Now, I wouldn’t consider myself outdoorsy by any stretch of the imagination. Sure, I enjoy biking, swimming and snorkeling. I’ve even dabbled in surfing a few times. But I’m not the kind of girl that would suggest a 20-mile hike or rock climbing (unless it’s inside of a gym). I’ve never really desired to become “one with nature.” But as life gets more hectic and technology gets more complicated, I have found myself longing for a simpler time. And I’m not the only one.

In 2009, Rue Mapp founded Outdoor Afro, “a community that reconnects African-Americans with natural spaces and one another through recreational activities, such as camping, hiking, fishing, gardening, skiing–and more!”

“As a culture, we are bombarded with messages of how dangerous nature is, especially in the Black community,” Rue says. “Outdoor Afro helps us understand our positive and sustainable past in nature, yet imagine ways we can build on our legacy to try new activities in the outdoors today.”

And here’s another good reason to get outdoors: it’s good for you and your health! “We have all heard data that reveals that alarming levels of obesity among African-American women and girls, and regular outdoor engagement is one way we can reverse these trends,” says Rue.

Instead of always going to the gym or signing our kids up for organized sports, try taking regular family walks or bike rides. You could also trade in the standard family movie outing for a weekend of camping or fishing.

One of my favorite childhood memories is the weekend my family and I went camping. There was just something refreshing about sleeping underneath the stars (well, inside a tent) and cooking our dinner on an open fire. It’s all about getting back to basics.

Fall is the perfect time to get reacquainted with nature. Sure, you can see the leaves changing colors while you’re in your car. But you can fully appreciate their beauty during a hike or a bike ride. “It is a fact that people who spend time in nature are happier, healthier, and are inspired to care about their local environment because of a personal connection,” says Rue.

If you’re interested in reconnecting with the great outdoors, Rue suggests asking your nature loving friends and co-workers for support and to remember the old adage “there’s safety in numbers.”

“Also, remember to take it slow, and you can enjoy nature close to home,” Rue says. “You will find a lot of local parks and botanical gardens have easy walking paths, or simply get out in your neighborhood, get to know your neighbors–both human and non-human! More importantly, remember that the outdoors is everywhere, and you can engage with it in it in whatever ways fit your lifestyle, interests and comfort level!”

For more information, please visit OutdoorAfro.com and @outdoorafro on Twitter.

L’Oreal Thompson is the assistant editor for Chesapeake Home + Living magazine, a staff writer for Harford and Howard magazines and a TV blogger for bthesite.com. She is addicted to cupcakes, shoes and all things purple. Follow her on Twitter @LOrealKT.

Reconnecting with the Great Outdoors is a post from: Heart & Soul

Courtesy of Alzheimer’s Association

Memory loss that disrupts daily life
One of the most common signs of Alzheimer’s is memory loss, especially forgetting recently learned information. Others include forgetting important dates or events; asking for the same information over and over; relying on memory aides (e.g., reminder notes or electronic devices) or family members for things they used to handle on their own.
What’s a typical age-related change? Sometimes forgetting names or appointments, but remembering them later.

Challenges in planning or solving problems
Some people may experience changes in their ability to develop and follow a plan or work with numbers. They may have trouble following a familiar recipe or keeping track of monthly bills. They may have difficulty concentrating and take much longer to do things than they did before.
What’s a typical age-related change? Making occasional errors when balancing a checkbook.

Difficulty completing familiar tasks at home, at work or at leisure
People with Alzheimer’s often find it hard to complete daily tasks. Sometimes, people may have trouble driving to a familiar location, managing a budget at work or remembering the rules of a favorite game.
What’s a typical age-related change? Occasionally needing help to use the settings on a microwave or to record a television show.

Confusion with time or place
People with Alzheimer’s can lose track of dates, seasons and the passage of time. They may have trouble understanding something if it is not happening immediately. Sometimes they may forget where they are or how they got there.
What’s a typical age-related change? Getting confused about the day of the week but figuring it out later.

Trouble understanding visual images and spatial relationships
For some people, having vision problems is a sign of Alzheimer’s. They may have difficulty reading, judging distance and determining color or contrast. In terms of perception, they may pass a mirror and think someone else is in the room. They may not realize they are the person in the mirror.
What’s a typical age-related change? Vision changes related to cataracts.

New problems with words in speaking or writing
People with Alzheimer’s may have trouble following or joining a conversation. They may stop in the middle of a conversation and have no idea how to continue or they may repeat themselves. They may struggle with vocabulary, have problems finding the right word or call things by the wrong name (e.g., calling a “watch” a “hand-clock”).
What’s a typical age-related change? Sometimes having trouble finding the right word.

Misplacing things and losing the ability to retrace steps
A person with Alzheimer’s disease may put things in unusual places. They may lose things and be unable to go back over their steps to find them again. Sometimes, they may accuse others of stealing. This may occur more frequently over time.
What’s a typical age-related change? Misplacing things from time to time, such as a pair of glasses or the remote control.

Decreased or poor judgment
People with Alzheimer’s may experience changes in judgment or decision-making. For example, they may use poor judgment when dealing with money, giving large amounts to telemarketers. They may pay less attention to grooming or keeping themselves clean.
What’s a typical age-related change? Making a bad decision once in a while.

