Death Doulas Give Time To Those Running Out Of It

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Chris Bruton said his dad got sick in 2017 and just never got better.

“He had fatigue and we didn’t know what it was,” he said.

By January 2018, they had an answer.

“He actually had stage four kidney cancer,” Bruton said. “He was basically given about two to four months to live.”

When Bruton was a kid, his dad travelled a lot, so he didn’t get to know his dad that well. But after Bruton’s mom died, his dad moved from North Carolina to live with Bruton in Colorado. Bruton was in his 40s, his dad was in his 70s.

A year later, his dad got sick. Once they got the diagnosis, a woman Bruton was seeing suggested a death doula.

“And of course, I’d never heard of it. It sounded a little bit, a little bit hocus pocus-y to me,” he said. “I thought, well, I don’t think my dad would be up for anything like that.”

But then his dad started to close himself off and isolate, so Bruton agreed to meet with Cindy Kaufman, an end-of-life doula who works out of Denver. And Bruton introduced her to his dad.

He remembers chatting before Kaufman asked his dad how he was doing – how he was really doing. In an uncomfortable silence, Bruton and his aunt left to give them space.

“And as I walked out, I heard sobbing from my father that I had never heard before,” he said. “This well of stress and fear, anxiety, sadness, it all just came out.”

Kaufman came by one or two times a week, and then drove down for the end. It only took about two months. Bruton said she even helped his dad’s dog through it.

“After my dad had passed, she said, ‘Hey, let’s get Matty up here on the bed and so she can see your dad.’ And I think that even helped the dog find closure and understand what was going on,” he said.

Even though he’d never heard of a death doula before, Bruton is now a convert.

“I had no idea how much work there was to do to help someone who’s going through the dying process until I saw what Cindy did. And yeah, changed our lives,” he said. “Changed our lives and changed my dad’s life at the very end of it.”

Death doulas are also called death midwives or end-of-life doulas, but whatever you call them, their numbers have blossomed in the last decade. There’s a few in every state, but Colorado is a hotspot in the Mountain West. Beyond being a doula, Cindy Kaufman leads the Colorado End-of-Life Collaborative.

“End-of-life doulas fill what we believe is a gap,” she said.

That gap is the space between hospices, which provide necessary medical care, and what she does – help someone with the actual process of dying.

Since the hospice industry started in the ’70s and ’80s, Kaufman said, it’s become more of a business with certain hours and staff caring for multiple clients. While they started as non-profits, the majority of hospices are now for-profit institutions.

“We don’t carry those kinds of case-loads, we work for (ourselves),” she said, comparing death doulas with hospice staff. “We don’t fall under insurance, we’re private pay.”

Kaufman said death doulas can bring ritual back into dying, and make it easier to say goodbye.

They can help plan legacy projects, say late-night prayers, figure out what kind of burial or cremation someone wants. For some, they just sit with people, right up to the end.

And death doulas are incredibly diverse, not only in what they offer but with their backgrounds. There’s no licensing requirement or mandatory training. Kaufman said some people use their own culture to inform how they practice as death doulas, and they don’t want more regulations.

“They want to be honored for the fact that they were trained within their own family and community to do what they do,” she said.

Still, several training centers have cropped up in recent years. Some are in places like Australia and the UK. And there’s one in New Jersey called the International End Of Life Doula Association, or INELDA.

Henry Fersko-Weiss is a death doula who created INELDA six years ago.

He said it’s good to take other cultures into consideration, but the profession needs standardization if they want to be reimbursed by Medicare or Medicaid. He said that could also improve quality of care – and help the fledgling profession evolve and gain trust.

“Anybody could call themself a doula without knowing anything, without having any training,” he said. “And I think that can do a disservice to the development of this field.”

Nancy L. Compton is an INELDA trainer based in Boise, Idaho. She’s also a certified hospice nurse assistant, palliative nurse assistant and death doula.

She’s proud death doulas can work outside normal constraints.

“Not everybody is born nor dies Monday through Friday, 8 to 5,” Compton said.

But she’s also proud of what her intimate knowledge of the dying process does for families.

“That’s where I am different and that’s where I pioneered this, especially in the Boise Valley,” she said.

Compton said a hospice paid her to practice there, and that’s unusual for a death doula. Medicare sanctions death doulas, but won’t reimburse for their care – yet. That would require a lot more standardization.

