Healthcare Crisis – You Can Make a Difference

by | Aug 31, 2022

It Starts With Us

In the last two blogs I provided stories and information about the health care crisis. If you did not get a chance to read them you can go back and check out “Where Have All The Nurses Gone” and “Who Will Care for 69.6 Million Baby Boomers?” found here: Blogs

Proposed solutions to consider:

Solution #1 – It starts With Us

Meet Marvin Eppard, caregiver and author, pictured with me.  I have so enjoyed getting to know Marv and tapping into his wisdom.

I met Marv at a presentation I was doing as a volunteer Community Educator for the Alzheimer’s Association. We traded books, my “Dancing With Lewy: A Father Daughter Dance Before and After Lewy Body dementia Came to Live With Us” for his “A Thief in the Pantry”.

In A Thief in the Pantry, Marvin shares how he took care of his wife Jan for ten years through the “devastating thievery of Alzheimer’s disease.”  Marv’s book is a heartfelt account of his caregiving journey, and how his faith sustained him.

In his 80s at the time, Marv diligently cared for his wife Jan at home as long as he could. He tapped into a support system including his adult daughters and their families, and his faith community who provided meals, respite, and support.  Marv was fortunate to find excellent and consistent home health care for Jan. Eventually he had to place Jan in a care home as he could no longer supply her day-to-day care needs.

Marv recognizes not everyone has the ability to care for a loved one at home, or has sufficient support.  Jan passed away in 2019 before the pandemic, and he recognizes the caregiving situation has become more dire in the last couple of years.

In the conclusion to his book, Marvin appeals to the medical community and administrators of care facilities to prepare for a coming surge in the number of people with Alzheimer’s disease.  In talking with him, he also emphasizes the need for families to prepare to care for their loved ones at home, as there simply are not enough care facilities available.

Marvin suggests we can all advocate for ways to improve care. He recommends these suggestions from the Alzheimer’s Association setting forth practical ways to advocate for improved care.

Alz.org Advocacy

What more can we do?

The National Alliance for Caregiving presents best practices and strategies to identify and address issues surrounding family caregiving.  At their website you can find a Collaborative Membership Directory, resources for Caregiving Coaltions, and ways to develop unified strategies to support family caregivers.  National Alliance

Advocate for reform and resources. Talk to your friends, your families, your medical community. Anyone can be an advocate by writing emails, contacting legislators, or joining a group or organization to advocate in an organized manner.  Go to town halls, communicate on Twitter, or contact your legislators here:

Let them know what matters to you and what you think about healthcare reform. They want to hear from their constituents.

Solution #2 – Educate the “Sandwich Generation”

I used to be part of the “sandwich generation”, but my children are adults and my parents have passed away.  Now there is a new group of younger people fitting in this category. The Webster Dictionary defines this group as:

A generation of people, typically in their thirties or forties, responsible for bringing up their own children and for the care of their aging parents.
(I add people in their 50s and even 60s to this group, as many people have children later in life, and elderly people are living longer.)

I gave this recorded speech specifically targeting the Sandwich Generation. It’s a ten minute listen and worth sharing with others, especially those you know in the Sandwich Generation.  Prepare to be a Caregiver

Solution #3 – Mental Health Intervention

Our society is becoming more aware of the need to provide mental health intervention. In a similar way, medical facilities need to actively provide mental health management strategies for their staff. They must recognize signs of Post-Traumatic Stress Syndrome (PTSD). For example, one incident of an angry or violent patient can lead to PTSD, and it should automatically require counseling and intervention by management.

Wolter Kluwer points out that all staff, including nurses, aids, and doctors, can benefit from mindfulness and resilience training.  Training

We need to take steps to address the mental health needs of these important people who take care of us.  Perhaps it could help stop the hemorrhaging of nurses and other medical staff leaving the profession.

Solution #4 – Address the shortage of Healthcare Educators

The Duquesne University School of Nursing in Pennsylvania addresses the shortage of educators. Nursing schools often have to restrict enrollment due to these shortages. This article states:

“The need is not only for nursing facilities to teach in associate’s or bachelor’s degree programs. Nursing assistants and health aides also need training. Furthermore, a need for nurse practitioners means that schools need faculty members who can teach in master’s degree programs and oversee clinical practice for aspiring nurse practitioners.”

Experienced nurses could be encouraged to become educators to help close the gap, especially if the pay for educators is similar to nurses pay.

