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Introducing Blogger Jeanne M. Hannah »

Why I advocate for seniors

Posted on November 3rd, 2006 by Jeanne Hannah in Aging In Place

hannah.jpgIn 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 jeannemhannah@charter.net.

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 PubMed—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.”

Active Mentors

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 mother—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 care—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 Geriatrics—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:

1) Delirium
2) Medication Errors
3) Adverse Drug Reactions
4) Falls
5) Dehydration
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 CENAs—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 junkie—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 jeannemhannah@charter.net. I’ll then share it with our community.

Aging in Place: Our Community

We live in a most unusual and incredible community—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 jeannemhannah@charter.net. Let’s make this an open discussion.

Cheers,

Jeanne M. Hannah

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Viewing 21 Comments

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    Jeanne,

    This blog is a needed step toward helping people talk about developing strategies to provide better care to the aging. Thank you for raising this important issue and creating a forum to share information and build resources for this important issue that affects, or will affect, each of us.

    Very truly yours,

    Jeffrey Zoeller
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    Jeffrey, thank you for your support of my efforts. Please stay tuned on this blog and offer your comments whenever you are so moved. If you have friends who are 65 or older and/or are family caregivers, do please forward on to them a link to this Blog. I sincerely hope that I will be able to reach many, many people in my efforts to help seniors COPE.

    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

    Once again, thank you for your input.

    Jeanne Hannah
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    Jeanne,

    Congratulations on setting up your blog. It speaks to an audience that needs to hear your input. I believe in this. We have set up a Free Service called http://www.KeepSeniorsHealthy.com , which helps seniors keep up their health. Please take a few moments to review it and share it with your readers.

    I also have a blog http://keepseniorshealthy.blogspot.com/ that also helps and may have benefit for your readers as well.

    Good luck and hopefully both of us can make a difference in the lives of seniors, and keeping them healthy.

    Steven
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    Dear Dr. Hacker:

    I have looked at your website and blog, and I have to say that your free service -- creating a personal medical record -- is exactly what I was looking for just last week. In fact, these personal medical records are critical to two concepts that are guaranteed to yield better medical care for seniors: continuity of care and strong support through transitions in care.

    I've had just a small amount of time to review your personal medical record program, but I am impressed with what I see, and I will be writing in more detail about your service within days.

    Jeanne Hannah
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    Dear Ms. Hannah,
    Your article was wonderful in the fact that our three adult children will not be living in this area, so we will be at the mercy of our physician, or the ER, or a long-term care facility to make judgments about what will be "wrong" with us....that can be frightening.
    I keep a notebook of all my physical issues, but still, after reading about what happened for your mother, it can happen to all of us!
    I will be having my daughter, who will be here for Thanksgiving Day, read this newspaper article and I will be making sure that she will honor my wishes of helping me in my old age with deciding my needs!! Fortunately, she is also an R.N., so that is my bonus!!

    Thank you for all your work in putting this news out there,
    Gail Jodway
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    Dear Mrs. Jodway,

    Thank you for your kind words. It's important that you have an advocate with you whenever you go to the ER, your doctor's office, or the hospital. The keen observations of a family member can make all the difference in the care you receive, especially in getting an accurate diagnosis. This is particularly true when you are not seeing your regular doctor.

    Sometimes we elderly people can and must advocate for ourselves. I hear you sounding frightened, and hope that you'll find the time to read my book. It should empower you to help yourself and your husband. You will learn what symptoms you should be concerned about and should communicate to a doctor or nurse so that you can avoid serious consequences of 6 common, potentially fatal, medical conditions. Getting an early and correct diagnosis and treatment is very important. Even more important is learning how to prevent these complications.

    Continuity of care depends upon someone being able to tell an ER doctor, for example, or the staff of a nursing home just receiving a new resident, just what is "normal" for a particular patient. That someone might just be you!

