During cancer treatment, the main focus is on the patient. However, a cancer diagnosis affects the entire family, including caregivers. A caregiver is any person who supports a patient during treatment; this can be a spouse, partner, sibling, son, daughter, or friend. Taking on the role of a caregiver can change the dynamic in a relationship.
Partners who were once equals can now have an imbalance and a child can often need to take on a parental role. Often the caregiver’s needs can be overlooked. It is important for the caregiver to keep their body and mind healthy in order to provide the best care to the patient. While this seems easier to say than do, working in some self-care does not have to take a lot of time or money.
Ways to put yourself first:
Let go of guilt. It is natural to feel guilty for taking time for yourself when your loved one needs so much. Try to remember why all airlines instruct passengers to put their own oxygen mask on first before helping others. The reason behind this is simple: You cannot care for someone else when you are depleted. It is important to acknowledge guilty feelings and find a safe place to share them, but do not allow them to stop you from caring for yourself.
Build in fun. Create a list of activities that make you happy. Playing your favorite song, taking a bubble bath, or going for a walk are just some of the possibilities.
Relax. Simple breathing exercises, guided imagery, meditation, and proper sleep habits. There’s even an app for that! You can download apps like Headspace and Calm to help guide you in relaxation practice.
Self-compassion. Cut yourself some slack! When you care for yourself and a loved one, it is normal to experience stress. Recognizing this stress in a non-judgmental way and taking small steps to combat it is the first step in self-care.
Your oncology social worker is there to help patients and caregivers, and we can help you make a personalized plan to cope with the challenges of being a caregiver.
Do I Have to Enroll in Medicare if I’m Still Working at 65?
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.
What Drives Racial and Ethnic Disparities in Prenatal Care for Expectant Mothers?
Prenatal care — health care for pregnant mothers — is one of the most commonly used forms of preventive health care among women of reproductive age. Prenatal care represents an important opportunity to detect, monitor, and address risky health conditions and behaviors among expectant mothers that can impact birth outcomes.
Both delayed prenatal care (i.e., care initiated after the first trimester of pregnancy) and inadequate prenatal care are associated with poor infant health outcomes such as low birth weight. Although researchers continue to debate precise causal effects, studies suggest that prenatal care brings important benefits — including reductions in maternal smoking, lower rates of preventable pregnancy complications like high blood pressure, and better management of the mother’s weight after giving birth. Furthermore, mothers who initiate care earlier are more likely to take their infants to well-baby visits after their babies are born.
As with other forms of healthcare, we see significant racial/ethnic disparities in access to and use of prenatal care. Although researchers have explored overall disparities in health outcomes rooted in differences in health insurance coverage, education, family income, and county-level poverty, more remains to be learned about how such factors affect various racial/ethnic inequalities.
Such knowledge is critical for achieving national public health goals and for addressing gaps in health outcomes for pregnant women. My research explores this area and can point to solutions that can improve and equalize health care for various groups of women and their children.
Disparities in First Trimester Initiation and Adequacy of Prenatal Care
My research quantifies how various factors contribute to gaps in prenatal care among non-Hispanic white, non-Hispanic black, and Hispanic women. By combining county-level U.S. Census data with rich data on children born in 2001 from the Early Childhood Longitudinal Study, I am able to pinpoint factors that typically cannot be considered simultaneously. For example, I can explore the effects of both maternal access to transportation and the availability of physicians in various counties.
My results reveal significant disparities among black, Hispanic, and white mothers in terms of the start of prenatal care in the first trimester of pregnancy. Although approximately 89 percent of whites initiate care during the first trimester, only 75 percent of black mothers and 79 percent of Hispanic mothers do so. Mothers from these groups also experience disparities in the adequacy of prenatal care they receive. Approximately 79 percent of non-Hispanic whites experience at least adequate prenatal care, while only 68 percent of Hispanic mothers and 69 percent of black mothers receive adequate care. What explains these differences? Here are the key findings from my research:
Socioeconomic characteristics like education, family income, and participation in the Special Supplemental Nutrition Program for Women, Infants, and Children explain far more of the racial/ethnic gaps in prenatal care than any other factors. These factors explain over half of black–white disparities and nearly half of Hispanic–white disparities in first trimester prenatal care initiation. Socioeconomic characteristics also explain far more of the racial/ethnic gaps in prenatal care adequacy than any other group of factors (although these factors account for considerably more of the black-white gap than the Hispanic-white gap).
