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“Ready Bag” for Hospital – And Other Necessities

Well before the onslaught of SARS COVID-19, I was working on a hospital “kit” to accompany a person who needs to be hospitalized. Some of the items had explanations attached.

For example, as part of the kit, I recommended a box of sanitizing wipes and Purell hand gel. This seems quaint these days. These once widely available products are worth their weight in gold now. And the awareness of transmitting a deadly disease through the spread of invisible organisms has skyrocketed. But it wasn’t always so. It’s not just nostalgic; it’s still important to remember that the coronavirus is not the only source of infection.

Here's the note to go with these kit items:

Sanitizing wipes and Purell: Keep these in a prominent place so people will see them.


Hospital-caused infections are a major killer—and a major cause of suffering and extended hospital stays. Most infections are the result of the spreading of “germs” from patient to patient on the hands of physicians, nurses, and other hospital workers, as well as to each other.

What will increase the chance that our care will be better and that we will not fall victim to all-too-many hospital-acquired infections?  There is no question --based on innumerable studies – that the best way to reduce this problem is very low-tech: the people who touch you in the hospital just need to wash their hands. Although this has been known for 150 years, hospital workers simply don’t always follow the basic rules of hygiene. Most healthcare workers understand the importance of hand washing but just don’t consistently do it. Often, they aren’t even aware of how inconsistent they are.

Ask every healthcare worker (including doctors) and visitor to wash his or her hands before touching you, your food, your medications, or equipment that will come into contact with you. Some hospitals instruct patients at admission to ask every healthcare worker to wash his or her hands. But many hospitals don’t take this approach. You need to do it yourself.    Studies have found that one of the most effective ways—better than training programs or rewards and punishments—to get healthcare workers to wash their hands is for patients to ask them to do so.

Yes, this is a matter of life and death – and you need to push back against any aversion you might have to feeling rude or pushy.  Be polite, but not passive. You can simply explain that you are following the suggestion of an article you read.

Reminders breed consciousness of patient safety measures. Simply understanding that it is acceptable and possibly life-saving to ask that everyone who enters a patient's room wash or use hand sanitizers to clean their hands can also lead to other pro-active and helpful actions.

Here is a Sign to bring with you:

“To all who come to care for or visit me – medical staff or friends and family – please wash your hands on entering and when you leave my room.” 

Keep in mind, this was written well before COVID-19 made its presence known. And it will apply long after its threat is mitigated. It will always be important for us all to observe careful hand hygiene. As the virus has made emphatic, we transmit illnesses to each other on a daily basis in any setting.

While we can no longer make these items available, there are other important (or just nice to have) items that we can have ready to go if hospitalization becomes necessary.

Put these in a bag (clearly labeled with a luggage tag) ready to go just in case. Visitors may not be allowed, so it’s especially important to have these things ready.

1. List of emergency contacts and phone numbers on paper.  This is crucial in case the patient is unconscious and phone is locked or battery ran out.

2. List of medications: name, dose, frequency. (Include initials after name of medication such as: XL, IR, ER, SR. These refer to how the drugs are formulated to be released into the blood stream.) Make sure the list is up to date.

3. List of emergency contacts and phone numbers on paper.  This is crucial in case the patient is unconscious and phone is locked or battery ran out.

4. Primary Care Doctor. Full name, phone number, and office address. 

5. A notepad with your name and phone number written on it and a couple of pens.

6. Cell phone charger - You could be in the emergency room for 6 to 48 hours!

7. Toothbrush and hair brush.

8. Extra underwear. (Depending on the condition of the patient)

9. Book / something to read.

10. Copies of legal paperwork such as Advance Health Care Directive, or POLST, if applicable. Copies of these, as well as emergency contact information should also be attached to the refrigerator. EMTs will check there.

11. CPAP machine information

12. If patient has a pacemaker or defibrillator: a copy of the pocket information card that states the brand, model number, and MRI compatibility.

13. If the patient has asthma or COPD, bring the inhalers.

14. Extra batteries for hearing aid or other medical devices.

15. Photographs of loved ones.

The medication list and Advance Directive should be placed in a large zip-lock bag. While the COVID-19 pandemic heightens our awareness of the need to be prepared, this advice is good at all times for all with underlying illnesses or who over 60 are.

Advance Directives: Lessons of COVID – 19

The need to have clear Advance Directives and discussions about life support is especially critical now.”

Do you have an Advance Health Care Directive?  If you are a client our Gilfix & La Poll, you do.

If you haven’t looked at your Advance Directive in a long time, now is a good time to make sure it still matches your circumstances and wishes.

  • Do you still want the health care agent you named?
  • Has your health changed in ways that might affect your instructions?
  • Are your values still the same?

Even if your wishes haven’t changed, it may be time to update; health care providers will be more confident following your instructions if your Advance Health Care Directive is relatively current. In addition, you may have some very specific wishes or fears that you can address in an advance health care directive.

Consider the people who need to know about your Advance Directive. Are they aware of its existence and what your instructions are? At minimum, be sure your health care agent has a copy. You may also want to send a copy to the doctors and medical facilities in which you would be most likely to receive treatment.


Your Advance Directive gives your health care agent broad authority to communicate with your medical and health care providers. In normal times, this communication may be during an in-person conversation. Now, when physical distance is necessary, you may want your directive to make it crystal clear that your agent may communicate with your health care providers by phone, email, video conferencing, or other means.

Expressing your wishes regarding intubation. In very severe cases of COVID-19, intubation—providing oxygen to a patient through a tube attached to a ventilator—may be necessary to keep you alive. In normal circumstances, if doctors feel they can potentially restore you to health by putting you on a ventilator, they're obligated to do that if they can. It makes sense to review your document’s language about intubation and resuscitation with this in mind. Recently, we have actually had conversations with some who have explicitly said that if hospitalized, they want to forgo being intubated if there is a shortage of ventilators. Some have expressed the desire not to be intubated even if there are available ventilators. Others worry about being denied ventilator support if needed.

Be sure you understand what your document says and that it accurately states your wishes. Add a note to your document that clarifies your directions; then make sure others know how you feel.

