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    Kids Volunteer to Aid Seniors & the Needy in Society via R Love.us When my grandma explained how many elderly men and women were often abandoned by their friends and families once they were hospitalized, I (Prayerna/ co-founder RLove.us) realized that I could help both my peers and many other high school students, in addition to the elderly... read more

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    May 23, 2014

    The Medicare Advantage and Hospice Care

    As we all know, the Medicare Hospice Benefit has never fully been integrated into Medicare Advantage. Once a patient chooses to enroll in hospice care, Medicare only covers some of the treatments the patients needs and leaves the rest to be paid in a fee-for-service fashion. This makes it so that hospice is not very accessible to patients in the first place, so when they finally are enrolled in hospice care it is often too late for the services to have any effect on the patient’s health. I’ve talked a lot about the benefits of hospice care in improving patients’ quality of life in their last stages of life (see blog post from March 30, 2013), so I am most certainly in favor of integrating hospice services into Medicare’s managed care program. This would allow for more focus to be placed on providing high-quality care to those who need it, rather than making hospice an inaccessible service where the focus is on who will foot the bill from day to day. If Medicare begins to cover hospice services, it will have more of a stake in ensuring that quality care is actually provided. Patients will benefit greatly if this happens, as good hospice care has been proven to provide high patient and family satisfaction and personalized care to palliative care patients. 

    Just a quick thought I had today after reading a news article about the potential elimination of the hospice carve-out from Medicare Advantage. Here’s hoping that idea comes to fruition.

    April 3, 2014

    Getting Emotional: Caregiving in Poetry

    Perusing through the The New York Times “New Old Age” blog (an old favorite of mine that I surprisingly haven’t written about in a while!), I came across a recent article that I couldn’t resist blogging about because it combines the subject matter of this blog, healthcare, with another one of my proverbial cups of tea: literature. I absolutely love reading and writing poetry, and this article by Jane Gross covers a book called Living in the Land of Limbo: Fiction and Poetry About Family Caregiving, compiled by Carole Levine. It contains a variety of poems and short stories by various authors, organized by relationship to the patient, about providing care for a loved one.



    I find this to be such a beautiful intersection of creative expression and healthcare. There are so many emotions associated with caregiving, especially for a loved one, and writing literature about these feelings can provide a really powerful outlet for them. The examples in Gross’s blog post use strong imagery and emotionally charged language to convey their experiences with caring for mothers, fathers, and grandparents alike. The result is a series of extremely real and raw emotions manifested in language that really evokes feelings of pain, confusion, and helplessness that are felt by people who must face the loss of a loved one. We often view end of life situations simply as sad periods of time, but these poems and short stories highlight the complexity of these situations and the myriad different emotions associated with them.


    February 10, 2014

    Psychology in Medical Decision-Making

    Today’s blog post deviates a little from my usual topics of choice, mainly because I happened to stumble upon an extremely interesting article in The Journal of the American Medical Association about medical decision-making and prospect theory. It talks about the different ways that a medical decision may be presented to a patient that can affect the way that they view it. The article cites Tversky and Kahneman’s findings in the field of behavioral economics as outlining the underlying facets to choice in the minds of individuals. My attempt at boiling their entire body of Nobel-prize winning work into a few simple points would look something like this:

    1. People simplify their choices by comparing differences between their options.

    2. Then, people find a reference point from which to make their decision. This has to do with how a question is viewed due to previous biases or simply the way the question is asked.

    3. Lastly, people place value on their options based on the projected outcome.

    If you’d like to read the article yourself, here is the link:


    How does this psychological theory relate to medicine? I wondered the same thing as I read through the beginning of the article. It went on to outline some seriously interesting points about the relevance of prospect theory to physicians. They included how knowing whether patients view a decision in terms of gains or losses affects their willingness to undergo certain treatments, as well as the differences between the decisions that healthy and sick patients make, can provide insight for doctors into the care they provide.

    This article really made me contemplate the many complexities involved in healthcare delivery. We often focus on policy and the logistics of what care patients receive, but it is not as popular to think critically about how this care is delivered. How a medical situation is “framed” to a patient can seriously affect the decision that gets made. It seems so crazy to me that just the words or context with which a question is asked can have such a dramatic impact on the outcome of a patient’s medical condition, which can often be a life or death situation. We tend to think of medicine as a highly scientific field (which it often is), but it is interesting to me how it is still susceptible to human biases. Psychology really is a fascinating field in that way, and I will definitely be looking to read more about the interplay of psychology and medicine in the future.


    January 8, 2014

    Don’t Forget Your Vitamin E!

    More than 5 million Americans suffer from Alzheimer’s Disease, a figure that is projected to triple by 2050. Worldwide, the number of patients is over 50 million and expected to surpass 100 million. It has been found, according to the results of a study published in the Journal of the American Medical Association, that Vitamin E can significantly slow the disease’s progression.  Patients given high doses of Vitamin E (more than 20 times the dose found in a multivitamin) for two years delayed progression of the degenerative brain disease by about 6.2 months, compared with those given a placebo.  Vitamin E acts as an antioxidant, which may delay or prevent cell damage, and boost the immune system.  This new study builds on earlier studies that showed slower disease progression with the use of Vitamin E and is the first to show it may help stall functional decline in those with milder forms of Alzheimer’s, according to the study’s lead author,  Maurice Dysken.

    There is hope that further studies may find that early introduction of  Vitamin E (or foods rich with Vitamin E) into the diet may eliminate the onset of this disease altogether.  Let’s hope so. Through my volunteer work, I’ve seen firsthand the effects of Alzheimer’s and it is absolutely heartbreaking. For the patient and their family members alike, it just exacerbates other health problems and creates pain and confusion for all. There really is nothing more heartbreaking than seeing the brain functions and memories held by your loved one gradually wither away due to Alzheimer’s. I would love to see this finding and subsequent theories of how to prevent Alzheimer’s come to fruition sooner rather than later.



