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When I talk to clients or participants at trainings I facilitate, friends and others about self-care, there is a resounding and recurring notion that implementing a self-care plan requires a lot of time and money. This isn’t a surprise to me. For years, I also carried this belief. I thought that having extra time and money were key components to maintaining a self-care practice. After all, without time how will you get to do the things you want to do, and without money, how will you finance your self-care activities?

There is also a misconception about what self-care is.  What usually comes up as a definition of self-care is spa days, time at the hair salon on regular basis, gym time and vacation. While all these activities are examples of self-care activities, the reality is that for many people these activities can be outside of their reach. Limiting our self-care definition to just a few select activities can hinder our ability to recharge ourselves.

Despite these beliefs, there is growing general agreement that self-care is essential for our overall well-being. Self-care is an effective way to manage stress and a key factor in keeping healthy physically and mentally. The definition of self-care that I have adopted is that of a practice that allows us to strengthen our bodies, minds, and souls.

The great news is that there are many ways to fulfill this endeavor. There is no one-way of doing it and there isn’t such a thing as one size fits all. Self-care can be practiced as it best fits people’s lifestyles, time and resources. And there are many free things that you can do. So let’s forget those standardized self-care checklists and create your own list based on what works for you.

To help incorporate self-care into our daily lives, I propose that rather than doing self-care as a one-time only extravaganza when we feel burned out, we sprinkle self-care throughout our day or week.

Here are a few ideas how:

Mindfulness Meditation. We can take what I call mini vacations through mindfulness meditation, a practice has been proven effective to reducing stress and preventing and managing mental health disorders like depression and anxiety. There are many types of mindfulness exercises. One such exercise is deep breathing. We can dedicate as little as 5 minutes a day to deep breathing (or as many times as you need it throughout the day). During our breathing exercises, we focus on our breath, inhaling slowly in and out through our nose.

Visualizations. With the deep breathing, we can add visualization, imagining a place that brings us tranquility and peace as we deep breath in and out or a past happy memory. We can do a variation to our breathing exercises reciting positive affirmations about ourselves or reflecting on things that are going right in our lives. But this is just one possible exercise. Mindfulness is much broader than that. As best put by mindfulness guru Jon Kabat-Zinn, mindfulness is paying attention on purpose in a particular way to what is arising and the present moment. I encourage you to look more into mindfulness.

Time management. Self-care involves self-awareness on the tasks that you can handle and those that may be too much. Practice saying no to extra commitments when your plate is already full or asking for help. Having too demands on us can lead to stress and overwhelming feelings.

Doing things that bring you joy. Do an inventory of things you truly enjoy— starting with little things to big. What is feasible to sprinkle into your day? For some people, it may be drinking your favorite cup of tea, lighting up a candle, listening to your favorite music on the way to work or while at home, going on a bike ride, spending quality time with family and friends, watching their favorite TV show, doing your favorite hobby, etc. Whatever it may be, make it a consistent part of your practice.

Creative Release Outlets. We have seen the explosion of “adult coloring books” marketed as stress reduction tools, and there is evidence to back this up. The trick of coloring is that it is an activity that requires focusing in one task and as we color or paint, it allows us to express ourselves and set free of our worries, even if it is just for a few moments. This can be a fun activity to do alone or with kids. If coloring isn’t your thing, try journaling.  You can experience a sense of release by writing when you are feeling stressed, frustrated, tired, etc., or you may simply enjoy chronicling your positive experiences and looking back to it when you need inspiration or extra boost.

Connecting with nature and exercise. Nature has healing and self-soothing power. A walk in our local park or outside can be the break someone needs and it is not only good for overall physical health but for it improves our mental well-being.

Exercise is an important part of staying healthy both psychically and mentally. One of the things I commonly see is that we may get excited about an exercise routine but that excitement may dwindle or barriers begin to creep in. Instead of thinking of exercise as one more thing to do, think about it as something you need to do for your survival, just like you need to eat, breathe and sleep. To this, adding a self-care buddy that you can enjoy your activity with may make the journey much easier and more fulfilling. Exercise does not have to break your bank. Take to your local park and walk the recommended 30 minutes a day, either during your lunch break, before or after work or get off the metro or bus a few stops before your destination and walk the rest.

