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Women Alzheimer’s Numerous studies show women have twice the risk of Alzheimer’s disease than men. What is behind that? Story on page 13

Meet Kaleida Health’s New CEO Robert J. Nesselbush joined Kaleida in 2019, after a 24-year career with Rochester Regional Health. Story on page 2

Early Intervention Challenged During Pandemic

Rice Noodles Why a beloved Thai noodle dish has skyrocketed in popularity

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Compliance Study: Women more likely to skip meds than men P. 11

Lessons from COVID-19 By Deborah Jeanne Sergeant


t’s been a tough several months. The COVID-19 pandemic has touched everyone in many different ways. Despite the losses and challenges, an event as far-reaching as a pandemic can unexpectedly teach us good lessons.

We need to become more self-sufficient with food

“I think that year-round people need to be conscious of food and keep a stock of some basic standards, some staples in their pantry that they can rely on,” said Mary Jo Parker, registered dietitian in private practice in Williamsville. Many people live week-to-week for their food supply. Exacerbated by job loss, food access became an even bigger concern early in the pandemic, especially in the light of food availability once some people began hoarding food and supply chains became disrupted. It’s good to build up a supply such as this for any emergency that can limit food access such as job loss, blizzard or other event. Stocking up doesn’t mean dropping a few hundred dollars for food at once. Picking

up a few extra items each shopping trip can quickly build up a supply. “If the meat supply is running short, it’s good to have tuna in your pantry, some jerky or cereal that’s higher in protein,” Parker said. “Have a stock of the ancient grains that are higher in protein and rich in nutrients.”

We need to be better prepared

“We weren’t as prepared as a society as we thought we were,” said physician Joshua Usen with Primary Care of Western New York in Williamsville. “We need to have a backup plan for things such as child care and alt ways to do your job.” He added that many people lacked a primary care doctor before the crisis, prompting many urgent calls and few available resources to help. He also said that those with pre-existing chronic illnesses who aren’t taking proper care of themselves are more vulnerable when a health crisis arises. As for providers, numerous health care organizations were short on personal protective equipment (PPE), among other supplies and equipment.

We need to think more of others

While it’s easy for healthy people to not fear illnesses that more heavily target elderly and sick persons, communicable diseases should be everyone’s concern. “Understand that the decisions you make for yourself impact your community,” Usen said. “People wear masks for the community, not

for themselves.”

We need to seek accurate information

YouTube videos, forwarded social media posts, anecdotal accounts and many other sources of information do not hold the same weight as peer-reviewed, double-blind studies upon which the information from reputable sources is based. “Listen to the experts, including the regional health departments,” Usen said. “Check the sources of your health information.” For searching online, physician Michael Dlugosz, — with Highgate Medical Group, PC in West Amherst — recommends sources such as the Centers for Disease Control and Prevention, World Health Organization and Mayo Clinic.

We need to improve hand hygiene

Whether it’s flu season or a pandemic, proper hand hygiene makes a huge difference in transmission. “It does work,” Dlugosz said. “It’s what our mom and dad taught us and now we’re re-emphasizing it. “At the beginning of all of this, we were hyper-vigilant about washing hands. I think now we’re reaching a point of risking complacency. We have to keep re-energizing these facts so we don’t see another peak.” He credits handwashing, along with social distancing, as key to flattening the curve and helping prevent the “terrifying forecast” of infection from coming true. But handwashing must include lathering the hands with soap and scrubbing for 20 seconds before rinsing and drying. “If that’s not available, use hand

Kaleida Health Announces Its New CEO


obert J. Nesselbush has been named chief executive officer (CEO) for Kaleida Health. Nesselbush, currently the organization’s chief financial officer, came to Kaleida Health in April 2019 after spending 24 years at Rochester Regional Health (RRH). He will succeed Jody Lomeo, who announced earlier this year that he will not renew his contract at year’s end. “Today’s announcement is true succession planning,” said Frank Curci, chairman of the Kaleida Health board of directors. “The board felt very strongly about keeping the team together; they have performed so well under Jody’s leadership. In particular, Bob and the executive management team really shined during the COVID-19 crisis. With Bob elevating to the CEO position, you get a results-oriented leader who has a proven track record in operations, improving quality, growing market share and managing financial operations.” At RRH, Nesselbush rose through the hospital system, beginning as the director of financial reporting and finishing as the executive vice president and chief operating officer (COO) of the $2.4 billion system. As COO, he led the merger integration of four health systems in June 2014: Rochester General Health System, Unity Health System, Clifton Springs Health System and United Memorial Medical Center. Rochester Regional has nearly 16,000 employees and consists of five Page 2

Robert J. Nesselbush is Kaleida Health’s new CEO. He has been the organization’s chief financial officer since 2019. acute hospitals (1,270 beds), including Rochester General Hospital. “It is a truly incredible honor to be asked to lead and serve this great health system of ours,” said Nesselbush. “In my time in Rochester, I was fortunate enough to watch the growth and expansion that was underway at Kaleida Health. So when I had the chance to join the organization in 2019, I jumped at the opportunity. As a proud Western New Yorker, I am very excited about building upon the many successes that Kaleida Health has achieved over the last seven years.” A big believer in the importance

of cross-functional teams, Nesselbush worked closely with nursing and physician leadership throughout his tenure in Rochester to help improve outcomes, quality scores and to reposition their hospitals in the region. One of the direct results was the “RRH Quality and Safety Institute (QSI),” which is focused on driving continuous quality and patient safety improvement. The structure and investment in the quality program led to Rochester General Hospital’s recognition as one of HealthGrades America’s 50 Best Hospitals (top 1% of hospitals in the nation). Nesselbush’s achievements in his

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • September 2020

sanitizer,” he said.

We need to stop presenteeism

“Presenteeism” was coined to describe workers who show up at the job even though they’re sick. Instead of touting this as a good work ethic, employers need to create an environment where employees feel secure enough in their position that they can take time off for illness as needed. “When you’re sick, it’s not only for yourself but for everyone around you,” Dlugosz said.

We need to vaccinate

As vaccines have become commonplace, it is easy to forget the dread of diseases that can badly sicken many people. Some people elect not to vaccinate; however, “COVID-19 gave us a glimpse of an unvaccinated world,” Dlugosz said. “If we didn’t have flu or pneumonia vaccine, it’s how bad it could be. When it’s flu season, get vaccinated or this is what can happen.” He hopes a COVID-19 vaccination will be available by the end of this year.

We’re pretty good at helping out

Dlugosz likens those pitching in to help during COVID-19’s spread to those volunteering on the home front during a war, “where you found people taking on other responsibilities for the sake of common good.” Whether sewing masks at home as individuals or pivoting as companies to make helpful products to fight the coronavirus, many Americans found ways to participate.

three decades in healthcare are many. Among them, he led the acquisition of over 80 physician practices, accounting for over 200 providers; developed and invested in a physician and nursing informatics department focused on improving the electronic health record; and partnered with physician leadership in GRIPA to manage various payer risk contracts. In his time at Kaleida Health, Nesselbush has worked closely with operations and the executive management team to standardize strategic, financial and operating planning processes for the system. In addition to this, he spearheaded revenue cycle improvements, instituted a new payer governance structure, and implemented a new revenue recognition model. “The opportunity to work with Jody and the executive team since my arrival last year, and now the ability to work side-by-side with them through this transition, affords me the ability to really hit the ground running,” Nesselbush said. “I want to thank Jody for all that he has done for the organization and community; I am humbled to follow in his footsteps. I also want to thank the board of directors for their confidence in the team and our strategy. We have a unique opportunity to emerge from these uncertain times as a stronger organization that will continue to focus on patients, team and executing our plan.” Prior to serving as COO at RRH, Nesselbush was the senior vice president of the health system’s acute care division and the president of Rochester General Hospital.

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September 2020 •

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper

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Your Doctor

By Chris Motola

Sarah Berga, M.D. New chairwoman of obstetrics and gynecology at UB talks about career and move to Buffalo, and her plans to expand range of services provided to women Q: How are you adapting to your new position at chairwoman of obstetrics and gynecology at UB? A: I’m a reproductive endocrinologist and infertility (REI) specialist, which is what I’d been doing for the past few years, but I’ve also been a chair[woman] previously. I was taking a break and just enjoying being a clinician for a couple years. REI is a very big field focusing on hormones for men as well as women. In OB-GYN there are several subspecialties: maternal fetal medicine, gynecologic oncology and a new one, female pelvic medicine and reconstructive surgery. And we have a few fellowships in reproductive genetics and the new field of embryo diagnostics, which sort of merges into pediatric genetics and cancer genetics. So it’s a real field, but it’s not exactly a subspecialty yet. And then we have a field called family planning that has fellowships, but isn’t recognized nationally. So in our field, we have four well-recognized subspecialties, and a bunch of not well-recognized ones. All of these people [in all those pseudo specialties] do a four-year residency as well as training in other areas, sometimes including research methodologies. There aren’t that many of us who have done that second step, maybe 5,000 in the whole United States. Q: Is that what brought you to Buffalo? Their ability to accommodate your niche? A: They wanted someone to help build the whole program, not just my area, which is something that I’ve

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done before. I was in Pittsburgh [University of Pittsburgh School of Medicine] for a long time. During that time, we launched a women’s health research institute, a menopause program and all sorts of other programs over the course of 15 years. And then I went to Emory [University School of Medicine] to try to establish some of the same things. Then Wake Forest [Baptist Medical Center], same role. Then I was just kind of minding my own business out in Utah [School of Medicine]. To be honest, I had looked at this job before, but was waiting for the new hospital [Oishei Children’s Hospital]. So what made it different for me this time is that the new hospital and school of medicine are remarkable. It’s a great leap forward for Buffalo and will allow us to do a lot more. It’s kind of a new era, and I’m trying to get as much of that done as

we possibly can. I feel like the pandemic knocked a bit of the wind out of our sails, but we’re trying to keep our eye on the ball and get back in the fast lane once we get a vaccine or whatever it takes to get this thing under control. Q: At least it looks like everyone else is in the same boat, too. A: Oh yeah. I actually think New York is ahead of everyone else. Q: At this point. It wasn’t looking too hot a few months ago. A: I know. Everyone thought I was insane moving here. People weren’t wearing their masks where I was. It’s an interesting thing that people in different parts of the United States don’t think they’re connected. People in the East don’t think much about people in the West. People in the West don’t think much about people in the East. Q: Except for hub cities like New York City, San Francisco and Los Angeles. They’re adjacent to each other, but Upstate is far away. A: Yeah, the super cities. It’s like that poster of New York City from long ago, looking west: it’s the Hudson River, New Jersey and then immediately Los Angeles. The largest fresh water system in the country doesn’t even exist. I do hope people understand that we’re all connected now. It seems more obvious. I think academic medicine is funny thing in that we’re often connected with people who are innovators in other parts of the world. Something you’re working on may have 10, 20 people in the whole world who are experts on it, and where they are seems pretty random. So I think we tend to look in a more global way, but I don’t think it’s a common perspective, unfortunately. Q: What will your efforts most directly be focused on with the new program? A: I know this is going to sound funny, but there is sort of a sequence of events that has to happen. So there are must-haves that serve as the bottom foundation. When you think of OB-GYN, it was a fusion product of obstetrics and gynecology, which have since differentiated into other subspecialties. In the beginning, gynecology mostly just meant gynecologic surgery, but it’s expanded over the last half century into interdisciplinary areas. So now there’s such a thing as women’s cardiology, or women’s psychiatry, and all of that kind of morphed into what we called gendered medicine. So looking at how men and women differ in common disorders. The kind of heart disease men get is different than the kind of heart disease women get, and the treatments can even be different. A heart attack also often has different symptoms for women than it does for men. So that whole field of gynecology has become highly interdisciplinary. And there’s one I haven’t really

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • September 2020

In the News Physician Sarah L. Berga, who specializes in hormones, stress and infertility, was appointed June 1 as the new chairwoman of the department of obstetrics and gynecology in the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo. She will also serve as president of UBMD Obstetrics & Gynecology and medical director of obstetrics and gynecology and maternal fetal medicine program development for Kaleida Health. She comes to UB from the University of Utah School of Medicine’s department of obstetrics and gynecology, where she served as professor and director of the division of reproductive endocrinology and infertility for two years. She succeeds physician Vanessa Barnabei, who served as chairwoman since 2012. mentioned yet, and it’s a hybrid of all of the above: pediatric and adolescent gynecology. It kind of grew out of REI, but grew into its own field. But it has to do with the maturation of the reproductive system. So any of the areas mentioned are areas that, nationally, may or may not have fully developed programs. So we want to bring these subspecialty areas together, both people who are here now and people we recruit. We actually have a lot of GYN-oncology subspecialties, thanks to Roswell Park, which is one of the strengths of this area. So that’s an example of a program that’s already here and works. Q: What’s step one? A: The first one we have to do is expand maternal fetal medicine. There’s also a plan to expand genetics inside pediatrics, which will also to expand genetics into maternal fetal medicine.

