A Blue Christmas?
December 10, 2009
Psychoanalyst Dr. Robert Schwalbe knows that when the Christmas carols start playing, the phone starts ringing.
The doctor, who specializes in treating men at his Upper East Side practice, said that much like a retailer, the holidays have become his busiest season.
“My practice booms at this time of year,” he said, estimating that he typically sees a 25 percent spike peaking in January. And that’s on top of the 50 percent increase he’s already noticed since the economic crisis began. [Read more]
Too Much Comfort and Joy
December 10, 2009
’Tis the season to celebrate with friends and family, and to eat and drink plentifully—often too plentifully.
According to a recent post on The Daily Beast website by nutritionist Susan Roberts, an adult typically gains between five and eight pounds between Thanksgiving and New Year’s by consuming approximately 20,000 excess calories.
“Everyone is at risk for over-consumption at the holidays simply because it is expected as a part of any celebration,” said Jeffrey Wilbert, a nationally recognized diet psychologist who is director of the Counseling Center for Emotional Eating in Ohio. Holiday office parties and domestic gatherings revolve around food and drink. [Read more]
Parenthood, Take Two
November 19, 2009
At 71, Fredericka Nelson should be the one being taken care of. After 40 years of cleaning offices to support a family on her own, the Brooklyn mother of six and grandmother of 21 thought she’d enjoy growing old in peace.
That was until her youngest daughter, who struggles with substance abuse, gave birth to Jessica, now 10. With the girl’s father out of the picture, Nelson was forced to make a difficult choice: she could adopt her granddaughter or send her to live in foster care. For Nelson, there was no hesitation. She’s been raising Jessica alone since the girl was a month old.
“I’m doing the best I can with her,” Nelson said of motherhood the second time around. But, she sighed, “It’s hard. I didn’t think I would have to start all over again… This is not the ‘Golden Years’ I imagined.”
While other grandparents have the freedom to “go anywhere, do anything they want,” Nelson’s days are spent rushing Jessica to school and helping with homework. She’d like to travel, spend time with her friends at the YMCA and take time for herself. But that’s not really an option.
“I can’t do so much,” she said. “Now my life revolves around her.”
Jessica is one of an estimated 83,000 children in New York City being raised in grandparent-headed homes (about 400,000 state-wide live with relatives who are not their parents, the latest census figures show). But these elderly caregivers are unique in that they face the task of parenthood at a time when they are coping with new needs of their own.
“[They] really thought they had hung up their gloves,” said Ivy Gamble Cobb, executive director of The Family Center in Midtown, which runs the city’s largest program designed specifically to help grandparents older than 60 raising young kids.
Many of the grandparents the center serves were thrust into the position of caregiver when they, like Carter, realized their children were not fit to parent. Some of their children suffer from substance abuse or mental health issues. Some are in jail.
Others, like Rosa Domenech, 83, have lost their children to cancer, AIDS or other tragedies.
When Domenech’s 44-year-old daughter died of cancer four years ago, she adopted her granddaughter Cassandra, now 10, into her Long Island City home. Cassandra’s father had a history of alcohol abuse, and his problems worsened when Cassandra’s mother died. As she was mourning the loss of her daughter, Domenech was forced to become a parent, again.
But Cassandra, like many children who suffer such a shocking loss, was deeply resentful of her grandmother.
“She was extremely angry with Rosa,” remembered Linda Meaney, the social services supervisor at The Family Center who has worked with Domenech and Cassandra over the years. The two, she said, had terrible fights. “She didn’t want that old woman taking care of her,” Meaney said. “You’re too old to be my mother,” Cassandra would repeatedly say.
And while tensions between the two have eased, Domenech, who is retired and suffers from high blood pressure, says it’s now getting harder and harder for her to keep up with her active granddaughter’s schedule.
“She’s getting older,” Meaney said. Things take longer. She grows tired sooner. She’s not as quick as before.
There are also financial concerns. Most of the grandparents the center serves are low-income African-American and Latina women who never planned on covering the costs of raising additional children. Unlike foster parents, grandparents do not receive a government stipend for raising their kin. A comprehensive survey of grandparent caregivers released this summer by the New York City KinCare Taskforce found that almost all must rely on public assistance, including the Administration for Children’s Services (ACS), Medicaid and Food Stamps and the New York City Housing Authority.
