Medical Advances for Us

Health1I have struggled with some slow healing wounds on my leg. One wound clinic could not help as I struggled for several months. Sooo…I followed a suggestion I heard a time ago;  “It makes no sense to repeat the same action over and over again and expect different results.”

I moved to a different wound care clinic at Tri Star Southern Hills on Nolensville Pike, they uncovered a MERSA infection, they cleared that up with antibiotics. Wounds were healing slowly, but not fast enough for Dr Sudberry. He decided to use a fairly new treatment using a stem cell matrix developed with amniotic stem cells.

Amniotic stem cells are the mixture of stem cells that can be obtained from the amniotic fluid as well as the amniotic membrane. They can develop into various tissue types including skin, cartilage, cardiac tissue, nerves, muscle, and bone.

The stem cells fooled my body into thinking the wounds were that of a small infant. My doctor told me that if an adult breaks a bone the ends have to be touching each other securely for good healing. If an infant breaks a bone healing will occur if the two ends of the bone are in the same room!

The stem cell matrix is working, two wounds are healed and one is almost completely healed. All this in a matter of weeks.health2

The message? We must take responsibility for our health care.


Alphabet Soup…NP’s, RN’s, LPN’s, CNA’s

hospitalI have noticed that some health care providers reverse their name badges, we can’t know their names or their job responsibilities.. During a 9 month period I stayed at 3 hospitals and two nursing homes, I tried to be responsible about who were the providers of healthcare and assistance. I learned to ask, “Who are you and what do you do here?”. Most badges have an alphabet soup of letters. This what they mean and what we should expect they provide us. Perhaps this will be useful for those of us with elderly parents or a spouse who needs rehab therapy.


Most* Nurse practitioners (NP), also called Advanced Practice Nurses (APN) have completed a registered nursing degree as a part of a bachelors degree, plus a masters degree. In addition, many now seek a doctorate level degree.

(*Not all NPs do have these degrees. In some states, NPs were licensed prior to these degree requirements, and were therefore “grandfathered,” meaning, they did not have to complete them.)

An NP may be certified in a specialty area, such as family health, oncology, or pediatrics. Nurse practitioners are clinicians, not unlike a physician who may have his or her own practice. He or she can serve as a patient’s regular healthcare provider, and may diagnose, order tests, develop treatment plans and write prescriptions.

Most NPs work in collaboration with a physician, which is usually required by the state they work in. They are accredited through several organizations, including the American Academy of Nurse Practitioners. Be sure you don’t confuse nurse practitioners with nurses. Their work with patients may be very different.

The nursing home/rehab I stayed at used a NP several days a week with a MD visiting once a week.


RNA registered nurse is a nurse who has graduated from a nursing program usually receiving an Associates degree and has passed a national licensing exam to obtain a nursing license An RN’s scope of practice is determined by local legislation governing nurses, and usually regulated by a professional body or council.

Registered nurses are employed in a wide variety of professional settings, often specializing in their field of practice. They may be responsible for supervising care delivered by other healthcare workers including enrolled nurses licensed practical nurses, unlicensed assistive personnel, nursing students, and less-experienced RNs.

Registered nurses must usually meet a minimum practice hours requirement and undertake continuing education in order to maintain their registration. Furthermore, there is often a requirement that an RN remain free from serious criminal convictions.

The RN’s at the nursing home/rehab I stayed at mostly gave out the meds and didn’t do much more then that except for the Wound Nurse who help residents with wound care.


You can often find LPN training programs at technical schools or community colleges, although some might be located at high schools or hospitals. Training generally involves a combination of traditional class work, such as biology and pharmacology, along with supervised clinical instruction. A person can generally become an LPN with two years of training; all U.S state and territorial boards also require passage of the exam.

Often, they provide basic bedside care. Many LPNs measure and record vital signs such as weight, height, temperature, blood pressure, pulse, and respiratory rate. They also prepare and give injections, enemas, catheters, monitor wounds, and give alcohol rubs, massages. To help keep patients comfortable, they assist with bathing, dressing, and personal hygiene, moving in bed, standing, and walking. They might also feed patients who need help eating. Experienced LPNs may supervise nursing assistants and aides, and other LPNs.

