Narcissism - How to Survive Being Their Caregivers - Tips to Keeping Your Own Sanity

Caring for an aging parent with narcissism is very difficult position to be put in. Many care givers find themselves in the unenviable position of providing care of the elderly narcissist at the cost of their own survival. Care giving is stressful, at times overwhelming and promotes guilt. The aging narcissist finds this to be a perfect scenario.

Care giver stress is real. When you choose to take on the role of care of the elderly and aging narcissist you may not be prepared for what is in store for you. Every culture or religion has some belief of "Honor thy father and thy mother." It does not say that you have to love or even like them.

If you are an adult child or a spouse of a narcissist you are in a situation of constantly trying to please a person that is unable to be pleased. The narcissist must control everyone and everything in their world. These individuals have an ego and an exaggerated sense of self importance. The aging narcissist considers their skills, their achievements and themselves to be far superior to any other individual that crosses their path.

On the exterior, the aging narcissist may appear cordial, friendly and confident. But underneath their false exterior is an individual that is trying to compensate for their own shortcomings, real or imagined. They have the inability to have empathy for others and push the individuals in their lives as far as they can. They always raise the bar of their expectations of what they want from an individual.

A spouse or a child that lives and cares for someone displaying the traits of narcissism is always trying to seek their approval, do things the "right" way. A narcissist is not capable of admitting they are wrong, never can say "I am sorry" and if there is a "thank-you" it may be followed by the word "but."

More on Narcissism -- How to Survive Being Their Caregivers  -- Tips To Keeping Your Own Sanity 

To survive care giving of an aging narcissist is to first acknowledge you have power over your own feelings and emotions. You have control over how you respond. You do not have the control over the negative behaviors that are directed at you.

Narcissists control by demeaning, demoralizing and even through character assignation. They will wear a person down until there is nothing but your outer shell of a body. Many family members that care for the aging narcissist feel as if they will have the very life sucked out of them.

As a self absorbed and selfish egomaniac, the aging narcissist is not capable of feelings for others, not even love. This is a difficult concept for many family members to accept. Those care givers that are always in the approval seeking mode eventually begins to feel a sense of anger, depression and sadness about themselves. Many family members work hard to keep the relationship going, not realizing that it is a one sided effort.

To survive the caring of a narcissistic family member, you must set emotional limits. Take the power of control over you away from the aging narcissist. This is not an easy task, as you do not want to confront or identify that the narcissist has any faults. I suggest you wear an invisible shield, one that the directed verbal and emotional abuse bounces off. I use that as a way of saying not to take anything that is said to you personally. If you do, you will not survive.

Narcissists, when confronted about any imperfections will respond with anger and even rage. The verbal and emotional abuse they can instill knows no boundaries. If you cross a narcissist, they will do anything and everything in their power to get revenge.

To respond to an aging narcissist, you must remain calm. Do not respond to their tirades. When they make statements or judgments do not hesitate to question them. Ask is a non confrontational way such as: "How did you come to that conclusion?" or "I'm confused, show me how it is to be done right"

It is always important for the care giver of an aging narcissist to always, and I mean, always, have an exit strategy in place or a plan B (possibly a backup care giving situation). Put time limits on your interactions, have a reason to leave the room. When in doubt or in a situation that has you losing control, run as fast as you can! Your very mental and emotional well being is being threatened.

The horrible truth of narcissism and the aging parent is that it is an extremely difficult situation to be in. For those that care for the elderly narcissist, many feel as if they have no choice. One last survival tip, is to consider allowing other to be the care giver and you take over as the over seer of the care. It may be the only way you wiil survive and keep your own sanity.

Successfully Approaching Marketing Professionals - How to Market a New Consumer Product or Idea

Many inventors and entrepreneurs are so excited about their concept that they neglect to learn, or practice proper business etiquette when soliciting marketing or investment assistance. This can ruin their opportunity, or at the least set prospects back sharply. The following are some simple rules to follow when making initial contact or presentation of your exciting new product or marketing concept.

Never Utilize Mindless Platitudes
My Company has been developing consumer products and marketing consulting for almost four decades. There is no bigger turn-off than to just meet a potential new client and hear something like: "I am going to put the Mattel Toy Company out of business with this new plush toy (or board game, or articulated doll, etc.)".

Another golden oldie cold shower is, "This is a multi-billion dollar opportunity".

We see this tried every day and it is a disqualifier.

Be realistic, humble and factual about the opportunity you present. Professional marketers and venture capitalists will appreciate and are more likely to reward the sober tone.

Always Tell the Truth, Never Embellish
The marketplace of ideas and new product ideas is huge, uber-competitive and non-forgiving. If you stretch the truth, embellish facts, or omit important facts that will affect your proposition two things will surely occur, they always do: You will be discovered. You will be dismissed.

Be absolutely clear and truthful about everything you represent as factual. I cannot tell you how many times we have met entrepreneurs with great product ideas and we dismiss them out of hand because of obvious methane in their story. It is far better to detail a competitive disadvantage your product might possess and offer a solution to overcoming the handicap than to gloss over and try to mitigate the flaw.

You Get One Chance to Make a Great First Impression!
I interview entrepreneurs for a living. I have certain screening questions that I use to separate the wheat from the chafe. Every venture capital firm, investment banker, consumer product marketing professional and licensing agent I know utilizes the same verbal qualifiers, or disqualifiers depending on how they are answered. The goal of your first contact is to get a face to face meeting with decision makers.

Do not try to close a deal on the first call. Do not hard or over-sell. Never attempt any type of sale or screening technique on an e-mail if you wish to be considered serious. Present yourself as a professional person who has a project that is well-vetted, serious, offers unique product features and benefits that will benefit consumers and retailers and that you would be appreciative of a meeting that should be of interest to all parties.

Do Not Detail Your Perceived Value of Your Project
Why? Because you do not have a clue what the REAL value of your project is. I have never read a non-professionally written business plan that offered an inkling of an iota of the true value, if any, ensconced in the project. You may have a wonderful idea. But without Execution, Cost of Goods balance, a customized Marketing Strategy that employ's unique Branding concepts and Consumer Product Features and Benefits that can easily be conveyed to consumers in a cluttered marketplace even the best product will not succeed.

Have a Great Elevator Speech
You will need to be able to excite decision makers in a brief few minutes of time. An initial call is always cold. This is the time to plant seeds of interest, not reap a harvest from a virgin field. The same principles that apply to the Executive Summary section of your Business Plan should apply to the Elevator Speech. Respect the time of the decision maker. Interest him (or her) with product features and benefits, a very brief summary of your due diligence and be prepared to answer questions, hopefully, if you have excited a level of interest from you target these will come. Remember, your goal should be to meet.

Ask Questions
After an introduction and a short, tight Elevator Speech, you will be asked questions if there is any level of interest from your target. Assuming you have done your homework and pass the screening exam you will have the opportunity to ask questions of your target. Do not get too detailed and specific. Save that for the time when negotiations commence, and that is still a long way off.

These are only a few of the most egregious flaws and shortcomings we see every day as our Marketing Consulting firm reviews projects. We get very interested in unique products. We only get truly excited when the entrepreneur is as good, or better, than the product they present.

by: Geoff Ficke

All Senior Citizens Need A Medical Alert System

A medical alarm can make a big difference in the lives of elderly people and people with special needs. Also known as a medical alert or Personal Emergency Response System (PERS), it was created to signal the presence of a hazard needing immediate attention and summon emergency medical personnel. Elderly or disabled people living on their own are the primary users of this sort of device.

An average medical alert system has three factors, the bottom unit, personal Help button along with a monitoring center. The Help button is usually in the form of a wireless pendant or transmitter that can be worn just like a wristwatch or pendant, and can be activated in an emergency. Whenever activated, a signal is transmitted towards base unit, which instantly dials a preset number that connects to an emergency service center.

There are numerous risk factors that may indicate that an person could benefit through having a medical alarm. This includes being over the age of 65, living alone or left alone for extended periods of time, having a medical history of falls (or at risk of falling), use of mobility assisted devices (such as canes, walkers, wheelchairs, and airlifts) and suffering from sensory loss (vision or hearing) or cognitive defects. People having one or more of the characteristics enumerated, specially the first two items, seriously consider obtaining a medical alert device.

In an emergency, the very last thing that folks involved want to do would be to work a complicated gadget. For this reason medical alert systems are deigned to always be an easy task to install and use. They are also far more convenient and safer than a phone. Because the alarm may be worn on the wrist, round the neck or on the belt, it's simple and easy, fast to gain access to, and there's no need to look for a phone.

Household accidents are common, but you will find instances where they may be fatal. They are mostly cases when victims may have survived if help had showed up sooner. Elderly people or people with disabilities have a greater risk for this stuff, and may be unable to deal with them without having assistance. This is when a medical alarm could be invaluable.

The standard of help that wearers of medical alert devices have entitlement to is another major selling point. People who answer calls at the monitoring center are educated to handle medical emergencies and will supply immediate support. Users personal information is usually kept on file to ensure good care and precautions are taken when answering medical problems or emergencies.

Among the reasons why seniors move to assisted living facilities and leave their homes may be the fear that there won't be any one to aid in an urgent situation or accident while living alone. On the other hand, there are many who feel that they may lose their sense of independence inside a nursing home or retirement home. Having a medical alarm can effectively get rid of the primary reason for going into an assisted living situation and allows seniors to keep their dignity and freedom intact.

