Nursing home staff put out tip jar

Dear Dr. Roach: My nephew, 62, is a stroke victim. He resides in a board and care facility, bedridden and in diapers. The family pays $4,200 a month out-of-pocket for his care.

I am questioning the protocols at the home. The home keeps a very large “tip jar” near the front door. The tips are allegedly used for pizza parties for patients.

I have no experience in this realm of health care. Is a tip jar typical? One aid told my nephew he would trim his fingernails for $10.

I would appreciate your point of view.

Anon.

Answer: A tip jar is also new to me. In my opinion, medical professionals should perform their jobs without expectation of a tip. What you are describing sounds like there is pressure on visitors to give money, which is uncomfortable.

On the other hand, I know that many caregivers, such as nursing aides and assistants, do not make a lot of money, and I am sure an extra tip is appreciated.

I’d be happy to hear opinions from readers by email at ToYourGoodHealth@med.cornell. edu or on my Facebook page (facebook.com/ keithroachmd).

Dear Dr. Roach: Is Addison’s hereditary? My dad’s brother and sister both had it, and I’ve wondered if I am susceptible.

Answer: Addison’s disease is one of the causes of insufficiency of the adrenal gland. The most common cause of adrenal insufficiency is when people have been taking high doses of prednisone, or a similar type of steroid medicine.

Addison’s disease is when the gland itself is unable to make adequate cortisone under stress, and causes can include damage to the gland by tuberculosis, hemorrhage, drugs, cancer or an autoimmune process. It’s the last condition, autoimmune adrenal insufficiency, that has a familial predisposition, and accounts for about 80% of cases of Addison’s disease now.

With all of that in mind, first-degree relatives of people with autoimmune Addison’s (which you are not) have, at most, a 10% risk of developing autoimmune Addison’s disease.