inspiration

Pruning The Holidays!

The holiday season is here and it’s OK to alter plans and refine your calendar if the days ahead look overcommitted and you’re feeling under-joyed!! Give yourself permission to modify or delete some of the tasks you might already have on your growing list. There are articles online about how to best manage the holiday season. Below are my top suggestions to make the next few weeks easier on you and your family.

Ideas to consider

  • Purchase holiday cookies (or at least to cover half your planned baking) for school, church, or other organizations including your own parties.
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Candy Melts to decorate the cookies.

Note: Want to keep the holiday tradition of decorated cut-out cookies? Consider using Candy Melts available in many colors. Tried this yesterday and cookies came out great. Candy Melts are available at stores such as Walmart and Michael’s. Amazon offers a great assortment of colors. Very easy! Used microwave for melting. No food color gel mess with powdered sugar and corn syrup. Only difference is there is no glossy finish. Benefit is the candy melt colors dry quickly. Suggest melting in small batches and one color at a time. Example: melt the green and do all the Christmas trees first. Fast, easy, and cookies came out great.

  • Send eCards instead of mailing greeting cards and only mail to those who don’t use email. You can include eGift cards with those of whom you exchange gifts, especially kids who like choosing their own. I use Punchbowl. Other eCards are Hallmark, Blue Mountain, and American Greetings. Internet search eCards for a number of other options.
  • Entertaining at home or potluck to a party – purchase a deboned honey baked ham and quarter it as shown in the photo or buy already prepared appetizer platters and dips.
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    Boneless Honey Baked Ham
  • Gift giving among large families or friends – consider Kris Kringle/Secret Santa instead of purchasing gifts for everyone in the group. The Elfster website will organize it for you!
  • Replace gift-wrapping with holiday bags.
  • Simplify gift giving that shape fond memories…movie tickets, a play, concert, zoo, museum or a January lunch or dinner out.
  • Prioritize and consider only one holiday party per week/weekend and kindly decline those you are not able to attend.
  • Schedule downtime for yourself or with family and friends. Snuggle on the sofa with a good book, enjoy holiday music, hot cocoa, tea or your favorite strong coffee brew. Watch a good holiday movie with friends or family. Play board games or cards. Drive through the neighborhood (with popcorn!) looking at festive landscapes!! If downtime is not scheduled, it probably won’t happen.

Consider pruning this holiday month! Making life simple this festive time of year will inspire you to prioritize your calendar, simplify greeting cards as well as gift giving and schedule downtime! May the next few weeks be special and memorable! And, be safe! May the joys of the holiday season be with you!!

I’ll be taking a break for the remainder of December to celebrate the Christmas season and will catch up with you in 2018!!

Happy New Year!! 

Life Lesson

Planning For A Healthy New Year? READ those labels!

Approaching the New Year in just 6 weeks, this is the time many set healthy habit goals to prepare for the coming year. Often this includes exercise either at the gym, home or outdoors and better eating habits along with purchasing vitamins and supplements. Before you head out to fill your cabinet with bottles of tablets and packets, here are some facts you should know.

“Dietary Supplements can be beneficial to your health — but taking supplements can also involve health risks. The U.S. Food and Drug Administration (FDA) does not have the authority to review dietary supplement products for safety and effectiveness before they are marketed.” Food and Drug Administration

Vitamins and supplements can pose a danger and be toxic. PLEASE refer to your physician or a licensed certified nutritionist before taking any vitamins and supplements. The reason your friends, family members, coworkers and acquaintances might be taking certain supplements should not be your reason. If someone is trying to convince you to take or buy a supplement pack and discourages you from talking with your physician or nutritionist, this is a great reason to say NO, THANK YOU. Especially, be very careful taking supplement products that promote weight loss or are used to build muscle. A recent article in the Wall Street Journal, New Evidence for Critics of Weight-Loss and Sport Supplements warns about liver damage and states…

“Dietary supplements make lots of claims and consumers often believe them: The booming U.S. industry has grown from $9 billion in sales in 2007 to $15 billion this year, according to Euromonitor International, a market research firm. But a new study gives ammunition to critics of the supplements and their potential health risks. The study found two banned stimulants and two previously unknown and little-studied substances in six weight-loss and sports supplementssold in the U.S. The researchers defined “banned” as “ingredients for which the U.S. Food and Drug Administration had taken enforcement action to remove from dietary supplements prior to August 2016 (when the samples were purchased).”

