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To make the choice that works best for their well-being and for their family's well-being as PVA says so eloquently in their testimony what is a more fundamental element of veterans choice than the choice to receive quality care at home from the people they trust the most one such veteran family I'd like to recognize here today is Kimberly Coble and her husband Scott who depend on the caregiver program after facing inconsistencies and roadblocks with the program and the difficulty of recognizing mental health trauma miss Cole has come here to offer her perspective she has submitted a statement for the record outline her outlining her suggestions for improving the caregiver program that I encourage everyone to read and I thank her for her work I'd also like to thank each of the almost 300 veterans and caregivers that engaged in the VA s request for information with the intent to improve the program I look forward to the Secretary's comments as well as the comments of the veterans service organizations and I'm hopeful today's discussion will lead to bipartisan support and to the expansion of the program so that it may better serve veterans of all eras this is the right and just thing to do and we can do better i before i close mr. chairman I just wanted to make a statement that mr. Woltz can't be here today that's why I'm sitting in this seat but he intends to submit questions for the record so with that I yield back mr. chairman I think generally for yielding and I'm honored we are honored today to be joined by our first panel by the Honorable dr. David Shulkin secretary Department of Veterans Affairs Secretary thank you for being here and thank you for the incredible job you're doing for our nation's heroes the secretary is accompanied by Margaret Cabot the acting chief consultant for care management chaplain and social work service and and dr. Richard M almond the chief consultant for the geriatrics and extended care service thank you all for being here and thank you for your service to our veterans mr. secretary you now recognized for as much time as you may consume okay thank Thank You chairman row and members of the committee and I do want to recognize congresswoman Brownlee that congressman walz is not able to be here but he's been a great steward and champion on this issue I think that you know I also do want to recognize the caregivers and the veterans who are with us here today this is a really important issue and it's one of the reasons why I always say that we have the very best committee in the house not only because of the leadership but because we tend to focus on the issues and I think everybody here can agree this program is really important it makes a difference in people's lives and we all agree that we want to.


How can the people around caregivers help support them? Is there a way that people try to help that actually stresses them out more?
Every caregiver is different and so are the people they take care of. You could just ask them directly however chance are they won't be able to think of anything.When I was still a caregiver for my dad I would take him out at least a few times a week. It was difficult because he lost mobility but wasn't aware of it himself. The apartment he was living in was not suitable either as there where 13 steps to the front door.I much appreciated the two boys next door who loyally helped my father up and down the stairs. In exchange I would sometimes invite them to the movies or for ice cream with my dad. I generally appreciated people who would acompany us on these outings as long as I didn't feel I'd have to entertain them or they wouldn't feel embarrassed. Later when it became more difficult to leave I would appreciate it when people would help me out with grocery shopping etc.The most important thing I believe is for the caregiver to know you're there for them and they feel they could count on you when needed.Edited for some typos
How do you find out what VA center is the best to go to in your area?
You can get an idea about which CBOC is any good by looking at Google and Yelp reviews. For VAMCs, you can find out the rank of your hospital on the VA website. Just know that they are ranked on a lot more factors than nice facilities and customer care. Some of the factors have to do with operations stuff that Veterans never encounter in their care, such as employee retention and financial efficiency, but you should get a general idea about which hospitals are likely to be a good one to go to.End of Year Hospital Star Rating (FY2018)
How difficult is it for a doctor or surgeon right out of medical school to get a bank loan to open his own clinic or surgery center?
Opening your own clinic/office? Probably not difficult at all. Depends on what you have in the bank, debt, credit rating, whether the bank thinks your location is likely to yield a successful (monetarily speaking) practice. If you are in an underserved area, or small town, and it's a local bank, the bankers may take into consideration the need of the area for the services you will be adding to the community. Will your being there help the town prosper and grow for example.Opening a surgery center is a whole different, and much, much more complicated and expensive ball of wax. Are you partnering with a local hospital? Are there other ASCs that prsimilar services close by? Have you done a “feasibility study”? How many surgical suites are you opening? Do you have adequate parking? Arrangements for Anesthesia/ ER services? Will you be the only surgeon using, or owning the facility? Is it single speciality or multi speciality? Are you violating any Stark Laws? Are insurers going to pay your facility? Are you going to be “in-network” or “out-of-network”? Does your location require a CON (certificate of need)? Are you prepared for annual inspections, bookkeeping, regulatory, “quality reporting” requirements, etc., etc., etc,?It's complicated. And those are just a few questions I thought of while I was writing this while sitting on the john. It's probably much more complicated than that. Really. Not the part about where I wrote this, but the rest of it is. Really.
Assuming that mankind originated from one single human pair, how many years would it take to fill the Earth with 7.6 billion people? Have any studies been carried out to support this?
“Assuming that mankind originated from one single human pair, how many years would it take to fill the Earth with 7.6 billion people? Have any studies been carried out to support this?”5,000 years, give or take. But it’s not what you’re thinking.Even assuming a single human pair, here’s a simple analogy. “Education Not Euthanization” asserts the following in a recent Facebook meme:“One female dog can produce 2 litters of 6–10 puppies per year. This means that one unspayed female and her offspring can produce 67,000 dogs in 6 years.”Humans are only slightly less profligate, and we’re talking about tens of thousands of years for modern humans to propagate throughout the planet.Population growth is geometric. However, as any global population graph against time will demonstrate, it is also self-limiting. The current 7.6 billion population load on the planet was simply not possible until humans learned two fundamental truths.First, it wasn’t until humans learned the connection between microorganisms and disease in the 19th century that they could begin to act affirmatively to extend average life spans and improve infant and maternal survival rates. Second, it wasn’t until humans learned how to aggressively manage food production in the mid 20th century that populations stopped being routinely decimated by famine.The real study, then, is the one that defines the critical population density necessary before an intelligent species can make those two giant intellectual leaps. And the answer is: you don’t need a study. Behind each of these leaps is the necessary framework of a philosophy of science and the concept of empirical experimental evidence. We know exactly when that occurred.Assuming global population hit a steady state before the first pyramids were built, that scientific framework is dependent not on population density but on the steady accumulation and documentation of thought. We know precisely how long it took to achieve that.Ignoring truly ancient prehistoric civilizations in the Indus Valley or Anatolia or other places, the first Egyptian dynasty is recorded at about 3100 BC. In 1638 Galileo published the method by which he for the first time in history teased out a fundamental law of nature by repeatedly rolling a ball down an inclined plane (See: Discourses on Two New Sciences).It took, then, 4738 years of intellectual accretion to lay down that philosophy. Another two hundred years to make that first great leap, and a century beyond that for the second.Your study is complete. The time required to grow from a single mating pair to steady-state population is irrelevant, because for those eons until humans began to record their thoughts, growth to 7.6 billion simply could not happen. After that point it required just under five millennia to learn how to feed and maintain the desired population.