As with all consumer products, medical alert systems vary in terms of price and features for example range, hours of standby power, repair and replacement options, payment options, and setup time. There are numerous suppliers and vendors with this service, so you will need to do some research and product comparison before buying. By doing this, users can be assured of a product that fits their demands and lifestyle.

Best Elderly Services Available For Your Situation

Most adults do not like having to depend on others. For those of us that do not have a choice it can be very difficult so we have to resort to some type of elderly services. When one loses their independence, it feels like they are losing control of their life. We also do not want to a burden to others. When we have to rely on others it can be very stressful for us and the person that we depend on.

In the past it has been that adults when reaching the age where they can no longer totally care for themselves, they resort to living at a nursing home. Now a days there are other types of facilities and services that cater to aging adults.

One of those options are assisted living facilities also known as retirement communities. In a retirement community, one can have their very own private apartment. There are optional elderly services available such as housekeeping and food preparation. One of the biggest benefits of this type of community is the companionship. There are the sometimes, 100s of other seniors there that one can meet and participate in activities with.

If you or your loved one chooses not to got to a retirement community and would rather remain at home, then there are home care services where someone can come and help out whenever needed or on a set schedule. The schedule options typically available are 4 hours a day, 8 hours a day, full days or full-time. In this situation, the person can remain in a familiar environment. The rate for this service usually depends on the services that will be rendered.

Home care elderly services include, first aid, laundry, washing, cooking and shopping. I can be difficult finding a trustworthy provider. I highly suggest using a referral service to help you find the best company or facility to take care of you or your loved one.

Becoming a Nursing Home Administrator

In the world of senior care jobs, few are as demanding - or as rewarding - as nursing home administration. If you are interested in nursing home administrator jobs, you should know that the road to becoming one isn't simple. A great deal of education and experience is generally required if you want a fair chance at making this dream a reality. That said, nursing home administrator jobs are highly rewarding and can pay very well. If LPN jobs and other nursing home jobs aren't for you, and you'd like to pursue a career as a nursing home administrator, check out the following steps.

Step #1: Get a Job in a Nursing Home -
You can't hope to qualify for a job as an administrator at some point without having any nursing home experience. Look for senior care jobs that appeal to you and apply for them. Ideally, you'll be able to find a job that allows you to learn many different aspects of assisted living facilities.

Step #2: Get an Education -
While working your nursing home job, whether full-time or part-time, hit the books. For best results, you are going to need two main things: a bachelor's degree and a clinical license. Ideally, the bachelor's degree should be in health care administration; the clinical license should certify you as a BSN, an RN, a PT or the like. Your education will be the stepping stone that will allow you to move up in the world of nursing home jobs. A Bachelors Degree, and ideally and advanced degree like an MBA or Masters in Healthcare administration shows you understand the business side, while a clinical degree like an RN, BSN, or PT designation shows you also have knowledge regarding the clinical side including Oasis, MDS 3.0, etc.

Step #3: Get Licensed in Your State -
Licensing requirements vary by state. Do some research to find out the specific requirements of the state in which you'll be looking for nursing home administrator jobs. Most of the time, you will have to take a test in order to become licensed. Make sure to study for the test so that you don't have to retake it in the future.

Step #4: Start Applying! -
Now that you've covered all of your educational, work experience and licensing bases, it's time to go out there and find a job. Like LPN jobs, administrator jobs are highly in demand. Many times, people fail to stick with them because of how demanding they are. As long as you understand that your job will be quite demanding, before going into it, you should be fine. There's always a chance that you could find a job at an assisted living facility that you've worked for in the past. Otherwise, you shouldn't have any trouble finding work elsewhere. This is one industry in which there's not a whole lot of ebb and flow - good administrators are always in demand.

Estate Planning Tools: Lifetime Gifting Program - Seven Factors To Consider

An invaluable part of any estate plan can be the strategic and systematic use of the annual gift tax exclusion. By properly planning your estate distribution strategy over a number of years, you can successfully lower, or even eliminate, estate shrinkage from administration, death taxes and probate costs.

A lifetime gifting program can help you to pre-administer your estate in a way that allows you to control how and when your assets are distributed. The following seven factors should be considered carefully as you look at your own gifting strategies and how you can obtain the biggest impact for your efforts. For this article we will illustrate a retired couple with three children, all of whom are married and each has two of their own children.

Seven Factors To Consider:

1. Both Retirees Alive: While both retirees are alive, they can each give $13,000 to each of their children (2011 gift tax exclusion amount) annually, as well as their children's spouses and/or grandchildren. If we just use the children and their spouses, each parent could gift up to $26,000 for a combined $52,000 annually to each of their three children's families. That's up to $156,000 per year that they could gift from their estate to their children.

2. Establish Multiple Joint Accounts: What if you need money after it has been gifted away? First of all, a gift means that you give up all interest in the gift when it is received by your children. But if your children agree to open up joint accounts with each other and invest the gifts with the intention of leaving them alone until both retirees have passed away, just in case they are needed, this is an acceptable option.

3. Trusting Your Children: Of course this program requires our retirees to have complete trust in their children and their spouses. If you let them know you are making these lifetime gifts in an effort to pre-administer your estate, saving time and money and trust they will take care of you if you ever need assistance, this can be a great way to see the benefits of your efforts while you are alive.

4. Sixty Month Look Back: If something happens to one or both of our retirees and they need to be admitted into a nursing home, any gifts that were made within the prior five years or the sixty month look back period could be reverted back to the retirees, or the nursing home for payment of those costs. If our retirees still have enough assets and income to cover these nursing home costs, the previous gifts may not need to be reclaimed.

5. Death Of First Retiree: Upon the death of either of our retirees, the annual gifting amounts now will be cut in half. If our retirees haven't started gifting yet, the maximum that can be gifted is now $26,000 to each family unit for a total of $78,000 annually. It is never too late to begin this program and the sooner a parent begins, the sooner the sixty month look back period will pass.

6. Life Estates: Another tool to consider if real property is part of a parent's assets is to establish a life estate. This program allows the transfer of ownership of their real property to their children, but maintains their use of the property for the remainder of their life. This transaction is usually handled by a local real estate attorney and if our retirees would rather stay in their home instead of moving into an apartment or other living arrangement, it can be a great strategy.

7. Nursing Home Expenses: If nursing home care is needed and our retirees have gifted away all their assets over the years, it becomes very important to keep an accurate calendar of when the last gifts were made. If they were completed over sixty months earlier, they should not need to be considered, but if they were less than sixty months ago, you will need to review your options. It may be beneficial for the children to give back enough of the gifts to cover the monthly nursing home costs that would be needed to exceed the sixty month requirement. After that point, our retirees could qualify for public assistance. While their pension and social security income will be used to cover these costs, the remainder of their previously gifted assets should not.

Summary: A good lifetime gifting strategy can have many benefits if it is done properly. Make sure that you contact a good financial and estate adviser and begin planning your program today. It can be done in smaller amounts, over more years as long as the guidelines are followed. The peace of mind, time and money saved by using this program can be a great way to leave a wonderful legacy to your loved ones.

To discover additional estate, financial and income tax strategies, check out my blog or download your FREE Wealth Expansion Kit by clicking here. The first step to creating wealth is knowing where you are and then charting a path that will enhance your financial strengths and correct your weaknesses.

A Career in the Burn Unit (ICU)

We are living in the world where accidents occur anytime and anywhere. Each day we come across with number of major, minor as well as minuet accidents, accidents that we don't even give an eye to or bother about. But all these major as well as minor accidents need some precautionary measures so that we can avoid them in terms of future perspectives. The accidents that had occurred due to some reason needs to be properly treated.

For every accident or misfortune there is a department that is specially trained to provide a complete treatment and cure to its respective accident.

One of the major incident that is ranked as the world's top incident or misfortune that can happen to any individual is the Burn! This incident can either be immense or miniature and most of the time it turns out to be fatal, taking the victims life or causing him permanent disability. This is the calamity that can happen anytime, anywhere and at any part of the world.

For the treatment of Burns, special unit is formed to take over this issue, which is given special training under expert's supervision who have years of experience in the current field and has treated number of burn victims and handled numerous cases from partly to entirely burned victims. The unit that handles all such kinds of cases is known as Burn Unit.

Burn unit comprises of specially trained doctors, surgeons, CNS, nurses etc. who treats patients with major as well as with minor burns and try their best for their full recovery.

Each and every staff member of this unit plays a key role in the recovery of the victim. Other than doctors, nurses also play a very important role in the burn unit, as they perform the toughest task during and after the surgery.

Most people think that it's just a burn! They really don't know that there are numbers of other consequences as well as health relating issues that may arise due to this burn. These health relating issues include; burned eyes which may lead to permanent blindness as well as affects the nerve system of the brain. Failure of kidney is another issue that occurs due to the trauma.

The most difficult duty for the nurse of burn unit is the dressing change and the bath of the victim, which is usually very hot as well as very long and special care is needed while performing these tasks.

Nurses for Burn unit are trained in a special way as they need to work with great dedication as well as hard work to perform their duty. They are trained to be more patient and more tolerant towards the victim and special classes are conducted in which nurses are trained and guided how to change the dressing as well as give the sponge bath to the burned patient. They are also trained for any serious medical condition that might have occurred due to the burn, which may include broken bones from MVC or the kidney failure from the trauma as well as several other health conditions.