Often, the vitamins you are already getting through food may be providing the essential vitamins you need. “But the combination of whole foods, supplements, and fortified foods raises safety concerns with experts. Eating fortified foods while also taking supplements can cause a person’s diet to exceed safe upper levels and potentially lead to a toxic buildup.” Webmd Only a physician and/or licensed certified nutritionist, often through the results of blood tests, can accurately discern what vitamins and minerals you might be lacking. Also, some supplements already contain vitamins other than the primary name listed on the label. It is very important you read the ingredient labels and small print before adding to your daily intake, to avoid duplicity. Here are a few examples.

I was taking ZINC as a supplement tablet. Then I started taking Ocuvite for eye health. I realized after reading the ingredient label, Ocuvite already has 40 mg of Zinc. I was exceeding Zinc daily recommendations and didn’t realize this for a few weeks. WebMD indicates the side effects of Zinc here.

Another situation came up where an individual I know began taking an IRON AID daily tablet. Within a week symptoms of delirium, rash, stomach issues suddenly came about. After reviewing all medications including supplements, discovered the IRON AID included 400 mcg of Folic Acid, which is not good when already taking a daily Folic Acid supplement of 1000 mcg. Toxic level of Folic Acid is noted at 1200 mcg daily and this individual was consuming 1400 mcg daily. Once taken off Folic Acid all symptoms disappeared within a week. Click here about Folic Acid and its side effects.

Below is a listing of common vitamins and toxic side effects possible (taken from the noted hyperlinked “article here” resources) when exceeding the recommended maximum amounts. New findings also suggest that the body doesn’t always flush out the excess of water-soluble vitamins. Therefore, even water-soluble vitamins pose a toxic risk when exceeding recommended amounts. In addition to these risks, taking vitamins/supplements may interfere with prescription medicine including over-the-counter blood thinners.

Almost 60,000 instances of vitamin toxicity are reported annually to US poison control centers. According to National Health and Nutrition Examination Survey (NHANES) data, in 2003–2006 33% of the United States population aged 1 year and older took a multivitamin supplement in a given month.  In a 2009 survey, 56% of US consumers said they take vitamins or supplements, with 44% saying they take them daily.   Vitamin Toxicity, December 21, 2016

Vitamin A – “Acute symptoms drowsiness – irritability, abdominal pain, nausea, vomiting, increased brain pressure. Chronic – blurry vision & changes, swelling and pain of bones, poor appetite, dizziness, nausea and vomiting, sensitivity to sunlight, dry rough skin, itchy peeling skin, cracked finger nails, cracked skin around mouth, mouth ulcers, yellow skin, hair loss, respiratory infection, confusion.” Article here.

Vitamin B Family

B1 – “Blue colored lips, chest pain, feeling short of breath; black, bloody, or tarry stools, or coughing up blood or vomit that looks like coffee grounds, nausea, tight feeling in your throat, sweating, feeling warm, mild rash or itching, feeling restless, or tenderness or a hard lump where a thiamine injection was given.” Article here.

B2 – “Sun-induced eye damage, itching or numbing sensations, and orange-tinted urine.” Article here.

B6 – “Nerve damage, decreased sensation to touch, temperature, and vibration, loss of balance or coordination, numbness in your feet or around your mouth, clumsiness in your hands, or feeling tired, nausea, headache, drowsiness, mild numbness or tinkling.” Article here. 

B12 – “Restenosis (reoccurrence of narrowing of a blood vessel) after stent placement, high blood pressure, acne, rash, itchy or burning skin, pink or red skin discoloration, facial flushing, urine discoloration, numbness, nausea, difficulty swallowing, diarrhea, increase in blood volume and red blood cells, low potassium levels, gout flare-up.”    Article here.

Vitamin C – “Diarrhea nausea vomiting heartburn abdominal bloating and cramps headache insomnia kidney stones.” Article here.

Vitamin D – “Buildup of calcium in your blood (hypercalcemia), which can cause poor appetite, nausea and vomiting. Weakness, frequent urination and kidney problems also may occur.” Article here.

Vitamin E – “If you have a condition such as heart disease or diabetes, do not take doses of 400 IU/day or more. Some research suggests that high doses might increase the chance of death and possibly cause other serious side effects. The higher the dose, the greater the risk of serious side effects. There is some concern that vitamin E might increase the chance of having a serious stroke called hemorrhagic stroke, which is bleeding into the brain. Some research shows that taking vitamin E in doses of 300-800 IU each day might increase the chance of this kind of stroke by 22%. However, in contrast, vitamin E might decrease the chance of having a less severe stroke called an ischemic stroke.” Article here.

