Letters From The Heart

Letter writing is becoming a lost art, one worth reviving. It is a soothing process and a way to soothe hurt. We've talked about reconciliation recently, and I would be the first to acknowledge how daunting it is to reconcile with people, face to face. Sometimes the words just won't come in conversation. The timing is not right. There is little privacy to say what needs to be said. The words will not come, or they come in a rush, all jumbled or not just right. " Stand up straight," Mother would say. Speak clearly, no stammering, no muttering, no hesitation!" It's a tall order, especially in an emotionally charged situation.

There is tremendous healing power in letter writing, both for the writer and for the reader.  For the reader, much like a cherished book, a heartwarming letter or card can be a treasure, kept and reread. Have you encountered someone in your life, who, minus, face-to-face inhibition, writes vicious, anonymous notes or letters? It is abuse of a powerful medium; a medium never to underestimate. Personally I do not have a good e-mail persona. My e-mails come across as clipped and too strongly worded. Texts really don't get it, either. In fact texting is becoming increasingly less popular, according to recent statistical studies.

If, like me, you are better off thinking and organizing your thoughts, before speaking, letter writing may be the best way to speak from the heart. Finding or creating just the right card can add creativity to the process. Imagery brings personality to an ordinary letter. The wording does not have to be fancy, nor does the handwriting. I once asked a friend what to write to my former voice teacher, who had been a wonderful influence in my life. My friend suggested three words, I love you.

The words, I am sorry, work well, too. Reconciling family differences can be more difficult than negotiating a treaty with a foreign government. Here are a few rules to consider. First take accountability for your part in a problem or impasse. Don't rehash how hurt or angry you were, or how wrongly you were treated.  Understand that some situations call for more than diplomacy. Some situations call for "a hero," in the words of Dr. Phil. To me, that is someone who does not focus on being right or wrong. Rather it is the person who can see past "sides," who can apologize or acknowledge the hurt and anger of another person or other people. Pen in hand, offer peace, not blame; no-one will be the worse for it.

If you wonder what you can possibly contribute to love and healing in a larger context, write to a perfect stranger. A young New Yorker, Hanna Brencher started an International movement, based on writing "love letters." The back story of how Hanna started the movement is on her website. Living alone in the City, a new college graduate, she found herself isolated and depressed.
https://moreloveletters.squarespace.com

...eventually (my) thoughts morphed into letters and I found myself myself ripping the letters out and leaving them all over New York City for people to find. I left them everywhere: Coffee shops. Libraries. Coat pockets in department stores. I liked to imagine who might find those letters.

Somehow that idea took on a life of its own after I blogged about it. My inbox was filled with the most heartbreaking stories I’ve ever encountered after I published a simple question on my blog: Do you need someone to write you a love letter today? Just ask. -Hanna Brencher

Become a letter writer. It requires slowing down a little, putting a bit more creativity and care into communicating. Become one of Hanna's letter writers. Either or both, will do your heart good.

Global, Permanent War?

On approaching the Big 75, I cannot say it is something I achieved. It happens. Because I have lived my life as a citizen of the United States, I know how fortunate I have been. I am lucky never to have been detained, questioned, arrested or tried anywhere outside of this country. Growing up as a U.S. career military officer's daughter, I was a privileged child. Granted, family life in the military is never simple, nor free from pitfalls. All else aside, even in harm's way, I was part of a peculiarly consistent, if regimented, life.

I was raised to be absolutely loyal to my Country, have always been proud of my Country. Once Russia launched Sputnik; the National Defense Education Act was signed into law. A Foreign Language major, I was eligible to compete for educational funding through the Act. Once again my country gave me an invaluable gift.  In what seemed months, rather than years, however, I was teaching high school students, who went off to war. The death toll prompted me to join in the protest movement early. The televised horrors of war crept into our homes and lives relentlessly. In our minds it was a vile, dirty, business. A family of  right wing Texans, moved in next door, the family cadillac, plastered with American flags and stickers. Put off by the flag-waving neighbors, I had only begun to recognize the implications of turning a blind eye to injustice at home and abroad.

Today I watched in renewed horror, as we played  a documentary film, "Dirty Wars." I am a year late in viewing the film, and in reading the book by Jeremy Scahill, which preceded the documentary. Both are extremely revealing,  even if you believe you have been reasonably well informed. First images of a Yemeni family and friends, slaughtered, right down to pregnant women and infants, assault the senses. Next is the realization that we are not at war with Yemen. We massacred 46 civilian family and friends for gathering to celebrate a wedding. If all this were not enough, we see a Yemeni journalist detained upon the direct orders of President Obama. (This, rather than permit him to disclose the details of the botched operation in his country.) It gets worse.

http://dirtywars.org/the-film

Something horrifying has emerged in the US permanent war: death and assassinations for which there is no due process nor accountability, and all too often no "within the margin of error" justification except that the government and military are able to get away with their actions. There are no public checks and balances. Whistleblowers are prosecuted and jailed at a faster rate under the Obama administrations than under the George W. Bush administrations. ~Mark Karlin, "Truthout"

What have we been telling ourselves to justify unbridled presidential powers and the emergence of JSOC, the Joint Special Operations Command? The implications of JSOC's powers and its actions, combined with those of President Obama and the CIA, are staggering. The War on Terror is global and ongoing. The U. S. is engaging in covert operations whenever and wherever. Whether you believe it or not, we have entered an era of zero accountability to the People of the United States, and it is not merely driven by the ownership of the government by the wealthy. 

http://www.theguardian.com/commentisfree/2013/mar/31/dirty-wars-terrorism-victims

Forgiveness and Reconciliation

Siblings!

Long ago I read "The Five Wishes" booklet, cover to cover. I'd read the critics' remarks, but not the booklet. For anyone who does not know, it is a booklet intended to provide a living will for people who would like to use it, and who live in one of forty-two states in the U.S. that accept it as a legal instrument. For many people, it is a helpful guide, particularly, for end-of-life issues. One of the questions it touches upon is forgiveness, but I don't believe the author(s) were addressing forgiveness in the context of religion. Rather it was in the context of reconciliation. You be the judge:

http://www.fivewishes.org. 

It seems to me there is generally a spiritual component to death, even sudden death, and dying. Regardless ... there are choices to be made.

Reconciliation with family members (and of family members) brings peace to many people facing death. For the living forgiveness is an everyday challenge, one we handle with varying degrees of success. Let's be clear. We are daily confronted with evil, with acts we do not consider worthy of forgiveness. What is your personal threshold for forgiving? Is it divorced from condemning certain behaviors, from forgetting?

