Make the Consumer Choice a Healthy One

Make the consumer choice…these words are ringing in my ears after hearing them in a governor’s press conference this week. They were uttered in response to a question regarding whether reducing restrictions on businesses is a good idea given a huge spike of COVID-19 cases in that state. “If you are scared…make the consumer choice to stay home.”

The consumer choice? Not all consumers have the same opportunity or options. This is true whether there’s a pandemic or not. There are things we can control and things we cannot. And sometimes the implementation of policy is beyond our individual control. Sometimes the implementation of policy leads to tragedy. Often the implementation of policy or lack of policy leads to less than ideal outcomes if we’re paying attention to details!

What consumer choice does an essential worker have other than to wear a mask and gloves? What consumer choice does the hairdresser mother of a disabled, medically fragile child have when her employer reopens a salon and her state disqualifies her for unemployment if she doesn’t return to work?* What consumer choice do I have when a police officer without a mask stops me for a broken tail light and asks me to exit the car? My mask will protect him, but his lack of a requirement to wear one puts me at a risk that I would not choose as a consumer.

I am all for individual responsibility. And good health is facilitated by individual choices. But it is unrealistic to develop policies that fail to recognize that some populations do not have the same access, means, and knowledge to make healthy choices. Filling these gaps is where our institutions have the opportunity to shine. As a whole, they are failing.

We are left having to determine the best path to health on our own personally and as a community through and around many obstacles. For some of us, the obstacles are an inconvenience. For others, they may be deadly. Right now, so many of us are trying to figure out how to survive, thriving may feel like a pipe dream. More on that in other posts.

For the moment, let’s focus on healthy choices. The top 5 stay the same:

  • Drink plenty of water. If the water provided by your city or well is safe, tap water is fine. No need to spend extra on bottled water.
  • Eat regularly timed meals filled with a variety of fresh fruits and vegetables, protein, nuts, seeds, whole grain carbohydrates, and healthy fat. Fruit, nuts, and seeds make great snacks.
  • Get plenty of sleep. Allowing some screen-free quiet time before bed can help you relax.
  • Move your body. Include a minimum of 150 minutes of vigorous activity each week. If you lift heavy boxes all day in your job, it counts. If you use the stairs to your 10th floor office, it counts.
  • Avoid foods, medicines, and products to which you have an allergy, intolerance, or adverse reaction. Avoiding known irritants reduces general stress on your system.

Even these basic choices may be harder right now. Food shortages can derail a menu plan. Your daily task list may now include childcare in addition to work. That leads me to another healthy choice: Be kind to yourself. It is less important to perfectly execute a plan than to do your best and let go of the rest!

In fact, it may be better to let the chores pile up for a day while you do something to reduce stress: read a book, binge watch, craft, paint, build something, plant some flowers, play video games, bike, bake, do yoga, or just pet the dog. It’s useless to pretend that this is a normal year. It’s not. What worked for you before may not now. It’s a great time to explore changing feelings and perceptions and be open to new inspiration.

Other health choices may be more complicated:

  • Should I take medication for IBS or should I try to manage it with diet?
  • Should I take my post-op opioid prescription or should I give lesser pain relievers a try first?
  • Should I have surgery on my knee or try rehabbing it with PT when studies say the overall outcome of surgery is no greater than PT but my doctor recommends surgery?
  • Should I get a second opinion if I trust my doctor?
  • What kind of therapy should I choose for PTSD?
  • Should I have chemo or not?

Any consumer choice should take into consideration your priorities, intentions, values, goals, flexibility, and resolve. It should be informed by facts. And it should take into account barriers beyond your control. Which brings us to today’s million dollar question, what should I do to avoid COVID-19?

When it comes to reducing the risk of contracting COVID-19, in general, less contact with people equals less risk. While maximum isolation is possible for some, it is not a realistic choice for others. In order to make responsible decisions, each of us must understand the risks of our potential behavior to ourselves, our families, and our communities.

