Saturday, July 6, 2013

Making the Choice to Execute a Health Care Power of Attorney and Living Will


Advances in medical technology, recent court rulings and emerging political trends have brought with them a number of life-and-death choices which many have never before considered. The looming prospect of legalized physician-assisted suicide is one such choice which severely erodes the inherent value and dignity of human life. The much-publicized efforts of certain doctors to provide carbon monoxide poisoning or prescribe lethal drugs for their terminally ill patients constitute euthanasia. So may the removal of certain life-sustaining treatments from a patient who is not in a terminal condition. Euthanasia and willful suicide, in any form, are offenses against life; they must be and are rejected by the vast majority of U.S. states.

However, people faced with these difficult dilemmas should be made aware that there are morally-appropriate, life-affirming legal options available to them. One such option, for Catholics and others, can be a "health care power of attorney" and "living will." South Carolina State law allows you to appoint someone as your agent to make health care decisions for you in the event you lose the ability to decide for yourself. This appointment is executed by means of a "health care power of attorney" form, a model for which can be obtained from your attorney.

A health care power of attorney can be a morally and legally acceptable means of protecting your wishes, values and religious beliefs when faced with a serious illness or debilitating accident. Accordingly, for persons wishing to execute health care powers of attorney, see the following instructions and guidance from the authoritative teachings and traditions of various religious faiths.

The intent of the health care power of attorney law is to allow adults to delegate their God-given, legally-recognized right to make health care decisions to a designated and trusted agent. The law does not intend to encourage or discourage any particular health care treatment. Nor does it legalize or promote euthanasia, suicide or assisted suicide. The health care power of attorney law allows you, or any competent adult, to designate an "agent," such as a family member or close friend, to make health care decisions for you if you lose the ability to decide for yourself in the future. This is done by completing a health care power of attorney form.

You...

o Have the right to make all of your own health care decisions while capable of doing so. The health care power of attorney only becomes effective when and if you become incapacitated through illness or accident.

o Have the right to challenge your doctor's determination that you are not capable of making your own medical decisions.

o CAN give special instructions about your medical treatment to your agent and can forbid your agent from making certain treatment decisions. To do so, you simply need to communicate your wishes, beliefs and instructions to your agent. Instructions about any specific treatments or procedures which you desire or do not desire under special conditions can also be written in your health care power of attorney and/or provided in a separate living will.

o Can revoke your health care power of attorney or the appointment of your agent at any time while competent.

o May not designate as your agent an administrator or employee of the hospital, nursing home or mental hygiene facility to which you are admitted, unless they are related by blood, marriage or adoption. 1996

Your agent...

o Can begin making decisions for you only when your doctor determines that you are no longer able to make health care decisions for yourself.

o May make any and all health care decisions for you, including treatments for physical or mental conditions and decisions regarding life-sustaining procedures, unless you limit the power of your agent.

o Will not have authority to make decisions about the artificial provision of nutrition and hydration (nourishment and water through feeding tubes) unless he or she clearly knows that these decisions are in accord with your wishes about those measures.

o Is protected from legal liability when acting in good faith.

o Must base his or her decisions on your wishes or, if your wishes cannot be reasonably ascertained, in your "best interests." The agent's decisions will take precedence over the decisions of all other persons, regardless of family relationships.

o May have his or her decision challenged if your family, health care provider or close friend believes the agent is acting in bad faith or is not acting in accord with your wishes, including your religious/moral beliefs, or is not acting in your best interests.

CONSIDERATIONS FOR ALL PEOPLE FROM CHRISTIAN/CATHOLIC TEACHING

The following is an attempt to gather information from the doctrines of Christianity, Catholicism, and Judaism to see if there are any commonalities with regard to health care agencies and living wills. We will see that all three religions have placed a value on dying with dignity and the right of the person to direct how their dying process will occur.

A major tenet of the faith is that it is unethical to take a life. It is not the highest of all values to stay alive, but you cannot affirmatively take steps to kill someone. The church is strongly against euthanasia and suicide. But often if the patient and medical care providers permit nature to take its course without heroic intervention, the person's life may be taken by God.

This is a narrow path. Taking a life is inappropriate; on the other hand, using heroic medical measures to keep a body biologically functioning would not be appropriate either. Mere biological existence is not considered a value. It is not a sin to allow someone to die peacefully and with dignity. We see death as an evil to be transformed into a victory by faith in God. The difficulty is discussing these issues in abstraction; they must be addressed on a case-by-case basis. The Christian church's view of life-and-death issues should ideally be reflected in the living will and health-care proxy.

Roman Catholic teaching celebrates life as a gift of a loving God and respects each human life because each is created in the image and likeness of God. It is consistent with Church teaching that each person has a right to make his or her own health care decisions. Further, a person's family or trusted delegate may have to assume that responsibility for someone who has become incapable of making their decisions. Accordingly, it is morally acceptable to appoint a health care agent by executing a health care power of attorney, provided it conforms to the teachings and traditions of the Catholic faith.

While the health care power of attorney law allows us to designate someone to make health care decisions for us, we must bear in mind that life is a sacred trust over which we have been given stewardship. We have a duty to preserve it, while recognizing that we have no unlimited power over it. Therefore, the Catholic Church encourages us to keep the following considerations in mind if we decide to sign a health care power of attorney.

1. As Christians, we believe that our physical life is sacred but that our ultimate goal is everlasting life with God. We are called to accept death as a part of the human condition. Death need not be avoided at all costs.

2. Suffering is "a fact of human life, and has special significance for the Christian as an opportunity to share in Christ's redemptive suffering. Nevertheless there is nothing wrong in trying to relieve someone's suffering as long as this does not interfere with other moral and religious duties. For example, it is permissible in the case of terminal illness to use pain killers which carry the risk of shortening life, so long as the intent is to relieve pain effectively rather than to cause death."

3. Euthanasia is "an action or omission which of itself or by intention causes death, in order that all suffering may in this way be eliminated." "[Euthanasia] is an attack on human life which no one has a right to make or request."

4. "Everyone has the duty to care for his or her own health and to seek necessary medical care from others, but this does not mean that all possible remedies must be used in all circumstances. One is not obliged to use 'extraordinary' means - that is, means which offer no reasonable hope of benefit or which involve excessive hardship.

5. No health care agent may be authorized to deny personal services which every patient can rightfully expect, such as appropriate food, water, bed rest, room temperature and hygiene.

6. The patient's condition, however, may affect the moral obligation of providing food and water when they are being administered artificially. Factors that must be weighed in making this judgment include: the patient's ability to assimilate the artificially provided nutrition and hydration, the imminence of death and the risks of the procedures for the patient. While medically-administered food and water pose unique questions, especially for patients who are permanently unconscious, decisions about these measures should be guided by a presumption in favor of their use. Food and water must never be withdrawn in order to cause death. They may be withdrawn if they offer no reasonable hope of maintaining life or if they pose excessive risks or burdens.

7. Life-sustaining treatment must be maintained for a pregnant patient if continued treatment may benefit her unborn child.

Such principles and guidelines from the Christian heritage may guide Catholics and others as they strive to make responsible health care decisions and execute health care proxies. They may also guide Catholic health care facilities and providers in deciding when to accept and when to refuse to honor an agent's decision.

CONSIDERATIONS FOR ALL PEOPLE FROM JEWISH TEACHING

Jewish tradition as understood by Conservative Judaism teaches that life is a blessing and a gift from God. Each human being is valued as created b'tselem elohim, in God's image. Whatever the level of our physical and mental abilities, whatever the extent of our dependence on others, each person has intrinsic dignity and value in God's eyes. Judaism values life and respects our bodies as the creation of God. We have the responsibility to care for ourselves and seek medical treatment needed for our recovery-we owe that to ourselves, to our loved ones, and to God.

In accordance with our tradition's respect for the life God has given us and its consequent bans on murder and suicide, Judaism rejects any form of active euthanasia ("mercy killing") or assisted suicide. Within these broad guidelines, decisions may be required about which treatment would best promote recovery and would offer the greatest benefit. Accordingly, each patient may face important choices concerning what mode of treatment he or she feels would be both beneficial and tolerable.

The breadth of the Conservative movement and its intellectual vitality have produced two differing positions put forward by Rabbis Avram Israel Reisner and Elliot N. Dorff, both approved by the Conservative movement's Committee on Jewish Law and Standards. Both positions agree on the value of life and the individual's responsibility to protect his or her life and seek healing. Both agree on a large area of autonomy in which a patient can make decisions about treatment when risk or uncertainty is involved. Both would allow terminally ill patients to rule out certain treatment options (such as those with significant side effects), to forgo mechanical life support, and to choose hospice care as a treatment option.

Nevertheless, important differences between the two positions may be found regarding both theoretical commitments and practical applications. Rabbi Reisner affirms the supreme value of protecting all life. Even the most difficult life and that of the shortest duration is yet God given, purposeful, and ours to nurture and protect. All nutrition, hydration, and medication should be provided whenever these are understood to be effective measures for sustaining life. Some medical interventions, however, do not sustain life so much as they prolong the dying process. These interventions are not required. The distinction may best be judged by our intent. We may choose to avoid treatments causing us fear or entailing risk or pain, in the interest of the remaining moments of life. We may not avoid treatment in an attempt to speed an escape into death.