Knowing can be a curse on a person's life. I'd traded in a pack of lies for a pack of truth, and I didn't know which one was heavier. Which one took the most strength to carry around? It was a ridiculous question, though, because once you know the truth, you can't ever go back and pick up your suitcase of lies. Heavier or not, the truth is yours now.  -Sue Monk Kidd, The Secret Life of Bees 


Withholding forgiveness can also be a curse on a person's life; it so often goes hand in hand with selective memory. As a parent my adult children's grudge matches overwhelm me with sorrow and a sense of helplessness. One thing I know, however, just as self-care comes before caregiving, forgiving oneself is key to forgiving another. 

With no siblings, living the military life, I knew how to adapt to nearly any environment, as well as how to handle bullies. One thing about moving constantly; it obviates the need to forgive classmates, friends or mean neighbor kids. For me, that left family, to provide role models. That was not to happen. Family did not speak to family. In speaking of other family members, there was plenty of judgment, but people tended not to reconcile.  If Christ's admonition of forgiving one's brother seven times seven hundred, does not speak to us, we can, at least, heal ourselves. "I forgive myself, not to say I am unaware of my faults, nor of misjudgments and consequent errors. Nor must I forget what I have learned from others."

Clinically depressed, I began mindful meditation in mid-life, as a single parent. Nothing else had helped, including crisis intervention and three years of psychoanalysis. Part of my meditation practice was to forgive, starting with myself. It proved to be a game changer, albeit subtle and gradual. I had been estranged from my mother for several years, when she died of a massive stroke. I had married two dysfunctional men, staying in the second marriage overlong. In the same timeframe I relinquished my profession. To say I was "on the ropes," would have been to understate. Part of my journey has been rebuilding, again and again, from ashes.

We have, in the life of Nelson Mandela, a model for forgiveness and reconciliation. His autobiography, Long Walk To Freedom, is a journey worth taking. It speaks to evil and to forgiving what seems unforgivable. Now, when I err, the first question is what to take away, along with whom and what to leave behind. Meanwhile I work on forgiving constantly; it is not a sometime practice.

U Is For Underestimated

A little Medication With That?

"Underestimated, under-identified, under-diagnosed and under-treated" are the terms the National Council on Alcoholism and Drug Dependence (NCADD) has used to describe the substance abuse epidemic among older Americans. An estimated 4 out of 5 elders currently being treated for the abuse of prescription drugs have been identified as alcohol dependent. The same agency estimates nearly half the residents of nursing homes are alcoholics. Of these, four in five abuse other substances. The agency projects opioid abuse will double to 3.5 million by 2020. As they reach retirement age, Baby Boomers are expected to represent a tsunami of substance abusers, due in part, to more permissive attitudes toward substance use.   

     "Overprescribed," by the way, was not among the terms NCADD used, nor did the Centers For Medicare And Medicaid Services (CMS.) The agency refers to prescription drug "over-utilization," and has proposed new protocols: "to protect Medicare beneficiaries and the Medicare Trust fund from the harm and damaging effects associated with prescription drug abuse." I would go much farther, and say, "use." 

What fascinates me about addiction and obsessive behavior is that people would choose an altered state of consciousness that's toxic and ostensibly destroys most aspects of your normal life, because for a brief moment you feel okay. -Moby

     In any case CMS wants Part D beneficiaries with "potential opioid or acetaminophen overuse, identified (presumably by medical providers.) Next would be to implement "appropriate controls" on these drugs for identified beneficiaries." -This seems to me punishing patients for using medications their physicians are eager to prescribe. It utterly circumvents the question of responsibility in marketing pharmaceuticals, both to medical professionals and the public. 
     The agency says it will employ data analysis to identify prescribers and pharmacies that may be engaged in fraudulent or abusive activities. Hmmmm, this would be a monumental task, considering how widespread the exploitive tactics are. CMS wants to use its data to guide its anti-fraud efforts, share results with Part D plan sponsors, law enforcement agencies, pharmacy and physician licensing boards, alluding to joint efforts to combat fraud and abuse.A key provision of the proposed rules would require Part D prescribers to enroll in Medicare. CMS believes this will ensure Part D drugs are prescribed only by qualified individuals ... fine, in theory. Additionally CMS seeks authority to revoke a physician's or eligible professional's Medicare enrollment if:

• The agency determines he or she has a pattern of prescribing Part D drugs that is abusive (i.e., it represents a threat to the health and safety of Medicare beneficiaries or otherwise fails to meet Medicare requirements.) 
• The DEA has revoked or suspended a physician's DEA Certificate of Registration.
• The licensing or administrative body for any state has curtailed a physician's or professional practice's ability to prescribe drugs.

Yet another proposed rule would provide CMS, its antifraud contractors, and other oversight agencies the ability to request and collect information directly from pharmacy benefit managers, pharmacies, and other downstream entities that contract or subcontract with Part D sponsors to administer the Medicare prescription drug benefit. The provision is designed to improve the investigative process, according to CMS.
Approximately a year ago CMS implemented the OMS (Overutilization Monitoring System) to combat Part D fraud and abuse. The agency reports a substantial reduction in the number of acetaminophen and opioid overutilizers in Medicare Part D."  We're waiting, but breathing all the while, for outcomes. Patient-oriented solutions ... that's another topic altogether. 

There is some hope that less expensive rehabilitation is becoming available. A drug in the form of a patch shows promise -- it is a Naltrexone patch. Naltrexone is already in use to treat alcohol addiction. In pill or injectable form, and under a number of brand names, it acts to prevent recidivism. It is also, interestingly, an opiate receptor antagonist, in other words, an individual who uses opiates will not become euphoric. It helps people addicted to opiates rapidly detoxify.

Be mindful my friend, of accountability, as it relates to choice. Preventing a problem is so much better than solving a problem through the backdoor.

