Tag Archives: health care

Try to Keep Up 
With Deb Bass

November 19, 2013 by
Photography by Bill Sitzmann

Deb Bass has essentially had three careers: She’s been an RN for 20 years, a startup entrepreneur for eight, and a CEO for about 12.

But don’t get the idea that Bass is calling this stage in her life anything like semi retirement. “I’m working harder than I ever have in my life,” she says with a laugh. As of 2012, she’s CEO of Nebraska Health Information Initiative (NeHII), a 501(c)3 dispensation with an ambitious goal to get electronic health records across the state talking to 
each other.

Health care has actually been a constant in Bass’ professional life. Specifically, the problems related to health-care information exchange.

“People don’t realize that someone who’s started a business has risked everything they own.”
– Deb Bass

“When I was a young nurse, I was in the operating room,” she recalls. “If a patient came in by ambulance, the EMTs would usually go to the patient’s medicine cabinet, empty it into a plastic bag, and bring that to the emergency room. And I would be there with the anesthesiologist, opening every bottle, looking at the pills, looking at the dates—people would put different pills in different bottles—and that’s how we put together   the pieces of what the patient was taking. That was our medicine query. By this time, we were doing surgery, and we were still trying to figure out if the patient was diabetic or if they had high blood pressure. And I remember thinking, there has got to be a better way to do this.”

Building Bass & Associates

That thought stayed with her even as she quit nursing to co-found Bass & Associates, a technology consulting business, in 1993. “February 2, to be exact,” she says. The date is firm in her memory. “We wrote the business plan, and I remember thinking, I sure do hope this works. You have to sign over your house, and…people don’t realize that someone who’s started a business has risked everything they own.” She recalls her 10-year-old daughter asking on family trips if they could please stop talking business 
for awhile.

Coincidentally, it was an aspect of health care that led Bass to reluctantly sell Bass & Associates just eight years later. “A 10 or 20 percent increase in health care every year.” She shakes her head. “You cannot build a business model that will absorb those kinds of increases each year, year after year.”

“The name has good brand value here… Throughout the years, she reiterated to me that you cannot afford to tarnish your reputation.”
– 
Bruce Peterson, executive vice president at Bass & Associates

Eventually a business has to pass on some of that cost to its employees. “And believe me, you pay as much as you can before you turn a cost back to your employees,” Bass says with emphasis. “It just got to the point where we needed to be an even larger organization so we could get better insurance.” In 2001, she sold the company and her stocks, though she stayed on as CEO and Bass & Associates kept her name.

“The name has good brand value here,” explains Bruce Peterson, executive vice president of Bass & Associates. He’s worked with Bass in several capacities over the course of two decades. “Throughout the years, she reiterated to me that you cannot afford to tarnish your reputation.” Having her name remain on a shingle she no longer owns would suggest Bass might be on to something.

 Stepping Up with NeHII

In 2007, Bass connected with NeHII (pronounced “knee high”) as a contracted resource through Bass & Associates to solve a different kind of health-care problem: the one she struggled with as a young nurse in the operating room. “To make it simple, we’re the Expedia model of health care information exchange,” she says. The public/private collaborative nonprofit that is NeHII enables electronic health records (EHRs) to speak to one another, across hospitals and across the state. “A physician enters a patient’s first name, last name, date of birth, and then we send crawlers across all participating hospitals, identify all the matches, and pull them into view on a screen.”

“She is passionate, passionate about NeHII.”
– 
Connie pratt, program director at NeHII

In an all but completely digitized world, it’s still not the norm for a physician to view a complete health record of a patient on a screen. Within one hospital, Bass explains, there may be as many as five or six different EHRs—one for the ER, one for the lab, one for the physician’s office, and so on. “Consumers get frustrated because they’re always asked to fill out the questionnaire with the  same set of questions,” she says. “‘You mean you don’t have this recorded somewhere?’ They don’t. Because they have all these siloed systems.” Benefits of a health information exchange (HIE), Bass says, include accurate data that doesn’t rely on the memory of laypersons; the ability to identify drug seekers; and facilitating consumer comparison by standardizing 
industry terminology.

“She is passionate, passionate about NeHII,” says Connie Pratt, the program director of NeHII. “She’ll go to the nth degree to make sure that it’s meeting people’s needs.” Pratt adds that the inevitable setbacks of such an undertaking don’t hold Bass’ focus for long. “She just keeps going—and that’s huge. Some people, when somebody says no, it’s done. Deb says, ‘Okay, that one said no, but we’re going to go over here now.’”

NeHII currently represents 51 percent of all hospital beds in Nebraska, on pace to represent 80 percent by 2015. The end goal, Bass says, is for all these state HIEs to connect to a federal architecture—a nationwide health information network, known in D.C. as The Healthy Way. Despite the fact that technology is ready for that scenario today, Bass says the industry is still a long way away from seeing Healthy Way work. “The challenges are the privacy and security policies and the politics.”

Maintaining the Pace

Pounding away at policies and politics means 7 o’clock mornings and 11:30 nights. “She is a doer,” Peterson says. “She was the pace car for Bass & Associates. Everybody that worked with her was trying to keep up.”

To cope, Bass sets another pace: twenty miles a week. “I really wouldn’t call it running anymore. It’s a run/walk.” And she lifts weights. “I have got to do it or my brain just goes nuts.”

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Also keeping her grounded are her three daughters. “For all the working women out there, we always worry we’re spending too much time working and not spending enough time with our children. ‘Do they know who I am?’ And to see them all grown up and be talented and independent is…” Bass breaks off the sentence with a huge smile. Fittingly, one of her daughters is a doctor, and the other two are successful 
in business.

As for herself, Bass isn’t planning to leave the business world any time soon. Nebraska is recognized as the leader in the U.S. for HIE, and some EHRs are trying to give NeHII a run for its money. “The race isn’t done,” Bass says. “You won’t know if you’re on the right horse until you cross the finish line. And we’re all still 
riding in it.”

The Affordable Care Act

August 26, 2013 by
Photography by Bill Sitzmann

The Patient Protection and Affordable Care Act (PPACA), better known as the Affordable Care Act (ACA), is a federal statute signed into law in 2010. The objective of the Act is to increase affordability and rate of coverage for health insurance and reduce the overall costs of health care, which will be executed through mandates, subsidies, tax credits, and other means. The ACA is divided into 10 titles with some provisions that became effective immediately, while others are phasing in over a 10-year period.