As part of their work, LPNs collect samples for testing, perform routine laboratory tests, and record food and fluid intake and output. They clean and monitor medical equipment. Sometimes, they help physicians and registered nurses perform tests and procedures. Some LPNs help to deliver, care for, and feed infants.

LPNs also monitor their patients and report adverse reactions to medications or treatments. LPNs gather information from patients, including their health history and how they are currently feeling. They may use this information to complete insurance forms, pre-authorizations, and referrals, and they share information with registered nurses and doctors to help determine the best course of care for a patient. LPNs often teach family members how to care for a relative or teach patients about good health habits.

The LPN’s at the nursing home/rehab I stayed at also mostly gave out the meds and didn’t do much more then that.


CNAMost training programs for CNA’s (Certified Nurse Assistants) do not last more than one year and are offered at a wide variety of institutions, including career schools, community colleges, hospitals, nursing homes & even high schools. Program lengths vary but average one year. Prerequisites for entry are typically a high school diploma or equivalent. After passing the examination, the candidate is added to his or her state’s nurse aide registry and is eligible to be hired on as a Certified Nursing Assistant.

Certified Nursing Assistants work very closely with their patients. Many times the patient is either elderly or chronically ill; both cases need consistent, long-term care. The usual work environment is either a hospital or a home, either private or health-related. They provide basic medical care and work directly under the supervision of doctors and registered nurses. The tasks listed below make up the majority of what you can expect to be doing on a day-to-day basis.

Working for certified home health or hospice agencies to support and comfort terminally ill patients and their families. Enabling disabled, chronically ill or challenged patients to live in the comfort of their own homes instead of healthcare facilities. Providing light housekeeping, shopping and meal preparation for elderly, infirm and shut-in patients. Helping developmentally or intellectually disabled clients learn self-care skills and providing employment support.

Certified Nursing Assistant Job Duties:

  • Provides patients’ personal hygiene by giving bedpans, urinals, baths, backrubs, shampoos, and shaves; assisting with travel to the bathroom; helping with showers and baths.
  • Provides for activities of daily living by assisting with serving meals, feeding patients as necessary; ambulating, turning, and positioning patients; providing fresh water and nourishment between meals.
  • Provides adjunct care by administering enemas, douches, nonsterile dressings, surgical preps, ice packs, heat treatments, sitz and therapeutic baths; applying restraints.
  • Maintains patient stability by checking vital signs and weight; testing urine; recording intake and output information.
  • Provides patient comfort by utilizing resources and materials; transporting patients; answering patients’ call lights and requests; reporting observations of the patient to nursing supervisor.
  • Documents actions by completing forms, reports, logs, and records.

The CNA’s at the Christian Care Center Rehab/Nursing home were God’s Angels on Earth. They made living tolerable for the elderly, disabled, stroke, and diabetic/other amputees. The CNA’s and UAP’s at the VA Medical Centers in Nashville and Murfreesboro are “lazy clods”


Unlicensed assistive personnel (UAP) is a class of paraprofessionals who assist individuals with physical disabilities, mental impairments, and other health care needs with their activities of daily living (ADLs) and provide bedside care — including basic nursing procedures — all under the supervision of a registered nurse, licensed practical nurse or other health care professional. They provide care for patients in hospitals, residents of nursing facilities, clients in private homes, and others in need of their services due to effects of old age or disability. UAPs, by definition, do not hold a license or other mandatory professional requirements for practice, though many hold various certifications.

UAP’s do many of CNA tasks.

The facilities and food at West Meade Place Nursing Home were superior to that of the Christian Care Center at 2501 River Road. But….the Physical and Occupational therapists who worked with the patients were not fully licensed but were what are called PTA’s (Physical Therapy Assistant) or OTA’s who finished a program at a Community College while licensed PT’s hold Doctorate degrees from schools like Belmont University.

