Wednesday, January 30, 2013

Take a Break: Make Decorations for the Super bowl/The Best Instant Hot Chocolate

 You can take the girl out of Baltimore, but you can’t take the “Bawlmer” out of the girl. Even though I’ve lived in Vermont for almost 25 years now, I still root for my home town team. GO RAVENS!!!!

With Super Bowl Sunday just days away, it’s time for some special preparation fun. Using your teams colors and logo try some of the following:

-       Pennants, using triangles made from paper or felt, and string them around the house Raven colors are black, gold and purple; 49’s are red and gold

-       Paper chains using appropriate colors.

-       Get some clear glassware from the Dollar Store and decorate with your favorite team’s colors or stencils.

-       Make stencils for your team. Use the stencils to decorate a cake, make a banner, decorate a T-shirt, using sidewalk chalk and make a special entrance for guests. Free Raven Stencils 

-       Make a ribbon wreath. Use a Styrofoam wreath form and use your choice of ribbon for the wreath. If using curling ribbon, put a number of strands together and then pin to the wreath form. For a “loop” wreath, cut the ribbon to sufficient length that it can easily be looped and pinned to the wreath foam. Decorate with footballs, little helmets etc.  
If the Super Bowl leaves you blah, consider making a batch of instant hot chocolate. Cooks Country, has come up with a rich and creamy version that you can use for gifts, serve at your sledding party (or Super Bowl) or enjoy through the remaining days of winter. This mixture will keep for three months, and if winter lasts that long in Vermont, I’m not going to be a happy camper. Consider giving some as a hostess gift the next time you go to a party. Best-Ever Hot Cocoa Mix 

Saturday, January 26, 2013

Part IV: Creating positive health outcomes for patients: Five Things Hospitals can do

 This is final post in the four part series on Creating Positive Health Outcomes for Patients:

Next week’s post will include a summary of all four posts, while this week’s focus is on what hospitals can do.

Hospital readmissions are an all too common problem, to say nothing of the complaints people make about the care they receive. "Readmission rates are a measure that shows that the system for care is not integrated well enough. It's not necessarily an indicator that the hospital is poor quality or the primary-care physician is poor quality -- it's the whole system," Audet said. "The only way we can achieve better health, better health outcomes and better cost is to bring everyone together. But it's quite a complex issue." Audet co-wrote an editorial that accompanied two new studies, which were published in the Jan. 23 issue of the Journal of the American Medical Association.  With both of these studies showing high rates of admission within 30 days after discharge, one of the findings is that patients need to understand their hospital discharge instructions. So this brings us to the first of the five things hospitals can do to create positive health outcomes:

1. Give discharge instructions to the patient and family member, advocate or friend at the same time.  All too often patients are given instructions and no one but them hears the information. By talking to the patient, with a family member, friend or advocate standing by to help with questions and writing down information, patients are more likely to have prescriptions filled, follow instructions, understand what’s normal in the healing process, who to call if they have a problem and in general address their concerns, thereby reducing the chances of confusion and the need for readmission. Because the response to this suggestion will be, “that’s a nice idea but with so many patients, who has the time to make sure this happens?” This leads to suggestion number 2.

2. Provide adequate staffing:  An appropriate workload, with sufficient nursing staff, makes for a better working environment, which in turn, according to new research,  reduces patient readmissions. If there is adequate staffing, the nurse can wait until some one comes to be with the patient at discharge, has the time to talk with them, and be sure all of their concerns are addressed.

Along with adequate staffing, hospitals need to consider when they schedule elective surgeries and admissions. Booking during holiday periods, or at the end of the week, where there is an increased chance that patients will have to be in the hospital over the weekend, isn’t the best idea as staffing is generally lower during these times.

Because the dollar is an important player in the healthcare game, it would be expected that the costs of increasing nursing staff would be offset by the reduction in the cost of readmissions.

