Christmas Gratitude

Merry Christmas!

The end of the year is always a time for reflection and for gratitude. I want to take a moment of your time to thank my staff, the clinic volunteers, my family and friends for their support and encouragement over the past year.

To quote Charles Dickens – “it was the best of times, it was the worst of times…” and 2014 had plenty of both.

We began the year with the Open Enrollment in the Marketplace – and continued to attempt to enroll our patients. It was a frustrating endeavor at times, but when we successfully enrolled someone in an affordable healthcare plan, it was cause for celebration. Open enrollment lasted until the last day of March.

April 1 brought the best news to the population we serve –“opening day” for the Healthy Michigan Plan – Michigan’s Medicaid expansion. I will never forget the first person I helped with enrollment in the Healthy Michigan Plan – the tears in his eyes, and the words his friend spoke: “now you can get your heart fixed.”

The first four months of 2014 the clinic continued to be incredibly busy with an average of 64 patients every Tuesday night. That number began to decline steadily after April 1. We saw an average of 29 patients each week from April through December.

I have to thank Connie and Linda, and our volunteers, who worked in a time of great uncertainty. There were hopes and fears about what the role of the clinic would be – would there continue to be a need? Would there be funding? What would we do?

I am one of those people that love change – and embrace the challenge of something new. For many though the uncertainty is unsettling and difficult. But, everyone persevered and we continued to care for those in need in our community.

We spend hours trying to teach people about the value of insurance; assisting them with enrollment in healthcare; and helping with the transition to a primary care provider. It is some of the best work we have ever done!

We continue to see people in need here at the clinic.  The population of the clinic has changed over this year. Many of those we see are employed, making in the $8 -$14 per hour range. Their employer either doesn’t provide healthcare or they cannot afford it. They make too much to qualify for the Healthy Michigan Plan, and cannot afford the premiums of the Affordable Care Act, even with the tax subsidies. It is not my job to judge what is “affordable” for any family – I give them the information they need to make that decision.

And, with all of these changes at the clinic, I also had family issues to deal with. My husband was hospitalized for a week in May; my dad was diagnosed with bladder cancer – and died in September; my mother had a major heart attack in July.

It is amazing to have a staff that can pick up the pieces and make sure that the clinic can continue without missing a beat. Connie and Linda did that for me all spring/summer/ and into the fall. The support from the two of them, and the volunteers at the clinic helped me to survive all that this year had in store.

And, then there was the joy that came with the birth of my second grandson –Andrew James. The circle of life was so evident, as he was born 2 weeks before my dad died.

It is impossible for me to express my gratitude adequately. I am humbled and awed to work with such an amazing group of people. In addition to Connie and Linda, I have the most amazing board of directors, who support and encourage me always. The volunteers here at the clinic are the heart and soul of the clinic. We would not exist without them.

So, thank you to each and every one of you. Merry Christmas to you and your families.

And, I for one, can’t wait for the New Year!

Ted and Alice

Ted and Alice showed up one night at the clinic several years ago. I swear – they were both blue. OK, maybe more of a gray-blue. Clearly in respiratory distress. Clearly not doing well at all. They scared us, and we are pretty used to seeing all kinds of things.

He was a farmer and worked part-time in a retail store; she was a farmer’s wife. They had no health insurance. It was the dead of the winter, and they had run out of money – for food, for heat and for medications.

They both had a history of asthma/COPD but had not had any medications for a while. They both had acute bronchitis. I don’t usually believe that we have “saved” someone’s life, but in this case… maybe. If they had not showed up at the clinic, they would have eventually showed up at the emergency room – in worse shape than they were here.

They both recovered and were long-time patients here. They made enough money that they did not qualify for Medicaid, but his job was part-time so he was not entitled to any health insurance.

She ultimately was determined to be disabled due to her respiratory status – she was on oxygen full-time.

Ted was one of the original Diabetic Clinic patients. He was as compliant as he could be. He came to the clinic each month, took the medications we gave him, checked his blood sugar and tried. Dietary habits are hard to change for people on limited incomes. He continued to farm, so he was active.

As I think about the success of the Affordable Care Act, Ted and Alice come to mind. We supported them while there was nothing else available, but now they have access to healthcare whenever they need it. They have both found a primary care provider that they like. Plus, Ted has had some of the preventive healthcare services that are not available to the uninsured.

Today, I can smile knowing that they are in a much better situation – and we helped them on the journey there.

The Importance of Stories

Richard Rohr writes: “I’ve never known anyone who really shared all of their story with me whom I could not love.”

It is so true – we make assumptions about people when we meet them or observe them a setting. It is easy to dislike or distrust someone who is not known. But, once you sit down with a person and hear their story, it changes everything.