Maternal health and characteristics of pregnancies (such as maternal age and number of previous pregnancies) explain 8.8 percent of black-white differences and 8.7 – 9.7 percent of Hispanic–white differences in the timing of the start of care in the first trimester. But differences in the adequacy of care are not related to maternal health or pregnancy characteristics.
Types of insurance coverage – whether women are covered by Medicaid, private insurance, or have no coverage — explain similar small percentages of differences in the timing of first trimester care, but again do not account for gaps in the adequacy of care.
The location of prenatal care facilities – in physicians’ offices and public health clinics — explained 4.7-6 percent of black–white gaps in timing of the start of care and 2.9-4.9 percent of Hispanic–white disparities. Location of care explained about 8.3 percent of black–white gaps in the adequacy of care but did not explain Hispanic-white gaps.
Maternal behaviors like smoking and state of residence and count-level conditions did not significantly contribute to racial and ethnic disparities in the initiation of prenatal care. But the availability of local gynecologists and state of residence did help to narrow black–white gaps in the adequacy of prenatal care, although these factors did not influence gaps in the adequacy of care between Hispanics and whites.
Addressing Socioeconomic Factors to Improve Prenatal Health
My research suggests that large and persistent socioeconomic disparities are primary contributors to racial/ethnic gaps in the timing and adequacy of prenatal care. This finding is not surprising — pregnant women with lower incomes and levels of formal education often do not have the resources necessary to obtain care early and often. However, participation in the Special Supplemental Nutrition Program for Women, Infants, and Children made a difference for pregnant women, suggesting that this public program can help meet the financial needs that remain an important barrier to timely and adequate prenatal care.
My findings suggest that policymakers should endeavor to help disadvantaged populations gain expanded access to healthcare. Medicaid expansions through the 2010 Affordable Care Act provide one promising intervention. Although such expansions target childless poor and near-poor adults, women who receive coverage prior to pregnancy can end up enrolling earlier in prenatal care; and they can obtain continuing help with the management of chronic health problems, potentially improving outcomes when their babies are born.
Ultimately, as my research shows, reducing economic inequality may help to close racial and ethnic disparities in prenatal care. Read more in Tiffany L. Green, “Unpacking Racial/Ethnic Disparities in Prenatal Care Use: The Role of Individual-, Household-, and Area-Level Characteristics,” Journal of Women’s Health 27, no.9 (2018).
Effective Self-Control Strategies Involve Much More Than Willpower, Research Shows
It’s mid-February, around the time that most people waver in their commitment to the resolutions they’ve made for the new year. Many of these resolutions – whether it’s to spend less time looking at screens, eat more vegetables, or save money for retirement – require us to forego a behavior we want to engage in for the one we think we should engage in. In a new report, leading researchers in behavioral science propose a new framework that outlines different types of self-control strategies and emphasizes that self-control entails more than sheer willpower to be effective.
The report comes at a time when environmental pressures and societal problems are making strategies for boosting self-control more important than ever, says Angela Duckworth, a University of Pennsylvania psychology professor and one of report’s authors.
“Temptations are arguably more readily available, more creatively engineered, and cheaper than any time in history,” Duckworth says. “Junk food gets tastier and cheaper every year. And then there’s video games, social media, the list goes on. In parallel, there are public policy issues such as obesity, educational underachievement, and undersaving that result, in part, from failures of self-control.”
Duckworth’s coauthors on the report– published in Psychological Science in the Public Interest, a journal of the Association for Psychological Science–are Katherine L. Milkman (The Wharton School of the University of Pennsylvania) and David Laibson (Harvard University). George Loewenstein (Carnegie Mellon University), a leading researcher in the science of decision making, is an author of an accompanying commentary.
Based on their comprehensive review of available research, Duckworth, Milkman, and Laibson propose a framework that organizes evidence-based self-control strategies along two dimensions based on how the strategies are implemented and who is initiating them.
