Is Food Medicine?

I've often been told and then tell my daughter that "food is medicine."

Is food medicine?

Would it be possible to persuade the Powers That Be that for someone with an eating disorder, FOOD IS MEDICINE?

And, if that is true, then would that mean a medical doctor could prescribe food?

And, if a medical doctor could write a prescription for food, would this prescription be permissible for someone on government benefits (SSDI or SSI) - to go beyond the SSI allocation re the portion for food or to replace food stamps (which are permissible) with delivered food, ready to eat?

And, if permissible, could an adult with an eating disorder obtain a prescription for a local Meals on Wheels or some kind of  daily (so one would not binge on the delivery of e.g. a week's worth of food) food delivery service that provided the calories needed for recovery?

Could this food that is prescribed and delivered be tax deductible as a medical expense?

Could this be a possible solution for someone who needs this kind of service to get on the road to recovery?

So many people with eating disorders literally panic when going into a grocery store let alone buying groceries, bringing them home, putting them in the pantry, and then selecting items to prepare food.

What a great solution this might be as a first step solo!

What do you think?

The Parent, Family and Friends Network - Insurance Information article by Susan Maccia

The Parent, Family and Friends Network of the National Eating Disorders Association publishes a quarterly newsletter.   One of the issues (fall 2011) includes several important articles (as usual) including a piece by outgoing PFN chair, Susan Maccia, on Single Case Agreements.  The article identifies an SCA as:

If the services to meet an identified clinical need are not available within the contracted network, necessary services are provided in a timely manner through an out-of-network provider.  A Single Case Agreement is a contractual agreement developed for an enrolled person (insured) based on that person's behavioral health needs and for a predetermined period of time.

Among the articles in this issue: a NEDA Conference recap (2011), Males and Eating Disorders, the NEDA Navigators, the existence of a NEDA Loss Support Network, an announcement of planned free webinars, and one about athletes and eating disorders.

To find out more about the PFN Network, click here

Update on Special Needs Trust/Financial Assistance for a Loved One with an Eating Disorder

I just received this link about a recent publication of the Special Needs Alliance for the benefit of a Trustee of a Special Needs Trust.

These trusts can be set up for loved ones who will need supplementary financial help during their lifetimes.  These trusts are designed so they will not interfere with continuing eligibility for public benefits.

I've written about Special Needs Trusts in an earlier post and you can obtain more information from the Special Needs Alliance Website.

Body, Mind, Spirit

Some years ago (actually in the 1970's)  the "Six Million Dollar Man" was a popular television show.  The series gave rise to "The Bionic Woman."  For those readers who weren't born yet, these series featured people who had what have now become more commonplace - artificial parts to replace or shore up our failing human biological components.  Nowadays, one can get implants or transplants for just about every part of the human body; an exaggeration, I know, but so often now we read of a new miracle of surgery and science.

My mother, had she lived a few more years, might soon have been able to see clearly again.  She lost her eyesight to the dry kind of macular degeneration and with the loss of her sight went her independence.  She soldiered on, as she put it, for a few years - until she turned 89 -  before she died after not surviving hip transplant surgery.  An artificial eye is on the horizon.  What a miracle that will be.

Any one of us now, given availability and more importantly insurance or a fortune or means to repay a loan, can get a tooth implant, a heart transplant, a liver transplant, and a new knee or hip, for example.  

One's teeth are covered by dental insurance, one's body is covered by medical insurance, in fact one's brain is covered by medical insurance, but the coverage of one's mind is at the whim of insurance companies or the government laws/legislatures.

Think about it.   Aren't your teeth part of your body?   I overheard someone speaking to my dentist this morning and he remarked he needed to return to his periodontist to be treated again at $20/minute.  One single tooth implant can cost upwards of $10,000 out of pocket  while a much larger and more complicated hip implant can cost you a relatively small copay if you have medical insurance.  If you suffer a stroke and are without insurance, you still can go to the hospital and get treatment that inevitably will be covered by some kind of insurance or absorbed by the hospital's financial machine (to its detriment).

