Welcome to my stroke website, I hope you find it helpful. My name is Ira Zadikow and I’ve created it primarily as a resource for individuals and families who have been affected by strokes, especially those who’ve been affected very recently. My primary aim is simply to offer a bit of help as far as providing some possibly useful information and tips, and to provide links to additional information and resources. Many of the links provided on this site will be for resources within
Some background as to why I created this site. In June 2010, my mother, who is elderly, had what is known as a “massive stroke” (and in her case, an ischemic stroke, the other type of stroke is hemorrhagic). She is now in a nursing home, which unfortunately is where she'll be remaining. Due to the circumstances I’ve done a lot of Internet searches, and I’ve communicated with political representatives, Medicaid representatives, a NY State Department of Health representative (who’s been absolutely great, and I’d like to thank him for all his help), among others, and I've done a fair amount of reading.
I created this site just as a way to share some of the information and resources that I’ve gathered along the way, and to possibly ease, to a small degree at least, the levels of frustration and anxiety that people newly experiencing this are certainly feeling. It can be an overwhelming experience, not only for the stroke victim, but also for the family and caregivers. Someone has to attend to the basic necessities of keeping the victim’s household afloat, paying bills, and having access to important information such as a list of bills to be paid (and whether monthly, quarterly, or annually, as well as possibly having to have access to the patient's checkbook), gathering paperwork for applications such as Medicaid, preparing for the future, and all this while dealing with the stroke victim, doctors, hospitals and nursing homes, bureaucracies, and, certainly an enormous amount of heartbreak and turmoil.
The first nursing home where my mother was, although probably a very good institution, and although it worked out very well for us considering the unfortunate circumstances, was a very frustrating experience. This was due to a combination of factors, the primary one being my mother’s current physical and mental condition, which is not good, my feelings and reactions to that, and my frustrations as far as her treatment and care. There's a large group of people to deal with and get to know, including nurses’ aides and nurses (on two or three different shifts, I might add, as well as sub's, etc.), business office people, social workers, therapists (physical, occupational, speech), etc. I’d also note that in the span of seven months my mom was on four separate floors (with new nurses and nurses' aides on each floor), in seven different rooms, which added greatly to my levels of frustration. (I’d note that one major reason for the floor and room changes is the fact that my mom made four emergency trips to the hospital in the midst of all this, also came down with additional illnesses, and also developed worsening bedsores. One additional reason for the room changes, to a major extent, is also due to how the nursing home is being paid, whether it's private pay or if it's Medicaid. There's much more flexibility with private pay.) I also believe that it's extremely difficult for health care workers to effectively take care of someone who basically cannot communicate or move, and the shifting among different workers who are not familiar with her needs is not a good thing. (Even with workers who are familiar with her, there are still helpful things that could be done that are often overlooked, especially as far as her comfort). (There’s also a substantial risk of shoulder subluxation with stroke victims, which can very easily be overlooked. See additional notes below). However, I’d also very importantly note that there are a lot of great people at this nursing home, a lot of people that are very skilled, and who really care, and I’d like to thank them greatly, from the bottom of my heart. It’s a very difficult situation for them as well, to attend to all the patients and their myriad (and constant) needs. It’s just an extremely frustrating and saddening situation. (I'd also like to thank all the people at the hospital that my mother made those repeated trips to, there were many very helpful and caring people). I’d also add one additional point about nursing homes, which comes from my observations to date: The floor that your loved one is on is actually very important. Meaning, I’ve found that different floors, even within the same institution, can have very different environments, as far as levels of care and attentiveness, cooperation, levels of involvement, etc. For example, in the new nursing home that my mom is at (see below paragraph), I’m extremely happy with the floor that my mother was placed on. But, I can’t tell you if that floor is representative of the entire institution, or, if we just got lucky with that particular floor.
