Celebrated each March, National Nutrition Month is a nutrition education and information campaign created by the American Dietetic Association to focus attention on the importance of making informed food choices and developing sound eating and physical activity habits.

Some say nutrition is now a fad. There is an exploding movement of “healthy eating,” “organic,” and “whole foods” almost to the point that every time you look you can find some new alternative form of healing, exercise, or eating. The designation “nutritionist” is thrown around quite a bit these days. In order to avoid the plethora of scams that arise to take advantage of an actual need, one thing you can do is to look for someone who is a registered dietitian (RD), whose responsibilities go far beyond helping people lose weight.

One thing is clear… the need for smart nutritional habits doesn’t stop with the awareness month:

“Food variety supplies different nutrients, so to maximize the nutritional value of your meal, include healthful choices in a variety of colors…”

Green produce indicates antioxidant potential and may help promote healthy vision and reduce cancer risks.

• Fruits: avocado, apples, grapes, honeydew, kiwi and lime
• Vegetables: artichoke, asparagus, broccoli, green beans, green peppers and leafy greens such as spinach

Orange and deep yellow fruits and vegetables contain nutrients that promote healthy vision and immunity, and reduce the risk of some cancers.

• Fruits: apricot, cantaloupe, grapefruit, mango, papaya, peach and pineapple
• Vegetables: carrots, yellow pepper, yellow corn and sweet potatoes

Purple and blue options may have antioxidant and anti-aging benefits and may help with memory, urinary tract health and reduced cancer risks.

• Fruits: blackberries, blueberries, plums, raisins
• Vegetables: eggplant, purple cabbage, purple-fleshed potato

Red indicates produce that may help maintain a healthy heart, vision, immunity and may reduce cancer risks.

• Fruits: cherries, cranberries, pomegranate, red/pink grape fruit, red grapes and watermelon
• Vegetables: beets, red onions, red peppers, red potatoes, rhubarb and tomatoes

White, tan and brown foods sometimes contain nutrients that may promote heart health and reduce cancer risks.

• Fruits: banana, brown pear, dates and white peaches
• Vegetables: cauliflower, mushrooms, onions, parsnips, turnips, white-fleshed potato and white corn

Read more about smart choices for eating and dieting

Open Health Market sells itself as the first and only online marketplace enabling group purchasers of health services to evaluate, compare and engage the services of a range of health-care providers. This is how it works:

Employers submit requests for health care proposals for a category of medical services and procedures — knee surgeries, for example, or cardiac care. Health care providers then submit competing bids, which are then evaluated by the employer.

Self-insured businesses looking to cut out the middleman when it comes to health care have a new way to solicit bids directly from doctors or hospitals.

Created by a doctor, a lawyer and a former benefits manager, Open Health Market is an online matchmaker of sorts: Employers submit requests for proposals for a category of medical services and procedures — knee surgeries, for example, or cardiac care. Health care providers then submit competing bids, which are then evaluated by the employer.

If an employer accepts a bid, the savings could then be passed along to employees in the form of incentives to go with the new provider, such as a waived deductible, said Don Crandlemire, the Concord lawyer who created the site along with Dr. Leonard Fromer of Los Angeles and Peter Hayes, former benefits manager at Scarborough, Maine-based Hannaford Bros. supermarkets.

The primary purpose is to shorten the distance between buyer and seller.

Some, however, are worried that this idea places too much emphasis on discounting cost, and perhaps not enough on the quality of care and service provided.

Learn more about this fasincating topic

It may be less obvious, however, that the key to what that president will need to do, and therefore also to how he will need to run, is health care reform: undoing Obamacare and replacing it with real reforms that can contain costs while providing consumers with high-quality care.

Capretta and Levin cast the argument for health-care reform not only against the backdrop of a worsening debt crisis, but also as the centerpiece for what is necessary for the current administration to remain in power.

Moreover, the time frame for what the authors call for isn’t only a function of the election cycle but also inherent in the design of Obamacare itself.

Once Obama-care’s major entitlement expansions go into effect in three years, it will be very difficult to reverse them. And the structure of our existing health care entitlements, combined with the retirement of the baby boomers (which began last year), means that serious reforms of Medicare and Medicaid are needed very soon.