But if you have a mental illness such as bipolar disorder or an eating disorder, good luck getting enough coverage or any treatment even if you have insurance with a mental health component so you don't have to go home prematurely (meaning before enough treatment is provided to reverse the effects of the disease) to die as someone I am somewhat electronically acquainted with put it recently.  

Aren't all of these organs from which these illnesses develop part of the human body?  Does it seem ridiculous to you as it does to me that there's no integrated insurance coverage to address all the ills of our bodies?  

Having studied anatomy and physiology in college, I became in awe of the interconnections of all parts of my body.  We spring from this tiny egg that is fertilized by a little sperm and eventually are born into this world with everything working correctly, if all goes well.  Beyond birth, our bodies are subjected to the vagaries of existence on this earth ranging from diet to shelter to opportunities.  

Yet when it comes to medicine, our bodies are splintered into parts that are addressed separately by members of the medical profession without regard to the fact that an abscess of a tooth can lead to death of the body, that dehydration and electrolyte imbalance can lead to death of the body, that a heart attack can lead to death of the body, that an infection from bacteria introduced to an opening in the skin when getting a transplant or implant or even a cut can lead to death of the body, that a imbalance of substances in the brain can lead to depression that can lead to suicide/the death of the body.

Read the above again.  Every single one of the things I've listed can and does happen to those with eating disorders.  Every single thing.  And yet our government of the people, by the people and for the people does not provide adequately for those who have a mental illness, even those who have insurance!!!!

And spirit?  What about spirit?  Wikipedia provides a rather broad definition of this term.  About three years ago I participated in a Family Week during which our group leader remarked that we are all spirits, if you think about it.  Our bodies are made up of molecules that are made up of particles that are in constant motion.  The body electric.  What happens over time to someone whose spirit is not nurtured, whose very being is maltreated or ignored.  Death.

Isn't it time to take a harder, more accepting look at  holistic medicine?

I think so.  I am angry that I need to go after these different facets to address and advocate for the well being of my loved one.  That one "side" won't work with the other "side" even though the basic team that meets includes all sides.  There's something wrong with our system.

Postscript : When the Financial Well Runs Dry - Minnesota leads the way

This article that appears in Minneapolis-St. Paul Star Tribune illustrates what can be done when insurance companies "get" that treatment for eating disorders is not only critical but also a necessarily prolonged process in order to help a person fully recover from an eating disorder.

In case this article is not accessible to the public beyond this week which often happens, the article written by Chen May Yee of the Star Tribune in the Lifestyle section on December 25, 2010 notes that treatment for eating disorders is available in Minnesota at a far higher level than in others due to "...the willingness of the state's insurers to pay for treatment." 


Two centers are cited:  the Melrose Institute in St. Louis Park Minnesota and the St. Paul-based Emily Program.  The Melrose program admitted ten percent of its patients from out of state and the Emily Program admitted six percent from out of state, according to the article.  The Emily Program has expanded to seven locations within the state.  The Melrose Institute apparently is considering opening another center in Twin Cities.


This development was spurred by an important and successful lawsuit ten years ago by Kitty Westin and her family after the death of her daughter when Blue Cross/Blue Shield failed to provide adequate treatment.  Now, to quote Dr. Murray Zucker, identified in the article as a medical director with OptumHealth, the care management arm of United Health Group, "...From a cost-effectiveness standpoint, it makes sense to treat eating disorders as quickly as possible and in as efficacious a way as possible."


I hope the national headquarters of these and other insurance companies will step up rather than wait for a similar lawsuit in other states.  To repeat what was said in the article, immediate and adequate attention to eating disorders can ultimately save hundreds of thousands of dollars for the insurance companies (there's that economic benefit again) as well as many lives.  The work of NEDA and other organizations is certainly important to this process.

When the Financial Well Runs Dry

This post will be updated occasionally as I continue to find sites and references.  The piece includes comments following the financial section re obtaining care.
[March 2019]

I celebrated when I heard the news that with the passage of the Health Care Act, families can include their dependents on their health care plans for a longer time - until age 26.  And, your son or daughter does not need to be living with you in your home, either.  I've noticed that some private plans and the State of New Jersey (at least, there may be others) actually already extend that age until 30.  

