Tagged: President

May 17, 2013

Helping Chicago’s Chinese American senior community

Many Chinese American seniors in Chicago suffer psychological distress, physical limitations and financial hardships, according to The Pine Report, a new study about the health and well-being of older adults.

Image: Wikimedia Commons — Image: China Town, Chicago via Wikimedia Commons

The Chinese American Service League, a nonprofit providing in-home aid and day services to more than 900 Chicago seniors, partnered with Rush University Medical Center for the report. From 2010 to 2013, researchers conducted face-to-face interviews with more than 3,000 seniors between 60 to 105 years old.

“Seniors are our biggest focus,” said CASL President Bernarda Wong, who helped form the organization 34 years ago with her friend and colleague, Esther Wong.

More than 75 percent of the community served at the CASL speaks and reads Chinese only at home, according to the report. Another 20 percent prefers Chinese. The league devotes resources to new immigrants who do not understand English. ”Sometimes the elderly come in with federal documents and mail they cannot understand, so we help them,” said Bernarda Wong.

More than half of the community’s seniors suffer from one or more limitations to carrying out instrumental activities of daily life, such as managing money, preparing meals or housework. ”We train volunteers to do household chores and go into the homes of the seniors” Bernarda Wong said. About two-thirds of the seniors served suffer from more than one chronic illness.

But despite the league’s vast assistance to thousands of Chinese Americans, many of them still sidestep discussions about end of life and advance care planning, said Debra Chow, an elderly service social worker with the nonprofit’s in-home care services. “It is too taboo for them. End of life is something very scary to all of us.”

“That is not a topic that we have touched on a large scale,” Bernarda Wong said, although noting the growing need for such discussions. “We are eager to work with Life Matters Media, to plan a seminar and allow our clients to ask questions and soak in information,” Chow said.

“Many seniors do not want to bother their families, so they keep it to themselves,” Bernarda Wong said.

Vermont votes to allow “Death with Dignity”

The Vermont House approved a measure allowing physicians the ability to prescribe life-ending medications to some terminally ill patients seeking to end their lives. Vermont is set to become the fourth state allowing the legislation known as ”Death with Dignity,” following Oregon, Washington and Montana.

The Patient Choice and Control at End of Life Act awaits approval from Gov. Peter Shumlin, a Democrat and supporter of the bill.

“By a 75-65 roll call vote, the House approved a bill largely that copies a law passed by Oregon voters in 1997 for three years and then shifts to a system with less government monitoring,” The Associated Press reports.

This marks the first time this type of legislation has been moved to passage by a legislature. With safeguards similar to the Oregon bill, patients seeking the prescription barbiturates must first state their intentions three times- once in writing. A second opinion from a physician indicating a patient has less than six months to live and proof of sanity, are mandatory. Patients must wait 48 hours before filling the prescriptions.

“It’s an important step for terminally ill Vermont patients,” Dick Walters, president of Patient Choices-Vermont, said after the vote. “It’s a big step forward for the region and for the country as a whole,” the AP reports.

Come 2016, changes advocated by some of the state senators seeking less government involvement during the process will go into effect, including less monitoring from physicians.

“It’s huge,” said lobbyist Michael Sirotkin, who for years has been involved with the issue in Vermont. “I think it’s going to have a major effect on other states’ willingness to vote on this,” he told USA Today.

But not all lawmakers approved of the bill’s passage. ”There can never be a dignified death using a handful of pills or a lethal cocktail,” said Rep. Carolyn Branagan, a Republican from Georgia, VT.

Other opponents were concerned about the radical changes the bill underwent while in the Senate. ”We are passing a bill that has not been vetted,” said Rep. Paul Poirier, an Independent from Barre. “Do we want to pass a bill … just accepting 100 percent what the Senate did overnight?”

The lack of advance care planning persists

Although more affordable senior care services are emerging as the U.S. population continues to age, most still do not plan for end of life care, as The Associated Press’ Matthew Perrone reports.

