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Health

A How To on Health Care for LGBTQ

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The United State’s system of health care continues it’s  progression in providing all-inclusive services since the repeal of the Defense of Marriage Act. Monday, July 1st , the Centers for Medicare and Medicaid Services (CMS) issued an official policy announcement declaring same-sex partners be given equal visitation rights at long-term care facilities regardless of their marital status. This new guidance policy applies to all long-term care health facilities receiving Medicare and Medicaid funding to include nursing homes and hospice facilities.

How does this effect agencies and staff?

Now that medical facilities are encouraged to be more inclusive of LGBTQ individuals and families, agencies are encouraged to evaluate existing programs and services as well as staff supports.

A useful tool that can be used by agencies is the Health Equality Index (HEI) developed by the Human Rights campaign and the Gay and Lesbian Medical Association (GALMA). The HEI measures the effectiveness of services provided to LGBTQ individuals.

2012 Health Equality Index Leader

Courtesy Human Rights Campaign

The HEI tests for the “core four”

  1. Patient Non-Discrimination
  2. Equal Visitation
  3. Employment Non-Discrimination
  4. Training in LGBT Patient-Centered Care

Responses to these questions are returned to the participating agencies in a comprehensive document for their use in service planning.

The U.S. Department of Health and Human Services Secretary Kathleen Sebelius describes the HEI as “an important tool for making sure LGBT individuals and families are treated with the same respect and care in these situations as anyone else.  It shines a light on what our country’s health institutions are doing to better serve LGBT patients.  And it’s very encouraging to see more institutions being recognized as “Leaders in LGBT Healthcare Equality.” Read More…

Participating organizations  reap several benefits including free online training for staff at all levels,a customized needs assessment for planning, as well as featured status in the HEI report as Equality Leaders.

Registration is free and open to all healthcare organizations in the U.S. with ten or more employees, whether inpatient or outpatient, network or individual facility.

The following are some Suggestions for Medical Staff interacting with LGBTQ Patients:

  • Assumptions: Do not assume the sexual identity or orientation of your patient please ask in a proper manner.
  • Education: Learning about LGBTQ sexuality and sexual practices this will allow healthcare providers to better assess patients support.
  • Language: Be aware of the language used and as well as cultural nuances of the LGBTQ population, including celebrations of the community such as gay pride, symbols that are representative such as rainbow flags and pink triangles and terms like butch, femme, dyke, and queer.
  • Communication: Properly educate patients about the effect of illnesses and the medical treatments on sexuality.
  • Compassion: Provide sensitive and compassionate service, if uncomfortable with learning about a patient’s sexuality  be honest and let a patient know.
  • Respect: Be respectful of a patient and the information they are sharing, this includes confronting coworkers of inappropriate comments.

Polly-Gean Cox, LCSWA is the LGBTQIA staff writer for Social Work Helper. Polly is a holistic Social Worker promoting cultural awareness for the LGBTQIA population within healthcare systems. Polly focuses on the importance of education among both micro and macro systems of Social Work.

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Child Welfare

Parental Medicaid Expansion Translates into Preventive Care for their Children

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When low-income parents enroll in Medicaid through the Affordable Care Act (ACA) state expansion program, their children have considerably better odds of receiving annual preventive care pediatrician visits, according to a new analysis by the University of Pittsburgh Graduate School of Public Health and Johns Hopkins University.

This “spillover effect,” explained in a study published online today and scheduled for the December issue of the journal Pediatrics, demonstrates that the potential benefits of Medicaid expansion extend beyond the newly covered adults.

“These findings are of great significance given the current uncertainty surrounding the future of the ACA and Medicaid expansions authorized by the law,” said senior author Eric T. Roberts, Ph.D., assistant professor in Pitt Public Health’s Department of Health Policy and Management. “Lawmakers crafting policy proposals that could curtail Medicaid benefits or eligibility should recognize that such efforts would not just limit the receipt of health care services by low-income adults, but also by their children.”

