![Upstate's HealthLink on Air radio show for Sunday, Nov. 19, 2023](../images/2023/111923-radioshow.jpg)
New poems and essays; playing pickleball safely; monitoring long-term care: Upstate Medical University's HealthLink on Air for Sunday, Nov. 19, 2023
Editor Deirdre Neilen, PhD, talks about the new issue of The Healing Muse, Upstate's literary and visual arts journal. Orthopedic surgeon Eric Bellinger, MD, discusses how to prevent pickleball injuries. Rebecca Alder goes over the rights of long-term care residents in New York state. She is the regional ombudsman manager at Arise Child and Family Services.
Transcript
Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," editor Deirdre Neilen shares the new issue of The Healing Muse.
Deirdre Neilen, PhD: ... There are only a certain number of stories that we keep telling over and over again -- you know, people grow up, people have suffering, people fall in love, people have babies. There's only a certain number of those, but everybody's take on it is so interesting. ...
Host Amber Smith: Orthopedic surgeon Eric Bellinger discusses pickleball injuries and how to prevent them.
Eric Bellinger, MD: ... If you were predisposed to plantar fasciitis, the pickleball can aggravate it. ...
Host Amber Smith: And long-term care advocate Rebecca Alder talks about the rights of nursing home residents.
Rebecca Alder: ... What long-term care ombudsmen do is help people that live in residential facilities, such as skilled nursing and assisted living. We help them work through any issues or grievances they have with their care..."
Host Amber Smith: All that, coming up after the news.
This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith.
On this week's show, we'll go over prevention tips for common pickleball injuries. Then we'll talk about the rights of long-term care residents in New York state. But first, a new issue of Upstate's literary and visual arts journal, The Healing Muse, is out, and we'll hear about it from the editor.
From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."
The field of medicine can be so demanding and important and intimate that sometimes it helps to get creative, and Upstate is one of the medical universities with an outlet for that creativity.
Host Amber Smith: I'll talk about that with Dr. Deirdre Neilen. She's an associate professor of bioethics and humanities at Upstate, and she's also the editor of The Healing Muse literary and visual arts journal.
Welcome back to "HealthLink on Air," Dr. Neilen.
Deirdre Neilen, PhD: Thank you so much, Amber. It's great to be here, as always.
Host Amber Smith: Let me first ask you to describe the cover of this, Volume 23, which is a work by a French artist.
What drew you to it to choose as the cover image?
Deirdre Neilen, PhD: 我很高兴你想从这个开始,因为当人们拿到他们的新缪斯时,我们得到了最大的热情. Kathy Faber-Langendoen, our associate editor, saw this picture on a website, and she brought it to us, and we said, "Oh, yeah, we love it. Let's see if we can get it."
And we found out that Raoul Brosseau is a French artist from Brittany, and the cover has three young bathing swimmers. They're in their suits, they have little caps on and goggles, and one is holding the hand of another. And the three stand together, and we loved it for its image of caring, protection. It's called "Le Protecteur" -- "The Protector." And I just thought it was perfect for what we tried to do with the Muse, that healing is for a single person, of course, but it usually bubbles out and envelops those who are around the person who is trying to heal.
And Brosseau, in his note, said, "Water is an element where you forget yourself and you disappear. Time no longer exists. When you come out of the water, you have that mysterious little smile, at once disillusioned and satisfied, that I put on all my swimmers."
So it was playful, but I thought there was a lot in it, and that's why we just loved it.
Host Amber Smith: Yeah, it's very striking.
Well, in this issue, at least three poems are from medical students, and I'd like to have you tell us about them.
Abha Japi received a writing award for a poem called "We'll Laugh Until Our Ribs Get Tough," about the durability of a friendship. What did you like about this poem?
Deirdre Neilen, PhD: Well, when I read it, I liked the title. I thought the title was -- was a little bit offbeat, but I do remember those times that you have such a deep laughter with a friend that you do hurt. It's just ... you can't stop yourself.
So that drew me to want to read the poem and then she mentioned, Lorde, the singer Lorde, in the poem, which led me to go look up Lorde. And indeed she does have a line in one of her poems about laughing this hard and long. So then I went back and read the poem again, and I think it's beautiful.
I mean, it's really about: This generation loves tattoos. My generation saw tattoos as something less than favorable, but I've become quite used to them, and I like some of them very much. And I thought, in this poem, where the speaker is talking to a friend and remembering how she asked her to get a tattoo, to make their friendship even more, I guess, deep and penetrating than it already is.
And then it's just delightful. She goes back and forth as to, OK, I'm trying to understand why you don't want to do that. And then she says, in the poem:
Permanence is scary, what if we get older, what if
our flesh sags in weird ways
And the words are distorted?
And the unsaid question: what if, one terrible, normal Tuesday I wake
up and I remember
we haven't spoken in months?