Iron – “Symptoms of an iron overdose include nausea, diarrhea, black stools, vomiting blood, a metallic taste in your mouth, stomach pain, fever and headache, which sometimes but not always occur within an hour of taking too many iron supplements. If you don’t get treatment, more severe overdose symptoms may include dizziness, chills, drowsiness, and pale or flushed skin, fast or weak pulse and low blood pressure.” Article here. 

Folic Acid – “Less serious side effects include digestive problems, nausea, loss of appetite, bloating, gas, a bitter or unpleasant taste in the mouth, sleep disturbances, depression, excessive excitement, irritability and a zinc deficiency. More severe signs include psychotic behavior, numbness or tingling, mouth pain, weakness, trouble concentrating, confusion, fatigue and even seizures. An allergic reaction to folic acid may cause wheezing, swelling of the face and throat or a skin rash.” Article here.

Magnesium – “Doses less than 350 mg daily are safe for most adults. When taken in very large amounts, magnesium is POSSIBLY UNSAFE. Large doses might cause too much magnesium to build up in the body, causing serious side effects including an irregular heartbeat, low blood pressure, confusion, slowed breathing, coma, and death.” Article here. 

Do older and inactive individuals require less vitamins? Well, this is not actually the case. As we grow older we tend to consume less calories, which means less food and therefore less vitamins from the foods we eat. This would indicate vitamin supplements may be needed. This article explains…Nutrition Over 70; A guide to Senior Dietary Needs. Published findings and talking with friends and family, however, ARE NOT to replace conversations about vitamins and supplements with a physician or their referral to a licensed and certified nutritionist.

There are no health risks when the body absorbs vitamins through a balanced diet of whole and natural foods. There is, however, a greater risk of toxicity from vitamins through dietary supplements and fortified foods. Best way to plan for the New Year…make an appointment with your General Practitioner, if you haven’t already. Discuss your physical fitness goals and review your everyday eating habits along with vitamin and supplement needs. AND, READ THOSE LABELS! Just because a bottle labels a certain vitamin doesn’t mean it doesn’t also contain other vitamins. Duplicity of vitamins can be toxic!

Additional Resources

What are the Most Toxic Vitamins? by LAURA KENNY

inspiration

Thanksgiving – Past, Present, and Future

“Gratitude is the inward feeling of kindness received. Thankfulness is the natural impulse to express that feeling. Thanksgiving is the following of that impulse.” Henry Van Dyke  (1852 – 1933)

Thanksgiving kicks off the holiday season and family customs! It is, however, a day that stands alone in its own rich meaning and tradition. My hope is that the significance of this special holiday does not become extinct over time…each year the enthusiasm and holiday rush comes too close to leap-frogging in front of our country’s celebration of thankfulness. Below is a brief refresher list of Thanksgiving historical facts. Following, is the Thanksgiving I enjoyed growing up along with a unique idea; Thanksgiving Gift Boxes we shared with our son from the time he was 8 years old until he went to college. Although he is now 25 years old, we are bringing these ornamental gift boxes back and sharing the idea with you.

Historical FactsSource wikipedia.org

Thanksgiving Day, American public holiday, fourth Thursday of November that began as a harvest festival. “First Thanksgiving celebrated by the Pilgrims after the first harvest in the New World, October 1621, lasting three days attended by 90 Native Americans and 53 Pilgrims.

Thanksgiving has been celebrated nationally on and off since 1789 and became a federal holiday in 1863 when President Abraham Lincoln stated…”Thanksgiving and Praise to our beneficent Father who dwellers in the Heavens.”

The New England colonists were accustomed to regularly celebrating “thanksgivings”—days of prayer thanking God for blessings such as military victory or the end of a drought.

Tradition

I live a few states away from the location where Thanksgiving was always celebrated at the home of my Uncle, Aunt and cousins. Each year, however, when I awake to the excitement of watching the Macy’s Thanksgiving parade, cooking and baking, it’s those family get-togethers growing up that tug at my heart and fill me with awesome memories; the amazing aroma of turkey in the oven with many courses being prepared including pasta and, yet to ever experience again, my Aunt’s incredible 3 meat stuffing! Traditional desserts covered the entire dining room table, too. It’s especially the conversations, old stories and laughter shared, which embellish those sweet memories. As families grow we become a generation spread out across many miles. But, time and space is graciously fluid when we can bridge holiday past with holiday present through such love filled reminiscences.

