In my experience mild exercise worked better than any therapy or medicine. Healthcare spending could be saved by matching people with depression/insomnia with volunteers that simply go walk, hike, paddle or start with gentle exercise. Insurance pays for everything except support for this powerful tactic. When a person is in this state - it is hard to get exercising by yourself and you don't want to bother your busy friends and family. Exercise changes brain chemistry, confidence and starts momentum in a healthier direction. My doctor says his family practice is largely treating people with depression/insomnia conditions which can linger and complicate any other conditions such as obesity. Exercise programs could save a huge amount of money spent supporting these people and keep everyone's insurance costs down.

Delirium is a common complication among hospitalized patients characterized by confusion, loss of awareness of time and surroundings, and memory failure. It affects at least 20% of hospitalized patients age 65 or older and is increasingly recognized as a disease entity in and of itself, an inflammatory condition leading to progressive and irreversible damage to the brain. The in-hospital mortality rate for delirium is as high as for heart attacks and sepsis. The rate of nursing home placement at discharge is three times higher, and delirium often initiates a cascade of progressive cognitive decline that results in long-term nursing home placement and the premature loss of our elderly to the nightmare of dementia.

The impact of delirium is profound. On a national level, the costs that accrue after hospital discharge because of the need for institutionalization, rehabilitation services, re-hospitalization, formal home health care, and informal caregiving are estimated at 100 billion dollars annually. The yearly cost to the state of Oregon is estimated at $87,675,000. These figures do not include the cost to society from families burdened with caring for loved ones at home, time taken off work, and non-medicare expenditures for informal dementia care and foster homes. The cost in terms of human suffering and the loss of the experience, companionship, and wisdom of our elderly citizens is incalculable.

Although it cannot be “cured”, there is compelling clinical evidence that delirium can be PREVENTED in at least 30 – 40 percent of cases. Despite being a marker of hospital care by the National Clearinghouse of the agency for Healthcare Research and Quality and identified as a top tier condition for improvement of care by The Assessing Care of Vulnerable Elders Project, there has never been a state-wide effort to eradicate this devastating and preventable condition.

The psychiatry department at Corvallis Good Samaritan Hospital has developed a comprehensive program of education, training, and prevention kits based on established clinical models that should eliminate between 30-50% of delirium cases in hospitalized patients. Were someone to fund a state-wide implementation of this or a similar program, conservative estimates would be a cost saving of $30 million annually in health-care expenditures alone, and the prevention of death and dementia for between 15-20 thousand Oregonians yearly.

Thanks,

Tom Lissman, M.D.

As an experienced RN and a nurse recruiter for a large not- for- profit Oregon hospital, I see first hand the number of newly graduated RNs who are struggling to find jobs. While there may not be a nursing shortage currently, it is an immanent reality in the very near future. These new grads have a passion and excitement for their new healthcare career and are eager to start on the road caring and compassion for patients in need. Unfortunately I have to turn many quality nurses away ultimately due to the effects of the economic downturn of healthcare. On the flip side of the stethoscope, I see many medically underserved people in the community that could benefit physically, emotionally, mentally and spiritually from the care of these new nurses. So....this synopsis brings me to my idea of creating missions, such as those that have recently been carried out in Haiti. Thankfully Oregon has not been hit with a natural disaster such as the one to rock Haiti but the need for healthcare professionals is just as great in our own backyard. My dream would be to acquire a couple of medical vans, staffed by new RN's and an experienced mentor. These vans would travel to the most underprivileged, underserved communities throughout Oregon with the purpose of providing wellness screenings and medical referrals when necessary. Ultimately, I would love to have established relationships with hospitals and physicians in many communities that would provide/donate care to patients most in need of life saving or life changing procedures. I realize hospitals write off much of their care to those who walk into their ED's uninsured or underinsured and I don't intend for this idea to increase their burden. I want it to lessen the amount by being proactive and providing preventative care to those who do not have easy access to it while at the same time providing jobs to nurses and increasing the sense of humanatarianism (I know this is not a word but I like it!) in all of us in our chosen profession of healthcare.

If we can teach people to recyle to take better care of the environment, we can teach people how to take better care of themselves so they can avoid chronic diseases like type II diabetes and heart disease. The teaching approach is what needs to be innovative to make this successful and best use of resources. Using a peer to peer strategy; educate community members who will pass the knowledge along. We need to teach people how to make good decisions in the grocery store and at restaurants. We can teach people how to exercise and increase their physical activity in ways that are realistic and affordable. The pay-off will be a healthier Oregon.

Nearly 1 in 10 Oregonians suffer from hearing loss. For those age 65 an older, 1 in 4 suffer from hearing loss. Hearing loss is also the 3rd most prominent ailment facing Seniors behind Heart Disease and Arthritis. In addition, those with Hearing Loss face wage descrimination and a loss of livihood along with a number of other emotional and economic symptoms. Hearing aids can assist many, but 30% of those who would benefit say they can't afford them. Insurance is only heling paying for around 30% as well. Thousands of people including children could benefit from a Million Dollar grant from the Meyer Memorial Trust. Comment and share you support for this idea.