    November 22, 2013

    Back-tracking on the One-Child Policy

    News came out earlier this month that China, the world’s most populous nation, has now made a decision to “ease” its famous one-child policy of 1979. The latest revision allows parents to have a second child if one of the parents was an only child. Previously, the second child was only allowed if both parents were only children. Both, the commencement of the one-child policy and now its revision, are decisions driven by economics. Back in sixties and seventies, China was a poor nation with too many mouths to feed. Now, China is the 2nd largest economy in the world, and it has become that due to its massive exports. The huge labor pool that drove this growth is now aging and with fewer children to make up the labor pool, the cost of labor is rising and growth slowing.

    China’s population is aging, much like most of the world. By 2050, 1 out of 3 Chinese will be 60 or older. Due to the effects of the previous one-child policy, one person will be responsible for the care of six elders: one set of parents and two sets of grand parents. Since China does not enjoy the (per capita) affluence of nations such as Japan, this will be a massive burden on society. It appears that the reversal of this ill-thought out policy is probably too late to have any material affect on altering China’s economic and social future. Although the one-child policy may have seemed like a good idea at the time of its institution, clearly times have changed and it has drastically affected China’s demographic makeup. I guess, the old saying  about “Be careful what you wish for” seems to fit China’s dilemma. There are several well written articles about this topic. Here is a link to one of them.


    October 28, 2013

    Expectations vs. Reality: South Korean Elder Care

    In my last post, I wrote about the state of growing old in England. Jeremy Hunt, the British Health Secretary was quoted saying that the English could learn from Asian countries about caring for the elderly. He went on to say that in Asia, putting elderly parents in residential care is the last resort, not the first option. Hans Schattle, a professor of political science at Yonsei University in Seoul, S. Korea, has penned a rebuttal to Mr. Hunt in The Guardian. Mr. Schattle, who has lived in South Korea for five years, states that the Asian model is not what Jeremy Hunt believes. He states that the frightening poverty among older people in South Korea is startling. Many elderly citizens live in squalor. Earlier this year, one of the major newspapers in S. Korea reported the poor conditions of Korean care homes that are plagued by filthy conditions including the stench of excrement and body odor. At one institution, residents were consistently bathed out in the open and then forced by staff to walk back to their rooms naked. Statistics in South Korea show that nearly fifty percent of the population over 65 lives in poverty and the suicide rate among the elderly has more than doubled in the past decade. Mr. Schattle goes on to cite the example of Japan, by far the wealthiest nation in Asia, where the number living in poverty has nearly tripled since the country’s economic downturn led to brutal cuts in welfare programs.

    It is so disheartening for me to see this phenomenon taking place in a country such as South Korea, where cultural values generally point to high levels of respect for the elderly. I would surmise that the effects of globalization and the sheer cost of caring for the elderly have contributed to the poor conditions of their elderly care facilities, as they have in many other countries. It appears that the issues facing the elderly are common around the globe. So far, I have not read of a nation with a completely successful model to combat this issue.  For the complete article, please see the link:


    October 19, 2013 

    “United” We Stand..and Fall

    It seems that the conditions of aging in England are not much better than in United States. There was a very telling article in The Telegraph a couple of days ago about the state of growing old in the United Kingdom. According to Jeremy Hunt, the British Health Secretary, there are close to 1 million elderly who are left lonely and without any social contact with family or peers. He has deemed it a “national shame” and will be calling for a change in social attitudes towards the elderly by urging younger people to change the way they treat their parents and grandparents. In addition, according to Campaign to End Loneliness, there are an additional 5 million seniors who say television is their “main form of company”. Mr. Hunt also said that families should be slower to put their elders in care homes, saying that families should learn from Asian countries where putting elderly parents into residential care is seen as a last resort, not the first option. In addition, the issue of elder abuse and the quality of care was also highlighted. Statistics show that there are more than 1000 cases of alleged abuse each week in England.

    The issues in Britain are no different than those issues we face here.  With a rapidly aging population, England and United States (along with many other nations) must address these issues head on or the consequences could be dire. The fact that such conditions exist in the United Kingdom as well the United States, two of the most advanced countries in the western world, lends credence to the fact that serious changes are in order. Here is the link to the article:


    September 27, 2013

    Obamacare Revised

    Open enrollment for President Obama’s signature health care program (Obamacare) begins next week on October 1. Through insurance exchanges, Americans will be able to sign up. After March 31, 2014, anyone without health insurance will be assessed a penalty of 1% of their adjusted gross income (with a minimum and a maximum fine). Over seven million people are expected to sign up through the federal exchanges and an additional nine million are expected through the state run programs (Medicaid). I thought we would highlight the impact of the Affordable Care Act on seniors. First of all, Medicare benefits will be expanding. Beneficiaries will save, on the average, about $ 4,200 over the next 10 years, primarily due to lower drug costs, free preventive services and reduction in the growth of health spending. The free preventive services include flu shots, tobacco use cessation counseling, screenings for cancer, diabetes and other chronic diseases. In addition, seniors will receive a free annual wellness check. Medicare Part B premiums are being reduced. For the Medicare Part D prescription drug program, many beneficiaries will be receiving a discount on prescription drugs. There are a host of other benefits and the following links provide greater details.




    I think that it will be interesting how these newly added provisions of the ACA will pan out with time. There are undoubtedly some extremely beneficial provisions in theory, but I am curious as to how their implementation will shape itself in reality. The ACA has been faced with much controversy about its effectiveness since its original implementation, and I am admittedly a little skeptical about it as well. Not to say I don’t think these are necessary benefits, but I do hope that they are actually able to have the effect that they are intended to.