Lifelines Name: Sarah Berga, M.D. Position: Chairwoman of the department of obstetrics and gynecology in the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo; president of UBMD Obstetrics & Gynecology; medical director of obstetrics and gynecology and maternal fetal medicine program development at Kaleida Health Hometown: Albuquerque, New Mexico, and Washington D.C. Education: University of Virginia Affiliations: Oishei Children’s Hospital/ Kaleida Organizations: Society for Reproductive Investigation; American College of Obstetrics and Gynecology; American Society for Reproductive Medicine. Diplomat of the National Board of Medical Examiners, the American Board of Obstetrics and Gynecology and the American Board of Obstetrics and Gynecology Division of Reproductive Endocrinology and Infertility. Family: Husband (Robert); four children; two grandchildren Hobbies: Tennis, skiing

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IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper

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8/25/20 11:22 AM

Live Alone & Thrive

By Gwenn Voelckers

Practical tips, advice and hope for those who live alone

An Antidote for Hard Times: Build a Home in Your Heart “Build thy home in thy heart and be forever sheltered.” – Anonymous This is one of my favorite quotes. It captures so beautifully what I practice every day — especially these days — and it’s what I emphasize in my Live Alone and Thrive workshops: that the relationship with ourselves is the most worthwhile and enduring of all. Most of the women and men whom have made peace with living alone are busy leading interesting lives even during these uncertain and changing times. They have challenged, as have I, the age-old belief that marriage, as it has been traditionally defined, is the only state in which we can be happy, fulfilled, secure and successful. Many are finding that time alone has proven to be a gift, not a burden. Whether divorced, separated, single or widowed, we are not spending this precious time bemoaning our fate. We have experienced hardship, fear and loss and are the stronger for it. We have taken our lives into our own hands and have embraced the choices and possibilities that living alone has to offer.

This is what we know . . .

• Living alone doesn’t mean living in isolation. Even with physical distancing, we can be together heart-to-heart. Those of us who live alone know

how vital it is to stay connected when times are good. We also don’t hesitate to pick up the phone, text, email or Facetime with friends and family when loneliness and sadness show up. • Accepting a virtual or in-person safe party invitation is worth doing. I attended an open-air graduation ceremony recently and enjoyed the camaraderie of masked friends for the first time in a long time. • Solo travel can still be enjoyed. We can still explore the world through virtual online tours of museums, national parks, landmarks and popular cities, from San Francisco to Paris. One of my favorite sites is GLOBOTREKS. • Figuring out how to join a Zoom meeting, make home repairs (thank you YouTube!), or grow your own vegetables can be very rewarding. I fixed my own water spigot the other day, and gave myself a highfive with my own Purell-coated hands.

We have learned that . . .

• Rediscovering your “true self” and identifying those things that bring meaning and happiness into your life can turn living alone into an adventure of the spirit. When rehearsals for my community band were suspended due to COVID-19, I decided to learn how to play a drum set. Awkward at first, I’m finally getting the hang of it. My neighbors may not agree. Ha!

s d i K Corner

Help Your Kids Navigate School Amid a Pandemic


his school year comes with special challenges for kids as the United States grapples with a coronavirus pandemic, but experts say parents can help their children navigate the tough emotional terrain. Whether returning to a school building, continuing online learning or adjusting to a hybrid school environment, it is normal for children and adolescents to have Page 6

some stress or anxiety about going back to school, said Samanta Boddapati, a child clinical psychologist and prevention coordinator at Big Lots Behavioral Health Services at Nationwide Children’s Hospital in Columbus, Ohio. Fears of getting sick or following school safety protocols for COVID-19 may make the transition even more difficult.

• Doing a “random act of kindness” is a great antidote when you’re feeling sorry for yourself. • Friends matter, especially now. Reach out. Nurture your friendships. And honor your commitments. If I make a plan to walk with a friend, I show up, even if I’m not quite in the mood. Without exception, I always feel better afterwards. • Caring for and serving others is empowering and helps us feel connected to a greater good. It can feed your soul. Even a simple gesture, such as sharing a word of encouragement, can turn someone’s day around. A larger gesture, such as shopping, dog walking, or lawn care for a neighbor who cannot safely leave home can give you a sense of belonging and purpose.

We will never forget that . . .

• Letting go of the idea that you need to be married or “coupled” to have any chance of being happy and secure is essential. This supposed idea will only keep you from finding a brighter and more fulfilling future. • Treating yourself well builds esteem. Prepare and enjoy decent meals at home. Get enough sleep. Exercise. You’re worth it. Tell yourself so by taking good care of yourself. • Continuing to celebrate holidays, birthdays, graduations, anniversaries and other important occasions is important. Be creative and find safe ways to recreate the special rituals that have enriched your life. • Our spiritual underpinnings and faith traditions, however defined, can be a real source of strength, hope, and inspiration. Believing that we are all connected to each other, even to those long gone, enables us to carry their vitality and energy in our hearts.

And we will always remember that . . .

• Expanding your definition of love beyond “romantic love” will stand you in good stead. Embrace

In a survey of parents by Nationwide Children’s, two out of five said they had concerns about their kid’s social and emotional well-being. Very young children can suffer from separation anxiety about being away from family and in new environments. For these children, experts recommend making a special goodbye part of your routine and reminding your child when you will see each other again. Some kids like a transitional object — an item that reminds them of mom or dad while at school. Older children being in a classroom might be uncomfortable. “Maintaining a routine is important, especially for families who are continuing to do online learning fulltime. Create a part of your child’s day that is structured and a part of their day that has some flexibility,” said Parker Huston, a Nationwide Children’s pediatric psychologist. The hospital’s experts offer these tips for parents and caregivers: • Tell your child there are a lot of

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • September 2020

“passionate friendships” — those relationships in which you can be yourself and feel completely comfortable . . . in your sweatpants. • Hanging out with negative people is a real downer. I enjoy spending time with friends who are finding silver linings amid the hardships we are experiencing. Imposed downtime has provided a needed rest and break from relentless striving and doing. We are feeling less stress, greater peace and healthier as a result. • We all have tools — inner resources — and now is the time to recall your best qualities and to draw upon them. It could be patience, generosity, creativity, kindness or a sense of humor. These qualities have helped you survive hard times in the past and they can serve you now. • Feeling and expressing gratitude starts a ripple of goodness that reaches further than you can imagine. Every note you write, every kindness you extend and every word of thanks will make a positive difference. It begins with you and ends with a joyful connection. Last month, I found a wounded robin in my yard. I took it to Wildlife Rescue, where I met with a young staff member named Jamie. She tenderly took possession of the robin and promised me they would do everything possible to restore the robin to good health. As I got ready to leave, I said thank you, but then it didn’t feel like enough. I turned back and said, “Jamie, if you were my daughter, I would be so proud of you.” Her eyes crinkled with a smile. Gwenn Voelckers is the founder and facilitator of Alone and Content, empowerment workshops for women, and author of “Alone and Content,” a collection of inspiring essays for those who live alone. For information about her workshops, to purchase her book, or invite her to speak, visit www. aloneandcontent.com

unknowns, but that you and others are there to help them. • Discuss fears and talk through options and alternatives. • Model coping skills to your children, so they know how to respond to unknowns and build resilience. • Help them understand special procedures in schools such as wearing a mask and undergoing temperature checks. • Find out what resources are available at school for your child, such as social-emotional support or counseling. “A certain amount of stress is normal, but parents, caregivers and educators should look out for drastic changes in functioning or behavior,” Huston said in a hospital news release. “Sleep changes, mood changes, inability to engage with social environments or friends, increased anxiety about things that they maybe weren›t nervous about in the past are changes you want to talk to your child’s pediatrician about.”

Taking a Stand

Dr. Mark Cavaretta Joins

The ups, downs of standing desk By Daniel Meyer


have a confession to make. I’m addicted to standing. After years of attempting to create makeshift platforms at work for my laptop computer and secondary monitor using discarded shoeboxes and other obscure objects, my wife purchased one of the most thoughtful and useful Christmas gifts I have ever received. After an initial stint of procrastination, I eventually enlisted the help of a colleague at work to help me set up my state-of-the-art standing desk, a piece of office furniture I firmly believe has dramatically changed my life both personally and professionally. Some of my co-workers, family members and friends were skeptical about my new workspace environment, with a few even telling me I wouldn’t regularly utilize the standing desk and revert to my previous workday routine of mostly sitting while in the office. I’m happy to say they were wrong. Over the past six months I have evolved into someone who spends almost my entire eight hours in the office on my feet, performing daily job duties at a standing desk as part of a regular routine that at times finds me wondering what it was like when I spent most of my work day in a seated position.

Stand up to challenge

I had done research on standing desks years ago and as I mentioned previously had made some attempts to build my own structures without much success. After receiving my standing desk as a gift at the tail end of 2019, I eventually committed to reorganizing my office and making this new piece of furniture the focal point for most everything I do during a typical eight-hour work day. I wanted to improve my posture and also attempt to eliminate or at least reduce the pain and soreness I regularly felt at the end of the day in my lower back and shoulders. I also wanted to be in a better position to remind myself to move more, even if it means just a quick walk around the hallway located right around the corner from my office or to walk down the 16 floors of our office building every few hours. The documented research about how sitting for long periods of time is unhealthy is everywhere. It has become what some call “the new smoking,” which convinced me to give standing while at work a chance. Now that I had the properly designed platform in place, I was determined to make it work. I know people with standing desks at work or inside their home offices who took different approaches than me adjusting to the concept of standing while at work, but for me it became normal and something I don’t even think about as the day moves along. While some people shared with me that they felt one or both of their legs going numb and complained of lower back pain during their first few days of standing while working, I fortunately had

Daniel Meyer

no initial physical ailments or complaints. There are some days where it may be four or five hours into my shift until I take a brief break and sit to write something down at my standard office

desk. I have found that I now walk around the office more, take more frequent breaks to stroll down the hallway or make that 16-floor jaunt down the stairwell. I do sit during in-person meetings and whenever I am writing something on paper that is lengthy and in-depth, but for the most part I have found that I prefer to stand for most of the eight hours I am at the office. Before using my standing desk, I was constantly hunched over or slumped in my chair, causing shoulder tension and other aches and pains in my forearms. I also recall that when I used to stand up to take a break or go out to lunch that my legs would be very tight because I had not shifted my sitting position or stretched my legs for an extended period of time. Now six months into standing while working, I have fully converted into someone who rarely sits in an office chair, moves more frequently during a typical day at work, and has much more energy at the end of my shift, meaning I am likely to be more active and participate in some sort of physical activity after I arrive home.