Approximately 70 percent reported that they can “barely manage to cover their expenses.” Thirteen percent reported they simply could not make ends meet. Again and again, the survey found problems securing housing, obtaining health care and navigating family courts, and repeated complaints about roadblocks in the system.
“Kinship caregivers, filling a void left by the absence of biological parents, have accepted responsibility for children at their own expense, both financial and emotional,” the report states. “Yet, the overwhelming conclusion of this study is that their efforts to obtain necessary benefits and services for these children are often met with unhelpful staff at city agencies, bureaucratic red tape, paltry benefits and misinformation.”
The survey implored the city “to recognize the magnificent service kinship caregivers perform,” and to do more to help the group survive.
But as city budgets are slashed across the board, government support has dwindled for the handful of city programs that assist this oft-overlooked population.
The Family Center, which provides family counseling, legal aid, grandparent support groups and other assistance, was informed in December 2008 that, thanks to the recession, it had lost its grant from the city’s Department for the Aging, reducing the operating budget by $100,000, or nearly 20 percent.
“That’s very significant for us,” Gamble Cobb said.
As a result, the center has had to cut back its outreach efforts because it can no longer afford to serve the number of clients it once did.
“When you’re having to deal with these very dire fiscal times, tough decisions are being made across the board,” she said.
By some estimates, unpaid caregivers, including grandparents, already save the government an estimated $6 billion that would otherwise be spent on foster care. Part of the problem is that most other city services are not designed for elderly mothers and fathers. For instance, most senior centers won’t even allow children inside their buildings. Assisted living facilities that accommodate children are extremely rare.
“They just don’t fit in anywhere,” Meaney said. And for grandparent caregivers like Nelson, this lack of support can be frustrating.
“We have to put our retirements on hold and take care of these children,” Nelson said. But, she complained, “They really don’t acknowledge grandparents. They put us on the backburner.”
Diane Mick-Feldman, 65, agrees.
Mick-Feldman knew it was time to step in when her grandson Evan, now 14, told her how bad the situation was at home during a visit to his pediatrician’s office three years ago.
“Grammy, things are so bad,” said Evan, who had grown quiet and withdrawn. “Be glad you don’t live with me. It’s really bad now.”
Evan’s parents had had a history of substance abuse problems and were having trouble paying the bills. They had no electricity, little food and no phone.
“Is it time for you to live with Grammy?” Mick-Feldman asked.
“Yes,” her grandson answered.
But Mick-Feldman and her husband, Henry, 71, said the transition from retiree to parent has been a challenge. Before Evan, she said, “We were happy empty nesters.” “We had freedom,” Henry agreed, describing dinners out, traveling and entertaining as they pleased.
With Evan in the home, “the spontaneity came to a halt.” Nights at the Angelika have been replaced with class parent meetings, homework help, taking Evan to football games and cheering on the sidelines.
Henry has had to continue working, knowing he must put another child through college soon.
“This is certainly a big change from what we expected,” Mick-Feldman said.
She urged the city to “step up to the plate” and do more to fund resources like The Family Center, which make life just a little bit easier for caregivers like her.
“The Family Center enabled us every stage,” she said. “For us it was critical…. Without the center, I think we really would have not had such a turnaround in Evan’s behavior and quality of life.”
Caregivers often forget to take time for themselves, and a great way to unwind is with a massage. Downtime Massage + Skincare, which recently re-opened at 698 10th Ave. and West 49th Street, is sponsoring a spa giveaway for a three-hour “Hell’s Kitchen” retreat package that includes a facial, body treatment and massage. Owner Greg Cartwright said the package is valued at $425.
“This package is about giving someone a service so they can feel that they fill their cup up,” Cartwright said. “If I can be of service to someone else and stick a smile on their face and make the difference in someone’s very hard year, I’d feel very accomplished.”
Patrons should also check out the spa’s “sugaring” treatments, based on a secret Turkish recipe for boiling down sugar to a paste and using it for hair removal.
Care for the Caregiver
To enter the contest, send a short email to mgt@downtimemassage.com nominating a caregiver, and explaining why this person could use this opportunity to “fill their cup back up.” The deadline is Dec. 21 and the winner will be announced Dec. 24.