Connecting with others. Connecting with others has been found to be a key factor in maintaining our mental health. While we may interact with people throughout the day either through work, school or at home, what I am talking about is having meaningful connections and relationships of people you enjoy spending quality time with. The kind of people who bring you joy, lift you up, listen to you and support you and vice versa.

While technology and social media have great benefits, too much of it can hinder our ability to be present and it can prevent us from enjoying what’s around us. Unplugging occasionally from technology and social media is vital in our quest to taking care of our minds.

Take small breaks during the day. Beyond your lunch break, take small breaks as needed during the day. Make it an intentional practice to move around in your office, school or home. Instead of sending that email to your colleague, walk over to deliver your message in person if feasible.

Self-care buddy. This is my personal favorite: designating someone to hold you accountable on your self-care journey. At work, appoint colleagues who can remind you to have lunch and/or someone you can go on a walk with when stressed. At home, appoint loved ones who can support you in staying healthy and remind you of your commitment to yourself.

Use smartphone apps to support your practice. Some of my favorite are Calm and Bloom. Calm has different visualization images like beaches, mountains, rainforests with natural sounds that match the images. You have to try it to see the impact. You will literally be transported to those places.  Bloom is an app where you can include daily reminders including inspirational notes that you can load with images (your own pictures or from stock) and music. In this app, you can include reminders such as remembering to take a break, remembering to take a deep breath. You can schedule those messages to pop up throughout the day. It is kind of fun to get the messages when you least expect them but when you need them the most.

These are just a few ideas of endless activities you can do to keep up with your self-care. What may work for one person, may not work for another. The key to self-care is doing activities that can nourish our minds, bodies, and souls. The tools are within our reach to practice consistently, as a necessity, as a way of survival just like breathing and eating.

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Cheryl Aguilar is a licensed clinical social worker, LICSW, LCSW-C, founder and lead therapist of Hope Center for Wellness, LLC, a multicultural behavioral health and training consulting practice serving DC metro area residents and organizations. She founded and co-leads Social Workers United for Immigration, a DC based network of social workers committed to the well-being and the advancement of immigrants and immigrant rights. She can be contacted at caguilar@thehopecenterforwellness.com.

          
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How The Cannabis Industry Illuminates Changing Political Dynamics Between Private And Public Interests

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According to the “Bootleggers and Baptists” theory of politics, coalitions of groups whose interests are usually at odds are more likely to be successful than one-sided coalitions. The theory is named after a classic instance in which bootleggers engaged in illegally producing and selling alcohol teamed up with Baptists to pass laws requiring liquor stores close on Sundays. Bootleggers got reduced competition for one day each week, while Baptists were happy that alcohol would not be sold on Sabbath. Thanks to the partnership, bootleggers had no need to press for new legislation, because Baptists lobbied state house members on their behalf.

The “Bootlegger and “Baptist” label now describe a large range of coalitions, although “bootlegger” no longer refers to groups engaged in illegal activity, but instead connotes groups taking political action in support of narrow economic gains. Similarly, “Baptists” now refers to groups that are not necessarily religiously motivated but espouse a greater moral purpose or advocate for the public interest. According to this theory, to achieve mutually beneficial policy victories, public interest groups are wise to team up with self-interested, usually profit-seeking lobby groups. The “bootleggers” make financial gains and sometimes share their takings with politicians while the “Baptists” allow politicians to offer moral rationales and gain the public’s trust.

This coalitional theory makes logical sense. However, in my research I utilize data from the legal cannabis industry in the United States to demonstrate that such partnerships may no longer be necessary. Today’s profit-driven, lobbying groups – like those in the burgeoning cannabis industry – may not need to partner with morally oriented organizations to achieve victories, and this shift will likely have major policy implications.