And I just, that just got to me, too, as such a wonderful, again, 一个年轻人想象未来的能力,在未来,我们现在感受到的深度可能不会存在,那将是多么可怕. But as the poem goes on, the poet resolves this for herself and decides she will get the tattoo and that she does believe that they will, as she says at the end, "no matter of time, space, and evolving skin and bone can change that." So it was, I think, such a nice testament to people's abilities to love others.
Host Amber Smith: Yeah, very nice. Another student, who had good reason to remain anonymous, also received a writing award for "More than Just a Number."
Were you surprised that this wasn't about a patient who felt unseen?
Deirdre Neilen, PhD: Yes. Yes. This poem came to us, and it is a surprise. Again, we live in the world. We know what is happening. The refugee crisis, the immigration crisis, people talking all the time about what do we mean by welcoming people, being an open society, what is a border, et cetera, so I wasn't thinking that because my head is always on the patients, physicians, et cetera. But this was a beautiful, beautiful, just a request. Can all of us just listen to this for a second? For a person who has been deeply impacted by what we're saying about borders:
I am more than just a number
I say to myself every morning
-- and then she goes into this poem, remembering her childhood before she immigrated and feeling the way you want children to feel, open, free, honest, I can say everything. And then letting us know that now that she's crossed the border, she has to be not open. She has to be careful. She has to be very cautious. And it's scary, and it changes you. And at the end, 我认为这首诗是一个响亮的宣言,这个人将继续努力工作,实现她小时候的目标,她作为一个成年人仍然在成长, and as she says:
To live, speak and move freely
I am here, I matter and my voice matters
-- and I thought that was good for all of us to read. I know that, at Upstate, we do take care of many people who might not have documentation yet, and our policy is, we are not asking questions about that, we are here to do the work of healing. And I like this poem because it reminds me that we are all here to listen, learn, be open, I think.
Host Amber Smith: Katie Farkouh wrote a poem called "Ego." Can you tell us what that's about?
Deirdre Neilen, PhD: Yes. I mean, anybody who reads it, I think they'll pick up on it right away. Katie's a very brave writer, I think, a med student, and her poem is remembering what her mother told her many years ago. and I like to keep thinking this is changing, 我们没有二元性别的东西,男性的自我是如此脆弱,以至于你不可能在纸牌游戏或课堂上打败他, but I guess from this poem, we see that now things are very similar.
So the poet remembers:
My mother told me as a child,
"He does not like that you are more successful. They usually don't."
And she says:
I'll never forget it.
She said it with pride,
Pride in her daughter's achievements,
But also as a warning.
然后她继续说,她的母亲是如何称赞她的,并告诉她,你取得了所有这些成就,这太棒了.
But she's also reminding her that you must be careful.
And the poem I think is very radical because at the end she says:
The world is better
When it is run by women.
Not perfect by any means,
But better nonetheless.
He will never understand.
They will never understand.
It's depressing. I mean, that's one of our depressing poems, but, I liked it because it's a young person who is out there saying, "This is what I've seen, and I'm not going to pretend that I'm other than what I am."
Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith.
I'm talking to Dr. Deirdre Neilen. 她是上州立大学生物伦理学和人文学科的副教授,也是《推荐最近最火的赌博软件》文学和视觉艺术杂志的编辑.
The latest issue is available now at thehealingmuse.org, and we're talking about some of the work that's included in this issue.
There's also a poem by pediatrician Jaclyn Sisskind, who won a writing award. How would you describe her poem, "Apart"?
Deirdre Neilen, PhD: I loved this poem, Amber, because it's about marriage, and it's about love.
And many times we get poems in which marriages are frayed and less than what the persons had hoped at the beginning.
But in this poem, what Jaclyn's speaker does is to just take a very short glimpse of what it's like when your partner has to be gone, has to leave, is doing work elsewhere, has left town or whatever.
说话者在洗衣服、叠衬衫、放袜子的时候,在回忆是什么让他们在一起的, and she says how it's so interesting that when he's there, she doesn't really feel that same need to straighten up and put things away, but when he goes, she does, and she says, because I have:
no urgency to stow away
But with you gone
I cannot bear the possibility
of a stray sock turning up in my sleeve
When the return of your foot against mine
is not promised.
So there's that little lovely like, "Oh, I hope you come back." I hope, the way we all worry these days about nobody knows what's going to happen. So I loved this poem because it was so short, but it's so full of love, and I just think we need those.
Host Amber Smith: I wanted to ask you in general how doctors, nurses, and other health care providers are using poetry. What have you seen in this issue and in previous years?
Deirdre Neilen, PhD: I think that they use poetry the way most of us do, first as a means of recording and reflecting on things that have happened in their lives.
Secondly, 我认为他们试图解决一些他们在最初的临床接触或手术中无法解决的问题,无论发生了什么. 但写作能让我们从事件的即时性中退一步,稍微思考一下.