But what does this mean for most seniors?

“If you don’t have insurance between age 60 and 65, that’s a concern.” – Andrea Skolkin, OneWorld Community Health Centers, Inc.

Individuals over 65 will likely find that not much will change as far as Medicare is concerned, says Andrea Skolkin, chief executive officer for OneWorld Community Health Centers, Inc. More preventive care is covered and prescription drug coverage will improve, she says, but most facets of Medicare will carry on as before.

“People who have Medicare, other than the little bit of expansion in the ‘donut hole’ [Medicare Part D coverage gap between the initial coverage limit and the catastrophic-coverage threshold for prescription drugs], should be secure in their coverage,” she explains. “The new marketplace isn’t for people who have Medicare.”

Sixty-plus individuals who will definitely be affected by ACA are those seniors who haven’t reached the Medicare eligibility age of 65 and are without medical insurance. In January 2014, uninsured individuals will be required to buy health insurance, available through an exchange, or pay a penalty tax. Some people will certainly struggle to finance the premiums, but currently, seniors who don’t yet qualify for Medicare and can’t get covered through an employer are likely to take their chances and go without health insurance altogether, Skolkin says.

EJ Militti, financial advisor with The Militti Group at Morgan Stanley Wealth Management

EJ Militti, financial advisor with The Militti Group at Morgan Stanley Wealth Management

“If you don’t have insurance between age 60 and 65, that’s a concern,” she says. “We see a lot of it—people 55 and up—who are being ‘right-sized,’ if you will, out of their jobs and are left without anything until they are eligible for Medicare. Especially at our new clinic in West Omaha, we see a lot of uninsured adults.”

From a financial standpoint, it’s fair to say that ACA will not spell good news for everyone’s pocketbook, says EJ Militti, a financial advisor with The Militti Group at Morgan Stanley Wealth Management.

“[For] the wealthy and those who have properly saved for health care and other retirement costs, there is less to like and greater confusion about government-mandated health care. Moreover, those considered wealthy will be helping foot the bill of this epic legislation,” he says, explaining that a Medicare tax increase and additional taxes on taxable investment income have been instated, and other proposals are pending. “In my opinion, there is little doubt higher-income earners are going to be paying more in taxes. Higher-income earners need to be aware of future tax proposals on the table.”

On the other hand, Militti points out, some Americans will clearly benefit financially from the legislation.

“[For] the wealthy and those who have properly saved for health care and other retirement costs, there is less to like and greater confusion about government-mandated health care.” – EJ Militti, The Militti Group at Morgan Stanley Wealth Management

“The poor, the lower middle class, the long-term unemployed, and those with pre-existing conditions will benefit the most, and that’s by design,” Militti says. “The entire premise for government-mandated health care is to provide taxpayer-financed subsidies for those who, otherwise, cannot provide for themselves.”

**

EJ Militti is a Financial Advisor with The Militti Group at Morgan Stanley Wealth Management. The information contained in this article is not a solicitation to purchase or sell investments. Any information presented is general in nature and not intended to provide individually tailored investment advice. The strategies and/or investments referenced may not be suitable for all investors as the appropriateness of a particular investment or strategy will depend on an investor’s individual circumstances and objectives. Investing involves risks and there is always the potential of losing money when you invest. The views expressed herein are those of the author and may not necessarily reflect the views of Morgan Stanley Smith Barney LLC, Member SIPC, or its affiliates. 

Morgan Stanley Smith Barney LLC (“Morgan Stanley”), its affiliates, and Morgan Stanley Financial Advisors or Private Wealth Advisors do not provide tax or legal advice. This material was not intended or written to be used, and it cannot be used, for the purpose of avoiding tax penalties that may be imposed on the taxpayer. Clients should consult their tax advisor for matters involving taxation and tax planning and their attorney for matters involving trust and estate planning and other legal matters.

Iraq War Vet Jacob Hausman Battles PTSD and Finds Peace

June 20, 2013 by
Photography by Bill Sitzmann and Scott Drickey

Growing up in Beatrice, Neb., Jacob “Jake” Hausman harbored a childhood dream of serving in the U.S. military. Both his grandfathers and an uncle served. He volunteered for the Army in 2002 and upon completing the rite of passage known as basic training, he finally realized his long-held dream. He made it as an infantryman, too, meaning he’d joined the “hardcore” ranks of the all-guts-and-no-glory grunts who do the dirty work of war on the ground.

By the time his enlistment ended three years later, Hausman earned a combat service badge during a year’s deployment in Iraq. He participated in scores of successful missions targeting enemy forces. He saw comrades in arms, some of them close friends, die or incur life-threatening wounds. He survived, but there were things he saw and did he couldn’t get out of his mind. Physical and emotional battle scars began negatively impacting his quality of life back home.

Headaches. Ringing in the ears. Dizziness. Nightmares. Panic attacks. Irritability. Depression. Anxiety. Certain sounds bothered him. He felt perpetually on edge and on high alert, as if still patrolling the hostile streets of Mosul or Fallujah. With his fight-or-flight response system stuck in overdrive, he slept only fitfully.

A relationship he started with a woman ended badly. He lived in his parents’ basement, unemployed, isolating himself except for beer-soaked nights out that saw him drink to oblivion in order to escape or numb the anguish he felt inside. No one but his fellow vets knew the full extent of his misery.

With things careening out of control, Hausman sought professional help. Hardly to his own surprise, he was diagnosed with Post Traumatic Stress Disorder (PTSD). Anyone who’s endured trauma is prone to develop it. Sustained exposure to combat makes soldiers particularly vulnerable. Not all combat veterans are diagnosed with PTSD, but nearly one-third are.

What did surprise Hausman was learning he’d suffered a traumatic brain injury (TBI). In retrospect, it made sense because the Stryker combat vehicle he was in absorbed an IED (improvised explosive device) blast that knocked him unconscious. Studies confirm ever-stronger charges like that one caused many more such injuries as the Iraq and Afghanistan conflicts wore on. Injuries of this type often went undetected or unreported in the past.