A Burned unit nurse is considered to be the most hardworking nurse in comparison with every other department nurse's therefore there are only a few of them in this department and many others are also needed. If one thinks about in making his carrier as a burn unit nurse then it's surely a very bright carrier opportunity for him / her to go with, as this carrier path is one of the most vacant as well as hard working profession of the nursing industry, and the best thing is that it also pays off good!

Probate of Will

What is Probate?

Probate is the process where after death the instructions of the Will are carried out. Will is admitted to "Probate" in the County Surrogate. Some people refer to the Surrogate as the Will Clerk. Upon the death of the testator or testatrix (maker of the Will), the probate procedure can begin. This is the legal process which establishes the genuineness of the Will. It is done by the Surrogate in the county where the testator or testatrix resided at the time of death.

The probate application must contain the following information:

1. the applicant's residence;
2. the name, domicile and date of death of the decedent;
3. the names and addresses of the decedent's spouse, heirs (those entitled to take under the laws of interstate succession), and any person named to serve as Executor;
4. the ages of any minor heirs; and
5. the names of the testator's children when the Will was made and the names of children born and adopted after the Will was made, or their children, if any.

To minimize time spent in the Surrogate, it is recommended, and in some counties required, that before an Executor submits the Will for probate the executor's attorney or executor send the Court:

1) a "data sheet" (referred to in some counties as an "information sheet" or a "fact sheet") containing the information needed by the Surrogate to complete the application;
2) a copy of the Will; and
3) a copy of the death certificate.

FILING A PROBATE APPLICATION

Upon the death of a person, a probate proceeding may be commenced by offering the decedent's (the dead person's ) last Will for probate in the Surrogate's Court of the county in which the decedent was domiciled at death. R. 4:80-1(a). Generally, the Executor nominated in the Will brings the proceeding by filing a verified application with the Court.

When the applicant files the original Will for probate, the applicant must also file a death certificate (and original with a raised seal). A filing fee of approximately $150 must be paid. Once the Will, application and death certificate are filed, the Surrogate will review the papers, and if there are no irregularities or objections, admit the Will to probate. Although New Jersey law prohibits admission of a Will to probate within 10 days of the testator's death, an applicant may submit the application prior to expiration of the 10-day period. If the Will is filed after the 10-day waiting period, many Courts will issue a judgment for probate contemporaneously with the filing of the probate papers.

Qualifying the Executor

Once the Will is admitted to probate, the Court will issue letters testamentary to an Executor who has properly qualified to serve. An Executor named in a Will qualifies to serve by filing a form affidavit in which the Executor agrees to perform his or her duties. The nominated Executor must also provide a power of attorney to the Surrogate empowering the Surrogate to accept service of process of claims against the estate. Once the Executor qualifies, the Court then issues letters testamentary.

How is an administrator appointed when there is no Will?

When there is no Will, an administrator, administratrix or personal representative is appointed by the Surrogate's Court. The surviving spouse has the first right to apply for the position of administrator; however, any heir of the decedent may be appointed. When one of several heirs seeks to be appointed administrator, all other heirs must renounce their right to be appointed administrator. In most cases, a surety bond must be furnished to cover the value of the real and personal property in the estate.

Mailing Probate Notices

After a Will is admitted to probate, the Executor's Attorney or Executor must mail within 60 days a notice of probate to the decedent's spouse, heirs and all beneficiaries under the Will. The notice of probate should contain the executor's name and address, place and date that the Will was probated, and an offer to furnish a copy of the Will upon request. Within 10 days of mailing the notice the Executor's Attorney or Executor should file proof of service of the notice with the Surrogate's Court. Once notice of probate has been sent and proof of mailing has been filed the probate process is essentially completed.

Completing the probate process should cause only minimal delay, perhaps a few weeks, in administering a decedent's affairs. The cost of admitting a Will to probate should be limited. Unlike in some other states, the Surrogate's filing fee in New Jersey is the same regardless of the size of the estate. See Zimiles "Probate is not a Dirty word in New Jersey" N.J. Lawyer pg. 14 (July/August 1992)

How do I begin the probate procedure?

The Executor or personal representative can be appointed and the Will admitted to probate in most cases by going to the Surrogate's Court with the original Will, certified death certificate, and, if the Will is not self-proven, at least one of the witnesses who signed the Will must prove the signature on the Will.

What kind of information should I collect?

The decedent's personal representative should make a list of all of the next of kin of the person who died, along with their degree of relationship, addresses and ages.

What if the Will is not properly executed?

The Surrogate will advise the personal representative as to the proper procedure in order to allow the Will to be admitted to probate. This procedure normally involves a formal hearing before a Judge of the Superior Court.

Are unpaid inheritance taxes a lien on property?

Yes, to sell real estate, you Will need to obtain "tax waivers" from the State Transfer Inheritance 'Tax Bureau, and the waivers must be filed with the County Clerk in the county where the land is located. Land held by husband and wife as "tenants by the entirety" need not be reported and may be transferred without a waiver. Other property may be subject to a lien for unpaid inheritance taxes such as bank accounts and certificates of deposit.

How about federal estate taxes?

In 2009 there is no federal tax due unless the estate exceeds $3,500,000. However, there is a New Jersey Estate tax for estates over $675,000.

There is also an unlimited federal marital deduction, which means unlimited amounts of property can be transferred between spouses without estate of gift taxes.

How many Surrogate's Certificates ("Shorts") Will I need?

When is the Will admitted to probate?

After all the proper forms are filed with the probate clerk, the clerk will prepare a judgment which admits the Will to probate. The Surrogate then signs the judgment and issues "Letters Testamentary."

What are Surrogate's Certificates used for?

Surrogate's Certificates act as evidence of the authority of the personal representative (Executor, Administrator, Trustee ) to act. These certificates are necessary to accomplish certain tasks such as transferring stocks, closing bank accounts, etc.

Is it necessary to send copies of the Will to the beneficiaries?

From the time the Will is probated, the Executer has 60 days to mail all beneficiaries a notice that they can be provided with a copy of the Will, along with a notice giving the specific date and place the Will was entered into probate. See Zimiles "Probate is not a Dirty word in New Jersey" N.J. Lawyer

Basically, what is the Executor/Administrator required to do?

The Executor or Administrator is, in general, required to collect and safeguard all of the assets of the estate and eventually to pay the debts of the decedent, as well as any taxes due, and be able to provide an accounting of his actions to the beneficiaries or heirs. An Executor or Administrator must obtain the necessary legal documents, called either LETTERS TESTAMENTARY (for an Executor) or LETTERS OF ADMINISTRATION (for an Administrator), are obtained through the Surrogate in the county in which the DECEDENT (the deceased person) resided at the time of death.

The duties of the personal representative include:

* - finding the Will and having it PROBATED. Probate is the legal procedure used to establish the validity of a Will.* - locating and protecting the assets of the estate.* - finding and notifying the heirs.* - paying the debts, expenses, and taxes of the estate from the assets of the estate.* - complying with the requirements of state and federal law.* - distributing property to the heirs after all proper procedures have been followed.

Is an attorney necessary in estate administration?

As a practical matter, it is very difficulty for a nonlawyer to correctly follow the required procedures in administering an estate without the assistance of an attorney. The personal representative selects the attorney for the estate. You may wish to call your attorney to give you further advice as to specific duties and obligations.

Where does the Executor/Administrator obtain the funds to pay debts?

The Executor may, in most cases, withdraw up to one-half of the funds in the decedent's bank accounts. Generally, the Executor should open an estate checking account which can be used to receive and disburse funds.

Edited by Craig Renitsky, Dickinson College

Adjustable Hospital Beds - What You Need to Know

An adjustable hospital bed is basically a single bed with a frame in three sections so the head or middle or foot of the patient can be raised as required. The tables and beds are a mandatory part of the patient's room. It may be ignored but it is very important and the most convenient and useful piece of furniture that one can have in such a room.

These beds are made in a specific manner which helps the patient to be more comfortable and at ease. These beds have many features in which the bed has controls to adjust its height, head and feet of bed, the side rails of the bed and also control over the devices which are kept alongside the bed. These beds also have a huge effect on the patient's health as these beds ensure the comfort and relaxation for the patient. So these adjustable ones play a major role in recovery of the patient from the accident and provide comfort for the patient which normal beds cannot do.

Adjustable beds, as the name suggests, can adjust according to the required position of the patient. They help in providing more comfort to the patient. They support the patients back and maintain a posture. This type of bedding is usually recommended for people who have back problems and not just in hospitals but at home too.

These beds are convenient for people who have stress, back problems, sleep disorders etc. as these can be adjusted to an inclined position which can be very relaxing and convenient. There are two main types of adjustable hospital beds, the heavy duty bed and the standard type of bed according to how severe the problem is.

There are many types of hospital beds from manual to electric. In case of manual beds, they are equipped with a hand crank which helps in raising and lowering the head and adjust the bed's height at the same time. The Semi-electric beds contain a few electric controls which help raise and lower the head and feet of the bed and also have a manual control to adjust the bed's height as per the patients need. The full-electric hospital beds take charge of all tasks to lower and raise the head and feet and the adjustment of the bed's height as they have complete electronic controls. These beds are used by many other such health organizations and clinics like nursing homes, assisted living facilities, old age homes, health care institutes etc.