Are there parts of it you wish you could change? Are there parts of it that you're going to take into the next encounter? I'm so struck, Amber, lately by the sense we get from our clinicians about how pressed for time they are. 我们人手不足,试图在更短的时间内看更多的人,并跟上电子病历的步伐,这是不对的, which was supposed to make everything simpler and more streamlined.
But I think our clinicians are finding out that there are good things about it, but it's not the best. It kind of encourages a rush-through and not thinking. So I think for those clinicians who like to write, I'm seeing in the work that they're sending us, more than ever, this sense that "this happened to me, I'm going to write it out, and then I'm going to try and figure out what was good about it or what wasn't good about it."
Host Amber Smith: Well, we've heard about the act of writing being therapeutic. Do you think the act of reading can be therapeutic?
Deirdre Neilen, PhD: Yes, speaking very personally. I think it does. I mean, 有时我很惊讶,我被允许说我的工作是做缪斯,因为阅读是一种强烈的治疗. It's such a privilege to read these, even the ones that we're not going to accept, even the ones that we think, "No, this isn't for us." You are being given a glimpse into someone else's reality. 的确,只有一些故事是我们一遍又一遍地讲述的, people grow up, people have suffering, people fall in love, people have babies. There's only a certain number of those, but everybody's take on it is so interesting, so I think that yes, if you sit down and read.
I'll give you this example. We just had our (The Healing Muse's latest volume) launch the other day, and it was on Zoom, and so you get to hear the poets read their own words, 那天晚上回到家,我做的第一件事就是拿出我的稿子,开始重读我刚才听到的那些诗人的诗, because the way they read it deepened for me how I had interpreted the poems. And I've got enough of an ego to say we chose wisely.
I mean, there wasn't a single person who read that I thought, "Oh, why did we take that?" I was like, "I'm so proud that we took that. It's a beautiful, beautiful poem or a piece of literature."
Host Amber Smith: Now in your editor's note, you write about The Healing Muse being a reliable way to turn down the noise, the heat, the anxiety.
Does it feel like that's more necessary today, either because of the pandemic or staffing levels or political turmoil?
Deirdre Neilen, PhD: Yes. I have not spoken to one person who says to me, life today is easy and not bad at all. Everyone talks about since the pandemic or since the elections or since -- I mean, you can put in what you want, but, I mean, it's just an ongoing struggle, I think, for people to find a space that feels safe, or at least like a good place to celebrate being human.
I think a lot of times looking at the news, we're not doing a good job. Whether it's to the climate, to the earth -- we just came through the hottest summers, and we're having all these hurricanes, and it's just a time when I think, yes, you need to have a quiet time. And I've stopped listening to the news as often as I used to just because I find it does provoke your anxiety. You can't do anything about some of the stuff that you're hearing or looking at.
But I think when we pick up a book, we can confront those same issues, but it's quieter listening to one poet tell me something about life.
Host Amber Smith: Well, 你刚才所说的一切都是我们问你的原因之一,我们为你愿意在每期“健康连线”节目的最后分享一段摘录而感到自豪."
If listeners tune in until the very end, they'll get a treat at the end, with a poem or a piece of literature. So thank you for that.
Deirdre Neilen, PhD: Oh, 谢谢你给我们这个机会,因为这对治愈缪斯的我们和你介绍的诗人来说意义重大. To hear their work, I think, it's a thrill. It's great.
Host Amber Smith: Well, in terms of the role of The Healing Muse, are most of the readers, do they work in health care, do you think, or do you have readers who have really nothing to do with health care?
Deirdre Neilen, PhD: We actually have readers who have nothing to do with health care, except that they have had an experience of needing health care, or someone they loved has needed health care.
We do have, obviously, many clinicians, nurses ... we have people who have retired from positions in the health field, and now they say, "Now I have time to sit down, and I'd like to write up something that I saw happen."
So I would say a majority of people do have some kind of connection to the health care system, but we do have very many writers that, tell us, "I live in the woods. I was given a copy of this. I liked it. Here's the story. What do you think?"
And sometimes it works for us -- you know, it's great.
Host Amber Smith: Very nice. Well, thank you so much for making time for this interview.
Deirdre Neilen, PhD: Oh, thank you again for having us.
Host Amber Smith: My guest has been Dr. Deirdre Neilen. She's editor of The Healing Muse literary and visual arts journal, which is produced by Upstate's department of bioethics and humanities.
You can learn more at thehealingmuse.org.
I'm Amber Smith for Upstate's "HealthLink on Air."
Preparing for pickleball -- next on Upstate's "HealthLink on Air."
From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."
Pickleball is considered a social sport that's good exercise and easy to learn, but with the sport's increasing popularity comes a rise in potential injury. Here with me to discuss common pickleball injuries and how to avoid them is Dr. Eric Bellinger. He's an assistant professor of orthopedic surgery at Upstate.
Welcome to "HealthLink on Air," Dr. Bellinger.
Eric Bellinger, MD: Thanks for having me.