“Nobody wants to go to a nursing home, it’s the last resort,” James Firman, president of the National Council on Aging, told the AP. “People want to stay in their own home, and if they can’t, they want to go to a place where they can get assistance but that still feels homelike.”

Nursing homes continue to be the most intensive and expensive form of long-term care, which often includes 24-hour medical supervision, the AP reports. The average cost of a semi-private room in 2011 was $81,000, according to a survey by MetLife. A private room can cost more than $90,000, as the average daily rate for a private room in a nursing home rose more than 4 percent in 2011.

Most seniors will not require extended nursing home care. However, Medicare does not cover less intensive care options, such as in-home help with meals and chores.

“The issue is that these are long-term costs and almost all of it comes out of pocket,” said John Migliaccio, director of research for Metlife’s Mature Market Institute. “It’s important to have some idea about what it will cost dad, mom or your husband to get the care they need.” Only some 5 percent of adults have long-term care insurance to help pay for these services. Some policies can cost $8,000 a year.

The National Association for Professional Geriatric Care Managers recommends families discuss long-term care options early on, before a medical emergency.

“Advance care planning is a dynamic process that evolves over time as a person’s health goes from well, to ill, to ultimately terminal,” LMM co-founder Mary F. Mulcahy, M.D., wrote for The Huffington Post. “Medical advances have led to few cures of illness, have prolonged the experience of living with chronic illness and have prolonged the process of dying.”

In 2000 there were more than 35 million Americans 65 and older. By 2030, there will be 72 million. According to the Georgetown University Public Policy Institute, almost 10 million seniors currently rely on others for daily care.

Learn more from the Life Matters Media Newswire:

Vermont Statehouse votes “Death with Dignity”

Dying at home may be more difficult than expected

Some doctors still believe in psychedelic drugs

January 24, 2013

“Consider the Conversation”: A discussion at Fourth Presbyterian Church

The acclaimed “Consider the Conversation: A Documentary on a Taboo Subject” was screened at Fourth Presbyterian Church in Chicago on Wednesday, in collaboration with the Chicago End-of-Life Care Coalition.

Directed by longtime friends Terry Kaldhusdal, a fourth grade teacher and filmmaker, and Michael Bernhagen, a hospice advocate, the film showcases interviews with health care professionals, religious leaders and the terminally ill in order to explain the importance of having the freedom to choose one’s end of life preferences. It also highlights the moral dilemmas surrounding the hastening of death, such as stopping eating and drinking, for those suffering and the artificial prolonging of life.

Loretta Downs, the CECC president, thanked the audience for being brave enough to watch such an emotionally evocative film. “Now we are living for years with chronic illnesses that before would have killed us. We think that we will never die, but we are required to talk about end of life,” said Downs, who is also featured in the documentary. “The film has inspired many people to have these conversations.”

The audience seemed to enjoy the film and engaged in a lively conversation afterwards. “I thought it was excellent, said Susan Thompson, 75. “It emphasized being natural in the most difficult moments of death and life.”

Downs acts out planning an advance care directive after film — Downs acts out planning an advance care directive with her colleague Daryl Isenberg, Ph.D., after the film for audience

Laura Pond, 54, said she did not like the film’s stance on hastened death. “I found it difficult to watch because I have a chronic illness and I thought people in the film were giving up,” she said. “You do not give up. It is not God’s plan.”

Marty Preiss, 60, said she found the film both compelling and engaging. She is planning a similar event for a screening at her church in Chicago’s northern suburbs.

The film has also been well received by health care professionals. “I have never recommended a film on the end of life before. But people deserve to see “Consider the Conversation” because it deepens our passion for life and enriches our lives,” wrote Compassion and Choices’ Barbara Coombs Lee.

“Consider the Conversation” has won multiple awards, including the Award of Excellence in End-of-Life Care from Agrace HospiceCare and the Silver Award of Excellence: Best Documentary or News Special from the Milwaukee Press Club.

