InSight December 2011

1 InSIght MagazIne FALL 2011

Home Care

INSIDE

BUILDING CAREERS tHROUGH HOME CARE PLUS: PEOPLE-fIRSt LANGUAGE A DAy IN tHE LIfE BENEfItS UPDAtES AND MORE

INSIGHTFALL 2011

The MAgAzine For norThwesT hoMe CAre Aides

www.MySeIubenefItS.org

2 FALL 2011 InSIght MagazIne

Welcome to the first issue of Home Care

InSight, the magazine for Northwest Home

Care Aides.

The SEIU Healthcare NW Training Partner-

ship and the Health Benefits Trust care about

your work and your health. As Home Care

Aides, your work makes a critical impact in the

lives of others every day. And while you work to

care for others, you must also care for yourself,

keeping you and your family healthy.

Through Home Care InSight, we want to

share with you skills to improve your health;

share best practices from others in the profession; and provide you with the

most updated information about your training and benefits.

To this end, in this issue we explore the importance of people-first lan-

guage, offer health and wellness tips and provide the latest updates to train-

ing and benefits information – and much more.

We hope you will find this magazine useful in your work as a Home Care

Aide. Please let us know what you think – to share feedback and ideas,

please contact [email protected].

Charissa raynorexecutive director

SEIU Healthcare NW Training Partnership

SEIU Healthcare NW Health Benefits Trust

Naomi Ishisaka

SEIU Healthcare NW Training Partnership & SEIU Healthcare NW Health Benefits TrustNaomi Ishisaka

Inye Wokoma Lora Shinn, Dori Cahn, Manny Frishberg, Alison Sargent, Gayle Roberts, Dr. Rick ShepardRegan Conley

David Rolf, Board ChairSEIU Healthcare 775NW President

Marty Levine, MD, Board SecretaryGroup Health Cooperative, Assistant Medical Director, Primary Care

Nora GibsonFull Life Care, Executive Director

Adam GlickmanSEIU Healthcare 775NW, Vice President

Sterling HardersSEIU Healthcare 775NW, Vice President

Seth HemondSEIU Healthcare 775NW, Director Member Programs and Participation

Linda LeeHome Care Aide

Jesse MaganaConsumer Advocate

Dan MurphyDSHS Aging and Disability Services Administration, Director of Legislative & Policy Analysis

Karen WashingtonHome Care Aide

Jan YoshiwaraState Board for Community & Technical Colleges, Deputy Executive Director for Education Services

David Rolf, Board ChairSEIU Healthcare 775NW President

Ryan Jacobsen, Board SecretaryAddus Healthcare Regional Director

Tess CannonAddus Healthcare, Agency Director

Sterling HardersSEIU Healthcare 775NW, Vice President

Seth HemondSEIU Healthcare 775NW, Director Member Programs and Participation

Dan MurphyDSHS Aging and Disability Services Administration, Director of Legislative & Policy Analysis

Misha WerschkulSEIU Healthcare 775NW, Legislative and Policy Director

StAff

PUBLISHER

GRAPHIC DESIGN

CONtRIBUtORSPHOtOGRAPHER

WRItERS

PROOfREADER

BOARD Of DIRECtORStRAINING PARtNERSHIP

HEALtH BENEfItS tRUSt

EXECUTIVE DIRECTOR’S NOTE

© Copyright Home Care InSight Magazine. All rights reserved.

Contact Home Care InSight at [email protected] for permission to reprint or republish content from Home Care InSight.

Contact Home Care InSight: [email protected],

635 Andover Park West, Suite 200, Tukwila, WA 98188

Home Care InSight Magazine is a publication of the SEIU Healthcare NW Training Partnership and Health Benefits Trust to serve Home Care Aides in the Northwest.

Home Care

INSIGHT

Do you have a story about yourself or someone you know that would make a good topic for the next issue of Home Care In-Sight Magazine? We want to hear from you! Do you have a letter to the editor, a healthy recipe or question you want answered? Let us know!

Pass on your story ideas to InSight Magazine Editor Naomi Ishisaka at [email protected].

Have a Story you Would like to SHare?

COVER PHOTO OF ILENE, LEFT, AND MICHELLE HANNUM BY INYE WOKOMA. PHOTO OF CHARISSA RAYNOR ON THIS PAGE BY NAOMI ISHISAKA

EDItOR


EXECUtIVE DIRECtOR’S NOtE

DEPARtMENtS understanding diabetesCountry spotlightnutrition QuizWord spotlightCoping With grief

2

4

CONtENtS

Emily Rogers, Self Advocacy Coordinator for The Arc of Washington State, speaks

about the importance of “people-first” language.

Page 18

first person

tHE CLIMBfaMily essay

Of CARE AND KINGSfeatures

URGENt CARE OR ER?

BUILDING SKILLS, CREAtING CAREERS

PUttING PEOPLE fIRSt

A DAy IN tHE LIfEbenefits

tRAINING INfORMAtION

HEALtH BENEfItS INfORMAtION

8

3

12

14

18

22

27

30

PH

OTO

BY

INYE

WO

KO

MA


Con•su•mer1. A term used by people with disabilities or older adults instead of patient or client to show the right to an active role in the quality of care and services they receive.

Why use the term consumer? Academics and advocates of people receiving care prefer the term consumer, rather than patient, client, customer, employer, or service-user, since it emphasizes the consumer’s self-determination: their conscious choice to receive services as well as their control over them. Some struggle to accept the term consumer, wary of confusion with images of department store checkout lines. The Training Partnership and Health Benefits Trust use the term to describe individuals needing services.

The best course of action is always to ask those around you what they would like to be called – but consider consumer a safe default.

For more on the importance of people-first language, see story on page 18.

– Alison Sargent

what is diabetes? Diabetes means you have a high amount of

sugar in your blood. Over 25 million children and adults in the United States have diabetes, according to the American Diabetes Association. That’s a big number – but what may be worse is that 79 million people have pre-diabetes, which means they will develop diabetes if they don’t correct bad habits.

Are there different types of diabetes?Yes. Type 1 diabetes is often diagnosed in

children, teens and young adults. There’s often a genetic link – for example, perhaps a grand-mother or father has Type 1 diabetes.

Type 2 diabetes is often diagnosed in adults. Many (but not all) adults who are diagnosed with Type 2 diabetes are obese and not physically active. Like Type 1 diabetes, this form of diabetes is often genetic – perhaps your mother or father had diabetes. People who are growing older (over 45 or so) are also at risk of diabetes

what are the warning signs of diabetes?The symptoms for diabetes vary, but slowly in-

crease over time, particularly in the case of Type 2 diabetes. Symptoms can include:

• Feeling very thirsty or hungry• Infections or cuts that heal slowly • Urinating more often• Fatigue

how is diabetes diagnosed?A doctor will order a blood test to check glu-

cose (or sugar) levels; it may be a fasting or non-fasting test. If your blood sugar levels are higher than normal, then you may have diabetes.

what’s next, after diagnosis?The doctor will want to meet frequently to

review how you are controlling your blood sugar. You will learn how to recognize signs of low blood sugar and high blood sugar, how to check your blood glucose levels, learn to plan meals to reduce diabetes symptoms and learn how to give insulin.

how is diabetes treated?People diagnosed with diabetes inject insulin

under the skin, which lowers blood sugar. People with Type 1 diabetes take insulin daily, while some people with Type 2 diabetes can manage with diet and exercise alone.

Eating stable, consistent meals that are low in sugar can help manage your levels. Your doctor and a dietician will help you plan your meals.

You will check your levels with a glucometer, a device that takes a tiny drop of blood to test your sugar levels.

what are some possible problems associated with diabetes?

• A higher risk of heart attack due to difficulty controlling your blood pressure and cholesterol

• Eye problems and sensitivity to light • Foot problems, including sores and

infections that could lead to amputation (removal of the foot)

• Skin complications and infections• Hearing loss

read more about diabetesAt the American Diabetes Association website:

www.diabetes.org

Departmentsword sPoTLighT UndersTAnding diABeTes Knowing the Facts to Stay Healthy

By Lora SHINN


1. All fats in food are bad.

True or False?

FAlse. Fats are an important part of our

diet and they make food taste good. They

supply important nutrients and help the

body absorb vitamins. But some fats are

not as good as others.

2. Items that have a high percentage

of saturated fat include butter, cream,

cheese and ghee. True or False?

True. Dairy products often have a high

percentage of saturated fats. Because

they raise cholesterol, a diet especially

high in saturated fats can lead to heart

problems and high blood pressure.

3. saturated fats are associated with

cancer and heart disease. True or False?

True. Eating too much saturated fat is a

risk factor for heart disease and cancer.

Foods high in saturated fat (cookies,

cheese pizza, hot dogs) can be good

choices every once-in-a-while – just not a

good idea three times a day, every day.

4. “Healthy fats” are found in nuts,

fatty fish (like salmon) avocados and

olive oil. True or False?

True. Unsaturated or “healthy fats” do

not raise cholesterol in the blood. While

it’s not good to eat too much fat, a mod-

erate amount of unsaturated fat is fine.

5. A low-salt, low-saturated fat diet

can cause high blood pressure.

True or False?

FAlse. A high-salt, high-saturated fat

diet is often associated with high blood

pressure. A low-salt, low-saturated fat

diet is healthier for most people.

6. sugar is mostly found in desserts.

True or False?

FAlse. Sugar is often found in soft

drinks (pop), breakfast cereals and even

crackers. It can be called things like

“corn syrup,” “lactose” or “glucose.”

Daily sugary treats can promote tooth

decay and make you gain weight, which

can lead to more health problems.

