How Economical Is A Geriatric Base for A CA?

If most of your patients are elderly, there could be serious considerations, economically.

1.Timing:They take more time (they move slowly,sometimes need someone to help them keep their balance as they navigate to the treatment room),take longer to get in and out of the chair, and have been known to take up to two hours to fill out the intake forms.Their intake can take much longer because most of them are deaf, so you need to position your chair to

allow you to speak directly into their good ear, and prepare to repeat a lot of your questions.Those who refuse to wear their hearing aids are difficult because they won’t tell you of their hearing loss at first, and they do tender to talk louder.Third: at their age, most of them are uninformed about Chinese medicine, so often need more ‘splainin’.

2.Care: There is more risk of injury from falls in the clinic because of their poor balance, so cannot be left on their own as younger patients can.When they have poor balance they will tend to hang onto objects as they move through the clinic, which could include the fragile folding screens or floor lamps.

2.They can have more paraphernalia (walkers or canes or oxygen tanks) with them, taking up more room and adding to the general crowding in a small clinic as well as potential for noise falling canes).

3.They have a polypharmacy condition that affects the effect of acupuncture on their systems.  They need to be warned about this, and reminded to be patient while waiting for significant improvement.Those on heavy meds will often blame acupuncture for new symptoms that arise after they begin treatment, forgetting that many of these symptoms can be side effects of many of these drugs.

4.Occasionally they will have a serious incontinence problem that results in a strong odor brought into the clinic, even though they bathe before their appointment, and try to don freshly laundered clothing.This is a very embarrassing subject with them, and difficult to address directly without causing a feeling of shame.

5.They need more reminders for their appointments, as some of them have a strong tendency to forget these things, and they will telephone you more often to ask when their appointment is.

6.Many of them come to us after a failed surgery on their spine, hips or knees.Healing is much slower, in these cases, because of their age and the fact that their bodies are full of both medications used in the surgeries and a lifetime of processed foods diet.

7.The elderly have greater difficulty changing their lifestyle than younger patients do, be it from lack of support, stubbornness, fear of the unknown, or stronger habit patterns.

8.Almost all of them will come in at the low end of the sliding fee scale.

9.They can break your heart when they suddenly disappear from the schedule, and you find that they’re in the hospital.Most of the time you never see them again.

Ways to avoid getting geriatric patients:

Online scheduling and online newsletters

2nd or 3rd floor clinics without elevators

What we miss when we exclude geriatric patients:

We miss diversity in our community if the elderly and the very young are excluded.

We lose their gratitude, even greater than the gratitude of younger patients, for this country has a dearth of geriatric specialists, for the simple reason that most doctors know they can’t make as much money with these patients, and that they’re a lot of fuss and bother.

We lose the occasional gems who look ordinary on the surface, but as you get to know them, discover that they are either once-famous greats or even unsung heroes and heroines who have created beautiful things in their lives.Or had wonderful adventures in their lives.Authors and photographers and artists , activists and humanitarians and adventurers.These folks carry a wealth of experience and knowledge inside, much of which has not been shared fully.

We lose our humanity.The elderly are like our grandparents and parents.And they are us, soon enough.

lumiel
Author: lumiel

I earned a B.A. in Hotel/Restaurant Admin, but soon realized that I wanted to do something more meaningful.  Became interested in nutrition and education when pregnant with my first child. Interest in health led me to becoming a foot reflexologist, which led to a massage practice and suddenly discovering the love of my life: Chinese medicine! Practicing for 18 years, Hawaiian/Californian, acu-educated PCOM San Diego/OCOM Portland. Started my CAP in <a href="https://www.communityacu.com/" target="_blank">San Rafael</a>, Marin County, July 4, 2006, even while earning my doctorate at OCOM.  This didn't seem to make sense, but it was my way of comparing the old way of practicing acupuncture to a simpler, truer expression of what I had learned in school.  I love it. And I love being a part of this grand movement to change the world by being true to our conscience. Reopened all over again when I moved to a place where no one had ever heard of me. 3 months open so far, and just beginning to meet expenses. I have no doubt this will succeed and I will be hiring by next year.

