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Forbes – A Startup Poised To Disrupt In-Home Senior Care

The stark reality is that we will all grow old at some point.

The years have a way of catching up with us–and when they do, we generally have one common wish: to live out our years in our existing homes in a safe and comfortable manner.

But finding a qualified caregiver for our loved ones, if we are unable to care for them, may be the most difficult part of realizing that wish.

The statistics are daunting when it comes to home care for older persons. There are some 55 million adults taking care of their parents, with over 2 million caregivers.

And close to 92% of adults when surveyed would rather live in their own home as opposed to a nursing home. The fact is that in a large percentage of cases, family members have difficulty caring for a senior relative, so searching for a caregiver is a necessity.

While there are tens of thousands of agencies across the country that can match you with a caregiver, there is no customization of the process, and you have no way of seeing what’s going on when you are not home.
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Programming since the age of 12, the computer engineer-turned-entrepreneur migrated to Silicon Valley working at Yahoo YHOO +0.00%, then transitioned to Bain Ventures.

After he and his family struggled to find a caregiver for his 93-year old grandfather who was previously living independently, Bruno decided to quit his job at Bain Ventures to start a company that would make it easier for families to locate and hire qualified caregivers.

“If you asked me four years ago what I would be doing now, there was no way I would have guessed that I would be working in aging—but these things all happen through personal experience,” said Bruno.

Bruno did some research, and after contacting and volunteering at several dozen homecare agencies, he realized what a huge need — and opportunity — exists in the $80 billion in-home senior care market, which today has a poorly organized workforce and a customer base often with chronic medical illnesses who may not receive the best possible care.

Bruno’s personal journey to find the best possible care for his grandfather uncovered myriad issues ranging from lack of coordinated training for caregivers to a feeling of emotional detachment that emanated in the quality and approach to geriatric care, he explained.

Without the proper tools for the families, and without the support from the caregivers themselves, there had to be another answer to providing high quality home care for seniors.

Bruno kept asking himself why the homecare industry was in such disarray, and by volunteering at several agencies, he became convinced that there was a more efficient way to improve delivery by using technology to power the change.

“We have focused on building a technology platform that supports caregivers and empowers them to do the best job possible, at the same time creating transparency for families so they can see what’s happening real-time in the home,” explains Bruno. “It also creates a very reliable service which demonstrates that we will do the work that requires older adults to be happy.”

Bruno’s core philosophy and company’s mission is simple: “Every older adult deserves a beautiful day.”

So, Bruno assembled a team of other like-minded 20-somethings, including Harry Heymann, who designed the architecture and wrote the backend code for Four Square, considered a pioneer of consumer mobile applications.

Hometeam, launched in 2013, is based in New York City, but also has clients in New Jersey and Philadelphia. The company plans to expand into nine more states within the next year. The company raised $11 million last year from Lux Capital, IA Ventures and Recruit Strategic Partners.

The company has already sent more than 250 caregivers into hundreds of homes throughout New York, New Jersey, and Pennsylvania.

The caregivers are made to feel part of a team, and are given employee status with health insurance and workers comp benefits, as opposed to being independent contractors or considered part-time workers. They are also compensated 30-50% more than a typical caregiver hired by a standard agency in current markets. While typical wages for a standard caregiver hover around $9-$10 per hour, Hometeam’s wages are closer to $15 per hour. Clients are charged from $20-$27 per hour.

The company’s mission is to transform the in-home care and aging experience by providing elderly clients with personalized care planning, expert caregiver matching, custom mobile technology, and proactive case management to improve older adults’ health and well-being while giving their families peace of mind.

Using technology to improve in-home care has other competitors currently in the marketplace. Among the notables, Honor, founded by Seth Sternberg, formerly of Google GOOGL -0.77%, launched earlier this year in the San Francisco Bay Area, and had raised 20 million by April of 2015. Touting itself as a technological solution to in-home care, its impressive line-up of supporters include Marc Andreessen, as well as Jeremy Stoppleman, CEO of Yelp. Its caregivers are not employees, but independent contractors.

CareZapp, a UK start-up in 2014, prides itself on its technological wizardry leading to more holistic care, allowing patients to communicate with other patients as well as doctors and family members. The app can also interface with other smart in-home technologies including motion sensors that can track movements and alert family members when there are aberrations.