Dances With Dogs

Cookie

      We have a family acquaintance, who has two Old English Mastiffs, a male and a female. Not to worry. The lady has the land and the financial means to support and protect her animals. Someday she would like to breed the pair. All good. Here is what I want to say to her. To breed mastiffs any sane owner would retire from his/her career. The government will not give FMLA leave, which would be the only other alternative. Next, once your female has produced a litter or two of fine puppies, have her spayed. Have your female spayed with as little delay as humanly possible.  
     Please pay attention to my story, because it is a cautionary tale. Not all of us have pedigreed dogs. I have a creeping feeling those who have dogs free of inbreeding, are the more fortunate among us. Your mutt is probably rocket scientist material, by comparison to many purebreds. My gorgeous, pedigreed, Irish setter, Mike, was a good example. Outside of field work, where his intelligence was nothing short of phenomenal, he was sweet, but goofy. When I lost Mike, my entire world collapsed. I wanted nothing to do with dogs for decades, outside of rescuing a young Labrador from a downtown planter box. I could not keep him, but he eventually went to an excellent home.
     More decades passed without pets in my life. Eventually, though, I bought a tiny puppy. The breeder, my neighbor, was in the end stage of HIV/AIDS. Unprepared though I was, my little foundling  taught me all I needed to know about terriers. I named her Cookie, after my temperamental Irish mother. I adored my little dog, but found that part of the territory was genetic defect, in Cookie's case,  a collapsing trachea. Nor had she been spayed, when I bought her, because she was a show quality bitch. 
     Spay surgery seemed a poor choice, given Cookie's choking episodes. I was worried, however, about disease. We went from one vet to another. A particular doctor seemed an excellent choice. She specialized in toy breeds, and owned a Yorkshire terrier female.  In her opinion Pyometra would be something worrisome, as would breast cancer. However, she  feels  Pyometra is an uncommon canine killer. She is not alone in that assessment. Also called Stump Pyometra, even veterinary colleges don't seem to agree about how common it is. So the good lady advised me to simply be a responsible owner (i.e., to breed only by intention.) No problem -- my silky did not like other dogs, particularly males. She did not care for strangers or their children, unless they had really good manners. She was not above teaching people how to behave. My question was how one would manage to breed silky terriers, intentionally or otherwise!
     At 13 years, Cookie was a fierce beauty and in glowing health. What an engaging little creature, smart and sassy! A famous lady in her own right, people everywhere in Denver recognized her, many of whom could not recall my name! Not long after the photo above was taken, I came home from a meeting, to find Cookie quite ill. It was not alarming, but she was having a digestive issue, and seemed uneasy. It was late, so I waited for morning to call the veterinarian's office. Dr. Smith was unavailable. I began to panic, ultimately reaching a vet who would make a house call. By the time he arrived, tiny Cookie was overwhelmed by infection, due to Pyometra. Her organs were shutting down. 
     Dr. Larry Magnuson had to euthanize Cookie, a tranquil, if untimely, death. I have never recovered ... not really. Dr. Manuson made a memorial contribution in Cookie's name to Pyometra research. I've made donations to rescues in her name. Meanwhile everything I have read on the subject of spaying and Pyometra contradicts what my "favorite" veterinarian told me. It is not so uncommon, as a bitch ages. Nor does it matter whether she has or has not produced litters. Don't take the chance. This is a painful, overwhelming disease. It does not matter the breed or size of the bitch. Do not delay. Spay your animal, because, if she dies of this condition, you will be heartbroken.
      Spaying and neutering are absolutely necessary for the health of pets. That said, I encounter so many owners who don't take care of this. I find myself wanting to say, "Come on, you know you aren't going to show or breed this animal!" I stay silent most of the time, because it is not my decision ... none of my business. 
     If you do not have the stomach for having the surgery (albeit routine and very safe) performed, adopt. Adopt anyway! Never think you cannot adopt a pedigreed companion, if that is what you desire. I helped a friend find an apricot poodle from an online source. She insisted it was the only breed she had ever owned, or wanted to own. She is ecstatic, and the poodle, thriving. A huge bonus of adoption is that the pet will have been ( or will be ) neutered or spayed, as a condition of ownership. Buying a dog, from a breeder you don't know personally, is not a good idea, but buying from a store is a horrible idea. As a consumer, a prospective pet owner, you play a vital role in preventing animal cruelty. 

-Me? I'm still dancing with terriers. My dog is a toy fox terrier, surprisingly calm and generous by nature.    

That Was Then ...

   

Signing Social Security Act

     Unlike a certain Supreme Court Justice, before discussing the pros and cons of any legislation, I like to read it. I want to know, not only the verbiage, but the spirit of the legislation. It is always a good idea to know the opposition's arguments ... so here goes. I'll revisit Social Security and the Roosevelt Administration's intentions, to begin yet another discussion about "fixing" Social Security.
     What could Franklin Delano Roosevelt have been thinking? To say he was a fiscal conservative does not go quite far enough. Roosevelt was a complicated man; as the Nation's President in 1935, he was faced with a hornet's nest of socio-economic issues. The citizenry was still recovering from the Great Depression and the Dust Bowl years, with millions of Americans dispossessed and/or unemployed. Anyone running for the highest office in the land would have to offer creative solutions for the immediate present and for the future. Here is a partial quote from President Roosevelt, upon signing the Social Security Act:

...This social security measure gives at least some protection to thirty millions of our citizens who will reap direct benefits through unemployment compensation, through old-age pensions and through increased services for the protection of children and the prevention of ill health.
   We can never insure one hundred percent of the population against one hundred percent of the hazards and vicissitudes of life, but we have tried to frame a law which will give some measure of protection to the average citizen and to his family against the loss of a job and against poverty-ridden old age.

     In looking at the numbered photo of those present at the signing of the Act, it is important to note that some of these legislators were fiscal conservatives, who had voiced opposition to the legislation. They stepped up and did the right thing; they compromised. I believe they showed the courage of their convictions (and of FDR's conviction,) something exceedingly rare in today's political climate. (See the Social Security Administration's history site, to see who was who at the signing: http://www.ssa.gov/history/)
     While the vicissitudes of life remain unchanged, the landscape has changed, as has the legislation. To suggest Social Security cannot or should not change again, is to deny history and avoid reality. One reality check came to millions of Americans in the form of what I call the Big Lies; 1) the Social Security Trust is backed by worthless securities and 2) the Trust is broke. The Social Security Trust is funded by United States Treasury Bonds; the bonds are not liquefiable, true; however, they are, by no means, worthless. The reason for funding the trust with treasury bonds is the same as the reason many Americans choose to invest in them. Interest on the bonds has remained reliable. More myths abound in the political rhetoric concerning Social Security, never mind generalities that do nothing to accurately spell out the issues. However one problem looms large on the horizon. It pertains to disabled Social Security beneficiaries (SSI recipients,) as discussed in the 2014 Social Security Trustees' Report: "Social Security’s Disability Insurance (DI) program satisfies neither the Trustees’ long-range test of close actuarial balance nor their short-range test of financial adequacy and faces the most immediate financing shortfall of any of the separate trust funds." Should you feel the need for a translation, the effect will be reductions in benefits to SSI beneficiaries and prospective beneficiaries by 2016. May I say that again? Substantial cuts in disability benefits will take effect in 2016, failing action on the part of Congress and the Senate. THE CLOCK IS TICKING. Am I screaming?
     What can be done to "fix" Social Security, if we have legislators who will act on behalf of both beneficiaries taxpayers? (Keep in mind, a certain amount of courage and a number of compromises will be required. Neither the courage of conviction to do what is right, nor the ability to compromise and garner bipartisan support is easily found in Washington D.C. these days.) Here is some of the change experts recommend:

