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• Care at home: Housecalls are back • The latest on Medicare enrollment • How telemedicine benefits health

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FALL 2020

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Donna received her law degree from St. John’s University of Law. She is currently the Chairperson of the Board of Directors of the Catholic Lawyers Guild of Queens and was past President of the Queens County Women’s Bar Association, past President of the Astoria Kiwanis Club, past President of the East River Kiwanis Club, and past President of the Catholic Lawyers Guild of Queens.

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CONTENTS • Care at home: Housecalls are back . . . . . Page 4 • The latest on Medicare enrollment . . . . Page 8 • How telemedicine benefits health . . . . . . . . Page 10 Publisher - Mark Weidler Section Editor - Peter C. Mastrosimone Section Coordinator - Debrah Gordon

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Senior Living Guide

Doctors are making house calls again by Mark Lord Chronicle Contributor


r. Erik Ilyayev began his career right after completing his residency when he was called upon to treat his own grandmother, who was in need of medical attention but unable to leave home to get it. He realized then and there the need for in-home senior medical care services. Thus was born myhousevisit.com, an anomaly in a world where it has become all but impossible to have a doctor show up at your doorstep. Ilyayev founded the business 10 years ago and said that it has already arranged more than 2,000 house calls in the Forest Hills-Rego Park area alone. There was a time when home visits by doctors were common. According to the American Family Physician journal, this was most true back in the 1930s, and for the next two decades, though to a gradually decreasing extent. But by around 1980, the practice was almost completely a thing of the past. Now, while finding a physician or other medical personnel to visit you at home can still be a challenging task, thanks to organizations like myhousevisit.com, and others that offer related services, there are several options available right here in Queens. And with an ever-increasing senior population, not to mention the advent of COVID-19, demand for house calls is perhaps at its highest level ever. “Since COVID,” Ilyayev said in a recent telephone interview, “we have a lot more requests for our services. We can offer virtual visits and go to a person’s home.” So, how does it work? In the case of myhousevisit.com, which serves most parts of the borough, it all begins with a telephone call. A member of the team will take down the patient’s basic information. From there, according to the doctor, a

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new patient can be seen in the privacy of his or her own home usually within 48 hours. Blood work, X-rays and a review of medications are among the services offered, as is remote patient monitoring. “Every time a patient takes his blood pressure, we can see it on our end,” the doctor said. Suggesting that “medicine has to go with the new, evolving technologies,” he called such monitoring capabilities “the Netflix of medicine.” Among his team members are several nurse practitioners, as well as various associates specializing in areas such as optometry, physical therapy, nephrology and podiatry. All Medicare patients and those with many other types of insurance are eligible, the doctor pointed out, prompting him to ask, “Why go to an office full of sick people?” For further information or to make an appointment, visit myhousevisit. com or call (718) 569-7808 or (718) 576-4652. Dr. Dov Rubenstein, who serves as an associate podiatry consultant on the myhousevisit.com team, also has his own practice, Home Foot Care, PC. While originally working parttime in his office, he made the decision “many years ago” to devote himself entirely to being a full-time house-call doctor. For a while after the pandemic outbreak, he saw patients only when absolutely necessary, as he was “getting more and more emergencies. June was the busiest month I ever had. “We provide the same podiatric care as we would in an office,” from routine nail care and wound care to corns, calluses and heel spurs, as well as diabetic foot care, he said. While his patients are grateful not to have to leave their homes for treatment, especially at this time, they are understandably cautious when allowing anyone in, including their doctors. “My patients and anyone else there

Drs. Erik Ilyayev, left, Dov Rubenstein and their colleagues with myhousevisit. COURTESY PHOTOS com offer in-home care to seniors in most of Queens.

