Tuesday, July 23, 2019

Helping Homebound Seniors Stay Safe in the Heat

Health News- Tips to Beat the Heat in Heatwave

By Constance Washington, RN, VNSNY CHOICE Health Plans

It’s July and the summer’s extreme heat is about to kick temperatures up a notch. When that happens we all need to keep a few important guidelines in mind. 

Oppressive humidity combined with temperatures in the high 80s and low 90s puts older and more vulnerable New Yorkers at increased risk of heat-related health issues. Many elders may not realize the dangers that can arise upon stepping out into hot weather unprepared. 

When taking into consideration additional factors such as air quality and cloud cover, temperatures can often feel much hotter than they actually are, posing hazardous conditions for those already at elevated risk of health problems. Now more than ever, it makes sense to stay mindful of hot weather health cautions.

My colleagues and I at VNSNY CHOICE Health Plans coordinate care for homebound seniors so they can live safely and independently in their own homes for as long as possible. Because the weather may slow down or prevent friends and family from visiting homebound seniors, it is important to ensure that they are safe and comfortable at home amidst high temperatures. 

Below are a few easy ways in which New Yorkers—old and young alike—can stay feeling their best as they brave the heat.

1. Drink up
One of the most important ways to maintain health during the summer is by drinking enough fluids to avoid dehydration. Drink plenty of water and eat foods containing water, such as fruits, vegetables, gelatin (Jell-O) and ice pops. Aim for 6 to 8 glasses of fluid a day (this amount includes the water in foods). Beware of coffee, caffeine and alcohol, which can actually dehydrate, rather than replenish, the body of fluids.

2. Keep a healthy appetite

Though your appetite may decrease in summer months, it is important to continue to eat well. Be sure your daily meals contain protein (lean meats, like chicken and fish) and carbohydrates (vegetables and whole grains). Salad, fruit and other small, cool meals can be eaten throughout the day to maintain strength. 

3. Cool down the body

Take cool baths and showers to keep your body temperature from rising too high (Be sure that the bathtub has a slip-resistant mat or safety bars to help with transfers and prevent slips and falls). Simply cooling the feet in a bowl of cold or iced water may also help sustain bring your temperature down. Having a damp cloth to wipe down your face and arms is convenient as well.

4. Seek out cool places

Visit your local library, shopping center, movie theater, community center, or anyplace with air conditioning. New York City opens cooling centers in air-conditioned places like these when the weather is deemed dangerously high, call 311 to locate your nearest cooling centers. You may also qualify for a free air conditioner through the Home Energy Assistance Program (HEAP); Call 1-800-692-0557 or 311 for more information.

Make sure you can get to important sites like the police station, fire station, pharmacy or hospital in case of emergency as well.

5. Consider a temporary care for an at-risk loved one 

For elderly people who are home bound or living alone, regular visits from friends, family or caregivers offer welcome companionship when excessive heat outdoors forces you to stay inside for long periods of time. 

A home health aide can also be arranged for a few hours to provide peace of mind for family members who can’t reach loved ones or check in when the heat is on to make sure they are getting fluids and staying safe at home.

6. Get it delivered

If possible, have something brought to your home rather than make the trek outside yourself. With many eateries offering delivery, and services like Postmates or Amazon Prime able to bring almost anything to your door, you can save yourself the trouble of carrying extra things around in the heat.

7. Skip the sun’s peak hours

The hottest time of the day is between 10 AM and 2 PM. Avoid cooking or spending time outdoors during this period. If you must leave the house during a heat wave, wear sunscreen, as well as loose, light-colored clothing and a wide-brimmed hat. Always keep a fresh bottle of water in the refrigerator and bring it with you when you leave the house. Be careful to avoid burns on metal, especially on walkers, wheelchairs or benches.

Constance Washington, RN, is a Care Coordinator with VNSNY CHOICE Health Plans. To learn more, visit or call 1-855-AT CHOICE (1-855-282-4642).

Monday, July 1, 2019

Lewy Body, The ‘Other’ Dementia

Questions to Ask When a Loved One Receives a Diagnosis of Dementia

By Susan Northover, RN, MHA, SVP Patient Care Services, Visiting Nurse Service of New York

When Alissa’s father was diagnosed with dementia after exhibiting cognitive, behavioral and physical impairment, his family assumed it was Alzheimer’s disease, the most common form of dementia. It was only when he ended up in the hospital, with severe psychiatric symptoms and a frightening reaction to medication, that the family received another diagnosis: What Alissa’s father actually had, the doctors informed them, was Lewy body dementia.

