Healthy Hudson Valley AUGUST 8, 2013
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ULSTER PUBLISHING
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HEALTHYHV.COM
Healthy Communities
Life cycles
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Rail Trails
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Independent pharmacies
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Bicycling for a cause
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Memory care
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Green farewells
ALAN CAREY
8, 2013 2 | August Healthy Communities EDITOR’S NOTE
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elcome to our Healthy Communities section. This time we’ll take you through cycles of life, from fundraising for Juvenile Diabetes by bicycling through Death Valley, to staying healthy by exercising and utilizing rail
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trails, a fairly new development in not having to go to the gym. We’ll look into how independent pharmacies stay in business versus the big chains, and see what developments are there for patients needing memory care. And we’ll look at natural burials to complete the cycle. Stay healthy.
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A new/old kind of pharmacy Jennifer Brizzi
T
hinking local is more than just buying tomatoes or eggs from the farm down the road, but also about patronizing small businesses you can forge an alliance with, some rather crucial. And what is more vital than your health? Personal relationships between pharmacists and customers that make for better, safer, healthier patient care seem to be something that’s going by the wayside as so many independent pharmacies are gobbled up or eclipsed by corporate chains. While independent pharmacies have not yet gone the way of the dinosaur, they are severely threatened, making modern pharmacy appear to be more about profit than good health. But pharmacists at independents generally can spend more time with patients, getting to know them in a more holistic way, working closely with them over time to help fine-tune dosages, spot drug reactions, educate about health and much more. Soon Ulster County will be home to a melding of traditional/modern pharmacy and natural patient-centered pharmacy care when pharmacist
While independent pharmacies have not yet gone the way of the dinosaur, they are severely threatened… Ed Ullmann opens up his independent pharmacy in High Falls in a few weeks. An approach that is lacking in many chain pharmacies will be the foundation of his practice and he told me he thinks High Falls is the perfect place for it. Other than
the Woodstock Apothecary and Village Apothecary in Saugerties, and Dedrick’s in New Paltz and the Dedrick’s and Nekos independent pharmacies in Kingston, Boiceville and Red Hook, they are few and far between in the area — and nationwide — and dwindling fast. Set between Rosendale, population about 6200, and Marbletown, population about 3400, “High Falls is the perfect community,” Ullmann told me,
“because the demographics are good.” He added that it’s an area with a history of progressive thinking that’s more open to alternative kinds of medical treatment than many others, and he believes the residents will appreciate this kind of pharmacy, which he hopes will be a model for others. He told me that of the primary physicians in Ulster County about 81-83 percent are in family practice, while nationwide it’s only 53 percent.
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8, 2013 4 | August Healthy Communities The relatively new specialty was created in the 1980s, he said, and is one that is “more comprehensive in thinking and more open to integrative approaches.” “If you can’t pull it off it Ulster County, you can’t do it anywhere,” he said. Mix of traditional and natural A challenge is that things are getting more complicated as health care merges more and more with communication systems, he explained, and as rural area health care becomes part of larger systems. Ullmann said that he started out trained in traditional medicine, then did a bit of traveling and got to know some alternative approaches. “I lost touch with the traditional side,” he said. As time went on he realized the value of both. “Now I like to integrate traditional and natural healing,” he said. But whichever approach you favor, “It should be about you,” he said. “I’m very personal with people,” he added. “I help guide patients to make their own decisions and to take responsibility for their own health care…It’s the most powerful thing they can do.” Key are trusting relationships with health care providers, consistency, and feeling that the provider really cares. “It has to be a good partnership,” he said. Ullmann’s “patient-centered pharmacy” will have a 12’ x 12’ clinical room “with beautiful art,” he said, for immunizations, blood pressure screening, managing diabetics, and to interface between the patient and their health care practitioner to get to the crucial right dosage for specific medications. Education is a critical factor, he added, to get people to realize they need to work with their doctor on fine-tuning dosages. “It takes time to monitor that,” he said. He feels strongly that people should avoid taking medicines unless they are necessary — “Don’t take it unless you need it,” he said — and if they have to it should be done right, and carefully.