 

The Hometeam Solution

Hometeam sets itself apart from its competitors by developing its own software that intelligently matches families with experienced caregivers, connects families to their loved ones through the use of mobile technology in the home, and helps caregivers plan days that improve the quality of life of older adults.

Hometeam also distinguishes itself is by having its caregivers identify activities which every patient prefers–something that can be challenging when a person has physical limitations which impair movement and mobility.
Hometeam iPad mood-3

The core foundation of technology for Hometown begins with an iPad for each home that is used by the caregiver to send texts, pictures, and update family members about any changes in medical conditions.

“I want older adults to live more comfortably and happily in their own homes,” said Bruno. “I want to imagine what a perfect day looks like for each of our clients and make it come alive with a combination of great mobile technology and the best caregiving team possible.”

The broader picture, however, may become the integration of technology-enabled apps that also can monitor key parameters of health such as blood pressure, heart rate, medication compliance, and ideally dispatch and communicate with a medical provider when there are aberrations in patterns of vital signs.

“America will face a tremendous challenge in caring for our senior citizens,” said Rich Able, Founder of X2 Biosystems and Partner, Stratos Group Seattle. ”It will be imperative to implement ‘The Connected Senior Citizen’.”

Family members, clinicians, and assisted care providers will need a new generation of technology platforms to help them stay informed, coordinated, and most importantly, connected,” added Able.

“Aging in place and staying in one’s own home environment is highly desirable to most senior citizens,” emphasizes Able, so in order to accomplish this goal, equipping the home with the most useful technology will become critical in the next few decades.

“Startups in the ‘Connected Senior’ vertical must develop meaningful biometric wearables that provide familty members, caregivers, and clinicians the information necessary to attenuate the need for costly emergency care, hospital stays, and multiple physician visits,” he added.

Bruno explains that his company is actively seeking partners to accomplish these higher level functions to advance the concept of such a “connected senior home.”

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OIG to CMS: Make EHR fraud prevention efforts a priority

[HealthCare IT News] The Office of Inspector General is once again calling out CMS for failing to adequately address fraud vulnerabilities in electronic health records. Despite submitting recommendations back in 2013, a new OIG report underscored that the agency is still dragging its feet with implementing EHR fraud safeguards.

Part of the Office of Inspector General’s role is to audit and evaluate HHS processes and procedures and put forth recommendations based on deficiencies or abuses identified. Turns out, a lot of these recommendations are ignored, disagreed upon or unimplemented, according to OIG’s new Compendium of Unimplemented Recommendations report. And EHR fraud is on that list.

“HHS must do more to ensure that all hospitals’ EHRs contain safeguards and that hospitals use them to protect against electronically enabled healthcare fraud,” OIG officials wrote in the report.

Specifically, audit logs should actually be operational when an EHR is available. And CMS should also develop concrete guidelines around the use of copy-and-paste functions in an electronic health record. According to OIG data, most hospitals using EHRs had RTI International audit functions in place, but they were significantly underutilized. What’s more, only some 25 percent of hospitals even had policies in place regarding copy-and-paste functions.

These recommendations have come up repeatedly in recent OIG reports, and despite CMS officials agreeing with the outlined recommendations, the agency is still not making it enough of a priority.

In a January 2014 report, OIG also called out CMS for failing to make EHR fraud a priority. Specifically, OIG said, the CMS neglected to provide adequate guidance to its contractors tasked with identifying said EHR fraud, citing the fact that the majority of these contractors reviewed paper records in the same manner they reviewed EHRs, disregarding the differences. Moreover, only three out of 18 Medicare contractors were found to have used EHR audit data in their review process.

When it came to identifying copy-and-paste usage or over documentation, many contractors reported they were unable to do so. Considering some 74 percent to 90 percent of physicians use the copy/paste feature daily, according to a recent AHIMA report, the implications are significant.

As Diana Warner, director of HIM practice excellence at AHIMA, recounted back at the October 2013 MGMA conference, that dueto copy-and-paste usage, they had a patient at her previous medical practice who went from having a family history of breast cancer to having a history of breast cancer. The error was caught by the insurance company, which thought the patient had lied, was poised to change her healthcare coverage. “We had to work for months to get that cleared up with the insurance company so her coverage would not be dropped,” Warner said. “We had to then find all the records that it got copy and pasted into” incorrectly and then track down the locations the data was sent to.