The second-most common form of dementia, Lewy body dementia (LBD) affects an estimated 1.3 million Americans, but few people have heard of it. Caused by an abnormal buildup of deposits (Lewy bodies) in the brain, LBD is closely related to Parkinson’s disease and is often accompanied by problems with gait and movement.

Like Alzheimer’s disease, LBD is progressive and irreversible, with palliative treatment and medications for symptom management recommended to help people maximize quality of life. But there are differences between the two illnesses, including which medications should be prescribed. For people with LBD, traditional antipsychotics should be avoided, as should a number of other medications, according to the Lewy Body Dementia Association (LBDA).

Alissa’s father was originally prescribed a medication contraindicated for LBD, which caused him great psychiatric distress.

“If my Dad had been correctly diagnosed, he wouldn’t have displayed such nightmare behavior or been hospitalized – which caused all of us a great deal of concern and stress,” says Alissa.

Unfortunately, there are no specific diagnostic screens—no definitive brain imaging or blood tests—for dementia and its associated illnesses, such as Alzheimer’s or LBD. Rather, doctors make a clinical diagnosis based on medical history, a physical examination, lab tests that might suggest one diagnosis or another, and a finding of marked changes in cognitive and behavioral function. Once you or a loved one receive such a life-changing diagnosis, you should seek referral to a specialist to learn more about what to expect day to day and in the long run, and what the latest treatments are (as well as what to avoid), says Dr. Ritchell Dignam, Medical Director for VNSNY Hospice and Palliative Care. Because LBD overlaps many specialties, she recommends visiting a neurologist, psychiatrist, geriatric specialist and/or movement specialist.

Three Differences

While both forms of dementia are characterized by significant cognitive and behavioral decline, there are three key areas of difference between the presentation of Lewy body dementia and Alzheimer’s.

Fluctuations in Cognitive Ability

With LBD, a person’s alertness and attention can fluctuate quickly, often leaving family members confused and alarmed. “You could be having a discussion with them, but then sounds become unintelligible,” says Dr. Samuel Weisblatt, a VNSNY Hospice Team physician. “Fifteen seconds later, they’ll have no recollection that they were unintelligible.”

People with Alzheimer’s, on the other hand, tend to experience a more steady cognitive and functional decline.

Difficulties with Movement and Gait

Much more so than with Alzheimer’s, patients with LBD often show a physical decline from the beginning of their illness that grows more pronounced over time. This may include difficulty walking, frequent falling, stiffness and tremors (resembling Parkinsonian movements). Physical therapy may help people with LBD, notes Dr. Dignam.

With Alzheimer’s, movement and gait disorders typically present very late in the trajectory of the illness, if at all.


People with LBD, even in early stages, often have vivid hallucinations. Alissa’s father saw animals—a horse, dog, and cat—and could describe in great detail what they were doing. Such vivid hallucinations are not a typical symptom of Alzheimer’s, although they may appear in late stages of the illness.

For more differences and similarities, see this LBDO reference chart

Coping Day to Day

Despite these distinctions, what the two dementias have in common—a progressive and profound loss of the ability to remember, think, and perform daily activities—outweighs their differences.

Behavioral health nurses offer the following advice for caregivers dealing with any type of dementia, no matter the diagnosis. The goal with all of these approaches is to keep your loved one safe and comfortable, manage his or her symptoms, and keep yourself, the caregiver, healthy.

Repeat, Repeat, Repeat.

“Know that they are going to ask the same questions over and over,” says behavioral health nurse Joel Genaw, who works with people with all types of dementia. “Try to keep them oriented, but you also need to be prepared to be patient about answering and explaining again and again.”

Keep Calm and Carry On

Always keep your tone and facial expressions calm, no matter the crisis. This is not easy. While you would be forgiven for getting agitated the hundredth time you explained something or the twentieth time you attempted help with showering, a visible rise in your stress quickly magnifies your loved one’s stress and makes the situation much worse. Caregivers can learn over time what increases their loved one’s agitation—including unfamiliar surroundings—and try to minimize those situations.