Independents
S
ome other independent pharmacies in the area: Woodstock Apothecary, 79 Tinker St Woodstock, NY
12498 Village Apothecary 31 Market St, Saugerties, NY Dedrick’s Pharmacy, 190 Main Street, New Paltz Nekos/Dedrick’s, 86 North Front Street, Kingston Nekos Boiceville Pharmacy on Route 28 in Boiceville Nekos Red Hook Drug Store, 7518 N Broadway, Red Hook Kingston Pharmacy, 516 Broadway, Kingston Phoenicia Pharmacy, 41 Main Street, Phoenicia
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Sleep problems A couple of issues close to Ullmann’s heart are sleep and pain control. “People don’t sleep,” he said. “It’s a bigger problem in this country than obesity.” He says the average person is in bed seven hours a night but only sleeps four and a half to five and a half hours, because they can’t fall asleep or they wake up in the middle of the night and can’t fall back to sleep. Our economic downturn of the past five years
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August 8, 2013 Healthy Communities isn’t helping either, adding to worries, he noted. “When we don’t get enough sleep we start to fall behind and can’t catch up,” he said, “Then our organs release hormones and enzymes.” Ullmann claims that of people who are prescribed opiate pain relievers, twenty percent are abusing it and eighty percent are actually dealing with chronic pain. “Doctors are getting scared,” he said. “Fewer will treat chronic pain now. They’re nervous about prescribing opiates.” He pointed out that in Ulster County we’re an aging community and there will be more need for pain relief. He mentioned fibromyalgia — “It’s real” — and patients in pain from gastric bypass surgery gone bad. He knows a few, he said. Acute pain is easier for doctors to diagnose, but the subjectivity of chronic pain is only one of its challenges. “It comes and goes,” he said.
and as mental health director. As an entrepreneur and pharmacist for chains he has been on both sides of the traditional/alternative health care spectrum and seems to never out of ideas and plans. His goal of viable independent phar-
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Green model Ullmann happily reported that when the pharmacy passed its inspection recently that the inspector said it was the “classiest pharmacy he’d ever seen.” Ullmann spoke of its lovely apothecary area with old time jars and bottles and that it’s a “totally green model” with green climate control and building materials, making the pharmacy an environmentally clean and healthy place to be. In 1985 Ullmann founded WellCare, a pioneer in managed care, and his political career included service for Ulster County on the legislature
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Linear parks The RX Factor of Rail Trails Lynn Woods
A
ll over the U.S., rail trails are increasingly being hailed as one of the most effective tools in battling the nation’s high incidence of heart disease, diabetes, and other diseases related to being overweight and out of shape. Unlike hiking trails, rail trails,
which are usually located in or near communities, are more accessible to the general public and less strenuous. Unlike the gym, they don’t cost anything. Unlike municipal streets, they are traffic free, making them safer for walkers and bicyclists. Often bordered by trees and other wild vegetation that serve as havens for birds and other wildlife, rail trails also offer a mental health benefit, serving as ideal places to decompress after a stressful day at the office. Anyone, no matter how unfit, can use them. And because people enjoy taking a walk on a rail trail, they naturally want to go there —
exercising is no longer an onerous duty they somehow have to fit into a busy schedule. For all these reasons, rail trails have taken off. Here in Ulster County, the County Executive’s office is making rail trails the centerpiece of its campaign to improve health. This local initiative echoes a national effort to combat the obesity epidemic in part by encouraging more exercise. According to the latest statistics from the Centers for Disease Control and Prevention, more than a third of Americans are obese. Almost half of non-Hispanic blacks are obese, compared with 39 percent of Hispanics and 35.3 percent of non-
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Hispanic whites. The medical costs associated with obesity in 2008 were estimated at $147 billion. Lack of exercise is clearly a factor. In 2001, the Surgeon General of the United States reported that less than a third of Americans met the federal recommendation of at least 30 minutes of moderate physical activity at least five days a week; 40 percent of adults engaged in no leisure-time physical activity at all. In 2010, under its Healthy People 2010 initiative, the U.S. Department of Health and Human Services set specific goals and objectives for increasing physical activity. The DOHHS designated walking as the mode of choice for trips under a mile, and trails were cited as one of the resources that would encourage people to do this. “A number of different studies show the health risks of physical inactivity, which coupled with
poor diet help cause cardiovascular disease,” the top cause of death in New York State, accounting for 50 percent of total deaths, said Martin Daley, project director at Parks and Trails New York (PTNY), a nonprofit organization that’s helping communities, including Kingston, develop trail
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8, 2013 8 | August Healthy Communities facilities. “Thirty-five percent of these deaths are directly linked to physical inactivity, so they’re quite preventable through diet and exercise. If we can get a segment of the population exercising, people will be less likely to suffer from heat disease, stroke, or injuries preventing them from being productive. It’s also much less expensive for insurance policies to work for preventative care” compared to the cost of treating diabetes, for example, he added. Verdant corridors Converting abandoned railroad tracks into walking and biking trails began way back in the 1980s. The aim of the passage of the initial legislation that allowed rail corridors to be sold off and preserved was for future transportation corridors, according to Daley. “The great irony is that while rail tails provide this great benefit of activity and exercise, the premise was that some day we could ...your answer for extremely natural skin and hair care products, freshly handmade in small batches in the Hudson Valley of New York State SOAPS • LOTIONS CREAMS • SALVES SCRUBS • BATH SOAKS ESSENTIAL OILS
