Issuu

ISUE IV - 2019

AGING...

Things The

GRANDKIDS

Will LOVE To Do With You!

Palliative Care:

Dr Ken Redcross

Redefining Hope

Understanding The Who, What and Why of CONCIERGE MEDICINE

THE FAMILY AND THE FACILITY THAT WESTCHESTER HAS TRUSTED FOR MORE THAN 30 YEARS WHEN IT COMES TIME TO FACE LIFE’S MOST DIFFICULT MOMENTS.

FAMILIES HAVE TRAVELED THE EXTRA MILE TO CALL UPON US, KNOWING FULL WELL WE WILL DO THE SAME FOR THEM.

Coxe

Graziano & FUNERAL HOME

767 E. Boston post rd. • Mamaroneck, ny 10543 914-698-5968 • info@coxeandgraziano.com

Contents 05 10 14

Palliative Care: Redefining Hope Palliative care is deeply appreciated during the most stressful and unpredictable of life’s situations; namely the diminishing loss of memory, functional status or during an acute illness.

When is it time to consider Assisted Living for Mom or Dad? If you have an aging parent, you probably have already thought, “Is my mom or dad safe living home alone?”

Exploring Concierge Medicine. An interview with Dr. Redcross When we hear “concierge” we often think convenience, first class and efficient.

Aging is Misunderstood.

Understanding Concierge Medicine

As Seen on Our Blog

Handy Checklist

Greenwich Botanical Center Celebrates 60 Years with Revitalized Rebrand

Although, accelerated aging is the norm in our society. We are getting older before our time. Causes being stress, toxicity, and less movement.

With the changing face of healthcare, primary care physicians say that it is becoming more difficult to provide quality patient care, while also being sufficiently compensated for their work.

What A Funeral Director Can Learn From Loss

EDITOR

Jen Graziano

CONTRIBUTING WRITERS Dr. Donna Colletti Jen Graziano Bryan Mirabella Richard Sgaglio Linda Ziac

Published By:

EMV publications

Copyright © 2019 All rights reserved. No part of this publication including but not limited to text and photographs may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the publisher. For permission requests, write to the publisher, addressed.

With the dawn of a new year, take a moment to evaluate your personal affairs.

In July of last summer, Meg McAuley Kaicher began a two-year term as Board President at the Greenwich Botanical Center.

From the

Editor The start of a new year always calls us to revisit our health. What will we do differently? What will we start doing? Is it time to shed a few pounds? Time to travel more? Rest more? Spend less? Sadly, many of the resolutions we made will have been long forgotten by the time this issue is published, but hopefully after reading through this new, “Coming of Age”, you will find hope to stay on track or at least get back there. Health is always among the primary resolutions we pledge at the beginning of the year. Our health is a very personal and often very sensitive topic to discuss and people’s opinions on the subject often vary. There are some who frequently visit their physicians and stay on top of their health while others who put it off until a medical emergency arises and requires treatment. Ultimately, we are united by our shared need for knowledgeable, trusted physicians to ensure our good health. We place our lives in the hands of our doctors and hope for the best outcomes. The doctor-patient relationship is

undoubtedly a sacred one. Today we are witnessing the dawn of concierge medicine, a new approach to treatment that reaffirms the commitment doctors have with their patients. Concierge medicine is largely a response to insurance companies that stifle doctor’s abilities to treat and render their practices cost prohibitive. There are many questions along with myths and misconceptions that surround this new wave of medicine, in the pages that follow, we hope to clear them up. The overriding message of this issue, however, is that your health is your responsibility and one that should be approached with weighted gravitas. The role of your doctor is to provide the utmost comfort, trust, treatment and peace of mind. None of these should ever be sacrificed. Best Wishes Always,

Palliative Care: Redefining Hope

P The practice of medicine became a better awareness of and appreciation for the Circle of Life.

alliative care is deeply appreciated during the most stressful and unpredictable of life’s situations; namely the diminishing loss of memory, functional status or during an acute illness. Although Palliative Care is available for all those with a serious illness, for those individuals who are specifically at end of life and considering hospice, compassionate care offers a choice to embrace an achievable hope that doesn’t focus merely on “more time” but rather assists in seeing past their illness and pain, focusing on values and the joy of being with those they love. Deciding on a plan of care for one’s self or a loved one is a difficult process. It is a task often filled with the anxiety

that surrounds uncertainty. Sadly, many of the critical decisions are made based in fear, guilt or a lack of information. What I refer to as “the evil trifecta”. Here is where Palliative Care can help. For those in need, it is simply water in the desert. It can reach beyond fear, uncertainty and pain ultimately leading to hope and healing for all. By taking extensive time to explore physical, psychological and spiritual pain, clarify a patient’s wishes, define their fears and aspirations or addressing family concerns and conflicts, Palliative Care assists in coping and creating a path beyond these issues. Whether the patient is at home, in a nursing facility or has an acute issue and hospitalized, Palliative care can lessen the stress of illness by providing information that empowers

the individual, their family and care givers. My introduction to Palliative medicine was through the witnessing of extraordinary acts of compassion and courage when my father was diagnosed at age forty with a cancer that resulted in disfigurement and loss of speech. While experiencing this vulnerability, all those involved in his life became more human. As there were no guarantees of survival there was rather the tacit understanding that he would be cared for one day at a time, with a focus on goals and needs.

His illness occurred over 55 years ago but given the present state of a technology driven culture of medicine, the intention for a model of a â€œPalliativeâ€? (i.e.: comfort based) plan of care like his, has become perhaps more relevant today than it was then. Many years as a practicing OB/ GYN expanded my capacity to understand compassion by assisting women and their families bear the pain of despair during infertility, pregnancy loss, the diagnosis of a life- threatening illness and the death of a loved one. This path was later re-

directed by the clarion call of parents who needed assistance. By observing compassionate nurses and home health aides, life and medicine were no longer a primarily linear path. The practice of medicine became a better awareness of and appreciation for the Circle of Life. At first blush, birth and death may appear diametrically opposed; in fact, the psychological and emotional issues are very similar. Both are about transitions. Guiding women through transitions was simply a stepping-stone to a mid-life career change, to a focus on Hospice and Palliative Care.

