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Mental health professionals have ‘abandoned’ duty of care in treatment of trans youth, therapist says

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Mental health professionals have ‘abandoned’ duty of care in treatment of trans youth, therapist says

Psychological well being professionals have deserted their responsibility of care relating to treating trans-identifying youth, and the long-term results could possibly be disastrous, a household therapist stated. 

“We have allowed our function to be modified within the public eye,” Stephanie Winn, a licensed marriage and household therapist in Portland, Oregon, informed Fox Information. Therapists’ new function is “primarily inexperienced lighting or rubber-stamping individuals alongside into these medical procedures when that is by no means been our function within the remedy of every other difficulty.”

Youth entry to gender transition medical remedy resembling puberty blockers, cross-sex hormones and surgical procedure have been extensively debated in recent times with critics saying minors are too younger to be altering their our bodies, typically completely. Advocates, nonetheless, argue that such care is life-saving since untreated trans youth face increased charges of despair and suicide. 

Winn argued {that a} narrative has been established that encourages psychological well being professionals to simply accept a baby’s trans identification with out scrutiny, leaving potential psychological diseases untreated. Youth experiencing suicidal ideation and different misery, consequently, aren’t all the time getting correct care, and in some situations, could obtain life-altering remedy that would trigger extra points in a while, she stated.

CAITLYN JENNER ON ‘FOX & FRIENDS’: THE LEFT HAS ‘HIJACKED AND POLITICIZED’ THE TRANS COMMUNITY

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Find out how to care for kids who establish as trans has grow to be a flashpoint throughout the nation.
(YouTube/Screenshot)

The variety of transgender teenagers underneath 18 doubled between 2017 and 2020, from .7% to 1.4%, based on UCLA analysis. The June report, based mostly on authorities well being surveys, additionally discovered that slightly below 43% of the 1.6 million individuals who establish as transgender within the U.S. are between 13 and 25.

Winn stated she’s changing into “more and more involved” in regards to the pattern of youth figuring out as transgender or non-binary and “the lifelong, irreversible medical experiments which are taking place to youngsters because of this ideology.” She added that in 10-15 years, “we’ll see a transition remorse disaster, and sadly, we’re going to have to fret about a few of the most scary psychological well being outcomes as a part of that.”

Up to now two years, 25 states have launched laws that will prohibit entry to gender transition medical remedy for minors. In the meantime, 27 states have handed laws limiting “conversion remedy” for trans youth, which GLAAD defines as “any try to alter an individual’s sexual orientation, gender identification, or gender expression.”

Psychological well being professionals concern backlash and will threat dropping their licenses in the event that they attempt to deal with gender dysphoria sufferers with something moreover transition remedy, based on Winn, who herself has confronted such bother.

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“A lot of my colleagues have deserted our responsibility of care, both as a result of ignorance or cowardice,” she informed Fox Information.

Gender dysphoria, as outlined by Mayo Clinic, is “the sensation of discomfort or misery which may happen in individuals whose gender identification differs from their intercourse assigned at start.” Recognized teenagers could also be handled with puberty blockers to stop undesirable modifications, resembling durations or the deepening of their voice. Later, they could obtain cross-sex hormones to develop traits of the alternative gender — resembling facial hair — in addition to chest and genital reassignment surgical procedures.

CBS NEWS RIPPED FOR PROMOTING STUDY SAYING GENDER SURGERY FOR 14-YEAR-OLDS ‘IMPROVES’ THEIR LIVES

Stephanie Winn, a marriage and family therapist, said the high rate of suicide ideation among trans youth is being falsely attributed to stigma and discrimination.

Stephanie Winn, a wedding and household therapist, stated the excessive charge of suicide ideation amongst trans youth is being falsely attributed to stigma and discrimination.
(Fox Information )

“A totally totally different customary of care” has been established for treating gender dysphoria in comparison with different psychological well being problems because of public strain and trainings from trans activists, Winn stated.

The therapist believes psychological well being professionals, in consequence, aren’t doing their due diligence when treating trans-identifying youth and are prematurely affirming and ushering children down a path of medicalization. She stated such professionals aren’t adequately attempting to find out if their sufferers’ emotions of gender dysphoria are manifested from different often related psychological diseases, fairly than the opposite approach round. 