Finding witnesses or a notary public. Making sure your documents are legally binding could be tricky during this time of social distancing. Besides signing the document yourself, it must be witnessed or notarized. So how can others sign your documents while abiding by guidelines for social distancing? Will updating your document and/or clarifying your wishes require that it be witnessed and/or notarized again?

It may be reassuring to know that you have a constitutional right to direct your own medical care. If health care providers have “clear and convincing evidence” of your wishes, they are duty bound to follow those wishes to the extent they are reasonably able to do so, whether or not you provide your instructions in a witnessed or notarized document.

It’s far better than nothing to write what you want and make sure your doctors and those who are close to you know your feelings. If there’s no conflict among your closest family members—those who would be legally entitled to speak for you—your wishes are likely to be respected.

Communicating with family during the pandemic. In the U.S., many hospitals are banning visitors.  This means that in the coming weeks as coronavirus cases are projected to grow, many Americans will be alone in the hospital.  And many Americans will die and die alone.

There is immeasurable comfort and reassurance in having a loved one with you when you’re ill. Even more relevant, having that person with you can be physically (and emotionally) therapeutic. It can be life-saving in some circumstances, but even if terminally ill, that presence can be essentially palliative. Just one story:

“Her husband sat in a small plastic chair beside her with his hand on her leg, smiling at some silly sitcom playing on the TV. I hesitated a beat. And then I entered.

I had to tell him. There was no way to soften the blow. The hospital is changing its rules, I said. No more visitors. When you leave today, you both need to say goodbye.

I watched their faces shift. My patient’s breathing quickened, and her ventilator alarm sounded. Her husband quickly moved his hand to her shoulder and her breaths slowed; the alarms silenced. He knew how to calm her. He had been there through all of it — hospitalizations for cystic fibrosis, the transplant, the bouts of rejection. When we took away her voice with the tracheostomy tube, he spoke for her.”

As hospitals banish visitors in an effort to protect against Covid-19, patients will be left alone. That leaves patients to “…suffer through their illnesses in a medical version of solitary confinement.”

“ Talking with one of the nurse practitioners in our hospital’s new Covid-19 I.C.U. one recent night, I asked what worried her most. “Patients dying alone,” she replied quickly.”

The writer goes on to describe efforts to make sure that patients in isolation for coronavirus have an iPad to keep them in touch with loved ones. It makes sense to plan ahead for this, as well. Not all hospitals are able to provide a way for patients to stay connected.

In “normal” times, as indicated in an influential report published in 2017, in the U.S. just 56% of people have had a conversation with their loved ones about end-of-life wishes. And only 27% have documented their end-of-life wishes in the form of an Advance Directive. Fewer than 20% discussed those wishes with their medical practitioner. Few have documented their wishes about end-of-life care. Often families have to make incredibly difficult life and death decisions on behalf of their sick loved ones. Needless to say, advance care decisions and planning should happen well before a medical crisis occurs. The reality is, many have not done this planning, and even if they have, they could not anticipate what a pandemic might portend. COVID-19 has made it even more important to think about how we can alleviate the loss of control it might mean.

Again, in times before the pandemic, if someone in dire straits lacked an Advance Directive, or available next of kin, the default approach would be aggressive, invasive treatment in the intensive care unit (ICU). This might include placing a hard plastic tube down your windpipe, inserting IVs into your blood vessels, and using machines to maintain regular bodily functions (a ventilator to provide oxygen, a dialysis machine to filter blood if your kidneys are damaged).

In this COVID-19 era, the protocols regarding aggressive, curative care aren’t as clear. Some hospitals are considering a do-not-resuscitate policy for all infected patients. Bioethicists have discussed the need for hospitals to create triage committees, a team of nurses and doctors that evaluate COVID-19 cases and make decisions about who should get that care. Individual providers should not have the burden of rationing care. Only a minority of elderly people and those living with serious illnesses who are put on ventilators will survive this pandemic to leave the hospital.

It is important to consider for each of us what we want in this situation. “The current projections indicate that the U.S. could have a shortage of some 1.3 million hospital beds and 295,000 ICU beds.” Some of us would prefer not to be hospitalized; many would not want ventilator care.

Doctors are contemplating their own end of life wishes. Some are sharing them publicly to encourage others to address them as well.

“Dr. Rana Awdish, an ICU physician at Henry Ford Health System and author of In Shock, wrote (on March 21st) on Twitter: “Today I had colleagues tell me that they’ve decided they’d rather die at home rather than come in and traumatize their colleagues who would have to care for them. Today we came up with contingency plans for our contingency plans. Today broke my heart.”

“Even trainees are having these important conversations. For example, residents at Massachusetts General Hospital decided to complete Advance Directives and assign health care proxies during their shifts at work. Perhaps through taking back control in even the smallest way, our own fears and anxieties about the unknown can be lessened, and maybe even our anticipatory grief.” (

Everyone – especially those who are in frail health already – should have the opportunity to talk about how they would like to be treated if they have a serious case of COVID-19. They need to specify who will speak for them if they are unable. These conversations should include what matters most to them, what they are willing to undergo for a chance to get better, and quality of life as each defines it.

Even though day to day life feels particularly uncertain, there are still choices we can make.


ODE TO MY O.R. TEAM [and my defunct hip]

Hello! My name is Myra.
You’ll be helping me today.
I’m new to having surgery,
And I’d just like to say…
As you likely know I’m pretty scared
So I truly appreciate that you’re so well prepared.

I’ve lived quite well for all these years
Despite my hip’s deformity
(Or perhaps more correct politically,
Its congenital abnormity).

Now I find myself in this predicament:
No longer can I hike and dance
With ease; without a moan.
Time wears on and so do ligament[s],
And cartilage and bone.

So now it’s time to face
That I need you to replace
The worn out hip that tried to serve me
But kind of, sort of did desert me.

When you clear out all that joint debris
I hope the pain is history.
If you amplify my range of motion,
To you I’ll owe my great devotion.

So goodbye sweet acetabulum,
Femur, ossified tissue, and labrum
Hello new prostheses.
I know you’ll fit in well.
Welcome to my body
Where thriving you will dwell.
Help me back to hikes and bikes,
To dances and romances.
Bring me to a renewed life
Full of second chances.

I put my trust in all of you
To keep me safe and sound.
I know that life is ephemeral
But I’m counting on you
to protect my femoral
Nerve and its surround.

