August Edition 2020
Inside This Issue
Coping with Stress, Anxiety and Sleep Issues Amid Current Events Sleep Problems Are on The Rise For Americans, But There Are Ways To Manage Them By Katie Console and Carlos Aleman, Doctoral students of Counseling Psychology Expert review by Carly McCord, PhD,
Vitamin D and Your Immune System See pg. 12
INDEX Legal Matters....................... pg.3 Oncology Research......... pg.6 Mental Health...................... pg.9 Healthy Heart..................... pg.10
Family Gatherings Aren’t as Safe as You May Think During COVID-19 See pg. 13
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ith the magnitude of COVID-19 in the United States, stress, anxiety and depression are on the rise. What’s more, reports and videos of police brutality toward Black Americans have sent the nation into outrage, and this chaos is certain to cause anxiety, stress and loss of sleep. Even before the events of 2020 began, sleep problems have been prevalent. Insomnia is the most common sleep disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and is characterized by difficulty falling asleep, staying asleep or sleeping too little. It is estimated that about a third of adults report symptoms of insomnia. How are recent events impacting my sleep? Sleep problems are often associated with other mental health issues like stress, anxiety and depression. With the restrictions put in place in many areas of the United States, more people are working from home, increasing screen time and getting less physical activity. This alone may be enough to increase stress levels, but there are also economic, medical, family and safety stressors. People are having to find new ways to adjust to
their current situation and new coping tools to manage stress. Amidst all of this, it may be normal to not sleep as well at night. How much sleep should I get? M a n y people believe the amount of sleep we need decreases as we age. However, there is actually little research to support this belief and more evidence to support that we are more likely to have
sleep disorders as we age. Adults should get seven to nine hours of restful sleep every night. What can I do about my sleep issues? For tunately, there are many i nter vention s to help manage sleep issues as well as other mental health problems that may be causing sleep issues. First are the things you can still control while the environment around you feels uncertain. Having variety in your schedule within the boundaries of physical distancing is important. Try exercising, eating healthy or trying new hobbies during blocks of free time. Whatever you choose, incorporating these activities in your everyday routine will physically target mental health symptoms that contribute to sleep problems. It’s also essential to continue to
Sleep problems are often associated with other mental health issues like stress, anxiety and depression.
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Legal Matters CMS To Assess Permanent Expansion of Telehealth Following Claims Data Review By Joelle Wilson, JD, Polsinelli, PC
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eema Verma, Administrator of the Centers for Medicare and Medicaid Services (CMS), recently released an article highlighting the impact that telehealth, which has been significantly expanded as a result of the COVID-19 Public Health Emergency (PHE), has on beneficiary access to care. The article outlined several steps that CMS will take to assess whether telehealth expansions and flexibilities should become permanent policy following the expiration of the PHE. Prior to the pandemic, Medicare covered telehealth services in very limited circumstances. Namely, Medicare beneficiaries had to be
located at a certified rural originating site, practitioner’s had to be located at a distant site, and the telehealth services were required to be provided via an interactive audio and video telecommunications system that permits real time communication. While CMS has long supported telehealth and telemedicine innovation efforts, the COVID-19 pandemic accelerated the use of telehealth by enabling beneficiaries to remain at home, to reduce risk of exposure to COVID-19, and access care at the same time. The use of telehealth has surged as a result of the PHE waivers and flexibilities, some of which include: • Elimination of geographic restrictions: Beneficiaries can receive telehealth from any location, including their home. • Expansion of services: CMS added 135 allowable services. • Pay Parity: Providers are paid for telehealth at the same rate they