Time is “Too slow for those who Wait, Too swift for those who Fear, Too long for those who Grieve, Too short for those who Rejoice, But for those who Love, Time is not.” Henry Van Dyke (1852 – 1933) American author, educator, and clergyman 

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Christmas 2000

Our own unique tradition began in 2000, when my husband, son, and I created Thanksgiving Gift Boxes. As shared in the blog post, Thriving Relationships, 1999 was a difficult year. To celebrate our renewed marriage and promising future in 2000, we identified heart-felt gifts from God, life transforming, which blessed us. The questions that led to “gifts”…In what way do we feel especially blessed this year? OR What gift (God’s grace and mercy) carried me through this past year? Here are some examples…forgiveness, emotional healing, physical healing, unconditional love, patience, perseverance, humility, faith, trust, joy, answered prayers, family, spouse, parents, good grades, genuine friendships, sports, extended family, church family, etc. The goal…choose one significant gift that was a blessing throughout the year. In 2000, though, our tree was FULL of boxes feeling generously blessed through a challenging year.  I’m excited that I found the photo to share with you! The ornament boxes hanging on the Christmas tree inspire the sentiment of thankfulness from Thanksgiving to Christmas and New Years.  fullsizeoutput_4101This year my gift box reads trust. May you enjoy these gift boxes with your family as much as we have throughout the years. How to make the boxes? Plain paper with colorful ribbon can be used or festive wrapping works, too. Labeling standard size gift boxes to place under the tree is another option instead of hanging as ornaments. Small size (jewelry) gift boxes can be found at Michael’s, Walmart and Amazon.

Thanksgiving Thanksgiving 2017.jpegis a holiday connecting the tradition of our country’s past to what we are presently grateful. Often these blessings are not tangible. Helen Keller perfectly states, “The best and most beautiful things in the world cannot be seen or even touched – they must be felt with the heart.” What has touched your heart this year? What challenges have you overcome or generous blessings received and enjoyed? Wishing you a Thanksgiving reflecting heart-felt memories of yesteryear, gratitude of present and being filled with hope for a future paying forward tradition and blessings, being a gift to others.

And, with deepest gratitude to our military who have served and are serving our country today, especially those not able to be with their families this holiday, deployed or lives lost. We are grateful for YOU and your families, the gift of freedom of which comes through such selfless service. Thank you!!

Happy Thanksgiving!!

home spaces

Multi-Purposing Seasonal Decor

It’s that busy time of year with Thanksgiving approaching and the holidays at its heels, when time moves so quickly we find ourselves celebrating the New Year in a blink of an eye. Each year I give thought on how best to manage time, reducing holiday angst to avoid feeling like I am racing through what should be a joy-filled time of year. Holiday decorating is one area that I have refined, saving time and $$$ by multi-purposing seasonal decor from fall to New Years. FYI…click on hyperlinked resources throughout the article, highlighted in orange font.

Multi-Purposing October through December! Consolidate your efforts and re-purpose from Halloween to the New Year. 

Faux Garland –  Halloween decor, why not decorate garland swags with spiders, webs, ghoulish ribbon and anything Halloween-ish that can easily be attached? In the fall leading to Thanksgiving, embellish wreaths as well as garland along staircases andIMG_0147 around doors with fall leaves, faux apples & pears. Garland with lights looks awesome against fall leaves. After Thanksgiving remove fall leaves and add holiday ribbon and festive decor touches. Faux fruit, if any, can remain. After the holidays it is important that garland and wreaths be stored for easy October access in your storage room if you plan on using this tip next year. Note: If hanging wreaths on windows I love the suction cup hooks large enough to hold BIG wreaths. Walmart carries Large Suction Cup Hook Christmas Wreath and Decoration Hanger. In higher elevations where pine trees surround homes, its OK to set up faux pine trees in the home, changing out seasonal ribbon and decor accessories through the holiday months.

Pumpkins – Nothing reflects fall better than pumpkins around landscape and inside a home. Those that are not carved for Halloween can be kept through Thanksgiving, to continue that warm glow of fall orange. Can pumpkins be used during the December holiday season? YES! Country Living  has some great ideas on how to repurpose pumpkins for a festive touch. Check it out!