“In combat and war, no one’s playing music in the background. It’s not passionate; it’s pure survival instincts.” – Jacob Hausman

It was because of these diagnoses that Hausman became a casualty among returning veterans. Some estimates put their numbers with PTSD and/or TBI at a quarter of a million. Statistics alone don’t tell the story. In each case, an individual experiences disruptive symptoms that make adjusting to civilian life difficult. The suicide rate among this group is high.

The scope of this health care crisis has strained U.S. Department of Veterans Affairs’ resources. In some locales, benefit claims are months behind schedule. Nebraska’s VA system has largely kept pace with demand. Hausman’s own claim was expedited quickly. He was found to be 90 percent disabled.

Six years after starting a VA treatment regimen of counseling and medication to address his PTSD issues, along with physical therapy to mitigate his TBI symptoms, his life has turned around. He earned bachelor’s and master’s degrees from Bellevue University. He’s gainfully employed today as a veterans service representative at the Lincoln VA. He also does outreach work with vets. He recently married the former Kendra Koch of Beatrice, and the couple reside in a home in Papillion.

They adopted a Lab-Golden Retriever mix dog, Lucy, from a rescue animal shelter. Kendra’s an animal lover like Jacob, who with his mother, Gayla Hausman, and his friend, Matthew Brase, own and operate the foundation Voice for Companion Animals.

Throughout his active duty Army tenure, Jake carried inside his Kevlar helmet a photo of his favorite adolescent companion, a Chihuahua named Pepe. Not long after Jake’s return from Iraq, the dog took sick and had to be put down.

Jacob and Kendra are seriously considering starting a family.

Emotional and physical challenges persist for him, but he now has tools to manage them. No longer stuck in the past, he lives one day at a time to the fullest and looks ahead to realizing some dreams. Contentment seemed impossible when he was in the depths of his malaise. His is only one man’s story, but his recovery illustrates PTSD and TBI need not permanently debilitate someone.

He’s certainly not the same Jake Hausman who joined the Army a decade ago. “I came back a completely different person. I had so much life experience,” he says. Good and bad. If nothing else, it matured him. His views on the military and war have changed. He’s not bitter, but he is wizened beyond his 28 years, and he wants people to know just how personal and final the cost of waging war is. He also wants fellow vets to know the VA is their friend.

Jacob, age 7, playing soldier at his childhood home in Beatrice, Neb. Photo provided by Jacob Hausman.

Jacob, age 7, playing soldier at his childhood home in Beatrice, Neb. Photo provided by Jacob Hausman.

Soldier Boy

Like a lot of young people, Hausman had a romantic view of soldiering. He saw it as a ticket out of his small town to find thrills and see the world.

“People live in Beatrice for a 100 years. It’s like my grandpa lived here, my mom lived here, and I’m going to live here, and I didn’t want that for myself. I struggled at school, I didn’t succeed, I was in trouble with the law, I didn’t have a bright future. And the Army at least promised adventure, intrigue. I just thought, Gosh, I want to be part of a story that can be told from generation to generation. I want to be part of something greater than myself.

“I didn’t feel connected [before]. I mean, I was social, I had friends and so forth, but I didn’t feel I belonged anywhere and I really craved that. I craved being a part of something bigger than what I was, and [the infantry] really gave it to me.”

You might assume the catalyst for his enlistment was the 9/11 terrorist attacks, but you’d be wrong. Long before then he’d made up his mind, he would enlist as soon as he could. He wanted it so badly that he was only 17 when the Army took him with his parents’ written consent. He completed high school early.

“I craved being a part of something bigger than what I was, and [the infantry] really gave it to me.” – Hausman

“Since I was like 5 years old, I wanted to be a part of the infantry. My mom’s father was in the infantry during the Korean War, and that’s why I ultimately joined. So I was always allured by the infantry because they’re the hardest, the best, the whole thing. I was beyond motivated.

“The struggle, the fight, well, that’s all true. You actually get to experience those things, and it’s not pretty and glorified. What I always tell people is that in combat and war, no one’s playing music in the background. It’s not passionate; it’s pure survival instincts. And when you’re in those situations, you’re not doing it for the flag. You’re doing it for your friend to the left and right of you.”

He couldn’t know the hard realities of war before experiencing it. He only thought about the excitement, the camaraderie, the tradition.

“Well, I got all those things, and I got a little bit more than I bargained for.”

Jacob, age 20, ready for action in Fallujah, Iraq, 2004. Photo provided by Jacob Hausman.

Jacob, age 20, ready for action in Fallujah, Iraq, 2004. Photo provided by Jacob Hausman.

You’re in the Army Now

His service almost got shelved before getting started. Weeks before leaving for basic training, he and some friends were out cruising Beatrice in his car. Open alcohol containers were within plain view when they got pulled over by local police. Jake was behind the wheel. Already on probation for underage-drinking violations, Hausman “freaked out” and fled the scene. He later turned himself in. Authorities could have used the pending charges to prevent him from going into the Army. A probation officer became his advocate.

“She went above and beyond for me,” he says. “She saw something in me and just really pushed for me and got it dropped. Two weeks later, I left [for basic]. About three years later when I came back, I told her what that meant to me and who I am now because of it. If it wasn’t for her, this story would have never happened.”

So off he went for the adventure of his life. Rude awakenings came early and often at Fort Benning, Ga., for this “spoiled only-child” who’d never done his own laundry.

“You grow into a man really fast. It kicked my ass.” Mental and physical toughness are required of infantrymen, and he had no choice but to steel himself for its rigors.

“You adapt fast or you suffer,” he says, “and I was one who adapted fast. The infantry is so hard. There’s a lot of hazing. It’s survival of the fittest.”

Hazing and all, he says, “I thought basic training was the best thing I’ve ever done. The reason why it was powerful for me is that it was all about the mission. There was no individualism; we were all a team. I really loved that.

“You grow into a man really fast. It kicked my ass.” – Hausman

“My master’s is in leadership, where the focus is on what can you do for the team, and that’s what the infantry is. No matter if you show up with a shaved head or dreadlocks, you get your head shaved. No matter if you’re clean-shaven or you have a beard, you get your face shaved. It’s just part of it. They strip you down to your very bare minimum, and it’s all about coming together as a team, being a man, learning how to get along with others, and learning different cultures.