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How one hospital boosted care transitions

From HealtCare IT News

Taps DataMotion to build Web portal
February 27, 2015

Faced with the imperative of sharing patient information when patients moved from the hospital to a nursing home, the technology leaders at Hackensack University Medical Center learned that the facilities they would be sending information to had no way to receive it electronically.

It might not seem that important to some – “just an email, just an attachment,” Hackensack UMC Chief Information Officer Shafiq Rab, MD, told Healthcare IT News, “But when your life is at stake, and when that information is critical for the person that’s going to be taking care of you, and it’s you, it becomes very important.”

It was also critical to get it resolved. Patient safety was paramount, Rab said. Also, direct and secure messaging is required by Stage 2 meaningful use, and the medical center would start its reporting on the requirements on July 1.

Hackensack UMC is a 775-bed facility that employs 7,600 people, including 1,600 physicians. It has an Epic EHR, and all nursing facilities associated with the medical center use EpicCare Link to provide web-based patient information to authorized healthcare providers.

For long-term care facilities not part of the medical center – there are seven of them – there was no way to connect to the portal and no other way to transfer patient information electronically in a secure way.

“These organizations did not have Direct addresses, accessible to them,” Mike Fitzpatrick, enterprise project manager at Hackensack, said. Hackensack UMC launched a search for a vendor with a Web portal or some type of tool that the medical center would provide at no cost to the facilities.

How difficult or easy the portal would be to use, the implementation plan and the services the vendor could provide were top of mind for Fitzpatrick.

After reviewing offerings from several health information services providers, or HISPs, Hackensack UMC tapped DataMotion to get the job done.

Shafiq Rab, MDDataMotion seemed best aligned with Hackensack UMCs tenets, Rab said.

“The people we talked to at DataMotion seemed to also care about patients first and business later,” he explained.

The job was done within three weeks of launching the project – and in time for the medical center to meet a July 1 deadline to start the reporting required to attest to meaningful use Stage 2, Fitzpatrick said.

“It was a very quick and effective process that DataMotion provided,” he said.

“In Hackensack’s case, they’re very IT savvy,” said Bob Janacek, founder and CTO of DataMotion. “They’ve implemented Epic. They have a very smart technology staff, so they have the capability to implement the technology to benefit their workflows and such. They’re ahead of their broader community, though, of referral partners, their community of care.”

To address that, DataMotion set up a Web portal that makes it possible for the long-term care facilities to receive patient records and view the attachments that are not readable in their native form. They are able to read these documents and also they are able to reply and send a message back into the medical center’s Epic system.

Bob JanacekThe portal is easy to use – similar to webmail, such as Yahoo! or Outlook, Janacek said.

Before using Direct, whenever a patient transferred to another facility, the discharge documents were printed out and were either faxed or given to the patient to hand to the next provider, according to a DataMotion case study of the project. This manual process sometimes resulted in patient transitions taking longer than desired, and often depended on the patient remembering to deliver the documents to the new provider. Automating the process is not only expected to improve the quality of care patients receive after discharge, but also decreases the time it takes to complete the transition.”

To Rab, quality of patient care is paramount.

“It’s not about the success of Hackensack, and it’s not about the success of DataMotion,” Rab said. “It’s not the success about Direct messages and that we got to meaningful use Stage 2 and the money. It’s not about that. I think the message in all of this is that different tools that different people are using make the lives of patients and the care coordination better so that we make our people healthier, quality of life better and at the same time decrease the cost of care.

“Healthcare needs urgent work,” he added. “As fast as we finish this conundrum, then we can get to the second and third layer of healthcare. That is using information and then analyzing it – what is the most appropriate way to decrease the cost of healthcare and how to maximize the benefit for the patient.

“Let the world know that those people who don’t have these things, they are waiting for it. They really want this information, and it’s our moral and ethical duty to provide it to them.”

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Patient Home Care Monitoring Will Revolutionize the Health sector in 2016

Real-time health care monitoring including the patient’s home continues to gain importance as pressures come from a variety of sources to reduce risks and costs of readmissions and hospitalizations.

The Centers for the Medicare and Medicaid Services (CMS), enforcing the 2012 Medicare Readmission Reduction Program, the States and managed organizations have to deal with tighter budgets, rising costs of service, and stricter capitation rates.