    September 14, 2013

    Affordable Care Act vs. Affordable Care Providers

    President Obama’s Affordable Care Act has been making headlines over the past year or so. It has created a very sharp divide (mainly along party lines) among our legislators, with most Democrats supporting it and most Republicans opposing it. Most of the discussion has been about the provisions relating to health insurance but a small part of this act relates to nursing homes. It grants state ombudsmen enhanced power to unveil nursing home corporate structures, as well as authorizing federal funding to those offices to pursue that task. It is designed to address the lack of transparency that allows nursing home owners/operators to hide their corporate structures from victims of abuse. State legislatures all across the nation are attempting to pass legislation to circumvent this provision of the Affordable Care Act. In Oklahoma, lawmakers are trying to pass “tort reform” legislation that would limit the amount of compensation victims of nursing home abuse and neglect can receive. In Florida, there is pending legislation that would immune owners of nursing homes from any accountability, and only management companies or licensees would be liable for nursing home neglect. In Kentucky, the nursing home industry is backing a creation of medical review panels for all abuse claims.

    Instead of passing legislation protecting the nursing home residents from neglect and abuse, our elected representatives are working hard to protect the owners of nursing homes from liability. What a shame. I think that the language surrounding these provisions should focus on the recipients of the benefits and how they are affected, rather than on how to circumvent their implementation. Organizations, such as AARP and Alzheimer’s Association (and other senior advocacy groups) must get involved in this battle. Here is the full article:




    August 27, 2013

    Volunteering: The Panacea

    Last week, a study by researchers at the University of Exeter Medical School in England  found that people who volunteered showed improvements in their mental health.  Specifically, the subjects reported lower levels of depression, increased life satisfaction and enhanced well-being.  Volunteers usually cite altruistic motives, such as “giving something back” to their communities, or supporting a charitable organizations that has helped them, but this study suggests that the effects of volunteering on volunteers may go far deeper.  The Exeter study goes on to state that the causes underlying the potential health benefits of volunteering are unclear.  Some conclude that physical benefits, for example, could be explained by the fact that volunteers spend more time out of the house.  However, the relationship with mental health may be trickier to determine, researchers add.

    To offer a personal opinion, I think volunteering poses substantial benefits in all fields! It obviously helps the community and encourages civic responsibility, but it is also so personally rewarding and fulfilling. I’m not a scientist doing research, but my instincts (whatever those may be worth) tell me that the researchers at the  University of Exeter may be on to something! 🙂 And with the aging population worldwide and hence a greater need for volunteers for the elderly, this news will only have a positive effect on volunteering.   Since RLOVE is trying to champion the cause of volunteering for the elderly, we welcome these findings with open arms.  Here is the link for the article:



    July 5, 2013

    Elder Abuse: When Will it End?

    Last month, a judge in Sacramento, California upheld a lower court verdict awarding $ 23 million (in punitive damages) to the family of a 81 year old woman.  (see link below) Emeritus Senior Living was found guilty of wrongful death and elder abuse of Ms. Joan Boice, who was under their care.  Ms. Boice passed away due to sustained bed sores.   I am currently working on (while interning with a law firm) a similar case where the elderly man suffering from dementia was severely beaten by a worker/caregiver at a retirement home.   Testimony revealed that the worker was seen in midair, hurtling from atop a dresser toward the bed, landing both knees onto the man’s belly.  The worker was subsequently convicted and the retirement home settled out of court.  In addition, the mortuary prepared the body for internment and buried him without reporting the obvious fractures and bruises.  These type of cases are becoming all too common now.  The  changing  demographics of our country require new, stricter laws about the treatment of the elderly and more importantly, an improved and stricter enforcement of the laws to protect seniors.




    June 25, 2013 

    The Elderly and Damned

    With a rapidly aging populace comes the ugly issue of elder abuse.  The National Center on Elder Abuse recently published statistics regarding elder abuse.  The results are startling. In 2010 (the latest year that statistics were available for), there were almost 6 million reported cases of elder abuse (people over 60 years of age).  I’m sure many others were never reported.  Basically, about 1 in 10 senior citizens was abused in some way or another.  The most common abuse was neglect, followed by physical abuse and then financial exploitation.  Sixty six percent of abuse cases were perpetrated by spouses or children.  Interestingly (and sadly), 42% of all murders of people over 60 were by the victims offspring and 24% were by the spouses.  So, two out of three murders of individuals over 60 years of age were committed by either their spouse or their children.  Wow!  If this is not evidence enough for the the need for stronger laws to protect the elderly, then I don’t know what is.  We have special laws that protect children.  Why?  Because children are helpless.  Well, so are many elderly.



    June 10, 2013  

    Costly Care

    We have all been hearing  about the high cost of medical care in the United States.  With a rapidly aging population that will require more medical care, our nation must address this issue immediately.  Recently, The New York Times started a series of articles about this issue.  The United States spends about 18% of its gross domestic product on health care, which is twice as much as most other developed countries.  The Congressional Budget Office has said that if medical costs continue to grow out of control, they will consume 100% of our GDP.  That is a scary thought.  It is a given that over the next few decades, we will be using more medical services.  What we have to address is the growing cost of those services.  Common procedures, such as a colonoscopy, which is performed more than 10 million times annually costs anywhere from $ 2000 to $ 9,000 per procedure in the United States.  In Austria, the same procedure costs between $ 200 and $ 300.  Other developed countries treat health care as a public utility, whose rates are set by the government.  Others use a system where the rates are negotiated with providers and insurers nationwide.  In the US, we treat health care as a free market.  The other major difference is the pharmaceutical and health care lobby.  Their efforts drive up the cost of medications and medical care.  It is currently the 11th hour for this issue, and if the underlying problems related to the cost of health care are not addressed quickly, we could be in for serious economic problems.




    May 24, 2013  

    Columbia Cares!

    At RLOVE, We are always looking to spread the word about the needs of the elderly.  It was so heartening to see this article from On Campus, the Columbia University  newspaper, about a student, Ashley Shaw, who has started a volunteer program for the elderly in New York City.   “At Your Service Volunteer Program” takes students from Columbia who volunteer 4 hours per week at Terence Cardinal Cooke Health Care Center to provide companionship for terminally ill patients.   This program is funded by Columbia College Alumni and Parent Internship Fund.  How great is that?  These sort of volunteering programs should be started at all universities.  Maybe, even some college credit could be earned by participating.  Let’s see.  I hope to continue our efforts by starting a RLOVE chapter at college next year (wherever that may be).   