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Responses

  1. Hi Lumiel, Thanks for your

    Hi Lumiel,

    Thanks
    for your deep reflections on the benefits (and challenges) of serving the elderly. I
    have a 92 year old who often comes in. She’s a bit curmudgeonly, but
    somehow that makes her more adorable to me. I think other patients
    really appreciate seeing the elderly being served, even if they are a
    bit louder. They see that acupuncture can help at all stages of life,
    and when you go the extra mile to give specialized care – taking extra
    time to help someone out of a chair, hand them their cane, help them
    get their coat on because they can’t reach their arm around their back,
    walk with them to the door, etc. – it opens everybody’s heart in compassion
    and respect for the elderly. All of this is just more good Chi for the
    treatment room.

  2. Lumiel, I couldn’t diasagree more with many of your points.

    Your observations do not reflect what my experiences have taught me.

    Aside from the fact that a population over the age of 55 – without exaggeration – built our clinic in Manchester, NH over the past 2 years and remain at least 40% of our patient population at any given time…

    Aside from the fact that the majority of our front desk staff who have been with us since our infancy are of geriatric ages…

    Aside from the fact the vast majority of elders who get treated in our clinic aregracious and more appreciative of changes that add up from their treatments, as compared to their younger counterparts…

    Aside from the fact we’ve seen absolutely no reason to suggest elders are paying any less than less mature people on the sliding scale…

    Aside from the notion that a valuable snapshot of the health of a community at large can be seen by how it treats its elder members…

    Aside from the fact the community of older people in our city seems pretty tight-knit, and so allows the good news of an affordable acupuncture clinic to travel like the wind…

    Aside from the fact that changes can come more slowly for an older person’s illnesses/conditions, this doesn’t mean changes aren’t forthcoming at all…and so often more rewarding when they do…

    Aside from the fact that elders have lots of poignant lessons to teach those with an ear for them…

    I confess to daydreaming of an elder-rich practice – and would urge anyone considering opening a community acupuncture practice to do the same if you are so inclined.

    I find it borderline-uncomfortable to have read ignorant generalizations in this post about a group of people for whom they are no more appropriate to make, than say….people of lesser means.

    Sure there are particular matters that are age-specific.  But this can be said of any age group, infants, adolescents or elders included.

    I do understand each of us are called to serve different communities.  I tend to be drawn to this crowd, and would hate for budding community acupuncturists to be dissuaded by superficial inaccurate representations of inconveniences attributed to this population.

     

  3. huh?

    lumiel, i think you meant well, but i must agree with andy that your conclusions are offensive because they are referring to whole group of people and making many assumptions along the way. i also will echo andy’s reflections on his experience and say that i have LOVED having a practice where elders and people with disabilities can find a way to get care and feel comfortable. in fact, it has been one of my goals from the start. we have lots of patients over 60 and several folks using wheelchairs, walkers etc. i have never thought that they do not fit into the CA format because of their age or disability, that “they” are more economically challenging for our practice or that they are more trouble to treat. in fact some of my most lovely and easy to treat patients are over 70 or wheelchair users. some people are simply more trouble to treat than others, because people are just different and it has little to do with their age or disability. the community practice model actually allows me to work with some of the more “difficult” personalities with a lot more ease and to grow to love and respect them and to be able to help them get healthier.

    if the people you are referring to in your post are also you (eventually), it might help to put yourself in their shoes RIGHT NOW and read your post from that perspective and see how it feels.

  4. I’m with Andy and Tatyana on this one

    I’ve had my sterotypes dispelled over and over about elders.  My experience has been like Andy’s all down the line.  Particularly, I find elders more open to acu than I expected and often more open than younger ppl.  I also find they can heal faster than I expected and pay at all levels on the fee scale.  

