November Vantage 2016

Supplement to The Oklahoman November 9, 2016

Illustration by Todd Pendleton, The Oklahoman

WHEN IT IS BETTER TO LOOK GOOD THAN TO FEEL GOOD?

Well, it finally happened. I got a call from my editor (who I believe) has finally asked me to do the impossible — to humorously write about the “high cost of staying well.”

Seriously, girl? How am I — an amateur humorist slash columnist slash smarty pants — supposed to write knowledgeably about this subject, when it absolutely does not affect me?

You see, I am married to a military man.

A retired one. Many people thought I married my Knuckle-Dragging Neanderthal for his good looks and charming manner — and while they would not be wrong — the health insurance associated with marrying a military man was just the cherry on top of his sundae.

I mean, face it. I married him, and in the end, I also married his Tricare health insurance — and his Tricare Prime, which covers all those nasty little expenses for which, Tricare doesn’t pay. When I married the Knuckle Dragger, I got a 2

veritable cornucopia of insurance — the trifecta if you will, of healthcare.

Of course, as with everything, there is a cost with that kind of insurance. In our case, it has come in the form of my man’s health, more specifically, his back.

Since August of last year, the Knuckle Dragger’s not only been bunged up, he’s had major back surgery and cannot walk without the aid of a cane and walker. He wears the constant pain from

WEDNESDAY, NOVEMBER 9, 2016

his back injury like a weighted blanket — his body seems to sink lower and lower into the earth daily. Pain is there when he’s awake. It is there he’s asleep — when he can sleep. It is inescapable — even with drugs.

It. Just. Hangs.

As a brave warrior, he has given his health, peace of mind and mobility to his country.

The least this country can do is to take care of him, in good times and in bad. Hence, the Tricare

and HIS high cost of staying well. (P.S. Really want to get me on a jag?

Ask me about the VA I have stories.)

As I continued to ruminate on the high cost of staying well, memory lane took me back to a time, many long years ago, when my child was little and I was “insurance-less.” Yes, I had plenty of jobs, which provided health insurance for which I could pay, but even back in the dark ages it was expen-

sive and too much for a poor working mother with an ever-growing mouth to feed. I remember many nights I lay in bed and wondered what would happen if I got sick and the constant conundrum. Food? Insurance?

Food? Insurance?

I can promise you — food won.

That being said, I remember taking strenuous steps to proactively take care of myself (even then) so I would NOT have to go running to

the doctor. Maybe that’s where we need to stop and think about what we can do to avoid the high cost of staying well. Off the top of my head: 1. A gym membership: Yes, it costs money, but not the kind of money the deductible from a triple bypass will cost you.

Take my word for it — I hate working out.

If I can’t do a task with FEEL GOOD ON PAGE 3

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FEEL GOOD

impending heart attack — as long as I can.

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2. Eating right.

a fruity drink in my hand or without sweating, I don’t consider it fun.

But recently, my assistant Sheila (She of the Bossy Voice) sat me down and said, “You’re getting fat. You have to go work out or you’re going to die.” She was right — on all counts. So off she dragged me to the gym.

Please note that I do not “dress” for the gym, even if I am going with Sheila, the Gym Goddess Queen. I do not have a happy snappy little bun up on my head. I do not wear gym appropriate attire.

You’re going to be lucky if I even have showered beforehand, though I can guarantee I have spritzed on something expensive so I don’t stink and at least, I have brushed my teeth. I’m there because I’m serious, I’m here to work, and I’m going to put off that

Oh, the joys of being married to the Knuckle Dragger are many. Many, which I can’t discuss here in polite company, but the big one I can — the fact that he can cook.

And cook he does. Coneys with real chili. Jambalaya.

Hamburgers, potato salad and baked beans with brown sugar.

Biscuits and gravy to die for — and that my friends is the point.

My husband is trying to kill me with food.

No, no, no. He isn’t really trying to kill me with food.

(That I know of.) He’s just doing what a good man does if he loves you — he feeds you.

Case in point? You should see my pantry. It looks like a survivalist lives here. It’s only the two of us, but I swear, it looks like all seven kids still live here. We could survive a

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nuclear blast, simply on our pantry alone.

I have spoken to him about the joys of veggies. How a salad can be tasty. Why fruit is important. He just looks at me, shakes his head and mutters, “They’re all communist,” which is truly the worst thing he can say about something. So I guess I’m going to buck up, eat healthy on the side and do a lot of portion control.

3. Take care of your teeth.

I think one of my favorite movie lines, outside of “I’ll be your beck and call girl,” and “I’ve got a touch of a hangover, bureaucrat — don’t push me,” has got to be, “If I known I was going to live this long, I’d of taken better care of my teeth” from “Peggy Sue Got Married.”

If I had looked at my teeth like an expensive Chanel scarf — a good investment, which managed carefully, would pay off with years of

good wear — I would still have super teeth. Instead, I took care of the kid’s teeth and just ignored mine. Now I’m looking at three dental implants, which are going to cost me a kidney and a major hair donation.

The lesson here? When in doubt, pay for your teeth.

In the end, Billy Crystal said it best when he muttered those famous words, “It is better to look good than to feel good.”

Considering the high cost of staying well, looking good may be our only alternative.

Lesa Deason Crowe owns atomic.marketing and you can share with her your foibles, gossip and howto’s at facebook.com/lesa. crowe. Norman’s (KnuckleDragger's) back is still puke-ie, her daughter Lila is making straight A’s at college and her son Taylor made his car payment by himself this month.

All things considered, life is good.

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EATING HEALTHY

‘Clean eating’ is a balancing act

BY MELISSA HOWELL The Oklahoman

T

o eat organic, or not to eat organic? It’s a question on the minds of many.

The answer is, it depends on what you’re eating.

What is organic really?

Jules Griswold [PHOTO BY NATE BILLINGS | THE OKLAHOMAN]

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So, what does it mean to be

organic, free-range, natural or grass-fed?

There is a lot of different labeling that goes on in the organic world,” said Jules Griswold, an Oklahoma Citybased nutrition and dietetics technician. “Definitely reading labels will be something that will help you the most to look to see what you are consuming.”

What’s in an organic label?

Basically, if a product contains less than 5 percent pesticides, hormones, antibiotics or synthetic fertilizer, it is permitted to use the USDA Organic seal, according to the U.S. Agriculture Department of Agriculture. It also must adhere to certain growing CLEAN ON PAGE 5

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CLEAN CONTINUED FROM PAGE 4

methods.

The USDA also lends its labeling scrutiny to “free-range,” “natural” and “grass-fed” animalderived foods which may or may not be organic.

These are: •Free-range — “The claim ‘Free Range’ can be used on any meat or poultry food product. A ‘Free Range’ label means producers must ensure there is continuous, free access to the out-ofdoors for over 51 percent of the animals’ lives.”

•Natural — “A product containing no artificial ingredient or added color and is only minimally processed.

Minimal processing means that the product was processed in a manner that does not fundamentally alter the product. The label must include a statement explaining the meaning of the term natural (such as ‘no artificial ingredients; minimally processed’).