Until recently, homecare reporting was archaic at best. The home was a “black box” where no information was generated when a home aide entered the residence and closed the door. Well-intentioned aides and nurses visited a patient’s home, administered and documented their visit in piles of paperwork that were often not reviewed or actionable.

Data input was first “modernized” to record home aide hours and minimal data about care by telephone. Such systems are used primarily for time and attendance. Aides visit the patient’s homes and use the patient’s home phone to document that their work shift has started. When the shift ends (and only when the shift is over), the home aide dials the phone to report the end of their shift, and with all the limitations inherent in pressing numbers on a dial pad, report that they had administered a few elements of care. Since they cannot see the output of what they entered, such data entry is error prone and of limited value.

To move home health care forward and to reduce costs requires a new approach. Forward thinking home aide agencies, health care providers, managed care organizations and hospitals are looking for innovative solutions that leverage the proliferation of tablets, smartphones and the ubiquitous Cloud to improve care at home, where patients spend most of their lives and where so many significant health events occur.

Thanks to technology, the “black box” of healthcare monitoring can be transformed into a sea of data where home health aides can gather 500-1,000 data points per month. The real-time collection and utilization of data from the home will offer these ten key benefits for specific patient populations, their families and every member of the patient’s care team in 2016.

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Health Sense: Group tries to reduce hospital readmissions

Group tries to reduce hospital readmissions

MADISON.com: Under the Affordable Care Act, Medicare penalizes hospitals that have too many readmissions, or admissions within 30 days of discharges, for patients with pneumonia, heart attack and heart failure.

But hospitals aren’t the only places that influence whether patients return. Nursing homes, home health agencies, home care agencies, aging agencies, hospices, pharmacies, ambulance services and others have an impact.

That’s a key motivation for the Dane County Community Transitions Coalition. Started in 2012, the group includes representatives from about 30 facilities or agencies that care for the elderly or chronically ill. The coalition meets monthly in an effort to improve transitions of care and keep readmissions down.

“We’re sending these people home and often they’re falling off the radar,” said Maria Brenny-Fitzpatrick, transitional care program director at UW Health and a co-leader of the coalition.

Preventing patients from returning to the hospital isn’t only about avoiding Medicare penalties. It’s also better for patients, Brenny-Fitzpatrick said. “Readmissions, on the patients, are very traumatic and very difficult,” she said.

One tool the coalition developed is an emergency medical information form that patients or loved ones can keep at home and give to paramedics and emergency room staff when needed.

The form includes major diagnoses, a list of medications and contact information for a care coordinator. It says whether the patient needs glasses or hearing aids to communicate or a cane or walker to walk.

Another information sheet, explaining supportive home care services, was developed by six agencies that provide such care in the county: BrightStar, ComForcare, Comfort Keepers, Home Instead, Midwest Home Care and Senior Helpers.

Other handouts focus on heart failure, when the heart doesn’t pump enough blood. One includes warning signs that should prompt patients to call a doctor or nurse, such as trouble sleeping or shortness of breath with regular activity. The handout also includes “red zone” symptoms requiring a 911 call, such as chest pain or a fainting spell.

In a related effort, Safe Communities of Dane County and the Wisconsin Institute for Healthy Aging plan to offer a Living Well workshop next spring focusing on heart failure.

Living Well workshops “build participants’ confidence in their ability to manage their health condition to maintain active and fulfilling lives,” according to the institute’s website. For more information about the workshops, contact Lynne Robertson, Safe Communities’ outreach specialist, at 608-836-9810 or lynnerob@charter.net.

Dane County’s readmission rate, of about 37 per 1,000 Medicare beneficiaries, hasn’t changed much in recent years. It’s lower than the state and national averages but higher than two-thirds of counties in Wisconsin.

Alzheimer’s research

I wrote an article in November about a study at UW Hospital of whether an experimental drug can protect healthy seniors whose brain scans show signs of risk for Alzheimer’s disease.

Now UW Hospital is part of a different study to see if another drug might slow the progression of the disease in people with mild to moderate Alzheimer’s. Patients who are ages 55 to 85 and have been taking the drug Aricept for at least six months might be eligible.