Join them in their Reality

This is especially helpful when caring for someone with LBD. Remember that their hallucinations are exquisitely real to them, brought on by the physical changes in their brain. While you don’t see the horses running through the fields or their mother sitting on the couch in the living room, never try to convince the person otherwise. Be patient and let them tell their story.

Don’t Take it Personally

It can be upsetting to see and live with such profound changes in your loved one, who might lash out at you in frustration or anger. But remember that it is the disease causing the personality changes. As an organization of professional caregivers, we know how difficult and how incredibly important caregiving is, and we extend thanks to family members and other informal caregivers whenever we have the chance. We also recommend connecting to caregiver support resources, because you cannot give care to others if you don’t take care of yourself.

Through all stages of the illness, it can be helpful for caregivers to be able to manage expectations. And when it comes to the especially challenging task of caring for a loved one with dementia, knowing what to expect can be aided—at least a little—by having the right diagnosis. 

For Alissa’s family, the deterioration of their beloved father and husband was heartbreaking. But once they received the diagnosis of Lewy body dementia, they found a small measure of comfort in knowing they were taking the right steps. 

“We could see him decline before our eyes,” she said. “But once we understood exactly what it was, we had a better idea what was going to happen next. That helped.”


Friday, June 14, 2019

HIV Long Term Survivors Meet to Celebrate Aging Positively

By Chandra Wilson

Wednesday, June 5th is designated as national HIV Long Term Survivors Awareness Day. The Long Term Survivors Wellness Coalition, a New York-based coalition dedicated to identifying and addressing the needs of people in the long-term survivor community hosted the event, “We’re Still Here!,” a day-long celebration. 

The Long-Term Survivors Wellness Coalition, which consists of representation from the  NYC Health Department, The New York  City  Lesbian, Gay, Bisexual & Transgender Community Center, Visiting Nurse Service of New York, SAGE Advocacy & Services for LGBT Elders, ACRIA, GMHC (Gay Men’s Health Crisis), and, was formed two years ago by AIDS activists and original ACT UP members, Andy Velez and Timothy Lunceford-Stevens, who envisioned a collaborative of HIV/AIDS service organizations and individuals.
HIV long-term survivors experience unique circumstances and special needs. They are pioneering the experience of aging with HIV and all its attendant challenges: medication management, drug interactions and side effects, comorbidities, maintaining good mental health and sexual wellness. They are a population of great resiliency and strength. Recently the New York City Department of Health held multiple focus groups throughout the City to explore gaps in care for this underserved population.

Timothy Lunceford-Stevens led attendees in a moment of silence in recognition of the recent death of the coalition’s co-founder, Any Velez. 
“As long-term survivors of HIV, we know how to be strong, resilient, and advocate for our health,” said Graham Harriman, MA, Director of the Care and Treatment Program at the Bureau of HIV/AIDS Prevention and Control. “Today we come together to celebrate in a spirit of radical self-love, knowing that in order to support each other and nurture a world that embraces all of us living with and affected by HIV, we need to start being mindful of our bodies, our diet, our mental health, our relationships, and our ability to be present with each other as a community.”

“As the number of long-term survivors throughout New York continues to grow,” said Oni Blackstock, MD, MHS, Assistant Commissioner of the Bureau of HIV/AIDS Prevention and Control in her opening remarks. “The Bureau remains steadfast in our commitment to both prevent and treat HIV/AIDS among all New Yorkers.”

Highlights of the celebration, which took place at the Baruch College Vertical Campus Conference Center, included a Long-term survivors panel discussion and an unveiling of GMHC/ACRIA’s new National Resource Center on HIV and Aging, by Stephen Karpiak, PhD, International AIDS Society member and Associate Director for Research at the AIDS Community Research Initiative of America’s (ACRIA/GMHC) ACRIA’s Center on HIV and Aging, and Associate Faculty at New York University.

The Long Term Survivor’s Wellness Coalition panel discussion was moderated by Ed Shaw, a founding member and Chair Emeritus of the Consumer Advisory Board at GMHC, who has dedicated more than 25 years to educating and organizing to raise awareness about the particular needs of seniors at risk or living with HIV/AIDS. The panel included Nationally recognized writer, speaker and long-time HIV/AIDS activist, Tez Anderson, founder of “Lets Kick ASS—AIDS Survivor Syndrome;” Julia Sanchez, a Certified Peer Worker and Facilitator for The Positive Life Workshop at The Family Center; Octavia Y. Lewis, MPA, a transgender woman of color living with HIV who works as an activist, advocate, mother and scholar, and is currently a Community Ambassador with AmidaCare; and Billy Fields, a former AT&T manager and advocate appointed to the NYC HIV Planning Council by former Mayor Michael Bloomberg and current Mayor Bill De Blasio.