Host Amber Smith: Well, I'd like to talk about specific lower- and upper-extremity injuries, but before we do, can you tell us if most pickleball injuries are from overuse or do you see players with acute injuries?
Eric Bellinger, MD: So we see a combination of both. 所以有一部分病人会因为脚踝扭伤或跟腱受伤或肩袖问题而来. That's more of an acute nature, but there's also a fair share of patients that will come in with a more chronic, tendinitis type of issue or something along those lines.
Either way, we're more than adept at treating those, but the treatment algorithms can change depending on what the nature of the injury is.
Host Amber Smith: Well, let's go over then, let's start with the lower-extremity injuries that you see that are most common and how you typically treat them.
Calf strains or tears: Do you see that?
Eric Bellinger, MD: Yeah, so occasionally we'll see some calf strains. Tearing really is essentially synonymous with strains. Strains are just kind of on the lower end of a lower-grade tear of a calf muscle, and generally speaking, that can be treated with getting over the initial point of the injury, the RICE: rest, ice, compression, elevation, anti-inflammatories, if medically you're allowed to take those. Those are all good things to kind of treat the initial. And then typically we'll start you, once your pain is at a more controlled level, we'll initiate physical therapy at that point.
Host Amber Smith: Do you ever see people with a flare-up from knee arthritis caused by playing pickleball?
Eric Bellinger, MD: Yeah, so that's another common one that we'll see. Patients that have pre-existing knee arthritis, the side-to-side motion of pickleball can set off, quote unquote the knee arthritis, and you can get a flare-up of the arthritis pain as well.
It's kind of treated similar to the calf strain initially: the rest, ice, elevation compression, anti-inflammatories. Those kinds of things are generally a good first go-to for these types of injuries. And then, again, depending on the nature of it and how long it's been going on, a short course of physical therapy might be helpful as well.
Host Amber Smith: Do you see plantar fasciitis that's caused by pickleball?
Eric Bellinger, MD: Plantar fasciitis is not often caused by pickleball. It can be exacerbated, so if you had plantar fasciitis or were predisposed to plantar fasciitis, the pickleball can aggravate it. But pickleball doesn't typically cause plantar fasciitis itself.
这是一种退化性疾病通常有一些潜在的问题而不是匹克球导致的.
Host Amber Smith: And so that would be like pain in the foot.
Eric Bellinger, MD: That's more pain along the bottom of your foot at the heel.
Host Amber Smith: OK. Hamstrings, because I hear about hamstring injuries, that is the upper part of the leg?
Eric Bellinger, MD: Yep, that's the back of your thigh. Hamstring injuries are something that we see commonly with pickleball. The side-to-side motion, the quick stop-start -- those are things that can cause a hamstring pull or strain, and that can usually be prevented if you're good about stretching before and after the pickleball.
Host Amber Smith: That's good to know. Now what about ankle injuries, ankle sprains or Achilles types of injuries? Do you see a lot in that area?
Eric Bellinger, MD: Yep. So the most common thing that we see is an ankle sprain, and that's typically a misstep with the side-to-side motion in pickleball causes somebody to turn their ankle, so that's probably the most common thing that we'll see.
Achilles injuries we will see. Now, Achilles injuries is a little bit more severe in that, depending on the nature of the Achilles injury, if it's a complete rupture of your Achilles, then we're having a discussion about potential surgery versus more of a long course of a recovery there.
Host Amber Smith: Do you ever see people with back injuries from pickleball?
Eric Bellinger, MD: Yep. We'll see back injuries. usually people have underlying back issues to begin with and the pickleball will kind of exacerbate it. 我们通常不会看到以前没有背部问题的人因为打匹克球而出现背部问题.
But if you are predisposed to having back issues beforehand, it can certainly flare it up.
Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with orthopedic surgeon Dr. Eric Bellinger about injuries that may occur from playing pickleball.
We talked about lower extremities, so I want to ask you about upper-extremity injuries that might happen, things such as what's called tennis elbow.
Eric Bellinger, MD: Yep. So tennis elbow is a common, probably one of the more common, upper-extremity injuries that we see with pickleball. As the name would suggest, racket sports very often will lead to a tennis elbow, or lateral epicondylitis is the medical term for that.
And that's an inflammation in one of the main extensor tendons of your forearm at the elbow level, and similar to some of the injuries in the lower extremity, rest, ice compression, elevation are the first line with some anti-inflammatories. Physical therapy -- this injury responds particularly well to physical therapy.
Almost everybody that does the physical therapy and the exercises associated with it will get better with time, and that's usually where we would start first line for that. Very rarely do we have to go much further past that.
Host Amber Smith: What about shoulder or rotator cuff injuries? Are those common?
Eric Bellinger, MD: Yep. Rotator cuff strains or tears are probably a close second to the lateral epicondylitis or tennis elbow, in terms of injuries that we see. 我们通常会让你很快进行物理治疗因为物理治疗会显著加快你的整体恢复速度.
