Care Plan 101 - An Introduction to Care Planning For Activity Professionals

Creating and implementing individualized care plans for residents in long-term care facilities is a very important responsibility of activity and recreation professionals. The activity assessment determines the content of the care plan. Not all residents will have an "activity-care plan", but most care plans should have "activity-related interventions" found in the comprehensive care plan. Care plans may be written regardless if a resident triggers on the MDS 2.0.It is important to set realistic, measurable goals, interdisciplinary interventions, and create care plans that are individualized and person-centered.

What is a Care Plan?
The RAI user manual defines care planning as, "A systematic assessment and identification of a resident's problems and strengths, the setting of goals, the establishment of interventions for accomplishing these goals."

Why write Care Plans?
- Document strengths, problems, and needs
- Set guidelines for care delivery
- Establish resident goals
- Identify needs for services by other departments
- Promote an interdisciplinary approach to care and assign responsibilities
- Provide measurable outcomes that can be used to monitor progress
- Meet federal and state requirements
- Meet professional standards of practice
- Enhance the resident's quality of life and promote optimal level of functioning!

What is a Care Plan Meeting?
A forum to discuss and review a resident's status including any problems, concerns, needs, and/or strengths.

Who usually attends a Care Plan Meeting?
- MDS Coordinator
- Nurse(s)
- CNA's
- Dietician
- Rehabilitation Therapist(s)
- Recreation Staff
- Social Worker
- Resident
- Family Member/Guardian

When are Care Plans written?
- A minimum of seven days after the MDS completion date
- Some care plans warrant immediate attention
- As necessary
- Must review at least quarterly

The Role of the Recreation/Activities Department
- Identify the resident's leisure/recreation needs
- Identify barriers to leisure pursuit and help minimize these barriers
- Identify the resident's leisure/recreation potential
- Provide the necessary steps to assist the resident to achieve their leisure/recreation goal/s
- Provide interdisciplinary support by entering a variety of recreation interventions on various (non-activity) care plans
- Monitor and evaluate residents response to care plan interventions

Components of a Care Plan
- Statement of the problem, need, or strength
- A realistic/measurable goal that is resident focused
- Approaches/interventions the team will use to assist the resident in achieving their goal
- Important dates and time frames
- Discipline(s) responsible for intervention
- Evaluation

Target areas for Recreation/Activities
- Cognitive Loss
- Communication
- ADLS
- Psychosocial
- Mood
- Nutrition
- Falls
- Palliative Care
- Activities
- Recreation Therapy
- Pain Behavior
- Restraints

Activity/Recreation Care Plan Samples
These are just a few samples. Remember, the most important aspect of care planning, is INDIVIDUALIZATION!

Statements (the resident's name is usually used instead of the word "resident")
- Resident has limited socialization r/t to depression
- Resident prefers to stay in room and does not pursue independent activities
- Resident is bed-bound r/t to stage 4 pressure ulcer and is at risk for social isolation
- Resident demonstrates little response to external stimuli r/t to cognitive and functional decline
- Resident enjoys resident service projects such as changing the R.O. boards
- Resident becomes fearful and agitated upon hearing loud noises in group activities r/t to dementia
- Resident has leadership abilities
- Resident prefers a change in daily routine and wishes to engage in independent craft projects

Goals
- Resident will respond to auditory stimulation AEB smiling, tapping hands, or vocalizing during small group sensory programs in 3 months
- Resident will actively participate in 2 movement activities weekly in 3 months
- Resident will remain in a group activity for 15 minutes at a time 2x weekly in 3 months
- Resident will accept in room 1:1 visits by recreation staff 2x weekly in 3 months
- Resident will socialize with peers 2x weekly during small group activities in 3 months
- Resident will respond to sensory stimulation by opening eyes during 1:1 sessions in 3 months
- Resident will actively participate in Horticultural Therapy sessions in the green house, 1x monthly in 3 months
- Resident will continue to assist other residents in writing letters on a weekly basis in 3 months
- Resident will exhibit no signs of agitation during small group activities 3x weekly in three months
- Resident will engage in self-directed arts and crafts projects 1x weekly in 3 months

Interventions/Approaches
- Provide a variety of music i.e. Big Band and Irish
- Utilize maracas and egg shakers to elicit movement
- Provide PROM to the U/E during exercise program
- Involve resident in activities of interest i.e. singalongs, adapted blowing and trivia
- Offer 1:1 visits in the late afternoon to discuss recent Oprah episode
- Seat resident next to other Korean speaking resident during groups
- Provide tactile stimulation i.e. hand massages and textured object i.e. soft baseball
- Provide olfactory stimulation i.e. vanilla extract and cinnamon for reminiscing
- Utilize adapted shovel and watering can during HT sessions
- Provide easy grip writing utensils and a variety of greeting cards/stationary
- Involve resident in small sensory groups i.e. SNOEZELEN and Five Alive
- Sear resident near a window
- Provide a variety of independent arts and craft projects
- Provide adapted scissors and paint brush

Exercise
Imagine that you are a resident in a long-term care facility and you are bed-bound for a health-related condition and are at risk for social isolation and inactivity. Write a goal and at least seven interventions/approaches that are relevant to you.

Drug Abuse And How To Treat It

Methadone was initially a medication designed to help those beat an addiction to opiate medications or street drugs like heroin. In fact, it is still used today for that reason. Methadone is also an opiate medication, so some may find themselves addicted to it as well. This likely happens due to abuse of the medication and not taking it in the manner in which it was prescribed. Some may take too much or add it with other drugs in an effort to gain the "high" they are addicted to. Methadone addiction is serious and could cause serious health related issues and even death.

While Methadone is an effective treatment for addiction, largely because it decreases withdrawal symptoms and does not allow for the euphoric sensation felt from taking opiates or heroin, it is also an opiate medication itself. This means that addiction is a possibility, especially if methadone is not taken properly. Doctors are aware of the potential for dependency but the benefits of Methadone are plentiful and doctors will monitor patients while on this medication. Unfortunately, some will become addicted to this medication while trying to wean themselves off of the drug they became addicted to.

Methadone addiction is potentially life threatening because this is a strong medication and typically is prescribed to be taken only once per day. For those who take it more often, the effects could be deadly. This is because this medication slows down breathing and too much could cause coma or death. It comes with the potential for side effects like drowsiness or weakness already, and increasing dose or coupling it with another medication is dangerous. Some other side effects include headache, missed period, sweating, fluid retention, and decreased sexual drive. Mood changes swelling are also a possibility. Most of these are not an issue until the medication is taken improperly. For nursing mothers, this drug may also be passed to the baby via breast milk, so it is especially important for them to beat addiction.

It may be that addiction to methadone is a gradual problem, and some may not realize a dependency is forming until it is too late. Signs for addiction include, extreme craving for the medication, inability to go for the prescribed amount of time before the next dose, changes in mood such as irritability or depression, and problems maintaining personal and work relationships. These are signs of a problem and should be discussed with a physician to determine the best course of action. Long term drug abuse can affect brain function and decrease intellect. It may also make paying attention for long periods difficult, as well as decrease memory. A study of methadone in animals showed an impairment in attention and brain function when large doses were given. Dependency affects your ability to take in information and retain it, as well as putting your life at risk.

Gradual decrease of this or any drug is crucial for the likelihood of success. Gradual decrease means fewer withdrawal symptoms and fewer cravings for drugs. Detoxification is of course necessary to rid the body of built-up toxins as a result of drug abuse, but this does not have to be a daunting task. Detoxification is scary when symptoms like hallucination, dehydration, nausea and vomiting, and shakes or tremors are a possibility, but there are medications that can help with withdrawal. For those hesitant to take these medications for fear of developing another addiction, it is important to note that all medications should be taken according to doctor advice. If you find yourself needing more or taking it improperly, it is time to discuss alternatives and other medication options with your physician.

After detoxification other support options are available to reduce the chances for relapse. Therapy with a trained counselor can help deal with past traumatic issues and avoiding situations where temptation is likely. Group therapy is available to talk with those who have the same problem and who can offer support twenty-four hours a day.

Drug dependency affects your life and the lives of those who love you. Work ethic becomes an issue and jobs may be lost. Beating addiction can improve your quality of life and put work and personal relationships back on track. Beating addiction can also save your life as coma and overdose are always a possibility. For those looking for a way to beat addiction detoxification, medications, and doctor supervision are the best alternatives. Medications can be prescribed to eliminate or decrease withdrawal and make a drug free life a strong possibility.

Skilled Nursing Facility Falls

Falls among patients in Skilled Nursing Facilities (SNF) are an all too common occurrence. Causes can generally be classified into 4 broad groups:

1. Patient characteristics
2. Medical care planning by physicians
3. Nursing care
4. Environmental factors

Prevention Entails

-A detailed medical evaluation and plan upon admission including diagnostic tests to identify patients at an increased risk for falls with special attention to medications or combinations of medications.

-Assessment by licensed nursing staff to create an ongoing care plan, follow-up meetings by members of the care giving team, efficient and readable chart systems, which facilitate communications between shifts and regular team meetings to generate progress reports and make changes in the plan when indicated.

-Facility maintenance, strict adherence to applicable codes and effective and efficient response to deficiencies when found by State or Federal inspectors.

