Long Term Care - Part 1: The Practical Implications of Caring for a Loved One

My mother fell and broke her shoulder in mid-January of this year. Receiving the news about four days after the fall occurred, (a family member did not want to alarm us!) my mother was now resting in the hospital, albeit in a lot of pain, stabilizing her shoulder with round-the-clock bed rest. That bed rest led her to an episode of pneumonia, followed by congestive heart failure, pneumonia in the other lung, and a long rehabilitative process.

As a Financial Advisor licensed in insurance, and certified in Long Term Care in particular, I knew, intellectually, that her situation was the one I had most feared, having heard dozens of horror stories from clients about their own family members and their lengthy illnesses. But it was one that, at the same time, I had covered, by protecting her through a good long term care hybrid product that would provide her the medical benefits should her condition warrant them.

What I was not prepared for, however, were the physical, emotional and spiritual impacts of my mother's injury on myself and the rest of our family. Everything I need to know about Long Term Care I did not learn by studying the manual. I learned it by taking care of my mother, along with my brother and sister, both of whom live considerably further away that I did.

This is Part One of a five-part series on Long Term Care from an insider's perspective. For one can obtain the intellectual "book smarts" of understanding Long Term Care by sitting through the hours long mandatory training session, studying the manual and taking the exam. But one simply cannot learn the necessary lessons of long term care until you have witnessed it and dealt with it on a first-hand level. Until you care for a loved one of your own, none of the training material settles into one's mind, heart and spirit. Here is our story.

Receiving the News

During laundry chores, my weekend early morning tennis ritual already enjoyed and over, I got a phone call with the news that my mom was in the hospital with a fractured shoulder. My aunt's voice was weak, but she was calm. Younger by just one year than my mom, they had a pact of secrecy, trying to protect us adult children from the inconvenience that any bad news, ever, might bring. The accident, an early morning fall, occurred several days prior without any of us, other than my aunt, knowing about it. A trip for me to visit my mom was not even in question; I would leave that night, given that I already had plans to be in New York City, which was directly on my path to Allentown, Pennsylvania where my mom lived and was now hospitalized.

It was late into the night by the time I got to her room. Sleeping amidst heavy medications to keep both pain and insomnia at bay, she did not even know that I was there. It was not until the next day that she responded to me. Her state of confusion and sedation was bothersome to me, but I was assured that she was simply medicated in order to rest comfortably.

Multiple trips to Allentown during the course of the next few months ensued. For her bed rest led to pneumonia in one and then the second lung; congestive heart failure, blood pressure issues and breathing complications all took hold on my weakened, bed-ridden eighty-one year old mother.

By the time April rolled around, she had recovered from anything life-threatening or permanently disabling. Now in physical therapy to strengthen her shoulder, we were assured that she would soon be back home and to her normal self again.

Things are Not Always as They Seem to Be

The practical implications of long term care require that family members and friends step in to deal with the very real, daily issues resulting from someone being unable to perform activities of daily living. Long term care looks at the commonly accepted activities of daily living (ADL's) when assessing how able one is to live quite normally. They include: eating, dressing, grooming, bathing, getting to and from places or things, ambulation or being able to walk or move in a wheelchair, and maintaining bladder and bowel control. Once a loved one is unable to perform and two of these ADL's, long term care is generally required.

For elderly people in particular, falls are extremely common, and they can lead to serious complications as a result. Elderly people do not usually face mortality from a fall per se; they die from complications from the fall. Once a family member or friend has a serious fall, you must consider the practical implications. How often can you travel to visit and provide care for this loved one? What will this frequent travel require? Hotel accommodations, meals eaten out and time away from your job or career all exact a toll. If you are the only family member or friend available to help, how are you going to manage the additional responsibility of care? For how long can you maintain this responsibility?

In our own situation, since I was the adult child in closest physical proximity to my mother, I was the one who volunteered to make these initial frequent visits to the hospital. I wanted to make regular visits to check on her progress, and she greatly appreciated the company. A hospital is a very lonely place; your loved ones deserve your time and attention when they are temporarily placed there.

What we could not foresee were the very real issues of an extended stay in the hospital. Most of the time we had cared for our mother during other periods of illness or injury involved short stints; one or two weeks in the hospital followed by a brief stay in a rehabilitation center were commonly accepted modes of care. Perhaps requiring an out-of-state visit from one of her children, but perhaps not, these short treatments become part of most adult children's range of vision. Moving into care for our parents once they reach their eighties practically requires us to start thinking in terms of how real these medical treatments are or will become.

Longer treatments at the hospital, in rehab centers or assisted living centers are another story entirely. Out of their routines, our older parents get discombobulated, irritable, off-balance and unsure of what their future holds. Add to that the lonely and isolating experience of a medical institution, and the picture becomes even bleaker.

These practical issues must be addressed by all family caregivers. Trying to put yourself into your parent's shoes will perhaps yield a different picture than the one you might have drawn for their golden years. In our own mother's case, since we could not imagine ourselves being stuck in a hospital room or assisted living facility and enjoying it, we started talking about how one of us might take our mother into our own homes. What that would involve, practically, as we thought through the necessary re-alignment of our own lives and those of our own children? Whose career could best take the "hit" of this newfound caregiver responsibility? What were the implications of our mother leaving the varied medical practices she had entered into dozens of years ago, with her family physician and specialists viewed by her as her trusted advisors?

My mother's story continues. Parts two through five provide details of the rest of her journey, including financial, physical, emotional and spiritual setbacks and opportunities for growth. I imagine your story does as well.

Activities of Daily Living For Elderly and Handicapped - Home Accessibility

Every human being that exists on planet Earth must engage in specific daily duties. From working to recreational activities, it is quite obvious that humanity has a need to be very busy. Personal obligations must be executed. Sometimes they are as simple like brushing your teeth or taking a bath and sometimes they are difficult. These actions that must be carried out on a daily basis are typically referred to as "Activities of Daily Living " or simply ADLs.

Unfortunately, there are millions of people that cannot function with the simplest of tasks because of an elderly age or some type of disablement. The performance of personal hygiene, occupational responsibilities, recreational activities, etc. is curtailed as a result of these impairments. ADLs is a reoccurring term used in healthcare circles to refer to daily self-care activities within an individual's place of residence, in outdoor environments, or both. The inability to perform ADLs is sadly all too common for millions of people worldwide. This lack of functional status of the individual necessitates some sort of assistance and without it depression can set deep within the psyche of the individual. Depression can cause devastating results. People can lose the will to live because of this debilitating emotional disposition.

ADLs are typically categorized within two compartments:

1. Basic ADLs - Includes eating, dressing, getting into or out of a bed or chair, taking a bath or shower, and using the toilet. In essence, Basic ADLs have to do with the fundamental necessities of life.

2. Instrumental ADLs- Activities related to independent living and include the ability to use the telephone, get to places beyond walking distance, go shopping, prepare meals, do housework, do laundry, take medicine, and handle money. In summation, Instrumental ADLs deal in particular with actions that are not necessarily required for the "essentials" of existence.

As one ages impairment reaches greater levels as they are illustrated in a rising disability over time for those in their 60s and for those in their 70s. Activities of daily living (ADLs) are "the things we normally do" in daily living including any daily activity we perform for self-care (such as feeding ourselves, bathing, dressing, grooming), work, homemaking, and leisure.

This impairment is not relegated strictly to geriatric individuals but as well to those who have been injured in some type of accident or individuals who were born with genetic abnormalities.

Because there are millions of people that are in dire need of some sort of assistance to carry out ADLs there must be something to help them. Mobility aids are specific devices that can ensure that the elderly and the disabled can carry out their daily activities with dignity. Mobility aids include but are not limited to the following:

Walking Aids- includes assisted canes, crutches, and walkers. These devices improve stability by providing additional points of contact as the individual endeavors to traverse horizontally. Additionally, they help to reduce lower limb loading and assist in generating movement.

Wheelchairs and Scooters -These vehicle type instruments substitute for walking by providing a wheeled device on which the user sits. Wheelchairs may be either manually propelled (by the user or by an aide) or electrically powered. Mobility scooters are electrically powered.

Stairlifts - A stairlift is a mechanical device for lifting people and wheelchairs up and down stairs. Sometimes special purpose lifts are provided elsewhere to facilitate access for the disabled.

Bath lifts - They are designed to help people get in and out of the bathtub safely. They gently lower the body into the tub and after the person enjoys a relaxing bath, they gently raise them to the top. There are so many types of bath lifts in the market, that it is a difficult choice for the buyer. However, it certainly helps knowing what is available, helping one decide what they want. Different ones cater to different needs.

As long as mankind lives, he or she must engage in some sort of activity. This is vital for survival. From the mundane to the complex, existence requires many types of actions to be carried out in a functional capacity. This is what "Activities of Daily Living" (ADLs) are defined as. It is unfortunate that multitudes of individuals that exist on planet Earth cannot execute these activities in particular. Fortunately, mankind has developed these wonderful mobility aids to assist these individuals in their time of consternation and depression. Happiness, contentment, and self-esteem can once again be restored to the elderly and the disabled.

