Illinois Prepares For Medical Marijuana
Posted on Tuesday, December 10th, 2013 at 8:53 am by lifemediamatters
As Illinois prepares for the January 1 rollout of legalized medical marijuana for some chronically and terminally ill patients, the Illinois Department of Public Health has been educating medical professionals on the benefits and limitations of the new pilot law. Connie Mueller Moody, assistant deputy director with the department, spoke about how the compassionate use of marijuana could supplement palliative medicine during a conference presented by the Illinois Hospital Association this month.
In August, Illinois became the twentieth state to authorize a program for the cultivation and dispensing of cannabis for medical purposes– the Illinois Compassionate Use of Medical Cannabis Pilot Program Act signed by Gov. Pat Quinn. On New Year’s Day, the four-year pilot program will begin. However, it may take several months before patients can actually receive the drug through the state-licensed dispensaries.
Moody was careful to point out that the law does not allow for recreational use, and patients and caregivers will not be able to grow their own supply- unlike other states with similar laws. No one under age 18 will be allowed to apply for the “medical cannabis registration card.” A registration program for qualifying patients must soon be established by the Department of Public Health. The Department of Agriculture will oversee regulation and licensure of up to 22 cannabis cultivation centers across the state; the Department of Financial and Professional Regulation will oversee licensure of some 60 medical cannabis dispensaries.
According to Moody, the various agencies are still developing draft rules, and they must be submitted within 120 days of Jan. 1. ”We want to do this right, our agency is very interested in insuring that this really does benefit patients,” she said.
Registered qualifying patients will be limited to purchasing 2.5 ounces of medical cannabis every two weeks. There are only 40 debilitating medical conditions in which an individual may be allowed medical marijuana; those include cancer, HIV/AIDS, hepatitis C and Rheumatoid arthritis. Anxiety and depression are not listed as qualifying conditions.
Dr. Jeanne Lewandowski, director of palliative medicine at St. John Hospital and Medical Center in Michigan, spoke about her experiences treating patients utilizing medical marijuana during the conference. “The vast majority of people in the State of Michigan that utilize medical marijuana smoke it, like in a joint or in a bong,” she said. “There is a group of people that will nebulize it with very specific devices, and there is a much smaller group of people that use edible marijuana. I think it’s very interesting that Illinois is looking into edibles as the primary source for medical marijuana, because that is not the case in Michigan.” The Illinois Department of Public Health is set to develop regulations for medical edibles.
Morgan Fox, communications manager for Marijuana Policy Project, the largest organization advocating marijuana policy reform, said the Illinois law is a positive step forward for both patients and doctors. “Any law that is going to prevent patients from getting arrested for just trying to treat their illness is definitely a good law,” Fox said. “It would be great if we could get some of the qualifying conditions expanded once the program is up and running.”
Jesus Wept. Why?
Posted on Saturday, December 7th, 2013 at 8:53 am by lifemediamatters
The death and resurrection of Lazarus remains one of the most unexpected and confusing pieces of the Christian Bible, yet the story continues to be a source of inspiration to believers dealing with the death of a loved one– and it also supplements countless Christian funeral sermons. What about Chapter 11 of the Gospel of John keeps believers coming back to it, and how did such a personal account of Jesus even emerge?
Now Jesus had not yet come to the village, but was still at the place where Martha had met him. The Jews who were with her in the house, consoling her, saw Mary get up quickly and go out. They followed her because they thought that she was going to the tomb to weep there. When Mary came where Jesus was and saw him, she knelt at his feet and said to him, “Lord, if you had been here, my brother would not have died.” When Jesus saw her weeping, and the Jews who came with her also weeping, he was greatly disturbed in spirit and deeply moved. He said, “Where have you laid him?” They said to him, “Lord, come and see.” Jesus began to weep. So the Jews said, “See how he loved him!” But some of them said, “Could not he who opened the eyes of the blind man have kept this man from dying?”
Then Jesus, again greatly disturbed, came to the tomb. It was a cave, and a stone was lying against it. Jesus said, “Take away the stone.” Martha, the sister of the dead man, said to him, “Lord, already there is a stench because he has been dead four days.” Jesus said to her, “Did I not tell you that if you believed, you would see the glory of God?” So they took away the stone. And Jesus looked upward and said, “Father, I thank you for having heard me. I knew that you always hear me, but I have said this for the sake of the crowd standing here, so that they may believe that you sent me.” When he had said this, he cried with a loud voice, “Lazarus, come out!” The dead man came out, his hands and feet bound with strips of cloth, and his face wrapped in a cloth. Jesus said to them, “Unbind him, and let him go.” – The New Revised Standard Version, John: 11: 30-44
Christopher N. Mount, an associate professor of early Christianity at DePaul University, told Life Matters Media it is significant that the raising of Lazarus is depicted within John, probably the latest and most philosophical of the four New Testament gospels. “The Gospel of John is dated about 90 to 100 c.e. We don’t know who wrote it, but church tradition attributed the gospels to apostles to help increase their authority. But none of the gospels identify themselves as having been written by apostles, a number of them, including the Gospel of John were actually written anonymously,” he said. Mount added that John has layers of composition– showing the text took shape over a period of time with various contributors. The Fourth Gospel also contains stories not found in the synoptic gospels– Mark, Mathew and Luke.
