Month: March 2015

Staying Connected

Ironically, one of the biggest challenges of the age we live in is staying connected to everyone. At a time when we have so many communication tools and social media sites of every sort, one of the greatest ironies of life is that it is still difficult to keep up with everyone we know. Between work, family, getting to the grocery store, making sure the car gets to the shop, making all the kid’s sports events, and maybe an occasional outing with friends, it often seems we’re lucky to even get to our social media accounts!

Working with Veterans on a regular basis, we see how easily they become disconnected from those outside the military and vice versa. It’s as if there’s an invisible dividing line and many civilians don’t often see or appreciate much of what their military friends and acquaintances do every day to serve the rest of us.

Now, however, The National Veterans Art Museum has a way to help us all stay connected to Veterans and their stories. On one of those days when we actually can get away, or even if we just plan a get away to the Windy City, we all have an opportunity to share in the lives of soldiers and Veterans.

The museum offers a variety of experiences as it is part gallery and part hands-on classroom, providing a creative outlet for veteran artists and educating the public.

The museum’s gallery coordinator, Destinee Oitzinger, said. “A lot of the art tries to explain things civilians don’t understand.”

The museum began as an art exhibition by Vietnam War veterans who opened the museum in 1996. With the wars in Iraq and Afghanistan creating a new generation of combat veterans, the museum expanded to include art from and about veterans of all U.S. conflicts. The art varies greatly, but every piece is by or about veterans.

In a small upstairs gallery in the artsy Portage Park neighborhood, the museum features a temporary exhibition — currently it’s a nine-year portrait project called “100 Faces of War Experience”, a permanent installation on the Vietnam War based on the book “The Things They Carried.” The Vietnam exhibit offers a literal and figurative illustration of the book’s title, with an extensive collection of everyday items that American troops carried in the jungles of Vietnam, from grenades to canteens, that visitors can pick up and examine. Also included are photos, letters and art showing the war experience through their lens.

The museum also rotates exhibitions from its 2,500-piece collection. One of several on display now is Maurice Costello’s “Autobiography,” in which the phases of the artist’s life, motorcycle-riding young man; soldier in combat; drug-addled veteran and family man, are laid out chronologically. His experiences are reflected in sunglasses drawn on brightly colored, enlarged cutouts of his head.

The nonprofit museum, which is supported though grants and donations, emphasizes education and consistently brings in groups of high school and college students. It also draws a mixed group, including those with no military connection, many veterans and even more loved ones of veterans who often yearn to learn about the experiences of those who don’t share them, Oitzinger says.

“It’s a way to get the story out,” said Jim Moore, a Vietnam vet, filmmaker and longtime museum board member. “It’s cathartic to a lot of the artists…they get to express some thoughts and ideas and feelings they don’t normally get to express in their day-to-day life.”

Healing and understanding are themes that come up repeatedly in conversations with those connected to the exhibits, and it sponsors art therapy classes by licensed clinicians. Executive director Brendan Foster said that outside of that environment, the museum, and it’s art,  the outlet it provides can help veteran artists who often deal with multiple stigmas — the perception that they are damaged, a persistent negative image associated with seeking help for the effects of trauma, and the very fact of working as an artist.

“We think there is inherent in the creative process a therapeutic element,” Foster said. “Bringing this all together can help alleviate some of those stigmas.”

Much of the museum’s collection deals with Vietnam, but with hundreds of thousands of veterans having served in Iraq and Afghanistan, new generations of artists are bringing their own style to the exhibits. Oitzinger said the GI Bill is now allowing more Iraq and Afghanistan veterans to get formalized art education.

Their art is “more conceptual,” she said, “whereas Vietnam veterans tend to be more, ‘This is how it was, this is what I saw.’ ”

For Giuseppe Pellicano, an Oregon artist and Army veteran who served in Kosovo, the museum is the hub of the veteran artist community. Pellicano, whose work has been displayed there, said veterans showing their experiences through art can bring them closer to other Americans, who often misunderstand them.

Exhibits are chosen by the board, and Oitzinger and Foster say they keep politics out of the equation. That is not to say the art is always apolitical — it ranges from anti-war to supportive of U.S. wars — but the museum strives to be open to all ideas and mediums.