    I’ve been doing CA for three years and find that frequent acu on almost anyone has challenged everything I thought I knew about Western medicine, Oriental medicine and healing.   

  5. sorry Lumiel…I also have to agree with Andy & Ann…

    (okay that’s funny)…I think you meant it to go in a different direction with that post.  It does sound a little elderly phobic…the point though of clinics leaving out a population of folks based on clinics that are hard to access physically is well taken. Those clinics may be leaving out more than the elderly.  However, those clinics also had to make hard choices based on trying to find open spaces that are affordable in large and expensive cities where their services are desperately needed.

     

     

  6. Here’s wishing you an “Ah-Ha” moment . . .

    Greetings Lumiel. As someone who peruses the front forum page, volunteers at and gets treated at a very elderly-populated CAP, and as a practicing Geriatrician, I can’t help but add my two cents. It would actually be too easy for me to let loose my visceral response and be very judgemental, but then I remember my “ah-ha” moment in medical residency, and what led me to persue the path of geriatrics.
    So what I’m going to do is what I frequently do with the trainees and practitioners I come in contact with all the time who hold onto negative stereotypes of a population (including myself often enough), in this case elders: Wish anyone who hasn’t realized it yet their own “ah-ha” moment.
    That is when the beauty of humanity, realized in our population’s elders, is recognized in such an instinctual way that we understand what we’ve always known, but either forgotten or had “beaten” out of us by the pace of a self-centered western culture. We are our elders. We are our infants, our adolescents, our Gen-X’ers, Gen-Y’ers, baby-boomers, (and I personally believe our animals, plants, stones, rocks, rivers, whatever). The effort it takes to help someone with a gait disturbance, pick up a fallen cane, find the right decibel in which to be understood, line a recliner with a plastic-backed pad, change a soiled blanket, etc is really not an effort at all. It is a privilege. It is an honor. It is a “thank you” moment. Even now, when I see the gratitude in someone’s eyes, I feel even a little guilty about the selfish pleasure I gain because IT JUST FEELS SO GOOD to make a difference in any way.
    Then the pee-stained clothes that I occasionally encounter are no different than the bad breath, stinky feet, tobacco rank, perfume cloud, or farts that can transiently occupy a CAP at any time. BTW, I’m letting all in on a little secret: I have inadvertently peed and shit my pants at inopportune times (is there ever an opportune time?) sometime in my 30s, and never once considered banning myself from places I like to go. One last “ah-ha” piece of advice: when looking at an elderly human with what you perceive as limitations, see the person they are, not the person you see.

  7. intersectionality, disability, etc.

    I think this post is maybe the opening for a series of conversations which could be hard, but very beneficial, for CANners to have.

    When I first read Lumiel’s list of economic considerations, I kept thinking, huh — I have lots of elderly patients who don’t fit those descriptions at all, and lots of young or relatively young patients who do. I can think of a number of able-bodied patients in their 20s, 30s and 40s who knock things over, need multiple reminders but still forget their appointments, blame acupuncture for the side-effects of their medications, and create embarrassing smells in the clinic.  I think all that is the human condition and doesn’t relate to age. I would agree that by and large elderly people heal more slowly, but even that can have an awful lot of variation among individuals.

    So then I started thinking that this is really a post about disability. Not all elderly people have disabilities, and plenty of people who have disabilities are not elderly. The issues of people needing more time, more care, and/or more space in the clinic based on what they can do or not do with their bodies are issues about ability and disability. Which is a honkin’ huge and complex subject.

    Here is a post that says a lot of things better than I could on the topic:

    https://badcripple.blogspot.com/2009/05/disability-as-complex-cultural.html

    and a quote:

    “our culture and physical environment is not easy to navigate from a
    wheelchair. Inclusion, socially and practically, is hostile to the
    presence of people with a disability. Kids may not be taught this, lip
    service is paid to disability, but the nitty gritty reality is that
    disabled bodies, disabled humans, are not welcome.”

