• Red Bell Peppers
• Carrots
• Almonds
• Sweet Potatoes
• Chicken Soup
• Garlic
• Ginger
• Salmon
• Mushrooms
• Dark Chocolate

the following is a link to a recorded Webinar for the above presentation: https://www3.gotomeeting.com/register/887814262

When you must make that drive through run (and we all have to at one point or another), here are a few options that won’t leave you feeling full of grease . . . or guilt:

McDonald’s

Choose the hamburger, side salad with low-fat balsamic vinaigrette and a bottle of water for a meal under 350 calories.

Steer Clear: The quarter pounder with cheese has 730 calories on its own!

Taco Bell

Order anything that sounds good to you off of the Fresco menu and take in a measly 9 grams of fat or less. 

Steer Clear: The Fiesta Taco Salad has 46 grams of fat!

Wendy’s

Perfect for fall and winter – enjoy a large chili for only 330 calories and 9 grams of fat. Feel free to have a cup of mandarin oranges for an extra 80 calories.

Steer Clear: The Big Bacon Classic has a whopping 580 calories and 29 grams of fat!

Subway

Subway offers many healthy options through its Fresh Fit Choices menu. The 6” turkey breast on white bread has only 280 calories and 3.5 grams of fat. This leaves plenty of room to load up on veggies. Pair with a bag of baked chips or apple slices and a water or diet drink. You will have a healthy, satisfying meal without the bulk.

Steer Clear: Be leery of heavy sauces. One tablespoon of mayonnaise can add an extra 5 grams of fat. Stick to lighter options like yellow mustard or lite mayo.

For more drive-thru dos and don’ts, visit:

http://www.fitnessmagazine.com/recipes/healthy-eating/on-the-go/healthy-fast-foods/?page=6

The result of all this is the Mad Tea Party, that is, the newer (atypical) antipsychotics: Risperdal, Seroquel, Abilify, Clozaril, Geodon. Or Alice might get the older (atypical) antipsychotics: Zyprexa, or even the old, old drugs: Thorazine, Haldol, Melaril. The problem is that these (and most other) drugs are not tested on demented elders. Their livers and kidneys are slower, so medications tend to build up. Add to that the fact that the elderly often wind up on many (7 is the nursing home average) medications and drug interactions are rampant. Then there is the problem that they are used to calm agitation: an off-label use. Oh, and there is the problem that their use doubles the demented elder’s chances of cardiovascular death. Did I mention involuntary movement disorders (tardive dyskinesia or TDK or extrapyramidal symptoms)? These symptoms are most problematic with the older antipsychotics.

The solution is not to switch to a different class of drugs (a temptation that we will see as CMS puts the pressure on to reduce antipsychotics).  The solution is to look for the causes of disruptive or problematic behavior…or even to call in a psychologist (hopefully not The Mad Hatter). The solution entails a little Sherlock Holmes. (Oh well, better to mix metaphors than drugs)…observe what goes on before, during and after “behaviors”. Then formulate an intervention that might work, without having to resort to drugs. This idea is largely missing from the proposed strategies on AP reductions.

Next episode*, what causes behaviors?

What is psychosis? Either delusions (“I am being poisoned…spied on…abducted by aliens”) or hallucinations (“I see aliens…hear commands to do things…smell rotting things…feel people touching me”). Being confused is not psychosis (“It is 1940…You are my father…we are in France…I have viagra to get home to feed the children”).

The over use of anti-psychotics starts looking crazy when you see studies that find that only 2% of nursing home residents have schizophrenia (the primary diagnosis warranting the use of anti-psychotics), and the rate of all types of psychosis runs about 10%.

So why all the fuss? Anti-psychotics in the demented elderly doubles their risk of heart attack or stroke. They are sedating drugs. They are expensive, costing Medicare about $13 billion per year. They increase the risk of falls and pneumonia.

How did it get like this? Stay tuned for the next exciting episode!

minding mds accuracy

 I know that the patients we care for are not actually our family members.  I also know that when I or a member of my family needs care, it’s not typically going to be a family member caring for us.  However, if we can treat, and be treated, with respect, kindness and compassion, then the world changes.

 A few months ago my wife, Cindy, was hospitalized for minor surgery.  The nurses who cared for her were great!  It made everything so much easier.  However, there was one nurse aide for whom caring for my wife seemed to be a chore.  This aide always had a reason why my Cindy would just have to wait, because the aide would get to her as soon as she could.  The aide, of course, explained how busy she was and how many other patients she had to take care of and besides she hadn’t really slept all that well the night before.  All these months later I can still picture that aide’s face in my mind.  Unfortunately, I don’t remember the faces of all the nurses that were so kind.  Because of the nurses that were so kind I would use that hospital again.  Just because they were kind. I suspect that the medical care would be the same in any hospital, but those nurses helped Cindy to feel comfortable and safe at a time when she was in pain.  I suspect that I can vividly remember the face of that one aide because, even to this day, the thought of her elicits a strong negative emotion in me. 