Certified occupational therapists (OT) typically hold Masters or Doctoral degrees in occupational therapy from an ACOTE accredited institution.

To practice in the United States, occupational therapists must receive a master’s degree and pass a licensing examination to become certified by the National Board for Certification in Occupational Therapy (NBCOT). Occupation Therapy Assistants (OTA) usually hold an Associates degree from a community college.

Almost all inpatient therapy I received was by a PTA or OTA while the PT’s and OT’s held administrative / supervisor positions. I usually saw a licensed PT or OT during an initial evaluation, otherwise they were in an office cubicle or roaming the therapy area.

Here is how I rank the hospitals I stayed at.

  1. Centennial was the best
  2. St Thomas was OK
  3. Veterans Affairs Medical Center (VAMC)-Nashville was a distant third but worst food than the Murfreesboro VAMC.
  4. Veterans Affairs Medical Center (VAMC)-Murfreesboro was dangerous.  I was infected with MRSA and was treated for pneumonia with continuous antibiotic IV’s and respiratory therapy for 7 days  in their Acute Care ward. In military parlance, I had dodged a bullet. I was virtually ignored by the caregivers. PT and OT was substandard. I twice fell to the floor, supposedly being assisted by a staff member, the second time my prosthetic hip was shattered in three pieces while the titanium ball joint pressed my sciatic nerve flat for six days until I could receive surgery to replace the broken hip. I was then sent to a nursing home under a VA contract.

cccRiverRdHard work and great therapy at the nursing/rehab facility by a licensed Physical Therapist and a military trained Occupational Therapist restored my physical condition to the point where I returned home to my lovely and very patient wife.

Hospitals, Long Term Care and Rehab…….about PT

Late 2013 one of my prosthetic hips became damaged with a split liner. I have a good surgeon who has worked on my joints for the last 30 years….but….the soonest they could schedule a joint replacement was late March 2014. I didn’t make it. On Feb 4, 2014 as I got out of bed, my legs collapsed. EMS took me to St Thomas West where I laid in a hospital bed until a repair was made on February 10 Then on to rehab on the hill at West Meade Place.

West Meade Place is a former Nursing Home which was called “Heaven’s Waiting Room” when we first moved to The Cloister. Later they expanded their business model to include Physical Rehabilitation since they already provided limited Physical Therapy and Occupational Therapy as part of what is called Restorative Therapy provided in nursing homes.

Some facts about PT(Physical Therapy) services provided by two different classes of technicians in a nursing home.

PT practice now requires a Doctorate Degree from a accredited University. while a PTA Assistant has finished only two years at a community college or tech school. Thus there are PT’s and PTA’s with huge differences between the skills and knowledge each has. Many nursing home residents leave Heavens Waiting Room “feet first” thus Restorative PTA’s addressed range-of-motion and mobility issues as their primary duty without the goal of returning a person to normal life outside of the Nursing Home.

Under the new business model these PTA’s are used as a resource supposedly  to return people to a more normal life outside of a nursing home. There are no signs on the backs of these people so in many cases it is impossible to know whether you are treated by a PT or a PTA.

WebconfusionHow can you be sure you are getting PT from PT professionals. Many Outpatient PT facilities use fully licensed physical therapist, an example is STAR Physical Therapy – Nashville, TN (Bellevue) ,7640 Hwy 70S, Ste 210,  Nashville, TN 37221

In-patient Fully Licensed and qualified PT is more scarce with the primary resources affiliated with hospital complexes rather than nursing homes.

More about my personal experiences in a future blog post……….

What is a Medical Neighborhood?

