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WHAT WE LOOK FOR
Accessible Approach
Open Wide Paths
SOLUTIONS
Inexpensive Fixes for Small Spaces
Expert Advice for All Barriers
Temporary & Portable Ramps
Many Types of Lifts

You may be eligible for federal tax credits for alterations to improve accessibility. Call now to schedule your free ADA inspection. 718-605-2626

Big number phones have been around for a while, but there are some new phone ideas that might be helpful for people who have more than vision problems.

This is a corded phone, a handheld phone and an alert system all in one, for seniors. No monthly charge for alert system. http://www.vtechphones.com/vtechphones/index.cfm/careline/careline-home-safety-telephone-system/?gclid=CKbUzt6X7bUCFYWo4Aod_S0AfA

These are phones for the hearing impaired. Using a corded phone is easier than trying to look for the button to push when a call comes in or the one to push when the call is over. http://clarity.factoryoutletstore.com

Big Button Photo Dialer

http://www.sharperimage.com/si/view/product/Big-Button-Photo-Dialer/200368?utm_source=Google%20Base&utm_medium=CSE&cm_mmc=Partners-_-CSE-_-Googlebase-_-NONE&pc=CSFS50&CAWELAID=1055099365%20&cagpspn=pla&gclid=CKTpv_-T7bUCFQyZ4AodB1cATA

These are just some of the ways new technology can help you to stay independent. We have no financial interest in the products mentioned. We are just interested in getting the word out about products that we feel will enhance the quallity of life of our senior population and will continue to do so as items come to our knowledge.

Lois is a 90 year old volunteer who frequently visits the 100 year old residents of an assisted living facility. During the past several years, she presented as capable of handling her own affairs and living in the present. Lois was always accompanied by an aide, who she said she needed because she had an injury to her spine. Recently, the aide told Lois that she would be leaving soon. This led Lois to contact me in regards to her options for staying at home or perhaps going to an assisted living facility. She was concerned that she did not have enough money for either, and was asking if I could help her to get Veteran’s Benefits, since her husband had served in the military. I was accompanied to this home visit by Caryn Isaacs, Patient Advocate who had previously spoken to Lois on the phone about her needs.

As happens, when people feel lost and are asking for help, they do not hold back for the sake of privacy concerns. Rather, they want their story to be heard to see if there is anyone out there who can help them. Lois began by telling me a horrific tale of physical and mental abuse perpetrated upon her by her daughter. After raising her daughter’s two children and sending them through college, the daughter punched and pushed her down, causing the spine injury that now gave her continuous pain. Then the daughter emptied the bank vault while Lois was in the hospital with the spine injury. Lois said she didn’t report the incident because ‘a mother doesn’t send her daughter to jail’. Her solution was to cut off communications with her daughter, who she said was not allowing the grandchildren, now grown with children of their own, to visit her either.

Even though she hadn’t spoken to any of them in years, she still wanted to leave whatever she had left to her grandchildren, even at the expense of her own comfort. She insisted that she would probably have to go to a nursing home on Medicaid if the VA would not assist her.

I gave her what sympathy I could and suggested we get down to the matter at hand, which was to determine her financial situation to see if she might be entitled to a Veteran’s Aid and Atttendance Pension or any other financial assistance. Lois continued to bring up money that she had been given and money that she had spent in the distant past. The only money she said she spent on herself was the monthly cash she gave to the ‘illegal’ who lived with her and helped her with her daily needs.

Finally, she showed me her bank statements and 1099′s which had just arrived since it is close to tax time. What I saw, was not what I expected. Lois had a substantial ammount of money in various checking and savings accounts, certainly enough to allow her to live at home with qualified attendants, or to move to a private assisted living facility and live out her life in comfort and safety. When I told her this, she said she was not aware of how much she had, although others had told her the same thing. She said that she relied on going in to the banks in the neighborhood to ask them how to keep the money safe. She also said she did not have a will or power of attorney, nor had she consulted an attorney at any time as others had suggested.

The problem I saw was that in each account, Lois was listed as the sole owner. I tried to explain to her that she had not protected the money for her grandchildren by having these types of accounts and that by paying the aide off the books, she was now not qualified for any type of assistance. I suggested that she retain an attorney who could advise her on the best way to protect her assets, while allowing her to either stay at home or move to assisted living, whichever was her preference. I suggested that some of the things she should discuss with the attorney were creating a trust to protect the assets she wanted to give to her grandchildren and funding the trust with the bank accounts so that they would pass to the grandchildren without probate.

Lois became extremely upset and said that was not what she wanted. She said that she did not want to do anything illegal and that her grandchildren should be happy if they got anything and that the government could take it all and put her in a nursing home. She even suggested that the assisted living facility could take all her money and then put her on Medicaid, even though I explained that they only charge for rent and services and would not accept a lump sum. She seemed to have mixed up things she heard about people going to a nursing home and winding up spending down to go on Medicaid, with what would happen if she directed her own care and chose to stay at home or go to a private facility. There was nothing I could do to assure her that no one was forcing her into a nursing home, or that her assets would be enough for her to have choices. She continued to go back and forth from asking me to help her stay at home, to help her move to the assisted living and then over to threatening to go to the banks, take out all the money and mail it to her granchildren who should spend it on themselves.