What Is Tinnitus? Causes And Symptoms

What Is Tinnitus?

Tinnitus is a medical condition typified by a hissing, buzzing or ringing sound produced inside the inner ear. The noises vary in pitch from person to person; they can be low or high frequency, intermittent or constant and can happen unilaterally (in one ear) and bilaterally (in two ears). Tinnitus can affect both sleep and concentration and it is estimated that approximately 15 % of the population have experienced it on some level.

Most of us have experienced 'phase change' which is a temporary buzzing in the ear after going to a concert with loud music or working in a noisy industrial environment. The ear ringing disappears after a few hours and most of us usually think nothing of it. However, those exposed to perpetual noise on a recurring basis are at risk of developing more long-term effects.

Tinnitus sufferers begin to notice they are missing obvious sounds like speech, doorbells or having to turn up the radio. Shortly after, they may begin to detect ringing or humming sounds at irregular intervals and initially in quieter settings, this later becomes a more constant sound.

What Causes Tinnitus?

Problems with tinnitus occur when the delicate hairs inside the inner ear become damaged and auditory cells send random electrical impulses to the brain which are translated into noise. This damage can occur as a result of age-related hearing loss (presbycusis) or through being exposed to loud and continuous noises, often in a workplace environment. This is commonly referred to as noise-induced deafness.

Where It Can Occur

Noise-induced deafness can be triggered in environments where some of the following equipment is used (amongst others):

• Welding tools


• Pneumatic drills


• Jackhammers


• Vacuum cleaners


• Lawn mowers

A report by Deafness Research UK has found that in 20 % of cases, tinnitus sufferers believe that working in a noisy workplace has given them the medical condition.

Treating tinnitus

In most cases of tinnitus there is no known cure. If you have the condition as a result of the build-up of ear wax then ear drops or ear irrigation are usually recommended. You should always seek medical attention if you have any symptoms as straining your hearing can exacerbate tinnitus.

Common treatments aim to handle the symptoms of tinnitus on a day-to-day basis and include the following:

Sound therapy

This involves filling quiet environments with indistinct repetitive sounds to detract attention away from the sound of tinnitus. Popular themes are natural sounds like rain drops or waves. Sound generators are electrical devices often placed on the bedside to aid tinnitus sufferers to sleep better.

Cognitive Behavioural Therapy

A popular treatment used for many conditions such as anxiety and depression. The notion of this therapy is based on the idea that people can change the focus of their behaviour through their thoughts.

Tinnitus counselling

A talking therapy usually administered by audiologists, it is designed to help suffers understand the condition and learn how to cope with the impact of tinnitus.

What you should do if you have any of the symptoms of tinnitus:

Contact a personal injury solicitor who will be able to assist you with a claim.

Contact your GP who will refer you to an Ear Noise and Throat Specialist for an audiogram to establish any damage. You will need a diagnosis in order to make a claim.

Begin a diary of when you are experiencing any of the symptoms as this will help you if you decide to make a claim against your employer.

Bear in mind that you will have 3 years from the date of discovery in which to make your claim for tinnitus.

How The Wall Clock Hidden Spy Camera Can Save Mom

Elder abuse in nursing homes and assisted living facilities are becoming a real problem in the United States. The whole issue was brought up front this past week when a childhood favorite of many seniors, Mickey Rooney, appeared before a Senate subcommittee on aging.

He testified about some of his own personal experiences as it related to family members taking advantage of his inability to cope as he got older. It always helps when a celebrity speaks out about an issue that sometimes they can do more good in one session before Congress than all the reports and studies in the world.

At the same time that he was testifying the General Accountability Office, or GAO, released a new report about abuse of our elders. The report showed that 14 percent of elders who aren't living in nursing homes and assisted-living facilities have been abused in some way. That's bad enough but the report goes on to claim that 84 percent of all abuses are never even reported.

With 13 percent of the population in the year 2008 over age 65, the demand for professional care of our senior citizens is growing. It is estimated that by the year 2030 nearly 20 percent of our population will be older than 65. Nearly 30,000 seniors a month now start qualifying for Social Security.

It's a very serious issue and one that needs to be dealt with. Most people cannot afford a nursing home or assisted care facility so home healthcare is about the only option.

There are many types of abuse from physical abuse, sexual, financial and mental abuse all of which play into the problem. There is the problem itself and then all the family dynamics that enter into it. Throw in dementia and Alzheimer's and you have yourself a real mess.

One of the best ways to detect elder abuse in a home healthcare setting is with a hidden spy camera.

Place a board camera inside an object that people don't think twice about seeing and you have a spy camera. One of the most effective spy cameras is the wall clock. It looks just like a regular quartz wall clock and can be placed just about anywhere in a home, office or business.

For a home healthcare setting I would recommend the wall clock model that has a built-in DVR. It is the easiest to use and will detect any wrongdoing on the part of a home healthcare giver. No one could tell that they are being recorded.

The wall clock hidden security camera can indeed save mom.

Comparison in the Role of a Licensed Vocational Nurse (LVN) And Psychiatric Technician (PT)

Licensed Vocational Nurse

The title "nurse" can refer to individuals with varying degrees of education and licensure. Job titles to which individuals may refer to themselves as "nurses" include the following: Certified Nursing Assistant (CNA), Licensed Vocational Nurse (LVN) / Licensed Practical Nurse (LPN), Registered Nurse (RN) of Nurse Practitioner (NP). LVN's and LPN's have the same training, licensure and scope of practice. The title Licensed Vocational Nurse is used only in California and Texas, while the title Licensed Practical Nurse is used throughout the rest of the United States. The job title used in Australia and New Zealand is Enrolled Nurse, while in the United Kingdom the job title is State Enrolled Nurse. In the United States, it is compulsory for a prospective LVN/LPN to have completed high school. Internationally, the scope of practice and title of the LVN/LPN may vary, depending upon country-specific criteria.

LVN's/LPN's work in hospitals, clinics (pediatric, geriatric, women's health, psychiatric) as well as skilled nursing facilities, assisted living facilities, correctional facilities and dental offices. LVN's/LPN's may perform specific nursing skills and procedures under the supervision of an RN, NP, Physician Assistant (PA), Physician (MD), or Dentist (DDS). They also may work collaboratively with RN's, and are licensed to delegate to CNA's or other non-licensed assistants. The LVN/LPN scope of practice includes performance and documentation of the following duties: basic patient care; vital signs; data collection on all body systems; carrying out wound care orders; preparing patients for diagnostic testing, including collection of urine, sputum, and fecal specimens; insertion and care of urinary catheters; insertion and care of naso-gastric tubes; and administration of medications, except intravenous medication (IV). In order to draw blood, or to initiate or administer IV medications, LVN's/LPN's must pass an additional post-licensure IV certification course. Even with successful passage of an IV certification course, LVN's/LPN's may not administer IV push medications. IV push medications are under the scope of practice of the RN.

Psychiatric Technician

Psychiatric Technicians (PT's) are trained and licensed to work in psychiatric facilities under the supervision of RN's or physicians. In preparation for licensure, there is some didactic coursework in common for PT's and LVN's/LPN's. These courses include Anatomy and Physiology, Nursing Fundamentals, Nutrition and Pharmacology. However, because their client base specifically includes individuals with developmental disabilities or those with psychiatric diagnoses such as (but not limited to) schizophrenia, bi-polar disorder, or depression, PT's require additional study in the area of psychotropic medications. Also, their clinical training is focused solely in psychiatric facilities.

Keep Seniors Happy and Comfortable With Elderly Care Facilities

As people grow older and reach mid sixties, their capacity to take care of themselves becomes goes down. Elderly people mostly have impaired mobility, low energy and less thinking power. It makes living independently more difficult.

Caring for aging and sick parents and elderly members of the family becomes too taxing for adult children and leads to lot of friction at home. Parents and elderly people, who are supposed to get more support and care during this stage of their lives, feel neglected. The option to provide parents, specifically if they are sick, adult home care resolves such issues.

For seniors who prefer living at home instead of availing elderly care facilities at nursing homes, adult home care is the best available solution. Adult home care is customizable to meet specific needs of a person for specific situation. It is a wonderful way of providing occasional assistance or 24-hour care. This eliminates shifting to a place outside your home.

At home, elderly people require companionship at a time when their children are working out, or have families of their own. Senior Care providers not only take care of house keeping and preparation of meals but also provide companionship.

Elderly care facilities provided by the senior care or adult home care providers include managing legal transactions, doing shopping and groceries, taking seniors to community centres for community activities and so forth. In case of medical emergency, the care taker takes the elderly person to the hospital for treatment.

Senior care providers also take care of daily things like giving baths, assisting senior with the toilet, giving them medicine.

Benefits of home care can be summarized as follows:

• Seniors are able to make productive use of their time.


• Seniors get help to meet people and establish friendships.


• They can keep fit by taking regular walk in the park with assistance of care taker.


• Seniors remain mentally alert since care taker reads to them and explains TV sitcoms if their hearing is impaired.


• Through care taker, seniors can remain in touch with family and friends.


• Although it costs more to get senior care, but the benefits of home care are far higher than its cash value.


• With adult home care, one can go to work or take business out of country without worrying about parents or elderly members of family.

