Health Disparities Concern All of Us

There are more than 304 million people in the United States of America, and each of us is unique. A little more than half of us are women; about a third of us identify as a racial or ethnic minority. Around 12% of us are living with a disability, while 14.5% of us live below the federal poverty level. Most of us live in urban areas (77%), but nearly a quarter of us live in rural communities. Four percent of us identify as gay, lesbian, bisexual or transgender.

These are just a few of the factors that may be used to describe, categorize, or prejudge us. Importantly, they may also contribute to differences in our health status. These differences are known as disparities, and it is important that they are recognized and addressed.

Healthy People 2020, the federal government’s prevention agenda, defines a health disparity as “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage.” Disparities are often tied to social determinants of health – factors such as access to fresh food, safe places to exercise, education, income, employment and housing.

Sometimes disparities are biologically driven. For example, we know that in women, heart attack symptoms are different from symptoms in men.

Disparities may also be environmental. People who live in neighborhoods that lack grocery stores – sometimes called food deserts – may have poorer health status brought about by poor diets.

Disparities may be related to attitudes and biases. For example, for decades women were told that their symptoms were caused by their emotions, and so heart disease was largely unrecognized as a women’s health issue.

In many cases, however, disparities are the result of multiple factors that combine to create devastating outcomes. For example, African American women have similar rates of breast cancer as white women, yet they are 42% more likely to die of the disease.

How can we address health disparities?

Solving a problem with so many root causes requires collaboration by government, healthcare providers, and community-based agencies. Here are a few projects addressing disparities:

  • Medicare Advantage may begin covering air conditioners for people with asthma, healthy groceries, and rides to medical appointments under rules proposed for next year.
  • Some hospitals are hiring patient navigators to assist patients with accessing effective treatment and preventive services.
  • New York State has supported community-based programs such as “Complete Streets” that promote safe outdoor spaces for exercise.
  • The Long Island Health Collaborative’s website offers links to resources to promote health and wellness. LIHC’s own “Ready Feet” program promotes walking as a form of exercise in communities across Long Island.

What can you do?

Be your own healthcare advocate, so that your health does not suffer as a result of environmental disparities.

  • Ask questions of your doctors, and make sure you understand all diagnoses and treatment recommendations.
  • Follow up on necessary screening examinations and diagnostic tests.
  • Speak up – don’t hesitate to discuss your concerns or questions with your doctor.
  • Be proactive by adopting a healthy diet and an active lifestyle

Recognizing the existence of health disparities is the first stop toward overcoming them. Contact Care Answered for help in lifting your voice to access your best care.

For more information, contact us.


Call a Friend Today – Science Says Social Connections are Good for Your Health

“When ‘I’ is replaced with ‘we,’ even illness becomes wellness[1].”

Human beings have always recognized themselves as social creatures. From an evolutionary standpoint, survival depended on social structure and being part of a group.

But in recent decades, evidence regarding the link between social connections and physical health has been mounting. A 2015 meta-study linked loneliness with a 45% increased risk of dying. By contrast, obesity only accounts for a 20% increase[2]. Unfortunately, society has evolved in such a way that increasing numbers of people describe themselves as socially isolated. As we sacrifice our connections with friends and family, loneliness could become a major public health threat.

Research around this topic goes back decades. Among some of the most intriguing studies are those that have shown that social rejection triggers the same parts of the brain as physical pain[3]. A 1988 study reported that lack of social connections could have more of a negative impact on health than obesity, smoking and high blood pressure[4]. Another study, completed at UCLA in 2010, linked stress brought on by social rejection with increased inflammation in the body[5].

The problem of social isolation appears to be more significant among the elderly who are no longer in the workplace and may not live near family members. Those with dementia report even higher levels of loneliness than their peers[6].

How can you avoid or reverse social isolation and loneliness? By all indications, it is the quality rather than quantity of social connections that matters, so having just one or two friends or family members with whom you socialize can yield positive results. Face-to-face contact is preferable, but if you live apart from friends and family, try at the very least to maintain regular telephone contact.