Patient Characteristics

By definition, almost all patients who require SNF care have significant restrictions of functional performance related to their activities of daily living. Many of the disease state syndromes that demand removal to a SNF create significant risks of falling. These syndromes include dementia, weakness, stroke, visual disturbance, night-time confusion, orthopedic limitations that produce dysfunctional ambulation and balance problems. Many of these can be aggravated by medications such as those used to treat high blood pressure, which can cause dizziness and momentary decrease in consciousness due to orthostatic hypotension on arising. Other common medications associated with falling are pain medication, many psychotropic drugs used to treat behavioral outbursts due to dementia and diabetic medications, which can cause excessive lowering of blood sugar.

Treating physicians have the responsibility to take these potential risks into account when planning care for their patients upon entering a SNF. Periodic visits to the facility to reassess patients' progress is essential. Physicians must either be available themselves or provide on-call 24/7 coverage to respond to urgent or emergency situations or concerns of nursing staff.

Nursing Care

The nursing care plan must provide for ongoing assessment to evaluate risk factors and the facility should have clear protocols for reducing fall risk in general and individualized plans for each patient. In the latter category would be included such things as bedrails, lowering the bed so that if a patient does fall out of bed the possible injury will be lessened, properly functioning walkers, geriatric chairs and other restrictive devices where indicated. Incident reports can provide information as to overall frequency and possible remedial needs.

Environmental Factors

Floors must be kept dry and non-slippery. Corridors and rooms must be well-lit during the day. High toilet seats and grab bars in bathrooms and halls are ancillary design characteristics to prevent falls. Ambulatory patients must have appropriate footwear

Medical-Legal Considerations

Falls in SNFs are an important factor in generating plaintiff actions. It is noteworthy that a traumatic event in an individual who is already compromised by significant illness and dysfunction may start a cascade of complications that leads to accelerated decline and often premature demise. This frequent series of sequelae often occurs even if the specific injury caused by the fall is successfully treated. What may seem to be a relatively trivial injury in a well person can be catastrophic to a SNF patient.

How to Get Children Involved in Community Service Work

Children learn a variety of skills while engaging in local service projects. Community service is an important part of local community building. Volunteer work develops children's moral character. Skills are enhanced and new interests and talents are discovered. Through service work, children gain an improved sense of self love. They learn to be giving, considerate and compassionate towards people and animals. Listed below are some basic ideas of how parents can begin to get their children involved in the community.

Hospitals
Many hospitals have a wealth of needs for volunteers. Call your local hospital's volunteer coordinator. Children typically will need to be accompanied by a parent or guardian. Some examples of meaningful volunteering tasks are helping to deliver flowers, reading to bed bound patients, or drawing people uplifting pictures for their hospital room walls. Some hospitals have cancer wards where children may need to stay for extended time periods. These longer term patients would surely love to have another child to provide them with companionship and friendship.

Nursing Homes
Nursing homes and assisted living communities welcome young volunteers. There are many activities at these types of facilities. Programs such as crafts, bingo, and social events typically take place at both nursing homes and assisted living facilities. Many volunteer coordinators have a need for room visits to bed bound patients. Some elderly residents may have family living out of state and would greatly appreciate a young volunteer visiting. Children may also read aloud to residents and make cards for them.

Humane Society
The local humane society opens its doors to volunteers of all ages. Dogs need to be walked and interacted with. Cats, kittens and puppies need companionship. You and your child could have a pet food and pet bed collection at church or at your child's school. Contact your local animal shelter to see what child friendly service project needs there are.

Soup Kitchens
Many soup kitchens have numerous needs and welcome volunteers of all ages. Children and parents can serve meals to those less fortunate. In some cases, canned goods need to be stocked and sorted. If the soup kitchen is part of a homeless shelter there may be other children living there. Teaching your child to share what they have and to donate a few of their toys is a great character builder!

When researching local volunteering project ideas, try to think of the interests your children may have. For example, if they adore animals, the animal shelter may be a good match. If your children are fond of cooking projects at home, the soup kitchens should be a great match. When volunteering, be sure to praise your children for their efforts. Encourage them and remind them of what an exceptional job they are doing while helping others.

Recognizing Nursing Home Abuse and Neglect

All residents in nursing homes are entitled to receive quality care and live in an environment that improves or maintains the quality of their physical and mental health. This entitlement includes freedom from neglect and abuse.

WHAT CONSTITUTES NEGLECT AND ABUSE?
Neglect: Neglect is the failure to care for a person in a manner, which would avoid harm and pain, or the failure to react to a situation which may be harmful. Neglect may or may not be intentional. For example, a caring aide who is poorly trained may not know how to provide proper care. Examples include:

• Incorrect body positioning -- which leads to limb contractures and skin breakdown;


• Lack of toileting or changing of disposable briefs -- which causes incontinence and results in residents sitting in urine and feces, increased falls and agitation, indignity and skin breakdown;


• Lack of assistance eating and drinking -- which leads to malnutrition and dehydration;


• Lack of assistance with walking -- which leads to lack of mobility;


• Lack of bathing -- which leads to indignity, and poor hygiene;


• Poor handwashing techniques -- which leads to infection;


• Lack of assistance with participating in activities of interest -- which leads to withdrawal and isolation;


• Ignoring call bells or cries for help.

Abuse: Abuse means causing intentional pain or harm. This includes physical, mental, verbal, psychological, and sexual abuse, and intimidation. Examples include:

• Physical abuse from a staff member, another resident, or visitor from outside the facility -- including hitting, pinching, shoving, force-feeding, scratching, slapping, and spitting;


• Psychological or emotional abuse -- including berating, ignoring, ridiculing, or cursing a resident, threats of punishment or deprivation;


• Sexual abuse -- including improper touching or coercion to perform sexual acts;


• Substandard care which often results in one or more of the following conditions -- immobilization, incontinence, dehydration, pressure sores, and depression;


• Rough handling during care giving, medicine administration or moving a resident.

REPORTING NEGLECT AND ABUSE It is a violation of State and Federal law for any person, including facility staff, volunteers, visitors, family members or guardians, or another resident, to neglect or abuse a resident.

• Anyone can and should report neglect and abuse. If you suspect neglect or abuse, or if a resident tells you they are experiencing this problem, it is important to believe the resident and REPORT THE ALLEGATION IMMEDIATELY. This will help prevent further suffering by any resident.


• Many states have laws that require the reporting of abuse and neglect. Find out what your state requires.


• Put your report in writing, date it, and keep a copy. Convey as much information as you can about the situation. Remember to include:

WHO The name of the victim, including age and address; the name of the facility and the people responsible for the victim's care; the identity of the person who you believe abused or neglected the resident; WHAT The nature and extent of harm and any physical signs of abuse or neglect; any previous incidents; what happened;

WHERE and WHEN the place where the incident happened and time and date of the incident.

Make Your Report To:

• The nursing home's administrator, director of nursing, and social worker


• The state or local Ombudsman


• The local police or State law enforcement


• Adult Protective Services agency - which is part of the Department of Social Services


• The state survey agency that licenses and certifies nursing homes (often in the Health Department)


• A citizen advocacy group or other church or community group that visits regularly.


• Keep trying until you get the assistance you need. You can locate the above resources in:

AFTER THE REPORT:

• Follow up with the resident and facility to make sure the neglect or abuse has stopped.


• Follow up with the person or agency conducting the investigation. Ask for written copies of investigative reports.


• If the perpetrator is charged with abuse or neglect, the charge will be referred to the state licensing authority. If the guilty person is a nurse aide, the charge will be reported to the state nurse aide registry. This registry is used by nursing homes to prevent abusive aides from working with the elderly. Nursing homes are required to check the registry before hiring a person.


• If all the safety options fail, you may have to contact the local media, the U.S. Justice Department, or seek private legal assistance.

Nursing Care Plans - An Organizational Tool For Elder Care

Nursing care plans are used by professional care providers for hospital stays, nursing home care, where skilled nursing is needed, and for home care services. If you will be the home care provider, you can help construct a plan using criteria developed by the North American Nursing Diagnosis Association (NANDA).

Knowing what a plan entails will help you decide if any of the services can be handled by family or if they must be contracted out to a licensed professional or other provider.

For example, there is a plan for "Impaired Home Maintenance Management," i.e., your parent is not keeping up with personal hygiene, household chores, nutrition, etc., even though he believes he is still independent.

Assess the Problem

Each plan starts with a comprehensive assessment. The information will come from:

* The observations of family and friends (referred to as "signs" of a problem or disorder);
* Complaints or statements from the elder (called "symptoms");
* The elder's medical and social history;
* The observations and testing by one or more professionals.

Set Attainable Goals

From the assessment a list is made of any medical diagnoses and the daily challenges confronting the patient, family or relationship problems, and existing strengths and supports. If you are conducting this process yourself without input from health professionals, this is a good time to consult with the elder's primary care provider, who can help you interpret the information you have gathered and provide direction for next steps.

With your "challenges and strengths" list in hand, ask whether each problem area can improve. If so, then set a reasonable time to work on improvement, and assess whether improvement has been made at the end of this time period. It is important that this improvement be:

* Specific--a goal you are looking for (such as "grandpa can walk to the bathroom by himself", rather than that "grandpa is better")
* Measurable (you can list what will be done to reach the goal and when)
* Attainable (break big challenges into smaller steps).

If the challenge or problem presented is not going to improve, then your care plan can focus on preventing it from becoming worse. Again, specific, measurable and attainable goals are set.

