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Question of Month

Humanism Beyond The Three A’s of a Hospital

Marc Harrison of the Cleveland Clinic Abu Dhabi  gets most of it right in his article  The three A’s of a Hospital but he leaves off you need to see the same doctor, caregiver, every time to use any of the three A's well.  That is continuity of care not just continuity of your paper chart.  You are so much more than a stack of papers.   The Three A's of a Hospital. http://www.linkedin.com/today/post/article/20130815121943-13527628-the-three-a-s-of-a-hospital His examples leave out the most human factor which is in my view the cure for the individual and global health care crisis.  Continuity of care, People, and relationships with those you choose to care for you are the cure for the global and individual Health Care Crisis and not building just your chart.  If you don’t choose the people but choose the institution you will generally be treated as a widget and number instead of what you want and need which is to be treated as a known friend by the care team you choose.  When you see a “new doctor”, person or caregiver they cant know you and you don’t know them.  Care will always be a first time event with no future even if they have your paper chart.  The chart is not you and is the most un quantified, superficial, non-human part of you which is not what you want treated. As a persons Care needs increase with age and disability the need for knowing the individuals who YOU CHOOSE TO CARE FOR YOU is compounded as we age and need more over lapping services and as mood, depression, and emotional heath continue to be additive in our care needs.  0Emotional health is rarely studied and is generally systematically excluded from all or most medical studies!! Emotional health and feelings are next to impossible to quantify, standardize.  Instead science just excludes it in the control group.  Your feelings as expressed by some mathematical average when groups with hundreds of other people in your group are assumed to be the same as the feelings of the other average in the other control group.  In fact, no two humans have even close to the same feelings, relationships, and lives.  That is the best science can do but we all need to use science and understand what they are not providing.  That is why a doctor is an artist and that is the art of medicine to balance what the studies do share with the greater amount that they do not share. Let me share a quote from Patch. “If you treat the disease you win or loose.  But if you treat the person you win no matter what the outcome.” When you understand “you win no matter what the outcome” you will start to understand old fashioned, relationship driven health care vs the new ceo, six sigma, A la Cart, Urgent care brand of care we are getting now and the difference from a sales claim of “we care” vs a relationship based, heartfelt caring.  You choose the care team; you decide what you want in care.  Especially when a loved on or yourself ages you need to build a relationship with the individual care team and care setting to start to get the care you want and need.  Doctors, caregivers, and care settings are ready to help you but you have to look for them. They wont have big advertising budgets but they all offer more care at a lower price.  You have to value the people, the care team and they will value you. Do not let advertising, and a hospitals saying of "the doctors are not representatives of this hospital excite you.  That is saying they don't accept any risk, responsibility for your care.  That is scary.  Clearly the hospital and insurance company directly impact what those doctors do no matter what the legal small print says.  That is my opinion anyway.  I need you to share your opinions.  Share, comment, like or you are just propagating the status quo. Here are examples of continuity of care that you can choose right now today! You can use these as example of what to look for in any care setting. Tender Loving Care Senior Residence Tender Loving Care Senior Residence, Costa Brava Dr Shawn McGivney

Improving upon “Life and Death in Assisted Living”