“We’re here to support that open conversation,” Oitzinger said.

Encompassing that range is Matt Mitchell’s “100 Faces of War Experience.” Mitchell, who is not a veteran, spent nine years seeking to paint a cross-section of those who went to war in Iraq and Afghanistan to better understand their experiences. Starting in 2005, he traveled the country to paint 100 portraits and gave his subjects a chance to provide up to 250 words to go unedited with their portraits.

Some wrote about their struggles, some wrote about their pride in service, some wrote poetry, a few wrote nothing; a collage of experiences veterans have, rather than the simplified version often portrayed in popular culture. For Mitchell, the National Veterans Art Museum was one place he could trust to portray those mixed messages, from subversive to flag-waving.

“Here is a group who is not going to try to gloss over or simplify the message,” he said. “They’re not afraid of a complex nature to veterans’ experiences.”

-Partial content courtesy of Heath DruzinStars and Stripes

About Long Term Care

What Is Long Term Care?

When a person requires someone else to help him with his physical or emotional needs over an extended period of time, this is long-term care. This help may be required for many of the activities or needs that healthy, active people take for granted and may include such things as:

  • Walking
  • Bathing
  • Dressing
  • Using the bathroom
  • Helping with incontinence
  • Managing Pain
  • Preventing unsafe behavior
  • Preventing wandering
  • Providing comfort and assurance
  • Providing physical or occupational therapy
  • Attending to medical needs
  • Counseling
  • Feeding
  • Answering the phone
  • Meeting doctors’ appointments
  • Providing meals
  • Maintaining the household
  • Shopping and running errands
  • Providing transportation
  • Administering medications
  • Managing money
  • Paying bills
  • Doing the laundry
  • Attending to personal hygiene
  • Helping with personal grooming
  • Writing letters or notes
  • Making repairs to the home
  • Maintaining a yard
  • Removing snow

The need for long-term care help might be due to a terminal condition, disability, illness, injury or the infirmity of old age. Estimates by experts are that at least 60% of all individuals will need extended help in one or more of the areas above during their lifetime. The need for long-term care may only last for a few weeks or months or it may go on for years. It all depends on the underlying reasons for needing care.

Temporary long term care (need for care for only weeks or months)

  • Rehabilitation from a hospital stay
  • Recovery from illness
  • Recovery from injury
  • Recovery from surgery
  • Terminal medical condition

Ongoing long term care (need for care for many months or years)

  • Chronic medical conditions
  • Chronic severe pain
  • Permanent disabilities
  • Dementia
  • Ongoing need for help with activities of daily living
  • Need for supervision

Long-term care services may be provided in any of the following settings:

Custodial Care versus Skilled Care

Custodial care and skilled care are terms used by the medical community and health care plans such as health insurance plans, Medicare, Medicaid and the Veterans Administration. They are used primarily to differentiate care provided by medical specialists as opposed to care provided by aides, volunteers, family or friends. The use of these terms and their application is important in determining whether a health care plan will pay for services or not. Generally, skilled services are paid for by a health care plan and custodial services, not in conjunction with skilled care, are not covered. However, custodial services are almost always a part of a skilled service plan of care and by being included, custodial services are paid by the health care plan as well. Many people have the misconception that only skilled services are covered. This is simply not true.

According to the American College of Medical Quality:

” Skilled care is the provision of services and supplies that can be given only by or under the supervision of skilled or licensed medical personnel. Skilled care is medically necessary when provided to improve the quality of health care of patients or to maintain or slow the decompensation of a patient’s condition, including palliative treatment. Skilled care is prescribed for settings that have the capability to deliver such services safely and effectively.

Custodial care is the provision of services and supplies that can be given safely and reasonably by individuals who are neither skilled nor licensed medical personnel. The medical necessity and desired results of skilled care must be clearly documented by a written treatment plan approved by a physician. A patient may have skilled and custodial needs at the same time. In these circumstances, only those services and supplies provided in connection with the skilled care are to be considered as such. The treatment plan must include:

•  The applied therapies;
•  The frequency of the treatment which is consistent with the therapeutic goals;
•  The potential for a patient’s restoration within a predictable period of time, if applicable;
•  The time frame in which the prescribing physician will review the case for the purpose of evaluating a patient’s status and before reassessing the medical necessity of ongoing treatment; or
•  The maintenance, palliative relief, or the slowing of decompensation in a patient’s status, if applicable.

