Archive for December, 2010

Obama Returns to End-of-Life Plan, blames ol’ Bush… (NYT,WSJ)

San Jose Care Resource Guide: So Obama is after Grandma again (Ok, maybe Great-Grandma).

Quoting the New York Times:

“…When a proposal to encourage end-of-life planning touched off a political storm over “death panels,” Democrats dropped it from legislation to overhaul the health care system. But the Obama administration will achieve the same goal by regulation, starting Jan. 1…”

Hey, we have the bully pulpit: If we can’t get it voted in, let us decree !

“…Under the new policy, outlined in a Medicare regulation, the government will pay doctors who advise patients on options for end-of-life care, which may include advance directives to forgo aggressive life-sustaining treatment…”

Question is:  Why does  the Obama administration want to take the risk of substantial fallout? For the possible Medicare savings, so that it continue catering to pet constituencies?

Answer:  Maybe, but more like social engineering and liberal credo  above all and   ”Damn the torpedoes” !

 Quoting the Wall Street Journal    (Dec,27,2010):

“…The new Medicare rule, issued Dec. 3, is less specific. It says advance-care planning includes a discussion of setting up an advance directive that would tell doctors what to do if the patient is too ill to make medical decisions…”

“… It [the White House] said the George W. Bush administration had already put in place guidelines allowing for Medicare to pay for end-of-life consultations….”      So, Obama tries to blame President Bush for this shameful attempt at pressuring the eldely and/or very sick to call it quits. Facts are a little bit different.  Quoting the WSJ’s article  again:

“…Corrections & Amplifications :
Congress passed a law making changes to Medicare in 2008 by overriding President George W. Bush’s veto. A previous version of this [WSJ] article incorrectly said Mr. Bush signed the legislation…”     Ooops! 

Let us now imagine the Dialogue Doctor and sick elderly. It would go something like this:

Medicare Doctor: Good morning Ms Jane Doe! How are we this morning?

Sick Elderly: Oh not so good: I feel weak and in pain.

Medicare Doctor:  Well, Jane, I afraid it is not go going to get better. Probably worse….

Sick Elderly:  What can you do for me?

Medicare Doctor: Jane there is this [expensive] chemotherapy , but the side effects will be hard. More [expensive] surgery is possible, but there are no promises that you will feel better, in fact probably worse….

Sick Elderly: But I will see my grand kids for a little longer….

Medicare Doctor: You might not be able to enjoy them through the coming pain…In fact it might be a traumatizing sight for them.

Sick Elderly: Really, I did not think of that….

Medicare Doctor: I am authorized to let you know we can help you part with dignity and less pain. Think of it…

Was the Sick Elderly lied to?  Probably not.  Was she led to believe it is OK to end a life softly and at will?  Probably so. You see, folks, it boils down to your philosophy: In a G-dless world were life is just an accident of nature, euthanasia  or the killing softly of the very sick could make sense to a lot of people. To a lot of  people turning their back on the Bible that is…..

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Possible causes of high blood sugar or hyperglycemia, besides Diabetes.

San Jose Care Resource Guide: “Wrong Diagnosis” is actually a website disseminating medical news. It’s post about possible  hyperglycemia (High Blood Sugar)  has actually a very long and varied list of causes, aside for diabetes.  Click Here for link.

San Jose Care Resource Guide: So if the reason is not diabetes, one could be in for  a  wait before the cause is found….

Talk to your Doctor

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Innovative Day-Care Program Seeks To Keep Frail, Low-Income Seniors In Their Homes

San Jose Care Resource Guide: From  Patricia Grace , (Aging with Grace)  this link to a Kaiser Health News/washington post   article on the  Adult Care Program PACE,  was brought to our attention.

San Jose Care Resource Guide:  This article by KHN underlines the efforts of the PACE program.What is PACE?  A government-subsidized day-care program for adults. Quoting the article:

“…One of PACE’s biggest boosters is Donald Berwick, a physician who heads the federal Centers for Medicare and Medicaid Services, or CMS, which oversees the PACE sites….”

Most important question: What are the income ceiling requirement to be eligible for a PACE program: Click Here for the requirement :

“..To be eligible for PACE, a single person’s income must be $14,500 or less; a couple’s income must be $17,000 or less.”

However,  Another blurb for the PACE program has a slightly different take on the elegibility issue:

“…Does PACE serve only the low-income elderly population? There is no income eligibility for participating in PACE. However, most current PACE participants have lowincomes and are eligible for Medicaid. In many states PACE originally was developed specifically to serve adual-eligible population. Participants not eligible for Medicaid pay that portion of the capitation privately. Long term care insurance, if available, also may pay all or a portion of this premium..”

