A FEW THOUGHTS ABOUT OUR HEALTH CARE

Healthcare/Medical 2015/One Woman’s Opinion
by – Sheri de Grom

Continuing rise of health care cost - Getty image.

Continuing rise of health care cost – Getty image.

Statistics regarding our U.S. healthcare system are often alarming and baffling at the same time. Numbers I’ve discovered while researching one topic or another include the following:

  • We’ve created a healthcare system in the U.S. in which 1.5 million people work in the health-insurance industry while less than half as many doctors provide the actual care.
  • America’s total health care bill for 2014 was $3 trillion. That’s more than the next 10 biggest spenders combined: Japan, Germany, France, China, the U.K., Italy, Canada, Brazil, Spain and Australia.
Getty Image

Getty Image

  • We spend $17 billion a year on artificial knees and hips, which is 55% more than Hollywood takes in at the box office. All the extra money the U.S. spends often produces substandard care or worse.
  • There are 31.5 MRI machines per 1 million people in the U.S. but just 5.9 per 1 million in the U.K.
  • We spend another $85.9 billion trying to treat back pain, which is as much as we spend on all of our country’s state, city, county and town police forces. Experts say that as much as half of that is unnecessary.
Getty Image

Getty Image

All of these high-tech advances: pacemakers, MRIs, 3-D mammograms, have produced an ironically upside-down healthcare marketplace. It is the only industry in which technological advances have increased costs instead of lowering them.

Healthcare is so hard to fix because it’s our largest industry, employing a sixth of the country’s workforce. Additionally, it’s the average American’s largest single expense, whether paid out of our pocket or through taxes and insurance premiums.

I’m always surprised when I check the numbers and learn the healthcare industry outspends all other interest groups for lobbying. Who would have thought healthcare lobbying would outspend the #2 Beltway Bandit by 4 to 1? Healthcare spends $4 to every $1 the military-industrial complex spends.

It doesn’t matter which population our congress serves. When our chronically dysfunctional politicians decided they wanted to mess with our healthcare, we knew we could bring them to their knees.

Getty image

Getty image

Obamacare gave millions of Americans access to affordable healthcare, or at least protection against being unable to pay for a catastrophic illness or being bankrupted by bills.

But, I ask, what about those of us that had our retirement accounts [accounts not belonging to the government but to the individual] robbed to make subsidies available for those who could not afford to buy insurance?

I’m not happy about this. Not for one minute. Would you want your personal 401k dipped into for a stranger to have insurance?

I’m not in favor of paying subsidies to anyone. I worked hard for my retirement and didn’t receive set-aside monies for my education. There’s been nothing privileged about my education or career success. I worked full-time while earning my college degrees plus took care of a family.

Each time Congress has been unable to fund a program in the last six years, they’ve looked to the federal employee or retired federal employee Getty imageand retired military to make the sacrifice. I don’t have a warm fuzzy when I know others are receiving subsidies for health insurance and my retirement funds are making it possible for them to live a life I don’t have the luxury to live.

The monies being taken are not from social security or medicare. They are not taken from any federal revenue sourced program. These accounts belong to individuals and no one else. We’ve saved monthly from our salaries to secure a safer retirement.

This is one woman’s opinion, but please, if you read this and you’re receiving a subsidy for insurance under Obamacare, think about the fact that I’ve worked 40 years while you are at home with your children or perhaps following another path more to your liking. I’ll be 70 next year and excuse me if I sound harsh when I say to you, pay your own way. I’ve paid for mine, more than once.

As always, thank you for reading with me. I appreciate you and wish you only the best life has to offer.

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ELDER ORPHANS; WILL YOU BECOME ONE?

Medicare/Medical 2015
by – Sheri de Grom

What are the chances you’ll become an elder orphan? Are you 65 or older, without children and alone?

No one knows exactly how many individuals fall into this newly-created medical care category. The theory is that 25% of all Americans over age 65 are at risk of becoming elder orphans or should already be classified as such.

This vulnerable population already exists, but they have no voice or support system. Elder orphans must have advocates. However, their needs must be defined first.

We do know elder orphans are aging alone, with no known family member or designated surrogate to act on their behalf. It’s imperative we determine which community, social services, emergency responses and educational resources can help them.

This population is growing as society ages and life expectancy increases.

Geriatrics Healthcare Professionals Logo

Geriatrics Healthcare Professionals Logo

The University of Michigan conducted an extensive survey and presented their findings at The American Geriatrics Society’s 2015 Annual Scientific Meeting, May 15-17, 2015. Their conclusion is that without intervention, elder orphans are at the greatest risk of a wide range of negative outcomes that include functional decline, mental health issues and premature death.

This is the population the study fears will utilize the most expensive healthcare resources because they don’t have the ability to access community resources while they’re well but alone.

The 2012 U.S. Census data supports the findings of the increasing number of elder orphans. About 1/3 of all Americans aged 45 to 63 were single, a 50% increase from 1980; nearly 19% of women aged 40 to 44 have no children, as compared to 10% in 1980.

Never leave your animals behind on moving day. Picture - Google

Never leave your animals behind on moving day. Picture – Google

Baby boomers, more than any other generation, have been mobile without much of a backward look. I’ve moved more often than most as part of my career and loved knowing another adventure was always around the corner.

Google - The surviving spouse sees the other through their illness and beyond.

Google – The surviving spouse sees the other through their illness and beyond.

The reality for Tom and me is that someday (probably sooner than we’d like) one of us will be an elder orphan. It doesn’t matter how much pre planning I’ve done, how many extraordinary providers of care I have in place—we’re it. We are a family of two.

Thankfully, we’ve been graced with the most amazing friends and I know they are only a phone call away. They have been there for us time and time again.

How about you, what are your thoughts about this new population of elder orphans? Have you put plans in place to protect your wishes? Is it possible that you could become an elder orphan?

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CHRISTMAS ALONE WITH AN UNINVITED GUEST – BIPOLAR DISORDER

Mental Health/Bipolar Disorder/Journal Notes
by: Sheri de Grom

NOTES FROM MY JOURNAL – MONTEREY, CA
CHRISTMAS EVE – 1991

My Grandmother Fromm taught me the importance of keeping a journal when I was 8. She said, "It is never simply a record of daily events."

My Grandmother Fromm taught me the importance of keeping a journal when I was 8. She said, “It is never simply a record of daily events.”

I departed Tom’s hospital room at 10:30 p.m. after his last medication dose for the day. I kissed him goodnight as he stared straight ahead. The light had gone out in his eyes and the shadow of his smile was gone.

What happened to Christmas? What happened to us? Tom and I were meant to be together and now we faced the fourth Christmas IN A ROW with him in the hospital. Please, this couldn’t be our destiny. We were meant to be together, not apart.

I had an uneasy feeling as I left Tom’s room that night. Stillness filled the lengthy corridors. Not a single Christmas decoration could be seen. The silence hung heavy, thick with tension. Were there stifled screams locked inside the lungs of lonely, frightened patients behind closed doors? I’d left the mental health unit several minutes ago but the eeriness lingered.

I normally didn’t allow myself to operate on autopilot, but numbness overtook me. I always reminded my team to never, ever let their guard down. Reprieves were deceptions. The world of those we investigated became completely out of control. We were in the business of turning people’s lives into chaos. They were to take nothing for granted and always be vigilant.

Many prominent citizens along the Central Coast considered our team their personal enemy. A current Veteran Affairs investigation had started simply enough when we’d run a routine paper trail to verify that nursing homes were being paid inappropriately for care provided veterans or not paid at all. The veterans, in turn, were to receive quality care and their pitiful $30 monthly allowance. Little did we know we’d end up with a multi-billion dollar fraud case plus thousands of medical and physical/mental abuse cases on behalf of those veterans.

Getty Image

Getty Image

The Veterans’ Affairs Administration had long passed their ability to manage long term-care patients and they contracted privately-owned nursing homes. Unfortunately, little oversight was built into the program and abuse by both family members and private facilities had reached a shameful crescendo.