7. Vegetables and fruits are part of a

healthy diet. True or False?

True. You can fill half your plate with

fruits and vegetables, both of which

supply great nutrients without many

calories. But try not to top them with too

much saturated fat (butter, high-fat salad

dressing).

8. eating meat is bad for you.

True or False?

FAlse. Meat is a fine way to meet your

protein needs. Choose lean or low-fat

cuts of meat for meals, and fish at least

twice a week. To avoid adding extra

fat, grill, broil, roast or bake meat, and

remove skin from poultry.

Departments

Are you a Nutrition Know-It-All? Find out with a quiz about fats, fruits and food

By Lora SHINN

HOW DID YOU DO?Add one point for each correct answer.

Count up your points and find your place

on the scale below:

0-3 poInTs: Need More Nutrition.

You’re on the right path by reading this

article. But it looks like you need to read

up on your nutrition.

3-6 poInTs: Nutrition Know-How. You

are fairly informed about healthy eating

options and you’re interested in learning

more. Keep up the good work!

7-8 poInTs: Nutrition Superstar. You

know what’s healthy and what’s not, and

you can help friends and consumers

learn how to take care of their health.

Read more about putting together

a healthy meal with the fun

“Choose My Plate” site from the U.S.

government: www.choosemyplate.gov

aBoUT Lora SHINN

Lora Shinn is a Seattle-based freelance journalist. She writes about career, business, food, health, travel and parenting for business, consumer, trade and custom publications. Her work has appeared in The Seattle Times, Wired, Parenting, Pregnancy, Inc., and many other publications.


STAgES Of gRIEfWhy do you feel so sad when waking up, a little better by

noon, and then angry by dinnertime? To help us understand, in

1969 Elizabeth Kübler-Ross outlined a model of grief’s stages,

in her book “On Death and Dying.” This model applies to

losses of every type, including death of a loved one, the end of

a serious relationship or a divorce, or the onset of a disease or

terminal illness.

People suffering loss may experience these stages in the or-

der below, but many people move back and forth between the

stages. You may first feel depression, then anger, acceptance,

and then move back to bargaining. You may even experience

different stages in just one day. You may not even feel all of

these emotions, but most people go through at least two.

deniALwhat you might say: “It’s fine, I feel fine, there isn’t a problem.”

what you might feel: You feel numb, in shock and unable to

cope with daily life. You don’t feel any emotions, but you also

have a hard time getting through the day.

Angerwhat you might say: “I can’t believe this happened to me.”

“Why me? It’s not fair!” “It’s all your fault that she died!”

what you might feel: You feel angry and rageful at the situ-

ation, at God or at a person you feel could be blamed (say, a

person who didn’t attend the funeral or someone who offered

insensitive advice).

BArgAiningwhat you might say: “If only I could change what happened.”

“I will give up all my bad habits if only it would fix everything.”

what you might feel: You wish you could change what is

happening or what has already happened. You may feel over-

whelmed with “what if” and “if only” thoughts.

dePressionwhat you might say: “I hate life.” “I don’t feel like getting out

of bed.” “There’s nothing good about today.”

what you might feel: You may cry and grieve for your loss,

either for a few moments or for hours. You recognize that what

has happened is final and you feel overpowered by heartbreak-

ing emotion.

ACCePTAnCewhat you might say: “It’s going to be OK.” “We had many

wonderful times together.”

what you might feel: You are in the process of acknowledg-

ing what happened – the good and the bad. You are coming to

terms with the fact that the loss is final, and you are beginning

to move on.

gOOD gRIEfDealing with the Types and Stages of Loss

By Lora SHINN

GRIEF continues on page 17

Departments

COmmON LOSSES• Death of close family member

(husband, wife, partner, parent, child)

• Diagnosis of serious illness

• Diagnosis of Alzheimer’s disease or dementia in a parent

• Divorce or the ending of a relationship

• Job loss

• Loss of a consumer or coworker you cared about


Ed. Note: Home Care Aides in the Northwest come from all over the world - East Africa, Asia, Eastern and Western Europe, Latin America. To help understand the people and cultures of the Home Care Aide population, we will present a spotlight on a country that many Home Care Aides come from.

When the owner’s of Seattle’s renowned Kokéb restaurant, Yeshi and Belete Shiferaw, arrived in Seattle 30 years ago, they were one of around 35 Ethiopian families living in the city. Since then, Seattle’s Ethiopian population has grown to over 25,000, making it one of the larg-est in the United States.

With its grey skies and rainy climate, Seattle is 8,300 miles and worlds away from Addis Ababa, Ethiopia’s capital city and the Shiferaws’ hometown. In 1974, Ethiopia’s emperor Haile Selassie was overthrown, causing many to flee the country. Belete Shiferaw’s father, a member of Selassie’s parliament, was imprisoned during the takeover.

“It was a very difficult time. A lot of people died,” says Belete Shiferaw over lentil sambusas at the Capitol Hill restaurant, named for “star” in Amharic. Belete fled to Sudan where he met and married Yeshi, also a refugee, and the couple immigrated to Seattle in 1980.

The regime fell in 1991 and the Federal Democratic Republic of Ethiopia (FDRE) was founded in 1995. The present government, led by Prime Minister Meles Zenawi, has been accused of rigged elections, as well as the sup-pression of widespread government opposition. In 2010, the Economist’s Democracy Index identified Ethiopia’s current leadership as an authoritarian regime.

The Shiferaws still hope to someday return to Ethiopia, but their children’s strong Ameri-can roots keep them anchored to their family restaurant, which has served Seattle delicious Ethiopian cuisine and culture for three decades.

Ethiopian staples include injera, a pancake-like sourdough bread made with teff flour which doubles as an eating utensil. Diners gather around a communal platter, ripping off spongy pieces of injera and using it to scoop up mouth-fuls of wat and alecha – traditional stews made with various meats, lentils, and vegetables. Berbere, a seasoning derived from red peppers, gives Ethiopian food its distinctive spicy flavor.

Yeshi and Belete Shiferaw share their family recipe for doro wat, or chicken stew. Wat dishes can also be made with vegetables, lamb, beef, or seafood. “The chicken, it takes a long time to cook and you only make it with chicken for a very respected guest,” Belete said. “Traditionally it’s a very, very special dish.”

Departments

Doro Wat (serves 4)

Ingredients:

1 whole chicken, cut into 8 pieces

2 tbsp. strained fresh lemon juice

2 tsp. salt

2 cups finely chopped onions

¼ cup niter kebbeh (herb butter)

1 tbsp. chopped, scraped fresh ginger root

¼ tsp. pulverized fenugreek seeds

¼ tsp. ground cardamom

1/8 tsp. ground nutmeg (preferably freshly grated)

¼ cup berbere (hot pepper spice mix available at

East African grocers)

2 tbs. paprika

¼ cup red wine

1 cup of water

4 hard-cooked eggs

½ tsp. ground black pepper

1 clove garlic

Pat the chicken dry and rub the pieces with lemon juice and salt. Put the chicken aside.

In a heavy 3 to 4 quart enameled casserole, cook the onions over moderate heat for 5 or 6 minutes or until they are soft and dry. Stir the onions constantly.

Stir in the niter kebbeh and when it begins to splutter, add the garlic, ginger, fenugreek, cardamom, and nutmeg, stirring well after each addition.

Add the berbere and paprika and stir over low heat for 3 to 5 minutes.

Pour in the water and wine, still stirring, and cook over high heat until the liquid in the pan has thickened to the consistency of heavy cream.

Drop the chicken into the simmering sauce, turning the pieces about until they are coated on all sides. Reduce the heat to the lowest point and simmer for 15 minutes.

With the tines of a fork, pierce ¼ inch deep holes over the entire surface of each hard-cooked egg. Then add the eggs and turn them gently about in the sauce. Cover and cook for 15 minutes more, or until the chicken is tender.

Fun FActsSeattle may be the birthplace of Starbucks, but Ethiopia

is the birthplace of coffee, the main export from the

region of Kaffa. Ethiopia is the only country in Africa

that was never colonized and one of the only with its

own alphabet. Ethiopia has been home to Christians,

Muslims and Jews, although the current population is

predominantly Christian and many of the words in its

official language, Amharic, bear religious significance.

somE bAsIc AmhARIc WoRDshello: tena yestilign (“ten-ah yes-tee-ling”)

Thank You: Igziabher yestilign (“ig-zi-ah-bear yes-tee-ling”)

SPOTLIgHT ON ETHIOPIABy aLISoN SarGeNT & eLaN eBaLING

WHERE IN tHE WORLD?

From left, Belete and Yeshi Shiferaw.

PH

OTO

S B

Y IN

YE W

OK

OM

A


Photos from Gayle Roberts’ hike up Mount Peak in the foothills of Mount Rainier.


The ClimbOne health care worker discovers that physical and emotional challenges require similar skills – perseverance, courage, and, most of all, support

“When we look at the potential for liv-ing more fully through facing our fears, we discover that what we as caregivers do matters deeply. It matters because we learn to honor life by allowing it to unfold on its own. It matters because we learn to be more appreciative of every moment. It matters because caregiving demands from us the best we have - body, mind, and soul.” - Beth McLeod

T he little town I live in is nestled in the foothills of Mount Rainier on a plateau. Hiking Mount Peak is a climb many locals frequently do when they want to get in shape. I had heard it was a beautiful but challenging hike, so one morn-

ing my son and I decided to climb Mt. Peak.It is not like I never exercise. I garden, I go for walks, I work

around the house. But just a few feet up the trail I realized I was not in the best of shape. I was out of breath from hiking straight up a hill instead of on level ground. It was painful and hard. I absolutely hated it! I complained to my son that I was in my 50s not 20s, and it may be too intense of a hike for me. About that time a woman in her 60s passed us going up.