•Grass-fed — “‘Grassfed’ means that grass and forage is the feed source consumed for the lifetime of the animal, with the exception of milk consumed before weaning. Animals cannot be fed grain or grain byproducts and must have continuous access to pasture during the growing season.”

An easier job for the body Why are these foods and their labeling so important? Griswold says it comes down to the stress that excess foreign substances puts

on the body.

“The biggest thing is to lower the toxic load to our bodies. When you cut out the toxins, it’s easier for our body to process food,” she said.

For Griswold, eating right comes down to making the best choices, not necessarily the perfect choices.

“I do the best I can, like everyone else.

When it comes to dairy and meat, it’s best to buy with no antibiotics.

No hormones. When I eat salmon, I make sure it is wild-caught.

When I eat vegetables and fruit, I try to buy organic, but things that have a thicker skin, such as avocados, I tend to let it go,” she said. “You might not be able to do everything organic, but everything you can do will have an impact.”

Evidence also exists that organic fruits and vegetables are more nutritious due to methods used by organic growers.

“Yes, there is evidence out there that the nutrition profile is better. How much better is a gray area,” Griswold said.

Is it best to cut out conventional food altogether? Griswold says not necessarily. It’s a balancing act.

“If I go out have a hamburger, I’m not going to die tomorrow.

But over a long period of time, it can start to be detrimental to our health, especially if it’s not in a healthy profile,” she said. “The cost of insurance is going up, everything is going up. I really believe nutrition is our first line of defense in disease.

It is taking care of our

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CHOOSING THE RIGHT ORGANIC PRODUCE Environmental Working Group’s “Shopper’s Guide to Pesticides in Produce,” updated every year since 2004, ranks pesticide contamination on 48 popular fruits and vegetables. It’s “Dirty Dozen” and “Clean 15” guide is based on results of more than 35,200 samples tested by the U.S. Department of Agriculture and the Food and Drug Administration.

DIRTY DOZEN 1 Strawberries 2 Apples 3 Nectarines 4 Peaches 5 Celery 6 Grapes 7 Cherries 8 Spinach 9 Tomatoes 10 Sweet bell peppers 11 Cherry tomatoes 12 Cucumbers

Ways to save on organic, natural foods What’s a shopper on a budget to do? If you want to buy organic foods but cash is tight, prioritize your organic purchases.

Choose organic for the foods containing the highest amount of chemical residue, and choose conventional foods for foods with the least residue (many of these have thick skins). Check out the Environmental Working Group’s list of the “Dirty Dozen” and the “Clean 15” listed If you cannot afford to purchase any organic foods, you should not avoid fruits and vegetables altogether. Experts agree that the health benefits from eating fruits and vegetables far outweigh the risks of eating foods with safe levels of pesticide residue.

Here are six tips from Columbia University clinical nutritionist Deborah Gerszberg, for buying organic foods on a budget: 1. Compare prices — some organic foods are no more expensive (or only a little more so than the conventional food.

2. Buy organic foods when in season —this is usually less expensive, the food is tastier, and nutrients are at their peak.

3. Buy conventional produce with skin that is going to be discarded, such as citrus fruits, avocado, papaya, onion, pineapple, cantaloupe, winter squashes, banana, kiwi, melon, and mango.

4. It is most important for young children, pregnant women, and those with weakened immune systems to eat organic food, so try to make sure those family members don’t eat excessive amounts of conventional foods from the dirty dozen.

5. When buying animal products (especially those that are not fat free, buy organic as often as possible.

Some companies aren’t certified organic, but still pledge not to use hormones or unnecessary antibiotics. This would be a good second choice. It is better to eat organic meat less often, making as an alternative lentil-and-bean dishes, which are both inexpensive and healthy.

Red and processed meats, organic or not, are known to increase certain cancers.

Source: Columbia University

CLEAN FIFTEEN 1 Avocados 2 Sweet Corn 3 Pineapples 4 Cabbage 5 Sweet peas frozen 6 Onions 7 Asparagus 8 Mangos 9 Papayas 10 Kiwi 11 Eggplant 12 Honeydew Melon 13 Grapefruit 14 Cantaloupe 15 Cauliflower

bodies and exercising as much as we can. If we practice this kind of lifestyle it will lead to better outcomes. In the end, it’s about what can you get out of your food that really doesn’t belong there.”

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EATING HEALTHY

Balancing nutrition What to know when you’re trying to eat better

BY CARRIE DENNETT Special to The Washington Post

What’s more important, the foods you do eat or the foods you don’t? Your health benefits when you eat more vegetables. It also benefits when you eat less added sugar. However, when you add or subtract something from your diet, it’s important to consider the other side of the equation in order to remain nutritionally balanced.

Not all replacements are created equal One of the lessons learned from the low-fat era was that advice to limit saturated fat wasn’t helpful without recommendations about what to eat instead. As it turns out, replacing saturated fat with refined carbohydrates isn’t good for cardiovascular and metabolic health, while swapping it for polyunsaturated fat does improve health.

Public attention has swung from fat to sugar, and while identifying sources of added sugar is one step toward a more healthful diet, it’s also important to focus on things like getting enough vegetables and protein.

Even healthy calories count It’s generally a good idea to focus on including more of the foods we benefit from, rather than simply on the foods we “shouldn’t eat,” because it helps ensure that we get the full spectrum of nutrients needed for good health. Plus, there’s a

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healthy mental aspect to being inclusive instead of exclusive.

However, when you add a new food without subtracting something else, you could increase your overall calorie intake beyond what your body needs. Although it’s hard to do this by adding broccoli, it’s easier to go over the top with a highercalorie option such as nuts.

One benefit of correcting the low-fat dogma is that healthy polyunsaturated and monounsaturated fats are back on the table. Nuts, seeds and avocados are full of heart-healthy fats, fiber, and a host of nutrients, but they also have a lot of calories (although recent research has found that almonds, walnuts and pistachios have fewer calories than previously thought).

Interestingly, research shows that regular nut consumption is not associated with weight gain.

This may be because nuts are satiating, leading nut-eaters to unconsciously reduce calories in other areas, or they may be consciously choosing to eat nuts instead of something else. For example, they might be having a handful of walnuts instead of a bag of chips, pumpkin seeds on a salad instead of cheese, or avocado instead of butter on toast.

Avoiding dietary tunnel vision Let’s consider two popular diets: paleo and vegan. The paleo diet, as generally practiced, excludes grains, pulses (beans and lentils), dairy and refined sugar. A vegan diet

When you add or subtract something from your diet, it’s important to consider the other side of the equation in order to remain nutritionally balanced. [PHOTO BY DOUG HOKE, THE OKLAHOMAN]

excludes meat, dairy products, eggs and other animal products.

But focusing too narrowly on those exclusions can turn them into something unbalanced and unhealthful. A paleo diet replete with bacon, sausage and coconut milk ice cream isn’t terribly good for you. Neither is a vegan diet that is full of white flour pasta, potato chips and soy ice cream.

A paleo diet should be about more than subtracting foods that were introduced to the human diet with the advent of agriculture (grains and pulses). It also should be about more than just adding meat. Simultaneously adding vegetables will bring in healthful carbohydrates and fiber to balance the protein and fat.