Many veteran disability checks were sent to a bank account where the family member had signatory authority. When the check arrived each month, the family didn’t pay the nursing home for care provided or give the veteran the cash allowance that was rightfully his. Instead, the money went to support drug habits, lavish lifestyles, fast cars, or to increase an existing income.

The veterans didn’t know why the nursing home wasn’t being paid nor could they understand why their families weren’t coming to see them. The patients would try to do odd jobs around the facilities to help pay for the occasional haircut and the patients that were able would help care for the ones that were unable to care for themselves.

I was reminded of how easy it would be for Tom to fall prey to a situation where someone was supposed to be watching out for him and greed would take over. I vowed never to put him in such a vulnerable situation. I had to make time to set up a trust for Tom and I couldn’t put it off. Tonight, I didn’t want to think about anything except how Tom and I were going to get our lives back.

The fight had drained out of me today. My legs didn’t want to propel me further and I ached everywhere. I needed a good soak in the hot tub. A massage would be nice too. But, that wasn’t going to happen.

A moment later a long, lean shadow slipped along a curved portion of the central corridor I needed to pass through. Sheri, GET A GRIP! For heaven’s sake, at least fifty people were moving about, what was my problem? When had I become afraid of shadows? And, then the shadow stepped away from the wall and became my deputy, Mike.

“Hey,” I said. “How long have you been here?” I took in a deep breath and tried to stand straighter. My body hurt as if I’d taken a beating.

Mike stepped forward holding his arms open wide and I walked straight into them. I set my briefcase down and wrapped my arms about him. I let out a deep sigh as he closed his arms around me. Tucking my head under his chin I caught the scent I’d become familiar with over the years.

I wanted it to be Tom holding me. I wanted the trace aroma of Tom’s woody aftershave comforting me. Most of all, I wanted Tom promising me everything was going to be okay. But, he hadn’t been able to promise me anything for a very long time.

In a cracked voice, I told Mike, “I can’t take this. Tom’s gone and I don’t know where. I don’t know what to do or who to trust.” Gasping for breath, “I don’t mean you, Mike. I know I can always depend on you.”

“You’ve always got me, boss.”

We sat awhile but I had to get home. It was Christmas Eve after all. Mike knew what Christmas meant to me and his sixth sense had picked up on how fast I was deteriorating.

I couldn’t imagine ever being comfortable in my own skin again. My world continued spinning and I didn’t know how to control it. I had changed along with Tom’s illness. My insides ached as if long fingers had reached in and rearranged my organs. The sensation made me suck in my breath. If only I could turn the clock back. Would I be able to breathe again?

Mike wrapped my cold hands in his warm ones. “Sheri, you’re not alone. I’ll always be here to help you through whatever this damn disease throws your way. You know I’m your friend first and partner second. “

Tom had often teased that Mike and I behaved like an old married couple. In the early years of our working relationship, we’d been together twenty-four/seven. We were both workaholics and our skill levels complemented each other. We knew people talked, but we didn’t care then and we didn’t care now.

Booming thunder met me as I left the hospital that night. Fierce winds and lightning lashed the starless sky. I waited for the Santa driving trolley to take me to my car. I didn’t want Santa, I wanted Tom.

Driving home, I listened to soft jazz on the radio. Again, Kenny G’s soprano sax and his rendition of ‘The Shadow of Your Smile’ haunted me. I wanted Tom’s fun loving smile, not a mere empty shadow.

The raindrops pounded the car. I wondered how high the small brook in front of our house had risen. I was in no mood for hauling out the sandbags.

I wanted to scream or throw something but I was just too damn tired. How much more could I take?

# # #

Rounding the curve of our drive, I pulled the car close to the front door and parked. I wanted to squeeze my eyes shut and crawl inside myself. I wanted calm but it wasn’t happening.

Lightning crackled. The air smothered me. The December storms matched my state of mind. Damn it. I wanted to scream, to rage at the weather gods. I needed the thunder to roll and then . . . I looked down. Farley’s little body trembled. He was without his beloved master. Burying my face in his hair, I let the uncontrollable tears flow. I wanted to promise him that his master would be with us soon and he’d be the man we knew. But, I could make no such promise. Not now and maybe never.

Farley had spent the day at my office, although I wasn’t there. Often when I was going to be away from home all day, I’d drop Farley off at my office and everyone would pamper him the entire day. He always knew he could go from office to office and steal cheerios from desk drawers and then return to Mike’s office to sleep in his basket. Mike loved to pretend he didn’t like little fuzzy dogs but oh, what a fun relationship they had. When Farley saw Mike approaching, he’d take off running and fly into his arms.

It was only natural that Mike turned Farley over to me at the hospital. After all, he was a member of my family.

Looking toward our house a shiver ran down my spine. The front door hung wide open. Black terror enveloped me. Had I forgotten to close the door in my haste to get Tom to the hospital? Again I shuddered at the thought.

I grabbed my trench coat and bundled Farley in it. Tossing my heels in the back, I held Farley close and, barefoot, sprinted across the drive, up the slippery stone steps and into the house.

Setting Farley down and after today’s events, I defied anyone to push me further. Infuriated with myself, I moved through the house, moving back and forth, and sweeping from side to side as I moved from room to room. Shadows crept in from outdoor lighting allowing me to see. Satisfied that I had left the front door open, I flipped the three light switches just inside the door and the entire house and outlying property lit up.

Morti, my twenty-two year old tabby, meowed with force. I must have left the door open, but had I? Morti didn’t like change; I’d missed his dinner hour and the house was cold.

I wished I could change into comfy sweats but I had to feed the cat or he’d never quiet down. I gathered all twenty-five pounds of orange fur into my arms. He responded to the attention by purring as loud as some freight engines I’d heard. I clung to his warmth and comfort.

“Hey, Morti. How are you?”

He looked at me as if to say, now what do you think?” He opened his mouth and I expected a howl but once I opened his cat food, he had no time for idle chatter. Pouring his daily allowance of whipping cream in a china saucer, I thought he’d be content. No such luck. Perhaps when I had a fire going he’d relax.

Farley hadn’t eaten either, but he had the patiences of a saint. I poured food for him, changed the water bowls and headed off to build a fire. Dry wood stood by the fireplace. Tom had always taken care of this task, but in the past few months, I’d been forced into chores he’d once performed.

Morti still fussed in the kitchen, but I couldn’t take care of anything else for another minute. I was beat. The house echoed with the despair I felt. Tom wasn’t home and I didn’t know when he would be. Each hospitalization seemed to take him further away from me.   

Falling in love with Tom had changed my life. I no longer wanted to be the fiercely independent woman who cherished being alone and answering to no one. Would I have to go back to being that woman? I didn’t like change any more than Morti did.

Roaming through the house, overwhelming sadness cloaked me. My mind slid backward in time. I dropped to the flokati rug in front of the fireplace and watched the shadows of the flames dance on the ceiling. Christmas decorations glittered throughout the house, the pounding rain on the roof soothed my shattered soul and I drifted back in time. Effortless, considering today’s events . . .

Posted in Bipolar Disorder, Mental Health, Veterans | Tagged , , , , , , , , , , , , | 89 Comments

BIPOLAR DISORDER – TOM PLEASE WAKE UP

Mental Health/Slice of Life/Journal Notes
by – Sheri de Grom

Notes From My Journal – Monterey, California
Continuation of Same Night, Late 1990s

My Grandmother Fromm taught me the importance of keeping a journal when I was 8. She said,

My Grandmother Fromm taught me the importance of keeping a journal when I was 8. She said, “It is never simply a record of daily events.”

The dash clock reflected twelve forty-five a.m. by the time I pulled into the hospital parking lot. My body was starving for air; I needed sleep. It hadn’t helped that my day had been blown out of the water. Nothing had gone as planned.

The time spent with my deputy, Mike, had rejuvenated me. If I had to have a meltdown, at least Mike understood me.

Tom would be asleep but I desperately needed to connect with him, to see him, to touch

Logo for those of us dedicating much of our lives toward advocacy on behalf of the mentally ill.