Deb Rawlings, at least, is fascinated by the diversity in this budding industry.

“It was amazing to find that there were so many differences in what the death doulas say that they do and what they offer,” she said.

Rawlings teaches palliative care at Flinders University in Australia. She’s one of the few people who’ve researched the occupation.

She found that many death doulas are former hospice workers or nurses. Some volunteer, others charge. Some help with a spiritual journey, others help with more physical tasks.

But even though they’re so different, death doulas have generally described their role to Rawlings like this: “We’ve got time. So I’ve got time to come in and sit with you. I might sit with the person who’s dying and let their family go and have a break. I might help and do the washing.”

In other words, they give time to those who are running out of it.

Complete Article HERE!

We all hope for a ‘good death’.

But many aged-care residents are denied proper end-of-life care

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Death is inevitable, and in a civilised society everyone deserves a good one. It would therefore be logical to expect aged-care homes would provide superior end-of-life care. But sadly, palliative care options are often better for those living outside residential aged care than those in it.

More than a quarter of a million older Australians live in residential aged care, but few choose to be there, few consider it their “home”, and most will die there after living there for an average 2.6 years. These are vulnerable older people who have been placed in residential aged care when they can no longer be cared for at home.

The royal commission has made a forceful and sustained criticism of the quality of aged care. Its final report, released this week, and the interim report last year variously described the sector as “cruel”, “uncaring”, “harmful”, “woefully inadequate” and in need of major reform.

Quality end-of-life care, including access to specialist palliative care, is a significant part of the inadequacy highlighted by the report’s damning findings. This ranked alongside dementia, challenging behaviours and mental health as the most crucial issues facing the sector.

Longstanding problem

In truth, we have already known about the palliative care problem for years. In 2017 the Productivity Commission reported that end-of-life care in residential aged care needs to be better resourced and delivered by skilled staff, to match the quality of care available to other Australians.

This inequality and evident discrimination against aged-care residents is all the more disappointing when we consider these residents are among those Australians most likely to find themselves in need of quality end-of-life care.

The royal commission’s final report acknowledges these inadequacies and addresses them in 12 of its 148 recommendations. Among them are recommendations to:

  • enshrine the right of older people to access equitable palliative and end-of-life care
  • include palliative care as one of a range of integrated supports available to residents
  • introduce multidiscpliniary outreach services including palliative care from local hospitals
  • require specific training for all direct care staff in palliative and end-of-life care skills.

What is good palliative care?

Palliative care is provided to someone with an active, progressive, advanced disease, who has little or no prospect of cure and who is expected to die. Its primary goal is to optimise the quality of life for that person and their family.

End-of-life care is provided by palliative care services in the final few weeks of life, in which a patient with a life-limiting illness is rapidly approaching death. This also extends to bereavement care for family and loved ones.

Unlike in other sectors of Australian society, where palliative care services are growing in line with overall population ageing, palliative care services in residential aged care have been declining.

Funding restrictions in Australian aged-care homes means palliative care is typically only recommended to residents during the final few weeks or even days of their life.

Some 70% of Australians say they would prefer to die at home, surrounded by loved ones, with symptoms managed and comfort the only goal. So if residential aged care is truly a resident’s home, then extensive palliative and end-of-life care should be available, and not limited just to the very end.

Fortunately, the royal commission has heard the clarion call for attention to ensuring older Australians have as good a death as possible, as shown by the fact that a full dozen of the recommendations reflect the need for quality end-of-life care.

Moreover, the very first recommendation — which calls for a new Aged Care Act — will hopefully spur the drafting of legislation that endorses high-quality palliative care rather than maintaining the taboo around explicitly mentioning death.

Let’s talk about death

Of course, without a clear understanding of how close death is, and open conversation, planning for the final months of life cannot even begin. So providing good-quality care also means we need to get better at calculating prognosis and learn better ways to convey this information in a way that leads to being able to make a plan for comfort and support, both for the individual and their loved ones.

Advanced care planning makes a significant difference in the quality of end-of-life care by understanding and supporting individual choices through open conversation. This gives the individual the care they want, and lessens the emotional toll on family. It is simply the case that failing to plan is planning to fail.

We need to break down the discomfort around telling people they’re dying. The unpredictability of disease progression, particularly in conditions that involve frailty or dementia, makes it hard for health professionals to determine when exactly palliative care will be needed and how to talk about it with different cultural groups.