This article also offers general ways to address the healthcare workforce gap:

  • Promote Public Health and Preventative Measures
  • Attract More Nurses to Primary Care Roles
  • Provide Online Healthcare Degrees and Certificates
  • Increasing Policy Initiatives Aimed at Supporting Human Resource Development
  • Collecting Reliable Data for Health Databases
  • Giving Healthcare Workers a Voice in Shaping Legislation and Policies

Read more detail about these ideas here: Duquesne – Healthcare Shortage

Lastly, The American Hospital Association offers a few more practical tips for healthcare facilities:

  • Customize retention strategies including flexible scheduling and breaks to recharge, strong management support, open lines of communication, input into decision-making, accessibility to mental health and well-being resources to cope with job-related stress, or help with child or eldercare.
  • Customize the workforce for Millennial and Gen Z workers. These younger professionals can be more selective in where they work, and they also appreciate the chance to be innovative. In particular, the Gen Z generation wants to find ways to share the mission, and they value diversity and inclusion.
  • Develop strategies to keep the workforce reskilled as changes come. Professional development will strengthen the talent pipeline.

American Hospital Association

If you work in a medical facility, I urge you to get involved in training, advocating for mental health services, and education for yourself and your co-workers.

Is There Hope?

There has to be hope because 69.6 million of us Baby Boomers are getting older every day.  Our need for care will affect every member of society.   It will require federal and local government agencies, healthcare facilities, legislators, and people like you and me to get involved and take a stand. It takes families to communicate and plan ahead.

Take a small step today, pick anyone of these issues, or tell your own story, and share it with your legislator.  Talk about the problem and proposed solutions to anyone who will listen.  Support and encourage healthcare workers in your life.

Take action today!

Who Will Care for 69.6 Million Baby Boomers?

by | Aug 24, 2022

Abandoned Again

When my husband and I moved into our new home five years ago, I needed to find a new medical practitioner at our local clinic.  I found “Theresa,” a Nurse Practitioner (not her real name.)

Immediately I could see she was warm, caring, and genuinely concerned with my health.  Then came the pandemic, and I only saw her behind mask and face shield.  But her voice still radiated genuine concern.

I saw Theresa earlier this year (2022). She wore just a mask, I could see her eyes were tired and she had aged. Still kind and helpful, at the end of the visit I told her how much I appreciated her care, considering how hard the last couple of years must have been. Tears glazed her eyes.  (I thought, “Is no one telling medical professionals how much they are appreciated?”)

Two months later I received a letter stating, “Theresa will be leaving the clinic to pursue other alternatives…”

I sighed. Abandoned by another medical care professional. Another loss for her patients, another hunt for a practitioner. I cannot assume she left because of exhaustion, but I cannot help but wonder why? And what is she doing now?

As a Baby Boomer, I know I will need more care as I age.

Who fits in this group of Baby Boomers (or “Boomers”?)  Apparently, those post World-War II parents loved children and had a lot of us.

There are:

  • 69.6 million people ages 58 to 76
  • US Boomers remain the second-largest population group in 2022
  • My husband and I are Boomers, along with family members on both sides, and many of our friends. If you are not a Boomer, you likely have family members fitting into this category.

In the first blog in this series you met Jenna, a critical care nurse who is at the breaking point. And Jenna is not alone. The Pew Charitable Trust reports, “ Exhaustion and burnout have taken an enormous toll on the health care workforce during the COVID-19 crisis. Nearly 20% of health care workers quit their jobs during the pandemic, and a third of those remaining acknowledged that they’ve thought about quitting, according to a survey by Morning Consult, a marketing research firm.”

As a Boomer I wonder, “Who will take care of us?”

The Pew Charitable Trust goes on to state: “The shortage didn’t start with the pandemic and won’t end with it.  In 2019, the United States had nearly 20,000 fewer doctors than required to meet the country’s health care needs, according to an estimate by the Association of American Medical Colleges…At the current rate, the group said, that gap could grow as high as 124,000 by 2034, including a shortage of as many as 48,000 primary care doctors.

…The U.S. Bureau of Labor Statistics estimates that each year through 2030, there will be nearly 195,000 vacancies for registered nurses. The St. Augustine report says that the profession isn’t producing registered nurses fast enough to meet the demand.”  Pew Charitable Trust

 The problem is self-perpetuating:

  • There is a shortage of doctors, nurses, X-ray technicians and more
  • The ones who are working are asked to work more shifts with fewer people
  • People get worn out or ill (COVID is still active) and don’t go to work, causing more shortages
  • Young ones are quitting, and older ones are quitting at a faster rate
  • The younger ones with families to care for wonder what to do?  They made need extra childcare for added shifts, or encounter unexpected school closures.  Many find themselves as caregivers for their aging family members.

This is not new news!