An update to the above paragraph: As of February 2011, my mother moved to a new nursing home. The reason for this is because while she was at the hospital (following her fourth ER visit (fifth if you include the trip immediately following the stroke)) her condition deteriorated. Her breathing, after 3 bouts of pneumonia, combined with her current general medical condition, worsened, and she was either using a breathing tube, or more often, a BiPAP machine, which blows out cold oxygen. Since the previous nursing home didn't work with BiPAP machines, my mother had to move to a nursing home that did. Which for me meant an entirely new cast of healthcare and administrative personnel to meet with and get to know, and very importantly, for them to become familiar with my mom. (However, I'd add that I'm extremely happy with the new facility). For my mother, her health status is now somewhat more guarded, and decisions will have to be made concerning the types of treatment that she receives. I received a bit of relief from the decision made at the hospital to arrange for a small amount of “hospice care” at the new nursing home, meaning, a small amount of additional nursing care/support provided by an outside nursing service. In this context, the term hospice care could also basically equate to “palliative care,” the purpose being to provide an additional level of comfort, as well as support, to the patient. (The usage of the term “hospice care” in this instance probably does not have exactly the same meaning as many would associate it with, however, it’s probably not that far off.) The additional nursing care is actually a great relief. It’s only four hours a day, Monday-Friday, however, it’s a nurse that’s with my mom exclusively. She provides additional care, but also very importantly, she also keeps my mom company, and hopefully my mom will be aware of this, at least to an extent. And when the weather becomes nicer, the nurse will take her outside most days, which is a nice change. And it’s reassuring to me that if I can’t squeeze out my usual tiny bit of time every day to see her during the week, I’ll know that the nurse is there, keeping an eye on her. In addition to the nurse however, the hospice care service provides additional layers of attention as well, including a music therapist (occasionally), a volunteer visitor (occasionally), and ongoing monitoring by their social worker, a primary administrator, and additional representatives. The nursing home that I’m referring to here is Isabella (inManhattan
(Note: Throughout this blog, when I refer to nursing homes, I’m generally referring to what are known as “skilled nursing facilities,” (SNF), which provide skilled nursing and rehabilitation services. This is different from what is known as “custodial care,” the providing of “non-skilled” personal care services. Services can be provided on either a short-term or long-term care basis).
An update to the above paragraph: As of February 2011, my mother moved to a new nursing home. The reason for this is because while she was at the hospital (following her fourth ER visit (fifth if you include the trip immediately following the stroke)) her condition deteriorated. Her breathing, after 3 bouts of pneumonia, combined with her current general medical condition, worsened, and she was either using a breathing tube, or more often, a BiPAP machine, which blows out cold oxygen. Since the previous nursing home didn't work with BiPAP machines, my mother had to move to a nursing home that did. Which for me meant an entirely new cast of healthcare and administrative personnel to meet with and get to know, and very importantly, for them to become familiar with my mom. (However, I'd add that I'm extremely happy with the new facility). For my mother, her health status is now somewhat more guarded, and decisions will have to be made concerning the types of treatment that she receives. I received a bit of relief from the decision made at the hospital to arrange for a small amount of “hospice care” at the new nursing home, meaning, a small amount of additional nursing care/support provided by an outside nursing service. In this context, the term hospice care could also basically equate to “palliative care,” the purpose being to provide an additional level of comfort, as well as support, to the patient. (The usage of the term “hospice care” in this instance probably does not have exactly the same meaning as many would associate it with, however, it’s probably not that far off.) The additional nursing care is actually a great relief. It’s only four hours a day, Monday-Friday, however, it’s a nurse that’s with my mom exclusively. She provides additional care, but also very importantly, she also keeps my mom company, and hopefully my mom will be aware of this, at least to an extent. And when the weather becomes nicer, the nurse will take her outside most days, which is a nice change. And it’s reassuring to me that if I can’t squeeze out my usual tiny bit of time every day to see her during the week, I’ll know that the nurse is there, keeping an eye on her. In addition to the nurse however, the hospice care service provides additional layers of attention as well, including a music therapist (occasionally), a volunteer visitor (occasionally), and ongoing monitoring by their social worker, a primary administrator, and additional representatives. The nursing home that I’m referring to here is Isabella (in
(Note: Throughout this blog, when I refer to nursing homes, I’m generally referring to what are known as “skilled nursing facilities,” (SNF), which provide skilled nursing and rehabilitation services. This is different from what is known as “custodial care,” the providing of “non-skilled” personal care services. Services can be provided on either a short-term or long-term care basis).
