I had been working with "Barbara," a sibling of a 55-year-old woman. Her sister, “Lucy”, had mild dementia, liver failure, kidney failure, and a history of alcohol and drug abuse. Barbara needed my help to get Lucy better health care, as she was not taking care of herself from a medical standpoint. Two weeks ago, I received a phone call from Barbara. Lucy was in the hospital, having been taken there after a friend called because she was emotionally and physically deteriorating. She was in full-blown liver failure, among other problems, and the hospital recommended hospice. However, Lucy declined. I was the liaison between Barbara and the hospital staff; A patient advocate (particularly one with a strong medical background) is indispensable at such a time.

 To make matters more difficult, we could not get into the hospital's medical records (we were pushed back at every junction) to see what was happening. The problem was that she was dying, had nowhere to go, and nobody to take care of her. Unfortunately, at that point, she didn't meet the qualifications for inpatient hospice.

 Over the course of a few days (and many telephone calls), I was able to speak with the hospice team and an incredible hospitalist. It turns out that, as with many hospital systems, they were still trying to keep the patient alive, giving her medication for her liver failure (Lactulose, which causes diarrhea to lower the ammonia level in a patient with liver failure and caused her to have bowel movements in bed) as well as medications to keep her blood pressure normalized as it began to drop. She was dying, and nobody was helping or listening.

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We have been remiss.  Remember back to the nightmare of 2020, into 2021.  Schools were shuttered, people worked from home, we couldn’t visit people in hospitals, see our grandchildren, and our loved ones were in isolation in nursing homes, dying from illness and loneliness.  Over one million Americans died, and that number is probably low.  Many more were affected and have long-term effects: COVID brain fog, insomnia, heart issues, to name a few.  And finally, we had a vaccine, and it helped.  Tremendously, life came back. We were left with children who had never been in school with others, and there were other issues we didn’t even think about.

 We hear COVID, and many of us think, “just a bad cold,” or “I don’t want to know because then I may have to isolate and miss ____” and “it’s no big deal.” And then we hear that the vaccinations are worse than the disease, and recently we learned that 25 children died from the vaccination.  That is 25 children too many, but how many died of COVID, and how many were saved because of the vaccination?

We are right in the middle of prime vaccine time, and it is easy to get a vaccination, unlike when they first came out.   However, the CDC has made it difficult to see who needs one.  They are recommended for those 65 and over, or for those with chronic illnesses, i.e. heart disease, who are immunocompromised, asthmatics, and those who live with people so afflicted. Yet so many people aren’t going to take one, and in my opinion, this may be a big mistake.

 I recently returned from a bus trip to Niagara Falls with a group

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Since moving to another state, I have become acutely aware of the current problems in our health care system. Moving 200 miles away from doctors, hospitals, and labs, we knew and trusted, has made me realize that I had to be responsible for informing each of our new providers of our health history, and that I had to track it all down (what I didn’t already have), and make it as easy as possible for the new provider to get up to date on our current and past medical issues.

That is not an easy task! Think about it, especially for senior citizens. It is vital to have one’s medical history, including past illnesses or medical events, and the results of routine tests.

For example, when was your last mammogram? Did you require special imaging? When will your insurance pay for the next one? I traveled four hours to Baltimore, my old “home,” and decided to get my annual mammogram while there, only to find out that I was 2 days early, so it wasn’t covered by insurance. I took all of my records (including the CDs so the new center could see the images, not just the report) and found a new facility to do it.

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I have relocated and am involved with a health and safety group preparing for possible power

outages prior to hurricane season and realize that “go bags” are vital for any emergency

situation. Don’t get caught without the necessities. I recently had a client who was admitted to

the hospital, and didn’t have anything with her, including a cell phone charger.

This is easily prevented, especially if you are going to see your health care provider for a “sick

visit” or going to an urgent care. We all should have our “go bag” ready. It doesn’t have to be

big, but it should include a few essentials:

1. cell phone charger

2. tablet or computer with charger

3. list (or picture of the bottles) of all your medications, Dr. who prescribes, when they were

last filled

4. a copy of emergency contacts

5. copy of Advance Directives

6. paper and pen

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The healthcare field is changing rapidly, and it is not for the better if you are the patient. We see many excellent physicians leaving the field because of the bureaucracy and pressure, forcing us to find new providers. Doctors no longer work for themselves; they work for health insurance companies and are told how many patients they need to see per hour/ day, etc., and it is not enough time, especially as they often have to deal with medication denials, finding alternative treatments, and spending time on the phone on "peer to peer" reviews. These are when your health provider (often after the second or third denial) has to schedule a time with a representative from your insurance company who explains why they are refusing to cover testing or medications.

I don't know a single person who has not had to deal with denials, delays, underpayments, etc. My husband had prostate cancer, and although the abnormality was seen on an MRI, our insurance at that time did not allow for an MRI-guided biopsy (now the standard of care) and would only approve a "blind biopsy," where the doctor took a sample of the 12 most common sites where cancers are. I fought it, and it was approved. The doctor

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As a senior (still hard to say this), I am very cognizant of the risk of falling, how easy it actually is, and how much damage can be done. I admit I have sometimes tripped on the stairs, even over my two feet. So far, all I have to show for my falls is three (badly) sprained ankles.  But I have no illusion that won’t change. As we age, our bones get more brittle, plus we don’t react as fast to stop a fall. One fall can change the quality of your life and all your plans and your retirement years.

