Category

Family man

A Vision of Paying for Value

By | Caregiver, Clinician, ePatient, Family man, Researcher, Uncategorized | No Comments

I’m the child, Custodian and Healthcare Proxy of my 89-year-old mother, Alice. I live in a different state. My mother has diabetes and is depressed. Her care team, beside herself and me, includes medical providers in various health settings, community support agencies, and a full-time caregiver that helps her schedule and get to health-related services. My problem is to understand what my mother wants for herself and to track who says they’re doing something for her (including my mother and me), what they’re doing, and when they’re doing it. I want to know what it takes to do it (Can she afford it? Can she get there? Does it agree with her? Who will be with her? etc.). I want to know if the actions have the effects we thought they would. I want to know what her risks are and how we plan to prevent or respond to them. I want to able to keep track of all this and keep it current. I want to share it or have it shared from day-to-day and from setting to setting even if I’m not present.

This scenario describes a vision of healthcare for a caregiver and his mother. The vision lives in a context of social circumstances, physical environment, individual behavior, genetics, and medical care – the determinants of health. In the best of circumstances, healthcare dollars pay for this vision of best health for people, their families, and communities.

The goals of any payment method should be to reward high-quality care and to permit the development of more effective ways of delivering care to improve the value obtained for the resources expended. These goals are relevant regardless of whether care is delivered in a predominantly competitive or regulated environment, and whether the ultimate purchaser is an employer or the patient/ consumer. Payment policies should not create barriers to improving the quality of care. Institute of Medicine (US) Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington (DC): National Academies Press (US); 2001. 8, Aligning Payment Policies with Quality Improvement. Available from: https://www.ncbi.nlm.nih.gov/books/NBK222279/

This means that payment systems for treatment and services recognize quality (best health), support improvement and reward stakeholders (patients, caregivers, clinicians, institutions, and insurers) for the process and outcomes of best health. Read More

CEO of My Health Team

By | Advocate, Caregiver, Clinician, ePatient, Family man, Leader, Researcher | One Comment

I am the CEO (Chief Executive Officer, the boss) of my health team with a ton of subcontractors: my primary care doc and her practice, my neurologist and his practice, the radiology department at my local hospital, the neighborhood pharmacy, the utility companies… You get the idea. They get paid through my employment benefits, your and my taxes, and out of my pocket. Right now I directly employ my massage therapist and acupuncturist – fee-for-service. I also have pro bono team members: my wife (my care partner), my family, friends, and advisors.

As CEO of my health team, I try to lead and manage. Leading is building and fostering relationships, finding service providers as needed, setting health goals, coming up with a plan to meet my goals, and learning from our mistakes (what doesn’t work).  As a leader I find ways to share information among the team, and, of course, I fundraise and cheerlead. Leading is also about succession planning.  Who will lead when I can’t? Managing, on the other hand, is negotiating service agreements (contracts), actually seeing that the tasks in the plan happen as desired, maintaining the team and it’s connections, and trying to fix what isn’t working. It’s a tough system to lead and manage. It’s exhausting. I have some of the skills I need, but nowhere near all. There’s very little training for Health Team CEOs- no certificate or degree. The pay stinks. There’s no vacation. I can’t resign. Read More

Fibro Mama – Book Review

By | Caregiver, ePatient, Family man | One Comment

Fibro Mama: Pregnancy and Fibromyalgia by Melissa Reynolds

Odd, isn’t it? A book review about pregnancy and pain by a guy! Well, I’m a dad, an Opa (grandpa), registered nurse, and a patient activist.  I have Multiple Sclerosis and I know chronic illness and pain management. We had home births with a midwife at one and no midwife at another. Enough about me. I’m reviewing the book because Melissa asked me to.  Thanks, Melissa.

Look, no one knows someone else’s experience, it belongs to them. As Melissa says in her introduction, “I can give you tips about what worked for me. … However, in the end, it’s you putting one foot in front of the other.  That’s how we live, right?”

