A Nursing Home at Christmas Time

Have you visited a nursing home at Christmas time? It can be as magical as watching little children light up when they see twinkling lights, pretty packages, Santa Claus, hear Christmas music and smell cinnamon, ginger and pine.

Nursing home patients vary in the levels of care they require so you will find there are some seniors who are quite cognitive, lively and actively involved in many activities and social interaction. There are also many patients that have some interaction and activity, but may not be constantly able to maintain that level of activity.

Then there are some patients that require much more care, may be bedridden or wheel chair bound. These need social stimulation to come to them as they are quite unable to reach out for it.

At Christmas time there are many sights and sounds that can stimulate these much less active seniors, but they still want to feel a part of many seasonal rituals and know they are as remembered and valued as when they were able to willingly join in.

If possible, a more active senior should be matched with one requiring a little more care, if it is practical given the care needs. For instance, one can hold a song book for both to sing from, or one can help the other with bingo. In addition to helping the one, the other can feel valuable by being needed.

For obvious reasons most care givers are younger than the seniors they care for and when a peer can be a companion for even short periods of time, this can help alleviate a sense of loneliness or isolation now and then. Pairs can participate in gift exchanges, crafts together, games and many other activities.

During the holidays the staff of nursing homes are usually busy with many activities to make the homes feel festive and happy. Laughter can be heard down many hallways and in activity rooms. Christmas music may be playing from a CD or radio in a few different rooms and someone, maybe even a guest or hired musician, may be playing 'Silent Night' or 'Santa Claus is Coming to Town' in one of the recreation or activity rooms where seniors are joining in a sing along.

Every Christmas party at a nursing home is different from the next. But all provide a festive flavour of cheer for the staff, seniors and their family and friends. You'll hear that jolly music, see wonderful crafts made by all the seniors decorating the rooms, hallways, lounges and recreation areas. The smells that fill the air are all the teas, ciders, pies, and cookies along side warm dishes of potatoes, turkey, and stuffing.

A Nursing Home at Christmas time is always fun, with performers or sing alongs, and you'll see seniors laughing, smiling, sharing and enjoying the company of their family and friends and appreciating the care they receive from all of the nursing home staff.

Quality Assured Activity Programming

Simply stated, Quality Assurance is a method of evaluating and monitoring services rendered within a department. The Activity Department should be an active participant in the facilities' Quality Assurance program. Many Activity Directors dread QA time, and often leave the analysis and report writing for the last minute, when in actuality, Quality Assurance should be occurring all of the time.

The Activity Director should utilize standards, policies, and regulations to guide the Quality Assurance process and set criteria. Once the criteria have been set, it is important to utilize a variety of tools and systems to collect data. The creative Activity Director utilizes data collection tools that have multiple purposes. For example: utilize an "Activity Evaluation Audit" to evaluate the appropriateness and quality of group activities, but use that same tool to evaluate the staff performance, which is useful information for the employee's performance appraisal. Another example is: utilize a "Sensory Program Record of Responses" to monitor resident responses to various stimuli for care plan compliance and evaluation, but use the findings from that survey (if positive outcomes are found) in a report to the Administrator demonstrating the need for additional multi-sensory equipment.

Next, the Activity Director should establish timelines to ensure that all data is retrieved in a timely manner throughout the course of the year. Data may be collected in a variety of ways such as audits, surveys, checklists, etc. Often times, residents, family members and facility staff may participate in the data collection process as well. Once the data is collected, the Activity Director must write a report to indicate the findings, by utilizing the facility's specific process, protocol, and format. Statistical information usually includes numbers, percentages, and values, and is often best illustrated in a table, chart, or various types of graphs.

The next step in the Quality Assurance process includes analyzing the data. Do the findings indicate need for improvement in a certain area? If there are issues, or concerns, provide further investigation to determine the scope and severity of the problem. At this point, the Activity Director should identify a plan of correction with goals, timelines, and expected outcomes. The plan should provide a detailed description as to what the Activity Department, and/or other departments will do to improve or correct various issues.