3. Provide easy to read information for patients/family/friends. In general, patients check into a hospital and they are given a patient handbook. This document may meet a mandated need but it ‘s rarely read because people aren’t able to concentrate and/or the material provided is overwhelming in length and literacy level. If your current patient handbook has phrases like To provide facilities and amenities that promote the highest quality care, afford solace, and enhance the surrounding communities, which is a quote directly from one hospital’s handbook, you’ve lost them.

As they can benefit both hospital and patient, family/friends need guidance about what they can do. Creating Positive Health Outcomes for Patients: Five Things Family/Friends Can Do  is good basic information for them. However, because the patient is in the hospital, they also need more information pertaining to the current situation. Such items to include in a simple handout, which is completed at the time a patient is taken to a room, include:
• Patient’s room and phone number
• Special needs and concerns for this patient. What to look for, when to call for assistance
• Treatment plan-keep it very simple, including medications and special procedures
• Who to contact: information for social services, chaplain, billing, patient coordinator etc.
• Where to go for food, snacks
• The URL for the hospital’s website

A good model to use is the handout you’ll find in hotel rooms that offers basic and easy to read information to help guests get what they need to make their stay as pleasant as possible.

Keep in mind that much of the patient information materials are written well above the level of many people. To help improve medical literacy, use the Removing Barriers to better, Safer care. Health Literacy and Patient Safety. Help Patients Understand Manual for Clinician’s Second Edition

4. Develop volunteer programs that can help meet patient needs. With people retiring at greater rates than ever, many will look for volunteer opportunities, where they will be able to make a difference. There are also students, in various medical disciplines, who want experience. A well run volunteer program can make a world of difference to both hospitals and patients. Programs to consider

• Sitters: Providing companionship, sitters spend one-on-one time with a patient and help to keep them safe. While sitters are often part time jobs for nursing students and retirees, many patients need them but can’t afford them. Volunteer sitter programs are more common in pediatrics. However, with the aging population, the need will significantly increase in the coming years. The No One Dies Alone (NODA) program is one example of a type of sitter program. Basically, a volunteer companion stays with a dying patient. This program was started at Sacred Heart Medical Center, Eugene, OR and is now being implemented in hospitals all over the country. 

• Advocates: There are situations when a patient does not have family or friends that can serve as their advocate while they are in the hospital. Even if they are a well skilled personal advocate, being sick, in pain, on medications etc., can compromise one’s ability to act on their own behalf. Patients need help in understanding: how to partner with their healthcare provider, be a good decision makers, how to navigate the health system and to obtain resources in their community. Examples of programs that teach advocacy include:

-    Health Leads: Health Leads enables doctors, nurses and social workers to “prescribe” basic resources like food and heat just as they do medication. They recruit and train college students to “fill” these prescriptions by connecting patients with the basic resources they need to be healthy. 

5. Write a “prescription” for condition specific and resource information: Patients are going to use the internet to learn about their condition, so help them by identifying websites that will be the most useful to their situation. Such sites can include:
• National Association of condition specific organization (e.g. American Cancer Society)
• Local chapter of condition specific organization
• Local community resources. This can be as simple as explaining 211, now available in every state. 2-1-1 provides free and confidential information and referral. Call 2-1-1 for help with food, housing, employment, health care, counseling and more. Learn more about your local 2-1-1 by looking it up here. 

Wednesday, January 23, 2013

Take a Break: Make Ice-Lanterns/Sun Catchers/Shot glass

Since we’re running temps in Vermont that are zero, give or take a few degrees (at the moment, it’s 3 below) this is the perfect time to experiment making things with ice. If you live where it’s warm-lucky you- ice lanterns and ice shot glasses are still an option, as they’ll make attractive centerpieces for a party.

Ice Lanterns: There are many different ways to make an ice lantern. The easiest is to take a container of any size, fill it with water, and let it freeze about 75%. Turn the container up side down and run some warm water around it so the “lantern” will slide out. Pour out the water that doesn’t freeze and insert your candle in that space. 

