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Question of Month

Big Business First to Benefit From Obama Care! Is Obama a Closet Republican?

SURPRISE, BIG BENEFITS FOR BUSINESSES IN AFFORDABLE CARE, OR OBAMA CARE! Who knew --a four way win.  Big Business, Part time and uninsured American’s, Hospitals and Doctors and Society all win!  Winner 1-Businesses save on benefits and workers comp.  Read this Bloomberg article on how Home Depot is using Obama care to get care for their part time workers and saving millions in the process Winner 2 -The part time and uninsured workers get care and care that can stay with them even if they have several part time jobs and move around.  That is essential in the process of health care to see the same care team who can know you, your social system, and emotional health better than any new doctor or care team even if they have your old chart on the first visit; first, visits are first visits with or without a chart.  Yes, first visit with a chart is better than nothing but is that really the comparison we want to make? Winner 3- Hospitals and Doctors benefit from not having to “eat” or write off the many uninsured, no pay claims, they get.  Winner 4- Society benefits in we can say we are really doing something for the 80% of Americans who work, make less than $20 / hr and support their fantastic families.  If we as a society can’t care enough to do a little like helping families and the people who do the work the rest of us “Administrator types”, “Managers”, and higher earners should be ashamed.  Also note, the first big benefit is to save businesses millions and keep their work forces healthy on the government costs.  Health care and workers comp expenses should decline and business profits should continue to rise.  Of note, Home Depot Stock rose 1.5 % today as Home Depot announced taking advantage of Obama care to cuts its costs and boost profits. Read more from Bloomberg News about how Home Depot is taking advantage of Obama Care and the Affordable care act!  Home Depot is moving 20, 000 part time employees off of their benefits and onto Affordable Care. Better for home depot workers to have a consistent helath care that stays with them in any job and BETTER FOR HOME DEPOT to save money on benefits.  Win-win.  Oh, also better for society to ensure hospitals and doctors get paid instead of relying on hospitals and doctors to “eat” the many no pay claims from uninsured people.     How does this affect seniors? All seniors have extended families and those families need to be healthy to help the seniors who came before them and this is a small step to providing that care.  Caregivers low paid, in families, senior family members who assume child care or senior care responsibilities are valuable to society’s function and building families and this helps them. The main benefit in my view to Obama-care is not preexisting coverage or covering the few who never had coverage but helping the many who have coverage to be sure they can have continuity of care and coverage.  If your insurance changes often you lose the most cost effective part of care, staying with one doctor for a long time. If you can’t do that the many in kind services that having a long standing doctor patient relationship provide will be lost and unnecessary duplicative services will continue.  Of course, I am happy to cover all too but I feel the benefits to all current insurance holders, hospitals, doctors, big businesses are undervalued and described.  Value Continuity of Care and not continuity of your chart. I have to say the effort to build a chart is VERY MISLEADING! DO NOT LET ANYONE SAY OR IMPLY YOU ARE YOUR CHART. Caring for the chart is not providing complete medical care or continuity of care.  Continuity of the chart is not continuity of care, the care team, individuals involved in the care.  Without continuity of the people, patients and care team, care, caring, and quality of care suffers.  You, society, get less value for their health care dollars.  Strive to know your doctor, value your doctor, and build a relationship as small local communities or groups with your doctor to get the best care and most cost effective care. A new doctor visit with any new doctor is not as good by far as seeing a doctor who knows you and whom you know.  Even if a “new” doctor has your chart that is a far cry from seeing the same doctor.  The chart is a very incomplete, partial, representative of who any of us are as individuals and people.  While it is a great way to reach the minimum legal standard of care for the system do not accept the minimum legal standard of care for you and your loved ones.  Value the doctor, one or a small group of doctors, in your community.  Please consider how you trust any new person and then how they trust you?  Trust is earned and is not reflected in the chart. Obama care is a small step in that direction for continuity of care. Shawn McGivney Like, Share, comment if you agree!

High Tech or High Touch to Age in Place?