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Home Care in Switzerland

Home care continues its negative showing due to maturity and pressure from private label

Sales of home care registered retail value declines across many categories in 2013, in part due to the maturity of a number of categories, such as laundry care, and the pressure from private label on value sales. While private final consumption grew at a fairly healthy level in 2013, consumers continued to display a strong preference for value-for-money home care. A further obstacle to growth was the strength of the Swiss Franc, which continued to provide a strong incentive for cross-border sales.

Home care continued to be heavily impacted by declining unit prices across virtually all categories as competition from private label and between branded manufacturers remained fierce. The strength of retail giant Migros’ private label continued to be detrimental to unit prices, given the fact that the retailer offers a large and popular range of value-for-money home care. Another source of pressure was the higher inflow of cheaper imports from the EU/EEA following the opening of the Swiss market in July 2012. In the face of growing competition from private label and cheaper imports, branded manufacturers responded with more frequent price promotions, thereby adding further downward pressure on unit prices.

Private label and large multinationals compete vigorously

Although there is a fairly large number of players present in Swiss home care, the majority of sales remained in the hands of private label and a small number of leading global players. The most significant player remained Swiss retail chain, Migros, with its private label range of home care accounting for the largest value share in 2013, and resulting in overall private label being ahead of branded products. After private label, the three leading global players, Unilever, Procter & Gamble and Henkel, took the leading positions, relying on their well-known global brands.

Discounters continues to gain but supermarkets remains the strongest channel

In line with the growing demand for private label home care, discounters registered the fastest growth in value sales in 2013. This was particularly detrimental to the value share of health and beauty specialist retailers and traditional grocery retailers, but also supermarkets and hypermarkets felt the pinch. The growing strength of discounters was further underpinned by the fierce outlet expansion pursued by German discounter chains, Lidl and Aldi, which in turn also put pressure on domestic discounter chain, Denner. However, in absolute terms, supermarkets remained the most important channel in home care in 2013, supported by the strong performance of the private label ranges of leading supermarket chain, Migros.

Lack of demand for premium products expected to hamper future sales of home care

Sales of home care are expected to register a stagnant performance in constant value terms at 2013 prices over the forecast period. While demand will remain positive across most categories, consumers are expected to grow increasingly reluctant to spend on premium products, especially in view of the growing availability of higher-quality private label alternatives. The uncertain outlook for Switzerland’s economic performance is further expected to impact consumers’ spending decisions to the detriment of home care. In addition, growing price competition between manufacturers, retailers and private label, especially following the recent opening of the Swiss market to cheaper imports from the EU and EEA, will result in unit price declines across virtually all categories, thus adding further pressure on value sales.

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Reality check-up for health care in Canada

Reality check-up for health care in Canada

Canada’s health care system has had an unhealthy cough for years and it’s not getting better on its own.

According to the Fraser Institute the median wait time for treatment after seeing a doctor is now 18.2 weeks. So, on Jan. 1, your doctor tells you that discomfort on your backside might be a disorder that causes you to grow a tail. He refers you to a specialist who confirms the diagnosis. Alarming news for sure.

You could try to manage your condition but you’ve noticed that your golden retriever is forever coming home with twigs and brambles in his tail, which would be embarrassing in an office setting. So, you opt for the surgery. Then your specialist delivers the bombshell. You can’t get in until May.

You briefly consider going to a veterinarian before accepting that you have to live with the pain and embarrassment. You will need to get your pants altered.

Now, please understand that the situation I have described is not based on an actual case. I use it only to illustrate the seriousness of the situation in Canada. In 1993 the same process would have taken 9.3 weeks, or about half as long as it does today. Doctors tells us the median time between seeing a specialist and getting treatment is three weeks longer than is “clinically reasonable.” This is health care in Canada.

Note too that spending on health care is rising. Depending on the province it may now consume as much as half of all provincial spending. The polls tell us that timely access to health care is always the public’s first or second priority. And yet after 20 years, many great speeches and campaign promises and trillions of dollars in government spending, the time it takes to access treatment has essentially doubled.

Let’s get specific and look at one medical condition and one province. Consider lung cancer treatment in Alberta.

On Dec. 15, 2011, Alberta Health Services announced “the Expedited Management of Lung Cancer Program aims to ensure that, by March 2013, 75% of patients will wait no longer than 30 days from the time of referral from their primary care physician to when a treatment decision is made, and 60 days from the time of referral from their primary care physician to surgery.” They proclaimed it a “top priority” and allocated $15 million to make it happen.

