The Veterans Healthcare System is the most important one we have in the USA.
One thing that all of the cable news networks and newspapers agree on is that issues of veterans’ health are ones on which all members of Congress seek to achieve a consensus. An interpretation of this that I have heard from the TV pundits is that all members of Congress, whether veterans or not themselves, respect those who risked their lives to protect the United States and police the world. Another interpretation I have heard is that all members of Congress need to face constituents who value service in the military and would not vote for a potential member of Congress who does not protect those rights. I prefer the first interpretation, although I would also accept the second. Veterans have earned lifetime healthcare services and those services should be the very best that the medical and social services can provide.
I was very happy to see the strong reaction of Congress to the poor candidate nominated recently to head the Veteran’s Administration. A doctor who has managed a staff of 70 healthcare providers is probably inadequately prepared to run a large federal agency with hundreds of thousands of employees, 9 million patients, facilities across the US, and many political entanglements. Just because you are the personal physician of the US presidents and praise the current president’s health in spite of his all-fast-food diet, borderline obesity, and behavior that indicates high levels of stress does not mean that you should be rewarded with a job in charge of the quality of the healthcare of 9 million veterans. And no doctor who hands out medications on airplanes without prescriptions or having personally met with the recipient (patient) and is accused of inappropriate interpersonal behaviors is deserving of being trusted with the health of our veterans.
For once, Republicans and Democrats agree that the candidate was not qualified to head the Veterans Administration. And they achieved this conclusion by consensus.
So the nominee did the right thing and withdrew from his candidacy after a lot of pressure from the White House.
Wouldn’t you like to see our elected representatives act with similar wisdom and common sense every time they make a decision? CONSENSUS!
Having dementia is, OBVIOUSLY, not a lot of fun. You feel bad mentally and physically and tired after just a little physical or mental activity. A couple of weeks ago when I had a six-hour professional meeting with two other people I went home and immediately went to sleep for 14 hours.
When you have dementia, it takes a lot of energy to just get through a day and figure out what you can do and how to do it. I have trouble with buttons so I find that I am leaving my preferred “office” shirts buttoned and just pull them over my head. I go to the trouble because wearing a dress shirt during the day — albeit without a tie and with the sleeves rolled up — makes me feel better.
Social interactions are among the most difficult things I have to deal with during the day. They are also the most upsetting to other people because they can see my vulnerabilities at the same time I may annoy the heck out of them.
So, one thing I try to do is to follow the 10 courses of action listed in the mind map below. I have increasing dementia after all so no matter how hard I try I doubt I get more than 80% of these things right. But by trying hard, my efforts are appreciated and reinforced by those family members, service providers, and others who have to deal with me when I am at my most stressed and tired and grouchy. And the fact I am trying lowers their stress.
Just because you have dementia, you are not excused from trying or being nice or appreciating others.
If North Korea became just like South Korea, their per capita income would be TEN TIMES higher. The North Korean life expectancy could increase by TWELVE YEARS. Democracy, a battery-powered car and 2 television sets, a great education for your kids, a couple of trips to Hawaii, and 12 more years of life. Turn off the nuke production and increase the quality of life.
The #1 thing that I have learned over almost a decade of living with dementia is that thinking in pictures (images, diagrams, doodles, etc.) is much more effective than using words alone. Hedge your bet. Use pictures that associate with words rather than just words. After all, in many types of dementia, you lose your words at the end while the pictures may escape loss.
Try it. You will probably like it. Creating visualizations of important events, ideas, feelings, and other information can be FUN.
I’ve been using visual thinking methods for the past 10 years. They work (for me).
In March 2018, @USNews and @AetnaNews published key results from their study of approximately 3,000 US counties. Each of these counties received a total score as an index of how healthy the community is as well as scores on 10 component parts of being a healthy community. Eighty indicators of community health were developed from standard, well-constructed, and valid datasets.
The Healthiest Communities rankings are based on well-collected longitudinal survey data from US government databases and those of well-established, not-for-profit organizations.
My professional conclusion is that the study is valid, reliable, and relevant. The index scores are based on a combination of expert judgment from independent professionals and data sources that are among the best available. Statistical analyses appear to be appropriate and expertly applied. Of course, as with all such studies, over time additional analyses can be made, interpretations can be added by experts of many disciplines not limited to health, and supplemental quantitative (numerical) and qualitative (judgment) data can be collected.
The report on America’s Healthiest Communities provides a summary of the top 500 communities. The remaining rankings are not revealed as the intent is to identify excellence and study it to establish models for other counties that are also working to improve the quality of life for their residents.
Data available on each community includes well-constructed indices of the following characteristics listed in the mind map below. Click on the map to increase its size.
I spent more than 25 years in my post-doctorate career studying the health of communities throughout the USA, including a) small “frontier counties” too small to be considered rural where there were 5 times as many cows as people and the trip to a doctor was more than an hour for more than 50 percent of the population; b) the fourth largest U.S. county in a location on the Mexican border; c) large-city neighboring “bedroom” counties; and d) healthcare systems in more than 100 other U.S counties. My work (in collaboration with my business partner Dr. Lisa Melchior and our staff at The Measurement Group) was primarily focused on developing high quality, effective, and accessible care and treatment for people with mental health problems, drug and alcohol abuse and addiction, HIV/AIDS, extreme poverty, unstable families, inadequate or housing, poor education, immigration status, criminal justice system involvement, dependence on public-supported health- and social-care systems, and legal unemployment with a subsequent dependence upon “illegal employment” such as selling drugs and sex work in order to support themselves and their minor children.
As we worked with health systems and clinics, what I concluded was that a very comprehensive service system with widespread support among residents, service providers, and elected officials was necessary to make a community healthy. It was clear that all of the major stakeholders in the system need to communicate clearly to the other stakeholders about what they could and could not do with available resources. Stakeholders needed to learn to how to leverage their resources with those of other stakeholders to provide better services for a lower cost. A permanent system of making decisions and sharing resources and improving services needed to be formed and nourished.
The basic components of our work included assembling data from sources such as surveys, focus groups, interviews, and public databases. We presented these data to groups of stakeholders and facilitated discussions on how various systems such as healthcare, public housing, law enforcement, and education-training could work together and share resources. Progress was monitored and evaluated and new cycles of data gathering, communicating, discussions, and program alterations were conducted.
The following diagram shows the steps our process went through in order to build a self-sustaining system of interdependent services and joint decision-making in order to make a community more healthy. Click on the mind map to increase its size.
It is often said that “it takes a village” to plan and implement long-lasting improvements in a community. It does, but it takes a few other things also as well. Click on the diagram to increase its size.