Logo for those of us dedicating much of our lives toward advocacy on behalf of the mentally ill.

him and it would be sheer delight to see a smile or feel the touch of his hand.

I’d never missed anyone or anything as much as I missed Tom. My heart may as well have been stomped on. I was having a difficult time coping without my mate.

I so wanted to discuss my office challenges but my always-brilliant strategist had disappeared into a drug-induced sleep.

Restless Sleeper healthnews.com

Restless Sleeper
healthnews.com

His ragged breath told me his body struggled against an overload of drugs. He’d always been a relaxed sleeper—or he had been before the demons took over.

Some days I never saw Tom awake, either at home or in the hospital. I couldn’t wait for a new life to miraculously appear while he slept. Too many people depended on me. If something positive was to come of the base closing, I had to make it happen. I’d made life-altering decisions before without his input. But, damn it, I wanted my life partner and he was gone.

I stayed an hour and watched Tom sleep. I didn’t wake him. What was the use? I was afraid he might have problems getting back to sleep.

I wanted to strip and get into bed with him . . . but hospital rules were hospital rules and I pushed the bar by being there outside regular visiting hours.

Leaving the hospital at two a.m., I drove the final leg of the trip home. The Christmas lights reflecting off Monterey Bay were magnificent but tonight I was battle-scarred. I could be summed up with one word—desperate. My pain was overwhelming. I needed to feel something other than profound grief.

Monterey Bay Pier coastal.ca.gov

Monterey Bay Pier
coastal.ca.gov

I knew my depression was getting worse and that changes had to be made if we were going to survive Tom’s illness. There was no predicting one day to the next. One moment we’d be riding a wild wave of mania. Then the ocean wall holding back that last tremendous crashing wave would break loose and the sinister, dark despair of depression would suddenly slide downward, and all light or hope disappeared.

I wanted to believe normality would return when Tom had energy-charged days with many things happening simultaneously. More often than not, these days were actually the precursor to mania. Each manic phase produced another artistic masterpiece or a broken promise. This could be the spontaneous fun-loving man I remembered. More often, it was not.

I’d experienced that big build-up many times. I reminded myself it was the disease but sometimes it felt downright selfish. Bipolar disorder became a third person in our marriage and I had to find a way to keep it from destroying us.

I’d read that 90% of all marriages where one partner is bipolar ends in divorce. I was not willing for us to become a number in that statistic. Tom and I would survive. Love would show us the way.

Traffic crawled and the road was especially dark. Normally the drive home was pretty at any time of day, but tonight it was just plain black.

I could see our lights in the distance. I wanted to find Farley and Morti and climb into bed, but I still had multiple chores. Final Christmas touches waited, holiday staff bonus awards and recommendations for payments needed to be written for the government Civilian Personnel Office and the list seemed endless.

I found Catherine, Josh (Tom’s apprentice) and other members of my team on the outdoor patio near the fireplace. Catherine had made snacks and hot chocolate for everyone and even Farley was enjoying the festivities.

I didn’t have the energy to get my briefcase out of the car. I looked down to pick up a folder of papers and spotted my wallet. How careless of me. It must have fallen out of my purse.

“Look who’s here,” Catherine said. “Was she surprised to see me?” Wrapping my arm around her waist, my heart lightened. She bounced on her toes and swayed to the Christmas music. I remembered earlier antics that day discussing the Christmas party and smiled.

“Thanks for holding down the fort. I’m almost asleep on my feet. I have to go to bed.”

“Of course, we’ll clean up here.”

“Come on Farley, let’s go to bed. This has been one long day. I bet that Morti cat has already claimed a pillow.”

I tossed today’s mail on the table; my eyes were too tired to read. I couldn’t think; it was too scary.

The above is the continuation of a normal day for me after Tom was diagnosed in Monterey and I worked on Fort Ord. If it hadn’t been for my best friend, Catherine and the team I worked with, I cannot imagine how I might have survived those days and nights of living and learning about mental illness.

Thank you for reading with me. Your thoughts are always appreciated.

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THERE’S NO PLACE IN THE FEDERAL GOVERNMENT FOR MENTAL ILLNESS

Mental Health/Journal Notes/Slice of Life
by:  Sheri de Grom

Notes From My Journal – Monterey, California
Late 1990s

My Grandmother Fromm taught me the importance of keeping a journal when I was 8. She said,

My Grandmother Fromm taught me the importance of keeping a journal when I was 8. She said, “It is never simply a record of daily events.”

My office on Fort Ord was quieter than usual: no laughter, chatter or copy machines running. Usually the investigators bantered with each other and the phones never stopped ringing. When had the silence settled in? Had another day passed me by?

Glancing up from my stack of folders, I saw Mike, my deputy, standing in my office doorway. He hadn’t made a sound; one of his unique qualities that always amazed me. I marvel at his ability to hold one pose motionless for hours on end. He’d told me it was a talent he’d honed along with his sharpshooter skills. He’d never shared with me exactly when he’d needed that expertise and I hadn’t asked. We’d shared the shooting range often enough to know that we could cover each other with confidence.

“Hey you, how long have you been standing there?”

“Long enough to know that we both have to get out of here. It’s almost nine-thirty and I heard you tell Cecelia [editorial note – my secretary] earlier that you were still going to the hospital tonight. I know for a fact that you haven’t had anything to eat in several hours, if at all today.”

Leave it to Mike to call it the way he saw it.

“And what have you eaten today?”

“Remember, I had that delicious lunch at the nursing home.” His body tensed and his hand grazed his belt as if the memory were physically painful. “I hope I live long enough on their food to finish the investigation.”

“We’ve seen the winning results of those meals haven’t we?” Mike went on to tell me how the patients’ lunches had consisted of chili dogs, potato chips, cooked cabbage and peaches in heavy syrup. Every tray the same. No allowances were made for diabetic or other medical nutritive needs and the high sodium content alone made the entire meal unacceptable. The indigestible component of the food for the patient population being served broke every rule.

Nursing home fraud routinely uncovers massive irregularities concerning patient nutrition. Thousands of dollars are saved annually by ignoring Federal guidelines.

We’d started our investigation as a Veterans Affairs fraud case but fraud opened up wherever we turned at the nursing home. We had no idea where this case was taking us, but it wasn’t going to be pretty. Every item we examined revealed additional improprieties.

“What do you say boss, let’s get out of here and go grab dinner.”

“I’d love to but I really must go the hospital.” The internist promised she’d keep me informed, but that’s not enough. How can I say Tom is my top priority when I’d admitted him that morning and hadn’t visited or called all day?

Suddenly I felt weird, the all-too familiar and uncontrollable perspiration running from every pore, and makeup slithering down my face. My hair was oily and wet and so was every inch of my body. Did I smell? My clothes stuck to me.

I couldn’t pull enough air into my lungs, my breath quickened but air came raw into my throat. Suffocating. There was that sensation of a trapdoor suddenly opening in my belly. Oh, God. Please don’t let me soil myself. My heart wanted to jump out of my chest . . . I was sure it could . . . it would . . . that was my heartbeat roaring in my ears, wasn’t it? It was uncomfortable to swallow; the perspiration intolerable.

I’d always worked hard to maintain my image—a professional woman. Could this be God’s way of saying, the joke’s on you? Was it my fault that Tom suffered?

My hands tingled and then they didn’t. Why couldn’t I feel anything? Had I lost touch with reality?

“Sheri, Sheri . . . can you hear me . . . it’s Mike. You’re here with me and you’re safe.”

I felt a hand on my arm and jerked.

“Don’t touch me. I feel so grungy.” I cringed. “I’ll never be clean. I need a shower.”

My legs folded under me. I wanted to stand, but couldn’t. Touching my lips, the tips of my fingers were wet. Blood. I’d bitten my lips so hard they bled.

“Sheri, breathe. Come on, deep breaths. Follow me. In-out. That’s it, now repeat. Over and over.”

I was calming down. My heartbeat was slowing. But I was still covered in sweat. The worst feeling ever.