That “portion of capitation”  could be very large!   As always, the US middle class is ignored, and left to their grief….. In our two careers family structure, cases where elderly parents and other family members require low level  daytime caregiving can present a substantial amount of stress to their relatives. Nevermind the risk to the elderly…chances are if the family or the elderly are above minimum wage/poverty level incomes, this beautiful PACE program could be a myth…

Life at the window: at least he's safe....

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Planning Your Estate to Care for a Disabled Family Member (brainline)

San Jose Care Resource Guide:

Planning the unthinkable, here is a youtube/brainline video by Michael Kaplen, ESQ, about planning the support of your cared one if something were to happen to you. Bravo to brainnline.org for putting that kind of info video on the net!

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Diabetes: Foot Care Vigilance Is a Must!

SJCRG: This article from French hospitals (sciencedirect) about  diabetic foot infections is not good news:

Quoting: “..In spite of being managed at specialized centres that were, in general, following the agreed-upon published guidelines, the prognosis for diabetic foot infection remains poor, with a high rate (48%) of lower-limb amputation”

Caregivers and Care recipients must be vigilant and react quickly: Better waste a doctor’s visit than being sorry..

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Care Charge Abuse is Real : How to Protect your Loved One (Warning:Graphic Video)

San Jose Care Resource Guide:

Here is a YouTube video by wbal, a Baltimore TV station. The  video shows  a hired caregiver abusing an elderly. Warning: This might be too much for some folks.  Even though it is painful/infuriating to watch, the need for background checks and serious inquiry will be burned into your memory, so watch it and remember!

Caregiver interviewing techniques

• For  a list of must ask questions during the interview
  • click here for the hiring process described at caregiverneeded
• If nobody relative is going to be around during the caregiving activities, a background check is in order
  • The law on background checks: ca.gov
  • an info.com list of companies involved in caregiver background checks
  • an info.com list of criminal background check companies

After the your due diligence...

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Caregiving Skills For Dementia (Lippincott’s Nursing Center)

San Jose Care Resource Guide:  This is a very rich article from the Lipingcott’s Nursing Center on dementia in its various forms. Essentially a class  for nurses , but family caregivers will benefit immensely from the information. Click Here for link

San Jose Care Resource Guide: Here are some of the  topics

• COMMON TYPES OF DEMENTIA
•  NURSING CARE MODELS (Techniques for interaction with a person afflicted with Dementia)
• INTERVENTIONS ( What can be done to improve the situation)
  • Illustrative examples of cases and what was done
  • Responses to specific dementia issues such as
    •  agitation
    • withdrwal
    • apathy

One of the best article we have seen in a long time!

Dementia Caregiving: Poor Skills=Frustration + Depression!

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Caregiving: Lifting Patients from Beds (SafetyInstruction.com)

DisaHealth:    Caregiving is not just a labor of Love, it is also a skill. Here is a YouTube video from SafetyInstruction giving a class about bed transfer safety

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FDA and Compounded Drugs

SJCRG:  Heard abound  drugs “compounded” by your pharmacist? They are custom made drug combinations made a MD’s orders.

Here is an interesting FDA video about such compounds

Seems that the pharmacy’s credentials are key and that the MD is taking on a lot of responsability. But sometimes there are not too many choices.

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Tetraplegia and paraplegia: “A guide for physiotherapists” Must Read Book By Ida Bromley

San Jose Care Resource Guide: This book looks full of important information on maintaining or improving the health of tetra or para people. Whether you give care to one or you are a paraplegic yourself.

Just look at the Table of content:

“….1. Spinal Cord Injury 2. Physiological Effects and Their Initial Management 3. Patient-Centred Practice 4. The Acute Lesion 5. Respiratory Therapy 6. Pressure – Effects and Prevention 7. Initial Physical Re-Education 8. Personal Independence 9. The Bio-Mechanical Principles Used in Transferring 10. Basic Functional Movements 11. Wheelchairs and Wheelchair Management 12. Transfers 13. Gait Training 14. Ultra-High Lesions 15. The Incomplete Spinal Lesion 16. Spinal Cord Injury in Children 17. Ageing with Spinal Cord Injury 18. Complications 19. Sport in Rehabilitation Appendix 1. Standard Neurological Classification of Spinal Cord Injury Appendix 2. Functional Independence Measure (FIM) Appendix 3. Spinal Cord Independence Measure Appendix 4. Major Segmental Innervation of the Muscles of the Upper Limb Appendix 5. Major segmental innervation of the muscles of the lower limb. Appendix 6. Functional Independence Appendix 7. Segmental Innervation of the Skin Appendix 8. Useful Addresses and Equipment Suppliers….” (from Ebay)

Does not replace the physical therapist, but sure has pointers!

Pumping it (WWRC)

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