For a little more elaborate lantern, but still easy:
  1. Put water in a container, (bucket, yogurt container, soda bottle) so it covers the bottom. Let freeze until solid
  2. Place a plastic glass, paper cup or other container in the center. Tape this to the sides of the original container. This will eventually be for your candle, so don’t fill with water. In the space between the large and small containers, fill with flowers, greens, berries, or whatever strikes your fancy. Then fill with water and refreeze until solid.
  3. To un mold, add hot water in the center bottle. As the ice melts, pull out the center container. Run hot water over the outside of the container and gently un mold. If it’s plastic, you can always cut it.
  4. If there are cracks in the ice, add a little bit of water to seal them and refreeze.
  5. Add a flameless candle and enjoy.
 With the Super Bowl coming up, add food coloring to the water, along with mini footballs, to make ice lanterns in your favorite teams colors. Use as a centerpiece, or line the driveway the night of the game.

Ideas for Ice lanterns

Ice Suncathers are easier than lanterns, in that you lay out items, such as leaves, in a cake pan or pie plate, either place strings, or put a paper cup which you can pass a ribbon through, and freeze.

Ice shot glasses: Can be used for tiny lanterns (votives) for an indoor party, but it would be very cool to serve something you want immediately chilled. You can purchase a mold, or follow these simple directions using a Dixie cup and shot glass. 

Saturday, January 19, 2013

Part III: Creating positive health outcomes for patients: Five Things Communities can do

Continuing with part III of the series on creating positive health outcomes for patients (Part I: Five Things Family/Friends Can Do and Part II: Five Things Patients Can Do Five Things Patients Can Do), this week’s post focuses on the role of the community. Loosely defined this can include civic groups (such as Rotaries, Lion’s Club); churches; schools; businesses, places of employment; social clubs, libraries etc.

Today, most people will develop some form of chronic disease, where they will spend 99% of their time in community, and live for many years with their condition. Since many will want to “age in place,” communities play a very important role in helping people stay independent. There are a number of things that can be done to help patients get the care they need and remain active and vital members of their community.

While four of the suggestions listed below can be implemented by any community group, it’s important to note some unique roles of certain organizations
• Libraries and librarians have a special role for their communities. Since this is where people often go for information or to use the computer, many patrons come to rely on their librarians for guidance and so turn to them, sometimes before family and friends. Libraries can best meet the needs of their community by having current and accurate health information both on-line and in print.

• Human Resource (HR) departments will be increasingly taxed with helping both the individual who has a serious illness as well as the employee who is the primary caregiver for an aging parent or a sick spouse or child. Not only having accurate information is key, but also forming community within the workplace to support these individuals. The first three items below provide specifics on how to organize and respond in these situations.

Of the five suggestions below, the first four can be done community wide or for individual groups for minimal costs. Recommendation number five suggests a collaborative approach among all aspects of community in order to create a healthy environment that promotes well-being.

1. Respond: Similar to the recommendation made for families/friends, it is important for communities to respond when someone is in need. Reading How to Respond When You Learn that Someone is Ill or Injured will assist in understanding the types of things that can helpful.

2. Provide current resource information on-line and in print: Whether it’s information about a specific condition, or where to go for help, having locations within a community that contain current and accurate condition specific information and resources is important.

With 80% or more of the adult population using the internet, information needs to be available to communities via the internet as well as in print. Things to consider:

• All communities have a variety of resources that can be of help. Unfortunately, many patients and those caring for them, are not aware of resources, and/or don’t know how to access them. Further, while hospitals, HR Depts.  and other organizations will have lists of the major  programs, a number of the things that local communities offer, such as what churches, rotaries etc. can provide, aren’t always included. In addition to making what is available known, consider adopting the Getting What You Need Checklist for your community. For an example of how this was done, check out the Cavendish VT edition. Organizing and maintaining resources would be a good community project for a civic group or school.