If you are physically able to get around, consider joining a club or a gym, attend religious services, participate in your favorite hobby to meet like-minded people, volunteer, or join a support group. If you are unable to travel on your own, look for community-based and faith organizations, many of which offer resources such as friendly visitors who check up on the homebound.

The effort to remain connected to others can be challenging. But in the long run, these connections will improve your quality of life and may even help you live longer.

Here are some resources to help you get and stay involved: offers detailed accessibility descriptions of leisure locations. offers discounted rates to New York state parks.  Also take note that those 62+ can access at NYS parks for free and reduced rates just with their NYS ID.


[1] Quote attributed to Malcolm X.
[2] Brene Brown: America’s Crisis of Disconnection Runs Deeper than Politics; Fast Company, September 12, 2017.
[3] Social rejection shares somatosensory representations with physical pain; Proceedings of the National Academies of Sciences, March 28, 2011.
[4] Social relationships and health; Science Magazine, July 29, 1988.
[5] Neural sensitivity to social rejection is associated with inflammatory responses to social stress; Proceedings of the National Academies of Sciences, August 17, 2010.
[6] Only the Lonely: Dealing with Loneliness and Isolation in Dementia; Unforgettable,

You Are What You Eat

You Are What You Eat. Choose a Diet That’s Good for Your Health.

What does diet have to do with health? Quite a bit, according to the experts. Generally speaking, it is well documented that lifestyle factors including smoking, exercise and healthy eating contribute significantly to a person’s risk of developing the most serious and common health conditions, including diabetes, heart disease and cancer. Many studies have also linked diet with the delayed onset or prevention of chronic health conditions. March is Nutrition Month, and in recognition, we have summarized some of the recent research around diet and health for you.

Mediterranean Diet

The Mediterranean Diet emphasizes fish, nuts, fruit and vegetables. A 2013 study found that women who followed the Mediterranean Diet in their 50s had fewer memory problems and fewer chronic illnesses as they aged. 

The DASH Diet

DASH stands for Dietary Approaches to Stop Hypertension. It is an eating plan developed to lower high blood pressure and reduce levels of LDL, the so-called “bad” cholesterol. Recent research has also linked the DASH diet to reduced rates of some kinds of cancer, stroke, heart disease, heart failure, kidney stones, and diabetes. The diet is centered on eating fruits, vegetables, low fat or nonfat dairy, whole grains, lean meats, fish and poultry, nuts and beans.

Preventing Diabetes

Evidence shows that lifestyle changes focusing primarily on diet and exercise can help individuals with pre-diabetes avoid the progression to diabetes. Selecting whole grains over processed grains and lean proteins such as nuts, beans and fish over red meat and processed meats are known to help prevent diabetes. Other dietary habits that can help include avoiding refined carbohydrates – think breads, cakes, white rice, pasta and potatoes – as well as sugary drinks.

The Future: Precision Nutrition

The newest breakthroughs in nutrition research concern precision nutrition. Because individual responses to dietary changes may vary from person to person, precision nutrition is focused on creating specific dietary plans based on an individual’s physical and environmental factors such as DNA, microbiome, metabolism, health history and lifestyle. Current research is exploring the use of precision nutrition in diabetes prevention.

So What Should I Eat?

Every diet wosaladn’t work for every person. Individual food preferences, convenience, access to fresh fruits and vegetables, time to prepare healthy foods, and a multitude of other factors may affect the success of a particular diet plan. If you are looking to improve your health, lose weight or just eat better, experts tend to agree on a few basic dietary guidelines.

  • Reduce your consumption of red meat
  • Eat a wide variety of vegetables and fruit
  • Choose lean protein sources
  • Limit fats, sweets and processed carbohydrates

Generally what’s good for your heart is also good for your brain. A qualified nutritionist or your primary care physician can provide additional guidance on what will constitute a healthy diet for you.

Bon appetit!

The Future Has Arrived…and It is Safer for Seniors

Technology is invading every aspect of our lives. Did you know that there is now a coffee mug that can be temperature controlled using your smart phone? Not only that, but the average new car comes with a futuristic array of technology to help drivers stay in their lane, find their way, adjust the climate, control their speed, and more.

Seniors are among those who are most likely to benefit from advances in technology. Devices hitting the marketplace can provide peace of mind to family members of older adults who wish to maintain their independence for as long as they can.

