Possible Abuse - What Would You Do?

Here's an interesting scenario:

Client is the Power of Attorney (POA) of an older senior lady "friend".  He is a senior himself who may be financially abusing his friend "paramour" of many years, herself a senior with dementia. The POA is  "active" control freak and will not "allow" live-in caregiver to even  take senior outside for walks or socialization, for example, even with visiting  family -- her sisters!

 

Her family sees evidence of a likely gambling addiction.  POA  is married (50+ years) to someone else.  His friend: mid-70s is a widow.  Her only child pre-deceased her.  She  owns several properties; husband left her financially comfortable. 

 

Live-in caregiver was placed on my  recommendation; hence, on-site information/feedback/data from  caregiver and from family when they visit have been shared with me.  POA  is clearly trying to alienate his friend from her family.  POA tries to manage  her care, attend to his professional life (he still works), keep up a "facade"  with his own family, etc.  POA's judgment is not good as he takes  friend to "gambling" cities/countries without caregiver.  

Family reports  that her psychiatrist likely "colludes" with POA, stating there is no problem taking her  to Las Vegas - he takes good care of her.  Family is concerned! 

Discovery is causing concern as client is the male senior who is the POA, not the elder female senior with dementia.

 

Approaches welcomed! Comments accepted below.  olga@agooddaughter.com

Whole Family Approach to Geriatric Care Management

An older man who takes medication to thin his blood to prevent a future stroke is hospitalized for an unrelated condition. Because the doctors in the hospital don't know what the usual dose of his blood thinning medication was before the hospitalization and they do not contact the spouse to find out the pre-admission dose, they inadvertently changed the dose and sent him home. The new dose turns out to be twice as potent as his usual dose and within two days he is rehospitalized with uncontrollable bleeding.  A Geriatric Care Manager (GCM) is called to help navigate through the crisis.  The family is in emotional turmoil.  Dad can't make family decisions and he is now confused.  

Care for an aging parent causes a family crisis because the rock of support becomes disabled.  A GCM needs to move this aging family through their crisis to a level of maturity as the care manager is the one who sees the parent/spouse in the here and now.  By reorganizing the aging family into a new team with a team leader, GCMs can now advocate for this new team as well as the patient.  GCMs identify this team leader/caregiver/spouse's needs and identifies what it takes to maintain her health and well being.  By using the whole family approach, a GCM uses family to advocate for the needs of the caregiver and older client himself (i.e., finding another family member to help pay for the spouse's respite or finding another family member who can take weekend care so caregiver can spend weekend with spouse). 

The role of a GCM in the hospital is to do routine care management tasks to: educate, assess, advocate, and move the client and family through the hospitalization process.  When an elderly patient is ill, weak, and confused the family visiting this patient in the hospital is often ignored, adding salt on the wound.  Yet they are also being asked to take on high tech medical care decisions at discharge such as bandaging, caring for wounds, and managing care.  

It is up to the GCM to educate the family to talk to physicians and technical staff.  She coaches the family in making a list of questions they'd like to ask the doctor, making it a running list that can be updated each time; she appoint a family spokesperson so only one person is asking the questions; she educates the family to communicate with the entire health team such as the social worker, Charge nurse, technicians drawing labs, etc. 

It is up to the GCM to advocate for the family so they get information they need. The GCM teaches them how to communicate with hospital staff to be respectful; to introduce themselves and shake hands; to ask questions in a grateful tone; to remain calm; to not be adversarial, etc.  

GCMs are the care navigators in this partnership moving a patient through care transitions.  If rehabilitation is ordered, we make sure it happens and on time.  If it doesn't we advocate with discharge planners.  We help the family understand health literacy teaching caregivers how to get, process, and understand basic health information.  Why?  In order to help caregivers make medical decisions for their loved ones, especially when the patient is incompetent due to temporary confusion or dementia.  We prepare the family to be trained as caregivers for discharge.  We help family ask questions and provide coaching to help them understand who in the facility has the answers.  The GCM is the real discharge planner since we get the family caregiver trained to give care when the patient transitions to the next level of care, help get a home care agency, educate family on community services, and assess the home for safety before the patient comes home.  