Now, here’s where the story goes off in the direction of wondering if Lois should be allowed to continue making decisions that were obviously not going to get her the results she desired and may even put her in danger. Is there is a duty to report the situation to some agency that could access her needs? It is always considered a last resort to call in the authorities and remove the persons rights by imposing a guardian, especially when that person has asked you for help. I was able to get Lois to call a friend who was aware of her situation and who had also recommended that she consult an attorney. Lois said she wanted this friend to act as Power of Attorney, but then said she did not want the friend to know anything about her finances and only wanted her to handle things after she had passed. When I tried to explain that this was not the purpose of a Power of Attorney, Lois went back to saying she was going to go to the banks to take out all the money and either give it all to an assisted living facility or send it to the grandchildren. I decided to leave at this point leaving the last suggestion, “Do not do anything at the banks until you speak to an attorney.” I told her that I would be happy to give her a referral or she should ask someone she knows for an Elder Law Attorney.

Sometimes you can laugh at what people say and sometimes they can make you cry, but when do you know that it is time to act?

Click the photo to see our 2013 products and services.

George Fehling, President and Vera, office manager wish you a happy and healthy New Year.
Call us for a no obligation quote. 718605-2626 E-mail: info@rampsforliving.com

http://newoldage.blogs.nytimes.com/2012/12/10/few-places-to-learn-nursing-skills-for-home-care/?ref=health

Here’s a story many of you may find familiar. Dad slides out of bed and winds up on the floor. Mom and the aide try, but can’t get Dad up. They call their son, he drives over and tries, but cannot get Dad off the floor either. Finally, you call the police. They come right over and help Dad back onto the bed, but this time they say you will need to sign a paper saying that you understand that he is at risk, since this is the third time you’ve called in as many weeks. Your back is aching and the aide is complaining about hers as well. Does this mean it’s time for a nursing home? All Dad may need is the proper lift.

There are brand new kinds of assistive devices that are easy to use and store. These are made for home use so that a single caregiver can quickly, safely and easily assist a person lying on the floor or lying in bed, unable to get up on their own. In a secure and comfortable way, they lift the user up into a seated position, ready for rising or transferring to a wheelchair or bed. They operate silently, no assembly is required, there are no batteries that need charging and the user instructions are always available right on the product.
Call us for a no obligation quote. 718-605-2626 or email us at info@rampsforliving.com

By Deborah Young/Staten Island Advance
on December 08, 2012 at 6:02 AM, updated December 08, 2012 at 6:40 AM

Carol Lazorisak’s Oakwood Beach home was destroyed by Hurricane Sandy. Adding to her frustration is the fact that adequate interpreter services from FEMA, the city and at public meetings relating to the disaster have not been made available, says Ms. Lazorisak, who has been Deaf since birth. Watch video
STATEN ISLAND, N.Y. — When police with megaphones rolled through Carol Lazorisak’s Oakwood Beach neighborhood in the hours before the hurricane thrust ashore, she did not hear their announcement about evacuation help.

In the days after the surge ripped her Tarlton Street home off its foundation, filled it with water to a depth of 5 feet and tossed her shed nearly a block away, she joined the thousands of other dazed victims at Miller Field in New Dorp, seeking some answers and a measure of comfort.

But for Ms. Lazorisak, who has been deaf since birth, walking through the bustling relief center was like being in a movie on silent. There were no signs providing information for the deaf or directing people to translation services. She left feeling more isolated than ever.

“I am extremely frustrated because of the lack of communication, the lack of help, the lack of information. I was left lost and in the dark for the first two weeks after Sandy destroyed my home,” said Ms. Lazorisak, as her friend Marybeth Imsho translated from American Sign Language — a service she has provided during virtually every face-to-face meeting with FEMA or city agencies, and at the borough president’s town hall meeting last month — where no interpreter was provided for nearly a dozen deaf audience members. “My home is going to be demolished by the city in the next week and I need information.”

Ms. Lazorisak — an Advance Woman of Achievement and a professor at Hunter College — understands the urgency of communication, especially during crises like Sandy, and the requirements of the American with Disabilities Act that everyone have equal access to services.

Even before Sandy hit, she lectured to municipalities on how to assist the hearing-impaired before, during and after natural disasters: In other words, how to avoid meting out the kind of treatment she said she has received at the hands of FEMA and the city.

“Now I’m the one who needs help and nobody has helped me and nobody has helped me on Staten Island,” she said.

Since the storm, she has sometimes used her car as a hotel room on wheels, or spending nights in friends’ homes near the Queens campus where she teaches and on the Island.

Her husband, who is retired and also deaf, left their home for Florida to live with their grown daughter. She plans to join him after she finishes the semester.

“I have nothing left here,” she said of the neighborhood where her family has lived for three generations. “I’m leaving New York.”

Her home of 40 years, which she, her husband and late father painstakingly restored and improved, is covered in grime and smells of growing mold. Cracks in the foundation can be seen in the brand-new bathroom. It cannot be saved.

Ms. Lazorisak said she has received not a penny from the Federal Emergency Management Agency because she has flood insurance. Her insurer has, so far, said it would pay $10,000 of a maximum of $20,000. Her homeowner’s insurance has refused to cover anything.