Dr. Andras Fenyves, here in a promotional video, says his group, Prominis Medical Services, will “find a way to send providers out” right away if a patient’s SCREENSHOT / IVAYLO SIMIDCHIEV / VIDEO EMPATHY MARKETING need is urgent. The home visits resumed in July. have to wear masks,” Rubenstein said, unless they can’t due to physical Now the doctor has seen “a very siglimitations. As for himself, he’s nificant increase” in requests for always equipped with an N95 mask house calls compared to the pre-panand maintains as safe a distance as demic days. Members of the Prominis team possible while treating patients. The doctor serves all parts of include cardiologists, urologists, Queens, and he says he can usually nutritionists and nurse practitioners. book an appointment within a week. Mental health services are also available. U lt r a“If there’s an sound, blood emergency, I tests, X-rays make it soonservice that has seen and medication er,” he said. prescriptions “Sometimes ‘a very significant are all availI’m in the area able at home. and I’ll see a increase’ in interest The compat ie nt who during the pandemic. pany accepts a calls within the variety of prihour. “We spend as much time with you vate and public insurance health as we would if you came into the plans. For further information or to book office, probably more,” he added. To contact Rubenstein, call (718) an appointment, visit prominis.com or 961-5320. You will usually hear back call (718) 852-5252. Parker Jewish Institute for Health from him the same day. Prominis Medical Services, a pri- Care and Rehabilitation, a senior livmary care group that serves all five ing provider in New Hyde Park, offers boroughs, offers much the same care a medical home visit program called at home that would be expected in an Parker at Your Door, or PAYD. According to Lina Scacco, viceoffice setting. And appointments can usually be set up within a week’s president for corporate engagement and community health services, time. According to Medical Director Dr. PAYD provides medical house calls Andras Fenyves, “If somebody has an that offer patients services similar to urgent problem, we’ll find a way to what they would receive in a doctor’s send providers out,” he said, indicat- office, including ultrasounds, X-rays, ing that same-day visits or prompt EKGs, lab work, annual physical exams and referrals to specialists. telemedicine are possible. She indicated that the service is As might be expected, COVID-19 altered the service’s ordinary routine. “only available for homebound quali“In the initial three months,” the doc- fied patients who are unable to leave tor said, “we suspended regular in- their homes due to health issues, person house calls except emergen- including dementia.” Patients must be aged 50 or over. cies. We tried to avoid contact” as PAYD serves Queens, Brooklyn much as possible. “There was a fear factor. People were not willing to and Long Island. Scacco said the service is covered come to the office and they were worried about house calls. We ourselves by Medicare. Other commercial and managed long-term care plans are didn’t want to spread” the virus.


also accepted. “Patients are encouraged to contact us to determine if their insurance will cover visits from PAYD,” she said. Patients without coverage or who choose to go out of network may also pay by credit card or check, she said. As has been the case with most of the at-home medical providers, “The need for PAYD’s services has grown dramatically as more and more patients find themselves unable to leave home for needed medical care,” she said. “Our goal is to provide high quality medical care within the comfort of the patient’s home,” she added. Most patients are seen by a nurse practitioner within 48 hours, she said. The team is accessible 24/7 to answer clinical questions from patients and caregivers. For more information or to schedule an appointment, visit parkerinstitute.org or call (718) 289-2606. Another option for those seeking at-home care is Nova Medical, PLLC, founded by Dr. Dina Zheng, its mission being “to offer superior healthcare and peace of mind for those who face the medical challenges of aging.” Nurse practitioner Eileen Miller, who has worked closely with the doctor since she joined the Nova team three years ago, comes with 45 years experience as a nurse, she said. In a recent telephone interview Miller said that “most of ou r patients are homebound. My whole priority is the patient. That’s what I base my life on.” At-home visits offer a full range of primary care services, including blood work, X-rays, EKGs and ordering any medications that are necessary. Once a phone call is made to the office, an appointment is usually available within two days, Miller said. “We’re very diversified,” she said, and thanks to modern technology, “We can communicate in any language.” Miller is even willing to put up with patients who practice what might be considered extreme caution over COVID-19. “They spray me with Lysol,” she said. “It’s OK with me.” For further information on Nova or to make an appointment, visit novamedicalpllc.com or call (718) 380-7800. The Mount Sinai Health System, which encompasses a total of eight hospitals and more than 7,200 physicians, was recently awarded a grant of over $300,000 that will go toward its telehealth services during the pandemic. The system also offers several continued on page 10

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Starting October 1, 2020, there will be a 30-month (or 2.5 year) “look back” period for people applying for Community Medicaid. That means that Medicaid will “look back” at fi nancial transactions made during the 30-month period before the date of application, and impose a penalty for any gifts and unexplained large asset transfers made during that period.