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reactivate them for rail use,” he said, noting that the trails came about as third parties intervened by filing for interim trail use. Rail trails transform derelict, abandoned right-of-ways into verdant corridors, beautifying cities and towns and the surrounding countryside and giving nature a boost. But the health benefits are the real impetus behind much of the federal, state and
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private funding that’s paying for the infrastructure improvements (mostly cleanup, removal of rails, smoothing of the trail, and signage). For example, PTNY has gotten a grant from the New York State Department of Health to assist Kingston in marketing its new trail, including developing a website, printing a brochure, and coming up with a brand. The Kingston rail trail, a 1.45-mile link cur-
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August 8, 2013 Healthy Communities rently under development by the Kingston Land Trust that extends from Midtown to the Rondout, is unique in the county’s rail trail network in that is entirely located within the city. That inner-city location makes the trail especially accessible to people who might otherwise never get out and walk. The lower grade of the rail trail compared to the steep hill on lower Broadway also makes it more appealing than walking in the street, Daley said. “People can walk to get to a restaurant, visit a friend, or pick up something at the grocery store,” he said. “It’s a very easy way to get out.” PTNY’s work with trails is based on the premise “if you build it, they will come,” not-
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ed Daley. Such an assumption is backed up by numerous studies showing that rail trails do increase the amount of exercise in a community. For example, in southeastern Missouri, a survey revealed that 55 percent of trail users are exercising more now than before they had access to a rail trail, according to the website of the Rails-to-Trails Conservancy, a nonprofit
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based in Washington, D.C. dedicated to creating a national network of rail trails. And the Indiana Trails Study, which surveyed trail users on six different trails in Indiana, found that in all six locations, over 70 percent of trail users reported that they were getting more exercise as a direct result of the trail, reported the Railsto-Trails Conservancy.
8, 2013 10 | August Healthy Communities
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The outdoor gym The rail trail “is the outdoor gym,” said Jennifer Carlson, who is on the board of the Wallkill Valley Rail Trail Association. That trail runs just over 12 miles from Gardiner to Rosendale, including the newly opened trestle walkway in Rosendale, and is in the process of being extended another 12 miles to Kingston. “You can run, walk, bike, horseback ride, and cross-country ski or snowshoe in the winter. It gives folks a full menu,” she said. It’s the accessibility and ease of use of rail trails that makes them so appealing, she added. “You don’t have to worry about researching gyms or paying membership fees. You can just relax and take a walk.” Carlson, who does a lot of endurance running on the trail, which she can walk to from her home, said another nice feature of rail trails is that they encourage a sense of community. “It’s fun seeing other people training for the same thing as I’m doing,” she said. “As you pass them, you recognize them and wave. The whole design of linear parks is to develop a sense of community in the middle of town without having to pay money. And because you aren’t riding or running on the road, it’s more of a carefree environment. For some people, it’s the only time they get outdoors during the day.” The Wallkill Valley Rail Trail’s eight points of entry make it easily accessible to people all along the corridor, she noted. “It’s so easy. And if people are unfit, they don’t have to deal with feeling uncomfortable around very fit people. All they have to do is take a walk. It’s a natural transition into a healthy lifestyle.” One positive development in Ulster County from a health perspective is that people are apparently becoming more active. According to the Institute for Health Metrics and Evaluation, which publishes a map of the U.S. indicating the prevalence of obesity and physical activity for every county compared with the state and national averages, the percentage of people who are physically active in Ulster County is slightly higher than the state and national averages. In
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August 8, 2013 Healthy Communities 2001, 57.4 percent of males were physically active and 47.6 percent of females, compared to a national average of 56.8 percent for males and 46.7 for females. However, those numbers increased from 2001 and 2011, by 1.8 percent for males and an impressive 7.8 percent for females. It’s likely rail trails have played a part in that increase. The O&W Rail Trail, which includes 12 heavily used miles between Kingston and Marbletown, opened a two-mile paved section along Route 209 in 2007, since planted with trees; the Wallkill Valley Rail Trail was extended in 2005, when Gardiner purchased its section of trail and agreed to give the Wallkill Valley Rail Trail Association a conservation easement. Both trails have been a huge success. “The O&W Rail Trail…has been a bigger hit than the Town every imagined,” notes the Town of Hurley website. “Walkers, bicyclist, skaters—the old, the young, families and singles, joggers and crosscountry teams—you can find them all on the trail through every kind of season, in all kinds of weather. The message is clear. Hurley loves rail trails.”
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Xtreme Fundraising Cycling for a cause Carrie Jones Ross
T
he competition for fundraising monies has become exceedingly tight, with less and less public funding for 501c3s and charitable organizations. To stay in the game, some are now cleverly making it more challenging for people to be in it. Charlie Lawrence of Kingston is training for his tenth ride through one of the country’s most dangerous terrains for humans — Death Valley, October 17-20. Lawrence and his son Chad will be riding to raise money and awareness for the Juvenile Diabetes Research Foundation. The Ride to Cure Diabetes aims toward the cure of a disease that more than 15,000 children and 15,000 adults — approximately 80 people per day — are diagnosed with in the U.S. every year. Each rider commits to raising $2000 each toward the cure. The ride raises one million dollars every year. The full ride for the JDRF Death Valley Ride to Cure Diabetes is 105 miles — that’s 52.5 miles out to the top of Jubilee Pass, which includes a grueling a seven mile climb, and the a return trip back to Furnace Creek. The ride offers optional turnaround points, giving the option for shorter rides...