In the event a big decision is needed and the doctor needs to include the Power of Attorney (POA), a GCM can advocate for a family meeting in the hospital.  The GCM decides who attends (usually the doctor, a key RN, the POA) and helps family make a list of all questions to be addressed.  What is the GCMs job during a family meeting?  To help family members express themselves; keep the meeting on track and focused on the patient's present condition and the next care transition. After the family meeting a GCM may create a care plan at the end, documenting decisions, submitting a copy to the family and a copy to the physician. In the end, a GCM has the entire family as a client, must assess the whole family, and must advocate for the family to help the patient have a successful outcome.  

If you'd like to share your story as a caregiver to an elderly parent/spouse while in the hospital, please use the comments link below.  olga@agooddaughter.com

Advocating For A Relative In the Hospital

I don't know why but every winter season in Florida numerous seniors slip and fall, fracturing femurs and hips, often needing admission for a host of antibiotic resistant infections.  Family members fly in to see their loved ones and wind up suffering in the process because many hospitals are under pressure to keep nursing staffs lean and communication suffers.  A personal advocate such as a geriatric care manager can be a valuable resource.  It may even be a relative or friend - as long as it is someone who can lobby on the adult child's behalf.  Families are allies and partners in the well being of a parent and should not be simply be seen as visitors when parents are hospitalized.  They should not be in the waiting room, wondering what's going on. Hospital staff worry that family input will take up valuable time but in the long run, it will save time since families are a valuable source of information.  

Recently, my client's daughter felt helpless while her 82 year old mother was recovering from a twisted bowel.  Her condition worsened and her doctor gave orders to have her moved to ICU. Because the charge nurse refused to follow orders, the transfer was delayed and she eventually died after surgery and several complications from infections which developed.  Luckily, I had ordered a night shift caregiver for my client on admission.  This nursing assistant was present when the charge nurse cancelled the doctor's order, calling me at 2:00 am.  I was able to reach the doctor ensuring the necessary transfer orders were followed so life saving techniques could be employed.  We were fortunate to have had a knowledgeable "team player" who didn't think twice about contacting us.  However, sometimes family members don't see the value of employing private caregivers when parents are in the hospital.  Because family members cannot be present daily 24 hours a day, advocacy in any form is the best protection.  At the very least it is another set of eyes while family members get their rest.  

For family members who choose to go it alone however, please remember to employ the following techniques:  

Ask everyone who enters your parent's room if they've washed their hands; ask nurses to read out loud the drug orders; make sure they check your loved one's ID braclet; always ask what new medications are being given for; be alert for pressure wounds; make sure parents are moved often and lifted when transferring; bring games to help patients with brain stimulation; keep a journal for observations; be patient and appreciative with staff as they may be administering to more sickly patients; don't hesitate to speak up if you have concerns, and if all of the lingo and the sight of blood makes you ill, hire an advocate such as a professional geriatric care manager who has sufficient experience interacting with medical personnel and can advocate for you and on your parent's behalf.    A GCM can partner with you to ensure the right procedures are being maintained and is somone who understands the medical process and today's limitations in healthcare.  Olga Brunner is a certified professional geriatric care manager and President of A Good Daughter Elder Care Management.  Email:  olga@agooddaughter.com

Tomorrow--Monday January 19--has been designated as a "National Day of Service".

A web-site was established [www.usaservice.org] which presents volunteer options available in your community.  There is quite a variety of volunteer opportunities so that there will be something appropriate for everyone's interests and abilities.  [Anyone can make peanut butter and jelly sandwiches for a soup kitchen; it takes a bit of "techie ability" to be able to help seniors hook up converters for digital television.]

The members of the Geriatric Care Management Association are actively supporting this effort.  I hope that the members of other elder organizations are also "pitching in" to improve your community.