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Assistant Secretary for Well being Rachel Levine stated in an April interview with NPR that “there isn’t a argument amongst medical professionals — pediatricians, pediatric endocrinologists, adolescent medication physicians, adolescent psychiatrists, psychologists, and so on. — in regards to the worth and the significance of gender-affirming care.” 

Levine, who’s transgender, pointed to quite a few medical organizations that — together with the American Academy of Pediatrics, the American Medical Affiliation, the American Psychiatric Affiliation and the American Academy of Little one & Adolescent Psychiatry — assist “evidence-based requirements of care” for gender transition remedy.

“We’re simply informed that if somebody tells you they establish on this approach, that is the tip of the story,” Winn informed Fox Information. “Do not ask any questions, simply affirm, simply agree, after which usher them alongside this path of medicalization.”

Winn used to deal with trans-identifying youth however stated she stopped after activists focused her. She informed the Oregon Board of Licensed Skilled Counselors and Therapists in December that “strangers on-line,” usually anonymously, had been threatening her and claiming that “my habits is prohibited they usually have grounds for making studies as a result of they imagine I’m in violation of the ban on conversion remedy.”

The board opened an investigation into Winn in April however dismissed it in June, the therapist wrote on her weblog.

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Along with affirming sufferers, Winn stated psychological well being professionals are anticipated to “drive a wedge between households.”

“We’re anticipated to inform dad and mom that they need to let their youngsters lead, although youngsters want construction, guidelines, self-discipline and limits,” she informed Fox Information. “And that if they do not, they’re bigots.” 

AS A DOCTOR AND DAD, I AM ASHAMED BY HOW HORRIBLY MY FIELD MISTREATS KIDS WITH ‘GENDER-AFFIRMING’ THERAPIES

Winn said she fears younger generations will face an even worse mental health crisis down the road due to transition regret. 

Winn stated she fears youthful generations will face a good worse psychological well being disaster down the highway as a result of transition remorse. 
(Michael Siluk/UCG/Common Pictures Group by way of Getty Pictures)

‘A really harmful narrative’

Failure to correctly root out the reason for a baby’s misery is not simply irresponsible — it may be harmful, based on Winn.

Transgender youth endure from psychological problems together with nervousness, despair, PTSD, ADHD, autism than their friends, and likewise face a better threat of suicide, research have proven. Based on survey by the Trevor Mission, almost one in 5 transgender and non-binary youth tried suicide prior to now yr — about double the speed of cisgender youth.

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“Our analysis reveals that only a single affirming grownup in a teenager’s life makes them 40% much less more likely to try suicide prior to now yr,” Troy Stevenson, the Trevor Mission’s senior marketing campaign supervisor for advocacy and authorities affairs, informed The Washington Put up in August.

Winn says mental health professionals have "abandoned their duty of care" when treating trans youth.

Winn says psychological well being professionals have “deserted their responsibility of care” when treating trans youth.
(Fox Information )

BIDEN PUSHES RADICAL TRANS ACTIVISM IN SCHOOLS

Winn argued that the excessive charge of suicidal ideation amongst trans youth is usually falsely attributed to stigma and discrimination. She stated the stat is used to strain docs and fogeys towards affirmation.

“I believe it is a very harmful narrative,” Winn informed Fox Information. By accepting that discrimination is a significant driver behind suicidal tendencies in these situations, Winn stated professionals are “ignoring the true issues” and “abdicating our duty” of psychoanalyzing children to find out if there are different or extra underlying points inflicting misery.

Winn, nonetheless, doesn’t downplay the chance of suicide amongst troubled youth.

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“Are youth expressing suicidal ideation? Completely. However are we treating that accurately? No,” she stated. 

“We have to have a look at—how can we do the least quantity of hurt, the best way to present the least invasive, simplest therapies, and meaning psychotherapy, not medicalization,” Winn informed Fox Information. Relatively than instantly affirming, psychological well being professionals ought to carry out an evaluation and examine how lengthy the kid has skilled dysphoria and the way psychological well being points or life modifications is likely to be contributing, she stated.

The household therapist, who usually sees dad and mom with trans-identifying youngsters, warned that there may later be a good worse psychological well being disaster stemming from transition remorse. 