would receive for an in-person service. • Expansion of Provider Type: CMS expanded the types of health care providers that can provide telehealth services, which now includes physical therapists, occupational therapists, and speech language pathologists. • Payment for Telephone-Only Services: Medicare will pay for evaluation and management (E/M) visits provided by audio-only technology. In addition to the aforementioned waivers and flexibilities, the Department of Health and Human Services (HHS) Office of Civil Rights and the HHS Office of Inspector General will exercise enforcement discretion with
regard to certain communication technology HIPAA violations and cost sharing requirements, respectively. As a result of these flexibilities and the resulting increased use of telehealth, CMS analyzed Medicare FFS claims data from March 17, 2020 through June 13, 2020. The data shows that over 9 million beneficiaries received telehealth services during that time frame. CMS reports that approximately 1.7 million beneficiaries received telehealth services in the last week of April 2020 alone, compared with approximately 13,000 Medicare fee-for-service (FFS) beneficiaries receiving telemedicine in a single week prior to the PHE. Claims data shows that a significant number of see Legal Matters...page 14
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Benchmark Research Now Conducting Trials In Austin; Seeks Participants to Test COVID-19 Vaccine
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his month, Benchmark Research, a trusted leader in the medical research field, will launch clinical research trials to test vaccines aimed at preventing the spread of COVID-19 in Austin. Participants, 18 and older—particularly front-line workers, individuals likely to be exposed to the virus, individuals over 65 and high-risk individuals with chronic health conditions—are needed for the upcoming trials. All participants will receive financial compensation. “The global effort to develop a vaccine has resulted in the need for thousands of study participants to join this historic fight,” Mark Lacy, chief executive officer at Benchmark Research, said. “We know that Austinites and central Texans feel like the problem is bigger than themselves, and this is an ideal way to be a part of the solution.” Since 1997, Austin-based Benchmark Research has developed a track record of safety and expertise,
having conducted more than 380 trials with 28,000 participants in partnership with the private and public sectors at clinics located in California, Louisiana and Texas. Past Benchmark Research studies investigated vaccines for H1N1 influenza during the 2009 H1N1 pandemic and Ebola virus during the 2014 Ebola virus epidemic. Now, the company aims to play a role in finding a vaccine for COVID-19, which continues to spread throughout the United States and several parts of the world. Ideal study participants are those who are highly likely to be and have been exposed to COVID-19 and those at risk for severe illness. This includes individuals who work in occupations that put them in regular contact with the public, including nurses, doctors, construction workers, teachers, retail staff, delivery drivers and other essential workers. High-risk individuals including those above the age of 65 and those who suffer
from health conditions such as obesity, heart disease, diabetes and asthma are also eligible to participate. Over the course of the trial, participants will receive compensation for their participation, which will include a specified number of visits to the facility and answering periodic phone calls regarding the study. Travel expenses will be reimbursed and all lab work is complimentary. Insurance is not required to take part in the trial. “I have worked to develop therapies and treatments for 16 years, and this is one of the most important of our time,” Laurence Chu, M.D., investigator at Benchmark Research, said. “A number of diseases that were once prevalent and often deadly, such as Polio, have been all but forgotten with the development of a vaccine. I can’t overstate the importance
of having willing participants to further research needed to develop a viable vaccine for COVID-19.” The United States’ long-standing vaccine safety program closely and constantly monitors the safety of vaccines. Data show that the current U.S. vaccine supply is the safest in history. Per the Centers for Disease Control and Prevention (CDC), clinical trials are conducted according to guidelines that the U.S. Food & Drug Administration (FDA) reviews to ensure the highest scientific and ethical standards. The clinical trial results are a part of the FDA’s evaluation to assess the safety and effectiveness of each vaccine. Those interested in participating should call 1-888-902-9605 or visit: www. benchmarkresearch.net to learn more.