From February 2014 Takacs Newsletter

We Are All Living in a Medical Neighborhood (Part 1)

The Medical Neighborhood is an emerging concept meant to address all the care needs of an individual. The Medical Neighborhood – a group of providers in, literally, the geographic area of the patient and the patient’s family – will identify and coordinate all medical and non medical resources available to manage issues which impact a patient’s health. The aim is to improve clinical outcomes, provide a more satisfying experience of care for both patients and providers, and reduce care costs.
What does the Medical Neighborhood mean for older persons and how will it improve the experience of care they receive from their Medicare providers? Actually, it is part of a larger concept called The Patient-Centered Medical Home that the U.S. Centers for Medicare & Medicaid Services is promoting as a future model for the delivery of care to people on Medicare.
In a Patient-Centered Medical Home, a Primary Care Provider (PCP) is responsible for providing “whole person care.” Under this model, the medical provider is challenged to engage an individual in managing more of his or her own care, to make shared decisions about care with that individual, and integrate with non-medical service providers to support the individual’s efforts. The individual is challenged with knowing how to manage optimum health between office visits and staying out of the hospital.
The Medical Neighborhood includes medical specialists, pharmacies, behavioral health, residential care facilities, non-medical home care providers, and other community resources. Working together, this group will educate and guide the individual in the direction of getting all their care needs met. To ensure that the individual receives optimal care, the Medical Neighborhood strives to meet psychosocial needs, address social and environmental factors that impact the individual’s health and well-being, and address financial and legal aspects that enhance or create barriers to care.
As an essential member of the Medical Neighborhood, the Elder-Centered Law Practice should have a presence early in an individual’s care plan. Within the Medical Neighborhood itself, an Elder-Centered Law Practice is regarded as a specialty: a team of nurses, social workers, licensed therapists, public benefits specialists and attorneys, under one roof, experienced in helping individuals find, get and pay for quality care.
Here is an example of a common situation many older adults and their families face. Frank, 87, is a frail man who has been diagnosed with Alzheimer’s disease. Living by himself at home, Frank is functionally dependent upon his overwhelmed son, Paul, to bring him his groceries, take him to the doctor, pay his bills, and get his medicine.
Is Frank living in a Medical Neighborhood? Where Frank lives – that is, whether or not he lives in a Medical Neighborhood – affects how successfully he and his son Paul will manage his care. That is the subject of our next issue of Elder Law FAX.

We All Live in a Medical Neighborhood (Part 2)

In last week’s Elder Law FAX, we introduced Frank, a frail, 87 year-old man who has been diagnosed with Alzheimer’s disease. Frank lives by himself at home and is functionally dependent upon his overwhelmed son, Paul, to bring him groceries, take him to the doctor, pay his bills, and get his medicine.

How would a traditional elder law practice view of Frank’s situation differ from an elder-centered law practice approach? And, how does the elder-centered practice approach meet the aims and goals of the Medical Neighborhood?

Under the traditional elder law view, Frank currently has or is expected to have a care financing and asset preservation problem. Typically, the elder law practitioner will be retained to put a plan in place to accelerate Frank’s financial eligibility for Medicaid benefits.

For example, the attorney (in another state) of a client of the Elder Law Practice explained in the written plan developed for the client that “the purpose of Elder Care Plans is to protect the assets of persons who have entered into or are about to enter into a skilled nursing facility … The primary way to protect assets is to seek eligibility for Medicaid.”

If Frank doesn’t need immediate nursing home care, Frank will get necessary legal documents in place and counsel on repositioning assets to make them unavailable or inaccessible to the State Medicaid program. If he is a veteran, the elder law practitioner will determine whether Frank is entitled to monthly payments from the U.S. Department of Veterans Affairs (the “VA”) to pay for his care. A plan will be developed that may require Frank to restructure his assets to qualify for a VA benefit.

This may be done by making Frank’s assets legally unavailable to him. If those assets are not available to him, the State Medicaid program and the VA can’t consider them available. The asset repositioning may result in a five-year Medicaid lookback period. Usually, the elder law practitioner will counsel Frank and Paul on the advantages and disadvantages of such restructuring.

How will Frank’s needs for personal care be addressed? Or his values, or safety, or the risk that Paul will suffer caregiver burnout? The traditional elder law practitioner will make referrals to personal care agencies or geriatric care managers, but typically does not align the practitioner’s asset protection plan with the client’s personal care needs.