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Major changes were made to Community Medicaid with the passage of the 2020 NYS budget in April. Currently, in order to qualify for Community Medicaid, which provides home care aides, an individual may only have $15,750 in total assets and income up to $875 per month and there is a one month “look back” period on the transfer of assets in order to get down to the $15,750 limit.

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and Consumer Directed Personal Assistance Programs, which allow hiring of family members, will be increased. Under the changes, a Medicaid applicant must have limited assistance with physical maneuvering in connection with three or more activities of daily living, or ADLs. However, individuals with a diagnosis of dementia or Alzheimer’s must need at least supervision with two or more ADLs. ADLs include bathing, personal hygiene, dressing, walking, transferring to the toilet, incontinence, eating, etc. Medicaid Level 1 housekeeping, which provides assistance to disabled individuals with chores such as shopping, laundry and meal preparation, will be eliminated. People already receiving these services will be “grandfathered in”.

Furthermore, the requirements for In light of this new law, you may eligibility for Medicaid’s community-based want to review how you wish to protect long-term care services such as home health care services, private duty nursing your assets with your attorney as soon services, assisted living program services as possible. – ADVERTORIAL –

Parker Jewish Institute urges older adults to get flu shots Parker at Your Door provides flu shots for patients New Hyde Park, New York, September 25, 2020 - Parker Jewish Institute urges older adults to get their flu shots as well as practice the recommended guidelines to protect against flu and other illnesses, including COVID-19. Parker at Your Door’s Medical House Calls service makes it easy for older adults to get their flu shots without ever leaving their homes. This includes providing flu shots for homebound older adults so that they achieve the best level of health possible. Parker at Your Door’s service is available to patients in Nassau, Suffolk, Queens and Brooklyn. Older adults are at high risk of serious complications from the flu. And mask-wearing, and frequent hand-washing are more important than ever to protect against flu and COVID-19, which remains prevalent in the region. Anyone 65 years of age and older should also be current with their pneumococcal vaccination, which Parker at Your Door provides to protect against pneumonia. “Each year we urge older adults to get their flu shots and to ensure that they are up to date with

their pneumococcal vaccination,” said Michael N. Rosenblut, Parker’s President and CEO. “Parker at Your Door’s medical practitioners help older adults reduce the risks of hospitalizations associated with the flu and pneumonia, so they can maintain optimal health.” Contact: Lina Scacco, (718) 2892212 or lscacco@parkerinstitute.org About Parker Jewish Institute for Health Care and Rehabilitation Parker Jewish Institute for Health Care and Rehabilitation is headquartered in New Hyde Park, New York. The facility is a leading provider of Short-Term Rehabilitation and Long-Term Care. At the forefront of innovation in patient-centered health care and technology, the Institute is a leader in teaching and geriatric research. Parker Jewish Institute features its own medical department, and is nationally renowned as a skilled nursing facility, as well as a provider of community-based health care, encompassing Social Adult Day Care, Home Health Care, Medical House Calls, Palliative Care and Hospice.