Host Amber Smith: So all of the injuries that we've talked about so far, it doesn't sound like they're unique to pickleball.
Do you see them with tennis and racquetball and other sports that use rackets?
Eric Bellinger, MD: Yes. So the rotator cuff injuries and the tennis elbow, racket sports and overhead sports, generally you'll see those types of injuries.
Host Amber Smith: So in order to prevent or to minimize the risk of injury, you did talk about stretching beforehand to help hamstrings.
Is there other advice you have that would help prevent some of these other injuries as well?
Eric Bellinger, MD: Yep. So just like the lower extremities, stretching out your upper extremities, there's certain stretches that you can do, and anything that you can do beforehand to warm up is helping prevent these injuries.
Host Amber Smith: Do you recommend people run or jog, or is it just stretching? Are there specific exercises that they should do beforehand?
Eric Bellinger, MD: For lower extremities, it is always nice to do like a light jog or something like that to get the blood flowing in your lower extremities.
And then you couple that with your stretching exercises after you've got the blood flowing in your lower extremities. stretching's going to work best if the muscles are warmed up. If you're just kind of coming out of the car cold, and go right into the stretching, the stretching's not going to be as effective.
所以在开始拉伸之前,任何能让血液在肌肉中流动的方法都是很好的经验法则, whether the lower extremity or the upper extremity.
Host Amber Smith: Now what about afterward? Is a cooldown helpful for helping prevent injuries?
Eric Bellinger, MD: Cooldown is just as important as the warm-up in preventing, soreness afterwards or an injury down the line. Cooldown stretching is something that we always will push our patients to do as well.
Host Amber Smith: In terms of equipment, do you have any recommendations or any concerns about choosing a racket or choosing shoes?
Eric Bellinger, MD: Yeah, not so much in terms of the racket; whatever is more comfortable to you. But in terms of, some of the lower-extremity stuff, that, for sure, a good pair of, running shoes is going to be paramount to helping prevent some injuries. If you are particularly prone to ankle sprains, sometimes a brace can be helpful.
Those are kind of the preventative things, at least in the lower extremity, that I would recommend, in addition to the stretching we already talked about.
Host Amber Smith: If someone gets hurt playing pickleball, 你有什么建议,如何确定他们是否需要去急诊室或打电话给他们的初级保健医生或等待,看看他们是否感觉更好的第二天早上?
How does a person determine what they need?
Eric Bellinger, MD: For lower-extremity injuries, one of the good rules of thumb is, if you can't walk on it, that's something that probably should be seen sooner rather than later. Anytime anybody can't weight-bear, so to speak, on their affected side, that's usually a good indication that that's probably something that you want to have looked at. In terms of the upper extremity, certainly any deformity, but that's relatively rare in this instance, but an excessive amount of swelling or bruising, something that's certainly something that you could certainly, want to be seen sooner rather than later for.
Host Amber Smith: Is there any sort of first aid that may help for the person until they do get care?
Eric Bellinger, MD: It's never a bad idea to, wrap an Ace wrap around an injured extremity to just provide a little bit of compression. Anti-inflammatories, if you're able to take them and don't have a medical reason that you can't, those are always helpful to bring some of the inflammation down, and then icing.
Host Amber Smith: Now pickleball is a sport that seems to be attracting, an older population. Are there special concerns, 或者你会对50多岁60多岁的病人和20多岁30多岁的病人进行不同的治疗吗?
Eric Bellinger, MD: The injuries that tend to occur in the, younger population tend to be different than the injuries that occur in the older population. So I would say it doesn't necessarily mean if you have the exact same diagnosis the treatment's different, but I would tell you in different demographs of patients, we tend to see different injuries.
So I guess the treatment would differ based on what the actual injury is.
Host Amber Smith: 哪些类型的损伤更容易在老年患者身上看到,而哪些损伤更容易在年轻人身上看到?
Eric Bellinger, MD: So, in the upper extremity, for example, the older population tends to have more issues with their rotator cuff, where the younger population tends to be more of a tennis elbow. That's not exclusive, but that's generally what we see.
In the lower extremity, obviously any of the pre-existing arthritis in the older population, so exacerbations of those arthritis (related problems), that's going to be something in the older population.That's kind of the differentiation there.
Host Amber Smith: Now, how do appointments work for Upstate Orthopedics, where you work? Are people able to get a same-day appointment, do you know?
Eric Bellinger, MD: Yeah, so we have a walk-in clinic here, so patients that have an injury, whether confirmed or suspected, are able to walk in and see a provider, whether that's a midlevel or a doctor, the same day. So we have a pretty good walk-in clinic readily available to take patients that have these types of injuries.
Host Amber Smith: And that is at the Bone and Joint Center at 6620 Fly Road (East Syracuse).
Well, Dr. Bellinger, I want to thank you so much for making time for this interview.
Eric Bellinger, MD: Thanks so much. I appreciate it.