By GaYLe roBerTS

fIRST PERSON

Gayle Roberts


I almost quit just before the last hill. I just could not catch my breath and real-ized the mild asthma I have was more severe from the exertion of this climb. My son offered to let me quit, but said, “You know, I think we have only one more hill left, and the view will be worth it.” So on we climbed.

When we got to the top, the view was amazing! Looking at how far I had climbed, I realized I couldn’t have made that climb alone. I needed someone to hike it with me, encourage me when I felt I couldn’t go on, and stop with me when I needed to.

On the hike down, I began to think about my life and the difficult climb I am in right now; caring for my mother who has dementia. It is overwhelmingly pain-ful to be a family caregiver and watch someone you love slowly get worse. After three hospitalizations in just two weeks, we made the difficult decision to place Mom in hospice. I am determined to be there for my mother. Being with her at this time matters greatly, to her and to me. This is one of the most difficult climbs I have ever made. And just like my hike up Mount Peak, I think it is important that I not try to do this climb

alone. Family can walk with me, friends, even professionals walk along at times. I need to remember that I can stop and rest when I need to. After all, this isn’t a race. I rest when I need to. When I am ready, I stand back up, and start climb-ing again. I know one day we will turn a corner, and realize we have made it to the top. That will be the day when I can go no further with Mom; she will have to climb to the higher elevation without me. I take comfort in my belief that she will be met by loved ones who have gone on ahead of her.

Caregiving has demanded of me the best that I have - body, mind, and soul. And to be honest, at times I have whined, complained, and said: “I can’t do this.” The mild problems I have in the lower lands – anxiety, fear, melan-choly – have become much worse when I am pushed to my limits. But I am doing this. One day, one step at a time, I am doing this. When I get to the top I know I will be pleased that I did my very best for Mom. That I didn’t turn away and let someone else do what I could not. I think when I get to the top of this climb, I will realize I am stronger than I ever thought I was.

aBoUT GaYLe roBerTS

Gayle Roberts is a longtime caregiver, homemaker and mother. She is a contract instructor for the SEIU Healthcare NW Training Partnership.

She started a site called the Beyond the Gate blog to share the “sweet, simple things in life.”

www.behindthegateblog.com

PH

OTO

S CO

UR

TESY OF G

AYLE RO

BER

TS


When Afi* entered our lives roughly six months later, he became the newest member of a family we had all ceased to be a part of. Grief had entered our house in the pre-cooked meals dropped off by friends, in home hospital equipment and dropping grades, averted eyes and closed doors. It entered us like radiation as our tight family nucleus rapidly divided, all five of us suddenly in more pieces than anyone could keep track of. How was Afi to navigate between my sister’s anorexia, my mother’s mindlessness, my brother’s silent stoicism, my absence?

We had been living with illness for months, but Afi was the hardest symptom to ignore. A large, middle-aged Samoan man, he was as thick and out of place in our house as the wavy black toupée he wore perched atop his bald-ing head, the occasional displacement of which becoming a sole source of humor. Afi smiled too much, he smelled too sweet and he made my father’s transformation into an impaired and dying man complete. I still needed my dad, but my dad needed Afi and I hated Afi for that. A hate that grew each time he readjusted my dad’s hearing aids, poured him water, helped him up the stairs, buttoned his shirt.

I hated that this was the man Afi knew. He didn’t know my dad the nature guy, who threw science experiment birthday parties, surprised me with cinnamon toast before early morning soccer games, brought home our family’s first guinea pig and helped us bury her in the yard six years later. My dad who played stand-up bass and mandolin, who dragged my fam-ily to bluegrass festivals and on camping

trips, who told bedtime stories about ghost cowboys and talking spiders and his delinquent teenage years growing up in Arizona. My dad who was so handsome his chemo and radiation nurses continued to make comments long after he lost his hair and his face swelled up from steroids.

Afi knew the dad who refused to speak to old friends, who cried with frustration when someone said something he couldn’t hear or understand, who inexplicably asked my mother again and again for a bulldog, who couldn’t get out of bed for my high school graduation. My dad who now sat and stared at hours and hours of late-night television, eyes glazed over, his bruised peach of a head rotting into the pillow.

I hated that Afi wasn’t experiencing our loss as profoundly and miserably as we were. My mother, brother, sister and I were sharing the same nightmare, and here was this person, wide-awake, watch-ing us toss and turn in our sleep. I kept

waiting to wake up, sure that any minute Afi would exit, the curtain would fall and he and my father would both re-enter, everyone join-ing hands for a communal bow.

I hated Afi but I also hated myself for hating him; an excess of hate that was compounded by discom-fort and confusion. Our relation-ship had no prototype – he was an invited but unwanted guest, an un-willing intruder seemingly able to make himself at home in a house where we no longer felt it our-selves. I didn’t know how to know Afi and I didn’t want to know him. How to be polite to some-one whose proximity makes your stomach churn? I wondered whether it would have been

different for my adolescent psyche had he been younger, older, a woman, a second generation American, thinner, whiter. But the real issue wasn’t who Afi was it was what his presence meant – his entrance into our lives marked my father’s exit.

Even now I try my best to erase him – to erase that entire year and a half. And still the only memory I have from my father’s funeral is of an impossibly solemn Afi draping a Samoan royalty mat across the wooden boards of my dad’s coffin. “Be-cause Daniel was a king.” I realized then that Afi knew our loss even if he couldn’t feel it; he’d probably known many before.

It was the first time I truly appreciated Afi and the last time I saw him. There were no re-entrances, no joined hands, no final bows, nothing to do but draw the curtain and begin again without him.

* Names changed to protect confidentiality

Of Care and KingsBy GINNY STaNSFeLD* fAmILY ESSAY

WE FOUnD OUT MY DAD HAD BRAIn CAnCER on november 1 my junior year of high school. It was a Monday, Dia de los Muertos, the day after Halloween, the eve of George Bush’s reelection; mornings were foggy and the days had just turned much, much longer.

PH

OTO

ILLU

STR

ATIO

N B

Y IN

YE W

OK

OM

A


> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >

> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >

> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >

Examples:■ Crushing or ongoing chest pain■ Profuse bleeding■ Loss of consciousness■ No pulse (start CPR)■ Choking, diffi culty breathing■ Limbs deformed or severed■ First-time seizure■ Signs of stroke: sudden numbness, weak-

ness, disorientation, diffi culty speaking■ Major burn or electric shock■ Sudden inability to walk

Symptoms that usually DON’T require

emergency or urgent care:■ Fevers, fl u, and cold symptoms■ Nausea, vomiting, diarrhea■ Rashes, skin infections, insect bites■ Minor burns and cuts■ Headaches

Call your doctor’s offi ce or the Consulting Nurse Service


Need care now? Not sure what to do?When sudden illness or a serious injury strikes you or your family, is your first

thought to go to the Emergency Department? For a life-threatening problem, that

is your best option. But if the problem is less urgent, other steps might get you

appropriate care even faster—and with a smaller co-pay. Here are some guidelines.

YESNot sure Not sureYES YES

No No

A CALL MAY HELP YOU GET HELP MORE QUICKLY

Your doctor’s offi ceKnows you and your medical history, and has access to your medical record. Group

Health medical centers and other personal physicians often have same-day appoint-

ments available, especially if you’re fl exible about which clinician you see.

Consulting Nurse ServiceAvailable 24/7 to help you sort through your symptoms and decide what to do. In an

emergency or urgent situation, nurses can direct you to the most appropriate care

facility. They can consult with a doctor—who is at the call center 24/7—on your behalf.

And, if you get your primary care at a Group Health–operated medical center,

nurses have access to your electronic medical record. In Western Washington, call

1-800-297-6877. In Eastern Washington, call 1-800-826-3620.

CAPITOL HILL URGENT CARE CENTER NOW 24/7

As of June 1, 2009, you can receive urgent care at our Capitol Hill Campus in Seattle

anytime, day or night. We also have Urgent Care Centers at Bellevue (24/7), Everett,

Olympia, Riverfront, Silverdale, and Tacoma medical centers. For details and hours

at all locations, go to www.ghc.org and search for “urgent care.”

26 NW Health Summer 2009 | ghc.org ghc.org | NW Health Summer 2009 27

Call 911

After hoursCall your doctor’s

offi ce or the

Consulting Nurse

Service for advice.

During offi ce hoursCall your doctor’s

offi ce for advice

or a regular offi ce

appointment. After hoursCall your doctor’s

offi ce or the

Consulting Nurse

Service


offi ce for advice or

a same-day

appointment.

Go to an Urgent Care Center if directed.

Examples:■ High fever that’s not coming down■ Severe asthma■ Possible broken bone■ Lacerations or severe cuts■ Puncture wounds■ Acute low back pain■ Second-degree burns■ Severe headache not helped by

home treatment■ Sharp abdominal pain lasting more

than an hour

CHECK YOUR ID CARD

The back of your health plan ID

card tells you what to do when

you need help in a hurry—

and includes other useful

information. It’s a resource you

can pull out anytime.

��

��

��

��

��

��

��

Is this a life-threatening emergency? Is this urgent? Is this non-urgent?

Between August 2010 and July 2011, Group Health mem-

bers from the SEIU Healthcare NW Health Benefits Trust (HBT)

made about five avoidable emergency room (ER) visits every

day, a total of about 1,700 avoidable ER visits during the year,

costing about $2 million. Most of this care should have been

provided in a different location at half the cost, and HBT ben-

eficiaries could have saved significant out-of-pocket expense.