Similarly, shunning refined sugar but doubling down on honey, agave or coconut sugar doesn’t benefit nutrition or health. Adding whole fruit is a better way to get the sweet taste we enjoy.

When someone goes vegan,

they are often on the receiving end of the question, “Where are you going to get your protein?”

This diet can certainly go too far in the carb direction, but including plant sources of protein with each meal (pulses, soy, nuts and seeds), along with vegetables and whole grains, can restore balance.

The peril of taking entire food groups off the table A diet made up of a variety of whole and minimally processed foods provides the spectrum of nutrients we need for good health. Avoiding certain foods or food groups isn’t always a choice sometimes it’s a necessity. Food allergies and celiac disease are hallmark examples. Either way, when you avoid entire food groups, it’s crucial to know how you will replace essential nutrients you would otherwise get from those foods.

An apple is naturally glutenfree and healthier than a glutenfree cookie. When you have a milk allergy or severe lactose intolerance you still need calcium and protein. Most plant-based milks are fortified with calcium, but almond milk does not provide you with the same amount of protein as dairy milk; soy milk does.

The bottom line In today’s food culture, it’s easy to tag the inclusion, or exclusion, of a specific food as the answer to whatever nutritional concern you are facing.

The truth is that it is the sum total of your diet that matters more than any single food.

Always keep your eye on the larger nutritional picture.

Dennett is a registered dietitian nutritionist and owner of Nutrition by Carrie.

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GETTING HEALTH CARE WHEN YOU NEED IT

Rates for individual coverage spiral out of control

BY PAULA BURKES AND MELISSA HOWELL

WOULD YOU LIKE SOME INSURANCE WITH YOUR INSURANCE?

The Oklahoman

The Obama administration announced last month that the President’s signature health care plan, the Affordable Care Act, will see double-digit premium hike.

In Oklahoma, premiums likely will increase by an average of 76 percent. The increases for individual market plans range from 58 percent to 96 percent, Oklahoma Insurance Commissioner John D. Doak said in a press released following the announcement.

These increases apply to plans bought on or off the government exchanges.

Forced to get a second job That’s especially bad news for Oklahoma City resident Mike Meier, 57, who consults on security installation for high-risk facilities. Meier, like most who are self-employed, must purchase an individual health insurance policy, which comes with a healthy price tag.

“Before 9/11, I always had insurance through an employer. But after that, the industry changed and I started consulting,” he said. “I needed to buy my own insurance but it came to the point it was going to cost me … about $900 a month for me and my family with a $10,000 deductible,” he said. “That was in 2009.”

In 2013, he moved to Oklahoma City from the Austin area to help care for his aging parents while continuing as a contractor in the security industry. He looked to healthcare.gov for insurance, but discovered subsidies would only be available if he quit working altogether and applied for public assistance.

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“The exchanges offered a wide variety of plans, but anything that came close to what I could afford didn’t really provide anything. I did get it as low $700 per month with a deductible of about $6,000. But at that point, the only value in it for me was if I had a catastrophic illness,” he said. “Rather than spending that money on insurance and not getting anything back — because I probably would not fulfill my deductible — I decided to spend it on myself and my kids for doctors’ appointments or drugs.”

But with three children in college, that plan was workable only for a short time. His only other option was to find a second job with health benefits.

“I had to go out and get (another) full-time job … with the whole purpose in mind to get myself plus three kids in college covered for medical and dental,” he said.

For now, he puts eight hours in at a low-income job from 3

to 11 p.m. and spends the rest of his time caring for his parents and digging up contract jobs to provide him an income that will pay the bills and keep his children in school.

The insurance premiums are better — $700 per month for himself and his children with a $1,500 deductible for each person insured — but he feels stretched almost beyond his limits.

“It’s what I have to do to get us covered. I feel more comfortable knowing that if some big illness comes up, we are covered at least for the initial hits.”

‘This is simply not sustainable’

In addition to finding a second job, Oklahoma City resident Mike Meier finds he might have to curb small luxuries — such as eating out — to afford his health insurance premiums.

[PHOTO BRYAN TERRY, THE OKLAHOMAN]

The vast majority of the more than 10 million customers who purchase through HealthCare.gov and its staterun counterparts do receive generous financial assistance.

“Enrollment is concentrated

among very low-income individuals who receive significant government subsidies to reduce premiums and cost-sharing,” said Caroline

For the first time in her life, 26-year-old freelance designer Susannah Lohr had to shop for health insurance this year.

She called up a major insurer in the St. Louis area where she lives, and it offered her a plan with a hefty $6,000 deductible — that’s the amount she would have to cover herself before insurance kicks in.

When she balked, the salesman on the phone suggested that she could buy a “gap plan,” a separate policy for $50 a month to cover her deductible.

Gap plans, used to cover out-of-pocket expenses like high deductibles, are becoming increasingly popular among consumers and businesses.

The rising price of insurance is driving the trend, explained insurance broker Ryan Hillenbrand, president of the Missouri Association of Health Underwriters.

With monthly premiums on health insurance going up, more people are choosing cheaper, high-deductible options. In 2016, more than 90 percent of people buying insurance under the ACA chose plans with an average deductible of $3,000 or higher.

“If you don’t qualify for a subsidy, you’re bearing the brunt of all that cost,” Hillenbrand said. “And here come the gap plans.”

About 8 in 10 people qualify for some form of subsidy on the ACA exchanges, helping to make insurance more affordable for consumers.

Businesses, on the other hand, are facing those costs on their own. And for some businesses, especially smaller firms, gap plans can make a lot of sense, said Alex Forrest, an insurance broker in South Carolina.

With a gap plan, he said, companies can offer a package of health benefits that keeps out-of-pocket-expenses for employees down. And they still spend less than they would on higher-priced plans with lower deductibles.

— Associated Press

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RATES CONTINUED FROM PAGE 7

President Barack Obama is leaving the White House in just a few months, but his namesake health care law will still be generating headlines. With premiums rising significantly and some insurers bailing out, the 2017 sign-up season that started Nov. 1 could get tricky. [AP PHOTO/SUSAN WALSH, FILE]

Q&A:

BY RICARDO ALONSO-ZALDIVAR Associated Press

WASHINGTON — President Barack Obama is leaving the White House in a few months, but the troubles of his signature health care law continue to make headlines. With premiums rising by double digits and many consumers scrambling to replace coverage because their insurer bailed out, the 2017 sign-up season that started Nov. 1 looks challenging.

Obama says it’s just “growing pains” but critics see the threat of market collapse, a death spiral.

Here are some questions and answers for consumers ahead of the law’s fourth open enrollment season: Q. I buy my insurance directly. So why are my premiums going up so much if I don’t use healthcare.gov?

A. The 2010 health care law aimed to create a single market in each state for health insurance purchased by individuals. That’s increasingly true as older plans that predate the law fade away.

So consumers who bypass the public insurance exchanges and

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New sign-up season; new woes for Obama health law

buy individual policies from an insurer are not insulated from premium increases. And they lack the income-based subsidies available to customers inside the government marketplaces.

The administration estimates that 6.9 million people currently buy coverage outside the marketplaces, and of those, nearly two-thirds would not be eligible for subsidies if they looked within the exchanges.

