Hello, My name is Kim and I am currently a first year nursing student at the University Of Madison. Coincidentally, I am enrolled in a health care class where we are discussing much of the same topics. I am still extremely confused on many of the health care concepts and feel that it would take years for me to learn and understand everything. With the growing number of older adults, long term care needs to be reformed- in my opinion. Below I will tell you why I believe this to be true.
When I first entered into the nursing program , I had this thought that I would be working with middle-aged persons or younger individuals. Much to my surprise, many of my clinical patients are ages 65+. Out of the past 8 months of clinical work, I can only remember maybe 5 or 6 of my patients being younger; and they were still all over 50. We need to realize that within the next decade or so the number of persons over the age 65 will reach almost 70 million (CDC, 2010). Also, it is alarming that the number of qualified professionals in geriatrics is extremely low. There needs to be more individuals educated in order to care for this growing population. I have seen first-hand the number of elderly patients that are admitted into the hospital on a daily basis.
A few weeks ago, one of my patients was a 76 year old man suffering from dementia and severe arthritis. During the day, I was in charge of administering his medication and helping him with his daily functions. His children were there the entire day and were critiquing my work. It was extremely frustrating as a nurse to have these individuals "watching me like a hawk" as I tried to care for him. This situation made me realize how we need a reform in long term care.
I feel that long term care needs to take on a more "home" based setting. Often, the children or close friends know the individual extremely well and have knowledge on how that patient would want to be cared for. Also, agreements between care givers must be made prior so individuals know how to handle certain situations. Another benefit of a more home-based care, is the attention the patient will receive. In a hospital or nursing home setting, it is impossible for the professional to be present 24/7. In a smaller, intimate, and more personal setting the care-giver can be attentive to the needs of the patient.
Lastly, I believe the health reforms this team proposed are accurace, consistent, and much needed in todays health care setting. There needs to be reform within the long term care setting and with proper action, this team could be the first to propose these important ideas.
Thursday, April 15, 2010
Growing up, my parents had medical insurance. I didn’t know any different. So when I was looking for employment as a young adult, finding an employer with medical insurance was a factor because down the road it would be necessary to have good coverage/long-term health care. When I married and had a family, I was the sole carrier of the medical insurance for my family for many years. I have been employed at a healthcare facility for 25 years and I realize times are changing. I am uncertain what long-term care will be available for me and I ask what lies ahead for my children? My parents have been retired for many years now, and continue to live at home independently. They have good healthcare.
I have had a grandmother spend her final years in a long-term health care facility. She was well taken care of and to be very honest, I have no idea what sort of long-term health care coverage she received. I would guess that it was medicare/medicaid. At 93 y/o, grandma suffered a stroke and they transported her to the hospital. It was her wish to have no life prolonging measures performed. So she was transported back to the care center and kept comfortable until her passing. 20 yrs ago, I believed my grandmother received proper long-term care.
Since that time, I’ve had my father-in-law in the same facility. My father-in-law was in his late 50’s and suffered from MS. My mother-in-law had already passed away and my husband was his power of attorney. We attempted to keep my father-in-law at our home for us to take care of, but with the young family we had and the care my father-in-law needed, it just was not possible. The county social worker visited and evaluated my father-in-law and in that very same afternoon, moved him to the care center facility in our town. My father-in-law was self-employed and therefore carried his own health insurance. After my mother-in-laws battle with cancer, my father-in-law was left with a great deal of debt. So any monies he had for his own long-term care was limited. When his own health care coverage ended, and a great deal of paperwork completed, he received Medicaid. I believe that my father-in-law was well taken care of for the less than ideal situation he was dealt in life.
This blog has brought some very interesting proposals. All of which could work for the right individual/situation. We can argue with the guidelines that the insurance companies are dictating for long-term care. But there will never be 100% approval. I believe that everyone’s situation is different; everyone’s expectations are different.