• Incorporate all of Social Security into the disability insurance (SSI.) That would combine the funds, changing the window of insolvency for SSI to 2033 (per the 2013 Trustees.) This would ensure benefits for something over eleven million disabled workers.
• Lift or eliminate the payroll tax cap, now fixed at $117,000. This change packs a large dollar wallop for the fund.
• Increase the payroll taxes that fund Social Security and Medicare, incorporating contributions of employees with those of employers and a modest (approximately) 3 percent for most taxpayers.
• Raise the retirement age for collecting full Social Security benefits. The retirement age is currently set at 67 for Americans born in 1960 and beyond. 
• Means test Social Security. This would reduce or eliminate Social Security benefits for people who have other incomes above a certain amount. 

Meanwhile it is important to know other measures actually have worked in certain parts of the country. I'll try to tackle this topic in subsequent posts.

Hysteria Over Ebola

Rainforest Development

The world of worriers has a new face. It is the face of the Ebola virus, and, yes, Ebola evolved long ago into an airborne disease, right here in the U.S. Certain primates in a federal lab and holding facility in Reston, Virginia, died of what was found to be Ebola. Workers in the facility became infected, but with a less deadly form of Ebola. Researchers believed the virus was spread to the workers by means of the building's ventilation system, but had mutated into a flu-like illness, Ebola Reston. The discovery of Ebola Reston dates back a quarter century. 

      There are five known strains of Ebola, including Reston, and outbreaks of the more serious strains have historically been confined to rainforest areas of Africa. The original host species is the fruit bat. Imagine, for a moment, the numbers of African fruit bats!  In it's deadlier forms Ebola is greatly to be feared, because, aside from nasty, painful, symptoms and 90% fatality,  Ebola has a long incubation period (21 days.) 

     Fear, as opposed to outright hysteria, is a natural reaction. Does anyone else, though, find it remarkable that people worldwide have been so rapid to spread hysteria regarding a potential Ebola outbreak on American soil?  On the other hand, we have been less than slow to react to the effects of Earth's load of toxic waste caused by overpopulation (not to mention obscene levels of  consumption in the developed world.)                                

     Understanding viral disease may help to dispel, if not the fear of Ebola, some of the nonsense we hear promulgated by ignorant politicians and in various media. Viruses are the natural world's supreme opportunists, so, yes, a virus infects rapidly, reproducing in overwhelming numbers; this allows a viral disease to skip from one species and one victim to the next with ferocious efficiency. We know the spread of Ebola to humans in West Africa has been assisted by the development of roads and places of human habitation; workers in remote areas were exposed by animal species, such as primates. Human to human transmission was exacerbated by traditional African burial and by lack of knowledge and consequent lack of precautions in medical facilities.

Here is link to Ebola facts from WHO (the World Health Organization:)

http://www.who.int/mediacentre/factsheets/fs103/en/

      
...the chief cause for the impending collapse of the world - the cause sufficient in and by itself - is the enormous growth of the human population: the human flood. The worst enemy of life is too much life: the excess of human life. ― Pentti Linkola,  Can Life Prevail - A Radical Approach to the Environmental Crisis     
  

     As to whether Ebola was originally developed as a biological weapon by the United States, or is now part of our weapons arsenal, I'd be hesitant to speculate. More likely I would be very concerned about the CDC, which undoubtedly  possesses sample strains of deadly Ebola. The fear is whether the CDC is worthy of implicit trust, given recent discoveries of neglected Anthrax samples, to mention just one messy incident.

      Preventing Ebola from entering the United States is a non-issue. The possibility of global pandemic is more to be feared. Among other aspects of the problem is International air travel. Travelers are not screened for viral diseases. I have to wonder whether it would even be possible, to do so. In any event, it would be preposterous to suggest a country might seal itself off from emerging infectious disease ... even an exceedingly virulent disease with high mortality. 

      What is there to take away from all this? In discussing a potential pandemic we are discussing human overpopulation and the exploitation of remote, wild places. Immigrants entering the U.S. by means of the southern border aren't likely to bring us Ebola (not unless they are bringing African monkeys in tow.) 

      This is really an issue of an immutable rule of nature; life will find a way. Humans, my friends, are a very badly behaved species, spreading like cancer. The concept that mankind can and, possibly, will be sloughed off the planet, like so many bad cells, offends the sensibilities. After all so many religions proclaim the supremacy of humankind. Believe me, religion aside, the issues are  worthy of humility of thought and a factual, not to say, mindful, approach.

Not Because I Am A Conservative

The Junior League Ball

     The oldest argument in the world promulgates the notion that "the poor will always be among us," and the poor, somehow, deserve poverty. It is a singularly American view, one that issues from our protestant roots. As Mother would say, "What did you do to deserve this?" As for the offspring of impoverished people, they inherit a legacy of misery ... an unfortunate, but immutable reality. The argument goes on to characterize the poor as incapable of self-sufficiency, mature judgment and accountability (i.e., they are not adults.) In a post yesterday by a conservative rag, a well-heeled woman pronounces herself fiscally responsible. I'll call her Ms. Right. She should provide, she declares, her own necessities, including contraceptives. It is not because she is a conservative, she proclaims. Rather it is because she is an adult. In other words, vulnerable populations are to be treated as children; however, deserve neither public assistance, nor  empowerment.
     Looking closely at her portrait, Ms. Right is neither very young, nor middle-aged. Ms. Right is a marketable employment commodity (translation: youngish, attractive, presentable, white, skilled, manageable ... in somewhat this order.) She is either married or marriageable. If she is married and a mother, Ms. Right is confident she will always have the means to provide for the kiddies. I can say this stuff, because I am white, educated, from an upper middle class military officer's family. There are one or two differences, however. Ms. Right may or may not have traveled to third world countries, but has certainly never ventured outside her (at least) 4 star hotel compound. She's definitely never soiled her pristine attire in a refugee center or camp. She volunteers alright, but I guarantee she's never touched a crack baby or mopped up after an AIDS patient.