Winn believes mental health professionals are too afraid to do anything but affirm trans-identifying youth due to public pressure and state legislatures cracking down on "conversion therapy." 

Winn believes psychological well being professionals are too afraid to do something however affirm trans-identifying youth as a result of public strain and state legislatures cracking down on “conversion remedy.” 
(iStock)

“You have got this epidemic the place the obstacles are getting decrease and decrease. There’s much less and fewer screening,” Winn stated. “The age of transition is getting youthful. Extra children are doing this. So the speed of transition remorse down the road can solely be anticipated to get increased.”

Winn fears that in 10 years, we may have “a technology of 20- and 30-somethings who really feel betrayed by their dad and mom, their academics, docs, therapists, pals, everybody who ‘affirmed them.’” 

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Widespread suicide threat elements embody persistent ache, lack of relationships, and an unfulfilling romantic and intercourse life, based on the Facilities for Illness Management and Prevention. Winn warned that children who bear medical gender transition remedy will face a better threat of those down the road. 

“They are going to be dealing with the truth that they cannot have children, that they cannot have intercourse, that their our bodies really feel damage and damaged and scarred they usually really feel embarrassed and ashamed and regretful,” she stated.

Advocates for Youth declined an interview with Fox Information. The next trans youth advocacy and assist organizations didn’t reply to interview requests: Equality Federation; Human Rights Marketing campaign; Nationwide Heart or Transgender Equality; Nationwide LGBTQ Process Pressure; Trans Youth Equality Basis; the American School of Obsetricians and Gynecologists; Homosexual, Lesbian, and Straight Schooling Community; Log Cabin Republicans; Columbia’s Gender Identification Program; and NYU Langone’s Transgender Well being unit.

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How a Company Makes Millions Off a Hospital Program Meant to Help the Poor

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How a Company Makes Millions Off a Hospital Program Meant to Help the Poor

Soon after being diagnosed with metastatic breast cancer, Virginia King sat in an outpatient clinic in Santa Fe, N.M, while a nurse injected her with a powerful drug to slow damage to her spine, where the disease had spread.

Even though the drug had a list price of about $2,700, the hospital that owned the cancer center billed Mrs. King’s insurance company $22,700. Her insurer paid $10,000, but the hospital wanted more.

She got a bill for over $2,500 — “more than half my take-home salary for a month,” said Mrs. King, 65.

She had unknowingly sought care from a hospital that participates in a federal program allowing it to buy drugs at a steep discount and charge patients and insurers a higher amount, keeping the difference.

The intention behind the program was for a small number of safety-net providers to have access to affordable drugs and be able to expand their care for needy patients. But instead, the program has exploded: Now, more than half of nonprofit hospitals in the United States take part. While some providers say it has helped keep their doors open, others — especially large nonprofit health systems — have been accused of maximizing payouts and swallowing the profits.

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The program’s escalation has driven up health care costs for employers, patients and taxpayers, studies show.

In 2023, for instance, New York changed the way it administers drug benefits for Medicaid patients, in part because the state had discovered the cost of the federal program had increased by more than 200 percent over three years, said Amir Bassiri, the state’s Medicaid director.

“The numbers and the growth were staggering,” he said. “We all bear the cost.”

Along the way, one little-known middleman has been cashing in, The New York Times found.

The company, Apexus, has worked behind the scenes to supercharge the program, according to interviews with current and former employees and emails, internal reports and other documents.

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Twenty years ago, the federal government chose Apexus to manage what was then a small program, negotiating with drug distributors and manufacturers to secure better prices and access to medications. But Apexus is allowed to collect a fee for almost every drug sold under the program, giving the company an incentive to help hospitals and clinics capture as many prescriptions as possible:

  • Its “purchasing optimization team” shows hospitals how they can make more money by buying different drugs.

  • A certification program and an Apexus-run “university” trains providers in boosting earnings.

  • Apexus employees give advice that broadly interprets the rules of the program so hospitals can claim additional patients and drugs.

Apexus was on track to double its revenue from 2018 to 2022, projecting $227 million that year, according to a 2022 internal memo written for the directors of Apexus’ parent corporation and reviewed by The Times. The company costs relatively little to operate and has enjoyed profit margins above 80 percent, according to that memo and three former employees.