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Senior Living Guide

What to know about Medicare coverage by David Russell

When a person is first eligible for Medicare, he or she has a seven-month initial enrollment edicare open enrollment runs from period to sign up for Part A and Oct. 15 to Dec. 7 but those interested Part B. People who are elican look at health and drug plans by gible for Medicare when using the Medicare Plan Finder beginning they turn 65 can sign up during the seven-month peritoday, Oct. 1. By visiting medicare.gov/plan-compare, od that begins three months people can compare their coverage with other before the month they turn 65, options, possibly being able to save money or includes the month they turn 65 or ends three months after receive extra benefits. New coverage for people making a change the month they turn 65. There is also an eight-month will begin Jan. 1, 2021. From that day through March 31, customers can change to a different special enrollment period that Medicare Advantage plan or switch to origi- starts either the month after nal Medicare and join a separate Medicare employment ends or the month after group health insurance based drug plan. “A lot of people are nervous,” said Queens on current employment ends. “A lot of people, especially this Interagency Council on Aging President Barry Klitsberg. “They don’t know what’s spring and early summer, lost their going to happen. Some of that is political, jobs,” Klitsberg said. “They need to some of that is the annual apprehension about apply for Part B so they don’t have a penalty later on.” the new plans.” One Medicare change is for People can call 1 (800) 633-4227 for a counseling program in which people are given assis- patients with end-stage renal disease, tance in looking for new plans. TTY users can who will be able to join a Medicare Advantage Plan beginning Jan. 1. Precall 1 (877) 486-2048. For free, personalized counseling, New viously, people with ESRD could enroll Yorkers can call the Health Insurance Informa- in Medicare Advantage plans under tion Counseling and Assistance Program at 1 limited circumstances. Organ acquisition costs of kidney transplants will have (800) 701-0501. Nearly 3.7 million residents are enrolled in coverage under the fee-for-service proMedicare in New York and almost 44 percent gram instead of Medicare Advantage of New York Medicare beneficiaries are organizations. Medicare Advantage plans will also see enrolled in Medicare Advantage plans. Klitsberg advises people to constantly check an increase in telehealth services and covtheir mail to see if there is something from erage allowing seniors to be treated by proMedicare, Social Security or their existing fessionals at home. Telehealth allows seniors to video conference with their doctor from plan. If a plan decides not to participate in Medi- their homes. The Centers for Medicare and Medicaid care for the coming year, the coverage would end Dec. 31 and customers will get a letter Services is giving Medicare Advantage plans flexibility to include telehealth providers in explaining new options. Medicare Part A covers hospital insurance certain practice areas including primary care, and includes inpatient care at a hospital, skilled cardiology, dermatology, psychiatry, gynecology and endocrinology. nursing facility or hosMedicare Advantage pice. It also covers several plans will offer benefits other services, including eniors should be for a variety of additional laboratory tests, surgery, supplemental home care doctor visits and home aware of changes services, including adult healthcare. while avoiding scams. day care services, inPart B covers things home personal care serlike clinical research, ambulance services, durable medical equip- vices, benefits for over-the-counter products, ment, limited outpatient prescription drugs and home safety modifications and meal delivery and transportation. mental health services. Starting in 2021, many participating drug Part C refers to Medicare Advantage plans, while some people opt for Medicare Supple- plans will offer a 30-day supply of insulin for mental Insurance to fill in the gaps in Parts A $35 or less per month. Someone taking insulin and B, as well as Medicare prescription drug who enrolls in one of the plans could save an average of $446 per year on out-of-pocket costs coverage, known as Part D. Medigap is Medicare Supplemental Insur- for insulin. One in three people with Medicare ance that helps fill “gaps.” As long as a person has diabetes. CNBC reported last Wednesday that there in New York is enrolled in Medicare Parts A and B, he or she can enroll in a Medigap plan at are questions about COVID vaccines being any time and premiums do not vary based on covered by Medicare. Medicare Part B, which generally covers approved vaccines deemed the applicant’s age or health status. This is also true for enrollees who are under necessary, does not extend that coverage to 65 and eligible for Medicare due to a disability. t hose approved u nder emergency-u se Premiums vary from one insurer to another authorization. In other Medicare news, President Trump and from one area to another. Associate Editor



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taxes for everyone.” People are told to guard Medicare cards like they’re credit cards. Medicare will not contact people for their Medicare number or other personal information unless the person has g ive n t h e m p e r m i s sio n i n advance; Medicare will not call to sell anything; Medicare will never visit someone at their home; Medicare can’t enroll someone over the phone unless a person calls first. Community Medicaid also has changes coming Oct. 1. There was no lookback period for gifts of assets that an applicant made prior to the month of their Medicaid application and, therefore, no “penalty period,” in which Medicaid would not pay for services because of these gifts. An applicant could make a gift in one month and be eligible for Medicaid home care services the next month, which differs from Medicaid nursing home care, which has a five-year lookback period and a penalty period during which applicants are ineligible for Medicaid if gifts were made during those previous five years. Under the new rules, there will be a 30-month lookback period for home care applications made on or after Oct. 1 with a period of ineligibility if the applicant made gifts during those past 30 months. Eligibility criteria for enrollment in Medicaid’s Consumer Directed Personal Assistance Program and Personal Care Services are also changing, as applicants will have to meet higher standards. In order to be eligible, people will need to be found as requiring at least limited assistance with two or more activities of daily living. Seven activities of daily living include bathing and grooming, dressing and undressing, meal preparation and feeding, functional transfers, safe restroom use and maintaining continence, ambulation, and memory care and stimulation. For individuals with dementia or Alzheimer’s, eligibility for enrollment is met if it is found that at least supervision is needed for assistance with one or more daily living activities. Jack Lippman, president of Elder Care Services, Inc. in Forest Hills, said a common question he gets is, “If I apply for Medicaid do I have to give up my health insurance?” The answer is no. “People can have Medicare, supplement insurance and Medicaid. Medicaid encourages them to have all three because the first payer is Medicare,” he said, adding, “That’s a big issue Q that a lot of people are not quite aware of.”