  • Government statistics readily quote the shortages of healthcare workers
  • States have addressed the issue with varied success rates
  • Hospitals and clinics certainly know it is a problem
  • Insurance companies are concerned:

Liberty Mutual reports “…the industry faces a historic labor shortage at a time when the work of healthcare is exceptionally challenging. Across the nation, overburdened medical professionals are feeling numb, burned out, and underappreciated — and that can lead to increased risks for patients, clinicians, and medical systems…

It is well documented that appropriate healthcare staffing lowers mortality rates, shortens how long patients stay in care facilities, and reduces preventable harm events. Short staffing can cause delays in treatment, misdiagnosis, and unintentional medical errors, as healthcare workers try to manage the same workload with less support.” (bold mine)  Liberty Mutual 

Who should care about this healthcare crisis?

  • Most certainly us Boomers, after all, who will take care of us?
  • Populations most at risk for healthcare disparities (defined by the National Institutes of Health) are especially vulnerable:
    • American Indians/Alaska Natives
    • Asian Americans
    • Blacks/African Americans
    • Hispanics/Latinos
    • Native Hawaiians and other Pacific Islanders
    • Sexual and gender minorities
    • Socioeconomically disadvantaged populations
    • Underserved rural populations
  • Younger people, including those with aging parents and grandparents. After all, they will become the problem solvers of their parents and grandparents healthcare needs. (I hope our sons are reading this…)
  • Every tax payer

I am writing these blogs to help raise awareness of the need, so all facets of society can find ways to address the labor shortage problem. There is hope, but it will require all facets of society working together.

In a future blog I will explore what can be done.

Where Have All The Nurses Gone?

by | Aug 17, 2022

A Nurse’s Pandemic Story

Comment: I started writing this series of blogs a couple weeks ago. Ironically, 15,000+ nurse in the Twin Cities (Minnesota) area voted to strike this week. Read “Jenna’s” story, one nurse out of thousands, who served us during the pandemic.

Zip back in your mind to mid-2020. It was no secret hospitals, nursing homes, and other healthcare facilities were plunged into a sudden and unexpected crisis. But few of us can truly appreciate the toll it took on healthcare workers, and how the effects linger today.

A primary effect of the pandemic on healthcare workers was the lack of Personal Protective Equipment (“PPE”).  Examples of PPE includes:

  • Masks and face shields
  • Respirators
  • Gloves
  • Full-body suits
  • Helmets
  • Goggles

“Jenna” (not her real name) is a critical care nurse in a major medical center in the U.S.  Jenna thought she had seen everything in her years of nursing, but nothing could have prepared her for the COVID-19 pandemic. Here is an example of a day in her life during the pandemic.  

It was early morning of her third 12-hour shift.  Glancing at her list, her first patient was a middle-aged man we’ll call Mr. H, whom she had come to know well. The unit had converted a family room into a storage room.  Jenna grabbed her zip lock bag and put on her first isolation gown, the N-95 mask, face shield and gloves.  She noticed that although her N-95 had been sterilized overnight, it was sagging from use and re-use.

“Where was the medication for Mr. H?” she mused.  Due to pharmacy-related staff shortages, it had not arrived on time.  Jenna knew she would have to leave the room and come back when it arrived.  “Good morning, Mr. H,” she greeted him with a smile, even though he had been intubated now for two months, his body wasting away, his mind deep in the depths of sedation. Would this be the day she’d hold up the iPad monitor while family on the other end said goodbye? Mr. H was a husband, a dad, a son. Those goodbyes never became easier.

After her assessment Janna took off her isolation gown, placed the N-95 in the take-out container, and wiped down the eyewear as she left the room.  The medication had arrived, so she re-dressed and headed back into the room. She would do this over and over throughout her 12-hour shift, and it would continue for months.

Imagine not only the fear of the respiratory disease killing thousands, but the inability to protect oneself.

Then imagine being on your feet for 12 hours, barely able to breath in the confining masks. And you come back the next day and do it again, and again, and again.

This continued on and on. In December 2020, the New York times reported there was still a shortage of PPE.  PPE Shortages  Add to this the endless, exhausting shifts, and an ever-increasing shortage of workers.

Fast forward to 2022.  Jenna, and nurses like her, anticipated an improvement in patient care. Perhaps staffing and equipment would go back to pre-Covid-19 levels?  Indeed, PPE is more readily available and there are less critical care patients due to COVID.  But when Jenna looks around, she estimates roughly 40% of her experienced colleagues have left. Constantly asked to work extra shifts, her workload leads to numbing exhaustion. Nurses like Jenna, in her 60s, think every day about early retirement.