    We are acculturated to think like this, all of us are. It doesn’t make a lot of sense to defend elderly people against stereotypes when the stereotypes themselves are really levelled at another group of people who don’t deserve them either. The problem is, once again, our culture. The same culture that makes life so fucking hard for working class people has it in for disabled people too, and we all absorb those attitudes along with the air we breathe. We have to become conscious of them and then we have to actively challenge them, it isn’t going to happen on its own.

    The people who already think CAN is a hotbed of political correctness are going to roll their eyes when they hear this, but it sounds to me like it’s time to start talking about the intersectionality of oppressions. If we’re trying to be inclusive, really trying, there’s a whole bunch of other stuff to look at. This society is not a level playing field, and we can’t attempt to level it in terms of class without at some point looking at all the other factors that make life harder for certain groups of people. Race, disability, age…that’s just the beginning of the list.

    Anybody game?

     

     

     

     

     

    “You know how people always say there’s a reasonable explanation for things like this? Well, there isn’t.” Daniel Pinkwater, The Neddiad

  8. A Modest Proposal

    Huh.

    I read Lumiel here and I think of nothing as much as Jonathan Swift’s “A Modest Proposal” where old John suggests that the Irish engage in cannibalism to solve their various economic troubles. Obviously I’m in a minority here. But if I’m right- Lumiel- well done!

  9. Different reads

    I’m still waiting for Lumiel to clarify her comments. It seems there are many possible interpretations. Although the title and some of the points raise, might tend to point towards an discriminatory narrow mindedness towards the elderly, I felt that the post could be a way of stimulating the reader to address those negative stereotypes in the manner of a skilled physician lancing a boil to release the collective pus in all of our minds. In which case it worked perfectly – here we are talking about it, thinking about it, figuring out ways to stay true to our mission to really serve our communities which is intimately linked with respecting and serving our elders (as Lumiel points out in closing).

  10. Disability oppression

    This is a very thought provoking blog piece. Okay, I’m a little bit game to discuss oppression of anything that doesn’t fit with the stereotypical American norm.

    Let’s start with discrimination against pedestrians and cyclists. I ride a bicycle and am teaching my six year old how to ride.  Today, we were in the middle of Broadway Ave. in Seattle, in a crosswalk. I was walking my bike, my daughter was slowing riding hers just to my right. The driver in the car for some odd reason did not see us even though we were in the middle of a marked crosswalk with a big sign overhead that said “Crosswalk”.

    As the car got closer and closer, my daughter kept cruising towards her death or certain trip to the ER with critical trauma, and I started screaming STOP! STOP! STOP! at the top of my lungs. With about one second and a few meters to spare, the car stopped. The person – who was actually the member of an oppressed religious and cultural minority herself, said sorry, and continued through the intersection in her car, leaving us standing in the middle of the road.

    This is complicated. The oppressed person momentarily becoming the oppressor – whereas I of the white skinned privilege background – am often oblivious of the oppression which even enables me to live in an area where I can bike to things instead of being economically marginalized to areas where having a car is the only realistic option (assuming one can even afford that). That sentence reads like a mess…it’s really complicated.

    And it’s simple. The experience of almost getting run over by a car culture which doesn’t see pedestrians or cyclists is happening a lot for me these days. It was just a few days ago that another car roaring out of a parking garage almost ran me and my daughter over and then the driver tried to lecture me for being in a dangerous place (we were on the sidewalk, crossing the entrance to the parking garage.) I gave him a few choice words and cut him off, unable in the moment to think about reconciliation. Talk about anger, this is my hot button, and I have to be really careful that I channel the anger instead of self destruct in a frothing nuclear explosion of rage.