Nursing care plans are useful organizational and brainstorming tools. They are not a substitute for professional advice and judgment. Please consult a physician or other professional where the health or safety of a loved one is concerned.

Consider A Consultant

When evaluating a nursing care plan or any other elder care, it is often helpful to consult an experienced, objective advisor as to how to plan and implement the services your elder requires and deserves. It is best to entrust your care only to those with the highest level of training, broad expertise, experience and ethical standards.

A variety of semi-professional organizations and franchises have arisen in response to the greater demands of our aging population. While some may be competent, carefully assess the reliability and accountability of any provider, as oversight laws are often slow to adapt to rapidly changing industries such as this.

Established professionals are already well regulated through government bodies and professional licensing organizations, providing a measure of comfort and security that you will be well served.

Professional Recruitment for Nursing Homes Improves When the Operation Does

Andria, a frustrated Plymouth, Michigan based social worker remarked: "If she gets one more call asking her to consider employment with what she considers to be the sloppiest nursing home chain in America she may drive to their corporate offices and vomit in the lobby."

Those remarks are a bit extreme but reflective of the thoughts of even the unemployed social worker, nurse and nursing home administrator who are thinking twice before accepting employment with nursing homes whose reputations are full of regulatory and operational blemishes.

An example of how bad some are rests with reports of patients pressing call buttons and seeking help only to wait an hour or two for someone to respond. In some of the instances we reviewed for this week's article, patient family members sat there and waited just to observe how long the response would take. In other instances training and development of staff is never innovative and limited to the bare necessities.

A review of public reports commonly finds fire safety, building hygiene and food handling violations. As a result, even the newly budding professional has to think 2 or 3 times before allowing themselves to be recruited into an organization whose approach to customer service and regulatory compliance is lackluster at best.

How can it get better? Four, (4) key operational principles can be of benefit.

A. Budget for Systems Inspector in at Least Every 2 Homes

This may not be the regional manager or regional vice-president. This can be a less expensive professional or para-professional whose sole job it is to examine and correct all non-clinical systems in operation including cleanliness, furniture safety, general maintenance, odor control and more. This could be a position for administrators in training and others with an eye for detail and who are willing and able to learn systems and protocol, while understanding they do not belong in the clinical side of the business.

B. Do Not Limit Training to Clinical Necessities

For every minute we spend teaching and reiterating important principles of protecting against blood borne pathogens, we could also be teaching staff the value and importance of how the right customer service approach affects nursing homes. We then tie it to their specific job performance and description and use innovative tools such as videos and live webinars, conference calls and other presentations available for nursing home personnel. There are even orientation presentations available, as brief as 20 minutes that nurse aide and others can sit at a computer and enjoy.

Topics include maintaining a patient's dignity, techniques for heightened care delivery safety and a host of other meaningful subjects.

C. Seek More than Credentials; Seek Maturity and Discernment

Polished personnel who may have helped a nursing home thrive for decades and helped make it a staple of care in the community in which it exists are moving on claiming their corporate employer is hiring inexperienced, cocky and excessively money focused young professionals who assign no value to the contentment of the patient being served.

D. Improve the Admissions Process

Allow your admissions process to go beyond verifying what insurance will pay. Take the time to schedule a conference with the patient's designated representative immediately upon admission, discuss discharge possibilities, ask questions about prior living arrangements, ensure they know what deadlines may apply, offer help to apply for veterans or other benefits or introduce them to private case managers.

What happens is all of this can combine to create a rather stellar operation and when packaged up will help recruit really committed professionals. The opposite side of the coin is being the laughing stock of the long-term care community and when that happens, very little else matters.

Will you follow these steps to improve your recruiting?

Thanks for allowing us to share.

Spotting the Signs of Nursing Home Negligence and Abuse

Making the transition for a loved one from his or her current resident to a nursing home facility is often a very difficult one. There is usually a good deal of emotional turbulence concerning the decision of whether or not to send the individual to a care home. The decision is almost always made with the best situation for the patient in mind, but there is often a good deal of hostility despite this. If the individual was angry about being sent to the home, if it turns out that the care home engaged in some type of abuse or negligence, you may feel responsible and very guilty.

But there is no reason to feel guilty; these facilities are often times incredibly good at covering up any signs of negligence when visitors come into the facilities. But despite the fact that it is very difficult to know when a nursing home may abuse or neglect patients, it is possible to spot certain tell tale signs that can be detected through the patient or the staff. Some of these signs include:

• Bruises, cuts or other injuries-the elderly are very fragile, so in many cases bruises or cuts may have just occurred naturally but in other cases they can be a signal of abuse. To find out, ask the patient about the injury and then ask the care home workers. If the stories do not add up, continue to find out more about the situation.

• Serious changes in personality-if the patient suddenly becomes withdrawn and shy, it may be the result of being yelled at or neglected.

Work at Home Nursing Jobs Change Lives!

If you have the right credentials, finding work at home nursing jobs is relatively easy. In fact, moms who have nursing certificates will discover that there are plenty of home nursing jobs to choose from.

Are you a mom? If so, the need for flexibility in your career is evident. You already have a full-time job - taking care of your children. It only makes sense to take advantage of the benefits online careers can bring.

Luckily for you, as a hard-working mom, the healthcare industry understands that work at home nursing jobs help the bottom line, and reduce employee turnover rates by keeping good workers happier.

You haven't quite secured your nursing credentials yet? If not, you still have an abundance of choices for telecommuting jobs. Just a few of the possible online careers in nursing include: being a case manager, training, and performing nurse triage - assessing a patient's medical situation and then directing the patient regarding healthcare.

Let's take a look at some great work at home nursing jobs. Whether you're a mom or not, here are a few opportunities to consider:

Humana: A Fortune 100 company, Humana's headquarters are in Louisville, Kentucky. This major healthcare company sells and administers Medicare plans, individual health insurance and group insurance through employers. The company has more than 11 million customers. Its telecommuting jobs including nursing, medical coders, chart auditors, physicians and licensed insurance agents. Pay varies with the position, and is based on your qualifications.

Covance: Based in Princeton, New Jersey, Covance is a biopharmaceutical development services company, that provides drug development services, including animal testing. Although it offers home-based clinical research positions, Covance workers are expected to travel about 65% of the time.

Health Net: Located in the Woodland Hills area of Los Angeles, California, Health Net is a managed healthcare insurance provider. In addition to government contracts, it offers PPO, POS and HMO healthcare coverage plans. Online careers at Health Net include case manager jobs, nursing and healthcare coordinator positions.

Conifer Health Solutions: Frisco, Texas is the headquarters of Conifer Health Solutions, a company which provides operational management solutions to hospitals seeking to boost their financial performance. It offers medical coding positions in addition to work at home nursing jobs.

Online careers in nursing are really hot. If you're interested in utilizing your nursing skills in a virtual environment, and changing your lifestyle while doing it, telecommuting is the way to go!

Aging Gracefully - They Say the Anger Response Is Natural

In a discussion over aging parents and relatives, my friend indicated that angry responses from aging adults are natural. I thought about it for a bit and wondered why. It seems the anger issues arise from their frustration of having to allow others to make some choices for them. But why?

As children we are expected to make no choices, in fact, we get very few. As adults, most of the time, we'd give our left testicle to be able to let others make our choices for us on those days when choices become too much. So, what is so difficult when we are overwhelmed with choices, with allowing others to make some of those choices for us? Why would we be so angry?

When my mother needed medical care she couldn't deal with on her own, she called me. I answered that call, by contacting the medical people she requested and making those appointments for her. The more I accepted those responsibilities for her, the angrier she got.

At one point, I'd over heard her talking to my sister - at least I thought that's who she'd been talking to. I wondered if my sister was doing okay, or if they'd talked about her next procedure, thinking it would be nice to know what they'd discussed. So, I asked. She became extremely angry and started listing off every phone call she'd made for the past several hours. I hadn't asked for an accounting of her calls, but simply about one call. Her anger became the center of the conversation and rather than continue the discussion, I just stopped talking. Eventually, she stopped focusing on the anger and ended her rampage to continue reading a book she'd brought from home. After several minutes, she raged at me, "I guess I'll just have to stop calling anyone if you're screening my calls now too."

My sigh of frustration must have caught her off guard because she got up and left the room.

My frustration is due to memories of her older sister responding in the same way to any questions we asked of her. I have no intention or desire to screen her calls. She has full access to the phone and any calls she chooses to make are fully available to her. That hadn't been my point or my idea, but rather hers. ?

In each decision, I've encouraged her to choose the day and time, and most of the procedural choices when she understood them. Even when she didn't understand the procedures, I encouraged her to ask questions or talk to me about them. The choices were still hers, but she'd shrug and say, "I don't know what to do, just make the choice for me." Then she'd add... "You will anyway."

When others asked about her attitude, I'd try to explain away her anger as a sleepless night, or even just frustration over her current health issues, but ultimately, I wondered. When I asked her Doctors and other medical staff, they assured me, angry responses from aging patients are natural. They didn't choose to grow old, it was forced upon them.

Perhaps that's the answer.

Job Outlook For Social Workers

Most areas of social work employment are predicted to increase significantly over the next five to seven years. Some geographical considerations also impact job projections. Current estimates are that for the years between 2008 and 2018 the field will enjoy a 16% expansion of employment. This expansion is considerably higher than that of most other occupations.

