Rural Living Elders Greatest Risk to Perish in Massive Western Fires

September 17, 2020

ELDERLY 2XMORE LIKELY TO DIE IN FIRES

The U.S. Fire Administration estimates that older adults are more than twice as likely than the general population to die in fires. One-quarter of the Paradise residents, in the devastating fire that burnt down an entire California town in 2018, through PG&E Malfeasance had a disability which is double the statewide statistic. One geriatric care manager who lives there, lost his home and practice trying to rescue a local older client.

Decades of research confirm that the physical limitations that accompany advanced age make it much more difficult to escape disaster, but so do the social isolation and stubbornness that experts say are common among the elderly.

BREATHING PROBLEMS FOR SENIORS UBER RISK IN FIRES

The elderly are at the greatest risk for fire-related breathing problems according to the CDC.So if they just live in fire-prone areas and do not lose their home the very air they breathe can make them ill or actually kill them. Wildfire smoke can in the worst cases be deadly, especially among older people. Studies have shown that when waves of smoke hit, the rate of hospitalizations rises, and patients experience respiratory problems, heart attacks, and strokes.

In 23 counties, older Californians overwhelmingly choose to live in fire-prone areas. Including in San Luis Obispo County, where 82% do live in rural areas.

That means nearly 2 million older Californians live in areas where wildfire is a formidable threat. It is not only the elderly who are losing homes in these rural Forest fires but those in facilities.

According to NPR in San Francisco, there are more than 10,000 long-term care facilities in California, from six-bed assisted living homes to large nursing centers.

Their analysis found that 35% of these facilities are in risky areas. With as many as 105,000 residents to safeguard if fire comes, these care home operators must now consider how to evacuate during a pandemic, a more complicated and difficult task.

California is aging faster than the rest of the country. In 10 years, the state projects the number of people over 65 will grow to 8.6 million.

SANTA CRUZ COUNTY FIRES TURNED REDWOODS INTO INFERNOS

In my county, Santa Cruz, wildfires in our Santa Cruz mountain forest burnt down 25 % of our county in the past month. Among the many senior facilities damaged was Brookdale Senior Living which was evacuated due to smoke damage and inhalation by residents, along with the Kaiser facility. Both had to send patients to the Bay area, where the Brookdale case, frail confused elders were sleeping on cots close to each other, risking COVID -19 and exacerbating their confusion, according to one daughter who moved her mother to her home in Santa Cruz permanently.
ELDERS COLLIDE WITH CLIMATE CHANGE

“There is absolutely a colliding of the events of both population aging and climate change,” said the University of South Florida gerontologist Kathryn Hyer.

TRUMP ANSWER CA MANAGE FOREST- YET FEDS CONTROL 57%- CA 3%

President Trump claimed when he came to California a few days ago that the problem with wildfires was forest management. Governor Newsome agreed but pointed out that 57% of California forests are managed by the federal government and 3% by the state of California. When it was pointed out in that state meeting that the problems with the forest were rooted in climate change, Trump’s answer was, it will get colder, you’ll see..

Trump has rolled back regulations, like auto emissions that prevented climate change- now ravaging our forests .“As a historic figure, he is one of the most culpable men in America contributing to the suffering and death that is now occurring through climate-related tragedy,” Jerry Brown, the former California governor who made climate change his signature issue, said in an interview on Sunday

It seems that it is only getting hotter, harder to breathe more dangerous for all Western residents

but radically more so for elders, who are number 1 in health problems, number 1 risk in COVID and breathing problems and live at home or in facilities in the middle of these mammoth forests, turned into infernos of death

5 Things Geriatric Care Managers and Concierge Physicians have in Common & and How Do you Market to Them

May 18, 2020

What Do you Have in Common with a Concierge Physician

Concierge Physicians and geriatric care managers have much in common

They both serve must serve the top 10% in the US. because of Income equality

Geriatric care management and long term care are not covered by Medicare, so the top 10% can only afford private geriatric care management.

