In this first blog entry, I'd like to introduce myself and to outline my ideas and goals for this blog. I welcome you to jump in any time with requests, questions, or suggestions. You can contact me at firstname.lastname@example.org.
About Jeanne M. Hannah
I've been practicing law since 1985. I was a late bloomer, graduating from law school at the age of 45. [You do the math! This explains, in part, my interest in aging!] I have focused in the area of family law for about 20 years. This means that in my law practice, I deal primarily with issues of divorce and child custody, support, property distribution, neglect and abuse of children, and simple estate planning. At the present time, my law practice comprises about 50% of my working life. Research and writing takes up much of the rest of my work week, along with some significant time that is devoted to the design and search engine optimization of websites for myself and for others.
Aging & Health and Well-being
A major focus of this blog will be issues dealing with the health and well-being of seniors. In order for you to evaluate the reliability of the information I plan to share with you, you'll want to know why, when, where, how, and from whom I have drawn this information.
Why & When
In September 2000, I became a family caregiver, together with my sisters Betsy and Jill, for a very brief period of time. When my mother died in November 2000, just 65 days after contracting a simple urinary tract infection, I felt compelled to understand how things could have gone so wrong in so short a time.
This led to a two-year period during which I spent all of my time researching the medical problems that had overtaken her, piling one atop another, leading to her death from complete systemic failure and "toxic encephalopathy." That latter term essentially means that a cause of death was brain death that had resulted from her medications building up in her body because her kidneys were unable to eliminate them.
In the end, I could not put what I'd learned in a drawer and forget about it. The information I'd gathered is just far too important. If I'd known in September 2000 what I now know, I have no doubt that my mother would have lived far longer, with a far greater quality of life. Her death was tragic and very preventable. Therefore, the end result of my research is a recently published book titled Taking Charge: Good Medical Care for the Elderly and How to Get It. Taking Charge teaches the elderly and their family caregivers how to detect six common potentially fatal medical complications affecting the elderly; how to communicate their observations to medical caregivers and to advocate for prompt, accurate diagnosis and treatment; and most important, how to work with medical professionals to develop prevention strategies since all of these complications are preventable.
Where & How
My research was primarily begun on the Internet. Initially, I used PubMedâ€”the National Library of Medicine which is accessed at http://www.ncbi.nlm.nih.gov/. This database allowed me to use the same type of keyword searches I'd learned to do in legal research in order to find medical journal articles dealing with topics I felt were important to an understanding of what had caused my mother's death. Once I found articles I wanted to read, I ordered copies from Munson Healthcare's medical library and also from the NMC library's interlibrary loan service. Later I also found medical journals that were available to read without charge online and I found continuing medical education seminars that I was able to “attend."
Along the way, I was fortunate (and brash) enough to make contact with some of the foremost doctors in this country, many of whom became strong mentors for my project. The first of these was Dr. Joseph H. Friedman, MD. Dr. Friedman is a Clinical Professor of Neurology at Brown University Medical School. He is also the Director of NeuroHealth Parkinson's Disease and Movement Disorders Center in Warwick, Rhode Island and the Editor in Chief of Medicine and Health, Rhode Island, the state's medical journal. I contacted him early on with questions about a particular medication given to my motherâ€”a Parkinson's patient. I was seeking answers to questions unanswered in a medical journal article he had written about PD and this medication. He is a born teacher, and as a result, a true mentorship began. Never did 24 hours go by between the time I'd send Dr. Friedman a question via email and my receipt of a detailed explanation from him.
Dr. Friedman ultimately became my co-author for Taking Charge, and in the first chapter, he explains the reason why it's so difficult for seniors to get good medical careâ€”primarily the difficulty of attracting doctors to the field of geriatrics because of the low reimbursements from Medicare and Medicaid. Another reason is that the low reimbursements often mean that the elderly cannot receive enough of a doctor's time for an adequate review of complex concurrent chronic conditions and/or an adequate review of the multiple medications used to treat these conditions, often prescribed by another doctor. Because medical students are not attracted to the field of geriatrics, there is a general lack of training in geriatrics among the doctors who traditionally provide care to the elderly. This is a problem that the medical community is now striving to resolve since the Baby Boomer generation is in such dire need of geriatric care. I am eager to share with you what I've learned about some innovative programs that are funded by various foundations to improve medical training and to improve the quality of care provided to the elderly.