I had that experience last week. A former patient called, wanting an appointment to review his health insurance coverage. He had been paying his premium for a year, had used his health insurance appropriately, and wanted to review it. A total success story! Except for the fact that when I heard his name, I just shuddered.

We ran into a few roadblocks during the process of reviewing his insurance coverage, so we had some time to talk. I had made some judgments about him. What I learned in the time we spent together was a completely different person than I had assumed.

His mother died when he was 8 years old. It had clearly impacted his entire life – including the fact that he was not able to finish school. He wasn’t “stupid,” he was uneducated.

He is married to a woman who lost five children in an intentionally set fire decades ago. She is broken – emotionally, physically, and mentally. His concern and love for her was evident.

Because of the time we spent together, my attitude toward him changed dramatically.

I see this so often with the population we see here at the clinic. It is so easy to make assumptions. I often hear someone say, “he’s just a user.” But sometimes that “user” is taking care of an elderly mother with dementia, or is the only parent to a young child, or is recovering from substance abuse. We never know the battles people are fighting in their lives.

We really need to take the time to hear their stories. 

Holy Batman!

Well, that was a first. We had to delay the opening of the clinic tonight… because we had a bat.

Oh, it’s not the first time we have had a bat – the clinic is located in the basement of a church, and bats seem to like churches. They are frequent visitors here. And we have even had them during the clinic, but we have never had to delay opening the clinic.

My feelings about bats vary on a scale between grossed out and terrified – depending on how close the bat is to me. I loathe them – especially when they are indoors. (Shudder!!)

Fortunately, we had a couple of volunteers that were eager to escort the bat out. If it happens when I am here alone, I have “Batman” on speed dial. Batman is my hero Patrick who serves as the sexton for our church and the Catholic Church next door. I’m guessing he has lost count of how many bats he has rescued me from!

Monica

As she walked into the clinic, my eyes about popped out of my head. She was beautiful – looked absolutely fabulous.

When I first met Monica, that is not how I would have described her at all.

I had known Monica’s mother for a few years. She called me one day very concerned about Monica and wanted to know if we could see her here at the clinic. They both came in on Tuesday evening. Monica was 21 years old at the time. She presented with fever, nausea, vomiting, weight loss, headache, aches and fatigue. She was dressed in jeans and a baggy sweatshirt. She was pale and clearly did not feel good.

We ordered some tests and put her on some medication for the nausea and vomiting. She returned two weeks later for test results, still not feeling any better.

At that point, I helped her with her application for the Healthy Michigan Plan. She was working in a low-paying job. She qualified immediately for the Healthy Michigan Plan, and was able to see a provider in our community. I lost track of her after that.

She came into the clinic to bring some paperwork. I hadn’t seen her in six months – and could not believe it was the same young woman. Because of having health insurance, she was able to get the care she needed. She still has some problems, but they are minor compared to what she was dealing with a few months ago.

She is in school, motivated to live her life to the fullest.

The outcome could have been very different – without a parent who cared and without access to healthcare.

It’s Flu Season

Everyone was in a panic about Ebola a few weeks ago, but how many of you have had your flu shot? It is the easiest way to prevent a disease that causes illness, loss of productivity and too often, death.

The timing of the flu season is unpredictable and varies from year to year. Most commonly it peaks between December and February. But, it can occur as early as October and as late as May.

Contrary to popular belief, the flu is actually a respiratory disease, not a gastrointestinal disease! The flu can cause vomiting and diarrhea, more commonly in children.

Flu symptoms include:

• A 100^oF or higher fever or feeling feverish (not everyone with the flu has a fever)
• A cough and/or sore throat
• A runny or stuffy nose
• Headaches and/or body aches
• Chills
• Fatigue

In general, the flu is worse than the common cold. Symptoms such as fever, body aches, tiredness, and cough are more common and intense with the flu. People with colds are more likely to have a runny or stuffy nose.

Seek medical attention immediately if you experience any of the following:

• Difficulty breathing or shortness of breath
• Purple or blue discoloration of the lips
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting
• Seizures
• Flu-like symptoms that improve but then return with fever and worse cough

The flu is most dangerous for infants, the elderly, and those with chronic health conditions such as diabetes, asthma, COPD, and cancer.

So please, get your flu shot!

Buzz

I wanted to take an opportunity to say goodbye to a dear man.

I met Buzz and his wife several years ago. The clinic was fairly new and one of the local food pantries called asking for some flyers so that they could let their clients know about it.

I put a handful of flyers in an envelope, but then decided it would cost too much to mail it. So, I got in my car and drove over to the food pantry to deliver them.

Buzz and his wife were volunteering at the food pantry when I got there. We just hit it off right away. They were so excited about our new ministry and were so aware of the need in our community.

I have always called this meeting a “God moment.” It was meant to be.

