Tag Archives: CDC

Dying for Opiates in Omaha

October 11, 2016 by and
Photography by Bill Sitzmann
Illustration by Kristen Hoffman

Getting high on injected heroin—or one of the several synthetic equivalents—does not feel like an orgasm or a dozen orgasms. That is a mythical description the average non-user appreciates, so it gets repeated. The truth is more sinister. Whether you spike a vein with melted oxy in a back alley or get your Dilaudid prescribed in-hospital, getting high on injected opiates feels like being 4 years old, falling asleep in your mother’s lap while watching your favorite movie. You feel safe, warm, satisfied, and content to do nothing. Your nervous system melts like butter with a warm tingling sensation. Emotional and physical pain dissipate. Trauma becomes meaningless. You nod off. Occasionally, you approach consciousness long enough to melt into it again. And on it goes over and over. The first time is always the best, and no matter how long you chase that first high, you will never see it again.

According to Nebraska’s Vital Statistics Department, at least 54 people died from overdosing on opiates in the state during 2015.

Anything above and beyond pain relief is experienced as a rush of dopamine to the pleasure center of the brain. Addicts will escalate the amount of opioids they consume until coming across a bad batch mixed with other drugs—such as large-animal tranquilizers—or they stumble onto an unusually pure source, take too much, and overdose. Some users accidentally consume a fatal cocktail of prescriptions with alcohol or other drugs. In recent years, overdoses involving opiates have claimed the lives of several celebrities: the musician Prince, actors Philip Seymour Hoffman, Heath Ledger, Cory Monteith, and the list goes on.

In the state of Nebraska, deaths from opiate overdoses are on the rise. According to Nebraska’s Vital Statistics Department, at least 54 people died from overdosing on opiates in the state during 2015. Nationwide, the U.S. Department of Health and Human Services reported that six out of every 10 drug overdoses involve opiates of some kind. From 1999 to 2014, roughly 165,000 Americans died from opiate-related overdoses, quadrupling the numbers from previous years, according to the Center for Disease Control. The death toll is climbing. The most recent CDC estimates suggest 78 Americans overdose on opiates every day.

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The Local Frontline

Russell Janssen is a case manager at the Open Door Mission, located between Carter Lake and the Missouri River. At age 20, he was introduced to heroin and was an intravenous user until the age of 39. Off heroin now for nearly two decades, Janssen spends his days treating people with the very addiction problems he has faced and continues to battle.

“I’ve been clean for 19 and a half years and I’ll still have ‘using’ dreams,” Janssen says. “They don’t affect me the way they used to. When I first cleaned up, I would wake up in cold sweats. I’d try to go back to sleep and just couldn’t. I still wake up to this day, but now I can lay down and go back to sleep. The thought is always there, though, and never leaves us.”

Heroin addiction is powerful, Janssen says, too powerful for anyone to be completely beyond it, especially if they think they are “too smart to get hooked.” And while most drugs will provide some high with diminishing returns, heroin burns out the brain’s pleasure center and forces users to do more and more in order to “stay even” and barely functional. Serious daily side effects include nausea, abdominal pain, high agitation, muscle cramps and spasms, as well as depression and cravings leading to relapse.

“The problem with heroin is you have to have it just to maintain,” Janssen says. “It’s not just about getting high. I’d go through $150 a day just to maintain for the 12 to 14 hours that I was up. If I wanted to get high I had to go above that amount because you gotta have it.”

And “it,” per Janssen, is never the same twice. Prescription opioids are a known quality, but black market drugs are unregulated and full of pitfalls. Drugs are cut with useless fillers and other substances to increase profits for dealers: “People die because they’re doing so many weird things with it. People died in Cincinnati, Ohio, because they were mixing elephant tranquilizer in with the heroin. And even though heroin addicts know that it’s out there—and they know it’s killing people—they go looking, thinking ‘I’ve got to have it just to maintain,’ so they’re willing to take that chance.”

Janssen says the access to opioids through prescriptions has changed the face of heroin addiction, making it easier and less stigmatic to start, the biggest mistake anyone can make.

