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I placed my elderly mom Rose in a skilled nursing facility three miles from my home for three and a half years. The short distance allowed me to visit her frequently. She had mild dementia at first, then it progressed to moderate. She was spared the devastating effects of Alzheimer’s itself but her memory and cognition became seriously impaired.The start of her decline occurred in her own apartment when she tripped while alone in her bedroom and broke her hip, necessitating surgery and the anesthesia that took her brain down a significant notch, a slippery slope that began with a three month rehab and then transfer to skilled care, permanently.While visiting the nursing home over the span of time, I became familiar with the residents in the wing. Sweet people, the married couple Fred, age nearly 100 and mentally with it, and his wife June, ten years younger, who developed Alzheimer's. Ironically, Fred took care of his young wife and then he was left alone in his twilight years.But what disturbed me most of all was the lack of visitors. Yes, there were a few, like the dental hygienist who brushed and flossed her mother Dorothy’s teeth daily even though mom had no idea what was going on but for whatever it was worth, she experienced a loving touch. And the gentleman who arrived daily after work at the DPW for dinner with his bedridden and blind wife, Teresa. She was taken by ambulance to dialysis three times weekly. You could say with certainty that her quality of life was poor — if not for the presence of her devoted husband.The few families who visited regularly got to know each other and we were all sure to stop in at their loved one’s room for a friendly hello. I knew that they were watching over my mom too, in my absence.I feel strongly that facilities with dementia patients need to develop some kind of educational program for the families — a power point, a video, a once a month discussion group, even just an introductory program upon admission, to provide information and techniques in helping their loved ones—after their handover of basic responsibility.They can stress the value and effect on the resident of ongoing communication, presence, touch, variety in their day, singing along, looking at photos or story books, bringing in youngsters in the family to meet them in the lobby area— and that such efforts are humane, helpful, and life-affirming.My experience is that bringing a relative into a nursing home is public relations heavy at the very beginning (they want to fill that bed), but quickly falls into pre-determined medical and safety routines to conform to state regulations and their bottom line.But I do not intend to judge the nurses and aides, only the for-profit system and the hired administration that is caught up in it. Caregiving professions and aides perform holy work. I have witnessed it with gratitude. Three of the aides applied to nursing school while working and raising families and made it through.The family of the resident, and friends too, can be tremendous allies, but it is a learning experience in a new environment and needs support. For families facing the downward spiral, it can seem hopeless, bureaucratic, overwhelming, easy to give up — and accept that there is no benefit to visits after a while, the condition will worsen anyway, so why do it.I went through the heartbreak of dementia for my mother and my husband. On a one-on-one- basis, I think I helped some poor souls in the locked wing. But I’d like to get the word spread around in the industry that there is more that can be done to involve and educate the family even as the disease progresses.Fred and June had each other. Dorothy had her daughter. Teresa had her husband. I will never forget to honor these beautiful people who endured such difficult journeys to the end.(Note that all names are fictional, except for my mom).

​​​Thanks Isha for A2A.The German Academic Exchange Service (DAAD) is the largest funding organisation in the world supporting the international exchange of students and scholars.Working Internships in Science and Engineering (WISE)The programme targets Indian students pursuing a degree in the fields of science and engineering who wish to do an internship at a German higher education institution or at a research institute.Who can apply?Students from selected Indian higher education institutions in the fields of engineering, mathematics and science who are in their fifth or sixth semester of a Bachelor’s programme or in their fifth, sixth, seventh or eighth semester of an integrated or dual degree programme. Students who have been awarded a WISE scholarship previously cannot apply again.What can be funded?A research internship at a public or state-recognized higher education institution or a non-university research institute in Germany to work with doctoral students, scientists or professors as part of on-going research projects.Duration of the funding?2 to 3 months in the period between May and July. Internships of less than two months duration cannot be supported.Value?A monthly scholarship of 650 Euros for undergraduate students (the monthly installment will be calculated on a daily basis, i.e. 21.70 Euros per day).A lump sum travel subsidy of 550 Euros.Payments towards health, accident and personal liability insurance covered by DAAD.Participation in a meeting of DAAD scholarship-holders in Germany.Step by step process:One should start mailing from September since later on many good colleges would have already taken interns and DAAD have their deadline around November.Start making your resume and cover letter. Get a template from your seniors or write your own cover letter.STEP 1: Getting an invitation from a German ProfessorMost important person in the entire process is the professor. Shortlist them on the basis of your