Buzz was very active in the community – he arranged for me to speak a couple of times at a service club where he was a member. He and his wife sent the clinic a check every single month.

Buzz died a couple of weeks ago. He will be missed by us here at the clinic, by his community and all of those who knew him.

Our sympathy to his wife and family. Buzz made a real difference in this world.

Happy Thanksgiving!!

A Prayer for Thanksgiving

Dear Lord,
As we gather together around this table
laden with your plentiful gifts to us,
we thank You for always providing
what we really need even when we didn't know we needed it.

Today, let us be especially thankful
for each other--for family and friends
who enrich our lives in wonderful ways,
even when they present us with challenges.

Let us join together now
in peaceful, loving fellowship
to celebrate Your love for us
and our love for each other.

We thank you for the turkey, the dressing and the gravy.
This table overflows with your abundant blessing.

Remind us always that all gifts come from you.

Amen.

Thank you Sr. Mary Ellen Howard for sharing this!

It’s the Most Wonderful Time of the Year!

I’m not talking about Christmas – I am talking about Open Enrollment in the Marketplace.

Open Enrollment for plans starting January 1, 2015 began on November 15. I LOVE helping people enroll in a healthcare plan – whether it is through the Marketplace or helping them enroll in the Healthy Michigan Plan – Michigan’s expanded Medicaid.

It brings me such joy to see people finally be able to afford and enroll in healthcare. Some of the people I am working with this year are re-enrolling. I love hearing the stories of how having insurance changed their lives – how they were finally able to have some long-needed surgery, or see a specialist that they could not afford before.

It is exciting to see people enrolled for the first time. I love teaching them about how insurance works, what their options are and showing them how their tax subsidies will make the insurance affordable for them.

This year, the clinic is once again providing individuals and families with a place to come enroll in healthcare with the assistance of Certified Application Counselors. Connie and I both completed the training for both the Marketplace and to assist in enrollment for the Healthy Michigan Plan.

Give us a call – see if we can help you!

I'm Back!

I have taken an unplanned hiatus from my blog.

Since the death of my dad on September 2 of this year, I have experienced grief up close and personal.

I have lost friends and acquaintances, I have worked with people who were dying, I have read about grief, taught about grief, and even written about grief, but come to find out – I knew nothing about grief.

My dad was the first immediate family member that has died. It is a bitch to lose someone so close to you.

I have done what millions of people do – I have cried, I have laughed, I have been angry, I have been exhausted, I have been sadder than I thought it was possible to be. Did I mention, I have been angry?

All of this is not a news flash for those of you who have experienced losses in your life; I know that I am fortunate to be my age, and this be my first experience with the death of a family member. I have just been surprised at how hard it is.

There are days when I have barely have enough energy to get through the day. Some days I spend the entire day crying. When someone asks about my dad, who doesn’t yet know about his death, the tears start flowing.

Yet I have survived. I have found joy in my life. And, hopefully, I can once again do the work I know I was called to do.

So – the blog is back! Thank you for checking in periodically, for the support many of you have given me over the past few months, and always – thanks for reading my blog!

 

Teresa

Teresa has been a patient at the clinic off and on for the past 4 years. She is a fairly typical patient – married, white, employed, with some college education and no health insurance.

I got to know her because she called me to complain about one of the providers who volunteers at the clinic. She was unhappy with the care she had received; she has dealt for many years with Graves' disease, an immune system disorder that results in the overproduction of thyroid hormones (hyperthyroidism).

Because thyroid hormones affect a number of different body systems, signs and symptoms associated with Graves' disease can be wide ranging and significantly influence your overall well-being. Although Graves' disease may affect anyone, it's more common among women and before the age of 40.

Common signs and symptoms of Graves' disease include:

• Anxiety and irritability
• A fine tremor of your hands or fingers
• Heat sensitivity and an increase in perspiration or warm, moist skin
• Weight loss, despite normal eating habits
• Enlargement of your thyroid gland (goiter)
• Change in menstrual cycles
• Erectile dysfunction or reduced libido
• Frequent bowel movements
• Bulging eyes (Graves' ophthalmopathy)
• Thick, red skin, usually on the shins or tops of the feet (Graves' dermopathy)
• Rapid or irregular heartbeat (palpitations)

Graves' disease is caused by a malfunction in the body's disease-fighting immune system, although the exact reason why this happens is still unknown.

As you can see – Graves’ disease is a difficult condition to manage; Teresa’s complaints were a perfect argument for the need for a primary care provider. The problem was not with the provider she had seen at the clinic; the problem was that she needed a provider who KNEW her – knew her history, knew her disease and how it had manifested.

Fortunately, we were able to enroll Teresa in the Healthy Michigan Plan – she now has access to a primary care provider and the appropriate healthcare for her condition.

F.A.S.T.

A stroke can be caused either by a blood clot or a ruptured blood vessel in the brain.