Remote Monitoring

Do you have a pacemaker, or know someone who does? If so, you are already familiar with the role of technology in monitoring health. Pacemakers and implantable cardiac defibrillators (ICDs) can be remotely monitored. When they are triggered, ICDs record information that can be analyzed by the cardiologist to assist with diagnosis and prevention of future episodes.

Similar technology exists to monitor weight gain in patients with congestive heart failure, blood glucose in diabetics and other vital information for those with chronic conditions. The benefit is that early detection of symptoms can trigger an intervention before a condition becomes serious enough that the patient requires hospitalization.

Aging in Place

Remember the pendant that could be activated if a senior living alone fell down and could not get up? It turns out that was only the beginning. Today, concerned family members can monitor numerous aspects of an elderly loved one’s life, from the number of times they open the refrigerator, to their daily use of the restroom, to their medication compliance.

Here are just a few devices that are helping Americans age in place safely.

MedMinder – a digital pill dispenser that locks and unlocks compartments to prevent patients from taking too many pills. It also monitors whether the dose has been taken at the right time, provides auditory reminders, and contacts a family member if the patient has not complied.

Reminder Rosie – a talking clock that is programmed with a loved one’s voice offering gentle reminders to take medication, eat a meal, or complete any task.

Wellness by – a series of sensors set throughout the home use machine learning to notify a loved one if there is a change in routine including activity levels, bathroom use, sleeping and eating patterns.

Phillips’ Lifeline (and other emergency pendants) – can be triggered during a medical emergency. Some versions are equipped with GPS and may be used outside of the home to summon help during a fall or other medical event.

Nannycams/grannycams- a camera, hidden or exposed, in the home can help loved ones feel confident in the care their family members receive.  Whether your family is trying to determine if a loved one can continue to live alone or ensuring the selected paid caregiver is the right choice, this may be an option.

Whether or not you are a fan of technology, it is clear that the future is now. Embracing at least some of the available advances can be the key to independence, safety and better health for the elderly and the chronically ill.

Want to learn more about whether technology can help your loved one maintain their independence? Contact Care Answered for a consultation about your options.

Healthcare Financing 101: How Health Insurance Works

understanding bills, health insurance

Healthcare can be confusing. Before you even step foot in the doctors’ office, you’ll need to understand the terminology and concepts surrounding health insurance. Knowing the difference between premiums, co-pays, co-insurance and deductibles will allow you to be a savvy healthcare consumer, help you anticipate out-of-pocket expenses, and avoid costly surprises.


Your premium is the amount of money you pay for your health insurance coverage. Premiums are usually paid monthly. If you obtain health insurance through your employer, your premium may be deducted directly from your pay check. Often, your employer will contribute a portion of the premium payment, making health insurance more affordable for you.

If you are a Medicare recipient, you may pay a premium for your coverage. Generally, Medicare Part A, hospital coverage, is provided with no premium to those over 65 who also collect Social Security or who are eligible for Social Security but elect to wait to collect it. There is a premium for Medicare Part B, which covers doctor’s visits, outpatient therapy and durable medical equipment. This premium is paid monthly; for some people, the amount is deducted from their Social Security payment.

Out-of-Pocket Costs

Out-of-pocket costs refer to the amount you will pay for medical services out of your own pocket, in addition to your premiums. There are three main types:

  1. Annual deductible – this is the total amount that you are responsible to pay before your insurance coverage kicks in. Plans with higher premiums tend to have lower annual deductibles; those with lower premiums will have higher annual deductibles. Costs of hospitalization, procedures, laboratory testing and surgery may be applied to your deductible. Co-payments and premiums do not count toward your deductible.
  2. Co-insurance – this is the amount you are responsible for after your annual deductible has been met. Together, you and your insurance company will share the total cost of your medical care.
  3. Co-pay – this is the amount that you are required to pay to your provider for an office visit or prescription.

Once your out-of-pocket maximum has been reached, you will likely no longer be responsible for co-pays and co-insurance.

Your costs may vary depending on whether you select an in-network or out-of-network provider. For this reason, it is important to read and understand your health insurance policy so that you can make informed decisions about when and where to obtain care and anticipate how much your care will cost.