High Tech or High Touch to Age in Place? Will Video chat and online telecommunications really make it possible? When I read the NYT article Choices Give New Meaning to “home Sweet Home” http://www.nytimes.com/2013/09/10/business/retirementspecial/choices-give-new-meaning-to-home-sweet-home.html?pagewanted=all&_r=2& My first reaction was they are missing the main points of what is needed in Senior Care and Aging in Place .  Seniors need interpersonal, human, contact and the emotional and social connection that brings.     Seniors generally miss the lack of social contact, lack of being needed, even if it is needed just as a companion and co TV watcher.  Somehow I don’t see an  I-pad screen sitting next to you and watching your TV in your home with you will replace the feeling and idle chit chat having a real person in the chair next to you offers. While video conferencing will undoubtedly be a tool it more reasonably will be a tool a new breed of old fashioned, primary care doctors who accept the role of being a full time Doctor and the responsibility of making all the medical decisions.   They will visit the house, know your family and social system and then can use these tools to support that direct, personal, attention all people need. If you build on the care team idea and continuity of care with ONE DOCTOR who does home visits, sees you in your own home regularly, and then add in some outside Home Care, a Back up video monitoring option that can succeed. While the programs and ideas we have known and used for decades, simple home modifications, and meals on wheels do give hope to those who are at home they will not begin to replace what they really need which is a doctor supervised home care team where the doctor visits, knows the senior and the seniors entire family. In the picture of the NYT article it looks like the two granddaughters and their mother all are very involved in the care of their grandmother.  If you have the human staff, then of course staying home is possible now!  The point I do not want you to miss is no technology will replace what senior’s need which is care and care from the same, consistent, care team.  If that is your own family and family are at home and not working then of course that works.  Even then you will do best with a Doctor and back up care system of known doctors and caregivers who you have an interest in and who in turn have an interest in you. Seeing a new doctor, new caregiver, is always the same no matter what their training.  That is a new interpersonal contact and as a new interpersonal contact their can only be the care and caring two people share on the first hand shake and no more.  No one just feels safe when meeting any stranger and the stranger also takes time to earn trust from you.  That is how relationships and caring that comes from a relationship develop.  I do not see technology replacing that any time soon. Technology is good, if the Senior is able to interface with it and does not have ANY cognitive decline but that is exactly why all seniors need home care, they can’t do it for themselves due to physical and or cognitive decline in function.  If they can use the technology then they don’t need it.  Moreover, if they can do it now when they age more this technology only plan will fail. If the senior has used video chat in the past of course then they might be better able to use it now.  Most have not and are two or three decades removed from that technology. Finally, communication skills will vary, language, and social customs and maybe most importantly understanding the fine print of your insurance.  What is covered and what is not will always require a care giver and generally younger person to sort out for most seniors What is needed is Coordination of Care from the top down.  You need a doctor you really can call your own.   Instead of looking for video conferencing one might look for care settings like Tender Loving Care Senior Residence Tender Loving Care Senior Residence, Costa Brava Where they offer continuity of care, complete with a relationship you can count on as you age.  They too use email and internet but we use it to help the family remain connected to the parent.  We know families all want to have the physical plant, staffing, skills and time to be able to care for their parents but often time s they do not have all of those resources.   We have staff sit with residents to email the families to help the FAMILIES feel connected and less guilty that they can’t do more. When it comes to providing human services Technology is only as good at the Individuals and the relationship they have to expand that relationship.  If you text a stranger you will be less inspired than if a known friend texts you and shares the same idle chit chat.  If you don’t know your doctor or are meeting a new doctor 3-4 times a year it is likely those will be “first dates” with the trust and caring that goes with a first date as opposed to trust that is earned through a relationship. Value the direct care team and you will get the best care and best value for your Senior Care Dollars. Disclaimer. I am a doctor who offers old fashioned primary care in a residential care home and know all of the patients and families by their first names. Dr Shawn McGivney Share, Like, Comment on this article to help us continue this exciting discussion.  

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