The sooner treatment is started, the less chance there is for serious damage and permanent disability. Time is of the essence – every minute counts.

To help spot the symptoms of a stroke remember F.A.S.T.

F – Face drooping: does one side of the face droop, or feel numb? Ask the person to smile – if the smile is uneven, it may be a symptom of a stroke.

A – Arm weakness: Is one arm weak or numb? Ask the person to raise both arms. If one arm drift downward, it may be a symptom of a stroke.

S – Speech: Is speech slurred. Is the person unable to speak or hard to understand? Ask the person to repeat a simple sentence.

T – Time to call 911: if any of these symptoms occur, call 911 immediately. Check the time so you will know when the first symptoms appeared. There are medications that may improve the chances of recovery, but they must be given within a certain period of time.

A person having a stroke could also experience confusion, trouble seeing, dizziness ore difficulty walking. Don’t ignore the warning signs – better safe than sorry! Every minute counts.

Have you met ALICE?

Across Michigan, 40 percent of households struggle to afford the basic necessities of housing, child care, food, health care and transportation.

That's why United Ways across Michigan have come together to bring you the ALICE Project. Standing for Asset Limited, Income Constrained, Employed - ALICE represents those in our communities who are working yet still struggling to make ends meet.

The ALICE Report is the most comprehensive depiction of need in Michigan to date. By unveiling new metrics including the ALICE Threshold, Household Survival Budget and Economic Viability Dashboard, our communities now have the proper tools to discuss need around the state. 
The United Way ALICE Report reveals:

· More than 60 percent of all jobs in Michigan pay less than $40,000 a year and low-income jobs are projected to dominate the state's economy for the foreseeable future.
 
· ALICE is men and women, young and old, of all races, closely mirroring our state's basic demographic make-up. More than 77 percent of the ALICE population is white and 42 percent are within their prime wage-earning years of 45 to 64 years old.
 
· Nearly three-quarters of Michigan's 1,529 municipalities have 30 percent or more households unable to make ends meet. The average income needed in order to survive in Michigan depends on local conditions and ranges from $47,000 to $62,000 annually for a family of four, more than double the official poverty U.S. poverty rate.
 
· Despite the combination of ALICE's wages and some public assistance, ALICE households still face an average 14 percent income gap in order to reach financial stability.

ALICE households are forced to make difficult choices such as skipping preventative health care, accredited child care, healthy food or car insurance. These "savings" threaten their health, safety, and future - and they reduce Michigan's economic productivity and raise insurance premiums and taxes for everyone. The costs are high for both ALICE families and the wider community.

United Way's in Michigan have come together to release the ALICE Report because recognizing the magnitude of the number of households facing financial hardship, as well as the different types of households and problems they confront, will make more effective change possible.

Check out the full report at www.uwmich.org.

 

 

 

Twelve Years

I almost missed it! Today is the clinic's 12th anniversary.

Twelve years ago today, we were waiting, pacing, preparing to open the doors for the first time. We weren't sure anyone knew about us; we weren't sure anyone would come. But, they did.

We were prepared for about ten people to come in; that first night, we saw nineteen. And we have never looked back. The numbers grew from that night on. Sometimes they grew way too much - like the night we saw ninety-nine. It was overwhelming, frightening, gut-wrenching - to see that much need in our community.

Last night, we saw twenty-one people. The Affordable Care Act has made a huge difference in our community. Working people now have access to healthcare. There are still those who fall through the cracks in our healthcare system; there are those who don't know where to go to get help - and it is always my hope that they will come here - that we can help them with healthcare and with enrollment. I want us to be that safe place where you can ask questions, get help and leave with the information needed.

I can't begin to thank all of the people who have been involved in the clinic over the years - as board members, Friends of the Free Clinic, volunteers, and staff. I am so blessed to have each and everyone of you in my life. Our community is richer because of the work you have done.

A Tribute to my Dad

All of you here knew my dad – he was your sibling, your husband, your father, your father-in-law, your grandfather, your uncle, your acquaintance, your neighbor, your friend. Each of you has memories of him.

The memories I am about to share are how I knew and experienced my dad.

My dad was very proud to be a Marine; he served in Korea. The Marine Corp very much shaped the man my father was. Honor, courage, commitment are the core values of the Marine Corp – and describe my dad to a t.  

My earliest memories are of sitting on his lap, with my ear to his chest, listening to him read poetry.

He was the quintessential father of the 50’s & 60’s. He loved us by providing for us. He was a workaholic. He graduated from high school – and by the end of his career was a top executive in an international corporation.

He always led by example. I can’t tell you how many times I heard him say, “You learn more from listening than you do from talking.” That said my dad was one of the greatest talkers of all times!!