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Benefits of standing

While there are other personal health routine changes I have made over the past half-year or so that have contributed to my significant weight loss and increased energy level, I do know that spending roughly 40 hours per week at work standing instead of sitting has greatly improved my overall health. I have less aches and pains when compared to what I coped with prior to using my standing desk. I’ve learned that sitting too much is bad for my health. I expect the results of an upcoming doctor appointment with my primary care physician to show that I have decreased my risk of diabetes and heart disease. I also believe I am more productive at the office and that my standing desk has had a positive influence on my mood and overall well-being because of an obvious increase in my energy level. After six months of standing, I do know I have no plans of returning to sitting. I believe my standing desk provides me pain relief, that standing while working is not a difficult routine to get into, and that being a creature of habit I am confident that incorporating more standing into my typical workday will lead to more productivity and increased energy for the foreseeable future.

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September 2020 •

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper

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Fauci, Cuomo Top Trump as Reliable Sources on COVID-19: Survey


espite facing continued criticism from the Trump administration, physician Anthony Fauci is still considered the best source for COVID-19 information, an online poll finds. A growing number of Americans say federal, state and local governments are doing a poor job of responding to the coronavirus pandemic — and a shrinking number see President Donald Trump as a reliable information source.

The survey was conducted June 19-26 by the University of Southern California’s Center for the Digital Future as a follow-up to an April study. The new findings revealed 44% of Americans rely on Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, more than anyone else. After Fauci, people rely on New York Gov. Andrew Cuomo (19%); CNN medical correspondent physician Sanjay Gupta or their local mayor (16%); and coronavirus response

coordinator, physician Deborah Birx (15%). In the June survey, 12% of Americans trusted Trump for reliable pandemic information, down from 20% in April. Two percent of liberals and 29% of conservatives said they relied on the president, though he was tops among 40% who identified themselves as very conservative. Fewer had faith in any governmental response to the pandemic. Forty-three percent said the fed-

eral response was poor — up from 39% in April. Eighteen percent called state and local response poor in June — up from 14% in April. In all, 28% called the federal government’s response good or excellent down from 33% in April. More than 1,000 people participated in the online poll. It has a margin of error of plus or minus 3 percentage points.

Healthcare in a Minute By George W. Chapman

Profits for Major Insurers Double This Year. Does it Mean We Will Get a Premium Rebate?


he short answer is: don’t hold your breath. A recent article in the New York Times by Reed Abelson explained. The Affordable Care Act (ACA) caps what commercial insurers can retain as profits. For small businesses and individuals, insurers must rebate “profits” over 20% of premiums. Profits include operating costs as well. For large businesses, insurers must rebate profits over 15% of premiums. Second quarter profits for major national insurers this year are almost double the second quarter profits of last year. Reported second quarter 2020 profits are $3 billion for CVS/Aetna, $2.3 billion for Anthem and $6.7 billion for United. COVID-19 claims, (most are Medicare), are easily offset by the dearth of claims from elective surgeries, emergency rooms and office visits. The Trump administration is well aware of these excess profits which by any measure are expected to continue throughout 2020. Washington has “encouraged” the insurance giants to rebate anticipated excess profits or reduce premiums during this fiscal year instead of waiting to calculate year-end results. Industry observers predict: OK, good luck with that. Before issuing any rebates, insurers are granted a three-year grace period following any fiscal year to be sure they have calculated all claims. In the meantime, individuals and businesses are struggling to pay their premiums and healthcare providers are struggling with the devastating negative impact of the virus on their bottom lines and staff.

Unrestricted Profits As discussed above, the ACA caps profits on insurance lines of business. Written 10 years ago, the ACA does not restrict profits on other lines of healthcare business now owned and operated by the largest commercial insurers. Carriers have purchased or started up their own clinics and have merged with major drug retailers. Retailers like Walmart have even jumped into the insurance and clinic fray. To date, the current administration and a lot of politicians have provided mostly lip service to effectively controlling drug costs. A bipartisan bill written up in Congress last year, allowing Medicare/ Medicaid to negotiate a couple dozen drug prices for starters, has yet to be presented to the Senate for a vote. Page 8

Telemedicine’s Future

COVID-19 is already considered a “black swan event” similar to other significant life changing occurrences — like both world wars, 9/11 and the launching of the personal computer. Up until the virus, telemedicine was ever so slowly being incorporated into the delivery of healthcare. Since the virus, telemedicine use has skyrocketed. Consumers are happy with the convenience and no copay. While some providers may still prefer office visits to virtual visits, all are happy with the enhanced reimbursement for telemedicine visits which, so far, are equal to an office visit. The billion-dollar question is: will enhanced reimbursement continue? The key is, what will Medicare do? (Commercial

carriers tend to follow suit.) Right now, the enhanced reimbursement is authorized in 90-day segments. The current temporary 90-day authorization ends Oct. 31. I’m sure all provider group lobbyists (AMA, AHA, etc.) are pushing for permanency. Their efforts must be working. CMS chief Seema Verma recently commented, “Reversing course would be a mistake.” While it remains to be seen what ultimately happens, the signs are good for permanency. Verma noted that 9 million Medicare members have used telemedicine since the pandemic. Medicare paid providers $9 billion for telemedicine services in March and April this year versus only $60 million in March and April 2019. The virus has exposed and compounded our embarrassing lack of a national health policy. It’s been every state for themselves. Consequently, due to the lack of a national health policy providing some consistency across state lines, the governors from four western states: Washington, Colorado, Oregon and Nevada, are collaborating to improve, standardize and coordinate telemedicine access and coverage for their collective populations.  

Veterinarians Are Flourishing As we postpone or even cancel healthcare due to the ongoing pandemic, physicians and hospitals will continue to endure the financial strain. Quite ironically, veterinarians are flourishing. Unlike human care, trips to the vet are way up. A recent Associated Press story describes this phenomenon. Vet offices and animal hospitals are scrambling to increase staff, phone lines and office hours to accommodate the average 18% surge in pet care. According to pet health insurer “Trupanion,” July business was up 28% over last July. Industry observers and vets themselves attribute the increase in business to more people working from home, pets as emotional support, increased pet

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • September 2020

adoptions from shelters and price. Pet care is still primarily cash on the barrel head, so veterinary offices and hospitals are much more transparent with pricing as a third-party insurer is rarely involved, which normally introduces price confusion.  

Private Practice Success

About half of all physicians are still in private practice. Despite the negative financial ramifications due to the pandemic, social media consulting firm PatientPop got enough physicians in private practice to respond to its survey. One of the survey questions asked for their non-financial indicators of success. Sixty-seven percent answered success meant a positive patient experience; 35% said effective patient communication; 30% thought strong or positive online reviews; 27% considered a high ranking in online searches to be an indicator of success; while 23% said their high performing website was an indication of success. When asked what frustrates them the most, 49% said dealing with myriad of insurers with their different fees, regulations and coverages; 33% said collecting what is owed them; 31% are frustrated with patient no-shows and cancellations (exacerbated by the pandemic); and 31% said dealing with compliance and related expenses.   George W. Chapman is a healthcare business consultant who works exclusively with physicians, hospitals and healthcare organizations. He operates GW Chapman Consulting based in Syracuse. Email him at gwc@gwchapmanconsulting.com.

A.: My first concern was for Bonnie, my wife of 37 years. She has been battling her own medical challenges for years, but this news has brought her considerable stress. For me, the surprise and shock of hearing that news has turned my life upside down —not so much mentally and spiritually — but physically. For whatever reason, in one weekend, my entire life’s focus has changed. Q.: What has helped you live with this news? A.: A blessing is having a supportive family and, in my case, one with a medical background. Bonnie has a sports medicine degree; my brother James is a physical therapist and my niece, Katie, is a nurse, so I have what a lot of families do not have — family members who know and understand the complicated health care system and who can communicate with my medical team. They have truly been a blessing for me. Q.: Who makes up your medical team? A.: From the start, I knew I needed an oncology medical team and through Bonnie’s research, the Cleveland Clinic was ranked fourth in the nation, so we made an appointment to visit them. I had known them in the wellness field and a Buffalo native, Dr. Michael Roizen, is the chief wellness officer at the Cleveland Clinic. Dr. Bassam Estfan, a medical oncology specialist at the Cleveland Clinic, is managing my care and working closely with my primary care physicians in Buffalo — Dr. Andrew Baumgartner of the University of Buffalo/MD Group and Dr. David Dogherty of the Buffalo Medical Group. They have been awesome. They are also straight shooters, which is what I like because I am a listener.

Q A &

with Phil Haberstro

Diagnosed with potentially terminal Stage 4 colon cancer, leader at Wellness Institute of Greater Buffalo faces challenge of his life with courage By Michael J. Billoni


hil Haberstro celebrated 30 years of leadership as founder and executive director of the culture-changing Wellness Institute of Greater Buffalo last fall. He and his team committed to a strategic plan to guide them through the next decade of their Healthy Communities advocacy work and begin planning for Haberstro to retire and pass the baton to Lucy Connery, his associate director. As the calendar moved into winter 2019, everything was smoothly proceeding with staff and volunteer input as preparations were made to launch its Healthy Communities 2030 initiative. The annual release of the Robert Wood Johnson Foundation’s County

Health Rankings, a key metric for measuring health and community quality of life, is usually a media event held in the WNED Studios in late March but it was cancelled due to the COVID-19 pandemic. The week leading up to Memorial Day in May is when Haberstro’s life took a very unexpected and radical turn in the midst of the uncertainty of the pandemic. After treasuring and enjoying 50 years of exceptional health, Haberstro, 72, one of WNY’s most visionary, dedicated wellness warriors, was diagnosed with potentially terminal stage four colon cancer. Q.: What were your first thoughts when you heard the prognosis?