Public Interests and Private Enterprise

Historically, the Bootlegger-Baptist dynamic explained how public interest rationales could justify advantages to certain private enterprises. Of course, the private pursuit of regulatory benefits is unsurprising – even Adam Smith, the famed 18th-century economist and author, warned that early industrialists might seek to influence the law to increase profit. And mixed Bootlegger-Baptist coalitions helped such interests achieve their political goals, because private interests seeking a benefit from the government – a subsidy, a contract, or a tax break – could work with other groups that would assert a greater moral purpose.

Such mixed-purpose coalitions have taken many forms. Profit-driven groups may stealthily advance moral arguments, or sometimes, there may be many independent, socially oriented groups. Cooperative partnerships have formed to bolster support, in which profit-driven, lobbying groups fund the morally and socially oriented groups. More complex cases also exist, where political actors coordinate a mix of interest groups to accomplish many goals, including their own.

The New Dynamic

However, significant shifts in today’s regulatory and political landscape may be making Bootlegger-Baptist coalitions less necessary. My research suggests that it is becoming much easier for profit-seeking enterprises to influence policy without working with moral or social partners who give them cover. U.S. policymaking about legal cannabis (that is, marijuana) provides a useful window into these changing dynamics. This industry has grown rapidly, faces complex regulatory hurdles – such as federal illegality and a maze of varied state laws. In addition, the industry includes multiple “Bootlegger” parties interested in profiting from the shifting policy landscape, while at the same time having to contend with multiple “Baptist” groups interested in the social implications of legalization.

According to my research, profit-driven firms in the cannabis space have managed to circumvent the Bootlegger-Baptist dynamic by using two techniques.

  • Pro-legalization groups have worked around strict regulation to achieve national presence, even in states where cannabis products do not have medical or recreational approval. For example, firms can invest in products and equipment that do not directly touch cannabis plants yet further the development of the product market. Groups lobbying on behalf of such investors free themselves from the need to work with moral and social allies to advance political goals.
  • Profit-driven groups have learned to adopt the practices of orthodox businesses to downplay negative associations with the cannabis industry. Such groups build an agreeable corporate image by emphasizing profitability and coordinating diversity initiatives. When cannabis firms are viewed by the public as just another high-growth, socially inclusive industry, they may no longer need public-interest partners to achieve legalization. By aligning their businesses with mainstream corporate practices, cannabis firms (and other firms acting in this arena) may also find it easier to raise capital and gain trust from traditional investors.

New Laws and Regulatory Directions

Profit-driven “bootleggers” may push for rapid increases in cannabis sales in states with legal or medical cannabis. Given that states with legalized medical cannabis have higher rates of adolescent use, such increases in sales may well lead to much more adolescent use of cannabis, which is associated with mental illnesses.

State-level regulators may need to respond by tweaking new laws to deal with cannabis sales and use rising at higher rates than originally envisaged. This, in turn, may give new openings to morally and socially oriented advocacy and non-profit groups, who will press for larger roles in state regulation of the now-legal cannabis industry. Such advocates and non-profits will jump at the chance to ensure they are not left out of the discussion entirely, since profit-driven groups may have so far been able to advance their own ends without support, input, or even connection to public interest or citizens’ groups.

In sum, as many current cannabis legalization battles suggest, for-profit “bootlegger” groups can now win major legislative victories without allying with public-interest Baptists to give them moral cover. Nevertheless, struggles and, at times, surprising coalitions, between Bootleggers and Baptists are unlikely to disappear altogether – and they can re-emerge in ongoing regulatory arenas even when they did not shape original legislative steps. Forward-thinking legislators will take this into account and structure both laws and implementing processes to ensure that public interest groups are not cut out of the discussion altogether.

Read more in Navin Kumar, “The Changing Bootlegger/Baptist Dynamic: Evidence from the Legal Cannabis Space” (forthcoming).

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What Are The Benefits Of Prenatal Exercise? And Why You Must Do It?

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As soon as you hear the impending pregnancy good news, the topmost suggestion received from people is to take care of yourself and get proper rest. Well, it’s not entirely wrong because you must take proper care of yourself during all trimesters of your pregnancy, but it doesn’t mean you have to stay inactive all day.

Working out can actually prove to be really helpful during and after the pregnancy. We all know exercising daily is good for our health and a pre-natal workout is just as important. Exercising during pregnancy has many benefits, and you can find pre and post natal personal training programs focused on exercises best suited for you.