Lived experience and a dollar fifty will buy you a Pepsi. Lived experience + self-awareness  + systems thinking + good storytelling is golden. Add brevity and it’s priceless. Melissa’s book is priceless. Took me half an hour to read it through once. I marked it up and spent a couple of hours reading it again. Here are the best parts (for me, a guy, who will never be pregnant):

  1. 16 natural pain relief suggestions – I use many of these myself for muscle tension and cramping. Great list. I never tried oils. I may.
  2. The sections about the three trimesters, immediately post-delivery, and the first 6 weeks all include sleep, exercise, meditation, and a pain management plan.  They’re basic and vital. She lays it out for you.
  3. I can’t evaluate the extensive section on nursing except to say that it’s comprehensive and empowering. I always love the response, “there is no wrong choice”.
  4. Using help is big, really big. Melissa has a great care partner. She says to insist that s/he/they be allowed to be with you 24/7 whenever you’re a guest in an institution. Absolutely. Pregnant or not pregnant, fibromyalgia or no fibromyalgia, this is true.
  5. Last, but so not least – Tips to Cope with a Fussy Baby When You’re Sore. She’s buying minutes for you. Dad’s too.

Thanks for the opportunity to review this fine book. You can get it here.

 

See also:

How Many Words for Pain?

Managing Pain

A Caregiver is [Not] a Caregiver, is [Not] a Caregiver

Health Partners

Blessings. Giving Thanks.

By | Family man | One Comment

Grateful for our blessed life together. Grateful for our home with the footstep rhythm of family upstairs. Grateful that our means are enough to live within. Grateful for the ability to do good work. With so much suffering in the world, grateful for those working to make our lives and others’ lives better.  We share 7% of our gross income each year. We give to Planned Parenthood, Amnesty USA, WBUR, WNYC, WGBH, Radiotopia (check out Ear Hustle), the National Partnership for Women and Families, Arlington Food Pantry, The Greater Boston Food Bankthe Free Wheelchair Mission, the Housing Corporation of Arlington, Partners in Health, Doctors Without Borders, the Museum of Fine Arts, Project Sleep, the Pann Mass Challenge, Wikimedia Foundation, Regina Holiday’s Cinderblocks and the Walking Gallery, Mothers Out Front, the Hispanic Federation, the Arlington Library Foundation, the Harlem Jazz Museum, and several others. We thank them for their inspired and inspiring work. We are one.

Receiving with Reckless Abandon

By | Caregiver, Clinician, Family man | No Comments

My boy, Mike, died 15 years ago today (sigh). Here’s a link to a video of an interview with Mike 4 months before he died. (11 minutes).

This anniversary and attending the National Caregiving Conference last week made me think about being a caree, someone who is being cared for. My grandmother, my mother, and Mike were carees. Mike accepted his mortality but didn’t want someone to have to wipe his butt. That was a point too far. As a Holocaust survivor, my mother craved being cared for all her life, yet was deeply ambivalent until her last days. She fought for control and felt deep gratitude for a warm, kind hand. My grandmother wanted more care than she needed (in my opinion, not hers). I mostly sensed fear. I’m only just tasting being a caree. Read More

caregivers hands

Caregivers Rule: National Caregiving Conference

By | Advocate, Caregiver, Clinician, Consumer, Family man | One Comment

I just got home from the 2nd Annual National Caregiving Conference in Chicago convened and hosted by Denise Brown and  NationalCaregiving.com. You know the drill – most health care anywhere in the world is provided by family caregivers and parents. The attendees, mostly active or recent caregivers, networked over their shared lived experience. Presentations about caring for elders with dementia was the most common thread and topic.  Occasionally I heard chatter about caring for children or depression. Sometimes the stories of frustration, exhaustion, and loneliness overwhelmed those of gratitude, survival, and inspiration. It’s hard for me to hear too many of the painful stories and maintain my pathological optimism.

I especially appreciated the session about surviving and blossoming as a couple while caregiving led by Frank and Lisa Riggi – heartfelt, practical, and humorous. 10 Activities to do With Your Spouse Every Year – 10!, Only 10? I ask many caregivers, “How goes your marriage/partnership?” Faces fall.  Cathy Sikorski‘s keynote, Preparation, Frustration, and Surrender…Boldness Throughout Caregiving was an intriguing combination of hands-on, funny, and legal. Imagine you’re talking to the Cable Company. Be Bold!

Did you know that a third of caregivers die before their caree? Crazy?  Not really. Caregiving wears you down, while caregivers put their caree before themselves. Self-care: I loves that theme. This crowd seemed to self-care better than many.

The entrepreneurial spirit shone. My favorites: Carla Macklin’s Adaptive Clothing; Mekhala Raghavan and Angie Creager’s bathing aids and fall prevention (Waiting for production of their vibrating neuro-responsive fall prevention mat and their wash and vacuum the water shower anywhere system. I’ll try anything for fall prevention for myself and narrow doorway bathrooms are endemic in older homes); Quikiks Hands-Free Shoes (I’m always looking for easy, safe, comfortable shoes); and Shirley Riga’s book, “Tools for the Exceptional Parent of a Chronically Ill Child” published by Strong Voices Publishing.  Check them out! I love to hear what works for people. Solutions from the trenches rule! (I receive no compensation from anyone mentioned here.)