I lay on my office floor; how could I compose myself after what had just happened? Even more puzzling, what had just happened?

Mike bent down and supported me while I stood up.

“Boss lady, you’ve given me one hell of a scare. We’re not going to do whatever that was again. I’m going to play Dr. Mike for the duration of the VA case plus all the other stuff you have going. You need a good meal and a way to blow off steam so you can focus on whatever you think you must do.”

“That’s quite a speech, partner.”

“Indeed it is. Now, if you like, you mentioned feeling dirty. I don’t see you that way but if you insist, I’ll give you time for a shower before we eat. However, don’t plan on my being so lenient in the future.”

“Yes, sir. Might I ask who made you the boss of me?”

“I thought that was pretty obvious. You asked God for help and I’m here. You know, our Lord does work in mysterious ways.”

“Don’t be a smart-ass.”

But in my mind, I was thanking God for this particular smart-ass.

“Go get your shower and no you don’t have time for makeup and all that girly stuff. I’ll pop us a couple potatoes in the microwave while you’re doing your thing.”

Standing on tiptoe and leaning in, I warned, “Don’t you touch me.”

Mike’s mischievous grin and flashing blue eyes were music to my seriously bruised and battered heart; I planted a kiss on his forehead.

One of the best features of having our offices in an old WWII barracks building was that plumbing was in place. No one had ever thought to take out the toilet and shower between each office. My theory was simple. I was a workaholic and I wanted some comforts of home. My shower connected to my office; how convenient is that?

I didn’t know what had happened to me earlier but I did know that I’d lost it and was sure that it was a result of trying to hold everything together and pretend I was coping, when in fact, I was falling apart.

I was sacrificing myself for everyone else and I didn’t need anyone telling me how that would turn out if I kept up my current pace.

Clean skin, clean hair . . . nothing in the entire world felt better . . . wel . l . l . not unless I could slip into a bed with crisp, clean sheets with Tom. But, that was a fantasy.

Pulling on favorite faded jeans and an old familiar flannel shirt brought a smile to my heart.

Lord, it was good to touch something as simple as a well-loved flannel shirt and have it fill my heart with pleasure.

I found a pair of socks to match my shirt and padded without shoes into Mike’s office.

“Wow, you’ve gone all out.”

His office had become a quiet library setting. He’d moved his lamps to softly accent the walls of books. They cast a glow across his leather-bound collector editions with their scripted gold lettering along the spine, soft jazz played in the background.

“This is wonderful. You’ve even rolled your sleeves exactly the way I love them.”

The staff was always teasing us about my preference for the sexy way Mike had of rolling up his sleeves. He had a special way of doing them that was a real turn-on, to me anyway. Tom had tried to duplicate Mike’s method numerous times and had even tried to get Mike to demonstrate his skill. Mike liked to tell Tom that it was the only thing he could do better than him and he wasn’t about to give away his one winner.

“This is so good and so much better than going out.”

“I agree.”

We’d laughed often calling the refrigerator in our personal supply closet our best secret weapon, and tonight it was proving itself just that. He’d prepared a wonderful assortment of the goodies that Cecelia kept stocked for us.

In the hour that followed, the conversation flowed easily. Mike exuded confidence and charisma. From time to time he allowed a smile into his voice as he shared his concern about how hard I was pushing myself. Those sharp, clear eyes of his told me he knew he was right on target. He’d seen me move into meltdown mode less than two hours ago.

“Thanks for dinner but I absolutely must get to the hospital. I can’t go home until I see Tom.”

“Why don’t you let me drive you to the hospital? I worry about you when you’re so tired.”

“Thanks, I appreciate the offer. But, I can make it on my own tonight. Thanks for the wonderful dinner and I’ll see you tomorrow.” I remembered a song we’d tagged as ours and laughed, “By the way, I’ve Had The Time Of My Life. I always do.”

ADDED NOTE: I have no idea how I would have had a successful career if I hadn’t surrounded myself with highly-motivated people who have become friends for life. During the many years we worked together as a team, I often thought they knew me better than I knew myself.

Names have been changed but my heart sings when I remember my friend, ‘Mike.’

How about you, have friends held you up when otherwise you might have fallen apart?

I’ve had many panic attacks like the one I describe in this blog. In my situation, they are triggered by my PTSD.

Thank you for reading with me.

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THE ELDERLY AND PTSD

Mental Health/PTSD
by: Sheri de Grom

Post-Traumatic Stress Disorder (PTSD) is a difficult mental health condition to treat and terrorizing to live with daily.

PTSD OFFICIAL RIBBON

PTSD OFFICIAL RIBBON

I’ve written hundreds of pages in my journals, over the years, detailing my own difficulties with PTSD and how the disease could and did stop me in ways nothing ever had before. 
The elderly who have had serious falls are now identified as high risk for PTSD. According to a study conducted by the Department of Psychiatry at Weill Cornell Medical College in New York, PTSD results increase as the elderly recognizes their independence is in jeopardy.

The most at risk for PTSD are elderly women who live alone and people who are unemployed or less educated. All participants in the study were assessed using the Post-Traumatic Stress Disorder scale, which measures 17 symptoms of PTSD.

Stress symptoms related to falling are supposed to lessen, over time, after the fall. At least, that’s what my doctors tell me.

I know from experience that the stress of possibly falling again doesn’t lessen with time. PTSD & TBI are often coupled together and that brings together a host of additional problems.Many of you are aware I’ve sustained multiple Traumatic Brain Injuries (TBIs), and each time I fall, I worry about what shape I’ll be in when I land. It terrifies me. My neurologist tells me, “Any blow to your head could be your last.” I’ve done enough research to know he’s not just trying to scare me into being more careful; he’s telling me the truth and I’m afraid.

I took a serious fall last month at a garden center. Any garden center is one of my favorite places in the world. Spring is here and I’m recreating my gardens.

I’m happier in the garden than anywhere else on earth. This is where I feel the closest to God and my ancestors that have gone before me. I have conversations with you, my fellow bloggers, and might I add, we are brilliant when we are in the garden.

About that fall last month; Tom was with me and witnessed the fall from beginning to end and that provided valuable information to me.

I was on concrete, noting the space around me was free of debris and other hazards. Joy surrounded me as I filled my cart with brilliant blue Delphiniums, fragrant Cloud Honeysuckle Vines, an exquisite Cheyenne Spirit Coneflower Mix, Red Satin Coreopsis, and Russian Sage along with Lavender. I have well over 50 bulbs to plant and about 30 wildflower packets ready to go and much more transplanting before beginning to plant my new bounty.

Foxglove for the early stages of my cottage style garden.

Foxglove for the early stages of my cottage style garden.

Tom told me later, “It was worth the trip to see you nonchalant, moving among the flowers, carefree for that moment in time.” Tom continued, “I thought you were happy and living the life you were supposed to be living; gone from your face was worry and that look of impending doom.”

It was indeed a gift to be at the garden center with him. A young man working there found Tom a pleasant place to sit and even ran for a soda for him. They sat chatting while I decided what appealed to me and of course, to Tom as well.

The young man, ever so polite and a wounded warrior, hit it off with Tom and they were

Make my gardens cottage gardens and I'm happy.

Make my gardens cottage gardens and I’m happy.

content talking about the rigors of returning to civilian life after being in the midst of ‘Being All You Can Be for Your Country.’ Their conversation was a blessing for the three of us. I didn’t have to worry because Tom was entertained by the young warrior and what fun for me to have freedom to discover endless possibilities for my garden.

Back to the dreaded fall; I can only avoid talking about it for a short time. Tom told me I didn’t seem to lose my center of gravity which is one of my biggest problems and common for TBI survivors. He told me it was as though my right foot collapsed and my body crumbled into itself. The result of my falling on concrete is 2 more cracked ribs and an extremely sore left side.

I’ve never associated my many falls with PTSD due to their direct causal effect from my TBIs. However, fear and falling always walk hand in hand.