I look at Jenna, there is a new sadness in her eyes.  She is angry about the people who would not get vaccinated, and ended up in her critical care unit. She is frustrated by the on-going staffing crisis and allocation of resources. I asked her if she has Post Traumatic Stress Disorder (“PTSD”), she replied “I’m sure I do.”

In March 2022, global analyst Walter Kluwer reported, “What nurse leaders should know about PTSD in nurses during COVID-19…over 1/3rd of nurses reported PTSD syndrome signs.

“Two years later, nurses and healthcare workers continue to face tremendous pressure and stress to effectively treat patients diagnosed with the virus, resulting in increased rates of mental health disorders, including post-traumatic stress disorder (PTSD), among frontline healthcare workers.”  Walter Kluwer

Could you blame Jenna, and many other nurses like her, if they left their job? What is the mental health of our nursing staff worth?

Sadly, this crisis is not just nurses; there is a shortage of physicians, pathologists, neurologists, radiologists, and psychiatrists. Add to this a reduced number of lower wage healthcare workers, medical assistants, home health aides and nursing assistants.

Are you like me, and wondering what is going on with our nurses and other healthcare workers? This is just a glimpse of what plagues them, 2-1/2 years after the pandemic began.

In future blogs we’ll take a deeper dive into the healthcare crisis, and seek positive solutions.

What Happens When Money Runs Out

by | Jan 24, 2021

Applying For Medicaid

 

You may come to the time when your loved one has to be in a care  home, and they do not have the financial resources. This is not just for elderly people, it can also apply to other vulnerable individuals.  In this situation, people in the U.S. may turn to Medicaid, otherwise known as Medical Assistance (“MA”).  This is not to be confused with “Medicare”, the U.S. government healthcare plan for anyone 65 and older. Medicare may cover a short term stay in a care home, but it does not cover long term care.

As happened with my family, we had to place my dad in a nursing home due to his advanced dementia.   He had limited assets, and I knew if he lived long enough, we would have to eventually apply for MA. (He needed it the last five months of his life; the cost at that time was $7,000 a month to stay in memory care.)  Important things you should know:

  • If you or a loved one may need to qualify for Medicaid one day, there is a five year “look-back” period. You will need paperwork regarding house sales, vehicles, and nearly every other expenditure.    Come up with a good system to track every dollar, including what is spent on health care.  Also needed are birth, marriage, and divorce certificates, military service paperwork, home and vehicle sales, immigration documents if applicable, and more.  Keep all such documents in a central location.
  • The person qualifying has to “spend down” their assets. At the time my dad qualified, he could have no more than $3,000 in assets, including life insurance. One way to offset future costs is to purchase a funeral plan.  If done correctly, this money does not count against one’s assets. When my parents’ house was sold, we immediately appx. $6,000 each in funeral plans for each of them, which did cover their deaths and basic funerals.  (This did not count burial, as they were buried for free at Fort Snelling, as my dad was a veteran.)  It is not cheap to die!
  • We then had to pay back to the state all his leftover assets (less than $2,000) to make up for receiving MA.
  • I recommend seeking the help of an elder care attorney to understand how this all works. The laws may vary from state to state, are complicated, and it is difficult  to find specific information.

I wrote this in the book “Dancing With Lewy: A Father Daughter Dance Before and After Lewy Body Dementia Came to Live With Us”:

“In September 2011, Dad ran out of money. Of course, I knew this was coming, so I was prepared. (Thanks to my mother and her bookkeeping, I still had the records from when I initially applied for MA assistance years ago when they did not qualify.) Finally Dad was approved, and the government paid his nursing home bills of over $6,000 a month.

When my parents sold the house in July of 2006, they gave each of us four daughters $1,000….For five years, I wondered what would happen if my parents ended up needing MA, as the government has a five year “look-back” period. Would we have to declare that they “gifted” us this money? I asked my oldest son who works for the county. He said yes, we would have to declare any significant funds they gave away within the last five years.

The date he began receiving Medical Assistance was in September 2011. The five-year period ended July 2011.

Coincidence? Luck? No, I don’t think so. I believe God was protecting my parents, just as he had promised, and he was also looking out for us sisters, as this $1,000 was basically our entire Inheritance.”

Here is a link to a brochure explaining more about MA.

https://www.medicare.gov/publications/#results&keyword=11409

As your loved one ages, keep in mind the five year look-back period.  Any significant gifts given away during that time may have to be repaid. Financial and other related records will be needed for that five-year look back period.  Again, you could seek the advice of an elder-care attorney to learn more about how MA works, and what may be applicable to your situation.