I attended as a panelist for The Family Connection: Supporting Essential Care Partners as Patients Transition to Home, with Geri Lynn Baumblatt, Mary Anne Sterling, and Cathy Crookston. Most nightmares I heard at the conference involved transitions to or from medical care. I did hear one story of the transition done very, very well. It can be done. If you’re lucky it’s because one person made a difference.  It shouldn’t be luck. Caregiving is hard enough.

Caregivers: How do you manage your marriage? When has BOLD worked for you? What’s the best transition you’ve experienced?

Honor the caregivers. Help the helpers.

From the Inside Looking Out

By | Caregiver, Clinician, Consumer, ePatient, Family man | No Comments

At the #PCORI2017 Annual Meeting, Alan Alda showed us a simple mirror improv exercise (remember Groucho and Chico Marx in Duck Soup?). Alan first showed us him mirroring an audience member, then the audience member mirroring him, and finally, them mirroring each other at the same time. It was an exercise in empathy.  Afterwards, someone at my table said,

From the outside looking in, it’s hard to understand. From the inside looking out, it’s hard to explain.

I first heard these words many years ago from a peer support professional describing the experience of depression and addiction. I understand this better now that I’m a person with a chronic illness. I work hard to explain what’s inside to my family and other members of my health team.  Often I don’t know or I don’t have words. Mindful meditation helps tremendously – deciding to become friends with what ails me. It’s all me and I love me. I’m not sure if it helps me explain, but it helps me know myself. And for sure, it increases my empathy when I’m on the outside looking in. Thanks, Alan, for reminding us.

See also other posts about Improv and

Patient-Centered Outcomes Research Institute

Learning from What Doesn’t Work

Celebrating Connection, Respect, and Help

By | Caregiver, ePatient, Family man | No Comments

I crave connection and respect. Not crave as a thirsty man crawling toward a mirage of water in the desert or a person constantly begging others to fill an overwhelming desire that can never be filled. Rather a need that sustains me and renews me.  Connection and respect fuel my inner fire so I can meet the challenges of life, continue to contribute, and have space to be curious. It helps that I’m an extrovert. Connection and respect don’t cost much day-to-day, yet they’re long term commitments and investments. Connection and respect can be tough to sustain. I get crabby and self-centered, especially when I or someone I care for is sick or stressed. Then being an extrovert doesn’t help. Yet banking the investment of connection and respect pays dividends.

I’m impressed with how difficult it is to ask for help. We have as much difficulty responding to offers to help as asking for help. When our boy, Mike, was dying, people came out of the woodwork, offering to help. How to respond? How awkward! We had to add it to our weekly family care management meetings. What do we need? What do we say?  Well, we didn’t think we needed much that those offering help could do. So we said that we needed food, companionship, transportation. We always needed a laugh and prayers. Caring helped. Read More

100th Birthday

By | Advocate, Family man | 10 Comments

We celebrated a 100th birthday around my Aunt Kikke, born during WWI in the Netherlands. She interrupted medical school and then emigrated to the US when the Nazi’s invaded.  She couldn’t get into medical school here because she was a refugee, a woman, and a Jew. She was finally accepted to Johns Hopkins Medical School on Albert Einstein’s recommendation. Yes, that Albert Einstein. Aunt Kikke, Kato van Leeuwen, practiced as a psychoanalyst through her 90’s. The US has thrived throughout its history from the inspirational careers of refugees and immigrants such as my Aunt.

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Penny Whistle for Father

By | Family man, Musician | 2 Comments

Who knew he loved penny whistles?  The pianist who accompanied his cello-playing friend on piano for years told a story yesterday at his funeral. At Christmas last year, this father who I knew as awkward, serious, unemotional, religious, conservative, classical music-loving, got the church choir penny whistles and led them in a performance of Good King Wenceslaus. While the story was told, the priest pulled a penny whistle out from the pulpit and tweeted a few notes.  “It’s there to keep me humble.”

I consider myself a good read of people. 50-75% of the time I’m spot on (That’s 25-50% spot off).  It leads me to an occasional empathy-challenged state. A penny whistle can tip the balance.

Happy Father’s Day all you fathers.  I love the father in my sons. Here’s to you, Cliff, a faithful reader of this blog. You’ll be missed!