Host Amber Smith: My guest has been Dr. Eric Bellinger. He's an assistant professor of orthopedic surgery at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."
Next on Upstate's "HealthLink on Air" -- what are your rights if you live in a nursing home?
From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."
Our topic today is the rights of people living in skilled nursing and assisted living facilities in Central New York. My guest is Rebecca Alder. She's the regional long-term care ombudsman manager at Arise Child and Family Services.
Welcome back to "HealthLink on Air," Ms. Alder.
Rebecca Alder: Thank you for having me.
Host Amber Smith: Can you describe what a long-term care ombudsman is and what they do?
Rebecca Alder: Yes. So a long-term care ombudsman is an advocate, first and foremost. What long-term care ombudsmen do is help people that live in residential facilities, such as skilled nursing and assisted living.
We help them work through any issues or grievances they have with their care.
Host Amber Smith: So what types of facilities? You said long-term care and assisted living. What is the difference between those, and then, what geographic area do you cover?
Rebecca Alder: Well, the difference between long-term care and assisted living is that basically assisted living, supports residents in a community setting with their activities of daily living. So, for example, assisting with the resident in getting dressed, or maybe preparing their meals.
Whereas skilled nursing, that's a higher level of care. It's actually considered custodial care, and it's in a more complex medical environment to meet those needs.
Host Amber Smith: So it's not independent living?
Rebecca Alder: No, it is not. That's another whole category that the ombudsman program does not cover.
Host Amber Smith: And then the geographic area, are you throughout Central New York or just Onondaga County?
We are Region 10, and we cover Onondaga, Cayuga, Cortland and Oswego counties. That's about 7,000 residents within both the skilled and the assisted living facilities.
Host Amber Smith: New York state famously has a lot of regulations. Are ombudsmen expected to be familiar with the regulations for nursing homes and assisted living facilities?
Rebecca Alder: Well, yes and no. We're not required to know every single federal or state regulation. However, there are many regulations that relate to quality of care, 因此,我们培训我们的司法特派员,让他们学习有关居民每周洗多少次澡或应该提供多少零食的规定, how many activities, things like that. We may focus sometimes: If a resident complains about the temperature of their room, I can certainly look and see what that regulation is.
We don't necessarily need to know the specifics, just enough to know when resident rights are potentially being violated.
Host Amber Smith: So a practical familiarity with those things, it sounds like, is important. Now, what are the rights of residents if they're living in skilled nursing or assisted living? What do you hear about most often having problems with?
Rebecca Alder: Well, 我觉得很多时候,我们收到的投诉是,居民们觉得他们没有权利表达自己的担忧或不满,而不必担心遭到报复, so that is absolutely a basic right that everyone in that residential facility has.
Another right is the right to a safe discharge. A facility cannot send a resident to a homeless shelter just because the bill has not been paid. Let's see here ... another right would be the right to participate in your own care, your own care planning, so that the facility is not putting out care plans that don't involve your thoughts and your goals.
Host Amber Smith: So do the rights deal with the quality of care, making sure that you have a comfortable living environment. That you don't feel discriminated against, is that covered as well?
Rebecca Alder: Yes, absolutely. And of course, you know, the right to be free from abuse, whether that be verbal, mental, financial, physical.
Host Amber Smith: So a person who's living in one of these facilities, 他们是否有权决定是否要转到另一家医院或者是否要出院?
Rebecca Alder: Absolutely. Yes. A resident should be aware of what their discharge plan is, and if they don't agree with it, they can certainly appeal and hope for a different outcome.
Host Amber Smith: Do they have a right to privacy? Because I know some of these facilities. It's not a private room necessarily, so does a resident have a right to privacy?
Rebecca Alder: They have a right to privacy within the realm of, yes, having to have a roommate. Basically, what staff really should be doing, what I instruct my staff and my volunteers to do, is when you enter a room, knock on the door: You know, Mrs. Smith, it's Rebecca from the ombudsman program, may I please enter? You know, showing that respect. When you're in the room, making sure that curtain is closed so that your roommate could not see you getting bathed or washed. So, it's difficult, but yes, that still is a right, right to privacy.
It just looks a little differently when you have a roommate.
Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with Rebecca Alder from Arise Child and Family Services. She's the long-term care ombudsman program regional manager, and we're talking about the rights of people living in long-term care or assisted living facilities.
So are the rights the same for assisted living versus nursing homes?
Rebecca Alder: Yes, they are.
Host Amber Smith: And do residents of these facilities have the right to come and go?
Rebecca Alder: That's a great question. It really depends on the facility. For assisted living facilities, yes. Many residents at assisted living facilities have a car, so they're able to leave the property when they want.
Now, with skilled nursing, it's a little bit different. Because of Medicaid guidelines, they cannot leave the facility for more than 24 hours. If they have another funding source, say, private pay, they can certainly do that. However, family members would have to sign them out. The facility does have a responsibility, knowing where their residents are at all times.
