A Patient Advocate's View

Letting Go of Perfection

Earlier, at about 3AM I was awakened by a call from a nursing home that one of my clients had passed. It wasn’t unexpected because she had been suffering from advanced Alzheimer’s for several years and had been praying to be released from this terrible disease. Her family, friends and I were happy that she could spend several years at Atria Kew Gardens where she enjoyed continuing her lifelong passion of eating healthy, working out with her personal trainer, Val and walking to Church on Sundays. In her final months she found comfort in living with the sisters at Ozanamhall.

This isn’t my first call to Schwartz Brothers where I make pre-planned funeral arrangements for all my clients, including my husband who passed at this same time of year. Actually I have been making these kind of calls for the past ten years. Most times I am the only person at the funeral, besides a few friends and their home health aide. My practice focuses on elderly people who don’t have anyone to help them or they only have people who are just not available because they live far away or are elderly themselves, our elder orphans. It’s always comforting to know that their wishes will be carried out.

Regardless of how well you plan and how much you know that the person welcomed their release, it is still a time of grief and all that goes with it. I have been working with a Widow Coach to understand my own grief process for the past year. The most helpful thing I learned was that we can’t change what is, but we can change how we think about it. So, keeping in mind the 90 second rule, I let myself dwell on the fact that I hadn’t changed the beneficiary on her life insurance which was needed for her Medicaid application and that I hadn’t gotten to bring her the framed poster I planned to give her for Christmas, with a personalized message from the Pope.

Since I was now wide awake, I started my day as usual checking emails and Facebook Groups. Usually I am pretty stoic, but one of the posts was a copy of a Eulogy from a son about his father. It was written in such a loving. funny way, even though the topic of discussion was someone known to be loud, abrasive and aloof. It really touched me that even though this person was far from perfect, he left only the good memories and any hard feelings were buried with him. Reading now through tears, I opened a daily email I get called the Daily Om. It’s a short daily inspirational message. It’s one of the few things I do in a day that has nothing to do with seniors or patients. The title for today is Letting Go of Perfection. It was a reminder that being imperfect is human and that trying to be perfect only leads to frustration and unhappiness.

This is a time of year for celebration and joy, but if this year of Covid, Lock Downs and Economic Uncertainty have taught us anything, it is that nothing will be perfect. We can only hope for the best and do what we can under the circumstances. I wish the gift of forgiveness for yourself to all my friends, colleagues and clients. I send you forgiving thoughts for any one or anything you are holding in your head or heart. I promise to embrace all the imperfection I see in the world in a loving way.

If you ever feel down or upset about being less than perfect, give me a call, because I need all the imperfections I can find to help me to learn and grow. I hope you forgive me if I have done anything less than perfectly. I will try to do what I can to make it less imperfect.

December 2, 2021 Posted by | Uncategorized | , , , , | Leave a comment

Starting Over at 70

Nothing ventured, nothing gained. As we enter the ninth month of contact-less networking, no get together for the holidays and binge shopping, I wanted to do something outside of my comfort zone.

Here are the first 3 articles I wrote for the North Shore Towers Courier after a conversation with Publisher Vicki Schneps of Schneps Media. I was thinking of doing this as a podcast, but Vicki suggested that I build an audience first to see if this resonated with the people I am speaking to.

Here’s what it looks like in the paper.

Here are the November and December articles.

November 20, 2020 Posted by | Uncategorized | , , | Leave a comment

Depending on the kindness of strangers.

Seniors depend more and more on Medicaid as they outlive their savings.  
Dr. Don McCanne of PNHP comments on this article which asks doctors to accept more Medicaid patients. 
Comment:  The expansion of Medicaid for low-income patients is one of the more troublesome features of the Affordable Care Act. Because of low payment rates, many physicians, especially high-income specialists, already refuse to accept Medicaid patients. Increasing the burden on those physicians who do accept Medicaid is apt to result in a pushback wherein access may be further impaired.
What can be done? Lawrence Cassalino has provided us with an excellent description of the dilemma, but I’m afraid that his 5% solution – physicians devoting 5% of their practices to Medicaid – will fail since it depends on physician professionalism, of putting patients first. After a career of trying to obtain specialized care for Medicaid patients, it was quite clear that that level of professionalism was not ubiquitous in my community, and I doubt that it is in most other communities. Relying on the pure goodness of physicians will not work because there are not enough so oriented to meet the need.
One important measure in ACA is the expansion of funding for federally qualified health centers. These centers improve access for vulnerable populations, though they still have difficulties obtaining adequate support of specialists. Today, the government announced a $150 million grant to assist these community health centers. $150 million? Unless the government becomes serious about community center funding, and unless something is done to attract specialists to support these centers, we cannot expect them to fill the void either.
There is a clear solution. We could establish a single payer national health program in which everyone has the same coverage and access to care. That may or may not renew the commitment of today’s physicians to professionalism, but at least it would create the appearance that patients would be placed first. For individuals considering a future career in medicine, professionalism would be a given.