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Oncology Research A Caregivers Guide to Covid-19 and Cancer By Jason Melear, M.D., Texas Oncology Austin Midtown
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aregivers play a critical role in the health and safety of cancer patients – a role that took on new meaning when the COVID-19 pandemic changed the world overnight. Whether you’re a full-time caregiver to a family member, a neighbor picking up groceries, or a trusted friend – your support and commitment to safety matter. Caregivers and other close contacts can take extra steps to protect cancer patients from COVID-19. Understand the risk. People with cancer, including patients currently receiving treatment, are vulnerable to illness and have a higher risk of infection and complications from COVID-19. According to the American Cancer Society (ACS), COVID-19 can impact cancer patients more seriously than those who don’t have cancer for reasons including the cancer itself, a
weakened immune system, and certain types of cancer treatment, among others. If you aren’t sure whether your loved one is at a higher risk, make sure the patient gets clarification from their healthcare team, with information specific to the disease and condition. Take action and stay vigilant. A cancer patient’s safety precautions alone aren’t enough if their caregivers and close contacts aren’t taking precautions too. The Centers for Disease Control and Prevention (CDC) provides a comprehensive list of safety guidelines at www.cdc.gov/coronavirus. Start with the basics: • Wear a face covering – regardless of setting • Practice social distancing. • Avoid crowds and contact with those who are sick. • Wash your hands often. • Disinfect surfaces. Another important measure: stay home. With cases of COVID-19 on the rise in Texas and across the U.S., now is not the time to let the guard down on safety. Consider the potential exposure risk even with family and close friends and make decisions with the highest
safety measures in mind. Because COVID-19 can be spread by people who are asymptomatic, a caregiver’s actions can unknowingly expose cancer patients and others at higher risk of contracting the virus. Know the symptoms. Some people experience minor symptoms with COVID-19, and symptoms may look different for cancer patients or those with a weakened immune system. The ACS advises caregivers to call their physician if they or the person they’re caring for has symptoms. The most common are cough, fever, shortness of breath, loss of smell or taste, nausea, and diarrhea. Call the patient’s physician or dial 911 for more serious symptoms like difficulty breathing, pain or pressure in the chest, confusion or being hard to wake, or bluish-colored face or lips. Mind your loved one’s mental health – and your own. Navigating cancer during a pandemic can feel isolating to patients who are secluded from friends, family, and their communities. Isolation can lead to depression and feelings of hopelessness. Being healthy requires a focus on mental and emotional wellness along with physical wellness. Reach out
to their physician if you feel your loved one is experiencing feelings of isolation or depression. The stress, anxiety, and fear caused by the COVID-19 pandemic also adds a layer to the deep physical and emotional commitment made by caregivers. Self-care is critical for caregivers. Find ways to relieve stress, communicate openly, and connect in ways that adhere to safety guidelines. The COVID-19 pandemic challenges caregivers and close contacts of cancer patients to reevaluate safety measures at home and in public. At Texas Oncology, we believe everyone plays a role in protecting vulnerable cancer patients from additional illness. Together, we can make a difference.
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Alternative Stroke Treatment Proposed to Protect Emergency Health Care Workers Against COVID-19
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esearchers are proposing the use of an alternative treatment for acute ischemic stroke to reduce health care workers’ exposure to COVID-19 in hospital emergency departments, according to an editorial published in the latest edition of JAMA Neurology. Specifically, the researchers are suggesting replacing the commonly used stroke drug alteplase with a similar but less frequently used treatment called tenecteplase. Alteplase and tenecteplase both fall in the category of clot-busting
as a single, five-second injection that requires about two minutes to mix, prepare and administer. In contrast, the conventional alteplase treatment takes about an hour to deliver. Warach co-wrote the editorial with Jeffrey Saver, M.D., a neurology professor at the David Geffen School of Medicine at UCLA. The pair contend that the simpler tenecteplase treatment may have additional advantages during the pandemic, because it cuts the amount of time health care workers spend near potentially infected patients.
