Medicare Alzheimer's Coverage - Are Nursing Home Costs Covered?

Alzheimer's disease is a form of dementia that affects older adults. It is a progressive disease characterized by declining memory and cognitive ability. Although some medications may help to alleviate or delay the progression of symptoms, there is no cure.

According to a 2008 report released by the Alzheimer's Association, an estimated 5.2 million Americans currently suffer from the disease. It is the most common form of dementia, afflicting 1 in 8 persons over the age of 65.

Medicare, a federal health insurance that covers people age 65 and over, provides limited coverage for Alzheimer's patients.

Prior to 2002, all Medicare beneficiaries diagnosed with Alzheimer's had been automatically denied reimbursement on the grounds that the disease was incurable, and medical treatment was ineffective.

Thanks to a governmental policy change in 2002, Medicare no longer denies claims for mental health services, home health care, or hospice care for these patients.

However, Medicare coverage for the care of Alzheimer's patients is still restricted. Medicare does not cover assisted living, senior housing, adult day care, or long-term nursing home care.

Medicare Part A (Hospital Insurance) will pay a limited fraction of the cost of care in a skilled nursing facility, but only if several requirements are met. First, the patient must have been hospitalized for at least three days for a medical condition. Second, the patient must be admitted to the skilled nursing facility within 30 days of being discharged from the hospital. Third, the patient must be admitted to the skilled nursing facility for the same condition for which he or she was admitted to the hospital. If all of these requirements are met, Medicare will pay in full for only the first 20 days in the skilled care facility. Days 21 through 100 will require a co-payment of up to $128 per day, and after day 100, Medicare payments will cease altogether.

Coverage of home health care is similarly restricted. Medicare Part A may pay for up to 100 visits, but only if the patient is also covered by Medicare Part B (Supplemental Health Insurance). To qualify, the patient must have spent at least three days in a hospital or skilled nursing facility, and be discharged within 14 days of the start of home health care services. The patient must be confined to home under a physician's orders.

Hospice care is covered if the patient is terminally ill and expected to have less than 6 months to live. Medicare initially covers two periods of 90 days, followed by an unlimited number of 60 day periods.

Signs of Elderly Theft

Placing your elderly family member in an assisted living facility or retirement facility can be a challenging decision for a family to make. Whether your family member requires care that you are unable to give or they live away from anyone who could provide them with care, an elderly care facility may be the best option for your family. Though this decision may be in the best interest of an elderly family member, there are real risks that should be considered and acknowledged when making this decision. Theft and fraud does occur to elderly adults and often by a close caretaker or assisted living facility employee.

The National Research Council Panel to Review Risk and Prevalence of Elder Abuse and Neglect has reported that over 1 million elderly adults have suffered abuse or have been exploited by a caregiver. This shocking number includes a number of different types of abuse, one of which is theft and fraud. Cases of elderly theft can even be as extreme as involving kidnapping and other threatening behavior. Though this is not the norm in a elderly care facility, it is something to inquire about when visiting any facility.

Elderly fraud can be prevented if a family is aware of suspicious behavior by their elderly family member. This may come in the form of sudden, unexpected changes in bank account access or transfers of funds. This may also include a change in a will or other important document. Any checks that are written as "loans" or "gifts" may also indicate irregular financial behavior.

For more information on what you can do in a case of elderly theft, please visit the website of the San Antonio nursing home abuse lawyers at Stouwie & Mayo.

How to Find a Reliable Car Accident Lawyer

When you meet an accident, you will be traumatized by the experience and make you susceptible to committing errors in judgment which you don't need at such a moment. Chances are you may require the services of a reliable car accident lawyer and you will have to quickly find one to protect your interest. In the internet you can easily come across websites that feature legal services where you can choose a good lawyer. There are considerations that you have to evaluate before hiring the lawyer who will represent you in the compensation claim for injuries and losses caused by the accident.

You have to be sure that the lawyer you are considering has adequate experience in handling personal injury claims. This can be deduced from the record of car accident cases won by the lawyer in the past. Having a reputable transport accident lawyer to handle your claim has a great influence on the attitude of insurance representatives who generally do not want court litigations and prefer to settle matters outside the courtroom. When you hire a car accident lawyer you have to be clear on how he wants to be paid for his services. Some lawyers want to be paid on an hourly basis but most personal injury claims lawyers go for a percentage of the compensation which usually is in the vicinity of 30 to 40 percent of the settlement. This means that your lawyer will be paid only if he is successful in pursuing your claim for compensation.

Good lawyers are usually members of an association of lawyers. This is a good indication of their good standing in the community. If you want dig deeper into your lawyer's qualifications, you may want to check what schools he attended in obtaining his career in law. After gathering all these information about the lawyers whom you are contemplating to hire, your choice will be a lot easier to make.

You should not expect lawyer to be a magician and do all the work for you. You have to cooperate with your lawyer and furnish him with all the information he will need in pursuing your claim. You have to act promptly because there are limits to the time you are given within which to file your claim. Always seek for other possible legal options since the amount of settlement you receive depends greatly on the legal services provided by your car accident lawyer.

Aging in Place: Tips for Living At Home As Long As Possible

Part of the long term planning we do in Elder Law involves coordinating where seniors will live their twilight years. Two factors that strongly influence the outcome are the following: First, that seniors prefer to stay in their own homes for as long as they possibly can. Second, that the Great Recession has caused such hardship that elders are no longer as financially able to leave their homes to enter senior communities and assisted living facilities.

Needless to say, there are many financial considerations to take into account when it comes to aging in place. However, just as important, and often overlooked, is the actual physical layout and condition of the home.

Most homes are built to be suitable for people who are young, healthy, and mobile. As people age, however, their home can present challenges that make living in the home uncomfortable, difficult, and even dangerous. With proper planning and some remodeling, however, seniors' homes can remain comfortable and elder-friendly.

Lighting, for example, is important to all people, but particularly so for older people. The home should be well lit, with easy to operate switches. Designers suggest equipping many of the lights with dimmers, so that the lighting can be maintained at a comfortable level, and increased or decreased as needed. Consider rocking switches, which can be easier on arthritic fingers than a traditional light switch.

The bathroom can be a major obstacle to aging at home. Many seniors suffer from arthritis, joint problems, and limited mobility. This can make getting into a traditional shower or tub difficult. A good solution is to replace the tub or shower with a walk-in shower that, if possible, is large enough for two people to sit or stand in comfortably. This will make it easier for a caregiver to assist with bathing if it becomes necessary. If grab bars are not added at this stage of the remodeling because they are not immediately needed, it would be wise to reinforce the walls so that grab bars can be installed in the future. A temperature regulator would also be a good idea to install in the shower or bath, because older skin is less sensitive to heat and can easily be burned. Consider installing a bidet.

Flooring is another important consideration. As seniors become less mobile, they can easily trip on rugs or have problems walking on carpet. A practical alternative is to install hardwood or laminate flooring that is smooth, easy to walk on, and reduces the possibility of tripping. Hardwood or laminate flooring is also a practical solution if the occupant needs to use a wheelchair or walker. Just make sure the flooring has enough friction and is not slippery.

Other useful modifications include to use drawers instead of cupboards or cabinets where possible, raise dishwashers and low cabinets to avoid excessive bending, widen doorways if possible to accommodate a wheelchair, and design an entryway that does not require a step. Many geriatric care managers suggest that your home be modified so that you can live on the ground floor if necessary. This may require installing a bathroom on the first floor, or expanding an existing half-bathroom to a full bathroom.

As baby boomers plan for the future, they are taking into account modifications they can make to their homes now to prepare for their later years. Manufacturers have also started developing product lines to meet the demands of an aging population that wants to age in place.

If staying at home for as long as possible is important for you or your loved ones, take steps now to put plans and modifications in place to facilitate this goal.

The Shocking Truth And Real Solutions

The reader is urged to make his own conclusions after reading this article. Everyone is independent in making their own choices for their own lives. Take what helps you from this article and use it to keep yourself healthy. If something you read here does not apply to your life or your current situation, then pass that information on to others whom it might help.

Choosing independence instead of depending on a nursing home or physical rehabilitation and care center can be the difference between life and death for you.

If this sounds unbelievable to you, do some research on the net and see what info is available to you about nursing homes.

Most of the stories that you hear about nursing homes are true. Society sometimes paints a picture of nursing homes or assisted living homes being the epitome of freedom and independence for senior citizens. But in reality, some of them are more like prisons than they are like hotels. If you are sitting in your own living room reading this and if you are dreaming that when you get older you will retire to a nursing home, think it over. Think again, and please reconsider your retirement plans. Depending on where you are located, depending on the individual place that you choose, your future life could resemble the life of an inmate, only you will have willingly given away your freedom by choice. You could sit there and think that I am exaggerating or you can keep an open mind and hear me out. Listen to what you might have to live with if you choose to live the rest of your days in a nursing home.

You might have to:

• Spend hours each day sitting in an uncomfortable wheelchair even if you do not need a wheelchair.
  
  
  


• Spend hours each day waiting to be accompanied to the bathroom or wheeled to the bathroom.
  
  
  


• Spend hours each day in a dining room that smells like it really needs to be cleaned.
  
  
  


• Spend hours each day trying to figure out where your own clothing is.
  
  
  


• Spend hours each day begging staff to bring clothing to your room so that you can leave your room.
  
  
  


• Miss your rehabilitation therapy because the staff lost your clothing and you are not allowed out of the room without your clothing.
  
  
  


• Spend days and even weeks waiting for a phone call because you have no phone in your own room and no staff will pick up the pay phone when it rings.
  
  
  


• Eat what they bring you even though you did not order that food. And beg them to change your menu even though you have put your changes in writing and they have made the changes in writing but they still bring the wrong food to you.
  
  
  


• Beg and plead and cry for the staff to bring you to your room and wait for hours and hours to get help because they are short-staffed, especially on weekends.
  
  
  


• Wear other people's clothing because they have lost your own clothing. You will wear clothing that does not fit you. And you will wear clothing that is stained all because you have lost so much of your freedom while living in that nursing home.
  
  
  


• Be extra careful and extra vigilant when they are giving you your medication because sometimes they give the wrong medication to the wrong patients. (I saw in one instance where they were giving the wrong medication to a resident and thank God the resident noticed the mistake and stopped them. What if this resident had been mentally-disabled and didn't notice the difference? That patient would have been wrongly medicated and would have perhaps died.
  
  
  


• Lose your freedom of choice in so many areas of your life.
  
  
  


• Be exposed to seriously mentally-ill individuals that are bunked on the same floor that you are bunked on.
  
  
  


• Be at risk of being attacked by patients who wander the halls because they are physically-fit to do so but not mentally-fit to do so. This list is only the tip of the iceberg. I have not listed everything. You need to decide for yourself if you will remain independent or not.