Senior care is available for both temporary as well as full time assistance. Full time care is usually split into 3 shifts of 8 hours each. You can also get specialized senior care plan for Alzheimer patients. This non-medical care can prove to be a lifesaver for your loved one for living at home, for as long as possible.

How Lasers Became Used to Remove Hair

It is ironic now to think that in 1958, when American scientist Charles Townes showed that a MASER could theoretically be made to operate in the visible region of the spectrum, his colleagues told him "that his work would have little relevance to the real world". The year was 1958, the 'hula hoop' was all the craze in Europe and Russian author Boris Pasternek declined the Nobel Prize in Literature as he feared the authorities would expel him from his motherland. I am sure the world had changed a lot when Charles Townes received the Nobel Prize in Physics four years later. Today, lasers are used in every aspect of life including a ever increasing number of cosmetic treatments, including skin resurfacing for wrinkle reduction and acne scars, removal of tattoos, removal of hair, removal of pigmented blemishes (age spots and moles) and the treatment of vascular lesions (port wine stains and spider veins).

In fact the real story of lasers started many years before. In the year of 1917, the great physicist, Albert Einstein postulated that atoms could be persuaded to emit tiny packets of energy called 'photons' in his treatise "On the Quantum Theory of Radiation." This sentinel piece of physics laid the groundwork for the theory of stimulated emission of radiation, which was later used by the by American physicist, Gordon Gould to coin the acronym LASER. In essence, the word is an abbreviation of the phrase light amplification by stimulated emission of radiation.

The year was 1957 and the Russians had just launched Sputnik 1 into the skies above a horrified US nation. Senator Lyndon Johnson spoke for the nation when he said "soon, they will be dropping bombs on us from space like kids dropping rocks onto cars from freeway overpasses!". The newspaper headlines of the day reflected his fear when one stated, "Soviet satellite circles globe every 90 minutes". In that year, plans were made to start the space race and America ushered in a new age of political, military, technological, and scientific developments. The Government formed the Pentagon's Defense Advanced Research Projects Agency and huge grants were poured into private and public laboratories across the United States to fund the creation of a new spacecraft and the first working laser.

In 1960, their efforts paid off when a physicist called Theodore Maiman working with the Hughes Electric Corporation in California, created the world's first working Ruby laser. The acronym LASER, although appearing theoretical is of more than passing interest, because it means a laser device must be able to make a new form of light. This light must be composed of one wavelength (colour), it must pass in one direction (coherent) and its waves must be parallel. These unique characteristics can be used by doctors to achieve different results. We know the different wavelengths can penetrate various depths of skin and they can also cause dissimilar effects by targeting differing coloured lesions. This means that laser A could be used to target haemoglobin (red) in the broken blood vessels (telangiectasia) of rosacea, while laser B may be used to target melanin (brown) in the hair on an upper lip of a female with hirsuitism. It also means that lasers could be used to vapourise water in tissues, thereby causing resurfacing and later collagen stimulation with significant improvements to wrinkles in the skin.

In 1961, research was focused on this new technology continued with the production of a new laser made from crystals of yttrium-aluminum-garnet treated with 1-3% neodymium. The worlds first Nd:YAG laser was developed. This laser emitted energy in the near infrared (IR) spectrum at a wavelength of 1060 nm. Although many Americans felt safer to have more powerful lasers being developed, doctors tried to harness its power as they found its high-penetration emission to be useful for vapourising tissues and thermally coagulating large blood vessels. It is interesting to see that the laser is still widely used in cosmetic medicine today. It has even found a new role targeting hair follicles in darker coloured skin. The following year, the first experiments into depilation by laser took place when Dr. Leon Goldman used the principle of selective target destruction with ruby lasers in an attempt to destroy the melanin in hair follicles.

Unfortunately for him, although the idea was good, he did not take into account that the laser emitted a continuous wave more adept at shooting down Sputnik and it also targeted melanin in the skin and burnt his patients. The other patients in the experiment suffered from post inflammatory hyperpigmentation and the experiment was abandoned. In that year, the argon laser was also developed. This laser emitted energy in the blue-green portion of the visible spectrum, making it more readily absorbed by melanin and hemoglobin than by the surrounding tissue. It was 1962 and the American public waited with baited breath as President Kennedy and Soviet Premier Nakita Khrushchev waged a battle of nerves over the Cuban missile crisis.

In 1963, the ruby laser became the first medical laser when Francis L'Esperance from the Columbia- Presbyterian Medical Centre used it to coagulate retinal lesions. In 1965 he began working with Bell researchers Eugene Gordon and Edward Labuda to design a better laser for eye surgery as the blue-green light of the argon laser is more readily absorbed by blood vessels than the red light of the ruby laser. After further refinements and experiments, they developed a laser that is still used to this day to treat patients with diabetic retinopathy. It also has a use in the treatment of port-wine stains. As the cold war developed, the US Government funded projects that covered research into more powerful lasers, ones that had the power to cut through steel.

In 1964, Patel at Bell Laboratories developed the CO 2 laser. This laser operated at 10,600 nm and it was similar to the Nd YAG in that it could be used for cutting materials like stainless steel. The advantage was that it could also be focused onto a smaller spot; a function that one day could be useful in space. Thankfully for cosmetic medicine at this wavelength, energy is also heavily absorbed by water, which everyone knows is the primary constituent and chromophore of cells in living tissue. This particular function made the energy generated by the new CO2 laser suitable for tissue vapourisation and a whole new era of wrinkle removal by skin resurfacing began. The experiments on trying to find the 'Holy Grail' of being able to remove hair by laser light followed the path of the emerging Beatles throughout most of the rest of the sixties.

In 1967, while Dr. Chris Barnard carried out the world's first human heart transplantation at the Groote Schuur hospital in Cape Town, attempts made to reduce the potential damage to background skin by directing the light energy to individual follicles through the use of a wire-thin fibre optic apparatus. Many of these devices were sold illegally in the United States throughout the late sixties until the FDA banned their use. In 1968, Union Carbide's commissioned a study by Dermascan (manufacturer of the Proteus thermolysis machine) of the effects of applying laser energy applied directly to each hair follicle. The results were largely unsuccessful in that the perceived depilation may have been related to a type of electrolysis effect. Today the company is more famous, for those three nights in 1984, their chemical plant in Bhopal, India, began leaking 27 tons of the deadly gas methyl isocyanate into the atmosphere exposing half a million people to the gas, resulting in the eventual deaths of 20,000 people.

During the 1970's research into finding a means of hair removal with laser continued with Omnicron Corporation producing a photo epilator that used coherent light to epilate hair. The device never produced marketable results and things remained that way until another attempt was by Lasertron inc. in the 1980s when they used an Argon laser to direct energy at the haemoglobin surrounding individual hairs. The device was marketed before proper clinical tests were done to establish its efficacy and before long patients were complaining as it proved to be unsuccessful for permanent hair removal. In 1983, Oshiro and Maruyama noted that hair was lost from after pigmented nevi were treated with a ruby laser. Whenever the increased the laser power to affect the hair follicles, the epidermis became severely damaged. These observations led to Anderson and Parrish developing the theory of 'selective photothermolysis'. This theory was based on the fact that a laser of particular wavelength and pulse duration of light could be used to target a particular chromophore, selectively destroying it while sparing the surrounding tissue. The space race started by the launch of Sputnik continued and in that year, Sally Ride, the first American female astronaut landed aboard the Challenger space shuttle.

While tumultuous things were happening on the world stage, including the fall of the Soviet Empire, the freeing of Nelson Mandela and Saddam Hussein's fateful annexation of Kuwait, the development of laser hair technology seemed to have reached an impasse. There were some highlights when Thermolase Corporation built and tested a low-power Nd: YAG laser for the removal of tattoos and birthmarks.

During the mid nineties the quest to find the 'Holy Grail' laser seemed to quicken when a company called ThermoLase used a topical suspension of carbon particles applied to skin followed by treatment of a Q-switched variant of this Nd: YAG laser called the SoftLight(TM) to treat hair. The laser certainly produced some results and within a short time it received FDA approval and became the first device for hair removal in the United States. ThemoLase went all out to market the product and within a short period they starting using the device in a chain of clinics called Spa Thira. It soon became apparent that this was not the 'Holy Grail' laser as the device seemed to only delay hair regrowth by 3-4 months, but it did not provide permanent hair reduction. This led to several lawsuits against the company and in the period1998-99; they closed most of their spas.

However, all was not lost for TheroLase because it is apparent that many clients who had unsuccessful hair-removal reported improvement in their skin's texture. It appeared the heat emitted by the laser in association with a lotion that was employed caused a form of skin resurfacing. Before long, Thermage exploited this benefit by obtaining FDA approval for SoftLight(TM) resurfacing, marketing it as a safe, fast and effective alternative to CO2 and erbium skin resurfacing.

In 1994, Nelson Mandela became President of South Africa. It was the same year that Doctors Anderson and Grossman working with Palomar Medical Technologies, first used a water-cooled delivery handpiece during epilation with a long pulsed Ruby laser. The laser was developed at Massachusetts General Hospital and the chilled head meant the laser did not thermally damage the surrounding skin, leaving it less irritating than other methods and relatively pain free. This EpiLight ® Ruby laser is still in use in many US clinics today.