    So reading about how the world looks to a person in a wheel chair, it makes me realize…oh yeah, that’s what it feels like to be on a bicycle in a culture which accepts you – up to a point, until it really counts, and then, well – the athletic program trumps the wheel chair lift, or, the cell phone wielding SUV driver trumps the due consideration for the lives of people not surrounded by a box of steel on four wheels.

    I realize this doesn’t have a lot to do on the surface with removing other-ism (which is what I am terming as the oppression of anything other than the predominant norm) in an acupuncture clinic, except that ultimately, removing these thorns doesn’t have much to do with the external circumstances. We just have to be willing to see outside our blinders and with deep compassion (not polite pity) consider how the world appears to people (and living beings in general) who do not fit into the square holes that cultural conditioning tries to hammer them. 

  11. For the most part, I read

    For the most part, I read this the same way Skip did.  The first part is unbalanced, and turned on it’s ear by the last part.  Supposed shortcomings are revealed to be outweighed by the benefits.

    I’ll give Lumiel the benefit of the doubt.

     

    One thing that I diagree with is the satement that online scheduling and email newsletters exclude seniors.  Online scheudling is only one way of making appointments — we’ve discussed this in the past (lumiel was included in that discussion) — every clinic that I know that uses online scheduling, also allows patients to book by phone or at the desk.  Online scheduling is an option that opens the door for some patients, but does not close it on any one.

    Lumiel, when you have the time, and are feeling up to it, I think a lot of us would love for you to clarify your intent.

    -David 

     

    Circle Community Acupuncture

    San Francisco

    http://www.circleca.com

  12. For me, the Game is Peek-A-Boo.

    My intent was indeed to prick, prod and provoke, to float this topic out there where our collective subconscious could react, question, and comment.  It is not an easy thing for me to do, to articulate issues that may still be a little murky, where layers of prejudice and denial still lurk and influence my decisions.  It was rewarding to see such valuable input on this topic, and to segue into still another important topic.

    Thanks for jumping into the fray, Jordan, and bringing it all back to how ridiculous it can all seem once you start to realize what’s happening.  I think I am playing this game to clear my vision, in order to see the One who is always there, in everyone.  That said, I suppose we need to include racists and bigots and others who similarly don’t hold our point of view.  I’m saying this with resignation, not sarcasm.

    (There’s this one patient who comes in regularly, I love this woman, she is the sweetest most wonderful patient to work with.  We seem to hit it off on so many levels…until last week when she was sharing her weekend with me, telling about the family activities involved with the church.  I was able to stay with it fine until she brought in her pro-life friends and activities….and there I was, looking hard at myself and what I think my beliefs are.  This week I’m fine with her again.  I just needed to realize who I was talking to.)

    And David,   yes, you are right.  Once the computer-illiterate realize that we can show them how to make appointments within that system that uses online scheduling, they relax and carry on as usual.

  13. this post and disability

    i cannot make this post work as satire or otherwise, sorry. i agree with lisa that it reads like a post about disability, that’s why i mentioned people with disabilities in my earlier response. i think it is a huge issue for us to look into and check in with ourselves about. i think disability opression is hard to work on within ourselves, because disability taps into a very strong fear – the fear of something going wrong with our physical bodies. this is such a big deal in a culture that is very physical appearance and performance centered. the other thing about disability (unlike race for example) is that we are all candidates. i guess poverty fits into this category as well, but i think disability is even more scary for most people. i think that a lot of opression of disabled people happens becasue we  see them as a reminder of our bodies’ fragility and mortality and we do not want to be reminded of that.

    i have had the fortune of sharing a home with a disabled friend (a quadruplegic) for a while, as well as working as a personal attendant for several people with disabilties and it was an incredible learning experience for me. i found myself confronting my fearful and opressive conditioning on a daily basis. it is definitely deeply ingrained, so it was not pretty to have to see it so clearly.

    i think the wonderful thing about community acupuncture systems and values is that they give us an opportunity dig up that conditioning, see it, and transform it by giving care to all kinds of marginalized populations.

    if anyone is curious about good (non-fiction) books on the disability experience, here are few i would highly recommend:

    Moving Violations: War Zones, Wheelchairs and Declarations of Independence by John Hockenberry

    Poster Child by EmilyRapp

    Past Due:
    A Story of Disability, Pregnancy and Birth
    and Elegy for a Disease: A Personal and Cultural History of Polio, both by Anne Finger

    i don’t like what this post says, but i am grateful it is bringing about this discussion.