Does all that sound horrible to you? Does all that sound unbelievable to you? Yes, it might sound that way. But reality is that all of these things can and will and did happen to residents in one or two nursing homes and rehabilitation and care centers right here in the United States of America. Just recently there was a news item that one resident died of bedsores and of maggots in his eyes. How in the world can a nursing home not notice a man develop maggots? The reality of this is that maggots would not first appear in a human's eyes but would first appear somewhere else on the body. The eyes are one of the last places that the maggots would appear. We know this just from knowing what happens to animals when they get fleas or other insects in their bodies. If you have a kitten or cat, and that animal develops fleas, the first fleas will appear on the body or tail. Once the animal gets infested with fleas, then the fleas will disperse to other parts of the body like the eyes and ears of the animal . Same thing with humans. Most likely those maggots first appeared on the human's torso or other body part long before the maggots progressed onto the man's eyes. Yet, this happened in a nursing home in the United States, not in a foreign country, but right here in the United States. After hearing this are you still thinking of living in a nursing home for your senior years?

Do this for yourself. Use a major search engine and put in the words nursing home, put yourself on alert so that you receive any and all news regarding nursing homes in America (or in foreign countries where you live). In less than one week, you will receive hundreds if not thousands of alert news bulletins that will bring you all the news that is related to any and all nursing homes in America or in your country. Most of that news will be bad news. Most of that news will tell you of all the horrible things that are happening to residents of nursing homes today. Try this and you will prove to yourself that every word that I typed here is the absolute truth. Do yourself a favor and do whatever you can do to stay in your own home and in your own apartment independent so that you never have to wind up inside a nursing home by yourself.

Near the bottom of this article there is a link for a page that tells you the truth about nursing homes and rehabilitation care centers in America. Check out that page if you ever consider living inside a nursing home. Check out that page if you ever are in need of services of a rehabilitation and care center as most of these therapy places are located inside of these nursing homes. Once you admit yourself to a rehabilitation and care center you are opening up yourself to the possibility of living in that nursing home for the rest of your life. I have actually witnessed someone go from mildly inactive (due to a surgery) to almost vegetative state due to the lack of care and negligence and malpractice inside of a rehabilitation center that was housed inside of a nursing home. Once the person was in the rehab center, they transferred him upstairs to the nursing home, in error and once he was upstairs the degree of care went from some to none. The center thought this person had no family so they proceeded to treat him like they treat many who have no visitors come there. And then one day when the visitor was able to finally visit, they found this patient laying in bed with nothing on but a diaper and t-shirt. The patient was not allowed out of the room without clothing and there was no clothing inside his room even though his family had brought over seven shirts and six pairs of pants, and underwear and t-shirts that were brand new. All of this man's clothing was lost and he was basically a prisoner in his room, in his bed due to that lack of care, lack of organization and due to the loss of all (not some) of his own clothing. Finally, when family mentioned the situation to staff, they scurried around to find someone else's clothing for him (because they could not find his own clothing). So that is what happened on weekends when the staff thought no one was visiting. Another weekend, family came upstairs and they were horrified at the odor on the floor that the family member was staying on. They got off the elevator and smelled this horrible smell throughout the entire floor and the staff didn't even seem to notice the odor. Was the odor from patients who were forced to sit in wet clothing and in wet diapers for hours at a time? What was the odor from? Even the dining room smelled of this foul odor. One family member of a different resident actually brought their own odor-repellent because they were almost vomiting from the odor on the floor. This is what some nursing homes are like.

Why isn't this on the front page of the news? It is not on the news because the nursing homes and rehab centers prepare the place and put it into better condition when they believe they will have the most visitors. In other words, during holidays or during the most heavily-trafficked visiting hours, the facility puts on more staff and assigns more staff to those areas where the visitors will be. By doing this, the nursing home and rehab centers can present a place that appears decent. Then once all the visitors are gone, the staff mysteriously disappears to somewhere else and hte conditions in the nursing home go back to the horrible conditions that existed before the visitors came. That day when the place smelled horrible, ti was very early--before the majority of the visitors came to visit. The place would smell like that horribly for hours, and then before the larger number of visitors were to visit, the staff would then get busy changing the residents diapers or getting the odors out of the rooms so that when the visitors came to visit they would see that -supposedly-- that residents were being cared for. No one would know the truth unless they had been there one or two or three hours earlier. (For example, if they expect the most visitors late afternoon on a Saturday, that means all Saturday morning, residents could go without their diapers being changed and no one would know and no one would care. That probably is what caused the horrible odor throughout the hallways that day. (A combination of diapers' odor and unclean floors and unclean laundry laying around in the hallways probably was the cause of the disgusting odor in the hallways). Why didn't the residents complain? They probably did. The ones that are able to be verbal do tell their family members what the place is like but when the family finally comes to visit, the family sees that the place looks nice and they think the seniors are making up stories. Another reason why this is not front page news is because usually when these places are having their inspections they are warned ahead of time and they have a chance to clean the place up. There is a vicious cycle going on in many of these bad nursing homes and no family members are aware of what is happening to their relatives. Do not kid yourself and do not be a Pollyanna when it comes to the subject of nursing homes and rehabilitation and care centers. These conditions exist and they exist today!

I urge you, that if your family member is complaining of horrible or bad conditions inside of a nursing home, please believe what they are saying to you, because most likely they are telling you the one hurndred-percent truth. You need to believe the residents if anyone is going to get to the bottom of the disgusting conditions that are happening inside of some nursing homes today. Now they have people trying to hide this condition and trying to tell people that the horror stories are not true or that they are exaggerated. When you hear this and when they tell you that , remember these words, it is really happening in some nursing homes and inside of some rehab and care centers, right here, right in the United States of America. It is happening right under our noses and not many are paying attention to it because they are not believing this could possibly be happening. You are reading the words that are telling you the truth. Some nursing homes and some rehab and care centers in America are treating residents and patients horribly and they are getting away with it because they can get away with it. I beg you to believe your family members when they complain to you about conditions inside of these centers.

The reasons why people end up in nursing homes:

• They cannot be left alone in their own homes or apartments because they have started fires with the stove or oven.
  
  
  


• They do not know when to take their medication or they forget to take it.
  
  
  


• They have flooded apartments because they forget to turn the water off.
  
  
  


• They let strangers into their homes and that puts them in danger.
  
  
  


• They wander off into the streets and their family has found them and put them in nursing homes.
  
  
  


• They have Alzheimer's or some other disease that makes it impossible for them to remain independent.
  
  
  


• They got an injury (i.e. broken hip) and they could not afford to stay in their own homes safely.

Those are some of the major reasons why older people or disabled people end up in nursing homes. (There are more reasons but those are some of the most prevalent reasons). Knowing these reasons and knowing the solutions to these problems can keep you or your family members independent and out of the vicious cycle and circle of nursing homes and physical rehabilitation and care centers. So, you are asking, what are the solutions to these above-listed problems?

WHAT YOU CAN DO TO REMAIN INDEPENDENT AND OUT OF NURSING HOMES AND REHABILITATION AND CARE CENTERS:

FIRES:

• Using microwave ovens (that have automatic timers) is one solution for the family member who leaves the stove or oven on. They can cook by microwave and thus be safe from oven or stove fires. What if your family member insists on using the stove or oven after they have already caused a fire? Close the gas off. Have the gas company come and close the gas off completely. When the gas company does this it is done in a safe way. (Use electric heat and hot water and keep the gas off). If you do not want to close the gas off, divide the house and keep the oven, stove and gas-operated appliances out of the rooms that the senior member has access to.

MEDICATION:

• Purchase timers or alarm watches to remind the person to take the medication. Keep a list on the refrigerator and a list near the television set with reminders of when to take the medication. Some seniors and disabled people are permitted to have home care or visiting nurse services visit and this will help solve that problem. You can have different members of the family telephone the person and remind them by phone to take the medication. You can set up other reminders also, for example, you can tell the family member to take their medication when a certain tv show comes on. (Time it to when the person needs the medication. Check local tv service to be sure that the timing is correct. Remember that stations change their shows and change their listings frequently so use this only as a last-resort method of reminders. You can have a neighbor visit to remind the person if that is available to you.

FLOODS:

• Floods are real problems in apartments where the seniors or disabled people live. The solution to this is reminders. If you know that your family member leaves the water running, you can do a few things to stop floods. First, always keep a large supply of towels and buckets around so that just in case there is a flood, there are proper clean up tools around. Second, if it is physically possible, see if you can safely limit the water pressure inside of the apartment. So this way when the faucet is turned on, the water will not come out like the pressure of a fire hydrant but will come out in a less forceful manner. Third, post signs on the front door, and on all the bathroom doors, signs that state did you shut the water off? You can make them funny signs with little cartoons. That will add a little humor and it won't seem like you are telling them what to do but it will just be a gentle reminder. If you have a neighbor who will check in or family member , of course that really helps things along. You can telephone the person a few times a day and then remind them to check the water before they go out of the house or before they go to bed. If you use all these methods, you probably can avoid any floods.

STRANGERS:

• This should be easy enough to handle. Most seniors who let strangers into the home are those who have hardly any contact with family or friends. See if the person wants to get involved with the local senior center. This will give them connections. Have visitors come frequently. Install a peephole on the doorway or an intercom system and instruct them to protect themselves and not let strangers into the home. Take the name off all the sales lists so that visiting salesmen will not knock on the door. Have an unlisted number. Most times salespeople find residents by their listed phone numbers. So take the name and address and phone off all the lists that you can take them off of. And keep them connected with other family members and other friends. (Most seniors who are scammed are scammed because they are found to be alone. When there are repairs to be done or when legitimate service people or delivery people are to visit, have a family member or two or three of them be there at the house. This way strangers do not know that anyone lives there alone. Word spreads fast, and almost always entire neighborhoods know when a senior or disabled person is living at home alone. Once the word spreads, that sole person becomes a target of unscrupulous unwanted strangers or salespeople. If you think this is not true, listen to your news stations and find out what is happening in the world.

WANDERING:

• How do you stop wandering? It is hard but not impossible. First, let the person know that they should always have proper identification on them. And they should always carry their keys with them even if they are staying at home. Many seniors get locked out and then if they have Alzheimer's or if they are forgetful they will wander. All of this can be avoided. Keeping keys handy, having a neighbor on alert, little things like this helps almost everyone. Having a busy schedule helps stop wandering. When family members know that someone is to visit soon, they will be at home waiting for them. Having nice neighbors too, helps. Do everything you can do to stay and be connected with people (people you know - not strangers). Sometimes it helps to use memory-improving tactics --and using these also helps stop wandering. Urge family members to use calendars, timers and to use the newspapers to keep connected and to keep up to date on what is really happening in their lives. The first slipping into wandering is when a person goes for days or weeks and does not know what day it is. These things can be helped if caught in time. Urge the person who is living alone to look at their calendars every day and mark off the day that it is at the end of the day. This keeps a person connected to reality. Urge them to use alarm clocks even if they can wake up naturally. Anything that helps routine - helps them. Most people have large families. Have family members visit (invited of course. Call the person and say you are coming over; Ask if that is okay). Solve some of the wandering problems by having help with shopping. Have meals-on-wheels deliver some meals. Call for take-out foods. There are many ways to keep from wandering. Have a gps device if you travel by car. The main and most important thing to do if you or your family member wanders is to ensure that they always have proper identification on them, along with emergency contact telephone numbers. You can give them a Trac phone or a life-alert button . All these are good solutions and good ways to stay at home and not wind up in a nursing home or rehab center.