“My life washed away in five minutes,” she said, recounting what a neighbor told her about how violently the water pushed inland, destroying the whole block within five minutes. “This was a tsunami.”

But the second tragedy came in the form of being shut out by the government and the people who were supposed to help, she said.

When FEMA came to survey the home, she texted that she is deaf but no such person accompanied them during her walk-through.

She gave up on Miller Field after the first meeting, but even at the Hylan Boulevard Center in Dongan Hills, where a sign proclaims interpretative services are available, they simply offered her a computer and told her to make a video call. “I asked them, ‘Where is the interpreter?’ They said, ‘We have these things to use.’ I said, ‘What do you mean?’ They said, ‘Equipment.’ I need a live interpreter, not a piece of equipment.”

She tried to use the video-relay equipment provided, which took 45 minutes to set up, only to be told by an operator that it was for outside calls, not individual meetings. “I lost an hour of time and I only had a five-minute question,” said Ms. Lazorisak. After that frustrating experience, she didn’t return until Ms. Imsho could clear space on her schedule and accompany her friend.

“It’s very emotional. There’s a lot of information. You have to take your own notes. It’s not something you can do while turning to look at a video,” said Ms. Imsho.

The city’s response was hardly better, she said, amounting to mobile devices, which did not work well, or an Internet connection.

“We don’t see the use of the iPad or the use of the video-relay interpreter as the whole solution, but we see it as immediate access to effective communication,” said Marcie Roth, director of FEMA’s office of disability integration and coordination, who could not comment specifically about Ms. Lazorisak’s situation but explained that all recovery centers have computer-assisted technology to allow for conversations to be interpreted.

“We are committed to providing access to effective communication. With the large number of disaster recovery centers open at once, it would be virtually impossible to provide enough interpreters from the moment they opened to the moment they closed each and every day.”

Still, she said, it is possible to call ahead and make an appointment with an interpreter.

Not so, according to Ms. Lazorisak and Ms. Imsho, who detailed how they pleaded with officials simply to provide appointments with interpeters.

Similarly, calls placed to local elected officials days in advance of public meetings to request a sign language interpreter were simply ignored, said Ms. Imsho.

According to FEMA, the agency will supply an interpreter, even if the meeting isn’t their own, if they receive a request in advance.

Although Ms. Roth could not offer a tally of the number of interpreters on call in the New York area, she said there is a staff. At a public municipal meeting on Long Island this week, FEMA provided interpreters, she noted; she promised to follow up with Ms. Lazorisak to explore the disconnect.

Meanwhile, the city sent a statement, reading in part:

“The city strives to meet the needs of the deaf and hard-of-hearing community. For example, as you recall, there were ASL interpreters at the mayor’s daily Hurricane Sandy briefings during the height of the storm. Furthermore, the city’s recovery centers have been instructed to provide this community with reasonable accommodation consistent with the ADA. This accommodation includes making arrangements for an on-site ASL interpreter, writing down instructions, and employing other mechanisms when practicable.”

For now, Ms. Lazorisak is looking forward to Monday’s multi-agency meeting and another, on Dec. 19, with attorneys, sponsored by state Sen. Andrew Lanza.

“We have asked them to provide services,” said Ms. Imsho, who was told they couldn’t help and she should do the interpretation, pro bono.

But she herself has to teach that night at St. John’s University, and cannot be there. “Of course I would volunteer. I’ve volunteered many hours to help. But it’s against the law for them to expect it. It’s their duty to provide equal access to everybody.”

New ED drama? Hospitals demand upfront fee for nonemergencies. More are charging patients up to $180 for problems deemed nonemergent. Some doctors say the policy could backfire and harm patients.

Physicians who take after-hours calls from patients often face a difficult decision: Which symptoms can wait for an office visit, and which ones require a trip to the emergency department? Now doctors find these decisions complicated by a troubling, rising trend: Will a trip to the ED mean an upfront charge for a patient if the problem is deemed nonemergent?

At least half of hospitals are making efforts to collect patient co-pays, deductibles or other charges at the time of service in the emergency department, said Richard Gundling, vice president of health care financial practices at the Healthcare Financial Management Assn. The organization has 39,000 members, including chief financial officers and other professionals in health care financing.

Gundling said a smaller but growing number of hospitals give patients whose problems are deemed nonemergent a choice: Pay an initial fee to get the problem treated in the ED, or seek care elsewhere. The fees range from $100 to $180 for uninsured patients, or the relevant co-pay or deductible for insured patients. He said it is unclear how many hospitals are charging ED patients up front for nonemergency care, but he added that hospitals financially squeezed by uncompensated care increasingly are opting for this collections model.

“That’s getting to be more and more common,” Gundling said, “because of overcrowding, and because hospitals tend to be filled with people who are using ERs as a regular physician office. It’s better to tell the patient up front that they have to pay a $150 fee than billing them at the end, when they may not have realized the difference in cost.”