drugs known as tissue plasminogen activators, or tPA. “Treating patients suffering from acute stroke in the emergency department during the pandemic is an especially vulnerable situation for clinicians, because stroke victims can’t always provide their own history to screen for COVID-19 and the urgency of assessing and treating stroke requires action before the results of COVID testing are known,” said co-author Steven Warach, M.D., professor of neurology at Dell Medical School at The University of Texas at Austin. Before the COVID-19 pandemic, some stroke centers across the country had switched from alteplase to tenecteplase for treatment of stroke, because it is quicker and simpler to use, costs less, and randomized clinical trials compared to alteplase showed it is at least as effective in limiting disability caused by stroke and may even be better in opening the blocked arteries causing the stroke, according to the editorial. Tenecteplase is given
Additionally, unlike alteplase, it does not require an intravenous infusion pump that follows the patient through other hospital departments and wards, possibly providing more surfaces for the virus and staff to touch. Because alteplase is effective at reducing blood clots, it is being used to treat severe lung complications in COVID-19 patients. Some regions have experienced shortages of alteplase because of this increased demand, according to Warach. “Tenecteplase treatment of acute stroke may be an efficient adaption to some of the challenges of the COVID-19 pandemic – reducing the exposure to health care workers to the virus and addressing shortages of alteplase supplies that might arise, especially in regions that are experiencing prolonged surges in COVID-19 hospital admissions,” said Warach.
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Mental Health Social Isolation: The Covid-19 Pandemic’s Hidden Health Risk for Older Adults By Marcia Ory, PHD, MPH
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s coronavirus cases rise again, it can be hard for older adults to see any end to the need for social isolation and the loneliness that can come with it. For months now, they have been following public health advice to reduce their risk of exposure by staying home, knowing an infection can have life-threatening complications. But sheltering at home has also meant staying distant from family, friends and the places that kept them active and engaged. Inadvertently, the COVID-19 safety guidelines to self-isolate have
created new health risks by leaving many older adults even more socially isolated and inactive than before. We have been examining social connectedness in old age and the detrimental effects of social isolation and loneliness on physical and mental health. We’re concerned about the paradox of government directives for physical distancing that protect older adults from COVID-19 but that might actually result in more social isolation. We believe public health officials need to look closely at this potential risk in their messaging and identify strategies to minimize the unintended consequences. Even before the pandemic began, national studies indicated that nearly a quarter of older Americans were socially isolated and about one-third of middle-aged and older adults experienced loneliness. Having few social connections and feeling isolated have been associated with myriad health-related conditions, including chronic diseases and psychiatric disorders. Social isolation is now viewed as a risk factor
for premature death, similar to cigarette smoking, physical inactivity or obesity. Social distancing during the pandemic was never meant to thwart social connections, but many family members, friends and neighbors of older adults are staying away to avoid exposing their loved ones to the virus. While that protects older adults from some health risks, the limited physical interactions reduce feelings of connectedness with others. It can also exacerbate other health risks. Without frequent and meaningful social interactions and stimulation, older adults’ cognitive functioning
can decline. As the days of isolation wear on, older adults are especially susceptible to depression and anxiety, and even suicidal thoughts. Remaining at home also makes it harder to engage in healthy lifestyles, including physical activity and eating well. Without exercise, muscles can weaken, leaving older adults more prone to falling. Inactivity can also lead to weight gain and other health problems, including declining heart and lung capacity. Access to healthy food is also necessary for staying healthy and for preventing and managing chronic conditions. While not everyone will see the same impacts, the older adults most likely to be affected include those who already experience social isolation, live alone or have limited financial resources, as well as those with multiple physical ailments, mental health concerns and memory problems.
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Healthy Heart Recent Survey Shows That 7 In 10 Respondents Worry Poor Health Will Limit Their Life Experiences By The American Heart Association
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he survey of U.S. adults from the American Heart Association and American Diabetes Association amid COVID-19 explores the role health plays in living a full life. Seven in 10 U.S. adults worry poor health will prevent them from doing all the things they’d like to do in life, according to a new survey from the American Heart Association and American Diabetes Association. The research was conducted by OnePoll for Know Diabetes by Heart™, a joint initiative of the American Heart Association and the American Diabetes Association which combats two of the most persistent U.S. health threats – type 2 diabetes and cardiovascular disease – and the devastating link between them. The survey asked 2,000 U.S. adults how the COVID-19 pandemic has impacted their views on time with friends and family, and generally, the role health plays in experiencing a full life.
