After a year in a practice devoted to the geriatric community, I am still on a quest to reward seniors with the benefits of traditional Chinese medicine. I joined a group of internists and geriatricians who also believed that complementary medicine was a possibility in light of pharmaceutical failures.I was enthusiastic about the possibilities of providing traditional Chinese medicine to the adult and geriatric community in the area, and determined that this age group would have very little difficulty accepting this natural, traditional form of medicine. It seemed to me that this age group - which preceded the revolution of antibiotics - would be most understanding.
This proved to be my first challenge. I gave presentations in retirement homes and assisted living facilities, and once even at a major hospital. The presentations were often received with great interest and curiosity. My lectures would summon recurring questions concerning how many treatments it would take for acupuncture to work, licensure and education, therapeutic usage for particular conditions, and financial matters.
Answering these basic questions made me realize how many seniors had yet to experience this system of healing; sadly, I wondered if they would ever have a chance to experience it. The vast knowledge traditional Chinese medicine holds for their ailments couldn't fail, even if it provided only the small benefit of personalized attention, but factors such as depression, arthritic pain, stroke, spinal stenosis, anxiety and insomnia were secondary to their biggest health concern: poverty. With every presentation, the underlying concern these seniors conveyed amounted to whether they could afford acupuncture.
A challenge wouldn't be a challenge if there weren't a chance for success. Financial matters are often a barrier to receiving good care, and this inevitably became my real first challenge in geriatric care. In a medical system that forces seniors to depend on Medicare insurance programs, acupuncture is at a disadvantage. There are over 40 million Medicare recipients, and very few seniors can afford the costs of acupuncture required to manage their care.
In one of my first interactions in a nursing home, I met an 85-year-old woman with an arthritic shoulder. She was bedridden due to a lack of personal attention and weakness in the legs. Her walker enabled her to get to the bathroom and back to her bed, but because of pain, her life was fixed to the four walls around her. After some discussion, we agreed to begin her care at a reduced rate, so long as she made an honest attempt to continue the therapy as necessary. Along with a poor financial situation, she was burdened by expensive pharmaceuticals and the costs of her nursing care. I found that rather than money, her commitment to being treated with acupuncture was more important if she was going to see any real benefits. I focused on general TCM principles for shoulder arthritis, and included tuina techniques.
After several treatments, she happily informed me of her reduced use of pain medications. Although at first I was reluctant to accept this as progress, I soon convinced myself. Instead of having to take pain medication every three hours, her pain relief lasted a few hours longer. Eventually, she switched to an over-the-counter pain medication. Her second problem was a fixed range of motion. To my surprise, one day, she moved her arm into full flexion and gracefully lifted it up past her ear.
Opportunities such as this one have allowed me to find the true payment our services in geriatric care provide. While the efforts to have acupuncture accepted by Medicare continue, and while it would be a great achievement for the geriatric community, its ultimate success will rely on the acupuncturists who make the services available for geriatric patients. I am reminded of a saying I learned in Dr. Tai Lahans' classroom: "Doctors are paid by patients who are well." This is certainly the case for patients of silver locks with empty pockets.
A special thanks to my teachers at the Adult and Geriatric Institute: Dr. Dinh Pham, Dr. Andres Mencia, Dr. Rosemary Mencia and Dr. Schneider.
Click here for previous articles by Virginia Pham, MS, AP.