Another group, roughly 1.5 million people, buy policies through the exchanges but make too much to qualify for subsidies.

The people in these two groups will bear the brunt of premium increases.

Q. What does the Obama administration say about rising premiums?

A. Officials finally acknowledged the price jump this week, revealing that premiums for a midlevel benchmark plan are going up an average of 25 percent across the 39 HealthCare.gov states.

The administration calls it a temporary market “correction” because insurers had set their premiums too low in previous

years. Officials estimate that 72 percent of HealthCare.gov customers will still be able to find a plan for less than $75 a month after taking into account subsidies.

Caveat: Those large subsidies tend to go to lower-income consumers, not those in the solid middle class. And switching to reduce your premiums may mean having to accept higher outof-pocket costs, or a different network of doctors, or a new list of preferred medications.

Q. Are premiums going up because some insurers are leaving the market?

A. While there’s strong evidence that competition among insurers helps to keep premiums in check, it’s not clear that insurers bailing out is the main reason driving double-digit increases.

Q. What are the key dates to remember?

A. Dec. 15 is the last day you can sign up or make a change in time to take effect Jan. 1. That has been traditionally been HealthCare.gov’s busiest day. And open enrollment ends Jan. 31, after Inauguration Day for the next president.

Pearson of the consulting firm Avalere Health.

But an estimated 5 million to 7 million people — the Congressional Budget Office estimates 10 million — are either not eligible for the income-based assistance, or they buy individual policies outside of the health law’s markets, where the subsidies are not available.

Oklahoma has been hit especially hard. Not only are premiums rising 76 percent, but insurance companies, too, are taking hit because the rising cost of taking on new enrollees.

“Health insurance carriers initially assumed that the Affordable Care Act would generate a broad market participation including healthy and sick individuals equally. Unfortunately that did not occur,” said Laura Brookins Fleet, executive director of the Oklahoma Association of Health Plans. “The market is much smaller and many more unhealthy individuals have enrolled than healthy individuals. Consequently, the Health Plans are having to account for this dramatic adverse selection in their 2017 pricing.”

One result of the ACA’s such unintended consequences is the departure of all but Blue Cross Blue Shield of Oklahoma from the state insurance market.

“In 2015, there were five health insurance plans participating in Health Insurance Marketplace. Over the past couple of years, health plans have decided to no longer participate on the Marketplace due to substantial losses with individual health plans,” Fleet said.

“Blue Cross and Blue Shield of Oklahoma has reported that they have had combined losses of more than $300 million since ACA was implemented in 2014.

This means that in 2015, for every dollar they collected in individual health premiums,

they paid out $1.38. This is simply not sustainable.”

Oklahoma City insurance agent Connie Morgan, president of Sue Wilson Brokerage Inc., said, “Anyone who receives a rate increase of 50 percent or more and is ineligible for a tax credit may find it difficult to absorb these high rate increases.

For many, the premiums will become unaffordable.”

Not worth the cost But where does that leave the unsubsidized consumer?

Melanie Alberts, 59, a single, self-employed attorney in Tulsa, said the monthly premiums on her Blue Cross Blue Shield of Oklahoma individual health insurance policy jumped from $350 in 2015 to $535 this year.

“I did shop around, but this was still the best deal out there,” said Alberts, who bought her policy off the exchange after learning on healthcare.gov that she earned too much to qualify for a subsidy.

Alberts’ policy carries a $6,000 out-of-pocket deductible that must be met before benefits kick in. If she lowered the deductible to $3,000, her monthly premiums would’ve been more than $700, she said.

Premiums are the same whether plans are bought on or off the exchange.

“I don’t think a $535 monthly premium is reasonable because I don’t get sick,” Alberts said.

“If I in December become ill or am in a terrible accident, I will have paid more than $6,000 for premiums and still have to pay a $6,000 deductible (toward care),” she said. “The policy is of no use to me unless I’m gravely ill.”

Alberts said she’s considering going without insurance next year and paying a penalty tax on her tax return. Effective this year, the penalty tax is the greater of $695 or 2.5 percent of 2016 income.

The Associated Press contributed to this story THE OKLAHOMAN | NEWSOK.COM

Ministries for medicine Faithful flock to Bible’s insurance alternative

BY STEPHEN PRESCOTT, M.D. For The Oklahoman

Call it a leap of faith.

As the costs of health insurance skyrocket, a growing number of Americans are looking to biblical principles for an alternative to the federal health insurance mandate.

Specifically, they’re joining health care-sharing ministries, religiously based networks in which members agree to help cover each other’s medical costs.

These faith-based alternatives to health insurance have existed for decades.

But interest in them has surged since the passage of the Affordable Care Act in 2010, which requires Americans to have health insurance or pay a fine.

Although the ministries stress they are not health insurance providers, people who join one of the sharing ministries that have operated continuously since 1999 are exempt from the requirement to have health insurance. As a result, membership has tripled over the last six years, growing from about 200,000 to more than 600,000, according to the Alliance of Health Care Sharing Ministries.

To understand how these networks function, let’s look at Samaritan Ministries International, one of the largest ministries.

(And because it’s been in

operation since 1994, it qualifies as an alternative to insurance under the federal health law.)

To join, members must agree to abide by a Christian lifestyle that includes abstaining from illegal and recreational drugs and tobacco (other than a “rare celebratory cigar … at the birth of a baby”), only moderate consumption of alcohol, and no premarital or gay sex. Then with a pastor’s verification, which is renewed annually, and an agreement to pay monthly “shares” that range from $180 to $495, you’re in.

Samaritan members send medical bills to the ministry, which directs other members to mail their monthly payments to the members in need.

If there are insufficient funds available in any month, members get a prorated percentage of their request and hope for further reimbursement when there are more funds available. Each year, one month’s fees go to cover the ministry’s administrative costs.

Although they might sound novel, sharing ministries hearken back to the roots of what was initially known as the mutual assurance industry. The idea, which got its start in 17th-century England to cover losses due to fire, was to have an organization owned entirely by

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policyholders. Any excess monies were returned to the policyholders. None other than Benjamin Franklin brought the concept to this country in 1752, when he established the Philadelphia Contributorship for the Insurance of Homes from Loss by Fire.

But, of course, the insurance landscape has changed significantly in 264 years. So it should come as little surprise that the ministries have incorporated certain modern approaches to their practices: Samaritan has a $300 deductible per each medical expense and pre-existing conditions are excluded, as are preventive care, most mental health care, birth control and claims resulting from behavior the ministry considers reckless or immoral. You must also pay extra to avoid a lifetime cap per medical condition of $250,000 — a figure that’s easy to exceed with a premature birth, serious injury or long-term illness.

The Affordable Care Act outlawed these sorts of exclusions and caps in insurance policies. So how’s it all working?

It’s tough to tell. Upon joining, members waive their right to sue. At Samaritan, disputes are settled by appeals panels consisting of randomly selected ministry mem-

bers. Earlier this year, a Samaritan spokesman said panels had been convened only four times in the ministry’s 20-plus years of operations.