interest, university etc... You can search for the best German universities online. Go through the profile of professor on his/her web page. Read about his/her papers, projects etc. Write him/her a mail and request him/her to offer you an internship. Attach a very precise resume.About the mail:Always address the professor by the last name with a proper title.For e.g. Dear Prof. Meyer, Respected Dr. Paul etcStart the mail by introducing yourself and your college. You can write about few major subjects you have studied/ lab techniques known. Mention about your research interest (you should get an idea about it after going through prof’s profile). You can also mention his/her current project that you are interested in. Clearly mention the dates of internship feasible to you (or at least duration). In the end, you can tell him that you will be applying for the DAAD scholarship.Best time to mail profs is Monday around 12-2 pm (Indian time), that’s 8-10 am in Germany. You can send mail to multiple profs. Try not to mail professors during weekend. Don’t write a generic mail. Don’t CC.You may not get a reply immediately, be patient, don’t freak out. I got a positive reply after sending mail to 30-35 profs, and the reply was after 10 days.Some profs may take telephonic interview or send a questionnaire/problem… be prepared for it.NOTE: Do not give any false information.STEP 2: Application DocumentsYou will be offered a DAAD scholarship on fulfilling following requirements.CGPA > 8.5 at the time of application.Acceptance/invitation letter from a German professor.NOTE: No proficiency in German language is required.Following documents are required at the time of application.Online application formCertificate of Enrollment with stamp of home institution.No Objection Certificate from home institution.Approval form by German host.Reference from Indian university teacher which provides information about the applicant’s qualifications.University degree certificates indicating final grade(s).More information about all these forms can be obtained from DAAD website.Your home institute may take a lot of time to prepare Certificate of Enrollment, No Objection Certificate and grade sheet. It’s better to apply for these a month prior to applying for the internship.Make sure you have your passport ready at the time of application. You will need your passport to apply for VISA.You will have to send a printed version of online application along with other documents to DAAD Delhi office.NOTE: Application deadline is 1st of November.I got an acceptance on 29th September. I wasn’t able to send my application by 1st of November, so I contacted DAAD Delhi office and told them my problem. They understood my situation and accepted my application which reached them on 5th of November.Results are generally declared by the beginning of February.STEP 3: After getting the scholarship1. Book your Flight Tickets: Tickets generally gets very expensive so buy then ASAP. Turkish Airlines are generally cheapest. But cheap is always not a good option. Cheap flight doesn’t have good facilities. Do check the luggage allowed before booking. If you can’t find a flight directly to your institute in Germany, you can consider travelling by train. German trains are fantastic.2. Arrange accommodation: Ask your professor to arrange an accommodation for you. If he agrees, nothing better else start looking online.1. http://www.stw-on.de/services/biete-und-suche2. http://www.wg-gesucht.de/en/Keep in mind the following points while booking online.1. Make sure you book a room close to university.2. Don’t pay anything in advance.3.Make sure you have a kitchen in your hostel/ apartment.3. Get Schengen Visa: It allows you to go to many European countries. Getting a VISA is an easy task for DAAD Scholar. Just take all necessary documents with you.4. Finances: DAAD will provide you the stipend once you reach Germany. You will have to open a bank account in there and send the information of your account to the address/fax-number given by DAAD. First instalment from DAAD will arrive in your account in about 7 days. So you must carry sufficient amount from India to stay there for 10-15 days on your own. Generally 200-300 euro will be enough but in case you need to pay security deposit or first month rent to your accommodation, 800-900 euro should be more than enough. To get the currency converted, you can contact any bank or private vendor.5. Socket Convertor: The Plug point in Germany is different from India. You can buy a universal travel adapter in INR 200-250.6. Food: If you eat fish and pork, you won’t have any problem. Pure vegetarians will have problem in finding food. Take some food along with you for first 1-2 days like Maggi, namkeen, laddu etc (Don’t keep any food stuff, spices etc in hand bag while boarding flight, everything will be removed when it is checked. Keep these things in baggage that will be kept in the luggage chamber). There will be a menza(mess) near your university. They generally have one veg dish. Few vegetarian things, one could get there are: breads, veg Pizza, garlic bread, yogurt, cake, fresh juice, packed food etc. You can browse several general stores to find some more new vegetarian food stuff. For cooking in Europe, flat heating plates are used instead of flames as in India. So, take vessels with flat bottoms for cooking. Other than spoons and plate, a frying pan was enough for me.7. Language: At your work place, language will be mostly English. Most of youth especially students know decent English but older people such as staff at hostels, general stores and other people generally know little or no English.8. Travelling places: This is the best opportunity to visit places in Europe. Europe is a beautiful place and I guess you won’t get better time in future toexplore places freely.Source www.daaddelhi.org/en/