Before the stroke, my mother was never overly sickly or prone to illness, or one to complain (well, except for a minor heart attack, a couple of “TIAs” (transient ischemic attacks, or "mini-strokes"), a long bout of GBS (Guillain-Barre Syndrome), macular degeneration, and a couple of cataract procedures), although she had been growing more tired and frail recently. However, since the stroke, she’s had pneumonia, four times, bronchitis, a fever, parotitis, C.diff (clostridium difficile), and a blood infection. Since her admittance into the nursing home, she’s been to the hospital four times, each time admitted through the emergency room. The reasons for all these ailments are the fact that she’s bedridden and cannot move much, thereby encouraging certain illnesses, her immune system is probably compromised, and the fact of the matter is that in institutional settings such as nursing homes and hospitals, patients are extremely prone to contract various ailments that easily spread. This latter point is an unfortunate fact of life that very often contributes to declining health in many patients, who end up contracting additional ailments, often with dire consequences. My mom’s also developed “neuropathy,” which is nerve pain, which is relatively common in massive stroke victims (she’s being given the drug Neurontin for it). (She's also possibly developed a shoulder subluxation/dislocation, which is a partial shoulder dislocation that often occurs in stroke victims). I’m not going to get into any sort of detail (now) as to my mom’s current physical or mental condition, because, quite frankly, it’s just too sad and unfortunate.
Much of the material that I’ve read has not at all prepared me for the actual experience of dealing with an elderly (or any) person that’s had a (massive) stroke. I’ve found that “every day is different” with my mom. Sometimes she sleeps constantly, sometimes she’s wide awake (a lot of this can also be attributed to her drug regimen at any point in time, especially the medications for pain, as well as for depression and/or anxiety, which all cause drowsiness). Sometimes she talks a bit (although unfortunately, not what you’d consider “conversational” speech), sometimes she hardly talks at all. Sometimes she makes a fair amount of eye contact, sometimes not much. She also has states of consciousness where she is dreaming, but her eyes are open, and recently she’s often been in a sort of “combination” dreaming and awake state. There was also a period of approximately 3-4 weeks where she stopped talking entirely, which was extremely disconcerting. I’ve basically gotten used to, and I’ve learned to accept, her various states of consciousness, etc., although at first I found these to be very upsetting and confusing. There was nothing that I’d come across, and still haven’t, to prepare me for this. (I’d add that by January-February 2011, her communication had deteriorated markedly).
I’d obviously add that although the stroke victim might survive, there’s the possibility that they might not recover to a great extent. I’d list the following among the primary factors that influence the possibility of recovery: The amount of time passed between the onset of the stroke and arrival at the emergency room (there's an expression for stroke victims, "time is brain"), the patient’s age, the patient’s health and medical condition before the stroke, and even family medical history.
I’m not an expert with these things, and I don’t purport to be. However, I will offer a bit of advice, gleaned from my personal experiences so far:
First, BE PROACTIVE. Be proactive with everyone, as much as you can be. (Admittedly, I’m saying this with the benefit of hindsight. It’s difficult to be proactive when you’re in the midst of a new, and ever-changing, situation). Read, talk to everyone that you can, and try to prepare yourself. Whether it’s about medications, therapy, treatments, levels of care, financial coverage, living conditions and arrangements, everything and anything that is, and will be, happening. Be PROACTIVE.
Very important: After a discharge from a hospital to a nursing home, make sure to follow-up that care plans discussed at the hospital are actually being implemented at the nursing home, and try to ascertain if those care plans have even been documented on paper. This refers to medical equipment, drugs, procedures, levels of nursing care, etc. I’ve personally found that it’s extremely easy for things to fall between the cracks at medical institutions, and especially during the transfer process.