Visit Home Accessibility For Aids to Assist in ADL's

Finding an Assisted Living Facility Alternative for Your Loved One - Home Care Solutions

The following information is available for individuals who are in the process of making a decision about home care or an alternative to assisted living facility living. If your loved one has decided he or she would prefer to remain in the comfort of their own home rather than an elderly living facility, take the time to decide the best in senior care option for your loved one; it's important to thoroughly research any professional in senior home care provider who will be visiting your home on a regular schedule.

If you've decided on home care as an alternative to assisted living facilities, the following information is important to consider before starting your search. First determine which type of services you or your loved one will need. It may be best to consult a physician or hospital discharge planner for assistance in evaluating your loved one's special needs and care requirements. After acquiring the names of several service providers, take the time to consider their offered services and reputations. Here are a variety of questions to ask senior care providers and other individuals concerning the track record and history of an elderly living facility alternative care provider:

• How long have you been in business as a provider of home care services?


• How do you select and train your employees?


• Do you provide nurses and/or therapists who evaluate patient home care needs?


• Who supervises the provision of care?


• How do you involve or include the patient and his or her family in care plan development?


• How do you bill for services?


• What procedures are in place in case of emergency?


• How is patient confidentiality handled?


• Can the home care provider supply a list of references?

Before choosing your senior living facility alternative and settling into a home care plan that works for you, remember that a little initial research can go a long way towards making the patient/senior care provider relationship beneficial to all.

An Alternative to Assisted Living Facilities: Assisted Living Care

You want your parent, friend, or loved one to enjoy their freedom and independence for as long as possible, and remain comfortable in their own household. As an alternative to elderly living facilities, home care is becoming a popular choice for seniors, as it enables them to remain in the safety and comfort of their own home, and relieves care giving duties from relatives and family members. Often times, your loved one may need help with activities or tasks that go overlooked-such as opening jars, driving, maintaining a clean household, and bathing. An alternative to assisted living facilities, home care provides support for those in need with personal care and daily activities and can provide part-time, full time, and as-needed support.

However, it's important to understand that senior living caregivers do not always provide health-related services. Home health providers offer medical care, such as trained nurses or physical therapy services for seniors. Assisted living caregivers assist with non-medical senior care.

As your parents age they may require assistance, but assisted living care enables your parent or loved one to continue living independently for as long as possible.

Consider assisted living care as an alternative to assisted living facilities. Your loved one may only need care for a few hours a day, but their quality of life can improve significantly with in-home assistance. Although this decision may be emotional and challenging, it's sometimes necessary to keep your loved ones safe, cared for, and comfortable.

How To Choose The Right Type of Assisted Living or Care Home For Your Senior Loved One

Your parent or elderly relative has reached the point where they can no longer live on their own, and now you must find them a solution. The idea of finding senior housing or care home for your loved one can seem overwhelming at first, but having a better understanding of all the available options can definitely make the process much easier and less stressful. Read on to learn about the types of assisted living and care home options for seniors.

Senior Independent Living

Independent living communities (also referred to as retirement communities) are the ideal option for healthy and active seniors who want to live independently amongst other seniors who they can join in educational, cultural and other social activities for entertainment. Many retirement communities feature extensive amenities such as hiking trails, swimming pools, golf courses, fitness clubs, monthly activities, and more.

A Senior Independent Living Community (Retirement Community) may be the right option if:

• The senior does not require medical assistance
• The senior prefers a low-maintenance home and/or lifestyle

Assisted Living

An assisted living facility is suitable for seniors who want to live independently but need help with day-to-day activities. Among assisted living communities there is a wide variation in the level of care that may be provided, however most assisted living facilities generally offer meals, housekeeping, social activities, and transportation. However, seniors in this type of housing should not have any serious medical conditions as most do not offer 24-hour supervision, and they are not required to have nurses and/or doctors on site at all times.

Assisted Living may be the right senior care home option if:

• The senior wants to maintain independence
• The senior is still active and wants to participate in social activities
• The senior needs help with activities of daily living
• The senior does not require 24-hour supervision

Nursing Homes

Nursing homes provide medical care for seniors with serious medical conditions 24 hours a day, 7 days a week from a registered nurse, licensed vocational nurse and/or certified nursing aide. Residents typically share a room, are served meals in a central dining area, and have the opportunity to be involved in social activities.

A Nursing Home may be the right option if:

• The senior has a serious medical condition that requires around-the-clock nurse assistance
• The senior experiences mobility issues

Alzheimer's Care

Alzheimer's care facilities specialize in the dedicated treatment and care of people with Alzheimer's and dementia. Residents generally live in semi-private apartments and have structured activities with staff members. Similar to an assisted living community, an Alzheimer's care facility will also provide personal services like help with eating, toileting, bathing, grooming, dressing, etc. Additionally, most Alzheimer's care facilities feature 24-hour support, a higher level of security to protect wanderers, and color-coded and/or circular layouts to prevent confusion.

Alzheimer's Care may be the right option if:

• The senior requires specialized care for Alzheimer's disease or dementia

Continuing Care Retirement Communities

Continuing care retirement communities are senior care facilities that offer flexible accommodations intended to meet the changing needs of seniors. They provide appropriate levels of senior care support for independent living, assisted living, or nursing care all in one facility so that seniors can move there and never worry about moving again.

A Continuing Care Retirement Community may be the right option if:

• The senior would like to select from a wide range of services and amenities
• The senior prefers privacy, but may require assistance later on

It's a big change for both you and your aging loved one to move to an assisted living or senior care home, but by gathering information prior to the need arising, you will have more time to fully explore all the possibilities, making the transition much easier.

Broken Bones and Elderly Adults

Breaking a bone can be a traumatic experience at any age, but the health concerns are often far greater when an elderly adult breaks a bone. The ability of an elderly adult to heal from a broken bone may not be nearly as great as that of a younger person. Often, accidents that result in broken bones are avoidable. This is especially true if a caretaker's negligence results in a broken bone or other serious injury. These situations cannot be overlooked or taken lightly because of the real impact that this type of injury can have on the health of an elderly adult.

Broken bones are a serious concern for many adults living in nursing home facilities. Often these homes do not properly facilitate preventative health practices like proper exercise and diet that could protect a resident against injury. Proper diet and exercise are crucial for muscle strength and bone strength at any age.

If a caretaker is negligent or even abusive in how they provide for the clients in their care, their inattention could result in painful injuries. Also, if a caretaker is not attentive or observant in their care of an elderly adult, accidents can occur. Even a low-level drop or fall can cause serious bone damage for a nursing home resident. If a caretaker fails to properly supervise his or her clients, he or she may not be able to stop a preventable accident.

Broken bones can be a serious health concern for elderly adults in nursing home facilities. If your loved one has been the victim of one of these accidents due to caretaker negligence, he or she may be able to secure compensation for his or her unnecessary and avoidable pain and suffering.

Assisted Living Facility Executive Director Answers 3 Important Questions for Seniors and Families

I'm here with Margie Veis, the Executive Director of Summerhill Villa, an assisted living facility in Santa Clarita, California. Hi Margie.

Margie Veis: Hi Kirk.

KH: How long have you been doing this?

MV: I have been an executive director for ten years, all of them at Summerhill Villa.

KH: This is an assisted living facility.

MV: Correct.

KH: Why is assisted living important?

MV: Assisted living is important because it can be a great alternative to living alone in your home, or living in a skilled nursing facility. It's that other alternative.

KH: What exactly is assisted living?

MV: Assisted living is a non medical alternative. We're licensed by the Department of Social Services and it's non medical, so we can have people live here that are independent or those that need assistance with personal care: bathing, dressing, grooming, meal making, laundry, medication assistance.

The biggest difference is we're not a skilled nursing facility so we don't have doctors on staff, we're not required to have nurses on staff, we don't do nursing care. We can't give injections, and we can't have IVs. We are that intermediate care for those that say: "I don't want to be at home, and I don't have medical needs. I just need some custodial care." So an assisted living can be a great choice.

KH: What do you say to people that say: "I will keep my parents at home at all costs?"

MV: I hear that a lot. Sometimes that works. My biggest question is - Is it safe? If it is safe, there are options that you can do to live at home. There are some people who are not going to leave their home. You can't force them even if there is a safety issue but you can get home care. It's costly but that's an option.

Some choose to have a family member move in so that there's somebody there, so there are ways to make it work but you've got to weigh the financial and the bottom line - Is my parent safe at home? That's the real question.

Independent Medical Examinations (IMEs) - Not So Independent

Every year there are more than 1 million injuries due to motor vehicle accidents in the United States. Many of these injuries are minor and go unreported. However, some injuries are serious enough to require extensive medical treatment, insurance and personal injury lawsuits.

There Is No Such Thing As An Independent Medical Examination

If you are injured from a motor vehicle accident, and make a claim against the driver who caused the accident, his or her insurance company has the right to have you examined by a doctor of its choice. This is variously called an "independent", "adverse" or "compulsory" medical examination. I refuse to use the word "independent" when referring to these exams, even though they are routinely referred to as IME's. I call them "Insurance Medical Exams,"or better yet, DME's or "Defense Medical Exams."The bottom line is that these doctors are hired for one purpose and one purpose only - to either deny or minimize a claim.

Whatever it's called, the doctor who performs the exam will testify about your injuries for the insurance company. Make no mistake- the insurance company pays the doctor's fee. The doctor is examining you not for the purpose of treatment, nor to help you find relief from your injuries. Rather, it is the doctor's job to obtain information that will either allow the insurance company to terminate its obligation to pay your medical bills or to cast doubt on your claim of injury should your case go to trial.