The personal cost to each beneficiary for an avoidable emer-

gency room visit is a $200 co-pay. As an alternative, doctor’s

offices and urgent care centers are capable and willing to treat

these same conditions, and your co-pay is just $10 for Group

Health and $30 for Kaiser.

What can you do to get the care you need in the best loca-

tion? You need care right away but may not be familiar with

your options. Here’s a brief guide to help you get care right

away when you need it.

when it’s urgent but not life-threatening - same day appointments

If you need help right away during regular office hours,

Group Health’s Medical Centers and most Group Health pri-

mary care network physician’s offices offer same-day appoint-

ments. Call your doctor’s office and explain why you need an

urgent appointment. You may be surprised how quickly you

can be seen. It’s best if people see their personal physician for

most things because that consistency leads to quality care.

urgent Care CentersIf you can’t wait for regular office hours or for an appoint-

ment, what then? Group Health operates walk-in urgent care

centers in Western Washington and in Spokane. Also, Group

Health contracts with many walk-in community urgent care

centers.

The capabilities and hours of urgent care facilities vary from

location to location. The Consulting Nurse Service or your

community physician can best direct you to the closest urgent

care center.

how serious is it? what should I do? Just call and askCall 911 if you think you have a life-threatening problem. If

you’re not sure where to go, what to do, or whether the situa-

tion you’re experiencing is life-threatening, don’t hesitate to call

Group Health’s Consulting Nurse Service, available 24 hours a

day, seven days a week. The Consulting Nurse Service phone

number is on the back of your Group Health insurance card.

Group Health emergency and urgent care physicians provide

on-location backup at the Consulting Nurse helpline for difficult

or unusual problems. This greatly increases the health care

advice and treatment that can be offered over the phone. In

some cases it’s obvious that 911 should be called.

What if you receive care from a Group Health community

Getting care in a hurry: urgent Care or er?When sudden illness or a serious injury strikes you or your family, is your first thought: “Maybe we’d better go to the

emergency room?” While this may be your best choice for a life-threatening condition, it’s probably not your best

option for urgent but less threatening needs.

By rICK SHeParD, mDYOUR HEALTH


physician who is part the provider network?

Many doctors provide after-hours care by be-

longing to “call groups” where several doctors

share responsibility for calls. Some doctors

take their own calls. Just check with your doc-

tor before an emergency arises.

In summary …Everyone knows that if you’re severely

injured, you go to the emergency room. But

what if you are getting miserable with a cold,

cut your finger, have sudden back pain, or

your child is screaming in pain? Your doctor’s

office or the Group Health Consulting Nurse

Service can direct you to the best care.

are you prepared?The very nature of emergencies is that they

happen fast and require quick action. Prepar-

ing ahead can save precious moments. Make

sure you select a personal physical and keep a

list on your refrigerator and in your wallet that

includes:

• Your doctor’s name and phone number.

• Your family’s Group Health consumer

numbers.

• The phone number for the Consulting

Nurse Service.

• Addresses and phone numbers of the

nearest urgent care and emergency facili-

ties.

• Any ongoing health conditions family

members are being treated for.

• Medications (and dosages) you’re cur-

rently taking.

• If you have advance directives (such as

durable power of attorney, living will, organ

donation card).

To get a free Medication Record card, call the

Group Health Resource Line at 206-326-2800

or 1-800-992-2279.

> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >

> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >

> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >

Examples:■ Crushing or ongoing chest pain■ Profuse bleeding■ Loss of consciousness■ No pulse (start CPR)■ Choking, diffi culty breathing■ Limbs deformed or severed■ First-time seizure■ Signs of stroke: sudden numbness, weak-

ness, disorientation, diffi culty speaking■ Major burn or electric shock■ Sudden inability to walk

Symptoms that usually DON’T require

emergency or urgent care:■ Fevers, fl u, and cold symptoms■ Nausea, vomiting, diarrhea■ Rashes, skin infections, insect bites■ Minor burns and cuts■ Headaches



Need care now? Not sure what to do?When sudden illness or a serious injury strikes you or your family, is your first

thought to go to the Emergency Department? For a life-threatening problem, that

is your best option. But if the problem is less urgent, other steps might get you

appropriate care even faster—and with a smaller co-pay. Here are some guidelines.

YESNot sure Not sureYES YES

No No

A CALL MAY HELP YOU GET HELP MORE QUICKLY

Your doctor’s offi ceKnows you and your medical history, and has access to your medical record. Group

Health medical centers and other personal physicians often have same-day appoint-

ments available, especially if you’re fl exible about which clinician you see.

Consulting Nurse ServiceAvailable 24/7 to help you sort through your symptoms and decide what to do. In an

emergency or urgent situation, nurses can direct you to the most appropriate care

facility. They can consult with a doctor—who is at the call center 24/7—on your behalf.

And, if you get your primary care at a Group Health–operated medical center,

nurses have access to your electronic medical record. In Western Washington, call

1-800-297-6877. In Eastern Washington, call 1-800-826-3620.

CAPITOL HILL URGENT CARE CENTER NOW 24/7

As of June 1, 2009, you can receive urgent care at our Capitol Hill Campus in Seattle

anytime, day or night. We also have Urgent Care Centers at Bellevue (24/7), Everett,

Olympia, Riverfront, Silverdale, and Tacoma medical centers. For details and hours

at all locations, go to www.ghc.org and search for “urgent care.”

26 NW Health Summer 2009 | ghc.org ghc.org | NW Health Summer 2009 27

Call 911

After hoursCall your doctor’s

offi ce or the

Consulting Nurse

Service for advice.


offi ce for advice

or a regular offi ce

appointment. After hoursCall your doctor’s

offi ce or the

Consulting Nurse

Service


offi ce for advice or

a same-day

appointment.

Go to an Urgent Care Center if directed.

Examples:■ High fever that’s not coming down■ Severe asthma■ Possible broken bone■ Lacerations or severe cuts■ Puncture wounds■ Acute low back pain■ Second-degree burns■ Severe headache not helped by

home treatment■ Sharp abdominal pain lasting more

than an hour

CHECK YOUR ID CARD

The back of your health plan ID

card tells you what to do when

you need help in a hurry—

and includes other useful

information. It’s a resource you

can pull out anytime.

��

��

��

��

��

��

��

Is this a life-threatening emergency? Is this urgent? Is this non-urgent?

aBoUT rICK SHeParD, mD

Dr. Rick Shepard is Group Health’s Medical Director of Network Utilization.

By rICK SHeParD, mD

COURTESY OF GROUP HEALTH


Michelle Hannum brushes her mother-

in-law Ilene Hannum’s hair as part of her

daily Home Care Aide responsibililtes.


When longtime health care

worker Michelle Hannum’s

mother-in-law needed

around-the-clock care, she knew she

was the best person for the job

“(She has) severe dementia, 100

percent incontinent

and immobile. She’s

100 percent depen-

dant, so it’s 24/7 care,”

Hannum explains.

“Someone in our family

is always here, but I am

the primary caregiver.

I do have a couple of

daughters here that

step in as well. So I do

have a good support

system here at home

so I am able to step out

when I need to.”

Hannum, from Spokane, worked

as a health care aide for a decade, in

skilled nursing facilities, adult family

care homes and as a Home Care Aide

before she and her husband decided

his mother should move in with them so

Hannum could assume responsibility for

her care.

“I got into this because I am a natural

nurturer. Just having kids of my own …

you just develop that nurturing state,”

she says. “I figured I would be best at

making money doing that. I find it very

rewarding to bring joy to another person

in a less fortunate situation, whether it’s

medically, emotionally, financially. I’ve

been in the caregiving field for about 12

years. I’ve worked in group homes and

in adult family homes. I’ve worked with

the developmentally disabled.” She says

she really prefers to work on-on-one with

individual consumers, rather than in

group settings.

“The group homes that

I worked in were not as re-

warding because it wasn’t

so much one-on-one. I

really decided that I like

the time that I can spend

one-on-one with a client,

whether it’s family or just

someone I’m taking care

of. Just caring for their soul

makes a tremendous dif-

ference in their lives.” Two-

and-a-half years ago, Han-

num, a member of SEIU

775NW, made another change, taking on

the job of caring for her mother-in-law,

Ilene Hannum, as a Home Care Aide,

through Washington state.

“The only way we can have her in her

home is because I am a paid caregiver

BUILDING

By maNNY FrISHBerG

CREAtING SKILLS

CAREERSSpokane Home Care Aide Michelle Hannum goes back to school with a Medical Assisting scholarship to build on her skills, improve her life

CAREER PATHWAYSP

HO

TO B

Y IN

YE W

OK

OM

A


and can stay home,” she says. “If I had

to go generate that income outside of the

home, it wouldn’t work to have her here.”

Providing 24/7 care for her mother-

in-law is not Hannum’s only full-time re-

sponsibility. Now in her mid-40s, she has

been married for the past 25 years and is

raising two girls and two boys of her own,

ranging in age from 14 to 22 years old.

She is also a full-time student at Spokane

Community College, working to earn

an AA degree. Thanks to a scholarship

from the SEIU Healthcare NW Training

Partnership she will be starting a Medical

Assistant program at the community col-

lege beginning of 2012.

“I got an email, because I’m a care-

giver in the union, stating they were

going to award 10 scholarships. Really, it

was an answer to my prayers because I’d

already enrolled in school. The amazing

thing is I get to start in January. I don’t

have to wait – it just gets the ball rolling

immediately for me.”

Hannum says she became interested

in becoming a Medical Assistant after

spending time with consumers (clients)

approaching the end of their lives.