Q.: Now that you are dealing with a terminal cancer prognosis, how are you dealing with it four months later? A.: With family, friends and prayers, I have been blessed with a wonderful network of support that gives me great confidence as I take on this challenge. I have not been depressed and I have not cried and asked God, “Why is this happening to me?” When you get to the point of talking about terminal cancer, the reality of life sets in. My goal has always been to live to 100 and right now I am 28 years short. I have always been a goal setter and I am still looking forward to seeing what the world will look like when I hit that century mark in birthdays. Q.: What is the medical game plan you are following today? A.: Along with the medical procedures to battle the cancer, they want me to eat and not worry about calories, so I have been enjoying a lot of ice cream and milk shakes and things like that. I can walk as much as I can, and I am able to exercise on the gym equipment in my basement. But mostly, they want me to stay active mentally so I will go to the wellness institute’s office in City Hall and be supportive of Lucy and her team on growing what we began 30 years ago. What I believe is helping me through this is that I have had 50 years of perfect health, which I credit

September 2020 •

to living my life by the book — good nutrition, exercise regularly, no drugs, no alcohol and stress management. I had been practicing my own form of mindfulness long before it became popular. If you look at risk factors for colon cancer, the only one I had was being a male. Q.: What lessons have you learned from this that you can share with others battling cancer? A.: The main thing is you must have a strong support network. You cannot take this on alone. Be open and do not be afraid to share your feelings with those closest to you. As word of this has drifted out, I cannot tell you how much the cards and words of encouragement have meant to me. I have so many people praying for me. I feel extremely blessed. Q.: How important is the spiritual aspect in this battle? A.: I attended St. John the Baptist Catholic grammar school and was in the first graduating class at Cardinal O’Hara High School in 1965. That religious upbringing provided me with a solid foundation and a strong sense of values. Even if you are a non-believer, you cannot leave the prayer out of the equation. We have all seen and heard about miracles and I am a true believer in the power of prayer. Q.: What do you see as unfinished business in your role with the Wellness Institute of Greater Buffalo? A.: That’s easy. We still are not as healthy as we should be in this community and that is why government, foundations, businesses and local funders should all get behind the Healthy Communities 2030 initiative Lucy is now spearheading. There is something in there for everyone to follow. I am also concerned about the health of our children and that is why I am honored to work with Erie County Clerk Mickey Kearns and many others in spearheading the Healthy District Initiative with several local school districts. That initiative must continue to grow because it has now expanded into dealing with physical and mental health for our children. Q.: What would you like to see when you celebrate your 100th birthday? A.: For one, several more designations for Buffalo and this region as All American Cities. The big one, though, is that all the necessary stakeholders continue to work together toward the goal of creating healthy communities in Western New York, especially for our children and seniors. It is most important the funders and government leaders not be afraid in pursuing positive community change and to be aggressive, persistent, and passionate about it because these elements are essential to achieving sustainable results. Q.: Reflecting on life experiences and lessons learned, any thoughts? A.: A vision is good; a shared vision is better! When you are young, keep learning — it will lead you to wisdom sooner. When you are older, keep learning — it will keep you young! Stay tuned; my final chapter has yet to be written!

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper

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The skinny on healthy eating

The Nutritious Perks of Whole-Grain Rice Noodles By Anne Palumbo


popular takeout during normal times, pad Thai — a beloved Thai noodle dish — has skyrocketed in popularity, according to recent surveys. In our house, we certainly love its bold, savory flavors and variety of textures! Rice noodles play a key role in this tasty dish, and while there are many varieties available, most restaurants use white rice noodles. Much like regular pasta that is made from refined flour that’s been stripped of its nutrient-dense bran and germ, white rice noodles are made from rice flour that has undergone a similar process. A stickler for whole grains when-

ever possible, I now make my own pad Thai with whole-grain brown rice noodles. The good news is, these healthier noodles are easily found at the local grocery store. The even better news is, they rock with some valuable nutrients that their refined cousins have left behind. Fiber is one of those important nutrients. Well known for its ability to keep us regular, fiber helps us in other ways that truly deserve a shout-out. From stabilizing blood sugars to lowering cholesterol, from keeping us satiated to reducing the risk of dying from certain diseases, this workhorse nutrient should be

Pizza Study Shows Body’s Resilience to Pigging Out


ver felt guilty for that occasional binge on high-calorie, fatty foods? Relax: A new study of folks overindulging on pizza finds that if you’re healthy and you don’t ‘pig out’ regularly, your body deals with it just fine. British researchers looked at the effects of eating until not just full, but so full that the participants could not take another bite. Then, they tested the blood of the 14 healthy young men who participated in the study to determine whether there were any changes in blood sugar, blood fats, insulin and other hormones. The team discovered that even when the men had eaten double the amount of pizza that it would take to make them comfortably full, their blood tests showed no negative consequences. “I think that’s the really remarkable thing here, that we have a huge capacity to overeat and, despite that huge capacity, the body does really quite well at controlling blood sugars Page 10

and blood fat after that meal,” said study author James Betts, a professor of metabolic physiology at the University of Bath’s Centre for Nutrition, Exercise and Metabolism. Betts said it was notable both that the body’s response kept blood sugar and lipids under control after such a big meal, and that it was possible for participants to consume so much excess food. When eating until full, they averaged the equivalent of a large pizza. When eating until maximally full, they ate about two large pizzas, Betts said. “We expected people to eat more when they were asked to go beyond full, but we expected that to be slightly more,” Betts said. “We were really amazed that it was almost exactly 100% more.” The study was published online recently in the British Journal of Nutrition. Betts and one of his co-authors stumbled upon the idea for the study while traveling to a conference. The only open airport restaurant was a

consumed daily. An average serving of brown rice noodles dishes up an impressive 3 to 4 grams. Phytonutrients and antioxidants, whose consumption, according to the USDA, promote good health by slowing or preventing free-radical cell damage that may lead to cancer and certain diseases, abound in whole grains like brown rice noodles. The intact whole-grain kernel also teems with a variety of other beneficial nutrients: B vitamins, several minerals, healthy fats and even some protein. The complex carbohydrates found in brown rice noodles are the “good” ones (versus the “bad” ones found in refined foods that zip through us). These good carbs take longer to digest, which keeps blood sugars and energy levels on a more even keel. A growing body of research shows that diets rich in whole grains and other less-processed carbohydrates may decrease the risk for developing Type 2 diabetes. Low in cholesterol, sodium and fat, brown rice noodles deliver about 200 calories per average serving. They are also gluten-free.

Healthy Pad Thai with Whole-Grain Rice Noodles 8 oz. whole-grain pad Thai rice noodles 1 ½ tablespoons brown sugar (or agave syrup) 3 tablespoons lower-sodium soy sauce 1 ½ tablespoons fresh lime juice 1 ½ tablespoons rice vinegar 1-2 teaspoons Sriracha sauce 2 teaspoons fish sauce (optional) 1 ½ tablespoons vegetable oil 1 lb. boneless, skinless chicken breasts or thighs, cut into 1-inch chunks (or, protein of choice) 1 red or yellow bell pepper, sliced into thin strips and strips halved 2 cups snow peas 1 cup matchstick carrots 2 cloves garlic, minced 5 green onions, whites minced,

McDonald’s, so they each got a McMuffin breakfast sandwich. “We ate those and enjoyed them and said, ‘Oh, I could eat another one,’” Betts said. “That prompted a discussion of ‘How many do you think you could eat?’ and ‘What would be the physiological responses to eating more and more?’” While researching during the long flight, they discovered there had been no previous studies about eating beyond full, Betts said. They chose pizza because it tastes good, so people would keep eating. Its high fat and carbohydrate content offered a big challenge to the body, Betts said. Typically, blood sugar and blood lipids increase in response to how much a person eats, Betts said. A small meal will result in fewer changes than a medium meal, for example. Yet, after overeating, blood sugar was no higher than after a normal meal. Blood lipids such as tri-

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • September 2020

Helpful tips

Look in the Asian/International aisle of your local grocery store for whole-grain rice noodles. Cooked rice noodles, stored in an airtight container or plastic bag, last about five days in the fridge. Add a variety of colorful vegetables to make your pad Thai even more nutritious! greens sliced into 1-inch pieces 1 cup fresh bean sprouts (optional) 2 eggs (optional) ¼ cup unsalted peanuts, chopped Cook noodles according to package directions, drain. In a small mixing bowl, whisk together brown sugar, soy sauce, lime juice, rice vinegar, Sriracha sauce, and fish sauce; set aside. Heat oil in a wok or large sauté pan over medium-high heat. Add chicken and sauté until cooked through, about 8 minutes, stirring throughout. Transfer to a plate, leaving oil in pan. Add bell pepper, snow peas, and carrots and sauté 5-6 minutes; then add garlic, green onions, and bean sprouts and sauté 1 minute more. Push veggies to edges of pan and crack eggs in center. Cook and scramble until eggs have cooked through. Return chicken, add noodles and sauce, and toss everything together; cook 1-2 minutes. Serve warm, topped with chopped nuts.

Anne Palumbo is a lifestyle colum-

nist, food guru, and seasoned cook, who has perfected the art of preparing nutritious, calorie-conscious dishes. She is hungry for your questions and comments about SmartBites, so be in touch with Anne at avpalumbo@aol.com.

glycerides were slightly higher, even though fat consumption was double. Insulin, which is released to control blood sugar, was 50% higher than normal. Hormones that increase feelings of fullness changed the most. Connie Diekman, a food nutrition consultant in St. Louis, said the study documents what scientists already understand about the body and its ability to process food. Sometimes people get confused when wondering whether they are eating right, should consume fewer carbs, eat fewer fats or should try something like a Keto diet or intermittent fasting, Diekman said. “I think it does demonstrate very nicely that our body knows what to do with the food we eat. It knows how to fuel us well,” Diekman said.

ly and otherwise,” said Elizabeth Deeks, special events specialist at Niagara Hospice, Inc. “We appreciate all the runners that are participating in the virtual event. You will notice that our cost is reduced from previous years. Your running date is flexible and packet pick up is scheduled for Sept. 19. That’s when you can drive through and pick up your medal, T-shirt and Mighty discount card that can be used throughout the year for discounted items locally.” The Mighty Niagara Hospice Dash allows participants to choose a date anytime before Sept. 20 and run in isolation or with a few friends on your own course. Formerly the Scrub Run, Miles for Mercy also changed to a flexible date and pick-your-own-course format. In addition, race organizers changed race packets to include COVID-19-friendly items such as a neck gaiter that can be used as a mask and a touch tool used for keypads at stores and banks. They are hoping they will see some new faces at the eight-day event with the format changes. “We normally see upwards of 300 runners in Cazenovia Park each year,” states Laura Nutty, development specialist for Mercy Hospital Foundation. “This year, we are hopeful that allowing people to run, walk, rollerblade or bike on their own course will engage new people.”

Turkey Trot featured event

Races like Mighty Niagara Hospice Race and Miles for Mercy are still happening, but virtually. Participants can choose the schedule and the route they want to pursue.

On the Run … Virtually WNY takes road racing to virtual level that involves actual racing with a flexible schedule By Catherine Miller


estern New York has a love affair with outdoor foot races. Whether you are running a 5K race to support a great cause, or are an avid collector of event T-shirts and swag, or just enjoy a hotdog in a beer tent when you are thoroughly exhausted, it’s something that many Buffalonians have missed since the onset of this great COVID-19 pandemic. Well, miss it no more. Several organizations have stepped up and gotten onboard the virtual race game, and they are taking it to the streets — any streets. Virtual races promote all the goodness of the traditional 5Ks and similar races. You are donating to a great cause; you will get a great workout,

and likely end up with some cool items in your packet bag. The difference is that you pick your own route and can invite your friends to join you on an un-crowded course. Coming up, we have “Miles for Mercy” to support Mercy Hospital on Sept. 11-19; Run Across America scheduled for Oct. 3 which supports a variety of non-profits; and the Glen Iris in Letchworth State Park on Sept. 13 supporting the local library in Castile. If you are looking for a bit longer trek than the 5K (3.1 miles), you can join the Mighty Niagara Hospice Dash 5K and Half-Marathon to benefit Niagara Hospice. “We understand that this is a tough year for everybody, financial-

The Buffalo Turkey Trot has also joined in the virtual race game. While it brags to be the longest held footrace in America and is going into its 125th year, it has opened the event up to the entire Thanksgiving weekend, allowing plenty of time to digest your dinner if you prefer to run after the turkey and football are over. The Turkey Trot benefits services for youth at the YMCA, so again, you feel good about the wobbly legs at the end of the run. Want to join the largest footrace in the country? The Run Across America race on Oct. 3 is when you can join thousands of others and your proceeds can be put toward the benefit of your choosing. Without the virtual races, many of these organizations would lose funding necessary to continue their efforts. The Mighty Niagara Hospice Dash event accounts for a large portion of yearly donations which Niagara Hospice counts on to afford hospice services in the area. Proceeds from the Miles for Mercy event help program development at Mercy Hospital, which includes COVID-19 relief efforts this year. Each runner participating in any of the races will make a difference to the area and get a great workout — two reasons to feel fabulous about partaking in the events. Information on many of the area’s virtual races can be found at www.itsyourrace.com. While you are there, check out the suggested routes in your local area. You can also check out www. ymcabuffaloniagara.org for information on the 125th Turkey Trot, and www.nationwiderun.org for information on the Run Across America race. Whichever race you choose, you are sure to enjoy the fresh air and knowledge that you are contributing to many great causes in the Western New York area. And don’t forget to grill up a hotdog when your run is over. You’ve earned it.