Withdrawal from work or social activities
A person with Alzheimer’s may start to remove themselves from hobbies, social activities, work projects or sports. They may have trouble keeping up with a favorite sports team or remembering how to complete a favorite hobby. They may also avoid being social because of the changes they have experienced.
What’s a typical age-related change? Sometimes feeling weary of work, family and social obligations.

Changes in mood and personality
The mood and personalities of people with Alzheimer’s can change. They can become confused, suspicious, depressed, fearful or anxious. They may be easily upset at home, at work, with friends or in places where they are out of their comfort zone.
What’s a typical age-related change? Developing very specific ways of doing things and becoming irritable when a routine is disrupted.

10 warning signs of Alzheimer’s is a post from: Heart & Soul

Trying to help the man in your life be healthier and live longer is like trying to wrangle a herd of house cats with a feather. For nearly 30 years, I’ve picked doctors, made appointments, kept medical record folders and asked questions. There was no big “Tah da! Today I am taking over.” We have an unspoken agreement that I take care of him now so he doesn’t get all broken down later.

It sounds easy, but if you’ve ever tried to take a triple-decker cheeseburger out of your man’s hand because you don’t want him to clog his arteries, you know how hard it is. What starts as an act of love becomes an argument about his car, your sister or the remote control. One minute he’s giving you a piece of his mind because you are all in his business. Then, in the blink of an eye, he’s showing you fungus-ridden toes or impacted wisdom teeth. From boils to bunions, these are the things we must be prepared to see, all in the name of love.

It doesn’t always go smoothly. You can try to sneak more fruits and vegetables into meals, if you don’t say, “We are eating more fruits and vegetables.” You can see him limping, or favoring one side when he walks, and he will look you in your eyes and say, “I’m just working on my swagger.” What?

You can send him articles about the perils of smoking and still catch him hiding behind the bushes in 10-degree weather, sending out smoke signals. Ask him if he wants to go to the gym with you, and he might say yes, or he might say, “Hell no!” Tell him that by knowing and controlling his numbers—blood pressure, cholesterol, diabetes—he’ll add years to his life. He’ll probably give you the okey doke. It’s easier just to tell him that it will improve his sex life. Play to your strengths.

Recently I overheard a conversation between my husband and one of his friends. He told the guy he was actually glad I try to take care of him. “She’s good at it, but you have to watch her like a hawk,” he said. “She takes you to the doctor, lays you down on the table and lets them cut you.” He’s still traumatized by last year’s skin biopsy for a suspicious mole. “That’s why I wear long pants and long sleeves and ski masks, even in my sleep. It’s only a matter of time until I’ll be like Toby from ‘Roots’ with my foot cut off so I can’t run from her anymore.”

And then he told the guy he saw a study (actually, I saw and told him about it) that says men who have women in their lives live longer than men who don’t. I think he’s finally getting it.

—Andrea King Collier

Nudging Your Guy Toward Healthy is a post from: Heart & Soul

Nick Ashford, 70, of the soulful powerhouse couple Ashford & Simpson, passed away Monday, after a battle with throat cancer.

The singer and songwriter penned some of our favorite slow jams with wife Valerie Simpson including “I’m Every Woman,” “Reach Out And Touch Somebody’s Hand” “Ain’t No Mountain High Enough,” “You’re All I Need To Get By” and their anthem, “Solid.”

He had undergone radiation for his illness, according to the Associated Press. Throat cancers occur mostly to those over 50 and men are 10 times more likely to develop cancers of the throat than women.

Ashford met his future wife and creative partner Simpson in 1964 at church, and soon began writing songs together. Along with classic R&B hits, they continued to take their talents to the spiritual world, creating the original theme song, “Be Blessed” for the 200th anniversary of Harlem’s Abyssinian Baptist Church in 2007. The duo also opened the acclaimed Sugar Bar in New York City, that features food and music to warm the soul.

After four-years of marriage and music,  Ashford & Simpson were inducted into the Songwriters Hall of Fame in 2002. The couple has two daughters.

Watch Asford & Simpson perform “Solid”:

Share your condolences and memories below!

Music Mastermind Nick Ashford Dies of Throat Cancer is a post from: Heart & Soul

A new study finds that HIV-infected women in Africa are more proned to spreading the AIDS virus when using hormone-based birth control, compared to women who don’t take the pill, according to the Associated Press.

One of the researchers, Renee Heffron of the University of Washington said that this is the first study to look at this question. Researchers agreed that it should not cause women to immediately alter their birth control practices.

The 2004-2010 study tested nearly 2,500 women in seven different African countries with HIV whose male partners were not infected. After making sure there was no major difference in condom use, sexual behavior, or any other factors that can significantly influence the results, researchers found that uninfected men had a 2.61 percent chance of contracting the virus if their partner used hormone-based birth control, as opposed to a 1.51 percent chance for those men whose partner does not use the pill.

Although it is unclear how the hormones may spread the virus, theoretical risks from earlier studies found an increase of HIV-infected cells in the cervical tissue of women who use hormonal contraception.