Anecdotally, I’ve heard several reports of satisfied Oklahoma members, who say that all of their needs have been met. One claim involved a life-threatening illness that incurred bills of almost $250,000. All of the expenses were reportedly reimbursed by other members, with their checks

often accompanied by notes bearing get-well prayers.

Because the ministries aren’t regulated by any outside body, members can’t go to the state insurance commissioner with a complaint if they feel they’ve been mistreated.

Likewise, if a ministry runs out of money, there’s no safety net for members.

In the past, one ministry ended up in receivership after complaints of $34 million in unpaid claims.

Subsequent investigation later found that the ministry’s leaders had spent millions on, among other things, luxury homes and vehicles, excessive salaries and vacations.

With about $16 million a month in eligible medical bills already spread among its 200,000 or so members, it remains to be seen whether Samaritan’s model will scale as its ranks continue to swell.

A physician and medical researcher, Stephen Prescott is president of the Oklahoma Medical Research Foundation.

Email him at omrfpresident@omrf.org.

WEDNESDAY, NOVEMBER 9, 2016

9

TAKING YOUR MEDICINE

Cost Control DID LANDMARK LAWS FROM CONGRESS ENABLE HIGH DRUG PRICES? By the Associated Press WASHINGTON — Lawmakers are venting outrage over high prescription drug costs, but lawmakers and presidents of both parties may have set the stage for the startling prices that have consumers on edge.

As the proverb says: Physician, heal thyself.

In the last 13 years, Congress passed major legislation that expanded taxpayerfinanced coverage for prescription drugs but lacked explicit mechanisms for dealing with costs, instead relying mainly on market forces. Lawmakers look like unwitting enablers in the eyes of some experts.

Congress “inadvertently created a situation where price increases are much more rapid,” said economist Paul Ginsburg, a Medicare expert who directs the Brookings Institution health policy center.

Government-sponsored coverage injected more dollars into the market for medications, and new consumer protections curtailed some blunt instruments insurers used to control costs, such as annual and lifetime limits on the dollar value of coverage.

“The history we see over and over again is that when the government steps in as a guaranteed payer without regard to price, it will be taken advantage of,” said Dr. Peter Bach, director of Memorial Sloan Kettering’s Center for Health Policy and Outcomes.

Congressional indignation was on display recently as House members grilled Mylan CEO Heather Bresch about price increases for her company’s EpiPens, prefilled syringes that deliver a rescue drug for people suffering life-threatening allergic

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WEDNESDAY, NOVEMBER 9, 2016

In the last 13 years, Congress passed major legislation that expanded taxpayer-financed coverage for prescription drugs but lacked mechanisms for dealing with costs. [AP PHOTO/MATT ROURKE, FILE]

reactions. The company was accused of gouging patients, but there was little introspection about the role of government.

It’s not as though a secret signal went out from Capitol Hill that it was OK for Mylan to charge $608 for an EpiPen two-pack.

Instead, government policies foster an environment that makes it easier to introduce new medications at a high price and to charge more for existing drugs.

“It has dramatically changed the pricing environment,” explained Ginsburg. “If a manufacturer sets the price higher, there will be less resistance to that price because a lot more people will be able to access that drug than in the past. The rational thing for the manufacturer would be to raise the prices both of existing drugs and newly introduced ones.”

“It’s not clear to what extent Part D and the ACA may have directly caused the very large increases in drug prices in the last five years or so,” said Rick Foster,

formerly Medicare’s chief actuary, or number-cruncher. “Having said that, it wouldn’t surprise me if the significant increase in insurance coverage — and especially the catastrophic protection — contributed to the drug price increases.”

The drug industry, a formidable lobby, rejects such speculation.

“Fundamentally, we disagree that there is not adequate cost containment for medicines built into Part D, or the ACA,” said Lisa Joldersma, vice president of policy and research with the Pharmaceutical Research and Manufacturers of America.

“We think the market is best able to manage the holistic picture and to strike the right balance across cost containment, access and continuous innovation,” she added.

The public seems receptive to government action. A Kaiser Family Foundation poll released recently shows strong

support for requiring drug companies to disclose how they set prices (86 percent), Medicare negotiations (82 percent), price limits on costly drugs to treat cancer and diseases like hepatitis (78 percent), and allowing Americans to import medications from Canada (71 percent).

Rep. Xavier Becerra, a senior California Democrat, says he doesn’t believe Obama’s overhaul is responsible for high-cost drugs. But he still thinks Congress has to act.

“I don’t think there’s anyone who doesn’t believe we need to do more aggressive oversight of the industry,” said Becerra.

Republican Sen. Chuck Grassley of Iowa said Congress needs to monitor the programs it sets in motion. “When companies are allowed to manipulate public programs, consumers and taxpayers lose out,” he said.

THE OKLAHOMAN | NEWSOK.COM

MOVING MORE

EXERCISE into 60s and beyond

BY JIM KILLACKEY For The Oklahoman

EDMOND — Thyroid and breast cancer failed to stop Sharon Jones, 66, from her path to athleticism.

She works out as many as six times a week at an Edmond fitness center and enjoys even the toughest weightlifting and cardiovascular routines.

“I am convinced that the Social Security years are indeed the best,” Jones said. She said the workouts “are great stress relievers.”

‘Poor family genes’ Competitive dancer Linda Kamp, 60, said she had to overcome “poor family genes” that caused her parents to be overweight and have high blood pressure, Type 2 diabetes and heart disease.

“When my mom was in her late 70s, she commented to me that if she had known she was going to live so long, she would have taken better care of herself.

That really hit me hard, and so I decided that diet and exercise were my only ways to combat my family genes,” said Kamp, who competed in the Dancing for a Miracle fundraising contest to help the Oklahoma Children’s Hospital Foundation.

Kamp participated in a 62.5-mile bicycle ride last fall. This spring, she ran in the Redbud Classic.

“Without continuing to

Sharon Jones, 66, foreground, exercises on a stability ball, and Rhonda Harryman, 62, uses a triceps weight-resistance machine at Mercy Fitness Center in Edmond. [PHOTO BY JIM BECKEL, THE OKLAHOMAN]

exercise and staying active, I don’t believe I would be participating in these kinds of activities. I think one of the best things you can give to your children is for them to see you staying healthy and strong as you age,” Kamp said.

Her father had to stop farming and her mother had to give up gardening because of physical struggles, Kamp said.

“I simply see myself as

THE OKLAHOMAN | NEWSOK.COM

someone who is aging and trying not to let age dictate what I can or cannot do,” she said.

Seniors on the rise Across Oklahoma, baby boomer and senior citizen memberships at fitness clubs and local YMCAs are rising. That’s true at the two Edmond YMCAs, said Mike Roark, executive director of the Rankin and

Mitch parks YMCAs. The same apparently is true at the new Mercy Fitness Center in Edmond.

“I see seniors every time I’m working out there.

They have fitness programs tailor-made for them,” said Rhonda Harryman, 62, who was Oklahoma Teacher of the Year in 1992 and had a career in Edmond Public Schools that included teaching at Russell Dougherty and

Cross Timbers elementary schools.

Her husband, Gil Harryman, is former chief of the Edmond Fire Department and also a fitness advocate.