This examination, and the doctor, are anything but independent. The insurance companies carefully and deliberately pick what doctors they want to perform specific evaluations. Most of these doctors have frequently done work for that insurance company and typically work for insurance companies exclusively. These doctors solicit business from the insurance companies by offering to do such 'independent' medical evaluations for them knowing that the insurance company will not refer patients to the doctor again unless the reports are favorable to the insurance company. This means that in order to stay in business, this 'independent' doctor, performing an 'independent' medical examination must be in the business of writing reports which negate injury claims, and serve only to bolster the insurance company's denial of your medical benefits. If this 'independent' doctor fails to write reports in accordance with the insurance carrier's specifications, then that doctor will not be referred any more cases to review from the insurance company.

Actions Speak Louder Than Words

Everything you do in the doctor's office will be observed and recorded by the doctor and his staff. The doctor often incorporates simple activities, such as sitting on the examining table or taking your shirt off, as part of their mobility testing. So, while you might think the doctor never saw you move, s/he did observe you take off your jacket and pull your shirt over your head, demonstrating certain mobility techniques. All of those observations are part of the exam, although not as obvious to you as other parts of the physical exam itself. Be particularly aware of surveillance persons in the waiting room. One particular insurance company, in a letter addressed to the IME physician preceding the exam, asked the doctor to "watch" you in the waiting room and document things such as opening up doors, sitting waiting for the evaluation, walking within the facility, etc. Sometimes the IME physician may even drop something on purpose to see if you bend to pick it up. Remain observant and watchful of everything you do when entering the offices of an IME physician. Stay seated and don't walk around.

Be On Time

Keep your appointment. Many insurance companies schedule exams through agencies that supply doctors who are willing to perform these exams for insurance companies. Your failure to attend the exam may result in your being responsible for payment of the doctor's fee or the suspension of payment of your medical bills.

Be Honest

Honesty is the best policy. The best way to "connect" with the doctor is to be polite, cooperative, and above all, truthful. If you lie or fake an injury during the exam, the doctor will recognize your deceit and mention it prominently in the report. Try to appear open and forthright by providing helpful and straightforward answers. Also, attempt to make eye contact whenever possible. Although you need to pay attention to the doctor's questions so you can answer them carefully, don't appear nervous. After all, you know the answers to the questions, so try to stay relaxed.

Prepare For The IME Exam:

Get organized! One way to strengthen your case and be more relaxed during the exam is to gather your thoughts so you can present your medical history in a logical and concise, but complete manner. Here are some topics you'll cover:

* Your medical history, including prior injuries;

* How the accident occurred;

* What areas of your body were injured;

* Your primary symptoms;

* When your injuries cause you pain;

* Movements or activities that aggravate your injuries and cause pain or discomfort;

* Treatment or medication that makes your injuries feel better; and

* Activities that have been affected or limited.

Review the summary before your exam, but do not bring the summary with you.

What the Doctor Looks For:

Once you are called in for examination the IME doctor will typically conduct a patient interview to learn the history of the accident and medical condition, and then conduct a medical examination. At some point in time, the IME doctor is also likely to consult other medical records provided before your arrival in relation to the plaintiff's (your) case. During this process, the IME doctor looks for a variety of factors about you, the injury victim, including:

General Appearance- The doctor will observe you not only during the examination, but while you walk in the examination room, how you stand, whether you have any difficulty climbing onto the examination table, whether you show any signs of distress while sitting on the examination table, how you dress and undress yourself, your weight and personal hygiene, and anything else that the IME doctor believes relevant to your injury or condition.

Meeting The Doctor- The IME doctor will ask questions to formulate opinions about your injuries. Be careful that you understand each question before you answer it. For

example, if the doctor asks, "How do you feel now?" you should find out if he wants to know how you feel that minute or at this point after the accident. You may feel pretty well at that particular moment, but may have had pain associated with your injury earlier in the day, so it's important to be specific and accurate in your answers. Take time to answer all questions carefully. If a question is unclear or confusing, don't be afraid to ask the doctor to explain or rephrase the question before you answer. If you make a mistake, correct it immediately. Avoid unnecessary elaboration. Remember that the doctor is hired by the insurance company to help its case. So, while you should always answer a question politely, honestly, and completely, don't ramble on or elaborate unnecessarily.

Signs of Deception- The IME doctor will typically be on high alert for any sign of deception or exaggeration, and can be expected to report any impression that you intentionally or unintentionally exaggerate any symptoms.

Objective Manifestations of Injury- The doctor will typically review any medical imaging studies, such as x-rays, MRI reports, CT scans, and EMG nerve conduction studies, to try to find objective manifestations of injury - that is, objectively measurable damage or injury to the plaintiff's body. The doctor will also evaluate whether your subjective symptoms of pain and discomfort are consistent with the objectively verifiable manifestations of the injury.

Subjective Manifestations of Injury- The doctor will often perform tests which require you to provide subjective indications of pain, discomfort, sensitivity or insensitivity. For example, a doctor examining for a lower back condition may have the patient perform a variety of movements which stretch or turn the back, and note the point at which the patient starts to report pain and the point where movement becomes limited by pain. The doctor may test the subjective manifestations in several ways, or at more than one point during the examination, to see if any claimed pain level or point of disability remains consistent.

Other Contributing Factors- The IME doctor can be expected to inquire about any other ailments or injuries, including any which have occurred prior to or since the accident, which may have somehow contributed to the injury, or aggravated the injury or impaired recovery since the time of the accident. The doctor will also likely address any lifestyle factors discovered within this process, such as drinking, smoking, overeating, and recreational drug use, which may somehow contribute to the injury.

What you should DO at an IME:

Be honest and cooperative with the doctor.

Be pleasant. At the same time, you should not behave in such a fashion that the doctor can say you were laughing during the examination.

Be concerned. Be serious. Be polite. Give the doctor accurate, but brief, history on how your accident or injury occurred.

Give the doctor an accurate history of your job details and what you do in terms of lifting, bending, stooping, carrying, and walking.

If the doctor asks you about any previous injuries or illnesses you had before the present one, be honest and tell him the nature of any injuries you had, and whether you had surgery in connection with those previous injuries. On the other hand, do not volunteer information.

If the doctor asks if you have had any previous injury claims, you should say to him, "I've had previous injuries" (if that is true).

If you are totally disabled, explain to the doctor that if there was any way you could be back at work, you would be there.

Keep copies of any document you fill out or sign at the IME's office. Don't assume the IME will keep your questionnaire. Many don't, and that may be the only proof you have that you told the doctor about some part of your medical history or injury. So keep your own copy.

This independent medical exam Doctor is going to ask you many questions in great detail. Keep in mind to answer his or her questions as simply as possible. Yes or no answers are the best you can give. Try not to elaborate on any subject. Never guess! If you are unsure or do not know the answer to a question, simply state "I do not know". If the physician is asking questions about your doctor, or your doctor's opinion, tell the exam doctor to look in the file that was provided to him or her, all that information should be in it. It is also ok, if you are uncomfortable, to tell the exam doctor that all of your injury information is also in the file. You can keep repeating this as much as needed. Independent medical examination physicians will try to get you to sing like a canary in hopes to get you to say something different.

Anytime this physician touches you or makes you do something that hurts tell him or her loudly! If you do not make it known that what is happening is causing you pain, the doctor will write in his or her report that the injured worker did not have any pain. Make your pain known!

Be aware that the doctor is sometimes performing the same test on you in more than one fashion and in more than one way. For example, the doctor may test your legs when you are sitting up and when you are lying down. This is the same test. Therefore, if you complain of pain inconsistently, the doctor is going to make note of it. Let the truth come out and you will obtain a more favorable report from the doctor.

Wear hand/arm braces and use any rehabilitative assistant devices like canes, walkers etc. at least two days before the exam, the day of, and two days after the exam. Be watchful and mindful you are likely to be under surveillance for these days as well. Look for strangers in your neighborhood or unfamiliar cars following you during that time period. If you are on good terms with your neighbors, ask them to alert you if they are contacted by anyone out of the ordinary. Insurance companies frequently use a ruse whereby they call you on the telephone and tell you they want to deliver some sort of mail or package. Be careful of strange phone calls.

During the course of your exam, without the doctor knowing it, keep track of the time the doctor spends with you and what is being done during each time period. For example:

2:00 p.m. Arrive at the doctor's office.

2:15 p.m. Appointment time

2:30 p.m. Go to examining room

2:40 p.m. Doctor arrives in examining room.

3:00 p.m. Interview ends, told to undress, doctor leaves

3:10 p.m. Doctor returns and begins exam

3:15 p.m. Examination over

3:20 p.m. Leave clinic

What NOT TO DO at an IME:

* Do not try to out-smart the doctor. They didn't go through all those years of medical school and residency to be fooled by someone who says ouch every time they move.

Those patients get less sympathy and even less credibility for their complaints.

* Do not volunteer any information not requested.

* Do not discuss who is at fault in your case.

* Do not discuss settlement of your case.

* Do not allow the doctor to take X-rays or conduct other diagnostic tests.

* Do not take any written tests.