If you (or your loved one) is bedridden (totally, or to a great extent), due to paralysis (or for other reasons), there is a tremendous risk of contracting pneumonia (due to a combination of the patient’s reduced mobility and the spread of infection in institutionalized settings). I would personally suggest being proactive and getting a pneumonia vaccine (pneumococcal vaccination) (even with the understanding that it is not 100% effective in preventing pneumococcal disease, it can still be 60%-80% effective, dependent on the patient’s physical condition). Even though you or your loved one will be in the midst of many other issues (therapy, pain, cognition, comfort, etc.), please try to attend to this, it literally could be life-saving.
At a nursing home: Try to find one or two people that care, that can offer a bit of extra help, and provide an extra set of eyes when you’re not around. This would be primarily among the nurses’ aides, who are the ones that are stuck with doing all the dirty work. (You can also often pay for additional care by having nurses’ aides (and others) spend exclusive time with your loved one. There might be an existing service that provides for this, or, you might be able to work something out on your own. In addition, organizations like the Visiting Nurse Service will supply nurses on a
Medicaid pays for long-term nursing home care, Medicare does not. (Although Medicare does pay for up to 100 days of skilled nursing home coverage after a hospital discharge. However, Medicare only pays fully for the first 20 days of that coverage. Your secondary/Medigap insurance will probably cover the balance for the remaining 80 days). To apply for Medicaid, make sure to get the necessary paperwork together. A lot of paperwork. Copies of the patient's birth certificate, spouse’s death certificate if applicable, utility bills, rent bill, bills for secondary health insurance (with a recent canceled check as well), bills for medical and other expenses, etc. You’ll also need copies of documents relating to your assets, including current investments, etc., and copies of monthly bank statements, going back either 36 or 60 months (depending on your particular circumstances, location, etc). You will also need, for the nursing home and hospital, copies of any “advance directives,” such as living wills, health care proxies, etc., as well as a power of attorney.
If you have monetary (and other) assets, those will have to be used for paying for the nursing home before your loved one can qualify for Medicaid (“spending down”). In addition, if your loved one already has long-term care insurance (“LTC” insurance), that can be used to pay for nursing home care. See the following link: http://wnylc.com/health/entry/96/ Also see the section below titled “Medicaid planning – protecting and transferring assets.” (The reason that you have to supply bank statements going back either 3 or 5 years for a Medicaid application concerns what is known as the “look-back period.” There are severe restrictions as to transferring assets in order to qualify for Medicaid).
How do you find a nursing home (if you haven’t as of yet)? I’d first suggest that you ask the patient’s doctor if they’re affiliated with any nursing homes. Failing that, ask the social worker at the hospital (assuming that your loved one is currently at a hospital) if they have any recommendations. There is also a link below under the title of “Nursing homes, Medicare, other” that might be helpful.
Keep in mind that I’ve basically tailored this blog towards the situation of a loved one who will be remaining at a nursing home, permanently (due to their medical condition, housing situation, age, etc.), because that’s the situation that I found myself in. Hopefully the situation for your loved one will be much different than with mine, and with the likelihood of a more positive outcome. I’d note however that I assume that your loved one will spend at least some amount of time at a skilled nursing facility upon discharge from the hospital.
For those stroke victims that live in an apartment building (or other housing situation where they’re paying rent to a landlord/owner): There’s a “six-month” rule concerning (apartment) rent retention, before your monthly payments to the nursing home are increased. (This concerns what is known as “community Medicaid budgeting”). This primarily concerns patients that might be, or will be, staying at the nursing home permanently. However, the six-month time period is not set in stone, and an extension (for an additional six months) can be requested. See the following link: http://wnylc.com/health/entry/117/ The amounts that Medicaid patients pay to the nursing home is the "NAMI," their "net available monthly income."
There are several drugs used to help prevent blood clots and/or to thin the blood, with the aim of preventing strokes and their recurrence. These include aspirin, Plavix, Coumadin, Heparin and Aggrenox, among others. For anyone who has had TIAs, I personally would strongly suggest that that person look into the use of one of these medications. If your doctor hasn’t brought it up, then you should. Be proactive.