Some baby boomers and seniors hire personal trainers or have fitness buddies they work out with several times a week.

Another fitness enthusiast is Jim Dolezel, 66, who has participated in the Sooner State Games since 1991.

The high jump and long jump are his specialties.

The Vietnam veteran trains at Rose State College in Midwest City, where he also operates Pelican’s seafood restaurant.

“Life is an adventure.

Enjoy it all you can,” Dolezel said.

Adapting to the environment Sharon Jones recalls getting Gary Larrison, a fitness instructor from Oklahoma City Community College, to travel north to Edmond’s Oklahoma Christian School, where she’s worked as a tenured employee for 40 years.

“Our grounds are loaded with hills, lots of pavement, a football field for wind sprints, a sand volleyball court for bellycrawling under a low net, playground equipment for pullups, curbs for pushups,” she said.

“Everything became workout equipment. We would find ourselves

jogging around campus holding landscape timbers over our heads singing a physical-therapy cadence or bear-crawling up Cross Hill or lugging 5-gallon gas cans filled halfway with water up the same hill.”

Larrison “took us down to Mount Scott near Lawton with the young people from his OCCC class, and we were to run up Mount Scott. I remember how we all felt pretty confident when four from our group reached the top before any of the others. That pretty much got us hooked on running, and it wasn’t long before Larrison encouraged us to enter a relay team at the 1994 Oklahoma City Memorial Run to Remember,” Jones said.

“Everything he did for us was not only fun, but empowering. We learned that we could push ourselves harder than we ever imagined, and that confidence carried over into other areas of our lives as well,” Jones said.

“To my peers, I say make a bucket list and set out to conquer everything on it,” she added.

Rhonda Harryman said, “When I think I’m too tired to exercise, I just remember my incentive after age 60 is to be able to do the Slip n’ Slide with our future grandchildren.

Feeling good, living a healthy life and being a good steward with the body God has given me are important.”

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Exercise offers tremendous benefits for seniors

BY JUDITH GRAHAM Kaiser Health News

Retaining the ability to get up and about easily — to walk across a parking lot, climb a set of stairs, rise from a chair and maintain balance — is an underappreciated component of good health in later life.

When mobility is compromised, older adults are more likely to lose their independence, become isolated, feel depressed, live in nursing homes and die earlier than people who don’t have difficulty moving around.

Problems with mobility are distressingly common: About 17 percent of seniors age 65 or older can’t walk even one-quarter of a mile, and another 28 percent have difficulty doing so.

But trouble getting around after a fall or a hip replacement isn’t a sign that your life is headed irreversibly downhill. If you start getting physical activity on a regular basis, you’ll be more likely to recover strength and flexibility and less likely to develop long-term disability, new research published in the Annals of Internal Medicine shows.

This encouraging finding comes from a study of people at high risk of mobility problems: men and women between the ages of 70 and 89 who were sedentary and had some difficulties with daily activities but were still able to walk a quarter mile without assistance.

Half of the group attended 26 weekly health education classes followed by monthly 12

[PHOTO PROVIDED]

seminars. The other half spent about an hour getting physical activity — primarily walking — at a clinic twice a week, followed by at-home exercises.

The goal was to have participants meet the government’s recommended standard of 150 minutes of weekly moderate physical activity and sustain that level over time.

Results confirmed the extraordinary benefits of physical activity, which has been shown in previous research to lower an individual’s risk of heart disease, cognitive impairment, diabetes, depression and some cancers.

The group that focused on walking and strength and balance exercises was 25 percent less likely to experience significant problems with mobility than the group that focused on education over a period of almost three years. Specifically, they recovered faster from episodes of being unable to

WEDNESDAY, NOVEMBER 9, 2016

walk and were less likely to have problems getting around after that recovery period.

The program “was a godsend,” said John Carp, 87, who didn’t make it a point to walk regularly before he joined the study. “There was an improvement in physical feeling and also my mental attitude.”

“If there was a pill that offered comparable benefits, it would be a billiondollar product and people would be all over it,” said Dr. Thomas Gill, lead author of the new paper and a professor of geriatrics at the Yale School of Medicine, as well as director of Yale Program on Aging.

There are plenty of places — YMCAs and senior centers, for instance — where seniors can take classes. Experts’ practical advice: It’s never too late.

“Older adults may think ‘it’s too late for me — I’m too old or too sick for this,’” said Patricia Katz,

a professor of medicine and health policy at the University of California, San Francisco. “The message from this study is it’s never too late.”

“Prescribing exercise may be just as important as prescribing medications,” Katz wrote in an editorial accompanying Gill’s report.

Focus on activity, not exercise. “Older adults, if you talk to them about exercise, will say that’s not for me, that’s for my grandchildren,” Gill said. “But if you talk to them about become more physically active, they’ll say ‘OK, I can do that.’”

“Basically, I walk in the park or around the neighborhood and move my arms and legs around at night in different positions, and try to flex my muscles,” Carp said, describing his daily routine. “It’s not hard, and it makes a big difference.”

Start slow. Some participants could barely make it around a track at the beginning of the study so “we started low and increased slowly,” offering remedial help along the way, Gill said.

Even small amounts make a difference. Newman’s study tracked more than 5,000 older adults over the course of 25 years. One conclusion: “There’s no threshold for benefit from physical activity,” she said.

“Every little bit helps.”

“You don’t need to get on a treadmill, go to the gym, or wear Spandex,” Newman said. All you need to do is start walking for a few minutes every day and gradually build up your strength and endurance.”

THE COST OF GETTING EXERCISE From staff reports There are so many ways to get exercise, it is difficult to list all of the different costs. The impact to your wallet can be from very little to quite a bit.

Here’s a rundown of ways to stay active and their costs.

EXERCISE CLASSES The Oklahoma City Parks and Recreation Department offers classes for older adults that are free or very low cost.

These include: Arm chair exercise — Gain upper body and core strength with this specialty fitness class using chairs. Participants may sit or stand during workout. Free.

Arthritis exercise— Exercise class targeted to persons with arthritis. Free.

Pickle Ball — A sport that combines many elements of tennis, badminton and Ping-Pong. Cost is $2 per class.

S.A.I.L Staying Active and Independent for Life — Exercise body and mind during this class that helps seniors with physical and cognitive fitness. Class combines cardio, stretching plus brain and memory games to help you stay asleep. Free.

Tai Chi for Balance — Clear the mind and lower stress levels with this exercise class that aids in balance and mental clarity. Free.

Walking Club — Participants may walk their own pace and whatever distance they choose. Free.

Yoga — Gentle stretching, breathing and balancing with relaxing and flexible movements. Cost is $10 per month.

Most classes are held at the Woodson Senior Citizens Center, 3401 S May Ave., or at Will Rogers Senior Activities Center, 3501 Pat Murphy Drive.

Visit www.okc.gov/departments/parks-recreation for more information.

HEALTH CLUBS AND FITNESS CENTERS Health clubs and fitness centers are everywhere but can be daunting for someone seeking a fitness routine appropriate for an older adult.

The YMCA offers specially designed classes for boomers and seniors such as water aerobics and circuit training. Cost for an individual membership is $38.75 per month and a onetime joining fee of $70.