“In the `70s, heroin addicts were the lowest of the low. Even other drug users didn’t want anything to do with heroin users. That’s changed a lot today because people get prescribed opiates, and they think that if a doctor prescribes it that it can’t be harmful for them. But that’s a way that people get addicted. We’re gonna see a lot more people out (in West Omaha) getting addicted.”

Chris Eynon is an eight-year recovering meth addict, a graduate of the Miracles Treatment Program at the Siena/Francis House, and, for the last two years, its treatment coordinator. He is seeing an increase in the number of people seeking help for heroin and opioid addiction.

“We are certainly seeing an increase in the amount of applicants wanting recovery here (in Omaha),” says Eynon, who has also witnessed the dire circumstances facing East Coast communities. He spent several weeks during March in Cumberland, Maryland, a town of roughly 20,000 where he was helping a friend to start a prayer service for heroin addicts. “Out on the East Coast, (heroin addiction) is really significant there. Just in the small community of Cumberland, they have been devastated. Last year in their county they experienced 14 deaths due to overdose, and as of this year already they have experienced over 30. Most of them are high school kids, and most of them are heroin overdoses.”

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From Vietnam Vets to Millennials

The current heroin/opioid epidemic is reminiscent of the Vietnam War era when access to plentiful and pure China White heroin combined with the stress of combat, and roughly 15 percent of all enlisted men had fallen into addiction. In 1971, Operation Golden Flow (the unofficial name of widespread military drug testing campaign) was designed by the Department of Defense to “clean up” American GIs before sending them home. While many came home and never used again because the circumstances of their drug use changed drastically, others relapsed at home as black market heroin followed the demand back from Vietnam to the U.S.

A New York Times article from May 1986 reported the number of U.S. addicts at roughly 500,000 (with 200,000 in New York alone). That heroin epidemic began subsiding as popularity for crack cocaine took over the streets. Studies from the Golden Flow era laid the groundwork for much of what we know about opioid addiction in 2016.

With the widespread prevalence of opiate prescriptions, a 2011 study by the Department of Veterans Affairs found that today’s veterans are at an even greater risk than their earlier counterparts for heroin addiction, as the VA was treating chronic pain with prescriptions for opioids “almost exclusively.” The 2011 study reported that veterans are twice as likely to suffer accidentally fatal opioid overdoses than non-veteran civilians. Since the 2012 height of the VA’s opioid prescriptions to veterans, the federal department has made an effort to decrease opiate prescriptions in favor of more comprehensive approaches to pain management.

Over the past 10 years, the CDC has observed that heroin use among 18-25 year olds has more than doubled in the general population. According to the CDC, 90 percent of people who try heroin have tried at least one other drug first, and, an astonishing 45 percent of heroin users were addicted to prescription opioid painkillers such as Vicodin, oxycodone, oxycontin, fentanyl, Dilaudid, and morphine before switching to heroin. In 2014, prescription opioids killed more than 28,000 of the 2,000,000 Americans dependent on them. From 1999 to 2013, the amount of prescription opioids dispensed in the U.S. nearly quadrupled.

With the widespread prevalence of opiate prescriptions, a 2011 study by the Department of Veterans Affairs found that today’s veterans are at an even greater risk than their earlier counterparts for heroin addiction, as the VA was treating chronic pain with prescriptions for opioids “almost exclusively.”

A May 2014 report from the National Institute on Drug Abuse explains: “It is estimated that between 26.4 million and 36 million people abuse opioids worldwide with an estimated 2.1 million people in the United States suffering from substance use disorders related to prescription opioid pain relievers in 2012 and an estimated 467,000 addicted to heroin. The consequences of this abuse have been devastating and are on the rise.”

Across Socioeconomic Divisions

While the Midwest currently sees fewer opiate overdoses than the coasts, that danger is growing across all socioeconomic segments of the population.

Janssen, Eynon, and several recovering addicts who spoke with Omaha Magazine on the condition of anonymity agreed that teens, the affluent, insured and educated are at risk—because when experimenting with opioid pills, youths often hold the false assumption that nothing bad can happen with drugs prescribed by a doctor, even if those pills were obtained without permission.