Missing out on milestones and time with loved ones is a reality for millions of people in the U.S. living with type 2 diabetes. In addition to being at a higher risk of death from COVID-19 if blood glucose is poorly controlled, people with type 2 diabetes are at double the risk of developing and dying from heart disease and stroke. For adults at age 60, having type 2 diabetes and cardiovascular disease such as heart attacks, heart failure and strokes shortens life expectancy by an average of 12 years, but there is a lot people can do to lower their risk. The survey found respondents with type 2 diabetes, heart disease or stroke are more worried that health will limit their experiences (89%, 90% and 87%, respectively) compared to respondents who don’t have those conditions (58%). COVID-19 Pandemic Created Greater Appreciation for Daily Moments with Loved Ones Survey results revealed the COVID-19 pandemic has changed the way
many think about daily moments, and how respondents view their experiences with others. Eight in 10 respondents said the pandemic has made daily moments with their loved ones more special. Even more, 85%, said the pandemic has made them more grateful for the time they spend with their loved ones. Eduardo Sanchez, M.D., MPH, FAAFP, American Heart Association chief medical officer for prevention, said COVID-19 shines a direct spotlight on chronic health conditions and the additional health risks they present. “Controlling blood glucose and managing and modifying risk factors for heart disease and stroke has never been more important,” Sanchez said. “If there’s a
silver lining in all of this, perhaps it’s a new appreciation for wellness and emphasis on controlling the controllable, the existing threats to our health that we know more about and have more tools to manage.” Lharissa Jacobs, Vice President of Health Strategies for the American Heart Association in Greater Houston, emphasized the importance of maintaining a healthy lifestyle. “Spending more time at home with our loved ones can be an opportunity to focus on our overall health and wellbeing. We can make healthy eating a priority and take the time with our families to go outside together and achieve the recommended amount of exercise (150 minutes) per week,” said Jacobs.
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Physical Activity Recommendations for Kids Active kids have a better chance of a healthy adulthood. How much activity do they need?
Be Active
Learn & Grow
Go Play
Fit in 60+
Kids should be active throughout the day. Replace sedentary behavior with activity whenever possible.
Encourage preschool-age children (ages 3-5) to engage in active play as well as structured movement. A good goal is about 3 hours per day of a variety of activities (light, moderate and vigorous).
Kids who are active have better bone health, physical fitness, brain function, attention and academic performance. They stay at a healthier weight and have fewer symptoms of depression.
School-age kids and teens (ages 6-17) should try to get at least 60 minutes per day of moderate- to vigorous-intensity activity. It can be broken up into shorter sessions throughout the day.
Live Healthy
Keep kids active at home and at school. Support physical education, walkable communities and safe places to play. Their future health depends on it.
Sit less and move more. Learn more at heart.org/movemore. © Copyright 2018 American Heart Association, Inc., a 501(c)(3) not-for-profit. All rights reserved. Healthy for Good is a trademark. Unauthorized use prohibited.
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Vitamin D and Your Immune System By Denise Hernandez, MS, RD, LD Austin Medical Times
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itamin D deficiency is a global public health issue. About 1 billion people worldwide have a deficiency and 50% of the population demonstrate a vitamin insufficiency. The Institute of Medicine considers blood serum levels of <50 ng/mL to mark a deficiency or insufficiency in most of the general population. This is based on what is generally considered adequate for bone and overall health. Because of this, vitamin D has been of vast interest in the health and wellness sector. It is well known for its role in bone health but studies have also shown that vitamin D enhances antimicrobial effects in immune cells, which in turn allows your body to fight against pathogens.