said that he will send $200 drug discount cards to 33 million Americans on Medicare. People can also switch to the electronic version of the Medicare handbook instead of receiving a paper copy each fall by visiting Medicare.gov/gopaperless or logging into their account at MyMedicare.gov. If a person needs someone to be able to call Medicare on his or her behalf, the person can fill out a “Medicare Authorization to Disclose Personal Health Information” form, so Medicare can give personal health information to someone other than the client. Visit Medicare.gov/medicareonlineforms to find the form or call 1 (800) Medicare. Medicare says people may want to take this step now in case someone is unable to do it at a later time. Visit medicare.gov/publications to view, print or download copies of publications, such as “Medicare & You,” on different Medicare topics. To stay up to date on social media, users can visit Facebook.com/Medicare or go to Twitter.com/MedicareGov. The Medicare website also advises people to be alert for scams. “Con artists may try to get your Medicare number or personal information so they can steal your identity and commit Medicare fraud,” according to the site. “Medicare fraud results in higher health care costs and

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Senior Living Guide

Technology brought unexpected benefits by Michael Gannon Editor


For the latest news visit•qchron.com SENIOR LIVING GUIDE Fall 2020

ewYork-Presbyterian Queens hospital first saw the benefits of telemedicine —the ability for doctors and patients to interact remotely — a few years ago; while the Queens Public Library system has steadily been reaching out to get the borough’s seniors engaged in health-related and other activities. But in the time of COVID-19, even good things can have unintended silver linings. “Telemedicine has been around for a long time,” Dr. Demetrios Paidoussis of NYPQ told the Chronicle in a recent telephone interview. “One benefit came to light insofar as senior patients are at a higher risk for COVID-19. Our medical group had been using it for about four years prior to COVID, so we were very well-prepared to see more patients remotely. We were in an excellent position.” He said more and more patients are comfortable with technology. The hospital had wel l ove r 18,0 0 0 telemedical engagem e n t s , i n clu d i n g with plent y of s e n io r s , b e t we e n March 1 and July 5. The appoint ments can take place on a properly outf it ted home computer or a phone. The hospital said the process is much like a Sk y pe or Dr. Demetrios FaceTime visit, but Paidoussis with a secure connection to protect a patient’s information and privacy. Patients who are interested must set up an account after downloading the NYP mobile app, available through the Apple App Store or Google Play. “Many of our older patients have smartphones, so there’s no need for a desktop,” he said. “Some might need their grandchildren or a neighbor to help them set up, or we can talk them through the process

When COVID-19 made telemedicine for many the preferred choice for doctor visits, physicians at NewYork-Presbyterian Queens hospital in Flushing were ready to go — and had been for nearly PHOTOS COURTESY NEWYORK-PRESBYTERIAN QUEENS four years. from our office.” The nursing staffs, technicians and others were ready as well. Even area pharmacies were brought on board whenever possible since the start of the pandemic. “Some people are more comfortable,” Paidoussis said. “They can have family members present. They can have access to their medicine and don’t have some of the aggravations of an office visit ... and I can attest that many people were afraid to go to the hospital with everything that has been going on. People should not be afraid to seek care, as we saw during the pandemic.” Paidoussis said there are, naturally, things that must be treated in office visits or even at hospitals. Some things a doctor or nurse can spot just by looking at the patient. Other methods evolved over time. They can assess a person’s breathing and other visible, physical signs of their health and well-being. The hospital said doctors would meet with COVID patients or others with COVID symptoms on a daily basis until they recovered. Nurses would at times evaluate the same patient two or three times per day when necessary. “Patients should always be aware of their

Medical services at home continued from page 4 options for homebound patients. Dr. Linda DeCherrie, clinical director of Mount Sinai at Home, a service that includes the Visiting Doctors program and the Hospitalization at Home program, indicated that patients in the former can receive “much of what they would in a primary care office,” including physical examinations, blood testing, taking of X-rays and physical therapy. “We’re interdisciplinary,” she said, with social workers and home health aides available to assist with the care, as well as visiting nurses.