Growing Population Of The Elderly

The job outlook for social workers entering the field of gerontological social work is especially good since the population of aging baby boomers will mean a larger demand for social services and health related care. Both public and private demand for social workers dedicated to this population will increase as the population needing this service expands.

Mental Health And Substance Abuse

One of the largest areas of growth in the social work field is predicted to be in the area of mental health and substance abuse. Experts are predicting nearly a 20% expansion of employment in this area of social work. Workers choosing this specialty will see employment opportunities in correctional facilities and in treatment of those released from correctional facilities as conditions of either parole or probation. Private treatment programs are also forecast to see a significant upswing in employment.

Child And Family

Experts predict around a 12% increase in social work positions involving child, home and family services. These workers investigate child abuse cases and are tasked with keeping children safe and placing them in protective and foster care among other duties. Keep in mind, however, that these positions are almost exclusively government funded. A precarious economy and lack of funding could change this prediction of expanded growth.

Public Health And Medical

The job outlook for social workers in the field of medical and public health is excellent. An estimated 22% increase is expected. This area dovetails into the realm of the gerontological social workers since medical and health care services for the aging baby-boomer population is expected to increase dramatically. Both public and private sectors should show significant growth. Private and partially publicly funded assisted-living centers and senior communities will allow for ample employment in the years to come.

Geography

Although a healthy expansion of the social work market is expected, some areas will offer more opportunity than others. The job outlook for social workers in rural areas will be the highest due to lack of competition and the unavailability of training centers that are more common to high density urban areas.

Conclusion

Prospects look particularly good in the field of social work in the near future. All areas are predicted to expand so it's a safe bet heading into this field. Geographical areas and possible public funding cuts are wild cards to keep an eye on.

Assisted Living In The Year 2020 - 3 Things You'll See

Although we'd like to think that in the year 2020 we'll all be invincible and have no need for assisted living, chances are this wont be the case. However, assisted living facilities, like everything else around us, continue to evolve every day.
So what should we expect from these facilities in the future?

1. Current health care services are expanding to meet the various needs of America's growing elderly population. That being said assisted living will remain to be very popular because it offers the perfect blend of privacy, independence, and personal care. What will not stay the same is how these facilities look, feel, and are run. As the elderly population continues to grow these facilities will look less and less like nursing homes and more and more like upscale communities, and lets be honest, who doesn't want to live in an upscale community?

2. Residents of these facilities will demand, and probably be granted more involvement and control in how the facility is run. Rather then just going along with the set schedule and prepared activities the residents themselves will have more control over what happens, when, and how often. And chances are, as the facility community changes and evolves, so will the desired activities. For example, for a few years the majority of residents may prefer to watch enjoyable movies together, hang out and eat popcorn and having an old fashioned movie night, then as new residents move in the general consensus might change to be that it's more fun to play... BINGO!

3. But the biggest change of all will be the role technology will play in assisted living facilities. New gadgets will aid in the general management of the facility and the care of its residence, allowing care givers to offer a higher level of care while still respecting the privacy that makes assisted living what it is.

a. Advancements in monitoring technologies will allow facilities to have things such as remote sensing to help the staff ensure that all residents are safe and not in need of assistance.

b. Tasks that can be found difficult for some residents, such as opening doors and turning lights on and off, can be automated for them! Also, systems will be in place to give auditory reminders or instructions to individuals who need help remember things. For example, maybe a resident would like to go play cards with a friend on the patio tomorrow at 2pm, they can set the system to remind them tomorrow afternoon! One thing that's expected to become very common place is a talking pill box, reminding you when to take what pills!

c. There will also be very easy and dependable alert systems allowing all residents to promptly call for help anytime they need. This will bring a new level of safety and general care to all assisted living facilities.

Gifts for Senior Women With Mobility Devices

As the holiday season approaches you may be looking for a practical gift for a mom or grandma who is using a mobility device such as a power chair, medical scooter or walker bag. If this is the case consider bypassing impractical gifts that probably won't get used very often and opt instead for stylish and practical carryall bags for mobility devices. Made from high quality fabrics and trims, featuring feminine designs and available in a wide range of patterns and colors, designer walker bags make for terrific gifts for women who use mobility devices.

As women get older it becomes increasingly difficult to shop for them. They really don't have much need for expensive gowns, fancy perfumes and glass figurines. Also, when women age they go through a process of downsizing and the last thing a woman who is moving into assisted living or a nursing home needs is more stuff. What they do need, though, is a practical and fashionable bag they can attach to a walker, power chair, transport wheelchair or mobility device that can carry all her important medical records, medications and personal belongings.

With a designer walker bag, women who use mobility devices get to regain their individual sense of style with fancy and attractive bags that feature vibrant floral patterns and contemporary silver and onyx damask designs. Before the advent of designer walker bags and carryall bags for mobility devices women had no choice but to either struggle dangerously with a traditional handbag or use dull utilitarian bags one would expect to find in a hospital geriatric ward. In addition to being bulky and impractical these bags only made adjusting to life with a walker or transport chair even more difficult since it simply highlighted the user's disability.

However, when women use designer walker and power chair carryall bags they instantly feel a sense of their style being restored and can move about with pride knowing that people will take notice of the stylish bag and not just the walker or power chair. Just because women have trouble walking doesn't mean they have to sacrifice their individual style. It's hard enough accepting the use of a walking aid without having it compounded by being forced to use an ugly bag that only makes women feel older. With a stylish and functional walker carryall bag, women not only have a practical bag for their personal belonging but also a stylish mobility device accessory that adds a unique sense of her character that will life her spirits as she goes shopping or visits with family and friends.

Learning How to Slow Down After You Retire

After working hard for many years, it is time for you to take it easy. Your retirement should be spent relaxing and doing things that you enjoy. However, many retirees end up feeling restless because they have spent so much of their lives in the workforce. If you find yourself feeling bored, then you may need to follow these tips to help you slow down after retiring.

Don't Live by the Clock

After having a set schedule day after day, you may find yourself setting the alarm clock before you go to bed each night. Rather than forcing yourself to follow a timed schedule, start living naturally. Allow your body to wake up when it is ready. Eat when you are hungry, play a game when you feel like it and go to bed when you are tired. You can still keep a loose schedule, but your activities will no longer be dictated by the hands on the clock. This will help you to relax a bit so that you can enjoy your retirement even more, and your body will adjust easily to its natural rhythm.

Volunteer

Many retirees feel uneasy about retiring because they worry that they are no longer contributing to society. If this sounds familiar, stop worrying. You make contributions daily by taking care of your home, supporting the stores in your community and paying taxes. If you feel that this isn't enough, then volunteer. Go to the nursing home to visit with residents. Stock shelves at the local food pantry, or read to the children at the public library. No matter what you choose to do, make sure that it is something that you enjoy and that is fulfilling.

Take it Easy

Don't be afraid to take it easy during your retirement. Invest in some comfortable lift chairs or recliners that will be easy for you to get into and out of. You can use these chairs to visit with guests, read a book, knit or watch television. The lift chairs will also be easier for you to use if you suffer from knee or back pain as you get older.

It can be very difficult to slow down after years of being dedicated to your profession. With some practice and patience, you will soon learn to enjoy the free days that you have ahead so that your retirement will be all that you had hoped for.

Top 5 Nursing Jobs - From Home Health Nurses to Floor Nursing Careers

Nursing is more than checking vital signs at regular intervals. The nursing field is full of opportunities for the new and experienced nurse who doesn't want to be limited in his or her choices. Here are five of the top choices in the nursing profession.

Once you graduate from nursing school, take a deep breath. The hard part is over and the fun begins. Now, you get to choose where you want to start your nursing career. The hospital floor is not the only choice out there anymore.

1. Home Health Nursing - People are living longer. With that comes the issue of care in the home. More seniors are opting to stay in their primary residence and take advantage of the home health benefits of their insurance plans. One popular nursing job is that of a home health nurse because they have the benefit of making their own schedule. They can take on as few or as many patients as they can handle. Home health nurses aid in bathing, wound care and dressing, general health assessments, and any other issues that the patient may have. There patients can be invalids or ambulatory folks that don't get around so well and seek a nurse that is willing to tend to their care within the home setting. Home health nurses are well paid for their skills and friendly bedside manner.

2. Nursing Assistants - Nursing assistants are an integral part of the nursing profession. They are not registered nurses but they provide patient care that falls under the category of the nursing profession. Nursing assistants are not only found in nursing homes. They work in hospitals, senior living communities, home health, psychiatric facilities, and other facilities where their care is needed. They care for terminally ill patients including children. Nursing assistants provide the care that others shy away from such as changing bedpans, bathing patients that can't bathe themselves, and feeding those patients whose disabilities prevent them from doing it for themselves. They bring respect to the area of nursing care and dignity to their patients. Nursing assistants see, on a daily basis, how their jobs impact the quality of life of their patients and their families. As patients get older, nursing assistants will be needed in big numbers.

3. Emergency Room Nursing - Have you been to an emergency room lately? You have a few doctors that see patients, but the majority of the staff is comprised of nurses. Nurses assess the patients and triage them according to injuries. They monitor them while they wait for a doctor or transfer to another department in the hospital. Emergency room nursing is a fast-paced and stressful atmosphere that satisfies the adventure junky in some of us. Nurses that think fast on their feet would get quite a bit of enjoyment from this area of nursing. There is no shortage of accidents on the road, in the home, and in the air. The job of these nurses is critical to the survival of patients that are hanging on by the thinnest thread.