This question asks that we answer with 2-dimensional thinking. This issue will never be solved by 2D thinking. What happens if we look at it with 3D thinking?What do we all want? We want good health. We want it all the time and available to us competently and affordably as intervention is needed, rich and poor alike. Ideally, we will be able to choose a physician relationship based on trust and know that that care provider will not be limited to fifteen minutes twice a year of well-care.When the first clinic opens up near me that I can join for a nominal monthly fee, say $100 a month or maybe even as low as $60… perhaps a family plan for $200 or so a month, I will join. How does that work? In return for that retainer, I would expect to be on a wellness regimen, seeing the doctor as necessary to put me on a track to good health, including nutrition and weight-loss counseling and programs, fitness and exercise too, and mental optimization.Some of these programs I might have to pay extra for, if I choose them, and there might not be a physician involved in those aspects, but certainly someone knowledgeable. If the clinic offered chiropractic and acupuncture as options, that would be a big plus for me because, despite my strong skepticism in both cases, they have proven to have unique value for certain issues. All programs would feed into a file that says whether I am on track and what the best way is to get me there.That is likely to involve nutrition advice or disease-avoidance based on my genetic profile. Should I be overweight or sedentary, perhaps I pay a higher fee for the risk I represent.But what if, God forbid, something terrible happens to me? Do I have to pay out of pocket? No, the clinic would insure all of its patients against calamitous health issues as part of what your fees go for.Does that not sound better, ideal even?I wrote a history of a medical school a decade back. The chief of the surgical department told me a story about taking a group of med students to an Hispanic free clinic where there was a woman with a six-week-old that was not prospering. He put his students to the task of figuring out what was wrong, which involved making a makeshift scale, sniffing soiled diapers, abdominal palpitation and so on.The students swiftly concluded there was no infection; the baby must be on the wrong formula. One of the clinic staff was sent out to her car to fetch the formula—sure enough, she’d been given formula for 12-months-and-up. A change of formula, and the follow-up with her showed the baby doing just fine. Then he added, “Do you know what that workup would have cost in-hospital? At least $2000.”Based on that story, I asked several physicians I interviewed to indulge me in a hypothetical. Physicians, who must always focus like a laser on the here-and-now, hate what-if scenarios. But I got three to go along. “Would it be possible to operate clinics that were not just free but that paid people to come for regular checkups on a break-even basis or even turning a profit?”All three eventually agreed it would be possible… theoretically, but very complicated. As one put it, “Do you realize how many laws you would have to change?”“Do you realize how many laws you would have to change?” traces back to the first government foray into the practice of medicine, the Flexner Report of 1910 and associated congressional hearings. Given that this was the Progressive Era, the thrust was to make certain that medicine remained a profession for Anglo-Saxon Protestant males. It shut down all medical schools not operating on the Prussian Koch school of medicine.* (Osteopathic medicine’s five schools survived the onslaught and became home to women, Jews and Catholics who wished to pursue medicine in the US. That included some blacks, though two all-black medical schools were allowed to survive, with two others shut down, on the thinking that would supply sufficient medical care to black communities.)The hearings also opened the door to the inherently costly “gatekeeper” model of medicine in which patient access to medicines and specialty services comes solely via their primary physician. They also put the American Medical Association firmly in charge, making it the nation’s first large-scale lobbying association (and the origin of most of those laws that need changing).I was out for a run one gorgeous day on the San Francisco Peninsula more than three decades ago when an athletically built red-headed gentleman fell in beside me. The discussion quickly turned to diet, and I laughed him off and told him I had never reduced my intake of butter, bacon, eggs and cream. Rather, I watched my intake of sweeter carbs and eliminated sugar from my diet.He told me I was an idiot asking for a heart attack. “There’s nothing wrong with sugar,” he blurted, “it’s just quick energy.” I thought this awfully presumptuous and asked him how heart attacks were unheard of among cultures that ate lots of animal fats or in Mediterranean diets and what about diabetes?The man started getting red in the face, his voice rising as he announced, “I happen to be a cardiologist. When I say you should watch your fat intake, you should listen.” His hands were now balled up in fists, so I simply veered left and went my own way without another word.For years, on the rare occasions I told that story, listeners would often chime in with him, “He’s right.” Now we all know he was wrong, dead wrong, as in people died because of his willingness to dispense pure ignorance.The Koch school of microbial medicine produced heroic advances, the wonder of the world. It has also produced antibiotic resistant “bugs.” It has caused a lot of other areas of medicine to be ignored to the point that, while a plague of resistant pathogens now stands as a distinct menace, our big problems are no longer medical.Thanks to my wife’s employment, I was privy