My own PTSD doesn’t center on falling, however it causes me to be more cautious than ever before. Falling hurts more each time but I refuse to allow my thoughts to control my activities. I know how devious yet paralyzing PTSD often is.

Someday I’ll share with you some of my journal entries about Tom’s and my PTSD. But,

My trusty journal travels the world with me.

My trusty journal travels the world with me.

today, I wanted to say, I now understand how PTSD symptoms develop in the elderly after they’ve sustained a fall. Often you feel yourself going down but don’t understand why or how. The fear of falling again and no one finding you can circle in your head for an eternity.

Coupled with Tom’s PTSD and other mental illness plus his declining health, he falls often. It is my responsibility to make our environment as safe as possible for him. I’m helping myself                                                   at the same time.

I’m a firm believer in the safety alert devices now available for individuals. Tom’s is connected to our home alarm system. When I’m successful at getting him to wear it, all he needs to do is push the center button (he can wear around his neck on a cord) and he has two-way communication immediately with emergency personnel. The device is also wired to 911 if something occurs and he needs help wherein law-enforcement is needed immediately. The wearable two-way communication affords me peace of mind when I need to run an errand or even be away from the house for a few hours. This same protection may be activated from any panel within the house.

I’m concerned: the elderly do not have easy access to quality mental health care. Most have never had any type of mental health care and are opposed to receiving any after a fall. Mental health care often means medications are dispensed and the elderly ends up in a nursing home.

Thank you for reading with me. I always appreciate your presence and am interested in knowing what you think about the classification of PTSD and the elderly after they sustain a fall.

Until next time, my special friends, your love, support, prayers and check-ins mean the world to me. God works in mysterious way and He never mentioned a word to me about what wonderful friends I would make on my blogging journey.

Next week I will bring you an excerpt from my journal wherein I struggled with my own PTSD. I didn’t know it was PTSD at the time as the symptoms first reared its ugly head as panic attacks.

Your continuing support, love, inspiration and prayers help me move through the day.

Happy spring everyone.

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PATIENT HEAL THYSELF – PHYSICAL VS. MENTAL

Mental Health/Bipolar Disorder/Mortality
by: Sheri de Grom

We’ve lived with Tom’s bipolar disorder for 26 years and it’s propelled us into a world we never envisioned.

Bipolar disorder had come to stay at our home and it was devastating. However, accepting the diagnosis was nowhere as traumatic as the daily trials we now faced.

Logo for those of us dedicating much of our lives toward advocacy on behalf of the mentally ill.

Logo for those of us dedicating much of our lives toward advocacy on behalf of the mentally ill.

December 7, 1941 is known as the hinge of history. When it opened, the world was never the same again. December 7, 1987 holds the same world-changing torment for Tom and I. From Tom’s first hospitalization, on that long-ago day, I’ve known the enemy of his illness could strike from any direction at any moment with no warning and our lives would change yet again. This enemy knows no mercy.

I’m convinced Tom’s many complicated physical illnesses have two direct causes: one is the result of years of taking harsh psychiatric medications and the second is the fact that physicians have not provided him with the quality of medical care they would have, had he been free of his bipolar illness.

The more I learn of physician neglect of individuals with mental illnesses, the more disturbed I become. These doctors are in essence playing God when they elect to hold back on life-saving care.

It doesn’t make a difference that our loved ones didn’t ask for these diseases.

I can’t imagine an orchard wherein you go pick the fruit of your choice. Would your loved one pluck a succulent ‘bipolar disorder’ fruit with its many mysterious layers?

Shiny schizophrenia hangs low to the ground waiting for a productive teen, in the prime of their life, for them to catch the fascinating fruit. This teen is never the same again nor is  his/her family.

The orchard is full of robust trees beckoning all to enter. What a tragedy it represents [except for those who make money from the chemicals that find their way into the bodies of the individuals we love. Heaven forbid ECT should be the resulting treatments.]

I’ve learned much about the destruction of Tom’s body due to his having suffered from bipolar disorder for the past 26 years. Learning by living through the process is catastrophic. I journal about our daily experiences but have found it impossible to place my words in a blog that would be coherent.

Some of the events Tom and I have endured during this past year in trying to find quality health care for him in the past 12 months has been some of the worst we’ve encountered. I feel the necessity of sharing with you how far mental health care HAS NOT ARRIVED in the 21st century within the medical community itself.

Some of my entries will not be in chronological order and I’ll do my best to keep each entry date stamped for your ease in reading.

I will share with you over the next several months what we’ve had to do to keep Tom alive. The medical community didn’t seem to care rather he lived or died. I wish I didn’t have to make this statement, but I do. It’s been proven to me time and time again. We’ve had one crisis after another for a full year now.

There’s nothing easy about being a 24/7 caregiver. It’s no longer about just providing care, there’s the responsibility for researching every new symptom, test, prescription, etc. You don’t dare miss a single opportunity or allow a single clue to go without research. Doctors have an interesting way of listing diagnoses on a patient chart and never once mentioning those very diagnoses to the patient or their caregiver.

I can’t begin to express how your outpouring of love, prayers, and support lifted me up in the many dark days since my last blog. It’s been an exhausting time and I’ve wanted to bring everyone up to date and continue to check in on everyone as well. [Where do the hours go?]

I continue to hold ‘Doc In The Box’ in the highest regard. I believe with my entire being that they saved Tom’s life.

It doesn’t matter to me that Tom’s heart surgeon said to me while Tom was in the hospital, “Never go to Doc In The Box, they’ll kill you.”

I spoke up immediately and said, “They saved Tom’s life when you were nowhere to be found!” I don’t think he liked my answer and continued on with his rage about all the small walk-in clinics opening and of course he didn’t want to discuss the medical needs they meet.

This same heart surgeon cleared Tom as being medically sound for his new pulmonary doctor to perform a bronchoscope the following day. Tom has complete faith in this new doctor [not me, I’d fire him if Tom didn’t like him so much.]

Tom’s endoscopy had been underway approximately 1 ½ hours when the doctor came to the waiting room to locate me. I knew immediately something was wrong or an assistant would have called for me.

The doctor escorted me to Tom’s area and explained he was unable to complete the procedure. Tom had a heart attack during the procedure and his right lung completely collapsed with the second lung in danger of doing the same. The doctor had wanted to take some biopsies but was unable to do so because of Tom’s critical condition.

The decision was made for Tom to be admitted to the hospital for continuing care. Each time the heart doc came in to see Tom, I wanted to give him a solid punch but refrained.

I have another blog prepared that predates this medical adventure but felt for simplicity’s sake, it was easier to bring you up to date of what was presently happening and how I believe it all ties into Tom’s mental health diagnosis.

It’s easy for us to overlook the most important health statistic of the past century. Life expectancy has increased dramatically in the U.S., from 51 years in 1910 to nearly 79 years (81 years in women, 76 years in men) in 2010. This increase converts to nearly 3 years of additional life every decade or a gain of almost 4 months every year.

 Unfortunately, reductions in mortality are not shared equally in this country. The same Centers for Disease Control and Prevention data show that mortality associated with mental illness should command the attention of anyone who cares about health disparities.

Most of the early mortality with the mentally ill is attributed to what is labeled “natural causes” such as acute and chronic co-morbid conditions (heart diseases, pulmonary diseases, infectious diseases). Only 17.5% of deaths are related to “unnatural causes” such as suicide and unintentional injuries.

The Center for Disease Control (CDC) estimates the increased mortality could be averted globally by a minimum of 8 million people. That is, 8 million deaths could be averted each year if people with mental illness received the same level of medical care those without a mental illness receive.

It’s a given that parity does not exist within the mental health arena but why should we have to fight so hard for equality of medical care for our loved ones with a mental health diagnosis who also happen to have bodies that are physically challenged over and over?

Again, I thank each of you for reading with me. Collectively we can make a change but we are going to have to stand to together in our endeavor to bring quality medical care to those with a mental health diagnosis.

Do you have stories to share wherein bad medicine played into the detriment of health care recovery of those you cared about?