Make this information available on-line via various community websites and social networking sites-such as face book and blogs. Any organization, such as a library, that offers free internet access will want to have this information book marked so patrons can easily link to it.  In addition, create a print version and make it readily available via the library, churches, local government offices, community based organizations, human resource departments, civic groups etc. Keep it current.

• If your community group offers internet access, in addition to having a local version of the Getting What You Need Checklist, have website links with accurate health information available. Links to consider include:
-       Taking Charge of Your Health University of Minnesota Center for Spirituality & Healing and the Life Science Foundation 
-       Healing Whole  Resources for those affected by chronic conditions
-       Caregiver Resources 

• Health care rapidly changes, so even within a year, materials can be quickly outdated. If your organization has some form of library, it is important that you make sure information is current and up to date. On a yearly basis, check print materials for accuracy. Have someone with medical knowledge do this. Since condition specific organizations [e.g. American Cancer Society] offer free materials, contact these groups yearly for new material packets.

3. Organize support: There are a variety of ways to do this. Consider what is needed by an individual or a group of people, such as seniors, yet be realistic about what your organization can provide or do.

• Organize volunteers to respond to the various needs people might have: meals, driving to appointments; advocates; yard work; chores; childcare; dog walking; shopping; house cleaning; friendly visits etc. You can make this process a bit easier by creating a free Open Community Lotsa Helping Hands webpage.  Frequently used by churches and civic groups, this is an easy way to organize volunteer help.
• Organize volunteers to meet a specific need. Many groups have a focus, which might lend itself to meeting a need. Some examples,
-       A garden club may offer their services to do lawn care, gardening or even planting a vegetable gardening.
-       A CSA (Community Sustainable Agriculture) may volunteer to provide fresh and in season produce for families at no or reduced cost.
-       A computer store can offer assistance in helping families set up Lotsa Helping Hands pages, provide refurbished computers, and/or provide technical assistance.
-       Students can be organized for a special weekend to do spring-cleaning or fall preparedness. The local hardware store can provide tools and materials needed for such an activity, while a local restaurant can provide a boxed lunch for the volunteers.

• If you have the space, offer to let support groups meet there for free.

• Create a “loan closet,” where people can borrow free wheelchairs, walkers, canes and other items needed for short durations.

• In the event someone needs blood, a bone marrow transplant or a specialized surgery, organizing fundraisers, blood drivers and bone marrow registries can truly save a life.

4. Offer workshops and programs: There are a wide array of workshops and programs that community groups can run on their own, in conjunction with their local medical center, local chapter of a condition specific organization (e.g. American Heart Association), senior network, and/or as part of national initiatives. Programs that help people bond and form community can encourage healthy behaviors. Consider some of the following:
• Educational Seminars and trainings: Such topics could include:
  • -       Smoking cessation
  • -       Self advocacy
  • -       How to be a “friend with a pen,” advocating for someone else
  • -       Living wills/Advanced directives and other legal issues
  • -       Staying in Control: Preparing for life’s final chapter
  • -       Tips and help in hiring a personal care attendant/caregiver
  • -       Help in understanding Medicare, supplemental insurance and drug plans
  • -       How to keep a health notebook
  • -       Care giving
  • -       How to communicate more effectively
  • -       Resilience and personal empowerment
  • -       Aging in place
 • Activities that offer both social connections and physical activity can be very beneficial. Such activities may include:
  • -       Bone Builders: A community based program for osteoporosis prevention
  • -       Walking groups
  • -       Arts and Crafts
  • -       Communal eating, such as senior lunches or community dinners
  • -       Exercise programs, including yoga, Tai Chi, Qigong
  • -       Massage
  • -       Meditation
  • -       Dance classes
  • -       Community Garden
  • -       Game nights
  • -       Continuing education

5. Create a community where the healthy choice is the easy choice. The Blue Zones project was started in 2004 to identify and evaluate those places in the world where people lived measurably better and longer. This research has resulted in a new direction-creating communities for better longevity and well being. Instead of relying on an individual’s behavior change, the focus is creating communities where making the easy choice is also the healthy one. By making wholesome foods more prevalent and accessible and less expensive than junk foods, more people will begin to eat healthier naturally. We’ve identified the lifestyle and environmental characteristics in each of these Blue Zones and help American cities optimize their own communities for better longevity and well being. Learn more about how communities are incorporating the nine principles of the Blue zones.