The pathway to doing so is intricate and works through many aspects of the immune system. Vitamin D comes from three potential sources: food, skin contact with UV rays, or supplements. Very few foods contain (natural, non-fortified) relevant amounts of vitamin D: fatty fish (salmon, mackerel, sardines, cod liver oil) or some types of mushrooms (Shiitake), especially if sundried. Getting adequate amounts from the sun depends on the following factors: season, time of day, length of day, cloud cover, smog, skin melanin content, and sunscreen. The suggestion is to get approximately 5-30 minutes of sun exposure between 10 AM and 3 PM at least twice a week to the face, arms, legs, or back without sunscreen. Dietary supplements include both D2 (ergocalciferol) and D3 (cholecalciferol) forms. Both appear to be effective for bone health, but D3 tends to be more potent at high doses. Adults without deficiencies should aim to get at least 600 IU per day, not exceeding 4,000 IU. The amount of
vitamin D required to treat a deficiency depends largely on the degree of the deficiency and underlying risk factors. If you find yourself having a deficiency, speak to your doctor or a dietitian to determine the best route for you. Addressing vitamin D deficiencies and insufficiencies is crucial to not only supporting bone health but also supporting immune health. If you would like to see whether you have a deficiency, the Results Center now offers functional testing that can test for 33 vitamins and minerals,
including vitamin D. We also offer supplements that contain both vitamin D and K because of their synergistic relationship. A particular study called the Framingham Offspring Study, found that higher serum levels of both vitamins D and K were associated with stronger immune function and a balanced inflammatory response. Contact us at nutrition@ houstonian.com for more information.ď ľ
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Family Gatherings Aren’t as Safe as You May Think During COVID-19 By Katie McCallum
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e’re all ready to start seeing our family and friends again, and continuing to forgo all social activities — especially gathering with your family — can seem like a lot to ask. But, given that COVID-19 spreads easily from person-to-person, the reality is that a family gathering is, unfortunately, just as unsafe as any other social gathering. Social distancing includes reducing close contact with people who are not a part of your household — even if he or she is a part of your extended family. In fact, we sometimes see members of the same extended family, from grandchildren to grandparents, being admitted to the hospital for COVID-19 — and the culprit is often a recent family gathering. Rather than planning an in-person gathering during the COVID-19 pandemic, the safest way to stay connected with your family is to gather virtually. If you do decide to take the risk and host a family gathering, here’s how to make it a little safer. Or, if you’re attending one, make sure whoever is hosting the gathering is taking extra precautions. High-risk family members should attend virtually Anyone can get COVID-19, but some people are more likely to end up in the hospital, or even the intensive care unit (ICU), while ill with this new virus. If you have a family member who is considered high risk, know that he or she is likely taking extra precautions to stay
Mental Health
Continued from page 9 What can older adults do? Although the immediate demand for COVID-19 screening, testing and treatment has made it more difficult for health care and aging organizations to reach out to older adults, many still offer opportunities for older adults to engage in a variety of meaningful ways within their homes or communities and to connect with helpful resources, services and programs. Some states, like Iowa, have set up free programs to connect isolated residents with counselors and support groups by phone and online during the pandemic. Older adults can also take steps on their own to stay active and engaged: 1. Plan your day. While the days may seem to be an endless blur, keep up with daily routines like getting
safe during the COVID-19 pandemic. To still include your high-risk family members in the gathering, use digital tools that can help you gather virtually. In addition, if someone in your household is high risk, avoid hosting a family gathering at your home, as this could put him or her at greater risk. Family members at highest risk include those who are over the age of 65, are immunocompromised or have one or more of the following underlying health conditions: • Lung disease • Moderate-to-severe asthma • Advanced heart disease • Diabetes • Obesity • Chronic kidney disease • Liver disease