    Delirium is misdiagnosed 95% of the time, according to research, despite the fact that it is common among the elderly and has many causes, among them, emerging medical conditions, diseases, adverse drug reactions. 26% of those people die within a year, usually of the underlying cause of the delirium. When delirium is missed, the underlying cause is often undiagnosed and untreated. But imagine this! It's a family member who can usually tell a doctor or nurse just exactly when an elderly person became delirious because the onset of delirium is sudden. An ER doctor might mistake it for psychosis, especially in a Parkinson's disease patient, because psychosis is often seen in end-stage PD. Sometimes, it's mistaken for dementia.

    One thing you and your family can do to increase the chances of accurate diagnosis and treatment is to maintain a good personal medical record. You'll find a very thorough medical history form in Appendix H of my book Taking Charge: Good Medical Care for the Elderly and How to Get It.

    You can access that Medical Record form and a separate form to keep track of medications (Appendix I) on my website http://goodmedicalcare.com Please feel free to make use of these valuable tools.

    The other issue you touch upon -- end-of-life care -- making sure that doctors and nurses honor your wishes for care near the end of life is addressed in Chapter Nine of Taking Charge. This chapter also describes the Geriatric Care Manager -- a professional who can assist elders whose own children live far away by helping to oversee healthcare.

    Thank you for writing. Please stay tuned for more articles on this blog that may be useful to you in coping with aging issues.
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    I appreciate your efforts in educating the public on Elder Care. It is also unfortunate that the teaching medical community doesn't consider Geriatrics important. However, once again I would like to address 2 things mentioned in your previous blog. Our CNA's at Meadow Brook must complete a 4 week intensive training with a certified instructor. They learn in the classroom first, with realistic maniquins how to complete ADL's (Activities of Daily Living), toileting, they even feed each other to see how it feels! Then the class goes out to the units under their supervisor's care to pair with "mentor" CNA's to watch and learn the art of caring for a Resident. They progress until they are ready to care for a Resident then up to a whole group. They must pass a clinical and written exam before becoming Certified with the state. We also possess a wonderful end of life care program. I personally feel passionate about how a person completes the end of their journey in life. Through a wonderful donation from the Meeder family were were able to construct a room called the Serenity Suite. This room is a place for friends and family to be with their loved one in their journey to the other side. This room is all inclusive and allows family to stay with their loved one and still be comfortable. We also have a Transitional Companion Program in place that ensures that no Resident will ever have to be alone during their journey. We have Volunteers and staff who are trained and avaiable to sit with the Resident providing comfort until a family member or friend is available to be with their loved one. We have gentle music, literature to ease the question of the dying process and plenty of love and compassion. The church community is also avaiable to provide for all Spiritual needs. Our Facility cares for the Spiritual, Mental and Physical needs, not just the medical part.
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    Michelle, thank you for sharing this important information about your facility. The end of life care offered by Meadow Brook sounds very much like Hospice care. How wonderful that you have the special suite so that family members can stay with their loved one and share the end of life experience. I very much appreciate hearing that even those who have no loved one to sit with them are provided with volunteers and staff to sit with them.

    I personally believe that even when in a coma -- as was true with both my father and mother at the end of their lives (both died in a hospital) -- people can hear everything that goes on around them. A dear friend and mentor -- Sharon Olson -- has instituted a wonderful program and provides beautiful harp music to Hospice patients.

    Are there other local facilities with similar services and programs?
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    Ms. Hannah- the question i googled was how could I become an advocate for the elderly and your blog came up. Thank you- I want to give something to those that don't have anyone- My dad passed away last year at age 92- He lived a wonderful life and I miss him terribly- I learned so much during the process- he ended up with hospice care. There are so many elderly that have no one to help them through the process- I want to help- even if it is only one person- any advice you have would be great
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    Dear Teri,

    The best way I can think of for you to give back is to become a volunteer for Hospice. I don't know where you are located, but here in Traverse City, Munson Hospice and Palliative Care can always use volunteers. Judy Goodrich is in charge of volunteers. Her telephone number is (231) 935-8485.
    Munson Hospice contact information is:

    Munson Hospice and Palliative Care
    105 Sixth St
    Traverse City, MI 49684
    Phone: 231-935-9328
    Toll free: 800-935-8536
    Hours: M-F 8:00-4:30

    I would also recommend that you consider joining one of the Hospice Grief & Support Groups. It's always good to have people to talk to when you're working through your loss.