Gender Bias
November 19, 2009
Nancy Gleeson never said “no.” When she saw sugar, she ate it, gorging on cookies, chocolate and banana splits every day for decades. She didn’t worry about the weight gain that left her tipping the scales at 225 pounds. She didn’t heed the family history that put her at high risk for diabetes—until she wound up in the emergency room with debilitating fatigue and a blood sugar level that was triple the norm.
“I didn’t realize I had to take care of my body until it was nearly too late,” said Gleeson, a mother and one of 9 million American women who have diabetes.
Exacerbated by the rise in obesity and increasingly sedentary lifestyles, diabetes has soared to record levels in the United States. This disease affects women differently than men, as only women develop gestational diabetes and are more likely to develop complications like damage to the nerves and heart.
Women of color are especially at risk, with double the likelihood of developing the disease. Since women are in greater
danger of getting diabetes, health experts are reaching out to women in the hope that they will help stem the tide of this health epidemic.
“This disease is a silent killer,” said Cathy Tibbetts, president of health care and education for the American Diabetes Association, based in Alexandria, Va. “Though 8.7 percent of American women have diabetes, a third of them don’t realize they are affected.”
Tibbets says that because diabetes can develop gradually with no obvious outward signs—and because Americans have such poor health habits—the disease has become the sixth leading cause of death among women in the U.S. today.
Diabetes is a disease in which the body fails to produce or process insulin, a hormone that is manufactured by the pancreas and helps convert food into energy. Over time, diabetes causes glucose or sugar to accumulate in the bloodstream instead of being used for fuel.
This buildup causes excessive thirst, frequent urination and physical exhaustion. It can also wreak havoc with the whole body, which is why diabetes often comes hand in hand with secondary complications like heart, eye and kidney disease.
Depending on the symptoms and age of onset, diabetes can fall into one of two categories. Type 1, in which the pancreas makes little or no insulin, usually strikes in childhood and can be treated with injectable insulin. Type 2, in which the body is resistant to insulin, usually strikes in adulthood and can be treated with prescription medication. Though both types are affected by genetic predisposition, health habits are more likely to trigger type 2 than type 1.
Though diabetes affects men and women in equal numbers, women’s concerns when it comes to this disease are especially pressing. Conditions like polycystic ovarian syndrome can increase the risk of developing either type 1 or type 2. Also, pregnant women run the risk of giving birth to an unusually large infant.
If a woman is as little as 10 pounds overweight before pregnancy, she could develop gestational diabetes, in which the hormones produced by the placenta interfere with insulin production in the mother. Affecting 4 percent of pregnancies in the U.S., gestational diabetes can increase the likelihood for a woman to develop type 2 diabetes later in life.
If a woman already has diabetes, gender differences can complicate her treatment. Women experience more fluctuations in the level of the hormone estrogen, which makes cells more receptive to insulin and thus lowers blood sugar. Thus, during the course of the menstrual cycle, female diabetics must monitor their glucose levels more carefully.
And female diabetics are more likely than male diabetics to develop secondary complications, such as cardiovascular disease and reduced blood flow to the hands and feet, though health advocates are not yet sure what accounts for this gender difference.
Studies show that women of color are at higher risk than white women. Due to a combination of genetic and lifestyle factors,diabetes is twice as common among African-American and Latina women, who are also more likely to experience eye problems and kidney failure.
Experts say that often, beating diabetes comes down to the individual—especially individual women. Diabetes websites and public service campaigns are targeted at women for social as well as statistical reasons.
“In most families, women are the ones who decide what kind of food goes on the table,” Tibbetts said. “They decide when
and how their families exercise. As women, we have the opportunity—and the responsibility—to protect ourselves and our families from this health epidemic.”
This article first appeared in Womensenews.org
Dr. Mozart
November 19, 2009
Michael Gruson, a successful attorney, got the worst possible news from his doctor in March 2005: His persistent headache was more serious than anything an aspirin could cure. It was the symptom of a malignant brain tumor.
A partner at Shearman & Sterling and the head of an eight-member household, Gruson, 69, was accustomed to success and responsibility. Now, with stage-four brain cancer, he was at life’s mercy.
“Our world went upside down with no advance warning or preparation,” said Hiroko Gruson, Michael’s wife of 45 years. “I realized that somebody had to be constantly available.”
Michael was suddenly dependent on doctors, treatments and Hiroko, who became his domestic caregiver. Both husband and wife soon realized something much simpler would also help them through this difficult time: music.