So where do we go from there? No matter what your views on health-care are, everyone would agree that an efficient system that does not waste resources is something to strive for. Capretta and Levin are adamant about about cutting back excess subsidies to the major health-care programs and providing fixed levels of financial support toward insurance and care that patients and control.

Our considerations of excessive waste must take into account the enormous bureaucractic burden that we have saddled ourselves with. In an op-ed by an Oregon-based physician, Samuel Metz argues for the creation of a single-payer system in his state as a way to eliminate wasted resources.

It would create thousands of jobs. It would provide health care to people whether they work full time, part time or are retired, disabled, sick or unemployed. It would stimulate Oregon business. It would reduce our state deficit. And it would provide comprehensive care to every Oregonian without spending more than we do now.

Where would the money come from? Oregon businesses and families already spend this money. But Oregon wastes $4 billion annually in private insurance administration. That’s premium money that never goes toward health care. Half is the insurance company overhead. The rest is what hospitals and providers like me waste collecting payments from insurance companies. Princeton economics professor Uwe Reinhardt, speaking recently before the Senate Finance Committee, said of Duke University’s 900-bed hospital: “We have 900 billing clerks at Duke. I’m not sure we have a nurse per bed, but we have a billing clerk per bed. It’s obscene.”>

Where do you think health-care should go? Are you for or against single-payer systems? Why? What does the government need to do differently?

Send us your thoughts via Facebook

For a good resource on health-care reform see:
T.R. Reid. The Healing of America. (http://www.amazon.com/Healing-America-Global-Better-Cheaper/dp/1594202346)

Home health… perhaps one of the more controversial topics in health-care. Controversial not because of the nature of the care involved, but rather its long-term feasibility as an alternative to assisted living and nursing homes.

The benefits are numerous:

• Some physicians find that patients recover more quickly and comfortably in familiar surroundings (home) rather than an exterior location such as a hospital
• Patients retain more independence (arguably raising their quality of life)
• Allows family and friends to be much more accessible and possibly involved in care
• Lifestyle can be better tailored to individual needs

And yet, the future of the industry is uncertain. Last year it looked like the home health services at Avera Marshall Regional Medical Center in Southwestern Minnesota were in jeopardy. Avera Marshall still has its home care programs, but the circumstances and realities paint a stark picture of what could be to come. In the prior fiscal year the program had a loss of about $194,000. Only part way through the following year their losses had already hit $58,000. 

However, there were still facts in favor of home health. The area served by Avera Marshall has private home care services available, meaning potential overlaps in services. And in general, home health can often work to reduce health-care costs when compared to the resources used in facility-settings. A study in 2008 by the Alliance for Home Health Quality and Innovation argued that “home healthcare is the most logical and cost-effective alternative to other sub-acute services, such as nursing home stays or extended hospital visits for recuperative and chronic disease care.” [1]

But the long-term arguments against home health may prove to hold greater weight. Andrew Carle, founding director of the Program in Assisted Living/Senior Housing Administration at George Mason University (GMU) points out that home health is not a sustainable industry in light of the demographic shifts on the way.

The biggest problem (with home health) is we are mathematically eliminated from having enough nurses and nurses’ aides to go into everyone’s home. We need to triple the number of these workers by 2050, but when the last of the boomers retires in 2030 there will be 35 million more jobs in the country — of any kind — than people to fill them.” [2]

Carlyle also points out that surveys are showing nearly 60% of 40-49 year olds intend to sell their house when they retire. Whether that is indicative of actual changes in preferences or simply the reality of economic and financial pressures, it sounds as if less and less people will even be in homes to begin with.

There may be no place like it, but without a home it’s pretty hard to get home health care…

That’s what makes the recent news so interesting. Health-care provisions plan to move Medicaid patients out of institutions, promoting a trends towards home and community-based environments. States are eligible to gain billions of dollars and 13 states were awarded $45 million in grants earlier in February.

“Our country recognized in the Americans with Disabilities Act that everyone who can live at home or community-based settings should be allowed to do so,” Health Secretary Kathleen Sebelius said in a statement announcing the grants……

Starting in October, states will also receive a 6 percent increase in the federal reimbursements for providing nurses and other home-based support to people on Medicaid.