Thank you for reading with me. I appreciate your support.

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DOC IN THE BOX SAVED MY HUSBAND’S LIFE

Medical 2015
by – Sheri de Grom

I started this post several months ago and had an entirely different opinion of Urgent Care Clinics. What we’d often called ‘Doc’s In A Box,’ saved Tom’s life on March 23, and they didn’t mention BIPOLAR DISORDER one time. I have a new respect for this segment of the medical industry.

I don’t believe I’m hasty in reversing my opinion. Let’s look at the objectionable facts leading up to this incident:

I’d been unable to reach Tom’s internist for 4 days and Tom breathing was shallower by the minute. His coughing was uncontrollable and none of our old tricks were working. We still didn’t know what was happening to his feet and he couldn’t walk. I’d been pushing him in a wheelchair for the better part of 4 months and tending to his every need for well over a year. I was beyond exhausted and had become a prisoner in our home.

I’d thought nothing could be harder than procuring excellent mental health care for the man I loved, but the playing field became upside down when we each turned 65. The past 8 months had been a living hell on earth as I watch Tom suffer and I knew it was needless.

For 25 years I’d read everything possible from lay books to text books and gained useful insight about Tom’s mental illness. I’d attended symposiums meant for medical staff only and participated in round-table discussions. I’d written legislation to change existing laws and felt confident that I knew what I was talking about and even demanding.

I insisted on what I thought was right from mental health care workers at all levels (including treating physicians), insurance companies, and legislators alike. I wrote legislation and spent night after night in committees until words were chiseled in such a way they could not be changed once they reached congressional vote. I refused to give an inch.

I entered a new area of health care exploration when Tom was hospitalized Sep 22 and diagnosed incorrectly. He suffered unimaginable pain while I searched for answers. Critical functions of Tom’s body were breaking down simultaneously and his doctor of record pumped him full of antibiotics by IV 24/7 with no discernible improvement. Of course, the physician didn’t know if Tom had anything that could be fought with antibiotics. We did not have one conclusive ‘test’ stating this fact.

Tom was in unbearable pain when he was admitted to the hospital on Sep 22 and nothing had changed when he was discharged 8 days later. The doctor sent him home with more antibiotics and pain pills!

I continued my research but the progress was minimal. Seven months passed as we continued to see a parade of physicians wanting to dispense more antibiotics and pain pills. Tom was continuing to fade away and I was becoming more and more frightened. We saw 7 new physicians and not one changed the admitting diagnosis of cellulites yet we still had not one shred of evidence that was what was happening in Tom’s body. More and more antibiotics were prescribed and more and more pain pills. We didn’t want antibiotics and pain pills, we wanted answers!

I’d had enough, on March 23, 2015, one day before Tom’s 67th birthday, I bundled Tom in a heavy coat and drove him to a new Urgent Care Facility (Doc In The Box). It was probably the smartest medical move I’d made in a year when it came to his medical care.

I couldn’t take him to the local ER where we had waited for 8 hours before seeing a medical attendant and were treated as though we were second class citizens.

For several months I’d been researching the provision of the Affordable Care Act which drives the latest boom in new construction which is in free standing urgent care facilities.

On this terrible day, I saw the ‘Doc In The Box’ as a means to an end, immediate care for Tom.

Rounding the sharp edge of their parking lot as fast as I dare go, I gathered Tom from the car and screamed for help as we made our way to the clinic. I didn’t have time for that dang wheelchair. I could get him there faster in my arms.

Where does the adrenaline come from, but damn it, I wasn’t losing him now. I knew somehow this was our last stop between life and death. It was our last hope!

Yanking the insurance cards from my pocket, I tossed them toward the admitting desk and an orderly rushed to help me with Tom. We were taken to a treatment room immediately.

The doctor’s momentum demanded action. Monitoring devises were placed and she barked, “Call EMT for cardiac arrest transport.”

Getty Images

Getty Images

How long did I hold my breath waiting for the man I loved to breathe again? Please, God, not like this.

One moment I heard the screaming sounds of the ambulance approach and before I could focus my tear filled eyes, Tom was whisked away. Time ceased to exist. We were living one breath at a time.

What did I learn from this experience: No one at the Urgent Care or ‘Doc In The Box, was trying to one-up their peer. They worked as a team and were a ballet in precision. The 4 were seamless and the immediate arrival of the ambulance allowed the smooth transport of Tom into the ambulance for his life-saving trip to the ER.

Much of what had kept Tom from receiving the care he so desperately needed over the past 9 months was doctors playing the one-up-man game and political-in-fighting. There were too many egos for Tom to receive appropriate medical care.

I lost all track of time from the moment Tom left for the ER and the time I arrived at the hospital to join him. A staff member asked if I would like someone to drive our car to the hospital and they would give me a ride.

Arriving at the hospital that night, the many times I’d arrived at hospital ERs for Tom rushed through my memory bank. How many times had I feared for his life, how many times had I prayed, God’s will be done?

The ER technicians, physicians, nurses, breathing specialist, cardiologist and the entire medical team worked in unison that fateful night. The primary treating physician told me I came within 3 minutes or less of losing the man I love that day. Why are doctors compelled to tell me how delicate Tom’s health is? I know I’m the one that’s on first. I know I’m the one that must be vigilant. WHY DOES THE MEDICAL PROFESSION GREET ME WITH SUCH RESISTANCE? I’d called 8 times to Tom’s regular providers asking for help as this particular episode turned into a life or death situation.

Is this another case of doctors discriminating against those with a mental illness? Please Lord, tell me it’s not so.

I have a new respect for the new Urgent Care Clinics springing up everywhere since the passage of Obamacare. I’m not saying I agree with how it’s being accomplished or that I like Obamacare, I don’t. I loathe the Affordable Care Act and what it’s done to our health care but on March 23, 2015, it saved Tom’s life. Urgent Care helped us when no one else was interested in providing the medical care we so urgently needed.

In my earlier research, I discovered it’s the few who are making millions on the backs of taxpayers in the building of the Urgent Care Clinics, but that’s the way Obama and Obamacare works!

The intent of the new clinics being built today is to insure health care availability where affordable housing is located. [This is the basic premise of the requirement – accessible primary healthcare for those who otherwise could not reach healthcare unless it was in their neighborhood].

The argument for building and financing the clinics was that with them being built in communities where low income populations with insurance lived; the health centers would drive the cost of health care spending down. It was to be a win-win solution.

A $100 million fund has been established to build community centers near affordable housing as demand for primary-care services are expected to rise. The law includes approximately $10 billion for the creation of new, federally qualified health centers.

As reported by the Wall Street Journal, “[the fund will rely on $87 million in loans from Morgan Stanley in exchange for tax credits to build 500 new affordable housing units and eight new health centers serving 75,000 people.”]

What I’ve noticed in our city is approximately 10 – 12 of these primary care clinics have popped up in less than 18 months. Do they serve a purpose? I must say yes, they saved Tom’s life when I had no other avenue.

Does our city need or meet the criteria for the clinics. The answer is a resounding no. The clinics are being built in affluent neighborhoods when they are targeted for inner-cities. Yes, the clinics are more likely to succeed in a city such as ours where we have fewer than 10 violent crimes per year.

I was less than pleased when I first read and started researching the hidden monies going into the Urgent Care Clinics masked as Primary Care Clinics. But again, they were there when I needed them and they rose to the occasion.

On a separate note, I’ve been away from the blog for many weeks and I cannot promise I’ll be around more than in the past months. Tom has been an extremely ill man and I spend my days and nights caring for the man I love. I think about little else.

I’m delighted to report we now seem to have a correct diagnosis but in the meantime the wrong diagnosis affected his entire body.

Every good ER doc reminds his patient to follow up with their internist or family doctor as soon as possible. Of course, this very thought returned to my 8 previous attempts to do just that before these life-saving measures were required.