Hiroko was a caregiver to her husband until his death in December 2005. She recorded his progress in a journal, prepared special meals for him, negotiated with insurance companies and coordinated with his colleagues about mail, travel plans and other logistics. When Michael was in pain, she massaged him and read books to him. To prepare for emergencies, Hiroko would also accompany Michael on business trips that he was able to tackle while not bedridden.
Equally significant was the emotional comfort that Hiroko provided, surpassing any professional help that Michael could have received.
“We would lie down and quietly listen to the music every night,” she said. “I was too afraid to ask or say something to him. We would just start to cry.”
Music helped Hiroko get through the painful experience of watching her husband die. The soothing melodies couldn’t cure her husband, she knew, but they consoled him during the final days of his life.
“Music pushed me forward when I just wanted to give up,” she said.
Music, particularly the calming Mozart and Thomas de Hartmann songs they would listen to, silenced their fears during the painful evening hours that they had to stay awake between doses of oral chemotherapy.
“In a way, it was a relief—music was a kind of common milieu,” she said. “We could connect without verbalizing the topics that I didn’t want to touch upon.”
The couple had witnessed the healing power of music in the formerly divided Berlin, where Michael and Hiroko lived during the first few years of their marriage. Seeing foreigners and Germans bond over a glass of beer at a free jazz or opera performance in the 1960s convinced Hiroko that music transcended social and political strata.
Acting upon her husband’s dying wish, Hiroko founded the Gruson Fund for Brain Tumor Research & Care in 2006, a nonprofit organization committed to brain tumor research. The organization has raised money through classical music concerts held at venues such as the Church of the Epiphany, on York Avenue near East 74th Street, and the Abigail Adams Smith Museum Auditorium, on East 61st Street between First and York avenues. A benefit gala took place at The Kosciuszko Foundation, on East 65th Street.
Hiroko hopes to extend the group’s services and sponsor music performances for an ever-larger number of struggling patients and their caregivers around New York City. Having sung to her husband and his terminally ill roommates at the Weill Cornell Medical Center, she says that music, “just might provide patients and caregivers with the courage to keep on fighting and carrying out caretaking tasks.”
Due to lack of sleep and proper nutrition, Hiroko fell ill several months after Michael’s death.
“I was too worn out to feel that I was exhausted,” she said.
Family caregivers claim to experience chronic illness at more than twice the rate of non-caregivers, according to the National Family Caregivers Association. Whenever she feels down, Hiroko quietly hums Man Arai’s popular Japanese folk song “A Thousand Winds.” Its sanguine lyrics and cheerful melodies reassure her that Michael is alive in spirit.
For more information about the Gruson Fund for Brain Tumor Research & Care, visit www.grusonfund.org/news.html.
Little Help for Hospice
November 19, 2009
We spend more money on healthcare in the last months of life than at any other time. It’s when we’re sickest and most in need of medicine, doctors and intensive care.
According to estimates, nearly 30 percent of Medicare’s annual $327 billion budget goes to caring for patients in their final year of life.
But despite the whopping price tag, palliative care has received relatively little attention as the battle for health care reform has roared on, leaving those in the business on the sidelines in frustration.
H.R. 3962, the Affordable Health Care for America Act, which was passed by the House earlier this month, includes a cost-saving provision that intends to reduce hospice reimbursements by almost 12 percent by 2019, according to Dr. Porter Storey, executive vice president of the American Academy of Hospice and Palliative Medicine, the professional organization for specialists in the field. With already-planned cuts, that number could surge to 14 percent.
Storey and other advocates say that, if passed, the cuts would deliver a crippling blow to the quality of hospice care.
“The hospice community simply cannot endure the productivity adjustments proposed,” the National Hospice and Palliative Care Organization wrote in an open letter to legislators in response to the America’s Healthy Future Act (or the “Baucus Bill,” which was passed by the Senate Finance Committee shortly before the bill in the House).
At the moment, hospice care profit margins nationwide stand at just more than 3 percent, according to a June 2008 MedPAC report cited by the letter.
But the margins vary widely across the board, explained William Dombi, vice president for law at the National Association for Home Care & Hospice, based in Washington, D.C. While some providers are raking in 30 percent profits, there are also numerous non-profits and smaller facilities, especially in rural areas, that make significantly less. Many operate at a loss or rely on donations to provide care.