“You’re talking about someone who, as a kid, had one black person in his class and now I had blacks, Hispanics, [and] Jamaicans in my barracks. I’d never dealt with that. I learned so much from other people; it was fantastic. They treated me like everyone else, I treated them like everyone else.”

Infantry training is largely about endurance. “The whole infantry thing is walking and running while carrying a 50- to 75-pound rucksack,” he says. “Can you walk a long ways with all that weight?”

Before making it into the infantry, one must pass a final crucible. Hausman recalls it this way: “They have this legendary walk that’s like 25 miles of water, hills, and so forth. It’s like your final capstone test at the very end. You know you’re an infantryman if you pass this thing. It’s hell on earth. I had to duct tape my thighs so they wouldn’t rub together. You walk through a river, and your feet are wet. One entire foot was rubbed raw. I mean, it was the most painful thing I’ve ever done.

“It’s just a whole mental thing—Can you get through the pain? It was so great getting that done. I was so proud.”

He then joined his unit in Fort Lewis, Wash., to await deployment. He says everything there was even more intense than at Fort Benning—the training, the hazing, the brotherhood, the partying. He felt he’d truly found his calling. “I became very good at being an infantryman. You really felt a part of the team; you bonded. I mean, you just had a lot of brothers.”

He says the drills he and his mates did in the field, including playing realistic war games, made them into a cohesive fighting force.

“We were a killing machine.”

Jacob, right, receiving his Combat Infantry Badge from Lieutenant Blanton in Mosul, Iraq, 2004. Photo provided by Jacob Hausman.

Jacob, right, receiving his Combat Infantry Badge from Lieutenant Blanton in Mosul, Iraq, 2004. Photo provided by Jacob Hausman.

Desert War

A downside to barracks life, he says, is all the alcohol consumption. “Drinking is the culture—I’m talking excessively. In the military, you’re drinking hard liquor, and you’re just drinking till you curl up. That’s the path that started going bad for me there.” But a substance abuse problem was the least of his worries once in Iraq in 2003.

His company was assigned to the new Stryker Brigade, which took its name from the 8-wheel Stryker combat vehicle. “Something in-between a Humvee and a tank,” Hausman describes it. “After Somalia, our brass decided we needed a vehicle that could put infantry in the city, let us do our thing, and get us out fast.”

It carried a crew of six.

“We built cages [of slat armor] on the outside to stop RPGs (rocket-propelled grenades).” The cages proved quite effective. However, Strykers had a problem with rollovers, a defect Hausman would soon experience to his horror.

“We had a lot of good intelligence from special forces initially. Every day, we would kick someone’s door down and take out a terrorist. We’d either arrest him, kill him, do whatever. We killed a lot of bad guys.

“Once the intelligence stopped, we kind of ran out of operations to do.” Then his squad’s duty consisted of doing presence patrols. “It basically was to show the Iraqis we were around, but in all reality, it was walk around until we got shot at so we could kill [the shooters].”

Draw fire, identify target, engage.

“You’re still seeing a human being face-to-face; you’re still pulling a trigger on someone; you still have that you’re-dead-or-I’m-dead reality. You cannot shake that experience.” – Hausman

Hausman was a specialist as the squad’s designated marksman. “I had an extra weapon—a snipe rifle. I’d go out with the snipers, and we’d do recon on special missions,” he explains. “We’d take fire here and there, but we’d maybe only get in a firefight every three weeks.”

He was part of a Quick Reaction Force unit that responded within minutes to crises in the field. That sometimes meant coming back from a long operation only to have to go right back out without any sleep.

“Once, we got into an 18-hour firefight when we were called to secure two HET (Heavy Equipment Transporters) vehicles hit by RPGs and abandoned by their transportation team. It was a residential district in Mosul. We got there and RPGs start blasting and IEDs started popping. It was just an ambush. The enemy had us surrounded 360 degrees. We were pinned down taking gunfire. This was life or death. At a certain point, you’re not thinking; it’s pure survival animal instinct.

“I turned the corner at a T-intersection, and there were muzzle flashes from windows. There were four of us versus about six muzzle flashes. It was just who could kill who fastest. A guy came across the roof, and I fired my 203 grenade launcher, BOOM, dead. A squad member got shot and paralyzed. Another got wounded by an RPG, his intestines spilling out. He was EVAC’d out.”

He says in situations like these you confront the question: “Are you really committed to killing another human being? And I have killed another person.” Despite today’s automatic weapons, he says, “You’re still seeing a human being face-to-face; you’re still pulling a trigger on someone; you still have that you’re-dead-or-I’m-dead reality. You cannot shake that experience.”

In the aftermath of such intense action, he says, “You’re hiked up; you can’t sleep.” Indeed, he “couldn’t let down” for his entire nine months in Iraq. “You just can’t let your guard down.” Even on leave back home, he was so conditioned by threats that “driving back from the airport,” he recalls, “I was looking for IEDs on the road, scanning the roofs for snipers.” When he could finally release the pent-up stress, he slept three straight days.

From left: Specialist Mower, Specialist Crumpacker, and Specialist Hausman, 19, in Samarra, Iraq, 2003. The photo was taken the day after the horrific Stryker accident that killed three soldiers. Photo provided by Jacob Hausman.

From left: Specialist Mower, Specialist Crumpacker, and Specialist Hausman, 19, in Samarra, Iraq, 2003. The photo was taken the day after the horrific Stryker accident. Photo provided by Jacob Hausman.

A Tragic Accident

As bad as firefights got, Hausman says, “The worst thing I’ve experienced in my life occurred about a month after I got to Iraq.” It didn’t involve a single gunshot or explosion either. It was his turn operating the Stryker. His team, followed by another in a second Stryker, were on a muddy backroad near Samarra heading to do recon. A ravine on their side of the road led to a canal. Suddenly, the road gave way and both Strykers overturned into the canal. The ensuing struggle haunts him still.

“We’re upside down, water starts running in, it’s miserable cold. I’m thinking, ‘Oh no, it’s over.’”

He recalls hearing his father’s voice telling him not to panic.

“I don’t know how I got the hatch open, I just muscled it, and the water rushed in. I took a deep breath and went down in it. My body got pinned between the ground and the vehicle. I’m struggling, I’m drowning. I thought, ‘Is this how I’m going to die?’ I escaped from the bottom somehow and got on the side,”…only to find himself trapped again. He began swallowing water.