Dealing with lights! 

Seasonal decor wouldn’t be the same without lights. Unfortunately, dealing with string lights can quickly put a damper on my festive mood. A number of years ago I thought the invention of pre-lit garland and Christmas trees was genius, until reality set in. Each year parts of the tree or garland go dark. This year we invested in a LED Christmas tree with hopes of getting more “light” years. Here are options to eliminate frustration and extend the life of your faux greenery.

  • Fill in the dark areas with 20 mini lights, perfect for filling in light
    where needed. Love that it only has the plug connector.
  • Consider purchasing LED pre-lit trees, garland and wreaths.
  • Purchase NON-lit trees, garland and wreaths and self string lights. When lights go dark it is far easier to remove and replace strands that are not manufacture installed.
  • Use timer battery operated light strands around non-prelit garland and trees givingProcessed with MOLDIV outdoor landscape a clean look without extension cords. Turn ON the switch to the timer once, at the time you want lights to go ON. Each night the lights will appear at that time. Typically they remain ON for 6 hours and OFF for 18 hours. Walmart has a great selection and on the Walmart website you can set your criteria on the left hand bar to narrow down choices to meet decorating needs.

Flock it yourself!

Love flocked greenery. This is something that can easily be done yourself be it on garland, wreaths or trees. Seeking a faux pine tree for front door decor, I was surprised to discover that already faux flocked trees are significantly more expensive than those that are not. At Walmart I found a perfect 6 ft Wesley Pine faux NON-LIT Christmas tree for $20. Also at Walmart, I purchased Santa Snow 9oz spray for $1.50. One spray can fullsizeoutput_4096covered flocking of the 6ft tree and 4 wreaths. Compare prices by clicking flocked trees HERE. Already having a beautiful pot for the tree, I used floral foam and rocks to secure the tree base. A decorative umbrella stand also works perfect as a base for faux trees, indoors or outdoors, (Amazon Cast Stone Umbrella Base). Your summer umbrella stand now in storage can be re-purposed to fit this need. Visit Umbrella Stands Re-Purposed – April blog post.

When time and money can be saved, I’m all over it! Multi-purposing seasonal decor fullsizeoutput_4090that can take you from October through December makes holiday decorating sense. This photo shows the front of my home, transitional, to take me to Thanksgiving. While many are fighting the shopping crowds on Black Friday, I’ll be decorating the front door faux tree and spray painting those pumpkins to re-purpose as landscape Christmas ornaments! Be creative, plan ahead, and consider these tips to multi-purpose your seasonal decor, taking you from October to New Years!

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Life Balance

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There are times I feel as if I am walking on a tight rope ready to fall off! Feeling this way, I’m probably not alone. We have become a culture where multi-tasking, task or goal switching and over committing is applauded; a modern measurement gauge for being efficient and well rounded for abundant living. There’s even a misconception that being exceptionally BUSY is admired and respected, be it in the workplace, school campus, neighborhoods, church, family, friends, etc. Those reading who have already traveled this road, you know, it doesn’t end well. Even when we think our priorities and focus are balanced, we slip now and then and balance becomes shaky at best. This post shares the consequences of multi-tasking, benefits of blocking time including self-care, and the necessity for calendaring health checks as a safety net.

Multi-Tasking Consequences

Recent studies have proven multi-tasking (a more accurate term is switch tasking) doesn’t work. Our brains can only thought process well through one task at a time. Quotes below summarize the effects of task switching. Recommend reading the hyperlinked articles for the reports on studies conducted. A blurry focus and divided brainpower does not produce quality work, a quality life or quality relationships.

“Recent estimates are that you can lose up to 40% of your productivity if you multi-task.”  The True Cost of Multi-Tasking, Psychology Today, 9/18/2012

“The neuroscience is clear: We are wired to be mono-taskers. One study found that just 2.5% of people are able to multitask effectively. And when the rest of us attempt to do two complex activities simultaneously, it is simply an illusion.” Why Multi-tasking Doesn’t Work Time.com, 4/20/17

…switching back and forth from project to project, like a hummingbird darting from flower to flower and then back to the original flower, can impair our ability to function at our finest. Why Multi-Tasking Is Bad For You. Time.com April 20, 2017

Time Blocking

Time blocking on a calendar is an effective and efficient means of staying on track, managing tasks and activities to function at our best. Have you heard or read the analogy of Rocks, Pebbles, and Sand in a jar? It was written to help people understand how best to prioritize life. This example never quite worked well for me because my rocks need wiggle room. A jar so tightly packed gives me anxiety just thinking about it!!! When you block time, consider what YOU need to function at your finest. What works for others may not work for you nor was it ever meant to. Self-care is identifying how you best function and allocating down time that nourishes YOUR mind and body. Here are some ideas to ponder.