Now, of course, one of the remaining hurdles is to provide parity in health coverage for those with brain disorders/mental illness including eating disorders.  The Eating Disorder Coalition and others are working towards that goal.  A recent decision re Wit v UnitedHealthCare written about by Steven Dunn on his blog www.adadsjourneywitheatingdisorders.home.blog  addresses this case and its ramifications.

On the insurance point, incidentally, Susan Maccia wrote an article for the Parent and Family Network Newsletter Fall 2011 issue titled, Insurance 201:Single Case Agreements outlining how to obtain special clearance for out of network treatment or out of state (e.g.) treatment.  There is precedent for this, even within Medicaid.

Here's a link to one woman's successful journey to effect change in her state (Missouri) as well as to obtain treatment for her daughter.  Annie Seal's story provides important tips on how to proceed.
 

In the meantime, and until your state or country enacts changes in the law to require insurance companies to pay for whatever treatment is necessary, what's a family to do when private health care coverage is not available for their adult loved one?  The Wall Street Journal among other media has occasionally run articles about people who have needed to declare bankruptcy upon exhausting all their funds.  Other families, whose members have working years ahead of them, have  chosen to completely decimate their retirement plans in favor of keeping a loved one in treatment.  What about people who are still in this battle and are retired or disabled themselves or literally cannot afford to exhaust their retirement funds.  What are other possibilities?

The first is to sit down and take a complete look at your financial picture and your age and ability to keep working.  If you're reading this, you have access to a computer and to sites like those offered by eg MetLife (there are many more and this is not an advertisement; I just happened to see it in the paper) or you can purchase software like Quicken  that has a planning retirement function to analyze what you'll need to live on post-retirement. 

This is an important step, too, because you need a complete picture with which to work when you do negotiate with residential facilities, many of which have funds set aside to help families whose means are not sufficient.  Do not hesitate to ask for help and be sure to factor things in like support for another aging family member or one with special needs.

The next is to consider treatment loans.  There are companies in this country that will work with you to finance long-term treatment.  Your doctor's office or local hospital may have literature about available loans.  edreferral.com provides all sorts of information about obtaining financial support - loans, trials, even free scholarships for the treatment of eating disorders including much of what I write about here.  For example, the non-profit organization called Project Heal also raises funds to provide assistance, if possible, to those who need it. 

A  legal ruling in New York State (legal work done by Kantor and Kantor) opens the door for support for nutritional counseling for those with eating disorders.  

At some point, there comes the time when other resources need to be considered and among those available for adults is Medicaid, SSDI and SSI, and other benefits at the State and Federal level such as Section 8 Housing and food stamps as well as private sources such as Catholic Community Services and similar church-run programs.  The Salvation Army is a resource, as well.

Your adult loved one may be eligible to apply for SSI (check on the asset limitations) or SSDI which can take time but is worth the time and paperwork. S/he should be able to find an attorney who will do this for her/him pro bono and as a compensation will receive a percentage of the declaration of support which usually is retroactive from the time your son or daughter sank into this quagmire of an eating disorder. The attorney will help your son/daughter figure this out as part of the application process.  A judge will have the final say. It's possible on at least the first go-round that the judge will deny your application. Your loved one (and you) needs to know not to give up! The attorney should know this, too, as it is not unusual.

In the meantime, if necessary for your family encourage your daughter/son to sign up for Medicaid which should be available to her/him as a low income/no income individual.  If your adult loved one has worked, s/he probably has paid into the system through payroll deduction and is eligible for these kinds of benefits. Some states offer a low cost health insurance program with a very small co-pay if the person is not eligible for Medicaid.  Many states are struggling with their own financial issues  but it's worth it for your loved one to pursue all these angles.

Once your daughter/son, should s/he choose to apply, is ruled eligible to receive SSI and begins to receive the financial assistance, her/his medicaid health coverage usually becomes part of this entire package.  Keep asking questions.  All states are different.