Until and unless your doctor has forbidden you from any kind of physical activity, it is always good to consider working out for at least 20-30 minutes every day. It is not only helpful in maintaining a proper posture, but it is beneficial post pregnancy too. For many years, there has been a myth that working out during pregnancy may result in complications during the pregnancy. However, researchers have turned down this theory. Pre-natal exercises are good for the baby as well as for the mother but make sure to do it carefully and preferably under supervision.

Here are some of the major benefits that you can reap from pre and postnatal training sessions.

Improve energy levels

No doubt pregnancy can drain your energy levels. However, working out every day can prove to be really beneficial for boosting up your energy levels and helping to increase energy throughout the day. Prenatal exercises improve your cardiovascular system this way you don’t feel tired very often. You can do your daily routine tasks without easily getting tired or drained.

Helps you getting better sleep

During pregnancy, most women can experience sleepless night, uneasy sleeping, and difficulty in finding the right position to sleep. By involving yourself in physical activities and exercises you are bound to sleep early. Exercising can be tiresome especially for pregnant women this helps you in getting better sleep at night.

Lower pregnancy-related risks

According to research done in 2017, women who exercise regularly during pregnancy are less likable to have risks that come with gestational diabetes. Moreover, you can surely avoid a C-section by staying active during pregnancy. Staying active and exercising during the pregnancy can fairly reduce the chances of undergoing a C-section. Cesarean delivery needs more aftercare and the recovery time is also more as compared to a normal delivery. Pre-natal exercises can definitely be very beneficial for you to avoid some of the complications during the pregnancy.

Lesser weight gain

We all know that losing pregnancy weight is not that easy in fact it can be quite stubborn. Women who exercise during pregnancy do not tend to gain a lot of weight. But this does not mean that you won’t gain weight however weight gain in inactive pregnant women is higher. Regular exercising helps in building muscles and burning fat, and as a result, you do not gain excessive weight which is very difficult to lose after the pregnancy.

Quick post-delivery recovery

Staying active and working out during the pregnancy and exercising will be beneficial for you during the pregnancy but will also help in faster recovery after the delivery. When you perform exercises during the pregnancy you are improving your fitness levels. As a result, you are able to recover faster. A study done in 2012 reveals that women who worked out or participated in some kind of physical activity during the pregnancy recovered faster post the delivery.

Uplifts Mood

Mood swings are very common during the pregnancy; in fact, pregnant women are more prone to depression, moreover, one in two pregnant women report some kind of depressed and anxious behavior during the pregnancy. This is very common and you can do a lot to stay away from depression during the most memorable time of your life. Many women notice a change in their moods after exercising. A prenatal workout is one of the best ways to stay fit and keep yourself away from pregnancy-related anxiety and depression as exercising keeps you busy and on the run.

Healthy baby

Pregnant women who involve in moderate exercising since the beginning of their trimester deliver healthier baby. In fact, mothers who indulge in prenatal exercises tend to have quicker mid-trimester growth rate, the baby is also nourished than those pregnant women who have a sedentary lifestyle. So it is always a good choice to work out and stay active during the pregnancy.

There are a number of benefits that pregnant women can reap from indulging in prenatal exercises. All in all, it is very beneficial for the baby and the mother in particular. However, if it is your first pregnancy make sure you are working under the supervision and also ask your doctor prior to deciding to workout daily. Until and unless there are some complications involved in the pregnancy medium intensity workout, it is always a good choice along with staying active make sure to have a balanced diet.

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Aging

How Universities Can Better Support Student Caregivers

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More than half of family caregivers are between the ages of 18 and 49 years old – and as the U.S. population ages, increasing numbers of these caregivers will be enrolled in colleges. Often categorized as “nontraditional students,” college-enrolled caregivers are responsible for children, spouses, and dependent parents with disabilities and chronic illnesses. Nontraditional students of all kinds are more likely to drop out of higher education because of obstacles in their non-academic lives, and this certainly holds true for those who have to balance caregiving with their studies.