4. Floor Nursing - There is a wide variety of options in this area. Floor nurses have the options of maternity, critical care, orthopedics, telemetry, surgical, geriatric, and pediatrics. Within these general categories are also oncology and burn units. A nurse can gain lots of experience working within one or several of these areas during their nursing careers. Floor nurses are responsible for a certain number of patients each shift. Patients have the comfort of getting to know their nursing staff and the staff has the pleasure of taking care of them.

5. Operating Room Nursing - Nurses work in the surgical area as well. Nurses can pursue careers as a circulating nurse in the operating room suite, surgical first assistant to the surgeon, and nurse anesthesia care. Nurses that provide anesthesia have at least two years of critical care experience and have attended a nurse anesthesia school for training. Circulating nurses are responsible for everyone in their operating room that day. They function as patient advocates--making sure that the patient being operated on is the correct patient and that the doctor is performing the correct procedure.

Nurses have many career paths available to them. They can pursue any of these five areas or another that they feel drawn to follow.

What is Catastrophic Injury?

A catastrophic injury can leave a person suffering from permanent disabilities for the rest of their life. Catastrophic injuries are any injuries that have serious, long-term effects on the victim. If compensation is not received for catastrophic injuries, the physical, emotional and financial strains can be devastating.

"Catastrophic injuries usually affect far more than just the victim," says Elliot Hillel Lewis, a catastrophic injury lawyer in Philadelphia, Pennsylvania. "They can often put serious stress on the victim's family because they may need constant supervision or assistance for the rest of their lives, not to mention a lifetime of rehabilitation and medical bills."

Catastrophic injuries can be caused by any number of different circumstances, and the results of the catastrophic injury can last for weeks, months, or even years. Some of the most common catastrophic injuries include:

* Back Injuries

* Neck Injuries

* Brain Injuries

* Burns

* Organ Damage

* Paralysis

* Paraplegia

* Quadriplegia

When a victim suffers a catastrophic injury, the impact can be enormous. Not only can a catastrophic injury prevent a person from gaining any substantial income, it can prevent them from enjoying their life, and it can cause their family huge amounts of stress. Catastrophic injuries to the brain can even change a person's personality, make remembering things difficult, and prevent them from recognizing their most loved family members.

A catastrophic injury lawyer will help you recover compensation for the damages that you or your loved one has experienced, including:

* Lost Wages

* Loss of Enjoyment of Life

* Mental Anguish

* Pain

* Suffering

* Lost Future Wages

* Permanent Disability

* Medical Bills

New Technologies Provide Help for Seniors and Caregivers

It's amazing to learn how technology is improving the lives of our aging loved ones as well as caregivers whether at home or in care centers. In my quest for innovative new technologies I've come across the following developments that are addressing both the physical and the cognitive needs of our seniors.

Monitor Wandering with Wandertrack
This wander management system has improved the quality of life in assisted living facilities that use WanderTrack. It's an invisible and wireless system that alerts the monitoring station when a resident, without having to use a GPS, passes through the designated perimeter. Residents can take walks outdoors and their loved ones will have the peace of mind knowing they are cared for without the risk of wandering too far from home. More information is available at silentpartnertech.com

Explore Retirement Homes in Windsor

Dakim BrainFitness
At FrontPorch the Model eHealth Community for the Aging, they started with just a few units and are now a major provider of the Dakim BrainFitness system. Dakim is a touch-screen system of clinically tested brain fitness exercises that through extensive and ongoing research is providing users with fitness exercises for the brain. The system includes more than 300 hours of content and over 100 exercises to keep the brain active, improve memory and help prevent cognitive decline. Complete information is at dakim.com

Carebot by Gecko Systems Helps Seniors recover at home
A fascinating new remote medical monitoring system that reminds me of Rosie the Robot Maid from the Jetsons, is CareBot??MSR (Mobile Service Robot) and is being trialed by Gecko Systems with selected individuals. Typical scenarios where an MSR could be an asset are in the following examples: A patient returns home after major surgery and a complication arises. The Carebot is set up to monitor the patient and transmit alerts of any complications to the Doctor or the Hospital ER and the patient is readmitted quickly.

Carebot's webcam allows caregivers freedom and peace of mind
In another scenario, a senior is staying with family and it's not safe for the caregiver(s) to leave the senior. Carebot attends to the senior with the installed webcam allowing the family to take care of other responsibilities while still being able to see and communicate with the senior at home.

The third scenario is one in which the senior is able to live independently but needs reminders of when to take medications, when Doctor's appointments are scheduled or when visitors are expected. Carebot is set up to remind the user of all of these and more, and is programmed to recognize emergency situations and potentially harmful events. In such situations including a fall, a fire or extended length of time where Carebot has not identified the user in the area, Carebot is programmed with a list of emergency contacts including 911; giving the individual and their loved ones peace of mind. Complete information at geckosystems.com

Gecko makes the wheelchair collision proof
Another innovative invention from Gecko Systems is the Gecko Wheelchair??Upgrade Kit. "This upgrade uses sensor fusion... and sonar range finding in addition to Gecko solid state compass, accelerometer and odometry sensor. The result - an automatic self navigating artificial intelligence software to be collision proof." (From the Gecko Systems Website). They are incorporation the sensor device from Microsoft Kinect in an upgrade kit ideal for placement on most electric wheelchairs.

The collision proof upgrade kit was recently sold to a Japanese wheelchair manufacturer and is being fitted with the joystick operated electric wheelchair. The user of the wheelchair operates the joystick as usual and the GeckoNav system automatically navigates according to the direction the operator wishes to go while avoiding stationary and moving obstacles.

Savoring the Dining Experience

Mealtime is a very significant part the day. It is a time to nourish and 'refuel' - but also to socialize and unwind. This doesn't change when people move to seniors housing. In fact, the dining experience may become even more important.

Having a say in what to eat, and in what kind of environment, enables senior housing residents to maintain the type of dining experience they were accustomed to before moving to assisted living. To accommodate this desire, many communities offer dining rooms complete with wait-service, entertainment and, of course, top-notch cuisine. Some menus even include delicacies such as filet mignon and prime rib. There certainly is a trend to go from institutional foods to more high-end foods, says food consultant Meureen Boyle of Boyle consulting. At the same time, she added, residents also still demand what she calls 'comfortable foods' such as macaroni and cheese and meatloaf.Combining the old way with the new way, Maureen says, seems to work best. What is most important is to offer choices.

A high-quality dining experience is a key ingredient for customer satisfaction in long-term care, according to ALFA's 1000 National Assisted Living Resident Satisfaction Study. While quality of care is always of foremost importance when selecting a senior housing environment for oneself or a loved one, the 'quality-of-life' services, such as dining, can make each day more enjoyable. When gauging the quality of dining services in a senior housing community, Maureen Boyle advises making sure the staff provides good 'wait-style' customer service, waits on one table at a time (serving everyone at the table simultaneously) and treats each resident as an honored guest. It's also important to look for menus that are reasonably varied to suit individual tastes. A variety of serving styles is essential as well. Instead of ordering at the table and having their food brought to them, some residents may prefer to dine buffet-style from time to time. Many residences offer all of these choices.

If a physician places a resident on a special diet, it's important to ascertain that the food services staff can tailor meals to meet the resident's nutritional needs. It can be a challenge motivating a resident to eat who is on a special diet, especially if the food they've been prescribed is not the food they want to eat. To make this easier, meals should appeal to all of the senses. Taste, texture and color should balance out as much as possible and meals should be eye-catching. Overall, the better trained the food services staff, the greater the customer satisfaction will be.

As you tour an assisted living or retirement residence, ask these key questions:

- Does the residence provide three nutritionally balanced meals a day, every day?
- Are snacks available?
- May a resident request special foods?
- Are common dining areas available?
- May residents eat meals in their units?
- May meals be provided at a time residents would like, or are there set times?

The dining experience in senior housing has changed a great deal over the years with a focus on greater customer service and satisfaction. The good news is that senior communities are listening more to what residents want and going out of their way to provide a meal that is both pleasurable and reminiscent of the way residents have been used to eating all of their lives.

Five Best Active Adult Communities in the United States

From the shores of the Pacific Ocean in Hawaii to the Atlantic coast of Florida, there are countless active adult communities that provide safe, active, and assisted living for senior adults. It is not an easy task to select five from such an extensive list and it is even harder because the interests as well as the needs of people differ so greatly. The good news is that regardless of what your own particular needs and wants might be there is one that will make your list as the top in the country. The following list is my top five Active Adult Communities in the United State.

* Saddle Brooke in Tucson, Arizona. This Arizona active adult community is one of several in the Robson chain located in Arizona and Texas. It is located near the art and culture of Tucson, Arizona, and features a 36 hole golf facility. It is also close to restaurants and shopping, and has a fitness center and several pools onsite.

* Osprey Cove in the St. Mary's River Basin of Georgia. This Georgia active adult community features a view of Georgia's vast tidal marshland. Money Magazine called Osprey Cove the "number one small town in America." The community features a year round championship golf course designed by Mark McCumber.

* Island Pointe in Merrit Island, Florida. This Florida active adult community features condos with six different floor plans overlooking the Intercoastal Waterway. The Recreation center has basketball courts, tennis courts, a heated swimming pool, and a sauna.