Information about “Dancing With Lewy” and links to caregiving resources may be found on https://nancyrpoland.com. 

Support for our Veterans in 2021

by | Jan 3, 2021

As we move in 2021, let us move forward cautiously with hope for health, economic recovery and a return to family and friends.  Let us also remember those who are grieving, fearful and suffering.

A group we all need to remember and support is our veterans and their families.  In this blog I’ll highlight a couple veteran’s resources.

Veteran Centers such as this one being relocated in Anoka, Minnesota, are community-based counseling centers, providing a wide range of social and psychological services, including professional readjustment counseling to eligible Veterans, active duty service members, including National Guard and Reserve components, and their families. These services help veterans make a successful transition from military to civilian life.  They also help after a traumatic military event. Looking forward to learning more about this facility when it opens.

As many of you know, veterans can receive healthcare and medications from a local VA Center.  They also offer mental health services and suicide prevention programs.   Your county likely has a Veterans Services Office (VSO) who can help connect you with benefits.

Here are a couple veteran’s services that may not be well known.

Program of Comprehensive Assistance for Family Caregivers (PCAFC)

Eligibility for the PCAFC has expanded.  Go to this website to download all these free materials:

https://www.caregiver.va.gov/

new Caregivers PCAFC – Expansion Booklet (PDF)

Caregivers PCAFC – Application Process Fact Sheet (PDF)

Caregivers PCAFC – Expansion Fact Sheet (PDF)

Caregivers PCAFC – Eligibility Criteria Fact Sheet (PDF)

Caregivers PCAFC – Monthly Stipend for Primary Family Caregivers Fact Sheet (PDF)

Caregivers PCAFC – Current Participant Fact Sheet (PDF)

The veteran and caregiver will need to apply together and participate in an application process to determine if you’re eligible for the Program of Comprehensive Assistance for Family Caregivers. You’ll both need to sign and date the application and answer all questions for your role.

You can apply online right now.

 

Aid And Attendance

This is my dad, as a young Navy soldier.

Another benefit was a life-saver for my parents, and one I had not heard of until my sister and I attended a dementia conference at the University of Minnesota.  It is a special benefit to war era veterans and their surviving spouses called Aid And Attendance.  You can read in my book “Dancing With Lewy: A Father Daughter Dance Before and After Lewy Body Dementia Came to Live With Us” how this benefit helped my family.

This tax-free benefit provides financial assistance to help cover the cost of long-term care in the home, in an assisted living facility or in a nursing home.  It is for those veterans and surviving spouses who require the regular attendance of another person or caregiver in at least two of the daily activities of living such as bathing, dressing, eating, toileting, and transferring.

It may take time to obtain the benefit. However, if your loved one qualifies, they will pay the monthly benefit back to the day you first apply.  If the application process seems overwhelming to you, contact your local VSO, or an elder care law attorney.  I had to follow up and be quite persistent when I applied for the aid for my dad, but he received the backpay, plus the healthy monthly allotment for several years. This allowed my folks to live in decent housing and have the resources they needed to live almost to the end of my dad’s life. I called the local VSO a number of times for advice on how to obtain this benefit.

  • If you or a loved one are veterans, be diligent in seeking out resources.
  • If you have the means, support veteran’s organizations that supply housing, healthcare, mental health resources or other needs for our veterans.

May God bless each one who is serving, has served, or has loved one who has faithfully served our country.

Free! Resources for Caregivers

by | Dec 6, 2020

Greetings friends.  We all feel like 2020 has been the longest road ever.  There will be an end, at least to 2020, and if all goes well, the pandemic.  Meanwhile, I offer hope, encouragement, and resources to caregivers.

Did you know there is a resource section on my website specifically for caregivers?  You can find it at: https://nancyrpoland.com/caregiver-resources/.

There are ideas for books, organizations, and links to other websites. All these resources below can be found on this caregiver resources page.

A gift for you – a FREE E-book, “Caregiver Anxiety –  Is there an Antidote?”  

With just a click of a button you can download the PDF of this booklet.  I speak from experience, as my husband and I have struggled with his health during the COVID crisis.

I offer a special section for veterans.  It is worth the time to seek out the many resources to help those men and women who have served our country.  Learning about and utilizing veteran’s resources made a huge difference in the quality of life for my parents. 

Check it all out nancyrpoland.com, and for more resources and ideas, you can subscribe to my monthly newsletter, “Caring for the Caregiver.”   

My passion is to help caregivers know there is help and support.  As we are in the midst of the holiday season, my heart is with you as we look forward to a better tomorrow.

God bless us, every one.