If you honestly feel that you're "too busy" to support a volunteer effort in your community, I would encourage you to donate at least one food item to a food pantry in your community.  [There are food pantries in every community--if you can't find one, drop off your donation at a local "faith based community".]  Food pantries always need donations--non-perishables which are not in glass containers are always needed.  Certainly you afford to donate a can of soup or a box of cereal or spaghetti!!  

THANKS for supporting your community!!  

Not So Reasonable and Customary

From the N.Y. Times Article on United Health Group, Inc.:  More big insurers should adopt a fairer and more transparent system for determining out-of-network reimbursements.  

New York State’s attorney general, Andrew Cuomo, and UnitedHealth Group, one of the nation’s largest health insurers, have agreed to set up a new system for calculating out-of-network payments.

UnitedHealth also has agreed to pay $350 million to settle class-action lawsuits brought by the American Medical Association and other groups on behalf of patients and doctors who claimed to be shortchanged for services provided out of network. Before approving the settlement, the courts will have to decide if the amounts agreed to are enough.

Typically, when patients use non-network doctors, their insurance company agrees to pay 70 percent to 80 percent of the “reasonable and customary” charges for a given medical service in the same geographic area. If the doctor’s bill is higher than that rate, the patient must make up the difference or the doctor must settle for less.

The rub comes in defining what is reasonable and customary.

That calculation for most of the industry is made by a company called Ingenix, which conveniently is owned by UnitedHealth. The whole system is rendered suspect by an obvious conflict of interest: If Ingenix pegs the customary rates low, it keeps insurance reimbursements low and shifts more of the cost to the patient.

Investigators for Mr. Cuomo contend that UnitedHealth and Ingenix have been manipulating the data through a variety of stratagems to keep the customary rate calculation low — and the insurance payments low.

Based on their own data collection and calculations, the investigators estimated that insurers have systematically underpaid New Yorkers for medical services by 10 percent to 28 percent, depending on where they lived.

UnitedHealth neither admits nor denies any wrongdoing, but the company does acknowledge the inherent conflict of interest and is paying substantially to put the issue to rest.

As a result of the agreement, future reimbursements should be less subject to manipulation and a lot more transparent. UnitedHealth is planning to close its Ingenix databases and shift responsibility to an independent nonprofit organization — possibly a university-level school of public health — that will be the sole arbiter of data collection and calculation methodologies.

UnitedHealth will contribute $50 million to help get the new system operating. Aetna has separately agreed to contribute $20 million. Both UnitedHealth and Aetna will use the new database.

The new organization will also create a Web site where consumers around the country can find out the prevailing charges for out-of-network medical services in their area. That would allow them to determine in advance what their insurance company will pay — and make it easier to challenge doctors’ charges that appear excessively high.

We urge other big insurers to contribute to this new organization and use the new database. The potentially corrupting influence of industry financing should be mitigated by putting Mr. Cuomo in charge and possibly setting up an endowment to keep the new organization independent.

New York’s attorney general deserves thanks for forcing the industry to adopt a fairer and more transparent system for determining out-of-network reimbursements. It has been a long time coming.

Time for a change?  Do you think we need to change to a single payor system?  Be sure to leave your comments.  olga@agooddaughter.com

Caregiver Conflicts Border on Elder Abuse?

New issue with a client in a rehab facility with 24 hour caregivers.  Client has dementia with fractured hip and is progressing nicely in agressive rehab facility.  She has two (12-hour shift) caregivers.  Daytime caregiver is clean, quiet, complies with therapy, activities, and personal needs of the client; night time caregiver is in R.N. school, caring, interacts well with client, family members, and geriatric care manager, takes care of the personal needs of the client and is professional.  Client is on 25% toe touch weight bearing per doctor's order.  She is highly motivated and her progress in PT is good as she has been athletic all of her life and understands the value of exercise.  The facility is a well respected one in the community with an excellent rehab department but the Dietary Department leaves a lot to be desired; residents complain mostly about dinner meal.  Today is the care plan session.  Client, family member, and GCM will be present to discuss progress she is making towards the desired goal of returning her to full function at home.  

