath care is the human level.  That is not a public health issues but an individual and local community issue.  A human element is essential to help balance dollar cost and  human benefit, socially and emotional.  That is how most people choose and calculate their individual values before they buy or act.  Like it or not the doctor is a part of the social fabric of each community! Many will be shocked to know that most studies specifically control for or remove as variables feelings, social issues, and caring from all treatments.  Most of us know that feelings are the final expression of all disease and of life!  We buy because of feelings, Mary and live because of feelings.  Feelings matter. Because science cant study or quantify them or control them they specifically remove them from all studies.  The studies doctor's quote when the doctor says the study showed is helpful only at the minimum data level.  It is not a treatment, not a total care plan at all.  Just because the study showed this or that it does not mean that will make you feel better.  The doctor is the person who adds humanity and practical use of those studies back for you.  You are in no position to evaluate how much the study helps and how much emotion, social or financial value there are on the alternative uses of time and money.  The doctor is.  He is your best guide to use your insurance, social system, and feel good.  The doctor can make you feel good himself. That is the value of a visit.  While insurance companies won’t pay for just seeing a friend to feel better we all know that has value.  We need to value continuity of care and our guide to using health care in our own individual social system with our individual unique resources and emotional needs. All of that is part of how continuity of care can save individual and global health care.  There are levels that vary for each individual and we need to make continuity of care the main variable and then let people choose how they value an independent option which is what doctors provide. Topics you can help with. Lets make this viral to help those who use Bills waterless toilet and vaccine cooler to show those around them that stealing these community resources will be social suicide.  We all know that we can better police our own streets by reporting abnormal behavior.  Without being vigilantes we need to report and look out for our neighbor and helping empower our neighbors to watch out for us can spill over to helping those lowest 2 billion to look out for their Gates Toilets and Vaccine Coolers.  Please share any ideas on how to protect the vaccine cooler socially through social pressure or more traditional methods? Help me get this out there so I can get Bills and Melinda’s attention. We invite Oprah, TV shows, and anyone to pick this up and share! Free Ways to Help! Dr Shawn McGivney

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