“They might steal them from a medicine cabinet or have their own prescription at some point,” Eynon says, echoing similar points made by the other counselors that middle-class white people with many relatives, each with several doctors, might find themselves practically surrounded by easily obtained and occasionally leftover prescriptions. “In my opinion, we will see a lot of West Omaha-type addicts. Prescription medication is usually attained through insurance coverage. In order to have insurance, you would need a job, which falls more into the ‘rich kid’ category.”

Sara B. comes from the less affluent segment of recovering addicts. A fast-talking 32-year-old with attention deficit disorder, also a mother of seven, she signed over the rights to her children to her counselor for their protection while she sought help. She is working hard in order to maintain a relationship with her children.

“I started because people around me, family members were doing it,” says Sara, who has been clean now for the better part of a decade. She still has to guard against relapse, maintaining sobriety for her children as well as her health. She is wary of family who are still actively using. “Which is hard because you have to stay away from users when you get clean if you want to stay clean,” she says. “It’s too easy to fall back.”

Justin Schwope is a 26-year-old recovering addict with four years of sobriety under Russell Janssen’s wing at Open Door. His habit of choice was a speedball, heroin and meth, though other stimulants can be substituted.

“I’d been messing with drugs since I was 16 and my grandparents died,” Schwope says. “I wasn’t able to get clean until I tried kill myself with Lipitor and woke up in Creighton three days later and then transferred to Lasting Hope.”

All sources interviewed by Omaha Magazine agreed that the transition from pure opiates to street junk is the greatest threat to the health and welfare of addicts. When the easy access to opiates runs out, addicts look elsewhere risking everything just to stay even, and even to get that high.

“In Maryland apparently, there was a mass supply of prescription drugs or ‘pill farms’ that were seized and, as a result, (users) turned to heroin, which is cheaper and easily available,” Eynon says. “They have an addiction to feed and, unfortunately, the heroin is not like prescription drugs which are regulated…and the pills are always consistent in strength and dose amounts. When they switch to heroin, they have no idea of the potency or what it might be laced with.”

Increased Regulatory Oversight

Tragic stories of opiate overdoses and abuse have become too commonplace.

After Omaha resident Carrie Howard suffered a severe car accident, she began taking prescription painkillers. The pills led to an addiction that culminated in a fatal overdose in 2009. The legacy of her untimely death made waves through Nebraska’s legislature. Carrie’s mother is former senator Gwen Howard; her sister is Sen. Sara Howard of Omaha.

The elder Howard championed legislation that created a prescription painkiller monitoring program in 2011. But the program fell short in many respects. Sara Howard continued the family’s fight for improved regulatory oversight of prescribed opiates when she introduced LB 471 to the state’s unicameral.

Upon receiving first-round approval in January 2016, several senators recounted their own families’ close encounters with opiate addiction. Sen. Brett Lindstrom of Omaha revealed that one of his own relatives had suffered from a prescription painkiller addiction, an addiction sustained by shopping around different doctors and pharmacies. When the prescriptions dried up, Lindstrom’s relative turned to heroin.

The unicameral finally approved LB 471 in February 2016. It comes into effect in the new year. LB 471 will require pharmacies to report when prescriptions are filled, and would allow pharmacists to check records of past prescriptions to avoid abuse. There are two phases to this. Beginning January 1, 2017, all prescriptions of controlled substances will be reported to the prescription drug monitoring program. Beginning January 2018, all prescriptions will be reported.

A few weeks prior to Nebraska approving LB 471, President Barack Obama had announced that $1.1 billion would be made available for expanded opiate-related treatment opportunities across the country. According to a statement from the White House, “More Americans now die every year from drug overdoses than they do in motor vehicle crashes.”

Already in the previous year, Nebraska received two significant grants to combat statewide opioid-related abuse: one for more than $3 million over four years from the CDC for prescription drug overdose prevention, the other for $500,000 over two years from the Department of Justice.