My dad was a fighter for social justice – though he never referred to his work that way. He moved our family to Bainbridge, GA, in 1965. His official job was plant manager, but the work he did integrated the work place – paying whites and blacks who worked side by side - the same wage; over the years, as the south slowly moved forward – he was instrumental in making the transition into fully integrated schools successful and safe.

We didn’t know he was doing that – it was just part of his life’s work.

The one story we did all know was the day he integrated the movie theater. Each year there was a holiday party for the employees and their families – and the company rented the movie theater for the event. Well, in south Georgia, in the sixties, the white people sat in the main part of the theater, and the blacks came in through a back entrance and sat in the balcony. My dad would have no part of that – and the front doors and main floor of the theater were opened to everyone. It stayed that way from that day forward.

My dad was color-blind – literally – but, also figuratively. He never judged a person based on their color.

He was always involved in the communities he lived in: the Red Cross, the Library board, PTA, Rotary, the TIFA board, the church. He always made a difference. He was one of the founders of St. Peter’s Free Clinic, based here in this church.

While my dad worked long hours, I remember Sundays as being family days. My dad joined the Episcopal Church in 1966. Our Sundays included going to church. Then we would come home and wait hours while he cooked, talked and talked…..to Fr. Atwood, or later to Fr. Charles.

There were also Sundays spent on the river. In a boat, but usually sitting, as the Sunday routine was to put the boat in the water, go a ways, then the motor would stop. So, we sat, while he worked on the motor. We never got completely stranded, that I remember, but sometimes it felt as if we would. If we weren’t boating – we still would often go to the river, where my dad would teach us to “do nothing” - to sit and enjoy, and to observe nature; to be still. It is one of the best gifts he gave me.

We rarely took vacations, other than our annual trip to Michigan to see relatives. But, the beach was always a big part of our lives – whether it was an impromptu week-end at a mom-and-pop hotel at Mexico Beach, or a house filled with extended family and friends. When he had something to “sort out”- off we would go to the beach. We had a “Red Box” filled with all the things we would need to grill breakfast on the beach. We would walk the beach, while he started cooking.

So many memories are around food. My dad loved to cook. And, he loved to cook for a crowd. There were Easter morning brunches at St. John’s; fish fries; shrimp boils; pancakes suppers; quail bakes; fondue parties; Brunswick stew; enormous pots of vegetable soup; and his famous spaghetti sauce.

There are many memories of sitting in the kitchen of whatever house my parents were currently living in, while my dad cooked – and talked. He would start telling stories – one would lead to the next and to the next and so on. He would continue cooking, telling stories, adding a little of this and a little of that – to both the stories and the food.

My dad loved his dachshunds. From 1973 on, he always had a dachshund in his life. Most of them we all loved, but not all of them!

One of the things I will always remember about my dad is how whenever he was asked how he was doing – not matter the circumstances – he always replied “Great!”

My dad was positive, stubborn, loving and the most amazing person I have ever known. It is impossible to describe him this briefly, but it was important to me to share some of this wonderful man with all of you.

We were all so fortunate to have him in our lives. The memories – they are all good ones.

Thank you – for being here, for your love and support.

 http://www.eaglefuneralhomes.com/Obituary/3621/Duane_Marsh

 

 

Healthcare Insurance Terms

I don’t know about you, but I find some of the terminology used in the insurance world pretty confusing. Imagine how difficult it is for those with low literacy.

Some of the common terms that are used in healthcare insurance are:

1.       Premium: The amount you pay to the insurance company to keep your policy in effect. You may pay this amount monthly, quarterly or annually.

2.       Deductible: The out-of-pocket cost you pay before your insurance company begins to pay.

3.       Co-pay: Your portion of a bill after the deductible has been met. It is a fixed rate, such as a $20 per office visit or $5 per prescription.

4.       Coinsurance: Your cost of a bill after the deductible has been met expressed in a percentage of the bill rather than a fixed rate, such as 20%.

5.       Maximum out-of-pocket spending: For plans sold on the Affordable Care Act Marketplace, the maximum is $6350 for an individual and $12,700 for a family. When these limits have been met, the insurance company pays 100% of all bills for providers in network. There may still be co-pays for care from providers outside the plans approved network.

6.       Provider Network: A network includes all the providers who have an agreement with the health insurance company to accept patients with their plans. Higher co-pays may be charged for out of network providers, or your insurance company may refuse to pay the bill.

7.       Covered Services: There are ten essential health benefits required under the ACA (see blog from August 28). Insurance companies may offer other benefits as well.

8.       Excluded Services: A list of services that are NOT included by an insurance plan, such as cosmetic surgery.

9.       Annual Limits on Services: There may be a limit on the number of visits or a dollar amount. Insurance companies are no longer allowed to put lifetime limits on insurance coverage.