An elder-centered law practice aims for whole-person care, assisting Frank and his son Paul with attaining their goals of addressing issues that impact health or that enhance or create barriers to care. What level of care does Frank need and what kind of care does Frank want? A plan will be developed and implemented to help Frank find, get and pay for the care that most closely aligns with his values and his needs today. Frank will get legal documents and asset restructuring advice, but care financing—albeit critical—is only one aspect of the representation.

The elder-centered law practice will employ a team of health professionals who will coordinate care and advocate for Frank and for Paul. The practice will have a working relationship with community resources including residential and in-home care providers. The practice will offer Frank options. It is the aim of the elder-centered law practice to support older clients and their families in the day-to-day self-management of their chronic illnesses.

Elder Law Practice of Timothy L. Takacs
201 Walton Ferry Road
Hendersonville, Tennessee 37075
Voice: (615) 824-2571
Fax: (615) 824-8772

Universal Design Makes Life Easier at The Cloister

Universal_Design_Floorplan_LGOne of the greatest advantages of home ownership at The Cloister is the Universal Design features built into every Cloister home. Universal design creates an attractive, stylish space that everyone, regardless of age, size, or ability, can live in or visit. A home with Universal Design makes it easier for us to live in, and for guests to visit now and in the future, even as everybody’s needs and abilities change.

Home Features and Products Using Universal Design

Downsizing to a universal design home is usually much cheaper than remodeling a house with traditional design features although I have seen a ranch style home on Brook Hollow Road in West Meade where the entire front yard was landscaped to change a four step entry porch to a stepless entry front entrance.

Having Universal Design features and products in a home makes good sense and can be so attractive that no one notices them — except for how easy they are to use.

Essential Universal Design features include:

  1. No-step entry: At least one step-free entrance into your home — either through the front, back, or garage door—lets everyone, even those who use a wheelchair, enter the home easily and safely.
  2. Single-floor living: Having a bedroom, kitchen, full bathroom with plenty of maneuvering room, and an entertainment area on the same floor makes life convenient for all families.
  3. Wide doorways and hallways: With your home’s doorways at least 36 inches wide, you can easily move large pieces of furniture or appliances through your home. Similarly, hallways that are 42 inches wide and free of hazards or steps let everyone and everything move in, out, and around easily.
  4. Reachable controls and switches: Anyone — even a person in a wheelchair — can reach light switches that are from 42-48 inches above the floor, thermostats no higher than 48 inches off the floor, and electrical outlets 18-24 inches off the floor.
  5. Easy-to-use handles and switches: Lever-style door handles and faucets, and rocker light switches, make opening doors, turning on water, and lighting a room easier for people of every age and ability.

There are many other universal design features and products that many people put into their homes, including:

  1. Raised front-loading clothes washers, dryers, and dishwashers
  2. Side-by-side refrigerators
  3. Easy-access kitchen storage (adjustable-height cupboards and lazy Susans)
  4. Low or no-threshold stall showers with built-in benches or seats
  5. Non-slip floors, bathtubs, and showers
  6. Raised, comfort-level toilets
  7. Multi-level kitchen countertops with open space underneath, so the cook can work while seated
  8. Windows that require minimal effort to open and close
  9. A covered entryway to protect you and your visitors from rain and snow
  10. Task lighting directed to specific surfaces or areas
  11. Easy-to-grasp D-shaped cabinet pulls
Before and After Bath Remodel

Before and After Bath Remodel

Beware of Increased Deductibles and Copays on Lab Tests and Procedures

Blue Cross/Blue Shield plan will cut out middle man markups that doctors and medical clinics charge for outside lab services …….a St Thomas MD and the Tennessee Medical Association give their opinion. doctor

Patients may get stuck with lab bills after insurers cut reimbursements
Dec. 6, 2013 |