"But then it is easy, too easy, to sermonize about the dangers of paternalism and the need to take responsibility for our own lives, from the comfort of our couch in our safe and sanitary home. Aren't we, those who live in the rich world, the constant beneficiaries of a paternalism now so thoroughly embedded into the system that we hardly notice it?"―Abhijit V. Banerjee, Poor Economics: A Radical Rethinking of the Way to Fight Global Poverty  
 
     Here at home Ms. Right chooses to ignore the suffering of other women and their children, although their plight is right under her nose. She does not see herself exhausted on a daily basis, holding two or three jobs. After all she has made judicious choices, and cannot envision being abandoned by a husband. Ms. right does not anticipate ever paying a hefty mortgage and bills, while feeding hungry children. In her wildest imagination she would never have to run from an abuser or a mentally ill relative, especially not with her little ones in tow. Equally myopic concerning the future, she cannot conceive of retirement without Mr. Right's earnings, living on Social Security benefits. 
     Here's the thing. It would take a lifetime to fill the gaps in Ms. Right's understanding. She may never awaken to her first thought, until it is too late. There is no hatred or judgment in me, especially not for Ms. Right. Hell, I lived next-door to her, belonged to Junior League with her, volunteered to be her charity's publicity chair. We did not chat over the back fence, don't get me wrong. But, we were civil, even, cordial. That is what we were raised to be. 
     Never mind that Mr. Right may suddenly, one day, become bored with marriage, may need to explore his sexuality, although we would have thought he'd already done so. He is equally unlikely, in her mind, to suddenly drop dead, leaving insufficient arrangements for his wife and children. Like Scarlet O'Hara, we shall worry about that another day. In any case, had I remained married and living in the suburbs of Boulder, Colorado, U.S.A., we'd be peers.
     At this point in my life, having been abused, abandoned, displaced, poor and distressed for myself and my children, I see Ms. Right as merely a dupe. Why on earth would Mrs. Right not stay invested in her comfortable life? Why would she not wish to protect her privileged status and that of her peers. Happy life, happy wife, isn't that the expression? 
     All I ask is an end to Ms. Right permitting the use of her image and words, to hold women like herself above women whose realities they cannot begin to grasp. Ah, but, perhaps you will think me childish in this naive quest.

Organic Panache

   

I do not live in one of Denver's toney neighborhoods, but visit upscale Cherry Creek occasionally, to shop. I like the Whole Foods store there. People like me do not  provide Whole Foods with its captive, well-to-do, customer base. Ordinarily I wouldn't give momentary notice to the price the wealthy pay for the panache of organic, gluten-free, grass fed baloney. 
     I shop at Whole Foods despite the "Whole Paycheck" reputation, not because my lifestyle must set me apart from elders shuffling down the aisles of Walmart. It is because Whole Foods spread itself all over Boulder, Colorado, like cage-free eggs on a frat house. Whole Foods promised, at the time, it would bring a more competitive marketplace for organics. In fact, like the invasion of Starbucks, it left virtually no alternatives for consumers.
     Change is upon us, people, and I am ready! Never a hard- core Whole Foods shopper, I welcome Trader Joe to Denver.  As for Whole Foods, its corporate management is determined to disenchant. Now the chain has been fined for cheating California consumers, and some of the price inflating methods have a familiar ring. Here's a link to the Reuters/CNBC coverage:  http://www.cnbc.com/id/101787636#.
     A fine of $80,000 is teensy for Whole Foods, but this incident adds itself to the revelation that Whole Foods uses producers in China for it's 365 Organic brand. Corporate protestations that Whole Foods carefully monitors its Chinese producers weren't comforting. 
       The days of organic exclusivity are numbered. Established companies are trying a new business model resulting in widespread availability of organics. Discount outlets will be carrying organic and some gluten-free cookies. Even better, these rise above the Sawdust Special of bygone years!
   

The only way to make sense out of change is to plunge into it, move with it, and join the dance. Alan Watts

The Governor, Some Kids and Gun Control

 

     Colorado Governor Hickenlooper has dipped his big toe in pretty hot water. His vacillation and outright lying concerning gun control legislation do not elicit amazement on my part. I'll explain. Though unrelated to Colorado gun violence, this is not the first time I've been aware of the man's lack of integrity.
     How we do rely on image in electing public officials, and what boyishness John Hickenlooper exudes! He fits right into what I'd characterize as The Boulder Scene, geeky, bland, overly sincere, firmly planted on moral high ground.  
     Nonetheless our Gov can certainly astonish people. His decision to grant a reprieve in the case of Nathan Dunlap, the Chucky Cheese murderer, smarted. In one swell foop, as the saying goes, he snatched closure (not to mention justice for their dead) from families, friends and a community. Mr. Hickenlooper took the high ground, characterizing the death penalty as inherently flawed. Righto, Sir, and I'd characterize Nathan Dunlap as craven and deliberate. Although the Nathan Dunlap matter drew national attention, the uproar soon died down.

 A little sincerity is a dangerous thing, and a great deal of it is absolutely fatal. -Oscar Wilde    

     A minor scandal, while Hickenlooper was the Mayor of Denver, drew brief local attention. The mini-scandal did not involve the Mayor directly, 'though it did offer me a brief look into his character. Denver's Channel 7 aired a report in early 2005 concerning juvenile offenders in Denver County. It seemed the youngsters were being removed from school to perform community service projects. The projects, however, served no educational purpose. Conflict of interest came into play. The juvenile work crew cleaned up after a party, presumably a drunken affair, at an Elk's Club. Oooops, two Sheriff's deputies belonged to the Club. Although the Order of Elks is a non-profit, its members could easily have cleaned the club after themselves or afforded to have the work done.  
     A former Juvenile Probation Supervisor, I'd managed work crews in actual community service projects. Our clients were assigned, as a third-strike measure (i.e., each client had been convicted of two prior offenses. None was in school, because all had been suspended indefinitely, expelled or had dropped out of school.) Clients were paid to work. Pay not used for restitution went directly into individual trust accounts for future educational needs. Every assignment was dedicated to preparing clients to complete probation, and return to community. The program attempted to ready clients for work and further education, or both. It was, by no means, a perfect program, but considerably ahead of its time.
     When I wrote Mayor Hickenlooper, asking him to comment on the educational and remedial values of Denver's juvenile offender work crews, he couldn't be bothered. His reply was non-responsive. In any event the uproar was short-lived, although the Denver Sheriff took some flak. In spite of his indifference, the Mayor publicly sounded sincere in his desire to see the right thing done, blah, blah, blah, blah, blah. 
     Since Mr. Sincerity has become our Governor, I've written more than once to his Consumer Affairs people, and to the Governor himself, to no avail. Colorado and federal taxpayers continue to pay for the Department of Human Services computer system, which has been seriously flawed since its inception. Backdoor fixes do not work; the experts all agree. That fact has not staunched the money hemorrhage, nor has it improved the lives of Colorado's low income households.
     In recent years CDHS erroneously denied 68.7 per cent of applicant households food assistance, terminating or suspending them from benefits. People, that is nearly 70 per cent. Yet the funding requests keep rollin' in, unchecked, and Director Bicha is keeping his job. 
     Meanwhile no DDHS client initiates a call to a technician. One phone number is available to clients, that of the Customer Service Call Center. Wait times are outlandish, sometimes hours long (as are wait times for personal interviews.) People re-certifying for benefits or reporting changes to their households are routinely booted. Clients who receive "snail mail" from the Department, do not get notices timely, often finding the window for appeal expired, before the notice arrived. Worse yet, DDHS appears to use its processes to lighten client and budgetary loads. Whether this is true or not, Colorado has been aptly termed, draconian by struggling citizens.      
     Every one of these instances should have drawn a rapid response from the Mayor-turned-Governor and his staff. Doesn't it seem a bit late in the game for Colorado voters to catch on? 