Still have questions?

Contact Care Answered. If you are trying to understand medical bills, or planning for future care needs, we can help you untangle the mess and make wise, well-informed decisions.

Health Literacy: Knowledge is Power When It Comes to Your Health

Do you know the difference between hypertension and high blood pressure? Between an MI and a heart attack? Between LDL and HDL?*

As health care becomes more complex, you may feel as if you need a medical degree to understand your own well-being. More to the point, effective communication with your health care provider is essential to ensure that you are an active partner in your care, understand your treatment options, participate fully in your recovery, and follow your doctor’s recommendations.

According to the US Department of Health & Human Services, health literacy is “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” Unfortunately, more than 35% of US adults are health illiterate.  This percentage is much higher for those over 65.

Before even seeing a doctor or other provider, a degree of literacy is required just to navigate the healthcare system, locate in-network providers and complete the required forms and paperwork. The ability to share health history and symptoms with providers is another element of the medical visit that can be impacted by health literacy.

Health literacy also involves math skills. For example, it is necessary to understand concepts such as risk, to calculate cholesterol and blood sugar levels, measure medications and understand nutrition labels. Complex math skills are also required to compare health plans, calculate co-pays and deductibles.

A basic understanding of biology and the way the human body works is another component of health literacy. This knowledge is required to comprehend the cause of illness, the relationship between lifestyle choices and health, and the need for certain tests and procedures.

Health literacy is not necessarily related to formal education. These skills and concepts are not taught in school. Many people struggle in at least one of these areas. Some experience anxiety when visiting the doctor which can affect their ability to process information.

You can overcome some of these challenges by preparing in advance for your doctor’s visit.

  • Make a list of your medications, including doses
  • Make a list of questions about your condition
  • Write down your medical history, including any hospitalizations and surgery
  • Write down your symptoms
  • Write down what your clinician says (i.e. suggestions, diagnosis, prescribed medications, tests ordered)
  • Bring a family member, friend or professional advocate

Here are more tips on preparing for a doctor’s visit from the National Institutes of Health.

Care Answered can help you navigate the healthcare system, understand your benefits, make sense of your diagnosis and treatment options, and select the most appropriate level of care. Contact us for more information.


*Hypertension is another name for high blood pressure. MI stands for myocardial infarction, the medical term for a heart attack. LDL is low-density lipoprotein, also known as “bad” cholesterol. HDL is high-density lipoprotein, also known as “good” cholesterol.

Cultural Competence in Healthcare: What It Is, and Why It’s Important

Mrs. M is an 80-year-old woman with congestive heart failure. She was born in Germany, but has lived in the US since she was a teenager. She is mentally sharp and understands English but still speaks with a slight German accent. Recently, she was rushed to the emergency room with difficulty breathing. “Do you have CHF?” asked a nurse. “No,” she replied. An IV was started, pumping her full of fluid. When her children arrived, they questioned why she was getting fluid, which is not typically the way she is treated due to her congestive heart failure. “She told us she doesn’t have CHF,” the nurse said. That’s because Mrs. M understands and would have answered correctly had she been asked if she has congestive heart failure, but she doesn’t know what “CHF” is.

Have you ever experienced a miscommunication with a healthcare provider? Or felt that the provider was not aware of how your individual health might be impacted by your gender, age or ethnicity? These gaps can result in misdiagnosis, inappropriate treatment, lack of treatment, or even death.

Cultural competence in healthcare is a way to bridge these gaps. It is a vitally important piece of the provider-patient relationship, particularly in an extremely diverse region like Long Island.

Cultural competence in healthcare can be defined as the ability of health care providers to recognize and address the unique values, beliefs, language, and behaviors of their patients. It is the recognition on the part of the provider that we patients are all different, and it’s important to understand how those differences affect our health

Here is a personal story to illustrate how a lack of cultural competence can impact one’s health.


I am an African American woman and I go to the dentist about every six months. For the past 10 years different dentists have seen shadowing in x-rays on the roots of some of my teeth.  After asking me if I had any trauma to that part of face and my response was no, most of them suggested I go to an endodontist for a root canal because that shadowing means the nerves of the teeth are affected. I have never had a root canal, but I know enough that I didn’t want to sign up for one unless I really needed it.  In these ten years I have never had pain in these “shadowed teeth” so I did nothing.