* Do not go to any other doctors or facilities without your attorney's approval.

* Do not lie. That can undermine your whole case.

* Do not drive yourself to the visit. Try to have your spouse, friend or neighbor drive you.

* Do not talk about your accident, injuries, insurance company or case in elevators, common areas or doctor's waiting room.

* Do not wear dangling jewelry or earrings.

* Do not come to the doctor with hands that look they are dirty from working on a car or changing the oil.

* Do not come to the doctor with elaborately painted fingernails (especially if you are claiming carpal tunnel or any other type of chronic pain syndrome).

* Do not jump on and off of the examination table at the doctor's office.

* Do not come in tight jeans or cowboy boots. Men, don't come unshaven. Ladies, don't come with make-up on or wearing high heels.

* Do not leave the doctor's office in a running trot or quick walk and jump into your car, because the doctor is probably watching you from his or her window.

* Do not use medical jargon or fancy terminology when discussing your case or describing your symptoms. If you are complaining of a neck injury, don't twist your head back and forth when the doctor is moving about the room in an effort to follow his movements.

* Do not discuss money or any plans of retirement with the doctor.

* Do not discuss your marital situation. Your marital situation is not relevant to the present examination.

* Do not exaggerate your problems.

* Do not moan, groan and wince or grimace in pain every time the doctor touches you.

No matter how lightly or heavily the doctor may touch you, be natural.

* Do not ask the doctor for medication or pain pills.

* Do not talk to the doctor about the insurance carrier, attorneys or the adjusters.

If you have a bad back, don't bend down and untie your shoes. Wear loafers and kick them off/slide them on.

* Do not discuss with the doctor the amount of your claim or the amount of wages you used to make. Politely decline to do so by saying that the insurance company has that information.

* Do not discuss with the doctor whether you have any hearings coming up on your case.

* Do not discuss what you deserve for a settlement or your plans for spending the money you may get.

* Do Not Expect A Fair Report. While a few IME doctors are highly professional, and seek to actually provide an objective evaluation, the vast majority of them know that they are being paid by the insurance company, which pay their bills and expect that the position of the defense will be improved as a consequence of the IME report. If the IME doctor prepares a report you believe to be unfair, let your lawyer worry about it.

You need to be principally concerned with what your treatinghealth care providers tell you about your condition.

After the Exam Once the exam is over and you have left the doctor's office, prepare a written summary containing the following information in as much detail as possible:

* What the doctor said to you;

* What you answered;

* What, if anything, was dictated into a tape recorder by the doctor during the exam;

* What tests or procedures the doctor performed;

* How much time the doctor spent with you;

* What was done during each time period; and

* Any inappropriate or unusual questions or comments made by the doctor.

The doctor will prepare a report for the insurance company describing his examination of you, along with his findings and opinions. It is extremely rare for the doctor to determine that you were injured in the accident or recommend any further treatment

Try to remember what goes on during the exam in as much detail as possible, but don't take notes in front of the doctor or bring a tape recorder into the exam - that could make it appear that you are more interested in getting money for your injuries than in improving your health. It is extremely important to note the exact amount of time the doctor spends actually examining you because the doctor will prepare a detailed report regarding your injuries despite having only spent a short time actually examining you.

As soon as you are home, sit down and write down every detail you can recall of your exam(i.e. time spent with a nurse or doctor, questions asked by the doctor and your answers, tests performed by the doctor, etc.). We understand that you cannot remember everything, but do the best you can. Nonetheless, your attorney is most effective when he/she has as much information as possible regarding your case. You must provide that information to the attorney. He/she is your advocate, not your private investigator. You are their eyes and ears, so give them as much information as possible- after all, the insurance carrier is doing the same thing to opposing counsel.

What Is A Personal Injury Lawyer?

When a person has been injured, either physically or emotionally, they can hire the services of a personal injury lawyer to represent their case in a court of law. The injury could be due to negligence or wrong doing by any person, company, a governmental agency or some other entity.

A personal injury lawyer often deals predominantly with what is known as Tort Law. This mostly includes civil wrongs to a person's rights, reputation or property resulting in either non-economic or economic damage.

Personal injury lawyers deal mostly with cases relating to Tort Law which includes but is not restricted to work-related injuries, slip and fall accidents, automobile accidents, consumer cases related to defective products, medical mistakes, and much more. Although they focus more on these types of cases, they are licensed and trained to handle virtually any legal case relating to all fields of law.

A personal injury lawyer carries out a number of responsibilities towards their clients. These include ethical as well as professional codes of conduct and rules laid down by the bar association of the state in which the lawyer was licensed. The lawyer can file a legal complaint on behalf of their client, argue their case in a court of law, offer legal advice and draft legal documents for their client.

It is the lawyer's duty to research the case thoroughly by interviewing prospective clients. They can then evaluate the case and study it carefully to identify the main grievance of their client. This would help them to build a strong case to defend their client and get the compensation that they really deserve. Quite often, cases handled by personal injury lawyers are amicably settled instead of going to trial. This provides timely relief to the victim in terms of adequate compensation. However, when a settlement is not reached, the personal injury lawyer would proceed to take their client's case to trial.

A personal injury lawyer, like all other attorneys, is expected to work towards the best interests of their clients. They are required to provide complete confidentiality and loyalty while handling a client's case. They need to follow a strict set of standards and conform to legal ethics when dealing with clients.

Although the guidelines for lawyers differ slightly from state to state, the basic codes of conduct require every lawyer to be knowledgeable in exercising competence and evaluating legal matters efficiently such that justice is served.

Top Ten Tips for Creating a Spectacular Activity Calendar

Creating a monthly calendar of activities can be a daunting responsibility of the Recreation Director. Coming up with original ideas, scheduling the right date, time, and location, and somehow, trying to fit it all into those little boxes so that it is legible and attractive, is not an easy task! It can be very difficult to create a well-balanced program of activities that meets the needs and interests of the population you serve. The following are some tips to help you develop your monthly calendars.

1.Conduct a Population Analysis and a Calendar Analysis on a regular basis. Compare the findings to ensure that the calendar is well-balanced and appropriate for the current population. These important forms can be purchased as part of the Recreation Department Review Manual developed Re-Creative Resources Inc.

2.You should try not to have the same activity domain back to back. For example: 10:00am Exercise 10:30am Trivia rather than 10:00am Exercise 10:30am Bowling

3.Keep the titles of the activities simple and easy to understand. Quite often, we create these fabulous names that do not clearly define the activity.

4.Don't wait until the last few days of the month to plan the next month's calendar. You should be planning your calendar months in advance-at least the special events, entertainers and such. Many Recreation Directors even schedule entertainment in January for the entire year!

5.Every facility or agency is different and the ways in which Recreation Directors create and display calendars is unique. There is more than one way to skin a cat and calendar development is really up to the creator. The primary concern is that the calendar reflects the needs and interests of the population. Style, format, color, font, etc. vary. Just be sure that the calendar can be read, understood and that it is not too intricate or over-stimulating.

6.Proofread the calendar for typing, grammar and spelling errors as well as times, locations, etc. The calendars must be presented in a professional manner.

7.Think THEME. I believe that themes are a great way to add fun and pizzazz to the Activity Calendar. Themes are very easy to incorporate and keep the activity program interesting and educational. For theme-related activities think about the following:

•Physical activity such as exercise and/or physical game
•Cognitive activity such as discussion, word game and/or trivia
•Educational activity such as discussion, educational videos, guest speaker
•Sensory-incorporating all 6 senses
•Creative activities such as music, writing, arts and crafts
•Food-related activities such as cooking, socials, etc.

8.Calendars can be created using many different programs or software. Whether you use Microsoft Word, Publisher, or special calendar creator programs, is up to you.

9.Create a calendar template to use as a guide. The first column is the general template and the 2nd column is the specific calendar of activities. Use a list of activities to guide you. Download your free list of activities.

10.Involve others in the calendars planning process. This is not a job solely for the Activity Director. Talk to the residents, activity staff or other people who may have invaluable input into creating a well-balanced, fantastic, activity calendar that is easy to understand and read and reflects the true interests and needs of the residents in the facility.

HAPPY PLANNING!

Evidence of Nursing Home Abuse

Every day families have to put loved ones in the care of nursing homes or assisted living facilities. And while no one would willingly place their loved ones in an environment that could potentially cause them harm, the sad reality is nursing home abuse is a common occurrence. People place their parents and grandparents in these facilities with the intention to provide them with quality care and an environment free from harm, but many times the exact opposite happens.

Trusting your loved ones with complete strangers is a very difficult thing to do and with so many facility choices out there, it is virtually impossible to tell in just a few visits if it is a safe place for your loved one. There are thousands of reports of nursing home abuse every year, from physical abuse to emotional abuse and trauma.

Elder Abuse Warning Signs

If your loved one in a nursing home does not tell you or someone else of the abuse he or she is enduring out of fear of repercussions, these cases may go unnoticed until it is too late. However, there are some warning signs you can look for that should raise alarm. These include:

• Unexplainable physical injuries


• Staff that refuse to allow you in certain parts of the building


• Staff members not letting you speak with your loved ones alone


• Disoriented actions due to overmedication


• Signs of withdrawal because of recent trauma

Suspecting or finding out your loved one is being abused at his or her care facility is extremely difficult, and you may not know where to turn. It can be difficult to make a case without proof, so you may need the help of a legal professional.