Thank you for those years of study,
Sweat and tears and getting bloody.
Of your awesome skill I am aware,
So I thank you for your loving care.

With gratitude,
Myra Gerson Gilfix

Advising Clients About Hospitalization And Operations

As attorneys working with the older population and with individuals with disabilities, we frequently encounter clients and client family members who face hospitalization and operations. Because this isn’t a “legal environment,” we’re typically not involved beyond the preparation of an advance directive or other document appointing health care surrogates.

Patient advocacy is nevertheless a growing need. We’re particularly well positioned to develop guidelines, at minimum, for our clients who face medical challenges.

I’m not suggesting that this type of support and advice is in fact or should be deemed legal advice. It isn’t. Rather, it’s vitally important information that we’re well equipped to offer in light of our experience dealing with health care systems and the vagaries of aging.

Patient Advocate’s Role

The hardiest among us find it difficult to be assertive and independent or to gather facts when we’re ill. The stress and anxiety of being ill are enough to keep us from functioning optimally at best. In addition, the hospital environment itself, perhaps unintentionally, strips us of our normal life role. We wear hospital gowns that are uncomfortable and too revealing. The most sophisticated and erudite among us are suddenly called by our first names, infantilized. A Nobel Prize winning client of my office, revered in the scientific community and always referred to as “Professor,” was suddenly called “Jim” by nurses, certified nursing assistants and other well-meaning hospital staff members.

So, it’s a multi-faceted challenge to ask the right questions and to protect ourselves.

While there are professional patient advocates who work in myriad settings, my focus is on helping families and friends with some tips about how to “be there” for their loved one when he’s facing hospitalization. To understand how important this is, one unfortunately has to understand that hospitals aren’t always safe havens. Far from it.

Clients Facing Hospitalization

Our clients are of all ages and health statuses—healthy, ill, injured, chronically ill, dealing with disabilities and/ or providing care for others.

We counsel all of them about end-of-life decisions. We help them express how they want to be treated when they can no longer make decisions. We encourage them to think about whether they want to be home or in a hospital when end of life is near; whether they want to be kept on life support and under what circumstances. We bring up many other issues that arise when someone has permanently lost capacity.

We push them to communicate to those closest to them, as well as to their medical professionals, their assumptions, thoughts, values and feelings.

The Basics

We often know whether a client has a chronic or life-threatening illness, is about to undergo surgery and/or is facing an imminent hospitalization. These experiences are in the medical realm, and we may not be involved unless a specific legal problem arises or long-term care (LTC) costs are on the horizon. However, we’re in a position to offer help. Knowing at least some of the basics about patient safety allows the opportunity to provide practical, possibly life-saving advice at a time when it can accomplish the most.

Medical error. The unintended down side of medicine is the very real risk of being harmed by errors and certain practices that may occur in medical care and the institutions that provide it. The estimated number of deaths in the United States resulting from preventable medical error differs. But, whether we accept the Johns Hopkins patient safety experts’ number of 250,000 (or 700 deaths per day)1 or the Journal of Patient Safety estimate of 440,000,2 either number is too high.

Preventable medical error may now be the third leading cause of death in the United States—more than respiratory disease, accidents, stroke and Alzheimer’s.3

Countless others suffer illness or injury as a result of medical errors.4

Dr. Martin Makary, professor of surgery at Johns Hopkins University School of Medicine in Baltimore and leader of the Johns Hopkins research 5, explained that the category of “medical error”6 includes a wide variety of ills, both systemic (such as failures in communication during patient transfers to another staff) and individual (such as individual doctors’ mistakes). “It boils down to people dying from the care that they receive rather than the disease for which they are seeking care,” he said.7

The Leapfrog Group8 underscored the need for hospitals to make patient safety a priority. However, more importantly from our perspective, the authors indicated that it’s in our sphere as patients, family members and friends to “…protect [our]selves and [our] families from harm…”9

As a practical matter, family members and friends are well positioned to serve as patient advocates. They may be named in advance directives or other documents appointing surrogates in the context of medical care decision making. However, if they are, the directive can indicate the desire for help with the medical world even when capacity isn’t impaired or absent. Perhaps you can suggest a document that allows Health Insurance Portability and Accountability Act (HIPAA) authorization for those whom the client/patient trusts the most.

Prominent geriatrician Dr. Mark Lachs asserts, “As perilous as hospitalization can be … I firmly believe that there is no health-care venue where laypeople—patients, families, concerned friends and neighbors—can have a greater impact on improving outcomes of care.” 10

That’s because many of the dangers of hospital care aren’t a result of technical procedures and tests. Most of the time those are done well. The devil, as they say, is in the details—those that occur before, after or in between the procedures or surgeries. Errors, as noted above, aren’t the only way that harm can be done.

The effects of hospitalization itself. Patients often suffer from being kept in bed too long, from confusion, even from malnutrition—all of which impair recovery. Concerned lay people can, among many other things, help to ensure that the patient is as mobile as soon as and as often as possible; they can facilitate communication and help to coordinate multiple medical professionals. Even a reminder to a staff person or a visitor to wash hands can be lifesaving. This simple measure can prevent a virulent hospital-acquired infection.

When family members or other caring individuals take such steps, they’re acting as patient advocates.

The Attorney’s Role The sheer number of clients we see who are facing medical issues, together with our awareness of the avoidable dangers of dealing with medical care, puts us in an opportune position to give practical tips and information that—while not legal advice—are uniquely valuable.

We can be proactive when a client or client family member faces hospitalization. We can encourage him to identify the best individual(s) who can help him survive a hospitalization and enjoy an effective rehabilitation experience. We can alert clients to their own and their family’s ability to facilitate recovery and avoid harm.

Sometimes it takes a village. A client may not have the perfect individual to advocate and otherwise watch out for her. Or, she may have one ideal advocate, but one individual alone can’t be there 24/7. Friends and family, as well as church and synagogue groups may be called into play to help. A professional patient advocate may be needed if no other resources present themselves.

Elder law and estate-planning attorneys routinely counsel clients and family members about health insurance, Medicare, Medicaid, HIPAA, medical malpractice, asset preservation in the context of LTC and other matters. Attorneys tend to become involved in the health care setting only when problems arise. They become involved reactively.