Rabbi Dorff finds basis in Jewish law to grant greater latitude to the patient who wishes to reject life-sustaining measures. He sees a life under the siege of a terminal illness as an impaired life. In such a circumstance, a patient might be justified in deciding that a treatment that extends life without hope for cure would not benefit him or her, and may be forgone.

Both Rabbis Dorff and Reisner agree that advance directives should only be used to indicate preferences within the range allowed by Jewish law. They disagree as to what those acceptable ranges are. In completing a health care power of attorney and living will, it is recommended that you consult with your rabbi to discuss the values and norms of Jewish ethics and halakhah. You also may wish to talk with your physician to learn about the medical significance of your choices, in particular any decisions your physician feels are likely to be faced in light of your medical circumstances. You may find it helpful to discuss these concerns with family members.

CONCLUSION

In the end, the decision to execute a health care power of attorney and living will is a uniquely individual choice. Every person has their own set of principles by which they will live, and by which they will eventually pass on. When executing these documents, it is wise to examine how these documents assimilate into your worldview and religious beliefs. While the topic of death and dying is an uncomfortable one, you are well advised to discuss this decision with your family members, friends, and members and leaders of your religious community that you respect. Having done this, you can rest easy knowing that you have made a good decision with regard to your health care power of attorney and last will, and that your last wishes will be respected and undertaken.

Tips For Taking Care of the Elderly


Caring for old people may be rough. At times, these old people become very hard to understand which makes it impossible for anyone to deal with their attitude. But patience is very important. During these instances, we are needed to show respect and provide help for them.

Numerous elder care arrangements have been provided for these senior citizens. The least expensive option is home care for the elderly. Only few house repairs and adjustments make up the expenses. When caring for the elderly at home, it is important for one to put handrails in the bathroom to hold the weight of the elderly; the bathroom floor could become slippery. The flooring should also be changed, linoleums are recommended, to prevent slip accidents in the house. In addition, a nurse or a caregiver may be hired if desired.

Home care for the elderly also gives the opportunity for the family members to spend quality time with their ageing loved ones. Personalized care and medication are provided while having the privilege of staying conveniently at home.

Other elder care options are assisted living facilities and nursing homes. Assisted living for the elderly is the most preferred option of families nowadays. This means of elder care provide assistance to old people while still giving them their independence. Nurses and caregivers assist in feeding, bathing, and dressing them. However, assisted living differs with nursing home care in the sense that old people in assisted living facilities do not need 24-hour medical assistance and supervision. Nursing homes, on the other hand, also provide assistance to old people especially the bedridden and very weak ones. Costs of assisted living facilities and nursing homes also differ. A room in a nursing home may cost three times that of an assisted living facility room. Extra charges for the use of certain amenities also apply.

Senior day care centers and independent living communities are also good choices. Busy family members who still want to live with their old loved ones may opt for senior day care centers. These day care centers offer fun activities and exercise programs for the elderly. They also provide nutritious meals and snacks. And similar to assisted living facilities and nursing homes, senior day care centers help the elderly become physically and socially active.

Independent living communities, however, do not provide medical assistance or supervision to senior citizens. This option is very popular among active old people who want to spend the rest of their lives relaxing and enjoying in health clubs and recreational centers around their community. An independent living community typically consists of low-maintenance apartments, condominiums, and town houses.

Whichever elder care arrangement is chosen, it is still best to keep in mind that a senior's personal safety and happiness are the most important.

Understanding the Job of Gerontology Nursing


With the rapid aging of the American population resulting in more and more seniors in need of continuing medical care, the health care industry has responded by devoting more attention than ever before to the unique treatment needs of elderly patients. The nursing segment of the health care industry has responded with equal vigor, and many nurses now focus their educational endeavors in the field of gerontology - the care of older adults. Gerontological nursing is now one of the fastest growing patient care specialties, and an area in which growth is expected to continue for at least the next several decades.

Gerontology nursing specialists are charged with providing treatment and care within hospitals, nursing homes, private medical offices, and even patients' homes. These nursing professionals also serve important roles in areas involving administrative, educational, and management responsibilities. Many elder care nurses serve within clinics and community centers, veteran care facilities, and acute care centers for the elderly.

Beyond the traditional educational requirements for a career in nursing, gerontology nursing specialists also take courses designed to provide them with unique specialty care skill sets to help them deal with the diverse range of treatment challenges posed by the elderly. Most programs provide mentoring and advisors who are responsible for arranging for the nurses' training in areas of health assessment and protection, theories on elder care, analysis of complex cases, management of common conditions endemic to seniors, and pharmacology. In addition, these mentors and advisors help to place gerontology nurses-in-training into clinical environments where they gain critical first-hand experience treating the needs of the elderly.

In some programs, nursing specialists are also given instruction in genomics to enable them to better understand the role that genetics plays in the aging process. As a secondary part of the gerontology education process, genomics helps in the understanding of why certain therapies are more effective in certain types of patients, and why some patient groups are more susceptible to certain chronic conditions than others. Other specialized information provided to gerontology nurses involves nutrition and physical therapy training that can assist nurses in helping the elderly to maintain a higher quality of life through improvement in overall fitness.

Gerontological nursing generally offers a slightly higher salary than standard general nursing opportunities. The latest national averages for this field of nursing indicate an annual salary of more than $55,000. As with other jobs in the nursing industry, the salary is dependent upon a host of factors that include geography, the experience level of the nurse, and whether the job is located within a hospital, private office, or home health care setting.

Salaries on both the east and west coasts of the United States can rise to as much as $70,000 or more, while those in certain areas of the Midwest tend to be somewhat lower than the national average. However, the benefits afforded to many in the nursing profession, when coupled with the actual salaries, create an overall compensation package that enables most gerontological nursing practitioners to remain near the top of their profession in terms of income earned.

Medicaid Nursing Home Spend-Down Program: 5-Year Look Back


Seventy seven million (77,000,000) middle class aging baby boomers are going to rely on Medicare as their default long-term health care policy. The Cato Institute estimates that $60 trillions of Medicare is an unfunded, unaccounted for obligation.*

The Medicare / Medicaid programs are dual eligibilities government programs for the aged, the blind, and disabled, and heavy long term care users for the poor of the poorest. Medicaid is the largest liability in state budgets having topped elementary and secondary education. For 2003, total Medicaid expenditures in most states were $267 billion. Of this, Medicaid financed nursing home care accounted for approximately $51 billion and home care $9.9billion.*

The new Tax Reduction Act of 2005 mandated that seniors spend-down all of their combined assets before the sick spouse can qualify into a nursing home. The act requires a 5-year look back for any transfers by seniors designed to deprive the state of those available resources to pay for the nursing home.

WHAT IS THE NURSING HOME SPEND-DOWN?

The spend-down provision is that "you must self pay" for your nursing home care with the sale of all your personal and real assets to the point of financial devastation of your life's savings driving you into financial destitution. Nursing home eligibility will be determined by your lack of any available resources designed specifically to punish/impoverish your healthy spouse.

WHY IS MEDICAID ESTATE PLANNING IMPORTANT?

The problem with the 5-year look back provision is that the new Medicare regulations do not consider the healthy spouse. It's a social punishment of the marriage certificate. It's a new social discrimination based on health. Eventually seniors will be forced to choose divorce for the sake of retaining their financial dignity.

WHAT'S HAPPENING WITH THE MEDICAID HEALTH CARE SYSTEM?

The gross mismanagement of the social security system is going to force baby boomers into giving serious thought about their long-term health care. There won't be any money by the time baby boomers reach retirement age. Health care has been escalating at an alarming pace. Government planners have figured out that they can save $10 billion over the next 5 years by increasing the look back provision from 3 years to 5 years.

WHAT'S THE 5-YEAR LOOK BACK FOR THE NURSING HOME PROGRAM?

Before you qualify for the government nursing home assistance program, there is a 60 month look back to see if and when you transferred your assets for less than fair cash value or you transferred your assets into a trust system or any system of transferring your wealth for the purpose of becoming eligible for the nursing home program depriving the state of all your available resources for your long-term health care.**

THE SOCIAL CHANGE AT HAND ON HOME EQUITY

According to the National Council of the Aging, 81% of America's 13.2 million households aged 62 and over own their own homes. Seventy-four (74%) of those seniors own their homes free and clear. Altogether seniors own nearly $2trillion worth of home equity.* You got to hand it to the government to help you figure out how to spend it.

They want you to use the equity in your home to pay for your own long-term health care! They are going to make it super-easy for you to borrow against it or "reverse mortgage" your way to creating a new government sponsored reverse mortgage industry. Based on this perceived wealth, it will not be long before government will mandate look back provisions of 10 years for most asset transfers to 20 years for real estate property.

WHAT'S A REVERSE MORTGAGE?

A Reverse Mortgage (RM) is a special kind of loan which can be obtained if you are at least 62 years of age (if married, the youngest must be at least 62) and own your own home, condo, or co-op. A Reverse Mortgage (RM ) converts a portion of the value (equity) of a home into instant cash. The main feature of this program is that you need not qualify for credit to obtain this loan.