Medicare rates for the physician are so low, especially Geriatricians,(who are the lowest paid that they disappearing), is one of the reasons physicians have fled to a concierge practice. This allows them to actually see a client for more than 10 minutes and make housecalls where they can actually observe the most about the patient’s ability to care for themselves.

Both in Business, Serving the Elderly & Wealthy taking health care into the world of Profit.

The third commonality is Concierge Physicians and geriatric care managers both make house calls have small practices and spend time with a patient like an old fashioned doctor. More important they both know that you see the most about the functional ability of the client/patient in their home not a brief office visit

Small CASE Loads a big Similarity

The fourth similarity is the caseload. Concierge Physician has an average caseload of 50, while the average internist has 2500 patients. The average GCM carries a caseload of 25-35. But even that may be too high when serving highly entitled concierge clients. Wealthy clients can demand boatloads of attention, have more family friction between adult siblings and the older parent-based on too much money, not enough love, and no skills passed on to nurture when the parent needs care. This constant bickering or worse cut off and often elder physical and fiscal abuse siphons lots of hours of the GCM’ s time to get the care that the older client needs. So large GCM caseloads among the uber-wealthy are almost impossible.

NO WAIT TIME TO SEE GCM OR CONCIERGE PHYSICIANS

The fifth kindred feature between the GCM and concierge physicians is “wait time”. Wait time to see your doctor in the US can be a very long time. According to the New York Times”A survey released in March by Merritt Hawkins, a Dallas medical consulting and recruiting firm, found it takes 29 days on average to secure an appointment with a family care physician, up from 19.5 days in 2014. For some specialties, the delays are similarly long, with a 32-day wait to see a dermatologist and a 21-day delay at the typical cardiologist’s office. But Concierge Physicians get back to their patient’s right away because of the small caseloads and the personalized one to one care they represent. Care managers, who offer gold standard care, generally get out to see new clients within a day. Both professionals go by ” Ask and Ye Shall Receive”.

BOTH TREATING COVID-19’s Hand of Death Reaching for Seniors

During the coronavirus both doctors and care managers, see their clients/ patients the largest target of the deadly virus, dying in deadly droves, especially in

nursing homes and are themselves overwhelmed by the stress of not being able to save or even see their caseload.

So when you market the Concierge Physicians, what benefits to do you offer that will allow her or him to refer to you.

We will use the “So What” that show benefits to any profession

1) You serve the same upper 10% with the same 1-1 hands-on excellent care “So What” you can support the physician’s patient without training

2) You do facilitation with dysfunctional families ( often in these patient caseloads) “So What” You will use your skills to get families to agree on care for the older person so concierge physicians will not have to deal with these difficult barriers to care

3)You will manage adult siblings who often disrupt older parent care because of ” Mom Loved You Best” squabbles “So What” so the Concierge physician can give the medical care the parent needs without hiring a social worker or trying to be one.

4)You can counsel families through technology through the fears of COVID1- and strategies to help clients cope with the choices they may have in the epidemic so what so the mental health breakdown of the aging family can address.

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The 2 Deadliest US Sites of COVID-19 Nursing Homes & Prisons

May 2, 2020

PRISON INMATES AND NURSING HOME PATIENTS NOT 6FT APART – 6 FEET UNDER

70% of inmates in federal prisons have COVID-19. In Kansas, the Lansing Correctional Facility had a riot of inmates over COVID-19 lack of care or protection It took the rebellion to get the coronavirus testing PPE and care. The Bureau of Prisons in Kansas confirmed finally that 79 staff have coronavirus and 88 prisons and prisoners dead.

Older residents in nursing homes cannot rebel like prisoners. Many can’t even walk. The Atlantic Magazine just published an article, We are Killing Elders Now. The writer states “In at least six states, these fatalities account for half of all COVID-19 deaths, and according to the World Health Organization, half of all coronavirus fatalities in Europe have been traced to nursing homes too. Some of this mortality is linked to long-term-care facilities that are shoddily run or that violate health standards. But most of them are doing the best they can with what they have. And they don’t have much”.