These conversations need to be held through the aged-care sector to overcome policy and regulation issues, funding shortfalls and workforce knowledge and expertise.

We need a broader vision for how we care for vulnerable Australians coming to the end of a long life. It is not just an issue for health professionals and residential care providers, but for the whole of society. Hopefully the royal commission’s recommendations will breathe life into end-of-life care into aged care in Australia.

Complete Article HERE!

Caring for a dying loved one

There’s no denying that caring for a dying loved one is a heart-wrenching experience. Through specialized quality care, however, patients and their families can continue to share meaningful moments, despite a terminal diagnosis.

Every year, hospices and palliative care centers across the nation unite to raise awareness of available options for end-of-life care. How does hospice and palliative care work? Hospice and palliative care maximize the quality of life of people with advanced or life-limiting illnesses through pain management, symptom control, psychosocial support and spiritual care, among other means.

What can you do to help?

Understanding what to expect and what you can do to increase a patient’s comfort level can help ease their suffering. Consider their unique physical, emotional and psychological needs.

• Re-adjust pillows beneath their head to help with labored breathing.

• Be calm and reassuring. Remind your loved one where they are and who is present. Seek help from a medical team if significant agitation occurs.

• Maintain a comfortable room temperature. Provide warm blankets in case of a chill or install a humidifier in a moisture-deprived room.

• Encourage your loved one to communicate unsaid thoughts. Ask open-ended questions about their beliefs or meaningful life moments.

• Seek clarity about the type of care your loved one wishes to receive, in case they can no longer speak for themselves.

• Invite family members and close friends to show their support and say their farewells.

Is someone close to you facing a serious or life-limiting illness? Visit www.nhpco.org for caregiver assistance and resources.

Complete Article HERE!

Covid Strikes Clergy as They Comfort Pandemic’s Sick and Dying

Pastor Marshall Mitchell of Salem Baptist Church in Abington, Pennsylvania, got his first dose of the covid vaccine in December. He believes it’s his spiritual duty to his congregation and community to take precautions to avoid covid-19.

By Bruce Alpert

The Rev. Jose Luis Garayoa survived typhoid fever, malaria, a kidnapping and the Ebola crisis as a missionary in Sierra Leone, only to die of covid-19 after tending to the people of his Texas church who were sick from the virus and the grieving family members of those who died.

Garayoa, 68, who served at El Paso’s Little Flower Catholic Church, was one of three priests living in the local home of the Roman Catholic Order of the Augustinian Recollects who contracted the disease. Garayoa died two days before Thanksgiving.

Garayoa was aware of the dangers of covid, but he could not refuse a congregant who sought comfort and prayers when that person or a loved one fought the disease, according to retired hairstylist Maria Luisa Placencia, one of the priest’s parishioners.

“He could not see someone suffering or worried about a child or a parent and not want to pray with them and show compassion,” Placencia said.

Garayoa’s death underscores the personal risks taken by spiritual leaders who comfort the sick and their families, give last rites or conduct funerals for people who have died of covid. Many also face challenges in leading congregations that are divided over the seriousness of the pandemic.

Ministering to the ill or dying is a major role of spiritual leaders in all religions. Susan Dunlap, a divinity professor at Duke University, said covid creates an even greater feeling of obligation for clergy, because many patients are isolated from family members, she said.

People near death often want to interact with God or make things right, Dunlap said, and a clergy member “can help facilitate that.”

Such spiritual work is key to the work of hospital chaplains, but it can expose them to virus being spread in the air or sometimes through touch. Jayne Barnes, a chaplain at the Billings Clinic in Montana, said she tries to avoid physical contact with covid patients, but it can be difficult to resist a brief touch, which is often the best way to convey compassion.

“It’s almost an awkward moment when you see a patient in distress, but you know you shouldn’t hold their hand or give them a hug,” Barnes said. “But that doesn’t mean that we can’t be there for them. These are people who cannot have visitors, and they have a lot they want to say. Sometimes they are angry with God, and they let me know about that. I’m there to listen.”

Still, there are times, Barnes said, that the despair is so profound she cannot help but “put on a glove and hold a patient’s hand.”

Barnes was diagnosed with covid near Thanksgiving. She has recovered and has a “better understanding” of what patients are enduring.