DISEASE and TERMINAL ILLNESS:

• Though this is hard it is not impossible. There are still ways to help family members or to help yourself stay independent and stay living in your own apartment or home. Remember that most times, staying in your own place will prolong your life and keep you healthier than if you are going to give in to live in a nursing home. You can help stay independent by having home care at your own home. If you cannot afford home care, try and hire private help. Most people think this is expensive. But trust me, this probably will be less expensive than if you go to a nursing home or rehab center. Your life is worth more than all the money you have so do not hesitate to hire help if hiring help will keep you independent in your own home and apartment. Try your best to stay living in your own place and do that by hiring help or by getting home care (even if you need 24/7 home care, that will be better than living in a nursing home). In the nursing home, if you wind up in a bad one, you will be a virtual prisoner and your life might be in danger. (Note, we said if you wind up in a bad one. But the problem is that you might not know it is a bad one until you are actually living there. Only the persons living there know what the real conditions are like inside the walls of many nursing homes). Use all the rest of the helps mentioned when you have illness, helps like alarm clocks and reminder timers, calendars and the connections between family and friends. If you have terminal illness, you are better off contacting hospice than you are contacting a nursing home. Most hospices have better reputations than nursing homes do. Take your chances with hospice before taking the chance with a nursing home. Most times hospice is free. (And if it is not free, it is probably covered by your insurance company). For food and other deliveries, use your same delivery people, do not try newer stores or companies that ring your bell or come to you unsolicited. Always think safety first. Check out your options of meals-on-wheels. You can find this charity through the local Catholic Charities office or through your local synagogues.

INJURIES:

• Falls and injuries are some of the main reasons that some wind up in nursing homes and in rehabilitation and care centers. So, avoid falls and spills. You can do this by going slow. For Heaven's sake, slow down. Know that in this time in your life there is never a reason to rush so much that you break a leg or other limb. Slow down! You can save your life by slowing down. It is common knowledge that once a person reaches a certain age, the most common cause of death happens due to a fall. When seniors or disabled individuals fall it is more serious than when a fully-abled person or younger person falls. You will have more complications and less chances of survival. You will need to survive the medical system. That means once you enter the hospital you run the risk of serious infection even if you are there for just a fall. It is public knowledge that thousands die each and every year from hospital infections. So once you go into the hospital you are at risk. And if you go in there older or handicapped, your risk is more than the average person. So, slow down. Prevent falls and prevent accidents. This is the very best thing that you can do for yourself. Slow down. I cannot repeat this enough. Most falls happen in or near the home and the majority of falls happen because someone was rushing to do something. Other falls are due to stroke. You can avoid that by watching your diet and your lifestyle. Take good care of yourself and your body will take good care of you. If you are smoking or drinking, save your life right now by stopping those unhealthy habits.

Those are all possible solutions that are available to you if it fits your lifestyle. Do only what you can do safely. You make the decisions yourself if you want to be independent or if you want to live inside a nursing home or rehabilitation and care center. The author urges you to make intelligent choices for your life. The author of this article is not a medical or legal professional but writes for entertainment, information and resources only. The author urges you to make your own decisions for your life. Regarding the suggestions or advice in this article, use only what is safe and helpful to you considering your own lifestyle and your own present living situation. Brainstorm with your family and friends and come up with the best solutions to your own problems. Remember that only you know what is best for you. Read the book, THE GIFT OF FEAR by Gavin DeBecker. This is a book that urges you to believe in yourself and trust your own instincts.

Here is a link about nursing home conditions in our world, http://www.safetyforum.com/nursinghomes/

I hope that you make the safest and most correct decisions for your life and for your future. If you remember nothing from this article at all, kindly remember these four most important things:

1. Have faith in God, and believe in God. Trust your own instincts and read the suggested book listed above.
   
   
   


2. Go slow. Slow down; avoid falls. Take good care of your health. And stay connected always.
   
   
   


3. Pass this article on to as many people as you can pass it on to. You just never know who might need to hear all of these words to help them in their own lives.
   
   
   


4. https://www.gavindebecker.com/books-gof.cfm

I appreciate your comments, ideas, suggestions or criticisms, and look forward to hearing from you today or in the near future. Now you have learned how to protect yourself and your health. Do everything that you can do to remain independent in your own home or in your own apartment. Trust me you will not like spending your life inside a nursing home or rehabilitation and care center.

Disclaimer: I am not saying that no patient should ever go into a nursing home. My message is clear that it is best for human beings to do whatever they can legally, emotionally, and physically do to remain out of nursing homes and physical rehabilitation centers if they can safely avoid doing so. I am saying that if you can recover or live in your own home or apartment, you are usually much better off doing that. Make your own decisions for your life but make your decisions with information and real facts.

Here is a link describing a true story of a patient at a nursing home who had maggots inside their wound

http://cbs2chicago.com/local/Oak.Lawn.Charlena.2.331345.html

Let me leave you with these last few thoughts. If you must live in a nursing home, stay connected with family and friends by the telephone, visits and by the internet. Insist on having a telephone in your own room if you are living there . You need that telephone connection as a life-preserver. Trust me on this issue, you must have a telephone if you live there. I found this out the hard way, when I discovered that in some nursing homes and in some physical rehab centers the staff does not answer the pay phones (that are supposed to connect residents with their friends and relatives). Sometimes it takes hours and sometimes days to connect on the pay phone at these centers. So, insist on a phone inside your room if you are staying at a physical rehabilitation center or a nursing home. If you have an internet connection in the recreation room, use that connection to stay connected to the people that you know. That might be your link to your health and to your sanity and freedom. Stay connected!

The Muse

Do you ever wonder what possesses a fiction writer to write what they write? Where do they conjure up such outrageous themes and story lines? Being a writer of fiction myself, I find it extremely difficult to answer that question when it pops up in interviews and casual conversations. Of course, we all write about our passions and what we think we know, but the truth is; I have no idea where it all comes from! It's all just there, somewhere in the recess of the imagination, awaiting conception.

The creative process is an amazing and undeniable roller coaster ride unlike anything else I have ever experienced. It is planted in the imagination with a simple thought or notion that takes root and grows on its own volition. Sometimes it comes as a slow winding process that unfolds in periods of relatively calm inspiration. At other times, it jump starts in frenzied growth spurts that spreads with wild abandon, sprouting branch after branch of blooming plots and character lines. When the latter is occurring, I have to wonder if there is a magical muse supplying a hefty dose of Miracle Grow to the equation.

During those manic writing sprees when the author tries to obsessively capture the story down on paper while it is fresh and clearly racing; it can feel as though it is unattached from the conscious mind entirely. It is like a separate whimsical entity demanding attention. The story will not be denied, and it hangs around in a full blown addiction until it is finally hammered out on the computer. It's almost impossible to think of anything else until the task is accomplished.

That's when I think of the muse; the writer's source of inspiration that was first invoked around 1374 in Chaucer's English poetry. In Greek mythology, the muse was defined as any of the nine daughters of Mnemosyne and Zeus, who presided over a different art or science to offer inspiration and guidance. I think the muse invokes herself on occasion and takes the reins on her own mercurial whims when she decides a story needs to be born. She can be an irritating little wench, intrusive and belligerent!

She dictates the development of one character from a first-draft rough sketch to inspire others to help it spring to life on the pages. Through physical descriptions and credible dialogue, the cast becomes real and takes on a life of their own. The protagonist usually requires a robust cast of characters to thrust them toward their intended finale.

In contrast, the credible antagonist is often in direct opposition to the hero, or heroes, whichever the case may be. Conflict and chaos reign supreme in the fiction writer's story line. A despicable, easy- to-hate villain is paramount. It's always easier to root for the good guy if the bad is guy is really, really bad!

Placing those characters in another time, place, or dimension; lost in adventurous situations with surprising plot twists will capture the reader's attention and keep them engaged. The m use is happy and all is well with the universe.

Fiction stories are as unique as the person who first imagined them but here may be stereotypical story lines and similarities across genre fiction. Some have become trite and contrived, but more good fiction is born every day in an endless plethora of creativity. It's all good as long as we can lose ourselves in a good book once in awhile to escape the mundane tasks and daily stresses of our chaotic lives.

I was recently given another explanation for the free flowing creative process that authors find so difficult to define. Although, my inner child delights in the thought of the wispy, fairy-like muse dancing around my head when I write, bringing me inspiration and imagination; I like the other version even more. It gives my writing much greater purpose and inspires me more than anything else I can think of.

In God's eyes every book is already written. He just needs someone to put it down on paper.

Protect Yourself In The Hospital - The Risks Of Risk Management In Hospitals And Nursing Homes

The Risk Management Priority - Protecting Financial Integrity

The last time I sat through a hospital orientation program, a man came into the classroom and gave a one-hour lecture on his role as a risk manager. His focus was on incidents that resulted in or were likely to result in a lawsuit. He told us about the case of a ten-year-old boy who is growing up with cerebral palsy that has caused severe spastic paralysis over his entire body. He said, "While I acknowledge that the hospital staff screwed up and contributed to this boy's terrible affliction, it is my job to protect the financial integrity of this institution. So, we are doing what we can to look for ways to defend against the allegations. The upper management decides and I follow orders."

The Moral Divide

The striking aspect of this comment was that accepting responsibility for wrongdoing had no place in this man's conversation. This is a microcosm of the corporate culture - one man or woman does his or her job to the best of his or her ability while the ethical considerations are someone else's responsibility. Middle managers often pass the morality buck to upper management, who pass it to the chief executive officer, who in turn pass it to the board of directors or trustees. The directors or trustees will consider only the financial welfare of the stockholders or the public trust.

The Ideal Risk Manager

The appropriate focus for a risk manager is to prevent malpractice and accidents and not just lawsuits for such things. The ideal risk manager will carefully study the common complications and injuries that take place because of being in the hospital and recommend changes that will prevent such undesirable occurrences. This activity should begin with investigating events that have already happened and assigning culpability where it belongs. This means also identifying any mitigating circumstances that contributed to the blunder or omission. This Utopian risk manager will then submit a report holding nothing back.