Tuesday, January 15, 2013

Take a Break: Create a “Take a Break” Area/Massage

Several weeks ago, I spoke with a woman who was caring for her elderly Mom who had memory issues, was reluctant to leave the house and most likely was depressed. Consequently, Emily (not her name) was beside herself trying to figure out what to do with her Mom.

Among the things I suggested was creating a "take a break" area for Mom, where she could do some simple arts and crafts projects, puzzles etc. but still be with the family. While I made other recommendations to help Mom, the one that Emily was able to easily implement was creating a craft area for her Mom in the family room. The results were dramatic. Not only did memory improve, but Mom was now staying up longer, engaging with the family and spending many happy hours drawing, working on puzzles etc. She was so inspired she even managed to make dinner for the family one night.

Taking a break and using your hands is very healing Having an area where things are organized just makes it more likely that you will take a break and make something.

My husband became tired of my stuff being spread out all over the place, and my constantly saying, “Have you seen my scissors (substitute just about anything).” He made me an area, with lots of shelves, to store all my “take a break” stuff.

I find that it’s not only very helpful to have everything in one place, but other members of my family can be found there periodically working on their own projects.

Not only is a “take a break” area suitable for home, but think about it for your office, waiting room, hospital, staff lounge, health center or business.

Location: Who uses the “take a break” area will determine its location and how you equip it. If you are making it for an elder living with you, or for kids, create it in a corner of an area where the family naturally gathers. If you want privacy, pick a place with little or no foot traffic, such as your bedroom, attic or basement. However, try to place it near a window for natural lighting.

Organizing the area: You will want a flat surface to work on, a chair, lighting, electrical outlet, electric strip and storage. While shelves are great, a desk with drawers underneath, or even an old door laid on two saw horses, with boxes on the floor and peg board on the wall are also fine. Work with what you have. Mason jars; tins and even yogurt containers are great for stashing paintbrushes, colored pencils etc. for both storage and easy access.

Stocking it: While you’ll want the basics of things like colored pencils, markers, paper, tape and scissors, depending on what interests you, stock it with what the person likes to do. While I do a lot with fabric, I tend to keep my fiber and sewing area separate from my general supplies of paints, glues, beads and other things that don’t necessarily mix well.

If you are creating a “take a break” area for someone else, things to consider include:
• Different types of paper, colored pencils, markers, paints (tempera, water colors, acrylics, fabric) scissors, brushes and tape. I have a shelf dedicated to different colors of Duct Tape.
• Clay-Model Magic is terrific for creating items that can air dry. For finer detailed work, such as jewelry, use polymer clay. This will require baking.
• Ribbons, colored string, wire
• Glues of various sorts including a glue gun
• Punches
• Puzzles
• Mandalas to color or paint
• Check out Archives 8/09-10/12 for hundreds of “Take a Break” ideas.

Looking for a different “take a break?” I was exploring Indian head and neck massage and came across Wings of Knowledge website. Lots of free videos and instruction on massage techniques, including self-massage, yoga, meditation etc.

Saturday, January 12, 2013

Part II: Creating positive health outcomes for patients: Five Things Patients can do

Continuing with the four part series on Creating Positive Health Outcomes, last week was Five Things Family/Friends Can Do, this week’s focus is what patients can do.

