Family inHome Caregiving Blog

There has been quite a bit of controversy over the use of robots for surgery, but now these machines are taking over more than the operating room.  Some hospitals now have robots in white robes donning a stethoscope roaming the halls!  USA Today recently profiled Mercy San Juan Medical Center outside of Sacramento where doctors are using the robots to check on patients via iPads and PCs running the robots.  Called the RP-VITA generation (manufactured by Roomba vacuum cleaner maker iRobot and InTouch Health), these robots have quite a bit to offer.    It seems bizarre, but one of the nice features of it is that the robot's head is actually an iPad where the Doctor can transmit his image and have a video conversation with the client, nurse or another physician.  One of the big benefits is that overworked doctors, some of which are on call 24-hours per day, can now check on patients from home while getting a bit of rest.  So far, the response from patients has been overwhelmingly positive so you will likely see more of these in the future.  In fact, California is one of the leaders in using robots in a hospital setting.

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As we prepare to fully implement health care reform (the Affordable Care Act) there have been a number of good and bad issues which have come to light.  Physicians, hospitals, private insurance companies and the government are working hard to make our expensive medical system more efficient and save costs.  One thing I like is that my physician put my records on a secure website where I can review results of tests and his notes.  With a click of a button, he can also send prescriptions to my pharmacy, a huge benefit over the days when paper was faxed back and forth and often got lost in the shuffle.  More than half of doctors and about 3,880 hospitals have switched to electronic records, in part due to pressure from the government but there have also been tax credits and other subsidies to speed up the process.  So far, our government has funded almost $15 billion to physicians and hospitals to upgrade to an electronic system, according to the Department of Health and Human Services (HHS). By 2015, the government will start fining medical providers who haven’t begun using electronic records to submit claims data.  Besides the cost savings, I believe there will be a huge upside for patients as different doctors are able to share records with each other.  Many of the elderly see multiple physicias, and they don't always share information with each other about their treatment plans.  This can be extremely dangerous, particularly if the patient is suffering from dementia or Alzheimer's disease and simply forgets to tell one doctor they are seeing another specialist.

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It's a sad day in California for any senior that needs in-home care and the millions of baby boomers headed for retirement.  A bill backed by the Service Employees International Union (SEIU) which could more than double the cost of care for those who need 24-hour in-home care passed the Assembly Appropriations Committee today.  It is on its way to the floor of the State Assembly and could be voted on by the end of next week.  In addition to the ridiculous cost which would be passed on to seniors (forcing many of them to go into a nursing home which will only cost the state more money) it would require those with Alzheimer's who have a set routine to suffer through twice as many (or more) caregivers as they have in their home now.  This is very disorienting and can make Alzheimer's victims violent, and life unpleasant for the senior, their family and other caregivers.  This bill is so unnecessary and will punish so many suffering from this horrible disease which both my father and my grandmother had when they passed away.  Please contact your local Assembly Member and urge them to vote no on this terrible bill and to favor the alternative AB 322 (the Home Care Services Act of 2013).  For more information on the terrible consequences of AB 1217, click here.

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The Nikkei Index in Japan dropped 7% today causing short-term jitters in the U.S. stock market.  Although they rebounded towards the end domestically, the Asian markets melted and many retirees and baby boomers here are wondering what to do with their money after the stock market has soared so much recently.  A quick drop in the U.S. market is a distinct possibility and for someone retired or on the verge of retirement, this isn't something they can suffer through again. USA Today just provided some great tips on a story which ran on page one of their Money section recently entitled, "What not do to: Top 7 mistakes people make," regarding retirement planning.  They spoke with a number of financial planners which made some good points like the fact that many people expect to spend less money when they retire, but they actually don't.  Joe Heider from Rehman Financial Group said that," Most people, in my opinion, initially after they retire, actually spend more money than when they were working.  When you have a job, you are in your office and you are not spending money.  But now you have 24/7 to shop, travel and do all the things people couldn't do before."  There were other important points like the rising cost of health care which many retirees haven't planned for.  It's likely that even more health care costs will be shifted from Medicare to retirees in the future.  The bottom line is that you need to have a realistic financial plan which is well thought out and includes your actual planned lifestyle, inflation and realistic expectations for growth in your assets.  And don't forget to have important papers drawn up like a POLST, living trust and medical and legal power of attorney so that your wishes are carried out in the event that you become incapacitated.  Most of us don't like to think about it but if you have a stroke or something else which puts you in the hospital for an extended period of time, your spouse may have a hard time getting by and carrying out your medical wishes without these documents.