In a statement, Apexus said it simply executed its government contract and did not contribute to the growth of the program, called the 340B Drug Pricing Program. “The drivers of growth are multifaceted,” the statement said.

But in the 2022 memo, the president of Apexus, Chris Hatwig, posed a question: “Are there other areas for program expansion within 340B that we are not thinking about?”

Government officials have told Apexus to focus solely on administering the program and not to influence drug purchases. But Apexus leaders have sometimes ignored that request, according to two complaints filed with a government watchdog and six current and former employees, speaking on the condition of anonymity because they feared professional or legal retribution.

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In its statement, Apexus said it was “fully transparent” with the Department of Health and Human Services and had never breached its contractual obligations.

The Health Resources and Services Administration, an agency within H.H.S. that oversees the program, declined to answer detailed questions from The Times. But in a statement, a spokeswoman said the agency “conducts rigorous oversight of all contracts,” and “to our knowledge, Apexus has not violated” its contract. Regulators and leaders of the company meet frequently to discuss the company’s work and prevent conflicts of interest, the spokeswoman said.

The growth of 340B has drawn criticism for years from Congress, drugmakers and employers, who say it has added to ballooning health care costs. But the role of Apexus has largely gone unexamined.

“They’ve got a license to hunt,” said Marsha Simon, who as a staff member of a congressional committee helped write the bill that authorized the program.

Established in 1992, the 340B program essentially requires pharmaceutical manufacturers to offer discounts on outpatient drugs to hospitals and clinics that treat a greater share of low-income and uninsured patients.

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The hospitals then can charge insurers and patients the standard price and keep the profits. Although the money is supposed to encourage care for impoverished patients, there are few rules to enforce that.

Patients rarely know they are part of this system. Their prescriptions can be counted as 340B when they get outpatient treatment at a hospital or clinic that qualifies for the program, regardless of the patients’ own income or insurance status. The provider can continue to make money off the patients’ future outpatient prescriptions, even if they get them somewhere else.

Apexus has had contracts to handle the program since the early 2000s. The government does not pay Apexus — instead, drugmakers and distributors pay the company a small percentage of sales.

Based in Irving, Texas, it is a subsidiary of Vizient, a private business owned by hospitals that negotiates a range of health care discounts. Apexus was established as a small nonprofit in 2007 but became a for-profit company in 2014.

Around the same time, 340B began to explode for a number of reasons. More hospitals qualified for the program after the Affordable Care Act expanded the number of people on Medicaid. Other health care systems qualified after acquiring hospitals and clinics in poor areas. Some, already eligible for 340B, bought up practices that used high-margin drugs, like oncology clinics. And a government rule change meant hospitals could make money from prescriptions filled at a greater number of pharmacies.

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A decade ago, sales of 340B drugs were $12 billion. In 2023, they reached a high of $66 billion.

Fighting the program’s growth has become a top priority for drugmakers, as well as some employers and insurers.

In North Carolina, prescription drug spending for state employees jumped almost 50 percent from 2018 to 2022. A report in May from the state treasurer’s office found that 340B was partly to blame: Hospitals that participated in the program billed the state health plan far more than hospitals that did not — almost 85 percent more for certain cancer drugs. In one example, hospitals bought a drug commonly used to treat melanoma for an average of $8,000 but billed the state $21,512.

In some cases, costs are passed along to patients.

Mrs. King, the cancer patient in New Mexico, refused to pay her $2,500 bill, and the hospital, Christus St. Vincent, sent it to collections in July.

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After The Times asked about the bill last month, a spokeswoman for Christus St. Vincent said the charge was “a misunderstanding and has been resolved,” adding that the drug program helped the hospital provide charity care and reinvest in cancer treatment and primary care.

Mrs. King switched to a free-standing oncology clinic that does not qualify for the federal drug program. That clinic billed her insurance $8,000 for the injection, about a third of what Christus St. Vincent had charged. Her responsibility was nothing.

Ms. Simon, who helped draft the legislation creating 340B, said the government chose an outside contractor like Apexus in order to negotiate with distributors and drugmakers on behalf of small hospitals and clinics without a lot of buying power.