Once the recommendations have been made, all designated departments and individuals must follow through with their responsibilities, otherwise there is no chance for improvements. The issue at hand should be closely monitored and re-evaluated as often as needed. If there have been little or no improvements, further analysis and recommendations will need to be made. If there have been significant improvements, it should be proudly noted in the next Quality Assurance report and the decision to monitor the identified area is up to the discretion of the Activity Director. It is, however, recommended that the Activity Director continue to monitor to ensure that the problem is corrected.

There are many different aspects of the Activity program that can be evaluated and monitored. Sample topics include:

- Supplies/equipment
- Environment
- Budgeting
- Programs
- Activity Audits
- Resident Satisfaction
- Quality Indicators
- Staffing
- Resident Rights
- Resident Council
- Calendars/Calendar Analysis
- Continuum of care
- Quality of Life Surveys
- Population Analysis
- Documentation
- Departmental Review

Activity Directors also play an important role in the Quality Assurance meeting. It is the time to demonstrate professionalism, knowledge, and purpose of the activity program. The Activity Director may be asked to give an overview of the area measured, report the findings, and state recommendations for further action, so it is important to be well-versed on the subject and have copies available, including any graphs, charts, tables, etc.

Activity program interventions should also be included in Quality Indicator monitoring. There are many ways in which the Activity Department can assist in improving or enhancing the services of another disciplines. For example:

- Residents who were physically restrained (remove restraints during activities; provide task-oriented activities for diversion; encourage movement and physical activity to promote strengthening.)
- Prevalence of falls (involve resident in specially designed fall-prevention program; provide manipulatives, pat mats, activity aprons for diversion; encourage movement of lower extremities to promote strengthening)
- Residents who had moderate to severe pain (encourage prayer or spiritual expression; provide aroma therapy for relaxation such as lavender; encourage resident to experience the multi-sensory room for pain relief and relaxation)
- Residents who have become more depressed or anxious (encourage resident to participate in discussion, remotivation, and reminiscence groups; provide manicures and make-up session; encourage physical activity and exercise)
- Incidence of cognitive impairment (evaluate the environment, involve residents in cognitively stimulating activities such as word games, trivia, discussion groups, and educational programs)

When we take on the role of Activity Director, along comes with that the responsibility of ensuring the activity program meets the needs and interests of the residents and follows standards of practice, regulations, and policies. Therefore, set criteria, choose the appropriate tools, gather statistical data, report the findings, analyze the data, make recommendations, and follow-up, and when done with all of that, start again!

Elder Abuse, Alzheimers and Our Aging Population

While taken seriously enough to be a legally reportable offense categorized alongside child abuse as either a misdemeanor or a felony - elder abuse does not seem to be taken as seriously by the public. Perhaps elders do not appear to be as helpless as children, but many times they are. And if helplessness is the yardstick, how does it account for the fact that domestic violence, which is not legally reportable, arouses more consternation and receives more attention and media coverage. Perhaps it's because of national neglect in respecting, supporting and caring for elders in general. Whatever the explanation, elder abuse is on the rise and in the coming years will become pervasive due to an exploding elder population and the simultaneous increase in Alzheimer's - a disease that ravages the mind and turns elders into confused, unruly and dependent children.

What constitutes Elder Abuse? It is the physical, sexual, emotional and/or financial abuse of older people (over 65 years), usually by family members or caretakers. Abuse occurs in both isolated settings and in nursing institutions by staff members. "Whether the behavior is termed abusive, neglectful or exploitative will probably depend on how frequently the mistreatment occurs, its duration, severity and consequences." (World Report on Violence and Health) It can happen for a variety of reasons - a debilitating physical or mental illness and/or unwanted long term proximity to the elder which wears down the family member or caretaker as well as greed, anger or money problems in the case of financial abuse. It is a growing problem presently affecting hundreds of thousands of elderly people in the United States, yet it is estimated that only one out of 14 incidents are reported.

