11/1996 - Florida Department of Elder Affairs

http://www.state.fl.us/doea/doea.html
Volume 6, Number 11 / November 1996
PUBLISHED BY THE FLORIDA DEPARTMENT OF ELDER AFFAIRS • E. BENTLEY LIPSCOMB, SECRETARY
Agency seeks increased funding for
Alzheimer's program
BULLETIN
BOARD
L
OOKING FOR IDEAS —
This is not the sort of news
item that will be of interest to
general readers, but some of you
professionals should find it
enticing. The Department of
Elder Affairs soon will be funding
creative intergenerational programs to offer opportunities for
youth to serve frail elders who are
at risk of institutionalization. A
Request for Proposals is being
advertised in the Florida Administrative weekly through midNovember. Be watching for the
advertisement to learn about an
opportunity for your agency to
initiate an intergenerational
program in your community. If
you do not have access to the
weekly and would like to receive
formal notice of this grant, please
write to Tonya Nicholson, Department of Elder Affairs, Office of
Volunteer and Community
Services, 4040 Esplanade Way,
Suite 260, Tallahassee FL 323997000.
✽✽✽
A
TTENTION-GETTERS —
November is National
Alzheimer’s Awareness Month, and
we’re observing it with a package
of stories and information. You’ll
find them on Pages 10 and 11. We
also direct your attention to Page
24 and the piece by Dr. Howard
Tuch. It’s the first in our series on
“Ethics and Personal Responsibility.” The articles do not necessarily
reflect the opinions and/or positions
of the Department of Elder Affairs; they are being run in the
hopes of generating meaningful
thought and discussion of several
issues related to ethical issues
involving elders. Let us know
what you think..
Increase would enable DOEA to serve 3,229 Alzheimer’s victims
A
lzheimer’s disease is a progressive, degenerative disease of
the brain and the most common
form of dementia. It also is one
of the major health concerns and
expenses for the United States
and its aging population.
Currently, the disease affects
more than four million Americans — 371,000 of them in
Florida — and those numbers are
expected to double by the year
2010.
In-home caregivers are the
backbone of the nation’s informal, long-term care system for
Alzheimer’s victims. Their
numbers too are expected to
grow significantly as the population ages.
During years of caregiving,
families experience emotional,
physical, and financial stress. They
watch their loved ones become
more and more forgetful, frustrated,
and confused. Many caregivers,
most of them women, juggle child
care and jobs while caring at home
for relatives who cannot function on
their own. As the disease runs its
course and the abilities of people
with Alzheimer’s steadily decline,
family members face painful decisions about the long-term care of
their loved ones.
Alzheimer’s also puts a heavy
economic burden on caregivers and
society. A recent study estimated
that the cost of caring for one
person with Alzheimer’s disease at
home or in a nursing home is more
than $47,000 a year; if the
Alzheimer’s victim receives Medicaid nursing home assistance, the
cost is still high — $28,577 annually. For a disease that can span
from two to 20 years, the overall
costs to families and to society are
staggering. The annual cost of
Alzheimer’s disease in the United
States is estimated at $80 to $100
billion.
Easing the strain on caregivers
is one of the important elements of
the Department of Elder Affairs’
Alzheimer’s Disease Initiative
(ADI). The program provides state
funds for day care and respite care
services — in which volunteers
“substitute” for caregivers, giving
them a needed break from the stress
of caring for an Alzheimer’s victim.
It’s a vital and cost-efficient
program. Currently, the department’s
average cost for in-home respite care
for its 2,271 clients is $2,070 per
year per person, while the adult day
care figure is $1,400 per year per
person.
But the current funding level is
such that less than 1 percent of the
demand for respite care is being met.
For this reason, the department is
requesting that the Florida Legisla-
ture next year significantly increase
the amount of funding for the
program, from $7.8 million to $19.4
million.
The department’s request would
expand the number of clients served
to 3,229, increase the average
number of hours per week that
respite care is provided from three to
eight per client, increase by five the
number of Alzheimer’s Model Day
Care projects providing specialized
respite care programs for
Alzheimer’s victims, and increase
funding for each of the existing day
care projects.
It also would expand the Senior
Companions program by adding 150
volunteers who would provide
156,000 hours of service to
Alzheimer’s victims. Senior Companions, who receive a small stipend
($2.45 per hour) for their expenses,
will provide an array of assistance in
addition to in-home respite, including transportation, meal preparation,
and companionship.
S T A T E
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ELDER AFFAIRS
Elder Update
NOVEMBER 1996
PAGE
2
Quit Complaining, Get Busy!
by George Hanna
I
ncreasingly, when I complain of
aching joints or a sore back,
someone will remind me that I’m
not getting any younger.
That’s true, of course. Not
comforting, but true.
What’s also happening more
and more often as I do not get any
younger is that I’m being startled by
people who apparently were never
told that it’s not nice to frighten
others.
If you’re among the 34 million
Americans over the age of 65 —
and you probably are or you
wouldn’t be reading Elder Update
— you know what I mean. Some
people are trying to scare the
daylights out of us — often for
commercial purposes — and doing
a good job of it.
Just watch television and you’ll
hear that if you don’t have enough
money for old age, then you’d better
get some or God help you.
Do you have insurance? You’d
better get more or there might not
be enough money to bury you
(Does that call to mind an old Mike
Nichols-Elaine May sketch or
what?)
Or a solemn voice confides,
“Many vision problems occur
gradually and are unnoticed until
it’s too late.” That’s sort of like the
termite commercial: Once you find
out you have them the damage has
already been done.
And so it goes: Have you been
checked for glaucoma? Do cataracts
keep you from living the good life?
Do you suffer from insomnia? Are
you over-medicated? Feel a sharp
pain in your lower back? Does the
pain move down the legs?
Uh-oh!
The print media offer more of the
same: How to avoid hip fractures ...
keeping heartburn under control ...
seniors being defrauded by people
they trust...banks can help fight fraud
against seniors.
The one who said old age is no
place for sissies had it right.
There are full-page newspaper
ads saying the sky is falling on
Medicare and Medicaid. Congressmen barely old enough to hold
office have become instant experts
and talk incessantly on C-span
about changes they say are needed
in Medicare as if they know what
Medicare is all about.
◆
◆
Your Comments Are Important to Us!
Elder Update recognizes corporate
members of the Elder Floridians
Foundation, Inc. Such recognition
does not constitute an endorsement
by the Department of Elder Affairs
of the products or services offered
by corporate members.
Editor, Kit Bauman
Database Manager, Barry Moore
Elder Update (USPS 403-710/ISSN
1060-4545) is published monthly by
the Department of Elder Affairs.
✁
POSTMASTER:
Send address changes to:
ELDER UPDATE
Department of Elder Affairs
4040 Esplanade Way
Tallahassee, Florida 32399-7000
Periodicals postage paid at Tallahassee, FL.
Mission Statement
T
he mission of the Department of Elder Affairs is to maximize
opportunities for self-sufficiency and personal independence of
Florida’s elders and to plan, advocate and administer programs and
policies that assure accessible, responsive and comprehensive services
and long-term care.
Information contained herein may
not be reproduced or reprinted
without permission.
NEW SUBSCRIPTIONS ONLY!!
If you are not currently receiving Elder Update, you may do so
by completing the form below and sending it to Elder Update, 4040
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Elder Update is distributed free to elder Floridians.
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The poet who said, “The best is
yet to be...” about growing old had it
wrong. Don’t tell me the best is yet
to be if those thirtyish congressmen
have anything to do with it.
A headline in Elder Update
reads, “Anxiety and depression are
overlooked problems among elders.”
I wish I could overlook them.
Some advice: The best thing for
folks who are not getting any
younger is to keep busy. I stay busy
about one-third of my waking hours
looking for my glasses and the rest
of the time trying, without much
success, to overlook anxiety....
George Hanna stays busy as a
guest commentator for WFSU-FM,
the Public Broadcasting station in
Tallahassee, and now as a contributor to Elder Update.
You will find Marriott Senior Living Services properties in the following areas:
Boca Raton
Stratford Court 800/464-1947
Boynton Beach
Brighton Gardens 407/369-7919
Coral Springs
Park Summit 305/752-9500
Deerfield Beach
Forum at Deer Creek
305/698-6269
The Horizon Club 800/223-9624
Fort Myers
Calusa Harbour 941/332-3333
Springwood Court 941/278-0078
Fort Lauderdale
Tiffany House 954/563-3116
Maitland (Orlando)
Brighton Gardens 407/645-3990
Palm Harbor
Coral Oaks, 813/787-3333
Stratford Court, 800/772-2622
Port Richey
Nature Trail, 813/863-2129
Port St. Lucie
Brighton Gardens, 407/335-9990
Venice
Brighton Gardens, 800/449-5598
West Palm Beach
Brighton Gardens, 407/686-5100
The Forum at Fountainview,
800/940-9220
Marriott is a corporate member of the Elder Floridians Foundation,
which partially underwrites Elder Update.
S T A T E
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ELDER AFFAIRS
Elder Update
NOVEMBER 1996
The Customers
Always
Write
Dear Editor:
This letter is in response to “Lorraine in Vero Beach,” a letter
that was published in the September edition of Elder Update.
As a mobile home owner since 1969, I sympathize with the letter
writer about large rental increases. Fortunately, when I moved to
Florida and purchased my mobile home, I also invested in a membership to the Federation of Mobile Home Owners of Florida, the
only organization that assists mobile home owners with their challenges. Through the years I have served in different officer positions with the organization and finally I became its president. But
that is only after watching how the organization operates and
seeing first-hand that this organization really assists homeowners.
Education is power, and the Federation of Mobile Home Owners, through its member publication, keeps us informed of what’s
being done to assist homeowners and what we can do to help ourselves. I encourage any mobile home owner to join and stay informed.
Bill
✽✽✽
Dear Editor:
I look forward to receiving Elder Update every month. What a
great newspaper for elders. The articles are so informative and I
always enjoy Lou Kaplan’s column.
The new bold-face type that you recently started using makes
reading easier. You are doing a fine service to the elderly with Elder
Update. I commend you and thank you.
I hope when I move from Florida, which I must for personal
reasons, you will continue to send me a copy each month.
Thank you.
Rosalind
Boca Raton
The Editor replies: Thanks for the kind words. Let our database
manager, Barry Moore, know when you move and he will see to it that
your subscription is not interrupted; use the form on the back page of
Elder Update. As for your comment about the bold-face type, others
seem to agree that it is a plus. We plan to print a future issue of Elder
Update entirely in bold face to see how it reads and whether we lose
PAGE
3
much space (it’s a subtle thing, but bold-face type takes up more room
than our regular type). We’ll keep everyone abreast of further
changes.
✽✽✽
Dear Editor:
Let me offer my congratulations and appreciation. At age 71 I
qualify as a reader of Elder Update, and for me that’s a plus. You
produce an interesting and useful publication.
Please let me ask one question: Why are letters to the editor
signed with first names only? Many elderly Floridians are bemused
by the practice of young receptionists and others they’ve never met
addressing them by their first names only. Although this is intended
to be friendly, it is often perceived by the elderly as a put-down. I
note that bylines in your fine newspaper are not limited to first
names.
Having been an editor of daily and weekly newspapers for
several decades I am reluctant to write you about this because I
know you have a good reason for your policy. I’m interested — not
critical!
Best wishes to you and your staff.
Sincerely yours,
Ed
Orlando
The Editor replies: We adopted the first-names-only policy several
months ago as a means of protecting our readers from unwanted
solicitations, letters, phone calls, etc. Not that we’re aware of any
problems — it just seems to make sense. Also, it’s an easier policy to
administer; we do not publish anonymous letters (except when we
decide ourselves to extend anonymity to a writer), but the first-namesonly approach effectively affords the same thing. In other words,
everyone gets treated the same....
✽✽✽
Dear Editor:
I’m not sharing a story for your paper but to tell you how many
memories flooded my mind as I read “Coasting in the old Model A”
in October’s Elder Update.
You’re too young to share the sweet memories I have of a similar
car, a 1936 model. My parents were so proud of it and I was in the
third grade...old enough to wait at the foot of the hill for my dad to
drive home from work and allow me to ride the running board
down Godby Street to the house. He put his arm out the window
and around me for that wonderful ride home. I loved it. Also, the
newer car, a sedan, had curtains that could be pulled down, allowing for quick changes into swim suits on picnic days at the river.
Thanks for the memories.
Pat
Orlando
The Editor replies: Thanks for the letter, Pat. One question — what’s a
running board? No, just kidding — some of us are indeed old enough to
remember them. A number of people have called and written with the same
reaction as yours. Sometimes the simplest memories are the best....
S T A T E
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Elder Update
NOVEMBER 1996
PAGE
4
SHINE helps widow win appeal before
Administrative Law Judge
A
be Berman, SHINE Local
Volunteer Coordinator in
Sarasota County, represented a
widow before an Administrative
Law Judge and won an appeal in
the amount of $1,654.48.
A beneficiary, since deceased,
purchased a power-operated
wheelchair and a claim in the
amount of $2,395 was submitted
to Florida Blue Cross/Blue
Shield. The carrier determined
that no allowance could be made,
based on a determination that the
supplier had not obtained a
written order from the appropriate
doctor prior to the delivery of the
item. Upon review, the carrier
modified its determination to
allow a reimbursement of only 80
percent of $326.90, or $235.46.
