A nice boatside Easter lunch

Here is our lovely boat, beside which we enjoyed a nice brunch…

Learning French this Spring!

Bonjour!

Je m’appelle Matthew, et Jat’s alle e knowe faux nowe! But I promise I’ll get better… I bet my HPM 761 grade on it! Check out the driver diagram and logic model for my personal improvement project. Rip-roarin for the PDSA cycle onslaught.

My 1am public health thought… pondering the future landscape of our state public health infrastructure post-budget cuts, and trying to integrate into my thought pattern the social ecological framework and community determinants of health, like socioeconomic status.

The Sound of Going Home

Hello All,

    A quick late night post to share a wonderful Dutch song that needs no translation. My spirit soars each time I hear it, thinking of Mary & I’s unborn children and the blessed life we’ve lived. Cheers to all that we make ourselves in these few revolutions on Earth. J

http://www.youtube.com/watch?v=ypXUsod3d5s

-Matthew

Neat Chart on The Accumulated Challenges of Long-Term Care

I was particularly proud of this chart I assembled from the following article,

Smith DB, Feng Z. The Accumulated Challenges of Long-Term Care, Health Affairs 29(1), January 2010, 29-34.

 

 

Time Period	Problem	Solution	Effect on the Problem	Consequences
1910-1930	Controlling Indigent Care Costs	Indoor Relief: Funnel the elderly into poorhouses	Because it relies of shame and few quality standards were in place, this action was the most cost efficient of the three option (others being cash payments, and auctioning off care)	Only cost efficient if the “woodwork” effect didn’t occur; shame prevented moral hazard of people flocking to receive aid. Quality was poor. This solution was not well protected if shame could be overcome, which happened in the Great Depression.
Great Depression floods the poorhouses. Too many to care for; too many indigent to punish in penal system.
1930-1950	Eliminating Poorhouses	Income Security: Title I of the Social Security Act of 1935	Shift from punitive poorhouse model to private boarding homes that received payments via Title 1.	The shift to boarding homes only considered housing and meals. Once medical needs of boarded clients are accounted for, costs escalate.
Universal health care bill fails. Public care models face routing to private models to contain cost.
1950-1970	Assuring Access to Affordable Medical Insurance	Medicare & Medicaid created in 1965	Provision of medical coverage for a limited number of people.	Philosophical change in handling care from the planned universal social coverage to a private coverage system that seeks to minimize moral hazard rather than seek quality. Nursing homes grow rapidly to cash in on new government Medicaid spending (poor implementation planning during creation due to speed of bill passage).
Nursing home growth overwhelms State’s capacity to provide oversight and quality control. Abuse & fraud runs rampant.
1970-1990	Controlling Provider Abuse	Strengthening State & Federal Enforcement: 1987 OBRA	The 1987 OBRA (Omnibus Budget Reconciliation Act) created minimum standards for nursing homes, which helped improve quality and reduce admissions to some sub-par institutions.	Resulting prospective payment method disincentivizes provision of care. When paired with decreasing nursing homes and a focus on avoiding cost, many elderly are forced to find other arrangements to receive the care they need. (at home, or limited options for private pay)
Nursing home flight leads to the next least-regulated Medicaid funding avenue, assisted living and waiver care. Potential risk of collapse due to baby-boomer pressure.
1990-2010	Providing Long-term Care the People Actually Want.	Market Reform	Private residence homes start for able-to-pay. Medicaid wavers for community care provide an alternative.	Medicaid coverage of non-institutionalized care increases from 10% to over 40%. Privately traded assisted living homes boom related to new 1915(c) waivers which allow community care funding.

Hello There!

I’m alive! Busy like a fiend.

The beginning is now… day 58:634

Not a whole lot of time to take pictures at the moment. I would say my anthem this week is Alicia Keys’s Empire State of Mind minus the whole “make it big” aspect of the song; just the ambition to make a new life and a dream of making the lives of others better.

Outside of being nervous and so happy that Mary and I are here together, life is a complete adventure and very exciting. Orientation tomorrow!

Today’s Note: Id’ like to remember…

- The fresh excitement of getting ready for courses and my RA position. Getting ready to excel!

- The quiet of the SPH and libraries on the Sunday before Orientation. How many days will be like this, an echo of myself… silent and reflective.

- The excitement of how my person will change over the next 2 years, or even 2 months…

- Sharing as much as I can with my family and my Love.

Tally-ho to the next 1 year, 8 months, 25 days!

A Master’s Degree in Pictures (Day 38:654)

My apologies for not posting for a while! I’m back on track now after wrangling some straggler assignments into submission, taming my ADD as I’m calculating how many boxes are needed for the move, and driving to the Nth meeting spot to wish my beloved friends and family farewell.

I’ve thought this a few times during this phase of the move: fragmented wedding. This phase is much like our wedding two years ago this August 1st (Love you honey!) During the wedding the world is whizzing by as you’re planning for details upon details, and the anticipation provides a unique mix of happy/acid-gut/tired as you watch each day slide faster down – the checklists, the calendar pages, the invitation list – until at some point you realize you are standing in a hall with your partner in hand, and all those familiar are surrounding you with smiles. Surreal in that it all actually came together, and magical that what you were really planning for is the realization that the other holding your hand is really all you needed. To see a smile and and “I do”.