Essential Health Benefits

All insurance plans purchased from the ACA Marketplace must include the following Essential Health Benefits. These benefits include,

·         Emergency Services

·         Hospitalization

·         Laboratory tests

·         Maternity and Newborn care

·         Management of chronic diseases, such as diabetes

·         Mental health and substance-abuse treatment

·         Outpatient care

·         Pediatric services including dental and vision care

·         Preventative services such as immunizations, mammograms and colonoscopies

·         Rehabilitation services

 

There are other protections in the Affordable Care Act that benefit all of us. No one can be denied healthcare insurance because of pre-existing conditions; there can no longer be annual limits on the benefits you receive; there is a ban on lifetime limits; preventive care and annual check-ups are free.

Current Clients

Who are you seeing at the clinic now? I am asked that question frequently. Now that everyone – in theory – has access to healthcare, who are we serving?

It has been an interesting journey – from anticipation to implementation – of the healthcare law. Connie and I became Certified Application Counselors in order to assist those looking to purchase healthcare insurance; we had very mixed results – some success, some who couldn’t afford to purchase the insurance that was offered. There were some who were skeptical about the whole process – they didn’t trust the system or didn’t understand what insurance would do for them.

Then, April 1, 2014 finally arrived and we were able to sign people up for the Healthy Michigan Plan (HMP), which is Michigan’s version of the Medicaid Expansion, a key part of the Affordable Care Act. It has been beyond our wildest imagination. From January to April we were seeing an average of 65 patients each week; we are now seeing an average of 31. And lately, that number is dropping.

So, who do we see? We see people who have fallen through the cracks – maybe they don’t qualify for Medicaid, but cannot afford insurance; maybe they were not aware of Medicaid expansion or the fact that this program is very different from the Medicaid of the past, so we provide them with healthcare, and we help them enroll in the Healthy Michigan Plan. We see immigrants, who have not lived in the country long enough to qualify for any of the programs; we see those who have enrolled in HMP, but have not received their insurance card in the mail – or who can’t get an appointment for another month; we see those that are new to our community and have no healthcare insurance. We are seeing fewer with chronic conditions and more with acute conditions. Most of the people we see are working and need to be healthy to keep their jobs.

We continue to help with enrollment; we are teaching those newly insured how to be healthcare consumers; we are offering smoking cessation sessions; we are going to start a program this fall or winter helping people make better lifestyle choices.

The clinic will be here as long as there is a need in our community. Our mission has always been to fill the gap in healthcare in our community. The gap has changed, but the fact that there is a gap has not.

Honestly, I feel like I can take a breath – we are able to be more present to those who walk through our doors when we are not so overwhelmed by the numbers. We can teach, we can listen, and we can provide a better quality service.

Smile!

I don’t know what made me think of Mark the other day, but something did. He was a patient here at the clinic from 2003-2006. He had a job – seasonal work with no benefits and not much income.

Mark had been in and out of trouble at times, but was a really nice guy. He’s a few years older than me, but had a mother who was supportive and worried about him. She and I became friends. We helped him get the medication that he needed, but that’s not the reason I remember Mark.

I remember him because of his smile. Not at first – he came in with dental issues the very first time we saw him here at the clinic.

Over the years here at St. Peter’s Free Clinic, we have tried to address the multitude of unmet needs that exist in our community. We have been fairly successful in providing healthcare services and medications to the low-income, uninsured residents of our county. But, not as successful in providing some of the other unmet needs – and dental care is a huge unmet need.

The importance of dental care has been expanded over time – we now know how important it is to maintain good oral health to protect physical health. Some of the disease processes affected by dental health are:

·         Diabetes: People with diabetes who happen to have periodontal disease may suffer excessive bone loss of the jaw or surrounding bone structure and have difficulties in healing.

·         Heart Disease: Experts have concluded that poor oral health caused by chronic dental infections may increase the risk for cardiovascular disease and stroke.

·         Stroke: Recent studies have linked periodontal disease with strokes.

Mark came in during a time when one of the local dentists was very eager to help our patients. Mark was one of the first patients to be seen by the dentist for the clinic. He came in, we made the referral, and then I didn’t see him for several months. When he came back to the clinic, he had a smile as big as the moon. His teeth had been fixed or replaced; he was no longer embarrassed to smile. He was grateful beyond words.

For many people, poor dental care is a barrier to jobs. No matter how smart, how personable, or how well-dressed a person is, if they have bad teeth, or no teeth, they are not going to get hired. Dental care can change a person’s life. It may also save a life!

I am so thrilled that the Healthy Michigan Plan (what Medicaid expansion is called in Michigan) includes access to dental care for adults (children on Medicaid have always had this benefit in Michigan). It will make a huge difference in the life of the working poor in our state.

Maybe we will see more people smiling?