The beneficiary passed away
during the review interval. The
widow requested a fair hearing on
behalf of the estate, which again
resulted in denial of any payment
based on a determination that the
prescription was not given by a
proper specialist. The widow then
requested a hearing before an
Administrative Law Judge. The
amount in controversy was
$1,654.48 (80 percent of the cost
price, $2,395, minus the amount
allowed, $326.90).
The beneficiary’s widow
testified on behalf of the estate.
She was represented by Berman,
a non-lawyer representative from
the SHINE Program. The general
issue at question was whether
payment should be made under
Part B of Title XVIII of the
Social Security Act for a poweroperated scooter furnished to the
beneficiary. The specific issue
was whether the beneficiary’s
condition met the test outlined in
the coverage manual.
After evaluation of the evidence, it was the decision of the
Administrative Law Judge that
the power-operated wheelchair
met the criteria and was covered
under the provisions of Title
XVIII of the Social Security Act.
Directory
S
HINE (Serving the Health
Insurance Needs of Elders) is
a free insurance counseling
program designed to assist elders
in sorting out their health-insurance problems. If you need
assistance with Medicare, Medicaid, or health-related insurance, a
SHINE counselor can help. For
the phone number of a SHINE
site near you, call the statewide
SHINE number, 800/96-ELDER
or 800/963-5337.
SHINE has counselors in the
following counties:
The carrier was directed to make
the appropriate payment of
$1,654.48.
✽✽✽
In an unrelated case,
Berman recently received a
“thank-you” note from a
client who had originally
contacted him about what to
do to recover a nursing
home overcharge. The
client said that she had
been trying for more
than a year to get the
nursing home to refund
money she had paid for
her mother’s care. Berman advised
her to contact the Long-Term Care
Ombudsman Council, which acts as
advocates for nursing home residents and their families.
The client wrote that on August
20, 1996, she mailed information
about the overcharge to the LongTerm Ombudsman Council and on
September 6, she received a check
from the nursing home for $977.60.
The client’s note said, “After
having struggled by myself for
almost a year and a half, believe
me, I am more thankful than I can
express for the help of SHINE
and the Ombudsman Council. You
are much needed. Many thanks.”
It’s one more example of how
SHINE gets results...
ALACHUA
FLAGLER
MARION
PUTNAM
BAY
HERNANDO
MARTIN
SANTA ROSA
BRADFORD
HIGHLANDS
MONROE
SARASOTA
BREVARD
HILLSBOROUGH
NASSAU
SEMINOLE
BROWARD
HOLMES
OKALOOSA
ST. JOHNS
CHARLOTTE
JACKSON
ORANGE
ST. LUCIE
CITRUS
LAFAYETTE
OSCEOLA
SUMTER
DADE
LAKE
PALM BEACH
VOLUSIA
DESOTO
LEE
PASCO
WASHINGTON
DUVAL
LEON
PINELLAS
ESCAMBIA
MANATEE
POLK
S T A T E
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Elder Update
NOVEMBER 1996
PAGE
5
Flu season’s coming, so get your vaccination
I
t’s almost flu season, and the
Centers for Disease Control
(CDC) is warning that a more
dangerous strain of the virus than
those seen last year — a particularly
bad year, too — will be circulating
this year.
That’s why its important that
elders get flu immunizations. The
current flu vaccine counteracts the
new strain — known as the Type AWuhan virus — and the two other
strains that officials have identified.
People over age 65 are at higher
risk than the general population
from influenza and pneumonia.
Nearly 3,900 elder Floridians died
from flu and pneumonia in 1995.
Individuals with long-term
illnesses such as chronic heart and
lung disease, diabetes, kidney
failure, impaired spleen or liver
functions, and sickle cell anemia
also are at higher risk.
The harsh Type A-Wuhan virus
has especially dangerous complications for elders when compared to
the two other strains, Type A-Texas
and Type B, according to officials.
“The more viruses like Wuhan, the
more people die,” said Nancy Arden
of the CDC’s National Center for
Infectious Diseases.
Annual flu immunizations are
important, according to the CDC,
because the viruses and vaccines are
constantly changing. The vaccine
cannot cause influenza; it is not
made of live viruses, but inactivated
ones that have been rendered noninfectious.
Flu immunizations are covered
under the Medicaid program and are
available upon request from Medicare providers under Medicare Part
B. As long as the healthcare provider agrees not to charge more than
Medicare pays, the patient pays
nothing; if the provider does not
accept assignment, the patient may
have to pay charges in addition to
the Medicare-approved amount.
(Individuals enrolled in HMOs
may be required to get their immu-
nizations through their HMO. They
should ask their HMO for information before arranging for the shots.)
As for pneumonia immunizations, in most cases a single
immunization provides life-long
protection.
K.I.S.S. is Keeping Independent
Seniors Safe
S
he was confined to a wheel
chair.
She had impaired vision, and
she hadn’t been outside her house in
a long time.
All that changed, however, with
a little K.I.S.S.
K.I.S.S. is the acronym for
Keeping Independent Seniors Safe,
a partnership program between the
Polk County Sheriff’s Office,
Explorer Post 900 of the Boy
Scouts, several elder service organizations, the Polk County S.A.L.T.
(Seniors and Law Enforcement
Together) Council, and the Department of Elder Affairs.
These agencies, along with the
assistance of area businesses and
volunteers, have provided supplies
and labor to several residents of
Polk County who otherwise would
not have had such things as smoke
detectors, peep holes, dead bolts, or
wheelchair ramps.
This project benefits the frail,
elder citizens of the county. The
Explorer Post provides the labor,
installing the needed items,trimming
trees and shrubs for better visibility
and accessibility, and re-numbering
homes in larger, brighter colors so
homes can be easily identified in
emergencies.
To qualify for the program,
applicants must be at least 60 years
old, must live in Polk County and
have maintained full-time residency
for one year, must be in the low- to
moderate-income range, and must
own the dwelling in which they live.
The program, which began in
April, has already served more than
20 elderly homeowners. The benefits are obvious, too — improved
peace of mind, social contact with
young people, and the ability to
remain living independently.
Not only has the program benefitted the elderly, it has provided many
of the county’s youth with an opportunity to learn the value of community
service. According to one member of
the Explorer Post, “We’ve learned that
even the smallest jobs can seem very
large to some people.”
Like the elderly woman mentioned at the top of this story. The
Explorers built and installed a wheelchair ramp for her home. When it was
finished they gently wheeled her
outside, reassuring her that the ramp
would support her.
At the bottom of the ramp, she
relaxed. She drew a deep breath,
exhaled, and then listened to the
sounds. Then she smiled, drinking in
the fresh taste of renewed independence.
K.I.S.S. had done its job.
Interested in seeing a K.I.S.S.
program started in your community? For information, write to
Luke Dickerson, c/o Polk County
Sheriff’s Office, 455 N. Broadway,
Bartow FL 33830.
Come visit
the Department
of Elder Affairs
ON THE INTERNET!
http://www.state.fl.us/doea/doea.html
S T A T E
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Elder Update
NOVEMBER 1996
PAGE
6
Fibromyalgia:
Coping with very real pain
Y
ou know pain when you stub
your toe. This article is about
a different type of pain. About 10
percent to 15 percent of people
suffer aches and pains much of the
time. They simply “ache all over.”
“This problem has been with
us a long time,” says Dr. Robert
M. Valente, a rheumatologist at
Mayo Clinic, Rochester, Minn.
“And it probably will be with us
forever in one form or another.”
As with many chronic, symptom-dominant problems, a good
deal of mystery still surrounds the
reason that some people are more
predisposed to hurt than others.
Among the biggest of such mysteries is fibromyalgia — a chronic
condition characterized by generalized aches, pains, and stiffness in
muscles, tendons, and ligaments.
Fibromyalgia is not a form of
arthritis, which affects the joints.
Fibromyalgia is a syndrome,
meaning there are several overlapping symptoms. It may be associated with anxiety, depression, nonrestorative sleep disturbance,
morning stiffness, irritable bowel
syndrome, and chronic fatigue.
It is estimated that for every
three people who “ache all over,”
only one goes to a doctor to report
the symptoms.
Women are five to 10 times
more likely to be diagnosed with
fibromyalgia than men. Dr.
Valente suggests that many men
might be less inclined to complain
about general aches and pains.
However, he notes that the incidence of a more socially acceptable ailment — disabling lower
back pain, for instance — rises
among men in the same age
groups in which the incidence of
fibromyalgia rises among women.
An estimated 2 percent of the
total population meet the medical
criteria for a diagnosis of
fibromyalgia.
To satisfy the American College of Rheumatology criteria for
diagnosing fibromyalgia, a person
must have widespread aching for
at least three months without an
alternative explanation. A certain
number of “tender points” about
the body (including around the
neck, hips, elbows, knees, and
edge of the upper breastbone)
must be abnormally tender under
relatively mild pressure. Some
physicians argue that the criteria
are too rigid and that any person
with otherwise unexplained,
chronic, widespread musculoskeletal pain and sensitivity may have
fibromyalgia.
Frustrations
No laboratory test can confirm
or rule out a diagnosis of
fibromyalgia. Doctors do not
entirely agree on how to define it.
People with fibromyalgia may
undergo several medical tests,
only to be told that nothing appears to be wrong.
Yet their pain is very real. As a
result, they may feel even more
frustration and anxiety, which in
turn may aggravate their symptoms.
Theories
Doctors have identified no
single cause for fibromyalgia.
Poor sleep, physical deconditioning, or stress — either physical or
emotional in nature — may
abruptly trigger fibromyalgia in
some people.
Within the general population
there is a group that is more
sensitive to hurting. People
within this group are more likely
to develop fibromyalgia if their
coping mechanisms break down.
“They lose their ability to cope
with a very real problem,” Dr.
Valente says. “They are not
making it up.”
Factors such as a lack of
physical conditioning, poor
posture, emotional or physical
stress, mood disorder, sleep
disorder, low self-esteem, or
obsessive personalities may make
some people more susceptible to
fibromyalgia symptoms. However, it should be emphasized that
fibromyalgia is not a psychiatric
disorder. Some researchers believe chemical or hormonal
differences contribute to the
syndrome, although no one
difference has so far explained
the condition satisfactorily.
Dr. Valente says many of
these factors may be interrelated.
“The hope that we can find the
cause for fibromyalgia, based on
the work currently being done,
may not be an attainable goal if
the focus is to find a single
‘broken part,’” he says. “Who we
are, how we react, and the environment that shapes our feelings
and actions must be considered
equally in the search for a cause.”
With no cure in sight, Dr.
Valente says treatment should
focus on the individual, taking
into account both physical and
emotional factors.
“We have to be honest with
fibromyalgia patients and tell
them that most people with
fibromyalgia have it for the rest
of their lives,” Dr. Valente says.
At the same time, patients may
find it easier to cope after learning that fibromyalgia is neither
progressive nor crippling.
Treatments
Here are some options to
discuss with your doctor:
• Pace yourself: Dr. Valente
suggests reducing stress and
taking steps to control your
environment. “You must be able
to say no’ without guilt. That’s
part of the management technique,” he says. It’s best to
avoid long hours in repetitive or
high-stress jobs. Some people
benefit from developing daily
routines that alternate work
with relaxation and sleep.
However, people who quit work
on disability status or drop all
activity tend to do worse than
those who remain relatively
active.
• Exercise: Most people with
fibromyalgia benefit from
regular, low-impact, gentle
aerobic exercise, accompanied
by stretching and better posture.
• Education: It helps to know
that you’re not alone. Learning
more about fibromyalgia and
joining the right support group
can help. Seek out groups that
emphasize maintaining function, rather than groups that
emphasize symptoms.
• Medications: Modest doses of
aspirin, ibuprofen, or acetaminophen can alleviate some of
the pain and stiffness. Small
doses of medications that
promote deep sleep have proven
beneficial to some people. Narcotic
pain relievers should be avoided
because long-term use lowers the
pain threshold further, may have
adverse effects, or, may lead to
addiction.
• Other techniques: Some people
benefit from massages, hot
baths, or relaxation techniques.
• Family: Dr. Valente says support from family members can
help fibromyalgia sufferers. He
adds that some family members
may face a difficult balance. On
one hand, it’s unhelpful to take
the “just get over it” approach.
On the other hand, it’s possible
to overreact to the point of fostering disability.
is available in both
braille, and on
cassette tape.
To order your copy,
call 904/239-6000.
S T A T E
O F
F L O R I D A
D E P A R T M E N T
O F
ELDER AFFAIRS
Elder Update
NOVEMBER 1996
PAGE
7
Non-Hodgkin’s lymphoma
Incidence is increasing rapidly, but so is survival
I
t’s become one of the most
rapidly increasing cancers in the
United States, and doctors aren’t
sure why. But while the rate of
increase in non-Hodgkin’s lymphoma trails only that of prostate
cancer, malignant melanoma (a
form of skin cancer), and lung
cancer in women, survival rates are
also increasing.
Lymphoma is a general term for
cancers that develop in your lymph
system. There are two general types:
Hodgkin’s disease, which has
declined modestly in recent decades, and non-Hodgkin’s lymphoma. Non-Hodgkin’s lymphoma
accounts for only 3 percent of all
cancers in the United States, but its
incidence has increased approximately 75 percent over the last 25
years.
The good news, though, is that
during this same time, doctors have
made significant strides in treatment. Survival rates were once very
poor. Today, up to half of people are
cured or able to live successfully
with their disease for several years.
Your body’s defender
Your lymphatic system is part of
your body’s immune system that
protects you against infection and
disease. It’s a complex network of
thin channels that branch like blood
vessels into tissues throughout your
body. The channels carry lymph —
a colorless, watery fluid that contains infection-fighting white blood
cells called lymphocytes.