The Real Risk Manager

Regrettably, in the real world, risk managers and investigators must walk within political boundaries. Their investigative goal is to counsel employees to document problematic events in a way that will not provide any evidence to the plaintiff in support of a malpractice claim. The usual advice for filling out an incident report is, "Document only what you find. For example if a patient falls, just say 'patient found on floor'. Describe the injuries if any, but do not say anything about how he fell. If there is anything in your observation that might suggest a cause of the accident like side rails down or slippery stuff on the floor, do not say anything about it. We do not want you to lie, but we also do not want you to offer any information or opinions that might help the plaintiff and hurt our defense."

The Two Definitions of "Risk"

There seems to be two definitions of "risk" in "risk management". One is the probability of losing money and the other is the likelihood of the same type of accident happening to the same or another patient. Hospital managers do not have to choose between one and the other because if they prevent further accidents they will save tons of money. During the past year, I have reviewed several cases in which the patient fell out of bed or from a chair two or three times with the permanent or fatal injury arising from the last fall. In each of those scenarios, if the hospital or nursing home management had a risk management program focusing objectively on the cause, the serious injury would have been avoided. Therefore, the hospital's risk management strategies were a factor in producing the injuries.

Case in Point

For example, John B. was a 76-year-old man who went to a local community hospital by ambulance after complaining of chest pain. The admission assessment revealed that while at home, he got up at night to go to the bathroom and fell and sustained some bruising on his left elbow and hip. The medical history revealed that he had mild emphysema with a chronically reduce blood oxygen level. Despite these obvious red flags, the nurses did not do a fall risk assessment and fall prevention was not a part of the care plan.

On the third night of admission, John wandered out into the hallway at two o'clock in the morning and fell in front of his doorway. The nurses who witnessed this picked him up and put him back in bed. The charge nurse filled out an incident report and gave it to the nursing supervisor. The supervisor counter signed the report and recorded the incident in the daily nursing office log. She also sent a copy to the risk management department. No one conducted any investigation nor revised the patient's care plan.

Three days later, one of the nurses found John on the floor in his room unconscious at six o'clock in the morning. She called for help and put him back to bed with the help of two others. Within six hours, John died of massive brain hemorrhage. An inquiry would have uncovered a serious problem in a lack of real risk management at the bedside level. The root cause of this untimely death happened because the slipshod attitude toward safety started at the top and oozed downward toward the staff.

Should we Punish the Lawyers or Hold the Real Culprits Accountable?

Several doctors and politicians are saying that there are too many medical malpractice lawsuits. The current rhetoric seems to blame personal injury attorneys for this problem, so the plan of attack is to take away the rights of victims to get justice by creating roadblocks in malpractice legal procedure and reducing the maximum contingency fees for the plaintiffs' attorneys.

This argument presupposes that hospital corporate executives, doctors and nurses are doing the best they can and the casualties are unavoidable. In my view, we need to seek federal and state legislation that will mandate fiscal responsibility and standards for safe hospital care. This law should also hold people in management positions personally accountable for being negligent.

The Call for New Legislation

Under current law, if a state or local health department investigates a patient's death after receiving a complaint and finds wanton disregard for patient safety at the managerial level, the harshest penalty they can impose is a fine. In other words, when high level health care executives commit criminal negligence resulting in a person's death, the current government response is to leave the offenders in charge and take money away from an institution that is already strapped for cash rather than charging the responsible parties with a crime or even insisting on their dismissal.

List of Elderly Care Solution For Seniors

Home Stay

Staying at home is considered one of the best elderly care for seniors who have good health and demand less supervision with the challenges of daily living. Providing elderly care in their own home offers the comfort and security that any senior home care facilities can never give. The familiar place, the old and memorable experiences these old people have on the four corners of their homes are treasures they can live out during the final years.

Living With a Close Relative

As part of the family, inviting the old folks and providing in-house senior home care is a big responsibility especially if you can shoulder the expenses. Despite the trouble catering elderly care for your aging family members, this is usually the right decision to make. This allows your loved ones to enjoy their final years in a place surrounded by familiar faces and the opportunity reinforce the family bond. In fact, this elderly care solution actually cost less since you don't have to pay for nursing home or the fee of maintaining a loved one's house.

Senior Housing Communities

This senior home care solution provides housing communities for elderly people to live independently which is perfect for seniors who require less help with day-to-day activities. Every apartment or townhouse are specifically made using the concept of providing the best possible care from wheelchair facilities, walking paths that promotes exercise and wider doors. However, most housing communities that offer elderly care do not provide round the clock emergency medical services for senior patients since they are staffed with doctors and nurses. Whenever an aging parent acquired or developed a critical health condition, he or she should be transferred to another senior home care facility.

Assisted Senior Home Care Facilities

These facilities offers help for aging parents that needs assistance to face the challenges brought upon by daily challenges. Additionally, emergency medical assistance are on the look out for any critical health condition that could happen anytime. There are medical doctors and health professionals that monitor medication and a 24-hour emergency medical care. Other services like bathing and food preparation and pampering can be done by family members although these services can be done by in-house assistants.

Nursing Home Checklist

One of the scariest moments for a daughter, son, brother, sister, niece, nephew, spouse, aunt, neighbor, best friend without family, etc. is the decision to have to put a loved one and/or a relative into a long-term care facility. As a past Director of Nursing for a large, skilled nursing facility, I have learned that it is of the utmost importance one seek the necessary information to keep their precious one safe, healthy and happy! In fact, it does not hurt to be guided by a simple checklist that will bring great piece of mind choosing the right location. My biggest complaint as the Director of a nursing home years ago was the staffing issue.

I remember one winter season when almost all of the staff had the seasonal flu at the very same time. To my disappointment, they would not allow us to use a pool of nurses or CNAs for no other reason than the cost of that pool. I hated the fact that greed was apparent and this is a real concern when checking out nursing homes. Our bed sores skyrocketed, meals were not timely, bathing became an issue, activities were lacking, etc. I pitched right in on the floor duties, but felt as though one person could not get the proper job competed in a timely fashion. Furthermore, my expertise was in nursing, not cooking, social activities, administration, housekeeping, maintenance, or any of the above.

Here are some of the most important things I can think of to ask in regards to long-term care facilities:

oWas the last State inspection positive? What did it reveal? How many "tags" did they have, and what were they?
oWhich safety measures does the facility have in place?
oWhat is the staffing ratio for registered nurses (RN), licensed practical nurses (LPN) and certified nursing assistants (CNA) to residents?
oIs the facility Medicare and Medicaid certified?
oWho owns the facility?
oIs the long-term home a non-profit organization or for profit?
oHow do they deal with call-ins and short-staff, i.e. what back-up measures are in place - do they use pool nurses and CNAs for help?
oAre there any pending lawsuits?
oWhat is the ratio of urinary tract infections, pneumonia, dehydration, bed sores and/or malnutrition?
oHave there ever been abuse issues, and if so, how long ago? What is the protocol for these incidents?
oWhat special therapies and activities do you have and how often? How leads these activities?
oDo you have a registered dietitian that plans the meals?

In addition to these very important questions, look around at the facility. Be sure it is clean and don't be afraid to talk with other family members and to the residents. Speak with the Administrator, the Director of Nursing, the social worker, the activities coordinator and to the dietitian to address any special needs that may be an issue, i.e. diabetes, hypertension, macular degeneration, poor skin turgor, weight gain or loss.

The decision is not an easy one, and it is certainly in your best interest and the patient's best interest to get all of your ducks in a row before moving forward. Make certain to inquire with other families that have gone through similar situations. Also, check the state records for the facility - they can be obtained via Internet quite easily and are a matter of public record.

Lastly, don't hurry or be in a rush when checking all of your options. Remember how important it is to keep your family member, or other special human being, in the best possible place. Don't forget to consult your checklist. Rule of thumb - how would you want to be treated in a like situation? I literally shutter to think what I could go through with my own loved ones, let alone what my children may have to face one day. Bottom line, keeping your very special one in a well respected nursing home that is run by experts can, indeed, give you peace of mind!

Importance of Hiring the Best Personal Injury Lawyer

Accident will happen if it is meant to happen. But once it happens you have to know what you ought to do. You must have the presence of mind so that you will not end up abused. This is the usual scenario once the victim does not have any idea of what to do.

In case of personal injury accident, keep in mind that you have the search for someone that can represent you legally. You must know the right person to contact once you fall as the victim of a injury case and this person is the Miami personal injury lawyer.

There are lots of Miami personal injury lawyer out there, but of course it is important that you have the basic knowledge about them. Accident may happen unexpectedly ad it will be painful o be a victim if this accident. But the pain will be ease once you have the right lawyer by your side. Victim of a injury accident usually suffer from different damages such as permanent or temporary damages. And because of this, it is important that you have to seek that right compensation that you deserve. And if you have the basic knowledge of the Miami personal injury lawyer, you will surely have a security blanket that will help you fight for your rights and interest. But sad to say there are still other people who are ignorant about the important role of the lawyers. And these people usually end up being abused. They do not ask anything for the injurer and suffer all the damages that the accident has caused them.

It is very important for every individual to make a research about these Miami personal injury lawyer. There are some incidences that you will need a legal representative that will guide and help you. But if you are someone who is ignorant about their importance you will suffer a lot.

Keep in mind that Miami personal injury lawyer are the right person to call in times of injury case. And because of the internet searching for the best lawyer is made easy. There are already websites that you can visit in order to check the names of possible lawyers that you can hire. You have to be patient in searching for the right lawyer so that you will be able to claim the right compensation that you deserve.

Hiring a Live-In Caregiver in Canada

When searching for a live-in caregiver many seniors will apply to hire an individual from abroad that wants to work in Canada; the Government of Canada HRSDC page outlines all the specifics required by the applicant for a live-in caregiver.

I'll capture some of the highlights and an overview of the process here.

If you will be an employer of a live-in caregiver from abroad, your first step will be to make application to the Human Resources and Skills Development branch of Service Canada requesting a Labor Market Opinion and they will then assess the impact of employing a foreign worker in the present labor market.

The prospective foreign worker must receive an offer of employment from the Canadian employer at which time he or she will make application to CIC (Citizenship and Immigration Canada) requesting a work permit. The request should include proof that a Labor Market Opinion has been completed by Service Canada.

Live-in Caregivers working in Canada will have up to four years from the time they arrive in Canada to be eligible, by satisfying requirements of employment, to apply for permanent Canadian residence. The basic required hours for eligibility are 24 months of full time employment or 3900 hours and a maximum of 22 months that may include up to 390 hours of overtime. Employer requirements are explained fully and the application form may be found at hrsdc.gc.ca

Your Responsibilities as an Employer
There is an initial placement cost of $3000 to be made to the agency and the initial application can take up to 4 months. That will allow time for the work-visa and immigration papers to be completed plus a criminal record check and health records check to be completed as well.