No Bananas Today

For so many of America's elders, hunger already looms large. The fact is, the Cost of Living Indices, fail to accurately reflect rises in the cost of necessities, such as food. According to national news this morning, long-predicted spikes in the cost of food are real, and they are here. Nor is the high price of groceries restricted to luxury items like coffee, butter, steak and the like. Now for the double whammy. Low-income households throughout the country, have also seen SNAP benefits slashed, often, to less than half last year's allotment. Sooooo I would ask legislators, in light of the "spike" at check stands across America, "What is the plan?"

The Social Security Administration actually has a "public policy" branch. Who knew? Here is a link to the policy arguments surrounding the (so-called) annual Cost of Living Increase; do not be surprised, however, to find the dialogue unrealistic, in terms of what you are  experiencing in real time. http://www.ssa.gov/policy/docs/ssb/v67n3/v67n3p73.html 

As we stagger to the grocery store check out lane along with other income-challenged folks, weeping as we pay, all "arguments" become irrelevant. Over the years of the economic downturn, our bunch of bananas shrank, until it would just feed a spider monkey. Imagine day-dreaming about banana pudding, reducing it to banana pudding without bananas, and you almost have it. Of course, there are no vanilla wafers or eggs, so you're stuck with powdered milk. So, now, envision a half-glass of powdered milk with one slice of banana floating, et voila, Chef!

The day hunger is eradicated from the earth there will be the greatest spiritual explosion the world has ever known. Humanity cannot imagine the joy that will burst into the world.- Federico Garcia Lorca

One only need glance at the history of Social Security COLA increases, to observe how bitter partisan politics and false priorities affect us all. Prior to 1975, COLA increases for Social Security recipients were legislated, so recent history begins in 1975. However, the decade beginning in the early 90s saw dramatic decreases in distributions. The most recent decade brought us to years of tiny and zero percentages in distributions. Call me crazy, but I would love to see policy-makers deal with shrinking budgets, enormous bills and greatly lowered government benefits, as do vulnerable citizens. http://www.ssa.gov/oact/cola/colaseries.html

One hears a great deal in social media about hunger abroad and childhood hunger here in the United States. No less tragic is the plight of older Americans, particularly, minorities, women and disabled or "frail" elderly. I want to ask the President of the United States why our government continues to give short shrift, wholesale, to older Americans. The presumption that charities are feeding elders nourishing food is hogwash. 

I can attest to the fact that Charity meals at senior centers are a nightmare, nutritionally, aesthetically, socially ... in every way. Food bank handouts, while they can save lives, are still severely impacted by the economic downturn in this country. (Not to mention, they were never meant to provide adequate nutrition.) Churches, hard-pressed hard-pressed to meet the needs of their own congregations, cannot pick up the slack. Any elder, who has received a monthly box of government commodities, can tell you, a box of powdered and steri-pack milk, canned pears and potatoes, a can of the world's worst chili or "beef stew," a bag of pinto beans, a bag of white rice and some variety of cold cereal, brings as little nutrition as it does joy. Meals on Wheels ... I won't even go there, except to say, school lunches, before reforms were imposed, weren't the only ugly lunches in America. 

Rachel Ray is one of the few celebrities I have ever heard mention hunger as an increasing specter for senior citizens, and I'd like to acknowledge her for paying attention. Often, if we have families, they help pick up the slack, but to the detriment of our self-esteem and their budgets. When families must see after the basic needs of their elder members, they put their, their children's and grandchildren's futures on the line. How can this be right for America? If you agree, please put your money, literally, where your mouth is. 

Speak up, create and join the dialog, contact your legislators directly, and vote, vote, vote! Don't just click on a petition (that's like just standing with your mouth open.) Get doing!

Speaking of Pain

Fibromyalgia is, by all accounts, a punishing disorder. Here, though, is a dilemma. To doubt a another woman who suffers from fibromyalgia, is not merely unkind; it has become politically incorrect. You may well wonder why anyone would doubt or minimize another woman's painful disorder. I admit it is an attitude toward fibromyalgia that stems from recent experience. I have become acquainted with two women, who say they suffer from the ailment. It has not been a pleasant acquaintance. One woman, 50, has been ill with fibromyalgia for a decade. I'll call her Becky. An individual whose illness is her life, Becky is self-involved, entitled and demanding. She's a devout church goer, however, having turned to religion to ease her psychological pain. It is extremely difficult to have a conversation with Becky; although she appears to be a bright woman, her 'fibro' and her church are her sole interests.

The second woman is Becky's friend and my neighbor, Mona. The two have become fast friends. Mona loves to discuss ill health, hers and others'. If you are in pain, however, do not enter the fray. Your drama will never earn the spotlight. If another person has an ingrown toenail, Mona has gas gangrene, and will have to have her foot amputated. Unlike Becky, Mona has interests other than  fibromyalgia. A food fanatic, Mona always has nutritional advice to offer. She is an organic, gluten-free, non-GMO, high fiber, low salt, no sugar, low fat kinda gal. Once Mona befriended Becky, fibromyalgia seemed inevitable.

