And remember wash your hands and if you are sick try to stay home! 

When you do contract the flu, there are antivirals drugs you can take.  While they don’t make the flu go away, the drugs will shorten the duration and severity of the flu. However, the antiviral drugs will only work if they are taken within the first two days and you do need a script to get them, they are not over the counter.  So if you think you have the flu, call the doctor asap!

For more information go to the CDC website:Click here: CDC – Seasonal Influenza (Flu) – CDC Says Take 3 Actions

The following is the list of preventive services now covered by insurance without out of pocket expense.  The list is taken directly from the government’s website.  For more information click over to http://healthcare.gov 

Preventive Services Covered under the Affordable Care Act

If you have a new health insurance plan or insurance policy beginning on or after September 23, 2010, the following  preventive services must be covered without you having to pay a copayment or coinsurance or meet your deductible, when these services are delivered by a network provider.

Covered Preventive Services for Adults

·         Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked

·         Alcohol Misuse screening and counseling

·         Aspirin use for men and women of certain ages

·         Blood Pressure screening for all adults

·         Cholesterol screening for adults of certain ages or at higher risk

·         Colorectal Cancer screening for adults over 50

·         Depression screening for adults

·         Type 2 Diabetes screening for adults with high blood pressure

·         Diet counseling for adults at higher risk for chronic disease

·         HIV screening for all adults at higher risk

·         Immunization vaccines for adults–doses, recommended ages, and recommended populations vary:

o    Hepatitis A

o    Hepatitis B

o    Herpes Zoster

o    Human Papillomavirus

o    Influenza

o    Measles, Mumps, Rubella

o    Meningococcal

o    Pneumococcal

o    Tetanus, Diphtheria, Pertussis

o    Varicella

·         Obesity screening and counseling for all adults

·         Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk

·         Tobacco Use screening for all adults and cessation interventions for tobacco users

·         Syphilis screening for all adults at higher risk

Covered Preventive Services for Women, Including Pregnant Women

·         Anemia screening on a routine basis for pregnant women

·         Bacteriuria urinary tract or other infection screening for pregnant women

·         BRCA counseling about genetic testing for women at higher risk

·         Breast Cancer Mammography screenings every 1 to 2 years for women over 40

·         Breast Cancer Chemoprevention counseling for women at higher risk

·         Breast Feeding interventions to support and promote breast feeding

·         Cervical Cancer screening for sexually active women

·         Chlamydia Infection screening for younger women and other women at higher risk

·         Folic Acid supplements for women who may become pregnant

·         Gonorrhea screening for all women at higher risk

·         Hepatitis B screening for pregnant women at their first prenatal visit

·         Osteoporosis screening for women over age 60 depending on risk factors

·         Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk

·         Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users

·         Syphilis screening for all pregnant women or other women at increased risk

Covered Preventive Services for Children

·         Alcohol and Drug Use assessments for adolescents

·         Autism screening for children at 18 and 24 months

·         Behavioral assessments for children of all ages

·         Cervical Dysplasia screening for sexually active females

·         Congenital Hypothyroidism screening for newborns

·         Developmental screening for children under age 3, and surveillance throughout childhood

·         Dyslipidemia screening for children at higher risk of lipid disorders

·         Fluoride Chemoprevention supplements for children without fluoride in their water source

·         Gonorrhea preventive medication for the eyes of all newborns

·         Hearing screening for all newborns

·         Height, Weight and Body Mass Index measurements for children

·         Hematocrit or Hemoglobin screening for children

·         Hemoglobinopathies or sickle cell screening for newborns

·         HIV screening for adolescents at higher risk

·         Immunization vaccines for children from birth to age 18 —doses, recommended ages, and recommended populations vary:

o    Diphtheria, Tetanus, Pertussis

o    Haemophilus influenzae type b

o    Hepatitis A

o    Hepatitis B

o    Human Papillomavirus

o    Inactivated Poliovirus

o    Influenza

o    Measles, Mumps, Rubella

o    Meningococcal

o    Pneumococcal

o    Rotavirus

o    Varicella

·         Iron supplements for children ages 6 to 12 months at risk for anemia

·         Lead screening for children at risk of exposure

·         Medical History for all children throughout development

·         Obesity screening and counseling

·         Oral Health risk assessment for young children

·         Phenylketonuria (PKU) screening for this genetic disorder in newborns

·         Sexually Transmitted Infection (STI) prevention counseling for adolescents at higher risk

·         Tuberculin testing for children at higher risk of tuberculosis

·         Vision screening for all children

Learn more detailed information on these preventive services.