The money borrowed can be in one lump sum, monthly payment, line of credit, or any combination. The Reverse Mortgage is a non-recourse loan. There's no personal liability to the borrower, their estate, or their heirs. The house is the only collateral and the borrower does not have to make any monthly payments; it's the reverse, the bank pays you.

What's wrong, is that the interest charged on the loan accrues and compounds on itself accelerating the amount of equity being removed from the home, not to mention the extravagant forced fees charged when there's no other alternative. What's wrong with Reverse Mortgage's is that the financial dignity of the senior will quickly evaporate, before their very eyes.

WHAT CAN YOU DO NOW TO AVOID THE GOVERNMENT MANDATED CONFISCATION OF THE MEDICAID NURSING HOME SPEND-DOWN PROGRAM?

Good planning is done when the seas are calm; it's often too late when the seas are stormy. It has become obvious that government has outspent their income and created more money with printing presses. As a boomer myself, I just don't like it when big brother has plans for my earnings and accumulated wealth.

The more money you throw at them the more they want, it's a black hole of the universe. If Government wants us to buy our own long-term health care, then why not make it tax deductible. Why on form 1040 heath care costs have to exceed 7.5% of adjusted gross income. Why not make deductions for long term care insurance 100% tax deductible, or better yet why not make it affordable.

*Source: Stephen A. Moses, Cato Institute, Policy Analysis, No. 549, Aging America's Achilles' Heel Medicaid Long-Term Care.

**Transferring assets at less than it's fair cash value i.e. transferring your home to your child for $100.00 is either considered a taxable gift in excess of the allowed $12,000 annual exclusion or it's considered a "fraudulent conveyance." See tax form 709 for gift tax consequences, see your lawyer for how to avoid fraudulent conveyance, or call Rocco Beatrice at 888-93ULTRA (888-938-5872) for a free consultation.

The Benefits of Companion Care For the Elderly and Disabled


Companion care of our aged and handicapped loved ones has been difficult and challenging as you are forced to make important decisions on how to provide home medical care. In this case, you may be stressed out and exhausted by the difficulty in managing time for commitments and other life activities. However, you cannot become a hero as taking care for the elderly and disabled is challenging. Home nursing and community nursing services can help you manage precious time and resources thereby improving the health and medical condition of the patient. You actually have two choices, face the burden to provide companion care or hire a home nursing agency to help.

The Real Facts

According to the Australian Bureau of Statistics 2003 report, there are 3.96 million (20% of the population) people have disabilities including 86% with specific limitations or restrictions. Accordingly, there are 3.35 million (16.9% of the population) people 60 years old and above including 51% with disability. These are glaring facts that show the significant number of elderly and disabled in Australia.

Statistics also show that majority of the elderly and disabled are living on their own with 2.83 million (14.3% of the population) people with disabilities including 1.38 million (7% of the population) elderly people with disabilities that need assistance with personal and other everyday activities. These statistics only goes to show that there is a growing need for companion care, home healthcare and community nursing services.

The Australian and state governments have established funded community care programs, Home and Community Care and Community Options Program, for people needing home healthcare services.

The Benefits of Companion Care

There is a big demand for personal care attendant services with a specific focus on companion care. Personal care workers are trained caregivers can act as the primary support for families with disabled or elderly loved ones. Aside from that, personal care attendants are much cheaper alternatives of registered nurses. They provide hands-on assistance with bathing, grooming, and dressing.

Companion care involves activities of daily living by assisting the patient to take a bath, dress, eat and walk, do light housework, meal preparation, take medications, shop for groceries or clothes, use the telephone and manage money.

More importantly, home nursing is much cheaper than institutionalised assisted living. The patients can still live in their own household but get similar services offered in nursing homes. Other than that, there is a much better interactive relationship between the caregiver and the patient. On the other hand, home care nurses are specially trained for certain home nursing services such as ambulatory care, paediatric care and geriatric care. They have the knowledge and experience in providing medications, monitoring nutritional intake and handling emergency medical situations.

For some patients suffering from specific disabilities, other healthcare providers provide specialists that include respiratory and occupational therapists, social workers and mental health workers.

The Necessity of Companion Care

There is a significant population of elderly and disabled in Australia and a greater need for quality home healthcare and companion care more than ever. Without reliable home nursing and home medical care services, the health of so many elderly and disabled would be jeopardised.

5 Tips for Choosing a Perfect Personal Injury Attorney


Experiencing any kind of accident can be an emotionally nerve-racking thing to deal with, but it can be even worse when there is physical injury also involved in it. Without a right personal injury attorney you may find yourself in a lot of difficulties like payment of sky-scraping medical bills. It is not very easy to pay these kinds of bills especially when you are injured and you are not able to do any kind of job. That is why it is very important to find a good personal injury lawyer who assists you in this type of situation.

These lawyers are able to assist you in dealing with different insurance claims, medical bills and most importantly handling your case in the court. Most of the people easily recognize these outstanding benefits of the personal injury lawyers and they do not make any kind of mistake in choosing a right attorney. Although some of them are under a lot of stress and due to this stress they make some mistakes in choosing a right attorney. It is very crucial to hire a good lawyer in order to make your case strong in the court. Following are some guidelines that should follow when hiring a lawyer.

1. The first and most important thing that you have to look in an attorney is its experience. Choosing a highly experienced attorney will ensure you that you are going in the court with skilled and trustworthy person. A good and experienced attorney is able to deal with all the complex paperwork and documents very efficiently and quickly.

2. Make sure that the attorney you are going to hire is giving the guarantee of his services. Today most of the good attorneys would not charge even a single dollar if you lost your case. Actually they are the ideal attorneys for every person to hire because by hiring them you are not taking any kind of risk.

3. You also have to make sure that your attorney must have a team of investigators. This team is able to deal with the different investigating aspects of your case. With the help of this information, your attorney will be able to build a solid and strong case for your claims.

4. When you are choosing an attorney for your case this is very important to choose a person who is objective and honest as well. You may want a big payout and fast settlement but an objective, honest and experienced lawyer will keep you from making any kind of hasty and foolish decisions.

5. An experienced and skilled lawyer will be versatile in its approach. It is essential to hire a lawyer who is able to deal with the lawyers of your opposition party in a professional and friendly way.

It is quite clear that hiring a right personal lawyer can make a big difference between losing and winning a case. Before hiring an attorney it is very important to do some research on the internet. If you follow the above mentioned guidelines then it will be very easy for you to choose a right kind of attorney for your case.

Friday, July 5, 2013

Independent Senior Living - Preferred Choice of Senior Citizens


As people get older, they look forward to more freedom than ever, as can be seen in senior citizens. Elderly people want independence in the way that they live, eat, work, and carry out other everyday activities. For these aged people, senior independent living is an ideal choice because they can be on their own. As human beings we will always have the desire to live independently, and this desire stays with us for our entire lives. With the increasing demand for these homes, there are a number of retirement apartments that offer complete freedom to their senior residents. They have their own space to enjoy their lives the way they want. So whether you are looking for the best retirement communities or a similar kind of facility, independent living is something you can enjoy anywhere. Usually senior independent living is a facility where senior citizens who are physically capable of taking care of themselves come together under one roof.

It is important to know that independent living facilities are different from assisted living facilities because the senior citizens have total freedom to handle their own cleaning and medical needs. It is the social need that brings these elderly people to the senior independent living facility even though they are physically fit and could live on their own without anyone's help. In old age, it's important to stay with peers, and sharing with people who think alike in this kind of environment is available in some of the best retirement communities. Senior citizens also need to feel safe and secure, which is another major benefit of retirement apartments. With age come social needs that are stronger than personal needs, so it is important for elderly people to live in an environment with their peers.

The senior independent living facilities offer basic services such as handrails and easy access to transportation, and the rest is managed by the senior residents themselves. If you are a healthy person and looking for retirement apartments, then you should always look for the facilities which allow you complete freedom and the right environment for your happy living. A lot of people fear that with age they will lose their independence, but with some of the best retirement communities around, this is no longer the case. For staying in an independent environment, aged people need to learn some home management skills and how to save money. Even at old age, senior citizens would never want someone invading their privacy. They want complete freedom, and for that they prefer senior independent living.

For senior citizens, it is important to live in an environment which is peaceful, happy, and free. Therefore moving into some of the best retirement communities allows them to enjoy the rest of their lives.

Assisted Living and Independent Living Differences


Assisted Living and Independent Living have huge differences and adult children make mistakes because they are not familiar with those differences. If I were a person looking for a place to have one of my parents live I would first consider what is known as Independent Living. It offers so much more in the conveniences of life to the average person with some eye, bone or other medical problems. Life is more rewarding in fun communities.

No question we need assisted living properties, but there are more people that do not need assisted living that are moved there by children that really have not realized the differences between assisted living and independent living. Their parents can function very well in an environment with services that fit their lifestyle. Services that include freedom to sleep in, freedom to exercise, socialize with others of their same age, enjoy a more active entertainment package, concierge services, theatre and Spa. I would always try independent living as a first choice of where to help parents relocate when the chores around the house become too much for them.