    If you're not located in or near Traverse City, you can email me at jeannemhannah@charter.net and I will help you find a hospice near your home.

    Jeanne Hannah
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    Hello, Jeanne:

    I just linked to your blog today and want to encourage you in your advocacy for seniors. I had an elderly friend who died of sepsis shortly after having hip surgery years ago. She was a positive role model for me regarding aging in place.

    Because of my own professional role as a hospital chaplain within the health care industry, I was able to intervene with my father when he became acutely ill after chemotherapy for treatment of prostate cancer which had metastatized. He had not informed family members about taking chemotherapy. He recovered after some time in a nursing home. My siblings and I contacted Hospice in Western Michigan for on-going care for him in his home which he had for about 1-1/2 years before he died. With my brother as the primary caregiver for my father, Hospice provided much-needed information and support.

    I will share this blog with other hospital chaplains and senior friends.

    Mary Flowers, M.A.
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    Hello Mary,

    Thank you for sharing your positive experiences as a family caregiver, particularly with respect to aging in place. I agree with you that Hospice services can provide so much comfort, support, as well as valuable and needed information. I have often been a volunteer for Hospice here in Traverse City—as a lawyer helping Hospice patients with end-of-life planning. Thus, I’ve been able to observe, sometimes first-hand, the peace and comfort that families can experience when death is not to be feared, but is embraced as a natural part of life.

    I appreciate your offer to share this blog with other hospital chaplains and senior friends. As you know, my mission began with an effort to make something good come from something that was very terrible. I look forward to years of service in my mission to advocate for the elderly.

    Jeanne Hannah
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    Hi

    My 92 year old mom recently was charged $10,000 for a three day stay at the hospital and although her insurance paid 90% she's still left with a $2,000 bill to pay. That's a lot for someone on a fixed income. Is there any way she can get this paid without having to take out additional insurance.

    Thank,

    Rudy Ferrara
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    Hello Mr. Ferrara,

    All hospitals, public and private alike, have the ability to reduce the fee for your health care, as do federally funded clinics and health centers. In what is referred to as sliding fee scale, fee reductions, and fee settlement, a lower charge is offered based on a patient’s income, which makes the health care more affordable. Federally funded health centers and HHC’s hospitals and clinics must ensure that a patient’s inability to pay for care does not create an obstacle to obtaining care, or cause financial ruin for the patient. It is HHC’s policy that no patient will be required to pay more than he/she can afford, and no patient will be denied care because of an inability to pay. Medical care, however, is rarely free and all patients are asked to contribute a reasonable and fair amount toward their care. Payment plans are also available, allowing patients to pay their reduced medical bills over time.

    You might also carefully review the statement and, if you can't get a willing reduction in the bill from the hospital, then ask them if the charges are in compliance with the Supplemental Compliance Program Guidance for Hospitals. To view the OIG's entire supplemental guidance please use the following link:
    http://www.oig.hhs.gov/fraud/docs/compliancegui...>

    Jeanne Hannah
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    I read today's article in the NY Times about aging in place and have read others from time to time. I am finally motivated to do something about this concept and have emailed several members of my community to try to interest others in thinking and doing something about this issue. Whether we will be able to achieve something as well organized as the Beacon Hill Village is yet to be determined. You are doing good work and I thank you for your insights.
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    My mom is in a nursing home and has been for 8 years. She came to be in a nursing home when she went into a coma from Septic. I only had less than 24 hours to find a place for her at the time she resided an hour and a half from me. The hospial called me and told me there was nothing else they could do for her and they would release her to a nursing home or the state if I did not find a place for her. She has come out of her coma and was able to go through rehab and learn to walk all over again to a point, she had a stroke years prior to this . My mother did not want to move in with my family she said she likes it there. My mother worked in nursing homes before her stroke.
    I go to the nursing home so much that my children know the residents better than I do.
    I am tyring to find someone who can help me with transferring my mother I have contacted for nursing homes after speaking to them and being told there are openings the nursing home where she is sends the information requested then all of a sudden they have no openings.
    I requested her records to see what is in them but I have not gotten them yet.
    2005 her leg was broken transferring her from herwheel chair to her bed at 9:00 at night I recieved the call from the nurse and then she called me from her room.
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    Cynthia,