But regulators and Apexus have expanded that role, allowing the company to build a highly profitable business off the program and the loosely written statute that authorized it. The company has been “aggressive” in helping health care facilities maximize their revenue from the program, said Shawn Gremminger, chief executive of the National Alliance of Healthcare Purchaser Coalitions, which represents employers who buy health insurance for more than 45 million people in the United States.

“This is a government contractor, and the goal of the government should not be, ‘How do we make more money for 340B providers?’” said Mr. Gremminger, whose organization has pushed for the program to be overhauled.

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Over the past two decades, Apexus has adapted its business model to harness 340B’s tremendous growth. A 2022 PowerPoint presentation obtained by The Times showed that Apexus employees received bonuses if the company increased its revenue each year.

With exclusive access to sales data, Apexus’ “purchasing optimization team” will analyze a hospital system’s drug-buying habits and compare them with those of their competitors, according to four current and former employees. In some cases, Apexus will suggest that a hospital buy more 340B drugs or tweak its inventory in ways that can churn more cash.

Apexus declined to answer detailed questions about its optimization team, but said in a statement that the company “only provides technical assistance” in keeping with regulations.

Apexus also holds “340B University” events to help providers and others in the health care industry understand the program, and it fields questions through a national call center. But the rules governing the program are ambiguous, and Apexus offers broad interpretations, according to four current and former employees.

For instance, one of the thorniest issues is which patients can be claimed by hospitals for discounted drugs. The further a hospital casts its net, the more patients and drugs it can include under the program, and the more money it can make. Apexus has advised hospitals that they can mine records as far back as 36 months for eligible patients they may have missed, two of those employees said.

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Similarly, Apexus employees have showed hospitals how to maximize the number of pharmacies they work with, boosting the number of prescriptions that can qualify for discounts, those employees said.

In its statement, Apexus said those examples were inaccurate but would not say how. It added that the company encouraged “conservative and responsible stewardship” of the 340B program, and that all information it provided was approved by regulators.

A spokeswoman for H.R.S.A. said it reviewed materials prepared by Apexus but declined to comment on that specific advice.

The company has developed other ventures that have brought in revenue:

  • About eight years ago, Apexus began selling a $750 course for people to become “certified experts” in 340B.

  • It started a business to give hospitals better access to specialty drugs — for conditions like cancer, H.I.V. and autoimmune diseases — which are major drivers of 340B’s growth. That company, Acentrus, helped hospitals and clinics provide data to manufacturers in exchange for deeper discounts and access to those drugs. It was sold last year.

  • The company charges 3 percent in fees for a line of generic drugs that are managed and provided by drug distributors, according to former employees. Apexus simply provides access to the health systems.

For the last decade, Apexus has earned millions of dollars on drug purchases made outside the 340B program: Because not all outpatient drugs qualify for 340B discounts, hospitals must stock their pharmacies with medication purchased through different channels. Apexus acts as a middleman, making fees off those transactions.

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That has frustrated drugmakers and competitors. In 2021, the drug manufacturer Baxter wanted to sell non-340B drugs to hospitals without going through Apexus, according to emails obtained under public-records laws. But government regulators would not allow it, a spokeswoman for Baxter said.

In early November, Premier, the main competitor to Apexus’s parent company, Vizient, sued the federal government over these sales. The setup, the suit argued, forces hospitals to pay higher prices for those non-340B drugs and drives revenue to drug manufacturers and Apexus.

In its statement, Apexus said its federal contract did not preclude it from developing other businesses, as long as they were not in conflict with the terms of the agreement.

Regulators were aware of these ventures, the company said, noting that its specialty drug business, Acentrus, was in “no way associated with” the 340B program. The 2022 company memo, however, said Acentrus “resulted in an additional $20 million” in revenue within the 340B program.

H.R.S.A. declined to comment on the scope of its authority over Apexus and whether it knew about all the company’s revenue-generating arms.

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About six years ago, Krista Pedley, then the director of the H.H.S. office in charge of 340B, reprimanded Apexus leaders in a Skype meeting, saying it was acting more like a sales-driven business than a program administrator. She reminded them that Apexus’ role was not to help 340B grow, according to five former or current employees familiar with the meeting.

For about a month afterward, regulators reviewed any communication Apexus had with health care facilities to make sure the company didn’t overstep, the employees said.