Today’s health care is  “patient centered,” which requires that the patient and/or their designee, make choices and decisions about treatments, tests etc. Since this is a shift from the “provider down” approach of old, it can be confusing, frustrating and challenging. It means that patients need to be as clear as they can be about what they want, so if the situation arises where they can’t speak for themselves, their wishes are carried out. As we age, this brings its own set of unique issues, particularly if there are no children or family to represent them.

As my brother-in-law noted recently, Whether family or friends, an individual anticipating decline must increase her/his awareness of the shortfalls which may occur in his/her care, whether hospital, nursing home or at home.  Part of growing older is losing friends and family so this may require building new networks of friends or family whose mandate is health management advocacy agreed to in a reciprocal compact.  This means conversation and planning in an informal forward looking way among the team members in an effort to take a role in each other’s care. 

As you go through the five things patients can do, you will see overlap. For example, “Keeping a health notebook” appears under three headings simply because it’s a good way to tract what happens and it helps when information doesn’t make it into the medical chart. Unfortunately, missing information from a patient’s chart is a very common occurrence and can compromise care.

1. Know your rights and responsibilities as a patient and act accordingly: Most hospitals, health centers and even states have specified rights and responsibilities. Be sure to check these sources. Below are general guidelines on rights and responsibilities.

You have the right to:
• Considerate and respectful care regardless of race, ethnicity, national origin, religion, age, sexual orientation, gender, payment source or health care condition.

• Current and understandable information concerning diagnosis, treatment and prognosis. Expect reasonable assistance to overcome language (including limited English proficiency), cultural, physical or communication barriers.

• The identity of the physician, nurses and others involved in your care, including those who are students, residents or other trainees.

• Work with medical providers in establishing the plan of care, including the refusal of a recommended treatment, without the fear of reprisal or discrimination. Be told of realistic care alternatives when the current treatment is no longer working

  Privacy and the expectation that all records and communication are treated as confidential.

• Your medical records.. Request that your provider amend your record if it is not accurate, relevant or complete

• Expect that an advance directive (such as a living will, health care power of attorney) will be honored by the medical staff.

• Receive timely notice and explanation of changes in fees or billing practices.

• Voice concerns, complaints and questions about care and expect a timely response.

• Expect that the medical caregivers will give the necessary health services to the best of their ability. If a transfer of care is recommended, you should be informed of the benefits and alternatives.

• Access to emergency services. In the event of a medical emergency, where you believe your life is in danger, you have the right to receive screening and stabilization without prior authorization or financial penalty.

As a Patient, You Have the Responsibility To:
• Provide your medical caregivers with accurate and complete information, and convey your understanding about what is expected of you in regard to your treatment. If you believe you cannot follow through with your treatment, let them know. Inform them of changes in your condition, care situation or modification or completion of important legal forms, such as advanced directives

• Meet your financial obligations as promptly as possible.

• Be considerate of the rights of other patients and medical personnel while in the hospital.

• Recognize the reality of risks and limits of the science of medical care and the human fallibility of the health care professional.

• Be aware of the health care provider's obligation to be reasonably efficient and equitable in providing care to other patients and the community.

• Become knowledgeable about your health care plan.

• Keep appointments and notify your provider if unable to do so.

For more information

2. Advocate for yourself.
Ask questions. Ask for what you need. Ask for your medical information (tests, treatments, records etc.)
Decisions: You are in charge of deciding what you want to happen. Don’t pretend you understand if you don’t. Don’t stay with a provider you don’t feel comfortable with them.                    
Voice your concerns.
Organize a health record and keep it up to date.
Communicate with your provider, family and friends.  Communicate what you want and feel-Be specific and put it in writing Communicating includes listening. Consider your priorities-what is it that you need and want.  Calling your provider-know how to reach them in case of emergency.  Choose health information carefully. Consider a second opinion. Choice-You have the right to refuse treatment
Advocate: Ask a family member or friend to help you get what you need.
Talk to others: Join a support group. Team: You and your provider are a team. You are the captain of the team. Treat your care team with respect and honesty. Take a “friend with a pen” to office visits. Think about questions in advance and write them down. Take your time in making a decision that will change your life Take responsibility for the decisions you make.
Educate yourself and others about your condition. Learn about local resources that can help you. Expert: You are the expert on you.