    You might consider hiring a lawyer experienced in elderlaw to help you with this problem. In the Traverse City area, you might contact John Rizzo

    Rizzo & Associates PLC
    830 E Front St Ste 301
    Traverse City, MI 49686

    Phone: (231) 933-5207
    Fax: (231) 932-1373
    e-Mail: jrizzo@rizzolawonline.com
    Web: www.rizzolawonline.com

    Another excellent lawyer who could help you is Sanford Mall. His office is downstate, but he helps clients all over the state.

    Mall Malisow & Cooney PC
    30445 Northwestern Hwy Ste 250
    Farmington Hills, MI 48334

    Phone: (248) 538-1800
    Fax: (248) 538-1801
    e-Mail: sjmjd@teclf.com
    Web: www.theeldercarelawfirm.com
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    Though it's an old article, but I still find it one of the bests, you are really great with your work! I have certainly got to know that Why you advocate for seniors.
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    Thank you so much for your comment. Jeanne
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    Hi & thank you for a place to perhaps help me in a mobile home park that I have now lived in just short of 4 years. I am being harressed almost everyday of what they will do to me because I called the city of St. Charles, Mo. about very, very tall weeds behind my home & ask that it be cut. I then talked to the "manager" & she said she didn't have time for that, she also at that time wanted to know why I just did not move since I did not like the reply of hers. I might add here about a year ago I asked if my rent could be reduced & I wanted the owners name please! She said she could not give me that & she would ask them for me. Well as you can guess they would not lower my rent. When I moved into this Mobile home village my rent was $270.00. I was 66 then. They have raised it every year now & it is $305.00. I might add here that there are several I have now talked to who's rent is $270.00, $230.00, & $275.00 to name a few, there are others that are different. I own my trailer, as everyone in the Mobile home park does. I have 1 amall dog & last night I was walking it by myself with a leash & her (the mgr's) husband came up behind me & said I had to have little plastic bags to pick up her pooh with me. We don't go but about 3 trailers away from home & she has a 9x3 ft. dog run.I told him I was not worried about that & then like he did not know I had the dog run behind my deck, he tells me I have to take it down. I said no I won't it has been there since I moved in almost 4 years ago. Then he would take it down, I then said "NO" you better not touch my property. He then started on me that I was a trouble maker because I had called the city about the grass behind my house, & other houses also. This is a tall hill & 2 years ago when the original owners sold the property they would cut this hill 2 times a year. Now he said I was going to pay $50.00 for my share of the hill to be cut. I by now was shaking all over from the stress of him just continueing to attack me. This was a very quiet place to live until they came here. Never any problems ever. It is like living in Russia here now, or at least that is how many feel. I have never been late with my rent, My neighbor cuts my grass because I simply cannot afford to pay some one to do it. Very kind of him! I get a SS check. By the time I pay my rent & bills I usually have about $35.00 left. And of course I cannot move out of here because of the cost to move the trailer. PLease give me some advice if you can? I feel like I can no longer live in peace, at 70 yrs old & I have always been very active but feel very depressed now. Thank You ever so much. Ruth
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    As Grandmother--who died healthy at 85, was fond of reminding us grandkids, 'there are only two options: we die young or grow old PERIOD. The former usually takes care of itself; it's the latter we need prepare for.'
    Well, my turn is here but... at 76, on a very low below-poverty-line-income and with metastatic cancer, how does one do that? I don't mean the psychological, emotional aspect of old age, disease and death. That one is the easier half: 'surrender, trust and keep trucking. Whatever brought me here will transport me hither!' I mean, who can afford a decent nursing home, decent hospice care, a decent space wherein to meet one's death with dignity and quiet? For now, I'm all right at home, but... later? That's my concern: managing the future before it arrives!
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