September 2020 •

U.S. Women More Likely to Skip Meds Than Men


n the United States, many women with chronic medical conditions aren’t filling prescriptions or are trying to make their medications last longer due to the cost, a new study finds. Not filling prescriptions, skipping doses, delaying refills or splitting pills may put their health at risk, the study authors noted. For the study, researchers collected data on patients in 11 high-income countries, including the United States, Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the United Kingdom. Among U.S. patients, one in four younger women (aged 18 to 64) reported cost-related non-adherence to their prescriptions compared with one in seven younger men. The researchers found that the largest disparities between men and women occurred in the United States 54%, compared to 33% in Canada and 17% in Australia. “Prescription drug coverage systems — like those in the U.S. and Canada — that rely on employment-based insurance or require high patient contributions may disproportionally affect women, who are less likely to have full-time employment and more likely to be lower income,” said lead researcher Jamie Daw. She’s an assistant professor of health policy and management at Columbia University Mailman School of Public Health, in New York City. “The disparities we found in access to medicines may produce health disparities between men and women that should be further explored,” Daw added in a university news release. The findings were published online Aug. 3 in the journal Health Affairs.

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Premature Births Drop Dramatically During Pandemic By Deborah Jeanne Sergeant


ewer babies were born prematurely in a number of hospitals worldwide during the pandemic lockdown period, representing a decrease among some hospitals ranging from 20% (Nashville) to 90% (Denmark). The March of Dimes states that close to one in 10 babies is born prematurely, that is, before 37 weeks’ gestation. Premature birth is linked to lower birthweight and increased risk of short-term and lifelong health complications. “We speculated that maybe women aren’t accessing care as much so providers may not be reporting premature births,” said Darcy Dreyer, regional of maternal-child health for March of Dimes. “It’s still early to say that the prenatal births are decreasing. In Western New York and the Finger Lakes area, we haven’t seen much change.” Dreyer added that some have speculated that among women with

high blood pressure who would be hospitalized and possibly induced early, perhaps a share of them were at home relaxing and avoided this outcome. Although a worldwide pandemic brings its own stress, being at home may be viewed as a welcomed retreat for introverts or mothers who would otherwise be working on their feet all day. “If she’s home with a partner, that could be helpful, but if she’s home and isolated, that’s the opposite,” Dreyer said. “Nutrition is definitely important for pregnancy. If you’re home relaxing and off your feet, that’s definitely a benefit. If you’re socio-economically disadvantaged and living in housing with more families that isn’t as beneficial.” Midwives are a big part of maternal care in Denmark, which may indicate moms receive another layer of care that American women typically don’t receive. While isolated, fewer women

Experts: Supplements Can Fill in Dietary Gaps By Deborah Jeanne Sergeant


f you’re concerned about the nutrition in your diet, popping a daily multi-vitamin may seem and easy fix; however, it’s not all that easy. “There’s a lot to sift through to make sure what you’re taking is safe and efficacious,” said Mary Jo Parker, a registered dietitian in private practice in Williamsville. She advises looking at supplements approved by consumer watchdog groups and bearing the USP seal or NSF international, independent labs that assure supplements are what they claim. Sticking with wellknown brand names may also help. “Companies that put their name on a label will do due diligence,” Parker said. She said that many common things affect women’s health, including hormones, age, malabsorption issues, dietary restrictions, chronic disease, pregnancy and lactation. Page 12

These can make it challenging to take a one-size-fits-all multivitamin. She takes an approach that individualizes a supplement regimen based upon testing a client. But in general, most women miss out on a few different areas, such as vitamin D. Sunlight stimulates the body to generate vitamin D, a pre-hormone that regulates many bodily functions, but in areas like the Northeast, limited exposure reduces stores of vitamin D. Parker added that vitamins C and E and magnesium, potassium and iron are often lacking in the diets of pre-menopausal, pregnant and adolescence women. “When you see that over 25% of Americans have intakes less than the estimated average requirements for the needs of 50% of the population, that underscores the push for not only improved intake for health diet but also it underscores the likely

were exposed to illnesses such as the flu, which is associated with increased risk for premature birth. Staying at home also reduces exposure to another preterm risk: air pollution. Fewer cars on the road contributes to this effect. Jennifer Lombardo, certified labor doula and breastfeeding educator, and owner of Buffalo Doula Services, LLC in Buffalo, said that stress likely played a role in reducing prematurity during lockdown. “My thoughts behind the drop in preterm birth aren’t very scientific, but many birth workers have seen firsthand that pregnant people and babies have been known to wait for ‘ideal conditions’ to give birth,” Lombardo said. “Mom’s partner is serving overseas and labor starts the night they get home on leave. Mom wishes for her own mother to be present at the birth and her long, slow-progressing labor seems to speed up after their arrival. A mom whose labor stalls when the OB-GYN they don’t care for goes on call and picks back up when their shift ends. Laboring women and babies show us time and time again that they need to feel safe, supported, and calm for labor to begin or progress. Did feeling unsafe and perhaps even fearful encourage babies to stay put?” The pandemic offered quite a bit of stress and uncertainty because of income loss, fear of the virus, isolation, shortages and canceled plans. Improved nutrition may also be a factor for those who home from work. Instead of missing meals or grabbing fast food, more people were cooking at home — likely in a comfortable chair, lingering over their meals. More down time also allowed more women to fit in exercise, such as walking. The entire pace of life slowed down to permit pleasurable pursuits that perhaps had been pushed aside. These kinds of experiences could help moms savor this time in their life as they await their little one’s arrival. “I also have heard of many wom-

en feeling unsafe in the hospitals during the pandemic,” Lombardo said. “Many local women sought out an out-of-hospital birth after the pandemic began, and perhaps felt comforted and less stressed with that decision.”

need for at least a well-rounded, low-potency multiple vitamin and mineral supplement. Most experts say that poses no risk and likely can confer benefits.” Parker said that women in general are at elevated risk for dietary missteps because they tend to go on restrictive diets for weight loss such as diets that eliminate entire food groups or cut calories. For these women, Parker recommends a good multivitamin. “If they don’t eat much meat, they may need a B-12, B-6 and riboflavin supplement,” Parker said. “If it’s a low-carb diet, they may not get the B vitamins they need. Some diets are low in zinc.” Age and stage of life also make a difference. Those of childbearing years should take a folic acid supplement. “It is important to make sure they’re getting 400 mg to prevent birth defects,” Parker said. It’s most effective to begin taking folic acid before conception. Parker also warned that older adults often see a decrease in absorption of vitamin B-12. They also may benefit from an “eye” formula to reduce risk of macular degeneration. These often contain a balance of zinc, copper, lutein and zeaxanthin.

Justine Hays, registered dietitian and owner of Justine Hays Nutrition in Buffalo, said that ideally, a diet of whole fruits and vegetables should provide the nutrients needed for good health; however, supplements may fill in dietary gaps. “Always check with your primary care provider before starting supplements,” Hays said. “If you take too many, you can have certain vitamin and mineral overloads. You want to do it safely and make sure your primary care provider is aware that you’re taking supplements.” She also cautioned that some herbal supplements can interact with medication or even aggravate allergies. Oral contraceptives, for example, may be affected by St. John’s wort. “I caution people in terms of just supplementing with individual minerals,” Parker said. “It doesn’t take a lot to get at a point at which the body may have difficulty clearing it. With supplements, you have to be more careful with quantity.” She added that nutrients inherent to food behave differently in the body, since fiber and other natural ingredients may block absorption if there’s too much.

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • September 2020

Risk Factors

The March of Dimes lists everyday risk factors for preterm labor and premature birth on its website: • Smoking, drinking alcohol, using street drugs or abusing prescription drugs • Having a lot of stress in your life. • Low socioeconomic status (also called SES). SES is a combination of things like your education, your job and your income (how much money you make). • Domestic violence. This is when your partner hurts or abuses you. It includes physical, sexual and emotional abuse. • Working long hours or having to stand a lot. • Exposure to air pollution, lead, radiation and chemicals in things like paint, plastics and secondhand smoke. Secondhand smoke is smoke from someone else’s cigarette, cigar or pipe. • Age and race as risk factors for preterm labor and premature birth • Being younger than 17 or older than 35 makes you more likely than other women to give birth early. In the United States, black women are more likely to give birth early. Almost 17% of black babies are born prematurely each year. Just more than 10% of American Indian/Alaska Native and Hispanic babies are born early, and less than 10% of white and Asian babies. We don’t know why race plays a role in premature birth; researchers are working to learn more about it.


Women at Higher Alzheimer’s Risk Compared to Men Older age not the only culprit for more incidence of Alzheimer’s among women, researchers say By Deborah Jeanne Sergeant


umerous studies have established that women have twice the risk of Alzheimer’s disease than men. Researchers assumed that it’s because women tend to outlive men on average and older age is one of the risk factors for developing Alzheimer’s. However, a recent study published in Neurology, “Sex-Driven Modifiers of Alzheimer Risk,” indicates there’s more to it than longevity. Researchers found that hormones appear to make a difference in risk. Though the study used a small sample — 85 women and 36 men — the results point to a higher number of vital biomarkers for Alzheimer’s disease among women who have experienced menopause, whether natural or bilateral hysterectomy

menopause. This factor was identified as associated with Alzheimer’s biomarkers more than age, health history, and comorbidities that increase risk such as diabetes, high cholesterol, smoking, poor diet and lack of exercise. Women using estradiol hormone therapy exhibited fewer factors that indicate development of Alzheimer’s. It’s still not clear why most women who transition through menopause will not develop Alzheimer’s and some will, nor is it clear if estrogen is a direct or indirect factor. “One concept emerging is that a woman’s reproductive history has been correlated with Alzheimer’s risk,” said physician Anafidelia Tavares, senior director of program for the Alzheimer’s Association and statewide research liaison.   Women with multiple live births

seem to have lower their risk of Alzheimer’s as do women with early onset menses and later menopause. Though this points to correlation with hormonal influences, Tavares said that more research is necessary to draw conclusions. In addition, Tavares said that known factors such as more years of formal education and more challenging mental stimulation place women currently in their older years at a disadvantage. The traditional pattern for this generation of women was to get married out of high school, stay home to rear children and not engage in employment or much social interaction. Though currently, more women than men are enrolled in college, that was not the case 50 years ago. Today’s young women may find in their older years that their higher education and opportunities for employment and mental engagement are protective. But other factors, such as delaying childbearing and limiting the number of children may mitigate the benefits of more intellectual stimulation. Tavares said that it’s hard to tell how these correlative factors will affect women. “That’s why it’s important we have this research to understand the drivers and the increased risk in women,” Tavares said. “We need to look at the modifiable risk factors.”

Risk factors Family history represents a non-modifiable risk factor.

Cancer Services Program Plans Online Series For Cancer Prevention Free web-based presentations will focus screening and awareness for breast, cervical and colorectal cancers


rie County Department of Health (ECDOH) and its Cancer Services Program will present three cancer prevention webinars. Each 40-minute presentation will have a specific focus, starting with breast cancer Aug. 31, followed by colorectal cancer on Sept. 28 and cervical cancer Jan. 10.