Historically, Student Affairs professionals have developed programs and services to meet the challenges faced by underrepresented and underserved students. Given the growing prevalence of student caregivers, academic institutions should keep their needs in mind when distributing funds and creating student support services. While each student caregiving experience is unique, the fundamentals are constant. Very often, student caregivers must choose between attending to a human being for whom they are responsible or attending to academic tasks.

Students managing such choices, balancing caregiving and academic demands, face significant barriers. For example, the amount of time they are able to spend with faculty and advisors is often limited by their caregiving responsibilities. Furthermore, efforts to disseminate information about support services on college campuses typically focuses on traditional students and thus may miss or leave out nontraditional students who are not part of established campus communication channels.

Student-Centered Teaching Can Help Caregivers

Student-centered teaching focuses on individual learning needs to promote persistence and success. Effective student-centered instruction is based on the understanding that one size does not fit all. When an instructor makes accommodations for student caregivers as emergencies arise, such flexibility demonstrates empathy and can promote success rather than indicate compromised standards.

Consider the following examples from the lives of student caregivers I interviewed in my research:

  • Waldo told me about his experience during his first year of college. He began caring for his mom, who had Huntington’s Disease, while he was in high school. He grew up in poverty and was the first person in his family to go to college. He chose to stay at home and commute to college so he could continue to care for his mom and save money. During finals week of his freshman year, his mom required brain surgery because of a fall. He asked his statistics professor if he could take the final at an alternative time due to his mom’s surgery. The professor replied that it was his choice whether he came to the final or not, but he would not alter the time.
  • Alex, an assistant professor, cared for his mom who had a stroke while he was completing his PhD. He told me he was lucky the stroke occurred around Thanksgiving, when he had a break from the regular requirements of the semester. As he navigated his mom’s recovery, Alex only had to negotiate with his dissertation chair – who allowed him to alter deadlines to ensure he had the time he needed to care for his mom.

Alex’s dissertation chair practiced student-centered teaching, while Waldo’s professor did not. The advantages to students of such teaching are evident, especially for student caregivers, who need a flexible learning environment to succeed academically and develop healthy coping skills while contending with the overriding needs of those for whom they care.

Student Caregivers, Technology, Insurance, and Health

Student caregivers are at a higher risk for stress-related illnesses than their peers, due to their time constraints and intersecting roles; and such difficulties can be compounded when students lack the time and resources to develop healthy coping strategies. Nevertheless, higher education policies have the potential to improve long-term health outcomes for student caregivers by providing access to appropriate supports and resources. Health is at the core of student learning and success. It is in the interest of university administration to ensure access to institutional support and resources, as the following examples suggest:

  • Natalia, a PhD candidate and caregiver, struggled with anxiety and depression. Her dissertation advisor empathized with her situation and allowed her to work remotely instead of commuting to campus when her mom needed care. She was fortunate to have access to all of the university’s technological resources while at home caring for her mom. Natalia’s advisor also encouraged her to apply for emergency funds. The flexibility and knowledge about university resources that Natalia’s advisor provided, helped her develop and employ healthy coping strategies.
  • Anne, a master’s degree student, told me about the university resources she received as a student caregiver. Assistive technology provided by her university was installed on her personal computer, allowing Anne, her husband, and their children to navigate various tools for coping with learning disabilities. Student health insurance provided by the university allowed her to get allergy shots, orthotics, and counseling to cope with anxiety and depression. Financial aid both increased and decreased stress. She worried about paying back the loans, but before she enrolled in graduate school her family did not have the financial reserves to weather a crisis.

Toward Equity for Student Caregivers

Like other students, caregivers seek higher education to improve their economic and social resources, but they face many obstacles and graduate less often than traditional students. To level the playing field for all students, administrators should ensure all students have access to health insurance, appropriate personally tailored learning technologies, and the flexible schedules and supportive resources they need to study even when caring for others. Colleges, students, and society alike only stand to benefit if student caregivers face easier routes to degrees.

Read more in Lisa Schumacher, “The Lived Experience of Student Caregivers: A Phenomenological Study,” University of Iowa, 2018.