If adventure is more your style, check out the Boathouse District. A monthly membership provides access to fitness classes as well as rowing, kayaking and paddle boarding.

Cost for an individual is $50 per month with a one-time $50 membership fee.

The Silver Sneakers program offers members free access to 13,000 gyms and fitness centers across the country to those 55 and older through their healthcare plans. At least 50 fitness facilities in the Oklahoma City area have partnered with Silver Sneakers. Classes, pools, saunas, courts, machines all are free of charge. To see if you qualify, visit www.silversneakers.com and click the “Join In” tab.

THE OKLAHOMAN | NEWSOK.COM

Cardiac rehab saves lives, but few give it a try

BY JULIE APPLEBY Kaiser Health News

Mario Oikonomides credits a massive heart attack when he was 38 with sparking his love of exercise, which he says helped keep him out of the hospital for decades after.

While recovering, he did something that only a small percentage of patients do: He signed up for a medically supervised cardiac rehabilitation program, where he learned about exercise, diet and prescription drugs.

“I had never exercised before,” said Oikonomides, 69, who says he enjoyed it so much he stayed active after finishing the program.

Despite evidence showing that such programs substantially cut the risk of dying from another cardiac problem, improve quality of life and lower costs, fewer than one-third of patients whose conditions qualify them for rehab actually participate. Various studies show that women and minorities, especially African Americans, have the lowest participation rates.

“Frankly, I’m a little discouraged by the lack of attention,” said Brian Contos, who has studied the programs for the Advisory Board, a consulting firm used by hospitals and other medical providers.

Now, though, advocates say cardiac rehab may be gaining traction, partly because the federal healthcare law puts hospitals on the financial hook if patients are readmitted after cardiac problems. Studies have shown that patients’ participation in cardiac rehab cut hospital readmissions by nearly a third and saved money.

Oikonomides, who lives in Charlottesville, Va., went for three decades without a THE OKLAHOMAN | NEWSOK.COM

Exercise physiologist Courtney Conners checks Mario Oikonomides’ vital signs before his cardiac rehab workout. [FRANCIS YING, KAISER HEALTH NEWS]

second heart attack, but he recently had bypass surgery because of blockages in his heart.

He is again rebuilding his strength at the University of Virginia Health System. “I attribute my 30 good years of life to cardiac rehab,” he said recently while pedaling on a stationary bike in a lightfilled gym at an outpatient medical center, a heart monitor strapped to his chest.

COST CAN BE A BARRIER But many patients still face hurdles.

Uninsured people simply can’t afford cardiac rehab. And for those with coverage, “the No. 1 barrier is the cost of the co-pay, which is frustrating,” said Ellen Keeley, a cardiologist at U-Va., who strongly encourages her patients to enroll.

Medicare and most private insurers generally cover car-

diac rehab for people who have had heart attacks, coronary bypass surgery, heart failure and several other conditions.

Most coverage is two or three hour-long visits per week, up to 36 sessions.

Insured patients usually must make a per-visit co-payment. For traditional Medicare members, that runs about $20 a session, although many have supplemental insurance that covers that cost. For patients with job-based insurance — and for enrollees in Medicare Advantage — out-of-pocket costs can range from nothing to more than $60 a pop.

UnitedHealthcare, with nearly 3 million members in Medicare Advantage plans, said patient payments for cardiac rehab vary widely. About 12 percent of members pay nothing, while 23 percent pay $50 a session. Another large insurer, Humana, has a similar range.

Nationally, the weighted

average payment for Medicare Advantage members is just a bit more than the $20 that patients in traditional Medicare pay, said Dale Summers, director of the Center for Medicare & Medicaid Services’ division of finance and benefits.

REFERRALS BRING PATIENTS BACK Another reason so few patients participate is that many are never referred to a program. Some hospitals are addressing this by building automatic referrals into their discharge system.

Patients may be reluctant to attend cardiac rehab, especially if they had not been physically active before their heart problem.

At U-Va., heart attack patients are given an appointment to come back to a special clinic within 10 days of discharge. Over about an hour,

patients meet with an exercise physiologist, a cardiologist, a nutritionist and a pharmacist — all in the same exam room.

Patients are encouraged to join U-Va.’s cardiac rehab program but are also given information about exercising on their own.

Patients face other barriers to this kind of care, including time constraints and having to travel long distances to the nearest program.

And existing programs aren’t enough to accommodate all patients who are eligible. A recent study that surveyed 812 cardiac rehab programs found that even if they were expanded modestly and operated at capacity, they could serve only 47 percent of qualifying patients.

“We have patients who are an hour away from any cardiac facility, and they can’t afford the gas money or the time,” Keeley said.

One alternative might be a home-based program, an approach that is less common but drawing increased interest.

“There are a whole plethora of different ways to provide cardiac rehab outside the traditional center model,” said Mark Vitcenda, senior clinical exercise physiologist at the University of Wisconsin Hospital and Clinics in Madison.

At his program, patients can start in a supervised program at a center for two or three sessions, then continue in a home-based model with occasional visits to the center.

About 30 to 40 percent of the Wisconsin program’s patients choose the homebased option, he said, with most being younger, working patients.

“If we can lower the barriers of transportation and cost, patients are able to be more involved,” he said.

WEDNESDAY, NOVEMBER 9, 2016

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WATCHING WHERE YOU STEP

Programs help Oklahomans prevent falls Exercise and education

BY JIM KILLACKEY For The Oklahoman

More than 450 Oklahoma senior adults die annually from injuries suffered from falls, according to state health officials specializing in the unnerving trend.

Seniors’ falls can cause serious head and brain injuries and broken hips, legs, arms and ankles.

Hundreds of those falls also can lead to enormous costs, including annual hospital bills alone of $250 million, health officials indicated.

Even worse, officials fear that the problem could escalate as Oklahoma’s senior population increases.

Every 13 seconds, an older adult is treated in an emergency room for a fall-related injury, officials said.

Oklahomans ages 65 and older are at the greatest risk for falls. More than half of seniors ages 75 and older will fall each year, according to the latest data.

Falls are caused by a wide variety of factors, including vision and hearing problems, impaired memory, poor lighting, footwear dilemmas, foot pain, broken or uneven steps, pavement cracks, tripping on floor clutter or pets, and a lack of handrails in bathrooms or along stairs.

Falls occur inside, outside and during all types of weather. Most falls happen in a bedroom or bathroom.

The Centers for Disease Control and Preven14

Seniors at a fitness class use resistance bands to strengthen muscles, which could help them avoid falls. [PHOTO PROVIDED]

tion cites these reasons for senior falls: lowerbody weakness; vitamin D deficiencies; difficulties walking and with balance; and the use of tranquilizers, sedatives and antidepressants.

In nursing homes and long-term care facilities, falls often happen when one resident gets pushed by or tangled up with another resident.

About half of the people who fall while alone at home cannot get up by themselves and must get help, said Laurence Z. Rubenstein, a fallprevention expert at the University of Oklahoma Health Sciences Center.

Alarm systems and nearby cellphones are particularly important, he said.