Why would anyone want their mother or father to go to a place where most of the people living there are needs driven. If your parents are able to get around at home with only a small amount of help it is a good chance they would be more satisfied in a place where there is a higher level of activity.

Here are some subtle differences in Assisted Living and Independent Living.

Assisted Living--------------------------------------Independent Living
  1. Medicine dispensed------------------------------1. Medical Alert System

  2. Scheduled Dining--------------------------------2. Freedom to eat on your time

  3. Bathing------------------------------------------3. Freedom to sleep in

  4. Diet Control-------------------------------------4. Choice of food

  5. Fitness Schedule---------------------------------5. Fitness Center

  6. Small TV room-------------------------------------6. Large Theatre & Movie Screen

  7. Small Apartments--------------------------------7. Large Roomy Apartments

  8. Cost Raised After Entry Level Services----------8. Prices Raised Annually

  9. Very little included after entry level------------9. Price all inclusive except phone

  10. More severe problems--------------------------10. Problems manageable

  11. Nurses aid on duty-------------------------------11. Managers or Concierges duty 24/7

  12. Nurse on call----------------------------------- 12. Managers or concierges on call

This is just some of the differences and there is a huge difference in cost of what is entry level services. After entry level services assisted living costs raise very quickly and most times it costs over double that of Independent Living.

Most doctors are not even familiar with the quality of life of Independent Living community. They are not aware of all the services, care of the management and staff and how more and more things are changing in Independent Living.

How hard is it to pick up a phone and give a call to tour an IL property before placing a parent, family member or friend in a place they are not happy.

Nursing Homes and Residential Care Homes Made Simple


Choosing the right care home for ourselves or a member of our family is not something we like to think about until the need arises. Nevertheless, with people living longer than ever before it is something we will probably need to do at some point in our lives. With the myriad of options available within the public and private sectors it can appear to be an increasingly complex area that families have to wade through at a difficult time in their lives. However, when broken down, you can see that there are several different types of home available offering a variety of support depending on the needs of the individual. Each one delivers specific assistance from personal through to nursing and specialist support. Some homes provide several types of support in the same location providing a solution for the changing needs of an ageing population. Homes with this kind of facility offer peace of mind to the residents knowing they will not need to relocate to another care home should their needs change.

Residential care allows an individual who has no need for additional nursing support to live within a residential home environment. Suitable for people who are able to look after themselves with the option of additional support with dressing and washing being available when required. Residential care is a long term option but can also be used for short term respite relief.

When illness arises, the need for a higher level of support is necessary. For those that need nursing help on a regular basis, nursing homes can deliver 24 hour support. Nursing homes have a higher proportion of qualified nursing staff and equipment than residential homes, offering a greater level of care.

Certain illnesses need specialist care. Specialist nursing homes that are equipped to deal with needs of patients with a specific condition are necessary. Both physical and mental issues are cared for with nursing staff qualified in conditions such as Parkinson's disease or dementia. Palliative care can also be offered with teams of dedicated health professionals offering the very best support to patients in the last days of their lives within their care home setting without the need for relocation to a hospital or hospice.

Combination care homes offer residents several types of support ensuring they will not need to move to a different residential care home when their needs change. They also offer the perfect option for elderly couples with differing requirements allowing them to stay together and receive support specific to their individual needs. They can relax in the knowledge that whatever happens in the future the support will be there to help them through.

Medicaid Planning With Your Elderly Parent


Medicaid, for many people, is the only long-term health care insurance available. If your elderly parent needs to go to a nursing home, unless he or she has substantial assets, your parent (or you) will most likely have to deal with your state's Medicaid agency to apply for financial assistance for the nursing home. This article covers the costs of nursing home care, what resources must be utilized by the elderly person to pay those costs, and what may be exempt so that costs don't completely impoverish your parent or other family members. You want to ensure your elderly parent receives the much-needed care that Medicaid can pay for while at the same time preserving property your parents have spent a lifetime to acquire. You will learn about how to preserve your parent's property while getting the care your aged parent needs.

Many people will try to keep their parents out of a nursing home for lots of reasons. One of the big reasons is the cost. Nursing home care is expensive. Expect to pay from $35,000.00 to $150.000.00 per year. Actual costs depend on several factors including the level of care provided and location. Typically it costs more in the northeast and in California than other locations. The average length of stay in a nursing home is around 2 翻 years or 30 months. The general rule is that before Medicaid will pay, your parent must spend all of his or her money except for the last $2,000.00.

Often times family members hope Medicaid will pay for their parent's health care costs but do not want Medicaid to take all their parent's money and property to pay for it. Some family members transfer property out of their parent's name into the name of another person so that Medicaid will not be able to take the property. Unfortunately Medicaid has a rule that says they can look at any property that your elderly parent owned for the last 5 years and take the property from the new owner to pay for nursing home costs. This is called the "5 year look-back period." People do not plan 5 years in advance for a parent's nursing home stay, so transferring property out of your parent's name will not work to keep Medicare from taking the property.

In many cases the family home is not something that Medicaid will take if the other spouse continues to live in the family home. In the case of a widow Medicaid still won't take the family home if the nursing home resident has the subjective intent to return home even if there may be no realistic possibility to return home. Often times all it takes to establish the subjective intent to return home is for your elderly parent to sign an affidavit stating that he or she intends to return home upon regaining good health. This preserves the house while your parent lives in the nursing home, but after your parent's death Medicaid can take the house to recover costs unless steps have been taken to avoid it.

Often times a simple strategy can be used to keep Medicaid from taking your widowed parent's home after he or she dies. That strategy is known as a life estate. It is simple to do. In addition to the affidavit of subjective intent to return home, your parent needs to sign a new deed to his or her house. This new deed gives the house to the beneficiary upon your parent's death while your parent retains ownership of the house during his or her lifetime. After the death of the parent, if the beneficiary acts quickly to complete the transfer of the title of the house from the parent to the beneficiary, Medicaid will usually not take the house. That is because Medicaid usually only intervenes in a probate to take the house, and the technique described above avoids probate.

This strategy avoids the problem of the 5 year look back period because your parent keeps the house during his or her lifetime so no transfer occurred. Then it avoids Medicaid using the house to pay for your parent's nursing home costs after your parent dies because there is no probate estate for Medicaid to file a claim against.

Since Medicaid is run be each state, the rules vary. This can get complicated very fast. Therefore you should not use this information as legal advice but should seek the advice of a lawyer who has experience in these matters.

To sum up you read about the possibility of your parent needing nursing home care, the costs of that care, and how long your parent may need that care. You also read that care is paid for by your parent and then by Medicaid. Finally you learned how to possibly keep Medicaid from taking the family home to pay for your parent's care.

This is a very complex area, and many different strategies are available to keep Medicare from taking family property. If you are facing the possibility of nursing home care for a parent and your parent owns a home or other substantial assets, it would be wise to seek the advice of an attorney who handles these matters to preserve family property.

Copyright 2011 Jeffrey B. Kent. You may reuse this article only if you use it unedited in its entirety and you provide a link back to my website.

Nursing Assistants Can Make More Money As A Home Health Aide


In today's economy, it would be imperative to increase a person's chances in obtaining work, by diversifying your career. As a Nursing Assistant there are opportunities available, but as a Home Health Aide you can add additional skills to your resume. This educational addition will take less time than a Nursing Assistant training.

Nursing Assistants work with multiple patients in various medical institutions and preform care such as bathing, grooming, transferring, and taking vital signs.These are skills that can lead the nursing aide to higher positions in nursing. Health Care is always needing competent staff to assist with patient care. So, it only makes sense for a Nursing Aide to work in home care. The skills are easily transferred to a Home Health Aide. An Aide takes care of patients in their homes. An aide takes care of one patient at a time. An Aide can work eight or twelve hours a shift. These shifts are assigned to the Home Health Aide by the Home Care Coordinator. The H.H.A can also work overnight in the patients home. This can be for three or four days straight.

The amount of pay may be capped off at a rate of sixteen hours for the day, because you will be sleeping and will not be paid when your sleeping.The advantage of this set up is that a certified nursing assistant can receive a Home Health Aide certification, by taking a conversion class at an agency that converts certified nursing assistant to H.H.A. This usually takes one day of class, which goes over additional skills that are not performed by Nursing Assistants, such as cooking, shopping, reviewing the plan of care, and safety in the field. Since Nursing Assistants already have the medical training background, which covers infection control, care of the elderly, bed making, one person transfer with a hydraulic lift, and light housekeeping their training conversion is fast. So, after the training is complete the student not only already has a nursing assistant license, but also obtains a home health aide certification. which makes that individual more marketable in this economy. The certificate remains valid as long as the Home Health Aide comes in for in service during the year. If the person does not work as a home health aide for two years, the certificate will expire. Then the individual must take the one day class over.

How Will Assisted Living Help My Parent?


It's not easy but the time will come when they have to decide if your parent needs to have help with their daily activities. If your parents don't need full assistance you won't want to put them into a nursing home. With an assisted living facility your parent or parents will be able to live a bit more independently but will get help with such things as eating, bathing, laundry, dressing, and medication.