Through 2014, states could see a total of $3.7 billion in new funds to pay for attendants who help individuals with daily activities such as bathing, and also to help move people by paying for utility deposits, rent or household supplies.

The federal government is currently seeking comments on how to implement this part of the law, but expects states to establish councils with a majority membership of people with disabilities and elderly individuals to design the programs.

Learn more…

What are your thoughts on home health? Is it an industry worth pursuing for us? Or are we shooting ourselves in the foot by taking it too seriously? Send us your thoughts via Facebook.

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[1] Alliance for Home Health Quality and Innovation. “The Future of Home Health Care: Containing Costs while Serving Patients Preferences.” May 2008. http://ahhqi.org/download/File/The_Future_of_Home_Health_Care.pdf (accessed March 23, 2011).

[2] Assisted Living Foundation of America. “Academic Outlook.” Assisted Living Executive. September/October 2010. PDF Link (accessed March 23, 2011).

March is National Brain Injury Awareness Month. Ironically brain injury has been brought to the forefront of headlines with the shocking stories of Arizona Congresswoman Gabrielle Giffords and former NFL player Dave Duerson.

These rare and fantastic examples are underscored by the reality that traumatic brain injury (TBI) can happen to anyone at anytime and anyplace. We must not forget that. Below are some examples of what is important in moving forward in our efforts to limit and prevent the damages done by TBI.

In Florida, public awareness is growing on several fronts. The Brain Injury Association of Florida recently unveiled a statewide campaign highlighting the 100,000 Floridians who sustain brain injuries each year. As part of the campaign, the association launched Florida’s first Traumatic Brain Injury Resource & Support Center, providing one-stop access to a vast network of information, services, education and advocacy through a Web-based portal (byyourside.org) and a toll-free helpline (800-992-3442).

And yet, Florida is still lagging behind other states

More can be done. Florida could expand services to TBI survivors and families, lower costs and improve patient self-sufficiency by adopting a nationally recognized privatization model. It combines Web-based and telephone assistance for mild TBI cases with more intensive family support services for serious injuries.

States like Minnesota and Indiana report impressive results, returning more than half of TBI survivors to work or school within one year of their injuries. Vocational rehabilitation referrals grew by nearly one-third, and work-force productivity of TBI survivors increased by more than $31 million a year.

Under the state of Florida’s program structure, TBI survivors aren’t being adequately served or documented. For example, in 2009, only a fifth of the 19,000 TBI hospital admissions were tracked by the state’s central registry with just more than 1,000 served. That includes 330 Medicaid cases costing taxpayers more than $30,000 per patient.

Read more about Florida. Georgia is also engaging in discussion and awareness-building. 

As the lead agency on traumatic brain injury for Georgia, the Brain and Spinal Injury Trust Fund Commission is joining the Sarah Jane Brain Foundation to host two town hall meetings as part of their 40+ state national tour to raise awareness about pediatric brain injury and to promote the sharing of ideas to help states develop comprehensive systems of care for children.

On Tuesday, April 5, 2011 from 7:30-9:30 p.m., brain injury program experts will gather at The Shepherd Center (2020 Peachtree Road NE, 7th floor Auditorium, Atlanta) for a panel discussion entitled: “Back to school after a brain injury: re-entry and long term planning issues…”

On Wednesday, April 6, 2011 from 4:00-6:00 p.m., medical specialists and other brain injury experts will gather at the Emory University School of Medicine (1648 Pierce Drive, Room 110, Atlanta) for a panel discussion entitled: “How do we prevent, identify and treat concussions in youth.”

Both events speak to the stifling number of cases reported each year and stories of concussion-related tragedies that have gripped recent news headlines.

Continue reading for more details

When you have an 18-year old kid and a 65-year old adult who both need a kidney transplant, who do you give it to? That’s the question being discussed right now by the United Network for Organ Sharing (UNOS)

Traditionally, priority is given to patients on the waiting list the longest. Under new rules, the system would match recipients and organs to a greater extent based on factors such as age and health in order to try to maximize the number of years provided by each kidney.