I suggest that attorneys become much more proactive, offering clients practical, fact and research-based advice and information to equip them to serve as advocates for their family members. Give this advice and information, in particular, to individuals named in advance directives. Family members who’ll be present in the hospital room or at doctor visits should be similarly educated and empowered.

In addition, you should add “patient advocacy” to your arsenal. Nothing prevents you from including it in your consultations, your correspondence or even your document preparation. It will expand your practice. It will add to the quality of health care for your client community as well.

Sample Documents

With this in mind, I share a typical handout for you, the practitioner, to expand, edit, adapt and distribute to appropriate clients and family members. (See “Sample Handout,” this page and “Sample Pre-hospitalization Letter” )


1. “Medical error—the third leading cause of death in the US,” BMJ 2016; 353:i2139 (May 3, 2016), Analyzing medical death rate data over an 8-year period, Johns Hopkins patient safety experts calculated that over 250,000 people die each year due to medical errors in the United States.

2.,_ Evidence_based_Estimate_of_Patient_Harms.2.aspx.

3. Supra note 1; Some argue that this estimate is too high, but that the real problem is a failure of the medical system to handle complex care. Seehttp://blogs.scientificamericancom/guest-blog/the-real-cause-of-deadly-medical-errors/.


5. Dr. Martin Makary’s research involves a more comprehensive analysis of four large studies, including ones by the Health and Human Services Department’s Office of the Inspector General and the Agency for Healthcare Research and Quality that took place between 2000 and 2008.

6. “Medical error” has been defined as an unintended act (either of omission or commission) or one that doesn’t achieve its intended outcome, the failure of a planned action to be completed as intended (an error of execution), the use of a wrong plan to achieve an aim (an error of planning) or a deviation from the process of care that may or may not cause harm to the patient. Patient harm from medical error can occur at the individual or system level. The taxonomy of errors is expanding to better categorize preventable factors and events. I focus on preventable lethal events to highlight the scale of potential for improvement. See supra note 1.

7. Ibid.



10. Mark Lachs, M.D., What Your Doctor Won’t Tell You About Getting Older: An Insider’s Survival Manual for Outsmarting the Health-Care System (2011).

Preserve Your Hearing! Practical Wisdom And Preventive Steps

  • According to the National Institute on Deafness and Other Communication Disorders (NIDCD), 15% of Americans (26 million people) between the ages of 20 and 69 are afflicted by hearing loss due to exposure to loud sounds at work or during leisure activities.
  • Every day, we are exposed to noises and sounds that damage our ability to hear.
  • In order to prevent this damage we first have to be aware of the danger and harm. Any sound above 85 decibels can potentially injure hearing.
  • We can prevent hearing loss and tinnitus caused by toxic levels of noise by avoidance or by simple, yet powerful steps.

Avoid loud noises, reduce the amount of time you're exposed to loud noise, and protect your ears with ear plugs or ear muffs. These are easy things you can do to protect your hearing and limit the amount of hearing you might lose as you get older.

We are all in danger of experiencing hearing loss as well as the misery of tinnitus. But some hearing loss is preventable.

“Preserve Your Hearing” is intended to be a wakeup call. We can easily implement practical solutions for ourselves and our loved ones.


In Judaism, one of the seven wedding blessings praises God for creating joy and gladness, loving couples, mirth, glad song, love, loving communities, peace, and companionship and asks that the sound of joy, of gladness, the voice of the loving couple, their jubilance, and of the youths from their song-filled feasts be heard.(paraphrased ecumenically)

I have to admit that this article came to be partly because of a pet peeve of mine. I love celebrating weddings and other festive occasions. I love the experience of community coming together in mutual joy, excitement, and support of the people who are celebrating an important life milestone – or just having a great time. We come together to enjoy music, song, dance, laughs, good food, drinks, and conversation. Friendships are formed and nurtured. Memories are created.

What I don’t love, putting it mildly, is the inability to carry on a conversation and the pain of poundingly loud music. And I love music.

Instead of enjoying the chance to dance and to talk with others, I find myself yelling to be heard, fighting a headache, and generally feeling somewhat miserable. Yes, I know many find the loudness itself exciting, exhilarating, and even intoxicating. Well, it turns out that the loudness is, indeed, intoxicating. At least it is toxic to hearing.

This loud music is literally poisoning our hearing.

We want our guests to enjoy themselves. We take care to provide food that is fresh. We’re careful to make sure the dance floor is free of hazards that could cause a fall. We provide for separate space where people who want to smoke can do so without exposing the rest of our guests to second-hand smoke. But when it comes to noise, I’ve found it difficult to get far enough away for comfort without leaving the party altogether.

Bands, orchestras and DJs have been raising the volume at celebrations of all kinds.  They believe the high volume creates high energy and excitement. In general, sporting events and concerts are also getting louder. And modern sound systems reach a higher decibel level than older ones, one that is damaging to ears at even brief exposures. While some people seem to crave loud music, many react to loud noise with anxiety and irritability, an increase in pulse rate and blood pressure, or an increase in stomach acid.  (Those people might quietly leave your party way too early because they don’t want to complain.)

Sadly and ironically, the more such joyous events we attend, the more damage to our hearing.

Remember, hearing loss usually develops over a period of several years. Since it is painless and gradual, you might not notice it. But you may have trouble understanding what people say; they may seem to be mumbling, especially when you are in a noisy place such as in a crowd or at a party. Ironically, you may become less able to enjoy music.


I don't go to see bands any more because I've got tinnitus, so I have to avoid loud music. You get used to it, but when it's quiet you hear a constant ringing. - Linton Kwesi Johnson

You also might notice a ringing or other sound in your ear (tinnitus), and that can become permanent. Tinnitus increases a person’s risk of serious mental health issues, including depression and anxiety. It can trigger episodes of extreme anger and suicidal ideation, according to the Hearing Health Foundation. No doubt most of us would become irritable if we lived with a constant ringing or buzzing in our heads.