* Beach Villas at Ko Olina, Hawaii. Located on the western side of Honolulu, Hawaii, this beachfront active adult community is the dream come true tropical paradise. It is on the famed Wainanae coast, and features everything one would expect from a Hawaiian beach resort. The rooms all feature natural wood and natural colors that invoke the spirit of the islands and of the sea.

* Yosemite Gardens in Clovis, California. This California active adult community is located near Yosemite National Park, and is famous for the food service that makes it seem more like a fancy restaurant than a retirement community. It has a full variety of social and outdoor activities available, and offers assisted living homes as well as independent living homes.

Your list may differ widely, but these are certainly among the top communities in the country. It would be hard to top them for the richness of the living experience they provide or the beauty of the area around them.

3 Common Signs of Nursing Home and Adult Care Negligence

Many times negligence that occurs in a nursing home or adult care setting can be prevented. The key is to understand the signs of the neglect before it becomes to severe where it cannot be handled. Below are three common types of nursing home and adult care negligence and the plans that should be in place to correct them.

1. Pressure Sore:

A pressure sore is a sore that occurs over a bony area of the body. Pressure sores are only caused by lying in the same position for too long. Pressure sores are usually found on the buttocks, over the tail bone, on the hips, and on the heels. If the resident is immobile or confined to bed, you need to find out what the nursing home is doing to prevent the resident from developing bed sores. There are a number of things that can be done to prevent bed sores, such as:

THE PLAN

• Turning and repositioning the resident at least every two hours;



• Elevating or floating the heels;



• Using a special mattress;



• Good nutrition and hydration;



• Keeping the resident clean and dry.



• If the resident gets a bed sore, it is important to make sure that the nursing home:



• Tells the doctor that the resident has a bed sore;



• Keeps all pressure off the bed sore;



• Checks the bed sore every day to make sure it is not getting any worse;



• Has in place a plan of care to make sure the bed sore does not get any worse;



• Has in place a plan of care to treat the bed sore;



• Ensures that the resident gets the proper nutrition;



• Ensures that urine or feces does come in contact with the bed sore.

If the resident gets a bed sore, you may want to take photographs of the bed sore during the times that the nursing home is changing the dressing. Never remove a dressing on a bed sore yourself. Simply ask the nurse when the dressing will be changed. Then, when the nurse is changing the dressing, take a picture of the sore.

2. Fall:

A fall is defined as an incident, whether seen or not, where a patient is found on the floor. Injuries from falls can be devastating to nursing home residents. Falls can result in fractures, dislocations, lacerations, and head injuries, including deadly subdural hematomas. Many nursing home residents sustain hip fractures in falls. Hip fractures usually require surgical repairs. Statistics show that 50% of all nursing home residents die within one year of hip surgery. Many residents die much sooner as a result of surgical complications and pneumonia.

It is important that the nursing home immediately assesses the resident to see if the resident is at risk for falls. Many things place a resident at risk for falls including, a history of prior falls, medications, strokes, poor safety awareness, instability, a new and unfamiliar environment, poor lighting, improper shoes or socks, slippery floors, and the wrong equipment.

THE PLAN

There are many things a nursing home can do to help those residents who are at risk for falls:

• Put the resident in a low bed;



• Use safety mats next to the bed;



• Put an alarm on the bed, wheelchair and resident;



• Place hip protectors on the resident;



• Take the resident to the bathroom every two hours;



• Timely answer the call light;



• Use a bedside commode;



• Seatbelt on the wheelchair.

When the resident is at risk for falls, it is important to make sure that there is a plan in place to address the risk for falls. If the plan does not work, then the nursing home needs to come up with a new PLAN. Restraints should rarely, if ever, be used. After consultation with the doctor, the nursing home, and after all else fails is the time you should even consider restraining your loved one. If you do decide to restrain your loved one, then there are many legal requirements for the use of the restraints.

3. Urinary Tract Infection:

A urinary tract infection usually results from bacteria getting into the urinary tract. This can occur from the nursing home's failure to keep the resident clean and dry.

THE PLAN

If the resident is kept clean and dry, they should not develop a urinary tract infection. Urinary tract infections are difficult to identify. If you notice a change in mental status or a fever, that is usually the first sign or symptom of a urinary tract infection. If those signs are present, the nursing home should notify the doctor, perform a blood test and take a urine culture. Untreated urinary tract infections can lead to deadly blood infections. So, it is important that urinary tract infections are identified and quickly treated.

This article has been prepared for informational purposes only and not as legal advice. The reading of this article does not constitute an attorney-client relationship. An attorney-client relationship does not begin until the attorney is hired to represent your claim in writing. Please do not act upon any information read within this article without first seeking legal counsel within your state.

How to Choose the Best Homecare Agency For Your Loved One

When it comes to caring for your elderly loved ones, you expect and they deserve the best care available. Many local families depend on homecare agencies to provide a high level of in-home help. Homecare companies offer a wide variety of services, such as dressing, bathing, toileting, cooking, housekeeping, championship, and running errands. Not surprisingly, homecare has become a popular option to care for people who are well enough to remain in their familiar surroundings rather than face the challenges of nursing homes and assisted living centers.

Choosing the right homecare companies for your loved one is certainly one of the quintessential requirements in making sure he or she gets only the best service and protection.

Why Homecare is the Way to Go
A homecare agency is essentially a company that's well equipped to perform non-medical elderly care. If you require qualified and experienced homecare services, it's important to research local homecare companies so you can make an informed decision. After all, you're placing your loved one's care and well-being in the hands of a caregiver that you have to be able to trust.

What to Look For in a Homecare Agency
There are many factors to consider as you search for the best homecare agency. The following tips should help narrow down your options:

• A homecare agency should be able to administer services that are thorough and competent. Without these two essential traits, the company is ill-equipped to handle the ongoing and evolving needs of your loved one.

• A good homecare agency also supervises its personnel and is responsible for any liability that may arise from a caregiver failing to administer the proper care.

• It is also good to know how long a particular Long Beach homecare agency has been in business. Choosing a company with ample experience and a long track-record of exceptional care and service will help you-and your loved one-rest easier.

• Another factor to consider is how well homecare providers can provide you with information about their history, areas of expertise, and people and processes. Are they able to comprehensively explain their services and fees? Are they able to furnish you with a complete outline of the rights and obligations from their end and yours? Can you interview the caregiver they will be sending to the house? Will your loved one have the same caregiver or will different caregivers be providing services? These are just some of the most common questions they should be able to readily answer for you.

• Last but not least, a Long Beach homecare agency should be licensed and meet the requirements set forth by the state.

Making the Final Choice
As with any major decision, it is helpful to seek referrals from trusted sources who have already gone through the process. Furthermore, there are various organizations out there that list and rate reputable homecare companies.

Along with the aforementioned tips and creditable referrals or recommendations, you're sure to choose the right homecare agency for your loved one's needs and lifestyle.

When Seniors Can No Longer Live Alone

My mother was 80 when my father died. She still drove, was relatively healthy, had an active social life, and had good friends nearby and a supportive church community. With a little help from her children and hired helpers she was able to manage the household and handle all the tasks of daily living. Two years later she voluntarily stopped driving. Then she had some health problems. Gradually her friends left the neighborhood. Then she fell a number of times, suffering minor injuries.

Friends and family did everything we could think of to improve her situation. We encouraged her to hire more help. We called and visited more often. We made small changes in her physical environment to make it safer: installed grab bars, removed throw rugs, signed her up for a medical alert response service, moved the microwave so she could reach it easier, etc. Still, she fell and fell again.

When she went into the hospital for a pacemaker, we started thinking about whether it made sense for her to return home after rehab. Over the years she had told us emphatically that she wanted to stay in her own home, and asked us to help her make that happen. How could we suggest to this fiercely independent woman, that maybe it was time to move? We tried to find more ways to ensure her safety and a good quality of life at home, and eventually decided to talk to her about our concerns.

How do you know when an elderly person can no longer live alone? Of course, there's no easy answer to this problem that is increasingly common as people live longer. There are, however, signs that families, caregivers, and the seniors themselves can look at in order to assess the situation, including:

• Uncharacteristic behavior
• Mental confusion
• Forgetfulness
• Falls
• Weight loss or gain
• Social isolation
• Depression, lack of interest
• Acute changes in appetite, energy level, sleep patterns, social interactions, housekeeping, or appearance
• Difficulty taking medication correctly and performing other health-related tasks

Evaluating a senior's situation and making a list of concerns makes it easier to take a rational look at this emotionally charged issue. Caregivers and seniors can go down the list and figure out if anything can be done about each concern. Social isolation might be lessened by time at a senior center, for example, where activities keep seniors engaged and active. A walker, handrails and "grab bars" in important places like bathrooms and hallways can reduce the risk of falling.

A list of concerns lets you take an orderly approach to the problem. When you can no longer match each concern with a viable solution, it may be time to consider other "aging in place" accommodations or moving to a fully supportive environment, like an assisted living community. It goes without saying that the senior needs to be an active participant in the process. Just because an elderly person is having difficulty performing certain tasks does not mean he or she is unable to think, reason, and make decisions.

The end of independent living is a major life transition; it's a process that takes time. Respectful communication between family members, caregivers, and the senior will help bring the discussion to a positive conclusion-but don't expect it to happen overnight.