The funding comes at a pivotal moment. America is experiencing a perfect storm for an opioid epidemic. War, health care in crisis, addiction, easy access, and low employment are among the many factors forcing opioids into the drug user’s spotlight. Once, only the lowest drug users shot junk. Today, if not tomorrow, someone you love might be the next junkie you meet.

To get help for substance abuse problems, call: 1-800-662-HELP.

Additional reporting contributed by Doug Meigs.

For more information about the epidemic, as told by a recovering addict from suburban West Omaha, read: http://omahamagazine.com/2016/10/my-battle-with-opiates/ 

Russell Janssen, case manager at Open Door Mission.

Russell Janssen, case manager at Open Door Mission.

ADHD

September 24, 2013 by

One of the most common neurobehavioral disorders found among children is Attention-Deficit/Hyperactivity Disorder (ADHD), according to the Centers for Disease Control and Prevention (CDC). And rates are on the rise.

Dr. Ashley Harlow, psychologist at Children’s Hospital & Medical Center, believes that this spike in diagnoses is due to a combination of factors. “Parents, teachers, and [health care] providers are more aware of the signs and symptoms and, therefore, are investigating this diagnosis as a possibility,” he says.

Because ADHD is so prevalent, there is concern that children are being misdiagnosed.

Misdiagnosis can go many ways, explains Dr. Harlow. “I think misdiagnosis is a problem, although I think it is important to consider misdiagnosis as both diagnosing another condition as ADHD and diagnosing ADHD as another condition.

“I see kids who have been diagnosed with ADHD because they do not like their teacher, they do not listen to their parents, or they do not follow through on what their parents tell them to do,” says Dr. Harlow. “These behaviors do not necessarily indicate ADHD.”

Also complicating the issue are instances where children have ADHD and are instead diagnosed with another disorder, like Autism Spectrum Disorder, or when high-school and college students use ADHD medication to support studying. “In these cases of students seeking study aids, misdiagnosis might occur because of misrepresentation of the symptoms by the patient,” adds Dr. Harlow.

Dr. Harlow says that visible signs of ADHD can include behaviors like “difficulty sitting still in the classroom, disorganization in completing homework or turning it in, making careless mistakes, staring off into space, interacting with peers in immature ways, or starting chores but not finishing them.”

Many children may demonstrate these behaviors, so Dr. Harlow advises careful consideration before jumping to conclusions. “[Health care] providers, in consultation with families, work to determine if enough symptoms are present and impairment is at a level to warrant a clinical diagnosis.”

The CDC states that “children with ADHD do not grow out of these behaviors. The symptoms continue and can cause difficulty at school, at home, or with friends.” Therefore, it is important to treat children who are afflicted with ADHD.

Treatment of ADHD focuses on reducing the impact of the symptoms, not eliminating them. “It is important to remember that ADHD is a neurologically based disorder, and so improving behavior likely means learning to manage symptoms rather than removing the symptoms entirely,” explains Dr. Harlow.

He recommends a combination of medical and behavioral health interventions, including setting up the environment (classroom or home) to be predictable and organized for the child and to make consequences immediate and consistent.

Children’s Hospital & Medical Center offers free parent education sessions related to topics surrounding ADHD. For more information, visit ChildrensOmaha.org/BehavioralHealth.

Button Batteries

July 22, 2013 by

Button batteries can be found in a variety of electronic devices. Things like wristwatches, calculators, toys, and even recorded birthday cards all use button batteries. Unfortunately, their small size means that they can be easily swallowed by children.

The Centers for Disease Control & Prevention (CDC) have singled out button batteries as the most harmful type of battery for young children if swallowed. They can get stuck in the esophagus, leading to serious injury, and are the leading cause of death by ingestion. Poison control centers across the United States report that about 3,500 button batteries are swallowed each year.

The symptoms of battery ingestion include vomiting, abdominal pain, fever, diarrhea, difficulty breathing, and swallowing.

Many times, swallowed batteries pass through the intestines and safely exit the body. This is not always the case, however, as they can easily get lodged in the esophagus. Batteries stuck in the throat cause an electric current and can leak corrosive chemicals, like alkaline electrolyte, that can cause internal damage.