In 1995, the world was gripped by the live television coverage of the Los Angeles trial of a former American football star and actor 'O.J.Simpson'. Further upstate in the small town of Los Gatos, dermatologist Patrick Bitter had other things on his mind. He postulated that if he used a Xenon flashlight to emit broad-spectrum light made up of multiple wavelengths, he could use a cutoff filter to restrict the bandwidth to a certain range. By applying different filters, he could imitate laser action by using the shorter wavelengths to clear pigment spots (lentigines) and broken vessels (telangiectasias) and the longer ones rejuvenate and smooth the skin. By using a range of wavelengths and some clever software a company could produce a device that could cure many ailments at once. In these moments the new concepts of Intensed Pulsed Light (IPL) and photorejuventation were born and the world moved closer to finding the 'Holy Grail' laser. Ironically, these devices would not be real lasers, as they were in reality flash lamps giving off white light, similar to that of a light bulb with wavelengths in the range of 400- 765nm.

In 1998, ESC Sharplan announced the introduction of the Vasculight ® and the concept of IPL ® technology for photorejuvenation. In the year 2000, this company became Lumenis and they introduced the Quantum SR as the pioneer IPL of the new Type I Photorejuvenation procedure.

By 2001, numerous companies began to produce IPL machines and market the photorejuvenation procedure. Later that year some of the people who had helped form ESC/Lumenis scientists created a new company called Syneron. In 2002, this company announced the introduction of the Aurora RF, a new type of laser that promised to enhance photorejuvenation by using the addition of RF (bipolar radiofrequency) to the pulsed light source. This action brought both companies into the U.S. District Court with Lumenis bringing a preliminary injunction against Syneron's sale of Aurora devices. In 2004, Lumenis granted Syneron unlimited non-exclusive worldwide licenses for Lumenis patents relating to the use of incoherent light in aesthetic and medical applications, including all of its IPL related patents. It was the same year that a tsunami spread throughout the Indian Ocean, killing nearly a fifth of a million people and devastating coastal communities across South and South East Asia.

CNA Inservices - Get Measurable Results

Continuing education should do more than fulfill annual inservice requirements. It should meet the learning needs of your CNAs and, in turn, have a measurable impact on client care. That's what you get when you utilize high quality inservice materials that have been created especially for nursing assistants by a reputable inservice provider. Consider these examples:

Renee was concerned about the large number of falls among the residents at her skilled nursing facility. "We purchased an inservice for our CNAs called 'Understanding Fall Risk Factors' to educate them on this issue," she said. "In the past month, our falls have been cut in half!"

Using quality inservice materials saved one of Temika's home health clients. "After presenting an inservice we purchased called 'Understanding Diabetes' to our home health aides, one aide recognized the signs of hypoglycemia and impending insulin shock in her client," Temika reported. "The aide called EMS and literally saved the client's life because of the information she learned from the inservice."

At her assisted living facility, Beth kept noticing poor documentation skills among her CNAs."Some of them were even using 'White Out'!" said Beth. "We purchased an inservice on 'Reporting & Documenting Client Care', and made it a requirement for every nursing assistant. Their documentation has improved significantly!"

In each of the above examples, the nursing supervisor had struggled with her problem issue for a while before purchasing a CNA inservice from an inservice provider. Could they have created their own inservice materials? Of course. But at what cost?

Let's take a look at Charlotte, a busy nursing supervisor. On top of all her other work, she needs to find a way to reduce the number of urinary tract infections among her home health patients. She thinks about this for an hour on Monday and decides to create an inservice on UTIs to present to her nurse aides on Friday.

On Tuesday, Charlotte begins to do research for the inservice. She spends two hectic hours on this, and while she knows it's not enough, she can't spare any more time. On Wednesday, Charlotte tries to write an interesting presentation-which is difficult between constant interruptions. This process takes her four hours. She tells herself that it will "just have to do". Now, Charlotte needs a couple of handouts. That adds another hour to the project.

On Thursday, with time running out, Charlotte remembers that she needs a quiz. And what about learning objectives? She spends another rushed hour on these finishing touches. Charlotte pats herself on the back for saving money by creating her own inservice and crosses her fingers that the inservice will make a difference.

But, did Charlotte really do her home health agency a favor? In total, Charlotte spent nine hours developing her inservice. Since she earns $25 an hour, Charlotte just cost her agency $225.00 for a "rush job" on an inservice that may not help reduce urinary tract infections. If Charlotte had spent just a few minutes surfing the internet, she would have discovered that for less than $50, she could purchase a high quality "ready made" CNA inservice. Instead of presenting a few slapped-together handouts, Charlotte could have provided her aides with a polished, in-depth look at how to prevent urinary tract infections. Which inservice is more likely to get measurable results?

In today's healthcare climate, nursing supervisors are too busy to do it all. The next time you need inservice materials for your CNAs, be sure to explore all your options. Purchasing materials from a well-regarded inservice provider may be your best solution.

CNA License Offers Eligibility to Work in a Health Care Center

In the United States of America, if it is your desire to get employed in a health care facility, you must earn a CNA License (or Certification) that offers you permission to work in a Health Care Setting. The federal OBRA-87 also mandates that a candidate aiming to get employed in a hospital, nursing home and long term care unit must be thoroughly trained through the approved nurse aide training program. The OBRA legislation further directs every state authority to evaluate the competency of the aspiring nurse aide candidate through the CNA Licensing test.

Steps Essential for Earning CNA License

• Complete the state and OBRA approved CNA Training Program, comprising of minimum 75 hours of classroom course instructions and clinical hands-on experience.

• Appear and pass the Certification Exam, which consists of the Written/Oral Test and Skill Test.

Once, the candidates clear the Licensing Exam, they are awarded with the CNA License and listing with the Nurse Aide Registry. The registration with the registry also awards these candidates a License No., which permits them to work legally in any type of the health care facility.

Validity of Nurse Aide Certification

The Nurse Aide Certification is valid for two years and you must get it renewed within 2 years, before it gets expired. You are required to submit a Completed Application and Renewal Fees to your state Nurse Aide Registry for the renewal.

CNA License Verification

On few occasions, working certified nurse aides forget to renew their certification and they are not sure if their current license is valid or expired. The Nurse Assistants are offered Online License Verification by the state Board of Nursing. You are required to provide your Serial Number to the Licensing authority and verify your certification online or by visiting the concerned authorities on their street address.

CNA License Transfer to another State

If you are moving from one state to another state for the CNA employment, you are not allowed to work in that state with your home state CNA License. You are required to complete certain basic requirements as needed by the state including:

• Reciprocity Arrangement between the states may exempt you from reappearing in the nurse aide exam and your licensing procedure continues in the same fashion as your License Renewal.

• If the states do not have Reciprocity Arrangement with each other, you may have to re-complete the state Nurse Assistant Training Program and reappear for the state CNA Certification exam once again.

CNA License Transfer to another State

If you are moving from one state to another state for working in a facility, you are not allowed to work in that state with your home state CNA License. You are required to complete certain basic requirements as desired by the state and these necessities include:

• Reciprocity Arrangement between states may exempt you from reappearing in the nurse aide exam, and your licensing procedure continues in the same fashion as your License Renewal.

• If the states do not have Reciprocity Arrangement with each other, you may have to complete state Nurse Assistant Training Program and appear for the state CNA Certification exam once again.

Humiliation in Nursing Homes

Making the decision to move a family member into a nursing home facility is not an easy one. But these facilities do plenty to ensure you that your family member will be well cared for and receive the respect and attention they deserve. It is crucial to ensure that is true if you have decided to place your loved one in a nursing home. Humiliation of residents is an unfortunate reality in many nursing homes.

A person's health or age is never a reason for them to be the victim of abuse. Yet elderly mistreatment is a real concern and does affect many of the clients who live in these facilities. Caregivers need to be held responsible for their actions towards their clients in order to ensure that every person in a nursing home gets the respect, attention, and care that they deserve and that you expect.

One of the dangers of elderly maltreatment is the possibility of humiliation. Many patients in these facilities are heavily dependent on their care givers for many daily functions. Every adult should be treated with respect and not made to feel like a lesser person because of their need for assistance. Care takers can be caring for a person negligently if they are humiliating them in private or in front of other residents.

Humiliation can occur in a number of different forms including public humiliation and sexual humiliation. These can take place in private or in front of other residents and can have devastating emotional and mental effects on a person, no matter their age.

Psychological Abuse in Nursing Homes

When a family must make the difficult decision to place their elderly family member in a nursing home, they expect that he or she will be well taken care of and treated with the utmost dignity and respect in their new place of residence. However, the unfortunate truth is that some residents experience abuse from caretakers in various different forms. Though physical abuse is the easiest to detect, psychological abuse may even more harmful and long-lasting.

The individuals who threaten, manipulate and harass senior citizens living in their nursing homes should be held accountable for their damaging behavior. The best way to make sure that justice is served for your loved one is by bringing this person to a court of law. If this kind of abuse has occurred and can be proven, your loved one may be entitled to financial compensation under the law. In order to increase your chances of a favorable result in court, it would be best to hire an experienced attorney to represent your case. That way, you make sure you claim is presented in an accurate, persuasive manner and help your family member receive the funds to which they are entitled.