Lesson of “A Star is Born”

For a vivid depiction of the devastation that tinnitus can cause, go see “A Star is Born.” The portrayal of Jackson Maine is much more than subtext for the love story and wonderful soundtrack. Jackson, who suffers from hearing loss and tinnitus, is seen consulting with an otolaryngologist who, along with Jackson’s manager, urge him to wear in-ear monitors. These are custom-molded ear plugs that musicians use to protect their hearing, while being able to hear themselves play. Sadly, Jackson refuses, and, as the story illustrates, perhaps it was already too late for him to save his hearing. More than 12 million people in the United States suffer from some degree of tinnitus, according to Stanford Health Care. At least 1 million experience ringing in their ears so severe that it affects their daily activities.

In any case, take no chances with excessive noise – the hearing loss it causes is permanent.

With healthy, well-functioning ears, we can detect sound from the softest whisper to the loudest thunder clap. Our ears are a miraculous gift. Needless to say, many people live full, happy lives without hearing. But, if given a choice, most of us would elect to be able to hear.


Many things that we cannot control or prevent, including age, cause hearing loss. However, noise, not age, is the leading cause of hearing loss. And it is in our power to prevent it from stealing our hearing. Protecting our hearing will not only prevent or delay hearing loss, it will also benefit our mental wellness.

According to Dangerous Decibels, a project of the Oregon Health and Science University in Portland, approximately ten million Americans are victims of noise-induced hearing loss. Noise-induced hearing loss is a permanent hearing impairment that results from exposure to high levels of noise for an amount of time that exceeds our ears’ ability to withstand damage. When noise is too loud, it begins to kill cells in the inner ear or cochlea (called “hair cells” or stereocilia). These are the cells that respond to mechanical sound vibrations by sending an electrical signal to the auditory nerve. Different groups of these hair cells are responsible for picking up different frequencies.

A healthy human ear can hear frequencies ranging from 20 Hz to 20,000 Hz.  Loss of hearing can be caused by a one-time exposure to loud sound (that exceeds 124 decibels, called acoustic trauma), but more typically, as the exposure time to loud noise increases or repeated exposure occurs, more and more hair cells are destroyed. As the number of hair cells decreases, so does your hearing.   And since this damage can happen without pain, we don’t even know when to stop or get away from toxic noise levels.

The average person’s pain threshold for noise is approximately 120-140 decibels, but damage can be caused by prolonged, sustained exposure to 85 decibels – the noise level of midday city traffic. This means that your ears could be sustaining damage at a wedding party even if you are enjoying lively music and having a fabulous time. The fact that you find the amplification tolerable, or even pleasurable, does not mean you are safe.

Fifteen percent of Americans between the ages of 20 and 69 experience high frequency hearing loss as a result of leisure or occupational activities, by the everyday noise that we take for granted as a fact of life.

Alarmingly, recent studies show an increase in youngsters’ hearing loss. Evidence suggests that loud rock music along with increased use of earphones may be responsible for this phenomenon. Twelve to fifteen percent of school-age children already have permanent hearing loss – enough to make it more difficult to understand even normal speech. Note: The rule of thumb for the use of earphones for music listening is that if you can’t hear someone talk to you while you have headphones or ear buds on, or if someone else can hear your music while your earphones are on, it’s too loud and is causing damage.

There are no mandated protections for professional music providers (or guests!) at parties or for teens listening to their phones. Nor are there restrictions on how loud music can be performed or played at parties and concerts. But we can exert control over how much noise we expose ourselves to and protect our ears.


To interpret the sound receiving process, a scale, known as decibels, was created. Sound intensity is measured in decibels (dB). Like a temperature scale, the decibel scale goes below zero. The average person can hear sounds down to about 0 dB, the level of rustling leaves. If a sound reaches 85 dB or stronger, it can cause permanent damage to your hearing. The amount of time you listen to a sound affects how much damage it will cause. The quieter the sound, the longer you can listen to it safely. A decibel is a logarithmic scale of loudness, so a difference of 1 decibel is perceived as a minimum change in volume, 3 decibels is a moderate change, and 10 decibels is perceived by the listener as a doubling of volume.


So, how loud is too loud? Here are some guidelines outlining the maximum allowed exposure time for different decibel levels. Noise below 85 decibels is generally considered safe even for sustained, long-term exposure. This includes the humming of a refrigerator (40 decibels), bird chirping (50 decibels), a normal conversational voice (60 decibels), the noise of a typical vacuum cleaner (70 decibels), and a crowded restaurant (80 decibels). At 85 decibels – which, as mentioned, is the noise level of heavy city traffic – damage can begin to occur after eight hours of sustained exposure.

Once the noise is at or above 85 decibels, it takes drastically less time to suffer hearing damage. For every five-decibel increase in sound intensity, the time you can be exposed before you risk hearing loss is reduced by half or more. You can be exposed to 90 decibels for four hours, 95 decibels for two hours; a volume of 100 decibels is considered harmful after just 15 minutes of exposure. Studies have shown that movie-theater sound peaks in the 100-decibel range at some theaters. This level of sound can cause tinnitus and hearing loss. If you are cringing during the previews, it’s too loud.  In a nightclub, where noise can peak above 110 decibels, without hearing protection you risk hearing loss in less than five minutes. Bands and DJ’s typically play music exceeding 100 decibels, and often keep turning up the volume as the event progresses in order to sustain the “vibe” in the room. The “safe” exposure time before damage occurs at 115 decibels is three minutes. Music may be exciting, melodic, harmonious, and fun, but it’s still noise.


Many of us voluntarily expose ourselves to harmful noise recreationally (musical concerts, movies,  disco bowling, eating at restaurants with loud music and conversation,  parties to celebrate weddings and coming of age ceremonies, use of power tools, hunting or target shooting with loud firearms, and, of course, simply listening to music with earphones. To protect ourselves and our children, we should take special care to avoid these toxic noise levels, just as we would avoid toxic smoke.

While there are sound-level apps that can measure noise exposure and indicate whether the volume exceeds safe noise limits, we only need to use common sense.  If you have to shout to someone 6 feet away to be heard above the music, or you feel the vibrations in your body, or if the music is painfully loud, you can be pretty sure the sound level has exceeded a safe limit and is damaging your hearing.