We finally saw Tom’s internist on March 31, a total of 6 days after he had gone into cardiac arrest but still the first appointment we could get. Thankfully, I’d advised the ER Doc we might not get in right away and that we had full pharmaceutical coverage. I was giving him permission to write prescriptions for whatever he thought Tom would need over the next week, for fear we couldn’t get an immediate appointment. The doc took my word and we had to use every medication the good doc wrote for Tom.

A miracle occurred as a result of this horrific scare and I do wish we hadn’t had to sacrifice nearly a year of our lives to arrive at the place where we are today but we now have a protocol in place for Tom’s immediate medical needs.

Many of you know I’ve always been able to call Tom’s psychiatrist cell phone direct whenever necessary. I respect the psychiatrist’s kindness but I don’t hesitate to call when we need his assistance. I also provide an e-mail with specific bullet items spelled out for his quick reference of what I’m seeing regarding Tom’s mental health.

Tom’s internist was furious when I explained to him what had happened to us over the past year, since Tom’s misdiagnosis on Sep 22, 2014. He knew the bolts and nuts as Tom’s internist but not the additional issues we’d had in obtaining the medical care Tom needed.

He told us if his nurse did not get back to me within 1 hour of my initial phone call, I was to call his appointment desk and advise them I needed an appointment within 12 hours. It didn’t matter if they told me there were no appointments available. His words, “Tell them Dr. Edwards said to double book.”

Leaving Dr. Edwards office that day, I had hope. Another private cell phone number should the occasion ever arrive when I couldn’t reach him.

Tom’s having some of the same problems today and I just called the doctor’s office. Something must have changed after he bellowed down the hall the day we left, “All staff, conference room now, everyone.”

Today the nurse returned my phone call within 30 minutes and offered an appointment less than an hour out, but I knew I couldn’t get Tom and I both ready to leave the house in less than an hour and be there on time. We have the next best thing, an appointment at 10:30 a.m. tomorrow.

Your prayers and kind thoughts mean the world to me and I try to make the rounds of reading your blogs as often as possible. I love and respect each of you and hope to get back into some routine of blogging soon. This past year I’ve learned more about this health care system of ours than I ever cared to learn. I’ve also learned much about the health care availability in countries around the world and we’ll do a bit of exploring there also.

Thanks for sticking with me. God Bless.

Tell me, what have you been up to lately? I’ve missed each of you.

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CONCIERGE MEDICINE – IS IT RIGHT FOR YOU?

CONCIERGE MEDICINE EDUCATING THE PUBLIC GETTY IMAGES

CONCIERGE MEDICINE
EDUCATING THE PUBLIC
GETTY IMAGES

Medical 2015
by – Sheri de Grom

The emerging model of concierge medicine has its roots in both patient and physician frustration.

BASIC CONCIERGE MODEL

  • Patients pay a monthly or yearly subscription fee to join a physician practice.
  • The physician controls the number of patients in his practice and his income.
  • The patients get 24/7 access to their doctor via phone and email, same-day appointments that can last hours, and a relationship in which the doctor’s and the patient’s interests are closely aligned.
  • Concierge medicine is a growing premise of provider care. A company, MDVIP is the largest concierge medicine consulting company in the nation with more than 700 physician members and more than 200,000 patients in 42 states.
  • MDVIP is a hybrid model that provides a comprehensive wellness screening of all patients. This patient screening becomes the foundation of the doctor-patient relationship. MDVIP accepts insurance, including Medicare, and 94% of patients renew with affiliated physicians.
  • A physician with MDVIP sees between 10-12 patients a day. He has a patient panel of about 400 patients, about 10% of his former patient load. He receives about $140 a month per patient and he cares for the children of patients at no charge. MDVIP takes care of all insurance billing and reimbursement.
  • Another example includes physicians who charge by age group. Sliding scales often range from a yearly fee of $750 to $4,500. Some doctors screen patients and others don’t.
  • A concierge physician has the freedom to include as many services in his practice as he wishes. He controls every aspect of his business. He may or may not have a traditional office.
  • At the extreme you might find a doctor with a vehicle equipped with advanced testing equipment and he sees all patients on house calls.
  • Another physician might make arrangements for their patients to receive lab and imaging tests for about 10% of the cost that providers bill insurance companies.

Concierge physicians receive guidance as members of the American Academy of Private Physicians (AAPP), a nonprofit group which works with its members to build sustainable concierge medicine practices.

According to the American Medical Association there are approximately 246,000 primary care physicians practicing in the U.S. Approximately 40% are employed by health systems and hospitals. That leaves about 148,000 primary care doctors in private practice.

The editor of Concierge Today reports there are 5,500 doctors practicing concierge medicine and that rate is expected to grow by 15% a year.

The American Academy of Family Physicians kept concierge medicine at arm’s length for years, but is moving quickly to embrace the direct care concept.

A recent study by the Annals of Family Medicine projects there will be a shortage of more than 50,000 primary care doctors by 2025.

John Rother, a policy expert at the American Association of Retired Persons (AARP) wrote, “Those who can afford to pay a monthly fee will get better health care than those who cannot. Medicare patients, who universally have lower incomes, are at a disadvantage under such an evolving two-tiered system.”

After battling our current health care system for Tom’s life over the past 8 months, we would have concierge care, if I could afford additional capital outlay. An internist in a nearby city has joined a concierge team and I hope to interview him in the new two months about taking Tom on as a patient. My frustration is born of not having quick access to Tom’s internist. I’ll be the first to agree that Tom’s body is medically complex but I believe if I could achieve intervention by a physician that cared about his physical health, we could prevent much of what turns into life and death situations. [A perfect example of this is the inability of getting a timely appointment and a virus turning deadly causing last week’s emergency of cardiac arrest].

Or, is the above another example of medicine turning its’ back on the mentally ill patient and physicians continuing beliefs that a patient couldn’t be as ill as reported when requesting an urgent appointment?

My own internist has a highly-qualified Physician’s Assistant on his staff and I have 24/7 access to medical care. I know that when I call my internist’s office, I may not get to see him within 2 days but I will get to see his PA and if my situation is something she needs to consult my doctor about, she does. This has worked for me.

Tom and I used to share this internist and we should have had the same relationship with him but the internist couldn’t get past the idea of Tom’s bipolar diagnosis and thus, was not a good fit for Tom.

I’m all for everyone finding the best medical care for themselves. For the past 8 months with additional medical complexities occurring with Tom, we needed a doctor willing to take calls and guide us through the medical maze that stood in our way. Instead, Tom might have lost both legs and worse, died of an unidentified infection.

It’s hard for some Americans to wrap their heads around the concierge medicine model. Under the law, every American is required to have medical insurance – but direct primary-care patients can seek less expensive policies, because they require coverage only for hospitalizations, surgeries and other specialized care.

Concierge medicine provides a direction to primary care and a less expensive insurance policy than those currently offered by Obamacare. This new approach covers all preventive services and insurance would only be required for hospitalizations, surgeries and other specialized care.

In my opinion, there’s much to be said in favor of concierge medicine.  I wish it had come along 20 or 30 years ago.

When people get good primary care, their maladies are diagnosed more quickly and can be managed before they grow into crises. Fewer patients wind up in expensive hospital beds. Emergency rooms treat genuine emergencies, not routine infections and minor injuries. Patients receive timely advice and encouragement from a trusted physician to shed those pounds, change that diet, drink a little less and exercise more. Insurance models discourage this holistic approach. Insurance pays for treating diseases, not addressing questions about preventative care.

It’s no wonder Primary Care Physicians prefer to cut their own path in their own medical practices. The Medicare Formula guiding payments to doctors will cut payments to all physicians by 21% on April 1, unless Congress overrules it. Primary care physicians are also facing a scheduled Medicare cut of 10% on January 1, 2016, unless Congress overrules it, which would be in addition to the cut all doctors will take on April 1, 2015.

Is it any wonder primary care physicians are leaving traditional medicine when in today’s

Getty Images

Getty Images

concierge medicine the average take-home payment is $200,000 to $250,000 per year and they don’t have to worry about Medicare or any other reimbursement policy change. Neither do they have to do mountains of paperwork. These groups of Primary Care Physicians treat their patients, the very reason they went to medical school in the first place.