“We can’t let the current focus on COVID-19 distract us from being proactive about recommended cancer screenings,” said Commissioner of Health Gale Burstein, a physician. “These webinars will provide useful information to make decisions about your health.” “The virtual meeting platform

offers a unique and engaging way to educate our community,” said Michelle Wysocki, Cancer Services Program director. “Our traditional outreach events like health fairs and community activities are closed to us for the moment, so we are being creative in reaching Erie County residents with this important infor-

September 2020 •

“With neurodegeneration, it’s unknown why there’s a difference between women and men,” said Lauren Ashburn, licensed master social worker and director of education and training for the Alzheimer’s Association, Western New York Chapter in Amherst. “They can have the same risk genes, but it’s faster progressing in women than men.” Alzheimer’s is present in one in nine people over 65; one in six of those over 75; and one in three over 85. Ashburn said that longevity is the greatest risk factor, but other factors influence likelihood, such as social influences. Like Tavares, she pointed to the limited formal education most women received in the first half of the last century. While nothing can change the genes you received, trying to mitigate the effects of their influence can help. Healthful choices may help reduce risk. “The earlier you start, the better, but it’s never too late as far as healthy living,” Ashburn said. “There’s not a ton of research on socialization, but we know it has an effect. “We know isolation increases our chances of developing Alzheimer’s. The earlier on in our life we can do it, the better. If you raised your kids and now you’re getting social, it’s better late than never. ‘If you don’t use it, you’ll lose it’ is so true. Challenge the brain as much as possible. More formal education builds a protective factor in the brain.” Because of the brain and body connection, physical activity helps maintain brain health. In general, what is good for the heart is good for the brain when it comes to diet, exercise and stress. Women tend to be the primary caregivers for both children and their elderly parents, in-laws and other relatives. This adds additional stress to their lives, along with the tendency for women to stretch themselves too thin to help others. Tavares encourages lifestyle changes to reduce risk of Alzheimer’s and improve overall health, including a healthful diet, tobacco cessation, prevention of brain injury (such as avoiding risky behaviors and wearing seatbelts and bike helmets), and engaging in regular physical activity. “Staying socially engaged, treat depression, and get a good night’s sleep,” Tavares said. “These are brain-protective.”

mation.” The webinars have been designed with the knowledge that the COVID-19 pandemic has disrupted many traditional approaches to cancer prevention outreach. Each webinar will be recorded and available online for future viewing. Attendees will have their names entered into a drawing for a grocery store gift card.  To register, email rachel.dusza@erie.gov at least one day prior to the scheduled event. Participants will need to provide their email for the link to sign in, and will also need the Zoom app installed on their computer or smartphone in order to see the event. For more information, call 716858-2913 or send an email to rachel. dusza@erie.gov.

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper

Page 13


COVID-19 and Dementia Isolation has had negative impact on people living with cognitive impairment By Deborah Jeanne Sergeant


ocial isolation during the pandemic has brought a myriad of changes, from the inconsequential to the lifechanging. For people with Alzheimer’s disease or another form of dementia, isolation can have lasting negative effects. “It’s a really complicated situation,” said Lauren Ashburn, licensed master social worker and director of education and training for the Alzheimer’s Association, Western New York chapter in Amherst. “Not only

do they already have impaired cognitive ability, but quarantining adds staying in their home. They may be confused. They may have difficulty in understanding what COVID is as a whole and remembering to follow their instructions.” Although most healthy people can go places even during quarantine, most people with Alzheimer’s or another form of dementia are likely elderly or have health issues that put them at higher risk. Many have both age and comorbidities against

them. “Being isolated can lead to decrease in cognitive ability,” Ashburn said. For those at a more advanced stage of the disease, it may be difficult to understand why their schedule has been disrupted, relatives aren’t coming to visit or they can’t go places they would like to go. “People living with Alzheimer’s live best with a routine and this is a complete routine disruption,” Ashburn said. “When disrupted, there’s more wandering, confusion and disorientation. Their cognitive abilities may lessen due to not having that socialization.” It’s also challenging for those with hearing impairment to understand caregivers who are wearing masks as their voices sound muffled and their lips and expressions are concealed. If the person with dementia would have normally gone to a day program, but have been at home with a caregiver trying to work from home full time, the caregiver is in a position of trying to juggle both responsibilities. Limiting interaction with people outside the household has also limited the possibilities for respite care, such as a caregiver helping out or taking the person to an adult day program. This can lead to caregiver burnout and less stimulation for the patients. “The caregiver is increasingly isolated and more stressed because they have to take care of their loved one all the time,” Ashburn said. “There’s no respite services. They may have less outside assistance which adds to the already high levels of caregiver strain.” For those who live in a nursing home or assisted living, their family cannot visit, they’re entirely dependent upon staff for socialization. Ashburn said some individuals may

feel confused about why no one visits anymore. “They have to find alternate ways to communicate,” she said. “Some of the offices for aging have been able to fund tablets for families.” Some families have visited by sitting outside their loved one’s room to have lunch and chat. Physician Anafidelia Tavares, who holds a Masterof Public Health degree, is the state-wide research liaison for the Alzheimer’s Association. She said that discussing neurological issues over the phone is difficult. In addition to its regular assistance, the organization’s 24-hour helpline (800-272-3900) has been offering families support in navigating telehealth, such as ideas on what to ask doctors over the phone and ways to discuss their own or their loved one’s mental health. “We’ve been working with health systems with how they might respond with their loved one’s COVID risk,” Tavares added.   The association is also helping people who have never used telehealth with tasks like logging onto Zoom or engaging in conference calls. “For the caregivers who are struggling in the pandemic, we are here for them,” Tavarez said. “Alzheimer’s disease doesn’t have to be a lonely journey. We have all these free, virtual services. Our helpline is available with well-trained staff and social workers to respond to whatever your needs are. We have emotional support groups and they share strategies that work for them.” She encourages caregivers to establish a new routine during the pandemic to help create a safe sense of normalcy for their loved one.  

Another COVID Hazard: False Information


e careful that the COVID-19 information you›re getting is accurate and not opinion masquerading as the real McCoy, says the American College of Emergency Physicians. Watch out for bold claims and instant cures touted on social media or by friends. Get health and medical information from experts like the ACEP and the U.S. Centers for Disease Control and Prevention, the physicians’ group says.

“A troubling number of purported experts are sharing false and dangerous information that runs counter to the public health and safety guidelines endorsed by ACEP and the nation’s leading medical and public health entities,” said physician William Jaquis, president of the college. “This kind of misinformation can not only be harmful to individuals, but it hinders our nation’s efforts to get the pandemic under control,” he

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added in a college news release. You should know that there is no cure or vaccine for COVID-19. Scientists keep learning more about the virus and how to treat it. COVID-19 can be spread by anyone even people who don’t think they›re infected. About 40% of those infected don’t have symptoms, but can spread the virus. The virus isn’t harmless, and its long-term effects are still being studied.

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Without a cure, the best defense is making smart choices and safe behaviors, the college says. “There are still many questions about COVID-19, but we know these three simple steps offer the best protection that we have until a vaccine is developed: cover your face, wash your hands frequently and practice social distancing,” Jaquis said.

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Special Needs: Early Intervention Challenging During Pandemic By Deborah Jeanne Sergeant


hen schools faced mandatory shutdowns last spring during the pandemic, education has shifted to virtual modes. For pre-kindergarten children needing early intervention for their special needs, meeting through Zoom or Facetime isn’t always effective. Many parents delayed seeking the intervention. Cindy Toleman, director and CEO of Clinical Associates of the Finger Lakes in Buffalo, serves families needing special education services for speech, language, occupational therapy, physical therapy and autism. Though she’s glad the state moved swiftly to approve teletherapy models, “it’s so difficult,” she said. “Not every family is prepared or has the ability to use that kind of service. It can’t be just phone calls but must include a video component.” Some families lack high speed internet access. Others must juggle all their newfound computing needs among several family members, such as parents working at home and trying to educate older children at home. Toleman said to compensate for this the virtual therapy, her therapists have offered more activities for parents to do at home with their children as well as interacting with children on the screen. “Our staff was great,” she said. “I’m a bit in awe with how quickly they adapted to this new service delivery model. Most of the struggle has been because most of the therapists are parents themselves and their children are at home trying to home school. Scheduling is always an art.” Since they’re also working around their own families’ needs,

the therapists haven’t been seeing as many children, but the smaller caseload also means less income for the therapists. “We all thought it would be a quick one or two-month thing,” Toleman said. “Now that the pandemic seems to be better under control, the state is opening to in-person visits. But a lot of children have not received the services to which they’re entitled.” She thinks that once therapists can evaluate a child’s status, they may find they need to begin “more intensive levels of therapy to make up for that lost time,” she said. But she’s not sure how long these effects will last. While engaging with children first hand is ideal, Toleman has seen more parental involvement because of both the unavailability of therapists to treat in person and also because parents’ schedules have otherwise cleared.


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Lori Prelewicz, children’s services supervisor at People, Inc. in Buffalo, said that at her organization some families have not participated in teletherapy because the parents are working at home and trying to educate their older children. They may not have sufficient access to devices to accomplish all these tasks or they may lack reliable internet access. “Some have been successful with teletherapy and some have not,” Prelewicz said. “Some have just had enough of it. The kids sometimes will engage. A lot of it is parent coaching. It has not been an ideal method for implementing services.” She added that some families don’t have the right supplies or equipment at home, although the therapists try to include objects most families would have available, such as couch cushions as aids in physical therapy. “One therapist said she has a difficult time and shows the child a toy and what she wants the child to do with it but the child can’t touch it,” Prelewicz said. “For some families it works very well. But even with those families it does work very well with, for how long it’s not as clear.” She thinks that the lack of early intervention will affect children longterm, since children develop many essential skills between birth and age three.

“I believe it will affect them for quite some time and it will take a while to catch up,” Prelewicz said. “Some of these kids, if they’re speech only, they need early intervention to catch them up but if they continue to not receive services they’ll need it possibly while they’re ready to go to school.” In addition to hampering the children’s short-term and possibly long-term development, delaying therapy costs more. It has been estimated that $7 to $12 is saved per $1 spent on early intervention done by age 3. Waiting costs the education system more money. In addition, early intervention sets up children who need it to be better learners. Like many others, the organization is beginning hybrid sessions— some in-person and some remote — but the regulations allow services to be delivered in a site with safeguards in places. Normally, they would meet with a family in the child’s home. Only a few exceptions to the rule are allowed. While the weather holds, therapists are meeting outdoors with families. “We’re hoping things will open up more,” Prelewicz said. “Our state has been opening up pretty well and our rates remain low so I’m hoping these children can receive the therapy they need as soon as possible.”