“With these cuts, a lot of these [smaller, non-profit] hospices will be closing their doors,” said Dan Chin, director of public affairs for HospiceCare Inc., a non-profit hospice network.
Even providers who are able to keep their doors open will have to be more selective in the patients they choose. They are also likely to cut staff, meaning lower doctor- and nurse-to-patient ratios and less time spent between patients and doctors.
Yet hospices have been shown to provide higher quality—and cheaper—care than the alternative. The letter cites one study by the Robert Wood Johnson Foundation that found that patients who receive hospice care save Medicare, on average, $2,300 each. Another found savings of $3,192 during the last months of life. Patients who receive hospice care don’t end up in emergency rooms. They don’t see numerous doctors and don’t double up on medications they don’t need.
The foundation study estimated that, in total, hospice care saves the program more than $2 billion a year.
A 2007 study published in Journal of Pain and Symptom Management reported that hospice patients live nearly a month longer than those in non-hospice care—a significant increase, considering life expectancy at the time of admission is six month or less.
Most of the reductions to end-of-life-care outlined in the proposed bills will come from slashing Medicare, which funds hospice providers on a per-day basis: the House bill calls for a $56.8 billion cut, and the Senate Finance Committee a $43.2 billion cut, according to Dombi.
If the cuts are approved, he said, “There will be serious access-to-care problems. This is like removing one of the legs of a stable health delivery system.”
New York would be particularly hard-hit by the cuts, Dombi said. New York State has been the leader in home and community-based care, and profit margins for home health care agencies here are generally lower than the rest of the nation, he said, meaning there’s less room to cut.
But the bills are not all bad. The Senate version does expand home and community-based services and shifts long-term-care spending to home-care rather than nursing homes, which patients overwhelmingly prefer.
One Senate proposal will discount the incomes of the spouses of Medicaid patients who are treated at home in the same way as those who are treated in a nursing home, making more people eligible, Dombi said.
But advocates say it just isn’t enough.
“I’m very disappointed,” Storey said of Congress’s priorities. The changes, he said, “will force a lot of people who would rather have comfort care at home to go back to emergency rooms and spend more time in the hospital.”
Let the Light In
October 9, 2009
While high-rise living is quintessential to urban life, it may also be limiting exposure to natural light for people living in a 12-story apartment—especially early morning light—and making those tenanats more susceptible to Seasonal Affective Disorder.
SAD, also known as seasonal depression or winter depression, begins affecting people in late fall and can last through early May; in accordance with the time of year when overall daylight is shortest.
The specific cause of SAD remains unknown. [Read more]
Simply Happy
October 9, 2009
Maybe we’ve been wrong about depression. Maybe it’s not simply a biochemical malfunction best corrected by a Prozac prescription or a psychological malady requiring soul-baring confessions to a therapist. Maybe, says Stephen S. Ilardi, associate professor of clinical psychology at the University of Kansas, what’s darkening our lives is the way we actually live.
“There’s increasing evidence that we were never designed for our sedentary, socially isolated, indoor, sleep-deprived, poorly nourished lifestyle,” says the bearded, wiry Ilardi. “If throughout the course of human evolution people were as vulnerable to depressive illness as 21st-century Americans, we would long since have gone extinct as a species.” [Read more]
Portraits of Strength
September 10, 2009
It’s a startling statistic: One in 8 women in the United States are diagnosed with breast cancer over the course of their lifetimes. But it’s a number that the Greater New York City Affiliate of Susan G. Komen for the Cure is helping change for the better.
Each year the organization hosts the Komen New York City Race for the Cure, a 5K run/walk that raises money for breast cancer research and local community outreach programs. It draws 25,000 participants, including 2,000 survivors. And of course there are plenty of children taking part with their families, friends and schools. [Read more]
A New Look at Breast Cancer
September 10, 2009
In the United States alone, statistics show that nearly 200,000 women may be diagnosed with breast cancer this year, and more than 40,000 might die from the disease.
This is why people like Dr. Larry Norton, physician-in-chief of breast cancer programs at Memorial Sloan-Kettering Cancer Center, remain important in the fight against this disease. For more than 40 years, Norton has been working on understanding the mathematics of tumor growth or, more simply, how cancer changes and spreads based on numbers. [Read more]