Would an increased risk for HIV impact your decision to use birth control?

Risk for HIV Rises for African Women on Birth Control is a post from: Heart & Soul

Beauty sleep is also better belly sleep. Research suggests that even with a good diet and regular exercise, a lack of sleep can throw a monkey wrench in your weight-loss progress. Sleepy heads eat more, expend less energy and store more fat. So if you’re running on minimum sleep, try adding a half-hour every week. If you need pharmaceutical or naturopathic help, use them on a short-term basis to help you ease into more Zs.

For more tight tummy tips, check out the June/July issue of Heart & Soul.

Better Belly Through Sleep is a post from: Heart & Soul

By Yanick Rice Lamb

Samantha Hawkins marked the seasons of 2010 from a hospital bed at Montefiore Medical Center in the Bronx. She was admitted in the spring for 83 days, came out for two weeks in early summer, and returned for five and a half months spanning fall and winter. Finally, Hawkins went home for the holidays on Dec. 21. For her family, the homecoming was a Christmas miracle.

At times, her relatives thought she might not make it, said her mother, Lula Hawkins. They held her hands, praying and shoring up each other through one complication after another from kidney disease, congestive heart failure, diabetes and a mysterious inflammatory ailment finally diagnosed as sarcoidosis. “That’s when things started going downhill,” said her older sister, Gwen Cooper.

Hawkins has endured a 10-day coma, three mini-strokes, three bouts of pneumonia, plus surgery in August to implant a heart pump. Despite her list of ailments, part of what kept the 45-year-old stuck in the hospital was her lack of insurance.

Once upon a time, Hawkins had medical coverage as a housekeeper at a hospital in Westchester County, New York. After she left that job three years ago, she took out a policy on her own, but then the insurance company dropped her. When Hawkins ended up at Montefiore, weeks turned into months as she lay in a hospital bed with no way to cover her stay there or her next level of care. In the meantime, the hospital absorbed her bill while trying to help her find a way to pay for nursing care at her mother’s apartment or for long-term care at a facility willing to monitor Hawkins’ heart device.

Hawkins is one of a growing number of uninsured people who need long-term care after hospital stays. They lack insurance because they can’t afford it, their employers don’t offer it or they were dropped by private carriers after taking out policies on their own. Consequently, these patients experience delays in moving on to the next step in their care once they are medically ready for discharge. They are stuck in the hospital, because it’s hard to place patients in long-term care facilities or send them home with a nurse when they have no coverage, especially when there are complications. Hospitals end up picking up the tab — sometimes even after patients leave. Those costs are ultimately passed on to everyone who pays taxes and anyone who has a medical bill.

“The person is caught in the middle, because some facilities don’t want to take them,” said Carol Levine, director of the Families and Health Care Project at the United Hospital Fund in New York.

Hard-to-place patients make up a small, yet costly and time-consuming, portion of the U.S. hospital population. Uninsured hospital patients between the ages of 18 and 64 in need of long-term care increased 16 percent over the last five years, according to the Agency for Healthcare Research and Quality (AHRQ) in the U.S. Dept. of Health and Human Services (HHS). The number discharged to long-term facilities or supervised home-health care rose from 104,581 in 2005 to 121,173 in 2009.

Representatives from roughly a dozen hospitals from California to Massachusetts shared similar stories of trying to juggle not only the medical and financial needs of hard-to-place patients, but also family, housing and other issues.

In Chicago, Northwestern Memorial Hospital decided to rent a room for $500 a month so that a terminally ill patient with heart disease and no insurance could have a place to stay and receive hospice care. That was on top of the thousands of dollars for his hospital bill. The man, who was in his 40s and didn’t want to go to a nursing home, died two months later.

In Washington, D.C., an uninsured patient who experienced respiratory failure and complex surgery for an abdominal wound spent 104 days at Howard University Hospital. The hospital bore the cost of $1.3 million until it was able to transfer the patient to a nursing home.

“Everyone is experiencing the same sorts of issues,” says Stephanie Rennke, a physician who works specifically with the complex cases housed at the 26-bed Mount Zion Hospital down the road from the main facility of the University of California Medical Center in San Francisco (UCSF).

“This is a growing national problem,” said Barbara Ozmar, director of patient care coordination at Piedmont Hospital in Atlanta. “It’s huge, and it’s going to get bigger across the United States.”

THE IMPACT ON PATIENTS

Being uninsured can affect patients physically, emotionally, socially and, of course, financially. The lack of insurance is stressful and places patients at greater risk of medical bankruptcy — that’s if they can pay anything at all toward their hospital bills.

The uninsured can afford to pay only 12 percent of their hospital bills in full, according to “The Value of Health Insurance,” a study released in May 2011 by the HHS Office of Health Policy. Patients without insurance had only $20 in financial assets on average, compared to $14,450 for the insured, the study said.

The 2007 Commonwealth Fund Biennial Health Insurance Survey also found that nearly half of working-age adults with no insurance had exhausted their savings and couldn’t cover basic necessities such as food, heat or rent.

But it’s more than finances.