A federal government Website managed by the U.S. Department of Health & Human Services
200 Independence Avenue, S.W. – Washington, D.C. 20201

The argument is that because many procedures are so complex; the patient may not understand all of her options. Or the patient may just be so overwhelmed by the diagnosis and prognosis; she is unable to sort through all of the information to come to a clear understanding of the options available to her. These are valid observations. However, that does not excuse or relinquish the responsibility of the physician to gain informed consent from the patient. Just as important, informed consent needs to go beyond the procedure, informed consent needs to encompass all the outcomes that may happen as a result of the procedure. Informed consent should be an ongoing process; it doesn’t always end after the initial procedure.

Recent research has also shown that while physicians believed their patients have understood and grasped the information they had discussed, in reality the patients had not. Why is this? Perhaps it is the physician talking in “medical-eze”, perhaps it is information overload, perhaps the patient is too distressed and overwhelmed to hear and comprehend what is being said. Regardless of the reason, it is imperative the patient has the resources to give informed consent.

Once again, this is where the Patient Advocate comes in. Every patient needs to have someone by their side, advocating for them, when they are making medical decisions. The patient needs an advocate who can help them sort through the medical muddle and the fog of apprehension and fear. The essence of informed consent is the informed part. The Patient Advocate ensures the patient understands the diagnosis and prognosis, the benefits and consequences and all of the options available. This gives the patient the freedom to choose which medical choice is best for her, allowing her to give clear informed consent. Always have an advocate, don’t navigate the healthcare system alone.

Here’s an example that happened to me last week. I ended up in the ER with an elderly client. We went through his medical history and shared the fact that he was allergic to penicillin. The admitting nurse noted the allergy in his chart and then proceeded to put a big red bracelet that said allergies in bold letters on his wrist. I thought it was noticeable, the patient thought it was noticeable, but apparently  the doc?  To him, not so noticable. He must have missed it in the chart as well! Long story short, the nurse comes in with the IV antibiotic and I remind her he is allergic to penicillin. In her surprise she responded “how allergic?” After I picked my jaw up from the floor, I told the nurse that today wasn’t the day we were going to find out. They ALL missed the bracelet. The bracelet with BIG BOLD LETTERS! Always ask always question, NEVER navigate the health care system alone!

For more information about patient safety in July click over to Trisha Torrey’s MSNBC interview yesterday. 
  http://ow.ly/2doGG    ctrl+click to follow link.

Things will fall through the cracks. Hopefully they will be just small things, but small things can sometimes snowball into big things. This can be troublesome, especially when it comes to communication and coordination of care. In order to minimize anxiety, issues and problems, have a plan.

Make sure whoever is acting as your advocate visits the facility on a regular basis, at least every other week. They should meet with both your loved one and the staff. There should be weekly check-ins with the caregivers, either by phone or email. When the caregivers know the resident has family or others involved with her/his care, they will be both appreciative and attentive.

Make sure you have a file or notebook that contains any information needed if your loved one has to see a doctor or go to the ER.
This information should include contact information for you and your local advocate, the patient’s insurance information and a copy of the card, his/her medical history, current list of medications (this should be updated on a weekly basis) and any health directives. This information should be with the facility, the resident, the advocate and you.
I would also include a signed HIPPA release form, the last thing you need during a trip to the ER, is to have HIPPA used to block medical information. I am not tech savvy enough to attach the HIPPA form here, but I can send it by email if needed, just leave a comment below. Don’t navigate the healthcare or senior care system alone!

Kiley

Happy Memorial Day!  Just a quick post, a little out of the norm, for all of you who adore your pets!

There was a recent article in the health section of the Times, in Tara Parker-Pope’s blog, one of my favorites, which addressed disaster pet planning.  http://nyt.ms/c6Y5Is.com  Check it out, it’s a great resource for pet lovers and hurricane season starts Tuesday. It also reminded me that advocates must also advocate for their pets, a lesson I learned the hard way.