Dealing with so much suffering affects even the most hardened doctors and nurses, she said. Billings Clinic staffers were devastated when a beloved physician died of covid, and rallied behind a popular nurse who was seriously ill but recovered.

“We’re not only taking care of the patients; we are also there for the staff, and I think we have been an important asset,’’ she said of the hospital’s chaplains.

In Abington, Pennsylvania, Pastor Marshall Mitchell of Salem Baptist Church said he believes part of his spiritual duty is to persuade his congregation and the broader African American community to take precautions to avoid covid. That is why Mitchell allowed photographers to capture the moment in December when he received his first dose of a vaccine.

“As pastor of one of the largest churches in the Philadelphia region, it is incumbent on me to demonstrate the powers of both science and faith,” he said.

Mitchell said he might have credibility in convincing other African Americans, who have been disproportionately affected by covid, that a vaccine can save lives. Many are skeptical.

The politicization of covid precautions such as masks and social distancing has put many pastors in a difficult position.

Mitchell said he has no patience for people who refuse to wear masks.

“I keep them the hell away from me,” he said.

Jayne Barnes, a chaplain at the Billings Clinic in Montana, says it’s awkward not to touch or hug a covid patient in distress. But sometimes she cannot help but “put on a glove and hold a patient’s hand.”

Jeff Wheeler, lead pastor of Central Church in Sioux Falls, South Dakota, said that his church encourages mask-wearing and that most congregants comply. However, the underlying tension is reflected in his message to members on the church’s website:

“As we move forward, we simply ask you to avoid shaming, judging or making critical comments to those wearing or not wearing masks,” it reads.

Sheikh Tarik Ata, who leads the Orange County Islamic Foundation in California, said that the Quran calls for Muslims to take actions to ensure their health and that congregants largely comply with covid guidelines

“So, our members don’t have a problem with mask mandates,” he said.

Covid has hit the Orange County Muslim population hard, Ata said. Religion has become an important source of comfort for members who have lost their jobs and struggled with illness or finding child care.

“Our faith says that no matter how difficult the situation, we always have access to God and the future will be better,” Ata said.

Adam Morris, the rabbi at Temple Micah in Denver, said he has turned to online video to meet with congregants sick with the coronavirus. When meeting with his congregation members in person, such as during graveside services, he worries that with his mask on people might miss seeing the concern and compassion he feels for their plight.

He conducts in-person graveside funerals for a small number of mourners but requires all participants to wear masks.

Observant Muslims and Jews believe it is important to bury the dead quickly after death, Morris said.

“Some traditions and rituals must go forward,” Morris said, “covid or not.”

Complete Article HERE!

50 Million Americans Are Unpaid Caregivers.

We Need Help.

Biden must make good on his promise to support families with sick loved ones.

By Kate Washington

Five years ago I stood in a tiny hospital room wondering how I was going to care for the man I loved most without succumbing to despair.

For four months, my husband, Brad, had been recovering from a stem-cell transplant that saved his life from aggressive lymphoma. The hospital administration said he must go home, but he needed a level of support that, I thought, only a hospital could provide.

His homecoming ought to have been cause for celebration. But I felt anything but joyful. The night before his discharge, unable to sleep, I felt so trapped and terrified that I called a suicide hotline, even though I wasn’t really sure I wanted to harm myself. I was so desperate I needed to hear a compassionate human voice, and I couldn’t think of anywhere else to turn.

Though isolated, I was far from alone: according to a 2020 survey by AARP, more than 50 million Americans now serve as unpaid caregivers for adult family members or friends. That number will rise as the baby boomers age. That’s the bad news. The good news is that with the Biden administration committed to a bold, integrated vision of care, we have a once-in-a-generation opportunity.

The plight of family caregivers, who often compromise work, finances, friendships and their own health to support their ill or disabled loved ones, has long been overlooked in U.S. policy. While some states offer programs to help caregivers, they can be inadequate and hard to navigate. The coronavirus pandemic has revealed many problems in our health system, and few more starkly than the way it both undervalues and relies on caregivers.

I became painfully familiar with caregiving’s challenges during Brad’s months of chemo in 2015, but it was his 2016 stem-cell transplant — a last-ditch treatment for relapsed cancer — that showed me just how broken our system is. When he was discharged, he was immunocompromised, blind, too weak to walk unassisted, and unable to eat more than half his calories.