These assisted living facilities also have medical care centers in the same building. However it may only be for the small problems and a regular doctor or hospital may have to be visited for the larger problems. When you put your parent into the assisted living facility a plan will be made that will detail the specific things that your parent may need help with. This will also ensure that your parent will receive the correct care that they need. Other names may be used for assisted living facilities, like residential care, supported care, board and care, adult foster care, sheltered housing, and adult homes.

Don't think of assisted living as a nursing home because it is not. In a nursing home your parent will have a lot less freedom. A lot of people think that assisted living is the same as a nursing home. However nursing homes are used for people who can't care for themselves or are too sick or frail to be in an assisted living facility. Where assisted living is used for a person who is more or less capable of taking care of them selves but may have problems in a few areas of taking care of themselves.

Most of the time a facility may have not only assisted living but also independent living and nursing home facilities all in one, this way a person can move to the different areas when they become worse and need to receive more care. Or a person from the independent living may be moved to assisted living when they aren't able to do all things anymore. When these facilities are combined a person can take advantage of services such as meals that may be prepared in a cafeteria.

If you put your parent or parents into a facility you will find that you have a choice of three types of contracts. They are extensive, fee for service, and modified. The three choices all include shelter, services, emergency care, and amenities. The difference in the contracts will be the fees per month. While if you choose the extensive contract it will include long-term care, and no increase will be notice in your monthly fees. While a modified contract will cover only specific things, while fee for service is as it sounds you will be charged for the different services that are used on your parent or parents.

This is never an easy choice as your parents get older to make but when you begin to notice that your parent seems to be having more problems with some of the daily things they need to do you will need to make that choice. At least with putting them in an assisted living facility you will give them sort of freedom but still gives them the help they need. Some parents may be a bit argumentative when it comes to placing them in a facility but all you need to do is be persistent and understanding and do what is correct and right for them.

Thursday, July 4, 2013

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


KH: What mistakes do families make when they start to talk about moving mom or dad into a facility?

Margie Veis: One of the biggest mistakes I see is plenty of kids know their parent is not safe at home, but they want to give the parent control.

Children typically tell me conversations with their parents go something like this: When I ask, "Mom, do you want to move to an assisted living?" "No." "Okay. Well, my mom doesn't want to move." Or "My dad won't move."

Well, are there safety issues?, I ask. "Yeah, there are many safety issues, and I'm not sleeping at night because I worry, and I have to go over there everyday, but my dad doesn't want to move and I can't make him." Or "My dad says it's too much money. He doesn't want to come here. My dad said: "I can still do it at home."

Many of our parents grew up in the depression. When they hear these numbers - because it's thousands of dollars - that's outrageous to them. Some of them are still thinking they can get a gallon of gas for 25 cents. Why in the world would they spend thousands of dollars to live here when they have a home?

You can't always let your parent be the parent. Sometimes you have to step in.

KH: How can families step in?

MV: Sometimes you can get a doctor involved. Sometimes you can say: "You know what mom, I need you to try this for me. We're not going to sell your house. You're going to live here for a month and try it. If you don't like it then we could move you back." Sometimes they're not going to move. Then you need to look at other alternatives - that could be in home care.

If it's really a bad situation, as hard as it would be you might have to call adult protective services and say: "This is not a safe setting for my parents. They're going to burn the house down. They're going to wander out into the street and get hit by a car. They're going to take the car and kill somebody. I can't do this myself, so you know what? I need to get an outside agency involved. I don't know what to do."

That's the absolute worst case scenario and last resort but that's what it can come down to sometimes.

KH: I remember taking mom's car keys away. It was one of the toughest things we ever did.

Margie Veis: I agree.

I've had that discussion with my mom a few times. We're not at that point yet but we started a dialogue and I think it's important as children to be having dialogues with our parents. "Do you have things set up? You're aging. I want to make sure that when the times comes and we have to do something that it's planned out and hopefully we're going to do it before it's a crisis."

If you can see that mom's unsteady and things are happening and she's not taking care of herself: her hygiene is not enough, she's not eating right, she's not getting out, or she's driving when she shouldn't, you need to be having that conversation and not waiting until it's a crisis and then something bad has happened.

Eight Types of Nurses


Nurses are respected and valued members of the medical community. They play a critical role in the health care field. Although the medical field is made up of many types of nurses, they are all exciting and rewarding careers. The following list outlines many types of nursing careers:

- Registered Nurse (RN): Registered Nurses work in almost all areas of the health care profession. They perform many tasks that include: administering treatments such as medications, performing certain medical procedures, monitoring vital signs, advising and supporting patients, educating patients about medical conditions, and keep families up-to-date on a patient's status. Registered Nurses can specialize in certain medical areas

- Certified Nurse Assistant (CNA): Certified Nurse Assistants are also known as nurses' aides, patient care technicians, home health aides, and home health assistants. CNAs are employed in a number of health care fields. They work in hospitals, nursing homes, private homes, and adult living homes. CNAs perform a number of duties that include: monitoring health such as recording a patients temperature, pulse, and respiration, helping patients eat, bathe, and dress, helping patients walk, keeping patients rooms in order, providing nutritious meals, answering patients' call bells, and making beds. They may also help patients to exam rooms and even assist with simple procedures. CNAs report to a Registered Nurse.

- Licensed Practical Nurse (LPN): Although Licensed Practical Nurses have less training than Registered Nurses, they are employed in all areas of health care. They work in hospitals, nursing homes, and medical clinics. LPNs perform such duties as monitoring a patient's overall condition, giving injections, recording vital signs, and applying dressings. They will also assist patients with personal hygiene and report any treatment reactions

- Critical Care Nurse: A Critical Care Nurse works with seriously injured and ill patients in the hospital. This type of nurse works in the ICU (intensive care unit) or CCU (critical care unit). Their job is to care for patients who are being treated for serious and life-threatening illnesses.

- Travel Nurse: A Travel Nurse is a nurse that travels to different areas and provides short term support when there is a nurse shortage. They will fill in when a full time nurse goes on maternity leave, during peak work times, if a nurse has a long term illness, or if a nurse is on an extended vacation. There assignments are short term but they are highly paid. An assignment usually runs for about 13 weeks. Travel Nurses often work in hospitals and medical clinics. Employers will provide many benefits such as free housing and health insurance.

- Licensed Vocational Nurses (LVN): Theses nurses perform the same job function as licensed practical nurses. LVNs provide certain medical services such as giving enemas, treating bedsores, bandaging wounds, and recording vitals. They also assist patients with bathing and dressing.

- Public Health Nurse (PHN): These nurses are registered nurses who have specialized in community health. They often go to community centers, homes, and schools where they assist individuals and families with health concerns. They work with community organizers regarding health related issues. They also perform the same duties as registered nurses.

- Nurse Practitioner: A Nurse Practitioner is a registered nurse who has specialized training and education which allows them to carry out many tasks normally performed by a doctor. Such tasks include diagnosing and treating illnesses and injuries. Some states allow practical nurses to write prescriptions.

These are just a few of the more popular areas of nursing. Nurses are on the front lines of health care and are usually the first people patients meet when faced with a health issue. Nurses provide valuable support for patients and their families making them an indispensable part of the health care community.

Medicaid Home Care in New York - What You Need to Know


As many people know by now, the eligibility rules for Medicaid changed drastically in February, 2006, when the legislature enacted the Deficit Reduction Act of 2005 (DRA). It is much more difficult to help clients needing nursing home care become Medicaid eligible.

What many people may not be aware of, however, is that in New York, there is no lookback period and no penalty period for Medicaid Home Care. Elder law attorneys are still able to do a lot to help seniors who need a home health aide in the home but are afraid of depleting their assets and becoming penniless.

It has been my experience as an elder law attorney that most people prefer to remain in their homes as long as possible. With a proper care plan in place, seniors are very often able to stay in their homes longer. As you might imagine, a senior's health may stay in tact much longer if he or she is getting proper meals and hydration, routine medical care and receiving supervision with walking and getting around, thus avoiding falls. This basic kind of care can keep a senior healthy and functional for years longer than may otherwise be possible.

There may come a time when a senior needs a nursing home level of care. However, it is just as possible that having care in the home may prevent the need to ever put that person in a nursing home.

Medicaid and New York Application Process

The process of getting someone eligible for home care and applying for home care in New York takes at least 3 months, if not longer. In New York, there are a few different ways of applying for home care. You may submit an application through one of the Medicaid field offices (called "CASAs"). You may apply through one of the Certified Home Health Agencies ("CHHAs"). You may also apply through the Consumer Directed Personal Assistance Program ("CDPAP"). Your elder law attorney will help you decide which avenue to go down depending on your particular situation. In New York City, for instance, I often apply through a CHHA, because once the CHHA is satisfied that all the application requirements have been met, it may put the care in place before the Medicaid agency even approves the application.

If a client already has an aide in place and wants to keep that person, assuming that aide is able to be certified, I would go through the CDPAP program, which allows consumers to hire their own aides, within certain parameters.

The home care application process is time-consuming and confusing. Once you foresee there may be a need in the future, you should start investigating your options as soon as possible, because, as with most governmental programs, there is a lot of paperwork involved.