So, what is the truth, is this shared ailing psychosomatic or sympathetic, or both? I neither choose to speculate, nor to share their pain dialog. I'm not the best at empathizing with these women, but will try to offer kindness, rather than judgement. Others in these women's lives have to stay the course and try to keep sane themselves, but, not me (at least, not me all the time.) In the interests of better understanding of fibromyalgia, however, here is a link to the May Clinic I found helpful:  http://www.mayoclinic.org/diseases-conditions/fibromyalgia/basics/definition/con-20019243

Bad things do happen; how I respond to them defines my character and the quality of my life. I can choose to sit in perpetual sadness, immobilized by the gravity of my loss, or I can choose to rise from the pain and treasure the most precious gift I have - life itself. -Walter AndersonWe have talked about chronic pain and stress management in prior posts, and, in the case of fibromyalgia, it seems particularly important to find and maintain both emotional and physical support. If you suffer the widespread pain and fatigue of fibromyalgia, make a conscious effort not to speak your pain, not in body language, facial expression and not in your conversation. At least try not to speak your pain constantly. The first benefit will be perspective; pain tends to recede with the importance we give it. The second will be a change in our ownership of pain; we can decline to own our pain, in favor of creativity, for example. Relationships will bloom with others who seek, speak and manifest wellness. A pain journal may help; it will not only help you to manage your chronic pain, but, also for care providers, family and friends who need greater understanding: http://pain.about.com/od/livingwithchronicpain/f/pain_journal.htm

Finally I offer a link to a site with practical advice and support for sufferers of fibromyalgia: http://www.cfidsselfhelp.org

Evil Computer

System Evil

Americans are constantly bombarded by blather regarding public assistance funding. The noise takes precedence over the dismal performance of the states in administering programs such as SNAP and Medicaid. I'll avoid the term, "broken system." It would just fall on deaf ears. In any event, broken implies reparable (not to mention, the will to repair.)
     Let's begin with Colorado, my state of residence.  A March 3, 2014 headline in "The Denver Post" read: OFFICIALS WANT MILLIONS TO KEEP UPGRADING TROUBLED COMPUTER SYSTEM. The Colorado Benefits Management System has been and remains, faulty, per Colorado Human Services Executive Director, Reggie Bicha. I'll give him that and, oh, so much more. 
     Here are the findings of the most recent state audit, which found Department of Human Services errors on the rise. The errors include: 1) inappropriate approval of approximately $26 million in food assistance benefits (2012 fiscal year;) 2) Erroneous denial of $11 million in food assistance to deserving applicants/clients, during the same period. This translates to erroneous denial, termination or suspension of benefits to 68.7% of Colorado households found ineligible for food assistance, beginning in fiscal year 2012.
     Here's the bottom line with regard to CMBS and the training to use it. It has cost the State of Colorado $300 million to operate, repair and update CMBS. The most recent state investment of $11 million (coupled with federal funds) resulted in increased system efficiency. This is according to the Governor's Information Technology expert, Kristin Russell. (In the interests of fairness, part of the states investment was used to prepare the State for Affordable Health Care and the associated Connect for Health Colorado.) Meanwhile errors continue to plague the system. More important these errors result in suffering, even, death.
     There is a concept in computer technology about faulty systems. Backdoor repairs do not work. In other words, to repair and update a fundamentally bad system is considered by most computer scientists to be futile. This is particularly true in government. California, for example, has been forced to examine the issue of chronic failures of government information technology projects. http://www.pe.com/opinion/editorials-headlines/20130212-editorial-determine-why-state-computer-projects-fail-routinely.ece   

Failure is not an option. -Confucius 

     Considering the audit error outcomes for the State of Colorado Department of Human services, the problem must go deeper than CMBS. I'll back this statement with personal experience as a client of the Denver Department of Human Services over a decade of misery. I do not use the term consumer, because beneficiaries are not treated as either "underserved" or "consumers." 
     From experience, it is impossible to reach a caseworker at DDHS. Supervisory personnel do not respond to calls from clients. It is nearly impossible, with wait times of an hour, to reach the Customer Service Call Center. There is no telephone number or e-mail listing, by means of which the client may communicate directly with a caseworker. Everything and everyone goes through the overburdened central system. 
The Department requires routine paperwork from clients. I have sent certified mail via USPS that failed to be acknowledged, resulting in the denial of benefits. Faxes have failed. Hand delivered documents with the DDHS date stamp prominently displayed, have gone astray. The most recent hand delivery resulted in February 2014 denials and the disappearance of a SNAP (EBT) distribution February 7. 
     By now, you're wondering whether I saved the documentation with receipts. Yes, without fail. DDHS has reluctantly rectified its errors, in my case, for a decade. Herein lies the second part of the problem. Outgoing mail from the Department is not merely slow; it often reaches recipients after the appeal window has closed, denying the household's right to appeal. Next benefits are seemingly cut forthwith.
     If I sound like a whiner, here's what happened following last year's fiasco. I was denied SNAP benefits, admittedly, due to my own error. I received the letter after my benefits were cut. The appeal window had closed by the time I received the notice. Unaware of the cancelation, got to the cashier at a local Safeway store, could not pay for my groceries with food stamps, nor by another means. A friend bailed me out, and, subsequently waived the debt. Anyone for a dose of extreme humiliation and angst? The popular term is "food insecure."  
This year it has happened again. I walked, waited and took a bus and train to DDHS, to hand-deliver my recertification documents in a blizzard. After I obtained a date stamp, I submitted the documents.
     A week later I receive the accusation and denial. In checking my SNAP benefits, I'd been cut off, before the letter arrived. The issue was subsequently resolved online. When I received a demand for yet another change report in March, I made corrections to some ancient expense information, and noted a $4.00 reduction in my rent, due to a reduction in the energy costs for the tax credit building, where I live. Within another week or so, I received a drastic reduction in food stamps and denial of my Medicaid program. Now I am scheduled to make the commute to DDHS and wait three or four hours to, hopefully meet with a case worker. 
     I lost my medical coverage on a similar occasion. The ground is constantly shifting under my feet, and, I must turn either to family or friends occasionally to cover bare essentials. American citizens and politicians actually believe food banks are the place to turn. That's another myth altogether, one I will not try to rectify today. Add this to a persistent attitude on the part of DDHS management and staff that beneficiaries are cheating, unworthy, ungrateful ... undeserving.
     Fix the attitudes and train people to do more than operate their computers. From the tonnage of paper I receive, generated by DDHS computers, the button pushers are certainly winning the paper war. Make the entire system accessible to clients, not just online, Mr. Bicha! Otherwise, even slaying your computer monster will not help. 
      If the latest round of funding is not approved, will Coloradans be worse off? It is hard to conceive, but we know what runs downhill. As for me, I intend to file a federal complaint for five years of denials relating to Medicaid SHIP.  For me, Colorado SHIP repairs have sailed.