Conflicts with family members have to do with the expense of all these caregivers.  The long distance family member would like for mom to go home immediately with Medicare paid physical therapy; the nearby family member is willing to wait until mother regains full function.  As her care manager I would like to see a doctor's order stepping up PT not necessarily waiting until her Feb 3rd return visit.  Client has been athletic all her life, is highly motivated, and ready to step up the program but because of dementia and her past athleticism, she thinks she can do more than she is able to right now, often attempting to get out of bed at night to walk to the bathroom by herself and doesn't think she needs all this help.  She needs supervision.  Because the nearby family member works, he is not able to supervise days.

Recent problem is that daytime caregiver not giving GCM daily report even though it has been requested of her.  She is an excellent and responsible caregiver but is lacking in communication skills with client, family, and care manager.  When this dementia client has an Alzheimer's related behavior issue she calls the GCM to intercede instead of using her training to redirect the client.  For example, in the past she and the cient's former roommate were openly critical of the night time caregiver's alleged snoring problem.  Whether or not the evening caregiver has a snoring issue is a moot point since the long distance family member relies on this caregiver's expertise and good communication skills for peace of mind.  

When the roommate went home we expected the issue to be resolved.  However, it resurfaced when I was called by the daytime caregiver, not about the client's issue with dinner, but to discuss the snoring problem.  I decided to stop by the rehab center personally.  On my way into the building I passed the caregiver on her way out and she began berating me about "what I should do or shouldn't do".  It has become apparent to me that the daytime caregiver is the problem.  It has become apparent that this alleged snoring problem is manufactured to assure her position as caregiver when the client goes home.  When interviewing the client, I found no other issue but the dinner issue which will be resolved today.

So, is this recurring problem manufactured by the daytime caregiver bordering on elder abuse? My client has a very sweet nature and because of her dementia, highly suggestable.  If someone puts an idea in her head, she repeats it and accepts it as her own.  I have worked with this client for the past two years and understand this willingness to please.  

I have interviewed the night time caregiver about her side of this issue.  She keeps nightly progress notes as to their conversations and night time activities.  She calls at 7:00 am to give me a detailed report at the end of her shift daily and is highly professional in meeting her patient's needs.  

Caregivers often have their own hidden agenda and are adept at doing whatever necessary to lock-in their position when a client returns home.  My goal is to keep my client in the rehab with PT and OT until she is quite ready to return to her former functional status.  Regardless of everyone else's agenda, a geriatric care manager functions as an advocate for the client.  When a caregiver plants seeds in a dementia client's mind to generate suspicious behavior against another caregiver, this is seen by me as elder abuse.  I welcome your comments.  

olga@agooddaughter.com

Back from the FGCMA Annual Meeting

The theme of this year's conference was: Challenges for the Care Manager.  It was an engaging and informative couple of days with a high caliber of speakers.  The event opened with Dr Huber's presentation outlining Assessing, Planning and Implementing Advocacy Interventions.  Dr. Huber's research interests include social work education; hospice; and National long term care Ombudsman program.  She is the recipient of the Trustees Award from the U. of Louisville Board of Trustees for her impact on student's lives. 

Margaret Dugger founded an independent consulting firm which specializes in developing products, services and marketing for older adults.  Her firm also provides strategic planning and organizational leadership training to Boards of Directors of several firms.  Her presentation - The Art of Advocacy - In Action centered around the legislative process of licensure for GCMs and was quite the eye opener for those interested in exploring a grass-roots effort to promote licensure. 

Jack Levine, founder of 4Generations Institute in Tallahassee is a communications and public policy consultant.  His expertise is in developing and delivering messages to the media, public officials, and a diverse network of advocates on the values of preventive investments in dignified services for elders.  He is the Director of GRAND Magazine, a national publication reaching out to some 77 million Baby Boomers.  His very animated discussion was titled, "Advocacy Lessons I learned at My Grandmother's Table."  He was named Floridian of the year by the Orlando Sentinel.  