“Seeing hospice come in, in several

different instances, I realized there’s so

much more to know out there, just about

the physical part of the body,” she says.

“So I’ve recently taken an interest in that

and wanting to further my education that

way, and possibly see where that takes me.

I am good at what I do but because I never

pursued higher education, I have reached

my max in responsibility and pay.”

Medical Assistants work with doctors

in medical offices and clinics, doing a

range of duties including greeting pa-

tients, updating patient medical records

and scheduling appointments as well

as performing basic lab tests draw-

ing blood, and preparing patients for

examination. The scholarships (10 were

offered to members of SEIU 775NW who

are employed as Home Care Aides) are

funded by a grant to the Washington

Health Care Worker Training Coalition

from the U.S. Department of Labor, paid

for the through American Recovery and

Reinvestment Act and administered by

the Training Partnership.

The scholarship will pay Hannum’s

school expenses for five quarters, time

enough to complete the Medical Assis-

tant certificate program. Although most

students can finish in one year, she says

recipients are given the extra time “to

lighten the load a little bit because we’re

all working.” Because she had already

completed the program’s prerequisites

and taken other classes before getting

the scholarship, Hannum will be just five

credits short of completing her Associate’s

degree, so she plans to take those after-

ward. She says she is confident that she

can juggle all those responsibilities since

the school is offering most of the program

online. She will be on campus for a three-

hour lab session one day a week, when

her daughters will be available to take

care of their grandmother, both of whom

are fully trained in her care.

“While I’m working I get to do school

as well as be home, so I just can’t even

think of a better scenario to construct

this,” Hannum says. After finishing her

schooling she expects to gain experience

in the job working in a doctor’s office or

clinic, though her long term goal is to

find a place in a hospital setting where

she can work nontraditional hours.

“I’m not necessarily looking for the

perfect 8-to-5 job, just because my kids

are older now and I’m more flexible,”

she allows. “I just see myself more in a

nontraditional setting. I’m not sure where

this will lead to at this point.”

One thing Hannum says really worries

her is the threat of further cuts to the

state budget in the coming year and

what that will do to funding for home

care. She feels that cuts to the program

that pays Home Care Aides like herself

would be penny-wise but pound-foolish.

“I just keep playing that out in my

mind, thinking, where does that send

these people that are getting in-home

caregiving? My mother-in-law, for

instance.” She says if the state cut the

funding that pays for her to work at home

and she had to go elsewhere to earn a

living, her mother-in-law would have to

be moved to an adult family home or a

nursing home. As a Medicare-Medicaid

recipient she qualifies for either.

“Both of those are higher cost to

the state than the in-home caregiving.

I’m the least expensive option of those

three,” Hannum says. “If these programs

are cut, we’re going to be faced with no

choice except to place her into a nursing

home, which will increase the state’s cost

for her care. So it’s mind boggling to me

that they’re cutting what is essentially

the least expensive option of the care of

these clients.”

PH

OTO

BY IN

YE WO

KO

MA


gET HELPThe healing Center: Offers grief support

groups and individual counseling for

adults, children and families who have

experience the death of a loved one.

Some services are offered for free, while

others are on a sliding scale (based upon

your income).

www.healingcenterseattle.org

group health Bereavement support. Of-

fers support groups for individuals deal-

ing with the death of a loved one. Free.

www.ghc.org/classesAndEvents/

bereavementgroups.jhtml

Psychology Today Therapy directory.

Use this website to find an independent

counselor or therapist to help you with

your loss.

http://therapists.psychologytoday.com

Ask your church, mosque or temple

whether support groups are offered.

If SOmEONE YOU KNOW IS EXPERIENCINg LOSS: DOS AND DON’TS

don’t: Try to make them feel better by

saying things like “He’s in a better place,”

or “Your divorce is for the better” or

“You’ll get over it soon.”

do: Ask how he or she is feeling. Say

you’re sorry for the loss and let her know

you are available to talk. Offer a hug or

your phone number for support.

don’t: Ignore a person going through

loss. Be aware that at one moment, they

may feel happy, then they may feel sad

or angry.

do: Ask how they’re doing and watch

for signs of depression (never laughing,

never smiling). If you’re worried about

them, let them know of your concern and

point out support groups.

IN THE WORKPLACE:

Many of us have to go back to work,

even when dealing with a loss or grief.

Here are ways to make it through the day,

with suggestions from Shannon Armitage,

a Seattle-based therapist:

1. summon a saying. Come up with a

reassuring phrase you can repeat when

you feel stressed or sad. Something like,

“Go easy on myself,” or “I promise to

take as good care of myself as I can.” It

can also be a prayer or religious verse

that has meaning for you, as long as it

brings comfort and peace.

2. hold on. Find a tactile object (a

special pebble, a piece of paper you’ve

written a saying onto, a piece of special

cloth) that you can keep in your pocket

for reassurance, or wear a favorite sweat-

er that comforts. “Children are comforted

by blankie,” Armitage says. “We’re not

that different from children, although we

like to think we’re different.”

3. Visualize the day. Imagine the kind

of day you’d like to have, before getting

out of bed in the morning or while on

your way to work. How will you respond

to your supervisor, your coworkers and

your customers? Visualize a calm, posi-

tive day.

4. Take breaks. Make sure you take

breaks throughout the day. During that

time, focus on your feelings. “Allow your-

self to feel sad or angry, but be gentle

with yourself,” Armitage says. Go for a

walk in the sunlight to “reboot” your emo-

tions, because emotional stress can also

drain the body. Or find a peaceful spot

on-site or in a park, where you can gather

your emotions.

5. Find an ally. Share your story with a

friend; you may find others who have

experienced a similar loss. A supportive

ear can help you cope emotionally.

GRIEF continued from page 6

Loss Q&A WIth shAnnon ARmItAGE a Seattle-area lICenSed therapISt

Q: does time really heal all wounds?

A: Time can help. The more recent

the event, much more strongly you

might be feeling your emotions. Or

you might feel numb until the emo-

tions set in, later. But in the immedi-

ate aftermath, it’s hard not to think

about anything else. Time does ease

this a little bit.

Q: is there a sign that you should

seek help?

A: If your feelings about this loss

start to limit or affect your daily

activities, that’s a warning sign. For

example, if you’re not enjoying the

things you used to enjoy or going

places you used to go, it’s gone

beyond what you can handle on your

own. You need to reach out to a sup-

port network or find a professional

person to talk to.

FIRsts

ticks and stones can break my bones

but words will never hurt me,” the old

schoolyard chant goes. Yet, while the les-

son it was meant to instill about not taking

taunts and teases to heart was a positive one, our

society has come to another conclusion: words

can hurt.

Emily Rogers is the Self Advocacy Coordinator

for The Arc of Washington State, which advocates

for people with developmental disabilities. As a

child growing up with cerebral palsy, she recalls

being teased by schoolmates.

“Kids get teased a lot, any kid will get teased,

but on occasion it seemed that in some regards

I got teased more and with more bite to it,” she

says.

It is no longer acceptable, as it was half a cen-

tury ago in at least some places, to unthinkingly

toss off a racial epithet like the notorious “N-

word” (now so taboo even discussing it requires

a euphemism). Still, one group that continues to

routinely face insensitive language is people with

disabilities. Most people still see nothing wrong

with saying: “Joe is wheelchair-bound” or “Sarah

is retarded.” But those are terms that make it

harder for others to see Joe and Sarah, first and

foremost, as just people.

“If you’re going to hear a couple of phrases

that people are most upset about, they would be

‘retarded,’ ‘handicapped.’ I guess the third thing

I would say is ‘wheelchair bound,’ ” says David

Lord, Director of Public Policy for Disability Rights

Washington. “You’re a wheelchair user but you’re

not bound to it, like basically somebody ties you

into it. You can get in and out. It’s actually a tool,

something that liberates you, as opposed to being

bound to it.”

The movement to change the way people talk

about disabilities and the people who live with

them has been around for decades. Groups like

PuttInG

PeoPleMovement toward “people-first”

language puts respect, independence front and center

By maNNY FrISHBerG

FALL 2011 InSIght MagazIne18

SdfSdfSadfSdfSdBEST PRACTICES

Emily Rogers, Self Advocacy Coordinator for The Arc of

Washington State, at work at the Capitol in Olympia during the special legislative session

in December.

PHOTO BY INYE WOKOMA 19 InSIght MagazIne FALL 2011

terms that stereotype and Devalue

the handicappedthe disabled

normal people/healthy individualsatypical kids

the mentally retarded; retarded peoplehe/she is retarded; the retardedhe/she’s a Downs kid; a Mongoloid

the autistic

the mentally ill; the emotionally disturbedis insane; crazy; demented; psychoa maniac; lunatic

he/she is learning disabled

the deaf

is deaf and dumbmute

the blind

an epileptica victim of epilepsy

a person who is wheelchair bounda person who is confined to a wheelchaira cripple

a quadriplegicthe paraplegic

a dwarf or midget

he/she has a birth defect

handicapped buses, bathrooms, hotel rooms, etc.handicapped parking

elderly

client, patient

Adapted from the Texas Council of Developmental Disabilities

People-First Language to use

people/individuals with disabilitiesan adult who has a disabilitya child with a disabilitya person

people/individuals without disabilitiestypical kids

people with intellectual and developmental disabilitieshe/she has a cognitive impairment a person who has Down syndrome

a person who has autism

people with a mental illnessa person who has an emotional disability with a psychiatric illness/disability

a person who has a learning disability

a person who is deafhe/she has a hearing impairment/loss

a man/woman who is hard of hearing person who is deaf and cannot speakwho has a speech disorderuses a communication deviceuses synthetic speech

a person who is blinda person who has a visual impairmentman/woman who has low vision

a person who has epilepsypeople with a seizure disorder

a person who uses a wheelchairpeople who have a mobility impairmenta person who walks with crutches

a person who has quadriplegiapeople with paraplegia

he/she is of small or short stature

he/she has a congenital disability

accessible buses, bathrooms, etc.reserved parking for people with disabilities

older adult

consumer

the National Easter Seal Society

and the National Rehabilitation As-

sociation have been writing about

respectful terminology for talking

about disabilities since at least the

mid-1980s. In 1992, John Folkins

of the American Speech-Language-

Hearing Association’s publications

board put out extensive guidance on

the subject as a resource for editors

and authors. Still, the movement

really gained traction when, in 2005,

Washington state led the way in

adopting what has come to be known

as “People-First Language” in the

state’s laws and regulations. Rogers

was one of the principal advocates

for the bill, which replaces older

terms in laws when they come up for

renewal or revision.