For more information

3. Be clear about what you want and need. Letting your medical provider, caregivers,  family and friends know what you want and need up front and in writing can save time, energy, reduce frustration, helps you get what you want and could even save your life. 
• Fill out advance directives, designate a health proxy, and be clear who people can go to for information about how you are doing and what you might need.
• If you have a serious condition, where it’s important for someone treating you in an emergency situation to know about, wear a medic alert bracelet as well as carry written instructions about what you might need, medications you are on etc. If you are unable to communicate, be sure to have accessible written information that you want them to know. It can help if you have your medical provider include a letter about your treatment protocol and how to contact them. Note that there are services, like MedicAlert  that can provide immediate information to appropriate medical responders with everything from advance directives, do not resuscitate orders, to important medical information. They will even contact your family if you desire.
• ICE your cell phone: Make sure your cell phone contains an In Case of Emergency number(s).

4. Manage Your Health
• Keep a health notebook: You can now do this on-line
• Maintain healthy habits by:
-       Reducing sugar & caffeine in your diet;
-       Limiting alcohol to a glass of wine daily if allowed with current medications;
-    Regular exercise as health permits (consider yoga, Tai Chi and Qigong); 
-       Getting sufficient sleep
•  Keep medical appointments
• Identify resources in your community that can help you get what you need. Use the Getting What You Need Checklist
• Develop and maintain good relationships with your health providers

Additional Information

5. Be aware of health fraud: If it sounds too good to be true, it probably is. People with chronic/life threatening conditions are often the target of fraud. The fact that serious illness causes great suffering, and can lead to death, has encouraged the marketing of hundreds of unproven treatments. Learn more about scams and health fraud. 

Wednesday, January 9, 2013

Take a Break: Replace the Christmas Tree/Percussion

I come from a tradition where the Christmas tree goes up on Christmas eve, and stays until January 6. After 12 days, when the tree comes down, it leaves a big hole. I miss the tiny lights more than anything.

Living in Vermont, people do all sorts of creative things with birch and other tree limbs, branches and saplings. Several people I know have taken large pots, put branches in them and strung them with lights. They are a wonderful part of their décor and cost little to create.

You may not want a floor to ceiling length tree limb in your home, but a vase with twigs and small branches, sprinkled with tiny lights can give you the same effect. You can even decorate it with small hearts for Valentine’s Day, shamrocks for St. Patrick’s and so forth.

So take a break today by going outside and finding twigs (or a limb) and create a new décor piece to brighten the New Year.

I was totally inspired this week by the Siberian Percussionists playing ice sheets on Lake Baikal. particularly when compared to their “land” video

Saturday, January 5, 2013

Creating positive health outcomes for patients: Five Things Family/Friends can do

This past week, I dealt with a number of people who are coping with a wide array of chronic and acute health care issues. Unfortunately, I witnessed a variety of ways patient care was compromised -understaffing; vital information not entered into a chart; a patient falling because the alarm buzzer hadn’t been set on their bed and so forth. When I discussed this with my sister, who has been a nurse for well over 35 years, she said, “It’s always been like this. ” Other people I talked to agreed with her and made comments along the same line, often shrugging their shoulders, telling their own horror stories, and saying, “So what’s new?" What can you do?” 

At this juncture, complacency isn’t an option, particularly with the aging population and the arrival of Obama care. It’s time we each do what we can do to make this better. Making a change in one area can create a whole new way of thinking and doing.

On New Year’s Day, I sent an e-mail to colleagues and friends detailing some of what I had witnessed and posing a challenge-to implement a demonstration project that would improve care that can be replicated for nominal costs.  This has created some very interesting dialogue and good suggestions. As a result, this is Part I of a four part series where I will be posting five suggestions each, for family/friends, patients, communities and hospitals, which they can do to improve health outcomes for patients.