Staying in the hospital longer than medically necessary can take a toll on patients. “The impact on the patient is much more than we can imagine,” Dr. Rennke of UCSF said.

“Being in the hospital can be an incredibly lonely experience for patients,” Dr. Rennke said. “They’re isolated from their families. They’re isolated from their communities. They feel a loss of independence.” Sleep deprivation is also an issue for some patients, she added.

Samantha Hawkins said that being away from her children, grandchildren, mother and siblings was the toughest part of being in the hospital despite regular visits. She also missed home cooking once she was able to eat solid food. “The hospital food was terrible,” Hawkins said. “I know it’s healthy, but it tasted like poison!” Each day, her mother brought her favorite meal:  liver with onions, grits and green beans with potatoes.

As their stay goes on and on, hard-to-place patients might see fewer hospital workers rushing into their rooms. The sense of urgency subsides once they are considered stable and medically ready for discharge.

“If they were in a skilled nursing facility, they would be at the top of the list in terms of need,” acknowledges Anne Meara, R.N., associate vice president of network care management at Montefiore. “In our facility, if you’re here because you’re a discharge challenge, you’re a little bit lower on the list, because the staff is used to taking care of those with acute needs.”

However, the most serious consequence of delayed discharges is that patients face greater exposure to hospital-acquired infections like septicemia, a life-threatening, bacterial blood disease. Extended hospital stays also delay the time that patients can receive medical treatment or rehabilitation in a setting that might be better suited to their needs.

“A rehab facility can provide two to three hours a day of rehab,” explains Mark V. Williams, M.D., chief of the Division of Hospital Medicine at Northwestern University in Illinois. “A hospital is typically only going to have rehab capabilities for 30 minutes or so.”

“It’s a cost issue,” he adds. “Hospitals are not set up to conduct long-term rehab. They can’t provide that intensity of services for patients.” Dr. Williams noted that hospitals are typically paid one fee for a patient’s diagnosis over a period of time, not necessarily for the extra days and extra resources. “And so these patients end up costing significant amounts of money.”

THE COST OF STAYING

Hospital bills for uninsured patients who need long-term care total at least $2.9 billion annually. Over the last decade, the average hospital bill for uninsured patients more than doubled. AHRQ figures show a 112 percent increase from $11,400 in 1998 to $24,140 in 2009 (compared to $28,204 for those who have insurance).

However, a stay for an uninsured patient with circulatory problems is 42 percent higher than the current rate, averaging $34,317. It’s nearly four times as much for “multiple significant trauma” at $93,365 — hence the $1.3 million tab for the uninsured trauma patient at Howard University Hospital.

That’s why simply waiting it out in a bed that’s costing a hospital thousands of dollars a day isn’t necessarily the solution.

Although many people complain about being released from the hospital sooner than they would like, the new normal is staying in the hospital for as few days as possible with as few procedures as necessary.

“Hospitals are no longer a place where you stay until you get better and then go home,” said Barbara Ozmar of Piedmont Hospital in Atlanta. “The general public at large doesn’t fully appreciate that we get you well enough to transition your care.”

“Well enough” means stable and out of crisis. It can also mean that a patient will still be in pain at discharge and require medical devices, such as a ventilator, for the transition to long-term care at home or another facility. “We are able to keep very sick people alive nowadays in a variety of settings,” Meara points out.

Over the last two decades, U.S. hospitals have reduced the average length of stay from 7.2 days in 1989 to 5.4 days in 2009, according to the American Hospital Association. However, hospital stays for hard-to-place patients are much longer around the country. They are typically 10 times longer at Montefiore, for example. “Your average length of stay is going to be like 52 or 53 days if you hit the 30-day point,” Meara explains.

It’s similar for hard-to-place patients at the UCLA Ronald Reagan Medical Center in Los Angeles. “Their length of stay varies from seven days to 46 days depending on their complexity from the medical standpoint,” said Mary Noli-Pilkington, manager of care coordination.

WHAT’S CAUSING DISCHARGE DELAYS?

Fifty million children and adults are uninsured in the United States, an increase of 5 million from 2007 to 2009, the height of the recession. Their ranks have swelled over the years, largely because of the drop in coverage by employers and a rise in the unemployment rate, which now stands at 9.1 percent overall and 16.2 percent for African Americans,the Bureau of Labor Statistics reports.

Uninsured people tend to be in worse health and are less likely to receive preventive or ongoing care, especially for chronic conditions. Some are in such bad shape and have so many extenuating circumstances, such as inadequate housing or family support, that many health professionals around the country have dubbed them “train wrecks.”

“Typical patients are the ones who come in here with emphysema, diabetes out of control, heart failure and a whole host of other issues,” says Jim Pile, M.D., the hospitalist at MetroHealth Medical Center in Cleveland. “Many of our patients are on 10 to 15 medications.”

In some regions, the uninsured overburden public and nonprofit hospitals that have a mission or mandate to admit them. For those who live in the nation’s capital or deep into neighboring Virginia and Maryland, all roads lead to Howard University Hospital, says Vivien A. Fonjong, director of Utilization Review, Case Management and Social Work. “If you don’t have insurance, this is where you come.”