‘Death Valley — as the name implies — is unforgiving…’
Chad, Melissa and Charlie Lawrence at Death Valley. but no matter how far you ride, the challenges are the same. Lawrence explained that riders need to stay hydrated and must stay with a buddy to keep an eye on one another for heat stroke. “Death Valley — as the name implies — is unforgiving,” Lawrence said. “As soon as we arrive at the ride staging area in Furnace Creek, another appropriate name, everyone reminds everyone else to drink drink drink. No matter where you are — walking, sitting, talking or sleeping — you must have a bottle of water with you. If you wake up in
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the middle of the night, you need to remember to reach for your bottle of water.” For the riders who have T1D (Type One Diabetes), the ride is even more challenging. The T1D riders need to balance nutritional intake with insulin dosage through constant checking of blood glucose levels. Every 17 or so miles of the ride, there are volunteers working at checkpoints where cold water, ice, sports drinks and munchies are available as well as medical staff. The munchies provide salt and needed electrolytes to prevent cramping and other medical issues. Support and gear trucks drive along the route as well as the California Highway Patrol. “First time I did Death Valley, it was a spiritual experience,” said Hurley resident, Marshall Courtney, whose daughter was diagnosed with TD1. He has ridden the JDRF’s Death Valley ride twice, and is planning to return for the third next year. Courtney said though he likes the “alone experience” of going at his own pace when he rides, Death Valley requires company. “It was such a grueling experience and so we shared the pain,
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Ulster County Walk to Cure Diabetes
U
lster County’s 2013 Walk to Cure Diabetes will be held at 11 a.m. Sunday, September 22 at Cantine Veterans Sports Complex, Bob Moser Drive in Saugerties. Registration for the three mile walk is 9:30 a.m. You can walk on a team or on your own. A team can consist of family, friends, coworkers, classmates, neighbors, or fellow volunteers. Many local businesses, companies, civic organizations, and schools form Walk teams as an effective way to foster teamwork and raise visibility in the community. The goal for the walk is to raise $98,969 to fight T1D. For more information, or to sign up, see www2.jdrf.org. and no one would let anyone fail.” Temperatures at the start of the ride may be as low as the 60’s but as the day wears on, the sun gets brighter and hotter. Between 10 a.m. and noon the temperature will approach or exceed triple digits. The potential exists for temperatures to exceed a punishing 110 degrees with a chance for 120 degrees. Relative humidity is usually single digits. As the sun rises and the angle of the sun changes, Lawrence describes the colors and texture of the desert landscape as changing from tan or brown to purple, red and other colors of the rainbow. The heat pours up from the surface. According to Lawrence, the reflection of the heat off the blacktop of the road can bring air temperatures at road level to 140 degrees or higher, “This means you are basically toasting your feet as you travel along the road,” he said. “Two years ago it got so hot that my front tire began to melt and actually warped,” said Lawrence. “I was never able to replace the tire and had to ride with a wobbling front tire. Seeing the beauty of the valley, bonding with and supporting as well as being supported by other riders and overcoming the physical and emotional strain of the ride make the event an almost spiritual experience.” Ride 2 Recovery Jack Shepard of Walkill injured his right knee during a training exercise in the military several years ago. When Shepard learned how his former pro-cyclist cousin, John Wordin, started a cycling program called Ride 2 Recovery to help injured soldiers and veterans recover through cycling, he was in. Shepard excitedly signed-up for the 9/11 American Challenge for the tenth anniversary of the 9/11 attacks to ride through all three crash sites. “That was the start of my addiction to cycling,” said Shepard. “That was also the first year since [the actual events] that the feelings about that day changed for me. For the first time in ten years, I couldn’t wait for it to arrive.” Police and motorcycles escorted 300 cyclists traveling from New Jersey into Pennsylvania. “Any time I felt like I had enough and wanted to quit, a man or woman with one arm, one leg, no legs would pass me and those feelings would be gone, instantly...if they could keep going so could I,” said Shepard. “And so I did, all the way into Shanksville, then all the way to the Pentagon. I saw men and women break down physically and mentally...and get back up again. I heard stories that made me realize any suffering on that ride did not compare to the day my new friends lost limbs or motor functions. I made life long friends on that ride.” Shepard said he has since cycled the 2012 Minute Man Challenge from Boston to New York, and will be riding again this coming September on the 2013 Minute Man Challenge Boston to Philadelphia. “I’ve had people tell me that before they found R2R, they really had no reason to live,” said Shepard. “One guy was in tears telling a group of us that at the end of the ride he planned to end it, but that thought was now out of his mind.” Shepard said that the helps to keep the riders “in the moment,” and away from the thoughts and memories of war, concentrating on the road, what gear they are in, who they are next to, or behind, avoiding pot-holes, speeding up, slowing down...there’s no time for those other thoughts. R2R started when a member of a local VFW reached out to his cousin, Wordin, and asked him to put together a cycling program for a small group of injured men, starting with only eight men riding down the California coast. It has since grown