KAISER FOUNDATION NURSING HOME STAFFING AND USE OF PPE NOT REQUIRED IN MOST STATES

Kaiser reports -Staff Screening. It is more common for states to recommend rather than require daily screening of staff for illness in NFs (24 states recommend, 16 states + DC require)

Use of PPE. More states recommend (23 states) than require (7 states + DC) staff to use PPE

Two States that require testing for coronavirus of ALL residents of nursing homes are Maryland where 556 have died as of the Washington Post article. and Tennessee

THE FEDS HAVE NO CMS FEDERAL GUIDELINES OR REPORTING

We have no federal guidelines for safety testing according to an article by the Kaiser Foundation

It is now estimated that 16,000 deaths have occurred in nursing homes and that is without the federal government revealing any numbers and not making available any testing. But the numbers are probably huge- if we could just do testing.

CMS announced it would have a meeting of a “panel” of experts “ sometime at the end of May”. After probably 20,000 older people died and the feds did nothing this shows their sense of urgency about this pandemic’s national “elder cleansing”.

WHAT CONNECTS PRISONS AND NURSING HOMES – CONCENTRATION CAMPS

So, what is the connection between the viral spread of COVID-19 in nursing homes and prisons- 6 feet ? Prisoners and residents, in nursing homes, and prisons cannot social distance. Jails and prisons have human beings crammed together with no choice. Nursing homes have 2 beds or if you are on Medicaid three to a room. Neither group has a choice to social distance. They are ” concentrated” as in concentration camps or death camps.

Do SOMETHING – HELP NURSING HOMES PREVENT MORE CARNAGE

So, as someone who has spent her career in aging, I am calling out to everyone, especially professional in aging – do something. Since the feds appear to be doing little- call your congressman, write a letter to the editor.

BE KIND LIKE RACHEL MADDOW REPORTS LA JEWISH HOME LA WAS

Rachel Maddow suggests calling your local nursing homes and see what they need. Be kind like the LA Jewish Home was to a smaller nursing home LA Brier Oaks. They wanted to test their residents and had no tests and the larger LA Jewish Home had tests and shared them with the smaller as a good neighbor. What they found was ravaging but it also showed caring and generosity. Care and be generous and show the helpless elders in nursing homes in your town you are opposed to -nursing home being prisons or concentration camps.

Medicare For All Includes Long Term Care – Perhaps Pay Attention Now With -Covid 19 Raging ?

March 25, 2020

Long Term Care Not Covered by Medicare

Geriatric Care management and home care, among other critical services tin aging are not covered Long term care services, is not covered by Medicare. In Bernie Sanders & Elizabeth Warren’s Plan, Medicare for all would cover long term care, a point that the Washington Post said that Sanders did not emphasize enough.

Medicare For ALL Would Cover Long Term Care

Time Magazine, recently reported that Covid-19 ‘s effect right now is making Medicare for all seem like the present need nor an unaffordable dream . The “Department of Housing and Urban Development halted foreclosures and evictions during the emergency; the Department of Education slashed federal student loan interest rates to zero and will allow borrowers to completely suspend payments if needed; Congress is negotiating a plan to send direct cash payments to families, and a version of paid sick leave just became law.”

What If We Had Medicare For All During Covid 19 Pandemic?

If we had Medicare for all during the Covid 19 pandemic, we would be better able to disburse funds in emergency situations and to purchase necessary machinery, such as ventilators ( that only the president seems to be able to dispense through the Defence Production Act & does not, during a crisis and get them where they need, like the 30,000 needed and missing in New York) face masks that as so needed that the CVC recommended bandanas and a 10-year-old student in Boston is sewing herself the height of the pandemic right now.

Unlike our current health care system, Medicare for All would include specific funding for dealing with pandemics or other health emergencies that could be distributed quickly without requiring additional legislation of presidential planning, which seems not to have happened at all. The United States cannot be left unprepared for mass health risks like COVID-19. It is time to put in place Medicare for All and better protect the health of the American public.