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Is Red Wine and Resveratrol Good for Heart Health?

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Red wine has been consumed by people for many centuries now, and in the last century, it has been identified that an element in red wine called resveratrol is good for heart health. In this article, we will try to explore some real facts about it.

As researchers have shown, it is true that red wine, when consumed in moderation, has some heart health benefits. Along with it, the alcohol content and certain elements in red wine known as antioxidants can help prevent CAD (coronary artery diseases), which is a condition leading to heart attacks and heart failure.

Red wine and heart health

Any known link between consumption of red wine and a lower risk of heart attack is not fully understood. However, the major part of the benefits may be related to the antioxidants, which may increase the levels of high-density lipoprotein (HDL and good cholesterol). It can also protect against bad cholesterol build-up.

While this news about red wine benefits may sound great to some wine enthusiasts, there are differences of opinion among doctors in terms of drinking alcohol and potential abuse. Even though consumption of a limited glass of wine along with dinner seems to be ideal, it may ultimately grow into an abuse especially if you have a family history of addictive behavior. Too much alcohol consumption regularly can have very harmful effects on your health.

Even though this is the case, a handful of doctors agree to the fact that red wine, overall, appears to help heart health. The antioxidants, flavonoids and resveratrol present in red wines available at Sokolin Wines all have significant heart-healthy benefits.

Why is red wine good for the heart?

Even though red wine has some heart health benefits, it is not better than consuming beer, white wine, or any other liquor. There is no clear-cut evidence as to how red wine is better for heart health than any other form of alcohol in terms of heart health. So, there is no evidential proof that red wine can always be good for health in all cases. However, the antioxidants present in red wine, such as polyphenols, are found to have a significant positive impact in lining the blood vessels and protecting them. Polyphenol, known as resveratrol, is a major subject in red wine, which has gotten significant attention in this regard.

Resveratrol

Resveratrol is a vital ingredient in red wines, which helps to prevent damages in blood vessels in the human heart. It can help reduce the low-density lipoprotein (LDL), which is the bad cholesterol, which ultimately prevents any blood clots. Some studies have shown that resveratrol can control low-risk blood clotting and inflammation, which may further lead to heart diseases. On the contrary, there are some other studies which show that resveratrol has no role in preventing any heart disease. There may be a need for more research in this regard to identify the actual impact of resveratrol in heart disease.

Resveratrol in grape skin and other supplements

Resveratrol content in red wine primarily comes from grape skin, which is used to prepare wine. Red wine is fermented from the skin of the grapes and so compared to white wine, red wine has more resveratrol content. On the other hand, simply eating grapes or drinking grape juice with the skin included may be one effective way to gain resveratrol than drinking alcohol. The red and purple juices may also have similar heart-healthy benefits as red wine.

Some other food items which also contain resveratrol are blueberries, peanuts, and cranberries. Although there is no conclusive data, there have been a few studies on the effectiveness of drinking red wine over the benefits of eating grapes or other food items containing resveratrol in terms of heart health. However, it is a fact that the volume of resveratrol in red wine and other food items may vary widely.

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How To Win America’s Fight Against The Opioid Epidemic

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Every day, an astonishing 115 Americans die from opioid overdoses, according to a 2017 report from the Center for Disease Control and Prevention. Approximately half of these deaths are due to the misuse or abuse of prescription opioid painkillers (such as Vicodin, Oxycontin, and morphine). Beyond that, increasingly, deaths come from overdoses of the illicit drugs heroin and fentanyl, which are often used after people become addicted to or misuse prescription opioids.

Each day, more than 1000 people are sent to the emergency room for prescription opioid misuse. In many of these cases, opioids were used along with alcohol or medications meant to treat anxiety or seizures (such as Xanax, Ativan, and Valium). When people ingest such mixtures, they face a heightened risk of injury or death as their breathing slows or stops.

Effective treatments exist. But as treatment for over-dosing is increasingly available, treatment for addiction is still not accessible to many of those who need it. Access to effective treatments for opioid addiction is the missing piece in America’s unsteady fight against the opioid epidemic.