    -tatyana

  14. Interesting interweaving of elders and disabilities

    Lots of great comments so far. I’m not sure if Lumiel meant to bring up these points as the way she sees them (as an opinion) or something she sees more as factual assumptions, but I have to disagree with many of them.

    Regardless of age, for me this post reminded me in general of the “high maintenance” patients. This can occur regardless of age, gender and whether disabled or not.

    I have had “high maintenance” patients of all ages. When I say “high maintenance” I mean they show up late then dilly-dally to the bathroom, search through their bag to check their calendar to make their next appointment, have to remember to fumble around and turn off their cell phone, etc. They may forget they had an appointment or are otherwise unreliable. These people take up just as much, if not more, of your time as people who may have a walker and need a little assistance getting into and out of a chair, or removing their shoes and socks and putting them back on, etc. The truth is that these little extra bits of help required due to disability are completely acceptable and are something to expect as part of our work, and it is important to do it with kindness and with a smile. We don’t have to put up with other issues of neediness/high maintenance issues in the same way – but to respect someone’s needs for a little extra assistance is not a big deal and goes a long way.

    I’ve had young patients come in and smell – no, stink! (smelly feet, body odor – these ring a bell for anyone?) and fumble around in their zero gravity chairs not able to figure out how to get into it (no biggie, I help them). Many of my younger patients pay the low end of the fee scale, as do some mid-aged ones – age seems to make no difference. And as for disappearances from the schedule – this can happen from any
    person, at any time. You can never cling to any patient. People come
    and go and that’s the nature of things. The blanket statement at the end that online scheduling and
    email newsletters excludes geriatric patients is not at all accurate
    (which David already mentioned). Clinics with online schedules also book patients by phone and in person. Some younger patients do not use computers or have access to them, so age is not the only piece that fits in here. And I have older patients who are quite computer saavy and enjoy my newsletters (even my grandmother- who turned 80 yesterday! – is a computer whiz and reads my newsletters).

     

    Also, I have to disagree that older people are more “set in their ways.” I think being set in one’s ways is just a personality trait – it can be in old people as well as young people. Some people are open and receptive and others have closed minds. Besides, what we do ultimately is give acupuncture – not talk therapy – so this shouldn’t be a big stumbling block.

    I think the topic of disability is a big one and one worth discussing. In addition to physical disability, I believe psycho-emotional conditions are worth discussing as well. How often do these create an issue in our clinics and in what ways? How do they impact the person we are treating – whether they are young or old? Indeed, what we see we are treating – whether it’s their physical limitations, psychological/emotional disturbances or a person’s chronic issue of discombobulation, disorganization and general dishevelment.

    Justine Deutsch, Lic. Ac., Acupuncture Together

  15. good point

    Racists and bigots can get “otherized” also. Not that we should ever put up with hatred or oppression for an instant. Instead, we need to look for the essential humanity in everyone. As soon as we lock them out of our heart, we perpetuate the collective discrimination and oppression which – although not innate to the human condition, has been rolling along relatively unchecked for a very long time.

  16. It was never my intention to joke or fool about this.

    I could never embarrass myself further by posting a satirical piece, as I know this is something beyond my abilities.  If you were fooled at first, it is probably because you did not feel the sincerity of my last words of this piece. At least one third of my practice is composed of elders, those 75 and older.  In focusing on this groups’ difficulties (not so much for me as for themselves), I did forget that younger people often have similar problems and can be more fuss and bother.  When I think about it, the only two people I have actually asked to find another practitioner were in their 40’s.