Written by
Tom Wilemon
The Tennessean

Patients may be writing multiple checks and paying more for a visit with their doctor as insurers slash reimbursements to physicians for blood work.
After a similar move by its competitors, BlueCross BlueShield of Tennessee has notified doctors that it will cut payments for lab tests in half. The trend puts the pinch on physician practices that do their own lab work as well as those that can make money by outsourcing the service.
The scenario sets the stage for consumers to be billed directly by lab companies, said Dr. Sally Burbank, a Nashville internist. Health care consumers could end up with multiple invoices for a doctor’s visit just as they do with a hospital stay. One bill would come from the practice for the time spent with a physician. The other would come from the laboratory that did the blood work.
“If we refuse to pay the lab bill, then the lab will be direct-billing the patients or the insurance company,” Burbank said. “If they bill insurance but it’s all deductible, then the patient has to pay it.
“The labs charge patients much, much more than doctors because patients have a history of not paying their lab bills.”
Burbank said that after Cigna lowered its reimbursement for lab work, her practice got out of that billing cycle.
“Every time I did lab work, I lost money,” she said. “I was paying people’s lab bills, then losing money.”
Patients on high-deductible plans were “madder than a hornet” when they received bills directly from the independent labs, she said.
BlueCross BlueShield gave doctors within its preferred network until today to reject the change but said it had the option of terminating network status for those doctors who did. Doctors removed from the BlueCross network would lose patients because it would cost their patients more to use an out-of-network physician.
BlueCross plans to cover only 52 percent of what Medicare pays for lab tests instead of matching the Medicare reimbursement rate as it currently does.
Paying market rates
Roy Vaughn, vice president of BlueCross in Tennessee, said the insurer simply wants to pay the real market rate for lab services instead of paying more than what its competitors pay. And he said the insurer has already contracted directly with lab companies that will do the services for the new reimbursement rates. Doctors have the option of sending specimens to those labs, he said.
“We want to make sure we are paying market rates — not more than market rates — because if we’re paying more than market rates, it inhibits our ability to win customers,” Vaughn said. “The bottom line of it all is when we pay more, it costs our customers more.”
The Tennessee Medical Association, which represents state doctors, has asked BlueCross BlueShield to reconsider.
“BlueCross is the biggest player in the state,” said Yarnell Beatty, vice president of advocacy for the association. “In most parts of the state, the largest pool of patients are going to be covered by BlueCross. It’s a volume issue. If you significantly cut reimbursements for a large pool of your patients, that’s going to have a significant impact on medical practices’ bottom line.”
Contact Tom Wilemon at 615-726-5961 or

Doctors are fighting mightily to maintain their income as Obama Care continues to reduce health care costs and they are squeezed by Medicare as the Baby Boomers reach Medicare age.

LabTestMDsIn a recent Blog……

The Centers for Medicare and Medicaid Services could have spent $1 billion less in 2011 by negotiating lower rates for lab tests in the same way that state Medicaid plans and private insurers did. This is the finding of the most recent inspector general’s report.

According to The Wall Street Journal recently, a review of rates for the twenty most common lab tests discovered that CMS paid 18 to 44 percent more than state Medicaid plans and private insurers, soaking taxpayer for at least $910 million in unnecessary expenses. The figure is likely to be much higher once all 1,100 lab test fees are reviewed.  A CMS spokesperson claimed that the department may not have the authority to revise payments, a claim that hardly seem feasible considering all of the cuts made my CMS in recent months.

Medicare is the largest consumer of clinical lab services in the USA, spending over $8 billion on tests in 2010.  The IG  suggested Medicare could cut costs by requiring fee-for-service beneficiaries to contribute with a co-pay or deductible for lab services. This is the norm with most private insurers. Eleven states also require lab fee co-payments in their Medicaid programs.


Mr. Bynon is a Medicare benefits expert, senior rights activist, proud U.S. Navy veteran and coffee achiever extraordinaire.  He blogs regularly on (Medicare news) and (senior health).  Connect with him on Twitter @MedicareWire.