For me, the major distinction of these sub-specialties in medicine is while Palliative Care redefines hope for patients and families when curative measures may or may not be considered, Hospice despite having the same intention, is reserved for those for whom cure is no longer possible. Their hope can be sustained by defining specific desires to be achieved and that is not an abstract concept for Hospice and Palliative Care providers. On a daily, weekly, monthly and not infrequently yearly basis, we work with those who suffer to clarify and define their fears and aspirations once they have stopped fighting for time - and rather focus on the people and goals they value. It is a hope which helps them imagine a future, whether it’s a day, week, month or year when they can see past their illness and pain to experience a life defined by their terms of what quality means. It is a hope that their families will have assistance in coping with their transition and beyond. You may have heard of or read the book Being Mortal by Atul Gawande, MD. It takes on the task of explaining the evolution of medicine’s current management of the elderly’s medical and psycho-social issues by exploring the quandary of how to maximize quality of life by providing care which patient’s want and avoiding care they don’t. No small task. However, what I found to be intriguing was his take on how as a society, we have employed an overly aggressive and primarily medical perspective to diverge

away from personal and selfdirected end of life care. In the hope of presumed longevity, we consequently trade off one’s daily happiness and independence. As we have seen, this can all too often be a regrettable pursuit offering a false hope. By telling the stories of how his father, grandfather and many patients experienced both the good and the bad in our healthcare system he laid out the case for self-determined care, guided by people who take the time to listen then respond with compassion to their patient’s needs which is by far the best situation. In doing so, he states the patient is given a “chance to shape their own story”, which “is essential to sustaining meaning in their life”. In other words, offering real hope. If this sounds familiar it is because that is the reasoning behind what Palliative and Hospice providers do and how they come know and admire the patients and caregivers who entrust them with their care and hope. It is by witnessing their dedication to caring for those who are dependent for physical, emotional and spiritual comfort that I continue to be renewed in my own commitment to both palliative and hospice care. It is through this work that as Dr. Gawande stated, we assist the aged and sick to maintain feelings of value and purpose in living rather than permit mere existence. In return for this effort, we receive no less than the honor of witnessing one of the most intimate and transformative periods in a person’s life, thereby fulfilling the true promise of medicine,

a sacred calling. So that even following the patient’s death, hospice continues to support their family in managing this change of life’s course by assisting in understanding, redefining and maintaining their hope in the year to come. My father died at the age of 86, having outlived most of his peers, his physician and surgeon. I had the privilege of caring for him and for my mother, who passed soon thereafter and five years later, being the founding Medical Director of the Stephen and Betsy Corman Palliative Care Center at Greenwich Hospital and the Medical Director for Greenwich Hospital’s Home Hospice. Seven years of working side by side with exceptional nurses, physicians and home health aides, witnessing Palliative Care on its front lines has led to a Palliative Care Scholar in Residence position at Fairfield University’s Egan School of Nursing and Health Studies, Kanarek Center for Palliative Care (KCPC) and returning to a Greenwich based private practice in Palliative Care that can start to answer, address and provide resources to community/homebased Palliative Care questions and needs such as the following: Isn’t Palliative Care the same as Hospice? No. ALL Hospice Care is palliative in nature but NOT ALL Palliative Care is Hospice. Palliative Care simply addresses the relief of pain (physical, psychological, social, spiritual or practical struggles) without expectation for cure of

its cause. Hospice Care is a type of Palliative Care specifically for those with a life expectancy of 6 months or less. How Do I Know Who Would Benefit from Palliative Care? If you been recently diagnosed with a serious or life-threatening illness and need assistance in understanding matters regarding goals of care options ie: living wills or advanced directives; long term care or hospice, a goals of care discussion may be of assistance.

If you are of advanced age

with changing physical and emotional needs requiring home health aides or simply help with routine activities of life, a goals of care discussion may be of assistance. If you are the caregiver of someone who is described above you may benefit from discussing their condition and their options for further care. Patient Resources: Links to information and videos that will explain more about palliative care. »» https://vimeo.com› Greenwich Retired Men’s Assoc. › Videos (link search: Dr Coletti) »» http://archives.warpradio. com/btr/wgcharchives/ goodliving/010918.mp3 »» The Schwartz Center »» Get Palliative Care »» National Hospice and Palliative Care Organization

»» Center to Advance Palliative Care In her book, Travelling Mercies, Anne Lamott noted that “I do not understand the mystery of grace, only that it meets us where we are but does not leave us where it found us.” Any hospice or palliative care provider would say the same for their daily experience on the job. I often speak of the “sacred space” we enter into when caring for these patients and their families. Once we enter that space where time becomes paradoxically compressed and expanded, we are forever transformed and we see ordinary life as extraordinary. In my experience, this space has been filled with the gamut of emotions both raw and complex but never once was it less personal or routine. Rather, it repeatedly manifested the uniqueness of the patient as they and their family experience a transition. Albert Einstein has been quoted as saying that “The most beautiful thing we can experience is the mysterious. It is the source of all true art and science.” He goes on to say that it allows us “to know that what is impenetrable to us really exists, manifesting itself as the highest wisdom and the most radiant beauty which our dull faculties can comprehend only in the most primitive forms.” That descriptive best captures a hospice and palliative care experience for me. Amid raw emotion, physical pain and

I do not understand the mystery of grace, only that it meets us where we are but does not leave us where it found us.”

with limited language, we are assisting and observing as one grasps at the divine while we fumble in the dark beside them. Rabbi M.J. Newman, a Palliative Care Chaplain at Greenwich Hospital often describes a patient’s experience as “dancing in both worlds.” So, as they spend more time “there” and less “here”, we often see glimpses of wonder, awe, acceptance and peace. Then just as they and we get comfortable with the nature of our relationship and each other, they are gone. So that along with their family, we are left to ponder the darkness and light of what we experienced and wonder what lies next for them and us. As the year of 2019 proceeds forward and we find ourselves in winter’s full stride, we are aided by the poetry of Mary Oliver. In “The Summer Day”, she expands on that paradox of time at end of life and challenges us to utilize the experience for the betterment of ourselves and others by asking: “Doesn’t everything die at last and too soon? Tell me, what is it you plan to do with your one wild and precious life”. We as Palliative Care and Hospice providers will do our part by honoring both the care and/or memory of our patients and their relative’s transitional period by continuing to support all in managing this change of life’s course and assisting in understanding and navigating their path in the year to come. I am indebted to all my patients and families; Palliative, Hospice and Ob/Gyn for allowing me in enter into their sacred spaces enabling us all to share in each other’s journey of mystery and grace.