Host Amber Smith: Do residents have to have access to a library or to newspapers or television, or are those things only available if they can pay for them?
Rebecca Alder: Again, it depends on the facility. Some facilities do offer free cable TV, free phones. Many do not. In the regulations, when it comes to activities, it's written as "giving quality activities for the residents."
It doesn't specify television, books, anything like that. So it's kind of a "read between lines" for activity directors. Again, many facilities do offer television, cable, phones, but residents would have to pay for that.
Host Amber Smith: Now, medical care is part of nursing home care, right? That's covered altogether?
Rebecca Alder: Yeah.
Host Amber Smith: But now what about dental care or vision care? 我在想那些住在养老院里行动不便的人,他们不能真正带自己去那些预约. How do they receive that type of care?
Rebecca Alder: Well, Medicaid does cover both vision and dental, and there are providers that go into the facility and see residents on a regular basis.
They bring the equipment to the facility. I just want to point out, Amber, because this is important: The resident does have a right to their own physician, their own provider; however, they may be responsible for paying for that.
Host Amber Smith: I see. Now, you touched on this a little earlier, but what does happen to someone who runs out of money and can't pay for the nursing home that they're in, but they're not able to live on their own?
What happens to that person?
Rebecca Alder: Typically, when a resident cannot pay for their care, in order to qualify for Medicaid, they must spend down their assets. but certainly they may need care in the interim. So how it works is that a resident will be in a facility and have a spend-down, a "NAMI," and what that is, is an amount paid to Medicaid every month, and that allows them to go through their assets.
But they're still receiving those medical services at the same time. They don't have to necessarily deplete all their assets before going into a facility. So it really is good for people that need that care, but maybe they have too many assets to qualify, but not enough to pay for $14,000 a year privately.
Host Amber Smith: You said "NAMI." What does that mean?
Rebecca Alder: NAMI stands for "net available monthly income."
Host Amber Smith: Now, some people are unhappy about their situation, being in a nursing home, because they're not able to live on their own, and others are cognitively impaired and may not fully understand where they are.
How do you advocate for these people?
Rebecca Alder: Well, we many times go into assisted livings that cater to people with memory impairment, or we're in nursing homes where there's a dementia wing. Typically, what we do is, if the residents cannot really articulate to us what's upsetting them, we use our senses. As ombudsman, we observe, is the resident clean? Are their breakfast trays picked up? Is there an odor in the facility? Is the resident dressed? Are they sitting up? Sometimes, sadly, I'll get calls on Monday mornings from people in facilities saying, "I was left in bed all weekend" because there just simply wasn't enough staff.
So we use our senses, observation, to assist people that really cannot necessarily speak up and tell us what they do not like about their care.
Host Amber Smith: How does a resident of a nursing home or assisted living facility reach an ombudsman?
Rebecca Alder: We try to create a regular presence in all facilities, particularly the nursing homes, just because we do see more complaints, but we are in assisted livings on a quarterly basis. We do have our posters up in every single facility. It is required to have our posters up with our hotline number. That's my direct line. And again, just going in there for those weekly visits and getting to know the residents and having them trust us and to say, "OK, well, here's an ombudsman. She doesn't work for the facility. I can open up to her."
Sometimes that takes a while, so that's why we want to establish that regular presence in their facility.
Host Amber Smith: In recent years, especially with COVID, nursing homes, like many other industries, have lost a lot of workers. Are you seeing more of a need for ombudsmen tied to staff shortages?
Rebecca Alder: Not necessarily a need for more ombudsman, but the number of complaints have increased, absolutely. And a lot of issues go back to short staffing. So if a resident is saying that they haven't received a shower in three weeks, when you start to investigate and go back to the origin, it's typically because of short staffing levels.
So yes, we have received many calls due to that. Thankfully, our program has gotten some recognition during the pandemic for the assistance we were able to offer residents, and thankfully we do have some increased funding, so we were able to hire more staff to serve the residents of Region 10.
Host Amber Smith: Well, before we wrap up, tell us how people can become volunteer ombudsmen if they're interested. Are you recruiting for more volunteers?
Rebecca Alder: I'm always recruiting for volunteers! Ideally, I would love to have a volunteer in every single facility we cover, which is about 62 different facilities. They can call me. The number here at Arise is area code 315-671-5108, and you can go to our website, Arise Child and Family Services, and look for the ombudsman program for our information.
Host Amber Smith: And what type of person are you looking for, and how much time should they allot to devote to this, if they're interested?
Rebecca Alder: Well, we're looking for anyone that is able to give a minimum time commitment of two to four hours a week. That's so that they can go into the facility on a regular basis and get to know the residents.
So it's basically the two to four hours a week and monthly in-service meetings to earn continuing education credits, so that they can retain their ombudsman certification. That's 18 credits a year. So once you go through the training and you are established with a facility, really the time commitment is only two to four hours a week, and then that monthly two-hour meeting.