After about 10 years, I switched to an African American female dentist for my six-month cleaning and check-up.  She did x-rays and saw the same shadowing. After asking me the same question regarding trauma to my face and listening to my history she said, “Oh, it’s very common in African American women as the bone density of the teeth differs in spots and the x-ray picks it up as shadows.  We will continue to watch it but no, you don’t need a root canal.”

Now, if I had a different mindset I could have caused myself needless pain and a lot of money getting several root canals because other dentists weren’t familiar with this issue and perhaps saw me as another mouth rather than an African American woman with a mouth.

Those are just two stories, but there are many more.  So many older adults get the “you’re getting older” diagnosis. I say this in all my seminars: Getting older in not a diagnosis!  If it were, I would be finest diagnostician in the world (and I don’t even hold a medical degree).  Every one of us is getting older.

Please take time to share your stories.  We can all learn from each other.

Now that you know what cultural competence is, here are some tips:

Talk to your clinician and/or the office staff with whom you make the appointment and ask questions like:

  • I am a person who is (blank). Does s/he have many patients who are (blank)?
  • As a person who is (blank), could these symptoms indicate any other diagnosis based on this?
  • If I had the same symptoms but was not of this (gender, culture, race, ethnicity, religion, etc.) would there be other suggestions you might have?
  • Do you feel comfortable treating a person of my (blank)?
  • My culture/religion/faith/ does or does not allow (blank). Do you have another potential solution for this?

If you are not comfortable with the answers, seek another clinician.  If you are not comfortable asking the questions call on an advocate; your health is at stake.

For more information, visit A.S.K. for your life, a website that provides resources that address health care disparities, with a particular focus on African-Americans.

Care Answered, as your advocate, can assist in the selection of appropriate clinicians.  We help them see you as a whole person so that you receive your best care.


What Does Medicare Cover, Anyway?

Medicare is the health insurance program run by the federal government for those who are 65 and older, as well as those under 65 who are disabled and collect Social Security Disability Insurance (SSDI).

When people learn that they need post-hospital care – home care, inpatient rehabilitation or a stay in a nursing home – they often assume that Medicare covers these services. But much like private insurance, there are limitations on the services that Medicare will cover.

Before you need this level of care, here is an overview of exactly what Medicare will cover.

If you are 65 or over you likely have Medicare coverage A and B. Medicare coverage part A is “hospital insurance.” It covers care you receive in the hospital. Skilled nursing (nursing home) or rehab care is covered ONLY if:

  • Your care is “medically necessary.”
  • You are expected to improve over time
  • You meet the 3 DAY inpatient hospital stay. This means you must be FORMALLY ADMITTED to the hospital. If you are in the emergency room for three days but not admitted to the hospital, or you are admitted to an “observation unit,” you will not receive insurance coverage for your rehabilitation or skilled nursing care.

Even if you feel you have great insurance to fill in the gaps of Medicare A and B coverage, if you do not satisfy the three-day admission rule, there is likely no insurance that will cover your rehabilitation or skilled nursing care.

How Much is Covered?

If you meet the three-day admission requirement, the first 20 days you spend in a skilled nursing facility is fully covered. On days 21 – 100, you are responsible for a co-pay of $167.50 per day. After the 100th day, you are responsible for all costs related to your stay in a skilled nursing facility.

What Isn’t Covered?

Custodial care, which provides assistance with performing the basic tasks of daily living, such as dressing, bathing or eating, is typically not covered by Medicare at all. You are responsible for the full cost of this type of care, which on Long Island can run upwards of $100,000 a year.

Questions? A healthcare advocate can help you navigate the system in order to maximize your benefits and help you sort out your options for care and payment.

You can learn more about Medicare Part A hospital and skilled nursing facility coverage. Visit for additional information. Care Answered is available to answer your questions and help you make the best decisions based on your individual situation and needs. Contact us here or call (516) 584-2007.


Do you need a long-term care policy?