The ACA provided states the opportunity to expand Medicaid coverage to all low-income people at or below 138 percent of the federal poverty level. So far, 31 states and the District of Columbia have expanded Medicaid coverage.

Roberts and his colleagues identified 50,622 parent-child pairs from data collected in the 2001 through 2013 Medical Expenditure Panel Surveys, a nationally representative survey administered by the U.S. Department of Health & Human Services that includes detailed information on family structure and demographics, including health insurance status and health care use.

They discovered that children of parents who had recently enrolled in Medicaid had a 29 percent higher probability than children of unenrolled parents of receiving their well child visit, which is recommended annually for children age 3 and older, and more frequently for infants and toddlers.

During the visits, the children are examined for growth and development and given immunizations, and their caregivers are guided on proper nutrition and child behaviors. Studies have shown that children who get well child visits are more likely to receive all their immunizations and less likely to have avoidable hospitalizations. The U.S. has persistently low rates of well child visits, particularly in low-income families.

“There are many reasons that parental Medicaid coverage increases the likelihood of well child visits for their children,” said Roberts. “It could be that insurance enhances the parents’ ability to navigate the health care system for themselves and their children, increasing their comfort in scheduling well child visits. Medicaid enrollment could be a sort of ‘welcome mat,’ in which eligible but previously uninsured children are enrolled after their parents gain coverage. It also could be that parental Medicaid coverage frees up more money to provide preventive services to their children, because even copays can be a deterrent to medical care among low-income people.”

Maya Venkataramani, M.D., is lead author on this research, and Craig Evan Pollack, M.D., M.H.S., is a coauthor. Both are from the Johns Hopkins University School of Medicine.

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Health

How to Develop an Individual Grief Plan

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Story’s Angel of Grief

My Mother always said that my Daddy was “a fool born on April fools”. This was the running joke all of my life.  April 1 came along this year and it was not a joking matter. I was heartbroken and devastated that I could not hear my father’s voice or see his smiling face on his birthday.

Earl, My Pearl, was diagnosed with pancreatic cancer June 20, 2016, after suffering several months of abdominal pain, significant weight loss and limited mobility. He passed away peacefully on September 9, 2016, 4:30 am. This process was very difficult for all of us to watch, yet, we were there every step of the way and handled it a gracefully as possible.

I worked as a hospice social worker for several years prior to my father’s diagnosis. Our journey was still difficult but I was familiar with the language and processes pertaining to the end of life which afforded me the opportunity to assist my mother in talking with our team of doctors and making decisions. She found comfort and security in that and this made me proud. I saw this as an attempt to make this living nightmare a little less scary and slightly bearable.

My hospice experience also somewhat prepared me for being around death. I spent time with my Daddy after he passed away and I combed his hair prior to his wake with an unusual calm.  These were tender moments that I will forever cherish.

I faced a dilemma as my Daddy’s birthday approached. My 8th wedding anniversary was a few days prior to Daddy’s birthday.  My husband wanted us to go away to celebrate the weekend of April 1st.  My plan had been to spend the morning at the cemetery with my mother.

After discussing it with my spouse and my mother (my voices of reason) I came to the conclusion that my father would not want me weeping at his grave on his birthday. He would prefer me to go away, live life and celebrate with my husband whom he was very proud of and admired. So, we continued with our anniversary plans although I did not know what April 1st was going to be like.

I was committed to getting through my Daddy’s first birthday in Heaven without ruining this special weekend that my husband had so thoughtfully planned.  So, I allotted uninterrupted time and space for my grief and I planned activities to pull me out of those dark places that have the ability to consume us if allowed.  I planned for my grief.  Sound weird; keep reading.  I hope my experience assists you in your process.

On the morning of April 1st, I woke up, attempted to post a memorial birthday wish to My Pearl on my Facebook page and the tears began.  I went into the bathroom and cried hard for at least an hour if not more.  I wasn’t simply misty eyed or a little teary; this was the ugly cry that people try not to do in public.

