Caregiving | Health Commentary

Larry Minnix Takes a Hands-On Approach to Labor Day

Thu, 28 Aug 2008 16:29:13 -0400

My good friend Larry Minnix, President and CEO of the American Association of Homes and Services for the Aging (AAHSA), never fails to frame a message within a story, and a story within an image. As we approach Labor Day, and in the middle of Political Conventions and the varying values and futures they portray, it's worthwhile to reflect on who we are, what we have become and where we wish to go. I share Larry's words of compassion, understanding and partnership with you, below, with his permission. You can find these and more at his AAHSA website.

Aug. 27, 2008

Hands

By Larry Minnix

My late mother, who died almost four years ago of cancer, was a colorful character. She was a modern woman before it was a popular thing to be. My daddy was a traveling salesman for many years, and both parents worked and had a kid to raise. I began working when I was 10. I sold Coca-Colas and blackberries. Bobby Moore, my lifelong friend, and I had a pine straws business as well. We would rake straw and strew it on flower beds in the fall for 35 cents per gunny sack. I did my share of lawn mowing and painting as well. It seemed like my parents worked all the time. They had to.

My mother had a standard request about her funeral. She wanted an open casket, but she wanted to wear gloves so “people don’t see my hands and think I’d worked myself to death.”

Hands. I remember, early in my career as a nursing home administrator, a frail woman in a wheel chair lamenting, “Nobody ever touches me any more. Oh sure, they bathe me and change me, but no real touching any more.” The power of touch, the importance of hands in what we do.

My late Uncle Aubrey, who had a wrecker service, garage, and cow pastures, had great hands. So did my late Uncle Clarence, who worked the night shift at the cotton mill. Both had calloused, hardened hands – with grease under the finger nails and embedded deep in the creases of the skin on those big, well worked leathery hands. I remember Jesse Barlow, Bob Young, Dalton Hollinger and Lewis Willis, all “maintenance men” (no gender slight intended) at Wesley Woods, had hands like Uncle Aubrey and Uncle Clarence. Hands that gave you the reassurance that they could do anything, fix anything. Strong hands.

Bobby Moore’s daddy sold John Deere Tractors. An ex-marine from Alabama, Mr. Moore became a mentor to the boys in our neighborhood. He took us fishing, taught us how to barbecue and gave us instruction on hand shakes. I remember one Saturday morning in his living room he gave us a lesson about the importance of a firm handshake – what it says about your strength. He had such big hands. They enveloped mine. To this day, I initially judge people on their handshake. I remember the hand shakes of key leaders I’ve known – board chairs at Wesley Woods like Palacia Seaman and the late Candler Budd – or friends like Dan Reingold or Judge Hilton Fuller, who shake your hand and pull you toward them for a hug – a manly hug. The hands of integrity and commitment. You work with men and women in your organization who say everything about their values with that initial handshake.

My wife has given me a gift of a massage on several occasions. I travel a lot, so my shoulders and lower back take a beating. A massage therapist I went to for a couple of years had healing hands. I could feel their warmth before she even touched my skin. The hands of healing are essential to the work we do with the elderly and disabled. Notice the hands of your nursing or therapy staff some time. They look warm. And they are soft and gentle. Healing hands are the most important tool in our repertoire of caring.

And think of the power of a pat on the back when we need a boost or a thank you. Remember what it feels like to have someone embrace your hands with both of their hands during a time of grief.

As we celebrate Labor Day together, let’s give ourselves a hand for the great and important work we do through people whose hands reflect their character and compassion. Give a Labor Day gift of a pat on the back or a 10 minute hand massage for every employee or resident.

Hands. Working hands. No, I didn’t put gloves on my mother in her casket. I was proud of those hands. They did a lot for me – and for countless others.

-- Larry

Women Informal Family Caregivers

Wed, 04 Jun 2008 16:48:32 -0400

The problem of "non-real work"

In the book "In Search of Excellence," published in 1982, Tom Peters made the case that solving most business problems requires a critical look at processes, and an active, critical reshaping of those processes to allow for simplicity, ease of use, efficiency and reliability. One term he coined, which has stuck with me for 25 years, is the phrase "non-real work". He was referring to all those chores that require time and assets but deliver nothing, and in so doing subtract rather than add benefit. A survey recently released by Gallup in conjunction with the American Academy of Family Physicians, focused on the challenges faced by women attempting to coordinate care for their families in our current health care system. It aptly describes the problem of "non-real work" in the flesh.