When this happens, a buildup of the chemical hydroxide may occur, causing dangerous burns within a couple of hours. Unfortunately, the damage caused can remain long after the battery is removed.

If your child ingests a battery, Boys Town Pediatrics recommends:

  • Calling the 24-hour National Battery Ingestion Hotline at 1-202-625-3333 or contacting the poison center at 1-800-222-1222.
  • Gathering the battery identification number, if you have it, found on the package or from a matching battery.
  • Contacting the child’s doctor. An x-ray may be needed to be sure that the battery has gone through the esophagus into the stomach. If the battery remains in the esophagus, it must be removed. Most batteries move on to the stomach and can be allowed to pass by themselves.
  • Watching for fever, abdominal pain, vomiting, or blood in the stool or vomit.
  • Checking the stools until the battery has passed.
  • Don’t induce vomiting and don’t allow your child to eat or drink until the x-ray shows the battery is beyond the esophagus.
  • Swallowing batteries is dangerous. Search your home for devices that may contain button batteries. Secure button battery-controlled devices out of reach of children, and keep loose batteries locked away.

Shingles

June 20, 2013 by

Most of us weathered childhood chickenpox years ago with no worse than some intense itching and a few missed days of school. But for approximately one out of three people who’ve had chickenpox—99 percent of us, according to the U.S. Department of Health and Human Services’ Centers for Disease Control and Prevention—that’s not the end of it. A painful viral infection called shingles can show up years later.

“It’s pretty common. About 30 percent of Americans will get shingles at some time in their lifetime; it turns out to be one million cases a year,” says Dr. Michael Walts, a family medicine physician with Alegent Creighton Health. “Usually shingles only occurs once. In most cases, it’s self-limiting; it goes away, and you don’t have any further problems.”

Shingles is so common because it’s caused by the varicella-zoster virus, the same virus that causes chickenpox, he explains.

“Although the [chickenpox] rash goes away, the virus doesn’t. It crawls into your spinal column, where it goes to sleep, maybe forever,” Walts says. “But maybe, for most reasons we don’t know, the virus wakes up and will crawl down one nerve of the spinal cord and into the skin. Wherever that nerve is going to, that’s where the shingles rash will show up.”

And unlike chickenpox, this rash is more than just annoying.

“The most significant risk factor for the development of shingles is age. The reason we think that’s the case is that the immune system, like everything else as we get older, just doesn’t work as well.” – Michael Walts, M.D., family medicine physician with Alegent Creighton Health

“You’ll have pain first, and then all of a sudden the rash appears…It can be excruciatingly painful,” Walts says. And for some, the pain is long-lasting, even permanent.

“One of the most significant complications of shingles, a small percentage of time, is that even after the rash goes away, the pain doesn’t,” Walts explains. “The condition is called postherpetic neuralgia, or PHN.”

Shingles is more common after age 60, Walts says. “The most significant risk factor for the development of shingles is age. The reason we think that’s the case is that the immune system, like everything else as we get older, just doesn’t work as well. And the older you are when you get shingles—if you do—the more likely you are to get postherpetic neuralgia.”

It’s even possible that people who’ve been immunized against chickenpox can still get shingles later, he says, and it also strikes people who believe they’ve never had the chickenpox.

“People will say ‘I got shingles, but I never had chickenpox as a kid,’ and my response to that is, ‘Yeah, you did. You just didn’t know it,’” Walts says. “Maybe you had a bump or two that nobody ever even noticed, or maybe you had a rash that somebody said was contact dermatitis, because there’s no way you can get shingles unless that virus is living in your spinal cord.”

It’s not all bad news. A single-dose vaccine called Zostavax may prevent shingles altogether or prevent a recurrence. And if a person suspects shingles, especially when a rash appears on only one side of the body, he or she can still see their physician for treatment.

“(Anti-viral) medication does help. It does speed up the resolution of the pain and the rash, so go to your doctor and make sure it’s shingles,” Walts says. “We’re not sure about this, but one of the theories is that maybe treatment will not only decrease the amount of time you’re symptomatic, but it might decrease your risk for that postherpetic neuralgia. That’s all the more reason to get treatment, because, boy, anything you can do to prevent that side effect—even though it’s not common—you ought to try.”