Team up with groups like Physicians for Social Responsibility and Oregon Health Policy & Research, Ecotrust, etc. to help create a broad innovative grassroots initiative to promote personal and environmental health including incentives to promote change at multiple levels: individuals, employers, schools, community organizations and health agencies: to provide innovative education inclusive of social advocacy skills and promoting a broader definition of health & well being including 1) how to avoid and change the widespread use of toxic chemicals in food, the home, landscaping, highway maintenance, etc. 2) how to support local sustainable farmers and small businesses; 3) how to avoid promoting animal cruelty (such as factory farms); as well as 4) eating healthy whole grains, fruits & vegetables (avoiding processed foods & foods with chemical additives), maintaining a healthy weight (BMI), exercising regularly and making informed decisions about health care; and 5) learning & practicing effective stress & communication skills.

Oregon's community mental health system is vastly underfunded and in dire need of improvement. I recommend adapting a model of care for mental health services that is already in use with older adults: the all-inclusive care model. Basically, the idea is to offer a wide variety of services under one roof, in a network of community clinics. While mental health clinics have long existed, they have never offered primary care, vision care, dental care, occupational therapy, and diabetes care--all things available in the older adults service model known as PACE (Programs of All-Inclusive Care for the Elderly). In addition to these services, a similar model for the mentally ill could offer things like housing and employment assistance, substance abuse treatment, and specialized therapy (all of which are surprisingly lacking in our current mental health clinics). Of note, the PACE model succeeds because it emphasizes multi-disciplinary staffing and a low patient-to-staff ratio. By adapting this model for the mentally ill, we would improve their well-being and reduce their use of hospitals and jails--while saving the state a great deal of money.

Create a system that allows Oregonians to put aside money from their paychecks into a flexible spending account to use at local grocery stores, farmers' markets, and farm stands for fresh produce. Just like the concept of healthcare FSAs, Oregonians can choose how much money they want to put aside (pre-tax) from their paychecks and access it only for produce. This may mean getting either a debit-card for their account or using the wooden token system already in place at many farmers' markets throughout the state. Creating the system would give Oregonians an incentive for buying fruits and vegetables and help to funnel that money into the local economy and support Oregon's farmers.

This proposal will design a program to monitor high risk patients via phone and or by email.

Designated clinic staff who are familiar with the clinic population will operate under this detailed plan to contact a designated family member when needed and/or to communicate with the provider when physical and/or mental parameters are exceeded.

This allows for rapid adjustments to the medication or treatment plan to avoid utilization of high cost services such as repeat office visits or emergency room or hospital admissions.

Program goals include:
* Decreased health care costs (less utilization of health care services)
* Enhanced patient/family/practitioner satisfaction
* Provision of a established and updated data base to quickly communicate with high risk patients in the event of adverse weather or a disaster.

Program implementation will include:
* Identification of high risk patients with specific thresh hold parameters (age, disability, diagnosis, vital signs, weight changes, high risk medications, etc.)

* Evaluation of effective communication strategies(telephone, family,computer etc) between the patient, primary practitioner and the family.

* Development of an effective treatment and communication algorithm with on-going review.

* Evaluation of appropriate and cost effective "aging in place" technology and implementation of feasible technologies if needed.

* Creation of a state wide network of primary care providers for implementation and improvement of this program.

Establish funds for use in educating the 10,000 plus EMTs and First Responders at the Oregon Emergency Services Conference. Every year emergency responders struggle with funding for education that will help us all get the best care when we have an emergency and call 911. Funding is getting squeezed in most agencies and the quality of our emergency care will suffer. A fund to help the Oregon EMS Conference could help fill the gap and provide great education at a low price. It will help us all and the state to be a place we want to live and play in.

Drug and alcohol abuse cost the state of Oregon $5.4 billion annually, in the criminal justice and health systems and in lost productivity. Every dollar spent on treatment and prevention returns $5 in cost-offsets. The same set of circumstances that lead young people to drink alcohol or take drugs are those that lead them to use tobacco, engage in risky sexual behavior, move towards academic failure and engage or in other delinquent activities. Prevention research shows that by providing adequate supports for people - from the pre-natal stage to emerging adulthood - we can ensure that they make healthy choices about their lives. Communities, where people know and support one another, are essential to prevention. We can stop tomorrow’s social problems today by shoring up communities and families so that they have the tools to help young people achieve healthy development.

Classes for seniors to introduce healthy, tasty, dishes that are inexpensive to make; easy to prepare in small quantities in small (often under equiped kitchens); use overlapping ingredients so that several meals can be made using the same ingredients which eliminates waste and cost and keeps variety in dishes. Introduce new, interesting, easy ways to use grains, beans, vegetables, fruits, and other ingredients, and teach shopping skills to maximize dollar value. Learn to shop specials, farmers markets, and buy food with others to purchase ingredients in bulk. Provide health nutrition education on sodium, fats, fiber, protein, calcium, and coordinate this information with easy, practical recipes. Introduce the Super Foods to maximize nutrition per dollar spent. Address issues of hypertension, obesity, cardiac health, and diabetes, and how seniors on limited food budgets can take responsibility for their own health every day by choosing what to eat. Project would develop a curriculum, train volunteers to teach statewide, and produce a book with the information to be written in English and Spanish. This approach is a natural to be offered in Senior Centers, public housing units, community centers. Could easily be an add on to nutrition/cooking education programs offered through the Oregon Food Bank's programs for parents and children, and adults on limited budgets. My experience offering similar classes as a volunteer in housing projects, senior centers, etc. leaves me convinced that they have a major impact on the participants. As well as addressing health, income issues, hunger, services in public housing, I have seen tremendous community building among participants who find they enjoy shopping, cooking, and eating with others in their facility and neighborhood.