Unfortunately, getting enough solid facts about SARS-CoV-2 on which to base a risk assessment is difficult. I believe it’s worth the effort, but it requires diligence and determination to ascertain the pertinent facts. With a novel virus, a swiftly changing knowledge base is to be expected. We’re learning as we go. But dissemination of reliable facts during this pandemic has been stymied by state health departments sending out contradictory, confusing messages, a questionable performance by the CDC, and misstatements from the WHO.

If you’re looking for a single source of guidance, I’d recommend this article published in The New Yorker –“Amid the Coronavirus Crisis, a Regimen for Reëntry” by Atul Gawande. The regimen is based on what healthcare workers at Mass General Brigham have learned about transmission through trial and error.

You may not have the consumer choice to stay home, but doing what you can to minimize risk doesn’t mean you’re scared or weak. It can mean you value staying healthy and keeping others healthy. It can mean that you’re strong enough to stay positive without social interaction. It can mean that you’re willing to do whatever you must do to protect the vulnerable. It can mean you respect healthcare workers.

Minimizing risk is a healthy consumer choice!

https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html

https://jamanetwork.com/journals/jama/fullarticle/2705186

Disclosure of Material Connection: I have not received any compensation for writing this post. I have no material connection to the brands, products, or services that I have mentioned. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: “Guides Concerning the Use of Endorsements and Testimonials in Advertising.”

*This is the policy in Arkansas.

Live to Fight Another Day or Fight to Live Another Day: Choosing a Health Care Proxy

Live to fight another day or fight to live another day…welcome to the struggles of longterm care. I wrote those words, and many that follow, last fall – long before I recognized the perils our vulnerable populations would face during a pandemic.

After a recent call from the nursing home, I realized I often feel like I’m walking a tightwire trying to decide whether to live to fight another day or fight to live another day. For the past three years, I’ve been in charge of the care of my mother’s first cousin who recently turned 99. Three months into my unanticipated stint as her POA, Trustee, and Health Care Proxy, she broke her knee.

Let me go back a moment. I began to fill all of those roles when my mother had a stroke and could no longer speak or take care of her own affairs. Unbeknownst to me, I was listed in all of the legal documents for her cousin as the successor. Yes, you read that right. I was not asked OR informed that I had been selected for those duties.

I’m not complaining. I’m just letting you know that I had not mentally, emotionally, or otherwise prepared for this eventuality. At first, it was just a matter of sorting through a mountain of records; getting power-of-attorney and contact information changed with banks, investment firms, insurance companies, social security, and the IRS; and paying bills. The work wasn’t fun, but it was routine.

Two months later, my mom died leaving me with an entangled mess of property to sort. A month after that, I got the call that added a whole other level of decision making to my responsibilities.

I was on the phone with an EMT who had just picked my cousin up off the floor of her home. He actually thought she was just bruised, but I knew I needed to make the three hour drive to make sure. In the meantime, I sent my sister to keep an eye on things.

When I arrived, the cousin was in bed for the night. I stretched out on the couch. In the morning, it was clear she had more than a bruise and we were headed for an X-ray…at the hospital…it was Easter. She couldn’t bear any weight on her knee and I was not strong enough to get her to the car.

In rapid-fire fashion, I went from trying to work the paperwork puzzle my mom had left me to deciding to call 9-1-1, choosing an orthopedic doctor, pushing for one more night in the hospital (luckily, the hospital social worker tipped me off that Medicare wouldn’t pick up the hospital tab unless we stayed three nights), then to picking a rehab facility while listening to my screaming patient (who was in pain) and explaining to her three times every five minutes what was going to happen and why in what I hope was a calm manner. You could call it orientation, bootcamp, or a rude awakening, but it was just the beginning of an ongoing fight to ensure my cousin continued to have the best quality of life available.

As I disseminated updates regarding her health and mental capacity, it has become clear that few of her friends or our relatives have had experience with dementia and longterm care. This leaves them unprepared should they be thrust into a similar situation. I now believe it is important to share what I’ve learned.

Let’s start with one overarching reality. If you are in a position to need a longterm care facility, you also need an advocate. Period. Choose one now. (Please get consent!) When it comes to the quality of your everyday life when you are aging, ill, injured, or incapacitated, this is as important as an advance directive.