A salary of approximately $1954 with deductions for CPP, EI, applicable tax and workers compensation, will be paid to the caregiver for a 44-hour workweek.

You as an employer will pay for the caregiver's transportation from their home country to Canada. You will also be required to pay for health insurance from their arrival date in Canada up to such time that he or she becomes eligible within the provincial guidelines to take over paying for this insurance. You will also be responsible for insurance covering work place safety for the period of time that you employ a caregiver.

You will be responsible for an employment contract that will describe details of employment as follows:
• The duration of the contract
• Duties of the position
• Hours of work including overtime, sick time and holidays
• Wages
• Accommodation arrangements as per provincial standards
• Health insurance
• Transportation costs
• Termination of employment or resignation terms
• Registration for provincial workplace safety insurance

You the employer will need to keep accurate record of the hours worked by the caregiver on a weekly/monthly basis, as the caregiver will need this for their application for permanent residence.

Caregiver Screening
Applicants into the caregiver program are carefully screened by CIC (Citizenship and Immigration Canada) before entering Canada and will have successfully met the requirements of the program, which are as follows:
• Completion of the equivalent to secondary school in Canada
• Six months of classroom training or one year of work experience as a caregiver or in a related field within the last 3 years
• Six consecutive months of employment with one employer
• Fluency in English or French to a standard allowing them to function in an unsupervised setting
• Security and medical clearance
• A contract signed with the you the new Canadian employer

Home Health Aide Certification Guide

One common thread among those looking to become home health aides is the wish to achieve a home health aide certification. Home health aide certification is an important component in achieving work as a HHA as it helps establish authority and experience as well as a minimum standard for the education of the HHA.

Home Health Aide Certification Requirements Each state ultimately has it's own Home health aide certification requirements so students need to check with the appropriate state departments in order to find out what these requirements are. This will allow potential or current students to make sure the HHA certificate training that they are receiving is within the bounds of the law. The most common governmental group involved in this promise is the states department of health. If they are not the proper governing body to inquire about the HHA certification, they will be able to forward you to the proper body. Some states may also require a CNA certificate before allowing HHA training to begin.

Generally speaking, HHA certification includes between 75-100 hours of course/class work as well as practical training. At the end of the training period, all HHA credentials will require the applicant to pass a written state exam as well as a practical skills test. Since some states also require CNA training or other classes, it is not uncommon to receive a CNA certification as well as a HHA certification at the same time.

Why do we need Home Health Aide Certification? Some potential HHA candidates wonder why all the need for certification exists. The short answer is that most home bound care recipients receive their care via medicare. In order to meet federal regulation, and receive medicare dollars, HHAs must be certified in their state. There is also a national HHA credential offered via the National Association for Home Care (NAHC). This makes it possible for HHA students in all states to receive their HHA certification.

At the end of this journey to HHA credentials, the HHA student will be recognized as a certified HHA. This will allow the HHA to work directly under a registered nurse and begin their career as a HHA.

Finally, there exist a number of HHA agencies that will offer HHA cert free of charge in return for a period of work that is contractually agreed to. These certifications are often times high quality as the student will need to be able to jump directly into the work force after their training period is over. One benefit of this arrangement is a guaranteed job after graduation. This should make any potential HHA certification seeker happy as the desire to help people should be strong in any HHA candidate.

What's Involved in a Medical Receptionist Career?

Are you looking for a career that involves helping people? Do you need a fulfilling work life? A career as a medical receptionist (also known as a medical secretary, medical office assistant or a medical office administrator) may be just what you're looking for.

In today's fast paced healthcare industry, administrators and office staff are essential elements in the overall efficient running of clinics, hospitals and other healthcare providers. A medical receptionist is often the liaison between patients and doctors, and their presence and work can often help make stressful, chaotic environments more workable and friendly.

The Healthcare field is expected to be one of the fastest growing job markets in the next few years, with an aging population ensuring a growing demand for medical support staff in all areas of health-related services.

As a medical receptionist, you will be responsible for a number of different daily tasks. These include:

• Greeting patients


• Scheduling appointments and diagnostic testing


• Answer patient queries over the phone


• Maintaining medical records


• Completing insurance forms and preparing bills


• Handling correspondence, billing and bookkeeping


• Maintaining medical supplies and equipment


• Managing examining rooms and waiting areas


• Liaise with medical professionals


• Oversee prescriptions and repeat prescriptions


• Transcribe dictation


• Filing and other clerical duties

Qualified or experienced medical receptionist can find work in a number of work environments, including:

• Private Medical and Midwife Clinics


• Offices of physicians


• Community Health Units


• Hospitals (there are obviously a number of departments within a hospital, and each one will have its own administrative side)


• Nursing Homes


• Insurance Companies


• Medical Transcription


• Medical Supply and Pharmaceutical Companies


• Chiropractic or Physiotherapy Clinics

Due to the wide range of responsibilities, a medical receptionist needs to be extremely confident and at ease working with a team and independently. They must also be well versed in the use of most computer software packages.

Typically, a medical receptionist will work standard office hours, however, as healthcare organizations often work outside the usual 9-5, employees may work on shifts. Salary for this type of medical office administration work can vary greatly, with it depending on what sort of healthcare organization is involved, how experienced the receptionist is and where the job is located.

Thankfully, there are now numerous medical receptionist programs where students can become accredited and gain practical experience. There are many online education courses that provide accredited certification for medical receptionists, however, it's possibly a better idea to attend a training program that provides some sort of practicum or co-op work opportunity. Doing so will help increase your job prospects. The best of medical secretary courses will train students in the basics of medical office administration, and provide an in depth knowledge of the human anatomy, medical terms and a general understanding of the medical profession.

What are you waiting for? A fulfilling career may be within reach.

Why Live in a Retirement Community

It's a fact; the human race is living a lot longer these days than it used to. For this reason, retirement communities have become increasingly popular. There are many reasons people want to be a part of these areas; the neighborhood, social activities, exercise classes, music concerts and much more. Another incentive to move to these communities is the climate. A large majority of these societies are based in milder climates such as Colorado, Arizona, Utah, California, Florida and Texas.

One key reason some people decide to move to these communities is the age of the other residents there. Some of these communities have age-restrictions to ensure a common attitude and stage in life among the residents. Having neighbors around the same age group helps prevent late-night noise, small children causing commotion, and unkempt landscaping. This helps guarantee that the neighborhood will be quiet and peaceful.

Of course one of the most important reasons to move to one of these communities is declining health. Some of these neighborhoods have people who help with landscaping, household chores, and basic home maintenance. Most of these societies have medical services within the neighborhood or close by, less traffic (most allow golf carts as well as cars), and social activities. Tennis courts, golf courses, swimming pools and community centers are very common within these areas. These are all very desirable aspects and features of a retirement community where residents can meet new people and enjoy the lasting years of their lives.

Along with the independent housing option in some of these communities, is the option for assisted living centers. The difference between independent living and assisted living varies from community to community but basically consists of housekeeping services, medical care, transportation services, exercising and physical therapy. In these assisted living centers residents are looked after and under much more supervision. At some point, if the residents' symptoms and illness becomes too serious they may need to be moved to constant hospital care or home care. Until then, an assisted living center is usually a less expensive option than in-home care.

Just like the price of a home can change in price, so can the cost of living in a retirement community. Depending on the amenities, location, and quality of homes in the neighborhood, the price of a home and community dues can be much more expensive in some locations rather than others. The services they offer and whether or not there is the assisted living option can alter the price as well.

When considering a retirement community there are many factors to take into account. Make sure you look at all of the features and aspects of each to find the right community for you!

The Independent Living Senior in Southern California

Freedom is usually associated with independence. Everyone desires independence -- it is a quality that defines American culture and history. Independence is not a prideful or stubborn quality; a person who takes care of himself or herself can be seen as someone who is respectful of others' time, polite in all things and who is willing to work for the niceties of life. However, as a person ages, sometimes he or she may have to relinquish some independence so that proper care can be provided. Even in this case, the desire for independence does not go away. Seniors may appreciate their independence but still desire to live in a community of their peers for security reasons. Caretakers may find that their aging parents want to perform their own daily tasks or contribute to housework chores so they can feel a measure of independence. Even a nursing home resident who has to be constantly monitored may appreciate the chance to do something on his or her own. This is important to remember when searching for facilities.

What do Independent Living Senior Southern California Homes Offer?

Southern California can mean a few different things. Usually when the word independent is used with senior living, it implies a community of retired seniors that live nearby each other in specially made apartments, houses or townhouses. These are not nursing homes, since residents are capable of taking care of themselves. They are not considered assisted living facilities either, because residents have total independence and handle their own custodial and medical needs. Why would someone in near perfect health be interested in an independent living senior Southern California home? Even where there are no physical needs that need to be provided, there are still social needs that can't be overlooked. Seniors that live in a community of their peers may find it a refreshing environment in which they can make plenty of friends. Furthermore, many seniors actually feel safer inside communities.

Living in these retirement communities is just like living inside your own house or apartment. Some facilities give you the option of renting or leasing. You are not provided any special in-home services but you can hire someone from the outside for custodial or home care. While there might be transportation services arranged, usually senior residents are independent and possess good communication skills, eliminating the need for constant monitoring by a staff. Some facilities even have gyms, swimming pools, spas, dining areas and other amenities that will keep the community active and happy. Though prices begin at about $1,500 the price of residence can vary among different communities. There are also low-income apartments by HUD, as well as homes that can be partially covered by the Medicaid program.

Choosing Between Independent Living Senior Southern California Communities

Choosing a facility is of great importance for the independently living senior. Southern California is a large place and lease agreements for residency may be months, years or even for life! How do you go about choosing the right community? The best option is to personally inspect each living quarters and take note of the most important features. If you are a busy person (and who in California isn't?) then this may be the most difficult part of the entire process. However, ElderHomeFinders can help you find the right independent living senior Southern California community. Our company does the legwork for you and inspects assisted living facilities and retirement community in Los Angeles and beyond. We can give you all the facts about retirement homes in the area, including specific details (such as amenities or provisions for the handicapped) as well as communities to avoid, and how much residency will cost you.

The older we get the more we realize there is nothing more important than life, family and freedom. When a person reaches retirement years he or she still desires each of these, perhaps with more intensity than ever before. When you are looking for a new retirement home, make sure it is a community thriving with life, that it is close by friends and family, and that it allows you as much independence as you need. And if you are having trouble finding that perfect home then ElderHomeFinders can help. Best of all, this service is provided free to the consumer. That's because someone told us a long time ago that the best things in life are free.