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Cases of skin cancer have been rising rapidly as the population ages.  There wasn't as much known about sun damage when seniors were growing up as there is today, and much of the damage that's already done is hard to erase.  Choosing a proper sunscreen to prevent further skin damage is difficult, and the choices are seemingly endless.  The myriad issues were highlighted in a recent issue of USA Today which pointed out that labels such as waterproof and sunblock are now gone being phased out due to new labeling requirements required by the U.S. Food & Drug Administration (FDA).  They have been replaced with warnings like the cream may not protect against wrinkles or skin cancer.  Although the aim of this is to make the labels less misleading, it can also be difficult to figure out exactly what you are getting.  And it's not just sunscreens which are getting the label makeover.  Makeup, moisturizer, lip balm and anything else that you use which has an SPF (sun-protection factor) number in it has been or is in the process of being re-labeled.  Most dermatologists recommend wearing something with an SPF in the 30-50 range.  But just as important is to wear a hat and other protective clothing because even at that high range, you won't get total protection.  If it's hot, you may sweat and wipe off the sunscreen, totally obliterating your protection.  Particularly if you have had skin cancer in the past or have very fair skin, it's important to look at not just what you put on your skin, but the clothes and other protective garments that you put on your body.

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Big brother seems to be constantly looking over our shoulder and as medical records go electronic, many are concerned about what employers, insurance companies, hackers and others will be able to glean off of leaked records.  This is an important issue because decisions about giving people jobs, covering them for insurance, even housing can be based on a person's health.  A new snooper has been thrown into the mix.  The New York Times recently reported that huge databases of patient and physician information is being used by large pharmaceutical companies to market drugs.  These databases allow drug makers to analyze which doctors are prescribing how much of a certain drug compared to their colleagues, while allowing them to access lab tests and personal information like your age, income and ethnic background.  This sounds like a terrible idea to me, but it doesn't seem as if there is a way to opt out.  This seems amazing given the government scrutiny which has been placed on Bing, Google, Yahoo! and other Internet advertising companies about disclosing what information is given to whom and giving the consumer the ability to opt out.  Physicians can opt out of the tracking system, taking their patients with them, but most do not.  A survey found that out of 767K practicing physicians, only 4% have opted out and many don't even know the tracking is happening.  There should be more public awareness about this issue.  Although Federal law requires that personally identifiable information be removed, we all know that cross checking various databases can narrow this down, particularly when small geographic areas are studied.  "I think the doctors tend not to be aware of the depths to which they are being analyzed and studied by people trying to sell them drugs and other by medical products," Dr. Jerry Avorn, a professor of medicine at Harvard Medical School, told the New York Times.  Pharmaceutical companies have turned to this new tactic because they are increasingly getting the door slammed in their face at doctor's office and they need more powerful selling tools.  As cost cutting by insurance companies and Medicare has forced doctors to see more and more patients, they just don't have the time to sit down and speak with pharmaceutical sales reps about different drugs.  This is an unfortunate unintended consequence of government and private insurance company efforts to cut down on medical bills. 

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Much of the health advice which has been passed down from generation to generation from family members, physicians and just general news articles continues to be challenged.  Part of this is due to advances in technology which allows more sophisticated research projects to go on, while another part is the pressure from government and private insurance companies to focus on solving the health problems which will give them the most bang for their buck.  The most recent thing to be challenged is trying to cut most salt out of your diet in order to improve your health.  Although it's true that overuse of salt can cause health problems, a new expert committee commissioned by the Institute of Medicine by the Centers for Disease Control and Prevention (CDC) recently came out and said there was no rationale for aiming to get sodium levels under 2,300 a day.  That's more than 50% higher than the 1,500 milligrams of sodium on the low end recommended by the American Heart Association (AMA), which contested the CDC-commissioned report.  They are sticking with their recommendation, which was issued in 2005, that sodium levels be kept in the 1,500-2,300/day range, and 1,500 or below if you are in a high-risk group .  The new report looked at data since 2005 and found, "As you go below the 2,300 mark, there is an absence of data in terms of benefit and there begin to be suggestions in subgroup populations about potential harms," according to Dr. Brian L. Strom, chairman of the committee and a professor of public health at the University of Pennsylvania.  Salt reduction, which is supposed to prevent heart attacks and strokes for people at high risk (in particular, those over 50, African Americans and anyone who has chronic kidney disease, diabetes or high blood pressure) can actually do the reverse.  The study found reducing salt intake too much could increase heart attacks and increase the risk of death.  There is evidence that extremely low levels of salt and extremely high levels of salt can have dire consequences, this is not under question.  The ambiguity comes in the middle.  How much is too much and how much is too little?  For most people, common sense should prevail but if you are in a high risk group you should definitely discuss this important issue with your physician who will likely have access to a lot more studies than the general public, particularly if you are seeing a specialist.    