Psychological abuse can take many forms and it is important to identify these behaviors early to act swiftly before more damage is done. The following behaviors may be considered abuse:

• Threats
  


• 
  Inappropriate sexual comments
  


• 
  Name-calling
  


• 
  Verbal harassment
  


• 
  Verbal manipulation
  


• 
  Humiliation
  


• 
  Intimidation
  


• 
  Isolation
  


• 
  Embarrassment or shame

No one deserves to live in an environment where they are not respected. Even elderly individuals who need substantial care to accomplish even minor daily tasks should be treated with dignity. When this is not done, you may be able to pursue legal action against those who have wronged you or your family member.

Elder-Care Mediation - How a New Breed of Mediators Helps Families Navigate Difficult Conversations

For elders and families who are navigating the complex and emotionally charged waters of end-of-life care, financial arrangements, medical decisions and estate matters, there's a new and powerful way to get some support and help.

Elder mediation, sometimes also called eldercare mediation or family care-giving mediation, helps families make vital decisions while also keeping communication channels open and avoid damage to family relationships. In elder mediation, an impartial person, the mediator, facilitates discussion and helps elders and families explore options that address the many needs families are trying to sort out together.

Elder mediation is often about more than reaching a specific agreement. Some find that the facilitated conversation helps them feel fully heard. Others say it helps them talk about the things that matter most, before it's too late. Still others say that they were able to accomplish in a few hours what hadn't been achieved in months and that it reduces stress for families already facing enough difficulty and stress.

A new breed of mediators now helps elders and families address matters including health and medical care, end-of-life care and decisions, how to share family care-giving, care-giving schedules and expenses, living arrangements, property maintenance, family members' role in decisions, guardianship decisions, financial arrangements, and probate matters such as wills, estates and trusts.

Sometimes elder adults initiate the mediation as a way to gather the family together before matters get too difficult. Some elder adults want their wishes about estate matters or end-of-life decisions to be fully understood by family members and find that a mediator can provide the support and structure to help that happen most constructively. Some want to have frank discussions with their children and grandchildren as a way to preempt the kinds of misunderstandings that lead to probate problems and legal action after they've passed.

Sometimes family members, such as an adult child, initiate the mediation as a way to sort through tension between siblings or between elder parents and adult children. Some want to resolve differences while parents or grandparents are still alive and before they escalate further. Some feel financially stretched and are seeking an economically efficient way to resolve differences. Some want to help the family get back on an even keel for better future joint decision-making.

Sometimes the staff of hospitals, nursing homes or assisted living facilities recommend mediation when disagreements reach a point beyond what a case manager or patient liaison has the time or training to manage. Additionally, mediators, who are specifically trained to help people navigate very difficult conversations, offer an impartial perspective that's separate from that of the hospital's or care facility's interests.

The need or desire to use elder mediation is not a statement about a family's ability to function together effectively. Even well-functioning families can experience tension when facing difficult end-of-life issues. Elder mediation is a choice for those who want the support, clarity and help of a caring, trained person who's familiar with geriatric issues and prepared to help them talk things out and preserve their most important relationships.

Copyright © 2005 by Tammy Lenski. All rights reserved.

Tips on Selecting Nursing Homes for Elderly People

Are you planning to place your grandparents or parents in nursing homes? Are you confused on how to choose the right facility for them? To gain insights and tips on how to select a suitable place for elderly people, read the article below.

Making a decision on whether to admit a loved one to a geriatric facility can be difficult because some elderly people are sensitive and they get upset by such decision. However, it is more daunting to choose the right facility for them.

With the busy and hectic schedules that we have everyday, seldom can we have time to care for our elderly grandparents and parents. No matter how much we love them, we have to make a decision on whether to place them in assisted living facility or not.

Some elderly individuals prefer to stay with their family as they grow old because they believed that nothing compares the quality of care given by family members than those they receive in assisted living facilities. More so, some of them like to live in long-term care homes because they do not want to become a burden to their loved ones.

Placing them in geriatric homes is not that easy because you have to consider several things to select the right facility for your loved one. Some families also experienced guilt, fear and regret when placing their loved ones in the hands of long-term care facilities.

Factors to consider when choosing a nursing home center for your loved ones:

• Location - You must select a place where you can easily visit them during your spare time. Choose a convenient place where they are comfortable, reassured and at home. Select a good quality facility which is accessible to you so you can spend more time with them whenever you can.


• Costs - Pick a long-term care facility which is within your budgetary requirements. However, do not risk the quality of care they received on the amount you pay for the services they received.


• Care givers and care workers - Be sure to select a facility which employs experienced, certified, competent and credible employees. Before you pick one, do some research to find out the quality of care they give to elderly people. With the rising cases of abuse committed to elderly people, we should not risk their safety and security. Be sure to know that they have enough employees to provide quality services to these people and make sure that their care givers are thoroughly trained to give critical care, emergency care and elderly care. Before you sign in a contract, take time to inspect and to evaluate the place to see how they treat their patients. Look for traits like patience, politeness, empathy and compassion in their employees.


• Facility inspection - Visit the facility that you are considering and assess if they did not commit any violations with regards to healthy and safety inspections. Take a look and investigate if it has enough fire exits, smoke alarms, fire extinguishers and specially fitted comfort rooms for disabled elderly people.


• Conducive living environment - Make sure to look for a place which is not dreary and isolated. Consider nursing homes which offer plenty of entertainment and fun activities for elderly people to keep them productive and busy. Make sure that their employees are cheerful, positive and accommodating. Try to ask around and investigate the opinion of elderly people who stayed there for a long time.

By considering the tips and suggestions mentioned beforehand, you can choose the right nursing home facility for your loved ones.

Things We Learn From Being A Nurse

As nurses, there are many things that we learn from what we do. The experiences and learning we get from our job change our lives and the way we view life and even death. For most nurses, these are the most common things that we often learn from our profession.

1. We may not always hear our patients say "thank you" but that doesn't mean we should treat them differently. Every patient is fighting his own battle and we don't know exactly how he feels. The best thing we can do to make that person feel better is to do our tasks and responsibilities to the best of our abilities. From time to time, we may meet patients who are not as cheery as the others. This only goes to show that patients did not choose to be in the hospital. But for nurse, we chose to be there and assist every patient assigned to us. That's why it is us nurses who should be more patient and understanding.

2. Being understanding to patients does not mean being a doormat. Just because we need to be more understanding of patients does not give them the right to verbally or physically abuse us. When this happens, we need to inform our leaders or superiors about it.

3. We know the importance of life and health. We have seen so many deaths in our profession that these moments give us a chance to take better care of ourselves and the people around us. We have also seen people who have been given another shot at life or being given the miracle of life. This makes us feel how precious life is.

4. We know that the amount of responsibility we have is immense. We are responsible for administering medicines to patients, checking their stats and giving physical and emotional assistance to them. We are accountable for our actions towards them and so it is essential to provide the right nursing care.

5. We do not know everything. While we may hold a nursing license, this does not equate us to being omniscient medical professionals. We need guidance and we need to ask for help when we are unsure of what actions and steps to take. When we look back at the time when we were still new to the profession, we always ask questions to people who are more knowledgeable- our mentors, superiors and experienced coworkers.

Beating Burnout In Helping Professionals

Helping professionals have a high risk of burnout. This is due to the intensity, significant responsibility, lack of control and decision making powers, and a culture that has unrealistic expectations of nurturing and self-sacrifice from helpers.

Burnout is defined as physical and emotion depletion caused by an intense involvement in a situation in which the person has little control and recognition. Burnout is most likely to occur in situations where an individual perceives little effect from his or her efforts. Burnout can be caused by unrealistic expectations and demands from an outside source, or from idealistic goals, perfectionism and unreasonable expectations of oneself.

Common Symptoms of Burnout

Those working in a high stress environment may experience many of the warning signs of burnout. Some of the most common symptoms are:

• Increased absenteeism


• Avoiding or rushing through patient care


• Rigid rules and "by the book" approaches


• Dehumanizing patients


• Anger and emotional outbursts


• Increasingly cynical attitudes


• Boredom


• Stress from work interfering in social and family relationship


• Physical symptoms of stress such as headaches sleep disturbance and tiredness.

Organizational Steps For Prevention of Burnout

The system itself is often not conducive to self-care. Administrators and supervisors don't always recognize or concern themselves with the level of stress experienced by nurses. They are often under tremendous pressure themselves. If you are lucky enough to have a supervisor/administrator who is concerned with the needs of the nursing staff, here are some suggestions that they might consider adopting to support the staff.

• Rotate staff as much as possible in order to distribute difficult patients and assignments


• Include staff in discussions of rotations, and stress reliever suggestions


• Build group cohesiveness by regular trainings, discussions, in-services


• Let staff suggest topics


• Encourage peer support


• Offer recognition for success, and excellence


• Vary professional responsibilities


• A monthly newsletter with updates and kudos is always appreciated


• Let staff know it is all right to ask for a "stress break"


• Watch for signs of significant stress in staff, and offer them help.

Asking for and accepting help must be part of the culture within the organization. Admitting to being stressed must be accepted and not viewed as a sign of weakness. It takes time to build the attitude required for this level of openness to occur. Although administrators at first might see these suggestions as daunting, they will soon see their efforts rewarded with lower staff turnover, fewer days of absenteeism, a more productive and satisfied staff, and improved patient care.

Helping Ourselves Prevent Burnout

If you work in a situation where support from administration is not forthcoming, you must do what you can both as an individual and with your colleagues to prevent burnout. In situations where administrative support is lacking, there is often a high turnover of staff. This creates increased responsibility and more stress on the remaining helpers. It makes it more difficult to build a supportive cohesive group, and increases staff burnout.