Dr. Brian Wolstenholme received his Doctor of Pharmacy from Nova Southeastern University in 1999 and is the President of MediSort Medication Consultants, PA.  He is a board Certified Geriatric Pharmacist (CGP) with nearly ten years experience and a member of the Fellow of American Society of Consultant Pharmacists.  He teaches Geriatric and long-term care Pharmacy to students in their final PharmD year at the U of Florida College of Pharmacy, a contributing Editor of RxWiki.com, and a Licensed Florida Pharmacist as well as a Licensed Florida Consultant Pharmacist.  His presentation was a standing-room only presentation at this conference of very experienced care managers.  As a GCM, I personally come in contact on a daily basis with the horrors of medication mis-management that exists today, seriously impacting our elder client's health.  Having access to a consultant like Dr. Brian, ensures our family's "peace of mind" that this very important piece of the elder care puzzle is in place.  

Break-out sessions were conducted by Victoria Peet Williams, a Member of Florida State Emerency Response Team for 2004 Hurricanes Frances and Jeanne, 2005 Hurricane Wilma, and Tropical Storm Fay in 2008.  The objective of her discussion was to inform and educate attendees about free services provided by Department of Financial Services, a regulatory agency responsible for assisting consumers who need information and help related fo financial services. 

Another break-out session was presented by Nanette Lavoie-Vaughan, MSN, ARNP.  Ms. Vaughn has a diverse background in Geriatrics, is currently employed as an adult nurse practitioner and a professional consultant, and authors articles on geriatrics for multiple publications.  An advanced directive tool was introduced that incorporates treatment choices, values/wishes, understanding of disease/conditions, goals of care and comfort measures.  This was followed by a role playing case study meant to illustrate the concept of advanced care planning.   

Saturday's first presenters began with a very comprehensive advocacy discussion titled, "Who's the Boss", advocating effectively that professional care managers acknowledge that the family caregiver is, indeed the boss.  Three real-life scenarios were distributed for discussion.  This presentation was coordinated between Brenda Bryant, author, co-author, and editor of numerous books and articles on mental health issues, racism, and communications.  She is also the V.P. of Mae Volen Senior Center in Boca Raton.  Ms. Bryant's co-presenter was David Levy, instrumental in the creation of the first Masters Level Program for GCM, founded at Lynn University.  I happen to be a graduate of this program.  Mr. Levy holds a Doctorate of Jurisprudence, Certification as a Caregiver Educator and Trainer, and Advanced Certification with Highest Honors in Gerontology.  He is a licensed Eldercare Mediator and Family Mediator in the State of Florida and teaches non-clinical Family Care giving at FAU.  

Final presenter was the Pacific Coast author of the Handbook of Geriatric Care Management, Cathy Jo Cress.  Cathy Cress has taught aging at Berkeley, San Francisco State University and owned a geriatric care management agency, Cresscare Case Management for Elders for 25 years.  Her discussion centered around advocating for a whole family approach to geriatric care management, asking GCMs to reassess our roles as GCMs to educate, assess, advocate, and move the client and family members through the continuum of care when the client is hospitalized.

The FGCMA conference closed following a Leadership Luncheon which included a lecture by Ron Kirsch about "Participatory Leadership" and coursework prep taught by Cheryl Whitman for GCMs about to take their certification exams.  For more information contact Olga Brunner, certified geriatric care manager, and founder and president of A Good Daughter Elder Care Management in Boca Raton, Florida.

olga@agooddaughter.com

GCMs meet with CMS to Improve Caregiving

Newswise – Leaders of the National Association of Professional Geriatric Care Managers (NAPGCM) and the National Academy of Elder Law Attorneys (NAELA) met recently with senior governmental agency representatives and experts from health care advocacy organizations, providers of services and foundations to brainstorm ways to improve caregiving.