I wish you all the best of luck in your time of need. If I can be of any possible help, please feel free to contact me.
Keep in mind that I’ve basically tailored this blog towards the situation of a loved one who will be remaining at a nursing home, permanently (due to their medical condition, housing situation, age, etc.), because that’s the situation that I found myself in. Hopefully the situation for your loved one will be much different than with mine, and with the likelihood of a more positive outcome. I’d note however that I assume that your loved one will spend at least some amount of time at a skilled nursing facility upon discharge from the hospital.
For those stroke victims that live in an apartment building (or other housing situation where they’re paying rent to a landlord/owner): There’s a “six-month” rule concerning (apartment) rent retention, before your monthly payments to the nursing home are increased. (This concerns what is known as “community Medicaid budgeting”). This primarily concerns patients that might be, or will be, staying at the nursing home permanently. However, the six-month time period is not set in stone, and an extension (for an additional six months) can be requested. See the following link: http://wnylc.com/health/entry/117/ The amounts that Medicaid patients pay to the nursing home is the "NAMI," their "net available monthly income."
If your loved one is bedridden, even partially so, one ongoing risk is the development of bedsores. For someone who is totally bedridden, the risk of these is even greater. Patients will generally get an air mattress put on their bed, and the patient is supposed to be turned/repositioned every 2-3 hours. (However, I’d note from my personal experiences at my mother’s nursing home that the reality of the situation does not come remotely close to what is “supposed” to be done). An article on new "smart beds": http://www.nysun.com/new-york/smart-beds-upgrading-hospital-stays/60620/
There are several drugs used to help prevent blood clots and/or to thin the blood, with the aim of preventing strokes and their recurrence. These include aspirin, Plavix, Coumadin, Heparin and Aggrenox, among others. For anyone who has had TIAs, I personally would strongly suggest that that person look into the use of one of these medications. If your doctor hasn’t brought it up, then you should. Be proactive.
Shoulder sublaxation/dislocation: It is relatively common in stroke victims to develop shoulder sublaxation, which is a partial or incomplete dislocation of the arm at the shoulder joint. This condition is caused by extreme muscle weakness (muscle atrophy) around the shoulder, and can also be caused by spastic muscles. For caregivers: Make sure to support the arm (and elbow). Never lift under the arms when helping a stroke victim (to move them, reposition them, etc.). I’ve provided a couple of links below.
For stroke victims who are in poor condition, and with poor communication skills, such as my mother, I would suggest to do whatever it takes to possibly aid with communication. Buy a TV for their bedside. Bring in a radio. I’ve brought in “talking” dolls, as well as “talking” greeting cards, which my mom actually always liked before her stroke. I’ve also brought in some small stuffed animals, which I’ve found extremely helpful, for the following reason. My mother has a very strong grip with her good hand, but the problem is, she grips anything and everything: Nurses and nurses’ aides (and while they’re attempting to work on her), the side of the bed, and very importantly, tubes that are attached to her, which is not good. So by her holding the stuffed animal (or doll), it gives her something to hold, and also, it possibly also provides a small level of comfort to her. (The sort of level of comfort that a small child or baby gets from holding a doll).
In many instances I’ve found a lack of communication between medical personnel and the caregiver, very often the caregiver is kept out of the medical loop. I’ve found this in the case of medications that are being used, as well as with treatments being given such as therapy. I’ve often found out about changes after the fact, sometimes by accident, sometimes after I’ve made calls after I’ve noticed that certain treatments are no longer being given. Some institutions and personnel are much better with communications than others. Try to stay on top of the patient’s treatment regimen as much as you can, however you can. This might sound fairly simple to do, however, very often, it’s not.
I wish you all the best of luck in your time of need. If I can be of any possible help, please feel free to contact me.
(Note: I will not be maintaining this website/blog as a “typical” blog. Meaning, I will not be adding “daily updates” and posts, that is not the point of this site at all. This site is primarily meant to serve as a resource tool, coupled with some of my observations and advice. I will be updating it, but only as far as this main page).