Helping professionals must learn to take care of themselves; this is much easier to say then do! Although there are more men in the helping professions today, in nursing the vast majority are still women. Womens' sense of self is often one of caretaker and nurturer, and our society perpetuates this view. Nurturing and care taking have long been associated with women in general and nurses in particular. Empathy is a mainstay of the helping professions, particularly the "womens' professions" such as nursing and social work. Nurturance has historically been intertwined with, and seen as a major function of nursing. Nursing has been called the "practice of professional nurturing".

When a woman must choose between caring for herself and caring for another, social pressure fosters the choice of nurturing of others. Women often experiences conflict when faced with what may seem like a continual choice of caring for others or caring for themselves. It is not unusual for women to have difficulty saying no or setting limits thus end up doing more than they really want to. They frequently nurture everyone but themselves consequential feeling conflicted, unappreciated, resentful, and burned out. As women, nurses already struggle with these issues, which are then further exacerbated by the nursing role of nurturer.

Some important reminders for all those in the helping professions are:

• Take care of you, it will relieve some of your stress and allow you to better take care of others


• Learn and use self-empathy and self-nurturing techniques


• Try understanding and treating yourself with the same care you give your patients


• Allow yourself to say no, offer alternatives, or even avoid situations if you feel unable to say no


• Increase your self-awareness


• Plan for a routine to help ease the transition from work to home. (Do not use alcohol to unwind)


• Do not expect all your feelings of self-esteem to come from your profession.


• Develop outside interests that have nothing to do with helping others!


• Try to avoid over-identification with patients


• Recognize and allow your own feelings


• Develop relationships outside of work where you can talk about your feelings


• Practice stress reduction techniques (exercise, relaxation, meditation, distraction)


• Plan for regular breaks, conferences, and vacations


• Talk with colleagues to not only complain, but also to also make plans for burnout prevention, take charge where you can


• Know when to say "enough", consider transfer if necessary

Burnout can and must be prevented. Recognition of your own level of stress and self-care are the keys to stress reduction and burnout prevention. When self-care is a priority, helping others can be the rewarding successful career it is meant to be.

Burnout can also have an unexpected positive influence in your life; it can act as a catalyst to make a much-needed change. It can be the impetus to move on to different more rewarding careers. Caregivers in search of something more have become entrepreneurs (the writer included) and have developed many ways of working as a helper that allow them more reward both financial and personal, and more control over their careers and their lives.

TAKE CARE OF YOURSELF!!

Why Horticultural Therapy Benefits Seniors Living in Retirement Communities

Gardening programs for Seniors should be designed to meet the special needs of the specific Senior population you are working with. The physical, mental and emotional benefits of gardening activities may be slightly different when working with Memory Care residents compared to very able Independent Seniors. But gardening is beneficial for Seniors of all ages and ability levels.

Garden related activities and "enabled gardens" should be created so they are easily accessible to all. For example, raised garden beds, raised boxes, wall gardens, hanging plants and small individual containers can all be used in Garden Therapy programs. Wide paved paths are helpful for Seniors using wheel chairs and walkers.

Seniors with physical or cognitive limitations should be encouraged to actively participate in planning and caring for the garden or small container plants so they feel a greater sense of accomplishment and ownership. For Memory Care residents, hand over hand instruction is useful in helping the residents complete tasks independently.

Horticultural Therapy or Garden Therapy programs are unique in that they use living materials requiring nurturing and care. The natural life cycle of plants provides participants with plenty of horticultural tasks and activities that stimulate thought and exercise and encourages an awareness of the seasons and the environment. This is especially important for Memory Care participants.

Gardening with Senior Citizens in retirement facilities and communities is a very gratifying activity for all involved. A recent survey by the National Endowment for the Arts found that 63% of survey participants ages 65-74 and 53% of those ages 75-96 work with indoor plants or garden outdoors for pleasure. Another survey by the Roper Organization indicated that 33% of people 60 years or older are likely to say that gardening is an avid hobby or interest.

Garden Therapy classes help retirement housing providers and health care administrators provide Senior residents with meaningful activities that improve quality of life, provide sensory and visual stimulation, social involvement, and healthy exercise. As the Baby Boomer Generation ages, we anticipate the need for beneficial activities like horticultural therapy programs will continue to grow in demand.

Gardening with Seniors should be about getting dirty without feeling guilty, enjoying the results of a job well done and taking the time to soak up the sun and serenity that being in nature offers all of us.

Benefits of Garden Therapy include:

Improved Physical Functioning- Garden activities provide moderate exercise and builds fine motor skills by planting seeds or transplanting seedlings. Activities like digging and weeding improve gross motor skills.

Sensory Stimulation- Aging often involves loss or reduction of sensory capabilities so it becomes important to stimulate the senses that remain. Simple garden tasks improve hand-eye coordination and touching plants and smelling herbs and flowers can stimulate the senses and trigger happy memories from the past.

Improved Emotional Status- Garden projects and activities help build each participant's self esteem and confidence as they are encouraged to make decisions and think creatively when completing personal projects. Working with plants fosters a sense of nurturing and purpose and these tasks and projects can often provide structure and activities that alleviate depression and alter negative feelings.

Social Skills- Garden programs provide an excellent opportunity for participants to interact with group leaders and other participants through sharing materials and creative ideas, assisting others with tasks, and sharing stories and memories of previous gardening experiences with others.

Gift Ideas for Seniors Living in Nursing Homes

There are some gift ideas that you can use if you want to buy a great gift for a friend or loved one who is currently living in a nursing home. Everyone can benefit from receiving a gift from family or friends to remind them that they are loved and appreciated. You want to provide your loved one with a gift that is practical and safe for him or her.

If you have a loved one in a nursing home who is able to get out and about every once in awhile, you might consider giving them the gift of an afternoon out with you. Of course, you will need to check with the staff to make sure your loved one is able to leave the nursing home and to have them approve the locations where you will be taking the resident. You can plan to take them shopping for a little while or even to a nice restaurant.

Purchase some good books for a nursing home resident if you know he or she loves to read. Perhaps you can buy him or her some books from their favorite author. You might even want to consider buying audio books for your loved one. Many residents also enjoy reading or skimming through magazines. Take a couple magazines with you for your friend or loved one when you go to visit. You might even want to consider purchasing him or her a magazine subscription.

Bring your loved one some crayons and coloring books. Sometimes individuals in a nursing home are not able to communicate as well as they once could. This does not mean that they still do not want to spend quality time with you. Bring some coloring books in so that you can color together for the afternoon. Your family member might be able to express him or herself well though the pictures they color.

Talk to the nursing home staff to determine if you can bring your loved one some candy or one of their favorite treats. You must check first to make sure they can safely eat these items. If the individual can only have one or two pieces of candy at a time, the staff might be able to give the treats to your loved one as they are able.

Purchase some stationary for your favorite nursing home resident if they are still able and still enjoy to write. They will love having the opportunity to drop a line to friends and loved ones. Make the gifts even better by including some postage stamps and a new pack of pens or pencils with the stationary or note cards.

One of the best things you can give to a loved one who is in a nursing home is your time. They will not care if you bring them a present as long as you bring yourself for a visit as often as possible. Take the time to spend a couple hours each week with your loved one. There is no greater joy that you could give your loved one than your love and attention in person.

Dementia Screening Within Assisted Living

There is a new method of self screening for dementia. This test can be conducted within the home, so it is only reasonable that this tool be used within assisted living facilities as well. If dementia is detected early enough, there are some things that can be done in order to slow down its progression. There is no cure for dementia or Alzheimer's disease at the moment, but that doesn't mean that a patient's standard of living cannot be improved with therapy and professional guidance.

The self test is performed on the computer, and is extremely easy to conduct-even for people that are not technologically savvy. Still, this test can be more easily conducted if there is supervision. Many elderly folk are unsure or not confident when it comes to computer usage. This makes having this test supervised within the assisted living setting even better for the people being tested. They are more likely to have an accurate portrait of their mental health illustrated.

The test revolves around the clock and telling time. Test subjects are asked to draw the hands upon a clock with a mouse or computer stylus. Upon completion of the test, results are sent to an analytical clinician and 13 different traits are assessed. The results can be determined quickly after completion. This allows for a patient to receive help as quickly as possible.

In practice, people with early stage dementia are more likely to make mistakes when drawing and completing their clock illustrations. They are likely to have incorrect or missing hands, and they are also apt to put extra numbers on the clock, or write in the numbers outside the clock. As simple as this test seems, it is a fairly accurate way to assess someone's mental fitness.

If this test were to become a common practice within the assisted living industry, the mental health of residents would be more readily known, and this would only have a positive outcome. The sooner people's dementia problems are discovered, the sooner treatment can begin for them. This is obviously superior to having problems go undetected until treatment will become pointless. Assisted living facilities will also benefit from having these tests conducted in house since they will more accurately be able to monitor their residents and provide the appropriate services. Knowing that a patient is beginning to lose their mental faculties is a good way to stay proactive with the amount of care being provided.

There is, again, no cure known for dementia and if left untreated, it will quickly unravel someone's life. With earlier detection, the patient's life can be more efficiently managed and they will have a higher quality of life for longer periods of time.