more than two decades back to a Kaiser Permanente study of profitability by member cohort. It showed that all of medical care was profitable.Guys like me who saw a doctor once a decade were quite profitable (they still didn’t approve of us… our thinking might catch on)Those who came to scheduled check-ups and followed doctors orders were the A students, and profitableThose with cancer, diabetes, lung diseases, heart disease, who followed their regimens… profitableWho wasn’t profitable?Those with sedentary to abusive lifestyles—incipient chronics—who failed to follow doctors’ orders (or, as in the case of my cardiologist running buddy, followed doctors’ ill-informed advice)Wary members, usually immigrants new to the system, who hold off presenting until the condition has become acuteA surprisingly large cohort of hypochondriacs, people who see the doctor multiple unnecessary times each year on flimsy pretextsAll of the cost overruns owed to behavioral problems! Foremost among the staggering cost of American medicine is the fact our present system has no incentive (except for Health Maintenance Organizations like Kaiser) to curb bad behaviors. Most of the government programs being pushed are not for medical care; they are insisting that all of us subsidize bad behavior.A local ENT, or ear, nose and throat doctor, a decade back requested my help with an announcement of being the recipient of a prestigious grant to develop a process that would take a common inner-ear problem from being addressed by referral to a specialist, a $2000 procedure, and allow it to be handled by a nurse practitioner with a quick stop at a clinic for $80.The reason he wanted my help was to craft it in a way that played up the prestigious aspect without giving away any hint that he was about to take an appreciable amount of cash out of the practices of his peers.When I was interviewing lots of physicians, they all, one way and another, were thankful for being in a cutting-edge profession. But then would come a revelation like, “When Tagamet came out, I lost half my gastric surgeries. I had a very tough year.” “When colonoscopy came on the scene, I lost all of my exploratory bowel surgeries. I almost went out of business.” “When the Beta-Blockers came out…” and so on.Those were all boons for us patients, but doctors are not aligned with our best interests. Having to revamp their practices and learn new skills is a hardship.My next younger brother visited more than sixty physicians over a fifteen-year period from his late twenties to his mid forties seeking to find out the source of his ceaseless nerve pain. Several primary-care docs offered to refer him to a psychiatrist. Several more scolded him for seeking pain killers and ordered him out of their offices. Most simply said there was nothing they could do for him.Finally he chanced upon a physician trained in Nigeria who had come here for a medical-research PhD. After reciting his symptoms, the man said, “You are describing the classic symptoms of Lyme disease, but surely, as many physicians as you say you have seen, you’ve been tested for that.”“No, I’ve never even heard of it.”Lyme disease has been a top emphasis of continuing medical education year-after-year for decades, since before he contracted it. The earlier the diagnosis, the more successful the treatment. My brother didn’t get a diagnosis until it was well into secondary stage and his quality of life was quite compromised. More than five dozen American primary-care docs failed my late brother utterly and completely.The winds of change need desperately to blow through the medical profession.The American College of Lifestyle Medicine is the new kid in town. They represent just one of the zephyrs that need to blow. We’ve reached the point, foretold by the Kaiser study mentioned above, where lifestyle issues, correctable by a change in lifestyle, account for some eighty percent of medical costs.But with government involvement and a lobbyist organization devoted to damping the winds of change as much as possible, those helpful breezes cannot blow. When I view proposals like the Patient Protection and Affordable Care Act, with my entrepreneurial mindset I see one thing only—a last-ditch effort to lock in the practice of medicine in this country in its present sorry state, an effort to keep subsidizing lower-quality care at unaffordable prices.What is necessary is a system that aligns costs and interests. A system thatputs the cost for poor lifestyle choices on those responsible, forcing changereduces the tremendous overhead of insurance-driven paymentsincentivizes physicians to innovate in the best interest of patientsdemands care providers stay up-to-date on the broad scope of health issues, not just medical onesrequires physicians to tackle rather than boot problem caseshave physicians pay for the insurance so that better patient outcomes produce lower operating costsis flexible in dealing with medical innovation and staying up on accurate informationprovides low-cost ways of profitably initiating lifestyle improvementsIf you look at the system I outlined at the outset, you will see that it has the potential to achieve all of these desirable realignments significantly reducing costs all around, substantially broadening the provision of care and making sure that our care providers have a financial stake in providing truly cutting-edge care to us so that we stay healthy and their balance sheet does too.* Well before the Flexner report, Sam Hahneman, the founder of homeopathic medicine, took to referring to the form of medicine that survived the Flexner shakeout as “allopathic” medicine, meaning “other than the problem.” It was an indictment of the tendency of western medicine to engage (expensively) in symptom management rather than address underlying issues, keeping illness a “cash cow.” The name stuck.