In 2010, the eldest baby boomers turned 65. During the next 30 years this population - one of the largest segments of our society - is on track to live longer and more than double the cases of Alzheimer's disease in the U.S. "An estimated 10 million American baby boomers will develop Alzheimer's in their lifetime placing enormous strains on the U.S. health-care system and the already overburdened network of caregivers, a new report predicts." (Washington Post, 3/18/2008) Presently, there are 5 million Americans living with the disease - not all of them elders. With this statistic in mind, elder abuse will increase exponentially. Why? Because people afflicted with this disease are difficult to take care of and easy to exploit.

A recent article in the New York Times entitled "The Financial Time Bomb of Longer Lives" focused on age related expenditures by government. The demographic shift that is taking place - " for the first time in history, people aged 65 and over are about to outnumber children under 5 " - means that this group is likely to shape the future of our national economic health and financial policies. Having to care for and support our elder family members will impact health care, housing, jobs, business policies, retirement and retirement funding, environmental issues and education. We will no longer be able to ignore this population. We are going to have to take them very seriously and begin to adjust our institutions or we will drown under the enormous economic and emotional burden they create. To begin with, we need to make psychological shifts so that elders are no longer perceived as a burden and potential debt load but as viable, valuable individuals with a lifetime of experience and wisdom to offer. This "attitude adjustment" will have the added benefit of reducing elder abuse.

To address the impact in more tangible ways we have to take a look at the institutions presently in place and begin to alter them so that they will more effectively accommodate this population. Health care, residential centers, community services, support groups, non-profit and private sector jobs, and education for caretakers to stem elder abuse are all areas where attention, growth and transformation are required. We can no longer stick our heads in the sand and continue to view elders' needs as a personal problem confined to their immediate family. They are a significant part of our society. They are living longer, growing larger and the concurrent health and financial problems are looming - threatening to unravel our social fabric.

The Keys Needed to Unlock a Successful Marriage in Your Relationship

Marriages are crumbling in America. There are many reasons why marriages are failing and it would be impossible to name all of those reasons here. Times are changing and people's concept of marriage has changed. Some people are waking up to the fact that they were probably better off single. Some chose an incompatible mate but chose to have a family and stayed with their mates. Many people chose to be married but live separate lives. Whatever the case, marriages are definitely on the rocks.

The family unit is giving into the pressures of society as far as how relationships are. On television, most families are characterized as being schizophrenic, sex crazed or having serious problems with extended family members. This has an effect on American society in which television has distorted what the family should be striving for which is an element of understanding, harmony or peace.

What has really did damage to marriages is the fact that parts of the civilized world has defined marriage as the woman wanting to be secure (home, possessions and security) while the man provides these things. Women are waking up and providing these things for themselves, making decisions for them, which according to patriarchal rules, is a no-no. So most women are choosing to be single and most men are not committing because of various factors. Society is changing as far as marriage, communication, and other aspects is concerned.

Most marriages are breaking up because of not understanding the purpose of the other individual. People want to expand their horizons of self worth within marriage and because of traditional rules that were made up to keep relationships subject able, many people are escaping that mentality of slavery in any kind of relationship.

So if you are married, there are several things that you must do to create an atmosphere of harmony between you and your spouse and here are some of those elements to make your marriage a happy marriage.

1. Create a portal in which your mate can explore her/his real life passion.

This is very important. Even within a marriage, each person is an individual. Though communication and socialization is important for better relationships, we all have our personal desires. You should help your mate accomplish their individual goals.

2. Give your mate plenty of room to grow and experience life.

Just because you are married does not mean that it has to turn into a prison. Let your mate do the things that they need to do to make them happy.

3. Make sure that your mate has significant time to themselves to think about their life purpose.

This is important. Everyone needs a time for reflection so provide your mate with those private times that he/she needs to get their mental and spiritual thoughts together.

Marriage and Family Counseling - Really Important!