The Human Resources Role in Creating a Leadership Development Blueprint

This is a supplement to a recent Ezine article of mine called "Creating a Leadership Development Blueprint for Your Organization." In that previous article, I said our Human Resource (HR) department provided the "life" of our program. What that meant is their encouragement to create a work performance measurement model within the operations division that would fit within the bank-wide performance assessment process already in place provided us with a great learning tool.

HR gained much by that encouragement because of the increased credibility of the leaders when making recommendations for promotions, salary increases, bonus, or simply annual wage increases. As the credibility of the operations leaders increased, the "defensibility" of any actions they took increased which made Human Resources very happy!

Other valuable contributions of HR to this program were:

• Leading the "Ask HR" segment of every monthly leadership meeting. They also made sure they sat in the front row and were highly visible and accessible.


• They assisted first-level supervisors with interviews of applicants.


• They made an effort to attend every presentation made by participants within the existing Leadership Development (LD) program such as project results and financial proposals as well as quarterly meetings with the participants in the Future Leaders program.

Their very active support for the program was explained one day by one of their key people:"As our division gains more high quality leaders and we have fewer remaining 'bosses', our headaches diminish. So actually we are being very selfish: it's in our best interests to help you make our jobs easier!"

Useful Metrics

Progress in any successful business environment depends on the presence of reliable and meaningful metrics. Without some method of measuring progress toward predetermined goals, we will have no method of knowing if we are making progress or even going in the right direction.

Your organization should already have some meaningful metrics in place through which they monitor their progress. Many of these can be used to measure the impact of your LD program. We suggest that you preserve as many scores as possible that coincide with the introduction of your LD initiative. This way, you have a benchmark against which to measure the impact of what you are doing.

First a caution. Look back at prior business performance trends so you will have some indication of an expected baseline of performance that will occur during the same time period forward from the introduction of your initiative.

In other words, you still want to know what levels of performance are forecast without the LD program so that anything above those expected levels are probably attributed to your leadership initiative. (Results should begin to show about 3 months in if you're diligent with metrics.)

Another warning is something called the Hawthorne Effect. Briefly, this came from a work study which was conducted in the early days of management science at a production plant near Chicago. The intent was to study the impact of various amounts of illumination on productivity.

Strangely, regardless of how the light levels were manipulated, production kept rising until it become so dark that workers literally could not see what they were doing well enough to continue and production finally fell. After much analysis, it was determined that they workers were simply responding to the attention they were getting being studied, not to the amount of illumination.

All of that to say this: Any early improvement in performance at the beginning of the program may just be the attention they are getting and the novelty of the situation. Do not put too much stock into the early positive numbers until they have created a trend of perhaps three to four months. Long enough for the novelty to wear off.

If you do not have as many metrics as you would like, here are some things to consider.

There is an old management saying that typifies the perceived value of measuring things: "What gets measured gets done."

Since long-and short range goals are built around metrics, as well as our methods of tracking progress toward them, it is very desirable that someone considering the installation of a leadership development program - this is probably someone from Human Resources - become more familiar with them.

Unfortunately, there are no HR profession-wide agreements on what to measure and how to do it. Unlike established professions like CPAs, Financial Planners, or scientists, where there are universally agreed-upon methods for measuring nearly everything as well as the reasons to measure those things, there are no such standards yet for HR Professionals.

The evolving profession of Human Resources is not that far away from its roots as the Personnel Department whose primary functions were to recruit, hire, and fire. As it matures, those universally understood and applied metrics will begin to appear and solidify as part of the body of knowledge.

So if you (may we call you a HR Strategic Partner?) are considering the installation of a program like this, you may wonder, "What metrics should we use?" There is a simple and obvious answer here. It's from Alice in Wonderland" and involves the whimsical philosopher, the Cheshire Cat.

"One day Alice came to a fork in the road and saw a Cheshire cat in a tree. 'Which road do I take?' she asked. 'Where do you want to go?' was his response. 'I don't know', Alice answered. 'Then', said the cat, 'it doesn't matter. When you don't know where you are going, any road will take you there.' (Lewis Carroll, Through the Looking Glass or the Adventures of Alice in Wonderland)

The question, "what metrics should we use" is basically the same as Alice asking, "which road do I take?" And, like the Cheshire Cat, our answer is basically the same: "When you don't know what you're measuring, any metric will work."

A very critical thinking process that is essential for a HR Strategic Partner is to consider the cause-and-effect sequence of events that lead to any outcome. Always ask yourself, "What led to the outcome we saw?" or "What needs to happen to lead to the desired outcome?"

The reason we mention the "cause-and-effect sequence" is this: we determine which metrics we should use by asking, "what outcomes are we talking about?" ("If you don't know where you're going, any road will take you there.") In other words, just because we CAN measure something doesn't mean we SHOULD!

The metrics we use in business should always be in support of our organizational goals. If the organizational goal next year is an increase in profits by 5%, then the HR Strategic Partner should ask, "what activities and their included measurements can lead to a 5% increase in profits?"

(A public sector organization's goal may be to reduce expenses by 5% next year. Since the public sector does not measure profit, they can and should measure efficiency which can lead to a reduction in expenses.)

Typical areas for improvement can be those monitored by the bank in our earlier article:

• Wage expense dropped by 18%


• Overtime expense from 8.34% to 2.3%


• Productivity increased by more than 20%


• Accuracy increased by 3%


• Corrections and adjustments ("rework" in non-bank jargon) dropped 51.5% and 8.2% respectively.

It is easy to see how that much of a reduction in expenses would go directly to the profit line in a business.

If you feel there are not enough metrics to help you document the impact of improving leadership in the organization, here are a few that may be useful to build a business case for the program. These are some common HR metrics that are used in different places for different reasons. You can decide which works best in your situation.

Remember two key criteria here:

1. Only measure what we NEED, not what's easy. This is a variation on saying just because we can measure it doesn't mean we should. (99% of the time the data we need supports decision making. The remaining 1% of data collection is for government data which doesn't necessarily support business decisions.)

2. Only collect data that helps make decisions toward business goals.

Measurements that may be useful for you are:

• Human Capital Return On Investment [we will refer to it as "HR ROI"]


• Revenue per Employee [RPE]


• Workforce Development Ratio [WD ratio]


• Profit per Employee [PPE]


• Labor Cost as a Percentage of Revenue

Please remember that trends in scores tell you much more than just a single measurement. These metrics are useful only to determine trends of things getting better, worse, or not changing at all.

Human Capital ROI (HC ROI)

The rationale for this is to illustrate the relationship between human capital investment, productivity, and profitability. HC ROI is the pre-tax profit an organization generates for each dollar invested in regular employee pay and benefits after non-human expenses are removed. Also note the organization must separate compensation and benefit expenses from normal operating expenses for this calculation to work.

HC ROI = (Revenue - operating expenses - (compensation + benefits costs))/ (Compensation + benefits costs)

Sample:

Revenue = $23,432,819 Operating expenses = $13,587,952

Compensation = $2,975,218 Benefit costs = 32% of compensation costs

HC ROI = ($23,432,819 - $13,587,952 - ($2,975,218 x 1.32))/($2,975,218 x 1.32)

HC ROI = ($23,432,819 - $13,587,952 - ($3,927,288)) / $3,927,288

HC ROI = $5,917,579 / $3,927,288 = 1.506

You may ask: "So what does the 1.506 mean?"

The answer is, "Nothing by itself. It's just a data point for reference. We will need many more to create a trend so we can tell if it is changing in a way that helps the business or harms the business."

Revenue per Employee [RPE]

This metric allows a company to determine its revenue per employee (full time equivalent abbreviated as FTE). This is widely considered a basic measure of a company's productivity. When combined with the Workforce Development Ratio (the next measurement), it allows a company to determine the impact of Workforce Development initiatives on the bottom line.

For example, if your company's RPE increased by 8.3% while the WD ratio has increased only 2.25%, it would indicate that you are getting a good return on your WD efforts.

Sample: RPE = Revenue/FTE There are 147 FTE employees and revenue is $23,432,819

RPE = $23,432,819 (revenue) / 147 (FTE employees) = $159,407 per employee

Executive question to the HR Strategic Partner: What is the easiest way to increase the RPE ratio?

HR Strategic Partner answer: If there are fewer employees across which to spread the revenue, the RPE will increase. (Note: Although it may be the best business answer, it may not be the best "human" answer. This takes a lot of careful consideration.)

A warning here is that the RPE can be manipulated to produce favorable outcomes by reducing the number of FTE. Although managing the size of the work force is a business obligation, a HR Strategic Partner will caution the executives about cutting "too close to the workforce bone" because there is a critical mass of employees that must be present to sustain the revenues.

As you become more skilled at measuring work efficiency and the productivity of employees using the measurement examples we have present in this manual, it will become easier for you to define that necessary critical mass of employees.

Additionally, as your Leadership Development program begins to gain root in the culture, you should start seeing the RPE number getting better without a reduction in workforce.

Workforce Development Ratio (WDR)

This identifies the ratio of the entire budget that is invested in workforce development. It is more important that the factors a company uses to determine the WD factors be consistent than "philosophically pure".

For example, whether a day spent in training class should be broken out as a WD expense or remain as a wage expense is less important than we consistently calculate it the same way every time!