Success in Fighting the Opioid Epidemic

Gains in the fight against the opioid epidemic have been made on several fronts. The physicians and nurse practitioners who prescribe America’s medications are being trained to be more judicious in their use of opioids to treat pain. They are also learning to consider, whenever possible, non-opioid medications and other treatments that don’t come from a pharmacy at all. National guidelines have been established for methods of relieving surgical, cancer-related, and chronic pain without opioids. Taken together, all these efforts are saving lives and reducing the volume of prescription opioids that can be diverted to illicit uses.

Similarly, emergency first responders and trained laypeople now have tools to help prevent deaths from opioid overdoses. Lives have been saved in many communities by the administration of naloxone – a medication which blocks the effects of opioids on breathing centers and reverses overdoses.

But what happens after emergencies – or to prevent them? Treatments for addiction can reduce the likelihood that people addicted to opioids will overdose and die. And such treatments are vital because, like any other chronic illness such as diabetes or heart disease, untreated addiction becomes more severe and resistant to treatment over time.

The Missing Piece – Access

What most of America is sorely missing, however, is sufficient access to the addiction treatments that are the most effective – and not enough efforts are currently underway to increase such access. Currently, the best estimates suggest that only one out of every ten patients seeking drug abuse treatment can actually get into a program. To sharply reduce U.S. opioid deaths, proven forms of treatment should be readily available, on demand, to all who need them. Policymakers, civic leaders, patient advocates, and journalists, should consider the following steps:

  • Treatment and reimbursements should be evidence-based. Research shows that the most effective approach is medication-assisted therapy (MAT), where patients are given methadone, buprenorphine, or naltrexone, alongside therapy to combat addiction. Too many private payers pay for treatments based on mistaken ideas. For example, detoxification is known to be highly ineffective against opioid addiction, yet it is widely practiced and reimbursed.
  • Insurance and other reimbursement systems need to acknowledge that addiction is a chronic disease that almost never goes into remission after a one-time treatment. Treatment for addiction needs to be ongoing and long-term, just like treatments for diabetes or heart disease. But currently most health insurance companies will only cover one treatment episode or a fixed number of treatment days per year.
  • Early, intensive treatment is the most effective and less costly over time. Currently, most insurance companies will only cover outpatient treatment for opioid addiction, and will only reimburse intensive inpatient treatment if the first effort fails. Evidence shows that in many cases, the opposite approach would work better: start with intensive treatment rather than with minor steps that allow time for the disease to progress.
  • Many opioid addicts could be treated within America’s current primary care systems. Two effective medications, buprenorphine and naltrexone, can be prescribed by primary care providers. With appropriate waivers, for instance, a physician can treat up to 100 patients with buprenorphine.
  • Medications need to be supplemented with therapy. Because most primary care clinicians do not have the resources or practice partners to provide the therapies patients need in addition to medications, they often limit the number of addicts they treat or avoid treating them altogether. The answer lies in making behavioral health providers more readily available to work with primary care providers, who could then prescribe effective medications more readily.
  • Patients brought to hospitals for opioid addiction and overdose should be enrolled in therapy and other treatment on the spot. Many patients with opioid addiction end up in hospitals and emergency rooms. The current approach is to stabilize them medically and then tell them, as they are discharged, to seek further treatments. But many do not follow up or have adequate access to the help they need. A better approach would be to start treatment while addicts in crisis are at the hospital – and directly transfer them to an addiction treatment facility upon discharge.
  • Jails and prisons are other places where opioid addicts need treatment. Efforts to bring medication-assisted therapy to the incarcerated could mitigate the larger opioid crisis – and also reduce the rate at which ex-inmates commit new offenses and cycle back to prison.

The bottom line is clear: Increasing access to proven treatments for all addicts who need them would save and improve countless lives, and effectively counter America’s current opioid crisis.

Read more in Peggy Compton and Andrew B. Kanouse, “The Epidemic of Prescription Opioid Abuse, the Subsequent Rising Prevalence of Heroin Use, and the Federal Response” Journal of Pain and Palliative Care Pharmacotherapy 29, no. 2 (2015): 102-114.

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Aging

Do I Have to Enroll in Medicare if I’m Still Working at 65?