Donna Coletti, MD MS is the founding Medical Director for Palliative Care Services at Greenwich Hospital (2012-2018) responsible for creating and overseeing the inpatient and outpatient models for Palliative and Hospice services as well as the educational curriculum for the Medical Residents and staff. She also held the position of Medical Director for the Greenwich Hospital Home Hospice Program. She presently manages a home-based practice in Palliative Care and holds the position of Palliative Care Scholar in Residence at Fairfield University’s Egan School of Nursing and Health Studies, Kanarek Center for Palliative Care (KCPC). Her career began practicing Obstetrics and Gynecology in Mt. Kisco, New York, and has been in Greenwich since 1999 practicing OB/Gyn until 2012. She held the position of the Assistant Director of Obstetrics and Gynecology at Greenwich Hospital and subsequently practiced Women’s Integrative Health at the Boyd Center for Integrative Medicine where she developed an interest in Hospice and Palliative Care Medicine. As Medical Director for VNS & Hospice Care of SWCT she managed medical care at the Rosenthal Hospice and in 2012, started the Stephen and Betsy Corman Palliative Care Center at Greenwich Hospital. As a lecturer on Palliative and Hospice issues for Fairfield University, Yale New Haven Health/Greenwich Hospital, Mercy College and local community groups, Dr. Coletti has also been featured on WGCH talk radio. Donna holds a Master’s Degree in Nutrition from Rutgers University, a Medical Degree from Weill Cornell Medical College and completed Internship and Residency at North Shore University Hospital in Manhasset, NY. She is Board Certified in both Obstetrics and Gynecology and Hospice and Palliative Medicine. She resides on the Board of Directors for the Fairfield County House, Board of Advisors for the Kanarek Center for Palliative Care (KCPC) and Sacred Heart University’s School of Nursing’s Board of Visitors.

When is it time to consider

Assisted Living for Mom or Dad? By Richard Sgaglio, Ph.D. Vice President The Osborn, Rye, NY

f you have an aging parent, you probably have already thought, “Is my mom or dad safe living home alone?” This is a difficult issue for many families. As people live longer lives, many older Americans want to stay in their homes as long as possible and caregiver children must be the catalyst for considering assisted living options. How do we know when the time is right? Unfortunately, there is often a precipitating

event that makes us review our parents’ living situation. Perhaps mom has fallen recently, or you realize that she has not been eating properly or taking her medications. Those are some of the signals that it may be time to look for an assisted living community. When asked, many seniors don’t want to move from their homes to senior living communities. However, for many people this move is the best option for staying safe and healthy.

Making the decision to move a parent or other loved one into an assisted living community is not an easy one but the process can be less burdensome if it is done while they are in relatively good health.

In fact, the best time to consider moving to an assisted living community is before a serious medical issue arises, when a parent feels they are still in control of their lives and capable of making an informed decision. Waiting until an injury or serious medical condition occurs leaves them with fewer choices. Having to deal with a health problem as well as a change of environment can cause added stress and you may find your parent more resistant to change. The following questions may help you determine if it may be time to consider assisted living for your parent. »» Have they fallen recently? »» Can they bathe themselves regularly? »» Are their clothes clean?

»» Are they eating regular, balanced meals? »» Are they able to cook and keep their homes clean? »» Do they ever forget to turn off the oven or stove? »» Is their home safe based on their individual health and mobility? »» Do they have a plan in place to get help in case of an emergency?

»» Are they still driving and if so, have they been evaluated to ensure they can continue to do so safely?

Your visits with your mom or dad can be less stressful and more meaningful.

»» Are they able to manage their finances? »» Do they have friends close by who will visit them to make sure they are not isolated or feeling depressed? If the answer to some of these questions is “no,” or you are

noticing changes in a parentâ€™s abilities and quality of life, it may be time to consider assisted living options. Making the decision to move a parent or other loved one into an assisted living community is not an easy one but the process can be less burdensome if it is done while they are in relatively good health. Such a move can help keep your loved one safe and hopefully happier. They will find new opportunities for socialization as they meet others in their age group to spend time with. As their children, you can experience more quality time with them when you can simply enjoy their company rather than serving as their caregiver. Of course, change is never easy, especially as we age, but after allowing for some time to adjust to a new living situation, children often find that they are able to spend more quality

The Osborn is a not-for-Profit 501 (C) (3) charitable organization located in Rye, NY and serving residents from Westchester, New York City and Fairfield County, CT. The Osborn offers options for Independent Living, Assisted Living, Memory Care, Short Term Skilled Nursing Care, Outpatient Rehab and Homecare.

time with their parent. There is less to worry about knowing they are being taken care of. Your visits with your mom or dad can be less stressful and more meaningful. If you or some you know is interested in learning more about The Osbornâ€™s assisted living options, please call 914-925-8243 or visit theosborn.org.

Quality time has a whole new meaning. When Dad’s condition became more complicated, we couldn’t manage it at home. Friends said the skilled nursing care their parents received at The Osborn Pavilion made a huge difference in all their lives. Now Dad has a lovely private room and we can both enjoy our time together — just like we did before. Your quality time doesn’t go away. It just moves to a new address.

Options for Living! A 5-STAR RATED FACILITY The Osborn Pavilion is Medicare-certified and accepts third-party insurance plans and private pay. It is not a Medicaid provider. The Osborn is a not-forprofit 501(c)(3) charitable organization accredited by CARF.

(914) 925-8203 101 THEALL ROAD | RYE, NY THEOSBORNPAVILION.ORG

Exploring Concierge Medicine An interview with Dr. Redcross By: Jen Graziano

When we hear “concierge”, words such as “convenience”, “top class” and “efficient” are called to mind. In the modern world we find ourselves needing to be in multiple places at any given time, and thus any opportunity for convenience is quickly seized. There are concierge services to assist with daily household tasks such as picking up dry cleaning and walking the dog or even deliver groceries to our front door. Our minds are wired towards finding solutions to simplify everyday life. We are looking for convenience yet also, quality service.