Yet many doctors interviewed for this article found the growing trend alarming. They said it unfairly targets patients with poor access to primary care and is unlikely to alleviate ED crowding because nonurgent problems make up less than 10% of visits. Emergency physicians added that the policy could result in tragedy, because some seemingly nonemergent conditions quickly worsen, and because some patients with life-threatening problems may wrongly decide to steer clear of the ED to avoid pay-first fees.

A Houston hospital that is part of Nashville, Tenn.-based HCA adopted the payment policy in 2004, and it has since spread to nearly half of the chain’s 163 hospitals, said company spokesman Ed Fishbough. Of 6 million ED visits to HCA hospitals in 2011, 80,000 patients with nonemergent problems left without treatment to avoid paying the upfront fee, Fishbough said.

“It has been a successful part of helping to reduce crowding in emergency rooms and to encourage appropriate use of scarce resources,” he added. “This helps ensure that the sickest patients get treated quickly and those who do not have an emergency have access to more efficient, less-costly care settings.”

In November, the Newton Medical Center in Covington, Ga., announced that it would charge $150 to uninsured patients who want treatment for nonemergent conditions and would collect co-pays or deductibles from insured patients. Two other nearby hospitals in Georgia — Clearview Regional Medical Center in Monroe and Rockdale Medical Center in Conyers — have adopted similar policies, a local news report said.

Hospitals implementing the pay-first policy say it complies with the Emergency Medical Treatment and Active Labor Act because all patients receive the federally required medical screening regardless of ability to pay. It is only after a patient’s condition is deemed nonemergent that upfront payment for further treatment in the ED is discussed. Fishbough said HCA hospitals exempt patients who are pregnant or who are younger than 5 or older than 65. He said HCA hospitals typically have a triage nurse and a physician make the determination that a patient’s condition is not emergent.

Some physicians, however, object to the idea. The pay trend is severely misguided, said Arthur L. Kellermann, MD, MPH, who served on an Institute of Medicine emergency care panel and now is a health policy researcher at the RAND Corp., an independent nonprofit think tank.

“People don’t go the ER as a recreational event,” he said. “If you tell me you have an urgent care clinic or walk-in clinic or other places where these people can go straight to, then OK. But to tell someone to just go away if you don’t have $150, you have to be ignoring the fact that if they had somewhere to go they wouldn’t be there in the first place. And you have to be damn sure that this patient doesn’t have a more serious problem.

Half of U.S. hospitals collect patient co-pays, deductibles or other charges at the time of ED service.

“This is putting a Band-Aid on a gunshot wound.”

Andrew E. Sama, MD, president of the American College of Emergency Physicians, also expressed reservations about the upfront-charge policy.

“What I’m worried about is that people are going to have second thoughts about getting serious symptoms evaluated, and that to me is a real compromise,” said Dr. Sama, senior vice president of emergency services at North Shore-Long Island Jewish Health System in Manhasset, N.Y. The hospital does not charge ED patients up front for nonemergent care.

Emergency medicine researchers said charging first for nonurgent care is unlikely to cut wait times significantly or reduce crowding. According to the most recent data from the Centers for Disease Control and Prevention, only 7.7% of ED visits are classified as “nonurgent,” meaning patients would not be harmed by waiting to receive treatment within two to 24 hours for their problems. Meanwhile, a June 20 Annals of Emergency Medicine study found that ED visits rose 15% between 2001 and 2008 and outpaced population growth by 60%. The time spent in the ED — one way to measure crowding — jumped 30%. But that rise was driven by a 23% growth in high-acuity patients who spent 41% more time in the ED undergoing tests and procedures. The number of low-acuity patients grew by only 6%, the study said.
Physicians who take after-hours calls from patients often face a difficult decision: Which symptoms can wait for an office visit, and which ones require a trip to the emergency department? Now doctors find these decisions complicated by a troubling, rising trend: Will a trip to the ED mean an upfront charge for a patient if the problem is deemed nonemergent?

At least half of hospitals are making efforts to collect patient co-pays, deductibles or other charges at the time of service in the emergency department, said Richard Gundling, vice president of health care financial practices at the Healthcare Financial Management Assn. The organization has 39,000 members, including chief financial officers and other professionals in health care financing.

Gundling said a smaller but growing number of hospitals give patients whose problems are deemed nonemergent a choice: Pay an initial fee to get the problem treated in the ED, or seek care elsewhere. The fees range from $100 to $180 for uninsured patients, or the relevant co-pay or deductible for insured patients. He said it is unclear how many hospitals are charging ED patients up front for nonemergency care, but he added that hospitals financially squeezed by uncompensated care increasingly are opting for this collections model.

“That’s getting to be more and more common,” Gundling said, “because of overcrowding, and because hospitals tend to be filled with people who are using ERs as a regular physician office. It’s better to tell the patient up front that they have to pay a $150 fee than billing them at the end, when they may not have realized the difference in cost.”

Yet many doctors interviewed for this article found the growing trend alarming. They said it unfairly targets patients with poor access to primary care and is unlikely to alleviate ED crowding because nonurgent problems make up less than 10% of visits. Emergency physicians added that the policy could result in tragedy, because some seemingly nonemergent conditions quickly worsen, and because some patients with life-threatening problems may wrongly decide to steer clear of the ED to avoid pay-first fees.