A need for that level of care means you have some sort of limitation. Limitations can make it difficult to impossible to get the quality of care we all desire. Dealing with the system can exhaust even the most energetic, healthy, well-balanced person you know. It is simply beyond the reach of most longterm care residents.

My mom’s brief stay in a rehab facility sent my stepfather into a mood of contentious petulance. I understood his frustration, but because he didn’t know when to drop an issue and live to fight another day, the staff had a desire to ignore any call to mom’s room. And who can blame them? They knew they were headed for a fight.

So goes the great balancing act of navigating longterm care. As the advocate, an unwillingness or failure to be a visible presence, question, push, talk to pharmacists, or get the doctor involved can mean your resident continues to receive medication that is causing diarrhea, bleeding, restlessness, or hallucinations.

It can mean that food allergies are ignored. It can mean that your impaired resident who cannot lift her dominant hand is left alone to try to eat with the other hand each and every meal even though she’s drastically losing weight. It can mean that your resident is drugged to the extent he cannot stay awake. Things can quickly reach the point at which you must fight to live another day.

On the flip side, too much pushing, monitoring, and interference may mean your resident’s care becomes less attentive, less responsive, and less cooperative. Any longterm care staff is made of humans who have a chronically stressful job and are often underpaid. They can run out of patience with interference. Some may choose to take that out on the resident.

Even the best facilities can be crazy-making. Choosing and acting as a Health Care Proxy requires careful consideration.

Here are some things to contemplate as you make care decisions:

What are the qualities needed in a Health Care Proxy?

Reliability
It is critical that a Health Care Proxy be reliable. It may be tempting to choose a person whose position in the family makes them seem appropriate, for example: a spouse or eldest child, but it is possible a trusted friend who is more reliable would be a better choice. Before you decide, consider that a time when your care hangs in the balance is not the time for hoping someone will show up. You need to know they will.

Decisiveness
A medically fragile, severely ill, injured, or elderly person’s condition can change quickly. If the Health Care Proxy cannot make decisions in a timely manner, it may hasten death or disability.

Trustworthiness
Always choose someone you trust to have your best interest at heart. That person can have a different philosophy about invasive treatments or medication intervention as long as they have the ability and willingness to set aside their point-of-view in favor of the guidelines you lay out for your own care. If you do not choose to set guidelines, it may be best to choose someone you trust who is more in line with your point-of-view.

In order for you to feel safe, especially if you should develop dementia, it is important to choose someone who will tell you the truth. That doesn’t mean someone who is harsh or blurts out things you don’t need to know, but a proxy who is willing to softly and kindly tell you you cannot go home if you are never going to be able to go home. In other words, choose a person who can deliver hard truths with compassion and calm.

Telling the truth to dementia patients not only shows them respect, it helps prevent added anxiety. Much like preverbal infants, people with dementia are highly attuned to what’s going on beneath the surface. They can see right through deception even when they can no longer process language.

Availability
The best care decisions will be made by those who can attend major doctor’s appointments and have time to seek additional information and education when needed.

A Health Care Proxy will not automatically receive sufficient information regarding medication side effects or drug interactions. They may need to learn on their own about different types of lifts and chairs or rehab techniques in order to make informed decisions.

Choosing a person whose schedule allows enough time or flexibility to be engaged can make a big difference in the quality of decisions that are made.

Adaptability
Swiftly changing circumstances often require new plans. Having an advocate who can easily adapt will prevent delays and keep plans moving forward.

Skilled Communicator
Serving as Health Care Proxy requires communicating well with many professionals including doctors, nurses, aides, patient techs, physical therapists, social workers, administrators, lawyers, dietitians, and pharmacists as well as the patient. It is important to have an advocate who is willing to ask questions of these professionals.

Calm
Some people remain calm in a crisis. Others quickly become overwhelmed or have difficulty functioning. Choosing a calm, attentive, and detailed Health Care Proxy will serve you best.

Fortitude
The Health Care Proxy will have to live with uncertainty, make peace with compromise, and accept that some decisions must be based on a best guess. The weight of making critical decisions and supporting a weakened, limited, or helpless patient will take a toll.

And the patient may not be happy and grateful for those efforts. It is not unusual for patients to be angry with the Health Care Proxy, family, and the whole care team.