My husband tried to console me but I asked him to allow me to handle this on my own.  I allowed the tears and emotions to flow without beating myself up for crying like a 37-year-old baby.  I did not attempt to suppress my feelings which is typically our natural response.  I went through the sadness of being Daddy’s little girl without her Daddy.  I experienced the “maybe I could have done more” routine that we wallow in sometimes.  I felt the guilt of not choosing to be graveside on his 75th birthday.

I felt horrible for abandoning my mother in her grief even though I knew she wanted me to continue with my celebration.  It went on and on and I allowed it until it ran its course naturally. Once I was completely done, I sat in silence for a while then cleaned myself up.  I felt weak, somewhat limp yet refreshed. My husband and I went to a lovely breakfast at our hotel; we changed our clothes and went to the gym together.

After that, I took a long hot shower, allowed myself to air dry across the crisp white comforter on our king size fluffy bed.  I then turned on some relaxing beautiful music.  I did not sleep, I simply allowed myself to be in total and complete relaxation for the remainder of the afternoon.  Our friends met us for cocktails and a show and it turned out to be an amazing and wonderful trip overall.  I planned for my grief, I executed and came through my Daddy’s first birthday relatively unscathed and empowered.

Make an appointment to grieve.

When we go to the doctor, we have an appointment.  You have called ahead, maybe weeks in advance, to make the appointment.  You have your appointment time, you see the doctor to discuss your health, meds, etc within your allotted amount of time (usually not over an hour) you say your goodbyes and you leave.  Think of your grief in that way.

I set my grief appointment for first thing in the morning because we were on vacation. We had nothing pressing planned that morning and we had guests meeting us in the evening. Whatever your day is going to look like, carve out space and time to be alone with your grief and make it happen.

This is important because if you allow the grief to have its way, it will show up throughout the day and consume you for the better part of that day and possibly beyond.  Take control of your grief by making an appointment, letting it present as it may, then, as you do with other appointments, say your goodbyes and leave it.

Don’t take “walk-ins”.

It is very difficult to walk into your doctor’s office and see them without an appointment. Apply this to your grief.  Say you had your appointment, you successfully followed all of the steps and are moving on with your day.  If grief shows up outside of its appointment time, turn it away:  “Look grief, your appointment was 8 am. We saw you and dealt with you then.  I will see you at your next scheduled appointment.” Acknowledge your grief but do not allow it to consume you outside of your appointment.  Commit to having power and control over the grief.

Plan to grieve alone.

Our family members and close friends mean well in trying to assist us in our grief, especially around holidays and special events that we would normally share with our deceased loved one.  Unintentionally, they can often be a hindrance, sometimes a crutch in our process. Additionally, we may subconsciously modify our grief in order to accommodate them and their level of comfort.

This appointment is not the time for such modifications.  Maybe we will cry but suck it up and move forward prematurely because they might feel like we have cried long enough.  Or maybe they, meaning well, will say the cliché things that people say when one is grieving in an effort to help ease the pain and stop the flow of tears:  “it will be ok” or “time heals all wounds” and my all-time favorite “he’s in a better place”.  We know that those things are true.

However, do we want to hear those things in our time of grief?  NO!!!  We are thinking “it won’t be ok because I can’t live without him”, “nothing will heal these wounds” and “the best place is here with me”.  None of those clichés are needed or welcomed for that matter, at this point in the process.  Again, you have to allow space and time for this process without guidance from well-meaning family members and friends.   It has to run its own natural course.  Friends and family have a more appropriate role in the next steps of this process.

Plan activities that you enjoy.

I knew that if I had grieved and simply remained still, I would have wallowed in a sad, hurtful place all day.  Therefore, I moved on to an enjoyable breakfast then a workout with my husband to take my mind to better places.  It’s not that you’re getting busy to suppress your feelings. Because of your grief appointment, you have dealt with your feelings and emotions head on and very appropriately.