Book Recommendations

When I am faced with a problem or a challenge, I tend to turn to books, both to gather information and as an escape.

Recent family health issues have led me to read several books that I highly recommend to anyone facing end of life issues. These books are much more about gathering information, but most of them are also about someone else on this journey at the end of life. Their stories have encouraged me, given me much-needed information and insight, and have helped me form the questions I have that need answers.

In no particular order, here are the books that have really spoken to me:

My Mother, Your Mother: What to Expect as Parents Age by Dennis McCullough, MD

 

Knocking on Heaven’s Door: The Path to a Better Way of Death by Katy Butler

 

The Best Care Possible: A Physician’s Quest to Transform Care Through the End of Life by Ira Byock, MD

 

A Bittersweet Season Caring for our Aging Parents – and Ourselves by Jane Gross

 

 

Planning Ahead: Durable Medical Power of Attorney

As you learn about making your way through the healthcare system, there are many things to think about. An important tool is the Durable Medical Power of Attorney.

A Durable Medical Power of Attorney helps to assure that the medical professionals and your family/friends are able to carry out your wishes if you are unable to communicate due to illness or injury.

A Durable Medical Power of Attorney is a document that you create. It grants the authority to a person of your choice to make medical decisions on your behalf if you are unable to participate in the care planning.

Durable Medical Power of Attorney is also known as Advanced Directives.

A Living Will provides instructions to doctors, hospitals and family/friends concerning the use of specific procedures designed to sustain life – such as ventilators, feeding tubes, or dialysis. A living will also authorizes medical facilities to withhold certain procedures if there is no reasonable chance for recovery. This document outlines YOUR wishes – there is no need to appoint anyone to carry them out.

You may have both a living will and a Durable Medical Power of Attorney.

To create a Durable Medical Power of Attorney, check the laws of your state. Often the forms are available at no charge online or at your healthcare provider’s office.

With a Durable Medical Power of Attorney, you are not giving up control; rather you are making sure that your wishes will be carried out if you are unable to make the decisions.

The person you choose does not have to be a family member, nor does it have to be the family member that lives closest. It should be someone who is readily available by phone in case of emergency. Select someone who knows you and is willing to carry out your wishes about your medical care.

Copies of your Durable Medial Power of Attorney should be given to your physician, your hospital, the person(s) you have chosen to represent you, and extra copies in a safe place such as a safety deposit box or a fire-proof cabinet. Make sure your emergency contact and at least one other person knows where you keep it and how to access it.

Often, we find it too difficult to think about these issues – we still have YEARS of a good life. But, if we don’t plan for the unforeseen, we could end up in a situation where our wishes are not taken into consideration. It is important to plan ahead, and to talk to those who will be making decisions on our behalf about what we consider to be quality of life. These conversations are much easier in theory than they are in reality, so plan ahead. Make your wishes known, and choose who will make those decisions if you can’t.

 

How to be a Good Healthcare Consumer

For the newly insured, there can be a learning curve about how to appropriately use healthcare services. Some of us who have had insurance for years could also use a refresher!

Once a person is insured, it is time to make an appointment with a healthcare provider. There are several options for care. Most insurers refer to a “Primary Care Provider” which is a healthcare provider who is chosen by or assigned to a patient and both provides primary care and acts as a gatekeeper to control access to other medical services.

The primary care provider can be a physician, either a DO or MD, but it may also be a Nurse Practitioner or a Physician Assistant.

There are actually two ways to achieve the title of doctor and practice medicine. One can become a medical doctor (MD) or a doctor of osteopathy (DO). Both licenses allow one to practice medicine and have equally rigorous testing.

Nurse Practitioners are registered nurses trained to be a primary healthcare provider. Their education is based on nursing model and philosophy. Master's degree with relevant experience + Certification + License to practice.

Physician Assistants are healthcare providers practicing medicine under the supervision of a physician. Their education is based on medical model. PA program + License to Practice.

Once you have an appointment with the Primary Care Provider you have chosen, it is time to focus on your appointment. First and foremost, this means turning your cell phone off. Paying attention to the visit with your primary care provider is important.

When you go to your appointment, make sure you have the following information:

·         Insurance card(s)

·         Driver’s license or other proof of identity

·         Any forms the office has sent you to fill out – and have them filled out

·         Health history for you and your family (any chronic diseases your parents, siblings, grandparents have or had)

·         A list of all medications you are taking – prescription and over-the-counter, including vitamins and supplements

·         A list of all allergies

It is important to be prepared to discuss your health with your primary care provider. You will have a limited amount of time for the appointment, and you want to leave with the information you need. Often it is helpful to bring a family member or friend along to be an extra set of ears.