I think Holistic health care is a good thing, but should be covered by long-term health care (chiropractic included). Education on holistic health care would need to improve for individuals to buy into, especially our elderly. Most medical doctors do not believe in Holistic therapy; so many patients won’t buy into it at first. Those that I know who use holistic therapy are those who are looking for a change because current and some times long term medical treatments are no longer working. For instance, I have a friend who has suffered from chronic pain for the last 10 yrs. Her medical doctor has prescribed meds for her pain, and then also offered her anti-depressants because, “Everyone who suffers from chronic pain also has depression.” So after years of masking the pain and treating her for depression never actually diagnosed, she has sought help from a homeopath who is addressing her pain which in turn is alleviating much of her pain and has taken away the antidepressants. Holistic Health care focuses on the entire person’s well-being. Isn’t that one of the most important issues we are looking for in long-term healthcare – everyone’s personal well-being? If this therapy is working, then shouldn’t our healthcare cover those expenses?
My employer does have an affiliation with a long-term healthcare facility in close proximity. Residents of this facility benefit from the closeness to our healthcare institution. Residents have choices regarding their care. They can choose from 1 and 2 bedroom apartment styles for independent living; Home healthcare; assisted-living programs; and on-site skilled nursing care are available when needed. If necessary a medical professional from our institution will make a “house call”. I don’t receive preferential treatment because this facility is associated with my employer (no part of my benefits). Many residents are individuals who have had and continue to live with life-long diagnosis that requires them to be seen frequently at our medical center.
As far as my own long-term healthcare, with the current changes in legislature, it is unclear what I will receive from my employer. I’ve already seen changes in premium payments and coverage. I’ve gone from 100% to 80% and my monthly medical insurance rate has almost doubled. I, like the majority of employees, supplement our retirement with outside plans because we will need more later in life. Many employees who are eligible are retiring this year because they’ve heard the future is not going to be good. At this time there is uncertainty and changes are evident. But will they be for the better or the worse? Who knows, maybe every American will be equal; everyone will receive exactly the same long-term healthcare.
I have had a grandmother spend her final years in a long-term health care facility. She was well taken care of and to be very honest, I have no idea what sort of long-term health care coverage she received. I would guess that it was medicare/medicaid. At 93 y/o, grandma suffered a stroke and they transported her to the hospital. It was her wish to have no life prolonging measures performed. So she was transported back to the care center and kept comfortable until her passing. 20 yrs ago, I believed my grandmother received proper long-term care.
Since that time, I’ve had my father-in-law in the same facility. My father-in-law was in his late 50’s and suffered from MS. My mother-in-law had already passed away and my husband was his power of attorney. We attempted to keep my father-in-law at our home for us to take care of, but with the young family we had and the care my father-in-law needed, it just was not possible. The county social worker visited and evaluated my father-in-law and in that very same afternoon, moved him to the care center facility in our town. My father-in-law was self-employed and therefore carried his own health insurance. After my mother-in-laws battle with cancer, my father-in-law was left with a great deal of debt. So any monies he had for his own long-term care was limited. When his own health care coverage ended, and a great deal of paperwork completed, he received Medicaid. I believe that my father-in-law was well taken care of for the less than ideal situation he was dealt in life.
This blog has brought some very interesting proposals. All of which could work for the right individual/situation. We can argue with the guidelines that the insurance companies are dictating for long-term care. But there will never be 100% approval. I believe that everyone’s situation is different; everyone’s expectations are different.
I think Holistic health care is a good thing, but should be covered by long-term health care (chiropractic included). Education on holistic health care would need to improve for individuals to buy into, especially our elderly. Most medical doctors do not believe in Holistic therapy; so many patients won’t buy into it at first. Those that I know who use holistic therapy are those who are looking for a change because current and some times long term medical treatments are no longer working. For instance, I have a friend who has suffered from chronic pain for the last 10 yrs. Her medical doctor has prescribed meds for her pain, and then also offered her anti-depressants because, “Everyone who suffers from chronic pain also has depression.” So after years of masking the pain and treating her for depression never actually diagnosed, she has sought help from a homeopath who is addressing her pain which in turn is alleviating much of her pain and has taken away the antidepressants. Holistic Health care focuses on the entire person’s well-being. Isn’t that one of the most important issues we are looking for in long-term healthcare – everyone’s personal well-being? If this therapy is working, then shouldn’t our healthcare cover those expenses?