    May 14, 2013

    Turning the Tables: Elderly Volunteering on the Rise

    The mission of RLOVE is promoting student volunteerism for the elderly.  With an aging population in the United States, the need for volunteers to assist senior citizens is growing rapidly.  Well, news came out last week that volunteering by seniors hit an all time high in 2011.  Data released from U.S. Bureau of Labor for 2011 shows that more than 20 million seniors aged 55 and older provided thee 3 billion hours of service, at a value of $ 67 billion.  According to the Corporation for National and Community Service (CNCS) in Washington, D.C., the percentage of volunteers who are seniors has increased from 25.1 percent in 2002 to 31.2 percent in 2011.  One reason for this increase is the fact that the percentage of our population who are seniors has also risen.  This is great news on two fronts.  One, much of this volunteering effort is for the assistance of other seniors.  Two, by volunteering, seniors are helping themselves by living active, healthy lives through volunteering.    Thus, volunteering for seniors seems to be a win-win proposition.  What could be better than that? On a personal note, my grandmother, who is now in her late 70s, has been volunteering at nursing homes for the past 20 years.   That is how my sister and I originally became aware of  the needs of the elderly. http://www.thenonprofittimes.com/news-articles/volunteering-by-seniors-hit-10-year-high/



    April 24, 2013

    Hospice Enrollment: A Matter of Timing

    USA News Today wrote an article about an issue that is faced by hospice patients around the world today — being enrolled in hospice care too late after their health has declined. I’ve talked about how hospice has been proven to prolong the lives and improve the health of its patients, but if a patient is enrolled once their health is already irreparably bad, there is very little that even the benefits of hospice care can do to fix it.


    The article talks about how doctors and hospitals often take an aggressive approach to caregiving, which can often place unnecessary stress on the patients. They also only suggest hospice as an option when all else has failed. This results in patients’ health worsening by the time they are enrolled in hospice, meaning that it is more difficult for it to improve once enrolled. A solution to this problem would be to change how people view hospice in general. While it is geared to help the needs, both medical and emotional, of the dying, it seems that too many people view it as exclusively this. However, it also presents a great deal of benefits to those who are not necessarily expected to die in the near future. The care that it provides can even improve one’s health by addressing all aspects of a patient’s life and being considerate of their conditions, rather than simply trying to cure their symptoms.

    In my opinion, they key to encouraging earlier enrollment in hospice care is changing the language around hospice care. I have met many people who simply view hospice as “taking care of people right before they die”, and in come cases they shy away from putting their loved ones in hospice in an effort to not face the reality of death. This does not have to be the case. Hospice should be viewed as what it actually is: a service that addresses not only the medical needs of its patients, but also aims to take into consideration other aspects of their lives, emotions, and families. It is an alternative to frequent hospital visits that provides constant care to help people in the long term, rather than intermittent care for short-term relief (as many hospital visits are).

    April 9, 2013

    Who’s Who?

    This article from “The New Old Age” blog addresses a prickly issue that has come about in society, as blended families grow in number and the lines of who cares for who become increasingly blurred.


    It raises an interesting issue unique to this day and age, when blended families are becoming more common and stepchildren are now faced with difficult to choices to make. Traditionally, the argument for caring for elders has been that “They have cared for me, and I should now return the favor”. However, this logic does not necessarily apply in taking care of stepparents, who are not biological relatives and may not have played a part in their stepchildren’s lives at all. This has resulted in many elderly patients being left without anyone at their side at the end of life, as a result of late-life marriages and blended families with children who have already grown up and gone out to live their own lives.

    The solution to this problem is unclear to me. While it is one thing to hold children accountable for the care of their biological parents, it becomes a grey area when trying to hold them accountable for stepparents who may not have had a relationship them throughout their lives. I would like to think that I would help my stepparents (if I had any) at the end of their lives simply because they are in need and have some sort of connection to me. However, I understand that not everyone would abide by the same reasoning because everyone’s feelings are different toward responsibility and as a result their actions would differ as well. It is difficult to find an absolute right or wrong in this situation, because there is a point where things are not so clear-cut and fall into major grey areas. Only time will tell what the decision will be among stepchildren of the world today.

    March 30, 2013

    Hospice Care in a Nutshell

    KPBS recently put out an article detailing some of the pros and cons of hospice care.


    It is entitled “Choosing Life or Death: Hospice Under Scrutiny”, and it details how hospice is meant to ease the pain of death, yet in some cases there are treatments available that can actually prolong one’s life. Patients are therefore faced with a choice between a less pain in death or actually having a chance at prolonging their life, because hospice is meant to do the former and often does not encourage the latter.

    This poses a very interesting question about a pivotal decision at the end of life. Should one choose to have treatments that can possibly cure them, risking the fact that the treatment may not be completely curative and only prolong their life for a small amount of time? It seems that it could simply be a better decision to face death instead and not spend money on treatments that may only put off death by a small amount of time. However, the other side could be that these treatments provide a chance to avoid death completely. It is a difficult choice to make to spend a lot of money on something that may not even work.

    To me, the decision made in this situation depends on the person. There are some people who are open to embrace death and can deal with not trying to live once they have lived the life they wanted to. However, there are others who appreciate life so much that they would not give it up so easily. These would be the people who are willing to spend the money on expensive treatments in order to have any chance of saving their lives. It really depends on how one views their life; whether they think they have lived it to the fullest or think that there is more they want to accomplish in their time in this world.

    March 3, 2013

    Bereavement Struggles

    This article focuses on the family members of dying patients, who suffer a great deal of anger and frustration when faced with the death of their family member.