It is easy to understand, therefore, how the medical field has joined on to the “convenience craze”. Why spend hours sitting idle in a doctor’s waiting room, amidst handfuls of infirmed patients, when you can be readily seen by a doctor? Why visit a large medical practice and be uncertain as to which doctor will examine you, when you can have an established relationship with a particular physician? Why wait for “normal business hours” to have your medical situation addressed when your doctor is just a phone call away? Welcome to the world of concierge medicine. Sometimes referred to a retainer medicine, concierge medicine is a relationship between a patient and a primary care physician in which the patient pays an annual fee or retainer. In exchange for the retainer, doctors provide enhanced care, including principally a commitment to limit patient loads to ensure adequate time and availability for each patient. The ultimate results of concierge medicine are convenience as well as more personalized, attentive medical care. We recently sat down with Dr. Ken Redcross, a nationally renowned concierge physician with a practice right in Westchester County. Dr. Ken Redcross, MD, is author of “Bond: The 4 Cornerstones of a Lasting and Caring Relationship with Your Doctor,” and founder of Redcross Concierge, a personalized medical practice designed to enhance the patient-doctor relationship while providing convenient access to a full spectrum of health care services and holistic and wellness counseling. As one of the first full-service concierge, personalized medical practices in the United States, Redcross’ patient portfolio includes executives, athletes and entertainers, as well as individuals from all walks and stages of life. His focus on developing the patient-doctor bond is a unique characteristic of his concierge services that allows for a more strategic and customized approach to each patient’s healthcare plan. Redcross earned his medical degree from Columbia Presbyterian Medical Center in New York, specializing in internal medicine. Here is what Dr. Redcross had to offer on the subject of concierge medicine;

Patients deserve more than seven and a half minutes, which is the actual average time a doctor spends at each visit according to several studies.

Q. Dr. Redcross, what inspired you to adopt the concierge model for your medical practice? A. I felt that patients deserved more from me, and from our healthcare system here in the United States. Patients deserve more than seven and a half minutes, which is the actual average time a doctor spends at each visit according to several studies. Patients also deserve to have an experience with a physician that is almost as closely knit as a family member. Most importantly, a bond in trust should be forged between doctor and patient to keep patients healthy physically, mentally and spiritually. This model has allowed me to provide all of the above and to be patient-focused. Q. What is the greatest difference or change you have noticed since utilizing the concierge model? A. The concierge medicine model has allowed me to merge both eastern and western medicine. I now recommend medicines and supplements that are closer to the earth. For example, as cold and flu season approaches, Oscillococcinum — one of my favorites — has been shown to decrease the severity and duration of flu-like symptoms when taken within the first 48 hours. This non-drowsy homeopathic medicine is backed by studies, has no known drug interactions,

and can be used in children 2 years of age and older. This sort of discussion and education for my patients is quite valuable. My concierge model allows me more time to discuss this and other remedies as an alternative or addition to prescription options. Q. What is the most common change or feature your patience have shared with you about seeing a concierge physician? A. They love the level of service and attention that they receive. Several patients like to discuss specific things that they typically would not have been able to in a conventional practice due to the time constraints during the visit. Q. Does being a concierge physician place a greater strain of demand on your personal time? A. I would never want to call it a strain or demanding, I prefer to think of it as what is sometimes required to make a difference. This sort of practice model is a choice, and I would go as far as to say it’s a blessing to care for patients this way. Can I get calls a bit late at night? Sure. Or, maybe I have to meet at a few less-than-convenient locations? Absolutely. But I always end up with a good result -- a happy patient. I like to call it trying to create patient nirvana! Q. What are 3 things you want our readers to know about concierge medicine?

A. If you want to have more access to healthcare and to your physician, concierge medicine is perfect for you. If you want to have the amount of time required to get a clear understanding and description of your medical concerns, concierge medicine is for you. If you want care when it’s convenient for you or wherever you may be located, then concierge medicine is for you. I enjoy making house calls. Q. Do you believe the concierge model will continue to grow? And if “yes”, how do you see it changing or evolving? Yes, it will continue to grow, especially as patients become more educated about the concierge model and the value it can bring them in terms of their happiness and improved health outcomes. You are already seeing the market starting to grow with concierge companies that have several physicians on staff with longer appointment times and a reduced workload so that the time can be put back into creating and solidifying the patient doctor-bond. I have written a book called “Bond: The Four Cornerstones of a Lasting and Caring Relationship with you Doctor,” which emphasizes the significance of trust, communication, empathy and respect.

For more information, Visit: www.drredcross.com and like on Facebook at: https://www.facebook.com/KenRedcrossMD or follow at @DrRedcross

Aging is

Misunderstood.

lthough, accelerated aging is the norm in our society. We are getting older before our time. Causes being stress, toxicity, and less movement. By taking control of your aging, you can slow and even reverse the aging process. Yes, you got that right. At the very least, you can slow it down to a crawl. To win the aging game, you must keep your biological age younger than your chronological age. Anybody can do this. It’s a very simple system. Once you learn this system you’ll feel better then you ever have before. First you need to understand there’s only ONE disease - A Malfunctioning Cell. All of us are made of little microscopic units of life called cells

and all of us began as one single unit of life in our mother then you became - not a body - but a ‘community of a trillion cells’. The basic unit of life is the cell, not your body. It’s all about the cells. So what is disease? Disease is when a cell is not malfunctioning normally. Simple yes? Then why so much disease and death out there? Because we aren’t changing diseased cells back into normal cells. All you have to do is to restore the cell’s normal function and all that’s wrong goes away. Ever hear or know someone who experienced spontaneous remission of cancer? Case in point. There’s only two reasons that a cell malfunctions; either it’s not getting everything it needs to function properly

(deficiency) or it’s getting things that are interfering with it’s normal communications (toxicity). This is the essence of this simple system and once you incorporate that into your thinking your body will almost immediately reward you. Do remember that when eliminating toxins and cleaning up your lifestyle that can be cleansing reactions which can range from mood swings to stints on the toilet but it’s normal and necessary. Ok, so how do we restore our cells to normal function? I recommend a vegan lifestyle. If that’s not possible then you must drastically reduce meat, wheat, and dairy because it’s creating a toxic overload to your cell. I’m sorry but what we have been taught was a marketing ploy to get you to eat certain foods so a corporation could profit. It had nothing to do with actual health. Luckily, I believe I have the answer for perfect nutrition -By consuming high grade Algae and/or Marine Phytoplankton which are the building blocks of life and the oldest cellular structures on the planet. They have all the essential fats for your brain and hormone function. They have all the essential amino acids to make perfect proteins that allow your DNA to be positively expressed unlike when you put toxins in your body and your DNA listens to that signal by NEGATIVELY expressing itself which is how disease manifests into reality by receiving epigenetic environmental triggers. The cell needs all of the raw metals it needs every day. What you put in is what you get out.