Host Amber Smith: Well, Ms. Alder, thank you so much for your time today.
Rebecca Alder: Thank you so much.
Host Amber Smith: My guest has been Rebecca Alder. She's the regional long-term care ombudsman manager at Arise Child and Family Services.
I'm Amber Smith for Upstate's "HealthLink on Air."
Here's some expert advice from Dr. Sharon Brangman, chief of geriatrics at Upstate Medical University. What can a person do if they have mild cognitive impairment (MCI)?
Sharon Brangman, MD: We have a lot of non-pharmacological approaches, but as a society, we always want a pill. So we don't want to hear things unless there's a pill. But there's a lot you could do for brain health, and as I mentioned, some people with MCI, it gets better.
There are a number of things that we encourage people to do. The No. 1 is exercise. Exercise is probably better than any prescription I could write. And we try to tell people that they need about 150 minutes a week of good activity. And that could be walking. You don't have to run a marathon. It could be swimming. I recommend that my patients figure out a way to take a walk for a half an hour a day. You could break it up into 15 minutes, twice a day. But it's very important that we figure out a way to incorporate exercise into our life, just like we brush our teeth every day.
The other thing you want to do is make sure you get a good night's sleep, because when we are sleeping well, that's when our brain cleans up all these little abnormal particles that build up during the day. And research shows that when we're in deep sleep, that's when our brain cleans up all of these little particles. So it's important to get a good night's sleep.
The other thing that people usually don't like to hear too much is that alcohol really isn't good for your brain. You know, 有很多研究——其中很多都得到了酒精行业的支持——表明红酒对大脑有好处. And we're starting to understand that alcohol is actually a toxin to nerves, and there is really no safe level of alcohol for our bodies in general and for our brains. 所以我尽量鼓励病人尽量少喝酒,如果他们必须喝酒的话,不要喝酒精含量很高的饮料. But maybe just save it for special occasions.
The other thing is to not smoke, to control your blood pressure, if you have diabetes, control diabetes, and to eat a heart healthy diet. 任何有助于心脏健康的饮食都有助于大脑健康,因为我们正在研究的是同样的血管. And what they call the Mediterranean diet, minus the wine, is probably one of the healthiest diets you can have.
And then the other piece that's important is being socially engaged. If you have connections with people around you, if you volunteer in your community, if you have friends that you meet with regularly, it's important that you maintain social connections. And we're just coming out of a period where everybody was very isolated, and that took its toll on a lot of people and their brain power.
And then the final thing that's important is to make sure that you can hear well and that you can see well. Because if you don't get good sensory input from your ears and your eyes, then your brain has less to work with. And studies show that that can be a risk factor for developing dementia. And a lot of people don't want to wear hearing aids or they deny that they have a hearing problem. It's very important to get your hearing checked and have your vision checked and to get them corrected if needed.
The majority of people with mild cognitive impairment never advance into dementia. 大约80%到85%的人可能会有这种恶化,他们只是觉得自己的脑力跟不上速度, but it doesn't get any worse, and sometimes it gets better over time.
Host Amber Smith: You've been listening to chief of geriatrics Dr. Sharon Brangman from Upstate Medical University.
And now, Deirdre Neilen, editor of Upstate Medical University's literary and visual arts journal, The Healing Muse, with this week's selection.
Deirdre Neilen, PhD: We lost a stalwart member of our Muse family in 2021, poet Joyce Holmes McAllister. She was a poet who proved that aging need not dim one's perspective or facility with words. Here are the last two poems she sent us. First is "A Question":
I wonder where they went, those 80 years,
In which I claimed each breath, called life my own.
A span of time when challenge held no fear
And youthful feet could feel no aching bone.
If I had known, when young, how life would speed
And leave me here, to grope my way alone,
I would have spent more time, and learned the need
To fence youth in, and keep it for my own.
I wonder if I started now to track,
With careful count, my age to backward time.
Could I keep on until my years subtract
And I am once again, just 29?
But who would know me then, with youthful face,
or minus aging wit, long-practiced grace?
And the second poem is called "things i can't write about":
to feel what it is like
to open the desk drawer,
see the blank checks
still in their box, unused
three years after your death
to wash fresh spinach,
suddenly taste vinegar on my tongue,
remember how you sprinkled it
over young cooked greens, and how i
used only butter
to see the shape of a car,
maybe the same model, year
parked in front of our house,
know someone else will step out,
turn his back, walk away
to stare at the collection of long, slim
note pads, read your name and address
printed at the top in blue; on the bottom
thank you for your continued support of animal wildlife
my writing has always been more about
what I leave out, than what I put in
Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York.
Next week on "HealthLink on Air," the crisis of eating disorders.
If you missed any of today's show, or for more information on a variety of health, science and medical topics, visit our website at healthlinkonair.org.
Upstate's "HealthLink on Air" is produced by Jim Howe, with sound engineering by Bill Broeckel.
This is your host, Amber Smith, thanking you for listening.
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