File Your Airline Complaint in Small Claims Court to Sue the Airline and Collect Compensation


Air travel may be luxurious and comfortable but there are a lot of troubles that can come along as well. Troubles like missing an important meeting due to a huge delay in flights, lost or damaged luggage, being stranded in the airport without compensation, being mistreated by the airline staff, being bumped off a flight without notification or compensation - there are a lot of other troubling situations that can put you in a nasty situation and make you want to file an airline complaint.

You can actually sue these airlines that are making you go through all these troubles. You should not be intimidated by them - you have a right to get the excellent quality service that you expect of them. And when that service is breached, you have all the right to file an airline complaint immediately.

You do not need to hire an expensive attorney to do this. There are ways to file a legal airline customer complaint in an affordable and easy manner. There are systems like these that would work and would allow you to get the compensation that you deserve for all the troubles that you have gone through.

Think about this. You are a businessman about to go somewhere for a meeting the following afternoon. Your flight gets canceled and the airline decides to let you take a bus trip instead to reach your destination without giving you any compensations. Or your flight gets canceled and the next flight is still on the next day and the airline would refuse to pay for your hotel lodging and meals. Imagine being in these situations and what it can do not only to your business but to you as well.

There are a lot of possible airline complaints that you can file. Some of the most common issues involve ticketing and reservation complications, discrimination and prejudice from the airline staff, meal or disability requests are being ignored, damaged and lost bags, injuries gained during the travel, pet issues, delayed and canceled flights and not getting the proper mileage credit.

There are thousands of frustrated travelers out there who want to get compensations for all the mistreatment that they have gone through but they do not have enough guidance and courage to demand for it.

Estate - Will You Lose Your Home To Medicaid?


The largest financial risk that seniors face today is the potential of assisted living and nursing home costs to devour the nest egg that has taken a lifetime to build. Many will end up relying on Medicaid to pay these costs. If that's the case for you, chances are that Medicaid will come after your home when you die.

Before you get alarmed, make sure that you are not confusing Medicare with Medicaid. Medicare, available to seniors who have paid into the government's Social Security system, covers roughly the first 100 days of skilled nursing home care following a hospital stay of at least 3 days. Medicare doesn't help with custodial care.

Since Medicare is, in essence, insurance you have paid for through payroll taxes, the government can't try to reclaim that money when you die. Medicaid, on the other hand, is a welfare program that provides health care to the poor of any age. Qualifying for Medicaid requires the patient's liquid assets to be no more than $2,000, not including their home.

Traditionally, Medicaid has allowed a patient to keep their home while they're in the nursing home. Since Medicaid doesn't force the sale of the home at that time, many seniors assume they will be able pass it to their heirs at their death. Recent actions by states are making that less likely.

Back in 1993, Congress passed a law that required the state agencies that run Medicaid to make every effort to get reimbursement for the money spent on each patient. This means the states are required by law to take any assets remaining at death, up to the amount spent by Medicaid. So if Medicaid spends $75,000 for your care, the states will seek to recover $75,000 from your estate when you die.

For years, many states completely ignored this law or only casually attempted to recover Medicaid costs. But those days are over. Facing budget crunches and exploding health care costs, many states are now aggressively pursuing recovery of their expenses.

There is a whole industry devoted to shielding seniors' assets from the government so that they qualify for Medicaid. These include the use of irrevocable trusts, placing assets in the name of a child or the purchase of an annuity. But there are already rules in place that disqualify you for Medicaid when assets have been transferred to a trust or child within 3 to 5 years of your application. It will not surprise me to see states try to make it harder to move or otherwise protect assets.

More common are situations like this hypothetical one. A widow named Thelma develops dementia and Ted, her son, moves his mom out of her house and into a nursing home. Thelma's meager bank accounts are drained and she soon qualifies for Medicaid. For the next two years, Thelma's health gradually declines and she finally passes away.

Several months later, Ted is preparing to fix up the old home place as a retirement home for him and his wife. But he's shocked when he receives a notice from Medicaid that $85,000 is owed to cover the cost of Thelma's nursing home care. Ted will then have to sell the old family home, get a mortgage on the home or use other money he has saved for his own retirement to pay the bill. Regardless, the result is that the bulk of Thelma's estate went to the state instead of to Ted.

What if Thelma's home wasn't worth the $85,000 that the state was trying to recover? States are now beginning to go after other assets and personal possessions such as vehicles, family heirlooms and antiques. The state can force the auction of all of Thelma's belongings by placing a claim against her estate.

The state can legally pursue any and all of Thelma's assets in an attempt to recover what was spent on her care. Fortunately, the state can NOT seek to recover any remaining shortfall from Ted.

Investigate the procedures of the state where care is being received, because each state has different standards and procedures for Medicaid cost recovery. The trend will continue for states to increase their attempts at Medicaid recovery from estates of recipients. Be aware so you aren't caught off guard.

Seven Reasons Why Seniors Want to Stay Home


I think that, as a group, seniors are some of the most surveyed folks out there.? Being in the senior home care business I am more acutely aware of the surveys then the normal person and like to see how the results of those surveys match up to my personal experiences.

More times then not the results do not go beyond the numbers to the underlying cause and effect or at least the feelings of those being surveyed.? In a recent survey it was reported that over 80% of seniors would rather live out the rest of their days in the own home and not in an assisted living or similar facility.? That's really not breaking news but it started me thinking about why the seniors are so motivated to stay in their home.

I started doing some research by going over my notes from prospective client families, care recipients and also our wonderful care givers.? So I have come up with seven reasons why seniors want to stay in their home.? These seven do not have real defined borders and have branches or even roots in other reasons.

  1. Comfort.? This reason really bleeds over into the others as well but the senior is comfortable in the house where they have lived for many years.? The TV is just the right distance from their chair and doesn't have any reflections on it, they know the HVAC system and where it needs to be for comfort, they have spent years getting the furniture the right size and in the right place.? So why should they leave.

  2. Safety.? Now at first glance this might be a reason for going into assisted living but most seniors feel safer at home.? They know the sounds of the neighborhood, when neighbors come home and when they leave and most can move around their house and even their yard blindfolded.? We have a 94 year old client who is almost totally blind and lives by herself but she knows where everything in her house is, even her meds.? She has her morning meds in one location and the bottles are arranged in a specific way and the evening meds are in another location.? She feels safe in her environment.

  3. Memories.? They have experienced the entire fabric of life in their home.? Birthdays, holidays, including dry turkeys, disappointments and celebrations, medical issues, retirement, aging and death.? The home has been the foundation of all that has gone on and they don't want to walk away.

  4. Independence.? From pre-teen years we all strive to achieve independence and now that the senior has had it for so many years they guard it with all the vigor they can muster.? If the car keys were taken from the senior earlier then this is the last vestige of independence.? Note to family: rescinded driving privileges will be the biggest fight but the home is second.

  5. Cost.? Assisted living expenses can run as much as $4,000 plus a month so staying in one's home can be quite a savings.? Add to that the possibility of a reverse mortgage and their monthly bills can be reduced but things like a gardener, pest control, etc have to be managed.

  6. Network.? This term might be used with younger folks but even my 94 year old client has a network...a social network of neighbors and friends who check on her and bring her treats.? Many times these social networks are shattered when the senior moves to assisted living.? My mother-in-law who lives with us still talks about neighbors she had ten years ago.? Don't discount these social connections.

  7. Family.? Many times the family home is just that and there are extra bedrooms for visiting family members.? Children of the senior can visit and bring their kids and now you have three generations staying connected in a home environment, not just visiting grandma at an assisted living facility.

Back in the day there were only two choices for seniors and that was stay in their home or live with the children.? Now there are so many more choices up to and including resort like living where you eat all your meals in a nice restaurant environment.? The choice we made was to have my mother-in-law live with us, it just made sense and we felt better about it.? But the transition wasn't easy, especially for mom.? But over the years she has settled in and knows exactly how many steps it is from her room to the bathroom.

It is important to hold family meetings with the senior included to discuss how it will work and if additional in home help will be needed for a portion of the day.? In home care can make everyone more at ease if it is decided that the senior will be allowed to stay in their home.

Wednesday, July 3, 2013

Car Accident Attorney: When To Seek Legal Advice


How long can you wait before contacting a car accident attorney? While there are no real time limits to when you can obtain legal representation, it is always a good idea to find someone that can help you as soon as possible. When a person attempts to handle a case on their own, they often run into all types of unforeseen issues. Without knowledge of the law and experience working with insurance companies, it can feel like running around in circles without ever making any progress.

Immediate Phone Call:
The first thought after a collision should be your personal safety as well as the safety of the passengers and individuals in the other vehicles. From there, the police usually show up at the scene and try to direct traffic away from the incident. At this point, a police report is created and the officer will determine who is at fault. You will receive a copy of the report as will the other driver.

If you already know that name of a car accident attorney, you can make your phone call right away. If you are not severely injured, you can call someone and set up an appointment in the near future. Most people are traumatized by the experience and often wait several days to make that phone call.