My employer does have an affiliation with a long-term healthcare facility in close proximity. Residents of this facility benefit from the closeness to our healthcare institution. Residents have choices regarding their care. They can choose from 1 and 2 bedroom apartment styles for independent living; Home healthcare; assisted-living programs; and on-site skilled nursing care are available when needed. If necessary a medical professional from our institution will make a “house call”. I don’t receive preferential treatment because this facility is associated with my employer (no part of my benefits). Many residents are individuals who have had and continue to live with life-long diagnosis that requires them to be seen frequently at our medical center.
As far as my own long-term healthcare, with the current changes in legislature, it is unclear what I will receive from my employer. I’ve already seen changes in premium payments and coverage. I’ve gone from 100% to 80% and my monthly medical insurance rate has almost doubled. I, like the majority of employees, supplement our retirement with outside plans because we will need more later in life. Many employees who are eligible are retiring this year because they’ve heard the future is not going to be good. At this time there is uncertainty and changes are evident. But will they be for the better or the worse? Who knows, maybe every American will be equal; everyone will receive exactly the same long-term healthcare.
Monday, April 12, 2010
Patient
I think that long-term health care needs to be made more affordable for everyone involved. Our family of seven grew up on a small farm, so extra money was not plentiful. There was no way to put any money away for a long-term health care situation or afford the insurance one may or may not use. As I recall from my younger years, health insurance was not a priority issue to my family because we did not run to the doctor for a scratch or cough. I don't remember Dad ever saying anything about medical insurance. We got out of the house and worked hard to get exercise and stay in shape to do the farm work. Also, back then medical procedures were a fraction of the cost compared to now.
This was one of several reasons why Mom didn't want to go to a nursing home when she became ill nearly ten years ago. She had visited friends and relatives in nursing homes over the years and had the opportunity to see how they were cared for. After seeing this she had always commented that she would never want to go to a nursing home. In conversations with other people who have patients in long-term care facilities, the patients are put on schedules and have to stick to them whether they like it or not. Everything is dictated as to when and where they have to be.
Fortunately, when Mom was diagnosed with an illness that would eventually take her life, she was able to make decisions about her care up until the last three to four months of her life. She was able to get around most of the time with the aid of a walker but it was still a challenge for her to do some things. Eventually she was down to where she had to use a wheelchair and eventually was confined to a bed set up in her living room. We were able to respect her wishes but it did no come without sacrifices to family and friends.
One thing she did have was a circle of family and friends that were willing to come in and visit with her. They made offers to help her do things around the house, run errands, sit and listen to her, or even entertain her in the privacy of her own home. This allowed her to do things that she wanted to and did not have to be on a schedule to do anything if she did not want to. With the help of her friends, the family was able to get time away to spend time with their own families. I am not saying Mom was a burden to the family, but many personal sacrifices were made to schedules to make things work and that everybody took their turn to help with her care.
Near the end of her life she has spent some time in the hospital which was harder on her because she did not want to be there. There was talk of sending her to a nursing home but Mom said no to this. She wanted to go home. We as a family, had to decide and work out a plan with our family/friends on how to grant her final wishes. When hospice came in to help we were able to get a home health nurse to come in several days a week to help her get breakfast and shower in the morning, and help her freshen up for the day. This service relieved some of the stress on the family and gave them opportunity to get a way for a little while. We simply knew that hospice was a call away if we had questions. I think that they were the most helpful during the long-term care process because they covered everything in detail to make things run smoothly.