NAPGCM and NAELA representatives joined about 40 other opinion leaders at the Center for Medicare & Medicaid Services’ Dec 10th Thought Leaders Conference on Caregiving in Washington D.C. Participants discussed ideas and strategies that could help shape public policy and a response to the increasing need for caregiving and the issues facing caregivers in the United States. From discussing the lack of financing for long-term care to the bias in favor of the existing institutional model for caregiving, the experts in attendance identified what they felt were the key issues impacting the industry.

“As the senior population grows, so does the demand for caregiving,” said Linda Aufderhaar, a professional geriatric care manager and NAPGCM Fellow and Past President in attendance. “We need to combine our resources to find new and innovative ways to provide these necessary services.”

The NAPGCM and NAELA representatives were selected by CMS based on their expertise and knowledge of caregiving as it relates to the problems of aging and people with disabilities.

“It was inspiring to see so many organizations come together to share ideas, all united by a mission to help protect our nation’s most vulnerable citizens,” said Peter J. Strauss, a New York-based elder law attorney, law professor and NAELA Fellow. NAELA’s 2006 survey found that one quarter of Americans aged 35 and older had to make long term care arrangements for themselves or other elderly family members.

“Caregiver’s work is exhausting, it’s stressful, but it’s essential—and far too often, it goes unrecognized. Even caregivers themselves don’t always realize how critical their role is,” said CMS Acting Administrator Kerry Weems. “I bet if you asked any of one these individuals how they manage to meet the day-to-day needs of their loved ones, they’d look at you with surprise and say: ‘I’m her husband’ … ‘I’m his daughter’… ‘I’m their mother…it’s just what we do.’ ”

Government estimates are that nearly 45 million Americans – or one in five adults –provide unpaid care to a loved one valued at a staggering $306 billion each year. Other organizations say the number eclipses the total spending of $342 billion for the 2005 Medicare program.

In addition, many caregivers are likely unprepared for the task ahead. In a survey of members of NAPGCM and the National Association of Social Workers (NASW), 63 percent of Sandwich Generation women (SGW -- aged 35-64 years who parent and also have a living parent) were not prepared at all for care planning for a parent or other aging relative. The study, in conjunction with the New York Academy of Medicine (NYAM), asked members about their experiences in working with SGW -- important since an estimated 59 to 75 percent of caregivers are women.

The conference participants agreed in principal on four specific areas of concern that require immediate focus: Transitions of Care (e.g. reconciliation of medications and care plans at each change in level of care and treatment), Budget and Financing (e.g. demonstrating and dealing with the adverse financial consequences of caregiving), Provider/Professional Education and Communication (e.g. Hospitals and other care settings working with caregivers) and Education and Communication with the caregiver (e.g. in the triad - physician/patient/caregivers).

This is not the first time NAELA and NAPGCM have participated in a CMS effort related to healthcare. In September, both associations were invited by CMS to participate in the launch of the federal organization’s new “Ask Medicare” Web site (www.medicare.gov/caregivers) program – which features insight from caregiving professionals as well as representatives of the healthcare industry.

Although spectators were not invited to attend the roundtable, CMS did tape the dialogue and will release it in a future Webcast.

ABOUT NAPGCM
NAPGCM was formed in 1984 to advance dignified care for older adults and their families in the United States. The association currently boasts a membership of over 2,100 care managers. Professional Geriatric Care Managers (PGCMs) are professionals who have extensive training and experience working with older people, people with disabilities and families who need assistance with care giving issues. They assist families in the search for a suitable nursing home placement or extended care if the need occurs. The practice of geriatric care management and the role of care providers have captured a national spotlight, as generations of Baby Boomers age in the United States and abroad. For more information please visit www.caremanager.org.  

olga@agooddaughter.com  (Certified Geriatric Care Manager)

 

Ask Now, Listen Forever

 As a former Activities Director I would set aside one Saturday a month to select a resident at our long term care facility and spend approximately three hours interviewing him/her about their past life.  At the end of my interview I'd photograph the person and designate this senior "resident of the month", including photo and bio in our monthly newsletter and hanging a poster-size bio and photo in our Actitivy Room.  I can't tell you how advantageous this was both to boost the morale of a senior who may not have been feeling too well.   The greatest advantage however, was to the staff.  They'd pass the article on their way to the dining room, stop to read a former historical account of a particular resident, and this vehicle connected both senior and staff members, facilitating many stimulation conversations about their past with staff who would not have otherwise known anything about the person they were caring for.