Mental pathway Meditation - Daily Breath work = stress relief.

Nutrition and hydration - Organic fruits and Veggies/ chemical free water.

Eliminating Toxins sugar, wheat, dairy, processed oils poisons.

Support your body’s Detoxification system - Learn how to do Lymphatic brushing and frequent saunas.

Movement is Life. If you’re not moving you’re DYING.

In conclusion, unlike a car that needs new parts after a certain amount of miles, you don’t wear out. You are a self-repairing system. That’s why sleep is so important because that’s when healing occurs. In 2017 Stanford came out with a study that showed that if you sit quietly for 5 minutes per day and you practice the subtle breath - low volume of air in and low volumes of air out (which is actually a deep diaphragmatic breath) the primal brain - the lower half of the brain stem - activates neurons that Stanford now calls “Pacemaker Neurons”. They scour the body and they literally turn on nonfunctioning cells. Your body wants, needs, desires to selfrepair. If you’re wondering why you haven’t heard this before please don’t. Just know that it was your law of attraction that brought you to this information at this present moment. True Health = True Wealth. In love, Unity, and health. Bryan Mirabella Human Performance Specialist Bryan@QuantumFitness.org

Understanding CONCIERGE MEDICINE By Linda Ziac | The Caregiver Resource Center | www.TheCaregiverResourceCenter.com

Be an Educated Consumer Healthcare is continually changing, and not always for the best. With the changing face of healthcare, primary care physicians say that it is becoming more difficult to provide quality patient care, while also being sufficiently compensated for their work.

Many of you may have experienced a situation in which a doctor is leaving the exam room while saying: »» “I’m going to call in a new prescription for you.” »» “I want you to see a new specialist Dr. May.” »» “You’ve waited long enough, it’s time for you to have knee replacement surgery.”

You have lots of questions. BUT YOUR TIME IS UP!

As reimbursement rates for physicians drop and the cost of business increases, it’s not uncommon for a primary care physician to have thousands of patients in their practice. Physicians often increase the number of their patients, in order to make sufficient income to cover the cost of overhead, malpractice insurance and to compensate for their low reimbursement rates.

In an effort to find a solution for physicians and patients alike, there have been a number of ideas that have sprung up over the past several decades. One such idea is Concierge Medicine, which according to Concierge Medicine Today, was first introduced in 1996 by two doctors in Seattle Washington Dr. Howard Maron and Scott Hall. These two doctors decided to limit the number of their patients, while also charging a yearly retainer of more than $13,000 per patient.

When a physician increases the number of patients that they see in a given day, the result is often longer wait times to secure an appointment, as well as less time actually in the room with the doctor.

As the years have passed, more physicians have explored and have even started practices referred to as “concierge medicine”, “retainer medicine” or “boutique medicine”, which will be referred to as concierge medicine in this article.

Concierge Medicine Keep in mind that concierge medicine is a very complex subject, with varying models, services, costs, patient agreements, etc. Before selecting a concierge physician or any other medical professional, it is important that you do your due diligence to learn as much as you can about the many aspects of concierge medicine, looking at the pros and cons for your unique situation and needs, while also thoroughly checking out the physicians’ reputation, credentials and references. This article will strive to provide a brief overview of concierge medicine, along with some terminology and topics that you may wish to research further as part of your decision making; as to whether or not you think that concierge medicine may be right for you.

What is Concierge Medicine Concierge medicine also known as “retainer medicine” or “boutique medicine” will be referred to

as concierge medicine in this article. The concept of concierge medicine was developed as an alternative to the traditional fee for service insurance billing. With concierge medicine, a patient contracts with a physician or physician group for a set retainer, in order to become a member of that physician’s practice. In exchange for this retainer and membership, the patient is able to receive a spectrum of services, which is clearly outlined in the required written contract with the concierge practice. The belief behind concierge medicine, is that using concierge medicine offers the patient same or next day appointments, more time with the physician, a greater focus on wellness and prevention, as well as 24/7 access to the physician (or their other medical staff such as a nurse practitioner (APRN) or physician assistant (PA-C). Some concierge medicine practices accept a patient’s traditional healthcare insurance, to cover the cost of such items as lab work, tests in addition to the retainer, while other practices do not accept any healthcare insurance.

Before signing any type of concierge medicine contract, it would be important for you to have the contract reviewed by your attorney.

1. Full Concierge Medicine Model (stand alone) This type of model usually provides a commitment from the physician to limit the number of patients in the practice, in exchange for a retainer for services and paying the cost of office visits. In most cases, the patient’s insurance, isn’t billed for these services. It is important to note that this model is limited to those patients, who have the financial means to afford to pay these fees.

Types of Concierge Medicine In most cases, a patient contracting for concierge medicine is responsible to pay privately (out of pocket) for any hospital services, prescriptions, consultations with specialists, medical procedures, as well as any other non-routine medical care that is not covered by the person’s health insurance. There is a wide range of evolving concierge medicine models. Below is a brief summary of four of these models. If you are considering concierge medicine, it will be important for you to research all available models along with their their pros and cons, prior to selecting a model that you feel best meets your unique needs and wishes.