But on March 27, 2014, the Canadian Institute for Health Information announced that the average wait time in Alberta between a specialist booking a date and the actual surgery was 85 days vs. 49 days, the national average. An epic fail.

I am not picking on Alberta. If the average wait times in Canada have doubled over the last 20 years then Alberta is clearly not alone. Canada’s health care system does not provide timely care and it’s not financially sustainable. Baby boomers are retiring in huge numbers. We are losing them as big taxpayers and gaining them as big patients.

There are a range of possible solutions. We shouldn’t shrink from discussing them just because they challenge old beliefs, many of which are crumbling under the weight of reality.

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Healthy living facts

Healthy living facts

This article is designed to give tips to readers about how they can improve or augment actions in their life to have a healthy lifestyle; it is not meant to be all inclusive but will include major components that are considered to be parts of a lifestyle that lead to good health. In addition to the tips about what people should do for healthy living, the article will mention some of the tips about avoiding actions (the don’ts) that lead to unhealthy living.

“Healthy living” to most people means both physical and mental health are in balance or functioning well together in a person. In many instances, physical and mental health are closely linked, so that a change (good or bad) in one directly affects the other. Consequently, some of the tips will include suggestions for emotional and mental “healthy living.”

Eating (diet)

All humans have to eat food for growth and maintenance of a healthy body, but we humans have different requirements as infants, children (kids), teenagers, young adults, adults, and seniors. For example, infants may require feeding every four hours until they gradually age and begin to take in more solid foods. Eventually they develop into the more normal pattern of eating three times per day as young kids. However, as most parents know, kids, teenagers, and young adults often snack between meals. Snacking is often not limited to these age groups because adults and seniors often do the same.

Tips:

  • Eat three meals a day (breakfast, lunch, and dinner); it is important to remember that dinner does not have to be the largest meal.
  • The bulk of food consumption should consist of fruits, vegetables, whole grains, and fat-free or low-fat milk products.
  • Choose lean meats, poultry, fish, beans, eggs, and nuts (with emphasis on beans and nuts).
  • Choose foods that are low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars; look at the labels because the first listed items on the labels comprise the highest concentrations of ingredients.
  • Control portion sizes; eat the smallest portion that can satisfy hunger and then stop eating.
  • Snacks are OK in moderation and should consist of items like fruit, whole grains, or nuts to satisfy hunger and not cause excessive weight gain.
  • Avoid sodas and sugar-enhanced drinks because of the excessive calories in the sodas and sugar drinks; diet drinks may not be a good choice as they make some people hungrier and increase food consumption.
  • Avoid eating a large meal before sleeping to decrease gastroesophageal reflux and weight gain.
  • If a person is angry or depressed, eating will not solve these situations and may make the underlying problems worse.
  • Avoid rewarding children with sugary snacks; such a pattern may become a lifelong habit for people.
  • Avoid heavy meals in the summer months, especially during hot days.
  • A vegetarian lifestyle has been promoted for a healthy lifestyle and weight loss; vegetarians should check with their physicians to be sure they are getting enough vitamins, minerals, and iron in their food.
  • Cooking foods (above 165 F) destroys most harmful bacteria and other pathogens; if you choose to eat uncooked foods like fruits or vegetables, they should be thoroughly washed with running treated (safe to drink) tap water right before eating.
  • Avoid eating raw or undercooked meats of any type.

Tips for special situations:

  • People with diabetes should use the above tips and monitor their glucose levels as directed; try to keep the daily blood glucose levels as close to normal as possible.
  • People with unusual work schedules (night shifts, college students, military) should try to adhere to a breakfast, lunch, and dinner routine with minimal snacking.
  • People who prepare food should avoid using grease or frying foods in grease.
  • People trying to lose weight (body fat) should avoid all fatty and sugary foods and eat mainly vegetables, fruits, and nuts and markedly reduce his/her intake of meat and dairy products.
  • Seek medical advice early if you cannot control your weight, food intake, or if you have diabetes and cannot control your blood glucose levels.

Physical activity and exercise

Physical activity and exercise is a major contributor to a healthy lifestyle; people are made to use their bodies, and disuse leads to unhealthy living. Unhealthy living may manifest itself in obesity, weakness, lack of endurance, and overall poor health that may foster disease development.

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October 10, 2015 / Posted by / Healthy living facts