My goal is to identify straight forward approaches that have minimal or no costs associated with them, are effective based on research and/or from those with extensive experience working in the field, and can be easily implemented in a variety of settings.

Please post your comments, suggestions and relevant resources below, or e-mail them to me at At the completion of the series, the posts, along with additional comments and suggestions, will be formatted into a simple PDF handout, which will be available by e-mailing

Five Things Family/Friends Can do to Create Positive Health Outcomes for Patients
Your relationship with the patient, how close you live to them, as well as the nature of their condition, will determine the full measure of what you can realistically do. However, whether you are a caregiver, or a distant neighbor,  everyone can do something, even if it’s just sending e-mails or notes of support.

1. Respond. How to Respond When You Learn that Someone is Ill or Injured is one of the most frequently downloaded items on this blog. It’s clear that many want to help but don’t know how. Read this post to learn simple ways you can provide support regardless of where you live or who the patient might be.

2. Learn to be an effective advocate. When a person is compromised by age, a variety of chronic conditions, critically ill,  and/or has been newly diagnosed with a very serious condition, they need help. Even on a good day, people only retain a portion of what transpires in a medical office visit, so if you’re very sick or compromised in some way, you may have no clue what the provider is telling you. Research shows that taking a advocate to appointments results in better visits and ultimately better patient care. 

Become a “Friend with a Pen.” Go to medical appointments, as well as visits with case managers, social service agencies and other places where they receive either medical care or social services support. Take notes, speaking up when the patient is unable to do so and with their approval when possible. 

Stay with them in the hospital, helping them obtain the care they have specified and need.

Further reading on this topic:
• Hospitalized: A Three part series to help patients get better care when hospitalized

3. Help them navigate the health and social service systems. Using the “Getting What You Need: Checklist" understand what the person might need and know what is available locally. This handout includes information on the following:
-       Resource numbers/websites-Among the resources are connecting with the local chapters of condition specific organizations, such as the American Cancer Society. These groups will often have advocates and case managers that can make this process a lot easier. They can also provide easy to understand information about the condition, treatment plans etc.
-       Building and organizing support networks-Don’t go it alone.
-       Legal issues
-       Health Insurance and paying for health care/medications/non medical needs
-       Benefits-disability, supplemental, worker’s compensation
-       Life settlements, viaticals, reverse mortgages
-       End of life care
-       Work-disability, vocational rehabilitation
-       Maintaining a personal health notebook
-       Case management
-       Decision making

4. Encourage them to be an effective/empowered patient: While there are times that family/friends need to take the lead, in general patients are their own best advocate. Since 99% of chronic care takes place outside of a medical facility, it is important that the patient recognize that they are in charge of their own care. Besides, research shows that more involved patients do better. You can help them in taking responsibility for their care by:
-       Role modeling advocacy skills
-       Letting them take the lead and only stepping in when they need help or are unable to speak for themselves.
-       Helping them set goals about what they want for themselves as far as healthy outcomes, treatments etc. This can be done in a number of ways- having them outline areas of concern prior to medical appointments; framing questions and concerns in ways that are more likely to get a response; identifying underlying and root issues to problems; completing legal documents, such as advanced directives; keeping a personal health notebook
-       Accepting what they tell you
-       Encouraging them to learn more about their condition, joining a support group etc.

Keep in mind that regardless of how helpful you want to be, it’s their life. You may not agree with what they are choosing to do, but it’s ultimately their choice to do what they believe is right for them.

Note that if the patient is capable of doing things on their own, and you do it instead, regardless of reason (they take to long; they may not do it right) you under mind their ability to do things on their own. 

5. Be a Healthy Caregiver: If you are in the role of primary care giver, it’s important that you take care of yourself. Use the Caregiver Resources page to learn about self-care as well as the various challenges of care giving and ways to deal with them. Note that there is also a Youth Caregiver page