Traumatic Brain Injury Poses Huge Risk to Senior Safety and Independent Living

Living independently is important for many of today's seniors. With the benefits of living alone though come plenty of risks. Protecting yourself from risks like traumatic brain injury resulting from fall related injuries is one way that you can greatly increase the length of your independence.

Did you know that falls are by far, the leading cause of traumatic brain injury? People over the age of 75 have the greatest probabilities of hospitalization or even death as the result of traumatic brain injury. Prevention of falls and fast access to care are the greatest weapons against permanent damage resulting from traumatic brain injury.

Symptoms of Traumatic Brain Injury

Mile TBI (traumatic brain injury) will often include these types of symptoms: low grade and lingering headache, changes in sleeping patterns, difficulty with concentration and memory, dizziness, blurred vision, increased or unusual sensitivity to light or sound, and a constant ringing in the ears.

Moderate TBI may include any of the symptoms of mild TBI as well as slurred speech, numbness in arms and/or legs, loss of coordination, seizures, pupil dilation in one or both eyes, worsening headache that will not leave, and nausea.

How Should You React if You Suspect TBI?

If you've fallen and had a blow to the head accompanied with the symptoms above it is a good idea to see your doctor right away. You should also see your doctor or emergency medical service provider immediately if you are taking aspirin, Coumadin, or any other blood thinners and hit your head (with or without any of the above symptoms).

When you see your doctor be sure to bring a list of all prescription and over the counter medications you are taking. Medications can have very dangerous interactions with one another in the best of circumstances. In the event of a traumatic brain injury those risks may be more profound.

Why does TBI Pose such a Great Risk to Seniors?

The problem with seniors when it comes to traumatic brain injury is that there are many times when they do not get the necessary treatment or care quickly enough. Many seniors live alone and are injured or disoriented enough that they cannot get to a phone and dial the numbers to get emergency medical attention immediately after the injury occurs. At a time when seconds matter, minutes can do irreparable damage, and hours can be more like days compared to the amount of damage that can ultimately be corrected or recovered from.

It is often the case that traumatic brain injury among the elderly isn't discovered until it is far too late to undo the damage that has been done because aging adults often live alone and frequently live very insulated and isolated lives. The other problem is that elderly or aging adults are at greater risks for these damaging falls whether by environmental hazards for tripping and falling or loss of coordination due to aging, medication side effects, or lack of exercise.

Medical alert systems can be an excellent first line of defense against permanent damage due to TBI that results from falls. You owe it to yourself or your loved ones to make sure that this line of protection is readily available.

6 Tips For Recognizing Nursing Home Abuse and Neglect

Abuse and neglect can certainly be issues in a nursing home facility, but it's important to understand that the vast majority of serious elder abuse takes place in private homes. Victims are typically women over 74 years old and are living with their abuser. While this is what the stats show, you still need to be vigilant when it comes to keeping an eye out for signs of abuse and neglect when your loved one is in a nursing home / long term care facility.

Whether intentional or unintentional, the most common forms of abuse - neglect - takes place in nursing homes. The following six tips should help you recognize neglect in your loved ones facility:

1. Allowing the elder to wear soiled or inappropriate clothing, an unshaven appearance, dirty or broken fingernails and dirty or greasy hair.

This is important as lack of attention to personal appearance can lead to social isolation, loss of dignity and depression.

2. Not assisting with eating or drinking

3. Not assisting with personal hygiene

4. Positioning or turning the elder's body in such a way that leads to bedsores

5. Ignoring call lights, buzzers, or cries for help

6. Not assisting with walking or range of motion exercises

In addition to these type of neglect issues, you'll also want to keep a keen eye out to ensure there is no financial exploitation going on.

1. Ensure that the staff is not misusing the elder's money by taking it from them under the guise of doing something with it that they don't do.

2. Be sure the facility is not keeping the personal allowance allowed to Medicare patients.

3. Keep an eye out for staff members forging checks.

4. Watch out for the facility not allowing your elder to have access to their money.

It's critical that your elder not be allowed to keep large sums of cash, ATM cars, or blank bank checks in their room. Not only do you have to be concerned for possible staff theft, but other residents as well. The facility should have safe in their office that should be available for residents. Some even allow for small safes in residents rooms.

How To Manage Nursing Home Care Without Losing Your Mind Or Your Cool

You've heard it said before, "If you want to have a quality nursing home experience plan in advance." Visit nursing homes in advance. Doesn't that sound like a great way to spend the day? Most people simply cannot rap their minds around the idea that they will need to be in a nursing home. The reality is that at age 65 your chance of needing long-term care is 45%. Look at yourself and look at your spouse; if it's not him/her it's you. Here are some tried and true methods to manage nursing home care without "losing it."

1. Realize, with age comes challenges. At the time of retirement, age 65, the chances of needing long-term care (nursing home/home health care) is about 1 in 2 and increases with age. The many age related medical conditions including joint instability, strength limitations, and systemic slow down often require some length of involvement with long-term care. It's probably going to happen to you, your spouse, or your parents. Now, what are you going to do about it?

2. Understand nursing home care can be long-term or temporary. When the words "nursing home" are spoken people often cringe with visions of the "Psycho" house or the "Hotel California" looming in their mind's eye. Breathe. You can leave...maybe. If you need therapy for a hip or knee replacement your nursing home experience may be short-term. Even more important than the reason you are there is if you have the resources and structures in place to get you out. If you don't have the financial and social support resources to remain at home after a disability, it may be a long-term stay.

3. Don't settle for less. The idea of being in a nursing home is difficult to stomach. The idea of having to fight with a bad nursing home is downright scary. Many people are not satisfied with their nursing home experiences and don't plan to return to the same facility. The key to avoiding this less than ideal scenario is to visit facilities in advance, be critical about the quality of your future home/rehabilitation center, and don't settle for less. If it doesn't feel right, look right, or smell right - move on. The future of your care will be affected by how critical and thorough you are in evaluating nursing homes.

4. Develop a tag team. The most powerful of human forces is a group of like-minded individuals bound together for a common cause. To ensure you and your loved ones get the care needed, make sure you have a tag team approach. The team should include other family members who visit often at varying times and a professional nursing home advocate who is at your disposal to help manage challenges with nursing quality of care and questions about therapy treatment programs.

5. Know what "Good" looks like. Most families have no idea what a good nursing home looks like, except maybe the opposite of the mental image in bullet number two above. If you are going to manage nursing home care well you want to find yourself in a good facility to start. No matter how good a nursing home is, there is always something to negotiate. Even if the food is decent, the staffing and response to call lights may be lacking, for example. Start higher on the rung of quality and you will have less territory to negotiate.

The long-term care systems, nursing homes in particular, are not transparent enough to make working with them easy for patients and their families. With due diligence and a backup plan you can manage nursing home care and keep your sanity.

Questions to Ask When Choosing a Continuing Care Retirement Community

Continuing Care Retirement Communities (CCRC) are communities that offer a blend of services to meet the needs of the elderly. The attraction of CCRCs is the "one-stop shopping" they offer for many senior living needs. Most CCRCs offer three components:

1. Independent living arrangements, which offer no support services, although meals are seved in common dining areas;

2. Assisted living facilities, with various levels of care and

3. Skilled nursing home care, with various levels of care.

The one-stop shopping draw is attractive to seniors who are seeking lifetime care from one stage (healthy) to another stage (conically ill) in the later part of their lives. CCRCs, in theory, take the worry out of your final years for you and your immediate family. Prospective residents will tour impressive dining facilities, peruse wonderful landscaping, be enticed by the neat living facilities and exposed to abundant recreation facilities. You will, no doubt, walk away being dazzled. But a CCRC is a very expensive proposition, with high entrance fees ($100,000 - $1,000,000), significant monthly maintenance fees and numerous pay for service fees, with costs that often rise over time. What was once affordable may become unaffordable in only a few short years. You have to be very cautious and review the contract carefully, preferably with an attorney who specializes in this type of contract law.

Questions that you need to ask:

1. Is the CCRC accredited by the Continuing Care Accreditation Commission (966-888-1122)?

2. What are the staffing levels?

3. What is the residence turnover?

4. Have there been recent fee increases?

5. How much have the monthly maintenance fees increased on an annual percentage basis over the past five years?

6. How does the CCRC determine when it is time for a resident to move from one level of care to the next level of care?

7. Ask current residents how they feel about the CCRC.

8. Ask current residents what surprises they experienced in the operations of the CCRC.

9. Is the CCRC financially solvent? Make sure you review the financials of a prospective CCRC for the past three years with a CPA.

10. Make sure you secure an attorney who specializes in CCRC contract law.

11. What happens to your entrance fee when you pass away?

12. Is you entrance fee 100% refundable upon death?

13. Does your unit need to be sold before you are refunded your entrance fee?

14. Is there any restriction on the sale of your unit?

15. Is there any minimum sales price on your unit that is required before you receive your entrance fee refund?

16. What percentage of your entrance fee is refundable?

17. What are the restrictions on getting your entrance fee refunded?

18. Is your entrance fee held in an escrow account? if not, be wary as this means your entrance fee may be used to fund operating expenses.

19. What happens to your entrance fee in the event of a CCRC bankruptcy?

20. What does the monthly maintenance fee cover? It should cover meals, transportation and various activities. Find out.

21. Are there different levels of monthly maintenance fees? If so, what are the coverage differences?

22. Are there extra costs for moving you or your spouse to assisted living or nursing care?

23. If care needs increase are there additional costs?

24. What happens if you cannot afford your monthly maintenance fee? Are you evicted? Is thee a benevolent fund available at the CCRC to help if you run into financial difficulties and cannot meet your monthly fee? If yes, review financials to ensure the funds are adequate given the size of the CCRC.

25. What is the maximum monthly maintenance fee you can afford and is the CCRC monthly fee well below that amount?

26. Make sure the occupancy rate is 90% or more. Occupancy rates below this could affect your future fees.

27. What happens if the CCRC's occupancy rate drops? How much will your monthly fee increase? Can you afford this increased fee?

28. Are there any plans for expansion or future renovations? Are there adequate funds for this expansion or the renovations?

29. How long has the current management group been operating the facility?

30. Can the CCRC sustain deficits and for how much and for how long?

Finding the right CCRC means asking the right questions. Do not go into a CCRC blind. You need competent professionals to help you ask the right questions and evaluate the responses. The risk is simply too great to do otherwise.

Signing a House Over To a Child? NOT a Good Idea!

I'm going to sign my house over to my eldest child. How many times have you heard someone make this statement? Every time it is said, it is said with great pride and joy. But it is far from being a clever thing to do. In fact it can have very serious consequences. Let me explain some of the potential threats. I am directing this article at those who believe that their home is their castle and their castle is their legacy to their children.