“My body got pinned between the ground and the vehicle. I’m struggling, I’m drowning. I thought, ‘Is this how I’m going to die?’” – Hausman

“I looked up and I could kind of see the moon. I started clawing, clawing, clawing, and gasping for air. I made it. I gathered my thoughts, climbed on the vehicle, and saw one of my buddies had gotten flung out. We went to the back,” where they found their mates trapped below, desperate for escape. “We were all fighting to get the hatch open. It was just terrible. We get the hatch open, and everyone’s there.”

A roll call accounted for all hands. Except in the rush to get out, a team member got “trampled over” and drowned. “We got his body out and did CPR, but it was five minutes too late.”

Hausman was “really good friends” with the lost squad member, Joseph Blickenstaff.

The driver and the squad leader in the second vehicle also died. Hausman was friends with the driver, J. Riverea Wesley. Staff Sergeant Steven H. Bridges was the squad leader lost that day.

Assessing what happened, Hausman says, “It was chaos; it was tragedy. That really shattered me for a while. I won’t let it ruin my life—I’ll go swimming and stuff—but it was just traumatic. It is hard to deal with—getting over it. There’s some parts of it I will never get over.”

OMAG cover OM1212-City-f_spread

The Aftermath Comes Home

War being war, there’s no time or support for processing tragedy and trauma. “It was shove everything inside, shut up, move forward,” says Jake. Those unresolved feelings came tumbling out like an “avalanche” when he got back home in 2004.

“I was just a trainwreck. I was miserable, destroyed. My emotions ran wild. I couldn’t sleep. I was just so anxious. I couldn’t take deep breaths, I would sniff, just like a dog panting. Like a 24-hour panic attack. You’re uncomfortable being you every second of the day. You’re not in control, and that’s what you’re afraid of. Just freaking out about stuff. I was so afraid at night I would get up nine or 10 times and check the lock on my door. The nightmares are incredible.”

Excessive drinking became his coping mechanism. The more he drank, the more he needed to drink to keep his demons at bay. “You’re in a vicious cycle, and you can’t get out of it,” he says.

“At one point, I contemplated suicide because I was like, ‘What is the point of living when I am this bad, this miserable? Is it ever going to get better than this?’”

His family saw him unraveling.

“Mom and Dad were worried, deathly worried, but they didn’t know how to handle it. They didn’t know if it was a stage or my turning 21. They didn’t know what to do with me.”

“Usually in this population, patients turn to drinking or to other substance abuse and the number one reason they tell me they do it is because they can’t sleep or to fight off nightmares,” says Omaha VA social worker Heather Bojanski. “They don’t want to come in for help, they don’t want medication, and drugs and alcohol are easy to get a hold of. They’d rather try to cope themselves before they come in for help or actually have to face [that] there is a problem.”

Omaha VA Hospital counselor Heather Bojanski.

Omaha VA Hospital social worker Heather Bojanski.

Jim Rose, a mental health physician’s assistant with the Lincoln VA, says recovery has to start with someone recognizing they have a problem and wanting to deal with it. “If they’re still reluctant to accept that as a problem, then it makes it very difficult. Help’s out there, but it is difficult with this group who by nature tend to be more self-reliant and have the world by the shoulders, and then to have something like this happen kind of turns things upside down.”

There’s no set timetable for when PTSD might present in someone.

“They’re all on a continuum,” says Bojanski. “Two veterans can come back who have seen and been through the same exact thing, and one will seem perfectly fine and the other may immediately start struggling. That all depends on a few things—what was going on in their life when they came back, and how much family support they have. It’s all going to depend on them and their family and what’s going on and how honest they are with themselves.

“If they come back and they have great family support and their family’s in tune and really watching them, then they’ll do well. But if nobody’s really paying attention and they’re just doing their own thing and they start isolating and drinking, then those are big issues to look at and people really need to encourage them to come in.”

Hausman says, “There’s a threshold of stress. It’s going to come out eventually if you don’t take care of it. For me, it came out real early. I was a boy; I was not equipped for getting used up in the war machine.”

“[Some veterans] would rather try to cope themselves before they come in for help or actually have to face [that] there is a problem.” – Heather Bojanski, social worker

Rose says PTSD tends to be suppressed among active duty military because they’re in a protective environment around people with similar experiences. But once separated from the military, it becomes a different matter.

“They feel isolated, and the symptoms will probably intensify,” he says. “It’s usually a couple years after discharge people reach a point where they just can’t cope with it anymore and something’s going to happen—they’re going to get in trouble or they’re going to ask for help, and that’s when we see them.”

That’s how it was for Hausman, who concealed the extent of his problems from family and friends and tried coping alone.

“I didn’t want to burden them with that…My friends, they thought it was just old Jake because I’m a partier, I’m gregarious, so they enjoyed it. But they didn’t see the dark side of it. They didn’t understand the mega-depression and anxiety. When I was drunk, I could shield it.

“But there’s usually one or two people in your life that know you. Robert Engel is probably my best friend to this today. He was in my unit. He lives in Kansas City, Mo. He recognizes when I’m down; I recognize when he’s down. We kind of pick each other up. He’s seen me at my lowest point but he accepts me for who I am, and I accept him for who he is, and we sincerely care about each other.”

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Getting Help

“When I decided I wasn’t going to kill myself, I resolved to figure this out,” says Jake. “I started reading spirituality, I started studying psychology.”

Most importantly, he sought help from the Veterans Administration. He and a fellow vet in Lincoln, Mike Krause, talked straight about what he needed to do. Like any vet seeking services, Hausman underwent screenings. He had all the classic symptoms of PTSD.

The intake process works the same for all vets. Bojanski says, “We sit down with each of them individually and decide what level of care they need.” In the case of Hausman, she says, “He came to the VA, and we started to treat him. Then when he started to take medication, he stopped drinking, and it was like an eye-opening experience to him that, ‘Oh my God, I’ve been suffering all this time.’ He started to go to groups, he talked to other people and realized, ‘Wow, I’m not the only one suffering.’ Other people he knew from his unit were going.”