Marriage and Family Counseling is important. Marriage and Family counselors help couples work out their problems to develop a system of love, trust and oneness in a relationship. Counselors can dig and see the root cause of the problem through enabling effective communication skills to overcome challenges for the couple or family. Marriage and family counselors are mental health professionals who bring a family perspective to a person, couple or organization. They treat families, mental, emotional and various health and behavior problems.

If you have children, it is great to have them as a part of the program since they are a part of the family. Marriage counseling considers peripheral characters, such as the Mother-in-Law, Father-In-Law, other relatives and the effects that they have on a successful marriage. This is accomplished via personality interviews with extended family members.

Marriage counseling brings out controversial issues. It could be some elements of a spouse's past that are hidden which affect the relationship deeply. Many of these issues can stop a marriage cold, such as incest, rape of a relative and abuse in a previous marriage. When problems like this occur, marriage therapy is truly needed to solve the problem. If your mate agrees, then this is one way to improve your marriage or else, the misery will continue.

Creating Fields of Love with Marriage

Many married couples are always confrontational because they can not forgive and forget. Some couples never recover from the problems in a relationship but choose to stay the course while being totally miserable with the choices that they made. They stop romancing each other and doing the things that allowed the relationship to flourish in the first place.

If you seek the professional help of a marriage counselor, they can provide a battery of tests and evaluate to study, comprehend and obtain new solutions for helping couples in their marriage. Most individuals resign themselves to live under a roof of controversy and loudness. This is detrimental to people who have families. Counseling is great and can heal the wounds of a person, family or extended family. Counseling can focus on brief, solution-focused, family-centered treatment which is center towards the cause of problems in your marriage instead of the symptoms. If you are married, you might want to consider this kind of treatment to resolve your problems.

Recognizing Certain Problems in Marriages

These issues are widely known to cause problems in marriages:

- Families facing severe mental illnesses and emotional disorders, such as schizophrenia and depression.

Many marriages have to take on the extra responsibility of a loved one or parent coming down with an illness. Sometimes, this causes pressure on one or both people in the relationship and can be financially taxing. The trend is to put that person in a nursing home or facility that can treat their disorder but a married couple can turn these kinds of situations into gold if they plan correctly and realize that not all is bad. This could actually enhance and help the marriage if looked at from a proper perspective.

- Substance abuse

A big problem in marriages is when a husband or wife has a drinking problem. Substance abuse can lead to spousal abuse. It can also cause children to become upset and carry memories of abuse for a long time. This issue has been studied for years and now, local governments are implementing free programs for spouses that have a problem with substance abuse to get help.

Overall, marriage can be a good deal if you really work at respecting each other and love each others purpose. This comes through better communication. It takes time to improve your relationships. Enhancing your communication skills is one of the quickest ways to improve your marriage because it is the key to an effective marriage.

What to Expect From Nursing Assistant Training

Nursing assistant training is one of the easiest ways you can consider to become a certified medical professional and begin your career by working in primary care facilities. Some of the major duties of certified nursing assistants (CAN) include assisting the patients in daily activities such maintaining hygiene, dressing, feeding, administering medications, socializing etc.

The primary responsibility of a nursing assistant is to meet the patient's needs in a timely manner. Any slight change in health condition of the patient has to be reported to the nursing staffs or physicians. During the training, trainees will likely learn how to work in a high stress environment.

Nursing assistant training programs are offered in various local community colleges. A typical CNA study program will last only about six weeks. There are even training facilities that offer accelerated training for CNAs, but their cost is considerably high when compared to fee of community colleges. For instance, the overall cost of training offered by community colleges is only around $300; whereas an accelerated training program will charge you approximately thousand dollars. As the training principles are same for both programs, saving seven hundred dollars can be fairly equated to a pay check of two weeks.

