Health and Disability

The passage of the Affordable Care Act (ACA) in 2009 marked another discernible leap forward. While the idea of consumer involvement in implementation of legislation was not a new one, two of the ACA's new platforms, the Patient-Centered Outcomes Research Institute (PCORI) and the Partnership for Patients, led to a sea change in the interaction of patients with hospitals, researchers, and other health care groups.(30,31) As PCORI sought to include patients in all aspects of research and the Partnership for Patients promoted patient involvement in driving down harm in hospitals, patients and patient groups found themselves being actively courted by organizations whose ear they had had trouble getting not long before. The principles of family-centered care have now gained wide acceptance, and in some hospitals patients have been placed on key committees throughout the institution—a move with transformative potential if purposefully done. Concurrently, the move toward accountable care organizations and community-based care has led to greater emphasis on provider collaboration with ethnically diverse and vulnerable populations on an outpatient basis.

This amounts to a great deal of change. Yet in many ways it is much less change than we would wish. In spite of much forward motion over the years, it is clear that many major patient safety problems have remained depressingly constant, and that gains in some areas have been offset by setbacks in others. One area that has seen significant advances is public reporting of quality data, at a federal level (Hospital Compare), in some states (hospital-acquired infection and sentinel events), and by private entities like Consumer Reports and The Leapfrog Group. Even so, raters have been constrained by the compartmentalized nature of publicly available data. This situation has the potential to change considerably with the availability of more granular "big data" like the recently released Medicare Part B Supplier Billing and Payment Data, but we are still far from meeting the goals of the earliest consumer advocates of providing information that will drive truly informed consumer choices.(32)

About a quarter reported having a "great deal" of stress (26%) over just the past month. People in poor health are more than twice as likely as the public as a whole to report a great deal of stress in the past month (60%).

People who are disabled are also much more likely to report a great deal of stress (45%). Other groups likely to report a great deal of stress include those with a chronic illness (36%), those with low incomes (<$20K) (36%), those who face potentially dangerous situations in their jobs (36%), single parents (35%), and parents of teens (34%).

Significant impact on lives

Bad effects on emotional well-being (63%) are the most common health effect reported by those with a great deal of stress in the last month, followed by problems with sleep (56%) and difficulty in thinking, concentrating, or making decisions (50%). About half of those with a great deal of stress as well as a chronic illness or disability say stress made the symptoms worse (53%) or made it harder for them to manage their chronic illness or disability (52%).

I’ll discuss what we can do to protect ourselves, our families, and our decisions in the face of incapacity. Creating an estate plan and finding inclusive care are two key components.

Estate planning is crucial, and not just to designate who receives which assets after death. It’s also about choosing people to act on your behalf for financial and medical decisions, and stating what your wishes are. For LGBT people whose families don’t neatly fit into a legal box or whose biological family members may be unwelcoming, this planning is even more vital.

A solid estate plan should include the following documents:

Now the thing about care plans put together by nurses, therapist and social workers is that they always contain lots of goals, but it’s never about anything fun or interesting. It's never about anything that's good for the soul. Getting blotto drug and waking up in a tattoo parlor in Reno is never a goal on these care plans

Other states have looked to Connecticut’s example and are considering similar nursing homes of their own. Kentucky is considering opening a private nursing home for geriatric prisoners. Georgia has also proposed opening a private nursing home for those with a criminal record. But critics of that plan note that it would be run by a private prison companywhose owner has overseen many of the state’s executions.

There’s an obvious incentive to such programs: if prisons move inmates out of their medical wards and into a non-correctional nursing home, they can get the federal government to pay for their care through Medicaid reimbursements rather than coming out of state coffers.

Alzheimers is a disease with seven stages. They don’t happen sharply or over a specified period of time, everyone is different and everyone’s progression may be different.

One of the symptoms of Alzheimers is dementia. As you’ll see from this list, the final 3 stages are the symptoms of dementia. Though other diseases cause dementia, the cause is most often Alzheimers.

THE SEVEN STAGES OF ALZHEIMER’S

Stage 1 - NO SYMPTOMS OF ALZHEIMER’S ARE SEEN.

Stage 2 - FORGETFULNESS: Very mild cognitive decline. For example, problems such as: vagueness of where familiar objects are, complaints about not remembering well, forgetting names once well known. There is however, no loss of abilities in social interactions or in employment situations.

And more.......

Certain barriers to communication do exist for older adults in long-term care situations, a critical realization for any professional serving in the long-term care industry.  Vision and hearing loss are challenges, as are cognitive changes such as reduced processing speed and working memory.

Stroke and Parkinson’s disease also make communication a challenge for older adults.  Plus, the very fact that the residents had to move from their homes and away from significant others who served as communication partners poses barriers to their effective communication with caregivers in their new communities.

Overcoming Barriers

• Person-Centered Care – Health care providers should take the time to learn about residents’ backgrounds, history, and family.  Families can aid in this process by providing recorded autobiographies, memory boxes, and photo displays.
• Ignoring Talk – Include the residents in discussions about their care, to make them feel valued and appreciated.
• Intergenerational Communication – Care staff may have ageist views and stereotypes of older adults that result in modified communication with them, and the resulting elderspeak has negative effects on the residents.  Caregivers should refrain from using intimate terms of endearment, asking closed questions and suggesting correct answers, and substituting “we” for “I.”
• And many more......