Rose says the medications commonly prescribed for PTSD are “a mixed bag” in terms of effectiveness. He emphasizes, “There is no medication that cures these symptoms, but we have got things that can help people lead better lives, including anti-depressants and anti-psychotics.” To supplement the meds, he says, “We try to steer people to cognitive-therapy counseling.”

A holistic mind-body-spirit approach has worked for Hausman.

“That’s why exercise is important, counseling is important, and you have to supplement it with medication,” he says. “It’s not just a one trick pony. You can’t just throw some meds at someone and expect them to get better, you have to do all those things.”

Rose salutes Hausman and anyone who embraces recovery. “It’s a fairly lengthy process, and it involves commitment. It’s not a passive act. Jake’s a testament to people that, if you really want to get through it you can.”

Lincoln VA substance abuse counselor Mary Ann Thompson admires him for getting sober and “remaining clean and sober and productive.”

“He easily could have succumbed to all those issues and who knows where he’d be at now, but I’m so proud of him for moving forward.” – Kendra Hausman, Jacob’s wife

Bojanski sees a new Jake, saying, “He has a much better outlook on life. He’s very proactive.”

More than most, Kendra Hausman appreciates how far her husband’s come: “I’ve seen a lot less anxiety. Overall, he’s more calm, more level-headed, he’s able to handle situations better. He doesn’t get as angry or as worked up about small things like he used to. He easily could have succumbed to all those issues and who knows where he’d be at now, but I’m so proud of him for moving forward. He’s very determined. Once he puts his mind to doing something, he’ll get it done no matter what. He’ll figure out what he needs to do, just like he did with his school and career.”

Jacob, himself, says, “I’ve come a long ways. Life is so much better.” What he’s realized, he says, is “There are just some things you cannot [do with] will power; you just have to get help from people. I’ve had a lot of good people in my life that have helped me. And that’s what I’ve learned—you have to ask for help, you have to be willing to get help. The VA is there to help people. They’ve helped me so many times.”

Bojanski says the VA’s more responsive to veterans’ needs today. “The VA realized we did a lousy job welcoming Vietnam veterans back home, so when this war started, we wanted to be proactive and make sure we welcomed our veterans home. We didn’t want them to have a stigma with mental health, we wanted to make sure everything was in place. So we created these clinics (OEF or Operation Enduring Freedom and OIF or Operation Iraqi Freedom), where we work very hard with veterans. It’s very confidential, so not everybody in their unit is going to find out. We have an ER open 24 hours a day.

“It’s not like it used to be when you just had to soldier on, or if you reached out for help it wasn’t confidential.”

She says there isn’t as much stigma now about seeking mental health care.

“It’s getting better; we’re still not where we need to be, but I will say the armed forces, the Department of Defense, and our population in general are changing their views about that. We also do a lot of outreach, a lot of speaking to communities to make sure people are aware it’s okay to get help.”

Hausman does outreach himself as a way of giving back. He says when he addresses audiences of freshly returned vets, he commands their attention.

“They believe in me because I’ve seen it, I’ve done it, and I’m working for the VA. I’m 90 percent service-connected; I’ve got a combat infantry badge. Seeing them is like seeing my reflection. I’m motivated to get them right before they take the wrong path. Someone got me over the hump, and I want to get them to that point, too. I want to help veterans get the services they need. It’s just so rewarding.”

Hausman with wife Kendra and dog Lucy.

The War that Never Ends, Moving on with Life

His PTSD still flare-ups now and then. “Recently, I had a little struggle for a while, but I didn’t fall back into the past because I’ve got good people in my life today.” He says he has combat veteran friends who still struggle because “they don’t have the support system.”

He accepts the fact he’ll always be dealing with the effects of war.

“There are some things I would change, but it’s made me who I am even with all the disabilities and struggles and everything I face. I think through all the suffering I’ve come to know peace. There’s some breaking points where you feel sorry for yourself and you have little pity parties, but then again I look around me and see what I have—a great support system, a wonderful wife.
It’s made me stronger.”

“I think through all the suffering I’ve come to know peace.” – Hausman

Finding Kendra, who works as a speech pathologist with the Omaha Public Schools, has been a gift. “She is the light of my life; she changed my life. Her enthusiasm for life is just breathtaking. She’s smart, beautiful, loving. She’s the greatest teacher in my life. She doesn’t need to understand everything I go through, but sometimes I need her to help me get through it.

“I was going through a low point, and she said something to me that no one else could say to me without offending me: ‘You got through war, now you can get through this, so suck it up.’ From her, that meant a lot. She knows me at that fundamental level to tell me what I need to hear sometimes. We’re really good together.”

Flareups or not, Jake’s moving on with life and not looking back.

If you have a concern about a veteran or want more information, call 402-995-4149. The VA’s local crisis hotline is 1-800-273-8255. For the latest findings on PTSD, visit ptsd.va.gov/aboutface.

Read more of Leo Adam Biga’s work at leoadambiga.wordpress.com.

Smoking Cessation Aids

March 25, 2013 by
Photography by Bill Sitzmann

The old saying “third time’s the charm” didn’t work so well for Laura Adams when it came to quitting smoking.

“Every time I quit, I’d be good for about six months,” she says. “Then I’d get stressed about something and decide to have just one. Well, once you start up again, it’s all over. It’s an all-or-nothing thing.”

Adams is not in the minority. Most smokers will try quitting multiple times before they are successful. There’s a lot more to smoking than meets the eye, say local smoking cessation experts. “There’s an addiction to nicotine, the actual habit, and the emotional dependence that all need to be addressed,” says Laura Krajicek, a smoking cessation coordinator for Nebraska Methodist Health System.

A smoker for more than 20 years, smoking had become a crutch for Adams. “It helped me deal with daily stresses,” she explains. “When I had a cigarette, that was my relaxation time, my ‘me time.’ Coffee, cigarettes, and break time all went together. It was hard to have one without the other.”

Adams knew that it wasn’t a “pretty habit,” nor one she was proud of. With a campus-wide no smoking policy at her place of employment, Alegent Creighton Health Immanuel Medical Center, Adams would have to “sneak” to an off-site parking lot to smoke. To mask the nasty smoke odor, she would slip on a different coat, pull her hair back in a ponytail, wash her hands, and coat herself with body spray before returning to the office. “It was an embarrassing addiction,” she recalls.