I think the verse shows a God who is present, a God that experiences what we do– even if it is in a small little way.
The story of Lazarus is about life and death, Mount added. “The issue becomes how does John deal with life and death, particularly in comparison to the synoptic gospels. A major difference is that John explicitly identifies Jesus as a divine being who descended to earth and will return to where he came from after his death,” Mount said. For example, the gospel begins with John 1:1: “In the beginning was the Word, and the Word was with God, and the Word was God.” In the synoptic gospels, Jesus is instead depicted as a Jewish peasant who becomes a prophetic figure and eventually a divine figure upon his resurrection.
“That difference expresses itself in the development of Christianity in terms of what can be called gnosticism: the myth of a savior figure from the heavens, entering into this world to bring knowledge to individuals who are trapped in darkness,” Mount added. “John is part of religious ideas that developed into gnosticism. Most scholars would argue that gnosticism in the developed form we see in the second century didn’t exist when John was written.” When it comes to Lazarus, Mount said John plays around with life and death, and that believing in Jesus allows one to transcend both. Jesus weeping after his spirit is disturbed is probably not about the physical death, but is instead about the failure of those around him to understand the truth of existence and his message. Lazarus becomes a sort-of parable.
According to Mount, many modern Christians may interpret the story of Lazarus and Jesus as showing Jesus identifying with the suffering of humanity. “You have the family grieving over the loss of a brother, and so the story goes to the fundamental suffering that human beings experience at the loss of a loved one,” he said.
And Pastor Rob Zahn, M.Div., said John 11: 35– “Jesus wept” – usually translated as the shortest verse in the Christian Bible– also begs the question of whether or not Jesus had to cry. “Is there deeper meaning in it? Does God cry? Does the creator of all things…cry? I think that is the question brought forward with that short little verse,” the pastor of Spirit Alive Church in Pleasant Prairie, WI, told Life Matters Media.
“I think the verse shows a God who is present, a God that experiences what we do– even if it is in a small little way. It may even be the reason for grace, unconditional love. Maybe unconditional love and acceptance come directly from some sort of cosmic understanding of what it means to be human,” Zahn added.
More From Life Matters Media
Indiana Hunter’s Decision To Stop Life-Sustaining Treatments Spurs Discussion
Posted on Friday, December 6th, 2013 at 3:55 pm by lifemediamatters
Tim Bowers, the 32-year-old Indiana hunter who fell 16 feet from a tree and suffered a severe spinal injury that paralyzed him from the shoulders down, recently chose to forego the life-support sustaining him, and his decision has sparked national dialogue about the rights of patients and the importance of advance care planning.
A version of this piece was originally published by lifemattersmedia.org
Taxes– And The Costs Of Long Term Care
Posted on Friday, December 6th, 2013 at 9:18 am by lifemediamatters
An estimated 3.3 million Americans currently live in the nation’s nearly 16,000 nursing homes. That number translates to 1 in 7 people ages 65 and up, and more than 1 in 5 of them are 85 and older. Many pay their monthly fees with their own financial resources, and some have the assistance of long term care insurance. These fees can range from $2500 on the low end to more than $8000 a month for full time nursing home care. Additionally, nursing homes may require an initial entrance fee, which can range from $50,000 to several hundred thousand depending on the type of “home” one is buying into, and the level of care required at the start of residency.
Nursing homes require an enormous financial outlay. Many of us have questions about whether this can be considered a medical deduction on our 1040 tax return- and the answer is yes – but with clear guidelines. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) gave rise to the favorable tax provisions relating to long term care services as an incentive for individuals to take financial responsibility for their care needs. These incentives broadened the medical expense deduction on Schedule A to include unreimbursed expenses for long term care.
So what does this mean for me? It means that if you have long term care services that are necessary, diagnostic, preventive, therapeutic, curing, treating, mitigating, rehabilitative and are:
- required by a chronically ill individual, and
- provided pursuant to a plan of care by a licensed health care practitioner, usually a physician you are most likely eligible for the tax deduction.
The amount of this tax deduction depends on:
- What you pay as an entrance fee
- Your level of care. If you are not chronically ill, fees paid to retirement communities and assisted living facilities are deductible as medical expenses only to the extent they are attributable to medical care. This deduction also applies to entrance or initiation fees if a portion of the fee is attributable to providing medical services.
So how do I know what to deduct? A good question. Before you sign your initial contract with the assisted living or nursing home facility, you should be provided with information on the percentage of the initiation fee that is deductible as medical (for the first year only). You should also receive an estimate of what percentage of the monthly fee will be deductible this year. In January of the following year, the nursing home should also give you a “tax letter,” stating the percentage you can take for the year past as well as a copy of your annual billing statement to take to your income tax advisor.