How about you, have you had experience with concierge medicine and if so, would you like to share?

Would you consider giving concierge medicine a try?

Medical care is changing. Can we afford to allow congress to dictate our healthcare needs? We must have give and take. What risks must we be willing to take?

For Tom and I, perhaps our ideal would include a Concierge Physician for at least Tom and we would continue to maintain the insurance coverage we have. My sole reason for the concierge — immediate access. We have insurance that provides coverage for the specialist in place as well as pharmacy and hospitalizations. I see the Concierge Physician as the doctor that just might be the one that could keep Tom alive!

Today, it’s not just a Medicare issue. Primary Care is everyone’s business.

Thank you for reading with me and as always, I look forward to hearing your thoughts on this all important subject.

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MEDICARE – RELIC OF A BYGONE ERA

Medicare/Medical 2015
by – Sheri de Grom

Have you tried to ask Medicare a simple question lately?

Have you tried to ask Medicare a simple question lately?

Medicare was created by Congress in 1965 under Title XVIII of the Social Security Act to provide health insurance for people aged 65 and older, regardless of income or medical history. Before Medicare, only half of older adults had health insurance, with coverage often unavailable or unaffordable for the other half.

Previous to 1965, older adults had half as much income as younger people, and paid nearly three times as much for private health insurance. Medicare was needed at its onset.

Medicare’s implementation of a one-size-fits-all program seemed a logical first step. Individuals without health care suddenly had access to physicians and necessary services.

Initially Medicare consisted exclusively of Part A which covered 80% of hospital and other inpatient cost. Part B was also initiated and it covered 80% of physician visits and other medically necessary services.

Today, the 80% coverage has been eliminated and all rates are negotiated with the Centers for Medicare and Medicaid Services (CMS), a component of the Department of Health and Human Services (HHS). The rates are not negotiated with physicians or other health care professionals that provide patient care but are decided upon by bureaucrats with no medical background.

In my opinion, it requires more than an MBA in accounting to successfully manage a program such as Health and Human Services and community service experience to manage the Centers for Medicare and Medicaid Services! These individuals are Presidential appointees.

The negotiated rates Medicare and Medicaid are demanding of each diagnosis makes it impossible for doctors to earn a satisfactory living treating Medicare patients. It’s no wonder these doctors who once opened us with welcoming arms no longer want to see us. We have become a deficit on their balance sheet.

The Medicare patient is still required to enroll in a Part D program, which partially covers

Part D is for partial prescription coverage.

Part D is for partial prescription coverage.

their medications unless they have a private insurance program. It’s not unusual to find senior citizens living on a fixed income dividing limited resources between medications, food, utilities and other necessities in their home – if they even have a home. This is one of the problems that sends elderly women to the streets where they join the thousands of homeless men and younger women and children already in the homeless population.

Citizens of the United States have a wide range of medical needs that can no longer exist under Medicare’s original intent. Every day 10,000 baby boomers join Medicare.

Like most of my fellow boomers, I continued working full-time after I’d retired from my career. I survived by paying the maximum into Medicare just as I paid higher income taxes.

We pay the maximum for Medicare Part B as required by law. This frequently happens when you have a second career after leaving behind a career wherein benefits begin at the end of 20 years regardless of your age. [That’s what happened to me. My career choice with the federal government required retirement at 20 years regardless of age. I was 54.] After what we’ve already paid into Medicare, not counting the $700/month for BC/BS plus dental & glasses insurance, Medicare is a scam of the worst kind.

Vietnam Wall, Washington D.C.

Vietnam Wall, Washington D.C.

What’s more troubling, Medicare is an assault on every retired military member and their families. Unless we enroll in and pay for Medicare Part B, our rights to Tricare for Life is taken away.

At the time soldiers were drafted and/or volunteered for Vietnam plus every conflict and war since then, the promise of free medical care for life for themselves and their families was guaranteed. This free medical care wasn’t of the VA variety but medical care in the civilian community upon a minimum 20 years service to their country.

David N. Walker @davidnwalker.com reminded me recently that there are only two people willing to give their lives for us: Jesus Christ and the American Soldier.

Tricare for Life is not an add-on-bonus for the soldier at the end of his career. A portion of his salary each month is allotted for Tricare. We can’t call that medical care free, can we? Now, the Pentagon and Congress require soldiers and family members sign up and pay for Medicare Part B making Medicare the main payer and then Tricare for Life the secondary payer.

My government is denying me freedom in the marketplace and I don’t like it. Tom and I have already paid in enough to Medicare to own a second home along the central coast of California [Big Sur, Carmel by the Sea, Monterey] and a third home on the Outer Banks of North Carolina.

Take Our Medicare Money and Give What Healthcare It Would Buy to Someone Else!

Take Our Medicare Money and Give What Healthcare It Would Buy to Someone Else!

Our medical expenses would be covered 100% without Medicare. Why is Medicare pushed at us when our nation is in serious financial crisis? My husband and I would be happy to give our share to someone who needs what we’ve paid. We’re far from wealthy but we’d be better off if Medicare would go away.

Medicare has made a shamble out of healthcare. It dictates what doctors must document and do to such a degree that they don’t have enough time for the patient in front of them.

If you are receiving care and are swallowed into the Medicare system, have you noticed your doctor handing you a sheet of paper or even multiple sheets to read? The information may be as basic as your hair may grow thinner as you age but nevertheless, your physician must educate you in order to check off another box to qualify for the maximum Medicare payment.

I want my doctor(s) to work for me. I consider my internist the single most important part of my health care team. Call me old-fashioned, but I believe my internist’s core obligation is to be honest with me about my medical risks and thoughtful about how I manage them.

It makes no sense that my physician is worth less to Medicare than he was before I turned 65 and was forced into Medicare.

The Affordable Care Act is rapidly changing the way Medicare is paying claims. One of the largest and one that has kept me away from blogging is the critical care I’ve been faced with in caregiving for my husband, Tom.

You may remember, in my blog of Nov. 21, 2014, I announced I was taking a much-needed blogging break and would be caring for myself until after Christmas. You may read that blog here.

Later I’ll write about how I almost lost Tom, and due to receiving the worst healthcare possible (governed by Medicare) he’s been in excruciating pain since mid-September. His pain is 24/7 and when he is forced out of bed for an appointment, he’s confined to a wheelchair [this would not have happened except for the gutted healthcare system we are caught up in].

Tom’s situation started with a physician’s incorrect diagnosis and we were further exploited by a second physician who had a God complex. It was during this 7-month odyssey that I learned a physician with a Medical Board Specialty would not treat a second diagnosis directly related to and in the same location of a more serious diagnosis. The physician may have more knowledge he can/will share with a patient and help them make more informed decisions. If the specialist extends care beyond his specialty, Medicare will reduce their payment in the form of a fine. Additionally, the patient is forced to find another specialist to address the second symptom related to the more serious diagnosis. In addition, the doctor would be using allotted time for another patient with an appointment. Doctors no longer have an extra cushion built into their schedule to allow for such events. This payment regulation makes no sense to me.

Tom was recently diagnosed with psoriatic arthritis and the rheumatologist made it clear that he would treat the arthritis but not the psoriasis.

This 7-month journey of obtaining the best health care for Tom continues in an exhausting form. There seems little time for much else these days. I will lay out all the facts of Tom’s care over the past 7-months. I’ve kept my journal during this painful journey and I’ve discovered new fields of medicine, doctors who sabotage the works of colleagues, the dangers of misdiagnoses and fear of other doctors unwilling to confront their peers’ mistakes as well as the continuing stigma we meet along life’s way. Once I sort out the mountain of paperwork, I’ll attempt to put the past months into a bulleted format.

I apologize for not visiting your blogs on a regular basis. I continue to appreciate your support. I’ve had days when I wanted to do nothing more than to stare into space but Tom’s needs have doubled. His not being able to walk has changed our lives on so many additional levels.

How about you, have you learned anything new about the state of our health care since we talked last?

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