Another thing that Mom did during her illness was to visit a chiropractor several times a month, but Medicare and Medicaid only allowed for so many visits to be covered. Her number of treatments exceeded this amount so she worked with the chiropractor to continue her care and not use all her finances to pay for care. This treatment helped relieve some of the symptoms of her medical illness. She was fortunate to live in a small town, where the chiropractor knew her and her circumstances and would help her with her billing to help prevent large bills from being accumulated. Sometimes I feel that living in a small community has some advantages when it comes to health care. One can be a person, not just a number. There are still people that care about the patient and not just the almighty dollar and how much they can collect from insurance companies or even the patient themselves.
It just does not seem fair that the government or insurance companies should be able to tell doctors or nurses how to take care of patients. Each case is unique in it's own way. I feel that it should be left up to the people who know the patient to get the proper treatments. I feel that the government should have less control over how much of the service can be provided to the individual in need, and the doctor should be able to work alongside the insurance company to help the patient to the best of their ability
We can not tell the government how to do their job. Sure we can protest but will they listen to the public? It takes a long time to have a specific government official voted out if we want to see some sort of change. I feel that the health care bill that was just passed may mess more things up than it will help but then who knows. I understand that everyone should have access to affordable health care, whether it is long-term or short-term but why does everything have to be so complicated just to get the coverage that we need? It is bad when the law that is passed is confusing even to the lawyers of the insurance companies! I heard that my employer's insurance company has lawyers working to interpret the current health care reform. I think that the government officials need to make the bill understandable to everyone! There is no reason why they continue to speak at a higher reading level that the average citizen of the United States.
Who is getting screwed? Us as a patient because I can't see the government screwing up, can you?
I feel that the health care reform that was recently passed may be a step in the right direction, but it is not going to solve all of our health care issues. I agree that we need to make health care more affordable, especially when it is coming to the end stages of one's life. I also feel that the patient should not be limited to a certain amount of care. Mom could have been more comfortable in the end of her battle with her illness if her insurance company covered more chiropractor appointments. Take into consideration what the patient really needs, not what you think is best for the patient. EACH PATIENT IS DIFFERENT!
Sunday, April 11, 2010
Guest Author
I'd like to share with you my personal experience with long term health care. I am 49 yrs old. My Mom was in a nursing home for 15 months before her death 2 years ago. She was a healthy 88 yr old when she could no longer live on her own. By healthy, I mean that she didn't have cancer or any other major health issues just those that come with being 88. Prior to going imto nursing home care my Mom lived in a beautiful apartment complex for seniors. She never wanted to go to the nusring home but there just were not enough services available for her to manage on her own. It's very hard to put someone you love in a place that they have asked not to go but the reality was that I worked full-time as did my other sister and Mom needed more help than we could provide on our own. Because of her age it was difficult for her to get around and she had a tendancy to fall. This made even daily tasks long and arduous for her. Showering, cooking, getting groceries, attending social functions and church were difficult and getting ready to attend tired her. I looked for services to assist with her daily living but such services are hard to come by and costly for someone on a limited income. I truly feel that she could have remained in her apartment if we could have found a provider to help her on a regular basis. We did find a grocery store to deliver her groceries but she lost the opportunity to squeeze the fruit, pick out the size and brand and even just get ideas for cooking that comes with shopping yourself. It would have been such a blessing to have somene take her to the store and help her, at her pace, choose her groceries. Personal care was also an area that she needed assistance. Once she fell while in the shower and laid there for six hours before being discovered. This is a traumatic experience for an elderly person. If we could have found someone to come in to help her bathe and clean herself and her things it would have aided in her ability to live independently. The place she lived did provide a noon meal, but the food was institutional and bland and frankly, she hated it. All of this forced our hand at placing her in nursing home care, against her wishes.