    Often times these family members feel frustration with God, themselves, and/or those around them when a tragic event such as the death of a family member is imminent or has already occurred. It takes a toll on their faith in many things and can often turn their lives upside down. The article also talks about forgiveness and resolving conflicts that remain with among family members at the end of life. It was found that not resolving conflicts of forgiveness led to greater depressive symptoms in dying patients.

    This article touches on a topic that is not often addressed when talking about the process of dying: the people that are left behind. I have seen firsthand the bereavement process of people who have recently lost a loved one and are having trouble grappling with unresolved issues, either within themselves or with the deceased family member. It can be heartbreaking to hear those “I wish I had said or done something” stories of moments that can never be regained. These sentiments often lead to a lifetime of regret and suffering over an event that has long passed. For this reason, it is extremely important to embrace the dying process not only as an end but also as an opportunity to resolve conflict. Closure can be one of the most beneficial outcomes that comes from this, so that one does not have to continue to live wondering about what could have been. Rather, talking about one’s issues and bringing an end to prolonged conflict can be a fruit of the process and bring comfort to those who are left to live in this world.

    February 18, 2013

    Keep Calm and Care On

    Here’s another fascinating article I found in The New Old Age blog on the NY Times website. It talks about applying Zen and Buddhist principles to caregiving. This one was particularly of interest to me because I have read a lot about Buddhist philosophy and principles; however, I’ve never thought of combining them with caregiving specifically, so this article caught my attention.


    The article is an interview with Judith Graham, who teaches a class at the San Francisco Zen Center that covers the concept of “contemplative caregiving”. What she means by this is being mindful of one’s emotions in dealing with the elderly and remaining calm when anger arises. She states that the aim is to build up a relationship with the dying, rather than turning away from them. Graham cites the fact that we are a death-denying society as the reason why this is so difficult for some who would rather ignore the reality of dying rather than embracing it as a part of life. I find this concept of “contemplative caregiving” to be so intriguing because of it is unlike anything traditionally practiced here in the U.S. We are prone to letting our emotions overcome us and lashing out at those who cause us to feel unpleasant feelings. I think that more people should embrace Graham’s Zen approach to caregiving by viewing it as a gratifying experience rather than a burdensome one. Often times people are so reluctant to care for their elders because they view it as an inconvenient chore. Graham encourages us to change our very mindset by viewing the “chore” as something that is beneficial for ourselves as well as the individual we are caring for. We learn about ourselves and our tendencies and as a result gain greater insight into what we need to work on in our lives. By changing our disposition, we will be able to change our reactions and control our feelings of anger and stress in our interactions with the elderly.

    January 25, 2013

    Restrictive Reimbursement Restrictions

    Medical News Today recently put out an article about restrictive reimbursement in hospitals, which has become a controversial issue since hospice enrollment has increased in recent years. Many hospices are finding that they cannot enroll patients with extremely complex and expensive medical treatments because of limited reimbursement of the Medicare benefit for hospices. It is limited to $140/day on average, which does not cover the costs of such complex procedures as chemotherapy, transfusions, or radiation.

    Many efforts are being made to increase the Medicare hospice benefit in order to cover these costs. I believe that it is extremely necessary for some reform to take place, especially because the limited reimbursement results in arguably the most needy patients being turned away from hospice care. This is simply nonsensical in a system that aims to provide patient-centered care to those who need it. The Medicare benefit for hospices needs to be altered to reflect the growing enrollment of hospice care and the increasingly advanced procedures that are available to treat its patients. Rather than punishing people for having demanding medical needs, Medicare should aim to accommodate them and satisfy those needs.



    December 15, 2012

    Questioning Quality of Life

    A bit of a different article today –this is a very personal blog entry by Tara C. Bradley on the Sesen Elder Care website about what constitutes “quality of life”.


    Bradley poses a very interesting question about the difference between “quality of care” and “quality of life”. She feels that quality of life is self-determined and constitutes such things as passion, and how one feels emotionally in their situation. Many times we are focused on the care provided to these patients and try to ensure that they receive the highest quality of care, while sacrificing their quality of life in the process. She suggests things such as asking our elders how their quality of life can be improved, and actually following up on the suggestions they make.

    I think that this is an extremely important distinction to make between good care and a good life. Of course, good care is surely important in maintaining and improving someone’s health and trying to alleviate their illness as much as possible. However, it is also important to consider how their surroundings will affect them emotionally. If they are faced with an impersonal and lonely environment, quality of life declines significantly. Patients enjoy their lives less if they feel isolated in their environments and feel that their feelings are no longer cared for. Whatever little we can do by providing company and support to our elders, no matter how difficult their medical situation, can help in improving their self-determined quality of life.

    November 27, 2012

    Exploring Your Options

    Heart Insight is a very informative blog created by the American Heart Association covering many topics regarding health and lifestyle for ill patients of all types, their families, and their caregivers. It’s a great resource if you’re interesting in reading about such topics. I really like this blog because it’s applicable to real life and provides practical tips for families in complex medical situations. This particular article covers the options for families who feel that their elderly family members need better care than what their families alone can provide to them.


    The author here covers a common misconception held by American families of today. Many believe that once they can no longer provide adequate care for their elderly relatives, their only option is to place them in a nursing home. The article cites many other options for those families in this position: home care, independent living, board and care facilities, and assisted living. All of these options provide specialized care for the elderly yet are more flexible to a family’s situation by being able to work in the family’s home and on a schedule convenient to them. Often times families do not research all of their options and consequently place their loved ones in expensive and uncomfortable nursing homes that don’t suit their specific needs. While nursing homes are a great option for some, it’s extremely important to become educated in other options as well so as to make an informed and appropriate decision for each family.

    The article also offers some important emotional tips as well when transitioning a loved family member to a facility where they will be better taken care of. This is extremely important because moving out can be a physically and emotionally draining process. These tips are useful in making the process as smooth and calm as is possible by taking into consideration the feelings of both the patient and the family as well.