That contrasted with the move is really interesting to me, in that there are the checklists, there’s the speeding of time to cover reality in a blink of what you thought would take weeks, and again people are smiling with tears in their eyes. Even the feeling is similar – happy/acid-gut/tired; and the tears goodbye & good-luck  the fertilizer on this next path which you both are preparing to walk. What is different is that in the end, you are in the hall together, alone; and the party is fragmented into a bunch of tiny emotional bursts. The work party… then boxes. A farewell dinner at the relatives from two towns over… then bubble wrap (to protect the cargo or the ties to this place, I wonder?) . And now, a mere five days from the move to North Carolina, I wonder what/whom else will step into that ballroom where my love and I will dance our next two years. Who will raise glasses with us as we toast time and pending research and future dreams. Will those ties last; will that bubble wrap do the trick…

And so my return here. May this entry – on the coattails of a most recent hiking trip to the Allegheny where I had some time to ponder much of this – be one of those ties that last. To my readers, my family, my love, and myself. So that whatever the future may be, I can remember and smile back at those who gather to make it possible.

Cheers to an expedited 1 year, 9 months, and 14 days to go.

Today’s Note: I’d like to remember…

- standing tall on the Allegheny lakeside against the multiple rainstorms – bare skin with boxers – glaring at them as wave after wave swept over the hills of Willow Bay. Yelling at them to bring more rain on (everything soaked at this point… and it listened. It came on twice as hard and I merely grabbed my trusty Glad trash-bag and laughed all the more… the nerve )

- Getting to spend some wonderful scenic moments with my father and brother.

- Risking it all, getting a fire going in that rainstorm with all the dry supplies we had left and making it last just long enough to to make a warm cup of coffee. Best cup-o-joe I ever had.

- Boxes….. and bubble wrap.

A Master’s Degree in Pictures (Day 23:669)

A wonderful day begun in the Metroparks running with my dad. Off to The Root Cafe for a pastry, and then preparing for my good-bye party at Lynne’s house. I’m so lucky to have had the opportunity to work with all of them, and I am so grateful for all the relationships that have been cultivated over the past three years. It is truly a blessing to start this next leg of the journey on such a supported note.

Only 1 year, 9 months, and 29 days!

Today’s Note: I’d like to remember…

- all the kind and supportive words said today, and all the energy and thought that went into such a wonderful conclusion to my three years.

- the laughter of children and the happiness/craziness they bring to life.

- that a well rested body and nurtured mind is needed to traverse this world sublime.

A Master’s Degree in Pictures (Day 22:670)

It feels good to be back at the post screen after a frustrating combination of distraction on video games and brown-outs. The weather is still simmering and the weekend my last as a LCGHD employee – a fact that turns up the heat in other, planning-for-moving kinds of ways. My how the time has flown; I remember so clearly sitting at the table in the nursing conference room, getting oriented to the health department. My first day in the building, wondering what was done in such a small building for such a large county (it is considerably smaller than Cuyahoga County’s health department). I remember my first program responsibility; my first crack at the DailyActivity in a desperate attempt to make it look halfway professional. My first screw-ups and other learning curves are going to be a thing I’ll miss in the academic environment… and one that I’m hoping my RA position will anchor my feet in. (real-world application of knowledge, that is.)

So, as a gift to myself I am going to extend my fast from coffee to PC videogames and an 11pm curfew as well. As hard as it’ll be at first, it is all very necessary to train my body for a different pattern I’ll be running in for grad school. For this August I’m planning to be heading to bed at 10pm, 6:30am up, out by 7:30, and at school by 7:45am.

My Love @ the Metroparks

Trial pic insert! Nice!

I’m off to bed now, dreaming away the rest of my 1 year, 10 months!

Today’s Note:  I’d like to remember…

- That the “meaning of a/my life” is a question that necessitates the past; in truth, such questions should ask what the “driver(s) of our life” is – namely, a reality that is accessible only in the current moment. Conclusion: Meaning in life is a moment’s perception out of the windows of our little boxcar called a body as it is driven. Otherwise stated, seek not to live a meaningful life; to do so will either lead a person to be too self confident in their beliefs or too depressed to believe anything outside of impulse for very long. Instead, live a driven life with actions that seek purposes that will become realized and/but fade, grow relationships that will blossom and wilt in time, and listen past the self to start hearing others.

A Master’s Degree in Pictures (Day 17:675)

Ah, the end of an exhaustive Fourth of July. We had a busy time at Mary’s mother’s house both Saturday – cleaning, dusting, organizing, and enjoying company until 2 am – and on Sunday – singing the national anthem at the parade and meeting many people afterward at the house…setting off a nice display of fireworks in the backyard as we munched on fruit, fish, chicken, cheesecake and fresh baked bread. On Saturday, we went on a creek walk as well – a creek that apparently had been formally paved with big blocks of stone over shale, creating a one-fifth mile glistening road of water – along with her brother Clarkie and his roommates Kyle and Ben. What an awesome time!

Today, we met my mom for a nice casual lunch and talked in air conditioning… ooh, blessed cold and nice conversation & company. I am blessed that this weekend has been full of such things. The heat, I feel, is the test for surviving North Carolina weather. Matthew 1, heat 0. Plenty of more scoring opportunities during the next 1 year, 10 months, 5 days!

Today’s Note: I’d like to remember…

- that a person can hear without listening, see without perceiving, and think without understanding, and act without actualization. To do all four well is to fully live a life worth living.

- how happy I am that this weekend was one of love: for family and country.

- that this is getting harder to do… getting to the familiar stage where all good things push through to their roots.

- “zealous crop” as an option for my picture editor. GIMP… you strike fear into my heart by its name alone: the destroyer of digital memories has come. (either that or it the name for some poor bird that has a very active metabolism)