You’re merely creating a beautiful welcomed distraction in order to move on with your day.  After the grief appointment, it is imperative to get up and get busy living.  This has to be planned for and executed.  At this point, your family and social support system could play a huge, meaningful role without hindering your process.  Remember, do not take walk-ins!

Take some time for relaxation and self-care.

My self-care was a long hot shower followed by resting to nice music.  Your self-care may look like a spa day, a long jog through your favorite park, a scenic hike, cooking an elaborate meal or a shopping trip.  Whatever makes you feel well, do it!  Think of this as a special gift from your loved one on this special day; it’s your reward for bravely facing your grief and taking control of your grief process.  I firmly believe that the ones that we loved and lost enjoy seeing us live happy and well despite their absence.

Be Grateful.

My father was here for all of my major life events: all of my graduations and performances, he moved me into my first apartment, he walked me down the aisle at my wedding, he was there during my pregnancy and formed a sweet relationship with my daughter…with all of that being said, how can I wallow in sadness?  I am so grateful for having a father that was present until he passed away.

Others have not been as fortunate and I acknowledge that. For that reason, I choose on his birthday, holidays and any day of the week to be grateful for him and his life rather than focus on his absence.  I am also grateful that he did not suffer long after his diagnosis.

As a hospice social worker, I saw patients and families suffer months and months; having their hopes of recovery dashed with the horrible news that their cancer had spread and there were no further options.  This was not our case.  We had our ups and downs but God was merciful and ended my father’s battle 3 months after he was diagnosed.  For that I am grateful. My gratitude list could go on and on.  My point is that in our sadness and on those birthdays and holidays, we have to immerse ourselves in gratitude in order to make it through.

The preceding technique is not the catch all or fix all for your grief issues around holidays and special occasions. This is merely a formula that worked for me and I was compelled to share it with the hopes of helping others.  If you are experiencing complicated, ongoing grief issues, please, seek help from a mental health professional.

Individual sessions, grief support groups, and other therapeutic interventions to deal with grief may be necessary depending on your individual needs.  Remember, death is inevitable for all of us.  However, being proactive in our grief process and planning for the same may assist and make facing holidays without your loved one bearable and beautiful.  It happened for me; that’s my hope for you!

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Aging

Social Workers Can Now Learn Medicare Online and Earn Continuing Education Hours

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Social workers can now earn continuing education hours while they learn Medicare at their own pace, anytime and anywhere with Medicare Interactive (MI) Pro, an online Medicare curriculum powered by the Medicare Rights Center.

MI Pro provides the information that social workers and health professionals need to become “Medicare smart,” so they can help their clients navigate the Medicare maze. The online curriculum contains information on the rules and regulations regarding Medicare—from Medicare coverage options and coordination of benefits to the appeals process and assistance programs for clients with low incomes.

“For over 25 years, social workers have been turning to Medicare Rights’ helpline counselors for clear and concise information on how to help their clients access the affordable health care that they need,” said Joe Baker, president of the Medicare Rights Center. “Now social workers can enroll in MI Pro and learn—or enhance—their Medicare knowledge at their convenience while fulfilling their continuing education requirements.”

The Medicare Rights Center, a national nonprofit consumer service organization, is the largest and most reliable independent source of Medicare information and assistance in the United States.

Licensed Master Social Workers and Licensed Clinical Social Workers can earn continuing education hours when they successfully complete any of the four MI Pro programs: Medicare Basics; Medicare Coverage Rules; Medicare Appeals and Penalties; and Medicare, Other Insurance, and Assistance Programs. Each MI Pro program is comprised of four to five course modules.

All MI Pro programs are active for one year following registration.

MI Pro courses are nominally priced. Additionally, social workers who purchase all four programs at once will receive an automatic 20 percent discount.

Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs, and public policy initiatives.

Available only through the Medicare Rights Center, Medicare Interactive (MI) is a free and independent online reference tool that provides easy-to-understand answers to questions posed by people with Medicare, their families and caregivers, and the professionals serving them. Find your Medicare answers at www.medicareinteractive.org.

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