Once an individual is enrolled for a nursing assistant training program, he or she is expected to study very frequently. A serious mistake that is commonly done by many people is not preparing enough to take up the state exam. Each and every state has its own set of requirements and method for analyzing the capabilities of students. Most of the states require the student to pass a verbal test simultaneously with a practical test where the trainees are required to demonstrate various medical procedures. For instance, during the training period, the students will be taught how to provide perineal care for patients. During the time of test, the students must state each steps verbally as they perform it. Most of the state requires the students to score about 90 percent or more in order to pass the test. Since nursing assistant training test is very strenuous, majority of CNA trainees cannot pass in their first attempt. But with good knowledge and self-confidence, you can pass test.

Since we live in a society which needs more and more nursing homes, CNAs will be in greater demands. For this reason, you don't really have to worry about getting a job after the completion of your nursing assistant training program.

A Career in Healthcare Management - What Does a Medical Manager Do?

Whether the title is manager, medical practice manager, physician practice manager, administrator, practice administrator, executive director, office manager, CEO, COO, director, division manager, department manager, or any combination thereof, with some exceptions, people who manage physician practices do some combination of the responsibilities listed here or manage people who do.

Human Resources: Hire, fire, counsel, discipline, evaluate, train, orient, coach, mentor and schedule staff. Shop, negotiate and administer benefits. Develop, maintain and administer personnel policies, wellness programs, pay scales, and job descriptions. Resolve conflicts. Maintain personnel files. Document Worker's Compensation injuries. Address unemployment inquiries. Acknowledge joyful events and sorrowful events in the practice and the lives of employees. Stay late to listen to someone who needs to talk.

Facilities and Machines: Shop for, negotiate, recommend, and maintain buildings or suites, telephones, hand-held dictation devices, copiers, computers, pagers, furniture, scanners, postage machines, specimen refrigerators, injection refrigerators, patient refreshment refrigerators, staff lunch refrigerators, medical equipment, printers, coffee machines, alarm systems, signage and cell phones.

Ordering and Expense Management: Shop for, negotiate and recommend suppliers for medical consumables, office supplies, kitchen supplies, magazines, printed forms, business insurance, and malpractice insurance as well as services such as transcription, x-ray reads/over-reads, consultants, CPAs, lawyers, lawn and snow service, benefit administrators, answering service, water service, courier service, plant service, housekeeping, aquarium service, linen service, bio-hazardous waste removal, shredding service, off-site storage and caterers.

Legal: Comply with all local, state and federal laws and guidelines including OSHA, ADA, EOE, FMLA, CLIA, COLA, JCAHO, FACTA, HIPAA, Stark I, II & III, fire safety, crash carts and defibrillators, disaster communication, sexual harassment, universal precautions, MSDS hazards, confidentiality, security and privacy, and provide staff with documentation and training in same. Make sure all clinical staff are current on licenses and CPR. Have downtime procedures for loss of computer accessibility. Make sure risk management policies are being followed. Alert malpractice carrier to any potential liability issues immediately. Make sure medical records are being stored and released appropriately.

Accounting: Pay bills, produce payroll, prepare compensation schedules for physicians, prepare and pay taxes, prepare budget and monthly variance reports, make deposits, reconcile bank statements, reconcile merchant accounts, prepare Profit & Loss statements, prepare refunds to payers and patients, and file lots and lots of paperwork.

Billing, Claims and Accounts Receivable: Perform eligibility searches on all scheduled patients. Ensure that all dictation is complete and all encounters (office, hospital, nursing home, ASC, satellite office, home visits and legal work (depositions, etc.) are charged and all payments, denials and adjustments are posted within pre-determined amount of time. Transmit electronic claims daily. Send patient statements daily or weekly. Negotiate payer contracts and ensure payers are complying with contract terms. Appeal denials. Have staff collect deductibles, co-pays and co-insurance and have financial counselors meet with patients scheduling surgery, those with an outstanding balance, or those patients with high deductibles or healthcare savings plans. Make sure scheduling staff know which payers the practice does not contract with. Liaison with billing service if billing is outsourced. Credential care providers with all payers. Perform internal compliance audits. Load new RBRVS values, new CPTs and new ICD-9s annually. Run monthly reports for physician production, aged accounts receivable, net collection percentage and cost and collections per RVU. Attach appropriate codes to claims for e-prescribing and PQRI. Have plan in place for receipt of Recovery Audit Contractor (RAC) letters. Make friends and meet regularly with the provider reps for your largest payers.