“Helping long-term survivors of HIV—both men and women—feel confident, proud and supported, with access to the health care they need to live full and active lives is what the coalition strives to do,” said Arthur Fitting, RN, LGBT Program Manager at the Visiting Nurse Service of New York. Other members of the Long-Term Survivor’s Wellness Coalition in attendance were: Stephen Karpiak, Gregg Bruckno, Timothy Lunceford, Vanessa Gonzalez, Bill Gross, Graham Harriman, Scott Spiegler, Sarah Kozlowski and Rafael Ponce.

Several awards presentations were made to advocates and members of the Coalition, and networking and breakout activates were held throughout the day focusing on food, cooking, nutrition and wellness demonstrations from Sophia Medinsky, RD at Heritage House, art therapy (by VisualAIDS), Yoga/Meditation (by Safiya Hassan), a sexual wellness discussion (by August Eckhardt from The Pleasure Chest) and a DJ, photo booth, dinner and dancing. The films Last Men Standing (documentary from San Francisco Chronicle) and Never Alone, developed by the Long View Coalition were also screened.


Thursday, June 13, 2019

Helpful Information about When to Visit Urgent Care Versus the Emergency Department

Monte Urgent Care Offers Alternative to ER Visit

By Dr. Amanda Parsons, Vice President of Community & Population Health at Montefiore Health System

HEALTH- Have you ever had a serious health problem and wanted to go see a doctor, but couldn’t get an appointment with your usual primary care provider so you ended up going to the Emergency Room instead? You are not alone. 

At Montefiore, we estimate roughly half of the visits that come to our Emergency Department could have been safely addressed in primary care or in Urgent Care centers. However, many patients are not familiar with Urgent Care or the services they provide.

Montefiore has three Urgent Care centers that are open 7 days a week, 365 days a year. They are open late (from 2 pm to 10:15 pm on weeknights) and on weekends (8:45 am to 5 pm on Saturday and Sunday). These sites feature high-quality board-certified doctors who can treat children and adults. They can also do a range of procedures on-site including lab tests, X-rays, nebulizers, splints, and stitches. 

For patients without life-threatening issues, Urgent Care centers can usually provide faster service than Emergency Departments while providing high-quality care. Montefiore Urgent Care sites accept all major insurances, including Managed Medicaid, Medicare Advantage, and Fee-for-Service Medicaid.

So, if you're feeling unsure about using Urgent Care instead of the Emergency Department, here are some facts you should know:

1. Habit and Comfort

• Many people are familiar with the high-quality care and one-stop-shop experience they get at the Montefiore Emergency Department. We want our patients to know they can get the same great care for their serious, but not life-threatening, issues.

2. Fear

• Feeling ill or having a sick loved one can be a very scary experience. Some people feel more comfortable knowing that the Emergency Room has lots of staff and services. However, Montefiore’s Urgent Care centers also have well-trained staff, services and the equipment necessary to deal with urgent but non-life threatening problems.

3. Medical Records

• Some people choose to go to the Montefiore Emergency Room because they know the clinical team will have access to their electronic medical records. The good news is that the Montefiore Urgent Care sites use the same medical records as the Montefiore Emergency Rooms, hospital and primary care settings, so they can look up the same historical information. This helps reduce the number of questions patients have to answer about their medical histories, and also helps makes sure that prior test results are available for consideration or comparison.

4. Answering Machines

• Some doctor’s offices, when closed, have an answering machine message saying the office is closed and that if you need attention, you should go to the Emergency Room. This is true if you have a life-threatening emergency (like severe chest pain, sudden paralysis, serious burns or broken bones), but if you have more minor issues like an asthma exacerbation, nausea, vomiting or diarrhea, cold or flu, muscle pain or a cut, you can go to Urgent Care instead.

