Merrily’s Items of Interest

Everywhere you look are life's lessons

Learning as We Go. Life’s Lessons.

What critical lessons have you learned in life so far?

One day when my older son was about mid-thirties, he said to me, “It certainly would be great to know, in advance, which of the life decisions you make are pivotal ones.” I agreed, and was happy that a child of mine had such insight. Then I pondered a bit and realized that all of our decisions are, in some way, pivotal. If you choose A then B is left behind. And the trajectory of your life depends on lots of decisions. Some made instantly. Some that direct us to a path on which we continue to travel.

Who you marry, where you live, who you call “friends”, how you vote, what you eat, whether or not you are sociable or reclusive – all of these are daily choices. In work, how you respond, how you conduct yourself, who you choose to spend time with, how you meet deadlines, and much more are your daily choices.

And some bad choices continue to be made, even fully knowing the consequences. We are human, after all, and we will continue to make mistakes. And that is good, as we will learn from those and forge on!

So, what critical lessons have you learned in life so far?

Indra Noori is considered one of the world’s most powerful women, and is currently CEO of PepsiCo, the 2nd largest food & beverage company in the world. Her critical lessons for business (some also applied to life, in general) are great.

Noori’s seven lessons translate into the seven characteristics of a great leader: Vision. Persistence. Persuasion. Listening. Learning. Collaborating. Humility.

1) Everyone needs a vision 

She knew that if PepsiCo wanted to continue to be successful in the 21st century, they needed to adapt the business to consumers’ changing preferences and offer them healthier food and beverage options.

Noori noted, “If we wanted to lower our energy and packaging costs and get a license to operate in water-strained markets, we needed to be more environmentally sustainable. If we wanted to continue recruiting and retaining world-class talent, we needed to meet the changing expectations of a new generation of employees…So, that’s lesson number one: Come up with a vision that not only reflects the direction of a company but moves people, inspires people to make it a reality.”

2) Think hard about time 

“A while back, The New Yorker published a great cartoon. The caption read: ‘Yes, the planet got destroyed. But for a beautiful moment in time, we created a lot of value for shareholders.’ It not only made me laugh, it made me think about how important it is to balance short-term and long-term interests. So, my second lesson is to think hard about your time horizon…When you focus on the level of returns alone, you’re producing returns that, however high they may be in the short-run, are not sustainable.”

3) Ensure that culture change sticks

“So we stuck with it and teamed up with others in the industry to create the Healthy Weight Commitment Foundation. And together, we removed 6.4 trillion calories from our food and beverage products, surpassing our pledge by more than 400% three years ahead of schedule.”

“It’s crucial, not just to have a clear message, but to have a critical mass of supporters who can help you deliver it.”

4) Listen carefully 

“If you learned to follow, you’d be a better leader.”

“We should listen to the wisdom all around us.”

5) Be a student for life

“I’m constantly trying to consume as much information as I can from as many sources as I can. I can’t afford to stop learning. None of us can. CEOs need to be students for life, and all our employees do, too.”

6) People are everything 

“The success of an enterprise usually comes down to one thing: the team.”

“You need to appeal not only to your employees’ heads but to their hearts.”

7) “Leave the crown in the garage”

Noori tells the story of a visit by her mother that was humbling, but also a great life’s lesson.

“None of us is just an employee. We’re also mothers and fathers, wives and husbands, daughters and sons, trying to balance multiple roles.”

“Let me explain something to you. You may be President of PepsiCo. But when you step into this house, you’re a wife and mother first. Nobody can take that place. So leave that crown in the garage.”

What critical lessons have you learned in life so far?

Let's Turn Healthcare Delivery and Receiving Upside Down

How Home Health Today Keeps Readmissions Away

It is, unfortunately, a common scenario. An older adult falls (as many as one-third to one-half of us, unfortunately, do; every 11 seconds, in fact). A fracture results, warranting a hospital visit followed by in-patient rehab in a Skilled Nursing Facility AKA SNF (40% of the time). The injured recovers fully and that’s the end of the story, right? If only. The reality is that more than half of us older folks will experience another fall within the next six months. And so, unchecked, the cycle repeats.