Ethical Dilemma

This lack of Medicare covering Long term care leaves geriatric care managers in an ethical dilemma of being able to only be able to serve the upper 10% and leaving 90% of seniors and thus under 64 with chronic care needs like MS, unserved.

Elizabeth Warren’s plan for Medicare for all could cost 20 Trillion over 10 years. Existing Medicare over the 10-year period would cost 16 trillion. The bill we are just passing in Congress to fund is 2 Trillion. We will need another bill. Are all the mounting deaths from Covid 19, 55,000 people with Covid 19 and counting, disruption to business, our lives and the hospital really worth not paying attention to Medicare for All- which it looks like we just might be able to afford?

Find out about this ethical dilemma and what care managers must do to serve the upper 10%, and ignore lower 90%, who have no long-term care under Medicare .

Since geriatric care management must be privately paid for, in the absence of coverage under present Medicare, in spite of our moral dilemma

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Do You Have Emergency Procedures For Coronavirus For Your Agency?

March 20, 2020

Do you have procedures for an emergency at your agency?

The coronavirus has put home care and geriatric care management agencies in a terrible bind. Most GCM ‘s or home care agencies had no emergency procedure in place for any disaster but even if they did a pandemic was not anticipated by almost anyone in the catalog of emergencies.

AGING LIFE CARE ASSOCIATION HELP WITH CORONAVIRUS

Now that it is upon us geriatric care managers can benefit from the Aging Life Care Association’s webinars on Zoom to help their ALCA and geriatric Care Management agencies. The ability of any care management agency, serving frail elders, to function despite an emergency is critical. For example for members the have an upcoming Webinar through Zoom-TAKING ON NEW CLIENTS WHILE BEING “QUARANTINED”, which is incredibly valuable

They offer a daily blog for geriatric care managers with updates on an ALCA of GCM Practice under the coronavirus threat and are much-needed resources in these highly traumatic times. With agencies unable to directly see clients in states where like California have imposed at Stay at Home order where geriatric care manager cannot see their clients except virtually and on top of that both care staff and care management staff may have come down with the virus, information about how to keep your agency going is invaluable. Membership in ALCA could be very valuable to geriatric care managers. If you join tell them I sent you.

NEED FOR AN EMERGENCY PLAN FOR EVERY DISASTER

An emergency plan for all emergencies is necessary for all geriatric care management and ALCA agencies. With massive hurricane Dorian lasting 2 weeks last year and the west once again facing massive wildfires, tornados already wreaking devastation this season and the polar vortex perhaps coming again next year-do you have emergency procedures?

Informal agency emergency procedures work in a start-up care management business but what if the solo practitioner is ill and out?

If illness, accident, some other unforeseen event overtakes an owner or manager, no emergency procedures can be suicide in an emergency, not to mention liability to your elderly clients.

You could be like these two GCM’s who lost their businesses in weather events that knocked them out.

PARADISE FIRE DEVASTATION OF A GERIATRIC CARE MANAGEMENT PRACTICE

GCM Jim Boyd of Paradise, California lost everything in the catastrophic fire in the town of Paradise, where he lived and practiced. He was trying to check on an aging client in Paradise, located in the midst of the Sierra forest when the huge forest fire immolated the entire town. Although a Go Fund Me started by the Aging Life raised almost $10,000 for Jim, he did not have enough to rebuild his home where he had his home-based GCM business. Then he and 90% of the residents of Paradise never returned.

Every geriatric care professional needs a formal, written backup plan that dictates action, should a disaster or emergency arise.

It ‘s necessary to assess your company’s risk of temporary or permanent service disruption if a disaster or emergency is experienced. This may seem an overwhelming task at first, but when you break it down into pieces, it becomes workable.

Learn about preparing for emergencies how you can prepare you, your clients and staff for disasters and absences of key personnel.

With pandemic’s, global warming’s effects causing floods, larger hurricanes, and the specter of more catastrophic weather events, you need to prepare now. Get the new Handbook of Geriatric Care Management 4th edition now– or out in Kindle or hardback with an excellent chapter on how to prepare your agency for disasters, plus forms to use, by GCM President Liz Barlow.