Your daughter/son may also become eligible for what's known as Section 8 Housing. The application process for this is also long and tedious but ultimately the cost (the rent) is subsidized.  The waiting period can be very long, however. 

Until your daughter/son obtains all/any of this assistance, s/he is going to need to find a place to live if s/he doesn't have one or cannot live with you (for a variety of reasons). S/he or an advocate (usually you) will want to check out long-term group homes or  shelters for those who have brain disorders/mental illness. If one is assigned, her/his mental health provider can help her with this. Usually these places are locked up at night and have someone who leads group sessions and that sort of thing during the early evening. Since they are run by non-profit organizations, there is usually oversight and rules. Often there are chores, so to speak, that they are assigned to do. Other options of course are group homes identified by a mental health provider or friends who are willing to share their home with your loved one for a low rent payment.  The Gospel Rescue Mission is an example here in Arizona.

Your loved one's journey may have included what is known here in Arizona as Title 36 procedures.  Depending on your State's laws, it may be possible for you to have your loved one picked up, taken to a hospital, and legally evaluated for their danger to self.  Some states prohibit this; others have a set time-line during which the person is evaluated.  

If the decision is to keep the person because of their mental/physical state, there is a time period within which next steps must be taken including a decision for a hearing with a judge.  These steps include a more thorough evaluation of, for example, their danger to self.  I'm keeping this general because there's so much variation among states.  

Ultimately, there is the possibility that the judge will rule the person to be SMI, meaning Seriously Mentally Ill, at which point the person can be assigned to a mental health provider that is by law required to oversee the mental health care and treatment of the individual. The judge's ruling may include Court Ordered Treatment. This can include treatment in a residential facility, especially if a precedent has been set.  Again, the laws vary as do the facilities.  Even where I live, those familiar with ED treatment know to which hospital one should take your loved one where they will encounter hospital personnel who are familiar with eating disorders and who are more likely to follow through with commitment and a thorough evaluation.  As I've said before, others are more inclined to simply provide an IV, stabilize electrolytes, and turn the [emaciated and endangered] person back out on the street.  I cannot begin to tell you what it feels like as a parent to watch a facility keep a loved one for only two hours in spite of the person's obviously emaciated condition and then release them.

As more information about eating disorders goes mainstream and doctors and other people in health care are educated, I believe that better and longer treatment will become available. 

Once the Court has declared your family member to be seriously mentally ill, the next step is to find a facility that has a contract with the State for this kind of treatment.  Often one does not exist.  Contact your state legislator or representative for help to find out more information.  If the person is under the age of 18, precedent may have been set by another person needing treatment for the person to travel out of state to good facilities that will accept Medicaid.  Florida, for example, has done this.  Arizona has in the past, as well. These arrangements are known as single case agreements.

Our local mental health community has collaborated in the development of a Crisis Response Center (CRC) at a local hospital where people can go for immediate help and evaluation.  Perhaps yours has done this, as well.  

Some law enforcement agencies require officer training to include working with people who have brain disorders/are mentally ill.  Others do not.  It's important for you to know what is available where you live.

Special Needs Trusts - Planning Ahead

In an earlier post, I mentioned a Special Needs Trust.  Anyone who has a loved one who has been declared disabled whether by a brain disorder/mental illness or by birth inabilities or by accident, to name some examples, would be wise to investigate this option when thinking about the future.  One does not need to be wealthy to think about this.  The goal is to make sure that if there are any assets left to pass along to a loved one, that those assets do not interrupt legal benefits; for example, disability payments (SSI), special housing allowances (Section 8 Housing), and medical care (Medicaid).

Typically, assets from the Trust may not be used for housing or food but can be used for other purposes such as health benefits not covered by medicaid or not available through medicaid sources.  This document needs to be prepared very carefully  by a knowledgeable attorney.

The Special Needs Alliance has set up a website to provide more information about this subject.

The National Alliance on Mental Illness,  its member associations, and other organizations have also published articles on this important subject.  By typing in the words "special needs" in the search engine of the nami.org website, one can access a wealth of information.