There’s a not-so-surprising solution, however, that’s finally getting the recognition it deserves: home health care, especially as an integral and immediate part of the transition from SNF (or hospital) to home. A recent study, “Transitions from Skilled Nursing Facility to Home: The Relationship of Early Outpatient Care to Hospital Readmission” verified what we in the industry already know – that in-home care reduces the likelihood of readmissions. And, if you take that out some, reducing readmissions from a previous fall, is also keeping the recent faller in better health and enjoying life more.

“In fact, a home health visit immediately after a discharge from a SNF was the factor most significantly associated with lower readmission rates,” the study confirms. And while there are certainly monetary benefits to be realized in reducing readmissions, for patients themselves and the SNFs and hospitals who will be penalized beginning in 2018, the brass ring is the reduced risk of harm to the elderly – from that first point of intervention upon returning home, and ongoing, for those fortunate enough to be able to afford or qualify for coverage for those services.

All of which brings me back to my concern over the potential future impact on Medicaid and overall health care changes that seem to be targeting the most vulnerable of our population – the poor, disabled, and elderly. Perhaps when money talks in the form of stiff penalties for readmissions, a solution will be created to do whatever it takes to keep seniors safe and healthy – at home. And, at a fraction of the cost of stays in a hospital. Again, the benefits are far greater than just monetary, as in the myriad other benefits of being in familiar surroundings with loved ones.

Soapbox revisited. I think I’ll stand on this soapbox for a few more years. Healthcare at home finally seems to be gaining the attention it deserves! All this talk about health care requires that each of us demand a system that works for all and does not cost an arm and a leg.

Perhaps focusing on wellness, prevention, self-responsibility, and avoiding hospitalizations/trips to SNFs and looking at the options for care at home will become a part of our revamped heathcare delivery/receiving system.

Given the unknown, choose home care when possible

To Stay Healthy (and alive) Longer, Avoid Hospitalization, if Possible

We’ve certainly come a long way from the pre-Florence Nightingale days, when one of the earliest hospitals, the Hotel-Dieu in Paris, offered dark, unsanitary, poorly ventilated wards, multiple patients per bed (many of whom were infectious), and a mortality rate of more than 40%. And yet, we’re still struggling with complications related to hospitalizations – not the least of which is cost. And, in the Hotel-Dieu days, hospitalization was for the poor. The wealthy had healthcare delivered by their personal physician in the comfort of their own homes.

According to the just-released Trends in Hospital Inpatient Stays in the United States, 2005-2014 report, hospital costs are now “one third of healthcare expenditures,” with the inflation-adjusted mean cost per inpatient stay increasing over this time period by an average of 12.7% – from $9,500 to $10,900. Those covered by Medicaid or private insurance saw an even greater jump – as much as 16 – 18%. Actually, if you think about it, the increase for a span of 9 years is not such a great percentage increase. The increases are in the numbers. Although the percentage of hospitalization for the older age groups has decreased, the increase in the numbers is outweighing that drop as well. So, if we could prevent hospitalizations, we would save a boatload of money!

Other highlights of the report include:

  • Mental health/substance use accounted for nearly 6% of all inpatient stays in 2014, up 20.1% from 2005.
  • Between 2005 and 2014, septicemia and osteoarthritis became two of the five most common reasons for inpatient stays. Septicemia hospital stays almost tripled. TRIPLED!
    • People who are already in the hospital for something else, such as a surgery, are at a higher risk of developing septicemia.
    • Secondary infections can occur while in the hospital. These infections are often more dangerous because the bacteria may already be resistant to antibiotics.
  • Nonspecific chest pain and coronary atherosclerosis decreased by more than 60% from 2005 to 2014, falling off the list of top 10 reasons for hospitalization.