Some tips for talking with your primary care provider:

·         Always remember that it is your body

·         Share your concerns and medical history quickly and accurately

·         Ask questions

·         Take paper and pencil to write down notes during the conversation

·         Make sure you understand any instructions that are given to you

·         If tests, procedures or new medications are suggested, ask some additional questions

o   Do I really NEED this test, procedure, medication?

o   What are the benefits and downsides?

o   Is there a simpler, safer option?

o   What happens if I do nothing?

o   How much will it cost?

Good healthcare is a cooperative effort between you and your healthcare provider. The best healthcare also involves family/friends/caregivers.

 

 

Healthcare: It's Personal

In the past 12 weeks, at one time or another, my dad, my husband, my aunt and my mom have been in the hospital. It has included 4 emergency room trips, 2 ambulance rides, 3 hospitals and countless hours.

This is my rant, my request for prayers, and my reminder to be grateful.

It is always frightening, anxiety-producing, and overwhelming to have someone you love in a life-threatening situation. Trust me – being a nurse does not make that any easier. I know enough to be terrified, but not enough to be helpful in most situations. I typically do not tell the healthcare professionals that I am a nurse – until either it is in the best interest of my loved ones, or if I am being treated patronizingly, then I will tell them.

My dad has been the most frequent inpatient – surgery, complications, a fall, more complications and a stay in rehab to regain strength from all the hospitalizations! He is 83, and as amazing as he has always been. His strength and determination are an inspiration to me – always, but especially now.

My husband ended up in the hospital for the third time in a year. “Ugh,” is all I can say. We are too young to be going through the things he has endured for the past year. I always hope that his health will stabilize, but there are no guarantees. New treatment options are in the very near future - exciting, and scary!

In the midst of my dad’s stint in rehab, my mother calls to tell me she has called the ambulance – she is having chest pains. I have to admit, I figured it was anxiety and stress. She has been through so much lately. But, I was wrong. She had a heart attack – the “widow maker” – her LAD nearly totally occluded. She was lucky – one stent – and she is feeling pretty good. Obviously, she started off exhausted, so it will take some time for her to recover. But, I am amazed at what can be done with minimal invasion and a short recovery time.

I have seen excellent care; I have seen awful care, and individuals I wanted to choke. As in any profession there are good people and there are those who just want to get by; those who are doing work that is meaningful and fulfilling to them, and those who just want a paycheck. It is too bad that people ended up doing work that they don’t like. It usually shows.

Our healthcare system is broken in so many ways – I have given the same information to a dozen people. The need for universal electronic medical records is one thing that jumps out for me – the emergency room and the cardiac care unit can’t even communicate with each other, so too much time is wasted asking the same questions again and again. Medications are changed due to the formulary each institution carries; referrals are not made; communication between the hospital and the primary care provider is incomplete; and, too often, there is not enough staff and response time can be long. It is frustrating and scary.

I don’t have any magic idea to fix things. But, I have a new appreciation of how hard it is to be the family of someone who is hospitalized. Some things would be easy to address: tell the family where they can get water, food, a restroom, and answers. Look at people when you talk to them – not at the computer or the paper in your hand. Answer questions in a manner that is understandable. Tell us the options – not just what you want us to do.

I also have a new appreciation for my family. Growing older is a bitch. It is not easy, it is not without issues and it is not the “golden years.” It is hard. I cannot imagine how people do it by themselves. I am exhausted and overwhelmed – and I have a brother, a sister, a husband, a son, a daughter who are all involved in the care of the various family members. I have the support of family and friends, and I am still overwhelmed and exhausted.

My cousin is dealing with the parallel issues with her parents; I can’t imagine how I could do this without her support, encouragement and presence in my life. We walk, whine, drink wine, laugh, talk and support one another on this journey.

So, this is my opportunity to say thank you to all the family and friends who have made this part of my journey easier – the kind words, the prayers, the time listening to my story, the glasses of wine and all the help. Thank you. I am so grateful to each and every one of you.

What has changed?

That was the question posed to Keith and me by a college student working in the pharmacy with us last week. What has changed since I started in nursing? Since Keith started as a pharmacist?

Wow – what a great question. Keith and I both started down memory lane. I remember mixing chemo on the unit – no gloves, no gown, and no ventilation hood. No gloves ever – for anything. I have never started an IV wearing gloves – that era began after HIV/AIDS. I remember seeing the first AIDS patient on our unit the same week that Newsweek came out with a cover story naming AIDS for the first time.

No DRG’s (Diagnosis Related Groups) – hospital stays were often weeks, if not months, for those newly diagnosed with leukemia. Antibiotics have improved; chemo has improved – the side effects can be so much better managed with medications today.

We talked about all the medications that were not available when Keith and I started. It was interesting to talk about – so many changes happen so gradually that you soon forget it hasn’t always been that way.

I guess that is true of most things in life.

I’m glad she asked the question – I will continue to think about the answer.