    October 3, 2012

    Social Networking Among Older Generations

    Wow! This article in The Huffington Post is truly a remarkable one. It covers a new trend among the elderly in combating isolation and loneliness by staying connected with the world around them: the use of social networking.


    This new discovery embodies the benefits of our digital age in helping those who are often left out of most social interactions, the elderly. It talks about how social media has become a forum for the elderly to battle the isolation of their daily lives by keeping in touch with relatives, religious organizations, news, and other social events via the Internet and social media. I think this is a great discovery for the elderly to keep in touch with the world. Often times we dismiss our elders as too old to learn how to embrace modern technology, and claim that it is too late for them to learn. However, this article’s findings prove that it is most definitely possible to “teach an old dog new tricks” and that it can even improve their lives considerably.

    There are several projects that have spawned from the elderly’s embracing of social networking that display the results of this trend. There are even such things as “elder blogs” that cover issues related to aging and the world of elder care. Not only is this a great way for elders to express their feelings and experiences, but it provides a support system for both the readers and the writers of the blog, who can find comfort in knowing that there are others who empathize with their feelings and share similar experiences.

    Here are some of the blogs mentioned in the article that are worth taking a look at. They are extremely telling not only in seeing this phenomenon in action but also in opening our minds to the perspectives of the elderly, who are often not given such an effective forum in voicing their opinions.


    http://jenett.org/ageless/supporters/ – This link will take you to the site of the Ageless Project, which features a great deal of elder blogs to take a look at.


    August 18, 2012

    Understandable or Unacceptable?

    Today’s article focuses on the other side of elder care that I have not really focused on as much on the blog: the adults who are caring for their elderly parents. Most of my focus has been on the elderly patients themselves, but this piece in the New York Times covers more of the social phenomenon of the adults who are now faced with the care of their older relatives.


    It seems to be a growing “trend” among adults that caring for their elderly parents has become a topic of conversation with their peers. Everyone seems to be in the same boat and is faced with difficult decisions to make regarding their loved ones’ health and medical treatments. Some of the titles of articles that have covered this seem extremely morbid to me, such as “Mom, I Love You. I Also Wish You Were Dead. And I Expect You Do, Too.” and “Why Caring for My Aging Father Has Me Wishing He Would Die”.

    It is both fascinating and saddening to me at the same time that such articles have gained such resounding popularity in recent times. On one hand, I find it to be good that adults can find support from others going through the same situation they are in caring for dying relatives. It is definitely positive that they are taking responsibility for their loved ones’ health and take it upon themselves to make the proper decisions to keep them safe. However, I can’t help but think that the attitude of these adults seems begrudging and bitter about helping their elders. This really makes me think about my own beliefs in caring for the elderly. I think that despite the fact that these adults are doing what they have to in caring for their relatives, there seems to be a lack of purpose and appreciation for what they are doing. It seems that they do it because they have to, not because they genuinely feel that they owe it to their elders to return the care they have always been given in their lives. This poses an interesting question: Is it enough to just go through the motions of caring for our elders, or is it necessary for these actions to be accompanied by deep feelings of appreciation and purpose?


    July 23, 2012 

    Emotional Strain Leads to Physical Pain

    Another interesting article I found from the NY Times’ “The New Old Age” blog.


    This is yet another fascinating article about how emotions can have an effect on one’s health, especially in old age. It was found that those elderly adults who reported feelings of loneliness and isolation saw their health decline over the years. They found themselves less able to participate in daily activities, and it was even found that those said to be lonely were 45% more likely to die. I find this to be a very telling discovery because it emphasizes further the work that we do with RLOVE. Not only does visiting and listening to the elderly patients help them emotionally, but it also poses health benefits as well. It was said that blood pressure tends to rise with increased stress, and loneliness exacerbates this bodily response. If these patients know that they are not truly alone and that there are people willing to listen and spend time with them, their feelings of loneliness will decrease and their health will see a marked improvement.

    This discovery is consistent with a lot of my personal experience in nursing homes and assisted living facilities. Those who have not seen their family or loved ones in a while are not only emotionally hindered, but they also have less will to carry out their daily activities. They are debilitated in mind and body, and it truly takes a toll on their health. Through whatever little we can do to alleviate this pain, we are helping to improve their health and hopefully improve their overall quality of life.

    June 20, 2012 

    Hospice: The Saving Grace

    I recently found this blog featured on the New York Times website called “The New Old Age”. It covers many topics that have to do with palliative care and old-age benefits, and I really recommend it if you are interested in keeping up with current events in the field.

    This article on The New Old Age blog covers a very current issue that deals with a situation many families face when their elderly family members fall ill.


    The article talks about the fact that studies have found that when an elderly patient is sent to the emergency room, they are more likely to be hospitalized and eventually, see their death come sooner in the hospital. The article cites several fascinating reasons for this phenomenon, such as the fact that the attitude in emergency rooms is to diagnose and treat symptoms, rather than to comfort and ensure mental well-being as well. It may seem implausible that a mere set of attitudes has the power to elongate lives, but the facts do not lie. This has resulted in many hospitals creating emergency units especially designated for elderly patients that are calmer than the general emergency units. This is an extremely interesting article to me because it details a situation that many families put themselves into without even a second thought. When an emergency arises, it seems to be the logical thing to do to rush to an emergency unit, and keep the elderly patient there for as long as allowed.

    However, the articles cites the so-called “magic word”: hospice. It was found that most of the elderly patients who did not have to visit the emergency room were those enrolled in hospice. It may not be a fountain of youth, but it has been shown to elongate the lives of its members at the end of life by providing a comforting environment of care, rather than an urgent one that is created by emergency rooms.

    It seems that the solution suggested by this article would be to place elderly patients under hospice care before a problem arises so urgent as to warrant immediate emergency care. Most patients are placed in hospice care after the fact, and as a result they are already approaching death by the time they receive the comforting care that would alleviate some of their ailments. If people were to realize the benefits of hospice care for elderly patients before they fall ill to a life-threatening disease, perhaps they would not have to say goodbye to their loved ones so soon.