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I've written a number of times on my blog about the huge impact analyzing genes is going to have on our health in the future, and in finding cures for a number of deadly diseases.  This became front page news not just in business and medical journals, but entertainment publications as well following the news that Angelina Jolie had decided to have a double mastectomy to reduce her risk of getting breast cancer from about 95% to roughly 5%.  This caused a flurry of women to call their physician to find out how to see if they have the BRCA1 gene, which puts women at extremely high risk of getting ovarian cancer and invasive breast cancer.  Many, however, got sticker shock when they found out that only one company has the rights to the gene test (Myriad Genetics) and the price can be up to $4,000.  Is it worth it?  Well, thankfully most will find it's a covered test, but not everyone.  Only about 1 in 400 women have BRCA1 or BRCA2, and only about 5%-10% of breast cancer cases are gene related.  But if you are in that minority, you would certainly want to know.  There was a story in the New York Times by a molecular scientist who said he could do DNA sequencing on 20,000 genes for about $1,000 or 5 cents per gene, and another company 23andMe charges $99 to test for gene variants that put you at high risk for 120 diseases.  Thankfully, most insurance companies and Medicare and Medi-Cal pays for the Myriad Genetics test, but this price-tag highlights the fact that those without insurance continue to be in a pickle when it comes to health issues.  There is a case before the U.S. Supreme Court which hasn't been decided yet which focuses on whether it's fair for companies like Myriad to control gene tests and make huge profits.  Clearly, monopolies aren't good for the general public.  I remember when the cable companies were monopolies and provided absolutely terrible service at a high-price until companies like DIRECTV and DISH Network entered the market and customers got more bang for the buck because of competition.  This may require some type of government intervention to make sure everyone has access to medical including testing for genes which can cause fatal diseases.

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It's hard to believe, but after all of the misery that this state has suffered through with the recent budget crisis, the state's independent budget analyst on Friday announced that we are projected to take in $3.2 billion more in revenue for the remainder of this year and through the 2013-2014 budget than the figures Governor Brown relied upon.  Part of the reason for the revised forecast is the fact that the stock market has been booming, so residents are going to have to pay more in capital gains taxes this year than what was originally projected.  I hope some of it goes back to seniors programs which have been cut, although the budget office is saying most of the money will have to go back to the schools.  Although that's a worthwhile cause, the money should be spread around amongst the numerous programs which have been cut, including many senior subsidies. Some Democrats in the state senate are pushing Governor Brown to restore adult dental care for the poor and mental health care, and I hope they are successful.  The Medi-Cal reimbursement rate cut of 10% should also be reversed, in my opinion.  There are so few doctors which currently take Medi-Cal and this flurry of cuts we have seen only drives more doctors to refuse to take the insurance.  With the Affordable Care Act (health care reform) putting many more people on Medi-Cal, it will be critical to find physicians who take the insurance.

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Employees of the city of Pacific Grove got good news last week when a Monterey Superior Court judge ruled a 2010 vote to put a 10% cap on contributions towards employees pensions is unconstitutional.  The rule was enacted by the City Council but challenged by the Pacific Grove Police Officers Association and Police Management Association.  The judge also invalidated a voter-approved measure which would have put the pension cap in synch with the city charter.  Although it's good news for employees headed for retirement, it's definitely bad news for the city which will have to struggle with the additional burden this will put on their budget.  It's also likely to make for prickly negotiations between the city and the police officers union, whose contract is currently up for renegotiation.

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