The same is true at other hospitals that attract patients near and far, such as Denver Health Medical Center, which covers much of Colorado; UCSF, which serves a number of counties in Northern California; and MetroHealth, which draws patients throughout Northeast Ohio

The National Association of Public Hospitals and Health Systems (NAPH) reports that the number of uninsured patients at member hospitals rose by 23 percent from the beginning of the recession in 2007 through 2009. During this same period, NAPH hospitals saw a 10 percent increase in uncompensated care, which is the total these institutions absorb in charity care and “bad debt” for costs that are unpaid by patients or insurers. It doesn’t include Medicare or Medicaid shortfalls.

Uncompensated care drives down profit margins for public hospitals, which averaged 2.5 percent in 2009 compared to 5 percent for hospitals overall.  The overflow of poor patients at safety-net hospitals also increased after neighboring hospitals shut their doors or closed costly trauma centers in Detroit, Los Angeles, New Orleans, New York, Washington and other cities. The tragedy is that sick and injured residents sometimes die if their trip to a hospital is even a just a mile or two longer than it was previously, said Sherry Aronson, vice president of Inpatient Operations at MetroHealth in Cuyahoga County, where the Cleveland Clinic plans to close Huron Hospital in October.

THE DISCHARGE DILEMMA

Hard-to-place patients occupy beds that could be turned over more rapidly amid regulatory and business pressures to control costs, reduce lengths of stay and avoid readmissions. Matthew J. Schreiber, M.D., chief medical officer at Piedmont, estimates that hard-to-place patients have added at least a day to his hospital’s overall length of stay.

“They require a huge amount of time and human resources to deal with them,” Dr. Williams of Northwestern Medical says, especially when there’s a pileup of complications. “It’s frustrating for staff, frustrating for patients and their families.”

Meara says that a floor at Montefiore typically has 14 discharges daily. “If a social worker has one of these patients on their floor, this could take up their entire day.”

And when ambulances drop off patients who are unconscious, social workers must double as detectives trying to ascertain not only their identities, but also the whereabouts of their families, says Janice Buildt, a social worker at MetroHealth. Buildt said she often has to be creative since she works with a lot of trauma patients who are sedated with breathing and feeding tubes. But Buildt loves “the drama in the trauma” and welcomes a challenge. “I get to do a lot of ‘CSI’ work,” she says, referring to the crime scene investigation series on television.

Social workers search wallets for identification cards, credit cards, business cards and scraps of papers with phone numbers scrawled on them. They surf the Internet. They check missing persons reports. Buildt gets excited when she finds a yellow and blue Blockbuster video card. She used one to find a patient’s sister, who had renting privileges on her brother’s card. The economy can make hot leads grow cold when a phone has been disconnected or when a house goes into foreclosure and neighbors can provide no clues.

If a patient remains incapacitated and no relatives can be found, hospitals may seek or arrange guardianship. “Once you are in the land of true guardianship, then you are into months because that process takes forever,” said Jeffrey L. Greenwald, M.D., a hospitalist at Massachusetts General Hospital in Boston.

MELTING POT TURNS UP THE HEAT

While their numbers are far lower than their political detractors would suggest, undocumented immigrants who need post-acute care are particularly time consuming, with few if any options for payment, hospital representatives say. Many are not only uninsured, but also ineligible for government assistance reserved for U.S. citizens.

“That to me right now is probably my biggest challenge,” says Alex Alvarez, R.N., director of the care management resource unit at Montefiore. “I’ve got three or four patients right now who are in that situation. … We’re scrambling as an institution to try and figure out how to move them without setting a precedent.” One of those patients has been at the hospital more than 300 days.

In such cases, hospitals reach out for assistance from families, elected officials, churches, civic groups and embassies. They often pay to transport immigrants back to their countries — if the patients agree — and sometimes cover medical bills in their homelands. This often costs less than absorbing the expense of continuous care in the United States.

In Washington, for example, an elderly woman spent nearly four months, 116 days to be exact, in a bed at Howard University Hospital for multiple health issues. She had no insurance and no place to go. Each day, the hospital bore the cost of her treatment at $2,000 a day.

As a last resort, the hospital went to court to win legal guardianship and eventually placed her in a suburban nursing home. Another uninsured patient stayed in the hospital from March 2008 to October 2010 to the tune of $3.1 million.

In Cleveland, an undocumented immigrant with no insurance had been at MetroHealth for more than a month after a motorcycle accident. The patient had severe brain trauma and extensive limb injuries. Hospital officials didn’t know when he might be leaving. And for each day, they covered a cost of at least $3,150.

Even with U.S. citizenship, language barriers can contribute to discharge delays. When caregivers spoke little English, the length of stay increased by two days to 6.1 days, compared to four days for the control group, according to a study published recently in the Archives of Pediatrics & Adolescent Medicine. In addition, researchers found a correlation in extended length of stay based on lack of insurance, which also resulted in fewer referrals for home-health care.

“Increasing the number and quality of trained medical interpreters and translators, improving the infrastructure for a multilingual approach to care, and further minimizing multi-tiered care based on language are important areas for advocacy,” the researchers said in a statement.