For some assisted living residents, the entire monthly fee might be deductible. But for others, only the percentage allocated to medical care services would qualify for the deduction. Only out of pocket expenses (not those covered by long term care insurance) are deductible.
In addition to these costs, which can indeed be substantial, other deductible medical costs include: Medicare and supplemental insurance fees including long term care, drug costs and physician out of pocket expenses, hospital, dental and medical supply costs. Medical mileage can also be taken for the ill individual. All medical expenses can be deducted on your tax return on Schedule A if they are above 7 1/2% of your adjusted gross income. In many cases, this huge medical deduction allows you to itemize your deductions – and often wipes out much, if not all, of your income tax liability.
We recommend that you consult with your tax advisor with questions concerning your own personal circumstances prior to entering an assisted living or nursing facility and at tax time- to ensure you get all the deductions to which you may be entitled.
Diane Meier: Palliative Care Improves Quality Of Life, Reduces Medical Spending
Posted on Thursday, December 5th, 2013 at 5:21 pm by lifemediamatters
Half of older Americans visit emergency departments in their last month of life; 75 percent in last six months of life
Palliative medicine helps improve quality of life and reduces unnecessary spending on emergency care for the chronically ill, said Dr. Diane Meier, director of the Center to Advance Palliative Care and a professor of medical ethics at the Icahn School of Medicine at Mount Sinai. Meier was the keynote speaker for “Palliative Care: A Major Paradigm for Care Coordination,” a conference presented by the Illinois Hospital Association in Naperville Thursday.
Meier opened her lecture with the true story of an elderly couple struggling without palliative support:
Mr. B is an 88-year-old man suffering mild dementia and admitted to the hospital via the emergency department for management of back pain due to spinal stenosis and arthritis. His pain is an 8 on a scale of 10 upon admission– he receives 5 grams of acetaminophen (Tylenol) each day. He has been admitted three times in two months for pain, weight loss, falls and altered mental status due to constipation. His 83-year-old wife is overwhelmed.
“He hates being in the hospital, but what could I do? The pain was terrible and I couldn’t reach the doctor. I couldn’t even move him myself, so I called the ambulance. It was the only thing I could do,” Mrs. B told Meier.
Meier pointed out to an audience of palliative care nurses and other medical professionals that among Medicare enrollees in the top spending quintile, nearly half have chronic conditions and functional limitations, just like Mr. B. Most of the costliest 5 percent of Medicare enrollees (61 percent) suffer from similar conditions. Nationally, spending on dementia-related services totaled nearly $215 billion in 2010.
“The emergency department has become the modern death ritual in the U.S.,” Meier added, because half of older Americans visit the emergency department in their last month of life, and 75 percent do so in their last six months.
According to Meier, a palliative care strategy with geriatric support could have helped Mr. and Mrs. B manage symptoms more adequately, and it could even have helped them avoid some unnecessary hospitalizations. “What we need to do is get out of our taxonomy silos, specialty driven silos,” Meier said. “Because of the concentration of risk and spending, palliative care principles and practices are central to improving quality and reducing cost.” The costs of Mr. B’s four most recent hospital visits totaled several hundred thousand dollars. But the Bs did not do anything wrong, Meier said, because the medical system encouraged their situation. What else could they do?
Meier suggested more home and community-based services to help reduce the number of seniors who find themselves in situations like the the couple– lacking an able-bodied caregiver and without an easily accessible medical provider. “Staying home is concordant with people’s goals, she said. “Based on 25 state reports, costs of home and community-based long term care services are less than one-third the cost of nursing home care.” For example, in a study published in the journal Health Affairs, researchers determined that simply having meals delivered to a senior’s home significantly reduced the need for a nursing home.
As HealthDay News reported: “If all 48 contiguous states increased by 1 percent the number of elderly who got meals delivered to their homes, it would prevent 1,722 people on Medicaid from needing nursing home care.” Still, the U.S. lags behind every other industrialized nation when it comes to the ratio of social to health service expenditures.
Hope Brown, a nurse with the Carle Foundation Hospital in Urbana, IL, said she appreciated Meier’s attention to the costs of care and the need for social support. “It happens every day, situations like the Bs. We definitely need to get people into social services earlier, even meal delivery,” she added.
Overall, Meier urged medical professionals to “treat the person, not the disease.” Since most patients prefer to live at home and remain independent, (76 percent rank “independence” as most important, followed by pain and symptom relief, and staying alive last) palliative medicine should reflect those wishes.
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- Illinois Prepares For Medical Marijuana
- Jesus Wept. Why?
- Indiana Hunter’s Decision To Stop Life-Sustaining Treatments Spurs Discussion
- Taxes– And The Costs Of Long Term Care
- Diane Meier: Palliative Care Improves Quality Of Life, Reduces Medical Spending
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