WDR = WD Expenses / Total Expenses

Sample:

Operating expense budget for this year = $13,587,952

Compensation + benefits costs = $3,927,288

Workforce Development budget = $478,500

WDR = $478,500 / ($13,587,952 + $3,927,288)

WDR = $478,500 / $17,515,240

WDR = 2.73

I caution against the use of this unless you have a strong training program that:

• Allows you to document how the training supports the business goals


• Has a secure learning assessment (test) at the end of each training segment (Note: our website can provide this for you) with results documented


• Implements a method of reinforcing the training back on the job.

If you cannot show evidence of a consistent and competent training design, you will have handed the executives a big budget cutting target.

They may see this money spent as a wasted expense, not an investment in their workforce.

Profit Per Employee (PPE)

This takes the pretax profit an organization generates and attributes this to each FTE. This metric provides an integrated picture of productivity and expense control efforts.

Like the previous metric, combining this with the WDR is another way of determining if WD efforts are having the desired results.

Sample:

PPE = Pre-tax Revenue / FTE

Pre-tax revenue = $23,432,819

FTE = 147 employees

Operating expense for this year = $13,587,952

Compensation + benefits costs = $3,927,288

Profit = Pre-tax revenue - operating expenses - (compensation + benefits costs)

Profit = $23,432,819 - $13,587,952 - $3,927,288

Profit = $5,917,579

Profit per Employee (FTE) = $5,917,579/147 = $40,256

Executive question to the HR Strategic Partner: "If our WDR has increased from 2.73 to 3.41 while our PPE has increased by 9.74%, is that good news, bad news, or no big deal?"

HR Strategic Partner answer #1:

A WDR increase from 2.73 to 3.41 is an increase of 26.3% [(3.41-2.73)/2.73]. If the PPE grew by 9.74%, I would want to know how much the PPE could have grown if the WDR number wasn't so high since I do not have much faith in our workforce development (training) capabilities.

Since I have little faith in them, that's BAD NEWS!

Or HR Strategic Partner answer #2:

Since I think we are on the right track in developing our training capabilities, I think that by sharpening our workforce development skills, we can get that number lower which should lift our PPE slightly.

Since I like the way the training is evolving for the better, it's GOOD NEWS for now and I think it will get better quickly.

This should also help you see how valuable a strong workforce development resource can be.

Labor Costs as a Percentage of Revenue

This looks at the percentage of revenue dedicated to compensation and benefits costs for regular employees. It provides insight into an organization's benefits and compensation programs.

Over time, this measurement can show if the organization is obtaining a higher or lower return on dollars invested in the workforce. Combining this with the WDR, the RPE, and PPE is another way to determine if WD activities are positively affecting your organization.

Sample:

Given these conditions:

• Our WDR has increased from 2.73 to 3.41


• Our PPE has increased by 9.74%


• RPE has increased 12.76%


• Labor costs $3,927,288

Executive question to the HR Strategic Partner: If our labor cost as a % of revenue has remained relatively steady, is that great news, good news, or no big deal?

HR Strategic Partner answer: If labor costs are staying steady with revenue - the percentage of revenue, we are not making much business progress.

The best situation is when we develop our workforce and work processes to maximum efficiency and productivity so revenues will grow at a FASTER RATE than labor costs. That way, the % of labor costs are declining.

Sample

Labor Cost as a % of Revenue = Compensation + Benefits Costs

Revenue

Labor Cost as a % of Revenue = $3, 927,288 / $23,432,819 = 16.7%

Lessons Learned

Every meaningful project should include a "Lessons Learned" segment in its wrap up. We will do the same here in a stream-of-consciousness mode which is one of the easiest methods of conveying information.

These items are in no particular order but are important to mention within the context of creating a Leadership Development blueprint.

• "You can't do things the way you always have and expect different results"


• Attributed to Albert Einstein as a definition of insanity, it makes a lot of sense here. Many organizational cultures are deeply rooted in the past and it will not be easy to install a program like this too widely at first.


• Try it in a smaller unit with a very strong executive champion who will support the new ideas that you are hoping will lead to new results.


• Training without a leader's involvement before and after the event is a waste of time and money

There is simply no way this program could have succeeded without the weight of our executive sponsor behind us. He made sure that "What have you done to develop your people since our last meeting?" was asked at every staff meeting he had and insisted that his direct reports include it as a fixed part of their agenda, too.

• Information and knowledge are not the same: we can speed information gathering but cannot speed getting the experience that leads to knowledge


• The fact that a participant can get them easily, study them intently, take an online test, and receive a certificate of completion in a matter of hours does not mean they have knowledge of the subject.


• That only comes from experience gained by applying the concepts taught. Please do not allow someone to create artificially early expectations of results.


• Patience - it may take at least 6-12 months to see improvements in the participants

It may take a while for people to feel safe enough in their understanding of the material and their trust in their leaders to begin applying what they have been taught. (The presence of a strong executive leader will speed this transition.)

Once they begin to apply it, it may take some time for the changes to ripple far enough, long enough, and strong enough to become measurable.

Think of this like planting a flower garden. You place the seeds in the ground, water it and nurture the area as much as you can and have faith that you have done it right and the shoots of new plants will soon begin to appear. You do not dig it up to see if it's growing!

• Many parts of this program are simultaneous, not sequential. Don't expect nor always insist on a linear pathway.


• As participants moved farther into the program, some seemed to grasp material faster than they had earlier. Their questions began to become more relevant and work specific.


• And as much as we wanted to control the growth and direction of the program, it began to have a life of its own and we were getting requests for participation from areas outside of Deposit Operations.


• There must be a "visible" structural component and an "invisible" cultural component for this to succeed.

The visible component was the structured sequence of progression through the freshman - senior levels with specific milestones along the way. This provided participants with a sense of accomplishment and could measure their progress against friends in the program.

The invisible cultural component was the belief that a leader could try something new, that making a mistake trying to improve a situation would not be a career killer (see Leadership Principle #7 in the previous article), that managers were being asked by their superiors "what have you done to develop your employees?", that a legitimate climate of change for the better was sweeping the division.

• You must be willing to allow participants to fail as part of their learning process. Could your organization tolerate temporary failure?


• If your organization's first reaction to an employee mistake is to launch a search for the guilty, you will never become better than you are today.


• Developing leaders requires pushing decision making as low as possible; are you willing to allow them to...


• Prepare and manage their part of the budget?


• Authorize expenditures up to an amount?


• Learn how to forecast market demand and capacity in relation to their productivity?


• There IS NO CORRELATION between the cost of your LD program and the results you should get!

Results vary DIRECTLY with the amount of training application, discussion, feedback, and management support within the organization. Do not let some high pressure sales person with a big corporate training name behind them make you believe it.

• You must roll out the program from the top down.

Although the most senior levels probably will not be willing to go through an entire course, you can give them the course outcomes and show them what to expect as a result. It is important they understand what is in the courses and what their subordinates will be learning. (If they don't know what's in the material, how can they reinforce it?)

Mid-level managers must go complete all of the courses but may balk at being awarded the freshman-senior levels of completion. Try to help them understand they are the role models for the lower leadership levels and it is an inconsistent message to show "do as I say, but not as I do."

The more examples that the lower leadership sees of the higher levels "buying into" the program, showing up in monthly meetings, and asking what they have learned lately will speed the emergence of a leadership culture in your organization.

Then, as current leaders in the program move upward and their slots are filled by graduates of the Future Leaders program, you will a constant improvement in your profit numbers.

• A strong HR REPRESENTATIVE to provide the 'life" of the program

This is what a strong HR presence did for our program:

• Allowed modification of the existing performance assessment process within our division to include locally-developed measurable standards and self-monitoring opportunities for employees.


• Added requirement for employee development evidence by leaders and employees as core performance elements within our division.


• Required and enforced quarterly progress meetings with LD program participants and their leaders within our division.


• We devised a series of minimum questions to ask at quarterly performance progress meetings with employees. The emphasis was to put the responsibility for their goals on the employee's shoulders.

The first quarterly performance meeting of the year had a minimum of two questions:

o "What are your goals for this quarter?"

o "How can I help?"

All subsequent quarterly meetings had a minimum of five questions that must be asked:

o "What were your goals for this quarter?"

o "How did you do?"

o "How do you account for the results?" (Whether above, at, or below expectations... simply explain how you arrived there. This gave the supervisor a chance to reinforce the good behavior resulting in exceeding the goals, or coaching or counseling about the behavior for lower results. In all cases, there was an analysis with the leader of what led to the results per Leadership Principle #6.)

o "What are your goals for the next quarter?"

o "How can I help?"

Being able to make the correct leadership choice requires that your participants:

• Understand the "big picture".


• Have the latitude to make a decision.


• Have sufficient resources available to support their decision.


• Do not fear retaliation for being wrong.


• Have a leader who has learned how to coach and counsel effectively for feedback on their decision.


• You CAN build a program like this yourself as long as you recognize your organization's limitations.


• Make it as good as you can and get started - you can adjust along the way!


• On line, self-study, and live classes are only as effective as the opportunity to reinforce the learning.


• The money you spend on professional help (if you choose to use a consultant for some of the more complex areas) can be recovered in the improved leadership.


• Strong management support can make lower-priced training content very effective.


• High-priced training content (alone) CANNOT make up for lack of management support.


• High tech delivery does not mean greater comprehension ("information" is not "knowledge").

Thank you for reading this article (and its predecessor, we hope) and wish you the best of luck if you're using this to research an actual Leadership Development initiative.

Please don't hesitate to contact me through our website if you need some clarification or help along the way.