Hundreds of lymph nodes —
tiny bean-shaped glands that trap
and help destroy disease-producing
organisms — are situated along
your lymph network. Clusters of
lymph nodes are located in your
underarm, groin, pelvis, neck, chest,
and abdomen. Other parts of your
lymphatic system include your
spleen, thymus, tonsils, adenoids,
and bone marrow.
In non-Hodgkin’s lymphoma,
cells in your lymph system begin
growing without restraint. Cancer-
ous tumors start to develop, often at
different locations in your body.
Most often, the disease affects
people between ages 45 and 70, but
it can occur at any age. Signs and
symptoms include swollen but
painless lymph nodes, fever or
chills, night sweats, fatigue, weight
loss, an enlarged spleen, and reddened patches on your skin.
However, except for swollen
lymph nodes, the disease usually
has no symptoms in its early stages.
And, the lymph-node swelling isn’t
the same as that caused by a sore
throat or infected cut, which is
temporary and sometimes tender.
As the cancer progresses, your
body often becomes less able to
fight off invaders, putting you at
increased risk for other disease and
infection.
Diagnosis and treatment
To diagnose non-Hodgkin’s
lymphoma, tissue from an enlarged
lymph node is examined under a
microscope. There are many types
of the disease, and the examination
also helps determine whether the
cancer is a type that usually grows
slowly (low-grade), moderately
(intermediate-grade), or rapidly
(high-grade).
Intermediate- and high-grade
lymphomas are potentially curable.
Low-grade lymphomas are generally not. However, treatment may
prolong survival.
Choice of treatment depends on
the type and stage of your lymphoma, your age and your overall
condition. Mainstay treatment
options include:
• Chemotherapy — A combination
of drug preparations is used to
stop the growth of rapidly dividing cancerous cells. Some drugs
are given orally. Others are
injected into a blood vessel or
muscle. Chemotherapy is the
mainstay treatment for intermediate- and high-grade lymphomas
and advanced stages of the lowgrade disease.
• Radiation — This involves use of
high-dose X-rays or other highenergy rays to kill cancerous cells
and shrink tumors. Radiation is
used to treat some low-grade
lymphomas in their early stages.
It’s occasionally used in combination with chemotherapy on some
intermediate-grade tumors.
• Observation — For some advanced-stage, low-grade lymphomas that grow very slowly and
cause few symptoms, your doctor
may wait until the disease shows
signs of causing symptoms or
organ impairment before starting
treatment.
• Stem-cell transplantation — This
procedure is used primarily to
treat intermediate- or high-grade
lymphomas that relapse after
initial, successful treatment.
Healthy stem cells — those
capable of producing new cells —
are taken from your blood or bone
marrow and frozen. After intensive chemotherapy treatment that
usually destroys your bone
marrow, the healthy stem cells are
thawed and injected back into
your body.
A brighter outlook
Forty years ago, few people
with non-Hodgkin’s lymphoma
recovered. Today, up to half of all
people with the disease are cured or
survive for a lengthy period.
For people with intermediateand high-grade disease, advances in
chemotherapy and stem-cell transplantation, along with the availability of better antibiotics and supportive care, are responsible for the
improvement in prognosis. In this
group, chemotherapy produces
complete remission 40 to 90 percent
of the time. In some people, the
disease will relapse and they’ll
require additional treatment.
If treatment isn’t successful —
especially for people with highgrade disease — the average survival is often less than 18 months.
Low-grade non-Hodgkin’s
lymphoma usually isn’t curable, but
is very responsive to treatment. The
10-year survival rate is about 60
percent.
(Reprinted courtesy of the
Mayo Clinic.)
Presbyterian Retirement Communities is a corporate member of the
Elder Floridians Foundation, which
partially underwrites Elder Update.
A
re you worried that an
elder relative or friend
may be the victim of abuse?
You can report known or suspected cases of abuse by calling the State of Florida's
hotline at 1/800/96-ABUSE
(962-2873)
S T A T E
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F L O R I D A
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O F
ELDER AFFAIRS
Elder Update
NOVEMBER 1996
PAGE
8
Nutrition drinks: Keys to a healthy diet?
I
t’s hard
to miss the advertisements for nutrition drinks aimed
at the aging population. Open a
magazine or turn on your TV and
you’ll likely see a smiling couple
toasting their golden years with
cans of their favorite liquid
supplement.
After seeing these ads, you
may wonder about your diet and
lifestyle. Should you be drinking
Ensure, Sustacal, or one of the
other brands available?
While nutrition drinks aren’t
rocket fuel for
your body, as
ads claim,
they do
contain
vitamins and
minerals you
need to stay
healthy. But
so do many other
foods. If your diet
includes a variety of
foods and three meals a day,
chances are you’re already getting
all the ingredients for a healthy,
active lifestyle.
But, if you’re at dietary risk,
liquid supplements may help you
get the calories and nutrients you
need.
New marketing strategies
Liquid nutritional supplements have been available for
nearly 30 years. Until recently,
their use was generally confined
to nursing homes and hospitals to
Eight classic myths
about food
T
he more things change, the
more they stay the same.
This adage holds true especially
when it comes to food. Despite
advances in understanding the
relationship between nutrition and
health, some food myths are as
prominent today as years ago.
Here are eight classics:
Myth: The only way to
lose weight is to eat less.
Fact: One of the best ways to
lose weight may be to eat more —
at least of certain foods. Which
seems like more to you — a
handful of peanuts or seven cups
of light microwave popcorn? The
popcorn, of course. Yet both foods
have 150 calories. The difference
is in the amount of fat and fiber.
Foods that are low in fat and
high in fiber (like popcorn) naturally contain fewer calories than
foods higher in fat (like peanuts).
Gram for gram, fat has twice as
many calories as carbohydrate or
protein. Fat makes a little food add
up to a lot of calories.
Myth: Vitamins provide
energy.
Fact: Calories from fat, carbohydrates, and protein provide
energy. Vitamins don’t have calories, so they can’t give you energy.
The myth likely stems from the
action of B vitamins. They don’t
actually provide energy. Yet each of
the eight B vitamins plays a critical
role in the chemical reactions that
release energy from foods.
help those with nutritional problems maintain their weight and
get essential vitamins and minerals.
But now, the drinks’ manufacturers are marketing them for
healthy, active adults. In the past
year, sales of liquid nutritional
supplements in the United States
rose to $669 million. Sales of the
Ensure brand alone topped $300
million.
Not a food replacement
Liquid supplements contain
water, sugars, oils, vitamins,
minerals and milk and soy proteins. But they aren’t better than
food, or a replacement for it.
In fact, other than brightly
packaged cans and catchy slogans, there’s little difference
between them and a vitamin pill
dissolved in a milk shake.
The best way to ensure your
nutritional health is to eat enough
of the right foods — breads,
Myth: Mayonnaise is a
prime suspect in foodborne illness.
Fact: Although often blamed as
the reason for a good salad gone
bad, mayonnaise actually protects
food from bacteria that can cause
food-borne illness. In fact, mayonnaise contains two ingredients —
salt and vinegar — that actually
slow bacterial growth.
Rather than mayonnaise,
protein-rich foods, such as chicken
and eggs, are the more likely
culprits. When handled improperly,
these foods are prime breeders of
Salmonella bacteria. You can
introduce bacteria from your hands
or work surfaces into a salad during
preparation. Keeping these dishes
nonrefrigerated on a buffet or
picnic table for longer than two
hours adds to the risk.
Myth: You were born to
be fat.
Fact: Heredity strongly influences your body size and shape.
fruits, vegetables and dairy and
meat products. Depending on
your age and lifestyle, you need
between 1,600 and 2,800 calories
a day.
If you have a less active
lifestyle, particularly if you’re a
woman, your caloric intake
should stay at the lower levels of
this range.
A dietary option
Your nutritional status is an
important vital sign, just as your
blood pressure and pulse are. If
age, illness, or other factors are
affecting your diet and appetite,
liquid supplements are one option
for meeting your nutritional
needs. But if you have a balanced
diet and aren’t at nutritional risk,
you probably don’t need them.
(Originally published in
Mayo Clinic Health Letter, July
1996)
Studies show that the weights of
adults who were adopted as children resemble closely the weights
of their biological parents, not their
adoptive parents.
But you don’t inherit fatness as
you do eye color or skin tone.
Instead, you may have a genetic
disposition toward obesity. That
means having overweight relatives
makes you more vulnerable — but
not destined — to obesity. To gain
weight, you still have to eat more
calories than you burn.
Myths continued on page 18
S T A T E
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ELDER AFFAIRS
Elder Update
NOVEMBER 1996
PAGE
9
by Karen Collins, M.S., R.D.
Q:
ers a real choice by offering white
and “whole” wheat bread.
A:
Q:
A:
I’m confused over conflicting reports of whether it’s
better to store fruit and vegetables in
the refrigerator wrapped in plastic
or unwrapped. What are the facts?
When produce loses moisture, it also loses nutrients.
Wrapping fruits and vegetables in
plastic wrap and storing them in
“crisper” drawers can help retain
moisture and, therefore, is recommended. This also helps to keep
them fresh and crunchy. Too much
moisture can lead to the growth of
bacteria and mold that speeds up
decay. Soak up excess moisture by
tucking a paper towel into bags of
vegetables like lettuce that might be
more susceptible to decay. Another
way to keep vegetables moist is to
enclose them in the new perforated
plastic wraps that trap some
moisture in but allow excess water
vapor to escape. You can accomplish similar results by poking a few
holes in standard plastic wrap.
Q:
A:
Is wheat bread really more
nutritious than white bread?
If the bread label simply
says “wheat bread,” then
the main ingredient is enriched
white flour, and the produce is not
nutritionally different from white
bread. Caramel coloring and tan
wrappings are often used in an
attempt to make the bread look like
it contains more whole wheat.
“Whole wheat bread,” and other
whole-grain breads, are important
sources of dietary fiber and contain
more of several nutrients, such as
vitamins E and B-6, zinc and
magnesium, as compared to white
bread. Ask restaurants you frequently visit to offer their custom-
What is the latest informa
tion on the safety of MSG?
Monosodium glutamate
(MSG) is a flavor-enhancing food additive classified among
those considered safe. Some people,
however, have claimed that it can
cause a group of reactions commonly called “Chinese Restaurant
Syndrome” (because MSG is so
commonly used there), including
headache, weakness, nausea, and
chest pain. Others worry about its
overall safety. Last year, the Food
and Drug Administration (FDA)
commissioned a thorough review of
MSG’s safety. The report confirmed the safety of MSG for the
general public at levels normally
consumed and found no evidence
linking MSG to any serious, longterm medical problems. The review
did note that some people may
experience short-term reactions if
they eat a large dose at one sitting
on an empty stomach. A few
individuals with severe, unstable
asthma may also experience a
temporary worsening of asthma
symptoms after consuming moderately high doses. The panel recommended continued study of the
groups who are unusually sensitive
to MSG, but found that, for most of
us, it poses no health hazard.
Q:
A:
Are all hot cereals wholegrain?
No. Whole-grain foods
are those that have not
had their bran or germ removed
in refining. As a result, they are
higher in fiber and several other
nutrients than refined grains.
While oatmeal and several
brands of whole-wheat cooked
cereal are whole-grain, some
other hot cereals, such as Cream
of Wheat and Cream of Rice, are
refined and very low fiber.
While it is not necessary to only
eat whole-grain products, many
experts recommend that we eat
three or four servings of them
each day. By choosing a wholegrain breakfast cereal, you can
make a good start toward that
goal.
Q:
I've decided to try including
tofu in my diet occasionally,
but I was confused by the different
choices when I went to buy some.
What are the differences between
them?
A:
Tofu, made from soybeans
and pressed into soft cakes,
is an excellent source of protein that
is very low in saturated fat. When
pressing is increased, it results in a
more concentrated product, or firm
tofu. For example, four ounces of
soft tofu contain about nine grams
of protein, while extra-firm types
may contain between 13 and 18
grams. Vitamins, minerals, calories, and fat are also more concentrated as firmness increases. Soft
tofu is ideal for blending in dressings, sauces, and dips. Firm and
extra firm are easier to handle for
slicing, marinating, grilling, and
stir-frying. Because tofu has very
little flavor by itself, begin experimenting with it by substituting it
for meat or poultry in stir-fries and
other recipes that include plenty of
added flavorings. Look also for
recipes specifically developed for
the use of tofu. Since it has always
been a major part of Oriental
cuisine, cookbooks on that subject
can be a great source of recipes and
ideas.
Q:
How do the candy and
caramel apples so common
around this time of year rank as a
nutritious snack?
A:
The candied apples
coated in a shiny red
coating are simply apples with a
sugar coating, so they are as
healthy as having any other
apple dessert that adds sugar
and calories. The caramels used
to make the dipping sauce for
the apples, however, not only
add sugar calories, but also fat.
Caramel-dipped apples contain
about six to nine grams of fat,
which increases even more if the
apple is rolled in chopped nuts.
The advantages of eating these
snacks are the fiber and nutrition of real fruit, not found in
many fruit-flavored snacks that
essentially contain no real fruit.
So, if other food choices leave
you with room for extra fat and
calories, go ahead and enjoy
these sweetened apple treats
occasionally.
“Nutrition-Wise” is provided
as a public service by the American Institute for Cancer Research
(AICR). Questions for this column may be sent to “NutritionWise,” 1759 R Street, N.W.,
Washington D.C. 20009. Ms.