Eldercare - Caregiving, Nursing Home, Medicaid, Living Wills Information and More

Elderly care is an event that most children do not wish to think about. No one wants to think about his or her parent growing old. We look to our parents for guidance and support, but there comes a time when the parenting roles reverse.

It is important to discuss future events with your loved ones and develop a long-term plan for their care for when they become unable to care for themselves. Developing an Eldercare checklist is a proactive way to ensure your loved ones whether parents or grandparents receive the level of care they need and services they want, or, in the case of artificial nutrition, they may not want.

There are several key points and strategies you will want to include on your Eldercare checklist:

1. What level of eldercare is needed, and where will this care be given?

2. How will you pay for the eldercare? The medical costs of eldercare.

3. What will be done with your parents' or grandparents' assets while they are receiving eldercare?

4. Are all legal documents including the Will and Living Will current? Have your parents' or grandparents' Wills and Living Wills been reviewed recently by an Attorney? What is an Advanced Financial Directive? What is an Advanced Medical Directive in eldercare estate planning?

5. Have your parents or grandparents designated a Durable Power of Attorney?

Making sure you have answers to these questions for your parents or grandparents eldercare early on will avoid confusion and distress later. Don't wait until there is a tragedy to make plans that will affect how your loved one spends the rest of their life. For the purposes of this article we will assume "loved one" to mean a parent or grandparent.

Where will eldercare be given, and by whom?

1. CAREGIVING AND ELDERCARE

INFORMAL CAREGIVER

There are two types of caregivers: informal and formal. An informal caregiver might be a spouse or child, and these caregivers do not receive direct payment for their services. Usually payment is made through services exchanged such as food or housing at no charge while caring for your parent.

FORMAL CAREGIVER

A formal caregiver is usually employed by an agency to provide quality care in the comfort of your home. If the formal caregiver is not associated with an agency, it is important to conduct a thorough check of references to ensure you are hiring a quality professional.

It is important to inform all formal caregivers of the responsibilities associated with your parent's needs. If your parent needs assistance in and out of a wheelchair, a hired caregiver should be able to perform this task without harm to your parent or to him/herself. To avoid injury to all persons involved, informal and formal caregivers should receive training on proper techniques for lifting and moving, proper use of bedpans, and how to maintain good hygiene for a parent confined to bed.

LOCATION OF ELDERCARE FOR YOUR PARENTS

There are many options for the location of care provided. Most people would agree that living our their remaining years in the comfort of home is more appealing than living in a state facility. If your parent wishes to receive care in their home you can make home modifications, such as a wheelchair ramp or seat in the shower, to accommodate their changing needs. You can also hire a formal caregiver to come and assist your parent with daily activities such as bathing, eating, taking medications, or regular exercise.

CONSIDERATIONS OF ASSISTED LIVING HOUSES OR NURSING HOMES

If it is not possible for your parent to remain at home, you can choose to place them in assisted living houses or a nursing home. Before placing your loved one in a facility, you should thoroughly check both the location and the staff. Make yourself familiar with required paperwork ahead of time to prevent delays when it comes time to move in, and, if possible, make several unannounced visits to oversee daily activities.

You should check if the facility is regulated by the state, and request to see any licenses they have for providing eldercare. Find out how the staff is trained and if they are required to have certification to work there. You should consider the cost of the facility and the living accommodations your parent will be provided.

Additional considerations when choosing a facility might be types of activities offered to residents and the quality and type of food provided. While no place will be perfect, you should choose a facility that makes your parent feel as comfortable as possible away from home.

2. MEDICAL COSTS OF ELDERCARE AND MEDICAID

Not many insurance companies are willing to pay for long-term care. It is important to check the details of your parent's policy and read the fine print for restrictions. For example, Medicare will not pay for long-term care but it will pay a very short-term benefit. However, Medicaid will pay for long-term care but only if your parent receives care in a Medicaid facility.

If you plan far enough ahead, you can begin setting aside money so you can afford to provide long-term care to your parent at home. You should consult a financial advisor or estate planner to go over your parent's bank statements and assets to determine how long their current funds will be able to provide medical care, and based on this assessment you can establish a savings plan to make up the difference needed for long-term eldercare. When figuring in additional savings you need, keep in mind that you will also need to continue paying any current bills your parent might have.

3. WHAT TO DO WITH YOUR PARENTS' ASSETS DURING ELDERCARE

Before you rush off and put your parent's house on the market, make sure you have discussed where they want to receive their long-term care. It would be quite devastating for your parent to come home from a hospital stay to discover you had sold the house and moved their belongings into a nursing home.

You should also ask your estate planner or financial advisor which of your parent's accounts you should withdraw money from to help offset costs. Some accounts, such as annuities, carry penalties for early withdrawal and may require you to pay taxes on income earned through these accounts. Also, once you begin withdrawing money from an annuity you cannot stop payments.

LEGAL ISSUES OF ELDERCARE

Hopefully, your parent has written a will and made you aware of its location. A Will should be reassessed by an Attorney every few years to make sure all the people listed as beneficiaries are still alive, and that your parent still wants them to receive a portion of their estate.

Moreover, your parents should have an irrevocable trust as part of their estate planning eldercare needs which will avoid the high expenses of probate, reduce estate taxes and possibly eliminate some earned income and your parents will gain the benefits of asset protection. Speak with a qualified and good estate planner such as Estate Street Partners who can guide you through this complex process.

4. IMPORTANCE OF LIVING WILL, ADVANCED FINANCIAL DIRECTIVE AND MEDICAL DIRECTIVE IN ELDERCARE ESTATE PLANNING

You should also council your parents on drafting a Living Will in the event they are unable to speak for themselves. Learn more about Living Wills and Advanced Financial Directives and Advanced Medical Directives by going to our website. The Advanced Financial Directives and Advanced Medical Directives are extremely important in eldercare estate planning when your parents cannot speak for themselves and will protect their financial and medical wishes.

5. DURABLE POWER OF ATTORNEY (DPOA) AND ELDERCARE ESTATE PLANNING

You should know ahead of time where these documents are before an emergency arises to ensure that your parent's wishes are followed. Having a DPOA allows someone your parents trust to act on their behalf and make legal and financial decisions for them, including the transfer of valuable assets, if they become incapacitated.

Are Your Nursing Assistants in the Know About Infection Control?

Norovirus. H1N1 flu. MRSA. VRE. Across the U.S., infections, outbreaks and epidemics continue to make the headlines. How are the nosocomial infection rates at your workplace? Could your CNAs use a refresher on some infection control basics? Here is some updated infection control information for you to share with your nursing assistants at your next CNA inservice meeting.

Staying On Top of Infection Control

Do you ever feel like infection control procedures waste too much time during your work day? Shouldn't it be enough to wash your hands a few times during the day? After all, how dirty can they get, especially when you're wearing gloves? Well, consider these facts:

• Eleven health care workers in one hospital came down with hepatitis A because they didn't wash their hands after caring for a patient with hepatitis.


• An epidemic of yeast infection spread through an intensive care unit for newborns because several staff members failed to wash their hands after playing with their pet dogs.


• At least half of all cases of food poisoning are caused by people not washing their hands before preparing food.


• Treating people for infections that they pick up while in the hospital can cost up to $30 thousand-per person! Nearly all of these infections could be prevented if health care workers used proper infection control techniques.


• Studies show that over 1.7 million nursing home residents catch an infection every year from germs spread by health care workers' hands.


• Every year, thousands of health care workers catch a cold, the flu or other infection from their clients because they fail to follow proper infection control procedures.

Have You Heard the Latest?

On Handwashing

Studies continue to show that health care workers wash their hands less than half as often as they should. Why? The reasons given include:

• "I don't have time to keep washing my hands all the time."


• "My skin gets dry if I wash my hands too often."


• "There's never a sink around when I need to wash my hands."


• "I don't need to wash my hands. I wear gloves."

Research shows that bacteria thrive on dry, chapped skin. In addition, washing damaged skin is less effective at removing bacteria. (So, if the soap at work causes your hands to become chapped and dry, ask your supervisor about using an alternate soap.)

On Influenza

Flumist is now widely available for those who are leery of injections. It is a pain-free nasal spray available to anyone (2-49 years of age) who does not have chronic disease or a weakened immune system and is not pregnant.

Flumist is a live virus vaccine as opposed to the shot which is an inactivated virus. Therefore there is a small chance of getting flu-like symptoms after taking it. The symptoms are usually mild and last only a day or two.

There are antiviral medications that help treat the flu. They must be given within 48 hours of getting sick with the flu and should not be taken for longer than five days.

On Tuberculosis

Health departments across the country have worked hard to control the spread of TB. Their hard work has paid off! Tuberculosis has been on the decline in the U.S. for the last ten years. However, this is no time to relax! More than 14,000 new cases of TB were reported in 2005 in the United States alone.

Ten years ago, about 25% of our tuberculosis cases involved people who had moved to the United States from other countries. Today, that number is 58%! If you work with clients who have recently immigrated to the United States, be sure to watch for signs of tuberculosis.

On HIV/AIDS

About one million Americans are living with AIDS and about one quarter of these people don't even know they are HIV+.