2. Direct Pay Concierge Medicine Model In this particular concierge medical model there is a contract established between the physician and patient. In exchange for a patient retainer, the physician provides primary care services, which may include laboratory, clinical and consulting services, Currently there are no laws in the state of CT governing the Direct Pay Concierge Medicine Model, and there is no current CT legislation being considered for Direct Pay Concierge Medicine. 3. Full for Additional/ Extra Care Concierge Medicine Model When participating in this model, a physician provides two available levels of services »» Services that are covered

under a person’s insurance, which will be billed to the patient’s insurance company »» Services that are “extra” that a patient requests, that re not covered under the person health insurance, and will need to be paid privately by the patient (out of pocket) 4. Hybrid Concierge Medicine Model This model is a physician practice, which is a combination of patients who are seen for traditional medicine utilizing the patient’s traditional insurance and government plans, as well as patients who choose to pay for a concierge medical model with a retainer and office visit fees. The benefit of a physician offering a hybrid model is that patients who can’t afford or choose not to pay for a concierge model, are able to remain under the care of the physician, utilizing their health insurance. Before signing any type of concierge medicine contract, it would be important for you to have the contract reviewed by your attorney. You may also find it helpful to review the CT General Statutes - Connecticut Title 38a Insurance. https://www. cga.ct.gov/2017/pub/title_38a. htm

Insurance and Concierge Medicine If you choose to contract with a physician or physician’s practice for concierge medicine, it is important to note that your health insurance will not cover the cost of your concierge medicine retainer. If you have a health savings account, it would be important to check to see if money from this account would cover the cost of your retainer. Some people mistakenly think that if they purchase a concierge medicine package, that they do not need to have health insurance. It’s important to note that concierge medicine is not by definition health insurance under state laws, federal statutes or the Affordable Care Act. As a result, a patient who contracts for concierge medical services will also need to purchase insurance coverage (however minimal) in order to be in compliance with the Affordable Care Act, to avoid tax penalties for having no insurance. When signing a concierge medicine contract, the contract will clearly outline what services are covered by the physician and their practice. Keep in mind that most concierge practices are provided by internists and primary care physicians, and do not cover specialty care (e.g. neurologist, cardiologist), prescriptions, hospital services, and most health procedures.

Medicare and Concierge Medicine People often ask if a physician can charge Medicare patients for services. The following information is being provided courtesy of Medicare.gov Concierge Medicine - A doctor or group of doctors charges you a membership fee. They charge this fee before they’ll see you or accept you into their practice. When you pay this fee, you may get some services or amenities that Medicare doesn’t cover.

Things to know Doctors who provide concierge care must still follow all Medicare rules: Doctors who accept assignment can’t charge you extra for Medicare-covered services. This means the membership fee can’t include additional charges for items or services that Medicare usually covers unless Medicare won’t pay for the item or service. In this situation, your doctor must give you a written notice called an “Advance Beneficiary Notice of Noncoverage” (ABN) listing the services and reasons why Medicare may not pay. »» Doctors who don’t accept assignment can charge you more than the Medicare-approved amount for Medicare-covered services, but there’s a 15% limit called the “ limiting charge .” »» All Medicare doctors (regardless of whether or not they accept assignment) can charge you for items and services that Medicare doesn’t cover. »» A doctor who has opted out of Medicare, can’t bill Medicare for services you receive, and isn’t bound by Medicare’s limitations on charges. Source: https://www.medicare.gov/ coverage/concierge-care

Know the Facts – Ask questions

Concierge Patient Agreement

To follow are a sampling of some questions, that you may find helpful to ask.

In most if not all cases, you will be asked to sign a Concierge Patient Agreement, before you contract with a physician or physician practice for any concierge medicine services.

»» What types of concierge model does your practice offer? »» How do I pay the physician? Do you accept quarterly or monthly fees? »» Do you accept Insurance? How compatible is your concierge medical practice and services with my health insurance plan? »» Do you participate in Medicare? »» Do you accept Medicare Assignment? »» If you accept insurance, will you file the claims for me? »» What services does the retainer fee cover? »» Do you offer preventive care? »» What is included in the annual comprehensive physical? »» What if I need to go to the hospital. Would you admit me, or would another doctor admit me? »» At what hospitals do you have admitting privileges in this area? »» Do you have same day appointments available? »» Are you available 24/7, if I need you? »» When I call you at 10:00 pm or 4:00 am for an urgent healthcare concern, what will happen? Will you be available, or will I speak with an APRN or a PA-C? »» What happens if I need to see a medical specialist, or if I need surgery? »» How do I contact you? - Call the Service? Email? Cell phone? »» Will you be the one to coordinate my care, if I need to see a specialist? »» Do you make house calls? »» Are you offering any sign up specials, or discounts at this time?

To follow are some of the topics that may be included in a concierge medicine contract. »» Definitions »» Services available within the program (What will be provided to you for your retainer.) »» The annual retainer fee, and if the retainer fee can be paid monthly, quarterly, or annually. »» Billing and payments »» Term, Renewal and Termination terms »» Medical care that is excluded in the contract and retainer »» Co-payments »» Non participating providers »» Communication and privacy »» Insurance Disclaimer (e.g. Services to be provided are not covered under any public or private health insurance program) Since a Concierge Patient Agreement is a legal document, it will be important to have a lawyer review the document before you sign it. This will help ensure that you understand what will and will not be covered by your retainer, if the contract meets the laws in the state where you will receive services, and whether the physician is providing true concierge medicine, VIP care, or a wellness program.

Is Traditional Medicine or Concierge Medicine Right for You This article presented a brief overview on the subject of concierge medicine. It’s time for you to explore for yourself, whether traditional medicine or concierge medicine, is right for you and your needs. Take some time to to learn as much as you can about your options, as well as the various providers in your local area. You may want to: »» Determine if you are satisfied with your current primary care physician, and if your needs are being met. »» Explore all your options for both traditional medicine and concierge medicine, based on your own unique needs and wishes. »» Look at and assess her current health. »» Take into consideration your family history. »» Make a list of all your medical expenses over this past year, as well as what expenses have been covered, and what expenses you’ve had to pay for out of pocket. »» Identify traditional and concierge physicians in your local area. »» Check references, and if possible, request a free meet and greet with the various physicians. »» Create a budget of the anticipated annual cost of remaining with your current physician and health insurance plan, vs. selecting a new traditional or concierge physician and health insurance plan

Remember That Help is Only a Phone Call Away!