    As is clear by this especially long blog entry, I could write essays upon essays about the benefits of hospice care. There is clearly a better way to deal with the plight of elderly than is being practiced now, and it is my sincere hope that more people will realize it in the coming years.


    May 12, 2012

    Music Alleviating the Effects of Alzheimer’s

    A documentary was recently released called “Alive Inside”, which takes an in-depth look at the effects of Alzheimer’s and the power that music has in making victims of Alzheimer’s feel, well, “Alive Inside” (watch the trailer here). It came out about a month ago, and I am looking forward to watching it and learning more about this interesting phenomena. I mentioned this concept a while ago in my blog with the “Pay it Forward” band that is composed of volunteers who play music in nursing homes. As mentioned in the trailer for this movie, many patients feel disillusioned when they first arrive in a nursing home, and their fear is only exacerbated by having Alzheimer’s to deal with as well. It’s heartbreaking to see people suffer from this disease, and equally as difficult to see their family members suffer as well. Alzheimer’s affects not only the patient but the people around them as well. The joy that comes when these people music provides a temporary but meaningful respite from the everyday effects of Alzheimer’s and is really uplifting to see. Despite the fact that not much can be done to combat against Alzheimer’s, the use of music to alleviate some of the confusion and bring life to its victims is a small step that brings hope for the future.

    The film was released at the Rubin Museum in New York, and with enough success they may be able to release it on TV channels for the general public to watch as well. For now, I’ve watched the short film that they released last year that covers the same concept. I’ve read really good things about this documentary, and am looking forward to watching it myself.

    March 29, 2012

    Even the Wealthy are Susceptible to Elder Abuse

    As many have probably already heard, the high-profile elder abuse case regarding Brooke Astor and her son Anthony Marshall just reached a settlement. Marshall was accused by his own son of committing various acts of elder abuse against his mother by cutting back on necessary medication, allowing her to live in squalor, and using income from her extremely large fortune to increase his own wealth after she was diagnosed with Alzheimer’s. Astor’s grandson, Philip Marshall, asked that his father be removed as his grandmother’s legal guardian because of his atrocious treatment. Marshall was accused officially of various acts of estate tampering, including grand larceny, criminal possession of stolen property, and forgery among others. Marshall was convicted of these charges back in 2009. The settlement that came about yesterday was regarding Astor’s will, in which Marshall was to receive $30 million. Instead, he received only half of it, with a remaining $100 million to be left to Astor’s favorite charities. This case was just interesting to me because it shows the fact that elder abuse can occur to anyone. Astor, who comes from an enormously wealthy family, was still victim to being taken advantage of for her money.

    Read about the settlement here:



    February 3, 2012

    Policies Affecting Seniors

    The National Council on Aging (NCOA) recently put out a piece about “The Top 6 Polcy Issues Affecting Seniors in 2012” regarding some very prominent old-age policy issues of the moment.


    In particular, I’d like to talk about #1, #2, and #4. The Older Americans Act is an important piece of legislation that seeks to accommodate the needs of the increasing aged population in our country. It is currently up for potential reauthorization It was previously reauthorized in 2006, and was initially passed during Johnson’s presidency Great Society reforms. Its original purpose was in response to concerns about a lack of services for the elderly in local communities. Policy

    Issue # 2 is a bit more controversial, because there are many that oppose Medicare’s expansion and want to cut its funding. Congress recently passed a temporary statement to extend certain programs, but they are now faced with making a long-term decision on the topic. Medicare has provided a copious amount of support in caring for the elderly and I really hope that Congress comes to the decision to support the Medicare programs mentioned in the article.

    #4 addresses the CLASS insurance program in place for the elderly to aid in the expenses of paying for end-of-life care. It encourages planning throughout life to save for end-of-life care rather than forcing the ill and their families to spend their entire savings on the extremely high expenses. Having had experience in the hospice business, I have seen how many families want to provide adequate care for their loved ones but are simply unable to keep up with the astronomical expenses. This program provides relief for those facing an issue that will only grow in this country as the population ages and end-of-life care becomes more in demand

    December 29, 2011

    Domestic Conflict in Elder Abuse

    I recently found another interesting article in the Chicago Tribune that concerns an interesting issue that, to be honest, I have not personally had much experience with. It covers the trend of elderly domestic abuse, in which often times the victim is unwilling or afraid to report the abuse out of fear for or threats from their loved one.


    This is a prickly issue, and I definitely see that there are merits to both sides. On one hand, there is obviously abuse occurring and great harm can come to the victim if it simply remains unreported. However, the other side is that this is a very personal issue, and someone may feel that they can change their abuser because of the close relationship or fears being responsible for punishment coming to their loved one. The part that interested me most was the idea cited by the article that domestic abuse is not really the “stigma” it is thought to be. Reporting such abuse will not always result in criminal charges, and may even lead to the loved one receiving the treatment they need in order to improve upon their relationship. It’s important to be aware of one’s options before assuming the worst of such situations. Especially true in the case of the elderly who face domestic abuse, the victims are often accustomed to the abuse and have it so deeply engrained in their minds that they no longer even consider doing something about it. Increased awareness of this issue will most definitely lead to more cases in which victims are willing to speak out against abuse.

    October 23, 2011

    It’s in the Music

    Hi all! A friend recently sent me this video about a volunteer band called “Pay it Forward” that plays live music for elderly patients at nursing homes.

    (Click the picture below and it’ll take you to the YouTube video.)