 The point of all of this is to remind each of us how important respect, kindness and compassion are in our relationships with our patients:

 Take the time to listen

Have you ever dealt with someone, in any type of relationship where the other person just didn’t listen to what you had to say? Often in healthcare people are so busy they just don’t take the time to listen.  Listening to someone lets that person know that they matter and that you care about what they have to say.

  Make eye contact

It’s funny, but when someone looks at you, right in the eyes, and holds your gaze, it means a lot.  You can tell a lot about a person by the type of eye contact that they make.

Physical contact

Patients in healthcare situations often feel isolated, lost and alone. They have lost something. They are out of that place where they feel comfortable.  They are at the mercy of others.  Appropriate physical contact, a handshake, a touch on the arm, etc. can be reassuring.

Say what you mean…

Be appropriately honest with people.  I once heard a definition of maturity as “the ability to honestly speak your mind while maintaining consideration for the feelings of the person that you are speaking too”

 …and do what you say

If you tell someone that you are going to do something for them, then DO IT.  Nothing says “you don’t matter to me” more that broken promises, missed appointments and the resultant excuses. 

When I think about my children someday needing to be cared for by someone else, I cry a little.  After all I’m their dad!  I want to take care of them. I want them to be safe.  I want them to know they are loved.  Each of the people that we take care of everyday was, at some point, someone’s child.  Please think about this as we are working with our patients!

That was the message Key Rehab’s Sr. Vice President Mike Gorman and I heard recently from Cynthia Morton, Executive Vice President of NASL (the National Association for the Support of Long Term Care), when she spoke to exhibitors at the Nebraska Health Care Association Spring Conference in Kearney, NE.

The term “lame duck” was first used at the turn of the century to describe the period and opportunity for defeated or retiring lawmakers to “preen their plumage” in November and December before their  departure.  Mike Gorman pointed out that ideally a lawmaker should always represent the will of their constituents, even if at odds with their own conscience (or the interests of lobbys, PACS, polls, or party). So, why is this lame duck session so scary?  

The Congressmen of the 2012 lame duck session can’t just sit back and rest on their laurels. Congress still has to address many big issues including what to do about the so-called “Doc Fix”.  If Congress doesn’t act, physicians will have to endure a huge cut in their Medicare reimbursement, a cut of somewhere around 30%.  If such a cut goes into place many physicians will opt out of the Medicare program and no longer provide services to senior citizens.

In addition, the lame ducks will decide on repealing the Bush Tax Cuts (lowering marginal rates, cutting capital gains and dividend rates, easing exemptions, and child tax credit relief), expiring payroll tax cuts, and again decide the fate of the Therapy Caps and the exception process.

If that’s not enough, decisions on 13 annual spending bills, social security cuts, the estate tax, transportation, highway, and armed services expenditures will all be crammed into just 25 days – the likely number of working days after the November election until year-end.

As one lobbyist said, “this lame duck session is approaching like the Four Horsemen of the Apocalypse”. It is vitally important for all of us to take the time and make the effort now to tell policy makers the stories of our patients.  Tell your Congressmen about what we do and why it’s important that Medicare continue to be adequately funded for the benefit of our senior citizens.  Let Congress know about the successes of our work and the positive impact we make on the quality of life of our patients.  Also, let Congress know about the devastating impact that arbitrary cuts in health care spending will have on patient care.   A lame duck Congress is typically considered a bad thing because it refers to people who no longer have a “horse in the race” (i.e. their own horse – as in running for re-election).  However, this lame duck session still has to tackle some tough issues and for once these politicians do not have to worry about pleasing lobbyists and big money backers.  For once they may be able to simply choose to do what’s right.

Contact US lawmakers through NASL, Leading Age, AHCA, APTA, AOTA, ASHA or your state congressmen and senators.  As, Cynthia Morton of NASL put it, “If we aren’t at the table, we’re on the menu”.

 I don’t mean to disparage used car salesmen.  I know many good people that work in used car sales.  I’m playing off of the old stereotype of used car salesman being shady and lacking in moral character.

 It seems that therapists are now viewed in that light, at least by healthcare payers like Medicare.  It’s an odd thing.  I’d like to argue that therapists are not unscrupulous.  In fact I’d like to make that argument for most professions. There are good and bad people in all walks of life and there is good and bad within all people.  It is easy for me to defend the integrity of therapists because I’ve met many great ones. However, I also have to acknowledge that where there’s smoke there’s fire. Make no mistake, there are crooks out there.

 So, what is the point of this blog article? It is both to condemn and defend. I am saddened by those among us who take shortcuts in life based on greed, laziness and truly being shortsighted. Likewise, I applaud people of integrity of all professions.  There are many.  I consider them heroes for living everyday life with the noble purpose to do good. Well, there’s not much else to say about that so I think I’ll end here.  I’ve got to go buy a car…

Pet therapy is a proactive way to fulfill this need and has been used around the world for many years but you may feel that this is difficult in your situation.

Be creative and think outside the circle to facilitate the person with dementia to interact with animals. As an alternative to a pet, consider introducing someone’s well-behaved pet or bird. You could also organize a regular visit to a local petting farm or maybe even the zoo for a more exotic experience.