They observe that in some cases the best self-control strategy involves us changing the situation to create incentives or obstacles that help us exercise self-control, such as using apps that restrict our phone usage or keeping junk food out of the house. In other cases, it’s more effective to change how we think about the situation — for example, by making an if-then plan to anticipate how we’ll deal with treats in the office — so that exercising self-control becomes more appealing or easier to accomplish.
Other strategies work better when someone else implements them for us. For example, our electricity company might use social norms to prompt a change in our thinking, showing us how our energy usage compares with that of our neighbors. And policymakers often use situational constraints to prompt behavior focused on the long-term. Examples range from incentives (e.g., tax rebates for eco-friendly building materials) to penalties (e.g., raising taxes on cigarettes and alcohol). Employers are increasingly using another type of situational constraint, defaults, to encourage employees to save for retirement; many are requiring people to opt out of an employer-provided retirement plan if they don’t want to participate.
The strategies, drawing from insights in psychological science and economics, can inform the efforts of policymakers, employers, healthcare professionals, educators, and other practitioners to address pressing issues that stem, at least in part, from failures in self-control, the authors write.
Identifying four types of self-control strategies that go beyond willpower sends an important message, Loewenstein writes in his commentary, given that people often believe willpower is sufficient despite its high failure rate. One of the reasons people tend to fail in their New Year’s resolutions is “naivety about the limitations of the brute-force approach and ignorance of the far more effective strategies enumerated in the review,” he writes.
But Loewenstein notes some important caveats to keep in mind when interpreting the research, which the researchers also acknowledge in the report. Many studies have examined self-control strategies in small groups of participants over brief periods of time, which raises questions about whether they will remain effective if implemented at a broader scale and how long the effects will last.
Duckworth, Milkman, and Laibson hope that their review helps to integrate existing research on self-control from several disciplines into a comprehensive whole.
“There is an urgent need for a cumulative and applied science of self-control–one that incorporates insights from theoretical traditions in both psychological science and economics,” the researchers write. “We hope this review is a step in that direction.
The full report and commentary are available online.
Report: Beyond Willpower: Strategies for Reducing Failures of Self-Control https:/
Important Things An Active Person Should Know About Feet
Most of us take thousands of steps a day by foot. An active person or someone who participates in sports will likely use their feet even more. We use our feet every day for very important reasons, but many of us still neglect to care for them. Paying more attention to our trotters can result in more attractive and healthier feet, so why do we ignore them? To learn more about your feet and the importance of foot care, read on.
The Proper Shoes Make A Difference
Ill-fitting shoes can cause blisters, bunions, and foot pain. Athletes and runners are especially prone to foot discomfort. Your shoes should always fit your foot, allowing adequate room for your toes to move, and supplying the appropriate support and cushioning. If you are a runner, investing in a good pair of running shoes is highly recommended. Basketball players, dancers, tennis players, and golf players should also wear shoes which are comfortable and suitable for their individual needs.
Foot Odor Is Caused By Sweat And Bacteria
Active people are especially prone to foot odor because they tend to sweat more. Sweating is healthy and is your body’s natural way of cooling itself, but it can lead to some nasty bodily odors. Foot odor is often characterized by a cheesy, vinegary smell. The feet are full of sweat glands and these glands can excrete up to a half-pint of moisture a day.
The best way to prevent foot odor is to keep the feet dry and clean. Washing your feet every day, changing your socks frequently, and alternating your shoes can greatly reduce unpleasant foot odors. It is important to alternate your shoes because bacteria and moisture can build up inside of footwear, which is what causes the bad odors. Letting your shoes fully dry out before wearing them again is recommended. In addition, there are various foot deodorizers available for those who suffer from foot odor.
Foot Fungus Is Preventable
Fungus loves feet because the inside of your shoes provides them with the perfect breeding ground. Damp and dark, your well-worn shoes attract the organisms which cause athlete’s foot and toenail fungus. Once fungus invades, it can be hard to get rid of. If the conditions are right, fungal infections can live on your feet for years.