Linda Ziac is the owner and founder of The Caregiver Resource Center. The Caregiver Resource Center is a division of Employee Assistance Professionals, Inc., which Linda founded in October 1990. The Caregiver Resource Center provides a spectrum of concierge case management and healthcare advocacy for seniors, people with special needs, and their families Linda is a professional with more than 40 years in the health and mental health as a CT Licensed Professional Counselor, CT Licensed Alcohol & Drug Counselor, Board Certified Case Manager, and Board Certified Dementia Practitioner. Linda assists seniors, people with special needs and their families, in planning for and implementing ways to allow for the greatest degree of health, safety, independence, and quality of life. When a person travels to a new place on vacation, they often hire a tour guide. This guide is very familiar with the location, can help focus on key points, while at the same helping avoid potential trouble spots. The Caregiver Resource Center role is similar, in that we guide people of all ages through the often complex and confusing healthcare maze. www.TheCaregiverResourceCenter.com

The information in this article is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient provider relationship, and should not be used as a substitute for professional diagnosis and treatment.

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As Seen on Our Blog

What A Funeral Director Can Learn From Loss October 2018 | By Vincent Graziano

ith just over 3 months left on the clock of 2018, I can definitively say its been a rough year. This year has been marked with loss thus far, from a dear family friend (more family than friend), to a cherished aunt, and the ultimate heartache of losing Ollie, a faithful 4-legged family member

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of 14 years. When loss hits the funeral director on a personal level, the sensibility, wisdom, and knowledge that enables you to assist others is nowhere within reach. Perhaps it is the finitude of death that makes its acceptance so difficult. No longer can you hear the voice or touch the hand of the one youâ€™ve lost. And despite the amount of times you watch people say

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their final goodbyes, it is never easy to offer your own.

Allow yourself the chance to plan a meaningful life tribute to the one you have lost.

What personal loss does provide, however, is an opportunity for reflection. It affords you an ability to deeply connect with the families you are helping because you emphatically share their pain. You start to realize what, in fact, helps you through difficult times and it allows you to bring forth this knowledge to those you are working with. Personally, what has helped me the most…planning a funeral. Whether it be going through photos for prayer cards or memorial videos, selecting poignant remembrance poems, or designing flowers that would beautifully tie in to enhance the room, these tasks are all therapeutic in nature. Admittedly, they distract from the emptiness and pain that follow a loss, but in the immediate aftermath of death, planning a funeral is the most direct way to honor and begin dealing with your own grief. Often, I find myself learning from my 6-year-old, perhaps more than she learns from me. In the moments after she learned of the loss of our dog, her tears stopped but for a moment. “Mom”, she said, “I want to have a funeral for Ollie”. “What is a funeral, Mia?” I replied…and without hesitation (but with a look

of shock that I actually asked that question), she said, “a celebration of someone’s life”. She was correct (once again). A funeral is a celebration of life. It is a time to stop and remember a loved one you’ve lost. Funeral homes are places of central gathering, places to cry, shed tears, reminisce, even share a laugh. There is a greater purpose being served when we stop to honor a life in that we afford ourselves basic needs such as grief and remembrance. Speaking for my family, we take the losses we have personally incurred in 2018 and allow them to reinforce our commitment to this sacred calling. One can’t adequately complete the work of a funeral director without an ability to feel or to connect with one’s personal emotions. And while we sorely miss the three lives lost in our family this year, and the countless in years past, we draw on our experience to better connect with those we serve. Our advice…plan the funeral. Allow yourself the chance to plan a meaningful life tribute to the one you have lost. Go through the photos, become involved in details. In honoring them you help their memory live on and you help yourself begin the process of grief. To have loved and lost…we understand.

Handy Checklist

ith a new year upon us, take a moment to reevaluate your personal affairs. Even if you have taken the prudent steps of creating health care and legal directives, as well as discussed your final wishes, take the time to reassess your personal thoughts and decisions and make changes if and where necessary. Use this helpful checklist as a guide;

LEGAL/FINANCIAL PLANNING Do you have a will? Do you have a power of attorney? Does your family/next of kin know the contact information of your attorney? Do you have life insurance? If yes, have you reviewed the policies? If you are married, is your spouse aware of finances and what to do in the event of your passing?

HEALTH CARE Do you have a health care proxy? Do you have advanced directives? Does your spouse, family or next of kin understand your wishes with respect to health care decisions? Do you have your medical information in a visible location in the event and emergency happens?

FINAL WISHES Have you made a pre-arrangement with a funeral home? If you have made a pre-arrangement, and that funeral home has since closed and/or relocated, have you selected a new funeral home? Do you wish to be buried or cremated? Do you own a cemetery plot? If cremation, do you want your ashes buried? Does your spouse, family or next of kin know your personal wishes? Have you completed an agent letter? Do you have a favorite photo, song, poem, reading or passage youâ€™d like incorporated into your service?

Our directors and staff at all Coxe & Graziano Funeral Home and Zion Memorial Chapel locations can walk you through all aspects of planning your final wishes. If you have made arrangements elsewhere, we will honor them at no additional cost. If youâ€™d like to schedule an appointment at your convenience for information with no obligation, please call us. Coxe & Graziano 914-698-5968 (NY) 203-869-5968 (CT) Zion Memorial Chapel 914-381-1809

GREENWICH BOTANICAL CENTER

with Revitalized Rebrand

n July of last summer, Meg McAuley Kaicher began a twoyear term as Board President at the Greenwich Botanical Center (formerly the Garden Education Center of Greenwich). Kaicher is a Greenwich resident, working mom and dedicated member of the Junior League of Greenwich. At the beginning of her term, Kaicher took on the challenging task of leading the member based nonprofit volunteer organization through a transition involving all new branding, website, and both internal and external communications plans, within an extensive strategic plan to diversify the organization’s revenue streams to ensure its longevity.