Part two: “Consider the Conversation: A Documentary About Unintended Consequences” will be released early next year.

Learn more from the Life Matters Media Newswire:

Psychological responses to end of life

The Breakers offers advice for caring for elderly parents

December 22, 2012

Hospitals fear Medicare cuts

With “fiscal cliff” negotiations stalling and entitlement cuts and changes pending in Congress, some hospitals fear they’ll be left to fill in gaps left by Medicare cuts. Both President Obama and House Republicans have proposed raising Medicare premiums and savings of at least $400 billion over 10 years.

The New York Times reports: “[T]here is already discussion of cutting special payments to teaching hospitals and small rural hospitals. Lawmakers are also considering reducing payments to hospitals for certain outpatient services that can be performed at lower cost in doctors’ offices,” although final details may not be worked out until next year.

Hospitals already face $155 billion in cuts over a decade as part of the Affordable Care Act, they now must deal with the prospect of losing billions more, the Times reports.

Some hospital executives and provider groups argue large cuts will affect beneficiaries- especially seniors and the poor. “There is no such thing as a cut to a provider that isn’t a cut to a beneficiary,” said Dr. Steven M. Safyer, the chief executive of Montefiore Medical Center.

“It is not particularly honest to say that provider payment reductions won’t affect beneficiaries. They’ll affect staffing, they’ll affect services, they’ll affect access,” Rich Umbdenstock, president of the American Hospital Association, told the Wall Street Journal. ”The cost of care does not go away.”

Illinois’ News-Gazette reports hospital executives already tightening up spending as much as possible to get ready for cuts on the way- either the 2 percent across-the-board sequester or possible debt deal. But they can’t plan for everything, they say.

“It’s hard to know what to be concerned about,” said Craig Sheagren, vice president of finance at Sarah Bush Lincoln Health Center, Mattoon Ill. “It’s kind of like crying, ‘The sky is falling. The sky is falling.’ ”

If no meaningful legislation passes to extend the federal debt limit, Medicare payments to hospitals and doctors will suffer deep cuts anyway, although much less than the current proposals of the President and Speaker Boehner, an estimated $123 billion from 2013 to 2021; doctors will face a 26.5 percent cut in their Medicare fees.

Learn more from the Life Matters Media Newswire:

Obesity and end of life: Weight affects care

More Latinas need advance care plans, a new study reveals

December 7, 2012

POLST Illinois moves forward

The Physician Orders for Life-Sustaining Treatment (POLST) program, designed to improve the quality of end of life care, is on its way to Illinois. Health care professionals met at Rush University Medical Center Thursday to discuss the form’s development and strategies for raising public awareness.

The Chicago End-of-Life Care Coalition sponsored the discussion led by Julie Goldstein, M.D., a clinical ethicist and palliative care physician at Advocate Illinois Masonic Medical Center.

POLST program forms are more detailed than conventional living wills or other advance directives. They allow patients to indicate preferences regarding resuscitation, intubation, intravenous antibiotics and feeding tubes. Such forms are intended for patients in their last year of life, and they can follow patients across in-state care settings and direct doctors to provide or withhold life saving treatment in emergency situations.

For instance, an individual may choose to decline resuscitation efforts, but of for artificial nutrition. An individual may choose artificial nutrition with set limits or permanent placement.

“POLST improves on the existing uniform DNR form,” said Goldstein. “POLSTs are medical orders and have to be followed by all medical care providers.” To be valid, a POLST form must be signed by an attending physician.

Loretta Downs, president of the CECC, told LMM that POLST is essentially about enhancing personal liberty at end of life. “For Illinois, accepting the POLST form is a statement encouraging people to take advantage of their liberty regarding end of life decisions. It empowers the individual to make a clear statement about whether or not he or she wants end of life care and what level of treatments.”