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The 2003 Woodstock Women’s Cycling Classic to thousands, and every challenge has a waiting list in the hundreds. United Healthcare pays all administrative costs, so 100 percent of the funds raised goes to injured soldiers. R2R supplies bikes — standard and customized to fit a specific injury — but also provides transportation to and from events, as well as food for those injured in the line
of duty. Ride 2 Recovery is a partnership with the Military and VA Volunteer Service Office to benefit mental and physical rehabilitation programs for the nation’s wounded veterans. For more information on Td1, visit jdrf.org. For more information, visit ride2recovery.com
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8, 2013 14 | August Healthy Communities
Medicaid reform New York State has managed to cut spending on long-term care Lynn Woods
I
n January 2011, governor Andrew Cuomo launched the state’s Medicaid Redesign Team, bringing stakeholders together from all sectors of the healthcare industry and from both sides of the political aisle. Their task was to come up with ways to cut costs, improve quality, and instigate reforms of the state’s Medicaid system. New York spends more per capita on Medicaid, the medical insurance system for low-income people whose costs are shared by the federal and state governments, than any other state. The current budget is $54 billion, and costs had been increasing at a frightening rate, particularly for longterm care, such as provided by nursing homes. Medicaid spending for nursing-home residents increased from an average of $42,759 per recipient in 2003 to $49,425 in 2009, a 15 percent increase. And all that money resulted in results that provided little to crow about. Despite its very high expenditures — the amount New York spent for Medicaid home care and personal care topped any other state’s, for example — New York’s ratings in terms of quality of care have been middling. Among the states, New York ranked number 22 in terms of quality of health care and 17 in
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terms of public health indicators, according to the 2009 Commonwealth State Scorecard on Health System Performance. It ranked dead last when it came to avoidable hospital stays and costs. The first task of the Medicaid Redesign Team (MRT) was to provide a blueprint to lower costs in fiscal year 2011-12. Next was to develop a multiyear action plan for reform which would align with the changes that will occur under the Affordable Health Care Act. The MRT has made progress. It cut spending by $4 billion the first year (despite spending being on track to rise 13 percent) while improving health outcomes, according to a presentation in May of this year by Jason Helgerson, director of the state’s Medicaid program. So far, the team has succeeded in wringing $17.1 billion from the system. The state requested a waiver from the Centers of Medicaid and Medicare Services, the federal agency that oversees the funds, to allow the state to reinvest $10 billion in MRT-generated federal savings in the health system. As of August, a year after the request was made, the state still hadn’t heard back.
So far, the team has succeeded in wringing $17.1 billion from the system.
Winding up in a nursing home Medicaid is fraught with problems and has caused a serious imbalance in the treatment of the aging, according to Kary Jablonka, administrator of the Columbia County Office of the Aging. That county has the oldest population in the state, with
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August 8, 2013 Healthy Communities a meal the person doesn’t answer the door and is found to have fallen [or in need of other help].� Overcharging Medicaid Long-term care facilities bilking the system has resulted in strict regulatory oversight by the state, causing honest providers of care to need to spend an inordinate amount of time on compliance. “Some fat-cat owners overcharge Medicaid, which affects all facilities,� said a nursing home director in Dutchess County who declined to be identified by name. “That causes a facility that tries to do what’s best for residents to work harder to provide a high quality of service.� In addition to annual audits by the New York State Department of Health, nursing homes are subject to financial audits by the attorney general’s office. If deficiencies are found in the first type of audit — and if the facility is prospering, the audits increase — the facility may not be allowed to admit more residents until they are fixed. The attorney general’s audits requires a significant investment of staff time and paperwork to ensure that the documentation is in order. “A lot of money is spent on this,� said the Dutchess source. “RNs are spending their time behind closed doors� — time better spent with patients, she said.