where he or she frequently interacts with people who are sick, like a hospital, or where social distancing is challenging, like a grocery store, his or her risk of exposure to COVID-19 is likely higher. If a family member has just traveled or dines at restaurants regularly, his or her risk of exposure may be higher as well. Keep your family members outdoors as much as possible An important part of gathering in a small group during this pandemic is doing so outdoors — in your backyard, for example. Before your family arrives, have plenty of tables and chairs set up outside. You can mingle in socially distant circles, but you’ll want to have a separate table for each family household if you plan to eat during the gathering. During your backyard gathering, make sure you have everything your family members may need readily available outside, including: • Plastic dinnerware • Napkins and paper towels • Alcohol-based hand sanitizer • Disinfectant wipes • Separate coolers with ice to keep food and drinks cold If kids will be present, make sure
there are plenty of outdoor activities so that they’re not tempted to sneak inside to play video games. While you want to avoid letting kids play contact sports, playing in the pool is fine — as long as social distancing is still happening. Social distancing still matters around family, as well as when you’re outdoors Even though you’re outside and even though you’re around family, you still need to maintain social distancing. While having a conversation, remember that six feet is probably further than you think — about two arm’s lengths. You may even want to use tables or other physical barriers as a reminder to keep your distance from family members that aren’t a part of your household. In addition, don’t feel like wearing your cloth mask is silly since you’re outdoors and social distancing. While it may not protect you from catching COVID-19, it may protect you from spreading it if you’re infected and don’t yet know it. Keep in mind, though, that a mask doesn’t mean it’s okay to break social distancing — the two are meant to work in tandem. Avoid sharing food While your past family gatherings
out of bed, getting dressed and adults can do to stay safe when being engaged with small activities. leaving home. For example, when Planning time for online classes, going outside, practice everyday calls with friends, reading, puzzles, preventive actions: Carry a cloth cooking, gardening or home repairs face covering, tissues and hand can give meaning to the days. sanitizer; encourage others to wear 2. Stay physically active. Find cloth face coverings when out in exercises that can be done at home public; and avoid close contact or in the immediate neighborhood, with others who are not wearing like walking. Many virtual and face masks to the extent possible. online physical activity and 5. Think of others. Regularly reach health promotion programs are out to others who may need to available, which can remotely hear a friendly voice on the phone. foster engagement and connection Volunteering has been shown to to others. have many positive health benefits, 3. Know your risk. Take the AARP and there are online opportunities Foundation’s Connect2Affect tool for doing so. to assess your risk for being socially 6. Accept help from others. Many isolated, and refer to the local individuals and organizations assistance directory for support are working hard to keep seniors services you might need. socially connected. Remain open 4. Don’t be afraid to leave home, to accepting the kindness and but do so wisely. New CDC support from family members, guidelines emphasize what older friends, health care providers and
social service agencies. Strategies for a healthier response Despite the ongoing COVID-19 pandemic and need for social distancing, there are ways to help older adults remain connected. Phone calls and online platforms offer older adults ways to safely connect with peers and professionals, as well as friends and family. Online learning and internet-based volunteering can also provide interaction and intellectual stimulation. For older adults, staying healthy and safe means also staying socially connected while following public health recommendations. Public health efforts to stop the spread of COVID-19 should also take into account the importance of social connectivity for maintaining older adults’ physical and mental health.
Limit the number of households coming together Gathering in groups is a risk in and of itself, but you can reduce that risk by making sure that both the number of family members you invite and the location of your gathering make maintaining social distancing and limiting contact with frequently touched surfaces as easy as possible. In fact, you may want to invite just one other family household to your gathering. Every household within your extended family has a different risk of exposure to coronavirus. For instance, if someone in your family works in a place
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see Family Gatherings ...page 14
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Sleep
Continued from page 1 feed your social functioning through phone conversations, video chatting or small, physically distanced interactions. With in-person interactions, the Centers for Disease Control and Prevention recommends wearing a face mask, keeping a distance of 6 feet and gathering outdoors if possible to reduce risk of spreading COVID-19.