The POLST form will be available in early 2013, a version of the IDPH DNR Uniform Advance Directive. Goldstein said it will be most similar to the California POLST. The final form awaits approval from state health officials and it may be “ultra pink.”

Many in attendance left hopeful that the form would help their patients. Kriston Kurelic, a social worker at Passages Hospice, says she is excited about the form’s implementation. “I’m very interested in the changes that will happen,” Kurelic said. “It will be very beneficial to long-term care. It will be beneficial to patients and families.”

Christine Nelson, director of nursing at Manor Care, agrees. “I think anything that helps us assess what people’s wishes are more clearly is helpful,” she said. “The only barrier I see is time being taken to explain the form to patients.”

The task of educating patients will likely fall on individual health care providers. Because it is a physician order, it is intended to be accompanied by a meaningful doctor-patient dialogue. Carol Blendowski, a Rainbow Hospice nurse practitioner, says time is what is required to have such conversations, but thinks patients will ultimately find the POLST easy to navigate. “I can see clearly now,” she said. “This form is user friendly.”

POLST was developed in Oregon in the 1990s, and now 15 states have POLST programs. Twenty-eight states are considering the use of POLST forms.

Learn more from the Life Matters Media Newswire:

What is palliative, hospice care?

POLSTs work, says Respecting Choices’ Bernard Hammes

August 30, 2012

Some doctors still believe in psychedelic drugs

Psychedelic drugs could prove beneficial to terminally ill patients suffering from anxiety and depression. The New York Times’ Lauren Slater outlines researchers’ optimism that such drugs can allay fears of death and dying. Psychedelics are undoubtedly controversial. The stain of the 1960s experimental phase remains with many American physicians, but some believe the drugs can help.

It’s been fifty years since many doctors became enamored with the drugs, known for causing hallucinations and vivid sensory experiences. The use of such psychedelics as LSD was skyrocketing. Slater writes how “psychedelics were embraced by many and used in a host of controversial studies, most famously the psilocybin project run by Timothy Leary.” President Richard Nixon called Leary “the most dangerous man in America.”

Researchers like Charles Grob, psychiatrist at Harbor-U.C.L.A. Medical Center, believe that drugs should be reconsidered as treatment options. Grob believes that a mystery remains surrounding drugs’ effectiveness against anxiety. “I don’t really have altogether a definitive answer as to why the drug eases the fear of death, but we do know that from time immemorial individuals who have transformative spiritual experiences come to a very different view of themselves and the world around them and thus are able to handle their own deaths differently.”

Psychedelic researcher Oliver Sacks recounts his own tumultuous relationship with the drugs for The New Yorker, describing his abuse of LSD and morning-glory seeds- and their inherent appeal.

He writes: “Many of us find Wordsworthian ‘intimations of immortality’ in nature, art, creative thinking, or religion; some people can reach transcendent states through meditation or similar trance-inducing techniques, or through prayer and spiritual exercises. But drugs offer a shortcut; they promise transcendence on demand. These shortcuts are possible because certain chemicals can directly stimulate complex brain functions.”

The transcendence would eventually help 55 year-old Pam Sakuda with her cancer diagnosis. “Shortly after having a tumor removed from her colon, she heard the doctor’s dreaded words: Stage 4; metastatic. Sakuda was given 6 to 14 months to live. Determined to slow her disease’s insidious course, she ran several miles every day, even during her grueling treatment regimens. By nature upbeat, articulate and dignified, Sakuda — who died in November 2006, outlasting everyone’s expectations by living for four years — was alarmed when anxiety and depression came to claim her after she passed the 14-month mark, her days darkening as she grew closer to her biological demise,” writes Leary.

She would take treatment from Grob. “As her fears intensified, Sakuda learned of a study being conducted by Charles Grob. . . who was administering psilocybin — an active component of magic mushrooms — to end-stage cancer patients to see if it could reduce their fear of death.”