So next time you or a loved one has a serious, but not life-threatening medical problem and you can’t get to your primary care provider, please consider visiting one of our Urgent Care sites:

1. Grand Concourse: 2532 Grand Concourse, Bronx NY 10458 (Between East Fordham Rd & E 192nd Street) Phone: 718-960-1569

2. Bronx East: 2300 Westchester Avenue, Bronx NY 10462 (Between Havemeyer Ave & Glover St) Phone: 718-409-8888

3. Cross County: 1010 Central Park Ave, Yonkers NY 10704 (Entrance on Allen Ave N) Phone: 914-964-4111

If you can’t get to one of those, Montefiore has a partnership with City MD. City MD has over 110 locations across New York and New Jersey including Bronx and Westchester. Visit for all locations and hours.

Learn more about when to use the emergency room at our first Emergency Department Utilization event in partnership with community boards 9, 10, and 11 on Tuesday, June 18th from 6-8 pm at the Morris Park Community Association Office (1824 Bronxdale Avenue). I will be representing the Montefiore Office of Community & Population Health in conversation with a local city council member and Dr. Frank Illuzzi, physician and Chief Medical Director of City MD.


Wednesday, June 12, 2019

10 LGBT Healthcare Issues You Don’t Know About

LGBTQ Pride is an Ageless and Essential Human Right 

By Arthur Fitting, RN, LGBT Program Director, Visiting Nurse Service of New York

HEALTH- There’s an old adage: “With age comes wisdom.” Applying that adage to our current healthcare environment is the next great challenge for all of us in the LGBT community—especially those of us in the Stonewall generation who fought to gain acceptance and rights that were once unimaginable. 

We’ve come such a long way since the days when being gay, lesbian or bisexual was considered criminal, sacrilegious or mentally ill behavior. Now we need to ensure that the healthcare industry completes that journey with us—and there’s no better time to focus on this challenge than right now, as we kick off World Pride 2019 and the 50th anniversary of the Stonewall Uprising.

Based on data from SAGE (Services and Advocacy for LGBT Elders), the country’s largest and oldest organization dedicated to improving the lives of LGBT older people, there are approximately three million LGBT adults over the age of 50 in the U.S., and that number is expected to grow to around seven million by the year 2030. As with all age groups, we, as members of the older LGBT population, face our own specific health concerns. According to SAGE:

• LGBT elders are twice as likely to be single and living alone;

• we are far more likely than our heterosexual peers to have faced discrimination, social stigma and the effects of prejudice;

• 34 percent of older LGBT individuals fear they’ll have to re-closet themselves when seeking senior housing;

• nearly 60 percent report feeling a lack of companionship; and

• LGBT elders are also hesitant to trust health care providers after decades of bullying, discrimination and verbal or physical abuse. 

As a registered nurse working on the front lines for nearly 30 years, I’ve tried to face these disparities head on. And while we’ve come a long way with rights like marriage and adoption, we need to keep going, especially where health care is concerned. 

Today, many older LGBT people still find it difficult to find a physician or other healthcare professional they feel comfortable talking to. As a result, they often avoid seeking care until faced with an emergency situation.

My goal as LGBT Program Director for the Visiting Nurse Service of New York (VNSNY) is to work with my colleagues to help bridge this gap. A good starting point is New York City’s LGBTQ  Health Care Bill of Rights. First announced one year ago by Dr. Mary Travis Bassett, MD, MPH, New York City’s Commissioner of Health, this is a critical piece of healthcare information that empowers those of us in the LGBT community to take responsibility for our own health. It lays out 10 important legal rights that every older LGBTQ person can assert, in any health care situation. 

The LGBTQ Health Care Bill of Rights

In any health care setting or health care interaction, you have the right to:

1. Be treated with dignity, respect and professionalism by all providers and all staff.

2. Receive compassionate, judgement-free and comprehensive care that is mindful of your sexual orientation, gender identity and gender expression.

3. Respectful discussions with providers about your health and health care needs, including your sexual history and current sex life.

4. Have your gender identity and gender expression recognized, affirmed, documented and accommodated.

5. Clear explanations of requests for your health information.

6. Clear explanations of all medical procedures and risks, and the right to choose or refuse any treatment.

7. Access health insurance coverage and benefits without discrimination based on sexual orientation, gender identity or gender expression.

8. Choose who will make medical decisions for you if you are unable. If you are a minor, you have the right to have your voice heard and best interests included in these decisions.