Collins does not respond to questions personally. ACIR also
operates a toll-free hotline that
offers advice about nutrition and
health. The number is 800/8438114; it operates weekdays from 9
a.m. to 5 p.m. Eastern time.
S T A T E
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ELDER AFFAIRS
Elder Update
NOVEMBER 1996
PAGE
10
Dealing with problem behaviors in
Alzheimer’s victims
A
nyone who works with people
who have Alzheimer’s disease
knows that the hardest part of caring
for these individuals comes from the
problem behaviors that can occur as
a result of the disease.
In some people, problems begin
in the early stages of the disease and
last until they die. Others seem to
live in their own world, and are
passive and maybe easier to deal
with.
Sometimes “problem” behaviors
are in the eye of the beholder. A
behavior that may be problematic
for one caregiver may not concern
another. The key to dealing with
behavior problems is for caregivers
to have a positive attitude and be
flexible.
Here are some guidelines for
dealing with problem behaviors.
• Remember that all behavior has
meaning.
• Remember that all behavior has a
stimulus or cause and a consequence or result.
• Everything surrounding a person
could contribute to the problem
behavior.
• It is essential to understand the
changes that occur in Alzheimer's
disease in order to understand
why behavior problems occur.
• It is also very important to review
communication techniques.
Listening to what a person with
Alzheimer's disease is saying both
verbally and nonverbally is a very
important part of managing
behavioral problems. Caregivers
also should be aware of their own
verbal and nonverbal communication.
• A thorough assessment of the
person, the caregiver and the
environment is absolutely necessary in order to plan an effective
intervention.
• Know the people well. Many
times problem behaviors begin
with subtle cues that only someone who works closely with a
person would know. This can be a
great preventive measure in
avoiding behavioral problems.
• Think ahead and plan for situations that could result in problem
behaviors.
• Trying to argue or reason with a
person who has Alzheimer's
disease only results in frustration
for both the caregiver and the
person. It is not possible to win an
argument with a person who has
Alzheimer's.
• Distract and divert whenever
possible.
• Keep the routine the same.
Changes in routine are upsetting
to people with Alzheimer's disease
and can cause problem behaviors.
• Promote a sense of security and
comfort when problem behaviors
occur. Problem behaviors often
happen because a person is
frightened and unable to make
sense out of the environment.
• Use positive reinforcements such
as food, smiles, a gentle touch,
personal attention and lots of
praise. These tools are much more
effective than negative reactions.
• Allow a person with Alzheimer's
disease some sense of control.
Being able to save face is important even to someone who is very
confused.
• Maintain a calm manner even
when confronted with threatening
behaviors. This can defuse a very
tense situation and help a person
become less fearful.
• Keep things simple. Complex
situations only cause frustration
for people with Alzheimer's
disease and escalate behavior
problems.
• If a caregiver becomes frustrated
and angry, it is best to find someone else to handle the problem
and have the caregiver leave the
immediate area. A frustrated and
angry caregiver will only intensify
problem behaviors.
• Caregivers should practice ways to
reduce stress when they become
frustrated and angry. Deep breath-
ing or talking to someone can be
helpful. Remember that stress
comes from many sources, including your personal life. Make an
inventory of stressful factors in
your life frequently.
• Remember that behavioral
problems result from the
disease. Don't take things
that a person with
Alzheimer's disease says and
does personally. Remember
that it is the disease speaking.
• Be creative when seeking
solutions to difficult behaviors.
• Use good common sense
when attempting to solve
problem behaviors.
• Keep a sense of humor even in the
most difficult situations. Humor
will help you cope with the frustrations of caring for people with
Alzheimer's disease.
Some problem behaviors
Alzheimer's disease is not just a
disease of memory loss. People
with Alzheimer's disease also show
symptoms of language problems;
problems with judgment, reasoning, sequencing, and planning;
problems with perception; loss of
motor skills; inability to carry out
daily activities; and personality
changes.
All of these deficits lead to
changes in behavior that can range
from simple repetitive behaviors and
lack of interest in past hobbies to
extreme agitation and violence.
Some of the problem behaviors seen
in people with Alzheimer's disease
include:
• Anxiety
• Wandering
• Stealing other's property
• Pacing
• Inability to remain quiet
• Disorientation to time, place,
and/or person
• Constant demand for attention
• Repetitive speech and/or actions
• Restlessness and fidgeting
• Inappropriate toileting
• Undressing
• Feeding problems
• Inappropriate sexual behavior
• Emotional outbursts
• Combativeness
• Screaming
• Cursing
• Lack of interest in activities/
surroundings
• Disturbance of sleep/wake cycle
• Sundowning
• Hostility
• Being uncooperative
• Easy frustration
• Hitting, kicking, biting
• Paranoid ideas
• Resisting care or refusing care
• Sadness, hopelessness, despondency
• Mood swings
• Catastrophic reactions (when a
demented person has an extreme
reaction, often due to sensory
overload)
• Hallucinations
• Delusional ideas
• Rummaging
S T A T E
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F L O R I D A
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ELDER AFFAIRS
Elder Update
NOVEMBER 1996
PAGE
11
Assistance and information about
Alzheimer’s disease
N
eed information about
Alzheimer’s disease? Looking
for assistance or services? Interested in learning more about events
and activities in your area related to
National Alzheimer’s Awareness
Month? The place to call is your
local Alzheimer’s Association
chapter or one of the Alzheimer’s
Resource Centers listed here.
✽✽✽
ALZHEIMER’S ASSOCIATION FLORIDA CHAPTERS
Brevard County Chapter
1250 S. Harbor City Blvd., #27
Melbourne 32937
407/729-8536
Broward County Chapter
8333 W. McNab Rd., Suite 203
Tamarac 33321
954/726-0002
Charlotte/Desoto Counties Chapter
118 Sullivan St.
Punta Gorda 33950
941/624-5724
Greater Miami Chapter
11900 Biscayne Blvd., Suite 440
Miami 33181-2726
305/891-6228
Greater Orlando Area Chapter
P.O. Box 3107
Orlando 32802-3107
407/422-9595
Greater Palm Beach Area Chapter
6401 Congress Ave., Suite 265
Boca Raton 33487
561/998-1988
Highlands County Chapter
74 Hickory Hills
Lake Placid 33852
941/385-8449
Manatee/Sarasota Counties
Chapter
350 Bradon Ave.
Sarasota 34243
941/355-7637
North Central Florida Chapter
1831 NW 13th St, Suite 1
Gainesville 32609
352/372-2038
Northeastern Chapter
2131 Mango Place
Jacksonville 32207
904/398-5193
Northwest Florida Chapter
P.O. Box 111
Pensacola 32591-0111
904/435-1558
Tampa Bay Chapter
9365 US Hwy 19 N., Suite B
Pinellas Park 34666
813/578-2558
Volusia/Flagler County Chapter
310 N. Nova Road
Ormond Beach 32174
904/253-9253
West Central Florida Chapter
P.O. Box 2070
New Port Richey 34656-2070
813/848-8888
✽✽✽
INDEPENDENT RESOURCE
CENTERS
Alzheimer’s Family Services
P. O. Box 786
Pensacola 32501
904/435-0990
Alzheimer’s Resource Center
P.O. Box 560129
Orlando 32056-0129
407/843-1910
Alzheimer’s Resource Center
of Tallahassee, Inc.
P.O. Box 3553
Tallahassee 32315
904/561-6869
Alzheimer’s Support Network
660 Tamiami Trail North, Suite 21
Naples 33940
941/262-8388
Alzheimer’s Resource Center of
Lee County, Inc.
9470 HealthPark Circle
Fort Myers 33908
941/437-3007
National Alzheimer’s Awareness Month
Calendar of Activities
8
Orlando — Third Annual
Community Appreciation
Breakfast honoring those who work
with Alzheimer’s victims and their
families. 7:30 a.m. to 9 a.m. Presidential Ballroom, Church Street
Station. $15. Call: 407/629-1997.
Winter Park — Open
house for the Greater
Orlando Alzheimer’s Association.
5:30 p.m. to 7:30 p.m. Miller Center
for Older Adult Services, 2010
Mizell Avenue.
Jacksonville
— “A Map
Through the Maze,” a conference for
14
14-16
caregivers of Alzheimer’s patients,
sponsored by the Northeastern
Florida Chapter of the Alzheimer’s
Association. Singleton Senior
Center, 150 E. 1st. Street. Call: 904/
398-5193 or 800/593-5065.
Gainesville — “Solutions
to Caregiver’s Problems,” a
training workshop for caregivers of
Alzheimer’s patients, sponsored by
the North Central Chapter of the
Alzheimer’s Association. 8:30 a.m.
to 3 p.m. Florida Farm Bureau
Building. Advance registration
required. Call: Melinda Gablehouse,
352/372-6266 .
15
Humana is a corporate member of the Elder Floridians Foundation,
which partially underwrites Elder Update.
Elder Update
NOVEMBER 1996
PAGE
12
Medicare ‘crossover’ snafu
is costly, confusing
to state retirees
Change in administrators led to problems in timely payment of medical claims
was Blue Cross Blue Shield, the
Jacksonville-based health care
insurance company which had
administered the program for the
last 18 years. It decided to formally challenge the decision.
That’s the point at which the
future problems began. Unisys
and Blue Cross Blue Shield
should have been holding discussions, planning for a smooth
transition from one administrator
to another, but no talks took place
while Blue Cross Blue Shield
sought to overturn the award to
D
on Slatton retired
from state government
almost 10 years ago, secure in the
knowledge that he would never
have to worry about health insurance coverage.
His confidence was not
misplaced...until early this year,
that is, when he started getting
notices from his physician about
unpaid bills.
“I couldn’t understand it,” the
Boca Raton resident said. “Nothing like this had ever happened
before. In the past, my insurance
claims were paid automatically.
It’s been a small nightmare to get
it straightened out."
Slatton is not alone in his
struggle. According to state
officials, some 10,000 state
retirees who also are Medicareeligible have been caught in a
quagmire of unpaid
insurance claims. Governor Lawton Chiles himself
intervened earlier this year when
complaints reached a crescendo.
What happened is one of
those good-intentions-gonewrong stories. Last year, the State
of Florida decided to switch
administrators for the program,
called a preferred provider organization (PPO) plan, which serves
about 240,000 state employees,
dependents and retirees. The
winner of the competition for
the contract was Unisys Corporation, the Pennsylvania-based
computer maker that acts as the
third-party administrator for
Medicaid in many states, including Florida. Unisys was given a
four-year contract worth about
fifty million dollars; the contract also allows for four additional one-year renewals at the
discretion of the State of Florida
each of those years.
The loser in the competition
before it was supposed to become
the third-party administrator.
“The system became dysfunctional,” said Rick Lutz, an administrator with the state’s Agency for
Health Care Administration
(AHCA), which oversees Medicare
and Medicaid spending in Florida.
“That’s an oversimplified way of
explaining it, but it’s accurate. It’s
the ‘crossover’ where the problem
has existed.”
Here’s a more detailed explanation of what happened. Medicare, of course, does not cover
"The system became dysfunctional...that's an
oversimplied way of explaining it, but it's accurate.
It's the crossover where the problem has existed."
Rick Lutz
Unisys. They couldn’t talk, in
fact, because of procedural rules
applying to appeals.
Blue Cross Blue Shield was not
successful in its appeal, so Unisys
officially became the manager of
the state retirees’ health insurance
program on Jan. 1, 1996. Unfortunately, because there had been no
communication between the two
companies, Unisys was not prepared to provide service. It did not
even get a signed contract from the
state until December 20, 11 days
100 percent of medical billings,
so retired state employees rely on
their state insurance plan to pick
up the balance. That’s the “crossover” claim that officials and
retirees are talking about.
“Blue Cross Blue Shield used
to wear two hats. It was, and it
remains today, a fiscal agent for
the federal government and has a
contract to serve as the Medicare
intermediary in Florida,” Lutz
said. “That’s a fancy way of
saying they pay Medicare claims.
Elder Update
It also was the third-party administrator for the state employees’
insurance plan.”
When Blue Cross Blue Shield
had the contract as the third-party
administrator of the state employees’ insurance plan, it would
routinely determine whether
Medicare beneficiaries were also
participants in the state’s insurance plan. If they were, Blue
Cross Blue Shield would automatically “crossover,” or pay the
payments, for the amount that
Medicare would not pay.
When Unisys took over
administration of the state’s
insurance plan on January 1, it
had not worked out an automated
“crossover” plan. A backlog of
unpaid claims began to mount.
“Basically, a state retiree who
was filing a claim with the state
system had to get a copy of the
Medicare claim and an EOMB
form and then manually file a
paper claim with Unisys for the
unpaid portion,” said Lutz.
Governor Chiles’ office,
which had been watching the
transition from Blue Cross Blue
Shield to Unisys, got directly
involved in the situation in June
“in a kind of monitoring process,”
said Gail Sittig, deputy director
of the Governor’s office of planning and budget. “In August, as
the complaints continued to
mount, we went to an oversight
mode. Another way of putting it
is that we went from the back seat
to the front passenger seat, to the
driver’s seat.”
The Governor's office began
meeting on a daily basis with
representatives of Unisys, the
Department of Management
Services (which oversees all
contracts between state government and private providers), and
the Agency for Health Care
Administration. An outside
consultant with experience in
“running these kind of programs”
also was brought in to advise the
involved parties.
Charles Salerno, an official
with the state’s Department of
Management Services, said the
NOVEMBER 1996
problems appear to be on the way
to being corrected. A big step in
that direction came when Governor Chiles personally wrote to the
chief executive officer of Blue
PAGE
she said. “We’re working on
making significant structural and
institutional changes because we
don’t want just a quick fix that
could result in problems arising
"Since the beginning of the contract, we've been
pushing Unisys to go back with Medicare and catch
those claims that have been missed...They've been up
and running the automated program for about four
weeks now, and they're determined to catch up."
Charles Salerno
Cross Blue Shield, asking that
they cooperate with Unisys in
smoothing out the bumps. Within
a week, the two companies began
talking.
“There are no more manual
claims being processed,” Salerno
said. “Since mid-September, the
‘crossover’ has been automated.
Unisys now has contracts in place
with Blue Cross Blue Shield to
accomplish this.
“Since the beginning of the
contract, we’ve been pushing
Unisys to go back with Medicare
and catch those claims that have
been missed,” he said. “They’ve
been up and running the automated program for about four
weeks now, and they’re determined to catch up.”
Blue Cross Blue Shield also
has begun providing Unisys with
the computer tapes that contain
all Medicare claims filed since
January 1. Unisys is “sweeping”
those tapes, looking for state
employees whose “crossover”
claims have not been paid.
Chiles’ office appears to be
somewhat satisfied, too, although
Sittig said the oversight will not
end until Unisys has a system that
is operating without any glitches.
“It’s a little early for us to do
a customer-satisfaction survey,”
again.”
Chiles’ office also is sending
a letter to “everyone who is a
member of the (state’s) insurance
pool, not just the retirees, explaining the situation and what’s
being done to correct it,” Sittig
said. “Part of the problem has
been that people who read or
heard about the problems don’t
know what to expect. This letter
will explain everything.”
13
An important part of the letter
is an explanation of how the
automated process works, said
Sittig. “Basically, it takes 30 days
to get a claim processed, and we
don’t want people to get unnecessarily concerned about their
claims. We also want those
retirees who may be concerned
about unpaid ‘crossover’ claims
to understand that we’re working
on it. It takes time to run those
(Medicare) tapes.”
Meanwhile, Unisys has taken
steps to improve its customer
service operation (see related
story on this page). It has added
additional telephone lines and
operators, and the hours in which
those lines are operational has
been extended.
Readers of Elder Update
should understand that the situation detailed in this story applies
only to those state employees and
retirees who are members of the
insurance plan now administered
by Unisys.
If you are a state retiree and
are concerned about an unpaid
“crossover” claim, you can contact
the Department of Elder Affairs’
SHINE program (see listing on
Page 4) and seek the assistance of
a SHINE counselor.
Unisys’ customer service
information
U
nisys is adding additional
telephone lines and operators to assist state employees
and retirees who are members
of the state insurance plan now
administered by Unisys.
Fifty new customer service
operators will be added by
November 1, and another 50 by
December 1. “The expectation
is that by December 1, anyone
who calls the customer information number will be able to
speak with someone almost
immediately,” said Gail Sittig,
deputy director of Governor
Lawton Chiles’ office of planning
and budget.
The toll-free hotline number
for inquiries and customer assistance is 800/767-7829. Operators
are available from 8 a.m. to 6
p.m. Mondays through Fridays,
and from 9 a.m. to 2 p.m. on
Saturdays.
Unisys officials say the nonpeak hours — in other words, the
best time to call — are 8 a.m. to
9:30 a.m. and 3:30 p.m. to 6 p.m.
weekdays, and Saturday.
S T A T E
O F
F L O R I D A
D E P A R T M E N T
O F
ELDER AFFAIRS
Elder Update
NOVEMBER 1996
PAGE
14
Awards presented to
job-training providers
“F
lorida Lifestyle Radio,” an hour-long show featuring news and
information of interest to elders, is now heard in 25 markets
throughout Florida. One of the regular segments of the program
features Department of Elder Affairs Secretary E. Bentley Lipscomb,
who interviews guests and discusses issues of importance to elders.
Here is a list of Florida’s Radio Network stations that carry the
show. Air times vary from community to community, so call the
station that is listed for your area to learn the exact day and time.
LIST AS OF 10-10-96
Bradenton — WBRD-AM (1420) 941/749-1420
Bushnell — WKFL-AM (1170) 904/793-9535
Chattahoochee — WTCL-AM (1580) 904/663-2323
Chipley — WBGC-AM (1240) 904/638-0234
Daytona Beach — WNDB-AM (1150) 904/257-1150
Defuniak Springs — WZEP-AM (1460) 904/892-5201
Deland — WXVQ-AM (1490) 904/734-9386
Englewood — WENG-AM (1530) 941/474-3231
Eustis — WKIQ-AM (1240) 904/357-1240
Ft. Myers — WEEJ-FM (100.1) 941/337-1112
Gainesville — WLUS-AM (980) 352/372-2528
Jacksonville — WXTL-AM (1010) 904/641-1010
Lake Worth — WPBR-AM (1340) 407/582-7401
Leesburg — WQBQ-AM (1410) 904/787-1410
Madison — WMAF-AM (1230) 904/973-6333
Marianna — WTYS-AM (1340) 904/482-2131
Milton — WEBY-AM (1330) 904/623-1330
Ocala — WOCA-AM (1370) 904/732-8000
Orlando — WWNZ-AM (740) 407/660-1011
Ormond Beach — WELE-AM (1380) 904/677-4122
Pensacola — WZNO-AM (1230) 904/438-1660
Port St. Lucie — WPSL-AM (1590) 407/340-1590
Punta Gorda — WKII-AM (1090) 941/639-1112
Sarasota — WTMY-AM (1280) 941/365-0521
St. Augustine — WFOY-AM (1240) 904/829-3416
Vero Beach — WTTB-AM (1490) 407/576-8366
Zephyrhills — WZHR-AM (1400) 904/576-1350
T
he Department of Elder
Affairs recently recognized
job-training providers for their
efforts during the year ending
June 30. During that period, the
providers statewide achieved a
placement rate of 70 percent, an
increase over the previous year’s
rate of 62 percent.
Three organizations were
singled out for special recognition as winners of the Department
of Elder Affairs Secretary’s
Awards. They are:
Brevard Community College
— Mature Adults Re-entry
Skills (MARS) Program — for
exceeding federal and contractual
performance standards with a 96
percent entered-employment rate
(up 8 percent from the previous
year), and for achieving an average-wage-at-placement of $6.92
(up from the $6.27 attained the
previous year; the program placed
54 students, which was 132
percent of its contractual placement goal; it also achieved an 11
percent surplus-expenditure rate,
demonstrating effective use of
contract funds.
Tampa Bay Regional Planning Council — for exceeding
federal performance standards and
increasing its entered-employment
rate over the previous year by 14
percent; providing Certified Nursing
Assistants training to more than
50 seniors, achieving a 93
percent placement rate
with an average
hourly wage of
$7.04; also
achieving a 6
percent surplus
expenditure rate,
demonstrating
effective use of
contract funds.
Mid-Florida Community
Services, Inc. — for exceeding
federal placement and wage
standards; placing 74 students, 95
percent of the planned placements; achieving an 11 percent
surplus-expenditure rate, demonstrating effective use of contract
funds.
A fourth award, the
Governor’s Award, was presented
to the Nurse Assistant Training
School. The program achieved
the highest placement rate and
wage of all Job Training Partnership Act (JTPA) older worker
programs in Florida during the
budget year. It placed 98 percent
of its graduates in unsubsidized
employment at an average hourly
wage of $7.49.
In a recent monitoring report
of the program, the following
statement appeared: “All of the
participants I talked with told me
of personal transformations as a
result of the program. In addition
to completing the program, they
had acquired a more positive
attitude toward themselves and
their abilities, had developed
better problem-solving skills, had
set limits about how they would be
treated by others, and had improved their physical appearance
due to exercise, improved nutrition, and general interest in the
way they presented themselves.
All attributed this to the
training they received; interaction with staff,
peers, and community; and
examples and
expectations of
instructors and
counselors.
S T A T E
O F
F L O R I D A
D E P A R T M E N T
O F
ELDER AFFAIRS
Elder Update
NOVEMBER 1996
PAGE
County, is one. She was born 79
years ago in New York City and
sold World Book Encyclopedias
to supplement her family’s income. Seeing her potential, her
boss (whom she later married)
influenced her to become a fulltime representative. She went on
to become a top salesperson and
worked her way to top management as Regional Manager for the
Northeast. In charge of 200
representatives, whom she hired,
trained, and put into the field, she
was the recipient of many awards
from her employer. Transferred to
Buffalo, then Ottawa, she and her
husband hired, trained, and
developed an organizations for
the publishers of World Book
Encyclopedias. In 1976, the
Canadian cold became too much
and she retired to Florida. Continuing her high-pressure activities but this time without remuneration, she became Legislative
Chairman for her local AARP
chapter, social director of her
mobile home park, membership
chairman of the Unitarian Universalist church, a member of the
local Board of Education, and codirector of a 13-acre, year-round
retreat that serves Alcoholics
Anonymous, religious organizations, and service-oriented
groups. She is FSHL Chairman of
Area 5.
If you are a voter, you can
become a member of the Florida
Silver-Haired Legislature by
sending your name, address, and
telephone number to: Florida
Silver-Haired Legislature, 800
Lane Ave., Titusville FL 32780.
by Bobbe Taffel
I
t seems everybody is either
talking, writing, or thinking of
campaign reform. The cost of
running political campaigns is
tremendous. Candidates either
have to be great fund-raisers or
have great personal wealth to run
and win an election. We have to
give good men and women a
chance to run for office and, once
there, to govern us wisely and not
be concerned with raising money
to run for re-election.
Congress has tried to alleviate
some of the problems. Corporate
donations have been disallowed,
and a cap on individual contributions has been in place for some
time. Recently, the Congress
agreed to voluntarily decline to
accept certain types of gifts.
Circumventing these rules, however, has not been difficult,
particularly with “soft money” —
money given to political parties,
which is legal, instead of specific
candidates.
Many people feel that using
only public money is the way to
go. According to the Federal
Elections Commission, more than
$258 million of public money has
been given to candidates and
political parties in this year’s
campaigns through August, and
the 1996 election is certainly not
over yet.
Counting the money raised to
qualify for this matching public
money, the staggering sum of
half-a-billion dollars has already
been given to candidates and
political parties in this presidential election year. If you add to
that sum of money the amounts
involved in state and local elec-
tions as well, a
billion dollars
would be a fair
estimate.
How many
programs for
children, the
disabled, frail
elders, and
crime prevention
could be funded with
this money? How many
bridges, roads, libraries,
and public buildings
could be built?
We need to cut down on
campaign spending. In order to
reduce spending money we have
to reduce spending time. In order
to reduce both spending time and
money we have to offer candidates free television slots, free
franking privileges, and limit the
number of weeks they can spend
on campaigning. We are the only
country in the world that charges
candidates for television time.
In Great Britain, free television time is available to political
parties, and only issues may be
discussed. Each candidate is
permitted to mail one election
communication to each household
in his or her area free of charge.
Paid political radio and television
advertisements are prohibited.
Spending is limited to approximately $5,000 per candidate, and
electioneering rarely goes beyond
five weeks.
India, with 595 million voters,
allows each candidate about
$15,000 for a campaign, and
every coin must be accounted for.
Candidates may not indulge in
15
“anti-tirades,” nor may they
appeal for votes in the name of
religion. The nation’s independent Election Commission sends
hundreds of officials across the
country to monitor candidates’
spending and speeches.
Lest you think appropriate
campaign reform cannot be
accomplished in this country,
please note that NBC, CBS, CNN,
and the Fox television networks
already have offered free television time to candidates.
The Florida Silver-Haired
Legislature presented
campaign reform bills
at its annual legislative
FLORIDA
session which, if
passed, will be taken up
POWER &
with state legislators
LIGHT CO.
and members of Congress.
• Proud to be a sponsor of ELDER UPDATE,
✽✽✽
Who is a SilverHaired Legislator?
Evelyn Winchester, of
Largo in Pinellas
• A provider of safe, reliable and cost
effective electricity for all our consumers.
Florida Power & Light Co. is a corporate
member of the Elder Floridians Foundation,
which partially underwrites Elder Update.
S T A T E
O F
F L O R I D A
D E P A R T M E N T
O F
ELDER AFFAIRS
Elder Update
NOVEMBER 1996
by Tom McMullen
G
etting connected to the
internet seems to be among
the most formidable tasks facing
the prospective net explorer. It’s
mostly a matter of getting things
together and putting them in the
right place.
Once you’ve chosen your
computer and monitor, the next
thing you need to get online is a
modem. Don’t settle for anything
less than a 28.8 Kbps (kilobytes
per second) modem. Modem
prices have gone down steadily
over recent months, and you
should have no trouble finding a
suitable modem for $100. Connecting the modem is simply a
matter of following the instructions accompanying the modem.
Always read the manual! It will
probably suggest that one of the
enclosed cords connects the
modem to your phone line (you
may need to get an adaptor that
will allow you to connect both
your phone and the modem to the
same phone line), and the other
enclosed cord connects the modem
to your computer.
Software included with your
modem should allow you to set up
your brand of modem with the
computer by simply selecting from
among dozens of choices on a
menu. This selection will usually
configure the necessary preferences in your computer for the
particular modem.
You must now have access to
an internet service “provider,”
which is an online address from
which you gain access to the rest
of the net “world.” There
are many providers
available: America
Online, Compuserve, et
cetera. It is common for
these services to charge a
monthly fee, together
with extra charges for
time online which exceeds a basic number of
hours (about five at
perhaps $5 or so per
hour). Be forewarned
that the basic hourly
allowance will never
provide enough time for
you to do what you will
likely want to do! You
may easily eat up that
basic allowance in one
sitting, then pay a good
deal more for the time
you will wish in addition.
PAGE
The best solution is to use an
internet service provider from
whom you may use “unlimited”
time for a set rate. It is common
in Florida for such rates to be in
the neighborhood of $15 to $25 a
month. This way you lead a
carefree online existence without
watching the clock or suffering
from guilt. In my household it is
not uncommon for the two of us to
be online for more than 80 hours a
month! If that seems excessive, I
invite you to join the club and see
for yourself how addictive it can
be! Look in local newspapers for
available sites. (Be sure the
16
provider has a local telephone
number for access! You should
not need to pay for long distance
service.)
Good browser software
(Netscape Navigator and
Microsoft Internet Explorer are
two of the best) is free and readily
available either by 800 number or
from some local club or from
diskettes found in magazines.
After you are online, you will
have ready access to updates by
simply “downloading” them from
the server — a simple procedure
Online
continued on next page
Orlando Regional Healthcare System is a corporate member of the
Elder Floridians Foundation, which partially underwrites Elder Update.
S T A T E
O F
F L O R I D A
D E P A R T M E N T
O F
ELDER AFFAIRS
Online
Elder Update
continued from page 16
(all of this is explained through
online manuals).
Once you are hooked up to the
service, the exploration of the
world is yours by simply entering
“addresses” for the millions of
sites available (those
www.whatever.com “things” that
are everywhere). It is simple to
create “bookmarks” for those sites
you may wish to access often.
You will be able to search for
materials on any subject of interest, and you can easily save these
files and/or print them to your
heart’s content.
None of this is especially
confusing, and, as has been said
before, it should not be difficult to
get help from a friend, neighbor,
or local computer “nerd,” by word
of mouth, or by contacting a local
computer club.
NOVEMBER 1996
The rewards in entertainment,
knowledge, varied interests, and
sheer fun, are worth the effort, not
to mention e-mail, chats, and on
and on and on! More on these
later...
DOMESTIC
VIOLENCE
Emergency: 911
Elder Helpline
Information and Referral:
H
17
The earlier, the better...
Almost half of all breast cancer occurs in women
65 and over. But the earlier you find breast cancer, the better your chances of beating it. A mammogram is the most effective way to detect breast
cancer early. Want to know more?
Call us. It's FREE.
The
Cancer
Information
Center
1-800-4-CANCER
The Public's Link to Cancer Information
1-800-262-2243
Florida Domestic
Violence Hotline:
1-800-500-1119
(TDD 1-800-621-4202)
Senior Games schedule
for November
ere is the schedule for the
Senior Games in November.
For general information about the
Senior Games themselves and the
Florida Senior Games State Championships in Kissimmee-St. Cloud
on December 3-8, contact Laura
Hallam at 407/943-7992; for information about specific games, call
the individual listed below as the
contact person.
PAGE
BIG SUN SENIOR GAMES
Ocala
Nov. 1-9
Call: Diane Leaf, 352/629-8351
GOLDEN AGE GAMES
Sanford
Nov. 3-9
Call: Lisa Jones, 407/330-5699
GOOD LIFE GAMES
St. Petersburg
Nov. 9-17
Call: Shirley Lewis, 813/892-1521
GOLDEN GAMES
Stuart
Nov. 10-20
Call: Bo Thomson, 407/221-1418
SPACE COAST SENIOR
GAMES
Palm Bay
Call: Carol Hamilton,
407/724-1299
Nov. 16-23
The Wound
Healing
Institute
You will find our team ap-
proach to successfully healing
stubborn, chronic wounds has
made the Wound Healing
Institute at University Hospital
and Medical Center a leader in
wound treatment and management.
A wound resisting the healing process can turn into a serious
medical condition, requiring advanced restorative treatment
and care. Diabetes, immobilization, and circulatory problems
may cause complications that delay the wound healing
process.
The Wound Healing Institute takes great pride in its
multidisciplinary team of health care professionals dedicated
to the theraputic treatment and healing of difficult wounds.
For questions or more information on the Wound Healing
Institute, call 724-MEND.
The Wound Healing Institute
7201 North University Drive
Tamarac, Florida 33321
For a free brochure or to schedule a tour call 954-721-2200
Medicare and most major insurance carriers accepted
Columbia-University Hospital & Medical Center is a corporate member of
the Elder Floridians Foundation, which partially underwrites Elder Update.
S T A T E
O F
F L O R I D A
D E P A R T M E N T
O F
ELDER AFFAIRS
Elder Update
Myths continued from page 8
Myth: Butter has more
calories than oil.
Fact: Ounce for ounce, butter
and oil are equal in calories — each
has about 40 calories in a teaspoon.
Butter’s unhealthful image is due to
its kind of fat, rather than amount.
Butter has five times more saturated
fat than vegetable oils such as corn
and safflower. Butter also contains
cholesterol. Vegetable oils don’t.
Saturated fat and cholesterol can
increase your blood cholesterol
level.
Myth: Fasting flushes out
impurities and toxins.
Fact: No evidence supports
the claim. Your body was de-
NOVEMBER 1996
signed to process food. This
includes removal of naturally
occurring toxins such as ammonia that result from the breakdown of protein.
For most people, one-day fasts
are neither healthful nor harmful.
But longer fasts threaten your
health. Risks include dehydration,
dangerously low blood pressure,
muscle and organ tissue breakdown,
and irregularity of your heartbeat.
Never fast if you have heart disease,
insulin-dependent diabetes, or kidney
or liver problems.
Myth: Wheat bread has
more fiber than white
bread.
Fact: Only if it’s “whole-wheat”
bread. Otherwise, wheat and white
bread are essentially the same.
Both are made from refined wheat
flour and have about one-half
gram of fiber in a slice. The only
real difference is color. Manufacturers often add caramel coloring
or molasses to wheat bread to
darken its hue.
To be sure it’s whole-wheat,
look for the word “whole” in the
first ingredient. The nutrition
label should also list fiber content
per slice at about 1.5 grams.
PAGE
18
oxalic acid binds iron, only 2 to 5
percent of the iron in spinach is
actually absorbed by your body.
Spinach does, however,
contain beta carotene. One-half
cup of cooked spinach has more
than half a day’s supply of this
important antioxidant.
Myth: Spinach is a good
source of iron.
Fact: Sorry, Popeye, but it’s
not so. Spinach does contain
plenty of iron, but it also contains
a lot of oxalic acid. Because
Help Wanted:
Naples
Volunteers are needed to assist
the staff of the Social Security
Administration office in Naples to
provide professional services to the
people of Collier County. Duties
will primarily be as a receptionist
who coordinates interviews and
provides basic information about
Social Security and Medicare. For
more information, contact Jack
Fordham at 941/597-5123.
Hillsborough County
Volunteers are needed for the
Foster Grandparents and Senior
Companions programs. Applicants
must be at least 60 years old and
income-qualified. Volunteers serve
20 hours a week for a non-taxable
cash stipend of $49, travel reimbursement, or bus pass. For information, call 813/282-1621.
Hardee, Highlands,
Hillsborough, Manatee and
Polk counties
The Long-Term Care Ombudsman Council for District 7 is
seeking volunteers to advocate for
residents of nursing homes and
Assisted Living Facilities. Indi-
viduals with special expertise —
physicians, pharmacists, and
dieticians — in particular are
needed. Advocates investigate
complaints and conduct annual
inspections. For information, call
813/871-7185.
Pinellas County
• Volunteers with computer skills
are needed at the Hospice of the
Florida Suncoast. For information, call Kathy Roble at 5864432.
• Neighborly Senior Services is
seeking volunteers for its Meals
On Wheels program. For information, call 573-9444.
Port St. Lucie/Fort Pierce/
Vero Beach area
The Long-Term Care Ombudsman Council for Districts 9 and 15
(Palm Beach, Martin, St. Lucie,
Indian River, and Okeechobee
counties) is seeking volunteers to
advocate for residents of nursing
homes and Assisted Living Facilities. Advocates investigate complaints and conduct annual inspections. For information, call 561/
837-5038.
Treasure Coast area
Volunteers are desperately
needed in Vero Beach, Fort Pierce,
Sebastian, Wabasso, and Fellsmere
to assist homebound patients of the
Visiting Nurse Association of the
Treasure Coast. Volunteers provide
grocery shopping, transportation,
and visitation to clients. For more
information, call Mary Ann Roussin
at 407/567-5551.
appointments, errands, etc. It also
needs volunteers to serve as
“Friendly Visitors.” For more
information, call Jackie Rickerman
at 813/547-4566
Broward County
• Volunteer opportunities are available
through the North Broward Medical
Center Auxiliary. Auxilians provide
a variety of services — assisting
patients and visitors, offering
Jacksonville, Miami, and
clerical support for hospital personOrlando
nel, and managing the auxiliary’s
consignment shop. For more
AARP is seeking volunteers for
information, call 954/786-2375.
Communications Specialist posi• The Red Cross of North Broward
tions in Jacksonville, Miami, and
Medical Center is currently recruitOrlando. Responsibilities include
ing volunteers for a variety of
composition of press releases,
services. For more information, call
networking with the news media,
954/786-2385.
attending meetings, and assisting
• Broward County’s Elderly Services
with production of the AARP’s
Volunteer Program is seeking
Florida newsletter. Applicants must
individuals for its “Friendly Visibe willing to travel; training and
tors” program. Volunteers provide
reimbursement for expenses will be
companionship, socialization, meal
provided. For more information,
preparation, and transportation to
call Kathy Marma at 813/576-1155
frail, homebound elders. The
Clearwater
program also needs volunteers to
Senior Guidance Services is
provide minor home repairs and
seeking volunteers to drive elderly
painting. For more information,
clients for groceries, medical
call 954/537-2936.
S T A T E
O F
F L O R I D A
D E P A R T M E N T
O F
ELDER AFFAIRS
Elder Update
NOVEMBER 1996
Life’s little lessons
by Grace S. Druyor
I
t was my grandmother who cared
for me when I was a little girl and
taught me many of life’s important
lessons. Dad had lost his job and
was looking for work — this was
during the Depression — and
Mother had gone to work as a
secretary, so I spent my days at
Grandma’s side.
Each day I’d assist her
as she went about rooting
out dust and washing
clothes. I also learned to
cream the sugar and butter
to make a cake, peel and chop
apples for applesauce, snap the
string beans and open the pea
pods. That was really fun for
me, and good training, too.
She also taught me to be
afraid, on days when a
storm threatened. We would go into
the huge pantry and hide. We would
stand against the wooden icebox and
pray while the house shook from
thunder and the sky radiated with
streaks of lightning.
Late in 1930, my father got a job
selling Frigidaires, and he sold one to
Grandma. She put the shiny new
refrigerator in that dark pantry.
Not too long afterwards, a storm
threatened, and we ran to the pantry
and stood beside the humming
Frigidaire, singing and praying. We’d
been standing there only a few
minutes when we heard some happy
whistling and realized that my Uncle
Al, who ran a grocery store, had
dropped by to bring us a loaf of bread
and slices of baloney. He found us
flattened against the white refrigerator
and began to laugh.
“Ma,” he said, “don’t you know
that if lightning did strike, you’d get a
jolt because you are standing near the
machine that brings the most electricity into this house?”
And then he turned to me.
“Gracie, you should never be
afraid of storm,” he said. “You should
PAGE
19
It seems like
Only Yesterday
Please write and share
your stories with us.
Send to: Editor, Elder Update,
4040 Esplanade Way
Tallahassee FL 32399-7000
think of it as God rolling ten pins
against the clouds. You can smile at
the noise, knowing that the rain helps
the grass to grow. Come into the
sunparlor and watch.”
We came out reluctantly and
watched the swirling rain. Grandma
was muttering under her breath in her
native Dutch, but she had to laugh at
my Uncle Al’s enthusiasm. And I was
happy to be taught a good lesson: not
to fear one of nature’s wonders...
Grace Druyor lives in St.
Petersburg.
Sprint is a corporate member of the Elder Floridians Foundation, which partially underwrites Elder Update.
S T A T E
O F
F L O R I D A
D E P A R T M E N T
O F
ELDER AFFAIRS
Elder Update
NOVEMBER 1996
PAGE
20
QUESTIONS & ANSWERS
Q:
I have just moved to
Florida from Michigan. I
have signed a Living Will there. Is
this Living Will good in Florida or
should I sign a Florida living will?
A:
Your Michigan Living Will
may be appropriate for
Florida. However, each state has
specific requirements for Living
Wills. To be safe, you should sign
a Florida Living Will.
The Living Will lets you state
your wishes about medical care if
you are in a persistently vegetative state or are terminally ill and
can no longer make your own
medical decisions. The Living Will
comes into effect only if your own
doctor and a second doctor agree
that your death would occur
without the use of life-sustaining
medical care.
It is also recommended that
your complete a Florida Designation of Health Care Surrogate
form. This form lets you choose
someone to make health care
decisions for you if you are unable
to indicate your wishes. A Living
Will becomes effective at the end
of your life; the Designation of
Health Care Surrogate form
allows you to appoint someone to
speak for you at any time you are
unable to make your own medical
decisions.
Both the Florida Living Will
and the Designation of Health
Care Surrogate forms must be
signed in the presence of two
adult witnesses, who must also
sign the document. The people
you appoint as your surrogate and
alternate surrogate cannot act as
witnesses. At least one of your
witnesses must not be a blood
relative. You do not need to
notarize either document.
For more information, or to
request copies of the Florida
Living Will and Designation of
Health Care Surrogate forms, call
the Center for Aging Resources’
Elder Helpline at 800/262-2243.
You also can visit the Center’s
new World Wide Web site, which
is filled with interesting information for seniors. The web address
is: http://www.mfaaa.org
Q:
I read something recently
about help on paying for
medicines. I take high blood
pressure and thyroid medicines.
What can I do to get help in paying
for these? I am a 77-year-old
widow living on Social Security.
A:
Despite the fact that we’ve
written about this program several times, the Pharmaceutical Manufacturers Indigent
Patient Program remains a
relatively little-known pharmaceutical initiative that can put
vitally needed drugs in the hands
of people living on very low
incomes. Forty-two pharmaceutical manufacturers participate,
making selected medications
available to physicians “in limited
quantities, at no cost to patients
who do not have the means to pay
for them.”
The program has not worked
very well, for several reasons:
• Some physicians are not aware
of the program.
• Some older people are discouraged from pursuing the program because of the limited
quantities of drugs available.
• Some people think their physicians do not have membership
in the program. In truth, there
are no “membership” requirements.
• Some physicians refuse to call
the companies on behalf of their
patients.
• Some doctors claim they do not
the time to participate.
You can obtain an individual
copy of a directory that lists all
participating pharmaceutical
companies and the drugs included. However, your doctor
must request the medications on
your behalf. The directory is
available from: The National I&R
Support Center, 1225 I St. N.W.,
Suite 725, Washington DC 20005
(the phone number is 202/8982578).
Q:
We are recent retirees to
Florida and have bought a
condominium. We like it very
much, but we find that storage
space is a problem. We’re thinking
about renting a self-storage unit.
Can you tell us about any pitfalls?
A:
Considering the space
constraints and limited
storage facilities in most condominium units, renting a selfstorage unit is an attractive
alternative. What you may not
know, however, is that by renting
this space, you may be taking a
bigger risk than you realize. In
fact, according to the Insurance
Information Institute, statistics
show that one in five self-storage
units are the victims of theft. Also,
water damage accounts for some
of the largest insurance claims for
self-storage units. And remember
that a locked door is not enough
to stop a fire from spreading to
your unit.
Having said all of the above,
here are some things you can do
to reduce the chances of problems:
• Do your own safety check
before renting from a facility. If
the items you are storing are
sensitive to humidity and
temperature, make sure you
select a storage unit that is
climate-controlled. Also, check
the walls and roof for signs of a
leaky roof.
• Check for round-the-clock
video monitoring. If there
isn’t someone at the facility 24
hours a day, make sure that
some sort of anti-theft device
is in place to protect your
property.
• Shop around for the best price.
Keep in mind that the average
monthly rental is $54. Local
price wars are common, so
look around before making a
decision.
• Before you store anything,
make sure that you are insured.
This is probably the most
important thing you can do to
protect your belongings. Ask
your insurance agent whether
your homeowner’s or renter’s
policy covers your things while
they are in storage.
Q:
I’m 71, and I don’t see
well when driving at night.
Sometimes things look blurry,
especially streetlights. Should I
have my vision checked?
A:
Yes. Your symptoms may
indicate more than just a
normal decline in vision due to
age. Blurry vision and “halos”
around lights are often warning
signs of acute glaucoma or a
cataract. Unlike the more common chronic glaucoma which can
go undetected for years, acute
glaucoma usually develops
suddenly. Attacks often occur at
night when light is dim, causing
blurred vision.
If it’s determined that your
driving vision problems are due to
normal aging, you can contact your
local Area Agency on Aging at 800/
96-ELDER for a list of vans and
shuttles, volunteer driver networks,
or transportation cooperatives
(people who join together to share
driving) that operate for older
adults.
PRINTED ON RECYCLED PAPER. PLEASE RECYCLE
S T A T E
O F
F L O R I D A
D E P A R T M E N T
O F
ELDER AFFAIRS
Elder Update
NOVEMBER 1996
PAGE
21
ELDER HELPLINE
1/800/96-ELDER (800/963-5337)
A Starting Point
An Information and Referral Directory by Area Agency on Aging and by County
If you, or elders you know, need help at home with activities such as meal preparation, transportation, homemaker services, or any other daily activities, information is available by calling the “Elder Helpline” in your county. Or you can call the statewide toll-free number, 800/96-ELDER
(963-5337), for assistance. TDD (Telecommunication Devices for the Deaf) lines are indicated with an asterisk (*).
Northwest Florida AAA
6500 B Pensacola Blvd.
Pensacola, FL 32505
904/484-5150
Escambia ................. 904/432-1475
904/432-0891*
Okaloosa ................. 904/833-9165
Santa Rosa
(Holly, Navarre, Gulf Breeze)
904/939-0477
(North) ................... 904/623-0467
Walton ..................... 904/892-8168
AAA of North Florida, Inc.
2639 N. Monroe St., Suite 145-B
Tallahassee, FL 32303
904/488-0055
Bay .......................... 904/769-3468
Calhoun ................... 904/674-4163
Franklin................... 904/697-3760
Gadsden .................. 904/627-2223
Gulf ......................... 904/229-8466
Holmes .................... 904/547-2345
Jackson ................... 904/263-4650
Jefferson.................. 904/342-0271
Leon ........................ 904/575-9694
Liberty .................... 904/643-5613
Madison .................. 904/973-2006
Taylor ...................... 904/584-4924
Wakulla ................... 904/926-7145
Washington ............. 904/638-6216
Mid Florida AAA
5700 S.W. 34th St., Suite 222
Gainesville, FL 32608
352/378-6649
Center for Aging Resources
1-800/262-2243*
352/375-1155 (local),
Alachua ................... 352/336-3822
Bradford .................. 904/964-4545
Citrus ...................... 352/746-1844
Columbia ................ 904/755-0235
Dixie ....................... 352/498-1280
Gilchrist .................. 352/463-3160
Hamilton ................. 904/792-2136
Hernando ................ 352/796-0485
Lafayette ................. 904/294-2202
Lake ........................ 352/326-5304
Levy ........................ 352/493-6700
Marion .................... 352/629-7407
Putnam .................... 904/329-8963
Sumter ..................... 352/793-5234
Suwannee ................ 904/364-5673
Union ...................... 904/496-2342
Northeast Florida AAA
590 S. Ellis Rd.
Jacksonville, FL 32254
904/786-5111
Baker ....................... 904/259-2223
Clay (Middleburg) .. 904/284-5977
(Keystone Heights) . 352/473-2112
Duval ...................... 904/798-9503
904/798-9518*
Flagler ..................... 904/437-7300
Nassau (Westside) .. 904/845-3332
(Fernandina Beach) . 904/261-0701
St. Johns .................. 904/824-1648
Volusia .................... 904/253-4700
Tampa Bay Regional
Planning Council
9455 Koger Blvd.,
Hendry Building
St. Petersburg, FL 33702
813/577-5151 (St. Petersburg)
813/224-9380 (Tampa)
Pasco County and In-State
................................ 800/861-8111
Pasco County (Out of State)
................................ 813/576-1533
Pinellas ................... 813/576-1533*
DeSoto .................... 941/494-5965
Glades ..................... 941/946-1821*
Hendry .................... 941/983-7088*
Lee .......................... 941/433-3900
Sarasota-North ........ 941/955-2122*
Englewood/N.Port. . 941/475-4056
West Central Florida AAA
5911 Breckenridge Parkway
Suite B
Tampa, FL 33610
800/336-2226
813/623-2244
Hardee ..................... 941/773-6880
Highlands
(Avon Park) ............ 941/452-1288
(Lake Placid) ......... 941/465-1199
(Sebring) ................ 941/382-1288
Hillsborough ........... 813/273-3779
Manatee .................. 941/742-5818
Polk ......................... 941/533-0741
Palm Beach/Treasure
Coast, Inc.
8895 N. Military Trail
Suite 201-C
Palm Beach Gardens, FL 33410
561/694-7601
Indian River ............ 561/569-8555
Martin ..................... 561/283-2242
Okeechobee ............ 941/763-9444
Palm Beach (In County)
................................ 930-5040
Palm Beach (Out of County)
................................ 561/547-8677
St. Lucie.................. 561/465-1485
Senior Resource Alliance
1011 Wymore Rd., Suite 207
Winter Park, FL 32789
407/623-1330
Brevard ................... 407/631-2747
Orange .................... 407/623-1380
Osceola ................... 407/623-1380
Seminole ................. 407/623-1380
Resource Center ..... 407/623-1380
Area Agency on Aging for
Southwest Florida
2285 First St.
Fort Myers, FL 33901
941/332-4233
Charlotte ................. 941/637-8019
Collier ..................... 941/774-8443
AAA of Broward County
5345 NW 35th Ave.
Ft. Lauderdale, FL 33309
954/485-6370
Broward Senior
Connection .............. 954/484-4357*
Alliance for Aging
9500 S. Dadeland Blvd.,
Suite 400
Miami, FL 33156
305/670-6500
Dade ........................ 305/670-4357
Monroe ................... 305/292-4520
(South Florida only) 800/273-2044.
S T A T E
O F
F L O R I D A
D E P A R T M E N T
O F
ELDER AFFAIRS
Elder Update
Calendar
of Events
N•O•V•E•M•B•E•R
6-7
Port Richey — “Getting
in Gear,” a driverimprovement program for individuals age 55 and older; experienced
drivers may be eligible for threeyear discounts on auto insurance
upon completion. 9 a.m. Phil
Mishkin Center, 7505 Rottingham
Road. $10. Call: 813/862-9291.
Jacksonville — Health fair,
including a variety of free
health screenings and informational
booths. 10 a.m. to 2 p.m. North
Main Street Baptist Church, 7137
North Main Street. Call: 904/7655502.
St. Augustine —
Arts, Crafts &
Collectibles Fair. 9 a.m. to 2
p.m. Senior Center, 11 Old Mission
Avenue. Call: 904/824-1646.
Pinellas County —
17th Annual Good
Life Games, featuring a lengthy
array of special events and activities
for seniors. Multiple locations. For a
guide listing events, call: 813/8921521 or 813/892-1571.
South Pasadena — Fourth
Annual Gulf Coast Golf
Classic, sponsored by Neighborly
Senior Services Foundation. 8 a.m.
Pasadena Yacht & Country Club,
6300 Pasadena Point Blvd. $75
(includes lunch). Call: 813/5739444.
Spring Hill — Luncheon
meeting of National
Association of Retired Veteran
Railway Employees, Unit #87.
11:30 a.m. Moose Lodge, 5214
Mariner Blvd. Call: 352/666-8015.
Jacksonville —
“A Map
Through the Maze,” a conference
for caregivers of Alzheimer’s
patients, sponsored by the Northeastern Florida Chapter of the
Alzheimer’s Association. Singleton
Senior Center, 150 E. 1st. Street.
Call: 904/398-5193 or 800/5935065.
Gainesville — Caregiver
training workshop, sponsored by the North Central Chapter
of the Alzheimer’s Association.
Florida Farm Bureau Building. Call:
Melinda Gablehouse, 352/372-6266.
9
9-11
9-17
11
17
14-16
15
NOVEMBER 1996
20
Clearwater Beach —
Neighborly Senior Services Annual Recognition Luncheon, with keynote speaker Hugh
Downs of ABC’s 20/20. 11:30 a.m.
Double Tree Resort, 400 Mandalay
Ave. $35 (reservations required).
Call: 813/573-9444.
Zephyrhills — Pancake
breakfast, a fundraiser
sponsored by Elderly Nutrition
Advisory Council. 7 a.m.
Zephyrhills Senior Center, 4645
Airport Road. Call: 813/834-3341.
Tamarac — “Crazy
Rhythm,” a live entertainment show, sponsored by Deborah
Heart and Lung Hospital Foundation. 10:45 a.m. departure by bus.
Sands Point Clubhouse #1, 8361
Sands Point Blvd. $35 (includes bus
fare and lunch). Call: 722-6412.
23
26
THROUGHOUT THE
MONTH
St. Johns County — Adult Education Classes, including health and
physical fitness programs, self
awareness, arts and crafts, music
and story telling, Tai Chi, and yoga.
Call: Gina Jones or Phyllis Wilson,
904/824-1646.
MONDAY
Margate — Monthly meeting of the
National Association of Retired
Federal Employees (third Monday
only). 1 p.m. Catherine Young Library, 5810 Park Dr. Contact: Irv
Kligman, 973-4596.
Palm Coast — Monthly luncheon
meeting of the Palm Coast chapter
of NARFE (National Association of
Retired Federal Employees). Call:
904/437-2911.
Palm Coast — Caregiver
support group (fourth Monday
only), with the Rev. Bob Bedell.
1:30 p.m. Flagler County Senior
Center, 1000 Belle Terre Blvd.
Call: 904/437-7300.
TUESDAY
Atlantis — “Coping with
Cancer” support group for patients
and families. 2 p.m. JFK Medical
Center, 170 JFK Drive. For reservations, call: 407/642-3900.
Atlantis — Cancer caregivers
support group (fourth Tuesday
only). 2 p.m. JFK Medical Center,
PAGE
22
170 JFK Drive. For reservations,
call: 407/642-3900.
Jacksonville — Aging and
Information Exchange, for providers
and professionals who deal with
services for aging adults (third
Tuesday only). 8:30 a.m. Mary
Singleton Center, 160 East First St.