Jason Helgerson, the state’s Medicaid director, claimed the MRT has brought fiscal accountability and transparency to the Medicaid system for the first time in history. Dozens of cost-cutting measures designed by the MRT, from buying in bulk to continually searching for price discounts, continue to result in new savings. Long-term care spending was down in 2011, after years of steep increases. “Change is enormously difficult, and the complexity is huge,� said Jablonka, who noted that Helgerson previously reformed Wisconsin’s $9-billion Medicaid system and has surrounded
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8, 2013 16 | August Healthy Communities
All About Memory Care Kim Davis
A
s the baby boomers age and the numbers of people diagnosed with dementia increase significantly, more attention is being paid to what’s called memory care. This fairly new term “describes the long-term care options for people diagnosed with memory issues who have difficulties with the activities of daily living but don’t require the intense care of a skilled nursing facility,” according to Kary Jablonka, administrator of the Columbia County Office for the Aging. With 49 percent of people age 85 or older suffering from dementia, of which Alzheimer’s disease is the most common form, according to the Alzheimer’s Association, the need is acute. Ten thousand baby boomers are turning 65 each day, and the number of people with Alzheimer’s is expected to soar, posing new challenges to caregivers and facilities for the aging, such as nursing homes. “Alzheimer’s is the tsunami of the 21st century. There’s a concern the country is not prepared for what’s coming down the pike,” said Meg Boyce, vice president of programs and services for the Hudson Valley/Rockland/Westchester/New York chapter of the Alzheimer’s Association. Acknowledging
the importance of the issue, President Obama just signed the National Alzheimer’s Project Act, which is the irst national plan dealing with the disease. Facilities solely designed to treat patients with Alzheimer’s 24/7 have sprouted up in other states but don’t yet exist in New York, according to Boyce. However, a few nursing homes and assisted living facilities in the area have installed memory care units for people with dementia, which are typically clustered in a separate section of the facility. The units are specially designed and secure (a common symptom of dementia is wandering) and most importantly, are staffed with specially trained caregivers. In choosing a facility with a memory care unit for a family member with Alzheimer’s, people should ensure the staff has been properly trained, said Boyce. Each staff member should have been trained for at least 21 hours — the length of time of the dementia-care training program offered by the Alzheimer’s Association. In addition, it’s important for both families and nursing home staff to be honest when applying for a place in the memory care unit, she said. “Families need to investigate the facility closely and ask the right questions, while facilities need to know if there are behavioral issues for the proper placement,” said Boyce. She noted that sometimes families fail to reveal a behavorial issue for fear their family member won’t get admit-
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ted to the facility — even though the facility may not be equipped to deal with combative behavior, for example. Among the senior facilities or nursing homes in the mid-Hudson Valley that have memory care units are Community at Brookmeade in Rhinebeck, Ten Broeck Commons, located in Kingston; Woodland Pond, in New Paltz, and Ferncliff Nursing Home, in Rhinebeck. Ivy Lodge, located in Saugerties, is an assisted living facility that just got certi ication from the state to open a memory care unit. (Such certi ication is required for assisted living facilities but not nursing homes, which are already regulated by the state.) Woodland Pond, a continuing care facility owned by Health Alliance that offers independent apartments, an assisted living facility and a nursing home, has 20 private apartment suites designed for people with early or mid-stage dementia. The secure units, accessible only to staff by code — there is also a “roam alert” system — have private baths; there is a common dining room, art and cultural center, and a full-time activities director, along with assistance for daily needs. Woodland Pond director of marketing Christine Wirthwein said such a facility is “unusual in New York. We’re fully booked. The likelihood of increased need is certain.” Ferncliff Nursing Home doesn’t have a memory care unit per se, which are designed for mild cases
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of dementia, according to Tara Martinez, director of staff development. It does provide special care to people in the later, much more challenging stages, with a capacity for 82 patients. “We try to keep them at functioning level,” said Martinez. The annual dementia-sensitivity training is intense: to simulate what it’s like to have dementia, staff members perform three tasks while wearing a sensitivity “suit” — consisting of popcornstuffed shoes, gloves tied to their hands, and eyeglasses they can’t see through. Ferncliffe also offers a short-term rehab program for younger people suffering from memory loss at its out-patient healing center. “There’s de initely a great need for placement of people with dementia who have behaviors,” Martinez said
the early morning and late afternoon. The other is located at the Clinton Alliance Church Youth Center, located between Rhinebeck and Red Hook, which opened nine months ago in response to the many seniors who were traveling to the Ulster Avenue location from across the river, according to Jami Anson, Always There director of development. It’s currently open only on Wednesdays and every second Mondays, but there are plans to extend the hours, said Anson. The Kingston location caters to approximately 15 to 25 participants a day — total capacity is 45, and at times “we do get illed,” Anson said — in addition to veterans participating in the Aid in Attendance program. The day, which includes two hot meals and snacks, is packed with activities, including yoga and dance, art activities, such as collage and scrapbook making and drawing, live music , word games, puzzles, and gardening. The garden, which was just unveiled, extends to beds planted on trays that can be raised up so that a person in a wheelchair can access them. A trainer brings in a therapy dog for the residents, who also participate in “nostalgia therapy,” which “brings a calming effect,” according to Anson. The trivia games and puzzles also help “give people moments of calmness and bring them back to
‘Alzheimer’s is the tsunami of the 21st century…’