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IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper

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Group Home Residents at Higher Risk for COVID By Deborah Jeanne Sergeant


new study of 20,000 New Yorkers published in Disability and Health Journal indicates that people who have developmental disabilities and are living in group homes have more than double the rate of death than the general population. Among those whom the Centers for Disease Control and Prevention states are at higher risk include: • People who have limited mobility or who cannot avoid coming into close contact with others who may be infected, such as direct support providers and family members • People who have trouble understanding information or practicing preventive measures, such as hand washing and social distancing • People who may not be able to communicate symptoms of illness These are true of many individuals who live in group homes for persons with developmental disabilities. The congregant nature of living in a group home, along with the continual circulation of employees who bring in outside exposure, also contribute to higher risk. Not all residents can wear masks because of health issues. This population also tends to experience higher rates of co-morbidities that have been associated with worse COVID-19 cases, including hypertension, heart disease, respiratory disease, and diabetes. Jennifer O’Sullivan is the director of communications with New York State Office for People with Developmental Disabilities (OPWDD) in Albany. “OPWDD has taken the threat of COVID-19 to the people we support and the broader community very seriously and all staff are fully trained on infection control practices, PPE use and quarantine protocols,” O’Sullivan said. “The agency activated our emergency response team at the onset of this public health emergency to closely monitor all reports of possible contact within our system and created a 24-hour emergency services number for providers and staff to call with any issues. We continue to monitor the needs of our providers and staff to ensure the continued health and safety of the people we support as we return to a new normal.” Similar to nursing homes, group homes have many factors that increase risk, yet little attention has been given to group home residents’ risk compared with nursing home residents.

People identify with hospitals and nursing homes because they’ve been in them,” said Jeff Paterson, CEO of Empower in Niagara Falls. “They’ve been there and have visited people. Our houses have no signs and they blend into the community so they feel they belong to the community. Because of that, they’re not recognizable to other people in the community.” Empower operates 10 certified group homes throughout Niagara County supporting people who live in group homes. Though group homes receive little press, Paterson said he is proud of how employees have worked to keep everyone safe. “We were able to put a lot of safeguards into place,” Paterson said. “We’ve had no cases of COVID in our group home.” In congregant settings like group homes, residents don’t have the opportunity to practice social distancing. Some may not understand the importance of hand washing and may not be capable of washing their own hands or wearing a mask. During the quarantine period, limiting outside contact, visitors and the number of different staff members coming into the home are just a few ways that group home directors have tried to curtail the spread of COVID-19. Paterson said that at Empower, the staff prepared off-site quarantine locations in case someone exhibited COVID-19 symptoms. All of their efforts have paid off; however, it wasn’t easy. “We’ve been chronically underfunded by the state so we have a serious staffing shortage and our wages have lagged behind,” Paterson said. “It’s challenging to keep the workforce safe and wanting to report to work. If you had employees with any cold and flu-like symptoms, we want them to stay home.” The cost of PPE rose as supply dwindled and Paterson said that although Erie County helped, the state of New York did not. He added that the state is planning to cut funding by 2% to 5% by Oct. 1, a move planned before the pandemic. “So far, they’ve been refusing to relent on this,” Paterson said. “The state received additional Medicaid federal funding through the CARES Act but did not allocate any of that to developmental disabilities, despite that we operated on Medicaid funding. The state is leaving us high

Jeff Paterson, CEO of Empower in Niagara Falls (right) with Dan Cecere and Anthony Salvo. and dry.” He said that Gov. Cuomo indicated even further cuts of up to 20% could be on their way unless the federal government doesn’t provide significant aid to the states. The budget cuts will make it even harder for Empower to continue to provide the extra measures needed to keep group home residents safe. Marisa Geitner, president and CEO at Heritage Christian Services, which operates 63 group homes from Buffalo to Rochester, believes that the factor of co-morbidities is why group home residents face such a higher risk than the general population. “Early on, we limited the amount of staff in and out of the program,”

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Geitner said. “The first two and a half months, we relied on a lean staff to keep the transition in and out of the program to a minimum.” When the pandemic first started, Heritage also started a 24/7 hotline to answer questions posed by employees and residents’ family members. Heritage also developed an inventory-based system to stock and distribute essential items and signed up each group home with an Instacart account to limit exposure. Like other such organizations, to help reduce the risk, she said that Heritage follows social distancing, masking, sanitation, and hygiene protocols as well as employee screening.

In Good Health is published 12 times a year by Local News, Inc. © 2020 by Local News, Inc. All rights reserved. 3380 Sheridan Dr., # 251 • P.O. Box 550, Amherst NY 14226 Phone: 716-332-0640 • Fax: 716-332-0779 • Email: editor@bfohealth.com Editor & Publisher: Wagner Dotto • Associate Editor: Lou Sorendo • Writers: Deborah J. Sergeant, Jim Miller, Gwenn Voelckers, Anne Palumbo, Chris Motola, George W. Chapman, Michael J. Billoni, Daniel Meyer, Catherine Miller Advertising: Anne Westcott, Amy Gagliano • Layout & Design: Dylon Clew-Thomas Office Manager: Nancy Niet No material may be reproduced in whole or in part from this publication without the express written permission of the publisher. The information in this publication is intended to complement—not to take the place of—the recommendations of your health provider. Consult your physician before making major changes in your lifestyle or health care regimen.

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • September 2020

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An Executor’s Guide to Settling A Loved One’s Estate Dear Savvy Senior, My aunt recently asked me to be the executor of her will when she dies. I’m flattered that she asked, but I’m not sure what exactly the job entails. What can you tell me about this?

Inquiring Niece Dear Inquiring, Serving as the executor of your aunt’s estate may seem like an honor, but it can also be a lot of work. Here’s what you should know to help you prepare for this job. As the executor of your aunt’s will, you’re essentially responsible for winding up her affairs after she dies. While this may sound simple enough, you need to be aware that the job can be time consuming and difficult, depending on the complexity of her financial and family situation. Some of the duties required include:  • Filing court papers to start the probate process (this is generally required by law to determine the will’s validity). • Taking an inventory of everything in her estate.  • Using her estate’s funds to pay bills, including taxes, funeral costs, etc. • Handling details like terminating her credit cards and notifying banks and government agencies like Social Security and the post office of her death. • Preparing and filing her final income tax returns. • Distributing assets to the beneficiaries named in her will. Be aware that each state has specific laws and timetables on an executor’s responsibilities. Your state or local bar association may have an online law library that details the rules and requirements. The American Bar Association website also offers guidance on how to settle an estate. Go to AmericanBar.org and type in “guidelines for individual executors and trustees” in the search bar to find it.  

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If you agree to take on the responsibility as executor of your aunt’s estate, your first step is to make sure she has an updated will and find out where all her important documents and financial information is located. Being able to quickly put your hands on deeds, brokerage

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Find out if there are any conflicts between the beneficiaries of your aunt’s estate. If there are some potential problems, you can make your job as executor much easier if everyone knows in advance who’s getting what, and why. So, ask your aunt to tell her beneficiaries what they can expect. This includes the personal items too, because wills often leave it up to the executor to dole out heirlooms. If there’s no distribution plan for personal property, suggest she make one and put it in writing.

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APRIL 2020 • ISSUE 66

CORONAVIRUS Getting on with our lives in this new age Special Issue

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Autism: Why Are Incidence Rates So High RECORD NUMBER OF PEDESTRIAN DEATHS IN U.S.

Local experts discuss the dramatic increase in cases of autism in the U.S.

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Executor Fees

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As the executor, you’re entitled to a fee paid by the estate. In most states, executors are entitled to take a percentage of the estate’s value, which often ranges anywhere from 1% to 5% depending on the size of the estate. But if you’re a beneficiary, it may make sense for you to forgo the fee. That’s because fees are taxable, but Uncle Sam in most states doesn’t tax inheritances. For more information on the duties of an executor, get a copy of the book “The Executor’s Guide: Settling A Loved One’s Estate or Trust” at Nolo.com. Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior. org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book.

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Ask The Social

Security Office

From the Social Security District Office

See Your Lifetime Earnings with My Social Security Did you know you can see your work history online all the way back to your first job? Your earnings history is a record of your progress toward your Social Security benefits. We keep track of your earnings so we can pay you the benefits you’ve earned over your lifetime. This is why reviewing your Social Security earnings record is so important. If an employer didn’t properly report just one year of your earnings to us, your future benefit payments could be less than they should be. Over the course of a lifetime, that could cost you tens of thousands of dollars in retirement or other benefits to which you are entitled. It’s important to identify reporting problems as soon as possible. As time passes, you may no longer have easy access to past tax documents, and some employers may no longer exist or be able to provide past payroll information. While it’s your employer’s


Q: I’m trying to figure out how much I need to save for my retirement. Does the government offer any help with financial education? A: Yes. For starters, you may want to find out what you can expect from Social Security with a visit to Social Security’s retirement estimator at www.socialsecurity.gov/ estimator. The Financial Literacy and Education Commission has a website that can help you with the basics of financial education: www.mymoney. gov. Finally, you’ll want to check out the Consumer Financial Protection Bureau, which offers educational information on a number of financial matters, including mortgages, credit cards, retirement, and other big decisions. Visit the Consumer Financial Protection Bureau at www.consumerfinance.gov. Q: My grandmother receives Supplemental Security Income (SSI) benefits. She may have to enter a nursing home to get the long-term care she needs. How does this affect her SSI benefits? A: Moving to a nursing home could affect your grandmother’s SSI benefits, depending on the type of facility. In many cases, we have to reduce or stop SSI payments to nursing home residents, including when Medicaid covers the cost of the nursing home care. When your grandmother enters or leaves a nursing home, assisted living facility, hospital, skilled nursing facility, or any other kind of institution, you must notify Social Security right Page 18

responsibility to provide accurate earnings information to us, you should still review and inform us of any errors or omissions so you get credit for the contributions you’ve made through payroll taxes. You’re the only person who can look at your lifetime earnings record and verify that it’s complete and correct. The easiest way to verify your earnings record is to visit www.ssa. gov/myaccount and set up or sign in to your personal my Social Security account. You should review each year of listed earnings carefully and confirm them using your own records, such as W-2s and tax returns. Keep in mind that earnings from this year and last year may not be listed yet. You can find detailed instructions on how to correct your Social Security earnings record at www.ssa.gov/ pubs/EN-05-10081.pdf. Let your friends and family know they can access important information like this any time at www. ssa.gov and do much of their business with us online.

away. Learn more about SSI reporting responsibilities at www.socialsecurity.gov/ssi. Call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) to report a change. Q: Are Supplemental Security Income (SSI) payments paid only to disabled or blind people? A: No. In addition to people with disabilities or blindness, SSI payments can be made to people who are age 65 or older and have limited income and financial resources. For more information, read Supplemental Security Income (SSI) at www.socialsecurity.gov/pubs/11000. html. Q: I pay my monthly premium directly to my Medicare prescription drug plan provider. Why can’t I also pay my income-related monthly adjustment amount directly to my Medicare prescription drug plan provider? A: By law, we must deduct your income-related monthly adjustment amount from your Social Security payments. If the amount you owe is more than the amount of your payment, or you don’t get monthly payments, you will get a separate bill from another federal agency, such as the Centers for Medicare & Medicaid Services or the Railroad Retirement Board. Read Medicare Premiums: Rules for Higher-Income Beneficiaries for an idea of what you can expect to pay at www.socialsecurity. gov/pubs.