First of all, I would like to say that signing your house over to one of your children is a very kind and generous thing to do. However you may not be prepared for the Government's response. We must all agree that signing a house over to a child is done for a reason. I mean, you don't get out of bed one morning and announce to the world that you feel bit bored and so will sign your house over to one of your children because you have nothing better to do. NO! The Government takes the view that you have done this to evade taxation or to deny the Local Authority the ability to recover the costs of long-term care like the cost of nursing home fees. In fact they are so upset by you signing your house over to one of your children that they believe you may have committed a crime. They even give the crime a name: The Deliberate Deprivation of Assets. If you have done this within six months of going into care then your guilt is assumed. After that, the local authority must prove your guilt. This can be very upsetting particularly if you are of the opinion that the house is yours because you have paid off the mortgage. The house is not ring-fenced. It is your asset and thus subject to taxation and assessment. There are things you can do to protect your home from being used to pay nursing home fees etc. but advice on this is given on an individual basis.

Secondly, what if you sign your house over to a child and that child already has their own house. Now the child has two houses, one of which is their primary residence while the other (your former house) isn't. Should that child decide to sell the house at a later date then they could be subject to paying Capital Gains Tax (C.G.T.). In other words, you have taken a property on which there was no tax after sale, and placed it in an environment where there could be tax to pay. That is not much of a strategy.

Thirdly, by signing your house over to a child you are effectively homeless. That child can legally sell the house out from under you. The house that you spent so many years paying off is no longer yours.

So please don't be tempted to sign your house over to your child. Talk to someone before making any rash decisions.

Assisted Living Retirement Communities Can Be A Big Help To Seniors

When the years of a working life are over and it is time to retire, a lot of decisions must be made about what the best course of action is. For some seniors, the best thing is to move into the home of one of their children. For others, they need the amount of care that can only be found at a nursing home.

But for some people, the best place to spend their golden years is in one of the many assisted living retirement communities. These kinds of facilities offer a great balance between complete independence and skilled nursing care that is available in a nursing or rest home.

When a baby boomer moves to an assisted living facility, an initial assessment of medical and personal needs is completed and a care plan is created. This plan ensures that the care that is need by an individual is given at the right time, in the right place, by the right person, in the right way.

The folks who staff these facilities are top notch elder care professionals. They have had the best training available and are indeed specialists in providing care to elderly residents. It used to be that the only kind of facility available was a nursing home. And the horror stories you heard about those were frightening indeed.

Those were just stories, of course, but if you were involved in a situation where you were responsible for a senior and what they needed was a nursing home, the guilt you felt was almost overwhelming. That is one of the many reason why assisted living retirement communities were developed.

Many retired people do actually need some help in managing their medications, or with a bit of physical therapy or some other daily living activities, and it is in the assisted living facilities that they can get a program that is tailored to their particular needs. It is no longer, "one size fits all" kind of care, in a great assisted facility, the individual is paramount.

Even better, is the philosophy of the assisted living places, that there is no reason to give anyone care that they do not need. This was a problem in a nursing home, where everybody got total care even if they did not need it. And that kind of care more often than not created a set of people who wound up completely dependent on their caregivers. And that is never a good thing, if you don't need that kind of care.

Assisted living retirement communities are a great blend of enough individual help, without an overwhelming amount of assistance. They are a great middle ground for many people, and they might serve your needs perfectly.

A Reconciliation - The Bible and Holistic Psychotherapy

The Source of All Good Healing

Psychology and fundamentalism at best have been polite opponents. In recent history, say the last 50 years, this opposition has become vigorous and often less than polite. Many churches, such as Calvary, completely eschew all mental health practitioners (whether social workers, psychiatrists or counselors) and staunchly maintain that all healing comes directly from God or prayer and that all you need in order to develop and maintain a robust mental health may be found in Scripture or a prayer session.

This rejection of psychotherapy may have been a reaction to the "I'm okay, you're okay" generation of therapists who did very little for most people except to allay the anxieties of narcissists and sociopaths by telling them "if it feels good, it is good." In the eyes of both Orthodox Jews and Christians, the field of humanistic psychology took the whole program of self-improvement one giant step too far, putting man in the center of the universe, particularly his own.

Their objections were not wrong. And I say this as a holistic psychotherapist with almost 25 years of experience in the field.

I have seen far too many well-meaning therapists do little more for their patients than make them feel better about being sick. They are loath to challenge or confront negative behavior or unhealthy thinking because they fear being seen as judgmental. As a result of their tentative relationships with the truth, they fail in their relationships with their patients. They do not see what needs to be healed so the patient is left unhealed. This is truly a disservice to the patient because what it ultimately does is feed the pathology and starve the essence of the person.

I think all good and true healing flows from the same Source which means that there can be an alliance-and an important one-between the Biblical and Mental Health communities. But only if we have an understanding of our terms and are actually seeking the same results.

What is Healthy? What is Unhealthy?

According to Samuel Hahnemann, M.D., after whom dozens of medical colleges around the world have been named, physical health presents with a very clear picture which is eternally derived from a healthy spiritual state.

"In the healthy human state, the spirit-like life force (autocracy) that enlivens the material organism as dynamis, governs without restriction and keeps all parts of the organism in admirable, harmonious, vital operation, as regards both feelings and functions, so that our indwelling, rational spirit can freely avail itself of this living, healthy instrument for the higher purposes of our existence."

He goes on:

"The material organism, thought of without life force, is capable of no sensibility, no activity, no self-preservation. It derives all sensibility and produces its life functions solely by means of the immaterial wesen (the life principle, the life force) that enlivens the material organism in health and in disease."

Therefore...health depends on a healthy wesen or life force or spirit. It is a process that proceeds from above down, from the inside out. This is also the philosophical underpinning of a proper holistic psychotherapy and the pivot point of all Scripture on the subject of good health.

Biblical Healing

Let us start with basics. What has the Bible been saying about health (whether mental, emotional or physical) for the past several thousand years? The following is a small sample of references:

"Do not be wise in your own eyes; fear and respect the Lord and shun evil. This will bring health to your body and nourishment to your bones." Proverbs, 3:7-8

"Hope deferred makes the heart sick; but when hopes are realized at last, there is life and joy." Proverbs, 13:12

"Look at the birds of the air, that they do not sow, neither do they reap, nor gather into barns and yet your heavenly Father feeds them. And are you not worth much more than they?" Matthew, 6:26

"This is what the Lord says: 'Your wound is incurable, your injury is beyond healing. There is no one to plead your cause, no remedy for your sore, no healing for you. All your allies have forgotten you; they care nothing for you.... But I will restore you to health and heal your wounds...'" Jeremiah, 30:12-14, 17

"Peace I leave with you; my peace I give you. I do not give to you as the world gives. Do not let your hearts be troubled and do not be afraid." John, 14:27

Even in this cursory perusal, it's easy to see that the biblical concepts of health are the same as those taught to graduate students in counseling: Hope, faith and an acceptance of reality, an understanding that we are not the center of the universe, peace of heart (a release of worry), generosity, service, humility, joy, and love. I am sure there is more, but I believe this is a good core to start with.

Clinical Healing

I have worked with individuals, families, couples and adolescents for almost 25 years. They have been both mandated to see me under duress and crawled in desperate for help. I have seen a wide enough range of people to ask a few pointed questions and hopefully seen enough recovery and healing to offer a couple of observations.

The first question: What are the things that lead to poor health, whether physical or mental/emotional?

In my experience, they are the same things the Bible warns us about over and over and over: Pride, Sloth, Greed, Gluttony, Envy, Lust and Wrath.

Almost every single patient I have ever had was doing battle with pride in some way. Some were engaged in battle with nearly all of them at once. And I admit openly that almost every pain I have ever suffered myself had something to do with at least one of those sins or as some people call them, "character defects."

One woman whom we shall call Sonia came to my office about 15 years ago. She was addicted to pain killers. She had some physical symptoms, but they were not the reason for the prescription or the solution for the pain she needed to heal. She complained about her mother, even though she had not spoken to her in many years and was enormously indignant (a combination of pride and wrath) about how she had been wronged. As she spoke of all the things her mother had done to her, she clenched her jaw and her hands.

When later in treatment I offered up the possibility that her continued rage (wrath) at what had been done to her those many years ago was actually only hurting her and that perhaps it was time for her to accept the fact that her mother had failed her and begin to consider forgiveness, she became outraged (pride). In her mind, accepting the reality of her mother's inadequacies (without making them her own) was unthinkable. Her mother had to be shown who was right and who was wrong. Sonia equated acceptance with excuse and could not, would not see it any other way. The end result? She stayed in pain and addicted to pain killers. Her pride would have it no other way. When the choice between being "right" or happy was presented to her, she chose to be right.

The second and perhaps more pertinent question: How do we treat these problems in the modern world? What is a psychotherapist to do if the purpose is to facilitate true healing and he or she is not a priest, pastor, or rabbi? We are not preachers. Our job is slightly different and the people who come to us are not always ready for (or necessarily interested in) an extreme spiritual make-over. People who may not be ready to go to a church or synagogue may need to someone objective who will just listen to them and hear their suffering. Many people need to talk before they can learn to pray. And the therapeutic relationship-if it is handled properly-can be the training ground for having other relationships, including one with God.

There is a difference between preaching and manifesting. It is good to inspire others with great thoughts about God. It is also good to manifest God's love through presence and compassion. There are times that a patient may be too angry at God to hear someone say, "God loves you," but not too angry to have God's love quietly demonstrated through patience, understanding, and honest integrity. And this may be the first time he or she has ever experienced it.

In my experience, what we have to do to be healing in psychotherapy is not all that different than scripture prescribes even if it is presented and packaged a little differently.

After working with patients for these 20+ years, I have broken it into five segments or stages, all of which I believe are biblically supported although none of these are dependent on one particular faith or point of view. All the seven deadly sins (or character defects) may be individually or collectively addressed at any point along these five stages. These stages are only clinical observations, not rules and shouldn't be approached legalistically.

I: Hope

All recovery-whether from drugs, depravity, or desperate fear-begins with a promise of hope, that there is "another way" to be, to live, to feel, to love and be loved. This hope is offered in different ways by different people, but I have found it best received by my patients in the form of personal and true stories of redemption (mine or others), of living examples of other people's recoveries, of their emotional, mental and spiritual salvations.

When we see the pain of the other person's struggles, feel the roller coaster of his unfolding temptations and challenges, identify with her frustrations and longings and then witness her release and deliverance...we can begin to hope. If it happened for them, perhaps it can happen for me...? All a good psychotherapist needs is one good perhaps and the work can at least get started.

Most of my initial work with patients is an infusion of hope. Some are so habituated to sadness, to pain, to loss, to deprivation, that they simply cannot imagine anything but the way they've always been. "But you are here in my office, so there must be some small ember still burning," I tell them. But many need quite a bit of tender care-a very careful fanning-for that flame to begin to burn again. So I pace them. (Pacing (*1) is a clinical term meaning that I am walking with the patient rather than running in front of him or dragging behind him.)