AIDS cases among people over age 50 are on the rise. Many of the cases come from heterosexual sex. (For example, many older people fail to use condoms because they are no longer worried about pregnancy.)

HIV is also on the rise among young people in America. Studies show that many young people are not practicing safe sex because they believe that HIV will never happen to them.

The treatment for HIV continues to change as new drugs are developed-and doctors learn how to use these new drugs. This is important since at least half of all Americans being treated for HIV are now resistant to the standard AIDS drugs. (For example, the AIDS drug AZT is no longer effective for 70% of AIDS patients.)

On Drug Resistant Bacteria

Doctors used to prescribe antibiotics freely, hoping that they might make a patient feel better. Now, doctors are becoming more cautious about prescribing antibiotics. For example, if they feel that a patient's illness is caused by a virus, they often prefer to "watch and wait".

MRSA and VRE continue to be the most common drug resistant bacteria in nursing homes and other long term care facilities.

In 1974, MRSA infections accounted for only 2% of all staph infections. In 1995, it jumped to 22%. Most recently, that number hit 63%!

Over the last 5 years, C. diff has become stronger, easier to transmit, and harder to treat. This new, stronger strain has spread to nearly every state in the United States and Canada and is becoming a worldwide problem.

In the past, C. diff only affected the elderly and chronically ill patients who had been on antibiotics. However, recent reports show healthcare workers have become infected even though they were healthy and had not received antibiotics before the onset of illness.

15% to 20% of healthcare workers are C. diff carriers. This means that they have no symptoms but can spread the bacteria to others.

What's the bottom line? Proper Infection control practices are never a waste of your time!

Your Loved One is Dying - When the End of Life May be Your Call - You're Not Alone

My mother died last year at the age of 95, after a decades long descent into terminal dementia. I was her only nearby relative, although I was constantly in touch with my brother who was overseas with the State Department. He basically turned over the decision-making to me, the person on the spot.

Mom's last 2 weeks of life smacked me in the face with something I only read about in the papers, the great debate over the End of Life and health care rationing. Mom's health began to falter sharply, and she shuttled back and forth from the nursing home to the affiliated hospital. As the named person on her health Care Proxy, I was the one who had to make the calls.

A tough young social worker from the nursing home pulled me aside and said: "Schmuck, it's time you faced something - your Mom is dying. Are you planning to prevent that?" Only a friend can talk to a friend like that, and we had indeed become friends over a couple of days. She convinced me that a Final Care Committee (I think that was the name of it) be convened. The committee consisted of the hospital administrator, the head of nursing, Mom's attending physician, and my tough little social worker friend. There was even a person on the committee called an ombudsman, the guy in charge of serving as the advocate for my mother, the patient.

The discussion at the meeting had one goal: to assist me to decide the course of treatment for Mom; palliative care or regular care. Never once in the meeting did I feel pressure to make a decision one way or the other, but the right choice became clear: Mom should be made to feel as comfortable as possible, be given palliative care, and let nature take its course.

My comfort in having come to a decision didn't last long. When I visited her after the meeting the first thing I noticed was that she was off telemetry, that scary video monitor that shows pulse, respiration, etc. I raced to the nursing station to point out this glaring error. Trained to deal with strung out next-of-kin, the nurse explained to me, with the kindest diplomacy I ever encountered, that telemetry was irrelevant, because I had decided to "let Mom die."

Let Mom die. The very phrase filled me with coldness, because I suddenly had a power I never wanted, a power over life and death of my own mother. I could have been a completely self-serving idiot - and believe me, the thought occurred to me - and opted for regular care, meaning that heroic efforts would have been made to keep Mom alive. But the good folks at the hospital, as well as my wife and brother, helped me to make what I now know was the right decision: let Mom die.

My wife was faced with a similar set of circumstances with the lingering death of her 89 year-old mother 3 years ago. Lynda was an only child, so hers was a lonely perch indeed.

My decision had nothing to do with economics. Mom was on Medicare and Medicaid, so any financial thoughts would have been academic. Believe me, when your Mom is dying, you do not think about the economic impact of end-of-life care on the economy as a whole. But we should think about it, especially as baby boomers like myself continue to gray and fall prey to a rainbow of ailments. A statistic that never seems to change is that 30% of all Medicare dollars is spent in the last year of life. Medical technology now enables us to add months of life for a person stricken with any number of maladies, including cancer. Months.

The idea of government imposed health rationing, death panels in the heated rhetoric of the debate, disturbs me. But this article is not intended to engage the great debate, not here anyway. My purpose is to talk to you, who is probably reading this because the issues I'm talking about confront you now. No, I'm not looking to educate you - a term we hear often - I'm looking to reach out my hand to you, and share with you my trying experience, and let you know that you're not alone. Your loved one is just that; so make your decision with love, and you can't go wrong. Sometimes the best thing to do is to let Mom die.

Epidemic of Nursing Home Abuse Endangers Seniors

This week, the New York Times reported that 90 percent of all nursing homes have been cited for violating federal health and safety standards. Even worse, 94 percent of all privately-owned facilities were cited for such violations. It is clear that nursing home abuse and neglect has become an epidemic, and anyone with a loved one in a nursing home needs to be aware of this issue.

Nursing home residents' rights are guaranteed by the federal 1987 Nursing Home Reform Law. The law requires nursing homes to "promote and protect the rights of each resident". Yet, as the New York Times recently made clear, nursing homes are not doing enough to protect their residents.

The National Center on Elder Abuse estimates at least one in 20 nursing home patients has been the victim of negligence and or abuse, though it concedes that the number is probably higher. According to the National Center's study, 57% of nurses' aides in long-term care facilities admitted to having witnessed, and even participating in, acts of negligence and abuse. Data from the U.S. Centers for Disease Control and Prevention show that nursing home neglect played role in the deaths of nearly 14,000 nursing home patients between 1999 and 2002.

The New York Times report detailed a study conducted by the inspector general of the Department of Health and Human Services. According to the inspector general, more than 1.5 million people live in the nation's 15,000 nursing homes. To participate in Medicare and Medicaid, facilities must meet federal health and safety standards. These programs cover more than two-thirds of nursing home residents, and cost taxpayers more than $75 billion per year.

According to the inspector general's report, in the past year, poor nursing home conditions were the subject of 37,150 complaints. Of those, 39 percent were later substantiated by inspectors, and at least 20 percent involved the abuse and neglect of patients. What's more, 17 percent of nursing homes had deficiencies that caused "actual harm or immediate jeopardy" to patients, the report said.

About two-thirds of the nation's nursing homes are owned and operated by for-profit companies. Non- profit organizations own 27 percent, while government entities own and operate 6 percent. Of the facilities owned by non-profits, 88 percent were cited for violations, while 91 percent of government-run institutions received citations. According to the report for-profit nursing homes averaged 7.6 deficiencies per facility, while not-for-profit and government homes averaged 5.7 and 6.3, respectively.

To protect a loved one living in a nursing home, it is important to understand what constitutes nursing home abuse and how to spot it. The most common type of nursing home abuse is neglect. Understaffing at nursing homes is the main culprit behind this kind of abuse. Evidence of nursing home neglect includes bedsores and stiff joints, as well as signs of depression. A patient who appears over medicated or is needlessly sedated could be a victim of nursing home neglect. The smell of urine or feces and poor personal hygiene are hallmarks of this problem. Extreme unexplained weight loss in an otherwise healthy resident can also be a sign of abuse. And if visitors are made to wait while the staff readies a patient to see them, - or does not allow the visit at all - neglect could be the reason.

Nursing home neglect is as much a crime as any other form of abuse. Nursing home neglect robs patients of their dignity, and it can be deadly. Neglected nursing home patients have been known to wander away from facilities, and sadly some of these patients have died of exposure. Other unattended patients have been allowed to die as a result of undetected internal bleeding or other ailments that could have been corrected with proper medical care.

Physical abuse is an unfortunate fact of life in many nursing homes. Nursing home staff are often guilty of this crime, but abuse among residents is not unheard of. About 2500 cases of physical abuse by nursing home staff are being reported each year. While physical abuse encompasses crimes like battery, it also includes placing a patient in excessive restraints or physically confining residents for no valid reason. Over-medicating patients simply to keep them quiet, or withholding medical care are also forms of physical abuse.

And sadly, sexual abuse also occurs in nursing homes. Again, both staff and other residents can be guilty of this type of abuse. According to a 1996 Medicaid Fraud Report, 10% of all physical abuse cases in nursing homes are of a sexual nature. Sexual elder abuse is defined as non-consensual sexual contact of any kind with a nursing home resident. Sexual contact with any person incapable of giving consent is also considered sexual elder abuse.

Often, nursing home sexual abuse goes undetected. Sadly, the physical and cognitive impairments common among nursing home patients make it impossible for them to fight off sexual assailants or report sexual abuse. Some physical signs of nursing home sexual abuse bruising around breasts, upper abdomen, or inner thigh; is often evidence of inappropriate touching or worse. Signs that a nursing home resident has been the victim of a sexual assault include bleeding from the vagina or anus; the presence of a sexually transmitted disease; troubles walking or discomfort when sitting; and irritation or itching in genitals.