Contacting Someone When You Get Home:
Once you are home and have had some time to recover from the shock and injuries, you probably want to make contact with a car accident attorney. Even if the other person seems genuinely concerned and promises to pay for the damage of their insurance company is calling and offering a generous settlement, there are still benefits to talking with a lawyer.

Check for someone that offers a free initial consultation if possible. He or she will be able to tell you whether or not you have a case worth pursuing. You can explain what happened, present a copy of the police report and show and medical bills that you have already accumulated. If you do have a case, this is the best time to get a car accident attorney involved. Right now, no settlements have been made, the details are fresh in your mind and your legal representative can start working on your behalf.

Waiting to See How Things Work Out:
Some people choose to wait and see how things are going to work out. They want to call the other person's insurance company and wait to contact their own insurance company. The goal is to handle the settlement without paying for a lawyer. While this seems like a way to save money, it could end up backfiring. You may end up agreeing to a settlement that will cover only the immediate expenses but not provide for issues that may come up in the future. In essence, once you have agreed to something, you may not be able to get out of it, even with the help of a car accident attorney.

Don't Abuse America's Seniors: Let Them Enjoy Life!


The New York City Elder Abuse Center posits various examples of elder abuse or neglect. A Mrs. Rose has a 'wonderful' 37-year-old son named Derek. He's got a drug problem, and he yanked a bloody swatch of his mother's hair out of her head during an argument when she refused to give him money. Mr. Koff's 44-year-old mentally ill daughter, Karen, threatened to rip the phone out of the wall and trap him in his bedroom while he slept if her father didn't let her boyfriend spend the night. Mrs. Goffard owned some jewelry that was precious to her. But her 21-year-old granddaughter, Ivy, sold the jewelry without permission and used the money to pay back a debt to an acquaintance. The 32-year-old stepson of a Mrs. Noonan forced her to watch pornography with him while he exposed himself.

Now, here's the kicker, thousands more Americans have one parent or both secluded in their homes. Most do not overtly abuse or harm them. However, they take the parent's social security check and pension money. They take away their autonomy under the guise of making sure they don't "hurt themselves." However, the biggest crime is the fact that the parent could still be quite active, enjoy outings, spend days or evenings with friends, cook or do hobbies, and enjoy being accompanied by their adult child on errands and shopping trips. But they are cast aside as if they are useless.

Contrary to what some may think, many seniors don't typically want to live in the home of a relative; for as long as possible, they want to live on their own. In fact, research shows that only about 1 in 1000 would prefer to live with their kids. This population is not helpless by any means. The facts indicate that Americans over the age of fifty own 75 percent of all American assets and spend half the money. Close to 70 percent of them still own their homes. They vote and are often more active in the community than are those who are younger. Many even exercise regularly and work out at gyms.

And caregivers must help seniors to remain as active and independent as possible for as long as possible. They must walk that fine line between using methods to preserve and promote normal functions for as long as possible while still beginning to assist the senior with overly difficult duties. In other words, most seniors express a strong desire to remain relatively independent for as long as possible and efforts can be made through exercise, diet, and physical activity in order to allow them that ongoing sense of accomplishment and self-respect. Aerobic exercise, brisk walking, leg and arm strength routines, and health monitoring is important. It is vital that senior mobility is evaluated consistently because adult falls often result in severe injury, including torn muscles or broken bones.

Authorities Mark Freedman and Phyllis Moen both write of a new demographic forming in America. By the year 2030 there will be about 72,000,000 individuals in the U.S. over age 65. That is twice the number of seniors in 2000. They call it the mid-course or the New Life-Stage. It will primarily encompass this baby boom generation. Millions of these "retirees" will actually retool themselves and launch second or third careers, develop new 'identities', establish new patterns with their significant others, and avoid boredom and helplessness at all costs. Abigail Trafford, Washington Post columnist, writes, "Something huge is happening here... The emergence of an older, more vigorous population is the most significant story of our times."

Fighting For Family Members in Nursing Homes


Whether your family member is in a nursing home or rehabilitation facility short or long term it is extremely important to be vigilant about their care. While many assume this is the responsibility of the facility providing care, do not become complacent and assume this is what actually occurs. Reality is often different. Many family members overlook or excuse the small things. A person not bathed frequently, a dirty room, increasing confusion or anxiety. There are so many things that can and do happen and if left unchecked continue to progress and become critical.

Consider the case of a father who had surgery and went for short term rehab. As a result of the surgery, this individual because anxious and extremely depressed. His daughter, knowing that dad had episodes of mental illness all of his life discussed this with the facility staff who mentioned it to the on call physician. The physician, having no background in mental health, prescribed ativan, a medication typically prescribed to calm anxiety. This worked for a brief matter of time until dad became increasingly depressed, a risk to self and according to the facility required 24-hour supervision which the family was forced to pay for privately if they wanted their father to continue to receive care.

More concerns were expressed by the daughter. The physician, again having no background in mental health, requested that a mental health social worker visit and make recommendations. The social worker proceeded to recommend an anti-psychotic medication that the physician prescribed. Unfortunately, dad had an immediate psychotic reaction from the medication and was transported to the local hospital emergency room for medication issues. In spite of the daughter requesting that the hospital emergency staff find a way to have her father evaluated from a psychological standpoint, they simply sent him back to the nursing home under 24 hour supervision.

This is a clear case of a daughter recognizing the needs of her father and the system failing to respond. The daughter, highly educated and intelligent, had no idea how to work within the system to achieve the desired result for her father. Fortunately I was contacted the evening of the hospital emergency room event and spent the next day having her father complete the requisite admission tests for acceptance into a psychiatric evaluation center.

It is important for families to understand that the health care system has limitations; that skilled nursing and rehabilitation facilities have limitations to the care they can provide. Even physicians, many who are general practitioners, are limited in their expertise. And that eventually the time comes to consult individuals versed in the situation with access to a wide range of resources. It is easy to assumewhat we know; yet more difficult to admit we lack the expertise to care for a family member. Many individuals experience panic in failing a family member because they do not know what to do. The best course of action is to admit help is needed and contact a professional who can help navigate the system.

Best Practices: How to Identify the Best Practices to Improve Productivity for Your Hospital


Google the words "best practices," and you will find about 75 million internet pages addressing the topic. Google "hospital best practices" and the list shrinks to a mere 9 million web pages. That this two-word phrase so quickly became a universally-recognized part of the management vocabulary is hard evidence that consultants have been at work.

It's all about timing (and a few other things)... Add the buzz word-like popularity of "best practices" to the staying power of a much abused saying "There's no point in re-inventing the wheel", stir in the culture's insatiable hunger for instant results, and shake well. You now have the potential makings of real trouble.

"Best practices" have been defined as "documented strategies, activities and approaches shown through research and evaluation to be effective in achieving the highest levels of excellence in productivity, profitability and competitiveness." Part of the concept's appeal is its elegant simplicity. Find the best way to do something and copy it. Problem solved. Ah, if only it was that simple.

Famed management guru Peter Drucker described the modern hospital as "the most complex social organization ever designed by man." That complexity is a fact. For that matter, so is the department head's frequent claim of "uniqueness." Every hospital differs from all others in literally thousands of ways. These differences exist even among peers that share the same basic mission and challenges. Here is a short list of hospital-to-hospital differences that can be found in countless combinations and permutations of combinations, each with tremendous implications for productivity, profitability and competitiveness:

  • Systems and Work Process Factors
    • Patient access.

    • Nursing care delivery.

    • Medication administration.

    • Order entry.

    • Results reporting.

    • Care documentation.

    • Patient discharge.

    • Supply inventory and control.

  • Organizational Factors
    • Organizational structure.

    • Planning.

    • Information dissemination.

    • Employee work schedules.

    • Patient appointment schedules.

  • Resource Factors
    • Clinical equipment.

    • Information systems.

    • Supplies.

    • Human resource numbers, skills and training.

    • Physical space adjacencies, size, and layout.

  • Business Assumption Factors
    • Mission and vision.

    • Strategic goals.

    • By-law requirements.

    • Resource commitments and constraints.

  • Organization Cultural Factors
    • Management focus.

    • Work ethic.

    • Employee commitment and buy-in.

    • Medical staff expectations.

The greatest shortcoming of the "best practices" concept in the long term is that it serves to stifle management creativity. Imitation by definition cannot produce progress. It would be more accurate (and instructive) to re-label the "best practices" concept to something like "best practices that we know about--so far!" More practically, the sheer number of performance-defining variables makes it impossible to identify with certainty those "strategies, activities and approaches" that can or should be universally emulated. The likelihood that visits to "best practices" hospitals will identify an exportable "cause" of high performance that will work in your hospital is vanishingly small.

Is it not interesting that the same managers who are quick to employ the "uniqueness argument" as a defense against adverse performance comparisons are usually among the first to insist that the best way to resolve the variance is to import a solution from "high performers" in their peer group? Aren't these the very departments that were previously claimed to be so dissimilar as to make performance comparisons invalid? (Note: These differences do not negate the value of benchmarking so long as peer groups are selected correctly.)