This time last year, my dog Kiley started to act unusual, she was lethargic, stopped eating and was occasionally vomiting.  Obviously I was concerned, so I brought her to the vet. I wanted to have her seen immediately; therefore I took the first appointment available. That appointment was with a young vet who was new to the practice.

 I explained Kiley’s symptoms and told him I thought she had something wrong with her stomach, because her breath really smelled bad.  He examined her, ran labs, and announced her breath was stinky “because she had barfed all over herself.” I found that unusual because she is a fastidious dog and I believed it was her breath, not her coat that smelled. He then prescribed some meds and told me to give them to her for a week and if that didn’t work, he would then do an x-ray, to see if there was an obstruction in her stomach.  Again, I’m silently questioning, wondering why aren’t they doing the x-ray now?  However, I’m new to dogs and figured the vet knows best. Even though it made no sense to me, an x-ray is the simplest and cheapest way to make a diagnosis. What a mistake, I should have been advocating for my dog!

At 3:30 I woke up to Kiley violently shaking, with her stomach rock hard.   She was in such tremendous pain, she cried when I touched her tummy. It was absolutely horrible. After a few frantic phone calls, I ended up barreling down back roads, driving through fog and dodging deer, on my way to an animal hospital.  I had never been to this hospital; the only thing I knew about it was that it was open and the closest animal hospital to me.  At the hospital I finally opened my mouth and told them to skip the blood work and go right for the x-ray.  She did indeed have an obstruction.  One surgery, a major infection, three thousand dollars and much angst later, she was better. The lesson is always act on your instincts.  Always act and always advocate!

Healthcare today is getting more complicated by the minute.  Different aspects of healthcare have become more fragmented, with different specialists for different diagnoses. Primary care doctors are overwhelmed with paperwork and short on time. Then you throw in the insurance issues, what is covered, what is not, who is in network, who is not.  Will home health be covered, long term care or rehabilitation?  Is the doctor in network, does the anesthesiologist even accept insurance?  No joke, I actually know someone who had major surgery and found out afterwards, (when they sent her a $5000.00 bill) that her anesthesiologists did not take any insurance. AT ALL! Despite the fact that the procedure had been pre-certified.  Amazing!!!  There are so many issues and obstacles to overcome in this maze we call our healthcare system. 

Patient advocacy is a fairly new field begun in response to the rapidly changing health care landscape.   Independent Patient Advocates work for the patient, not the doctor or hospital, but we can help both the doctor and the hospital by helping the patient become informed.

The Patient Advocate supports and empowers the patient and their families.  They make sure the patient is aware of all the options available to them, they research disease and illness, they assist in obtaining physicians and homecare…nurses and home health aides, physical therapist and occupational therapists.  Patient Advocates research and facilitate short and long term care options and rehabilitation.

The concept of patient advocacy focuses on patient and family centered care.  That means the priority in  healthcare are the needs of the patient and their family.  All aspects of care from physicians, nurses, therapist, social worker, etc as well as the medical facility administration, work in a concentric circle with the patient at the center. The Patient Advocate is the one who drives this bus, coordinating all the various activities and ensuring the patient’s needs are fully met.  The Patient Advocate, also known as a Healthcare Advocate, coordinates the care between the different healthcare providers and facilitates communication across the medical continuum.

Why would you need a Patient Advocate?

There are many hats Patient Advocates wear. I will cover different aspects in each blog.  We’ll start with the initial diagnosis of illness.

Everyone at some point gets sick.  Some people get very sick.  Anyone familiar with a new diagnosis knows it can be overwhelming.  You leave the doctor’s office with your head spinning and only later do you wish you had asked a question.  Or, you don’t quite remember exactly what was said, because there was so much information coming at you all at once.   With a Patient Advocate, you come prepared with the list of questions that need to be asked.  The Patient Advocate listens, clarifies, probes and follows up giving you the ability to make informed decisions about treatment.  

Patient Advocates research disease and specialists and make sure you understand all of your medical options.  A patient can only give informed consent when they have the tools to make educated decisions.   Our healthcare system is complex and confusing.  Being newly diagnosed with an illness can be overwhelming and scary. Grappling with the stress of illness is difficult enough. Don’t navigate the healthcare system alone.