  1. Self-Care – What do you need to feel your best? Self-care is so important it should be the first you calendar at workable times. If you don’t feel your best, you will not do well in other areas of your life. It’s like the example of the oxygen mask on an airplane…put it on yourself first BEFORE you can function well for anything or anyone.

Sleep – at least 7 hours per night

Exercise – regularly to take care of your body which benefits the mind

Downtime – that brings you joy and builds confidence; hobby, reading, prayer/meditation, other? AND, guilt is not welcome to downtime.

Body rest is great for the mind. Love this quote a friend shared by bodyholiday, Saint Lucia, “Give us your body for a week and we’ll give you back your mind.” So true!!

Prioritize Relationships – What time is committed to your spouse, your children, and those closest to you, in this order. If you are a person of faith, God first.

Work – Realistically block time on your calendar, be it a flexible schedule or structured workday. This is focused time in order to be productive. And, when able, breathe and take mental breaks necessary to clear the mind, especially in between tasks.

2.  Distractions – Although you may have successfully blocked time on your calendar, distractions can FAIL best-intended plans. Identify temptations and have your response planned in advance.

Bite size distractions that are disruptive, with jumbo size consequences, for you. Everyone is different.

Emailtake it off your menu bar and check it twice per day Identify important emails by flagging, star, or smart phone VIP (instructions by Techlicious)

News and Text NotificationsMUTE

Phone callscustom ring tone those calls you must take and voicemail all others (Instructions by Whistleout)

Social Media (not work related) – take off the menu bar and check after work hours

To Do List (work & personal) – trust what is on your calendar and focus only on today

An important note or situation to remember – use smart phone journal app, such as Day One, and voice dictate to instantly record thoughts 

 Deep rooted distractions that dominate concentration and focus?

Commitments that are not a priority – consider revisiting to delegate or eliminate when a commitment has run its course

Influenced by the goals of others instead of maintaining passion for your own work, commitments and ambitions– only you have authority over what is important to you

Life struggles – financial, relational, health causing worry and angst – create a plan for progress to solve life struggles, because worry only robs what you are able to control

Other?

Health Checks

It’s easy to slip and not even realize it’s happening until stress and despair is felt again. We slip when feeling so well balanced we become vulnerable to the illusion of “I can take on more” fed by overconfidence and pridefulness. Once a quarter review self-care, family and job responsibilities, goals and ambitions, along with all commitments on your calendar. Make adjustments where needed. Typically, I have found self-care always needs refocus, which led me to writing about this topic. Health checks ensure we remained balanced and catch ourselves before we are so far off the mark…we fall!

Living life well is like walking on a balance beam. Multitasking day-to-day tasks, task/goal switching and overwhelmed by commitments only leads to racing against the clock, taxing the body and mind. It doesn’t end well. To live a joy-filled life know and accept the authority you have over your priorities, ambitions and time including managing self-care. If you don’t assume this role, others will. What can you do differently today to balance on the beam of life?

Resources 

The True Cost Of Multi-Tasking, Psychology Today, September 18, 2012, Susan Weinschenk, Ph.D

Why Multi-Tasking Is Bad For You, Time, April 20, 2017, Cynthia Kubu and Andre Machado

Rocks, Pebbles and Sand

 

 

Life Lesson

Color Your Communications!

 

A number of years ago I began managing my mother’s medical care. When I moved out-of-state in 2014, online communications with medical staff was an easy solution for healthcare management. Processing and managing prescriptions and vitamin supplements – far more challenging.  This published post shares a simple idea for managing prescriptions if you live miles away or in another state, yet continue to maintain responsibility for assisting parents, extended family members, or friends.