How To Find the Right Caretaker for Your Elderly Parents

As the years pass there comes the sad truth that our parents are not going to stay young forever and it may get to the point that your elderly parents are going to need some kind of help to get through their daily life. This can be extremely hard on both you and your parents and it can also be very draining on your emotions especially if you feel guilty because you can't take care of them yourselves. When you do realize they need help you should know how you can find them a good caretaker so that you can feel secure in knowing they are being well taken care of.

When it comes time to make this decision you should get together with the entire family and discuss whether you parents can stay at home with some help or if they are going to need something with more help like a nursing facility or an assisted living facility.

You should also find out by contacting Social Security to see if there are any benefits offered that will help out with the money that will be needed for this kind of care. After you do that you should find out if there are other members of the family that might be willing to help you pay for whatever Medicare won't pay for so that you can come up with a some sort of budget for your parents care.

Go and visit the ElderCareLink.com website and register there so you can have access to the different resources that deal with taking care of elders. They also have a search where you can find caregivers in your area, find senior housing and elder care management that provide great articles about the elderly.

Another place you can get help to find caregivers in your area is Care.com and you can search for caregivers by entering in your zip code. They too have articles that center on seniors that can help you with different issues your parents might be facing.

Another helpful website would be New Lifestyles Online and they will try to help you make the best decision when it comes to your senior parents care. They will go into detail about the different types of care such as assisted living, independent retirement communities, nursing homes, home care, etc. They also will give you plenty of information on other services and products available for seniors. They also give you information on licensing for most states that has to do with this kind of care.

If you are leaning towards having home care for your parents don't forget to visit the website Visiting Angels. This is a national network that is non-medical but is a private duty home care agency that gives senior care, personal care, companion service as well as respite care. They do all of this in order to try to help seniors stay in their homes for as long as they can.

Administrative Jobs - Tips to Deal With Your Boss

Different jobs offer different duties and chance to interact with the boss, like an HR executive will have greater chance to talk with boss than a software programmer. People involved in administrative jobs have to thus learn to deal with boss personalities so that they are able to give them a satisfactory reply each time and save themselves from arguments.

This is not easy, of course it is not, after all boss is a boss who has the power to ask hundred questions for simple things completely confuse employees and still seek proper replies. I have in fact seen numerous employees into administrative jobs shiver when they have to talk to the boss regarding some critical issue and there are hundreds of other people who leave their jobs as they are unable to cope with their boss.

Boss personalities can be classified into various unique categories, however three of the most important are, authoritative, egocentric and everyman boss. When you are into administrative jobs you need to understand your boss's personality and deal with them accordingly.

An authoritative boss is very specific about the manner in which the task is done and loves to know the details. To work with them collaboratively and want that they should appreciate you for your work then you need to make sure that you work efficiently to complete all assigned tasks with details so that you have accurate answers to all the questions asked.

An egocentric boss is self-motivated and less cooperative with the administrative staff. He/she is less interested in feedback or suggestion on any issue and wants that things or processes should be done or followed as per their instructions. Calm is the most important thing needed to deal with such bosses because it is only when you are calm that you will able to deal with their nature.

Everyman boss is a little easy going and gives staff space to talk freely and suggest different things. However these bosses are often seen to be weak in leading the team. Administrative staff should understand their weakness and use it to their advantage by using leadership skills whenever you feel that the decision taken is incorrect.

Nursing Homes of the Past, Present and Future

The concept of Nursing Homes was not yet known to man in his early days on planet Earth. Based on Biblical accounts, people did not have need for such institutions since people then reached ages of around 800 to 900 years. I wonder if they were using the same calendar systems we have now. That could render their reckoning of time measure, and therefore of the value of their age on earth or longevity indicators, erroneous. Nevertheless, we use their data as a benchmark since there is no popular document yet that refutes that.

Most of these early Earth inhabitants died peacefully in old age without today's symptoms of weakness and helplessness. Others died in battles and wars and therefore no care was needed except burial.

From factual historical and fictional readings, later civilisations had very unfortunate fates for the old and dying. They were left alone in the streets or wilderness, some devoured by wild carnivorous animals. It was such for "primitive" man who seemed not to feel guilt in treating their old and dying like a lowly animal. Only the ageing royals were cared for even into their deathbeds in secure castles and palaces up to the last breath.

Nobody can pinpoint a date nursing homes started to come into being. Written accounts in the West indicates the presence of "poor farms" or "almshouses", established and maintained by the state for its impoverished, most aged and incapacitated citizens, alongside the homeless, the inebriated and the insane. These facilities were characterised by dilapidation and inadequate care services. This was a most lowly and shameful way to spend one's end days and states seemed to encourage that stigma of disgrace and humiliation to keep its ageing citizens from relying on it. It was somehow bizarrely been made a "motivating factor" for the productive age group to work hard and prepare for old age.

The elite of those days dreaded that stigma and some women's and religious groups, in order to avoid such fate for their once-respectable members, established the first models of our present-day nursing homes. But these facilities carried with it an exclusivity reserved for "their own" with better care and facilities, in stark contrast to the almshouses.

The New Deal of 1935 helped promote the idea that US elderly citizens should be federal beneficiaries of assistance on the basis of need. The Social Security Act signed by US President Franklin D. Roosevelt provided old age assistance (OAA) grants to retired workers. Non-payment of these benefits to those living in almshouses paved the way to the establishment of private old-age homes, the precursors of the present-day nursing homes.

However melancholy old age seems to be, it is a fact of life and must be confronted like any other worldly matter. It is not a matter to be needlessly worried about. There are various ways we can prepare for that eventuality in this age of opportunities and sophisticated commerce.

Free CNA Training Classes

In Oklahoma, nursing abuse fines are funding free CNA training classes, expected to begin in 2010. The free program was organized when the Oklahoma State Department of Health (OSDH), in cooperation with Tulsa Community College and Oklahoma Department of Career and Technology Education established a fund of $371,000 that will cover the cost of training approximately 900-1,000 CNA students in 2010.

The money to provide free training classes comes from penalties collected from nursing homes that were fined by OSDH for delivering substandard care, i.e. nursing abuse. It is possible that Certified Nursing Assistants from these very same nursing homes will be turn out to be beneficiaries of the scholarship, which has aims of improving overall patient care in long-term care facilities. The core of the free CNA program is to upgrade the skills and knowledge of nursing assistants to a level CNA 2. Tulsa Community College also offers more advanced training for those nursing assistants who wish to advance to the CNA 3 level, but this level is not currently funded.

To fund the program, the OSDH is using civil monetary penalties collected by the agency from nursing homes that were fined for delivering substandard care. CNAs who work with long-term care patients in nursing homes and skilled nursing facilities are eligible to apply for the OSDH-funded training. The aim of the program is to serve as a career ladder for working CNAs - appropriately named the Certified Nursing Assistant (CNA) Career Ladder Program. The new course blends online learning with traditional classroom and lab work geared towards passing a CNA skills test. All students must have already completed online coursework and have reliable computer access in order to participate in this program.

All applicants to the program must be already accepted to Tulsa Community College. However, admission to the college does not guarantee admission into the free CNA training program, nor a guarantee of funding. Early application is encouraged, as funding and space is limited. In order to be eligible for funding consideration, all applicants must take and pass the College Placement Test (Reading and Sentence Skills only). The minimum score that an applicant must achieve is 80. Additionally, all applicants are expected to have completed a minimum of 12 college credit hours, with a minimum GPA of 3.0. Additionally, all applicants must have worked in a health care facility for a minimum of six months. All applications must include a letter of recommendation from their administrator.

The free CNA training classes consist of 30 hours, comprising of 11 modules, each three hours long. The five full days of training will focus on safety, teamwork, aging and illness, communication, nutrition, quality of life, dementia care, the importance of family, culture change and restorative care, spirituality, and dying. Students will then need to take and pass the state exam to receive their CNA certification.

Within the state of Oklahoma, there are approximately 66,000 individuals on the CNA Registry certified or entitled to renew their licenses as long-term care aides. Most of the 66,000 are considered potentially eligible to apply to this free CNA program. Therefore, the competition is potentially very high, since only 900-1,000 students will be funded in 2010. If accepted, students will be notified by mail, which will also include information and instructions about immunization requirements, a criminal background check, and a drug screening test. To be sure, applicants will be scrutinized for prior citations or suspicion of nursing abuse.

In addition to Oklahoma's program, there are other free CNA training classes, some of which are available online -- also funded by the nursing abuse settlements. Be certain to check whether the training programs are specifically designed as preparation to take the CNA exam, or for general informational purposes.

Caring For Aging Parents - Prevent Nursing Home Nightmares

The headlines are scary. From cigarette burns to sexual assault, elder abuse is one of the more heinous crimes in our world. If you have the responsibility of caring for aging parents, the worry of how your loved one is being looked after can keep you up at night.

You can protect your loved one, though. Caring for aging parents starts by recognizing the signs of abuse as well as risk factors that potentially create an abusive environment.

Sexual Abuse
An elderly woman's pelvic bone was broken during a sexual assault by another patient in an Illinois nursing home in 2006. In another case, an employee at a care facility was convicted of raping and assaulting a 90-year-old woman.

If you're caring for an aging parent, you know that few things are more stomach-churning than the thought of sexual abuse against the elderly in a nursing home. Sexual abuse includes rape, indecent touching, and sexual assault, as well as coerced sex or forced nudity.