A final note: My mom passed away in May 2011, 11 1/2 months after her stroke. I'd like to once again especially thank the people at Isabella and MJHS for all their caring and help, as well as the people at Lenox Hill Hospital and DeWitt Rehabilitation and Nursing Center. For useful links and resources, please see the list below:
A great link to various resources (Thanks to the Stroke Survivor blog):
A resource guide for caregivers (especially targeted for caregivers in NYC):
http://www.psgdc.org/resourceguide.pdf
General information on strokes:
http://www.clivir.com/lessons/show/what-are-the-chances-of-survival-after-a-massive-stroke.html
Great resource pages at the National Stroke Association:
http://www.stroke.org/site/PageServer?pagename=las
http://www.stroke.org/site/PageServer?pagename=awareness
The National Stroke Association:
Great resource pages at the National Stroke Association:
http://www.stroke.org/site/PageServer?pagename=las
http://www.stroke.org/site/PageServer?pagename=awareness
The American Stroke Association:
http://www.strokeassociation.org/STROKEORG/
National Institute of Neurological Disorders and Stroke (NINDS) – Information, publications, links:
National Medicare/Medicaid link:
Two recent articles (November 2010) on Medicare coverage of skilled nursing home care:
http://www.elderlawanswers.com/resources/article.asp?id=8738&Section=4&state=
http://www.nytimes.com/2010/11/02/health/policy/02medicare.html?_r=1
Signs of a stroke:
http://recoverfromstroke.blogspot.com/2010/11/seeing-stroke.html
http://signsofastroke.blogspot.com/
TIAs (Transient Ischemic Attack, or “Mini-stroke”):
Nursing homes, Medicare, other:
http://www.medicare.gov/NHCompare/Include/DataSection/Questions/SearchCriteriaNEW.asp?version=default&browser=IE%7C7
7CWinXP&language=English&defaultstatus=0&pagelist=Home&CookiesEnabledStatus=True
http://www.medicare.gov/nhcompare/static/tabsi.asp?language=english&activetab=3&subtab=17
Medicare Rights Center:
http://www.medicarerights.org/
Medicare and home health care:
http://www.medicare.gov/publications/pubs/pdf/10969.pdf
Medicare and home health care - Recent rule:
https://www.elderlawanswers.com/resources/article.asp?id=9059&Section=4&state=
Medicare Rights Center:
http://www.medicarerights.org/
Medicare and home health care:
http://www.medicare.gov/publications/pubs/pdf/10969.pdf
Medicare and home health care - Recent rule:
https://www.elderlawanswers.com/resources/article.asp?id=9059&Section=4&state=
Ombudsman, NY State - The ombudsman program is dedicated to protecting the rights of people living in long-term care facilities. Help, complaints, other:
http://www.ltcombudsman.ny.gov/
Long Term Care Community Coalitiion (LTCCC):
http://ltccc.org/
Nursing Home 411 (Another LTCCC site):
http://nursinghome411.org/
LTCCC guide to quality of life issues in nursing homes:
http://www.ltcombudsman.ny.gov/resources/2010VolunteerTrainings/LTCCCLTCOPTrainingsPresentation2010.pdf
Recent article on Medicaid assisted living residents going to the hospital:
http://www.elderlawanswers.com/Resources/Article.asp?ID=8926
PACE – Helping the elderly remain at home instead of moving to a nursing home:
http://www.elderlawanswers.com/resources/article.asp?id=9091&Section=4&state=
Archcare: http://www.archcare.org/
http://www.ltcombudsman.ny.gov/
Long Term Care Community Coalitiion (LTCCC):
http://ltccc.org/
Nursing Home 411 (Another LTCCC site):
http://nursinghome411.org/
LTCCC guide to quality of life issues in nursing homes:
http://www.ltcombudsman.ny.gov/resources/2010VolunteerTrainings/LTCCCLTCOPTrainingsPresentation2010.pdf
Recent article on Medicaid assisted living residents going to the hospital:
http://www.elderlawanswers.com/Resources/Article.asp?ID=8926
PACE – Helping the elderly remain at home instead of moving to a nursing home:
http://www.elderlawanswers.com/resources/article.asp?id=9091&Section=4&state=
And organizations affiliated with PACE, as well as providing care on their own:
CCM – Comprehensive Care Mgmt, of Beth Abraham Family of Health Services:
http://www.ccmny.org/ http://www.bethabe.org/Archcare: http://www.archcare.org/
Elder Law Answers:
A great resource page (information on Medicaid, Medicare, nursing homes, etc.)