Lord explains, “Over the last few

years we’ve been going through

a process of changing all of our

statutes and all of our regulations to

language that’s respectful to people

with disabilities.” He says some

examples are using the term “people

with disabilities” and not “disabled

people” or “handicapped.” Lord says

the coalition to lobby for that change

was spearheaded by people with

developmental disabilities who had

a particular dislike for the word “re-

tarded.” Ironically that bill didn’t get

rid of that particular word because it

continued to be used in federal laws

and they wanted to make sure that

the change did not cause any confu-

sion. That was remedied a few years

ago when a national bill to discard

the term was passed.

Rogers adds that while the real

process of change comes through

educating people, one by one, she

is hopeful that the statute can help

affect people’s perception of what is

respectful and appropriate.

“It’s not going to come from

top-down,” she says, “but rather

(through) personal conversations with

FALL 2011 InSIght MagazIne20


one another.”

While the movement to change the

ways we talk about someone who uses

a wheelchair to get around or a person

with a developmental disability is mak-

ing headway, advocates for people-first

language face ridicule for promoting

“political correctness.” But Rogers says

the real issue is respect.

“So many people that I worked with in

the past … have felt really disrespected

and really put down and really upset by

the use of some of the old terms referring

to folks with disabilities,” she says. “It’s a

visible reaction that people have to terms

like ‘retarded’ and that sort of thing. So,

for them it’s very personal and it’s very

emotional. Really, the respect issue is

huge. Lots of folks with disabilities feel

hugely disrespected and almost as if

(they’re) second-class citizens because

of their life experience.”

The concept of “people-first language”

is the idea that disabilities are not people

and they do not define who a person

is, so the general rule is to not replace

personal nouns with disability nouns, like

“the schizophrenic,” “stutterers” or “the

hearing impaired.” Instead, advocates

say, use terms that emphasize the per-

son rather than the disability by putting

the person-noun first, using phrases

such as “the lawyer who has dyslexia,”

or “people with cleft palate.”

“In terms of people-first language and

respectful language, the idea is that the

person is going to come first in the way

that you speak, and the way that you

describe it,” Rogers says. “It’s really

about having the disability be the thing

that comes after the descriptor of the

person. So there’s sort of a separation –

I’m a person, then I have a disability, and

then I’m a mom or a dad, or a husband,

or whatever it is. As a person with a dis-

ability, my value doesn’t come from my

disability. It’s part of my life and it’s part

of how I experience life, but it’s not me.”

At the same time, Lord acknowledges,

not everyone with a disability feels

equally strongly about the issue. He says

there is no unanimity on which words or

phrases are to be avoided

“I hear a lot of people refer to them-

selves as handicapped. People have

different perspectives,” he says. “A lot

of people don’t care, and other people

think that it’s really important. There’s an

approaching consensus on some things.

I think there’s probably consensus on the

word ‘retarded.’ Fairly recently the medi-

cal community figured out that was in

the same category as ‘idiot’ or ‘imbecile’

– words that used to be legitimate medi-

cal terms that are now obsolete and of-

fensive and slurs. That’s where ‘retarded’

is right now. There’ll be another word

some other day.”

From the perspective of Home Care

Aides and others who work with people

with disabilities, it can be a matter of pro-

fessionalism, one of those things people

learn when they’re in a profession. How

much it matters to a client may be an

individual preference.

“There’s some things, like how you do

a transfer – you can do a transfer right

or you can do it wrong,” Lord says. “But

there’s also variations – different people

have different kinds of views on how they

want the transfers done. I think it’s that

way with language. It’s good to know and

to be sensitive.” At its core it is a ques-

tion of respect, on both the individual

and societal levels.

“I think that words have huge power

and that we need to be conscious about

how we speak about one another, includ-

ing people with disabilities,” Rogers

adds. “I’m hopeful that in changing the

way that we speak that we take on a

different angle. For me the difference in

language means that everybody has the

same opportunities.”

I’M A PERSON, THEN I HAVE A DISABILITY, AND THEN I’M A MOM OR A DAD, OR A HUSBAND, OR WHATEVER IT IS. AS A PERSON WITH A DISABILITY, MY VALUE DOESN’T COME FROM MY DISABILITY. IT’S PART OF MY LIFE AND IT’S PART OF HOW I ExPERIENCE LIFE, BUT IT’S NOT ME. - EMILY ROGERS

Then-Gov. Gary Locke at the 2004 bill signing to create a “people-first” language standard for Washington state. Emily Rogers is next to him on the left.

PH

OTO

CO

UR

TESY

OF

EMIL

Y R

OG

ERS


A DAY IN THE LIfEfrom exercise, medication, cleaning, transfers, grooming – a day with Home Care Aide Rae Kirumbi is anything but dull

W hen you ask Rae Kirumbi about his job as a Home

Care Aide, his face breaks into a wide smile. A soft

spoken man with kind eyes and a gentle manner,

Rae positively beams when he talks about his work. “It’s very,

very rewarding,” he says. “You feel your life is richer.”

Before he was a trained Home Care Aide (HCA), Kirumbi

volunteered with people in hospitals. “On my days off I would just

go to hospitals and visit people and spend some time with them,”

he says. “If I have something to buy, just one orange, I go there

and give (it to) them, and just spend time with them and show

them how much you care. You don’t have to know the person but

the way they appreciate, you go home with that satisfaction. It’s

something you cannot buy.”

His first consumer (or client) suggested he go to an agency to

get paid for the work he was already doing. Employed by Full Life

Care for almost five years now, he also works in the memory care

unit at Emeritus assisted living facility in Bellevue, where he has

become an assistant director.

STORy By DorI CaHN

PHOTOS By INYe WoKoma

SPOTLIgHT

Above left: Rae Kirumbi and Loren Mott study the exhibition guide for the Frye Art Museum’s resident collection.

Above: As a part of their weekly routine Kirumbi helps Mott do exercises. Right: Kirumbi gives Mott a haircut.


Kirumbi and Mott frequently go on walks and outings

after they finish their weekly household duties. One of

Mott’s favorite places to visit is the Frye Art Museum.


Going to work in someone else’s

home requires trust and mutual respect.

Knowing how to achieve this comes

from experience and guidance, which

Kirumbi offers to new workers through

the Training Partnership’s peer mentor-

ing program. “That’s a training I wish I

had when I started,” he says. “Because

having this person who is not your

supervisor … you create that friendship,

and they are free to ask any questions.”

Kirumbi helps mentees learn how to

develop relationships while maintaining

professionalism.

Kirumbi came to the United States

from Tanzania in East Africa nearly 10

years ago. Growing up in a home with

seven children and a large extended

family prepared him to deal with many

kinds of relationships and people, but

the cultural differences he finds here

have sometimes surprised him. When

the mother of a 45-year-old male con-

sumer showed Kirumbi how to give her

son a bath, he was shocked to see a

woman bathing an adult male, some-

thing that would never happen in his

home culture.

Navigating cultural differences can

take more than acceptance and adapta-

tion. He tells of a co-worker whose

consumer asked her to cook pork, some-

thing that the HCA could not do. But the

consumer did not want to lose the Home

Care Aide, and so they had to brainstorm

ways for the consumer to get the food

he wanted without asking the HCA to do

something against her wishes. Fortunate-

ly, Kirumbi has never found that these

differences inhibit building relationships

with a consumer.

Working in memory care is Kirumbi’s

favorite job. While it can be extremely

challenging to care for people with

Alzheimer’s and dementia, he finds it

exciting. Those consumers are also some

of the most grateful and rewarding, often

because they have the hardest time

showing it.

“I have one person, I was working my

shift and I went to change him. This per-

son, he used to be a doctor, and he lost

his ability to speak. So after… making

sure he was comfortable, on my way out,

I was at the door, holding the door, and

at the back I heard him say ‘thank you.’

That meant a LOT to me. Just thinking

Navigating cultural differences can take more than acceptance and adaptation. Kirumbi tells of a co-worker whose consumer asked her to cook pork, something that the HCA could not do. But the consumer did not want to lose the Home Care Aide, and so they had to brainstorm ways for the consumer to get the food he wanted without asking the HCA to do something against her wishes.

Kirumbi meets with Luster Mitchell Sr. on a weekly basis.

Mitchell uses a wheelchair to get

around most of the time, however with a leg brace he is able

to go short distances using a walker.


about how hard he tried to have that

word. I can never forget that.”

Working in memory care also means

seeing consumers pass away, some of

whom may have been in care a long

time. “We have some people who have

lived there for five years. You used to

play puzzles with this person, they used

to be able to do everything by them-

selves.