To protect yourself, at least periodically leave the room and go to a quiet place to allow the ear to recover from the noise and avoid sustained exposure to dangerous sound levels.  Better yet, wear earplugs. They are common among those who work with noise but should help avoid damage for party-goers’ ears at celebrations, as well.   Properly fitted earplugs or muffs reduce noise 15 to 30 dB. To be effective they must totally block the ear canal with an airtight seal. Earplugs must be snugly sealed so the entire circumference of the ear canal is blocked. An improperly fitted, dirty or worn-out plug may not seal and can irritate the ear canal. Ordinary cotton balls or tissue paper wads stuffed into the ear canals are very poor protectors; they reduce noise only by approximately 7 dB.


The most effective solution, of course, is to simply avoid the problem in the first place by ensuring that music is played at safe levels. That includes the “silent parties” where people can wear earphones to hear the music. At these parties others can converse without shouting, and each person can control the decibel level or take off the earphones. And for those wearing them, note that ear buds and exterior headphones are safe if the volume you are using doesn’t keep you from hearing someone talk to you. If someone else can hear your music while you are wearing them, you are definitely in the danger zone. Remember, the input from a personal music system at maximum volume into stock earphones can generate a sound level of over 100 dB.

If you think you have grown used to loud noise, your ears have likely been damaged. There is currently no treatment – no medicine, no surgery, not even a hearing aid, that truly corrects your hearing once it is damaged by noise. This doesn’t mean you should just turn up the music to louder and louder levels. You can still protect what remaining hearing you have. While it may seem silly and obvious to point this out, usually the best way to prevent future injury from noise is to avoid exposure to noise!  If you are exposing yourself to the unsafe level of noise, stop doing it!


Avoid loud noise when possible.

Stop going to excessively loud venues, such as concerts and restaurants where the “background” music already challenges hearing and conversation is correspondingly louder. Share this information with your friends and family.

If you are forced to endure loud noise, use ear protectors properly. Wear earplugs when attending concerts, loud group-fitness classes, working with loud machinery, such as lawn mowers. The plugs need to fit properly. In a pinch, disposable foam earplugs (available in stores or online) may help a little, but follow directions to place them properly.

For louder sounds, or prolonged exposure to moderately loud sounds, invest in musicians’ earplugs, which can reduce the volume by 30 decibels, or in protective earmuffs. Remember that 85 decibels is the cutoff for what you can safely be around for eight hours. For every 3-decibel increase above that, the safe listening time drops significantly.  For very loud sounds, use both earplugs and earmuffs. There are earplugs that allow for you to enjoy the music without destroying your hearing.

Your general health matters. If you smoke, quit. Smoking harms hearing because it impairs circulation.  Some conditions, such as high blood pressure, heart disease, thyroid disorders, and diabetes can contribute to hearing loss by compromising blood flow. Research shows that consuming excessive amounts of alcohol can cause further hearing loss and make tinnitus more noticeable.   Treat Ménière’s disease (a disorder of the inner ear) and shingles; these can take a toll on your hearing. And some medications — including some chemotherapy drugs, antibiotics, erectile dysfunction drugs and high doses of aspirin — can be toxic to the ear. Tell your doctor if you notice any change in your hearing.

Assess the volume. Maybe you can avoid the noise. In addition to common sense indicators – such as too loud to be able to hear someone who’s talking 6 feet away; feeling the vibrations in your body; finding yourself shouting to be heard --  there are good-quality sound level apps you can download onto your smartphone to gauge the noise levels wherever you are.

Take care not to be the source of loud noise, such as by hosting a party or event at which music is played at decibels toxic to the human ear. This may entail a serious conversation with the band or DJ you have hired. For a sample letter or email to your DJ or band, click this link

We indeed hope and pray that we all can participate in many joyous celebrations that will allow us to hear the festive, exuberant sounds of happiness, well into old age.

Further Resources

For further reading on the subject of hearing safety, see the following.

American Hearing Research Foundation:

Dangerous Decibels:

Deafness Research UK:

Maximum noise exposure chart:

Marek Roland-Mieszkowski, Ph.D., “Common Misconceptions About Hearing”:   offers risk assessments, referral links and information about custom earplugs, which are far more effective in preventing damage and evenly conveying sound frequencies than conventional earplugs.

Marek Roland-Mieszkowski, Ph.D., “Common Misconceptions About Hearing”:

Clean Hands, Save Lives, and Avoid Misery

by Myra Gilfix

It's flu season again.

All of our staff members want to do what's best for our clients. That includes, we decided, making sure that we, as an office community, make good hand hygiene a habit. At our last staff meeting, I gave a presentation on how to avoid getting the flu, respiratory, and GI illnesses that are so easily spread, especially during this time of year. I'd like to share highlights of what I presented and of our staff discussion.

Personally, I hate getting sick. So I got a flu shot, which the CDC says is about 60% effective. The Center for Disease Control recommends getting a flu shot as soon as the vaccine becomes available. I like the fact that getting the flu vaccine protects the people around me, as well. And I read up on what else helps prevent illness.

The best thing we can do is like a painless vaccination: wash our hands. It seems the most effective way we can follow the Golden Rule is to practice excellent hand hygiene. We owe it to each other, and especially to our clients, to do what we can to avoid spreading illnesses. In fact, nearly 80% of sickness-causing germs spread via the hands.

The average hand contains about 150 species of bacteria and viruses, including those that cause flu and other diseases.

How Diseases are Commonly Spread

How are diseases most commonly spread? First, you touch a contaminated surface with your hands. Think of all the places where there are a lot of germs: ATMs, elevator buttons, cell phones, dishcloths, sponges, keyboards, faucet handles, work desks, and bathrooms, to name a few. Second, you touch your eyes, nose, or mouth. That will transfer the germs into your body. Keep in mind that viruses live for hours outside the body, sometimes even days. They settle on surfaces after being breathed, coughed, or sneezed out. People who are sneezing or coughing frequently get them on their hands, which become contaminated. Same with the extra microbes you acquire when you visit the restroom. Unless you wash these off, your hands are officially contaminated. They, in turn, touch surfaces which become contaminated. UC Berkeley researchers found that over a three hour period, people touched their faces an average of about 16 times per hour.