Some care situations last decades. It takes fortitude to continue to show up and be a good advocate in challenging situations.

Compassionate
Compassion can bridge many gaps to create a more positive environment for the patient, the care team, the medical team, and the Health Care Proxy.

Knowledgeable
If you have a sudden change in health status, it will be helpful for your proxy to be familiar with your medical history and plan for care in advance. In reality, this may not be feasible or possible. As long as you choose someone with a willingness to learn, the information can be gathered along the way.

Finding all of these qualities in a single person is a tall order. A good Health Care Proxy does not have to shine in each and every area listed.

The best choice will boil down to these questions:
Who do you trust to do their utmost to give you the best quality of life for as long as possible in accordance with your wishes? Of those people, who do you believe will have the best success navigating the system to accomplish that?

There’s also the flip side to consider. If a loved one comes to you and asks if you will serve as Health Care Proxy, can you and are you willing to commit? If you know that this is not a responsibility you can shoulder, it is more kind to say no up front than it is to say yes and hope your bluff is never called.

The longterm care system has many, many challenges. None of us want to have to think about them, but being prepared in advance to live to fight another day or fight to live another day will make navigating those challenges easier.

Sadly, we now know even the best Health Care Proxy may not be able to override public health policy that puts you in danger. Having an advance directive prepared even if you haven’t yet chosen an advocate is the best way to ensure your wishes will be followed.

There will be much to untangle once we’re through this pandemic. Hopefully, we will improve protections for all vulnerable populations and develop policies, plans, and systems that will keep them safe even during times of public health emergencies. This will not happen without deliberate action, dedication, and valuing those lives.

I hope we will use this opportunity to examine our values and priorities. I just watched a commercially built rocket head for space. We are capable of amazing things. We can do a better job protecting our seniors, prisoners, medically fragile, minorities, homeless, poor, and underserved. What we do with our resources, policies, and energy is a choice.

https://www.nia.nih.gov/health/advance-care-planning-healthcare-directives

https://www.americanbar.org/groups/real_property_trust_estate/resources/estate_planning/living_wills_health_care_proxies_advance_health_care_directives/

https://www.bankrate.com/glossary/h/health-care-proxy/

https://www.everplans.com/articles/8-reasons-you-should-decline-being-a-health-care-proxy

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Who Said Life Would Be Easy?

Many of us seem to be frustrated that things are hard right now, but who said life would be easy? Of course life isn’t easy! Why do we act like it should be? And why do we choose to accept that difficult is inherently bad?

Difficulty breeds innovation. It gives us an opportunity to appreciate moments of comfort and ease. Meeting a challenge brings a sense of accomplishment. These are not bad things.

Yes, we’ve been served a big dose of strong medicine all at once. But that’s not really the problem. The problem is trying to force things to go “back to normal.” That normal is gone. Adjustment is necessary.

strength

Adjustment often comes with a sense of loss, grief, helplessness, fatigue, sadness, frustration, fear, and anger. That does not automatically spell catastrophe unless we choose to define it that way. Most of us have within us the resources to weather much more than we imagine. We just need to believe it and draw on those resources.

When our internal resources need bolstering, we can say so out loud to someone capable of holding our truth, lending assistance, and encouraging us. I promise you, there are people who will listen, feel empathy for you, and can help hold your burden. There are people who can, and will, provide you with food, clothing, or assistance with bills.

It may not be those you WANT to or believe SHOULD provide for you. But holding onto the fantasy that a dismissive parent, self-focused friend, humiliating spouse, or bureaucratic system will suddenly change prevents you from finding better resources. Now is the time for letting go!

I am not discounting the strength and courage it takes to move forward when you’re terrified. I lived with underlying fear for at least my first 55 years. I am skilled at talking myself off the ledge. But that’s just it: I feel confident I can push through my fear and shift swiftly when I need to. I am, if anything, adaptable.

At this moment, I keep hearing Jack Nicholson in my head saying, “You can’t handle the truth!” like he did in the movie “A Few Good Men.” It feels like many people currently accept that as fact and choose to avoid information that is hard to hear. That’s a choice that can put you at additional risk both health-wise and financially.