WEDNESDAY, NOVEMBER 9, 2016

A long time on a floor or outdoor surface is “a particularly dangerous thing to happen,” with the possibility of damage to muscles and skin, he said.

Reducing the risks Yet, “most falls happen in homes and are preventable,” said Rubenstein, a professor in OU’s Geriatric Medicine Department.

There are many things seniors can do to reduce the risk for falls, he said.

Those include: •Getting into a regular exercise program or routine

— one that increases strength, balance and endurance. Many senior centers and YMCAs offer senior-exercise programs or tai chi groups to improve muscles and balance.

•Reducing so-called environmental hazards.

Especially important in a home is removing hazardous rugs and clutter, and installing ramps as needed.

•Focusing on medications — trying to eliminate or cut down on drugs that can cause confusion, imbalance or hypotension. Even overthe-counter medications can cause difficulties.

“Many people who fall, even if they’re not injured, become afraid of falling. This fear may cause a person to cut down on their everyday activities. When a person is less active, they become weaker and this increases their chances of falling,” said Rubenstein.

Education on falls

is considered a key for parents, grandparents and neighbors.

Falls and fears of falling are being addressed by the state Health Department and the Oklahoma Healthy Aging Initiative.

The health department wants seniors to have vision screenings at least once a year. The wrong prescription eyeglasses or health conditions such as glaucoma or cataracts limit vision and may increase the risk of falling.

Also, the agency recommends keeping items needed for regular use in easy-to-reach places that don’t require the use of a step stool. It advises the use of nonslip mats in the bathtub and shower.

The “Tai Chi: Moving for Better Balance” muscle-strengthening program has been proven to reduce the risk of falls by half with regular practice, state health officials said.

It does not matter how strong, flexible or active senior citizens are, officials said, Tai chi is designed for people of all health levels.

To receive information on tai chi classes, contact the state health department’s Injury Prevention Service at 271-3430.

The Oklahoma Healthy Aging Initiative, meanwhile, offers classes statewide. The program is a six-week series that meets twice weekly for one hour.

For more information, call (855) 227-5928 or 271-2290.

“Once seniors have completed the class, they can continue practicing on their own with a friend,” said Brandy Hise, an OHAI program director.

The Healthy Aging Initiative offers these recommendations: •Talk to a health care provider. Ask for an assessment of your risk of falling. Share your history of recent falls.

•Regularly review your medications with a pharmacist. Make sure side

effects are not increasing your risk of falling. Take medications only as prescribed, including amounts and frequency.

•Get your hearing checked annually; healthy ears are a key to keeping seniors safely on their feet.

•Wear secure shoes and avoid unstable footwear.

THE OKLAHOMAN | NEWSOK.COM

CHECK FOR SAFETY

Oklahomans ages 65 and older are at the greatest risk for falls. More than half of seniors ages 75 and older will fall each year, according to the latest data. [PROVIDED]

A home fall prevention checklist for older adults FLOORS:

The cost of fall prevention FROM STAFF REPORTS

Ceiling Light fixture installation Average cost in Oklahoma City is $127.30 to $356.59, according to homewyse.com Vision and hearing exam Free or low cost to uninsured or low income Oklahoma County residents.

some services, immunizations, exams, physicals, and information on free prescription drug programs to low income and uninsured people in Oklahoma County.

Oklahoma Caring Van Program

•3401 NW 63 •316-7170 A Mobile clinic for the county, offers some very basic services from nurses and other medical professionals.

Charity Eye Clinic

•701 NW 8 •236-5212 Mostly focuses on eye exams, glasses, and other forms of free or low cost vision care.

Health Department Oklahoma County

•921 NE 23 •427-8651 The local government funded health care community clinic. They can provide THE OKLAHOMAN | NEWSOK.COM

Grab bar installation $98.40 to $ $263.68 per bar according to homewyse.com

parison of medical alert systems — some with fall detection, others without — finds monthly service costs range from $26 to $60 per month for landline and cellular based devices. For GPS enabled devices, the cost goes up to $30 to $70 per month. But the comparison isn’t all “apples to apples.”

The systems vary in features including range, 911 call ability or in-house monitoring. Systems also come with added charges such as device fees, activation fees and equipment costs.

Tai Chi

Medical alert devices Medical alert devices with fall protection cannot detect 100 percent of falls but clearly can be lifesaving in the event of a fall. A Consumer Reports com-

Through the Oklahoma Health Aging Initiative, Oklahoma County Libraries offer Tai Chi classes free of charge at the Belle Isle Library, 5501 N Villa, and Northwest Library, 5600 NW 122.

Look at the floor in each room.

Q: When you walk through a room, do you have to walk around furniture?

Ask someone to move the furniture so your path is clear.

Q: Do you have throw rugs on the floor?

Remove the rugs or use double-sided tape or a non-slip backing so the rugs won’t slip.

Q: Are there papers, books, towels, shoes, magazines, boxes, blankets, or other objects on the floor?

Pick up things that are on the floor. Always keep objects off the floor.

Q: Do you have to walk over or around wires or cords (like lamp, telephone, or extension cords)?

Coil or tape cords and wires next to the wall so you can’t trip over them. If needed, have an electrician put in another outlet.

STAIRS AND STEPS:

Look at the stairs you use both inside and outside your home.

Q: Are there papers, shoes, books, or other objects on the stairs?

Pick up things on the stairs.

Always keep objects off stairs.

Q: Are some steps broken or uneven?

Fix loose or uneven steps.

Q: Are you missing a light over the stairway?

Have an electrician put in an over-head light at the top and bottom of the stairs.

Q: Do you have only one light switch for your stairs (only at the top or at the bottom of the stairs)?

Have an electrician put in a light switch at the top and bottom of the stairs. You can get light switches that glow.

Q: Has the stairway light bulb burned out?

Have a friend or family

member change the light bulb.

Q: Is the carpet on the steps loose or torn?

Make sure the carpet is firmly attached to every step, or remove the carpet and attach non-slip rubber treads to the stairs.

Q: Are the handrails loose or broken? Is there a handrail on only one side of the stairs?

Fix loose handrails or put in new ones. Make sure handrails are on both sides of the stairs and are as long as the stairs.

KITCHEN:

Look at your kitchen and eating area.

Q: Are the things you use often on high shelves?

Move items in your cabinets.

Keep things you use often on the lower shelves (about waist level).

Q: Is your step stool unsteady?

If you must use a step stool, get one with a bar to hold on to.

Never use a chair as a step stool.

BATHROOMS:

Look at all your bathrooms.

Q: Is the tub or shower floor slippery?

Put a non-slip rubber mat or self-stick strips on the floor of the tub or shower.

Q: Do you need some support when you get in and out of the tub or up from the toilet?

Have a carpenter put grab bars inside the tub and next to the toilet.

BEDROOMS:

Look at all your bedrooms.

Q: Is the light near the bed hard to reach?

Place a lamp close to the bed where it’s easy to reach.

Q: Is the path from your bed to the bathroom dark?

Put in a night light so you can see where you’re walking.

Some night lights go on by themselves after dark.

Source: Centers For Disease Control And Prevention

WEDNESDAY, NOVEMBER 9, 2016

15