II: Surrender

Surrender is a word that gives moderns the shudders. What we are told to want for ourselves is power and control. We are carefully and consistently taught in graduate school to nurture in our patients their "self-empowerment" and imbue in them a solid sense of control. This can be important and necessary in very measured doses, particularly when a person has been abused and even the most personal controls have been denied them. But it can go too far and be endowed too freely.

Even some evangelists have done that with "prosperity gospel." In that philosophy you can tell where a person is spiritually by what he owns and how well his career is doing. Ask and ye shall receive, they remind us. But instead of its focus on the spiritual it has become a modern, media spin on the Doctrine of the Elect and Predestination: How do we know you have found God's favor? Because you're successful. How do you get to be successful? By God's favor. So, the goal is to acquire wealth, prestige, and power. Somewhere along the line even the ministers have forgotten, "Blessed are those who are persecuted for righteousness' sake, for theirs is the kingdom of heaven."

In the beginning of my own rebirth into sanity, the idea of surrender terrified me. I know from my own experience that surrender is at the very least an uncomfortable concept for most people. And some are not just tentative about it, they are panic-stricken, which is only reasonable since they have not yet come to trust that the universe is purposeful, creative, and meaningful. (For me that is God and, again, my surrender only came when I came to believe that God actually loved me.) For many of those just coming into therapy, the universe has been a hurtful, oft-meaningless, chaotic, unfair place. We cannot surrender to the abyss, to a vast darkness, to a deist blob that couldn't care less whether we existed or not, to a universe without love or meaning. I certainly can't imagine doing that. And I didn't. I couldn't. So, I present it in the way it was successfully presented to me-with great care and in small steps: Initial surrender means to accept reality. That's it. Not to like it or excuse it. Just to accept it as real.

Accepting reality is something people can consider even when reality is harsh, even when they are scared, hurt, or confused. Accepting reality is the underpinning of sanity. Denial is the basis for all insanity. When surrender is presented initially in this way, it becomes manageable.

So, what can they surrender to? I keep it simple. They can surrender to the fact that their lives are not working, or the unhappiness they live with at home, or the way they feel and make other people feel when they're drinking. They surrender to the facts first.

Why? We surrender first to reality because as we've been told: "The truth shall set you free.

Surrender in this way, taken in these gentle, baby steps, is what gets us strong enough to make the fuller, sweeter surrender, to take the leap into the love-both human and Divine-that is, as C.S. Lewis and Peter Kreeft call it, our heart's deepest longing.

III: Honesty

If truth is what we need, then honesty is what we must give. Why isn't my life working? Why is my spouse always angry? Why am I so easily offended? Why do I have trouble stepping out of the house? What do I feel? What do I need? What do I stumble over myself again and again and again?

This is a coming-clean, a venting, an admission of wrong-doing, a confession of mistakes and a map of wrong turns. It is what Alcoholics Anonymous has called a Fourth Step, what the Church calls a moral reckoning or examination of conscience, and the Jews a "tikun" or correcting. And it is absolutely necessary, whether one is an alcoholic or not, whether one is in a 12-step program or not, whether one belongs to a religion or not.

It is a brave step, this one. It takes courage to say "I really loused up that relationship," or "I was a coward when it came to my career," or "I was as abusive as she said I was."

Interestingly, it is at this point that the need for hope returns. It is very painful to look at all we've done wrong and terribly hard to imagine that it can ever be any different. In my work, this is a good time to remind someone of what is possible, returning again to the stories-the true stories-of redemption and the view from the top of the mountain.

Some ways back I knew a young woman (details disguised to protect identity) who had been seen by numerous therapists. She'd been diagnosed with PTSD, Bipolar disorder, and borderline personality disorder. She'd been medicated, treated with a dozen techniques, restrained for cutting, and finally written off as hopeless.

We spoke about her life, current and past. After about a month of piecing together her history, we landed on the issue of an abortion she'd had when she was 15. She had been so afraid: the boy who had father the child had abandoned her, her parents were busy with work and a very high-level social life, and she had no older or wiser siblings to guide her. Her life with the family's church had been cut off earlier because everyone had been simply too busy to bother with it. (She had been raised and baptized Catholic.) Ultimately her support and direction came from the media and from the information available at school.

I asked her about the abortion and how she felt about it. She answered with honest curiosity, "Why are you asking?"

"Because it's a big event, especially for a little girl," I said.

"No one else seemed to think so."

"What do you mean?"

"Everyone else seemed to think it was no big deal. You just go and do it."

"Did you see it as no big deal?" I asked.

She started to cry.

It took some time and many tears, but she was neither borderline, bipolar, nor hopeless. She was guilt-ridden, not by my accounting but her own. In an effort to be what her surrounding culture believed she was supposed to be, she had to lie about how she felt, what she wanted, and what she really needed. Telling the truth was her first step out of the pain and the pathology.

This accountability is a way of owning our mistakes so we can move forward to owning our achievements. If everything is everyone else's fault, then we are the victims of happenstance and there truly is no hope. People are awfully skittish about being accountable because they have been shamed and blamed to excess, but this is not about shame. This is the yellow brick road to freedom.

IV: Service

What does it take to make it better once we know what we've been doing wrong?

This is actually a more controversial question than one may imagine because according to many people in the field one must always focus on the positive. And by in large, they make a convincing point. Noticing what works often works. For some patients, I am the first one in their entire lives to say, "I see you. I see what is good in you. Let us look further to see what else you have that is good and can get better."

However, I think going fully in either direction-focusing only on the positive or focusing only on all the wrongdoing-is a mistake. There must be a balance, an acknowledgment of both aspects or inclinations of our natures. As the first story of Adam and Eve illustrates, we are not wholly good or wholly evil. We have capacities in either direction and to become good or to continue to be good, it takes a conscious effort and awareness of both those inclinations. We must nurture the one and starve the other.

How is that best done?

• First and foremost, through service and good works, even when we don't feel like it. There's nothing better for someone full of self-pity and hypochondria than to get out and volunteer. I had one young woman volunteer at an old age home. I had another at a soup kitchen. It doesn't matter how we give, but in order to grow, we must start somewhere.


• Through humility even when we feel boastful or proud or angry or indignant. We must do for others, like say we are sorry, even when we want to dig in our heels.


• Through patience and generosity even when we feel deprived and impatient.

Service to others is seen by many as a healing of a higher order, which is why it comes later in the 12-Steps of A.A.-we can only offer what we have learned or gained. "If you want to keep it [recovery], give it away," recovering addicts and alcoholics are told. The meaning there is clear-you must first have it to give it.

There is another side to this, though. Some of us call it "Act as if" and contend we only learn what we teach and only get what we give away. I think it works both ways and it is up to a good clinical team (meaning the patient and the therapist) to determine when and how to go about this. I am no Solomon. What I know, though, is that service-at any time it seems possible and right-is beneficial to the mind, the heart, the body, and the soul.

V: Forgiveness

Without forgiveness, we are stuck in the wrongdoing and don't get to move forward into our new lives. My feeling is that pride is usually the blockage on this. We won't forgive because we're right, damn it! And we want to be vindicated even more than we want to be free or happy.

Forgiveness never denies the wrongdoing (Romans 3:10,23). But it forgives the doer, who clearly knows no better or is too sick to ever see the difference.

Forgiveness doesn't mean we need to open our door to thieves. It doesn't ask us to be fools. The irony is that the less one forgives, the more hardhearted, vengeful and angry one becomes and therefore the less one is able to see the truth of any kind. Hatred does not only reject joy, it rejects truth and can't recognize a real threat when it's there.

Forgiveness is often the last step in this small ladder to emotional and spiritual freedom.

As Corrie Ten Boom, a Christian woman who survived a Nazi concentration camp during the Holocaust, said, "Forgiveness is to set a prisoner free, and to realize the prisoner was you."

One of the best examples of forgiveness is the story of Joseph and his brothers, who had collectively betrayed him and left him to die because of their own envy and greed. He crawled to survive, then was enslaved and thrown in prison. Many years passed. Still, when his brothers came to Egypt many years later, he not only forgave them after he saw that they had changed (and showed true repentance), he rejoiced in them.

Suffering: Is it Necessary?

There is one last issue I'd like to briefly address and that is the notion of suffering. I haven't allotted it its own stage of recovery because it involves all of them.

The worst part of modern psychotherapy is that it does not allow for the existence of suffering. It insists on happiness as a human "right" and promotes its open-throttled pursuit along with everyone else in mass media and entertainment. This is the parting of ways between what is ordinary psychotherapy (and even those preaching the Prosperity Gospel I mentioned earlier who believe they can petition God for whatever worldly goods or emotional rewards they desire, quoting "ask and ye shall receive" as if it offered proof of God as the Great Pez Dispenser) and a holistic psychotherapy that is based in traditional Biblical values.

Part of the problem is that the modern age of psychotherapists see happiness-which is defined as the attainment of some desired goal-as the end goal of healing.

Orthodox Jews and Christians have a different take on this subject. While it is seen as normal to want to be happy, to be healthy, even to have material comfort it is not seen as the purpose of our existence. It is not even seen as terribly important. It is considered far more critical to be good than to get what you [think you] want. Happy is fine. Goodness and purposefulness and joy-they are far better and reach in far deeper.

What is even more troubling to me is that I see people wanting the rewards of happiness without even the minimum of self-sacrifice. Americans particularly believe it is their "right." We have been told so repeatedly by the media and psychologists, and even a whole generation of "hip" preachers. Do what makes you happy. It's all that counts.

The philosophical pinnacle of this thinking is in New Age theology, where sickness, injury and tragedies are defined as self-inflicted manifestations of poor core programming. In that epistemology, Mystery is abolished and we are responsible for everything that happens to us and around us. If abundant health and wealth and beauty are our birthrights, then suffering means we have either done something wrong to deserve it or written bad scripts for our lives.

Given this mental and emotional mulch we are planted in, it is no wonder that we are so worried about our bodies, our bank accounts, and our images. We fret about face lifts more than we do about whether we have a neighbor that needs our help because she has been bed-ridden for a week.

Denying suffering has a price that is incomprehensibly enormous. Because when we deny suffering (which as Buddha said is inevitable in this life), we must also deny death. And to deny death, we must deny life.

Why should it be included in psychotherapy, though? Shouldn't we want to banish it forever? Why shouldn't we want to avoid it altogether? What's in it for us, anyway?

This is the answer I came up with: By being present for suffering, we become present for the whole of life, for the wholeness of another person. And the reward is nothing less than the ability to love-and be loved-fully. We suffer because we love and want to continue loving. It is a poignant irony, I think. In our attempt to avoid suffering, we cut ourselves off from the one thing that can mitigate it: each other.