But that did not seem to dampen the company’s pursuits. (In an email, Ms. Pedley said she did not recall that meeting, and noted that her former office met regularly with Apexus.)

In 2021, an unnamed Apexus employee filed a complaint with H.H.S.’s Office of Inspector General, an internal watchdog, saying the company was “always trying to grow the program.” The company, the employee wrote, had hired “sales-type” staff to influence hospitals’ drug-purchasing decisions.

The complaint said that regulators did not understand Apexus’ business, and that employees had been told by company leaders to describe its work as “education.”

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Another anonymous complaint, filed in 2022, echoed the allegation that Apexus had hired staff to help shape hospitals’ purchasing decisions, and said it was using “data in ways to drive revenue for itself, without asking (or asking and disregarding) the government’s opinion.”

Apexus declined to answer specific questions about the meeting with Ms. Pedley, but said The Times’s account was a “mischaracterization of our day-to-day, collaborative discussions” with the agency.

Apexus rejected the allegations in the anonymous complaints and said it had been unaware of them until The Times provided it with copies. The spokeswoman for H.R.S.A. said that it, too, had been unaware of the complaints.

In interviews, four current and former employees said that for years, Mr. Hatwig, Apexus’ president, acknowledged that regulators did not want the company to develop sales-focused arms of the business but encouraged his staff to do so anyway, saying that the government would not know.

Apexus denied that, saying that “everyone at Apexus understands the expectation that they conduct themselves and perform their work in an ethical and compliant manner.”

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Julie Tate and Carson Kessler contributed research.

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3 signs your aging loved one may be ready for assisted living

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3 signs your aging loved one may be ready for assisted living

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As Mom and Dad grow older, the big question might be looming in the background: When is the right time to provide living support?

Dr. Macie P. Smith, a licensed social worker and gerontologist based in South Carolina, shared with Fox News Digital that there may be a few telltale signs that it’s time to make a move, whether it’s hiring an at-home aide or seeking out a living facility.

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1. They’re at risk of harming themselves

Most importantly, Smith noted that if a senior is at risk of hurting themselves or getting into dangerous situations, it’s most likely time to call in help.

DEMENTIA REPORT REVEALS ‘SHOCKING’ SIGNS AT AGE 60 THAT YOU’LL DEVELOP THE DISEASE BY AGE 80

Smith, who specializes in seniors living with Alzheimer’s disease and cognitive impairment, recommended starting with enlisting at-home aid before pulling a loved one out of their home.

Memory loss can cause dangerous environments and behaviors for aging adults, experts warn. (iStock)

“The last thing anybody wants to lose is their independence,” she said. “The last thing anybody wants is to live in a space with 50 other strangers.”

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At-home support can help lower the risk of self-inflicted danger from incidents like leaving the stove on, or mobility issues that could lead to falls.

2. The person is having memory issues

As people age, their capacity to remember things begins to naturally slow down.

DEMENTIA RISK FOR PEOPLE 55 AND OLDER HAS DOUBLED, NEW STUDY FINDS

Sometimes, this presents in the form of diseases like Alzheimer’s or dementia. The severity of memory loss in seniors dictates whether living support is necessary, according to experts.

Smith mentioned how forgetting familiar tasks and activities, like eating, can pose a danger to someone’s health.

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Grandmother and granddaughter together outdoors

“Respect them enough to have the conversation, because they still have the ability to make decisions about their life.” (iStock)

“If their nutrition is poor, it may be because they are dealing with some pain that they are not expressing to anyone else,” she said. “They may be dealing with some depression and, frankly, they just don’t have the motivation.”

“Respect them enough to have the conversation, because they still have the ability to make decisions about their life.”

The expert advised watching out for signs of spoiled food in the refrigerator. 

The person may also forget how to do simple tasks like making a bed, doing laundry, washing the dishes or following cooking instructions.

AGING ‘HOTSPOT’ FOUND IN BRAIN, RESEARCHERS SAY: ‘MAJOR CHANGES’

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“If they’re having trouble cognitively, they’re having trouble making decisions, and that’s going to ultimately impact … how they live independently,” Smith said.

3. They repeat themselves

Repetition of thoughts is also common in individuals living with Alzheimer’s disease and dementia.