The ethically fraught potential changes, which would be part of the most comprehensive overhaul of the system in 25 years, are being welcomed by some bioethicists, transplant surgeons and patient representatives as a step toward improving kidney distribution. But some worry that the changes could inadvertently skew the pool of available organs by altering the pattern of people making living donations. Some also complain that the new system would unfairly penalize middle-aged and elderly patients at a time when the overall population is getting older.

This is quite a significant shift, as waiting lists have long been the preferred method of matching donated organs to people who need them. Some believe that the new method represents a form of “age discrimination” because a person in their 50s or 60s, who could gain another 20-30 years of life from a transplant, will almost certainly never see the best kidneys from adults under 35. 

Kidneys are the most sought-after organ for transplants by far. Of the 110,000 Americans on the waiting list for organs, there are over 87,000 who need kidneys. Unfortunately, only about 17,000 Americans get them each year, and almost five thousand die due to not getting one in time.

Arthur C. Caplan, a University of Pennsylvania bioethicist says that the trend is moving “away from a save-the-sickest strategy to trying to get a greater yield in terms of years of life saved.”

The approach, if adopted, will likely have extensive implications regarding the allocation of scarce resources across the board beyond organs, possibly including rare and/or expensive medical drugs and equipment needed during emergencies.

Learn more about this issue…

Joan Engle is our new Director of Community Relations. With over 15 years of sales & marketing experience, Joan will help Cascade Park continue to thrive by working towards achieving our maximum occupancy and realizing our full revenue potential.

In order to attain this, Joan will use her skills to attract qualified prospects to our programs (particularly those from professional outreach activity) and converting those prospects into residents and participants. In addition, she will be responsible for directing, planning, supervising, conducting, and coordinating both internal and external sales/outreach activities to assure that our target census goals and marketing objectives are achieved. 

Joan will work closely with the rest of the CPC community outreach team: Lincoln Strand (Vista’s administrator), Nancy Huseman (TBI Program Manager), Gloria Tucci (Resident/Family Liason), and Peter Adams (Marketing Director).

We are all very excited to have Joan on our team. Her first official day of work is Thursday, March 31st.

You can contact Joan at her new email address: jengle@cascadecares.com

A recent article in the Wall Street Journal took a hard look at the discussion and decision to move parents into some form of assisted living. In a 2006 survey of one thousand people, about 42% of adults between ages 45 and 65 reported this as the most difficult issue to discuss with their parents. 31% said their biggest communication obstacle is getting stuck in the parent-child roles of the past.

The challenge of breaking down such barriers to communication is almost as seemingly silly as it is difficult.  

Although it is true that there are seniors who do fine at home, others require residence at care facilities or a home aide. An estimated 70% of people over 65 are expected to need some long-term care services at some point in their lives. Over 40% will spend time in a nursing home. The average time seniors need help is three years, but about 20% are expected to need long-term care services for more than five years.

Paul Hogan, chairman of Omaha-based Home Instead Senior Care has emphasized the importance of starting the conversation early. This allows families to make decisions as a whole after thoroughly discussing all of the issues. Research indicates adult children who feel hurried during conversations about their parents’ changing care needs may tend to prematurely push them toward the most efficient option, such as getting more help or moving to an assisted-living facility, rather than taking the time to encourage them to work on staying independent as long as possible. 

This decision is a family matter. Caregiving is a family matter. Everyone who will play a role in looking after the care of the person in question must be on the same page. The list of items to address is lengthy, including financial management, power of attorney, logistics of moving, and sharing any responsibilities. When it comes to the care of an elderly family member or close friend, it only takes one person to say or do the wrong thing and squander the entire attempt.

The issues are complicated and usually involve a plethora of conflicting emotions. But in the end it all comes down to this: the discussion and decision must be based upon what is best for the person who needs care.

Read the full article at the Wall Street Journal

If you are thinking about assisted living for you or your loved ones, you need to start thinking about how to go about finding the place that is the best match. Below is a list of important questions straight from our Admissions Director Iris that are important to ask when approaching any assisted living facility.