“They really encourage us not (to get)

attached. I don’t know how you can work

without being attached. Because this

type of work needs people who are car-

ing. And you are caring for them every

day. I don’t know how you can do that,

but most training they say, ‘OK, you be a

professional, just go there to work, and

don’t be attached to them.’ But these are

people, they affect our lives.

Kirumbi also continues to work with

in-home consumers. When there is a

family in the home, relationships and

respect need to be built with every mem-

ber of the household. One of his current

consumers is person who is recovering

from a stroke who lives with his fam-

ily, including a wife and grandchildren.

Noise and activity fill the house, and

Kirumbi tackles the task of becoming

an integral part of the household while

maintaining his professional role. The

consumer had already kicked out several

Home Care Aides by the time Kirumbi

met him. “The first time we are trying to

read each other, and I’m trying to make

him comfortable. Everyone called him

grandpa, so I asked him, ‘Is it OK if I call

you grandpa?’ He said OK. I just wanted

to blend in. And slowly he started to treat

me like he treats his grandchildren.”

Once the family could see the relation-

ship Kirumbi had with the grandfather,

they came to appreciate him and respect

the systems he created that ensure

complete and methodical care for his

consumer.

A Home Care Aide may sometimes

want to change the consumer’s routine,

but if the consumer is free to make

choices and be themselves, “they are

able to trust you. They know you don’t

judge them, you are their friend, you

have that unconditional friendship,” he

says. “You help them to feel good and

… not to become totally dependent

on other people.” Sometimes it means

letting the consumer make choices that,

while safe, may be unconventional, like

wearing two different socks or sleeping

until two in the afternoon. Sometimes it

means having to confront a family mem-

ber’s expectations or desires; they may

want their loved one dressed a certain

way or be awake when they come to

visit.

It often will fall to Home Care Aides

to help families come to grips with the

changes that aging or illness has brought

to their loved one.

“It’s hard. I don’t think I’ll be able to

do this to my mom or my dad,” Kirumbi

admits. “When I have a difficult situation

and I’m trying to explain something (to a

family) and they don’t understand, I just

try to put myself in their shoes, and say

‘maybe I’ll be like them.’ And that helps

me not to criticize or be mad, helps me

to be more professional, to know I will be

like them too.”

The intangible rewards of the work

have kept Kirumbi working in home

care for more than seven years. “If

you want to work as a Home Care Aide

just for money, it won’t work,” he says.

“What we do is way more than what

we get paid for. I can say this – you get

two paychecks. There’s one paycheck

you get after every week or at the end

of the month, and there’s one you get

every day, that you got the chance to

help someone. You can go home and

lay down on your pillow and say, ‘ah, I

helped this person.’ ”

Kirumbi and Luster Mitchell

Jr. help the senior Mitchell

transfer from his wheelchair to another seat.


for assistanceComuníquese con el Centro de Recursos para Miembros al 1-866-371-3200 si necesita asistencia para registrarse en su entrenameinto o para saber cuál es su elegibilidad para los beneficios de salud.

如需在安排培训日程或了解您是否有资格获取保健福

利方面获取协助，请致电 1-866-371-3200 联系会员

资源中心。

hãy gọi trung tâm nguồn lực thành Viên theo số 1-866-371-3200 nếu quý vị cần được trợ giúp trong

việc lên lịch đào tạo hoặc tìm hiểu về điều kiện để nhận phúc lợi y tế.

훈련일정을 잡거나 건강혜택 자격 확인을 위해 도움

이 필요하시면 회원지원센터 1-866-371-3200로 전

화주세요.

Если у Вас есть вопросы, связанные с определением расписания занятий, или относительно получения Вами пособия по нетрудоспособности, обращайтесь в Учебно-методический центр по телефону 1-866-371-3200.

traInIng QuICk Start Individual providers1. Find Your Training standards• There are different Home Care Aide standards depending on what category of care

you provide.• Use the online Training Wizard – a tool to help

you know which category applies to you – to find your individual training standards. Go to: www.myseiubenefits.org/wizard to complete the Wizard.

2. schedule Training early• Locate or create your Username and Password (see page 8 of your Benefits Book).• Go online to www.myseiubenefits.org to log in to register for training

or call the Member Resource Center at 1-866-371-3200. 3. get student id Card in the Mail• Your Student ID card will be mailed to the mailing address you provided to your primary DSHS contact. If you don’t receive your

ID card within 7-14 days of your hire date, fill out a Contact form at www.myseiubenefits.org/contact or call the Member Resource Center at 1-866-371-3200.

agency providers1. review chart on of your Benefits Book to see who can support you.

GEnERAL benefItS InforMatIon

health benefItS QuICk Start1. Check your eligibility for health insurance benefits and enroll

individual Providers: Go online to www.myseiubenefits.org to log in to see your eligibility and enroll online, or call the Mem-ber Resource Center at 1-866-371-3200. Your eligibility for health insurance depends on the number of hours you work. Agency Providers: Contact your employer to see if you are eligible for health benefits through your employer.

2. Make an appointment with your primary care doctorGo to your health insurance provider’s website or contact them by phone (see contact info on Page 5) to find available doctors and other providers. See the Health Benefits section for more details.

In this SectionThis section of the magazine will update you on changes to your Training and Health benefits since the Benefits Book was published in July 2011. In addition, this section will highlight important information and resources that may be helpful to you. If you do not have a Benefits Book and would like one, please contact the Member Resource Center.

UPDATED DECEMBER 2011


I-1163 PASSES, NEW tRAINING StANDARDS BEGIN JAN. 7, 2012With the November 2011 passage of Initiative 1163, new training

standards for Home Care Aides go into effect on Jan. 7, 2012. These

revised training standards apply only to those home Care Aides hired

on or after Jan. 7, 2012. If you were hired before Jan. 7, 2012, check

with the MRC or your employer to determine your training require-

ments. To understand these changes, please see the revised training

grid below.

ORIENTATION AND SAFETy BASIC TRAINING CONTINUING EDUCATION

orientation 2 hours safety training 3 hours

Accelerated basic training 30 hours

basic training 70 hours

Parent Provider class 7 hours

continuing Education 12 hours certification

Required?

agency provider (ap)

Completed prior to providing care

Completed prior to providing care not required within 120 days

of employment not required 12 hours/year for the renewal of certification yes

Individual provider (Ip)


Completed prior to providing care not required within 120 days

of employment not required 12 hours/year for the renewal of certification yes

Credentialed ap not required not required not required not required not required 12 hours/year for the renewal of certification yes

Credentialed Ip not required not required not required not required not required 12 hours/year for the renewal of certification yes

parent Individual provider (hCS/aaa)



within 120 days of employment not required not required not required, unless

voluntarily certified no

parent dd Ip (ddd) Completed prior to providing care

Completed prior to providing care not required not required within 120 days

of employmentnot required, unless voluntarily certified no

Childcare Ip (ddd) this training category no longer exists under 1163. If you were previously this type of worker, you will be recategorized as either an Individual provider or a limited Service provider.

respite worker (ddd) this training category no longer exists under 1163. If you were previously this type of worker, you will be recategorized as either an Individual provider or a limited Service provider.

limited Service provider (see note)



within 120 days of employment not required not required

not required, unless voluntarily certificed as a hCa.

no

adult Child Individual provider (hCS/aaa/ddd)



within 120 days of employment not required not required 12 hours/year on date

of birth no

benefItS InforMatIon tRAInInG

For providers whose categories are eliminated when 1163 goes into effect:• If you were a Childcare IP or Respite

worker, you will be re-categorized

as an IP or Limited Service Provider,

depending on the number of hours

worked per month.

• Re-categorization will occur on January

7, 2012, at which time you will have

120 days to complete the appropriate

basic training (either 70 or 30 hours).

Certification requirements may apply.

basic training Exemptions • If you worked in 2011 as an IP, AP or

Parent Provider, you are not required

to take any additional basic training,

as you are grandfathered in.

• If you were hired prior to Jan. 7,

2012, you are only required to com-

plete the training standards in effect

at the time of your hire. Your deadline

for training does not change.

certification Exemptions • If you worked as either a standard or

credentialed IP or AP in 2011 and

have completed all your training, you

are not required to take and pass the

certification exam, although you may

elect to become certified.

FoR ExIstInG WoRkERs

tRAInInG stAnDARDs - applIeS to thoSe hIred on or after Jan. 7, 2012


tRAInInG benefItS InforMatIon

use the training wizardStart with the easy online Training Wizard to find the training

you need. Go to: www.myseiubenefits.org/wizard to complete

the Wizard.

register early for trainingIf you need Basic Training, we encourage you to register for

your classes within the first 30 days of hire to get the best

choice of class options. If you need Continuing Education (CE)

classes, register as early as possible to get the best choice of

class options before your deadline. If your birthday falls before

or on June 30, 2012 your deadline is June 30th, 2012 and

you are required to complete 10 hours of CE. If your birthday is

after June 30, 2012, your CE deadline is your birthday and you

are required to complete 12 hours of CE.

NOTE: If you are an AP, please refer to page 26 of your Benefit

Book for who to contact to get registration support.

take online learning for Continuing education CreditsOnline Continuing Education courses are an easy and conve-

nient way to get the CE hours you need as a Home Care Aide.

You can view available courses, take classes and view your cred-

its all from your computer – 24/7. NOTE: If you are an AP, please

check with your employer before registering for online CE.

go online for fastest Service and SupportThe www.myseiubenefits.org web portal is your comprehensive

resource for available classes, your current training status,

benefits eligibility and much more. Log in to the portal first to

get the answers you need. Instructions to getting a username

and password are in your Benefits Book on Page 8.

update your Contact InfoEnsure you are receiving the most current information about

your training by updating your contact information with your

employer. If are you an Individual Provider, update your infor-

mation with your primary DSHS contact. If you are an Agency

Provider, update your information with your employer.