Whenever possible, the first suggestion is to participate in prescription mail order. This allows the patient (in many cases) to get a 90 day supply of ongoing prescriptions compared to a 30 day supply. Less ordering simplifies prescription management. Second, have a plan in place to monitor prescriptions running low as the care receiver may not always tell you prior to a dwindled down supply. This could include calendaring when to reorder and/or asking if the prescription/vitamin supplement is running low. Problems come into play when elderly vision is poor (even with glasses), which makes reading small print on glossy labels very difficult. If the care receiver has been diagnosed with low vision impairment, reading prescription and supplement labels is impossible. Often times my mom would call and request a refill but couldn’t read the name of the medication on the bottle. Asking for a reorder of the “large white pills” doesn’t suffice when most all the pills are white and size is subjective. This dilemma has led to color coding prescription and vitamin supplement bottles with stickers, using different shapes to accomodate many bottles.

Instructions for Color Coding

  1. Inventory prescriptions and supplements to determine quantity of bottles that require color coding.
  2. Purchase stickers, making sure the colors are distinguishable for the care receiver. Example – using both light pink and standard pink might be difficult to discern. Purchase different shape stickers, such as dots and stars, if working with many bottles. Although not shown in the blog photo, all prescriptions could be stars and the supplements could have color dots or vice-versa.
  3. It’s CRITICAL to place the color stickers on the BOTTOM of bottles because most bottle caps are universal. A serious problem could ensue if the wrong color coded cap got on prescription bottle.
  4. Create a color coded chart and be sure one copy is at the home of the care receiver. Keep a hard copy at your home for quick reference and distribute to others who might need this information, perhaps emailing as an attachment for recipients to save as a computer copy. This hyperlinked PDF, Prescriptions and Vitamins w.RX# – color coded,is an example of such a chart. Place the chart so it is visible in the care receivers home, serving a dual purpose to provide vital information in the event paramedics are called, for their quick emergency care response.

Refill Solution 

When medication or supplements are running low the care receiver simply calls you (texts or emails) and requests, “reorder the orange label” or “reorder the blue star”. When refill bottles arrive, if the care receiver is not able or you don’t reside locally to place color stickers on the bottles, have someone you trust do this for you. When visiting the care receiver it is always a good idea to check all medications and supplements to be sure the color stickers align with the color chart.

Managing healthcare for aging parents, family members, or friends has its challenges, especially when living at a distance. Workable and safe solutions can make life easier on everyone. Color your communications and see how this effective and efficient solution modifies your ability to be a dependable and trusting caregiver to those you love.

Resources

Amazon.com color stickers available:

 

Life Lesson

Patient Beware UPDATE!

Pataient Beware UPDATE _edited-1

This article is an update to the published blog, Patient Beware, posted on May 11, 2017 explaining the Medicare issues that arise when a patient is admitted to the hospital “under observation”.

“While under observation, patients can be liable for substantial hospital bills, and Medicare will not pay for subsequent nursing home care unless a person has spent three consecutive days in the hospital as an inpatient.” New Medicare Law to Notify Patients of Loophole in Nursing Home Coverage

A new law came into affect this past March 2017, which requires WRITTEN notice by hospitals to patients admitted under observation for more than 24 hours.Medicare Outpatient Observation Notice (MOON)

“The new notice drafted by Medicare officials must be provided after the patient has received observation care for 24 hours and no later than 36 hours. Although there’s a space for patients or their representatives to sign it “to show you received and understand this notice,” the instructions for providers say signing is optional. By law, hospitals now must tell Medicare patients when care is ‘observation’ only – March 9, 2017.

The hyperlinked article above does a great job explaining the law and patient rights.

At the time a patient is admitted to a room, the patient and family member advocates have a right to know status; inpatient or observation and why. As noted above, written notice is legally required if the patient receives observation services beyond 24 hours.

A recent experience prompted this post writing because of confusion around whom to ask about admittance status and the appropriate words to use when asking. This is a true story. Patient identity is being protected.

After this law had been in affect for 5 months, an individual was hospitalized and admitted to the ER for chest pains in August 2017. Given a thorough check along with a number of tests, the ER doctor determined this person should be admitted. After assigned a room, a family member spoke with the attending nurse and asked, “Is admittance inpatient or under observation?” The nurse replied, inpatient. The question was asked again, to be certain, and the attending nurse this time replied, “I assure you, this patient has been admitted and given this room as an inpatient and not under observation.”

