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Today’s Exposure: Good Grief

14 Thursday Jan 2016

Posted by Mark Netoskie, MD in Uncategorized

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challenges, death, grief, loss

IMG_405357 years ago, my brother Steve entered this world and started his journey, changing peoples lives—but not in the usual way. It would seem unlikely that someone with my brother’s many physical and mental challenges could do much of anything. In fact, the established view at the time he was born, both medically and socially, suggested that he be locked away and forgotten. My parents and especially my mom who was only 20 at the time didn’t agree. Their plan was simple—to love, nurture and support him, no matter what. To watch him grow. To help him reach his highest potential.

After about a year, I came along. One of my earliest memories of my brother was playing with building blocks. I was the builder and Steve was the demolition guy knocking over my creations. We were the perfect property development team. Four years later, my brother Neil was born and I suddenly became the middle child. For those that share my plight, you understand. I was devastated.

Steve had a number of unique medical issues, but they did not define him. Throughout my early life I was able to observe many physicians and therapists. I saw those that treated Steve and those that cared for him. There is a difference. Doctor’s offices became familiar places to me—and I was comfortable there. I learned that I wanted to help others also. My career as a physician I owe to Steve.

People often underestimated Steven’s abilities. On the surface, many dismissed him outright. Even professionals scoffed at what we hoped he might accomplish and predicted a short life. He exceeded all expectations! Steve loved music, and movies, and gadgets. He loved the Sound of Music and Mary Poppins. He liked riding fast.   Above all, his favorite thing was opening presents, lots of presents, even when they weren’t his. Of course, birthdays and Christmas were his favorite days of the year. He was especially fond of Mr. Rogers. It was an unusual day if Fred Rogers was not a part of our daily experience.

Who was Fred Rogers? Many of you know him. He was an advocate for children, author, songwriter and activist. He was a symbol of compassion, patience, and morality. He always wore sweaters on his TV show, Mr. Roger’s Neighborhood, all knitted by his mom. I would like to read a quote from “The World According to Mister Rogers: Important Things to Remember”:

“Part of the problem with the word ‘disabilities’ is that it immediately suggests an inability to see or hear or walk or do other things that many of us take for granted. But what of people who can’t feel? Or talk about their feelings? Or manage their feelings in constructive ways? What of people who aren’t able to form close and strong relationships? And people who cannot find fulfillment in their lives, or those who have lost hope, who live in disappointment and bitterness and find in life no joy, no love? These, it seems to me, are the real disabilities.”

Common themes of Steve’s interests were love, kindness, hope, friendship and fun. He loved pretty blond nurses. He liked watching football and listening to baseball games. For some reason, he loved Tejano music—played very loudly! He liked parties. Like you and I, he had good days and bad, and he would let you know it.

As a family we learned many things from my brother. We learned the value of small blessings. Optimism and hope was a staple in our daily life as well as how to deal with frustration. Steve was our barometer of people’s character—was he acknowledged by them? Was he treated as others would expect to be? Personally, I became a more sensitive person. More patient. A better listener. Unfortunately, he did not make me a better driver.

My experience also taught me that the system is hard for families like mine. Many become isolated. Many give up, waiting for resources that might allow them to care for their loved ones in the home. I learned that you have to be bold to advocate for those that are weak and unable to speak for themselves.

I learned that doctors don’t always know what, or why, or how—and that’s ok. I learned that you have to sometimes stop fighting and love yourself a little now and then, even when no one else seems to care. Forgiveness is harder than it seems. I learned the value of my family of friends and the strength they give me.

Finally, although she would not describe herself this way, I grew to admire my hero, my mother. I doubt that I could care for and advocate for another person for 57 years in such a selfless and devoted way. She has always stood for fairness, loyalty, and excellence. She has always been the rock and conscience of our family.

Steve had a unique life and he influenced many. Without him, I would not be here and would not know the life I lead today. I don’t believe in randomness. I believe in connection and purpose and my brother had a wonderful purpose. I believe that my brother is now free of the shackles of his physical limitations. I love him and immensely miss him, and look forward to the time when we meet again.  I imagine that when he entered heaven they were playing, “It’s a beautiful day in the neighborhood”.

As a family we have known this day would come for some time, but it is still difficult.  We are finding our “routine” lives to be somewhat empty, though I welcome the diversion.

Check out basic information about grief by clicking on this link.

Mark J. Netoskie, MD

Today’s Exposure: Care Givers–You get what you pay for?

27 Sunday Dec 2015

Posted by Mark Netoskie, MD in Uncategorized

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care givers, health aids, home care

As caregivers for my brother, our family has been told a lot of things over the years.  Probably the hardest to hear and understand was regarding home aid services: “well, you know that home aids don’t make very much money”.  I am not sure how to interpret this statement.