80,000 walk away from HCA

A Houston hospital that is part of Nashville, Tenn.-based HCA adopted the payment policy in 2004, and it has since spread to nearly half of the chain’s 163 hospitals, said company spokesman Ed Fishbough. Of 6 million ED visits to HCA hospitals in 2011, 80,000 patients with nonemergent problems left without treatment to avoid paying the upfront fee, Fishbough said.

“It has been a successful part of helping to reduce crowding in emergency rooms and to encourage appropriate use of scarce resources,” he added. “This helps ensure that the sickest patients get treated quickly and those who do not have an emergency have access to more efficient, less-costly care settings.”

In November, the Newton Medical Center in Covington, Ga., announced that it would charge $150 to uninsured patients who want treatment for nonemergent conditions and would collect co-pays or deductibles from insured patients. Two other nearby hospitals in Georgia — Clearview Regional Medical Center in Monroe and Rockdale Medical Center in Conyers — have adopted similar policies, a local news report said.

Hospitals implementing the pay-first policy say it complies with the Emergency Medical Treatment and Active Labor Act because all patients receive the federally required medical screening regardless of ability to pay. It is only after a patient’s condition is deemed nonemergent that upfront payment for further treatment in the ED is discussed. Fishbough said HCA hospitals exempt patients who are pregnant or who are younger than 5 or older than 65. He said HCA hospitals typically have a triage nurse and a physician make the determination that a patient’s condition is not emergent.

Fear of unintended consequences

Some physicians, however, object to the idea. The pay trend is severely misguided, said Arthur L. Kellermann, MD, MPH, who served on an Institute of Medicine emergency care panel and now is a health policy researcher at the RAND Corp., an independent nonprofit think tank.

“People don’t go the ER as a recreational event,” he said. “If you tell me you have an urgent care clinic or walk-in clinic or other places where these people can go straight to, then OK. But to tell someone to just go away if you don’t have $150, you have to be ignoring the fact that if they had somewhere to go they wouldn’t be there in the first place. And you have to be damn sure that this patient doesn’t have a more serious problem.

Half of U.S. hospitals collect patient co-pays, deductibles or other charges at the time of ED service.

“This is putting a Band-Aid on a gunshot wound.”

Andrew E. Sama, MD, president of the American College of Emergency Physicians, also expressed reservations about the upfront-charge policy.

“What I’m worried about is that people are going to have second thoughts about getting serious symptoms evaluated, and that to me is a real compromise,” said Dr. Sama, senior vice president of emergency services at North Shore-Long Island Jewish Health System in Manhasset, N.Y. The hospital does not charge ED patients up front for nonemergent care.

Emergency medicine researchers said charging first for nonurgent care is unlikely to cut wait times significantly or reduce crowding. According to the most recent data from the Centers for Disease Control and Prevention, only 7.7% of ED visits are classified as “nonurgent,” meaning patients would not be harmed by waiting to receive treatment within two to 24 hours for their problems. Meanwhile, a June 20 Annals of Emergency Medicine study found that ED visits rose 15% between 2001 and 2008 and outpaced population growth by 60%. The time spent in the ED — one way to measure crowding — jumped 30%. But that rise was driven by a 23% growth in high-acuity patients who spent 41% more time in the ED undergoing tests and procedures. The number of low-acuity patients grew by only 6%, the study said.
Physicians who take after-hours calls from patients often face a difficult decision: Which symptoms can wait for an office visit, and which ones require a trip to the emergency department? Now doctors find these decisions complicated by a troubling, rising trend: Will a trip to the ED mean an upfront charge for a patient if the problem is deemed nonemergent?

At least half of hospitals are making efforts to collect patient co-pays, deductibles or other charges at the time of service in the emergency department, said Richard Gundling, vice president of health care financial practices at the Healthcare Financial Management Assn. The organization has 39,000 members, including chief financial officers and other professionals in health care financing.

Gundling said a smaller but growing number of hospitals give patients whose problems are deemed nonemergent a choice: Pay an initial fee to get the problem treated in the ED, or seek care elsewhere. The fees range from $100 to $180 for uninsured patients, or the relevant co-pay or deductible for insured patients. He said it is unclear how many hospitals are charging ED patients up front for nonemergency care, but he added that hospitals financially squeezed by uncompensated care increasingly are opting for this collections model.

“That’s getting to be more and more common,” Gundling said, “because of overcrowding, and because hospitals tend to be filled with people who are using ERs as a regular physician office. It’s better to tell the patient up front that they have to pay a $150 fee than billing them at the end, when they may not have realized the difference in cost.”

Yet many doctors interviewed for this article found the growing trend alarming. They said it unfairly targets patients with poor access to primary care and is unlikely to alleviate ED crowding because nonurgent problems make up less than 10% of visits. Emergency physicians added that the policy could result in tragedy, because some seemingly nonemergent conditions quickly worsen, and because some patients with life-threatening problems may wrongly decide to steer clear of the ED to avoid pay-first fees.

80,000 walk away from HCA

A Houston hospital that is part of Nashville, Tenn.-based HCA adopted the payment policy in 2004, and it has since spread to nearly half of the chain’s 163 hospitals, said company spokesman Ed Fishbough. Of 6 million ED visits to HCA hospitals in 2011, 80,000 patients with nonemergent problems left without treatment to avoid paying the upfront fee, Fishbough said.