HOW tO GEt tHE MOSt OUt Of yOUR tRAINING

home Care aide (hCa) provide care to a consumer living in his or her home. employed by a private homecare agency or dShS.

Certified home Care aide provide care to a consumer living in his or her home having succesfully passed the doh certification exam. employed by a private homecare agency or dShS.

agency provider (ap) provide care to a consumer living in his or her home. employed by a private homecare agency.

Individual provider (Ip) provide care to consumer living in his or her home. employer of record is dShS

Credentialed agency provider this is an ap with a current healthcare credential as a registered nurse (rn), licensed practical nurse (lpn), nursing assistant Certified (naC), physical therapist, occupational therapist or Medicare-Certified home health aide.

Credentialed Individual provider this is an Ip with a current healthcare credential as a registered nurse (rn), licensed practical nurse (lpn), nursing assistant Certified (naC), physical therapist, occupational therapist or Medicare-Certified home health aide.

parent Individual provider (hCS/aaa) this is an Ip who provides care to his/her own adult child and contracted through home and Community Services (hCS) and/or an area agency on aging (aaa).

parent dd Individual provider (ddd) this is an Ip who provides care to his/her own adult child with a developmental disability and is contracted though the department of developmental disabilities.

limited Service provider (hCS/aaa/ddd) this is any Ip who provides care 20 hours a month or less for one consumer.

adult Child Individual provider an adult child providing care for his/her biological, step or adoptive parent.

HOME CARE AIDE WORKER CAtEGORIES - EffECtIVE JAN. 7, 2012


benefItS InforMatIon tRAInInG

NEW ONLINE CONtINUING EDUCAtION CLASSES, BOOKMARKING AVAILABLE

In an ongoing effort to provide multiple platforms for taking

Continuing Education, the Training Partnership released a num-

ber of new additions to the Online Continuing Education portion

of the web portal.

In early December, six new English-language classes were

added:

• Relationships between Consumers

• Home Care Aides Make a Difference

• Supporting Consumer Independence

• The Faces of Down Syndrome

• Dispelling Disability Myths

• Promoting Creativity

important note: These courses were available in early 2011

for a short time so if you took them at that time, you cannot

take them again. If you did not take them then, they are avail-

able to take online.

In addition to the new English courses, there are 10 addition-

al Spanish-language versions of existing Online CE courses.

In addition, the system will now allow bookmarking, which

will make it more convenient for students to take classes

online.

Prior to Dec. 2, if a student stopped an eLearning course

before completing it, they had to restart it from the beginning.

As of December 2nd, they will no longer have to do that. The

next time they take an incomplete course, they will be taken to

the screen previous to the last screen they were on when they

stopped the course.

With online classes you pick the time and topics that work

for you. You can see the available courses, register and access

courses, receive credit, and navigate help information – all online

and all 24 hours a day!

new online continuing Education Lineup

Best Practices for the Professional hCA

Now available in English AND Spanish

Multiple sclerosis


Traumatic Brain injury


Body Mechanics


infection Control and workplace safety

Updated for Error


Better health through nutritious Cooking


An introduction to developmental disabilities


An introduction to Physical disabilities


An introduction to Mental illness


An introduction to dementia


NEW: relationships between Consumers

NEW: home Care Aides Make a difference

NEW: supporting Consumer independence

NEW: The Faces of down syndrome

NEW: dispelling disability Myths

NEW: Promoting Creativity

Each online course takes about one hour to complete,

which may vary depending on learning style, material

covered and Internet connection speed.


Please substitute the following update

for Frequently Asked Question #12 on

page 54 of your Benefit Book.

what happens if i work fewer than 86 hours

in a month after i am enrolled in the plan?

You must first determine if you are con-

sidered a “Grandfathered Agency Provid-

er.” “Grandfathered Agency Providers”are

those agency providers who have coverage

as of September 30, 2011. Grandfathered

Agency Providers who do not meet the

ongoing eligibility requirements will have

their health coverage terminate the first

day of the first month following the month

that they no longer meet the ongoing eligi-

bility requirements. Grandfathered Agency

Providers shall continue to be considered

“grandfathered” unless and until the

Agency Provider is required to re-establish

initial eligibility.

Example: If an Agency Provider is

enrolled on Sept. 30, 2011 but does not

meet the work requirements for ongo-

ing eligibility in October 2011, her health

benefit will terminate on November 1.

2011 (unless she arranges to pay through

COBRA).

If you are not a Grandfathered Agency

Provider, there is a lag month between

when you do not meet ongoing eligibility

and when your health coverage ends.

As a result, all other eligible Participating

Employees (Agency Providers, who enroll in

coverage on or after October 1, 2011 and

all Individual Providers), who do not meet

the ongoing eligibility in a given month will

not be eligible for coverage the first day of

the second month following the month they

did not meet the eligibility requirements.

Example: If a non-grandfathered Par-

ticipating Employee fails to work eighty-six

(86) hours in January, her health coverage

will terminate on March I (unless she ar-

ranges to self-pay through COBRA).

Why there is a difference? In the past,

agency providers did not have a lag month,

while Individual Providers did. The Trust

was asked to adopt a policy that establish a

lag month for Agency Providers. As a result,

all new Agency Providers wait an extra

month for health benefits, and have their

health benefits continue an extra month,

once they no longer meet the ongoing eligi-

bility requirements. Existing Grandfathered

Agency Providers, however, started their

health benefits without the lag month (one

month earlier than everyone else). As a re-

sult, they do not have a “lag month” when

they no longer meet ongoing eligibility.

hEALth benefItS InforMatIonPOLICy UPDAtES

PARtICIPAtING EMPLOyERS UPDAtEWashington employers whose employees are

eligible for benefits through the Health Benefits

Trust. noTe: This list may change, check with your

employer to verify participation.

AAA Residential ServicesAddus HealthcareAmicable HealthcareCatholic Community ServicesCDMChesterfield HealthcareCoastal CAPFull LifeHome Care Services of MontanaKWALower Columbia Community Action CouncilOly CAPResCareSenior Life Resources NorthwestState of Washington (employer of record)Visiting Nurse Home Care

benefItS InforMatIon hEALth

dId you know?Urgent Care is a much more affordable option for Home Care Aides through the Health Benefits Trust. The out-of-pocket cost for a trip to the emergency room is $200 (waived if you are admitted to the hospital) vs. just $10 for a trip to Urgent Care with group health options and $30 with Kaiser.

where to find urgent CaregroUP heALTh oPTions: Seven Group Health medical clinics have Urgent Care Centers, most with evening, weekend, and holiday hours. Use the Provider Directory online to find urgent care providers in other areas.

KAiser: Find an Urgent Care Center at www.kp.org

Check your eligibility for health benefits• You must work at least 86 hours per month for three consecutive

months to be eligible for these benefits. You do not need to wait until you are eligible to enroll, you can complete the form after you’re hired.

applyindividual Providers: In order apply for enrollment an enrollment form must be complete and received by the Trust. Forms can be found by logging into www.myseiubenefits.org Agency Providers: Talk with your employer about applying for enrollment.

look for your Id CardAfter you apply for enrollment and eligibility is confirmed, you should receive an ID Card in the mail. You will need the ID card number to access your benefits. If you do not receive the card by the 10th of the month that your coverage starts, call the MRC at 1-866-371-3200 if you are an Individual Provider or if you are an Agency Provider, talk with your employer. Look for and write down your nearest Urgent Care Center and keep it with your card for reference.

fill out your health profile or health assessmentThe Health Profile or Assessment is an online quiz and report to help you manage your health. To help encourage participation, you will receive a check for $25 for filling it out.

Make a primary Care appointmentUse the online provider directory at www.ghc.org or www.kp.org to find a primary care doctor who’s a good match for you. You will receive $10 for attending a preventative care/wellness ap-pointment within the first three months of your coverage.

locate your nearest urgent Care CenterAs soon as possible, you should identify the closest urgent care center to you in case of an emergency. You can find urgent care centers online at www.ghc.org or www.kp.org.

Manage your prescriptionsIf you have existing prescriptions, have them transferred to Group Health Options or Kaiser Permanente. Next, set up mail order prescription refills online to save money and save time.

URGENT CARE

URGENT CARE

URGENT CARE

URGENT CARE

URGENT CARE

HEALtH BENEfItS QUICK StARt



635 ANDOVER PARK W. SUITE 200, TUKWILA, WA 98188

www.MYseiUBeneFiTs.org

WhAt Is homE cARE InsIGht?Home Care Insight is the go-to magazine for over 50,000 Home Care Aides in Washington and Montana. Its relevant writing engages readers with columns and articles that highlight the interests, needs and experiences of the Home Care Aide, as well as detailed infor-mation they need to access the best of their benefits. Other articles encourage readers towards healthier living, through nutrition, good use of health care and exercise. Home Care Insight is an indispens-able resource for Home Care Aide and their families, consumers and employers. cIRcuLAtIonHome Care Insight is mailed directly to more than 40,000 actively employed Home Care Aide living in Washington, Idaho, Oregon and Montana. It is available at more than 100 agency and state offices, reaching thousands more direct care workers in healthcare. Total Circulation: 50,000; Readership: 150,000+

AdVerTisewIth hoMe Care InSIght

editorial Calendar, Ad rates and Production specificationsFor details on our editorial calendar, ad rates and production specifications contact Christine Jimenez at 206-254-7125 or [email protected].

InSight December 2011

Documents

Transcript of InSight December 2011