WHAT HOSPITALS ARE DOING

Many hospitals are taking steps to address discharge issues overall, with some assembling senior-level strategic teams to expedite decisions on the most complicated cases. The Difficult Discharge Response Team at Northwestern Memorial in Chicago came up with the idea to pay rent for the terminally ill man so that he’d have a place to receive Dobutamine infusions for heart failure, said Jessica Soos Palowski, senior social worker and case manager.

At Montefiore in the Bronx, patients move onto the radar of the Complex Advisory Team once they’re in the hospital for at least 20 days. “That’s when we start really pulling our hairs out,” Alvarez said. “Each case has its own individual flavor and idiosyncracies.”

The team, which has been meeting every other week for about four years, has helped to cut the number of cases in half, to no more than 20 at any given time.

The UCLA Ronald Reagan Medical Center closely tracked 19 patients in their medicine unit from March 21 to May 2. Only four remained in the hospital after this period, Noli-Pilkington said.

Denver Health has a Complex Discharge Committee that meets every Friday to discuss patients who have been medically ready for discharge for at least 10 days. The committee’s work along with the hospital’s waste-cutting initiative, LEAN, have helped to cut average hospital stays from six to four days, said Philip Mehler, M.D., chief medical officer. But two patients have been there for about a year.

During any given week, the hospital has about 20 complex discharges at a combined cost of roughly $3 million. Sometimes a solution can arise from the expertise of the administrators on the committee. A patient suffering from head trauma and respiratory problems had been in the hospital for 100 days, but couldn’t be transferred to a skilled nursing facility because he needed to be suctioned three times a day.

At Dr. Mehler’s request, a physician was able to get the patient down to once a day, an acceptable limit for placement. In one case, the committee recommended that the hospital install a video conferencing system so that patients could “attend” guardianship hearings from a hospital bed rather than be taken to probate court.

As part of their community partnerships, hospitals are also providing training and resources to other long-term care facilities and other institutions so that they can accommodate the patients being discharged.

For example, UCLA has provided training on IV infusions for pulmonary hypertensive patients and for liver-transplant care. Montefiore pays $52,000 annually for two beds in a Bronx apartment building where homeless patients can receive long-term treatment that would be impossible at shelters.

INTEGRATING CARE

Broader initiatives that show promise, medical professionals say, include:

§ Transitional Care Model: In this program, a nurse coordinates care that follows a patient—in the hospital, at a skilled-nursing facility, at home and even on follow-up doctor’s appointment. “The goals of transitional care is to create a seamless transition,” says Mary D. Naylor, Ph.D., TCM’s founder and director of the New Courtland Center for Transitions and Health at the University of Pennsylvania School of Nursing. Studies have shown improvements in all quality measures as well as fewer rehospitalizations and lower costs.

§ Project RED (Re-Engineered Discharge): Brian Jack, M.D., created this program in 2006 to calm what he calls a “perfect storm” in discharge. Like TCM, it also designates a point person, in this case called a Discharge Advocate, so that things don’t fall through the cracks. For backup, there’s a discharge checklist and a virtual discharge nurse named Louise to review information with patients and families.

§ Project BOOST (Better Outcomes for Older adults through Safe Transitions): “BOOST is aimed at improving the overall discharge process for all patients,” says Dr. Williams, co-chair. Started by the Society of Hospital Medicine, the program is being used in more than 60 hospitals, including Northwestern Memorial, Piedmont, Massachusetts General and UCSF. It has also shown early drops in readmissions by targeting high-risk patients and improving coordination and communication in all aspects of their care.

In addition to Project BOOST, Dr. Schreiber said that Piedmont also implemented a hospitalist program, a growing trend at hospitals nationwide to hire staff physicians to help centralize care coordination and cut back on visits by primary-care physicians. Dr. Williams says that hospitalists are also having an impact in making complicated discharges less complicated and minimizing delays, although this is largely anecdotal.

“A lot of times the hospitalist can be helpful because they are interacting more with the social workers and the care managers than a busy office-based physician who may not be able to take the time to conduct family meetings and interact with the staff.”

However, Toby S. Edelman, senior policy attorney for the Center for Medicare Advocacy Inc. in Washington, cautions that hospitalists aren’t created equally and that some don’t want to do rounds. “Hospitalists work for the hospital,” Edelman emphasizes. “They’re primary loyalty is not to the patient. It just makes more fragmentation.”

A PATIENT’S PERSPECTIVE

From Samantha Hawkins’ standpoint, hospital efforts to improve coordination of care on-site and with other medical facilities in the community are paying off. She and her family were pleased with her care at “Monte,” the nickname some Bronx residents use for Montefiore.

“The staff is excellent,” Hawkins says. “I’ve been there so many times that they know me by the back of my head.”

The hospital helped her overcome the uneasiness of being uninsured by helping her obtain Medicaid to pay for long-term care at home. Hawkins has adjusted to her heart pump, the cable running through her abdomen and the black battery case strapped across her torso. Her mother and older sister Gwen, now her personal drill sergeant, make sure that she monitors the battery-indicator lights on the device to prevent a potentially fatal disruption in pumping. Together with her eldest daughter, Na’Teria, they sort her pills and dole out 26 throughout each day. Her mother, Lula, takes responsibility for dressing the cable opening in her abdomen.