As we already know, seniors love to talk but seldom do they have listeners.  This is why I'm introducing  www.storycorps.net -- a group I discovered on Facebook.  Following is their company overview and mission statement:  

"Since 2003, over 40,000 everyday people have shared life experiences with family and friends in our story booth.  Each conversation is recorded on a free CD and is preserved at the Library of Congress.  Listen to our broadcasts on public radio and the web.  StoryCorps is the largest oral history project of its kind.  Everybody's story matters.  Every life counts.  Help us reach out to reach out to record our history, hopes, and common humanity by going online to:  http://www.storycorps.net.  Our mission is to honor and celebrate one another's lives through listening.  We accomplish this by providing access to both the storycorps interview experience and to the content that emerges.  StoryCorps reminds us of the importance of listening to and learning from those around us.  It celebrates our shared humanity.  It tells people that their lives matter and they won't be forgotten.  Through Story Corps we hope to create a kinder, more thoughtful and compassionate nation."

I sincerely applaud the StoryCorps effort and thought I'd pass this information along to the readers of this blog.  They can also be found on the NPR website who has a started a "National Day of Listening", celebrated each year around Thanksgiving.  A very worthwhile activity with a loved one.  

olga@agooddaughter.com

Downturn stress impacting Health

New posting below:

Financial uncertainty is definitely going to impact the health of baby boomers who were sure of retirement at 65 and now see having to continue to work until age 75 due to the current economic downturn.  Yesterday's South Florida Business Journal reports a recent survey conducted by AARP which states one in five adults over the age of 45 is suffering health problems due to financial stress.  The survey also found health problems due to financial stress is having a greater effect on those between the ages of 45 to 64 than on those ages 65 and older.  

Over the last five years, health insurance premiums for families have increased by 65 percent, according to AARP. The average cost of health insurance for an American family now exceeds the yearly income of a minimum wage worker.  

This survey information is no surprise and exactly correlates to participant responses during a community discussion held in Boca Raton last Sunday afternoon.  The outcome of the Boca health reform survey  was delivered to the Obama Transition Policy Team on Health Care Reform.  These non partisan forums were held in similar forums throughout the country, surveying the most relevant issue today which is how to revamp our current health care system.  

According to the Kaiser Family Foundation, health insurance premiums have increased 119% from 1999 to 2008, while workers' earnings have risen just 29%.  

Can something actually be done to fix our broken health care system?  If so, how do you recommend it be fixed?  Share your recommendations with us in the comments section below. 

olga@agooddaughter.com

Benefits of Blogging for the Small Business

Reprinted from WebProNews:

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Blogging is the most cost-efficient business strategy any company can have in the midst of this dire economy. People on both the buyer side and the company side are reaching out to the Web and utilizing it.

As Jennifer Evans Laycock of Search Engine Guide explains, consumers have less money to spend and therefore research their purchases more. Companies see their revenue falling and put a stronger effort on understanding their consumers. Usually the companies and consumers end up meeting through social media.

Interestingly enough, many of these companies are small businesses that compete on a global level as a result of the abilities of the Internet. Social media is the key in making this possible since it does not require a large budget. Speaking specifically about blogs, Jennifer lays out several reasons why a business should have a blog:

1.    Showcase your personality
2.    Create a feedback cycle
3.    Build a loyal community
4.    Create an emotional investment
5.    Increase your credibility

These reasons for having a blog are also benefits of having a blog. Time is the only drawback to having a blog. It takes a lot of time and is a full time commitment, but it produces many benefits as evidenced in the points shown here.

Personally, blogging has helped drive my website from page eight this year to page one on google.  It takes persistence, but in three weeks I've been able to see results.  Besides, it's great fun for those who like to write.  olga@agooddaughter.com