    The only satire in this piece was private to myself, as the title of the blog resembles the research paper on CA practices I have submitted for publication.

    Certain hot spots may have been pushed, some tempers riled, but all in all, a lot of compassion and social responsibility expressed. I can walk away from this enriched from the conversation, and hope that this helps to inform would-be CAPs.

    If there are further questions and conversations involving myself pending, please grant me a leave of absence for 11 days, as I prepare to sink into a 10-day study retreat, where I do not expect any internet connection.  I will respond when I return, though I wonder how much value that will bear.  Another blog or thread on disabilities perhaps would be productive?

  17. Some advice Lumiel

    About your writing. You seriously buried your lede. Not effective. You caused all sorts of confusion as a result and that’s your responsibility as the author. I thought you were using satire because otherwise the post is mainly (to me) just bitchy and I was giving you the benefit of the doubt.

  18. I’m game

    “The problem is, once again, our culture. The same culture that makes
    life so fucking hard for working class people has it in for disabled
    people too, and we all absorb those attitudes along with the air we
    breathe. We have to become conscious of them and then we have to
    actively challenge them, it isn’t going to happen on its own”

    As far as I can tell, that culture is actively trying to literally destroy all life.  Of course there is a heirarchy, and position within that heirarchy determines how much violence is forced upon a person, who gets to commit violence to whom, and whether a person’s property is considered more valuble than the well being of another person.  It also seems like the culture values the health of the economy over the health of any living beings.

    I don’t think that’s political correctness as much as it is refusing to live in denial.

  19. Elderly people are me…I am nearing 46 years old and

    am soon qualified for AARP.  I get ‘seniors’ online dating ads.  I have patients in their 50’s and in their 20’s who don’t smell so rosy.  Sometimes I’m imbalanced and knock things over.

    I guess this is like Rorschach…does it look like spilt milk?  

    I’m sticking with Andy’s original response to this post…it is pretty fairly on the side of offensive.

  20. ?

    It sounds like what Skip said, that the lead got buried. That really the point of the post was to say how delightful it can be to work with people with “a wealth of experience and knowledge inside,” which seems to imply that elders bring something to a community setting… just as do all other people, with all our varied experiences and backgrounds.

    Is this thread provocative? It did generate a lot of great comments and worthy exploration about hidden–or maybe not so hidden–prejudices.

    I might not be getting it, but people are people are people right?

    In terms of the discussion about people with disabilities, there is still a problem with access to acupuncture, at least in my case. Our clinic is brand-new, and I love it, but it is a 2nd floor walk-up. (We could afford the rent).  So if people aren’t walking up the stairs, they are not getting treatment, sliding scale or not. I have had a lurking dark feeling that every health care provider needs to be accessible to everyone, as much as possible, and when my  lease is up, I feel obliged to do everything possible to move the clinic.

    So this discussion may bring some good things.

    Thanks.

     

  21. I love my elderly patients!

    I have found that once my elderly patients know the drill, they are the easiest patients to work with. They come on in, get comfortable and ready and rest for a good while and keep coming back. Their schedules are open, and they are ready to return to keep feeling better. 

    Last month I posted a forum topic trying to help my elderly patient avoid getting an epidural for pain. Not only did I have to win her over, but I had to win her daughter over.  My first 3-4 treatments were not very successful, but thaks to talking it out on CAN), her treatments are now working.  Since her treatments are working, her daughter is happy and less anxious about spending time dropping her off or picking her up.  She sees the difference. 

    Not only do I love my elderly patients, but my other patients like them too.  And the make comments on their way out about how wonderful it is to see someone “of that age being open to getting acupuncture.”  Hopefully one day it will be common that anyone of any age is getting treated, but for the time being, I will take it and run with it.

    Thanks Lumiel

  22. I’m of 2 minds

    Yep, it would be SO much easier to keep on schedule if it weren’t for the damned sick people.