Choosing a nursing home
Nursing Home Compare, a federal website:
Various
Medicaid/Long-term care/Nursing homes:
http://www.nytimes.com/2010/12/12/nyregion/12medicaid.html
http://www.nytimes.com/2010/12/12/nyregion/12medicaid.html
Isabella Nursing Home, Geriatric Center
http://www.isabella.org/
http://www.nyhealth.gov/ (Various sub-links follow):
Additional Medicaid/long-term care/nursing home resources:
http://wnylc.com/health/ (A couple of sub-links follow):
and:
http://www.nyconnects.org/
Human Resources Administration (HRA), New York City:
http://www.nyc.gov/html/hra/html/home/home.shtml
Human Resources Administration (HRA), New York City:
http://www.nyc.gov/html/hra/html/home/home.shtml
Neuropathy:
http://en.wikipedia.org/wiki/Stroke_recovery
Pneumonia:
http://www.merckmanuals.com/home/sec04/ch042/ch042a.html
Pneumonia:
http://www.merckmanuals.com/home/sec04/ch042/ch042a.html
Therapy (physical, occupational, speech, etc.):
http://en.wikipedia.org/wiki/Stroke_recovery
Shoulder subluxation/dislocation:
http://www.ohiohealth.com/documents/neuro/shoulder_subluxation_after_stroke.pdf
http://ezinearticles.com/?Treating-Post-Stroke-Shoulder-Subluxation&id=3866891
Nursing services:
(Nurses available, through private pay or Medicare)
http://www.mjhs.org/ Metropolitan Jewish Health System – MJHS
http://hospicenyc.org/# MJHS hospice and palliative care
Shoulder subluxation/dislocation:
http://www.ohiohealth.com/documents/neuro/shoulder_subluxation_after_stroke.pdf
http://ezinearticles.com/?Treating-Post-Stroke-Shoulder-Subluxation&id=3866891
Nursing services:
(Nurses available, through private pay or Medicare)
http://www.mjhs.org/ Metropolitan Jewish Health System – MJHS
http://hospicenyc.org/# MJHS hospice and palliative care
http://www.vnsny.org/ Visiting Nurse Service of New York
Article: "Frank Talk About Care At Life's End" (palliative care, hospice care):
http://www.nytimes.com/2010/08/24/health/24brod.html
Article: "Murky Path In Deciding On Care At the End":
http://www.nytimes.com/2010/02/23/health/23life.html
Article: "In Talks With a Dying Patient, Affirming Life":
http://www.nytimes.com/2009/06/02/health/02case.html
Article: "The Pain Of Losing A Spouse Is Singular":
http://www.nytimes.com/2010/04/06/health/06cases.html
Article: "After a Death, the Pain That Doesn't Go Away":
http://www.nytimes.com/2009/09/29/health/29grief.html
Article: "Our unrealistic attitudes about death, through a doctor's eyes":
http://www.washingtonpost.com/opinions/our-unrealistic-views-of-death-through-a-doctors-eyes/2012/01/31/gIQAeaHpJR_story.html
Article: "Frank Talk About Care At Life's End" (palliative care, hospice care):
http://www.nytimes.com/2010/08/24/health/24brod.html
Article: "Murky Path In Deciding On Care At the End":
http://www.nytimes.com/2010/02/23/health/23life.html
Article: "In Talks With a Dying Patient, Affirming Life":
http://www.nytimes.com/2009/06/02/health/02case.html
Article: "The Pain Of Losing A Spouse Is Singular":
http://www.nytimes.com/2010/04/06/health/06cases.html
Article: "After a Death, the Pain That Doesn't Go Away":
http://www.nytimes.com/2009/09/29/health/29grief.html
Article: "Our unrealistic attitudes about death, through a doctor's eyes":
http://www.washingtonpost.com/opinions/our-unrealistic-views-of-death-through-a-doctors-eyes/2012/01/31/gIQAeaHpJR_story.html
Long-term care (LTC), and LTC insurance:
http://www.elderlawanswers.com/resources/article.asp?id=9172&Section=4&state=
http://www.longtermcare.gov/LTC/Main_Site/Planning_LTC/Importance/index.aspx
http://www.elderlawanswers.com/resources/article.asp?id=9172&Section=4&state=
http://www.longtermcare.gov/LTC/Main_Site/Planning_LTC/Importance/index.aspx
A book on nursing homes:
“Nursing Homes – The Family’s Journey” by Peter Silin
A good general article on hospital billing, and reducing costs:
http://www.charlotteobserver.com/2010/09/28/1722553/put-your-hospital-bills-under.html
Article: Hallucinations in Hospital Pose Risk to Elderly
http://www.nytimes.com/2010/06/21/science/21delirium.html?pagewanted=all
Legal services:
Legal Aid Society, New York
212-577-3300, 212-489-0323
Legal Aid Society, Brooklyn Office of the Aging (“BOFA”):
718-645-3111
Additional legal services, other:
“Medicaid planning” – Protecting and transferring assets:
People can also find an elder law attorney who specializes in the above:
I would also suggest that people contact their political representatives (local and state). They might be able to provide you with useful contacts and information.
Moving from a nursing home back into the community (Including the “Money Follows the Person” program):
http://www.aarp.org/home-garden/housing/info-06-2010/the_great_escape.html
Access-A-Ride (New York City) (Great MTA service provides transportation for people with disabilities and the elderly):
http://www.mta.info/nyct/paratran/guide.htm
Muscle loss, atrophy:
http://www.nytimes.com/2010/08/31/health/research/31muscle.html
Access-A-Ride (New York City) (Great MTA service provides transportation for people with disabilities and the elderly):
http://www.mta.info/nyct/paratran/guide.htm
Muscle loss, atrophy:
http://www.nytimes.com/2010/08/31/health/research/31muscle.html
Social Security Administration:
http://www.ssa.gov/
NY Times article on nursing homes "gaming the system:"
http://www.nytimes.com/2014/08/25/business/medicare-star-ratings-allow-nursing-homes-to-game-the-system.html?hp&action=click&pgtype=Homepage&version=HpSum&module=first-column-region®ion=top-news&WT.nav=top-news&_r=0
A note to readers of this website:
http://www.ssa.gov/
NY Times article on nursing homes "gaming the system:"
http://www.nytimes.com/2014/08/25/business/medicare-star-ratings-allow-nursing-homes-to-game-the-system.html?hp&action=click&pgtype=Homepage&version=HpSum&module=first-column-region®ion=top-news&WT.nav=top-news&_r=0
Funeral services, NYC (Manhattan)
Riverside Memorial Chapel — Ann Marie Colletti, Walter, Sal
http://www.riversidememorialchapel.com/ (212) 362-6600
Rabbi
Charles Rudansky (Please contact me for phone number)
Charles Rudansky (Please contact me for phone number)
A note to readers of this website:
1) There are a couple of very helpful people, whose names and contact information I haven’t posted on this site. However, if anyone has the interest, I’ll supply you with their contact information, if applicable to your situation. One person is at Medicaid, having to do with nursing homes, and one person is at the NY State Department of Health, Office of Health Insurance Programs, Bureau of Compliance & Customer Service, NYC, who can be very helpful with the Medicaid process and any questions that people might have.
2) If there are additional areas of interest or concern that readers would like me to possibly post information about, please let me know.