Sakuda is quoted as saying, “I started to cry. . . . Everything was concentrated and came welling up and then . . . it started to dissipate, and I started to look at it differently. . . . I began to realize that all of this negative fear and guilt was such a hindrance . . . to making the most of and enjoying the healthy time that I’m having,” after the drugs.

“We may seek, too, a relaxing of inhibitions that makes it easier to bond with each other, or transports that make our consciousness of time and mortality easier to bear,” writes Sacks. Sakuda may have experienced her mortality in a different way, which was unique to her.

Researcher David Nutt, professor of neuropsychopharmacology at Imperial College London, told The Guardian: “Psychedelics change the brain in, perhaps, the most profound way of any drug, at least in terms of understanding consciousness and connectivity. Therefore we should be doing a lot more of this research.”

Learn more about psychedelics at NPR

Men help women with Alzheimer’s

With women at higher risk of Alzheimer’s or dementia, men are stepping up and taking care. USA Today’s feature on John and Mary Ann Becklenberg is a heartwarming example of resourcefulness. Since Mary Ann was diagnosed with Alzheimer’s six years ago, her husband John has devoted his life to helping her. The couple, both 68, has been married 42 years. Alzheimer’s is irreversible and worsens with time, usually making victims forget family, friends and daily functions.

Today’s Janice Lloyd writes: “Women are still more likely to be caregivers, but the number of men caring for loved ones with Alzheimer’s or dementia has soared from 19% to 40% in the past 15 years, according to the Alzheimer’s Association. Among people over age 65 with the disease, about two-thirds are women (3.4 million), one-third men (1.8 million).”

It is not easy for anyone to become a full-time caregiver for a patient suffering from mental disease, especially a man. According to Beth Kallmyer, spokeswoman for the Alzheimer’s Association, “One of the problems with Alzheimer’s is it can go on for such a long time,” she says in the feature. “While everyone deals with it in their own way, male caregivers can sometimes find it harder to ask for help than women.”

“Males try to fix stuff,” says John. “We get out in front of ourselves a little bit too much. But by doing this instead, I ease her anxiety. I think it’s helped her in the long run. It’s also helped us both keep our integrity, and that’s important in a relationship.”

Gail Hunt, president of the National Alliance for Caregiving, is quoted in the feature: “Unlike other illnesses, like cancer, with Alzheimer’s in the later stages, the family member doesn’t know who you are. And that’s really devastating to families.”

August 12, 2012

Some choose assisted suicide

According to a recent feature in The New York Times: “Dr. Richard Wesley has amyotrophic lateral sclerosis, the incurable disease that lays waste to muscles while leaving the mind intact. He lives with the knowledge that an untimely death is chasing him down, but takes solace in knowing that he can decide exactly when, where and how he will die.” Dr. Richards is based in Washington, which has the Death With Dignity Act.

Katie Hafner’s feature probes the issue of “Right to Die.” She notes critics of the law’s morality, some of whom feel the poor will be unjustly persuaded to die early for financial reasons. Ironically, Hafner notes: “Dr. Wesley is emblematic of those who have taken advantage of the law. They are overwhelmingly white, well educated and financially comfortable.”

The law is similar to what Massachusetts will vote on this fall. According to Hafner: “Two physicians must confirm that a patient has six months or less to live. And the request for the drugs must be made twice, 15 days apart, before they are handed out. They must be self-administered, which creates a special challenge for people with A.L.S.”

Some doctors, such as former president of the Massachusetts Medical Society, Dr. Barbara Rockett, oppose assisted death. “We as physicians must avoid the so-called slippery slope of attempting to save money by doing less for our patients rather than rendering the proper care to them. To substitute physician-assisted suicide for care represents an abandonment of the patient by the physician,” she wrote for Boston.

There is support for the Massachusetts law. Hafner quotes Stephen Crawford of Dignity 2012, “Support isn’t just from progressive Democrats, but conservatives, too.”According to Crawford: “It’s even a libertarian issue. The thinking is the government or my doctor won’t control my final days.”

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this: