Oregon, the 5th BEST state to grow old in

That's what this article says:

The 5 best and worst states in which to grow old

[...] 5th best: Oregon
Oregon scores well on the quality of care available in the state, although its assisted living and nursing home costs tend to be in the middle of the pack. The state's population is rapidly aging, with its over-65 age group growing by 18 percent from 2010 to 2014, as the Baby Boomers hit retirement age.

The average cost of a year in an assisted living facility in Oregon is almost $47,000, according to Caring.com, while a nursing home will require almost $96,000 in annual costs. [...]

And the 1st best? South Dakota. Who knew?

     

Pioneers of Hospice: Changing the Face of Dying

I saw this video recently. Here is the first 18 minutes on Youtube:



The full video runs about 50 minutes. It's very informative, well worth watching the whole thing. I've been looking for a copy, but the DVD seems to be out of print, with no indication of when it might become available again. Does anyone know? https://www.academicvideostore.com/video/pioneers-hospice offers it for $249.00, but that's way beyond my budget.

I'm surprised the video has not been re-released and made more readily available. IMO, Hospice is a much misunderstood concept. This video does a lot to clear up those misconceptions. I hope that whoever owns the copyright will release the video for publication again, or else release it into the public domain, where it could do a lot of good.
     

The Myth of Scandinavian Socialism

Here is the Myth exposed:

No, Bernie Sanders, Scandinavia is not a socialist utopia

When Bernie Sanders was asked during CNN’s Democratic presidential debate how a self-proclaimed socialist could hope to be elected to the White House, he gave the answer he usually gives: Socialism has been wonderful for the countries of Scandinavia, and America should emulate their example.

“We should look to countries like Denmark, like Sweden and Norway, and learn from what they have accomplished for their working people,” Sanders said. When the moderator turned to Hillary Clinton, she agreed that America has to “save capitalism from itself” and that, yes, Scandinavia is great. “I love Denmark,” declared Clinton. It was the only time in the debate a candidate uttered the verb “love.”

Liberals have had a crush on Scandinavia for decades. “It is a country whose very name has become a synonym for a materialist paradise,” observed Time magazine in a 1976 story on Sweden. “Its citizens enjoy one of the world’s highest living standards. . . . Neither ill health, unemployment nor old age pose the terror of financial hardship. [Sweden’s] cradle-to-grave benefits are unmatched in any other free society outside Scandinavia.” In 2010, a National Public Radio story marveled at the way “Denmark Thrives Despite High Taxes.” The small Nordic nation, said NPR, “seems to violate the laws of the economic universe,” improbably balancing low poverty and unemployment rates with stratospheric taxes that were among the world’s highest.

Such paeans may inspire Clinton’s love and Sanders’ faith in America’s socialist future. As with most urban legends, however, the reality of Scandinavia’s welfare-state utopia doesn’t match the hype. [...]

The rest of the article goes into detail about how Scandinavian prospered in spite of socialism, not because of it. How socialism nearly destroyed their prosperity, and how they have spend years rolling back welfare and taxes, and re-introducing free market reforms. How much of the success of Scandinavian countries has to do with who they are:

[...] The real key to Scandinavia’s unique successes isn’t socialism, it’s culture. Social trust and cohesion, a broad egalitarian ethic, a strong emphasis on work and responsibility, commitment to the rule of law — these are healthy attributes of a Nordic culture that was ingrained over centuries. In the region’s small and homogeneous countries (overwhelmingly white, Protestant, and native-born), those norms took deep root. The good outcomes and high living standards they produced antedated the socialist nostrums of the 1970s. Scandinavia’s quality of life didn’t spring from leftist policies. It survived them. [...]

Read the whole thing, it's short and it gets to the point, with many embedded links to back up what it says.

BTW, I've no objections to looking at Scandinavia as a model, so long as we look at everything, their successes and their failures. We could learn a lot from both of those. If some things they've done were successful and could be adopted by us, so be it. It's just the sweeping generalizations based on fantasy that I'm leary of. Read the whole article. Why adopt policies from the Scandinavians that they themselves have discarded as unworkable? Even policies that work for them in their largely homogenous culture, may not necessarily transplant to ours. When looking for role models, let's keep it REAL, shall we?
     

Death and dying in America

Seeking a ‘Beautiful Death’

[...] Dr. Volandes, a staff physician at Massachusetts General Hospital in Boston, noted that “in the abstract, fighting every second of the way and pursuing aggressive life-prolonging interventions sounds admirable.” But he wants doctors, patients and families to consider the likely outcome of the fight and how much suffering it will involve.

He recognizes that “there are no right and wrong decisions about medical care at the end of life” but insists that all decisions should be fully informed. To ensure that patients and families understand the options, he has developed a video tour of what medical interventions like ventilation, CPR or placement of a feeding tube look like, which often prompts a change of heart. As one patient put it, “It looks so different on television.”

The video, produced by ACP Decisions, a nonprofit group devoted to advanced-care planning, is licensed to health care providers and insurers who can show it to patients and families to facilitate shared decision making in planning for care at the end of life.

In a randomized trial of the video’s effectiveness among 50 patients with advanced brain cancer, a quarter of patients in the control group who had only a verbal discussion about end-of-life care with their doctors chose life-prolonging care, half opted for limited medical care and only one-quarter chose comfort care. But none of those who saw the video opted for life-prolonging care, a handful chose limited medical care, and 92 percent decided on comfort care, Dr. Volandes reported. After watching the video, patients said they had a better understanding of their choices.

However, even just a discussion with their doctors about goals for end-of-life care can often make a huge difference. The one-third of patients in a 2008 national Coping With Cancer study who had such a discussion were less likely to undergo CPR, be put on a ventilator or be placed in an intensive care unit. Most enrolled in hospice, suffered less and were in better physical shape and better able to interact with others and for a longer time.

Their survivors, too, fared better; six months after the deaths, they were markedly less likely to experience major depression.

Options regarding end-of-life care should be discussed well before an emergency — or for those with dementia, during the early stages of mental decline. “The absolute worst time to contemplate decisions about medical care is when one is critically ill and in the hospital,” Dr. Volandes writes.

The kinds of questions doctors should be asking:

[...]

They are some good questions. Read the whole thing for embedded links and more.

     

Too RUDE, but All Too True

Anyone who lives in Oregon should understand this:

John Oliver leads left-wing cable television slam-a-thon of Cover Oregon



The parody was excellent.

     

What happens when vaccinations stop?

The green is Whooping Cough, the red is Measls:



The toll of the anti-vaccination movement, in one devastating graphic

[...] A couple of manifestations stand out. One is the prevalence of measles in Europe -- especially Britain -- and the U.S. Measles is endemic in the underdeveloped world because of the unavailability of the MMR (measles, mumps and rubella) vaccine.

But in the developed world it's an artifact of the anti-vaccination movement, which has associated the vaccine with autism. That connection, promoted by the discredited British physician Andrew Wakefield and the starlet Jenny McCarthy, has been thoroughly debunked. But its effects live on, as the map shows.

Vaccine panic also plays a role in the shocking incidence in the U.S. of whooping cough, also beatable by a common vaccine. Researchers have pointed to the effect of "non-medical exemptions" from legally required whooping cough immunizations -- those premised on personal beliefs rather than medical reasons -- as a factor in a 2010 outbreak of whooping cough in California.

These manifestations underscore the folly and irresponsibility of giving credence to anti-vaccination fanatics, as Katie Couric did on her network daytime TV show in December. We examined the ethics of that ratings stunt here and here.

Among other worthwhile examinations of the impact of the anti-vaxxers, see this piece about growing up unvaccinated in Great Britain in the 1970s, and this disturbing piece by Julia Ioffe about her battle with whooping cough, a disease no American should have. [...]

The original article has embedded links.

Measles Outbreak Spreads from Coast to Coast

State health officials in New York recently reported 16 cases of Measles in northern Manhattan and the Bronx, and others say the Measles are becoming a coast-to-coast problem. The New York City outbreak consists of 7 adults and 9 children, and while 2 of the children were too young for the immunization, 2 others were children whose parents refused to get them their shots. Massachusetts, Rhode Island and Pennsylvania have also witnessed a Measles outbreak in recent weeks.

Measles is a contagious illness spread through respiration. Classic symptoms of Measles include fever, cough, runny eyes or nose, and a recognizable rash. Less severe side effects of Measles include diarrhea to more serious and life-altering ones such as pneumonia, brain damage, and corneal ulceration. Risk factors for Measles are malnutrition, immun0deficiency, pregnancy and Vitamin A deficiency. In developed countries such as the U.S., children are immunized against Measles by the age of 18 months. Un-vaccinated individuals are at risk of contracting Measles. [...]

But what about the nine adults? Had they been vaccinated, and got it anyway? I got measles when I was 15, even though I had a vaccination when I was younger. I don't think it always works.
     

Funding the Affordable Care Act

Or not. With 2.5 million Americans leaving the workforce, that's 2.5 million less paying into it. Even the CBO (Congressional Budget Office) can do math:

White House: It's A Good Thing That Obamacare Will Drive 2.5 Million Americans Out Of The Workforce

[...] By 2024, says the CBO, Obamacare will reduce the size of the U.S. labor force by 2.5 million full-time-equivalent workers. That’s roughly triple what the CBO had estimated three years ago. Such a sizeable decline in the labor force will have substantial detrimental effects on the U.S. economic and fiscal picture.

[...]

In its annual, 182-page Budget and Economic Outlook, the CBO undertook an overhaul of the way it analyzes the effect of Obamacare on the job market. The new, larger estimate of the law’s negative impact on the labor force derives from three factors: (1) Obamacare’s employer mandate, which will discourage hiring and reduce wages offered by employers; (2) Obamacare’s $1 trillion in tax increases, which will discourage work and depress economic growth; and (3) the law’s $2 trillion in subsidies for low-income individuals, which will discourage many from remaining in the labor force.

Let’s focus on that last point, because it’s the one that has been the least-discussed in the media. In the past twelve months, a spate of research from academic economists has concluded that the health law, by offering economic benefits to low-income individuals, will disincentivize some of these individuals from continuing to work. Casey Mulligan of the University of Chicago has been particularly persuasive on this front, publishing two papers with the National Bureau of Economic Research.

Several economists, like Harvard’s Kate Baicker, MIT’s Amy Finkelstein, Texas A&M’s Laura Dague, and Northwestern’s Craig Garthwaite have found that expanding Medicaid is associated with rising unemployment. “Taking that research into account, CBO estimates that expanded Medicaid eligibility under the ACA will, on balance, reduce incentives to work.”

More significantly, as Casey Mulligan has warned, the new subsidized insurance exchanges will allow low-income workers to work less while maintaining the same effective income: what economists call the income effect. In addition, because the subsidies decline on a sliding scale as you make more money, that sliding scale means that as workers work more, they make less per hour worked: what economists call the substitution effect.

When Mitt Romney signed his health-reform legislation in Massachusetts in 2006, economists didn’t discern a substantial impact on the labor market. That led many Obamacare cheerleaders to dismiss concerns that the law would depress the workforce. But Mulligan observes that the Massachusetts law did not have a meaningful impact on income tax rates, unlike Obamacare. The ACA “increases national rates about 12 times as much as the Massachusetts law increased rates,” notes Mulligan; “among other things, [Massachusetts’] employer penalty is an order of magnitude less.”

CBO staff, to its credit, read the sheaf of new research on this topic, and revised its estimates accordingly. Hence all the hubbub about the new report. But wait—there’s more!

Carney: Americans should stop working ‘to pursue their dreams’

After the CBO review came out, White House Press Secretary Jay Carney published a statement in which he declared, remarkably, that it’s a good thing that millions of Americans may drop out of the work force:

Over the longer run, CBO finds that because of this law, individuals will be empowered to make choices about their own lives and livelihoods, like retiring on time rather than working into their elderly years or choosing to spend more time with their families. At the beginning of this year, we noted that as part of this new day in health care, Americans would no longer be trapped in a job just to provide coverage for their families, and would have the opportunity to pursue their dreams.

Bored with your job? No worries—now you can quit, thanks to the generosity of other taxpayers. Want to retire early? No worries—now you can, thanks to the generosity of other taxpayers, and also thanks to the higher premiums that young people will be forced to pay on your behalf. The White House’s apparently sincere belief—echoed by progressive pundits at MSNBC, The New Republic, and the L.A. Times—is that it’s a good thing for fewer Americans to be economically self-sufficient.

If you’re one of the chumps out there who still toils away at a challenging job, and still pays taxes so that others can “pursue their dreams,” you have a right to resent the White House’s argument. And the “dream-pursuers” themselves should become aware of all the research suggesting that earned success, through hard work, is the most reliable path to true happiness.

Participation in the labor force was already declining, thanks to the poor economy and the retirement of the Baby Boomers. Obamacare, it appears, will accelerate that process, forcing fewer and fewer taxpayers to support a greater number of government beneficiaries.

No universal-coverage plan is immune from this problem

I should issue two caveats before I go on: any health-reform plan that seeks to offer coverage to the uninsured will have this type of effect on the labor market. As Josh Barro notes, the new Republican plan to replace Obamacare offered by Senators Tom Coburn (Okla.), Richard Burr (N.C.), and Orrin Hatch (Utah) also has a means-tested subsidy to help the poor buy health insurance.

In addition, it is genuinely a good thing for us to move to a system where people control their own health dollars and their own health coverage, and aren’t stuck at a job because they’re afraid of losing the coverage they have. But giving people the opportunity to switch jobs is quite a different goal from encouraging them to drop out of the work force altogether.

The negative effect of Obamacare on the labor market is far worse than any Republican alternative would be, because the ACA dramatically expands Medicaid, and because the law heavily subsidizes health insurance for those nearing retirement. In addition, Obamacare depresses economic growth through a $1 trillion tax increase, and increases the cost of hiring new workers, because of its employer mandate requiring most businesses to offer health coverage to every worker.

The CBO report harbors more bad news

The new CBO report contained a lot of other interesting information. CBO projects that economic growth will be more sluggish than they had previously projected. From 2018 to 2023, nominal GDP growth will average 4.2 percent, compared to the CBO’s previous estimate of 4.4 percent. Over the same period, unemployment will average 5.6 percent, higher than the previous estimate of 5.4 percent.

Because of this slower economic growth, CBO projects that from 2014 to 2023, the federal government will receive $1.4 trillion less in tax revenue than it had projected last year. As a result, “CBO now estimates that the cumulative deficit for the 2014-2023 period…would be about $1.0 trillion greater than it projected in May [2013].” [...]

The biggest problem with the ACA, the way it is, is funding it. Parts of it were fine, and the Republican plan embraced those parts. But other parts are unsustainable. What is the point of passing legislation that is unsustainable?

Ideally, the president should have worked with Democrats and Republicans in Congress to combine aspects of both their plans, into something that would work. But that didn't happen. We got the Democrats plan shoved down our throats. Now what's going to happen, as this disaster continues to unfold, and it starts to fail?

It looks like we shall see. We will all have front row seats, whether we want them or not.

The full article at Forbes.com has many embedded links, graphs, and videos.

     

The Affordable Care Act. IS it? What IS it?

It's an honest question. Nancy Pelosi said we'd have to pass the Act, to find out what was in it. Now we find out:

Deep Inside The Hot Mess Called Obamacare: It's Time For Honesty.

“Oh what a tangled web we weave when first we practice to deceive,” wrote Walter Scott in Marmion. It begins to appear that the Obama White House, right up to the president, cut class the day that Marmion was being taught. The ensuing breakdown in America’s health insurance system, and the political backlash, shows what happens when integrity is drained from politics.

[...]

“[P]oliticians made a series of short-term fixes that all but guaranteed long-term problems.” Politicians, elected officials, and career civil servants are guided by different incentives than businesses. And follow them. And then are, or act, incredulous when this time officious meddling yet again degrades the quality of goods and services in whose markets they have intervened.

Who would have guessed that tampering with the free market will end, as it always seems to, in tears. Who would have guessed? Not Pyongyang. Not Nation For Change. And, apparently, not freshman Senator turned president Barack Obama. As Abraham Lincoln noted, you can fool all of the people some of the time….

Under the rapidly unraveling deceit what’s really going on?

Is Obamacare really stealth capitalism? Or is it really stealth socialism?

Or is it really something far older and more pitiful? The one thing all seem to agree upon is that it, whatever it is, is stealthy. Is Obamacare simply a badly designed system tangled in a web of lies woven to mask the hubris and the incompetence of those who are, as former U.S. Treasurer Ivy Baker Priest once wittily described herself, “often wrong, but never in doubt”?

In this case progressives have given the American people the hot mess called Obamacare. Who — other than the Republicans, libertarians, conservatives, supply siders, and Tea Partiers vilified by the mainstream media — as well as most Forbes.com columnists — could have guessed that the Affordable Care Act might actually serve to make health care less available and less affordable?

At a certain point spin becomes deception. The promotion of Obamacare crossed that line.

The American people do not appreciate being hoodwinked.

Stealth capitalism? Stealth socialism?

Nobody knows which.

But we mere voters know stealth. And don’t like it. [...]

A shit brick, by any other name...

It's such a mess, I have to wonder if it was ever intended to work, or if it was intended to merely destroy the healthcare system we had, so the government could then try to fix the problem they created by shoving a single payer system down our throats, which is what so many of them wanted right from the start?

I don't think every element of the Affordable Care Act is bad. But as a whole, it is a mess. Republicans should have taken the initiative for healthcare reform when they had the chance. They didn't, so the Democrats did, they did it all THEIR way, and now we have The Shit Brick.

We are just a few days away from January 1st, and I still don't know if we will have insurance by then. Our group policy was cancelled. We were steered toward the state health exchange. We made a choice from there. Half of it went through, half was botched up, and we're still trying to sort it out.

Meanwhile, our old insurance policy was suddenly resurrected for another year and offered to us, with only six days to decide, but by then we'd already committed to the new plan, yet headlines are NOW screaming that the State Exchange is on the verge of running out of money, and our registration with the new plan seems in limbo at the moment.

And what will it do to our taxes? The cost of our previous health insurance was a deduction. The new plan comes with tax credits. Deductions are subtracted from what you owe. Credits are subtracted from what you pay. So our income tax is going to go up as well. So then, how much will we actually save? I guess it's the Nancy Pelosi method: "You have to pay more taxes before you can see how much you will get back".

I want to be optimistic and believe it will all come right in the end. And perhaps it will. But this sure is not encouraging. And it is NOT the way to do business.
     

The Truth: You can't keep the plan you had

Sticker shock often follows cancellation notice for those with individual health care policies

MIAMI — Dean Griffin liked the health insurance he purchased for himself and his wife three years ago and thought he’d be able to keep the plan even after the federal Affordable Care Act took effect.

But the 64-year-old recently received a letter notifying him the plan was being canceled because it didn’t cover certain benefits required under the law.

The Griffins, who live near Philadelphia on the Delaware border, pay $770 monthly for their soon-to-be-terminated health care plan with a $2,500 deductible. The cheapest plan they found on their state insurance exchange was a so-called bronze plan charging a $1,275 monthly premium with deductibles totaling $12,700. It covers only providers in Pennsylvania, so the couple wouldn’t be able to see the doctors in Delaware whom they’ve used for more than a decade.

“We’re buying insurance that we will never use and can’t possibly ever benefit from. We’re basically passing on a benefit to other people who are not otherwise able to buy basic insurance,” said Griffin, who is retired from running an information technology company.

The Griffins are among millions of people nationwide who buy individual insurance policies and are receiving notices that those policies are being discontinued because they don’t meet the higher benefit requirements of the new law.

They can buy different policies directly from insurers for 2014 or sign up for plans on state insurance exchanges. While lower-income people could see lower costs because of government subsidies, many in the middle class may get rude awakenings when they access the websites and realize they’ll have to pay significantly more.

Those not eligible for subsidies generally receive more comprehensive coverage than they had under their soon-to-be-canceled policies, but they’ll have to pay a lot more.

Because of the higher cost, the Griffins are considering paying the federal penalty — about $100 or 1 percent of income next year — rather than buying health insurance. They say they are healthy and don’t typically run up large health care costs. Dean Griffin said that will be cheaper because it’s unlikely they will get past the nearly $13,000 deductible for the coverage to kick in.

Individual health insurance policies are being canceled because the Affordable Care Act requires plans to cover certain benefits, such as maternity care, hospital visits and mental illness. The law also caps annual out-of-pocket costs consumers will pay each year.

In the past, consumers could get relatively inexpensive, bare-bones coverage, but those plans will no longer be available. Many consumers are frustrated by what they call forced upgrades as they’re pushed into plans with coverage options they don’t necessarily want. [...]

The article goes on to give more examples, from people in lower income brackets than the Griffins, who are also loosing the plans they had, and will now have to pay more.

I've been given a 90 day notice that my insurance plan is being canceled.

Health care reform, done properly, should offer us more choices of things we want and need, not choices made by bureaucrats that are shoved down our throats. I want the health care I had, not somebody elses decisions.

The problem with the ACA right from the beginning was that there was no significant bipartisan input. Reform was needed, but it was too one-sided, and this is the result.

Two interesting comments under the article:

UCanKeepthechange
11/3/2013 10:11 AM PST
The WH is attempting to blame cancelled policies on insurance companies. However, the truth is that it is due to the ACA.

The so called grandfathering in of existing policies was dishonest. If the cost to the consumer of a policy went up a single dollar ($1) since the law passed in 2010, it was DISQUALIFIED from the grandfather clause.

When the law passed in 2010, the administration already knew the following:

80%+ of individual market policies would not conform to ACA and would be eliminated by law
65% of policies for small businesses and their employees would not conform to ACA and would be eliminated by law
45% of policies for large businesses and their employees would not conform to ACA and would be eliminated by law.

So, when you hear the administration's talking heads blaming insurance, understand that it is simply another lie. This one is all on Obamacare.

Salverda
11/2/2013 7:10 PM PDT
Don't be deceived, by the latest straw-man argument, into thinking that insurance companies are some how sabotaging Obamacare. Think for a minute: Who wants the "individual mandate" forcing every American to become a costumer of the insurance industry? And: Why would insurance companies want to infuriate half of their current customers by canceling their existing policies, without having the law on their side? The insurance companies know that they won't loose their clients, they will just be "transferred" or "channeled" into more expensive plans that call for higher premiums and larger deductibles. The complicit insurance companies are in cahoots with Obama on Obamacare; Why aren't they speaking up right now while Obama falsely accuses them of canceling policies, and charges them with selling "inadequate" and "unsatisfactory" "bad-apple insurance" products to their costumers? They keep quiet and just take it, because they are colluding with Obama, open your eyes! Sure there were coverages (no coverage caps, pre-existing conditions, 26 year old "child" dependents) that the insurance industry was reluctant to offer, at first. Their costumers would not have stood for the increased costs of these extravagant, and even unnecessary, services. However, under Obamacare they have found a way to get us to pony up, and now, they view these services in a different light. Their clients will be forced by law, to pay for these things, and they have been "allowed" to charge us for them. To the insurance industry, it is as if all of their costumers have been upgraded into their highest cost Cadillac plans. And they are lapping it up, taking full advantage of the situation.

     

My Brilliant Career, Part III: Medical Coding

Medical Records and Health Information Technicians

It's not exactly exciting; it sounds like the medical equivalent of tax preparation. It's mostly sitting in front of a computer all day. But the stats at the site above (Occupational Outlook Handbook, by the Bureau of Labor Statistics) gives it a job increase outlook of 21%, up till 2020. And another reason to consider training for it now is this:

ICD-10 Medical Coding

[...] ICD-10 is an upgraded diagnostic and procedural medical coding system that, by law, must be implemented throughout the healthcare industry by October 1, 2014. This new coding system is radically different from the version currently in use, so it’s important to start preparing for and implementing the massive changes to the existing coding system.

This online program offers you comprehensive, robust training in diagnostic and procedural coding, using the ICD-10-CM (diagnostic) and ICD-10-PCS (procedural) coding manuals. This training includes detailed instructions for using the coding manuals, understanding the coding guidelines, and accurately applying the ICD-10 coding steps. There are more than 40 quizzes and exams for diagnoses and procedures by body system to test your knowledge and understanding.

In addition, you will find information on the impact of the coding changes on medical coders, healthcare staff, physicians, software systems, documentation, and information technology. [...]

Most of the current coders are trained on ICD-9. So people who train for ICD-10 now, will be poised to "catch the wave".

But... it could still be too boring, sitting at a computer all day. In comparison, I think Pharmacy Technician actually looks better.

The Occupational Outlook Handbook had a lot of interesting information on Health Care jobs. Take this one for instance:


Home Health and Personal Care Aides

What Home Health and Personal Care Aides Do
Home health and personal care aides help people who are disabled, chronically ill, or cognitively impaired. They also help older adults who may need assistance. They help with activities such as bathing and dressing, and they provide services such as light housekeeping. In some states, home health aides may be able to give a client medication or check the client’s vital signs under the direction of a nurse or other healthcare practitioner.

Duties

Home health and personal care aides typically do the following:

• Help clients in their daily personal tasks, such as bathing or dressing
• Do light housekeeping, such as laundry, washing dishes, and vacuuming in a client’s home
• Organize a client’s schedule and plan appointments
• Arrange transportation to doctors’ offices or for other kinds of outings
• Shop for groceries and prepare meals
• Provide companionship

Aides often keep track of when a client’s prescriptions need to be filled or when the client has his or her next doctor’s appointment. Aides may prepare leisure activities, including exercise, to keep their clients active and healthy. They may go for walks with their clients or play games with them. In some states, home health aides may be able to provide some medical services. Aides may be expected to complete unpleasant tasks such as emptying a client’s bedpan or changing soiled bed linens.

Some aides are hired directly by the client or the client's family. In these situations, the client or the client's family supervises the aide and gives the aide tasks to do.

Home health aides, unlike personal care aides, typically work for certified home health or hospice agencies that receive government funding and therefore must comply with regulations. They work under the direct supervision of a medical professional, usually a nurse. These aides keep records of services performed and of the client's condition and progress. They report changes in the client's condition to the supervisor or case manager. Aides also work with therapists and other medical staff.

Home health aides may provide some basic health-related services, such as checking clients' pulse, temperature, and respiration rate. They also may help with simple prescribed exercises and with giving medications. Occasionally, they change simple dressings, give massages, care for skin, or help with braces and artificial limbs. With special training, experienced home health aides also may help with medical equipment such as ventilators, which help clients breathe.

Personal care aides—also called homemakers, caregivers, companions, and personal attendants—provide clients with companionship and help with daily tasks in a client’s home. They are often hired in addition to other medical health workers, such as hospice workers, who may visit a client’s home. Personal care aides do not provide any type of medical service.

Direct support professionals work with people who have developmental or intellectual disabilities. They may help create a behavior plan, provide employment support, and teach self-care skills, such as doing laundry or cooking meals. They may also provide other personal assistance services.

[...]

Job Outlook
Employment of home health aides is expected to grow by 69 percent from 2010 to 2020, much faster than the average for all occupations. Employment of personal care aides is expected to grow by 70 percent from 2010 to 2020, much faster than the average for all occupations.

As the baby-boom population ages and the elderly population grows, the demand for home health and personal care aides to provide assistance and companionship will continue to increase. Older clients often have health problems and need some help with daily activities.

Elderly and disabled clients increasingly rely on home care as a less expensive alternative to nursing homes or hospitals. Clients who need help with everyday tasks and household chores, rather than medical care, can reduce their medical expenses by returning to their homes.

Another reason for home care is that most clients prefer to be cared for in their homes, where they are most comfortable. Studies have found that home treatment is often more effective than care in a nursing home or hospital.

Job Prospects
Job prospects for both home health aides and personal care aides are excellent. These occupations are large and expected to grow very quickly, thus adding many jobs. In addition, the low pay and high emotional demands cause many workers to leave these occupations, and they will have to be replaced.

The Occupational Outlook Handbook has a lot of data on many different  Healthcare Occupations, so you can compare them. I've compared some that I was interested in:

Occupation:        Outlook (thru  2020):          Median Pay:

CNA                    20%                                     $24,010.
LVN                     22%                                    $40,380.
RN                       26%                                    $64,690.
Phrm Tchn           32%                                    $28,400.
Med. Coding        21%                                    $32,350.
Hme Hlth Aide      70%                                    $20,560.

Many of the higher paying jobs require two or more years of college. Pharmacy Technician still looks the best to me, considering the education requirements, job outlook, and pay rate. I didn't include the education requirements in my list here, but you can find them on the Handbook site, and much more too. It's a great resource.
 

The changing face of healthcare

I recently came across this article, which is aimed at American physicians:

Getting ready for emerging care models

Like it or not change is coming to healthcare. The government, employer groups and other purchasers of healthcare are demanding higher quality and lower costs in the delivery of healthcare. The Affordable Care Act of 2010 started this evolution and whatever you call it -- value-based purchasing, accountable care, patient-centered healthcare, etc. -- it is taking root and starting to grow rapidly.

[...]

To get an idea of what you should be thinking about, let’s look to a healthcare market where these “new” healthcare delivery models are the norm and have been in place for years. One such market is in the Netherlands, where 90 percent of demand for care is generated in the primary care setting and providers (private) are paid a lump sum based on conditions and work in integrated care networks.

In the Netherlands today, 99 percent of physicians use a computer, 97 percent are Internet-enabled, 90 percent store all types of health records electronically, 84 percent receive lab results electronically, and 26 percent exchange data electronically with other providers – all benchmarks that the United States aims to achieve in the next 3-5 years. The international standards used in the Netherlands are consistent with U.S. conventions, as HL7 and ICD-9 are used in healthcare and ICD-10 is being adopted. Also, as in the United States, Holland does not have a dedicated health ID number or “smart card” for patients that some European countries have adopted but which are not relevant in this country. In these respects, the Dutch market is extremely similar to the U.S. market. This market is where our own company history started, and where our care collaboration and disease management solutions have matured.

Here is what you need and why
To participate in a value-based delivery model you must be willing and able to coordinate and collaborate on patient care with other ambulatory providers; the goal is to render the right amount of preventive care, avoiding health complications and resulting in better patient care with lower attendant costs. Once this mind shift has taken root -- a very different and, for some, a difficult way of thinking -- you need the basic tools and capabilities to engage in care coordination. These tools must:

Enable you to store patient information electronically. This does not have to be the typical full-blown EMR that legacy vendors have been marketing. These EMRs were developed in the fee-for-service model to optimize billing and reimbursement and resemble digital renditions of paper records. Not to mention they are expensive to acquire and maintain even when they may be subsidized by the ACO. Instead, you need a platform that is designed for the new delivery model focused on optimizing patient care, with a workflow that fits your practice pattern. For more on this see the 2010 PCAST Report titled "Realizing The Full Potential of Healthcare Information Technology to Improve Healthcare."

Enable patient-centric care, including making sure that patients receive reminders for preventive services through multiple channels based on their personal profile.

Support the care team network, allowing all providers, physicians, facilities, etc., involved in treating particular patients to share relevant information through collaborative and coordinated care.

Manage patients proactively.

Be able to generate electronic referrals.

Be a cloud-based solution. Cloud-based solutions require little or no local IT support and investment. This is really important for the average physician practice. Also the pricing level and payment structure with predictable cash flow more closely matches the size of the practice.

To distill down these capabilities into specific tool sets means you should expect to have the following: an EHR; a care collaboration/coordination solution; and the ability to exchange electronic referrals. The key in selecting the right solutions for your practice is to pick one with the right workflow for your practice. The solution(s) must be cloud-based so you can avoid the costly hassle of purchasing and supporting local software installations, which is expensive and not your core competency. If you do not have these capabilities you either might not be a candidate to participate in an ACO, clinically integrated care delivery network or PCMH, or the ACO will force you to use their solutions.

You should expect the ACO to provide other required solution capabilities such as clinical decision support (CDS), analytics, population health tools, health information exchange platform (HIE); reporting tools, etc. These are expensive solutions tailored for a large organization to manage and support. [...]

It goes on to describe the current inefficient, entrenched ways of doing things, and how they are going to be forced to rapidly change, as has happened in many other industries (It has an embedded link to an article in Forbes).


Also see:

Have Smart Phones to do Medical Work
     

Real Pharmaceutical Marijuana?

Is it comming? Maybe:

Pot in a pill: All the pain relief without the smoke

[...] Let me introduce you to dronabinol. It turns out that the miracle that is modern psychopharmacology has now shown it IS possible to render pot's analgesic effects into capsule form. And according to a new study, it works just as well as smoked marijuana at tamping down pain. But the capsule's effects last longer, and they come with fewer of the "abuse-related subjected effects" (i.e., feeling high) than does smoked marijuana.

Face it, potheads: You knew it was just a matter of time before "the man" got a hold of weed and snagged all the profits. But who knew he'd suck the fun out of it too?

For the record, dronabinol did induce some of smoked marijuana's other side effects, some of which have medicinal value to certain populations: It did increase appetite, decrease nausea and improve sleep.

The new research appeared Monday in the Nature journal Neuropsychopharmacology. It was authored by a group from Columbia University's College of Physicians and Surgeons. [...]

The full article goes on with details about how it was tested, which I also found interesting.

     

Have Smart Phones to do Medical Work

And save us lots of time and money, too:

Visit NBCNews.com for breaking news, world news, and news about the economy

The doctor being interviewed talks about waste in the medical industry, and suggests that a third of all drugs prescribed are unnecessary or even harmful.

He demonstrates how a Smart Phone can be used to replace many costly and time consuming tests that waste time and money. Yet I wonder how far he will succeed with this medical phone apps technology? It would cut into the profit margins of those who are heavily invested in the old way of doing things.

 http://www.nbcnews.com/id/21134540/vp/50582822#50582822  

Rawanda Healthcare: Lessons for us all?

Rwanda's Historic Health Recovery: What the U.S. Might Learn

[...] Over the last ten years, Rwanda's health system development has led to the most dramatic improvements of health in history. Rwanda is the only country in sub-Saharan Africa on track to meet most of the Millennium Development Goals. Deaths from HIV, TB, and malaria have each dropped by roughly 80 percent over the last decade and the maternal mortality ratio dropped by 60 percent over the same period. Even as the population has increased by 35 percent since 2000, the number of annual child deaths has fallen by 63 percent. In turn, these advances bolstered Rwanda's economic growth: GDP per person tripled to $580, and millions lifted themselves from poverty over the last decade.

The rest of the world, wealthy countries and well as poor, can learn from Rwanda's rapid rise.

[...]

Rwanda achieves exceptional results not from how much money they spend on health, but from how they spend it. A recent article in BMJ, led by Farmer, examined World Health Organization data and sought to identify why Rwanda developed so rapidly, and to clarify the lessons for other countries. Rather than a single cause, the authors identified a series of interconnected factors that contributed to the country's turnaround.

First and foremost, credit belongs to the government of Rwanda's centralized planning. In 2000, the Rwandan government created a plan, called Vision 2020, to develop economically into a middle-income country over the next two decades. Dr. Agnes Binagwaho, Rwanda's Minister of Health, explained that "health is a key pillar of our development" and that without improving health, they will never alleviate the country's poverty.

[...]

While the specific context of Rwanda cannot be replicated, Dr. Farmer contends that Rwanda's focus on evidence-based policy, central planning, health systems, and equitable access to care should be heeded both by countries looking rebuild their health system and those with strong systems already in place. "In our commitment to understanding complexity," said Farmer, "we need to not forget that there are generalizable lessons to delivering care that are not acceptable to ignore."

While the United States still exceeds Rwanda in most traditional health metrics (such as life expectancy), and its hospitals and medical care surpass those in Rwanda, U.S. health outcomes still falter because too many patients fall through the cracks. The U.S. health system relies too heavily on doctors and hospitals to provide care. A growing body of research suggests that more frequent health care use and higher costs may lead to poorer health.

Farmer believes that, if the United States extended health care into the community like Rwanda, care for chronic diseases would markedly improve while costs would over time drop. Indeed, community-based pilots in the United States have proven effective in settings from inner-city Boston to rural Mississippi. [...]

There is much more in the full article. Lots of food for thought.
     

Re-engineering Human DNA?

Sounds like someone wants to:

Breakthrough Changes Thinking About DNA

Sept. 7, 2012 -- In what scientists call the biggest breakthrough in genetics since the unraveling of the human genome, a massive research effort now shows how the genome works.

The human genome contains 3 billion letters of code containing a person’s complete genetic makeup.

The biggest surprise is that most of the DNA in the genome -- which had been called "junk DNA" because it didn't seem to do anything -- turns out to play a crucial role. While only 2% of the genome encodes actual genes, at least 80% of the genome contains millions of "switches" that not only turn genes on and off, but also tell them what to do and when to do it.

Eleven years ago, the Human Genome Project discovered the blueprint carried by every cell in the body. The new ENCODE project now has opened the toolbox each cell uses to follow its individual part of the blueprint. The effort is the work of more than 400 researchers who performed more than 1,600 experiments.

The genome, with its 3-billion-letter code, reads from beginning to end like a book. But in real life, the genome isn't read like a book. The ENCODE data shows it's an intricate dance, with each step carefully choreographed.  [...]

OK, that's all very interesting. It's a fascinating article. But this jumped out at me:

[...] Eric D. Green, MD, PhD, director of the NIH's National Human Genome Research Institute (NHGRI), notes that most known disease-causing DNA mutations are in the small part of the genome that encodes genes.

"Most of these known mutations cause rare diseases," Green said. "But for the great majority of diseases, it's changes in the switches themselves. Diseases that are more common probably involve multiple DNA variants outside the genes. Common diseases like hypertension, heart disease, and diabetes are probably caused by things sitting in these switches." [...]

No. The "switches" don't cause the disease. The causes are things like bad diet and lack of exercise, etc, conditions which in turn cause the body to have a natural response by triggering things in the switches.

The disease is a warning that we are doing something wrong. Dr. Green seems to be implying that if we can turn off the triggers in the switches, we can stop the disease. But if we do that, you can be sure that the imbalance that would have triggered the disease, will then manifest somewhere else, some other way, in perhaps even a worse form.

Duh! I don't need a PhD to see that.

It's an area of study that we will inevitably pursue, but how that knowledge is used should be approached very conservatively. Nature does things for a reason. Altering that should not be approached lightly. Anyway, it IS an interesting read.    

Truely Bipartisan Health Care Reform

Unlike Obamacare, the Wyden-Ryan plan is truely a bipartisan effort, that does not dump any grandma's off a cliff. From Senator Wyden's website:

Bipartisan Health Options

U.S. Senator Ron Wyden (D-OR) and U.S. Representative Paul Ryan (R-WI) introduced a new proposal that represents a major advance in the effort to build a more secure future for the millions of seniors who rely on Medicare.

The new report from Sen. Wyden and Rep. Ryan, titled “Guaranteed Choices to Strengthen Medicare and Health Security for All: Bipartisan Options for the Future,” outlines a detailed proposal to offer expanded health care choices for older Americans while preserving a traditional Medicare plan as an option. The report also proposes to give Americans under 65 more power and freedom to purchase insurance products they can carry with them into retirement.

[...]

Why do you say Wyden-Ryan won’t “end Medicare as we know it?”  Won’t allowing seniors to choose private health plans be a major change?

First of all, the hallmark of Medicare is not its structure but its guarantee that every American will have high quality health benefits as they get older.  And, as has been mentioned before, “Medicare as we know it” will end in 2022 if nothing is done to change its current course.  Wyden-Ryan takes action to ensure the Guarantee is preserved.

Contrary to what many believe, every Medicare beneficiary does not currently get their Medicare from the government-administered Medicare insurance plan.  Many seniors are already getting their Medicare from private health insurance plans.  In Oregon, for example, 56 percent of seniors currently get all or some of their health coverage from a private plan. (15 percent of Oregon seniors purchase private Medigap policies to supplement their traditional Medicare, while 41 percent of Oregon's Medicare beneficiaries are enrolled in private health insurance plans through Medicare Advantage.)Wyden-Ryan would allow seniors to continue to choose between the traditional government-administrated Medicare option and privately administered plans.  But instead of maintaining separate programs, Wyden would make those private plans more robust and accountable by forcing them to – for the first time – compete directly with traditional Medicare.

Every private plan that participates in the program would be required to offer health benefits that are AT LEAST as comprehensive as those offered by traditional Medicare and premium support payments would be pegged to the actual cost of health care in a given area, determined by an annual competitive bidding process.  Therefore, every senior – whether they get their health insurance from a private plan or the government – will be guaranteed to have the high quality health benefits that has long been Medicare’s promise.

How will Wyden-Ryan ensure that private insurance companies don’t take advantage of seniors?

All participating private plans will be required to offer benefits that are at least as comprehensive as traditional Medicare, with such standards enforced by the Centers for Medicare and Medicaid Services.  Any plan that is found taking advantage of seniors or providing inadequate care will be kicked out of the system. Cherry picking healthier seniors will be made unprofitable by robust risk-adjustment, and the Medicare Exchange where plans will seek to offer coverage to seniors, will be policed by the federal government.

It is worth noting that the Medigap law Senator Wyden authored to regulate the private market for Medicare’s supplemental insurance market has been protecting seniors from unscrupulous insurance practices for more than two decades.

How will Wyden-Ryan guarantee that health care will be affordable for all seniors? Isn’t it just a voucher?

A voucher suggests giving seniors a fixed amount of money indexed by a set rate of growth that may/may not have anything to do with the actual growth of health insurance costs.  Vouchers would not guarantee that seniors could afford health coverage.  (This is what the last year’s House Republican Budget did.)

Wyden-Ryan does not give seniors vouchers.  Instead Wyden-Ryan would guarantee that seniors can afford their health insurance premiums by giving seniors premium support payments, the amount of which will be determined by the actual cost of insurance premiums each year.

It would do this through a competitive bidding process in which private insurance plans, wanting to cover Medicare beneficiaries, would submit their benefit packages and the amount they will charge in premiums for the upcoming year.  The amount seniors receive in premium support will be determined by either the cost of traditional Medicare premiums or the second cheapest private plan available on the exchange (whichever is cheaper.)  This process will take place each year, so if health care costs – and therefore insurance premiums -- grow dramatically from one year to the next, so will the premiums support payments that seniors get to pay for them – thus ensuring that every senior can afford their health insurance premiums.

And again, every private plan in the Medicare exchange will be required to offer benefits that are at least as comprehensive as those offered by traditional Medicare. [...]

It's not a "Radical Plan to Kill Medicare". It actually builds on the Medicare options that already exist, in a way that will both control costs and offer more choices. And it's a plan we can actually afford!

It's definitely worth reading the whole thing. It's pretty much the same Medicare plan that Paul Ryan is advocating on his website.

In an interview for Human Events, Ryan explains the history of bipartisan support for the reforms he's advocating.

   

Oregon's New Growth Industry?

Oregon Unveils New Alzheimer's Care Plan

The state unveiled its new plan to improve care for people with Alzheimer's Monday. Between 2000 and 2010, the number of Oregonians with Alzheimer's or a related dementia has increased by one third.

That growth is a result of people living longer. The older we get, the more likely we are to see the symptoms.

Speaking on OPB's Think Out Loud, Jon Bartholomew, the public policy director of the Oregon chapter of the Alzheimer's Association, says about 76,000 Oregonians now have the disease.

"That's approximately the entire population of the city of Bend. And by 2025 we're expected to add enough to raise that to 110,000 people in Oregon and that's like adding all of Clatsop County to Bend."

Similar growth is being seen across the nation. In fact, there's already a federal Alzheimer plan. Oregon is just the latest state to set up its own.

Oregon's plan has a number of goals, including providing treatment; optimizing the quality of care and improving access to care -- especially in rural areas. [...]

I expect it's happening in other states too, that have lots of retirees.
     

Vitamin D and Depression; which comes first?

Vitamin D Deficiency Linked to Depression

[...] The relationship between depression and vitamin D is likely a two-way street, Pathuk says. "People who have depression are at high risk for vitamin D deficiency because they stay indoors, don't exercise too much, and are likely not eating a healthy diet."

There are also vitamin D receptors in areas of the brain that help regulate behavior and emotion, she says.

"It is not unusual for people with depression to be deficient in vitamin D and treating the deficiency may make a huge difference in how they feel," Pathuk says.

If you are being treated for depression, ask your doctor to test your vitamin D levels. "If you are deficient, get treated," she says.

"People often feel better when they take vitamin D," says Michael Holick, MD, PhD. He is the director of the Vitamin D, Skin, and Bone Research Lab at Boston University. "One of the effects that vitamin D has on the brain is to improve serotonin levels -- which is the same chemical that many antidepressants act on."

"This is an interesting study," says Erin LeBlanc, MD. She is an endocrinologist and researcher at the Kaiser Permanente Center for Health Research in Portland. "It does show that vitamin D and its effects on things besides bone should be studied more." [...]

     

What's all this talk about Hepatitis?

Here's two articles I've seen recently:

CDC: All Baby Boomers Should Get Tested for Hep C
1 in 30 Baby Boomers Infected With Hepatitis C, but Few Know It

May 18, 2012 -- One in 30 baby boomers may be infected with the hepatitis C virus, but few know it until it's too late for their livers.

In the wake of new statistics showing more than 2 million baby boomers in the U.S. are infected with hepatitis C, the CDC is proposing new guidelines calling for all adults of that generation to be tested for the virus.

Officials say baby boomers, the generation born from 1945 through 1965, now account for more than 75% of all Americans living with the virus. But recent studies show few are aware they are infected or at risk for infection.

"Identifying these hidden infections early will allow more baby boomers to receive care and treatment, before they develop life-threatening liver disease," says Kevin Fenton, MD, PhD, director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and Tuberculosis Prevention, in a news release.

Current hepatitis C testing guidelines call for only those with certain risk factors to be tested for the virus.

The announcement of the proposed change coincides with the first-ever National Hepatitis Testing Day on May 19. After a public comment period, the new guidelines are expected to be finalized later this year.

Hepatitis C: Hidden Killer

The hepatitis C virus is spread through exposure to infected blood. The most common means of infection is through sharing of needles or other equipment used to inject drugs.

Researchers say most baby boomers were likely infected with hepatitis C when they were in their teens or 20s.

Some may have been infected when they experimented with injection drugs, even just once. Others may have been exposed to the virus through blood transfusions before modern blood-screening procedures came into effect in 1992.

Once infected, the hepatitis C virus causes progressive damage to the liver and can go undetected for many years without symptoms. Some people may have symptoms -- like fever, fatigue, dark urine, and abdominal pain -- six to seven weeks after getting infected.

Hepatitis C can lead to serious liver disease and liver cancer, which is the fastest-growing cause of cancer-related deaths. It is also the leading cause of liver transplants in the U.S.

The CDC says one-time testing of all baby boomers for the hepatitis C virus could identify more than 800,000 people infected with the virus, allow for early treatment to prevent liver disease, and save more than 120,000 lives.

Researchers say therapies can cure up to 75% of hepatitis C infections.

"With increasingly effective treatments now available, we can prevent tens of thousands of deaths from hepatitis C," says CDC Director Thomas R. Frieden, MD, MPH, in the release.

Read the original article, for the embedded links.

There are no vaccines for Hepatitis C, but there are for type A & B:
Vaccines for Hepatitis A & B

You may have a family member who has viral hepatitis. Or perhaps you recently saw a news brief about a celebrity who contracted hepatitis A or B. Whatever the reason, you want information about a viral illness that you may not have thought much about. What is viral hepatitis? Are you at risk for it? Do you need viral hepatitis vaccines?

Hepatitis A and B: Diseases of the Liver

Hepatitis is an inflammation of the liver, most often caused by a viral infection. There are three common types of hepatitis caused by viruses: hepatitis A, hepatitis B, and hepatitis C. Vaccines have been developed that protect people from contracting hepatitis A and B. There is no vaccine for hepatitis C.

Hepatitis A and hepatitis B can be spread from person to person, although in different ways. They have similar symptoms, which include abdominal pain, fever, fatigue, joint pain, and jaundice (yellowing of the skin and whites of the eyes).

Over the last 20 years, there has been a 90% decrease in cases of hepatitis A and an 80% decrease in hepatitis B cases in the U.S. Health experts believe that immunization efforts have led to this drop in rates of infection.

How Hepatitis Is Spread

Hepatitis A: About 20,000 people in the U.S. contract hepatitis A each year. The hepatitis A virus is found in the stool of the infected person. It is spread through contaminated food or water or by certain types of sexual contact.

Children who get hepatitis A often don't have symptoms, so they can have the virus and not know it. However, they can still spread it easily. Fortunately, children are now routinely vaccinated against hepatitis A.

Most people who get hepatitis A recover completely within two weeks to six months and don't have any liver damage. In rare cases, hepatitis A can cause liver failure and even death in older adults or people with underlying liver disease.

Hepatitis B: Every year, about 40,000 people in the U.S. become infected with hepatitis B. Acute hepatitis lasts from a few weeks to several months. Many infected people are able to clear the virus and remain virus-free after the acute stage. However, for others, the virus remains in the body, and they develop chronic hepatitis B infection, which is a serious, lifelong condition. About 1.2 million people in the U.S. have chronic hepatitis B. Of these, 15% to 25% will develop more serious health problems, such as liver damage, cirrhosis, liver failure, and liver cancer, and some people die as a result of hepatitis B-related disease.

Hepatitis B can be spread from one person to another from the blood, semen, or other body fluids of an infected person. In the U.S., sexual contact is the most common way that hepatitis B is spread. It can also be spread by sharing needles or other equipment used to inject drugs. In addition, a mother can pass hepatitis B to her baby during birth.

Hepatitis B cannot be spread by contaminated water, food, cooking, or eating utensils, or by breastfeeding, coughing, sneezing, or close contact such as kissing and hugging. [...]

The article goes on to describe who's most at risk, the effectiveness of vaccines, and who should have them. I found it interesting, partly because I've been thinking about getting training to work in healthcare. The vaccines are recommended for healthcare workers, and the article answered all my questions about the vaccines and how they work. Very informative.
     

Testosterone for Heart Failure?

It may help:

Male Hormone May Help Heart Failure Patients

[...] Heart failure is a leading cause of hospitalization in people over the age of 65 in the U.S.

About 5 million Americans have heart failure, and each year about half a million more get diagnosed with it, which means their hearts have a reduced capacity to pump blood efficiently.

When this happens, the heart can become enlarged, fluid may build up in the soft tissues and organs, and people typically become exhausted with exertion.

"Patients with heart failure don't feel very well, in part because they can't exercise," says Clyde Yancy, MD, chief of cardiology at Chicago's Northwestern Feinberg School of Medicine and a spokesman for the American Heart Association.

"The idea of a novel treatment approach that can help improve exercise capacity is very intriguing," he says.

The studies included nearly 200 patients, most of whom were men. They were 67 years old, on average.

About half the patients received testosterone by injection, patch, or gel, for as little as three months or as long as a year. The other half got a placebo.

The study appears in the journal Circulation. [...]

Read the whole thing for the details.