The program has proven so popular that, according to the doctor, there is a six- to eight-month waiting list. And while it is currently available only in Manhattan, discussions are underway to explore expansion to the other boroughs in the future. “It doesn’t help in a crisis,” she admitted. But once a patient is enrolled, medical assistance is available 24 hours a day, seven days a week, she said. She also noted that a patient would pay the same for the home service as they would in a doctor’s office. For further information on the Visiting

bodies,” Paidoussis said. “If we see something that concerns us, we’ll recommend they come into the office. We will never allow patients to wait for that.” Paidoussis also said there has been an ironic twist since the COVID-19 outbreak. “We can see each other’s faces in telemedicine,” he said. “In the office, everyone would be wearing masks — so in a way the remote visit is more personal.” Madlyn Schneider, coordinator of the Queens Public Library’s Older Adult and Mail-A-Book prog ra ms, a nd Ta ma ra Michel, the library’s community health coordinator, are aware of the hospital’s embrace of technology to benefit patients. “We work with a lot of hospitals on our programs,” Schneider said. “NewYork-Presbyterian has had a doctor on a teleconference with a group once a month.” Schneider said like the hospital, the Queens Public Library system already had online programs for seniors and others in place before COVID-19 struck. “What happened was our programs just expanded,” Schneider told the Chronicle. “We have community health programs almost every day,” Michel said, including chair yoga, Zumba classes and others. Doctors program, call (212) 241-4141. Most patients enrolled in Mount Sinai’s Hospitalization at Home program begin treatment in an actual hospital emergency department. If they meet certain medical and social criteria, they qualify for the athome program, which would then provide them with additional hospital-level care. This program is available in four of the five boroughs, including Queens. The hospital’s visiting doctors work in conjunction with its community paramedics. Dr. Kevin Munjal, the medical director of the Community Paramedicine program, said, “It’s an emerging field,” which he indicated “saw a 500 percent increase during the [coronavirus] surge in the spring.”

Schneider said they have classes for painting, drawing and more. They have programs teaming with the Queens-based Noguchi Museum and Museum of the Moving Image, and even Manhattan institutions such as the Whitney and the Intrepid. Michel said there is a tangible effect for seniors who may have been restricted to their homes for months out of COVID concerns, people for whom the library’s free programs have been offering socialization and a relief from isolation. She said some newcomers will watch the video portion but take some time before turning on their microphones. Others will begin opening up by typing a few comments before eventually engaging more fully. “I appreciate the feedback,” Michel said. “ It help s me c r e at e mor e a c cu r at e programming.” Schneider has worked for the library system for more than 30 years, and has been the older dult coordinator for the last decade. She said that, like the hospital, they already were in a good position before COVID-19 ever happened. She said she had long focused on programs to help seniors combat loneliness and isolation based on experiences with her own mother. The Mail-A-Book program, which sends books, music and movies to those unable to leave their homes because of illness, age or other reasons, is an example. She and Michel — “Our programs overlap a lot” — already had programs available, and, just as important, the library system already had the technology in place to deliver them. All people needed to have was a phone. “That was before the libraries closed,” she said. “We had been creative in engaging older adults ... I didn’t have to do much pivoting.” Schneider said between March and September the library has offered more than 9,000 individual online programs. “And 7,898 seniors have attended those programs,” she said. Information on available programs is Q available online at queensibrary.org. Through the program, paramedics visit patients at home, where a patient’s vital signs and other relevant information are collected, and make a clinical assessment. “We provide a lot of what a hospital provides,” the doctor said, adding that the program is “a great service and can help with minor conditions and guidance for major conditions.” Each visit includes a telehealth visit, which, the doctor said, is covered by most types of insurance. The EMS treatment is not currently covered, he added. At least for now, the service is not directly available to patients but must be requested through a member of the patient’s care team, Q the doctor said.

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