“He’ll need attendance 24 hours a day,” his oncologist told me. I stared, panic rising.

“How am I supposed to do that? We have two kids,” I said. Even meeting our family’s most basic needs would be impossible.

“Well, usually family steps in and it works out fine,” the doctor replied, waving away my concerns. Our family had been extremely supportive but couldn’t drop everything indefinitely. A nurse suggested organizing shifts of friends, but my friends, like me, were working parents.

Besides, caring for Brad wasn’t simply watching him. He came home with 35 medications that had to be administered on a mind-boggling schedule, as well intravenous nutrition that I had to hook up, a complex procedure that I learned to perform in a hasty training session from a nurse. He needed blood sugar tests and assistance with toileting, showering and other intimate acts at which even close friends might well balk.

Insurance does not cover home attendants even when medically necessary. Our benefits did pay for skilled nursing visits and home health aides for assistance with showering twice a week, but for the 24-hour care the doctor prescribed, we had to pay out of pocket. The summer after Brad came home, we spent more than $21,000 on in-home care, dipping into savings and an inheritance from my mother to do so. We were very fortunate to have those resources; for many families, it would be out of reach.

It’s often noted that the United States is alone among rich nations in not providing maternity leave; support for child care is likewise abysmal. Similarly — but often more invisibly — we leave millions of caregivers with little or no support in managing the financial, logistical and emotional difficulties of helping ailing parents, spouses and children.

The Biden-Harris campaign made an ambitious caregiving plan a key plank of its platform. Early signs from the new administration are promising. Mr. Biden’s $1.9 trillion coronavirus emergency relief package includes measures benefiting caregivers: extending stimulus payments to cover previously overlooked adult dependents, tax credits, and paid family and medical leave. Some of these benefits would help family caregivers of all kinds; others specifically aid those tending people with Covid-19.

Although pandemic relief is the most urgent priority, change must not stop there. The plan Mr. Biden rolled out during the campaign proposed an integrated approach to supporting child care, care for older people, paid care work, and family caregivers. Among other measures, it floated a $5,000 tax credit for unpaid caregivers, Social Security credits for those who must leave their jobs to provide care, and 12 weeks of guaranteed paid family leave.

The plan would also offer wider access to home- and community-based long-term care and support services. Gaps in Medicaid coverage for these services has resulted in long waiting lists and made it harder for people to receive needed care at home.

Such changes would clearly benefit both family caregivers and paid workers, who are disproportionately women of color. With few job protections, in-home workers have long had difficulty finding stable, well-paid work, a plight worsened by Covid-19. The Biden policy team has argued that its plan would create up to three million jobs in care work and education, benefiting populations hit hard by pandemic job losses.

The changes wouldn’t help just caregivers like me; what’s good for caregivers also benefits those who need assistance. Expanding home care can keep frail elderly people out of nursing homes, the drawbacks of which have been painfully exposed by the pandemic. Easing financial strains and burnout for caregivers can mean better, more compassionate treatment, which in turn can improve quality of life and outcomes for our most vulnerable citizens.

Even though I had support systems and family to help, and we could afford supplemental care, my husband’s long medical ordeal was almost unbearably stressful. Supporting a catastrophically ill person will never be easy — but in the United States today, it’s far harder than it needs to be. Our system largely abandons those with less privilege than I have to struggle alone caring for those we love most. The result for many is burnout, bankruptcy and profound suffering.

Though my husband remains chronically ill, he has recovered his vision and his independence. There are millions more out there now as desperate as I felt five years ago, crying for relief. A Biden administration primed for change, with the slimmest of Democratic Senate majorities, means there’s a real opportunity to reform and mend our broken systems of care. If we are to have the caring society we all deserve, caregivers and recipients alike, we must not lose that chance.

Complete Article HERE!

Mac study looks to help families discuss end-of-life care during COVID-19

By Maria Iqbal

Long-term-care staff are so swamped with COVID-19 protocols that end-of-life discussions aren’t occurring with residents and families, says a McMaster University professor.

Sharon Kaasalainen, a professor in the school of nursing, says she’s hearing from families that they’re feeling excluded from decisions about their loved one’s care.

“Compassionate care is missing because it’s all around public health protocols,” she said, noting the absence of these conversations is causing “serous concerns.”