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Continued from page 3 beneficiaries are seeking services via telehealth, often at similar rates across demographics. Beneficiary Use of Telehealth by Location Rural 22% Urban 30% Beneficiary Use of Telehealth by Sex and Age Female 30% Male 25% Below age 65 34% Age 65-74 25% Age 75-8 29% Over age 85 28% Beneficiary Use of Telehealth by Race/Ethnicity Asian 25% Black 20% White 27% Hispanic 28% Other 26% Beneficiary Use of Telehealth by Dually Eligible (beneficiaries
With these guidelines in place, you could talk with a friend in a park, set up an outdoor movie or even play a game like charades with a few friends in your backyard. Another suggestion is making sure that you maintain good sleep hygiene. For example, avoid caffeine, exercise and screen time close to bedtime. Instead, try relaxing activities like reading, meditating or journaling. It can also be helpful to create a relaxing bedtime routine and go to bed at the same time daily. If you are struggling with
keeping up with your daily routine, social interactions or your mental health throughout these difficult times, consider reaching out to a mental health professional. Mental health professionals can provide much needed interaction, hold you accountable to your goals and help you find new perspectives amid this pandemic and social justice awakening. It may also be helpful to consult a medical professional on the use of supplements and sleep medication as needed.
that qualify for both Medicare and Medicaid) vs Medicare-only Beneficiaries Dually Eligible 34% Medicare-Only 26% Office visits or Evaluation and Management (E/M) visits are among the most common form of telehealth service being provided, with 38% of beneficiaries receiving such visits via telehealth. Mental health services have similarly seen frequent use amid the pandemic, with 60% of beneficiaries receiving such services via telehealth. CMS claims data provides significant and timely insight into the benefits that telehealth has on beneficiary access to care. CMS announced several steps, outlined below, the agency is taking to assess the temporary waivers and flexibilities to determine their potential for permanent implementation via regulatory action. 1. CMS will assess whether telehealth is clinically appropriate and safe for patients compared to in-person visits. This would include
examining outcomes related to new versus established patients receiving telehealth services, particularly with regard for those with acute needs. 2. CMS will assess Medicare payment rates for telehealth services. Such assessment will take into account resource needs for telehealth visits and determine if rate adjustments are necessary. 3. CMS will assess program integrity implications to protect beneficiaries and tax payer dollars. Such assessment will take into account the potential for fraud and abuse in telehealth. While the current telehealth waivers and flexibilities are set to end in line with the expiration of the PHE, there is hope that many of the temporary policies will become permanent. The steps CMS is taking to assess the current state of telehealth is vital for a future that seeks to expand access to care in line with technological advances.
Family Gatherings Continued from page 13 were probably always centered around sharing some delicious home-cooked meal, gatherings during a pandemic shouldn’t be. In fact, it’s best for each family household to bring its own food and drinks. One relatively safe way to serve your family food is to serve freshly cooked meat directly off of your grill or barbecue pit. However, it’s best to have only one person from each family fill a platter of meat for his or her entire table. Each household should still bring its own sides and drinks. As an alternative, consider buying prepackaged meals and setting separate, unopened containers out at each household’s socially distant table. And make sure to remind kids that, if they want August 2020
a snack, they should grab from the bag of chips at their own household’s table. Have a direct route to the restroom While you’ll want your family members to be outdoors as much as possible, nature will likely call. To limit the risk of your guests touching potentially contaminated surfaces inside your home, as well as potentially contaminating surfaces themselves, make sure your guests know exactly how to get to your restroom. In addition, you may want to have paper towels in the bathroom so you and your guests aren’t sharing a hand towel. Keep your family gathering short Back in the day, it was totally safe for
your family gatherings to last as long as you wanted them to. During a pandemic, the longer you gather, the riskier the gathering becomes. There’s no hard and fast rule as to how long your gathering should be — any amount of time increases your risk — but avoid letting the gathering drag on for several hours. Catch up, laugh and enjoy one another’s company — and then don’t be afraid to kindly let your family know that it’s time to say your goodbyes.
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