“It has been a successful part of helping to reduce crowding in emergency rooms and to encourage appropriate use of scarce resources,” he added. “This helps ensure that the sickest patients get treated quickly and those who do not have an emergency have access to more efficient, less-costly care settings.”

In November, the Newton Medical Center in Covington, Ga., announced that it would charge $150 to uninsured patients who want treatment for nonemergent conditions and would collect co-pays or deductibles from insured patients. Two other nearby hospitals in Georgia — Clearview Regional Medical Center in Monroe and Rockdale Medical Center in Conyers — have adopted similar policies, a local news report said.

Hospitals implementing the pay-first policy say it complies with the Emergency Medical Treatment and Active Labor Act because all patients receive the federally required medical screening regardless of ability to pay. It is only after a patient’s condition is deemed nonemergent that upfront payment for further treatment in the ED is discussed. Fishbough said HCA hospitals exempt patients who are pregnant or who are younger than 5 or older than 65. He said HCA hospitals typically have a triage nurse and a physician make the determination that a patient’s condition is not emergent.

Fear of unintended consequences

Some physicians, however, object to the idea. The pay trend is severely misguided, said Arthur L. Kellermann, MD, MPH, who served on an Institute of Medicine emergency care panel and now is a health policy researcher at the RAND Corp., an independent nonprofit think tank.

“People don’t go the ER as a recreational event,” he said. “If you tell me you have an urgent care clinic or walk-in clinic or other places where these people can go straight to, then OK. But to tell someone to just go away if you don’t have $150, you have to be ignoring the fact that if they had somewhere to go they wouldn’t be there in the first place. And you have to be damn sure that this patient doesn’t have a more serious problem.

Half of U.S. hospitals collect patient co-pays, deductibles or other charges at the time of ED service.

“This is putting a Band-Aid on a gunshot wound.”

Andrew E. Sama, MD, president of the American College of Emergency Physicians, also expressed reservations about the upfront-charge policy.

“What I’m worried about is that people are going to have second thoughts about getting serious symptoms evaluated, and that to me is a real compromise,” said Dr. Sama, senior vice president of emergency services at North Shore-Long Island Jewish Health System in Manhasset, N.Y. The hospital does not charge ED patients up front for nonemergent care.

Emergency medicine researchers said charging first for nonurgent care is unlikely to cut wait times significantly or reduce crowding. According to the most recent data from the Centers for Disease Control and Prevention, only 7.7% of ED visits are classified as “nonurgent,” meaning patients would not be harmed by waiting to receive treatment within two to 24 hours for their problems. Meanwhile, a June 20 Annals of Emergency Medicine study found that ED visits rose 15% between 2001 and 2008 and outpaced population growth by 60%. The time spent in the ED — one way to measure crowding — jumped 30%. But that rise was driven by a 23% growth in high-acuity patients who spent 41% more time in the ED undergoing tests and procedures. The number of low-acuity patients grew by only 6%, the study said.

Full Article: http://www.ama-assn.org/amednews/2012/12/03/prl21203.htm

Many disabled are stuck in Coney Island and other locations where elevators are not working and no time frames are known as to when they will be fixed. Click the picture for the article.

Our 1100 battery operated stairlifts worked normally during the Sandy power outage. We only lost one to the storm surge and that was left by the owner at its lower level when the water arrived suddenly.

George and the crew went out immediately after the storm to service clients affected by Sandy. Some of our owners ran the batteries down with excessive use. This could have been avoided by observing a little restraint in using their chairs while there was no power to recharge the batteries.

Unless you know someone who is already benefitting from using a stairlift you may be a little unsure of what is involved in owning and using a stairlift.

It is a popular misconception that stairlifts are fixed to the wall. This is rarely the case with domestic stairlifts which are usually fitted directly on to the staircase itself.

A stairlift has three basic components. Firstly, a track is fitted to your stairs and a power pack (the drive unit) is fitted to the track. This is the unit that will travel along the track. Then the seat that most suits your needs is fitted to the power pack.

All stairlifts are operated by a switch or toggle that is held in the direction of travel to make the lift move. When it is released the lift will stop moving.

All Handicare stairlifts are battery powered meaning they can still be used during a power outage. You can operate them yourself, so even if you find yourself alone, you will be able to get up and down the stairs.

Call Ramps/Lifts for Better Living for a no obligation quote 718-605-2626 or email info@rampsforliving.com
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George is out helping people to find and organize the paperwork they need to apply for assistance from FEMA. Click the picture for an article about applying for FEMA after Hurricane Sandy.

How to apply for FEMA Assistance

You can apply for FEMA assistance over the phone or online. In both cases, particularly over the phone, have patience. The system may be overloaded with many people trying to make claims at the same time. And remember, the people working for FEMA are doing their best to help you, extending them your patience and courtesy can go a long way in helping your claim get registered accurately.

When you make your claim, be sure to have the following information ready to make the process go more smoothly:
■Your Social Security number.
■Current and pre-disaster address.
■A telephone number where you can be contacted.
■Insurance information.
■Total household annual income
■A routing and account number from your bank (if you want to have disaster assistance funds transferred directly into your bank account)
■A description of your losses that were caused by the disaster.