At the most difficult time in my brother’s life, we need help at home with his day to day care.  These are services that traditional insurance rarely pays for, though Medicaid does support this service for some types of patients.  For the rest or for better options that don’t take insurance, aid services are completely out of pocket.   When home services became available through Steve’s Medicaid plan, we had a vision of caring, thoughtful people that understand the family needs and would be willing to become a part of our life.

As it turned out, multiple aids were interviewed and hired from multiple agencies.  We never found someone that worked in our situation.  For us, common themes were noted:

  1.  Most were recently “trained”.  Few correctly understood common aid skills such as transferring, lifting and bathing.  Most were either very young or much older.
  2. It was very difficult to find someone that could speak our language (English).  I was challenged to understand why it was so difficult to meet this need.  I felt that those in our community that lacked English proficiency fared better regarding this issue.
  3. Practically all of the aids were single parents, lacked transportation, or had their own health problems making them unreliable for my family.  The key to trust and security in these situations is reliability.
  4. For those that lasted more than a few weeks, most left for better paying jobs.

For the aids that came to our door, we did not accept a “warm body”.  Those that we found to be literally sleeping on the job, listening to music, eating our food, or doing things to my brother that were inappropriate were let go.  One disgruntled aid reported my mom to Adult Protective Services for not feeding my brother.  That was fun.

My belief is that this is not just about paying more for aids to deliver better care.  Part of the challenge in this industry as well as in other areas, is that we are not hiring the right people.  We are not adequately selling the beauty of assisting families through the difficult stages of life.  We are not weeding out inappropriate applicants.

Being an aid does not require advanced math skills.  But it does require a healthy amount of empathy, common sense, a willingness to partner with family members and to take on the risk of  becoming emotionally involved with those that require care, often at the end of life.  No–pay is not great, but the value that good aids bring to families is immeasurable.  It is unfortunate that our society does not reward more for keeping families together.  We know that failure to support families through difficult times can result in greater ER use, inpatient hospitalization, and increased illness for caregivers, both physical and mental.

It is good that these workers now have minimum wage benefits:

https://youtube.com/watch?v=IwMP9ghvKKs%3Frel%3D0%2522%2520frameborder%3D%25220%2522%2520allowfullscreen%253E%253C

Those that run aid agencies should to do a better job at attracting the right talent for these important roles.  Check in with families early in the care process to determine gaps that need adjustments.  Do not tolerate the uncertainty created by poor work effort.  Families deserve more than what they are getting.  We need to develop a better way to promote quality transparency within this service category for family caregivers.

What are your thoughts and experience?

When helping hurts

22 Tuesday Dec 2015

Posted by Mark Netoskie, MD in Uncategorized

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care coordination, health navigation, home care, patient disruption

85

Photo courtesy USNews

Do you access customer disruption when providing service?  Within many industries, and especially healthcare, providing assistance can adversely impact the daily routine of the patient and/or family.  Generally, little is done to minimize these adverse outcomes.  Consider the simple act of having a nurse come to the home 3 times per week for evaluation and labs:

  1.  Which days?  What happens if a day must be changed?  Will that impact medication administration?  Lab testing?  etc?
  2. What time of day?  Will the visit interfere with meals, other routine appointments, and social activities?
  3. What is the recourse if the caretaker doesn’t show up?  Do they call you or you call them–or a third party?  What is the back-up plan?  What if that fails?
  4. Will the nurse be the same or will this be whomever is available?  Does continuity matter for care?  Will this cause more confusion for the patient and/or family?

As you can see, there are multiple opportunities for things to go wrong often leaving the patient in the middle.  Of course, there are usually phone numbers to call but those on the other end generally relay information to those that can respond, leading to further delays and potential gaps in care.

Unfortunately, the public has grown accustomed to this “yellow cab” experience–you get what we send you or you can call someone else.

For patients, especially those that are homebound or with complex disease, it is vital that each day has reasonable predictability.  Long waits, missed meals, altered caregivers can all lead to challenges that are often invisible to those that are delivering care.  If you are a provider, are you addressing this aspect of your operation?

If you are a patient or relative caregiver, are you putting up with uncertainty and confusion?  Are you demanding accountability from those that are serving you?  You have the right to know how to engage with someone that has the authority to address any of your concerns.  If paid for by insurance, who is your case manager (or how can you obtain one)?  Find out who regulates the service since most providers must abide by minimum standards of care at the local, state or national level.  Report problems if not resolved.  Obtain the services of an advocate, sometimes referred to as patient navigation.  Call 2-1-1, the national local resource organization (www.211.org).

Resources can be very useful at times, but can be applied in a disruptive way, impacting preferred outcomes.  If you are a provider, think about your process and how to minimize these issues.  If you are a patient, take action to report concerns to those that can assist.

Recent Posts

  • Today’s Exposure: Good Grief January 14, 2016
  • Today’s Exposure: Care Givers–You get what you pay for? December 27, 2015
  • When helping hurts December 22, 2015
  • Health Ownership December 20, 2015

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  • When helping hurts
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