Determinations of the medical necessity of skilled care must be based on the applicable standard of care.”

Writers and advisers who are not part of the medical community often confuse custodial care and skilled care with specific care activities. For example help with the activities of daily living and many of the items on the list in the previous section are care activities thought to be by definition custodial care. Whereas the monitoring of vital signs, ordering medical tests, diagnosing medical problems, administering of intravenous injections, prescribing and dispensing medicine, drawing blood, giving shots, dressing wounds, providing therapy and counseling are all activities normally associated with skilled care. But many non-medical advisers and writers don’t know that skilled and custodial refer to the people who deliver the care not the actual care given.

A skilled care provider can also provide services normally thought to be provided by custodial caregivers. Such things as help with activities of daily living and so-called instrumental activities of daily living are often furnished by skilled providers in the course of their treatment. Or a skilled care plan may call for services that can be delivered by a custodial caregiver but it would still be under the skilled plan of care for that individual. On the other hand people who deliver custodial services may from time to time perform those activities supposedly reserved for skilled providers. Such things as taking blood pressure, administering medicines, giving shots or changing wounds might be provided under certain circumstances by a custodial provider.

Please remember that the terms skilled and custodial do not refer to specific types of long-term care services but rather who delivers those services. Also the delivery of skilled services must be done under a written plan of care which often includes custodial care services.

Does Medicare Cover Custodial Care?
Of course it does. Medicare routinely pays for custodial care in every skilled care setting for which it provides payment. Medicare will not pay for custodial care in the absence of a skilled care plan.

Medicare covered nursing home stay
A patient receiving skilled care in a nursing home from Medicare not only receives care from skilled providers such as nurses, therapists or doctors but also receives care from custodial providers such as aides or CNA’s. This care usually consists of help with bathing, dressing, ambulating , toileting, incontinence, feeding and medicating. Medicare does not exclude the custodial services but pays the entire bill because custodial care is a necessary part of the skilled care plan in a nursing home.

Medicare covered home care
Custodial care is always a part of a skilled care plan for home care. The patient receives skilled care from a nurse or therapist and custodial care from an aide for help with bathing, dressing, ambulating , toileting, incontinence, medicating and possibly feeding. Medicare pays for both types of services.

Medicare hospice care
The hospice team consists of a doctor, a nurse, a social worker, a therapist when needed, a counselor and an aide to provide custodial care. Help with activities of daily living is provided at home or in a Medicare approved hospice facility. Custodial care is always a part of a hospice plan of care and Medicare routinely pays for these services.

Please note that there is no such thing as a custodial nursing home.  All nursing homes are by definition skilled care facilities because they have nurses who are skilled care providers.  Also be aware that not all states license intermediate care facilities which might provide less than 24 hour registered nursing care. “Skilled care patients” in nursing homes are referred to as such because they are receiving payment from Medicare or sometimes payment from private health insurance plans.  Practically all nursing home residents have medical needs but Medicare and other insurance plans will only pay for patients that have certain acute medical needs where recovery is anticipated.  Patients with chronic medical problems are typically not covered by Medicare but would be covered by Medicaid.

The confusion with understanding the term “skilled nursing care” probably comes from Medicare itself. To be a certified Medicare nursing home and receive payments from Medicare a nursing home must meet the Medicare definition of a “skilled nursing facility”. This means there must be registered nurses on duty 24 hours a day, there must be a doctor on call at all times and there must be ambulance service to a local hospital. Medicare may also require additional staffing and facility arrangements to receive certification. It is unfortunate that the word “skilled” is used in this definition. All nursing homes whether they meet the definition of a “skilled nursing facility” or not provide services from a nurse, doctor or therapist and this meets the medical definition of skilled care. Many states have adopted the same federal criteria for licensing their nursing homes. In some states the “skilled” definition is the only option for a nursing home. But in some states facilities with lesser services can receive different licensing classes. These might be called intermediate care facilities or “small nursing homes”.

by Thomas Day; courtesy of NCPC