When we interviewed the nursing home where she moved we asked a lot of questions. They presented the facilities in a different light than what we actually experienced. First, they put her in a wheel chair right away. She went there walking on her own and within a week she was hardly walking at all. I understand that this has to do with safety concerns; they were concerned about her falling but I also think that it simplifies things like getting the tenents to and from meals and around the facility. It also seemed to keep her in her room more. Next, they prescribed medication for her, one of which was an anti-depressant. My Mom had never really taken meds and these prescriptions threw her into turmoil. It wasn't easy getting them to stop giving the medication but they finally agreed. Another thing they boasted in our pre-placement interview were the social activities that were offered daily. What they didn't tell us was that if they asked her to come and she said "No" they would just go on to the next patient. My Mom was so new there and afraid. I wished they would have talked with her and encouraged her more to participate. Instead she sat in her room more and more. In the end my Mom was in her room alone, day after day, after day. She stopped eating in the lunch room, stopped going for strolls in the halls and just basically stopped living. Shortly after she went there five friends and I took six pre-made Bloody Mary's to her room to have a short social time with her. We had discuss alcohol before he was admitted and told them that she enjoyed an ocassional Bloody Mary. When we got there my Mom was so excited to see us and eager to have her cocktail. As we started to enjoy ourselves a Nurse came in and very rudely and loudly kicked us out. My Mom was so confused about why this was happening. I remember the look on her face as I took the drink out of her hand and told her that we had to leave. My heart was broken that this place that we had move her wasn't like her home at all, but rather, it was an institution. I think that long term care needs to be a place that is more like home. I don't understand why all the rules change and that what the elderly want is not available. I wish that there were senior apartments that provided a safe, homey place and still offered services like grocery shopping, self-care, cleaning, social activities and a place that the residents could be proud of and feel like they were able to function on their own. I don't know if I would do anything different with my Mom, because I know that during that time I was doing the best I could for her. But I do know that more services need to be available to allow people to stay in their homes and I pray that I never have to go to a nursing home myself.
When we interviewed the nursing home where she moved we asked a lot of questions. They presented the facilities in a different light than what we actually experienced. First, they put her in a wheel chair right away. She went there walking on her own and within a week she was hardly walking at all. I understand that this has to do with safety concerns; they were concerned about her falling but I also think that it simplifies things like getting the tenents to and from meals and around the facility. It also seemed to keep her in her room more. Next, they prescribed medication for her, one of which was an anti-depressant. My Mom had never really taken meds and these prescriptions threw her into turmoil. It wasn't easy getting them to stop giving the medication but they finally agreed. Another thing they boasted in our pre-placement interview were the social activities that were offered daily. What they didn't tell us was that if they asked her to come and she said "No" they would just go on to the next patient. My Mom was so new there and afraid. I wished they would have talked with her and encouraged her more to participate. Instead she sat in her room more and more. In the end my Mom was in her room alone, day after day, after day. She stopped eating in the lunch room, stopped going for strolls in the halls and just basically stopped living. Shortly after she went there five friends and I took six pre-made Bloody Mary's to her room to have a short social time with her. We had discuss alcohol before he was admitted and told them that she enjoyed an ocassional Bloody Mary. When we got there my Mom was so excited to see us and eager to have her cocktail. As we started to enjoy ourselves a Nurse came in and very rudely and loudly kicked us out. My Mom was so confused about why this was happening. I remember the look on her face as I took the drink out of her hand and told her that we had to leave. My heart was broken that this place that we had move her wasn't like her home at all, but rather, it was an institution. I think that long term care needs to be a place that is more like home. I don't understand why all the rules change and that what the elderly want is not available. I wish that there were senior apartments that provided a safe, homey place and still offered services like grocery shopping, self-care, cleaning, social activities and a place that the residents could be proud of and feel like they were able to function on their own. I don't know if I would do anything different with my Mom, because I know that during that time I was doing the best I could for her. But I do know that more services need to be available to allow people to stay in their homes and I pray that I never have to go to a nursing home myself.
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