Bossiness and fussiness aside, Hawkins is exactly where she wants to be — with her close-knit extended family and Taco, a frisky Chihauhau who growls and barks if anyone touches her. Best of all, she lived to see her newest granddaughter, Jahana, now 5 months old, and laugh at the faces and gestures that her 8-year-old grandson Nai’rell makes.

“I’m making it,” Hawkins said. “I’m happy to be here by the grace of God and my family.”

Yanick Rice Lamb is associate publisher and editorial director of Heart & Soul. She also teaches journalism at Howard University. Diasia Ellerbee and Dandrea James Harris served as research assistants. This ongoing project was conducted through a Health Performance Fellowship sponsored by the Association of Health Care Journalists and the Commonwealth Fund. 

Stuck in the Hospital: Some Uninsured Patients Wait Weeks and Months for Long-Term Care is a post from: Heart & Soul

View more videos at: http://nbcwashington.com.

First Lady  Michelle Obama not only surprised students at Alice Deal Middle School with an unannounced visit on Tuesday, but wowed them with her dance skills including the Dougie, Cha-Cha and Running Man. Obama stopped by the D.C. school to join students in performing the Beyoncé “Move Your Body” workout commissioned by the first lady’s “Let’s Move” campaign. More than 600 schools participated in the the “Let’s Move Flash Workout”around the nation, performing the workout simultaneously.

“Beyoncé is one of my favorite  performers on the planet,” Obama shared with the students.

The star also surprised teens at PS 161 in Harlem. Beyonce joined 85 students as they started the workout to her song and completed the routine in stilettos.

As the first lady reminded students in D.C., working out can be a lot of fun.

What’s your favorite fun way to break a sweat?

First Lady Michelle Obama and Beyonce Work Out With Students is a post from: Heart & Soul

This week discover the truth on medicine for children, blood pressure medicine woes and the risks of addiction for pain medicine. Post your questions below!

Let me say this right off; children are not little adults. That’s particularly true when it comes to medication. So, when considering over the counter medicine for your
children, you shouldn’t give them any drugs that don’t indicate the correct dosage. Most over the counter medicine have dosages that are based on a child’s age

and weight. In some cases, the medication will give two prescribed dosages, one based on the child’s age and another based on the child’s weight. In that case, use the dosage based on your child’s weight, particularly if your child is overweight. It’s more accurate and will better relieve the symptoms. If the medicine does not provide dosage and suggests you ask your doctor, do just that. Ask your doctor!

Finally, always use an appropriate measuring device for liquid medications, not household utensils, which are not necessarily accurate. If you ask nicely, your pharmacist will most likely give you tools for free.

Q: I’m turning 60, and my wife keeps bugging me to take all these shots she says that people my age need. What is she talking about?
A: She’s right. There are a number of vaccinations that people in their 60s or older should strongly consider to protect themselves against life threatening illnesses, such as influenza, commonly referred to as the flu, pneumonia, tetanus and shingles. As people get older, their immune system weakens, that is particularly true for people with chronic medical conditions, such as diabetics and those with heart conditions. Each year thousands of people die from the flu and pneumonia or contract shingles, a painful, debilitating rash. So, please visit your doctor or your local pharmacy to be vaccinated against the flu, pneumonia and shingles. The influenza vaccine can be given at the same time as the pneumonia vaccine. You cannot receive shingles, however, on the same day as a pneumonia vaccine.
Everyone needs protection from tetanus, is a serious disease that leads to death in about 1 in 10 cases. Tetanus, also known as “lockjaw,” causes painful tightening of
the muscles, usually all over the body. If you have not had a booster shot in 10 years or more, you should receive a tetanus shot. If you never had the initial childhood tetanus vaccines, you should receive a series of three tetanus shots. In most cases, no prescription is required for pneumonia or flu vaccines. Shingles and tetanus, however, will require a doctor’s prescription.

Q: My uncle is supposed to be on blood pressure medication. But he stopped taking it, and it’s only been five weeks. He says it makes him feel bad. How can I get him to start taking his medicine?
A: Unfortunately, your uncle is not alone. He’s not even a rarity. One in four patients stops their anti-hypertensive medicine within six months, according to medical research. The result is more strokes and hospitalizations. They stop because some patients have bad reactions to these medicines. The answer is to identify their problems and seek alternatives that can control their blood pressure without intolerable side effects. So, you really need to get him back to the doctor where he must explain in detail to the physician what symptoms he is experiencing. The doctor may want to change the strength of the drug. The doctor may want to change how often your uncle takes it. Or, the doctor may want to change the drug altogether. That said, don’t let your uncle continue without medication to keep his blood pressure under control. Otherwise, he could be looking at a paralyzing stroke and possibly death.