“I speak on behalf of the GBC Board and staff when I say we are extremely proud to celebrate our 60th year in this community. Although we’ve been here for six decades, many families in the community are unfamiliar with our offerings and mission. Our goal moving forward is to remedy this disconnect with modernized programming and relevant messaging that better serve all generations of nature lovers in the Greenwich area and beyond.” The GBC is located within the Montgomery Pinetum Park, a public park owned by the Town of Greenwich comprised of properties generously donated by the Tuchman, Pomerance, Seton, and Montgomery families. As a separate entity from the Town, the GBC relies on funds generated from events, membership dues, tax-deductible donations, sponsorships, and venue rentals to provide the public with a broad slate of environmental education resources. Memberships levels include Student $35.00; Senior $50.00; Individual $65.00; Family $125.00; Organization $250.00; Germinator $250.00; Cultivator $500.00; and Grower $1,000.00. Membership supports the Center’s efforts to provide exceptional public offerings through which everyone can enjoy nature. All

WE’RE SO FORTUNATE TO HAVE A PLACE LIKE THE GBC FROM WHICH SO MANY GREENWICH RESIDENTS HAVE BENEFITED OVER THESE PAST 60 YEARS

members receive discounts on plants and merchandise in the Greenhouse as well as special member pricing for programs and events.

The new GBC website launched in December with a user-friendly calendar featuring a wide variety of activities and events for people of all ages. March 4th is their day trip to the Philadelphia Flower Show. Upcoming events include Frolic in the Forest on April 28, May Gardeners Market on May 4th, and Grandiflora Garden Tour on Saturday, June 7 and Sunday, June 8. Sponsorship and underwriting opportunities are available for these annual events. In addition, the GBC’s calendar is updated on a daily basis with entertaining workshops,

classes, lectures, and field trips. “We target the multi-generational family with our offerings,” said Kaicher. She continued, “New moms and dads visit with small children while meeting neighbors; long-standing members bring their grandchildren. Students and scouts use our Teaching Vegetable Garden on field trips. The GBC community is a great place to network and meet new people while learning world-class environmental best practices. We also provide volunteer opportunities for adults and teenagers.” Volunteer opportunities include off-site Youth and Senior Outreach programs, along with hands-on experience in the Greenhouse with Director of Horticulture, Lisa Beebe. The Greenwich Botanical Center was founded by Jane Duff in 1958 as the Greenwich Garden Center. Duff and her husband were from Pittsburgh and moved to Greenwich in 1928 with their small children. Once the children got older Duff became President of the Riverside Garden Club and launched

the Greenwich Garden Center with help from the Town of Greenwich, the Greenwich Chamber of Commerce and Civic Leaders. The idea for the Center was inspired by the need to provide educational resources at a low cost to the community. The concept of a public horticultural education center was very well received. As Duff moved forward with the launch of the GGC she reached out to similar organizations in Pittsburgh, Cleveland, and Cincinnati for help with constructing the bylaws and programs. Within a few weeks, she received phone calls from

notable horticulturists in the local community that offered their support and the organization was launched. “We’re so fortunate to have a place like the GBC from which so many Greenwich residents have benefited over these past 60 years,” said Kaicher. She continued, “My hope is that we continue to grow our reach throughout the region and preserve this special place for many generations to come.” Legacy and planned

giving is another wonderful way to support and preserve the Greenwich Botanical Center. This type of gift will leave a lasting legacy that will help sustain the organization’s mission for generations. To make a donation or inquire about sponsorship, please email Administrative Director, Lisa Carmona (lisac@ greenwichbotanicalcenter. org). To learn more about the Greenwich Botanical Center please visit the GBC website (greenwichbotanicalcenter.org).

About Greenwich Botanical Center Since 1957, Greenwich Botanical Center (GBC) is a member-based non-profit volunteer organization dedicated to promoting horticulture, conservation, and the arts through educational programs, outreach activities, and special events. Originally founded by Jane Duff as Greenwich Garden Center in 1957, who thought it a good idea for local garden clubs to leverage their work as a group. The goal was to draw people from neighboring communities and provide educational environmental resources. Today, the GBC holds true to its founding mission and provides an oasis for environmental connection offering multi-generational enrichment, events, and education. The organization serves its community as a central resource while providing exceptional public offerings through which everyone can enjoy nature. The GBC is located within the Montgomery Pinetum, in Cos Cob, Connecticut, with greenhouses, a teaching vegetable garden, classrooms, pond, and collections of evergreens, woodland trails, wildflowers, as well as a peony garden, old stone structures, sculptures, and a gift shop.

28 Celebrating

Concierge Case Management & Advocacy We are available when you need us: »» CT Licensed & Nationally Certified »» Services are provided in the home, doctor’s office, hospital, short term rehab, assisted living, long term care facility, and hospice

Years of Service

The Caregiver Resource Center Greenwich CT | 203-861-9833 www.TheCaregiverResourceCenter.com

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BRUCE MUSEUM GREENWICH Masterpieces from the Museum of Cartoon Art Bruce Museum Greenwich Masterpieces from the Museum of Cartoon Art The Bruce Museum is a community based, world-class institution highlighting art, science and natural history in more than a dozen changing exhibitions annually

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TAKE IN A SHOW AT THE EMELIN THEATER http://emelin.org/the-very-hungry-caterpillar/ Emelin is one of the few performing arts venues in our region offering a broad mix of entertainment appealing to all ages and tastes, attracting audiences from Westchester County and beyond.

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JUNIOR CHEFS CLUB AT SUR LA TABLE, WESTCHESTER MALL www.surlatable.com/product/ CFA-4156493/Junior+Chef+ Cooking+Club+for+Kids Junior Chefs Club at Sur La Table, Westchester Mall a place where serious cooks found a surprising selection of culinary tools from around the world, with helpful, knowledgeable employees who loved cooking, too.

AMERICAN MUSEUM NATURAL HISTORY DISCOVERY ROOM http://emelin.org/the-veryhungry-caterpillar/ Every major field of Museum science and research, from anthropology to zoology, is represented. Children, accompanied by adult, can explore an array of artifacts and specimens, puzzle; and scientific challenges.

NORWALK MARITIME AQUARIUM www.maritimeaquarium.org The Maritime Aquarium inspires people of all ages to appreciate and protect the Long Island Sound ecosystem and the global environment through living exhibits, marine science, and environmental education.

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COXE & GRAZIANO FUNERAL HOME The Family, The Facility, The Commitment to You

For locations and more information, visit WWW.COXEANDGRAZIANO.COM 134 Hamilton Avenue • 203-869-5968 • Greenwich, CT 06830 • info@coxeandgraziano.com