Marketing: Introduce new physicians, new locations and new services to the community. Recommend sponsorship of appropriate charities, sports and events in the community. Recommend sponsorship of patient support groups and keep physicians giving talks and appearing at events. Thank patients for referring other patients. Track referral sources. Recommend use of Yellow Pages, billboards, radio, television, newspaper, magazine, direct mail, newsletters, email, website, blog, and other social media. Prepare press releases on practice events and physicians awards and activities. Recommend practice physicians for television health spots.

Strategic Planning: Prepare ROIs (Return on Investment) and pro formas for new physicians, new services, and new locations. Forecast potential effect of Medicare cuts, contracts in negotiation or over-dependence on one payer. Discuss 5-year plans for capital expenditures such as EMR, ancillary services, physician recruitment, and replacement equipment. Explore outsourcing office functions or having staff telecommute. Always look for technology that can make the practice more efficient or productive.

Day-to-day Operations: Make the rounds of the practice at least twice a day to observe and be available for questions. Arrange for temporary staff or rearrange staff schedules for shortages, meet or speak with patients with complaints, and meet with vendors, physicians and staff. Open mail and recycle most of it. Unplug toilet(s).

Stay Current in Healthcare: Attend continuing education sessions via face-to-face conferences, webinars, podcasts and online classes. Maintain membership in professional organizations. Pursue certification in medical practice management. Network with community and same specialty colleagues. Participate in listservs, LinkedIn and Twitter.

What did I leave out? Take a lunch?

Suffered A Whiplash Injury? Here's What The Claims Process Involves

Whiplash injury may be sustained as a result of a road accident, sporting accident or work accident. No matter what the cause of your injury is, if the accident was not your fault, you can pursue a whiplash injury claim and recover compensation for your damages.

Before you start making a claim, the first thing that you need to do is seek medical attention. This will help you get proper treatment for your injury and also help you get your injury documented.

It may be quite easy to prove liability if you had been involved in an accident involving rear-end collision. But, if the accident was a side-on collision, head-on collision, sporting or work related accident, then you will need to work towards preserving more evidences. This can include obtaining contact details of people who witnessed the accident.

The next step towards making a whiplash claim is seeking legal advice. You will have to approach a firm of injury claim lawyers and instruct them to represent your case. These days, there are a number of legal firms who will handle your claim on a genuine No Win No Fee basis. A No Win No Fee is a scheme that eliminates financial risks and allows the claimant to pursue an injury claim free of cost. For this reason, it is essential to look for injury claim lawyers who will use such a scheme when handling your whiplash injury claim.

But, for a lawyer to represent you on a No Win No Fee basis, he will need to evaluate your case and establish that the claim has merit. After the evaluation, your lawyer will be able to tell you whether your claim is likely to succeed or fail. If your claim has good chances of winning, your lawyer will take care of the paperwork involved in the legal proceedings and represent your case.

Under the No Win No Fee scheme, your lawyer will be paid only if the claim is successful. If the claim is not, your lawyer will not charge you any fees and you will be under no obligation to pay your lawyer anything. In addition, for most personal injury cases, your lawyer may recover the legal costs from the responsible party. This means that you will be able to take home full compensation.

Before your claim is started, you may also have to undergo medical examination that will be undertaken by a nominated specialist. This will ensure that the medical report is independent and in no way prejudiced or biased. Once your lawyer has obtained the independent reports, evidences and relevant documents, a whiplash claim for compensation can be initiated.

Based on your injuries, damages and financial losses, your lawyer will prepare a schedule of losses and send a letter of claim to the responsible party. If the claim is straightforward, it will settle out of court within a matter of few months. However, if your opponent does not admit liability, your lawyer may consider taking the case to court where the judge will make the final decision.