Here are some of the findings:

"Nearly 60 percent of respondents said they face challenges in obtaining health care for themselves and/or family members. And when they do receive care, they enter a system of confusing communications, duplicative paperwork and tests, and, at times, contradictory recommendations from different doctors. The survey found that when receiving healthcare for themselves and/or their family members:

43 percent of the respondents said they have had to fill out complete patient histories and other forms at each medical provider’s office.

26 percent said they have had to inform one medical provider what another had recommended or diagnosed.

16 percent have had to carry lab reports, x-rays and other test results from one medical provider’s office to another.

11 percent have received contradictory recommendations from different medical providers.

Nearly 10 percent have had to repeat lab tests unnecessarily because of lack of communication between medical providers."

The AAFP and others have been advocating a Medical Home remodelling of health care. What would that entail?

"The medical home model employs a team-based approach to care that provides patients with:

preventive care, sick care and help managing chronic conditions;
expanded hours and same-day appointments;
care coordination across all settings – doctors’ offices, hospitals, nursing homes, consultants, and other components of the complex health care system;
electronic health records that serve as a “library” where the essential elements of a patient’s history and health care interactions are stored;
effective use of technology, making it possible for doctors to communicate with one another and stay up to date on mutual patients’ medical conditions;
virtual office visits via a secure e-mail system; and
the convenience of transmitting prescriptions electronically to pharmacies. "

Putting it all together, it is useful to incorporate process reengineering into new health reform modelling. As this latest survey correctly points out: women are playing primary roles in coordinating care logistics and care decisions, and their efforts are laden with non-real work imposed by broken processes which are both inefficient and non-productive. Moving the primary loop from "hospital - doctor's office - hospital" to " home - care team - home" is a critical needed step to reorient the center of care and to emphasize forward planning. But if we preserve our chronic disintegrated and non-coordinated processes, and continue to ignore informal family caregivers, leaving them socially isolated and non-integrated with the formal care team members, our gains will be eaten up in short order.

Home-Centered Health Care Applications

Wed, 13 Feb 2008 19:01:46 -0500

The case of SAILWhen I speak about Home Centered Health Care, I'm frequently asked, "What can we do right now?" My standard response is:

1. Build teams.
2. Include informal family caregivers.
3. Get into the home.
4. Embrace technology.
5. Don't wait for permission.

Case in point, as described in a recent note to me from Ann Alpert of Madison, WI reporting on SAIL:

"You have affirmed for us that we are on the right track with SAIL and our work here at Oakwood Village Retirement Community. SAIL - Support for Active Independent Lives is a non-profit membership program for people 60+ living in their own homes.

We provide a core set of services for $25 per month aimed at helping them attain and maintain their highest level of functioning. We network the members, provide vetted vendors (handyman, housekeepers, painters, etc), personal health coaching, computer assistance, daily automated check in and many other services.

SAIL is sponsored by two CCRC's, a home health agency and community based hospice center. In 2007, we developed two programs available to SAIL members and our CCRC residents: Active Care and Enriched Care. These programs were developed by Program Development Director, Alan Lukazewski, R.Ph., UWGeriatric Medicine's Dr. Steve Barczi, along with Oakwood's dietician, physical therapist, occupational therapist, personal trainer, social worker, parish nurse and most importantly a group of elders. The programs specifically screen for the existence of and/or risk of depression, memory loss, incontinence, poor bone health, nutritional deficits, medication misuse/overuse, balance and gait issues, pain dueto arthritis or other chronic conditions. Following the screenings, each person assists in developing their personal health plan where they receive 1:1 personal health coaching, weight resistance programs, lunch talks on the above topics, buddy system, and post-program followup/screenings. The personal health coach assigned according to how his/her profession fits with the client's needs. A strong emphasis is placed on lifestyle changes and peer support.

In addition to this, SAIL is working on integrating web-based technology into the homes of members to assist with health monitoring, home safety and social connections as we recognize that this will be key in managing health needs at home."