You will receive a FEMA claim number. Write this down and keep it! You will need it for future reference! You can make a claim at the FEMA Individual Assistance Center. You may also be eligible for aid from the Small Business Administration if you are a business owner.

To Organize Life’s Details call for a no obligation quote 718-605-2626 or email Info@VitalOrganizationalSystems.com

Don’t wait for an emergency to plan for a way across, call Ramps/Lifts for Better Living at 718-605-2626

The likelihood that you and your family will recover from an emergency tomorrow often depends on the planning and preparation done today. While each person’s abilities and needs are unique, every individual can take steps to prepare for all kinds of emergencies from fires and floods to potential terrorist attacks. By evaluating your own personal needs and making an emergency plan that fits those needs, you and your loved ones can be better prepared. This guide outlines commonsense measures individuals with disabilities, special needs, and their caregivers can take to start preparing for emergencies before they happen. Preparing makes sense for people with disabilities and special needs. Get Ready Now.

1) Get a Kit – Of Emergency Supplies

The first step is to consider how an emergency might affect your individual needs. Plan to make it on your own, for at least three days. It’s possible that you will not have access to a medical facility or even a drugstore. It is crucial that you and your family think about what kinds of resources you use on a daily basis and what you might do if those resources are limited or not available.

Basic Supplies:
Think first about the basics for survival – food, water, clean air and any life-sustaining items you require. Consider two kits. In one kit put everything you will need to stay where you are and make it on your own for a period of time. The other kit should be a lightweight, smaller version you can take with you if you have to leave your home. Recommended basic emergency supplies include:

* Water, one gallon of water per person per day for at least three days, for drinking and sanitation
* Food, at least a three-day supply of non-perishable food and a can opener if kit contains canned food
* Battery-powered or hand crank radio and a NOAA Weather Radio with tone alert and extra batteries for both
* Flashlight and extra batteries
* First aid kit
* Whistle to signal for help
* Dust mask to help filter contaminated air and plastic sheeting and duct tape to shelter-in-place
* Moist towelettes, garbage bags and plastic ties for personal sanitation
* Wrench or pliers to turn off utilities
* Local maps
* Pet food, extra water and supplies for your pet or service animal

Include Medications and Medical Supplies:
If you take medicine or use a medical treatment on a daily basis, be sure you have what you need on hand to make it on your own for at least a week. You should also keep a copy of your prescriptions as well as dosage or treatment information. If it is not possible to have a week-long supply of medicines and supplies, keep as much as possible on hand and talk to your pharmacist or doctor about what else you should do to prepare.

If you undergo routine treatments administered by a clinic or hospital or if you receive regular services such as home health care, treatment or transportation, talk to your service provider about their emergency plans. Work with them to identify back-up service providers within your area and the areas you might evacuate to. If you use medical equipment in your home that requires electricity to operate, talk to your health care provider about what you can do to prepare for its use during a power outage,

Additional Items:
In addition, there may be other things specific to your personal needs that you should also have on hand. If you use eyeglasses, hearing aids and hearing aid batteries, wheelchair batteries, and oxygen, be sure you always have extras in your home. Also have copies of your medical insurance, Medicare and Medicaid cards readily available, if you have a service animal, be sure to include food, water, collar with ID tag, medical records and other emergency pet supplies.

Include Emergency Documents:
Include copies of important documents in your emergency supply kits such as family records, medical records, wills, deeds, social security number, charge and bank accounts information, and tax records. It is best to keep these documents in a waterproof container. If there is any information related to operating equipment or life-saving devices that you rely on, include those in your emergency kit as well, and also make sure that a trusted friend or family member has a copy of these documents. Include the names and numbers of everyone in your personal support net- work, as well as your medical providers, if you have a communication disability, make sure your emergency information list notes the best way to communicate with you, also be sure you have cash or travelers checks in your kits in case you need to purchase supplies.

2) Make a Plan – For What You Will Do in an Emergency

The reality of a disaster situation is that you will likely not have access to everyday conveniences. To plan in advance, think through the details of your everyday life. If there are people who assist you on a daily basis, list who they are and how you will contact them in an emergency. Create your own personal support network by identifying others who will help you in an emergency. Think about what modes of transportation you use and what alternative modes could serve as back-ups. If you require handicap accessible transportation be sure your alternatives are also accessible. If you have tools or aids specific to your disability, plan how you would cope without them. For example, if you use a communication device, mobility aid, or rely on a service animal, what will you do if these are not available? If you are dependent on life-sustaining equipment or treatment such as a dialysis machine, find out the location and availability of more than one facility. For every aspect of your daily routine, plan an alternative procedure. Make a plan and write it down. Keep a copy of your plan in your emergency supply kits and a list of important information and contacts in your wallet. Share your plan with your family, friends, care providers and others in your personal support network.