    Screen Shot 2013-07-16 at 4.58.32 PM

    The video really illustrates the joy that music and other recreational activities can bring to the patients in these facilities. I’ve seen it myself– what seems like an everyday activity to me, such as hearing a live band play as you’re walking down the street, can actually mean the world to someone in a nursing home who doesn’t have the privilege of being able to go out to concerts and hear live music at their will. Due to the circumstances, these patients are often [for lack of a better word] trapped inside these facilities and encouraged to stay in their rooms for most of the day. I do recognize that this is often necessary for their health, as many elderly patients should not be overexerting themselves physically by going to concerts and being out and about all day. However, it’s nice to bring the joys of the outside world inside to them, so they too can enjoy life as we young people are fortunate to be able to do. “Pay it Forward” really has the right idea in this respect; it’s clear that the elderly patients in the video are overjoyed and touched by the effort put in to provide entertainment for them and make them happy. Just like the rest of us, they love to feel appreciated and cared for during a period in their lives when such feelings are few and far between. What more can one ask for?


    September 6, 2011

    Kane County Combats Elder Abuse

    I just found some interesting news I found that I’d like to share. I came across an article in the Chicago Tribune about expanding efforts throughout the state of Illinois to combat elder abuse and neglect.


    As mentioned in the article, Kane County’s efforts to raise awareness and response to elder abuse came about because of an elder abuse case involving an elderly woman and her two daughters several years ago. I think that it is really positive to see that they have not only continued their work on the Elder Fatality Review Team but have also improved upon it throughout the years and are now expanding to neighboring counties. The goal of this task force is not necessarily to prevent the deaths of the elderly, because that is often difficult to do (as there are many health complications that could be faced at the end of life), but rather to provide oversight of elderly fatalities to investigate whether or not they faced abuse at or around their time of death, if the abuse played a factor in the death, and what can be done to prevent similar mishaps in the future. In the case that sparked the creation of the Kane County EFRT, the elderly woman’s body was cremated before allegations of abuse could be investigated, a blunder that greatly hindered the service of justice in this case. With the creation of this Tri-County EFRT, the efforts to provide more examination of elderly deaths to determine the presence of abuse abuse now have more resources and expanded access to cases in order to hopefully eradicate these types of cases in the future.

    I would love to see more of these task forces arise throughout the country, because elder abuse has become a growing issue in this country due to the aging population and growing number of people in nursing homes and facilities. It is important that we do not simply attribute all elderly deaths to health conditions (although a reasonable explanation, it is obvious this is not always to case) and overlook the abuse taking place right under our noses.

    Here’s some more information about the recent formation of the Tri-County EFRT:



    July 23, 2011

    RLOVE UPDATE + Music Practice

    It’s been a while since my last post, so I have a lot to share. Firstly, we’ve gathered other volunteers that are willing to start RLOVE clubs at  Troy High School and Yorba Linda School. We’ve gained a lot more volunteers and are excited to expand the volunteer experience to more people! Also, we’ve already had a few visits to an assisted living center in San Dimas. Our volunteers have come up with many ideas of activities for our next visit, such as arts and crafts, nail-painting, and music. Some volunteers have shown and interesting in drawing, which will definitely result in some RLOVE artwork in the future. Music has been the main focus recently, with everyone contributing their talents of playing piano, bass, violin, viola, cello, and also singing! I’ve shared some photos and video from our most recent practice. Although it is the middle of summer, we have been practicing Christmas songs for our winter performance, as well as some other songs for our next visit.


    Music Practice


    Two volunteers practicing a song for our next visit


    January 16, 2011

    RLOVE Club Volunteer Training

    Hello all! Today we had our volunteer training for the members of the RLOVE Club at our school, Valencia High School. Pastor Regie Bolus and Beatrice Tan led the training, and they briefed the new members on how to properly volunteer for the elderly. We got through about half of the training requirements today, and we’ll be finishing it up on January 30. After we have finished, we’ll officially be able to volunteer for the hospice service. I’m looking forward to having all of the members together for our first volunteer experience!

    October 27, 2010

    RLOVE Club at Valencia High School

    Today, my sister and I officially established the RLOVE Club at Valencia High School! We received many sign-ups from people who were thrilled to hear about our organization and help us out with our volunteer work. Our first meeting will take place over the course of the next few weeks, and we look forward to involving others in our work with the elderly. We are looking at forming RLOVE Clubs at Troy and Sunny Hills High School as well, which will be established soon. If you would like to start an RLOVE Club at your school, please feel free to contact me at mayher@rlove.us for more details on how you can get involved!

    September 20, 2010

    Volunteering at Riverside Board and Care Facility

    Wow! What an experience! Yesterday, we had our first volunteering encounter at a board and care facility in Riverside. My sister and I, along with other students from Valencia, Troy, and Sunny Hills High School, visited and talked with the patients there. It was amazing to see how us just being there made such a difference in their day, and I could tell they truly appreciated our visit. We spoke with them about their lives, interests, and anything else that came to mind. They constantly thanked us for visiting, saying that it was nice to have young people around them after so much time. Overall, it was extremely fullfilling to visit them and see how our smallest actions can mean so much to them.

    July 1, 2010

    Volunteer Training

    Hello everyone! I hope you have had a productive summer, because we sure have! On Monday, we completed our volunteer training for RLOVE. Pastor Regie Bolus of Ultimate Care Hospice was kind enough to train us in what it takes to be a good volunteer to the elderly. We learned about various ways to comfort those in need of care, and other tips on how to succeed in our particular field of volunteer work. We have received the certificates that mark our completion of the training, and we are eager to start our volunteering! Our plan is to visit some of the patients of Ultimate Care Hospice this weekend, and apply the skills that Mr. Bolus taught to us. We’ll be sure to keep you posted on our volunteering and other upcoming events.
    Thanks for reading, and have a wonderful day!

    Volunteer Training 7-1-10
    Training session on June 28, 2010.

    Volunteers are eager to learn during one of our training sessions.

    Pastor Regie Bolus excitedly teaches us about volunteering for the elderly.

    Hi, I am Mayher Uppal, one of the co-founders of RLove.us (along with my sister, Prayerna).  I hope you appreciate the effort and cause I have started this blog for.  Look around and PLEASE contribute appropriately to our efforts of charity & volunteer help for the elderly and needy people the world over.

    Thanks and have a great day!