“When I had a cigarette, that was my relaxation time, my ‘me time.’” – Laura Adams, former smoker

When Adams learned about Alegent Creighton Health’s smoking cessation program, Tobacco Free U, she decided this might be the extra push she needed to help her quit for good. The program focuses on the use of group or individual counseling in combination with a smoking cessation aid such as nicotine patches, nicotine gum, or medications.

According to the Cochrane Review, an internationally recognized reviewer of health care and research, combining counseling and medication improves quit rates by as much as 70 to 100 percent compared to minimal intervention or no treatment.

“Success rates rise drastically when you combine the two,” says Lisa Fuchs, a certified tobacco treatment specialist at Alegent Creighton Health. The counseling portion helps people tackle the behavioral addiction, and the smoking cessation aids help with the nicotine addiction.

Which smoking cessation aid is recommended depends on how heavy a smoker, health conditions, as well as what seems to be the best fit for that person’s lifestyle, notes Fuchs. These aids are most successful in individuals who have been counseled on how to use them appropriately. The most common aids include:

Nicotine patch – The patch is a long-acting therapy that delivers a steady dose of nicotine over a 24-hour period and is designed to curb a person’s cravings for nicotine. This may be appropriate for very heavy smokers. The dosage is gradually lowered to wean a person off the nicotine habit.

Nicotine gum or lozenges – Gum and lozenges are short-acting therapies that deliver smaller doses of nicotine and can be taken as needed to curb the nicotine urge. Tom Klingemann, certified tobacco treatment specialist at The Nebraska Medical Center, recommends that smokers schedule the doses so that they maintain a steady state of nicotine in the body to avoid the nicotine cravings and temptation to smoke. In general, he is opposed to short-acting nicotine replacement therapies because “they keep people looking for a chemical fix even though they may not be smoking anymore.” They are also very expensive, and most people trying to quit can’t afford the $40 a week price tag they would cost if used appropriately.

e-cigarettes – These work by heating up a liquid nicotine substance that is inhaled as vapor. The product is not regulated by the Food and Drug Administration (FDA) and many still have a lot of chemicals that may not be any healthier than actual smoking, notes Klingemann. “These are not intended to help people quit but keep them addicted to nicotine,” he says.

Medications – The two primary prescription medications used for smoking cessation include Zyban and Chantix, with Chantix being the preferred of the two, says Fuchs. “Zyban is an anti-depressant and may be recommended for a person with mild depression to help with moodiness as well as decreasing cravings and withdrawals,” notes Fuchs. It is believed to work by enhancing your mood and decreasing agitation related to trying to quit.

Chantix is a newer drug and works by binding to nicotine receptors in the brain and blocking them so that nicotine can no longer activate those receptors, causing a person to get less satisfaction from smoking. At the same time, it also triggers a small release of dopamine, the reward neurotransmitter in the brain. It appears to be safe and quite effective, notes Klingemann. Krijicek says that her clients have seen the most success with this aid.

“Success rates rise drastically when you combine [counseling and medication].” – Lisa Fuchs, certified tobacco treatment specialist at Alegent Creighton Health

Adams used Chantix, which she said helped curb her nicotine urges. But what helped the most, she says, was to change the habits that she associated with smoking. For instance, instead of coffee and cigarettes in the morning, she reached for coffee and orange juice. Because she normally smoked while driving, she changed the route she drove to work. She also replaced the time she would have spent smoking with more positive habits like walking her dogs, running, bicycling, and swimming.

“Once I quit, I started making healthier decisions in other parts of my life as well,” she says. “I started eating better, drinking less caffeine, and exercising more. I feel better now.”

“For 90 percent of smokers, the addiction is behavioral,” notes Klingemann. “It’s all of the other stuff that drives the smoking addiction. Until you start changing your behaviors and routines, it’s really hard to quit.”

Comprehensive Assessment

February 25, 2013 by
Photography by Bill Sitzmann

“Our family will forever be indebted to Suzanne,” says Melanie Miller of Suzanne Myers. It was Myers whom Miller turned to when her ailing father needed help. With Miller in New York City, her brothers also living out of Nebraska, Myers, owner of Encompass Senior Solutions, filled in where needed.

“Hands down, she is one of the best people I have ever worked with,” Miller praises.

Myers was basically an extension of their family, caring for Miller’s father in Omaha until he passed away last July. She took care of everything from providing a personal driver when his car keys were taken away to bringing in hospice as his health failed. Myers even helped plan the funeral.

Myers worked with Miller’s 88-year-old father, a prominent lawyer in town who’d been living in his own home, still driving his car, and even going into the office on a weekly basis. Everyone in his life thought everything was fine.

It wasn’t until Miller was in town visiting her father that she realized that things just weren’t right. From bills going unpaid to the house being in disarray, Miller says, she and her brothers knew they needed to find some assistance for their “fiercely independent” father.

“I called Encompass, and Suzanne returned my call that night.”

With a background in social work and experience working with seniors in hospital settings, Myers says that she has witnessed her fair share of seniors being “railroaded” into a bad situation. “I just saw a lot of people giving the wrong information, and I broke out of that.” Three years ago, she opened Encompass Senior Solutions with the focus of giving her clients the whole picture of options available to them, rather than a limited view that may be benefiting someone else’s agenda.

“[I wanted to] make things right for seniors, give them a choice, because some people don’t give them the whole truth,” says Myers. “And, lo and behold, if you give people all the information, they make really good decisions.”

Myers explains that at Encompass, she gives her clients comprehensive assessment, helping them to evaluate the situation that they are currently in and what options will best serve their needs in the future.

“Ultimately, what people want to know is if they can remain in their home and how they can make staying at home a safe option for them.” – Suzanne Myers, Encompass Senior Solutions

Along with an RN, Myers meets with everyone involved in the senior’s care, as well as the senior if they are able. “My preference is for everyone that loves and cares for the person to be available.” Of course, this is not always possible, and Myers understands that. She is very adept at working with out-of-town relatives and considering the feedback and concerns of all those involved.

The Encompass team looks at the medical and psychological history of the senior, their finances, their power of attorney, and living wills. They consider the environment they are currently living in and if the senior can continue living on their own.