Other significant mentors who fostered my research, who read my early manuscripts, and whose support and interest in my project made Taking Charge a reality include Dr. Wendy S. Harpham, MD, FACP. Wendy is an internist and the author of 5 books about cancer, most recently Happiness in a Storm: Facing Illness and Embracing Life as a Healthy Survivor. I owe an enormous debt of gratitude to Wendy for her incredible mentoring. Taking Charge would not exist but for her enthusiasm and encouragement.
Joel Shuster, PharmD, BDPP, Clinical Professor of Pharmacy at Temple University School of Pharmacy in Philadelphia and Trustee of the Institute for Safe Medication Practices gave me valuable insight into the safe use of medications, read the two chapters on medication errors and adverse medication reactions, and encouraged me over the long haul. Dr. Mark Beers, at the time Editor-in-Chief of the Merck Manual and the Merck Manual of Geriatricsâ€”who with his colleagues is responsible for the research that forms the basis for the government's oversight of safe medication use among elderly patients, inspired me with his advocacy and was generous with his time, answering many questions about safe medication practices.
Aging in Place: Health & Well-being
Some of the topics about which I'll write in this blog will thus be medical issues. I want to tell my readers what I've learned about these six common, potentially fatal, preventable conditions that affect the elderly:
2) Medication Errors
3) Adverse Drug Reactions
6) Protein-energy Malnutrition
My message will be one of enlightenment and empowerment. I want to encourage you to take an active role in your own healthcare if you're a senior and to take an active role in your loved one's healthcare if you are a family caregiver. My goal is to convince you that you don't need medical training in order to be a valuable member of the medical caregiving team. I want to encourage you to develop the knowledge and confidence to become an effective member of the caregiving team since you are the one who can provide the most important component in that medical care: continuity of care. You are the one who spends the most time with the patient to be able to see the onset of complications. Becoming an effective advocate is essential. Don’t be a pain in the neck; do be a helpful and resourceful team player.
I'll also write about end-of-life issues and some of the local resources you have at your fingertips in this community to help you deal effectively with these often difficult issues.
I'd like you to keep this acronym in mind:
C – Continuity of care
O – Observations communicated to doctors and nurses
P – Prevention plans developed with the help of doctors and nurses
E – Empowerment — the confidence to know that you can advocate for yourself and your loved ones
Aging in Place: How You, as a Family Caregiver, Can Increase your Loved One's Well-Being in a Nursing Home
The same financial problems that impact training of doctors, nurses, pharmacists, and medical care providers across the board impact nursing homes as well. Levels of reimbursement are so low that most nursing homes are understaffed. Moreover, most of the hands-on care in a nursing home falls to CENAsâ€”competency evaluated nursing assistants. CENAs have minimal training. Their work is difficult, not always rewarding, and they are at the low end of the pay scale. Turnover of CENAs in many nursing homes is nearly 100% per year. You can imagine what this does to continuity of care!
I'll be writing about some of the things you can do as a family caregiver to increase your loved one's safety, well-being, and quality of life if he or she lives in a nursing home.
Aging in Place: Alternatives to Nursing Home Care
I am enthusiastic whenever I learn of a new innovative alternative to nursing home care. Recently, several new ideas have come to my attention. I'm a newspaper junkieâ€”have been ever since college in the early 60s! Right now, I'm reading several newspapers online: The Record-Eagle, of course. The New York Times, The Boston Globe, The Chicago Tribune, and The Washington Post. I'd like to add the Guardian to my list . . . but there are only so many hours in the day!
If you, the reader, happen across an article about alternatives to nursing home care, please share it with me by email at email@example.com. I'll then share it with our community.
Aging in Place: Our Community
We live in a most unusual and incredible communityâ€”one that attracts young families because of the quality of our schools, libraries, the college, employment, community activities and service organizations, the professional community providing services to our citizens, the opportunities for cultural enrichment, and of course, the quality of the medical resources and services that are available here. These same community resources have made this a Mecca for retirees.
I've found some unusual and workable programs that can enrich our retirement communities even more. I'm going to lay them out for you. Then I'd like to hear back from you. Who are the movers and shakers who could develop programs like these in this community? What can we do in this community to implement creative programs that will keep seniors in their own homes? Who are the grant writers, the investors, the developers who can make these ideas work in our community? That's where I'm really going to want some feedback from you, the reader.
Aging in Place: My Invitation
Once again, if you, the reader, have any unanswered questions that you feel I might be able to answer or if you have requests or suggestions for topics you'd like me to address here, I invite you to communicate with me by email at firstname.lastname@example.org. Let's make this an open discussion.
Jeanne M. Hannah