Feeling the Heat

Everyone loves a little fun in the sun, but when people linger in the sun’s rays a little too long, it can have harmful effects on their health, especially for seniors.

Heat-related illnesses, collectively known as hyperthermia, occur when the body overheats and does not have the sufficient means to cool itself down. According to the Centers for Disease Control and Prevention, the elderly are more prone to the sun’s harmful rays because they are more likely to have a chronic medical condition or take medication that inhibits normal body responses to heat.

“People who work in high heat develop a certain degree of tolerance. With the elderly, their ability to adapt to extreme temperatures is limited, and the body’s ability to maintain status quo is much more at risk,” says Kris Stapp, vice president of community and public health at Omaha’s Visiting Nurse Association.

Heat exhaustion is a mild form of heat stress. Continuous exposure to high temperatures, combined with high humidity and physical exertion, can lead to dehydration. If you develop heavy sweating, a pale complexion, muscle cramps, and a sense of tiredness, you may be suffering from heat exhaustion. If not controlled, heat exhaustion can escalate to heat stroke, which can cause permanent brain and organ damage.

Stapp stresses the importance of taking into account the timing of outdoor activities, especially strenuous ones such as gardening or walking. Older folks may need to adapt their outdoor plans in times of extreme heat.

“What is dangerous about any heat-related illness is, it comes on so subtly that people don’t realize it’s happening until the symptoms really set in,” Stapp says. “When people get to the point where they are confused, it can lead to unconsciousness.”

To combat heat stress, the CDC advises drinking plenty of non-alcoholic beverages. Make sure to get plenty of rest and try to stay in air-conditioned environments during the heat of the day. Also, make sure to wear lightweight clothing if venturing outdoors.

“Be smart,” Stapp says. “It’s about turning all this information around, and not only knowing the warning signs, but also how to prevent it from happening.”

Avoiding Falls

February 25, 2013 by

Did you know falls are by far the leading unintentional injury, accounting for more than 8.7 million emergency room visits each year in the United States. One in every three adults age 65 and older falls each year, according to the Centers for Disease Control and Prevention.

Most falls are preventable. Many people attribute falls to being clumsy or not paying attention, but many risk factors exist. Physical hazards in the environment, vision, health conditions, and lack of exercise all increase the risk of a fall. Winter weather introduces an additional risk when ice and snow are on the ground. Reduce your risk and find fall hazards in your workplace and home to prevent injuries to yourself and others.

Tips for a fall-free year:

  • Maintain good lighting on outdoor walkways.
  • Wear sensible footwear. Consider changing from dress shoes to boots when walking outside.
  • Check the condition of outdoor handrails, walkways, and steps and repair as necessary.
  • Remove fallen leaves or snow from outdoor walkways as soon as possible to keep ice from forming.
  • Keep your shovel and de-icing products in the garage or inside the house so you won’t have to walk on a slippery surface to get your supplies.
  • Be aware that alcohol or other drugs, including prescription and over-the-counter medicine, can affect your balance and increase risk of falling.

Older Adult Falls. Older adults are more prone to become the victim of falls and the resulting injuries can diminish the ability to lead active, independent lives. According to the Centers for Disease Control and Prevention, the following tips can greatly help older adults prevent falls, but are beneficial to those of all ages:

  • Stay active. Chances of falling can be reduced by improving strength and balance. Examples of activities include brisk walking, tai chi and yoga.
  • Fall-proof your home—inside and out. This includes taking advantage of the tips above and removing indoor tripping hazards like rugs and clutter.
  • Review your medications. Have your doctor or pharmacist review all the medications you take, both prescription and over-the-counter. Some medications or combination of medicines can make you drowsy or light-headed, which can potentially lead to a fall.
  • Check your vision. It’s best to have your vision checked at least once a year to make sure you have the best prescription for your glasses. Poor vision greatly increases your risk of falling.

Tips adapted from the National Safety Council website. For more information, including local fall prevention resources, visit safenebraska.org.