But you can handle the truth. Life is hard. That’s not devastating news.

My eldest son told his wife the other day, “I was built for this.” I feel the same way. That doesn’t mean the current state of affairs would be our first choice. It doesn’t mean we don’t value easygoing, fun times. It just means we know about ourselves that we can handle this new reality. We will find our way through the challenges and feel our way through the heartache. It will not destroy us.

You will have new challenges today that you did not anticipate a month ago, a week ago, or yesterday. It feels like that is something new, but isn’t that always true in life? Think of all of the unanticipated challenges you’ve already faced. Those allowed you to build the emotional muscle you need to meet an even bigger challenge.

Celebrate your courage, bravery, stamina, and good decisions! Flex your resilience muscle by supporting your friends, family, or a vulnerable population that moves your heart. When your hands are busy, your mind will settle. When you channel your energy into helping others, the reward is always yours.

This week, when you meet each day, see if you can feel however any new difficulties make you feel and then let those feelings go or channel them into energy to make the most of the opportunities presented. After all, the flip side of a challenge is always an opportunity.

Life is hard. You cannot control every detail. There will be uncertainty. Within that uncertainty are opportunities for greatness and excellence! I choose to embrace and celebrate those no matter how small! And I am grateful for the chance to do so. I have never believed that life will be easy. Who said that anyway?

https://www.theschooloflife.com/

Face Mask Memories

mask

I already have face mask memories. Soon you will too. It seems my mother was ahead of her time. She wore a mask so often we called her “the woman with no face.” Of course, during ragweed season she also plugged her nose with silk panties so maybe she was just weird. Even though I was small during the silk-panty-nose-stuffing era, I remember it vividly. I wonder what children will remember from this time?

My grandson DJ is the same age I was when those visuals were burned into my brain. Yesterday, he and I made up songs about coronavirus because, well why not? I was explaining why he couldn’t take swimming lessons right now. It was about the 15th virus-related thing I’d had to explain yesterday. He’s sick of hearing about washing his hands, using a tissue, not touching his eyes, not running out to greet our neighbors, and why we need to take his temperature even though we’re pretty sure he just has allergies. At least putting the reason to a beat made it a bit less tiresome.

Soon, face masks will become part of his experience too as will bandanas over the face. I associate that look with farmers, but it probably makes most people my age think of bandits or bank robbers. This can cause some confusion when a car backfires, the police sensors pick it up, and a bandana masked policeman shows up at your door. Is this a bandit posing as a policeman or a policeman who wants to rob you?

Now I know that sounds like a far-fetched, made-up scenario. But that’s because you don’t own a 1978 International Scout and live in a neighborhood where gunfire is common. We had just such an event on my street last night. (That bandana part could be made up. I didn’t see the cops faces. But it makes for a better story, don’t you think?)

And the weirdness of that visual accurately reflects how things feel right now. Nothing that was true two weeks ago is true today. Thinking has to shift swiftly. In a pandemic, you only get one chance to prevent. You cannot go backward.

Financial thinking will have to shift quickly as well. Did I make a mistake putting that 2019 IRA contribution in my account last week? Should I have kept it as a reserve instead? I don’t know. None of us know. We are facing territory we aren’t familiar with.

Can some of the unemployed in Georgia shift their thinking quickly enough to harvest the currently ripening blueberries and squash that farmers lack migrant labor to harvest? If so, we can prevent holes in our food chain, save some farms, and get income in their hands. But it will require a shift from predominant thinking. And uncertainty often leads to one of the four F responses: Fight, Flee, Fawn, or Freeze.

This is another opportunity for face masks to help. Just think how many superheroes wear face masks: Batman, Spider-Man, Wolverine, and the Flash all wear masks. And so do our real-life superheroes: healthcare workers. If we follow the new CDC guideline, we can all be superheroes!

Superheroes are powerful. Viewing ourselves as powerful can help bolster us as we navigate our way through uncertainty. Perhaps the face mask will become a symbol of courage and community-mindedness.

Hopefully, that’s what our children will remember from this time, our courage and willingness to adapt quickly for the benefit of our entire world community. At least that’s my wish for new face mask memories!

https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover.html

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