The following day the patient was discharged and the Patient Care Coordinator (PCC) requested papers to be signed. These papers noted, “admitted under observation”, and the patient could be liable for additional fees for medical exams, tests, x-rays, medications, etc., that may not be covered under Medicare because of observation status. The PCC could not disclose the $$$ amount of additional fees, if any, and stated that patient services received would be reviewed and fees determined by the hospital’s accounting department. Here is the problem. The attending nurse assured patient and family the prior day about inpatient status. Now patient and family member are preparing for discharge under observation and without knowledge of costs incurred. Unsettling for sure!

The family member questioned the PCC about this misunderstanding; however, the coordinator makes it clear that admittance according to hospital records was not “inpatient”. The PCC asks, “Did the nurse use the word patient or inpatient, because only the word inpatient refers to hospital admittance. Just saying patient refers to observation status.” When a family member is in the hospital with angst running high and nerves frayed, have we really come to that point of having to wordsmith conversations with hospital staff?? It appears so!

The PCC then states to the family member that the attending nurse was not the right person to ask about admittance status. The family member should have spoken with the doctor or the PCC and not nursing staff. Below are my two responses to this statement:

  1. If someone on staff assures you of admittance status, especially the attending nurse, what reason would you have to seek an answer from anyone else?
  2. It IS the responsibility of hospital management to advise/train employees to discern questions they can answer and questions that must be referred to appropriate hospital staff. This is NOT the responsibility of the patient and/or their family members.

Even though a law is in affect regarding required communication protocol when patients are admitted to the hospital, this doesn’t mean it will be followed. Patient and family members, therefore, need to be vigilant.

What you need to know

New Medicare Law to Notify Patients of Loophole in Nursing Home Coverage discusses the legal requirement that patients be given verbal notification about their observation status followed by written notice using the Medicare form MOON if the patient is receiving such services exceeding 24 hours. MOON requires all hospitals (as of March 8, 2017) to also explain WHY the patient is receiving care under observation and not as inpatient, along with charges Medicare may not cover once the patient is discharged. The form is available in English – CMS-10611 MOON_v508 and SPANISH – CMS-10611 MOON Spanish_LARGEPRINTv508 . Also see MOON-FAQs, an informative document for review.

Anytime you (or a family member) are sent to the ER and referred to a hospital room, ask the hospital doctor or PCC about admittance status. Any other hospital staff may not be authorized or able to provide accurate information.

If you/family member are being held under observation, also ask those authorized; length of anticipated hospital stay, specifically why observation and not inpatient and additional costs, if any, that Medicare (or medical insurance) won’t cover. Even through the Moon Form is not required until observation status exceeds 24 hours, the patient has the right to know this information verbally at the time a hospital room is assigned.

“When patients are too sick to go home but not sick enough to be admitted, observation care gives doctors time to figure out what’s wrong. It is considered an outpatient service, like a doctor’s visit. Unless their care falls under a new Medicare bundled-payment category, observation patients pay a share of the cost of each test, treatment or other services.” By law, hospitals now must tell Medicare patients when care is ‘observation’ only – March 9, 2017. 

If already diagnosed at the ER, it would appear observation is not necessary. So, why wouldn’t the patient be admitted as an inpatient? Typically, only a doctor can explain this and request inpatient status for the patient. Speak to your doctor, especially if diagnosed at the ER with an anticipated stay greater than 24 hours. It appears patients most vulnerable to HUGE out of pocket expenses are those admitted under observation who require nursing rehab care when discharged. If you are hospitalized, suggest having a family member or trusted friend with you when asking these questions and signing any paperwork.

How did it end for the patient whose story is shared above? Discharged by the 24 hour mark. Did not require nursing home, rehab or assisted living services. The family member signed the discharge papers noting next to the signature, that the patient and family member were assured inpatient admittance, therefore, additional fees or charges, if any, resulting from observation status are not to be the patient’s responsibility. Thankfully, no additional fees were invoiced to the patient.

We don’t know what we don’t know until we experience it first hand or through the experience of others. The purpose of this blog is to SHARE information, especially on important issues that can negatively impact someone’s life. Be prepared and know about patient’s rights whether coverage is through Medicare or individual health care plans. What you learn now will save you time and money later, especially when spending quality patient time with family is your top priority. Let’s all be informed and share these posts with those you know – Patient Beware and Patient Beware Update.

Resources

  1. Medicare Outpatient Observation Notice (MOON)
  2. New Medicare Law to Notify Patients of Loophole in Nursing Home Coverage
  3. New Medicare Law To Notify Nursing Home Coverage NY TIMES …
  4. Are You In The Hospital Or Not? AARP