Since we can't see microbes, it's hard to avoid them. A University of Arizona study used a non-infecting virus similar to those causing colds and stomach ailments to contaminate a push-plate door at a building with 80 employees. Within two hours, the virus had contaminated the coffee pot, microwave button, fridge door handle -- and then continued to spread. This is similar to what happens in stores, theaters, even our own homes. Clearly, it is impossible to completely avoid cold and flu viruses -- but it isn't pure luck whether you catch them or not. You don't usually get sick with only one virus; you become ill when so many viruses enter your body that you cannot cope with them. If fewer viruses enter your body, you have a much better chance to fight them back.

It is easy to touch your face without noticing you're doing it. If your fingers have viruses on them and you touch your eyes, nose, or mouth, you are likely to infect yourself. What do you do?

We've all been taught to wash our hands after we go to the bathroom. But do we always?

Well, actually only about two out of three people wash their hands after they go to a restroom. And, according to a study at Michigan State, only five percent of the 3,749 people observed in restrooms washed their hands correctly! Virtually everything the other 95% touch is likely to have some contamination.

That makes it all the more important that each of us wash hands as often as possible. Washing correctly and often will stop viruses and other nasty microbes from being passed from your hands to your eyes, nose, and mouth. This can be done with soap and water or with an antibacterial hand gel. Water alone doesn't do it. And you should NOT use an antibacterial hand soap because that can breed superbugs, harder to get rid of. However, hand gel should have at least 60% alcohol.

In fact, good hand hygiene -- washing or gelling -- is the single most effective way to stop the spread of infections. And it is the major method used in hospitals to fight infection.

Make it a Habit

We talked about making it a habit to wash hands at certain times, including 1) before eating a meal OR A SNACK, 2) after going to the toilet, 3) when returning home after work or shopping, 4) after being close to someone who has a cold or flu, and 5) after sneezing or coughing. Of course, good etiquette means using a tissue to catch a sneeze or a cough, disposing of the tissue, then washing hands, and if no tissue is available, cough or sneeze into your elbow instead of your hands.

We pledged to remind each other to wash hands as well as to be more mindful. We'll make reminder signs to put up in strategic places. We also have hand sanitizers at our desks and make them available for anyone who comes into the office. So feel free to use our gel!

Some people think that catching colds or the flu makes their immune system stronger. This is true -- but only for children under a year old who are still building their immune systems. There are over 200 different viruses that cause these illnesses, so it is decidedly better to avoid catching them at all. And you can catch a virus when someone sneezes or coughs if you're with three to six feet of them. So, if you notice someone sneezing or coughing, keep your distance. But, again, remember the real danger is that the viruses fall on surfaces (think stair rails, tables, keyboards, TV controls, desk tops, counters, etc.) that you may be likely to touch. These viruses can live on your hands for as long as three hours, and up to three days on some surfaces. Deceptively simple, hand washing/gelling is the single most important way to stop them from spreading.


We wouldn't shake hands with someone whose hands were clearly dirty, or if we saw them sneeze or cough into their hands, but we do shake hands with others whose hands are full of microbes that can be harmful.

To our clients: We pledge to wash our hands often.

We enjoy greeting you, but there are ways other than a handshake that would let you know how glad we are to see you. We discussed several less germy possibilities: a fist bump, a bow, even a hug is less likely to pass germs, as long as we don't breathe into your face! What kind of greeting would you prefer?

Does it Really Work?

People often remain skeptical. We don't see germs. A lot of folks think they just won't get sick. Some even think it's kind of "macho" to avoid washing hands or that it takes too much time. Does it really make a difference to wash/cleanse your hands?

There have been many studies that demonstrate that frequent hand cleansing does indeed cut down numbers of illness. One that I like involved a survey showing that a lot of new recruits in the Navy had some form of cough or flu-like illness in the first few months of training. Living in dorms (think of your college kids, too) increases the chance of illness spreading. Sick soldiers or sailors are not good security. So in 1996 an Illinois Navy base began "Operation Stop Cough," a course to teach new recruits to be more hygienic. The rules: 1) Recruits must wash their hands at least five times per day; 2) Soap must be available at all sinks; and 3) Officers in charge trained on hand washing by medical staff. To determine effectiveness, the number of illnesses the recruits had were recorded before "Operation Stop Cough" was implemented and compared with the number after. Findings: When they washed hands more often, the recruits caught HALF the number of illnesses they had before. The more times per day a recruit washed hands, the more likely NOT to catch a cough or flu. The U.S. Center for Disease Control confirms, "Hand washing is the single most important means of preventing the spread of infection." More: A Wirthlin study of 305 Detroit students washed their hands at least four times a day, resulting in 24% fewer colds and 51% fewer stomach upsets. A Minnesota daycare provider reported that teachers helped kids wash their hands every morning when they arrived and the staff disinfected areas parents may have touched. The result was 50% fewer illnesses at those daycares.

Needless to say, washing or gelling your hands is most important when you've been in busy places -- work, school, cafes, shops, public transport, where a lot of people have touched hard surfaces, like escalator and stair rails, table tops, chairs, handles, computer keyboards, shop counters and money. So it's a good idea to wash when you come home or into your office after being away. And of course, being in close quarters with someone who is ill means you should wash your hands before you accidentally touch your face.

We already practice good hygiene in many ways. We store our food in refrigerators, we throw away spoiled food, we wash our dishes and eating utensils. Washing hands regularly is at least as important. Make it easier to do by providing non-antibacterial soap at every sink, preferably one that smells good and is in a pump dispenser. Remember, antibacterial soap can breed the bad superbugs that are so hard to get rid of. If it smells good, your hands will smell good, and that will remind you not to touch your face when you bring your hand close to it -- an added precaution.

Keep hand sanitizing gel in rooms in convenient locations. Match hand washing with everyday cues. For example, keep a hand gel near where you put your keys when you come in. Be a role model for others. People are more likely to wash or gel if they see others do it and agree to remind each other.

How to Effectively Clean Hands

So we know to keep our hands clean, but most people do a pretty cursory job. Many don't even bother with soap. They fulfill the "letter" of the "law" but not the substance and reason for it. Washing without soap has little effect on, say E. Coli, for example.

So what's the best way -- the effective way -- to wash or clean hands? First of all, you need to realize that you should clean all surfaces, including backs of hands, wrists, between fingers, tips of fingers (the number of germs on your fingertips double after you use the toilet), thumbs, under fingernails (90% of the germs on hands are found under fingernails), and under rings, watches and bracelets. If you wear a ring, there could be over 700 million germs under it.

