DEAR DR. ROACH: My nephew, 62, is a stroke victim. He resides in a board and care facility, bedridden and in diapers. There has been some cognitive damage, although he is able to speak coherently. The family pays $4,200 a month out-of-pocket for his care. There are three other patients at the home, only one of whom is ambulatory.
I am questioning the protocols at the home, which is owned by a registered nurse who is rarely on-site. There are three staffers: a woman who cooks and keeps records of medications and two male aides. One male is always there.
The home keeps a very large “tip jar” on the counter near the front door. I dropped $10 in the jar a while ago and was floored to see several $100 bills in the mix of money. The tips are allegedly used for pizza parties for patients; although when it was my nephew’s birthday, I personally paid for pizza and birthday cake for the house.
I have no experience in this realm of health care. Is a tip jar typical? Is a patient’s family expected to pay “extra” so that the patient gets the attention and treatment we already pay for? One aid told my nephew he would trim his fingernails for $10.
While I don’t need a diagnosis, I would appreciate your point of view. And, if possible, I would like to know the experience of others with loved ones in care. — Anon.
ANSWER: A tip jar is also new to me. In my opinion, medical professionals should perform their jobs without expectation of a tip. What you are describing sounds like there is pressure on visitors to give money, which is uncomfortable and leads to someone reasonably worrying that their loved one isn’t getting good care unless they pay additionally.
On the other hand, I know that many caregivers, such as nursing aides and assistants, do not make a lot of money, and I am sure an extra tip is appreciated. I’d be happy to hear opinions from readers by email at ToYourGoodHealth@med.cornell.edu or on my Facebook page (facebook.com/keithroachmd).
DEAR DR. ROACH: Is Addison’s hereditary? My dad’s brother and sister both had it, and I’ve wondered if I am susceptible. — J.E.
ANSWER: Addison’s disease is one of the causes of insufficiency of the adrenal gland. The most common cause of adrenal insufficiency is when people have been taking high doses of prednisone, or a similar type of steroid medicine. Over time, the adrenal gland becomes less able to respond to stress, which forces the gland to make high doses of the body’s endogenous steroid, cortisone.
Addison’s disease is when the gland itself is unable to make adequate cortisone under stress, and causes can include damage to the gland by tuberculosis, hemorrhage, drugs, cancer or an autoimmune process. It’s the last condition, autoimmune adrenal insufficiency, that has a familial predisposition, and accounts for about 80% of cases of Addison’s disease now. About 1/3 of people with autoimmune Addison’s have an affected family member, but the risk of familial involvement is more common when Addison’s is part of a condition called polyglandular autoimmune syndrome, type 1 or 2.
With all of that in mind, first-degree relatives of people with autoimmune Addison’s (which you are not — your aunt and uncle are your second-degree relatives, as opposed to your parents, siblings and children who are your first-degree relatives) have, at most, a 10% risk of developing autoimmune Addison’s disease.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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