For more Health articles, visit www.foxnews.com/health

Smith noted that if your loved one is repeating themselves more frequently, it’s a good idea to bring in some support not only for help with day-to-day living, but also for attention and friendship.

senior father bonding with his son

The repetition of thoughts is common in individuals who suffer from Alzheimer’s disease and dementia. (iStock)

“In some cases, it’s because they’re lonely,” she said. “It’s because they’re living by themselves, and they don’t have any type of engagement or motivation.”

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‘Very difficult’ decision

Smith emphasized how difficult it can be to make the decision to place a loved one into care, especially if it means removing them from their home.

The senior should “always be a part of the conversation” when it comes to deciding the next steps, she urged.

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“The last thing you want to do is come in and uproot them from the place where they feel the most comfortable and safe, just because you feel they shouldn’t be there,” Smith said. 

“Always include them in the conversation, even if they’re in the early stages of dementia,” she encouraged. “They still have a lucidity … to be able to participate in the decision-making process.”

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Bonding moment of father and son embracing and giving emotional support

Taking away your loved one’s control and independence can cause issues, the expert warned. Instead, “we need to be there to support them and wrap services around them.” (iStock)

Whether the decision is to bring in care or move somewhere new, Smith said the senior should never be made to feel unsafe or unfamiliar, as this can increase dangerous behaviors, cause agitation and lead to health decline.

The conversation also should not start with the assumption that the senior will not accommodate your request or suggestion.

“Don’t assume they’re not going to remember,” Smith said. “Don’t assume they’re going to be irritable and combative.”

“Respect them enough to have the conversation, because they still have the ability to make decisions about their life.”

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Cancer Remission Like Catherine’s Does Not Always Mean the Illness Is Cured

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Cancer Remission Like Catherine’s Does Not Always Mean the Illness Is Cured

Princess Catherine, wife of Prince William, reported on Tuesday that her cancer was in remission. But what does it mean to be in remission from cancer?

Doctors discovered her cancer unexpectedly last March when she had abdominal surgery. She has not revealed the type of cancer she has, nor how advanced it was when it was discovered.

But she did say she had chemotherapy, which she said had been completed in September. She told the British news agency PA Media that she had a port, a small device that is implanted under the skin and attached to a catheter that goes into a large vein. It allows medicines like chemotherapy drugs to be delivered directly to veins in the chest, avoiding needle sticks.

Catherine told PA Media that chemotherapy was “really tough.”

“It is a relief to now be in remission and I remain focused on recovery,” she wrote on Instagram.

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Her announcement “certainly is good news and is reassuring,” said Dr. Kimmie Ng, associate chief of the division of gastrointestinal oncology at the Dana-Farber Cancer Institute in Boston.

But cancer experts like Dr. Ng say that the meaning of remission in a patient can vary.

In general, when doctors and patients talk about remission, they mean there is no evidence of cancer in blood tests or scans.

The problem is that a complete remission does not mean the cancer is gone. Even when a cancer is “cured” — defined as no evidence of cancer for five years — it may not be vanquished.

That makes life emotionally difficult for patients, who have to have frequent visits with oncologists for physical exams, blood tests and imaging.

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“It’s really scary,” Dr. Ng said. “The amount of uncertainty is very very hard,” she added.

But that ongoing surveillance is necessary, despite the toll it takes on patients.

“Different cancers have different propensities of returning or not returning,” said Dr. Elena Ratner, a gynecologic oncologist at the Yale Cancer Center.

As many as 75 to 80 percent of ovarian cancers, she noted, can come back in an average of 14 to 16 months after a remission, depending on the stage the cancer had reached when it was found and on the cancer’s biology.

“Once the cancer returns, it becomes a chronic disease,” Dr. Ratner said. She tells her patients: “You will live with this cancer. You will be on and off chemotherapy for the rest of your life.”

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Dr. Ratner’s gynecological cancer patients have to come back every three months for CT scans to keep an eye out for evidence that the cancer has returned.

“The women live CT scan to CT scan,” she said. “They say that for two and a half months, they have a wonderful life, but then, in time for the next CT scan, the fear returns.”

“It costs them — it costs them a lot,” she said.

“It’s awful, yet I am amazed every day by their strength,” she said of her patients.

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