The statistics are staggering: up to 75% of those 65 and over may require a stay in a nursing home at some point in their lifetime[1]. Long Island is the most expensive region in the state to receive nursing home care; here it can cost an average of $390/day or $142,350[2] each year.

None of us is exempt; any illness or injury that robs us of the ability to care for ourselves can create the need for some type of long-term care at home, in an assisted living facility or a nursing home.

To help prepare for this possibility and protect their family’s assets, many people elect to purchase long-term care insurance or have a long term care rider on their life insurance policy. Long-term care insurance may cover some or all of the costs of care at home or in a facility.

“A long-term care insurance policy gives you a cushion to help prepare for the future financially without using the majority of your assets in a short period of time,” says Bonnie S. Laffie, CLU, ChFC, CLTC, a Long Island-based Investment Advisor Representative.

In addition to helping protect income and assets, some long-term care insurance premiums may be tax deductible. On the federal side, 10% of long-term care premiums are deductible up to certain limits that vary according to the taxpayer’s age. For example, those aged 40 and under may deduct up to $410; those 41 to 50 may deduct $770; between the ages of 51 and 60 the number jumps to $1530; and those between 61 and 70 may deduct $4090. Over the age of 70, the premium deduction is $5110[3].

Many people believe that there are government programs that will cover the cost of long-term care. Medicare will cover nursing home care for a limited time following a hospital stay of three days. Medicaid does provide coverage of some home care and nursing home care, however recipients are required to spend their own income and assets before they qualify for Medicaid. In this situation, the savings that you may have worked hard to accumulate will have to be spent down[4].

If you are considering purchasing long-term care insurance, speak with your financial advisor, lawyer, estate planner, and/or tax professional in order to fully understand your options. Care Answered can suggest some of afore mentioned professionals who have successfully assisted our clients.

Care Answered can help you navigate the healthcare system to select the most appropriate care setting should you need to obtain long-term care, either with or without a policy.  If you already have a long-term care policy and want to submit your claim, call us first to advocate for the full coverage you need. Contact us at any time.

[1] Genworth Financial, quoting 2015 Medicare & You Handbook, Centers for Medicare & Medicaid Services

[2] New York State Department of Financial Services: The Cost of Long Term Care in New York,

[3] Deductibility of Long Term Care Insurance and the 2017 Limits, Ronald Fatoullah & Associates,

[4] Genworth Financial

Hospice Care vs. Palliative Care: What’s the Difference?

Patients facing a serious or life-limiting illness may sometimes be offered hospice care, palliative care or both. The terms are often confused. A lack of understanding can make the conversation around these topics emotionally fraught. Hospice care and palliative care are different in a few key ways. Here is an overview of the two:

Hospice Care

  • Hospice care may be offered to patients whose prognosis is six months or less assuming their disease follows its expected course.
  • Hospice care is provided only to patients who are no longer pursuing curative care. This might occur when the patient is no longer receiving any benefit from active treatment, or the patient has decided that he or she no longer wishes to undergo treatment.
  • Hospice care is often provided at home or in a nursing home, but there are some residential hospices as well as hospital beds designated for hospice patients.
  • hospice patient, If you no longer want to receive hospice or your prognosis changes you can discontinue hospice care at any time.
  • Hospice care is generally covered by Medicare, Medicaid, and private insurance.


Palliative Care

  • Palliative care may be provided to patients at any stage of the disease process, regardless of the prognosis.
  • Palliative care is focused on alleviating the pain and addressing quality of life issues that occur with serious illness. It may be provided to patients who are on hospice, or those who are continuing to receive curative treatment.
  • Palliative care may be provided in the hospital, at home or in a long-term care facility, or in the doctor’s office.
  • Aspects of palliative care, including physician visits and prescription medications, may be covered by private insurance.



  • Both hospice and palliative care involve multidisciplinary teams of professionals, often including physicians, nurses, social workers, pain management specialists, and spiritual care personnel.
  • Both hospice and palliative care focus on the patient as well as the family unit.


If you or a loved one are facing a serious illness, hospice care or palliative care may be beneficial. Care Answered can help you understand and select the most appropriate care during a stressful time. For additional information, give us a call or contact us via email.