Always There Perhaps the most exciting development in memory care is the growth of programming that not provides for the basic needs of adults with dementia, but also promotes a happier, more productive quality of life. Programs offering creative activities and one-on-one care is available both in an adult daycare setting as well as within the nursing home setting. Most people with Alzheimer’s are cared for by a relative at home, which places huge demands on the caregiver. Adult daycare centers are not only helping ease the burden, but also improving the quality of life for the aged parent or relative. Always There, a nonpro it providing a variety of home-care needs that was started by the Junior League of Kingston over 40 years ago, operates two adult day-care facilities. One is located at 918 Ulster Avenue and is open ive days a week and includes roundtrip transportation (from most points in the area) in
| 17
reality,” said Anson. “We treat people as individuals with family memories, not children.” People who formerly might have spent their day alone at home blossom in the atmosphere of fun and comradery, making friends. They also sometimes defy the stereotypical behaviors associated with dementia. “One man grabbed my hand one day and I asked what he did for a living. He said he was a grocer, which was so cool. An hour later, Alzheimer’s patients are usually asking what time is it, but he looked at me and said ‘thank you.’ When I visit, people know me by name,” Anson said. Community at Brookmeade, a nursing home located in Rhinebeck, started a similar day program for its 120 residents in February 2012. “It’s a structured program with cognitive stimulation,” said administrator and executive director Karen Zobel. “We do baking, provide an arts program and arts and crafts, collage making, and also have a music and memory program,” which includes a personalized music program for each person on an ipod. Ninety- ive percent of residents attend the program at least one day a week, and the positive results have been dramatic: “These collaborative activities have reduced the amount of drugs taken as well as the incidences of dif icult behavior and the need for restraints,” said Zobel. Brookmeade also just opened an interactive garden in a courtyard that offers a refreshing change from the institutional setting. “Folks and their families can go outside and enjoy the serenity of being outdoors,” said Zobel. The residents help maintain the garden. Residents particularly enjoy sharing trivia from the 1920s and 30s, which “give them a feeling of calmness…today for example we were talking about shoe shines, the smells and stories that came from that. Some people were talking about their fathers. It’s an opportunity to reminisce and engage their adult children.” Zobel said the program, which at times has a waiting list — she hopes to expand it into a day program for people in the outside community — has helped transform the nursing home simply from a place people go to die. “It’s about enjoying each day and living each moment.”
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8, 2013 18 | August Healthy Communities
Dust to dust The natural burial movement gains adherents Violet Snow
T
wo decades ago, when I learned to forage for wild foods, taking the lives of innumerable plants to feed my own life, I began to feel indebted to the earth. I hoped that at the end of my life I might be able to give back by allowing my body to break down and feed the relatives of the plants and animals that had nourished me all these years. “Some people get squeamish when they think about that,” said Joel Rabinowitz, director of Greensprings Natural Cemetery Preserve near Ithaca, one of the largest “green” cemeteries in the Northeast. On the other hand, he added, “Many people reject the idea of all the trappings, the artificiality of embalming. They don’t like idea of the body being confined inside a metal casket, or inside a concrete or metal vault. Being buried in a beautiful setting and allowing the body to go back to the earth is appealing.” Like most cemeteries that are part of the growing natural burial movement, Greensprings looks more like a nature preserve than a graveyard. Its flat headstones are laid flush to the ground. Regulations forbid embalming, except in the rare circumstances that legally require it. Burial containers must be biodegradable. In the Dutchess County town of Rhinebeck, the municipal cemetery has acquired an adjoining section that is in the process of being surveyed for natural burials. Rhinebeck resident and former SUNY-New Paltz professor Suzanne Kelly is helping administer the new property. “We live in a culture where humans are set apart from nature in all kinds of ways, especially at death,” Kelly said. “We’ve set up a system where the human body doesn’t matter to nature. Through natural burial we recognize that there really is no separation.” According to the Green Burial Council (GBC), a non-profit group that aims to promote natural burial and support environmental standards for the green “deathcare” industry, there are about 30 natural cemeteries across the country, some of them hybrids like the one in Rhinebeck. Rabinowitz came to Greensprings from his involvement in land conservation, helping the Finger Lakes Land Trust acquire property for nature preserves. “I had some personal experience with rampant development in places I’ve lived,” he explained. “The Greensprings idea is a nice extension of the land preservation movement.” Avoiding embalming The GBC’s vision statement asserts the environmental aims of many participants in the natural burial movement, including, “protecting worker health, reducing carbon emissions, conserving natural resources, and preserving habitat.” “Worker health” apparently refers to a National Cancer Institute study released in late 2009 revealing an elevated incidence of myeloid leukemia among funeral directors. “Fortunately, there are now several formaldehyde-free embalming fluids,” states the GBC website, “including one made entirely of nontoxic and biodegradable essential oils, which recently earned the GBC seal of approval. The sanitation and preservation of a corpse can almost always take place without the use of chemicals, as is done in just about every nation in the world — with the exception of the US, Canada and a half-dozen others.” Many people believe that embalming is a legal requirement, but Rabinowitz said it isn’t. A handful of states (not including New York) have laws that mandate embalming when transporting a body by commercial carrier or outside of a specified timeframe. Greensprings will accept such bodies for interment if necessary, but so far all of its 150 or so burials have taken place without embalming.