Although imitation has been described as the most sincere form of flattery, as a technique to advance performance improvement in the modern hospital it may not produce the best results. After all, it does not matter in the least that Mercedes Benz has the best transmission in the world if that transmission cannot operate in your Buick.

We suggest the following approach to applying the "best practices" concept in any hospital:

  • Look inside your organization first! Identify performance limiting factors. Consider both the cost of "fixing" those factors as well as the cost of not fixing them. These may involve:

  • Systems and work process factors.

  • Resource factors.

  • Organizing factors.

  • Business assumption factors.

  • Hospital culture factors.

  • Specify target outcomes. In other words, describe the conditions the hospital wants to exist as a result of resolving performance-limiting factors. Quantify them when possible.

  • Select, develop, and implement the solution that will work best in your hospital. Consider the institution-wide effect on all departments, the medical staff, and other stake holders. In some cases, the best solution can be internally designed or purchased "off the shelf." In other cases, a customized solution may be necessary.

It is during this last step that you might consider emulating "best practices" from other hospitals or industries but only after the potential solution has been thoroughly evaluated to insure that it fits the unique operating and cultural characteristics of your hospital.

Hospitals have expended much treasure, time, and energy attempting to import "best practice" solutions that had great initial surface appeal but ultimately proved to be unworkable because of internal factors. The solutions that will work best in your hospital will necessarily be those that most closely match your organization's unique characteristics.

穢 1990-2011 Frank J. Brady & Associates, Inc.

Advocate For Senior Citizens - Protecting Against Abuse and Fraud


Ruth is 87 years old this year and has been living alone since 1997. She is in good health, however the daily chores around the home became increasingly difficult. Ruth turned to her church bulletin and found a ‘Home Care Company’ advertised.

Ruth is not unique in the fact that she is widowed and lives alone. According to the ‘2002 A Profile of Older Americans’ published by the Administration on Aging ([http://www.aoa.gov/aoa/stats/profile/4.html]) 41% of women age 65 and over, are widowed and live alone.

“The ad was in the church bulletin, I assumed this was a good company,” her voice cracking from the pain and embarrassment this home care service eventually caused her.

Unfortunately, Ruth is also not alone in the fact that she became victim to fraud. According to U.S. Senator Larry Craig, past ranking member of the U.S. Senate Special Committee on Aging, ‘Vulnerable elders are being abused, neglected and exploited within their own homes and communities at an a alarming rate.’

“The lady they sent to me was well groomed, she was polite, and I had no reason to distrust her. You could tell she was from a good family …” Ruth went on to justify how quickly she was robbed of $4,200.

Barbara Mascio, founder of Senior Approved Services, states “Ruth’s story was just one of many incidences of abuse that I learned of while employed with a national home care company. The stories of abuse and fraud against this precious generation became the driving force behind the creation of Senior Approved Services.”

Senior Approved Services actively assists in protecting seniors by helping to connect them with businesses that have a verified history of providing excellent care. “We remain actively involved, a link between the senior receiving care and the business providing the care.”

“We are building a nationwide network of services, resources and products that seniors and their family caregivers can feel safe in contracting with. We are inviting all those concerned with the right of all seniors to receive excellent and safe care to help.”

Elder Abuse Prevention in a Nursing Home With a Spy Camera


As the general population ages, more of our elders spend their final days in a nursing home. If you think they are free of abuse there-forget it! It has been reported that one of six nursing homes or assisted care facilities report some type of elder abuse. That is a scary stat.

The abuse can come in many shapes and forms-verbal, psychological, physical of course and mental abuse are all reported. For patients with Alzheimer disease abuse seems to be higher with theft being much more common.

If you have loved ones in such a facility how do you go about catching it? One of the best ways is with a hidden spy camera or common spy camera foe elder abuse prevention.

There is a new generation of spy camera with a DVR built in. These new high-tech hidden spy cameras are basically simple board cameras hidden inside everyday household or office objects. The more common the better. Most are working products that can further carry out the deception. Some examples include clock radios, tower fans, air purifiers, exit signs and more.

The DVR has an 8 GB SD card that can record up to 144 hours of activity. Motion activation is a feature along with area masking and a date time stamp. The motion activation feature could allow up to a weeks' recording depending on the activity level.

These new DVR hidden spy cameras make covert recording of potential problems very easy and by comparison very cheap. Be proactive and stop elder abuse with your folks now.

When are you getting one?

Tuesday, July 2, 2013

Doctor House Calls at Assisted Living Facilities - How They Help Families and Residents


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

KH: How long have you been doing this?

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

KH: One thing I really liked about mom's gerontologist was he came here, actually making house calls. The fact that mom didn't need to go to his office was a real benefit to me and brothers. Is that a trend among doctors that have patients in assisted living?

MV: I know the few physicians that do that. I'm probably not knowledgeable enough to know if that's a trend or not, but I know in Santa Clarita there are a few and we utilize them.

KH: It occurs to me that having the synergy between the staff and the doctors watching out for the parent all the time is a huge plus.

MV: It's great when we have a good relationship with the physician that we know is going to answer our fax or answer our request when we pick up the phone and say: "We have these concerns. What do you think?" and work together to better treat our residents. It's a great benefit.

KH: Families might not get that at home - that constant awareness of what's going on with their parents.

MV: No, because if they're at home it's up to them. Here they have many different sets of eyes looking out for their parent. They have food servers, they have a nurse, they have an administrator, an activity director, a bus driver, the house keeper - everybody is looking out for their best interest versus it all just being on the family.

KH:: Or whomever they hire for home care.

MV:: Or whomever... Right... If they have a caregiver, it's only one perspective.

KH: And it's not 24/7.

MV:: Not unless you pay for 24/7 care.

Caregiver Certification and Training Programs


Employment as a senior caregiver brings fulfillment beyond a paycheck.  Job duties include assisting with meals, laundry, medication management, daily exercises, bathroom visits, bathing and maintaining a clean household.  In addition, companionship is an important part of senior care as friends may have passed away and family members may live far away.

What are the employment opportunities for senior caregivers?


  • Nursing Home Nursing Aide

  • Hospital Nursing Aide

  • Assisted Living Nursing Aide

  • Senior Home Care Agency Caregiver or Nursing Aide

What certifications are required?

Nursing homes and most Assisted Living communities will require caregivers providing hands-on assistance to be certified as a nursing aide or home health aide and some senior home care agencies also require certification for some assignments.  However, the specific certification varies depending on the requirements of your state's department of health.

Training for most certification programs requires classroom work, along with field work where the caregiver will work in a hospital or nursing home with the supervision of the trained staff.  Most certification courses for nursing aides and home health aides require the following for admission:


  • High School Diploma or Equivalent

  • Criminal Background Check

  • Turbeculosis Skin Test

  • Reading Comprehension Exam

  • English Competency

  • Drug Test

  • Minimum Age of 18

A state exam must be passed for final certification.  The cost of certification programs can be from $600 to $2,000 and often financial aid and grants are available, especially through community college programs.  Caregivers increase their job prospects by becoming certified and are able to show potential employers that they have an understanding of the basic skills needed to safely provide care for a senior. 

If you are thinking of obtaining certification, research programs early and talk to other certified caregivers to learn about the challenges they experienced.

Pass CNA Exam and Earn Certification


The importance of CNA Exam can be best understood by the fact that, if you pass the exam, you will get registered with state Nurse Aide Registry. The registration also provides legal working permission in the hospitals, long term care facilities and other health care settings.

CNA Exam is also known by different names, such as Competency Evaluation Test, Certification Exam and Licensing Exam. The Exam is regulated and managed by the State Board of Nursing (BON), and administered through BON, D & S Technology, American Red Cross, Prometric and Pearson Vue.

But, it is also true that to get the eligibility to appear in the Certification Test, a student must attend and complete the state and OBRA-87 approved CNA Training Program. Though, training programs can be attended through various schools, community colleges and technical institutes, the programs offered by the American Red Cross in 36 states of America are termed as the best.

In few states, such as Hawaii, Massachusetts and Georgia, the American Red Cross is authorized to administer the required Nurse Aide Competency Evaluation Exam (NACEE) also.

Massachusetts Red Cross CNA Exam

Any student, aiming to get certified in the state of Massachusetts as a Nurse Aide, must complete MS State approved Nurse Aide Training Program and sit for the Red Cross offered NACEE.

The Nurse Aide Test has two separate parts - the Written/Oral Test and the Clinical/Skill Test.

The Written/Oral Test comprises of 60 multiple choice CNA Exam Test Questions and administered in a group setting. The time limit offered to complete the test is two hours. The students have the option to appear for either written test or oral test. The Oral Test is provided through a CD player and only ARC Regional test sites conduct the oral tests.

Clinical/Skill Test is offered individually and administered in a scenario, where candidates are asked to replicate providing care for a resident. The test administrator evaluates each skill demonstrated by the individual candidate on a live model.

Both the Written and Skill tests are independent of the each other and can be taken in the same day by the candidates. If any candidate fails in one test, he/she is still permitted to sit for another test. The candidate has to pass both tests to earn Certification.

The candidate is offered four chances to clear the written test and three chances to pass the skill test. The failure to pass the exam in the offered chances, require retaking and completing CNA Training Program once again.