Wet your hands; then use enough soap to cover them completely with soapy "gloves." Rub the palms together, interlace fingers. Then rub the backs of the hands and interlace fingers. Then...Better yet, take a moment to watch this video. You can use a paper towel to turn off the faucet. I often use my elbow instead since we're in the middle of a drought.

Drying Your Hands

Drying your hands is also important. Damp hands spread 1,000 times more germs than dry hands. Do it with a paper towel gently but thoroughly. Wet hands can pick up bacteria more easily, so make sure they're thoroughly dry. Don't rub your hands together to dry them. It's okay to use a hand blower that doesn't require rubbing your hands together. Use a paper towel to open the door.

Too Much Time?

If you're worried that it takes too much time to wash long enough, remember that the 20 seconds you spend may save you days in bed. Also, use the time that you're scrubbing your hands to meditate, to breathe, and enjoy the break. Clear your mind. Think about something good. As you wash, roll your shoulders and neck to ease tension. If you can't stand singing "Happy Birthday" twice or the ABC Song once in your head, pick another song that you like that takes about 20 seconds and sing that one instead. It will also save time to keep hand gels near where you work.

Dry Hands?

Gels can be less drying to the skin than normal soap and water, and are usually just as effective, so use them except when your hands are soiled or if there is an outbreak of C. difficile. C. diff is a nasty sickness that can cause life-threatening diarrhea and can only be defeated with soap and water washing. Stay hydrated. Drink lots of water. Avoid harsh soaps and detergents. Use warm, rather than hot water. Use a moisturizing soap or gel. Keep a cream or lotion next to the sink and use it after you dry your hands. Keep your skin healthy; avoid chapping.

What Else Can We Do?

Carry an anti-bacterial hand gel with you. There are a lot of occasions when it is not convenient or easy to wash your hands. You can use the gel to wipe down surfaces that might be contaminated, such as that restaurant table where you're about to have your meal.

Don't forget to clean surfaces that are likely to be contaminated with bacteria and viruses -- doorknobs, keyboards, light switches, tables, etc. that are in your environment.

You can use a solution of one part bleach to 10 parts water. Spray surfaces and wipe with a paper towel.

Avoid using artificial nails and remove chipped nail polish. These have been associated with an increase in the number of bacteria on the fingernails.

Spread the Word -- Not the Germs

Encourage children to wash their hands regularly. Show them how and when, by doing it with them. Sing songs while washing hands. Give them their own foamy soap dispensers. For children too young to wash their own hands, get them used to keeping them clean by helping them and by using gel on their hands.

Hand hygiene improves community health as well. Hand washing education reduces the number of people who get sick with diarrhea by 31%. It reduces diarrhea illness in people with weakened immune systems by 58%, and it reduces respiratory illnesses, like colds, in the general population by 21%.

Convincing People to Wash their Hands: What Works.

Education definitely helps, but there's more.

For example, the "ick" factor often works. One mom showed her kids a video about parasites that can reside on hands. She never had another problem getting them to wash up after seeing photos showing all kinds of microbes on hands. Videos of people sneezing on their hands, then touching doorknobs or other objects that we commonly have to come into contact with. Setting an example. People take cues from others. If you wash your hands, the people who see you will be more likely to wash theirs. Help people realize that washing their hands protects others. We tend to be more motivated to help others and we're more likely to think we're "immune" (literally and figuratively) to getting sick, while knowing that others are not.

A Quick Checklist:

  • Wash/cleanse your hands as regularly as possible. In addition to washing visibly dirty hands, you should also wash your hands before you eat or drink and after you use the bathroom, play with animals or take out the trash.
  • Avoid touching your face (or try to use a tissue if you need to).
  • Use tissues to "catch" a sneeze or cough, then put them in a bin immediately. Wash or gel your hands as soon as possible.
  • Keep at least a 3-foot distance between yourself and ill people.
  • Keep frequently touched surfaces clean. Use a mix of 10 parts water to one part bleach. For cell phones, make an alcohol and water solution: 1:1 ratio of 70% isopropyl alcohol and distilled water.
  • Use a spray bottle, lightly moisten a lint-free microfiber cloth and gently wipe down screen and case.
  • Clean corners with lint-free foam (not Q-tips) and don't ever spray directly onto the phone.
  • If you're ill, stay home until your fever has subsided for at least 24 hours. Flu is contagious a day before symptoms appear and for four to five days after symptoms occur. If someone in your family is ill, use separate towels and keep them in one room.
  • Wear a mask if there is a risk that catching a virus will make you seriously ill. The best are Particulate Respirators, which are round. These are called N95, FFP2 or FFP3 masks. These need to fit properly to work, so learn how to put them on. Also, since viruses will collect on the outside of the mask, throw it away carefully by putting it into a plastic bag, seal, and then wash your hands.
  • Practice other good health habits. Be active, eat healthy foods, stay hydrated, and get enough sleep.
  • To help avoid breeding superbugs, ask questions when your doctor wants to prescribe an antibiotic.
  • At least 30% of antibiotic prescriptions are unnecessary and taking one can kill the good bacteria, leaving you more susceptible to other illnesses, especially C. difficile. Ask your doctor if you really need an antibiotic. If you do, then ask if it can be one that is specifically targeted to your particular "bug." Find out the minimum time necessary to use it for it to be effective. Ask about the possibility of using probiotics (even a few bites of yogurt) to counteract the bad effects of killing off the good germs.
  • Spread the Word -- Not the Germs. Let other people benefit from your knowledge about preventing infections. Teach your children. Remind your family, co-workers and friends.


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Be a “Patient Advocate” for Hospitalized Loved Ones

Hospitals can be unsafe places. Mistakes happen. Sleep can border on the impossible. Hospital based infections happen far too often.

To combat all of this and to enhance and protect the well-being of a loved one who is hospitalized for any reason, family members and individuals named as agents in Advance Directives must become protective advocates when a loved one is hospitalized.

In this timely article, I explain the challenges in practical terms. I offer guidelines and specific action steps that can and must be taken to measurably enhance safety and quality of care in a hospital setting.

Read and use the article, which appeared in the September 2017 issue of nationally renowned Trusts & Estates magazine.

Click here to view the article.

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