If the person you've hired to help in the caring for aging parents is sexually abusing your family member, here are some of the signs: inappropriate affection by a home employee, bruises on the inner thighs, breasts, buttocks, or genitals, torn or stained clothing, or fear of a particular staff member.

Emotional abuse
When those caring for an aging parent intentionally inflict mental anguish or distress toward your loved one, the result is emotional abuse. This form of abuse includes humiliation, threats of violence or sex abuse, insults, and forced isolation.

Caring for aging parent strategies should include being aware of the signs that a caregiver is emotionally abusing your loved one. These warning signals include out-of-character anger, silence or sullenness, unwillingness to talk openly, confusion or disorientation not due to a medical condition, and fear.

Physical abuse
The allegations are shocking. The nursing director of one California home has been accused of restraining elderly patients by giving them powerful drugs, resulting in the deaths of three of the residents. The state's attorney generals said the director drugged one of the patients simply for glaring at her.

From shoving and hitting to kicking and spitting, experts say physical abuse is the number one type of abuse directed at the elderly. Bruises, burns, puncture wounds, and unexplained weight loss are all telltale signs that the person you've trusted in caring for aging parents may be abusing your family member. Also, if your loved one is reluctant to discuss how they got an injury, it can be a sign of physical abuse.

Neglect
In 2001 a nursing home resident wandered into a courtyard after employees had disabled alarms so they could smoke outside. The door locked behind her, trapping the woman, who had a heart ailment, outside. The result of the negligence? The 88-year-old died of exposure.

In short, negligence happens when the staff doesn't do its job. One of the more common forms of abuse among those hired to help in caring for aging parents, some of the signs include obvious malnutrition, patients not clothed properly, the smell of feces or urine on the resident, and untreated medical conditions.

Financial exploitation
From forging a senior's signature to coercing an elderly person into signing a will or other contract, financial exploitation is another nursing home nightmare. Signs of financial abuse by those you've hired to help in caring for an aging parent might include inappropriate bank account activity, obviously forged signatures, or recent changes in legal documents-especially if your family member is incapable of making informed decisions.

Protect your loved one from abuse
Experts in elder abuse say that there are some risk factors that indicate a facility or its employees have the potential for abusive behavior. As part of your caring for your aging parent, watch out for facilities with poor building maintenance overcrowding, high employee turnover rate, or high employee absenteeism.

Anytime you suspect those charged with caring for your aging parents are being abusive, contact local law enforcement as well as your local agency on aging.

How to Start an Assisted Living Business

If you are looking for an investment or a business with a guaranteed demand, look no further! The outlook for assisted living is booming. Tens of millions of baby boomers are approaching retirement age. Many of them will need medical or personal care. You could own the Real Estate or be the company that provides the service. Or combine them and get the best of both worlds.

Assisted Living for seniors combines the best of Real Estate Investments. You can operate a business needed in every city and have the security of owning Real Estate.

The increasing need for assisted living is driven by more than 55 million older Americans needing care over the next twelve years. Is that the type of demand you want for your new business?

Investing in Assisted Living is not just about real estate. When starting any new venture you need solid business data backed by extensive research, you need a solid operational manuals that help you avoid costly mistakes. We offer what you need.

Investing in Assisted Living also demands a decision about how involved you want to be in a business that requires some knowledge of both the Health Care and Hospitality Industries.

Whether you want to run an Assisted Living Business or buy one and hire a professional to operate, this kind of investment requires you to have a solid grasp of the industry.

But here's the problem. People wanting to start their own Assisted Living Business have so many barriers to overcome. First, there are many rules and regulations when working in Senior Care. It can all be so confusing. Do you register with the state or with your local government? Do you have to become certified? Is your home inspected? And, if so, who does this? It all seems so complicated and overwhelming.

Besides the legal issues, you know that you must take good care of your residents. You just don't plunk them down in front of the TV. This leads to so many more questions, such as: what should you feed your residents? What skills training are best for your facility? What do you do when you have an "incident" with a resident? How do you get referrals and how do you get paid? What are the legal issues? All this along with dealing with the "day-to-day" issues can seem overwhelming.

One more thing. There is just not much information available on how to start an Assisted Living home. What's available is expensive and incomplete. Even the expensive books and start up packets don't give you clear-cut procedures, they don't give you good advice and they don't tell you everything you must know.

Because of all of these barriers, so many people dreaming of helping others through owning an Assisted Living home just give up. They just don't start because it all seems so hard and they can't get any good information.

This doesn't have to happen to you. You can start with confidence and without anything stopping you.

Start here. Knowledge is power! Even if you have a background in Assisted Living, unless you have a background in how to start an Assisted Living Home you will need to gather good information. The best place to start is to find a mentor. Find someone that has already been successful in the Assisted Living Business; see if you can duplicate their efforts.

Business plans and operations manuals are crucial to the success of any new business but they are vital to your success as you start your new Assisted Living Home. When you are dealing with peoples very lives you must be very exact in how you operate. Take the time to get the best data you can.

If you don't have practical experience in the field take the time to get to know the business. If you plan to work in the business you will need to have a few years of hands on experience or at least a working partner who does. Regardless if at all possible volunteer your services with local nursing homes or at other Assisted Living Homes, while you may not be able to help with all the residents needs you will get a good idea of what can be expected. This will also give you the opportunity to see what works and what you would do different.

The next step is finding out what you state and local requirements are. This is where a good Mentor can save you time and money.

Once you know the State and Local requirements, you need to decide the size and type of home you want. You will need to decide if you will build, or find an existing building. At this point your business plan should be nearly complete and you will be ready to find financing.

Sixty to ninety days before you open you will want to hire and train employees, and start your marketing efforts. Again finding a Mentor or a source of information that helps you in a systematic way will be worth its weight in gold.

When accepting new residents be careful. Many people fall into the trap of taking everyone that comes through the door. You must keep in mind that you are creating a community and the first few residents will set the tone for years to come.

The Assisted Living Business while being profitable is also a way to make a difference in your community and in the lives of those people and their families who are in the sunset of their lives.

Nursing Homes: Increase Occupancy in Your Nursing Home With Bulk DirecTV

When it comes to finding an assisted living facility or senior housing for an older adult, the decision maker is normally one of two people; the older person themselves, or a close family member, such as a son or daughter. The selection of a nursing home is one of the biggest decisions you can make, as it will probably serve as the last place an older family member will live. The adjustment is a big one; going from a normal home with all of the freedoms, privacy, and features to an assisted living center can be tough. The way to best sell your nursing home, though, is to try and make it as much like home as possible, by providing all of the amenities and entertainment features that an older adult might have had previously. One way many centers have elected to do this is by ordering a bulk DirecTV service for nursing homes.

First, what is bulk DirecTV? Such a service makes use of the programming offered by satellite television company DirecTV, but at a price that is more cost-effective for a facility with dozens of rooms to purchase. When a nursing home orders from a company that offers these bulk TV services, they're able to pick out the specific channels they'd like to offer their residents, and can get each channel at a wholesale price per unit, as opposed to paying a traditional cable bill for each room to have access to the programming. Bulk DirecTV can also provide special features to organizations like nursing homes; for instance, special community information channels, music channels, and more. Depending on the company you work with, you could also gain some additional perks, like a DirecTV Upgrade system, which gives you the ability to add new channels for residents who request them, as well as an in-facility move theater setup.

This is just one step of a few you should take to make your nursing home feel as welcome and hospitable as possible to potential residents. Those who are considering their options for an assisted living facility will have many to choose from, and being the one that provides the most home-like experience and makes the transition as stress-free as possible for an older resident can benefit from doing so. If you provide the same television experience as a senior might have had in their original home, that could go a long way in having your facility be the one they choose.

Scrapbooks Can Sell Beds in Nursing Homes

One of the most difficult decisions an adult child may have to make is whether or not to move an aging parent into a nursing home.

There are many factors that can lead to this difficult decision. Perhaps the parent can no longer take care of themselves. This may be due to a weakened physical condition or it might be a medical condition such as Alzheimer's.

Not all nursing homes are the same. What better way for a nursing home to show what they have to offer than through scrapbooks?

When a parent does have to move into a nursing, even if it's a temporary move, they want to be able to have some sense of familiarity. A scrapbook showing personal bedspreads on beds can be helpful in showing that residents can indeed some of their own belongings.

Is there a closet in the room? Show the closet door open with clothes hung inside. This again shows a family that the future resident will be able to bring an assortment of their clothing with them. Is there a dresser in the room? Are residents able to have a few knick knacks and photos on the dresser? If so, take some photos of current resident's dressers, showing the personalization each resident can create.

What about meal time? Where do the residents eat? What does their tray of food look like? When we eat in restaurants, the chefs work very hard at creating a plate that looks very appealing. They mix color. They choose foods that compliment each other visually. What does the nursing home do? Do the trays of food all look pale and bland? Or do the plates of food look appealing and attractive? Show breakfast trays, lunch trays and dinner trays.

What activities are offered? Is there singing? Are there movies shown? Are there arts and crafts programs? Is bingo offered? Seeing photos of residents attending programs will help in making the decision to purchase a bed from your facility. I would want to see happy, smiling faces of people involved in activities through out the week.

By creating a scrapbook of all the reasons why someone should choose your facility, you'll ease the minds of those making this very difficult choice.