Health News Roswell Park’s researcher joins national COVID-19 Native Expert Panel Roswell Park Comprehensive Cancer Center’s Rodney Haring, Ph.D., director of the Center for Indigenous Cancer Research, has been named to the COVID-19 Prevention Network (CoVPN) Haring Native Expert Panel, formed by the National Institute of Allergy and Infectious Disease (NIAID). In July the NIAID, part of the National Institutes of Health (NIH), established the CoVPN — a unified new clinical trials network aimed at recruiting volunteers to sign up for large-scale Phase 3 trials of COVID-19 investigational vaccines and monoclonal antibodies. The CoVPN is a unit of Operation Warp Speed, the U.S. Department of Health and Human Services initiative to deliver 300 million doses of a COVID-19 vaccine by January 2021. Haring, an enrolled member of the Seneca Nation of Indians, Beaver Clan, is one of a dozen individuals from indigenous nations across the United States to sit on the new panel, which is led by Dave Wilson, a scientist from the Dine’ Nation who serves in the NIH’s Tribal Health Research Office. The Native Expert Panel aims to ensure that diversity and education are included in the review of clinical trials, examine how clinical trials are conducted from nation to nation and delve into research and ethics that surround pharmaceutical collaborations and tribal governments and provide guidance on what materials are best suited to accomplish meaningful partnerships. “Through our work at Roswell Park and the Center for Indigenous Cancer Research, we look at the way science is conducted in indigenous communities and nations,” said Haring, who is also a faculty member in Roswell Park’s office of community outreach and engagement. “I hope this panel will view the COVID-19 trials through a similar lens. All too often, indigenous populations are left out of trials, so inclusion is of utmost importance. We need to learn whether the science will work in diversified communities.” The CoVPN Native Expert Panel is hosted by Fred Hutchinson Cancer Research Center in Seattle, Washington.

ECMC awarded accreditation for medical rehab program The Commission on Accreditation of Rehabilitation Facilities (CARF) announced that Erie County

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • September 2020

Medical Center (ECMC) Corporation’s acute inpatient rehabilitation unit has been accredited for a period of three years through June 30, 2023. This is the third consecutive accreditation that the international accrediting body has awarded to ECMC. The first was awarded in 2014. “This achievement is an indication of ECMC’s dedication and commitment to improving the quality of the lives of the persons served,” read a letter issued by CARF. “Services, personnel and documentation clearly indicate an establishment pattern of conformance to standards. Your organization should take pride in achieving this high level of accreditation.” ECMC President and CEO Thomas J, Quatroche Jr., Ph.D., said, “To receive this third consecutive accreditation is further confirmation of the expertise and dedication of our entire rehabilitation team of physicians, nurses and therapists. Knowing the added challenges this year due to the pandemic, I am especially proud of our rehab clinicians for their resilience, reliability and continuing delivery of quality services to their patients. Their commitment to maintaining the high-quality level of ECMC’s rehabilitation services contributed significantly to this important reaccreditation, which benefits our patients, improves their overall quality of life and has a positive impact on our entire community.” An organization receiving a three-year CARF Accreditation has put itself through a rigorous peer review process, according to a news release issued by ECMC. “Due to the ongoing COVID-19 pandemic, ECMC’s acute inpatient rehabilitation unit demonstrated to a team of surveyors during a virtual online visit its commitment to offering programs and services that are measurable, accountable, and of the highest quality,” according to the release.

Cardiologist Al-Khafaji now practicing in Williamsville Cardiologist Nawfal Al-Khafaji has recently joined the Williamsville office of Trinity Medical WNY, located at 825 Wehrle Drive. Al-Khafaji — known as Dr. Al — received his bachelor of medicine and bachelor of surgery degrees from the University of Baghdad College of Medicine. He completed internal medicine residency at Chicago Medical School and then a fellowship in Cardiovascular Disease at Creighton University School of Medicine. Currently he is a member of the American College of Cardiology, American Society of Echocardiography and American Society of Nuclear Cardiology. Al-Khafaji has been with Trinity Medical Cardiology in 2018. Operating in conjunction with Catholic Health, Trinity Medical provides community-based specialty and primary care practices, serving the needs of families throughout Western New York.

H ealth News Grant to help increase access to dental care at ECMC Erie County Medical Center (ECMC) Corporation department of dentistry, oral oncology and maxillofacial prosthetics recently received the Ryan White HIV/ AIDS Program Part F Dental Reimbursement Frustino Program grant award of $58,977, according to notification ECMC received from Health Resources and Services Administration (HRSA). The Ryan White HIV/AIDS Program Part F is a dental reimbursement program designed to improve critical access to oral healthcare services for low income, uninsured, and underinsured patients with HIV/ AIDS and to train the next generation of dental providers to deliver specialized care to people with HIV/AIDS. Funding is provided by defraying a portion of unreimbursed dental care costs incurred by ECMC by treating low income, uninsured, and underinsured people with HIV/ AIDS because the hospital is an accredited dental education program recognized by the Commission on Dental Accreditation. Up to 56 grants were awarded by HRSA for this purpose to accredited programs nationwide. “We are grateful for this grant from HRSA,” said dentist Jennifer Frustino, director of oral cancer screening and diagnostics, division of oral oncology and maxillofacial prosthetics at ECMC. “These funds will enable ECMC to provide access to critically important oral healthcare services to those HIV/AIDS patients who may not have the resources otherwise. The clinical training component of this grant will increase the number of dentists qualified to administer the specialized care necessary for this vulnerable patient population.” The ECMC department of dentistry has a strong collaborative relationship with ECMC’s YOU Center for Wellness (formerly the Immunodeficiency Services Center). This relationship supports timely, comprehensive oral care for individuals with HIV/AIDS. Patients do not need to receive care at the YOU Center to be seen for oral healthcare at ECMC. ECMC dentists are highly specialized in treating individuals with HIV/AIDS. They provide comprehensive oral healthcare including preventive, restorative, prosthetic, and implant dentistry.

BlueCross BlueShield extends $0 telehealth To ensure members continue to

have access to affordable and convenient care, as well as to encourage physicians to continue to leverage telehealth when appropriate, BlueCross BlueShield of Western New York is extending telehealth coverage at no cost share or co-pay for fully insured commercial and Medicare Advantage members through Dec. 31, 2020. The recent announcement by the region’s largest health insurer to waive cost-sharing for all telehealth services through the end of the year is an extension from the initial set date of Sept. 9, 2020. Since March, the local health plan has seen five times more utilization of telehealth services, compared to all of 2019. The increase has been experienced across all age groups, with nearly 21% of telehealth use in 2020 coming from members 65-plus, up from just 6% in 2019. In addition, more than 33% of members used telehealth for the first time during the height of the pandemic. This includes visits provided by Doctor on Demand, a telehealth service offered to most BlueCross BlueShield members. “It is vital that Western New Yorkers seek out the care they need, particularly during this time,” said David W. Anderson, president and CEO, BlueCross BlueShield of Western New York. “As telehealth visits continue to surge, it’s clear that care delivered in this way is helping our community members maintain their health. Equally important, it has eased some of the administrative billing burden for providers by eliminating co-pays and cost-share. Aligned with our non-profit mission, we know it is the right thing to continue to cover the cost of telehealth services for our members through the end of this unprecedented year.” In addition to increased volume, telehealth provided quality care during the COVID-19 pandemic as well. Eighty-five percent of BlueCross BlueShield members agreed that their telehealth experience exceeded their expectations, according to a survey that the health plan conducted. The local health plan also identified the top three reasons for telehealth usage among its members as preventative care, sick visits and medication management.

Independent Health adding nutrition info in app designed to make it easier to stay healthy Independent Health recently announced it is deepening its partnership with Brook, the innovative Seattle-based health-technology company that helps individuals take better care of their health. Based on the expanding needs of its users, Brook is broadening its feature-set to give actionable tools to augment the personalized, on-demand health support provided 24-hours a day, from real health experts. “We’re excited to announce a new feature in the Brook Health Companion app that makes it easier

than ever for users to log their meals, instantly receive detailed nutrition information about their food, and get expert advice in a way that’s never been done before,” said Oren Nissim, Brook CEO. Unlike other food-logging apps, which can be very tedious to use, requiring users to do a lot of work manually entering food and interpreting the data on their own, Nissim said Brook makes it simple. “Brook’s new Food Journal with Meal Intelligence Technology allows users to add their food in their own words to instantly receive easy-to-understand nutrition information and the expert support to translate that information, providing feedback and steps for improvement. For example, just tell Brook that you had a turkey sandwich and salad for lunch. Brook’s technology takes it from there. Brook has made it that simple.” “Food is an important part of a healthy lifestyle. Research shows logging food regularly helps people make better food choices, lose more weight, and help keep it off long term,” said physician Michael W. Cropp, Independent Health’s president and CEO. In addition, Cropp said the Brook team — which includes registered dietitians, certified diabetes educators, and nutritionists — are available every day of the year to answer questions and “help implement the small changes that can add up to big results.” The app will remain to the Western New York community during the COVID-19 emergency.

Mental Health Advocates Names Melinda C. DuBois its New Executive Director


he Mental Health Advocates (MHA) of Western New York board of directors appointed Melinda C. DuBois as the agency’s new executive director, effective Sept. 1. She will replace Kenneth P. Houseknecht who is retiring after serving nine years in the position. DuBois comes to MHA from Planned Parenthood of Central and Western New York, where she served as vice president of health services since 2015. There, she provided leadership to 145 staff at nine health centers serving 18 counties from Niagara Falls to Syracuse. Dubois brings to MHA 25 years of experience managing multidisciplinary health and human service organizations, is a respected administrator with a reputation for building relationships and coalitions, and has served as a government advocate in Albany and Washington DC. She joins MHA at a time of tremendous growth and change,

September 2020 •

according to the organization. Under Houseknecht’s leadership, MHA saw agency revenues more than triple to $2.1 million. The agency is one of seven nonprofit organizations that make up the WNY Human Services Collaborative. The collaborative will soon move into the newly renovated shared space facility at 1021 Broadway next to the Broadway Market in Buffalo. “I am incredibly honored to be named the next executive director of the Mental Health Advocates of Western New York,” says DuBois, “and to join such a well-established and well-respected agency. Under Ken’s leadership, the MHA of WNY has developed into an innovative and collaborative bedrock of the community. The isolation and fear created by the COVID pandemic, the collective trauma of systemic racism, and the instability of an unknown future all contribute to a greater need to advocate and support the social and emotional well-being of our community. The work of the MHA is more important than ever. I look forward to our move to the new location at 1021 Broadway where we will be joined by other nonprofits in an innovative project sharing space and sharing support services. And I look forward to working with this incredible board, the dedicated staff and our passionate supporters to guide the future of the MHA.” According to Suzanne Furlani, MHA board chairwoman, this is an unprecedented time for all and, especially now, for the MHA. “The board is confident that Melinda brings the right mix of talent, skill, experience and compassion to navigate the challenges in the months and years before us. She will build on the strengths of this agency’s programs and staff, and forge new collaborative relationships as we move in with our partners at 1021 Broadway.” DuBois joined Planned Parenthood in 2014 as the regional director of patient services and was promoted less than a year later to vice president of health services. Prior to that, she was administrative director of student health and counseling at SUNY Geneseo, executive director of Buffalo Womenservices LLC, and a clinical coordinator of maternity services at Baker Victory Services. She is a current board member of Horizon Human Services, a member of Health Leadership Fellows Cohort 6, past president of the Crisis Services board of directors (2008-2010), a 200 Hour registered yoga instructor and comes with a history of additional community involvement serving as a board or advisory committee member of various health, civic, and cultural organizations. She is a graduate of SUNY Buffalo with a bachelor’s in psychology and a master’s in social work. She currently resides in East Aurora.

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ECMC’s state-of-the-art KeyBank Trauma and Emergency Department is now open.

Welcome to your new emergency department World-class care now has a world-class facility By listening to the needs of our patients and caregivers, the facility now matches the high-quality care we deliver to over 70,000 Western New Yorkers each year. We thank the entire community for their support and hundreds of donations to provide the very best technology and environment for our patients and their families.

Designed to treat more patients comfortably, the new Trauma and Emergency Department includes: • 57 spacious treatment rooms • Decreased wait times • 100% of RNs with specialized ER training • 100% attending doctors board-certified in ER medicine

©2020 ECMC

• New imaging and lab spaces

The difference between healthcare and true care ECMC.edu


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