And of particular interest to me, as I mentioned above: the report uncovered a substantial decrease between 2005 and 2014 in the rate of hospital stays in the elderly – more than 20% in the over-65 age bracket. No data to back up my suggestions, but it seems to indicate that either older adults are taking better care of themselves, that because of the reputation of infections in hospitals folks are avoiding hospitalizations, if possible, that the provision of home care is working to delay or prevent hospitalizations, what we now call pre-acute care – or a combination thereof. With the significant risks to hospitalized older adults (delirium, bed sores, falls, serious and sometimes deadly infections, just to name a few) it’s crucial to stay OUT of the hospital; and thankfully, it seems we’re headed in the right direction.

 

 

10,000 Boomers turn 65 each DAY!

Help Me Understand This

Sometimes, when there’s a difficult concept to grasp or a difficult decision to be made, it helps to go back to the basics. Start with what you know. For many of us, particularly lifelong learners, and the young, a picture – or a hands-on experience – truly is worth a thousand words. Compare trying to understand Newton’s universal gravitation constant equation at face value (Fgrav = G*m1*m2/d2, where G = 6.673 x 10-11Nm2/kg2) with witnessing a 3D model in a science museum that demonstrates exactly what this concept looks like in the real world.

It seems that understanding, and agreeing upon, the best healthcare plan for our nation has become such a convoluted process that perhaps looking at it from another, more basic angle could help. And there’s one angle that it seems everyone is missing altogether: simple demographics.

And demographics do not lie. Unless we have a pandemic or some widespread disaster that changes life as we know it, the projections are seemingly accurate.

Picture, for example, you provide a service to 100 people, and that group swells to 1,000. Will you be able to continue providing the same level of service to those additional 900 people, at the same cost, or does it stand to reason that the expenses associated with providing your service will grow accordingly? You’ll either need to cut your level of service to 1/10 of what you were providing, or increase your expenses by 900%.

In the real world, demographics show us that Baby Boomers are turning 65 at the rate of 10,000 per day. In 13 years, the last of the Boomers turn 65, and the oldest are turning 84. By age 84, many people are in need of some type of care or assistance with activities of daily living. Now imagine what it’s going to take to ramp up home care or other essential services to meet this burgeoning wave of elderly – and add to that picture the fact that there’s no safety net of care for them.

Help me understand why, when planning for the healthcare of a nation, NO ONE is looking at the demographics? And what’s it going to take to make sure the voices of those slated to be most impacted by this plan are heard? I seriously want to know.

 

Getting old or being disabled should not disqualify one for care.

The Bottom Line About Healthcare

There’s a time and a place to remain quiet. Schools now have mandatory silent sustained reading time, where students cannot speak but are engaged in the pages of a book for 20 minutes. Movie theaters warn us to silence our cell phones when it’s time for the show to begin. Silence is indeed golden at times.

But of course, there are times when being silent is foolish – or even dangerous. We wouldn’t be silent if we noticed that same movie theater that just urged us to silence our cell phones was on fire. And I believe the healthcare crisis we’re on the brink of is of equal measure, preventing my ability to remain silent.

I’m not sure why the topic of healthcare has become so political. Is having access to medical care a right or a privilege? Is it not a requirement for us all? What can each of us, who care about our health and being able to pay for care, should we need it, do today? How can our voice be heard?

Regardless of political party, the lives of many depend on some safety net, and it terrifies me that a safety net for our most poor and disabled will go away. In the words of our former President, “Simply put, if there’s a chance you might get sick, get old, or start a family – this bill will do you harm. And small tweaks over the course of the next couple weeks, under the guise of making these bills easier to stomach, cannot change the fundamental meanness at the core of this legislation.”

In the arena of aging care, my personal niche, it’s a fact that care at home is, usually, a lower cost alternative. However, when pricing and comparing, we do not include the cost of maintaining the home. If one moves elsewhere, that cost is included in the cost of care. When you are really sick, the only thing you can think of is a) stopping the pain; and then b) getting better. Being unable to afford necessary care should never come into the equation.

I wish I had the answers, but I do know that healthcare should not be a partisan issue. We should, as a nation, and as polite and caring people, decide what is important to us, and then we should figure out a way to cover basics. All the rest should come after that.

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