"Life and Death in Assisted Living"  is a great article by A.C Thompson  for anyone who is involved in any way in senior care.  It shows with many example why Assisted Living often fails as a care setting.   My comments add hope and practical ways to improve on this unfortunate system that is described in this article. They break it down to four parts and I will share some comments on each part.   Senior care is a service and requires you to know WHO you are getting   much more than the name of the care setting.  All Assisted Living, Senior Care, Health Care, and even Doctors Care are providing the same thing – Care.  You need to know who is providing the care to get the best and most cost effective care possible. The story in this article will always be true.  That is business and advertising will provide a misleading picture that heavily favors getting you to buy and providing as little as the law allows.  That is business and the accepted legal minimum standard of care.   What is also true is Americans are free to choose, vote, and modify how they spend their senior care dollars and use their other social and government resources.  Take the time to read this and you will make time to learn more about your choices! Life and Death in Assisted Living Part 1. “The Emerald City” In part one they build up the growth of Assisted Living as a profit maker for wall street and giant corporations. My added insight when reading this section is to be aware that advertising can say pretty much what it wants.  Many are lured in to business deals, stock scams, with unreasonable promises and Assisted Living, Senior Care, and Health care are no different. Health care, Senior Care and Assisted Living are services and require relationships to get the most caring possible.  Providing an intangible DVD player is not the same as caring for someone. Caring, emotional health and helath care require time, compassion, listening, and ongoing relationships to achieve caring.  Don’t be confused when everyone says “I care” or “We care”  if you don’t know then and they don’t know you at all levels of the care process from Owner, Administrator, down to direct care giver they are likely to care less than those who know you and have on going relationships with you AND YOUR SOCIAL SYSTEM. Everyone wants to make money but if you also require a social and business relationship with the customers you can make profits while providing care.  When the seller and the senior and family as consumers fail to value relationships with the owner, administrator, doctor and direct care team they are missing most of what they are buying. Hopefully after reading this all of us will be better able to search for Senior Care and health care.  Meet and choose the individuals on the care team for the best care and most cost effective care. Life and Death in Assisted Living Part 2  “They’re not treating Mom Well”. This is not unexpected.  Many do not know that Assisted Living has one administrator for up to 150 residents, and three caregivers for 50 – 100 residents who cover a large, multi floor, building.  The three caregivers can’t physically be in more than one place at a time.  If you know the staffing alone in terms of numbers it is impossible to expect anything more than minimal care at any time.  When people move in they usually need less care than they do as they age.  Quickly that becomes evident.  If the staff is letting it slide most seniors and people will down play what they need as well since they want to believe they do not need anything.  Believing you are sick is counterproductive to feeling well so most people just say “I am fine” but the guy next to me ( who looks exactly like them) looks sick”.  That is normal.  The mistake of not planning for the care you will need is the biggest mistake that allows the advertising to mislead people. You can’t blame the Big Assisted Living financial machine from making it sound like you are young, you will stay young, that is what sells.   It is up to all of us to realize that when we need Assisted Living, or any minimal amount of physical assistance we need to start to build LONG LASTING RELATIONSHIPS WITH OUR CARE TEAM AND PROVIDERS.  For example that is not choosing a health insurance where you see a different doctor every day, or a senior care setting that does not follow you in all care settings even if just as a friendly visitor.  Care requires both sides, care team and you,  to value the other side somewhat. Point realize why you are looking for Assistance, Assisted Living and realize they provide very little assistance and have very little ability to provide more assistance when needed.  Meet the individual Administrator, Owner, Medication Techs and care givers and try to decide if they are willing to individually and as a team role their sleeves up and do the work when needed? Part 3 A sinking ship. This section starts to describe the process of aging.  When you first need any small amount of assistance expect to need more assistance. My favorite quote from the movie Patch “If you treat the disease your win or loose but if you treat the person you win no matter what the outcome.”  That last part is the key to understanding what you need and should value when looking for senior care.  No matter what the outcome.  Seniors know they are aging, and that they need more care.  What they want is a team to stand by and provide heart felt insight, hand holding and medical care to improve each day.  There are many low risk interventions that can be modified to each person but it takes time, and a relationship to the person and their social system to provide that.  If the entire care team knows you and your social system you are going to get better value and care in senior care.  Each of us has to value the Care team as individuals and not just as a DVD player where one DVD player is the same as the next.  Each care team is different.  If the care system pays the ceo the big money then understaffs to maximize their profits that might not be the best balance for the senior and family.  It is up to each of us to meet the entire care team before we spend our 4K / mo or 48K / year.  