Active individuals should take preventive measures against foot fungus by wearing clean socks, washing the feet often, and wearing protective shoes in public places which can harbor fungus.
If you contract nail fungus or athlete’s foot, it is important to treat it with topical creams and antifungal medications. Doing so prevents the fungus from spreading and getting worse. The sooner the condition is treated, the easier it will be to manage.
Your Feet Can Be Linked To Your Health
Certain diseases like diabetes and peripheral arterial disease can cause symptoms in your feet. Undiagnosed diabetes is known to cause dry skin because glucose levels affect sweat and oil production in your feet. Loss of feeling in the feet due to nerve damage is also a common symptom of diabetes.
Peripheral arterial disease (PAD) can cause thin, shiny skin on the feet. PAD causes poor blood circulation and raises your risk of heart attack and stroke. If your feet show any signs of circulation issues, consult your doctor promptly.
Taking care of your lower extremities and looking for any unusual signs and symptoms is the best way to maintain healthy feet. Keeping your feet clean and rotating your shoes is also a good idea, especially if you are active. Doing so will prevent foot odors and fungal infections. Your feet are essential to your body, so treat them as such.
The Mind-Body Connection
One of the most important things I learned from my experience of depression was how closely linked my physical and mental well-being are. In the thick of it, I remember many days of trying to figure out why I felt so low. I talked through with my therapist all the various stressors which could have been affecting me that day. This included all my thoughts and feelings, and possible resolutions to my troubles. Only to figure out later on that I hadn’t had enough sleep the night before…and when I got enough sleep the next night, my mood was hugely improved.
It’s still true if I don’t sleep well, I’ll invariably feel a bit low the next day. Not to the extent that I’m depressed, but I definitely notice being more irritable and sensitive to things which wouldn’t normally bother me that much. Being sick is another example of when not feeling great physically affects my emotional resilience and makes everything else that much harder. On one occasion, when I was horribly sick and sleep deprived, I burst into tears because I dropped my toast, butter side down, on the kitchen floor!
And who hasn’t heard of the phenomenon of being “hangry” ie: getting so hungry you start getting angry. I’m sure this is a regular for me coming up to lunchtime at work.
The Mind-Body Connection
It seems so obvious now, the mind-body connection is important, but it took me such a long time to figure it out. For the longest time, I didn’t realise every little fluctuation in my level of happiness didn’t necessarily indicate anything major going wrong other than my body trying to say, “take care of me, please!” Of course, sometimes there are other things going on when you’re feeling down. But I guess I found it useful to realise that my physical health is connected to my emotional well-being, too.
Now that I’m working as a therapist, I’ve noticed this theme with clients as well. Whenever someone says to me they are having a bad day, the first thing I ask about is how they’ve slept, whether they’ve eaten, or if they are sick at the moment. Of course, the answer is not always this simple but I’ve been surprised at the number of people who will say, “Actually, I didn’t sleep at all last night…and now you mention it, no wonder I’m feeling a bit crappy today.”
Separating Mind and Body
These days we are very good at separating mind and body. Our mind – our thoughts, perspectives, moods, and emotions – almost seems like a completely different thing to our physical experience of the world.
These days, it’s essential to think about our physical and mental well-being as interconnected and it’s equally important to take care of both. I’m not one to preach about what this might mean for you. I’d be the last person to advocate that everyone should stick to any particular health regime – I’m firmly from the school of doing whatever works for you!
But I think what it boils down to is a little self-care (and for me personally, a healthy dose of balance) is good for both body and mind. I find noticing the effect of one on the other is helpful in understanding my experience of the world.
What are your thoughts on the mind-body connection?
Right from the Start: Investing in Parents and Babies – Alan Sinclair
It is widely accepted the earliest months and years of a child’s existence have the most profound impact on the rest of the lives. Attachment theorists believe the early bonds and relationships a child forms with his/her carer(s) or parent(s), informs that child’s ability or inability to form successful and healthy relationships in the future.
Alan Sinclair’s ‘Right from the Start’ is the latest in the Postcards from Scotland series of short books, which aim to stimulate new and fresh thinking about why us Scots are the way we are.