Q: I have recently been prescribed a medication for pain. It’s fairly strong. I know it contains codeine, and I’m afraid that I could become addicted.
A: That’s a legitimate concern when it comes to some pain medications. Use of opiods, such as oxycontin and oxycodone, is rising. Hospitals and police are reporting more cases of abuse, overdose and more of the drugs are ending up ending up illegally on the streets. In most cases, however, it’s highly unlikely that most patients prescribed pain medication will develop a drug dependency, especially if they are being taken for a short period of time to treat an acute illness.
If you are taking the medication for mild to moderate pain, such as Vicodin, most likely it will be for a short period of time. So, dependency is highly unlikely. If you’re taking something for chronic pain, such as oxycontin, you should be fine. This is a potentially addictive drug, which is why doctors only prescribe it in 30-day intervals. So, it’s important to be extremely candid with your physician about your reaction to the drug.

Dr. Daphne Bernard, Pharm.D., is a registered pharmacist in Maryland, Virginia and the District of Columbia. She is currently assistant dean at the Howard University School of Pharmacy and a member of numerous boards and associations. Email your questions to questions@askyourpharmacistrx.com.

Ask Your PharmacistRx: From Children’s Medicine to Shots for the 60-Plus Crowd is a post from: Heart & Soul

Welcome to our new column Ask Your PharmacistRx, to answer your health and prescription inquiries. Get the scoop on sunscreen, ringworm, the absence of Tylenol and more in this week’s post. Post your questions below!

Unfortunately, most people labor under the mistaken notion that what pharmacists primarily do is just put pills into bottles.  Consequently, they sometimes get irritated when it either takes longer than they expect for us to put those pills in those bottles or we simply refuse to do so.

Actually, our jobs are a lot more complex than that.  Our number one responsibility is to keep you safe.  We do that by making sure you are taking the right medication in the right dose at the right times and that it does not conflict with other medication you might be taking.

Sometimes, prescriptions come to us in which the dosage appears out of synch, or the frequency at which the patient is supposed to take their medication is out of tune with normal.  That means we have to call the doctor’s office to get clarification. It would be dangerous, irresponsible and unconscionable for a pharmacist to knowingly give a person medication that might cause harm or accidentally produced a bad outcome without due diligence.

Another issue is medicines that interact with each other negatively, or what we call contraindication.  Some drugs, if taken together, could actually harm a patient.  In that case, we definitely need to talk with the doctor.  So, be patient with us. For pharmacists, your safety is foremost.  Consequently, sometimes that means it may take more than 15 minutes to get your prescription filled.  So, as we go about the business of protecting your safety, be patient with us.

Q: My son has ringworm.  What should I get him?
A. There are a number of over the counter antifungal medications available to treat ringworm.  I recommend Lamisil AT or Lotrimin Ultra.  You should see results within one to two weeks.  In cases where it doesn’t disappear within that period, see your doctor.  The doctor will probably prescribe Griseofulvin, which is an oral medication that can be found in liquid or tablet form.  Ringworm is contagious and can be passed easily from person to person.  So, be on the watch out for possible re-infection.

Q. I am 77 years old, and I’m taking a lot of medication.  Sometimes it is confusing, because I get some pills at one pharmacy and others at another.  I’m afraid I may end up taking the wrong dose or I might have a bad reaction from the pills.
A. You are wise to be concerned about this, because drug interactions can be harmful, even life threatening. Keeping up with your drug regimen can be difficult.  I have three suggestions.  Let’s have all of your medications directed to one pharmacy, so your pharmacist can make sure there are no negative interactions among your drugs.  The pharmacist can then also check to be sure that you’re not taking too many drugs, such as more than one drug that does the same thing.  You may also want to separate them in daily doses in pill boxes.  Just be sure to keep the original containers that the drugs came and keep one pill in each container so you can always identify which medication you are taking.

Q. I know that I need to use sunscreen to prevent skin cancer, but if I use sunscreen, can I still get a good tan?
A. Yes, you will definitely get a tan, even a great tan.   And at the same time you will greatly reduce the risk of damaging your skin.  Sunscreens come in a number of SPFs (Sun Protection Factor).  I recommend an SPF of at least 30.  At SPF 30, you are blocking 97 percent of the sun’s harmful UVB rays.  And because you are blocking so much of the harmful sun, many experts question whether using a sunscreen with an SPF above 30 provides much more protection.  Also, remember to reapply it frequently, particularly after you come out of the water. No sunscreen is truly waterproof. Instead, they can be water resistant and need to be reapplied every few hours or according to the manufacturer’s instructions. And no sunscreen really provides all-day protection.

Q. I can’t find Tylenol anywhere.  I’ve looked and looked and looked.  What happened?
A. Recently Tylenol tablets and liquid were recalled nationwide because they did not meet certain required specifications.  Motrin and Benadryl liquid for children were pulled for the same reasons.  The good news is the generic form of Tylenol, Acetomenophen, is available.  It is just as effective and in this case, safer than the brands.

Dr. Daphne Bernard, Pharm.D., is a registered pharmacist in Maryland, Virginia and the District of Columbia.  She is currently assistant dean at the Howard University School of Pharmacy and a member of numerous boards and associations.  Email your questions to questions@askyourpharmacistrx.com.

Ask Your PharmacistRx: Goodbye Tylenol , Hello Sunscreen is a post from: Heart & Soul