Create a Personal Support Network:
If you anticipate needing assistance during a disaster, make a list of family, friends and others who will be part of your plan. Talk to these people and ask them to be part of your support network. Share each aspect of your emergency plan with everyone in your group, including a friend or relative in another area who would not be impacted by the same emergency who can help if necessary. Make sure everyone knows how you plan to evacuate your home, school or workplace and where you will go in case of a disaster. Make sure that someone in your personal support network has an extra key to your home and knows where you keep your emergency supplies. Teach them how to use any lifesaving equipment or administer medicine in case of an emergency. If you use a wheelchair, oxygen or other medical equipment show friends how to use these devices so they can move you if necessary or help you evacuate. Practice your plan with those who have agreed to be part of your personal support network.

Inform your employer and co-workers about your disability and let them know specifically what assistance you will need in an emergency. This is particularly important if you need to be lifted or carried. Talk about communication difficulties, physical limitations, equipment instructions and medication procedures. If you are learning impaired, discuss the best ways to alert you in an emergency. If you have a cognitive disability, be sure to work with your employer to determine how to best notify you of an emergency and what instruction methods are easiest for you to follow. Always participate in exercises, trainings and emergency drills offered by your employer.

Develop a Family Communications Plan:
Your family may not be together when disaster strikes so plan how you will contact one another and review what you will do in different situations. Consider a plan where each family member calls or e-mails the same friend or relative in the event of an emergency. It may be easier to make a long-distance phone call than to call across town, so an out-of-town contact, not in the impacted area, may be in a better position to communicate among separated family members. You may have trouble getting through, or the phone system may be down altogether, but be patient. For more information on how to develop a family communications plan, visit vww.ready.gov.

Deciding to Stay or Go:
Depending on your circumstances and the nature of the emergency, the first important decision is whether you stay or go. You should understand and plan for both possibilities. Use common sense and available information to determine if there is immediate danger. In any emergency, local authorities may or may not immediately be able to provide information on what is happening and what you should do. However, you should monitor television or radio news reports for information or official instructions as they become available. If you’re specifically told to evacuate or seek medical treatment, do so immediately. If you require additional travel time or need transportation assistance, make these arrangements in advance.

Consider Your Service Animal or Pets:
Whether you decide to stay put in an emergency or evacuate to a safer location, you will need to make plans in advance or your service animal and pets. Keep in mind that what’s best for you is typically what’s best for your animals. If you must evacuate, take your pets with you, if possible. However, if you are going to a public shelter, it is important to understand that by law only service animals must be allowed inside. Plan in advance for shelter alternatives that will work for both you and your animals; consider loved ones or friends outside of your immediate area, pet-friendly shelters and veterinarians who would be willing to take in you and your pets in an emergency. For more information about pet preparedness, visit http://www.ready.gov.

Staying Put:
Whether you are at home or elsewhere, there may be situations when it’s simply best to stay where you are and avoid any uncertainty outside. Consider what you can do to safely shelter- in-place alone or with friends, family or neighbors, also consider how a shelter designated for the public would meet your needs.

There could be times when you will need to stay put and create a barrier between yourself and potentially contaminated air outside. This process is known as “sealing the room.” Use available information to assess the situation. If you see large amounts of debris in the air, or if local authorities say the air is badly contaminated, you may want to take this kind of action. For more information about “sealing the room”, visit http://www.ready.gov.

Evacuation:
There may be conditions in which you will decide to get away or there may be situations when you may be ordered to leave. Plan how you will get away and anticipate where you will go. Choose several destinations in different directions so you have options in an emergency. Ask about evacuation plans at the places where you spend time including work, school, community organizations and other places you frequent. If you typically rely on elevators, have a back-up plan in case they are not working.

Fire Safety:
Plan two ways out of every room in case of fire. Check for items such as bookcases, hanging pictures, or overhead lights that could fall and block an escape path. Check hallways, stairwells, doorways, windows and other areas for hazards that may keep you from safely leaving a building during an emergency, Secure or remove furniture and objects that may block your path, if there are aspects of preparing your home or workplace that you are not able to do yourself, enlist the help of your personal support network.

Contact Your Local Emergency Information Management Office:
Some local emergency management offices maintain registers of people with disabilities so you can be located and assisted quickly in a disaster. Contact your local emergency management agency to see if these services exist where you live or visit http://www.ready.gov to find links to government offices in your area. In addition, wearing medical alert tags or bracelets that identify your disability can be a crucial aid in an emergency situation. When traveling, consider alerting hotel or motel workers if you will need help in a disaster situation.

3) Be Informed – About What Might Happen

Some of the things you can do to prepare for the unexpected, such as assembling an emergency supply kit and making an emergency plan are the same regardless of the type of emergency. However, it’s important to stay informed about what might happen and know what types of emergencies are likely to affect your region. For more information about specific types of emergencies, visit http://www.ready.gov.

Be prepared to adapt this information to your personal circumstances and make every effort to follow instructions received from authorities on the scene. Above all, stay calm, be patient and think before you act. With these simple preparations, you can be ready for the unexpected.

Preparing Makes Sense for People with Disabilities and Special Needs. Get Ready Now.

This information was developed by the US. Department of Homeland Security in consultation with AARP, the American Red Cross and the National Organization on Disability.

Here is a full emergency guide prepared by the National Fire Protection Association, http://www.nfpa.org/assets/files/pdf/forms/evacuationguide.pdf