In my previous book review in the Scottish Journal of Residential Child Care, I commended the author of ‘Hiding in Plain Sight’ (another book in the same series) Carol Craig for her ability to write succinctly and accessibly about a complex subject matter. I feel the same way about Alan Sinclair’s writing in this book.
The premise of this book, put simply, is laying out the bare truths of how good and bad us Scots are at parenting as well as having the appropriate supporting systems in place for parents and carers of our most vulnerable children.
A consistent thread throughout the book is the author arguing that by investing in parents and babies ‘from the start’, governments and the surrounding systems who support children and families can relieve the heartache of tomorrow in the form of poorer outcomes in education, employment and in health.
The book begins by acknowledging the UK’s position on the UNICEF global league table of child well-being, ranking 29 of the world’s richest countries against each other. The UK is placed 16th, our particular challenge being a high proportion of young people not in work, training or education. Although the league table did not single out the devolved nation of Scotland, the author describes the UK as a ‘decent proxy for Scotland’.
The first 1,000 days
The author goes on to explore the theory of the first 1,000 days of a child’s life. This theory suggests this is the most significant indicator of what the future holds for them. He touches on child poverty, which we know from well-cited research can lead to adversities in life, but he also mentions too much money can be an issue as well.
This point is explored more deeply later in the book’s in a chapter titled: ‘Is social class a factor?’. The author is effective at challenging the popular rhetoric that it’s the least educated and most poverty-stricken parents in society who are most likely to neglect their children. He talks about the longitudinal study, Growing Up in Scotland, which tracks the lives of thousands of children and families from birth to teens. Amongst many other findings, the survey shows 20% of children from the top income bracket have below average vocabulary; it also finds problem-solving capabilities are below average for 29% of this group. This proposes child poverty is only a small indicator of the child’s developmental prospects.
Where the Dutch Get it Right
The most intriguing part of the book from my point of view is the comparison the author makes between raising a child in Scotland versus the Netherlands (which ranked first in the UNICEF league table). In Holland, pregnant women have visits from a Kraamzorg, an omnipresent healthcare professional who identifies the type of support required. Post-birth the Kraamzorg plays a very active role and can typically spend up to eight hours a day supporting the new mother in her first week of childcare. The Kraamzorg also becomes involved in household chores including shopping and cooking. And it doesn’t stop there. The Dutch system includes Mother and Baby Wellbeing Clinics, which support families from birth to school age and have been doing so effectively for the last century.
On reading how the Dutch system operates, it’s hard to not make comparisons to the system here in Scotland (and the wider UK) within our NHS where mothers are wheeled in to give birth and very quickly wheeled out again to free up bed space. I exaggerate slightly here and I do not want to discredit the incredible job hard-working NHS staff do, but I’m sure I’m not alone in feeling envious of the Dutch system and thinking they’ve got something right, in comparison with Scotland. This was neatly summarised at the start of the book in a quote from a Dutch woman who had spent time living in both Holland and Scotland when she said: ‘In Holland we love children. In Scotland you tolerate children.’
But it’s not all bad. As the author remarks himself: ‘Scottish parenting is not universally awful: if we were we would not be almost halfway up the global table of child well-being’ (p. 12).
The penultimate chapter explores some real-life examples of parents who are struggling and striving to succeed in bringing up children with some success despite the odds stacked against them. I found the author’s injection of such human stories among the explanation of evidence useful as it allowed a chance for the reader to reflect on how all this is applicable in everyday life in Scotland.
To me, there was, however, a glaring omission in these stories: a voice from the LGBT community. Gay adoption in Scotland was legalised almost 10 years ago in 2009, and at the same time the Looked After Children (Scotland) Regulation 2009 came into force allowing same-sex couples to be considered as foster parents. It would have been interesting to hear from this historically marginalised part of our society what the experience has been like and how different, or similar, this was from the other stories included in this chapter. Are they arguably better equipped as carers of Scotland’s most vulnerable children given their own life experiences of being marginalised?
The book ends with the author setting out his vision for a better future for Scotland’s children where they have better life chances and are fully nurtured. It’s clear we have some way to go but reading this book makes you feel a glimmer of hope that could, one day, become a reality.
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