Not Home Alone

December 25, 2012 by
Photography by Bill Sitzmann

As the largest generation in American history, often referred to as the post-war “Baby Boomers,” begins to reach and pass their 60th birthdays, the sheer size of the population is predicted to overwhelm the current facilities intended to meet the needs for assistive care and skilled care. That fact, along with many seniors’ desire to remain in their familiar, comfortable family home, have prompted many Americans to turn to companies and resources that can help them stay in their homes safely, happily, and productively and at a reduced expense.

The “Aging in Place’ trend has gained steam in recent years, and is expected to continue to grow in popularity in the next decade. The Centers for Disease Control and Prevention (CDC) has defined “Aging in Place” as “the ability to live in one’s own home and community safely, independently, and comfortably regardless of age, income, or ability level.”

Finding quality providers of at-home products and services is one of the most important aspects in preparing a successful plan for aging in place. Omaha has a wide selection of service providers, caregivers, and equipment providers who can work with the individual or the family to make aging at home a viable option.

Matt Nyberg, owner of Home Care Assistance of Omaha, says that while the majority of “Baby Boomers” haven’t yet reached the point of requiring home-care products and services, his company is preparing for the deluge of demand ahead. His firm provides seniors with non-medical, hands-on assistance with activities of daily living, bathing, and transferring, with what he says is an innovation in the business. Each client has an RN (registered nurse) who assesses needs, manages services, and attends doctors’ appointments, if requested. The RN then communicates with the family (with the client’s permission) in order to keep the family up-to-date on the client’s condition.

Laurie Dondelinger, marketing director at Kohll’s Home Care in Omaha, recently took this writer on a tour of their 10,000-square-foot showroom, which contains hundreds, perhaps thousands, of assistive devices from canes to stairway lifts to walk-in tubs to ceiling lift tracks which literally lift a disabled person out of bed and motor them anywhere in the home where the ceiling track has been installed. Kohll’s has in-house contractors who can install assistive devices as well as remodel a home to accommodate such devices.

Dondelinger tells of a satisfied client who installed a stairway lift in his three-story house. He is so thrilled with the ease in moving from floor to floor that he feels as if he now lives in a ranch-style home, and he’s no longer faced with having to sell his beautiful home on the river where he has lived for many years.

Bob Sackett, owner of Complete Access in La Vista, got into the home-accessibility business because of a personal crisis facing a family member 25 years ago. He is now a licensed elevator sales and installation provider specializing in modular ramps, stairway lifts and elevators, for the home serving customers in western Iowa and central and eastern Nebraska. His company sells both new and previously owned products, allowing him to meet the needs of even tight budgets. Like so many in the stay-at-home business, Sackett has a true fervor about his business, which he says is not only cost-effective in keeping people in their own homes, but also improves clients’ quality of life.

However, Sackett says that, in his initial assessment, he looks and listens to learn whether or not the person can survive happily at home. If his accessibility services could result in a person living 24 hours alone with no human interaction, then he isn’t interested in the business opportunity because then he would not be providing a high quality-of-life service.

Spirit Homecare is a newcomer to the Omaha home-assistance market, providing skilled hands-on care such as administering medications and treatments per doctor’s orders, as well as non-medical services via homemakers and companions, including meal preparation, transportation services, and light housekeeping. They also provide supervised hands-on assistance with personal care needs, help with prescribed exercises and medical equipment, and much more. Up to 24-hour care and live-in companion services are available as well.

Spirit Homecare is part of St. Jude Healthcare, a company that provides services in Wisconsin, Nebraska, California, Arizona and Kansas. Although non-medical assistance is not reimbursable by Medicare, sometimes Medicaid and private long-term care insurance does provide reimbursement. Tom Moreland, CEO of St. Jude Healthcare, says that his company is the only one in the Midwest that provides services in a manner consistent with the Ethical and Religious Directives for Catholic Health Services.

The above providers are but a tip of the iceberg of services, providers, and products available to assist with aging in place. It cannot be emphasized too much that if one wants a future at home, one should begin the planning as soon as possible.