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One of the most common questions asked by seniors these days is “Do I need to enroll in Medicare if I’m still working at 65?” The answer isn’t black and white. It depends on multiple factors and personal preferences. If you don’t plan on retiring at 65, you are going to want to ask yourself these questions to figure out when you should enroll in Medicare.

What is the Size of My Employer?

The first thing you need to consider when deciding to enroll in Medicare at 65 is the size of your employer. If you work for a small employer with less than 20 employees, you need to enroll in Medicare when your Initial Enrollment Period arises.

Medicare will become your primary insurance and your group plan will be secondary. Your group plan monitors your age, so there is a chance that they will stop paying your claims if they realize you are eligible for Medicare and don’t have it. You will also have late enrollment penalties later on because you missed your Initial Enrollment Period for Medicare.

If your employer has 20 or more employees, it’s considered a large employer. When working for a large employer you have three options during your Initial Enrollment Period.

  • Stick with your group plan and delay enrolling in Medicare until you retire.
  • Disenroll from your group plan and enroll in Medicare.
  • Have both your group plan and Medicare for extra coverage.

It’s advisable to research and compare premiums costs for both your group plan and Medicare to see which option is best for you. If you choose option one, you will have a Special Enrollment Period once you retire to enroll in Medicare without penalty.

Do I Have Retiree Benefits?

Retiree benefits are health plans that some employers offer to their retirees. Medicare is the primary insurance for these types of health plans. This means you need to enroll in Medicare if you have retiree benefits.

One type of plan that retirees often ask about is COBRA. COBRA allows the retiree to have health coverage up to 18 months after their retirement. However, Medicare requires you to enroll within the first 8 months of having COBRA if you are over 65. Keep in mind that COBRA can also stop paying claims if they realize you are eligible for Medicare, yet you don’t have it.

What if I Don’t Sign Up at All?

Choosing to not enroll in Medicare when you are expected to can cost you a world of trouble. You can end up getting late penalties and delayed coverage if you don’t sign up on time. Yet we see this all time. A healthy person decides not to enroll and doesn’t realize that later he will have considerable penalties because he simply didn’t know the rules.

In this scenario, he must now wait until the next General Enrollment Period (GEP) which begins January 1st and ends March 31st. When you enroll during the GEP, your coverage doesn’t start until that July. This means that you have gone months without health coverage.

How Can I Enroll in Medicare?

Most people qualify for premium-free Part A, so you might as well enroll in at least that when you are first eligible. If you do decide to enroll in full Original Medicare when you are first eligible, you will be safe from the chaos that occurs when you don’t enroll on time.

If your group plan has decent drug coverage, you don’t have to enroll in Part D for drug coverage. Be sure to check if your group plan includes drug coverage because if it doesn’t, you will need to enroll in Medicare Part D.

You can enroll online at the Social Security website, in person at the Social Security office, or over the phone during your Initial Enrollment Period (IEP). Your IEP is a seven-month period. This one-time window begins three months before the month that you turn 65 and lasts for three months after the month that you turn 65.

Can I Disenroll from Medicare if I Return to Work?

Sometimes people retire and then decide to return to work, perhaps in a new field or part-time. If your new employer has more than 20 employees and offers health insurance coverage, you can enroll in that coverage and drop your Medicare Parts B and/or D if you want to. This will save you from paying those premiums. Be sure to confirm that your employer’s plan is equal to or better than Part D benefits so that you don’t incur a penalty later on when you re-enroll in Part D.

There is usually no need to disenroll from Part A since Part A costs nothing for most people. It can coordinate with your employer coverage and potentially reduce costs if you incur a hospital stay. Just keep in mind that you cannot contribute to a health savings account while enrolled in any part of Medicare, so if your employer plan provides an H.S.A., you’ll want to keep that in mind.

Later when you decide to stop working again, you’ll have a special election period to re-enroll in Parts B and D.

Dealing with Medicare while you are still working at 65 can be difficult. It’s important to learn what type of coverage your employer has along with what changes might be made once you get Medicare. Doing your research ahead of time can help you avoid any enrollment mistakes.

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