Call: Nancy Alexander, 904/3967553.
Palm Coast — Alzheimer’s
support group (second Tuesday
only). 2 p.m. Flagler County Senior
Center, 1000 Belle Terre Blvd. Call:
904/437-7300.
from depression. 10 a.m. Pembroke
Pines Hospital Professional Building, 2261 University Dr. Free. Call:
305/967-2055.
St. Augustine — Alzheimer’s
support group (first and fourth
Thursdays only). 10 a.m. Social
Services Meeting Room, 7 Old
Mission Ave. Call: 904/824-1648.
St. Augustine — Monthly dance
(third Thursdays only), with music
by Al Bonati and his combo; refreshments. 7 p.m. to 10 p.m. Senior
Center, 11 Old Mission Avenue.
Call: 904/824-1646.
WEDNESDAY
FRIDAY
Atlantis — Prostate cancer
support group (first Wednesday
only). 4 p.m. JFK Medical Center,
170 JFK Drive. For reservations,
call: 407/642-3900.
Atlantis — Leukemia, lymphoma
and multiple myeloma support group
(second Wednesday only). 7 p.m. JFK
Medical Center, 170 JFK Drive. For
reservations, call: 407/642-3900.
Fort Lauderdale — “Sessions for
Seniors,” a series of educational
classes on life-enhancing topics. 10
a.m. to 11 a.m. Osswald Park Community Center, 2220 N.W. 21st Ave.
Free. For program specifics, call:
Laura Newman, 305/485-6370.
Fernandina Beach — Alzheimer’s
Support Group (fourth Friday only).
2:30 p.m. to 4 p.m. Nassau County
Council on Aging, 1367 South 18th
Street. Adult sitter service is available
but must be requested in advance. Call:
904/261-0701.
Port Charlotte — SHHH (Self
Help for Hard of Hearing People)
meeting (first Friday only). 1:30 p.m.
to 3:30 p.m. First Presbyterian Church,
2230 Hariet St. Call: 941/627-3670 or
625-1782, or write SHHH, P.O. Box
3685, Port Charlotte FL 33949-3685.
Sarasota — Linkages in Sarasota,
an intergenerational awareness networking group (first Friday only). 10
a.m. Community Room, SouthGate
Mall, US 41 at Siesta Dr. Call: 813/
957-3020.
Jacksonville — Monthly meeting
of the Jacksonville Duval County
Council on Elder Affairs (third
Wednesday only). 10 a.m. Mary L.
Singleton Center, 150 East First
Street. Call: 904/630-0995.
THURSDAY
Boca Raton — Monthly meeting of Chapter 647 of National
Association of Retired Federal
Employees (second Thursday only).
Boca Community Center, 1504 W.
Crawford. Call: 561/499-5456.
Green Cove Springs —
Alzheimer’s Support Group (third
Thursday only). 2 p.m. Green Cove
Springs Senior Center, 604 Walnut
St. Call: 904/269-6345, 904/2645699, or 904/284-5977.
Macclenny — Alzheimer’s
Support Group (second Thursday
only). 2 p.m. 132 Florida Ave. Call:
904/259-6568.
Pembroke Pines — Social
support group for men suffering
SATURDAY
Daytona Beach — Meeting of the
Volusia County Retired Educators
Association, Unit I, District IV (fourth
Saturday only). 11:15 a.m. Stacey’s
Restaurant, Daytona Beach Outlet
Mall. Call: 904/322-7788.
SUNDAY
St. Augustine — Celebrity Chef
Breakfast (second Sundays only), a
fundraiser for the St. Johns County
Council on Aging. For time and
location, call: 904/824-1646.
R•E•U•N•I•O•N•S
WHO: Graduates of Abraham
Lincoln High School, of Brooklyn,
New York. WHEN: February 16, 1997.
WHERE: Davie, Florida. CALL: 561/
478-0164, or write to: Fred Strongin,
3818 DaVinci Circle, West Palm
Beach FL 33417-1071.
S T A T E
O F
F L O R I D A
D E P A R T M E N T
O F
ELDER AFFAIRS
Elder Update
NOVEMBER 1996
PAGE
23
MEDICARE/MEDICAID FRAUD
Medicare fraud has become one of the nation’s fastest-growing crimes, according to the FBI and other authorities. In Florida
alone, the tab is estimated at $1 billion annually, roughly a tenth of the state’s total Medicare billings. Who suffers when Medicare is defrauded? You do — because it’s your tax dollars that end up in the pockets of swindlers, and it is these frauds that have
prompted Congress to propose reductions to Medicare. Here are some recent news stories related to Medicare and Medicaid
fraud in Florida:
Fraud fight nets nine more
lorida’s battle against health
care fraud has netted another
group of individuals who are accused
of trying to bilk the state out of $1.5
million. Among them are a cab driver
who overcharged Medicaid patients
and a small-town pharmacist who
filled fake prescriptions.
In all, eight people and one
corporation were charged. The
indictments by a special grand jury
in Tallahassee looking into Medicare
and Medicaid fraud were the fifth
series of charges returned by the
grand jury in the last seven months.
So far, the sweeps have accounted
for charges against 59 people and
F
Postings
by Bud Wylie
T
he Japanese soon will have an
opportunity to see how Americans conduct themselves during the
older stages of their lives.
A Japanese television crew spent
several weeks in September and
October videotaping how AARP
members in the Tampa Bay area
spend their days. The production will
be shown in Japan.
A key segment of the documentary focuses on Dorothy Romano, of
Pinellas Park, who is the State AARP/
VOTE Coordinator. VOTE is the
division of AARP that seeks to
educate and involve older citizens in
the governmental process. It is strictly
non-partisan.
“The television crew is taking an
intimate look at everything from
volunteerism to beach outings involving older people,” Romano said.
three corporations that state officials
say are responsible for stealing more
than $6 million.
One of the more unusual cases
involves a 63-year-old Chattahoochee
pharmacist who is accused of illegally
filing at least 2,700 prescriptions
without doctor authorization between
January 1991 and July 1992.
According to Florida Department
of Law Enforcement records, Wallace
Peacock was paid more than $70,000
in reimbursements from the state
employees health insurance prescriptions program.
He did it, according to an FDLE
affidavit, by forging doctors’ signatures and dispensing more than
160,000 pills. Witnesses have told
investigators that Peacock distributed
prescription drugs to individuals
without a doctor’s authorization.
Others named in the latest round
of indictments include:
• Ronald Knight, 48, of Indian River
Yellow Cab of Melbourne, who is
accused of taking $12,000 from
Medicaid last year by inflating the
mileage of cab rides for dialysis and
mental health patients.
• Maria Avila, 38, of Miami, who is
accused of billing Medicaid for more
than $230,000 between 1994 and
1996 for equipment that was never
provided to patients by her medical
equipment company.
“They have even come into our
home to see how my husband, John,
and I spend our days. We also took
them to Congressman (Bill) Young’s
Florida office for a half-hour chat.
Japan does not have an organization
similar to AARP, and the documentary should be a revelation for older
Japanese.”
The television crew went to
AARP’s national headquarters in
Washington, D.C., for additional
footage.
Older Japanese tend to be
more family oriented than Americans. Whereas AARP Connections for Independent Living
seeks to help older people remain
independent in their homes and
communities, the older Japanese
frequently stay within a family
group, with their children caring
for them.
Akihiko Sugie, a representative of the television company,
expressed interest in the Presidential and Vice Presidential debates.
“We are interested in older people
in politics. We are focusing on
political action by them, how they
involve themselves in government,
and what effect they have on elected
officials,” he said.
✽✽✽
Computerized contacts
If you haven’t computerized your
calls to elderly shut-ins to see if
they’re doing okay, you might take a
page from Tamarac’s system.
Disabled persons, shut-ins, and
other seniors who need to be checked
at their homes, can receive a computerized call each day. Three members
of Tamarac Chapter 1430 — Jack
Kramer, Wayne Whisler, and Thelma
Zimberoff — have been working with
the Broward County Sheriff’s department developing the free community
service.
“We already have about 100
names of persons to be called in the
computer, and we eventually expect
to have 300 or 400,” Zimberoff said.
“The computer is located in the
Tamarac branch station of the
sheriff’s department.”
If you are a shut-in or senior
living alone and one morning you
don’t answer on the third phone call,
the computer will list the name of the
person you have designated to check
“Operation Restore Trust”
is an anti-fraud initiative by the
federal government. The target
is the elimination of fraudulent
and wasteful activities in the
Medicare and Medicaid programs. If you suspect or have
knowledge of fraud or waste in
relation to these programs, you
can report it by calling the
operation’s toll-free hotline,
800/HHS-TIPS. The hotline’s
hours of operation are 9 a.m. to
8 p.m. (eastern time), Mondays
through Fridays....
on you. That person will be contacted and sent to your residence for
direct contact.
The program is called “Are You
OK?” Similar programs have proven
successful in several southeastern
Florida communities, Zimberoff said.
✽✽✽
Pension problems on
the rise
Other countries are making
changes in their social security
systems.
In Japan, for instance, under a
revised government pension system, Japanese will have to wait
longer for their retirement benefits.
The fully pensionable age, which is
now 60, is scheculed to increase to
age 65 in a series of steps. For
men, starting in the year 2001, the
age increase will be added in
stages, finally reaching the goal of
65 in 2013; for women, eligibility
for a full pension – currently age
65 – will rise to 65.
There are some exceptions, such
as those for people with physical or
mental disabilities.
Elder Update
NOVEMBER 1996
PAGE
24
Medical care at the end of life
W
e live in a culture that finds
very little meaning or value
in the lives of the old and the sick,
the people who I care for all the
time. It is a culture that has little
patience for suffering and, worse
yet, often views suffering as an
insult or an assault on the integrity
of our lives. Our medical culture,
which mirrors the values of our
larger society, acts to prevent death
almost at any cost. In the process we
have made dying in our health care
institutions, the place where more
than 80 percent of us will die, a very
difficult grace.
The dying process
itself can represent
a great movement
toward integrity
and honesty.
Despite this, many people die
with great dignity and integrity and
even wisdom. Our deaths are as
unique as our lives. Every death is
different and there is no right way to
die. Often, however, the way in
which we die can help us and help
the people around us learn a little
something about who we are and
why we have lived.
The dying process itself can
represent a great movement toward
integrity and honesty. We cast off
ways in which we have changed to
accommodate the world, ways in
which we have been fixed. What
remains is often a clearer picture of
who we are and the larger meaning
of our lives. There is great honesty
in the relationship with the dying.
Families can come together, important concerns can no longer be put
by Howard S. Tuch, M.D.
off and must be resolved. The
search for meaning at the end of
life, our need to make sense of
things, can lead to important
changes both in ourselves and in the
people around us. The absence of a
sense of meaning and purpose can
greatly increase the level of suffering that an individual endures. The
movement toward integrity that is
part of the dying process can be
very powerful — so powerful that it
can pull along all those around the
dying person, pull them along with
the dying person toward a greater
sense of purpose and value.
Caring for the dying is always
difficult, but it also is a great privilege and honor. This is truly one of
the best-kept secrets of our culture:
how much a privilege it is to be a
part of the life of a patient or
patient’s family at this time.
Many people have a deep distrust
of medicine’s ability or our willingness
to alleviate the suffering at the end of
life. The growth of the euthanasia
movement, acceptance of Jack
Kevorkian, best-selling books on how
to kill yourself, and the growth of
alternative medicine — all are evidence of that distrust. The people that
Dr. Kevorkian kills are not generally
people at imminent risk of dying. They
are people with Alzheimer’s disease,
brain damage, or cancers. They often
are people in pain, depressed and
facing difficult futures alone. One of
the great challenges in the work that
we do in Hospice is to help people find
value at the end of life. We don’t
always succeed, but it is important to
realize that human experience and
potential for growth and hope remains
vast even as we die. Perhaps especially
as we die, we can give those around us
a very precious gift by allowing those
we love to be close.
Let me end by offering a few
suggestions that I hope can ease
some of the inevitable suffering that
occurs as we die:
• Fill out a living will and designate a
health care proxy. Also, make sure
that you directly communicate your
wishes to your doctors, family, and
any other people caring for you.
• Be strong advocates for yourself and
your family members. You have the
right to refuse any medical interventions. Make sure that any proposed
treatments have very explicit goals
and that they have a good chance of
diminishing suffering.
• Realize that we have powerful and
safe tools to treat pain and other
distressing symptoms at the end of
life. If your doctor is unable or
unwilling to provide good pain and
symptom relief, seek help elsewhere.
• People need to feel safe as they are
dying. Often they feel abandoned by
their doctors who can do “nothing
else for them” or their families, who
may be in too much pain themselves
to confront the reality of the person
dying. This feeling of isolation can
greatly increase suffering.
• Lastly, recognize that despite the pain
and suffering, the end of life can and
often does have enormous value in
the lives of patients and their families. Sometimes just being present
with the dying person, listening to
the events of their lives, recalling
past joys can be very comforting.
Importantly, fundamentally connecting with another human being can go
a long way toward relieving suffering. The gesture of caring at the end
of life, and the realization that we
receive every bit as much as we give,
is one of the things that makes us
most human, relieves suffering, and
paradoxically reaffirms the value of
our lives even as we are dying.
Dr. Howard Tuch is Director of
Palliative Care Services for Genesis
Eldercare, a hospice serving clients
in the St. Petersburg area. His
remarks are drawn from a speech
he gave recently at the Florida
Conference on Aging.
NOVEMBER 1996
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