    But seriously, as one of my patients told me once “just because you can’t see the disability doesn’t mean there isn’t one”.

    In young people we see ADD/ADHD behavior, in elderly we call it senile.  In young people we see phobias and OCD behavior, when they’re older they’re eccentric and set in their ways.  Young women may have PMS, older women are just cranky.  (I’m using an inclusive “we” here, not a personal one).

    I have learned my best lessons from one long-term semi-elderly (61) patient.  Other practitioners wouldn’t treat her – they didn’t like her chattiness (I find her erudite and challenging), they felt she wasn’t compliant in trying to lose weight (it was never her goal, just theirs), they felt she wasn’t trying to change her nutritional intake (she had no kitchen), didn’t like that she was late (some days the pain made her move a lot more slowly, and sometimes the handicapped parking was taken when she arrived), she wouldn’t keep a food log, a blood-sugar log, a whatever other documentation (but she has a great memory if you just ask). 

    This person has been such an inspiration to me in so many ways that it completely changed my feelings about who makes an “appropriate” patient.  She has had wonderful improvement in many areas, including financial – together we found ways to get someone to help her in the house, she moved to a place with a kitchen and now eats healthier and cheaper.  The increased quality of nutrition made her memory better, and for some time she was able (with MD’s approval) to be off some of her meds.  Acup only, no herbs.

    I had arguments about this with teachers when I was in school – they insisted that they as practitioners be the primary health care provider, that the patient be held accountable for complete compliance (or else?), they would not prescribe herbs if the patient was on medication.  But I wondered, how many patients are out there like that?  I would much prefer to treat someone based on the life they’re already in, rather than some theoretical baseline.

    Anyone who is working to rise above classism should define that term to themselves.  As Jordan pointed out (though this wasn’t the intent of the post, I think), anyone could become disabled at any time.  And we’re all becoming older by the minute.

    I don’t know if this really adds anything to the dialogue, but Lumiel, “I got it”.

    MM

  23. Awesome story!
    I had a new

    Awesome story!

    I had a new patient this week who related that a friend had told her acupuncture wouldn’t work for her because she was still smoking cigarettes and eating lots of sugar and whatnot.  She wondered if this was true.  Her list of complaints included ptsd from childhood abuse, maintaining sobriety while in recovery from alcoholism, neck and back pain (along with all over fibromyalgia pain), and a long list of other things.  I told her I couldn’t imagine acupuncture not helping her!  Of course she knows that she’ll feel healthier when she gives up smoking and eats better, but right now she’s just trying to survive through the day.  It’s so important to meet people wherever they are and help them.  Everything else just sounds whiny.

  24. Just wanted to say that I

    Just wanted to say that I love my elderly patients!

    I think it’s much better with CA really. It’s more affordable. They have a much easier time getting out of recliners versus in and out of tall massage beds. 

    Maybe it’s because my previous experience has mostly been with the elderly in South Florida before MN.

    But I really love my older patients. They have all become like mini grandmas rooting for my success.  They are the ones that ask about how my clinic is doing. They are my most ardent supporters going out and telling people. 

    They are really the ones I think community acupuncture benefits the most. Because even if it $15 a treatment sometimes people can’t take the time out to come more than once a week or even once every two weeks. It’s the elderly retired population where acupuncture really working its miracles. They are walking much better, feeling much better. 

    They were my inspiration in the first place really…all those people over the years that were only on medicare that couldn’t afford to pay the $60 at the BA clinic I was working at. I know acupuncture can help them walk better, it can enable to keep their independence for longer, and keep the amount of medications down so they don’t become confused.  But how many retired people could afford acupuncture 2-3 times a week at $60?

    Aging and disease is a transformative experience. And all those older patients have a lot to teach me.

    -Jade 

    Jade Community Acupuncture, Winona, MN

    acupuncturewinona.com