Senior care is expensive and no matter what your price point is by valuing the senior care team and meeting and interacting with the full team you will get better care in all care settings. A second caution is to look carefully at the language of communication and the dedication of the staff to use that common language especially in Memory care, Alzheimer’s Care or Dementia Care Certified homes.  They say in the article “language left her”  This is a big part of dementia care and speaking a persons native language is essential to promote communication, health and wellbeing and to reduce agitation and confusion. Part 4 “Close the back door.” I paraphrase this section.  The front office or business office and management try to encourage / force the staff to keep residents who’s care needs far exceed the staffing.  Since the Ceo, managers, administrators have little personal connection to residents and the families it becomes easier to see it all as widgets and dollars and cents instead of care.  Care requires relationships. We don’t need to give to charity but can do good works right at home for those around us. Visit a friends parents in a Senior Care home, Help as a visitor to a home bound person through church, Visitors are great therapy and are often times better than pills. My own rule from The Tlcsr Blog https://www.tlcsr.com/ The Golden Rule is meet the entire care team in any senior care setting. The article echo’s this view when Rick Grims of The Assisted Living Federation of America Quotes in the margin.  “If you have seen one Assisted Living Facility you have seen one Assisted Living Facility.”  All Assisted Living, Senior Care Settings and Doctor are different since they have very different owners, administrators, and care teams.  You need to meet the owner, Administrator, and entire care team care managers, nurses, doctors, medication techs and direct care givers to start to know and evaluate what or who you are getting at any price. Summary All senior care, health care are expensive but we have many supports we can use.  We need to understand them, support them, and then build upon them.  They are not all government provided but are many social, family things we can each do to be ready for the next extended family crisis that will come. Society, social groups, and expended families always share the burden since this is too big for any one individual.  If you are sick you need help.  That is it.  Fortunately there are many around us at all levels who did not get sick who can help.  The amount and degree of help will vary of course but we need to be socially mindfull that health care and senior care are expensive and that we need to invest in society, our own communities, families and the PEOPLE WHO LIVE AROUND US to best protect ourselves or those we love who live around us. Medicare covers 20-30% of people WHO ARE LESS THAN 65 YRS OLD.  Yes, Medicare could cover any of us at 20, 30 or 40 when we are in a car accident and are disabled.  We all are covered by Medicare disability which is Medicare! Medicaid covers all of us when we lose our job and or are sick, have social issues like a divorce that devastates us and many million other life circumstances.  Do not forget you CANT BUY health care, senior care, medications yourself.  It is too expensive.  While you think you can when push comes to shove you need insurance of some kind.   Also when any one of the extended family including your parents are sick your estate, inheritance and you are directly affected.  These are necessary social programs. Most of all even without any Medicare or Medicaid you have the friends you helped when they were sick.  How many parents of a friend have you visited?  If it is zero trips to the senior care setting to help as a friend those around you might expect/provide the same in return when you or a extended family member are sick.   We all need to make time to care for each other because we can all be sick too.  In some cases sick tomorrow when we are young after an accident or medical event. When choosing any health care or senior care setting plan to pay a little extra to ensure you can keep the individuals in the care setting as you age. Do not accept the sales lady’s promises that “they” will be there to help.  Meet the people who do the work at all levels and not just those that do the bookkeeping or deposit your check.  A continuing care community wil have you change rooms, staff and move many times the most consistent thing is who is depositing your check.  The big institution who does not know you.  You need to know the people who you are hiring from the top down.  In the old days knowing and paying, trusting your doctor was a great start but now with Advantage Medicare we rarely see any doctor who visits us in all settings even if they are not the doctor of record but visits as a friend.  That is a two way street.  If you don’t put forth effort and compensation even token gifts the doctor is less likely to do “extra” uncovered things for you.  That is how service and relationships work.  Divorce, family, and life are social two way streets”. I hope this long article and my comments have given all ideas on how to better look for health care and senior care The article is great to show how bad the situation can be.  My comments show what we can each do right now to affect the care we get and how to get more caring for the same price.  Health care and senior care are expensive but you can do a lot to get more care and value if you meet the owner, administrator and direct care givers you are hiring!!  Do not accept meeting a sales lady, the brochure, or tour. Help us spread the word.  Click for Free Ways to help. https://www.tlcsr.com/free-ways-to-help/ Click for The Best, Most Cost Effective, Assisted Living, Memory Care, Alzheimer’s Care Alternatives. Tender Loving Care Senior Residence http://tlcsr.com Tender Loving Care Senior Residence, Costa Brava Or http://costabrava.tlcsr.com Dr Shawn McGivney https://plus.google.com/110369423724793129269?rel=author

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