 So, what do we do?  We recently moved to a condominium with all hardwood floors, so we purchased quite a few carpets, which I know can be dangerous.  I bought pads that prevent them from moving, but I also went the extra mile and taped the edges down.  I am also diligent when I walk down stairs and look down.  Many years ago, I had a severe ankle sprain when I missed a step, and I don’t want to do that again. When you carry a clothes basket or something else, missing a step is easy. Going down stairs is more dangerous when you wear bifocals, as looking down, you see “close,” making it more difficult. 

 A few tips. Look ahead, and don’t do anything else when walking, such as texting on your phone. Such   distractions pose a significant risk of falling.  Always use the handrails (i.e., in the subways and escalators).  Yes, they may be full of germs, so use a tissue, have a pocket-sized hand sanitizer, or wash your hands when finished.  Don’t carry too many things at once, affecting your balance. If you carry a

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To so many of us, hospice is an obscene word: sending someone off to die. It's giving up. And it is so far from that.

  I was fortunate to spend the last decade of my career as a Physician Assistant working in an oncology practice with a sensitive, caring oncologist who bent the rules and gave patients the time they needed, not what the insurance company dictated. We were honest about what they were going through, and as soon as a patient was given a diagnosis of stage 4/incurable cancer, we discussed palliative care and hospice so there would be no surprises. 

 I just said “goodbye” to one of these patients. Donna was diagnosed with breast cancer many years ago, and it became metastatic 11 years ago! She has lived with metastatic cancer for 11 years and, for the past few having the benefit of palliative care, being taken care of, and still being treated.  She is still alive, talking with her family and friends, and beginning to say good-bye.  But nobody knows when she will actually pass, but it will be with dignity, and no pain.

 Palliative care is not hospice. It provides comfort and supportive care to people with

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The healthcare field is changing rapidly, and it is not for the better if you are the patient. We see many excellent physicians leaving the field because of the bureaucracy and pressure, forcing us to find new providers. Doctors no longer work for themselves; they work for health insurance companies and are told how many patients they need to see per hour/ day, etc., and it is not enough time, especially as they often have to deal with medication denials, finding alternative treatments, and spending time on the phone on "peer to peer" reviews. These are when your health provider (often after the second or third denial) has to schedule a time with a representative from your insurance company who explains why they are refusing to cover testing or medications.

I don't know a single person who has not had to deal with denials, delays, underpayments, etc. My husband had prostate cancer, and although the abnormality was seen on an MRI, our insurance at that time did not allow for an MRI-guided biopsy (now the standard of care) and would only approve a "blind biopsy," where the doctor took a sample of the 12 most common sites where cancers are. I fought it, and it was approved. The doctor told us that if a blind biopsy had been done, the cancer would not have been found. However, it took a long time for the doctor's office to get paid, leaving a red "balance due" in his chart. When my husband called to make a follow-up appointment after telling the office staff that he was diagnosed with cancer, they refused to make it since he "owed money." That is where an advocate can come in. Some patients would hang up, embarrassed, and not have a follow-up. I called and got it resolved. He was able to see the doctor and continue his follow up care. But how many people have the tenacity and stubbornness to do this? A good Patient Advocate will do it and more.

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Now that we have moved out of state and to a 55 and over community, I have a new perspective and believe it is so important, especially when getting older or facing a change in your life, to think about what a move would entail and should you make the decision to do so. We decided to live closer to our adult children and family. The drive to see our grandchildren was long, and making plans was complex for everyone, especially as they became busier.  Now it is much more doable.

 Moving is challenging both physically and emotionally. Here are a few questions to ask yourself:

 1-Is it time to move?

2-Is the neighborhood changing? Are the people moving in young or people with small children?

3-Do you still have friends in your neighborhood?

4-Where do your children and grandchildren live? (I don't advocate "chasing" the children, but if you have grandchildren, it's nice to drive to see them instead of having to fly all the time.)

5-Can you navigate the stairs safely? Do you think you will be able to do so in 3,5 or 10 years?

6-Can you perform the usual tasks for the upkeep of your home, or has it become too much?

7-How much of your home do you use or need? Many of us live in family-size homes and "live" in 3 rooms daily.

8-When you do find a new home, will there be enough storage? We rotated clothes depending on the season. Can your closet accommodate (if needed) 4 seasons of clothes? Will you need to buy all new furniture?

9-If something medically happened to you, and you couldn't return home, how would that impact your children?

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My husband and I moved to Baltimore, his hometown, 36 1/2 years ago.  I cried every day for months. I had no friends, two small children, and he was traveling for work. 

 Fast forward 36 years, one son moved from Virginia to Philly, and the other, with my grandchildren, lives in Long Island.  The question posed by my son seemed innocuous enough, "what are you still doing here?  You are 71, and you have no family left in Baltimore.“ 

 And the reality was that we were living with our heads in the sand.  We had a great house and wonderful friends, but our family was far away. How long before we had to make a change?  Living here was manageable, and the thought of moving was daunting and terrifying.  All new doctors ---that is the scariest part.   

 So, we started looking at places between both sons and found some 55 and over communities in central Jersey.  We found a condo that checked the boxes (2 bedrooms with an office) facing the woods.  (We love our birds and wildlife!) Our house sold in 5 minutes (literally), and not four months after we made our decision, we moved out of state, away from friends and our comfort zone. 

 My advice: don't wait.

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