1. Do you take Medicaid clients? If I move in as private pay when my money is runing out what do I do? Do I have to move?
2. What type of rooms do you have? How big are they and what do they include?
3. What services do you provide and not provide?
4. Do you have a licensed nurse on site? How many hours are they there each day?
5. Do you take clients with diabetes? 
6. Do you care for clients on hospice?
7. May I see your state survey report?
8. May I take a look of your menu & activity calendar?
9. What is longevity of your management team & staff? Conversely, what is your turnover rate? 
10. What is your caregiver-resident ratio?
11. Is your facility part of a corporation or local privately owned?
12. Does your facility allow smoking? (important if you are a smoker OR non-smoker)
13. Do you accept pets?

These are only some of the many issues that you must think about. Knowing WHEN to move someone is also a HUGE part of the process. Consider these ten questions to ask BEFORE moving a parent into assisted living. [1]

[1] Also see Levy, Elliot S. “When to put a parent in assisted living or a nursing home.” Journal of Behavioral Studies in Business. http://www.aabri.com/manuscripts/09386.pdf (accessed March 17, 2011)

Last year on this week, President Obama signed his reform bill, the Patient Protection and Affordable Care Act, into law. This year, supporters celebrate and opponents decry the changes and expected changes to our health-care system.

Health Care for America Now (HCAN), a coalition of advocacy groups, is sponsoring 75 events in 27 states this week. The program of events is a coordinated attempt to rally against the opposition and focus on spreading awareness and information regarding not only the specific legislation, but issues facing providers, clients, patients, businesses, and individuals in the health-care industry.  

The events and actions feature seniors, youth, small businesses, and faith communities across the country coming together to explain how they are benefiting from the law and to highlight what they see as at stake as their opponents work to overturn the legislation. 

Each day of the week has a particular theme:

• Monday: Protecting Small Business’s Care
• Tuesday: Protecting Seniors’ Care
• Wednesday: Protecting Patients’ Rights
• Thursday: Protecting Women’s Care
• Friday: Protecting Young Adults’ Care.

A big theme behind this movement is the unity and cohesion in moving forward together. 

Read more on this series of events at the HCAN blog.

What do you think about the ACA legislation and its effects on the American health-care industry in the last year? 

Send us your thoughts via Facebook

New research suggests that drugs for combating osteoporosis can raise the likelihood of unusual fractures in people who start taking drugs before they are officially diagnosed with the disease.

Dr. Jennifer Schneider was one of the first to have her case reported in a medical journal. She was on the subway in New York City when her thighbone suddenly snapped after she shifted her weight to her right leg because the train jolted. She knew it was broken but was baffled as to “how this possibly could have happened from standing on a train.”

Even more strange was the fact that the fracture occurred at the part of the femur that is usually the strongest. Generally, older bones tend to break at the ball-shaped head of the femur.

A deeper look revealed a disturbing trend of unusual fractures occurring among long-term users of bisphosphonate drugs such as Fosamax, Actonel, Boniva and Reclast. Unfortunately, much of the evidence is mixed, with conflicting studies reaching a range of conclusions. However, a new study from Canada, which is the largest one on this topic, has found that women who’ve been on bisphosphonates for more than five years have nearly three times the risk of suffering from unusual fractures when compared to those with little consistent exposure to the drugs. [1]

The problem is that these same drugs are effective in preventing the much more common hip fractures caused by osteoporosis. The trick is knowing WHEN to prescribe the medication.

Like many women — and their doctors — Schneider thought she’d be better off if she started on an osteoporosis drug before she developed the actual disease. So she began taking Fosamax on the basis of a bone density scan that showed some thinning.

Now she thinks that was a mistake.

Like antibiotics, we have to be careful not to just throw these drugs out at anyone who may have some thinning in the bones. That is to be expected in old age. Needlessly putting someone on osteoporosis medication before they actually develop the disease seems to facilitate exactly what we’re trying to prevent. 

One expert sums up the lesson: “Don’t start one of these drugs too early; wait until you actually have osteoporosis. And once you start, don’t stay on one of these drugs longer than necessary.”

Continue reading to learn more

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[1] Park-Wyllie, Laura Y., Muhammad M. Mamdani, David N. Juurlink, Gillian A. Hawker, Nadia Gunraj, Peter C. Austin, Daniel B. Whelan, Peter J. Weiler, and Andreas Laupacis. “Bisphosphonate Use and the Risk of Subtrochanteric or Femoral Shaft Fractures in Older Women.” Journal of the American Medical Association 305, no. 8 (2011): 783-789.