9. Decide who may and may not visit you if you are admitted to a health care facility.

10. Privacy and confidentiality.

As a nurse, I’ve met so many LGBT people—of all ages—who still live in fear, and to whom these basic rights have been withheld, miscommunicated or culturally garbled, much like that old game of “telephone.” But it doesn’t have to be that way—which is why my colleagues and I are working so hard to educate our fellow New Yorkers about these rights, as well as the steps people can take to ensure they are upheld.

In particular, everyone should know that New York City provides several options for anyone who feels that their rights have been denied. If you believe you have been mistreated or denied care because of your sexual orientation, gender identity or gender expression, you can call The New York City Commission on Human Rights at 718-722-3131, or call 311, or file a complaint online to report discrimination (

Maintaining our health and navigating the healthcare system can be a difficult balancing act—especially as we age. Please keep this information close at hand, and remember, we should never get sick due to silence or fear!

Have a Healthy, Happy and Safe Pride Month! And remember, your right to quality health care without discrimination is what we stand for 365 days a year! 


Friday, May 31, 2019

7 Tips for Caring for Loved Ones with Alzheimer’s

When memory fades: Strategies for caring and coping

By Joanna Ignatiades, RN, VNSNY CHOICE Health Plans

HEALTH- Watching a loved one slowly lose his or her memory is tough. Watching that same person forget who you are is downright heart-wrenching. There are so many emotions caregivers go through—sadness, anger, depression, frustration, hopelessness—and they’re all perfectly normal. They need to know that they’re not alone.

More than 100 million people – more than half the U.S. population – have been touched in some way by Alzheimer's. Managing the stress when someone you love has memory issues or early-stage Alzheimer’s or dementia can really be a challenge. 

As a nurse care coordinator with VNSNY CHOICE Health Plans, my job includes educating family caregivers about how to support their loved one and also how to best care for themselves. Here are a few reminders that I encourage family members to keep in mind when caring for a loved one with memory issues:

1) Know You’re Still Needed

There may be times when your loved one is not sure who you are, and this can be frightening for them. It can be difficult for them to trust that you have their best interests at heart, so make sure you come from a place of caring and remind them of your ties to people they do remember. Be patient and kind. 

2) Cover the Basics

If your loved one is prone to wandering, don’t wait for an accident to happen, begin introducing safety precautions such as nightlights and double door locks early on. Encourage use of a safe return bracelet and consider home monitoring devices. Ensure that the person with memory loss carries identification and keep recent photo of your family member with you as well. Being prepared can help you relax.

3) Scale Down Communication

Using short sentences and simple words—and a calm, reassuring tone of voice—will make it easier for your family member to concentrate on what you’re saying. Reducing distractions, such as a television in the background, may also help.

4) Get Support

I encourage caregivers to find a support group or someone they can trust so that they can understand that they’re not alone—can help them live their own lives—and be better caregivers. Don’t be afraid to ask for help. You can also visit websites such as the New York State Office of the Aging or the Alzheimer’s Association for information that can help you manage symptoms and treatments.

5) Make Time for Yourself 

If you notice yourself feeling overwhelmed or frequently worried, are sleeping too much (or not enough), gaining or losing weight, or experiencing headaches or other unusual discomforts, you may be experiencing caregiver stress. Don’t forget to take care of yourself. Getting enough sleep and making sure to allow time to attend to your own needs can work wonders when it comes to easing your frustrations. If you sacrifice your well being for the person for whom you are caring, eventually your own physical and emotional health suffers.  Your loved one can easily pick up on negative emotions, making your job that much more difficult.

6) Encourage Visitors 

Your loved one may not remember who the visitors are, but simply having company and social contact is a good thing—for both of you. Don’t be afraid to invite friends and visitors over for a visit.

7) Fend off Frustration

It can be frustrating to answer the same questions repeatedly, but saying to your loved one, “I already told you this” or “Do you remember Aunt Sally?” will add to your—and your loved one’s—feelings of stress. Understanding that memory loss is a symptom and that repeated questions are an early sign of cognitive impairment can be helpful when it comes to alleviating your frustration. 

For a library of caregiver resources, including helpful videos, please visit

To learn more about health plans that help elder New Yorkers live more comfortably, safely and independently in their own homes, visit or call 1-855-AT CHOICE (1-855-282-4642).