“Ultimately, what people want to know is if they can remain in their home and how they can make staying at home a safe option for them.” Things as simple as rugs, stairs, and placement of furniture are assessed, as well as more involved concerns, such as medications, hoarding, substance abuse, and dementia. “No question is too small or too big,” says Myers.

As to what triggers to look for or when is the right time to consider seeking assistance, Myers says the right time is anytime there is a concern. “There’s not necessarily a crisis, but you feel that something’s not right.” It could be weight loss, poor hygiene, lapses in memory, or any number of issues.

Encompass offers full assessments and targeted assessments. “In a targeted assessment, a decision has been made to move somewhere, and we can be brought in to make the best decision regarding that move,” she says.

Changes, no matter how big or how small, can be difficult for seniors and their families to accept. But Myers says that it’s often the family members that are the most apprehensive to address the issues. She says that most seniors being assessed, when confronted with the concerns, realize that there is a problem. “Fifteen to 20 minutes into the assessment, they figure out, ‘Wait a minute…she’s on my side. She’s not trying to pack me up and send me somewhere.’”

She says that often, the senior is able to stay in their own home, even those with memory issues. Myers and her staff make recommendations on what will be best for the senior, both in near and distant future. Rehab may be a necessary as a short-term solution, but they may be able to return to their home at a later time. Myers says she works with all scenarios and with all timeframes.

After years in the field, she has a wide network of resources allowing her to cover all the bases for her clients. From personal drivers, cooks, and housekeepers, to physicians and living communities, she will contact the right people for the specific situation. “We’ve done a lot of creative things for people to allow them to stay in their home.”

“[Suzanne] understood both sides of [my dad]…that he had dementia and was still a person. She made it the best it could possibly be.” – Melanie Miller

Such was the case with Miller’s father, who was able to stay in his own home but had to relinquish his car keys when Myers presented the situation to him. “Dad was able to accept from her what might have been very difficult to accept from his kids,” says Miller.

Miller appreciated the fact that Myers saw her father as a whole person, not simply as someone with dementia that could be difficult at times. “She understood both sides of him…that he had dementia and was still a person. She made it the best it could possibly be.”

Darold Jordan is another client of Myers’ who has been working with her for several years. Referred to Myers by a friend, Jordan hired Encompass to assist him and his wife when they needed some extra help around the house. “They’re flexible…they’ll do as much or as little as needed.” Jordan explains that Myers would spend four hours a day with his wife, helping her with her needs and tidying up around the house.

“[Encompass has] been very satisfactory and they have fulfilled our needs for a couple of years now,” he says. “They have several phases of assistance, which makes it adequate for most people’s needs.”

When Jordan’s wife died in June, Myers continued to help him with sorting through his home. He is currently in the process of downsizing and moving into an independent living community in the near future. The assistance that Encompass and Myers brought to Jordan and his late wife made a world of difference for which he is extremely grateful. “We actually got to stay in our own home,” he adds, obviously pleased.

Retirement Planning To-Do

I know a doctor who is thinking about retirement. He’s not overly concerned about his future. But his retirement is five years away.

The No. 1 factor, in my opinion, affecting anyone’s retirement savings is inflation. Inflation is relatively tame at the time of this writing, but it can still be harmful—even if you plan to retire in five years. So, here’s what I suggest:

1. Don’t quit on stocks. “To achieve returns to sustain a 30-year retirement, you need to still be investing for growth,” states Money magazine in its “Retirement Guide 2013” series published last October. If stocks make you nervous, then finding a way around that concern could be difficult. According to Bankrate.com, one-year CDs offer a 0.76% pre-tax yield. Money market accounts pay 0.49% per year. Yields on two-year U.S. Treasury bonds are even worse: 25%. (Figures through November 13, 2012.) You’d lose out to inflation if all you had in your portfolio were low-yielding investments. So, if you’re near retirement, based on your risk tolerance time horizon, I’d likely recommended a stock investment allocation of 30-40%.

2. Wait before taking Social Security. In general, most individuals should delay receiving their Social Security benefits. Money states that your payments can be 76% higher if you begin taking them at age 70 instead of at age 62. “Your payment will increase by about 6% a year for every year you delay filing before your full retirement age (between age 66 and 67 for most folks),” Money claims. “After that, holding off earns you another 8% a year until age 70.” Of course, your decision as to when to retire is a personal one. What’s best depends on a number of factors, such as your current cash needs, your health and family longevity, whether you plan to work in retirement, whether you have other retirement income sources, your anticipated future financial needs and obligations, and, of course, the amount of your future Social Security benefit. See Publication No. 05-10147, “When To Start Receiving Retirement Benefits,” at socialsecurity.gov to learn more.

3. Consider taking spousal benefit Social Security income early. Assuming your spouse is 62 and has been the lower income earner, and you are 62, you could file for benefits and postpone collecting them until you turn 70. Your spouse can begin collecting 50% of your benefit right now. See “Retirement Planner: Benefits For You As A Spouse” at at socialsecurity.gov.

4. Plan your retirement health care. If you retire before Medicare kicks in at 65, you could have a big expense ahead. “For a 62-year-old couple with one spouse in ill health,” states Money, “premiums run up to $2,300 a month on the individual market.” Ask your financial planner about bringing in a health insurance specialist, or look for an independent agent at nahu.org. Check with your company’s human resources department. You may be able to buy health care coverage when you retire. Remember that long-term care insurance will run about $4,000 a year for a couple in their early 60s, states Money. But if your assets total more than $1.5 million, I say pay for your long-term care as you go.

5. Line up some income. Want to consult? Now’s the time to gather clients and stay abreast of your field. You could also buy an annuity, which is a contract between you and an insurance company that pays out income and is designed for retirement purposes. Finally, practice living within your retirement income budget today. Doing so grounds your retirement planning in reality.

Jerome “Joe” P. Bonnett, Jr., CFP®, ChFC®, is an Independent Wealth Manager and President of Bonnett Wealth Management, Omaha. He is a 1987 graduate of the University of Nebraska with a bachelor’s degree in business administration, finance, and banking. He is a Registered Representative of Securities America, Inc. Member FINRA/SIPC. Bonnett resides in Omaha with his wife, Susan (Engdahl), and their two children, Jake and Claire. Bonnett Wealth Management and Securities America companies are unaffiliated.