Tag Archives: senior living

Safe Harbor-Lesson in Assisted Living

Mom and Step mom were human.  The X- Wife, Susan Sarandon, was jealous of the younger, new wife, Julia Roberts, but in the end when her breast cancer was progressing, the mom, Susan Sarandon, wanted the best for everyone even her X husband, her kids and her rival the Step Mom, Julia Roberts.   That is the power of people, caring, and relationships.  That power is invaluable and hard to quantify in Dollars.  Look for that and you will get the best value for you Senior Care dollars.

Saw the movie Safe Harbor and wanted to share my Senior Moment http://tlcsr.com/blog-Assisted Living-Happy-seniors The Safe Harbor is another creative way to show that even when one is dead.  The Mother who guided the new wife to help her husband and kids still has value.  I see the similar values to families, society and seniors as they age.  Images of what was, is and can be continue to be powerful influences to families and society.  I know no simple dollar formula for love, hope, trust, feeling needed, wanted, productive and valued.  Likewise defining “safety” is hard for most seniors to swallow since the social worker, family, or individual defining “safety” for the senior often times is focused more on financial, legal, or physical safety than on emotional well-being, continuity of care and relationship building. I see families faced with aging, loss as individuals who are aging and families who are losing large parts of who they are. In losing a senior, but in all cases they want to help each other. Seniors know they are aging and they just want to be known, remembered, and to help if they can.

Feelings are the end point of all process.  Pain hurts less when you are holding your own new born or a grandchild.  The sum of all pains, pills, and Emotional and social therapies including continuity of care and relationship building is part of the treatment.  Complex and powerful therapies, and feelings like hope, trust, belief, faith, belonging, parenthood, creation, choice and empowered to choose, take time and social relationships to achieve.  Seniors and all of us know helping can mean getting others to provide the care so the Family can visit, email and carry on.  Pain and life have large emotional elements that doctors cannot study.  Indeed, few studies add in emotional health and wellbeing since you can’t “study” or quantify it and it varies so much person to person and day to day.  However, that does not mean we don’t value those things.  Indeed, those are the things we buy based on even if we do not know we are. http://tlcsr.com/blog-Assisted-Living-Senor-safehousehttp://tlcsr.com/blog-Assisted Living-change

http://tlcsr.com/blog-Assisted Living-seniors If you want to be “Safe”, have a “Safe Hospital Discharge”, “Safe transition to any Senior Care Setting” look for individuals, people, and care teams with continuity of care.

Sub segmented systems based on business organizational flow sheets and financial payment models pale in comparison to Continuity of Care and Relationship building to make someone feel safe.  To feel safe you have to know and trust the individuals who provide the day to day care and who the problem solves or manager are.  They have to know your social system and visa a versa.  You have to respect what they do and value it also.   Then you can hope to feel safer in a process of transitioning to a senior care setting.

Aging and even dying are not bad they are expected.  What is bad is not having a care setting with caring and a relationship to allow physical care to be transcended to Family-style care we all want.

Two quotes from Patch Adams of the Movie, Patch, that show Caring is more than care.

  1.         Treat the most devastating problem of all indifference or apathy.
  2.        If you treat the disease you win or lose but if you treat the person you win no matter what the outcome.

http://tlcsr.com/blog-Assisted Living Grandkids To me, even if you die, that is not as much of a loss if they had someone who was there, caring, respecting, all that that person has done and continues to do for the family.  That sets a social and family example of valuing people and not just disposing of them which helps each of us in the family, caregivers and all the people surrounding the senior.  I care for my dad and he helps me every day by giving me some space to work.  Yes, he comes in but he then let’s me finish work and that is helping.

http://tlcsr.com/blog-Assisted Living grandparents

Seniors who can find a safe haven or care setting with caring and continuity of care can help their social system and continue to enjoy family life.

Look for Continuity of care in any care setting Assisted Living, Home Care, Hospice Care, Residential Care, Dementia Care, and Alzheimer’s Care, Memory care, Respite Care, Elder Care, Nursing Home Care and any Senior Care setting.  Meet the entire care team and you can find caring with the physical care that all promise you.

Help us spread the word. Click for Free Ways to help. Click for The Best, Most Cost Effective, Assisted Living and Senior Care Alternatives. By Shawn McGivney

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/

Check Out This Facebook Tutorial.

Special Topics and Article Reviews. In launching our Facebook page we came across essential reading for all who use Facebook. Privacy and unintended sharing has devastating consequences to the user, you, and the person you are posting about when that information is read by an unintended person. This free Facebook tutorial is very easy to use, complete, and interactive.  As an educator I was impressed and wanted to share it to all.  While we want everyone to “like” our FB page,   http://www.facebook.com/TenderLovingCareSeniorResidence   We want everyone to protect themselves and the others they are posting about http://www.gcflearnfree.org/facebook101   Seniors in all care settings need to be stimulated to goout, do what they can and learn.  Indeed, Learning and activity are the best treatment for Dementia Care, Memory Care and Alzheimer’s Care.  Seek Assisted Living and Senior Living Care settings where the staff and management will work with you to do joint activities at your speed.   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/  

Myths and Misconceptions – Initial Post

Myths and Misconceptions: We provide unique views and insight to topics that you would otherwise not get. In addition, to more detailed discussions of topics on the free blog we cover two additional strings that help the reader interface and apply the theory we discuss on the free blog. Those two sections are Myths and miss conceptions and Case manager corner. Myths and misconceptions. Myths and miss conceptions is about alerting and educating you to be cautious on how you hear and understand many of the terms used in health care. Misleading words might include “Assisted Living”, “Normal”, or Needed and “Not Needed”. A second, set of misleading items are numbers like we pay 80% or even 100%. Sign up now to learn why in some cases you may not want the one that pays 100%. For example, many may not realize how something as simple as mis understanding the definition of “Assisted Living” might affect your decision of which care setting is best for you. We help you see beyond the mere definition of “Assisted Living” which will mean different things to each person when you quantify what you get, from whom, at what time and at what dollar cost. The facility offering the amount, degree and type of assistance might not value or define the amount, degree, type, or timing of the “Assistance” as you do. We help residents and families see beyond the words to help them better access and compare types of assistance. Through discussion with families, other members, we help members reevaluate what they think they need, want, and is available to them when making this difficult choice. We emphasize high quality care requires a relationship with the people providing the care. We believe continuity of care is a necessity to each resident and family valuing the Assistance as high quality assistance. The more continuity of care the better the resident will feel about the care. We feel that by considering continuity of care, the care you get will be of higher quality and more of the care we think people expect when they define the word “Assistance”. If you just learn how the doctor, insurance company, lawyers, advertisers and others define the same words you use you will be more informed when you hear them. Words and phrases like “You must leave or you must go to a nursing home may not mean “must” if you decide to choose something else. We want to help everyone see choices that they may be passing up today.   These Medical myths and misconceptions are common in all care settings including Assisted Living, Residential Care Homes, Hospice Care, Home Care, Dementia Care, Alzheimer’s Care, Memory Care, Nursing Home Care, Elder Care, Respite Care and Adult Day Care.  Knowing what you and the other person mean when they use a term helps you understand what both of you will expect. 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/