DION OGUST
The Woodstock Artists Cemetary. Wicker is quicker Proponents of natural burial frown on burying toxic formaldehyde in the ground because it’s a pollutant and because it prevents decomposition of the body. Similarly, burial vaults and metallic coffins are seen as barriers to uniting the body with its surroundings. A plain pine box will eventually break down, as will wicker and cardboard, which are also options in natural cemeteries. Rabinowitz recently buried a customer in a casket-shaped basket of woven grapevines, and he’s heard of switchgrass coffins. An even quicker way of joining the soil is to be buried in a simple shroud. “We get a lot of interest in shrouds,” said Rabinowitz. The law requires some sort of container for the body, but it can be made of cloth, usually cotton or muslin. At Greensprings, the ratio is about three coffins to two shrouds. “Funeral directors that are used to working with natural burial are used to doing shrouds,” said Rabinowitz. “In the Jewish religion, a shroud is required. You can be buried in just a shroud or in a shroud inside a box. Jewish funeral homes are used to the prescribed ways of doing it. “ The Lansing Funeral Home, near Ithaca, is certified by the GBC to provide natural burial services and offers “a variety of American-made ecofriendly caskets and shrouds.” Presumably, once the Rhinebeck cemetery’s natural burial section is up and running, local funeral homes will acquire similar expertise and products. The Rhinebeck approach The Rhinebeck cemetery exemplifies the history of America’s cultural approaches to death and
mourning, explained Kelly. People in rural areas were traditionally buried on farms. As towns and cities grew church graveyards became overcrowded, causing disease and a certain stink. In response to this problem, the rural cemetery movement arose in the 1820s, promoting the idea that cemeteries could be parklike open spaces where the living would enjoy picnics and visit the dead. Green-wood Cemetery in Brooklyn is an example, with elegant tombstones and extensive plantings of trees and shrubs to create a beautiful setting. The Rhinebeck cemetery, created in the 1880s, is a smaller version, said Kelly, “but you can tell by the obelisks and trees that it’s in that style. The trend died out by the 1920s, when they started streamlining away from grandiose monumentation and elaborate inscriptions, and people stopped going to visit the dead. The newer part of the ceme tery, from the first half of the ninteenth century, is flat and ugly. We’re trying to re-tree there.” So the natural burial trend is a step back toward the rural cemetery movement of the 1800s. In New York State, Kelly said, a cemetery can be owned by a municipality, a church, or a cemetery association. It must maintain assets to support the maintenance of the property. The Rhinebeck cemetery was run for over a century by an association, which finally petered out for lack of funds in 2002. “Most towns will close the cemetery in that case,” she said, “since they don’t make money. But because this one was still active and such a part of the community, the town did take it over.” When locals expressed an interest in adding a natural burial section to the 38-acre cemetery, Kelly was asked to be on the committee for orga-
August 8, 2013 Healthy Communities nizing the acquisition. “As a Ph.D. student, I did work on the intersection of feminism and ecology,” she said, “and I was focused on research about the body. I became interested in the cultural conceptions of the dead body, and I liked the idea of green burial.” The first green cemetery in the U.S. opened at Ramsay Creek in South Carolina in 1998, and Kelly wrote about it in a book and in academic publications. Her reputation prompted her inclusion on the cemetery committee. “The 100-year-old men who used to run the association loved me,” she said. “They made me in charge of the committee. It’s been a lovely experience working with them.” The green burial section at Rhinebeck was once pasture land for the historic Grasmere estate that was owned by Beekmans and Livingstons. The parcel is now covered by a young hardwood forest. Digging up roots may be a challenge, Kelly acknowledged, “but our cemetarian is very skilled.” The surveyor has almost completed marking out gravesites on the first two and a half acres of the 17-acre site, and she expects the area to be open for burial by late September. Greensprings, in contrast, is mostly meadow with a buffer of forested land around it. Of the almost 100 acres, only 16 have been surveyed for
gravesites thus far. One section is reserved for Jewish burials. “When you go there, it doesn’t look and feel like conventional cemetery at all,” said Rabinowitz. “We don’t remove the dirt that is displaced by the coffin. We cover the body with all the dirt and rocks that came out of the grave, so we end up with mounds that slowly settle down over several
years. The caretaker grooms them with nice soil on top for reseeding of grass. We have a list of recommended native species that people can plant. A lot of families come out and tend the graves.” For more information, see http://friendsofrhinebeckcemetery.org/, http://www.greenburialcouncil.org/, and for Greensprings Cemetery, http:// naturalburial.org/.
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