Sex Talk

With so many Baby Boomers single again, do you wonder how (or whether) we should approach dating and marriage? I am, personally, neither elderly nor a female boomer. My elder daughter is too young to be a Boomer, but, in her fifties, she is an extraordinary woman, a ferocious, hard-working single mother. My daughter has raised a handsome, gifted, loyal man without support. So, when she met a nice man recently, I thought, "What a joy. She will have a little light-hearted company." Her newfound friend, however, made classic errors. He rushed her into romance. He began to demand her full attention. He insisted she would learn to change, and accommodate his lifestyle. Three proved to be the charm. She wished him the best, while wishing him gone.

I am profoundly relieved by my daughter's astute reaction. Dating and marriage are distinctly tempting at any age. However, divorce and domestic violence are on the rise among Baby Boomers. Later in life domestic violence is closely related to other potential elder abuse, and the question is one of cooperation among entities that address domestic and elder abuse. In any event, thinking about the potential for things to go right in a relationship goes hand-in-glove with considering the chances things will go amiss.
http://www.ncea.aoa.gov/Resources/Publication/docs/nceaissuebrief.agingnetworkguideDV.pdf

“Impertinent submissive,” Raoul snapped, and his dark brown eyes turned mean. “Nothing new for this one. You're doing a lousy job of bringing her to heel, Marcus.”
“Bring me to heel? Like I'm a dog?” Without thinking, Gabi instinctively yanked away and snapped out, “Bite me.” --Cherise Sinclair, Make Me, Sir

Let me be clear. Sexually transmitted disease is also a significant, growing, issue among people who should know better than to have multiple partners or unprotected sex. Absent the fear of pregnancy, however, many older Americans have multiple partners, and are ignoring the dangers. Have we forgotten about HIV/AIDS and treatment-resistant strains of Syphilis and Gonorrhea? Or, do we choose to believe these are unlikely outcomes among people ostensibly sadder and wiser? Boy, do I have news: http://www.nytimes.com/2014/01/19/opinion/sunday/emanuel-sex-and-the-single-senior.html?_r=0

Spring is here, my dear, so be smart. Most boomers are too smart to participate in the club scene, unless I'm mistaken. If not, it goes without saying; remember the harsh lessons of youth. Do not think about online dating or personal ads. Take your time; meet people in correct contexts, and know who people are. Be extremely cautious about social media. Never trade personal information from the get go ... no exchanging personal addresses. Agree to a luncheon, a cup of coffee. Meet at a public event, by all means, but meet there. See a person long enough to become actual, not virtual, friends, before dating. Once you are dating, take a long think, before taking steps toward combining your life with a partner's life, whether or not this means rushing toward the altar. There is absolutely no such thing as Internet privacy. Everything you post or write online (including your personal e-mails) is public information. We don't have to talk about sexting, I'm reasonably confident, but anything at all you don't want public, do not share in the name of love and romance.

Date for months, not days, before being intimate. Have "the talk" about sexual histories and protection, beforehand. You knew all this as a dating greenhorn, so how come you don't know it now? If you are a woman who finds it awkward to carry, offer and apply condoms get over it! Broach the subjects of sexual history and protection without hemming and hawing. It is a brave new world, ladies and gentlemen. Nobody will care for us, if we do not care for ourselves.

Shared responsibility is a good thing. Individual Responsibility is everything.

Dangerous, Dangerous Places

Empty Too Soon?

     Patient safety, as much as it is discussed in this country, appears to be foundering. What is your take on the progress and enforcement of patient rights? What is working and what is not working? Personally the possibility of surgery does not frighten me nearly much as the possibility of a hospital stay. It is a grim prospect to have even more federal support for hospital services disappear: http://www.mcclatchydc.com/2013/02/28/184476/looming-federal-spending-cuts.html 
The price tag will be preventable deaths, a disproportionate number of which will be deaths of elder patients. Three years ago the HHS Inspector General estimated 180,000 patients per year die as a result of poor hospital care; this estimate is three years old and was conservative in 2010. 
      However, if a close friend or family member requires skilled care outside of home, the risk is magnified by receiving care in a skilled nursing facility. One out of every three of patients will be injured or will die in such a facility. The number is staggering, considering there are 15,000 skilled nursing facilities in this country. Here is a link to the Pro Publica website. The following article concerns skilled nursing facilities. By all accounts, including the estimate of Medicare's Inspector General, 22, 000 injuries per month will occur (more than 1,500 fatal.) According to Medicare nearly sixty per cent of these cases could be prevented:
http://www.propublica.org/article/one-third-of-skilled-nursing-patients-harmed-in-treatment
     Predictably representatives of America's huge, growing, nursing home industry answer by protesting any suggestion that insufficient light shines on the quality of care patients receive in their facilities. They claim government inspection is vigorous. Clearly annual inspections, however vigorous, are ineffectual. One suggestion by Johns Hopkins makes sense. It is to develop metrics to track improvement, as an adjunct or alternative to annual inspection.

 "...a system of long-term care that’s trying to retrofit to be a system for post-acute care. The resources to care for (these patients) and commitment from those sending them from one facility to another haven’t kept pace." -Dr. Jonathan Evans, president of the American Medical Directors Association

     Consumers know nursing facilities have to deal with Medicare itself; it is a given. Medicare payment is a significant part of the problem; it is both insufficient and slow. However, this has not slowed industry growth, so skilled nursing facilities must be profitable. Are nursing homes beleaguered by underpay and overwork? I believe it is likely. Are they places where people work purely for love and concern for their patients? I think this is a gross exaggeration. In any event, it is no consolation to injured or dead patients or their loved ones.
     In addition industry representatives decry abbreviated hospital stays, alluding to the original intent of nursing homes. Their facilities were intended to provide care for medically stable patients, but they currently admit many patients whose hospital stays have been cut short, too short. Assuming this is not buck-passing, the healthcare system is failing miserably to assign joint accountability in what it calls the continuum of care.
      Richard Mallot, Executive Director of New York’s Long Term Care Community Coalition characterizes skilled nursing facilities as "dangerous, dangerous places. " He believes the industry entirely capable of addressing the staggering numbers of medication errors, bedsores (infections) and falls experienced by patients. He does not fault Medicare's standards of care, stating standards of care are poorly enforced.
     As families and friends of patients, we are on our own, left to advocate for people we love. To begin be certain the condition of the patient warrants dismissal from the hospital. Before choosing a care facility, check Pro Publica's Nursing Home Inspect, for information about available skilled nursing facilities: http://projects.propublica.org/nursing-homes/
Once a patient has been admitted to a skilled nursing facility, keep a close watch on the patient, If necessary, enlist a team to be present randomly and regularly for the patient. Never dismiss anything a patient says. Advocate with medical staff, the patient's primary care physician, and nursing home management. Promptly contact an ombudsman, as well as your state's oversight agency, if you deem a problem to be ongoing.