Kaasalainen recently met with the Ontario Long Term Care Association and other long-term-care leaders to raise the issue. The point of compassionate care, she says, is to help people become more comfortable talking about death and supporting families through that process.

Kaasalainen’s research involves helping facilitate conversations about end of life in long-term care. She recently received funding to adapt her research for COVID-19, including by developing online tools to support those discussions. The goal is to help residents, families and staff prepare for decisions at the end of a patient’s life.

While COVID-19 poses major staffing challenges, Kaasalainen says palliative care also has to do with education and a home’s priorities.

Her study will pilot online tools at homes in three provinces. Locally, that includes St. Peter’s Residence at Chedoke on the west Mountain, where she expects to roll out the online resources in spring.

The tools in the study include pamphlets on conditions common to long-term-care residents to help both residents and families learn what to expect as a disease progresses.

Pam Holliday participated in an earlier part of Kaasalainen’s research. She says the tools taught her to ask care providers more specific questions about the health of her elderly mother, a resident at Shalom Village in Westdale.

Holliday says palliative care conversations can help even before a person’s death. In her case, her mother got sick multiple times, but bounced back.

“You try to make them better, but you try to make them enjoy what they have,” Holliday said about the approach.

She adds that the resources are particularly helpful during COVID-19, when there are restrictions on visits to long-term care.

“We’re totally reliant on staff communicating any changes with us,” Holliday said. “It’s (about) asking the right questions.”

Kaasalainen says care conversations can also include the type of music a person would like to hear when they’re dying and which loved ones are with them. But avoiding the discussions affects the quality of care during a patient’s final days and how families cope after a death.

“We’re seeing families very distressed, having to make decisions unprepared, and it leads to poor bereavement,” Kaasalainen said. “They have these lingering feelings of guilt and stress.”

In March, Kaasalainen is also planning to launch a national community of practice with the Canadian Hospice Palliative Care Association. It would bring together researchers, care providers and families in long-term care to discuss palliative care.

Her hope is to see families involved in care decisions feeling better prepared.

“The goal really is good death, peaceful death and families feeling guilt-free and prepared for death when it happens.”

Complete Article HERE!

Patients With Poor Health Literacy Less Likely to Elect Hospice

By Jim Parker

Patients who have low levels of health literacy are more likely to seek intensive curative treatment at the end-of-life, as opposed to choosing hospice care. In addition to disparities in hospice utilization associated with race or ethnicity, a patient’s understanding of their condition and the available treatments may also be a contributing factor, according to a recent study in the American Journal of Hospice & Palliative Medicine.

Health literacy is the degree to which individuals can obtain, process and understand basic health information and services needed to make appropriate health decisions, according to the Institute of Medicine. A health illiterate patient may have a strong overall ability to read or have an advanced education but have a limited understanding of information specific to health care.

“Medicare beneficiaries who resided in low health literacy areas were likely to receive aggressive end-of-life care,” the study indicated. “Tailored efforts to improve health literacy and facilitate patient-provider communications in low health literacy areas could reduce end-of-life care intensity.”

Patients who lack an understanding of health care information or terminology, do not understand their own illnesses, or who misconstrue the nature of hospice or palliative care may lack the necessary tools to make an informed decision about their end-of-life wishes

For the study, researchers conducted a retrospective analysis of nearly 650,000 Medicare fee-for-service decedents who died between July and Dec. 2011. They used a Health Literacy Data Map to calculate health literacy scores by ZIP code. For the purposes of this study, a score of 225 or lower was defined as low health literacy. Aggressive end-of-life care measures included repeated hospitalizations within the last 30 days of life, no hospice enrollment within the last six months of life, and/or in-hospital death.

Close to 83% of decedents in low health literacy areas pursued aggressive end-of-life care, compared to about 73% in high health literacy ZIP codes. Patients in low health literacy areas were also much less likely to utilize hospice.

Low health literacy is very common in the United States, often impacting older adults. As many as one-third of Medicare enrollees have a low-level of health literacy, and research indicates that this increases across-the-board health care costs by as much as 5% annually.

“Elderly managed care enrollees may not have the literacy skills necessary to function adequately in the health care environment,” a Journal of the American Medical Association study found. “Low health literacy may impair elderly patients’ understanding of health messages and limit their ability to care for their medical problems.”

Complete Article HERE!