November 8, 2013 Posted by | Uncategorized | , , , , | Leave a comment

Vistaprint is Great!

I reodered my vistaprint rack cards which have increased my business by leaps and bounds. For some reason the back came out crazy. I called them and they gave me a full credit and are sending the corrected cards ASAP. Thank you VistaPrint for making me look great.

Source: via Caryn on Pinterest

September 5, 2012 Posted by | Uncategorized | , , , , , , | Leave a comment

Licensed Home Care vs Companion Care

I worked with Kathy Livingston, Senior Vice President of Senior Helpers in January 2010, on the newsletters for Senior Umbrella Network of Brooklyn . We spoke several times that spring about how she came to be the co-owner of a Home Care Companion Agency after working in the corporate world, helping franchise owners with their own home care agencies. Kathy invited me to participate in a lecture series at the Brooklyn Public Library, where she talked home care and I talked Patient Advocacy. Then, it was as if Kathy dropped off the face of the earth. She was going through the NYS Department of Health’s process for operating a Licensed Home Care Services Agency (LHCSA). The process took almost two years of full time work.

Last week I sat down with Kathy to ask her how operating a LHCSA has changed the services Senior Helpers offers. “We realized as a Companion Service that many of our clients required a higher level of care than we were able to provide. As a LHCSA, we have two nurses on staff so that we can provide services to people who have more complicated medical needs such as wound care.” Kathy explained, “Legally, we can treat many more people.

I have referred clients to Companion Agencies because they told me they just needed a little help. Sometimes I find that their needs really include medical services, such as actual help in the toilet, not just supervision to get to the bathroom. “People call our Agency and the first thing they want to know is what it is going to cost. That’s the wrong way to decide which type of Agency is right for you.” Kathy tells prospective clients, “The best way for me to help you is for me to understand your needs. As a LHCSA, we have a nurse who determines the level of care required and a Social Worker who coordinates the services for each client and matches them with the appropriate attendant.”

“There are four areas we review before deciding on a care plan, health, social, family and financial.” Kathy told me that resistance is the number one problem she encounters when children think care is required but the parent is not ready to accept the help. “We need to get to speak with the client. Others may think they know the kind of care their parent needs, but we are the experts. We are there to tell the client what they need. A client may insist on an attendant who drives, but that should really be on the bottom of the list of qualifications. LHCSA’s have strict training and quality rules that the Department of Health looks at before approving our license. We also seek Accreditation from the Joint Commissions, which is a periodic external evaluation by recognized experts that provides impartial evidence of the quality of care delivered to clients.”

Kathy recommends the book, Treat Me, Not My Age: A Doctor’s Guide to Getting the Best Care as You or a Loved one Gets Older, by Mark Lachs,MD. “Our goal is to do the best job possible, and the LHCSA model allows us the opportunity to provide care for people over a long period of time, as they require more or less care.”

Kathy Livingston, Senior Vice President
Senior Helpers
353 West 48th St. New York, NY 10036

February 27, 2012 Posted by | Uncategorized | , , , , , , , | Leave a comment


I have an unusual amount of new clients who could be considered hoarders. Here is an article about this condition and the senior population.

July 5, 2011 Posted by | Uncategorized | , | Leave a comment


Redesigning Medicaid and Health Care
Total Medicaid spending including federal, state and local spending of $52.6 billion represents a decrease of $337 million, or minus 1 percent. Future growth in Medicaid will be limited to the 10-year rolling average of the Medical CPI, currently 4 percent. As with education, the budget includes a two-year appropriation.

The budget includes a cap of $15.3 billion on Department of Health Medicaid state expenditures, which represent the largest and one of the fastest growing component of state spending.

The budget process brought together health care providers, labor, government and other Medicaid stakeholders to form Governor Cuomo’s Medicaid Redesign Team (MRT). Tasked with identifying ways to provide critical health care services at lower costs and control unsustainable growth, the MRT recommended a series of proposals to fundamentally restructure and reform New York extensive Medicaid program.

Overall, the budget implements a majority of the MRT recommendations. The budget reflects $2.3 billion in spending reductions supplemented by $425 million in lower-than-expected expenditures to achieve the Governor’s original savings target of $2.85 billion.

The budget implements significant reforms including a major expansion of patient-centered medical homes, better control of home health care services, and care management for individuals with complex and continuing health care needs. New models of integrated care, such as Accountable Care Organizations, will help assure long-term control of health care spending.

Savings will be assured by an overall spending cap, enabling the Commissioner of Health to make additional savings actions during the year, if necessary. Here is the briefing book by subject.

April 7, 2011 Posted by | Uncategorized | , , , | 1 Comment