Neglect - A Form of Elder Abuse

When a loved one disappears from a nursing home due to neglect, it's a sign of elder abuse.

The phone rang. It was the sheriff's deputy. Martin Avadian disappeared from the nursing home.
What? Did I hear that correctly?

Only twelve hours after my father walked across the threshold into a secured nursing facility, we received the worst possible news.

What happens when your parent is missing?

After hours of searching frantically -- around the adult day care center he had attended until just days earlier, a nearby hospital, and neighboring homes, we found nothing. We stopped people to show them my father's picture... nothing. He was no where. What were we going to do?

Stricken with fear, we questioned the good deed we had done months earlier by moving my father from his Wisconsin home of 45 years into our home. Trembling, we feared he might be dead.

The phone rang. It was the deputy sheriff. They found my father in the Mojave Desert walking along the freeway in another county. He was trying to get a ride home to Milwaukee.

Did a movie scriptwriter make this up!

That night, we walked into the nursing home administrator's office.

"I don't know if we can keep your father here," she said.

What? After all that time asking questions of the staff, visiting the home at different times and days, and completing aaalllll that paperwork? NO WAY!

Although, my father was a victim of neglect (a form of abuse); we can't simply sue to solve our problems. We need to collaborate. Even when the administrator got the company attorneys involved, I reminded her that during the admission interview, the leadership assured me that the nursing home had a person at the front desk at all times to monitor comings and goings of residents; especially, after a new resident is admitted. It is even in their procedures.

The nursing home had excellent procedures in place.

The problem was they weren't following them.

As stressful as the idea was that my father could be evicted despite all the preliminary work we did to insure this was the best option for him near our home, I held my ground. They did not have a person at the front desk to notice that their newest resident (my father) was leaving with a handful of visitors that evening.

7 TIPS to Prevent Nursing Home Abuse

1. Follow-up with the staff and management. I followed up to ensure they followed their procedures -- for example, that they covered the keypad when entering the code to exit the area, so that visitors or mildly demented residents wouldn't see the code.


2. Visit often and talk with visiting families about their experiences. I learned from residents' families and well-meaning staff about others' experiences.


3. Attend all quarterly care plan meetings and support group. I gave feedback during the quarterly care conferences, even when I felt the staff wasn't listening. I also attended most of the support group meetings.


4. Remain involved.


5. Keep a current photo of your loved one handy. Keep several photos in your phone. (A picture is still worth a thousand words.)


6. Make sure your loved one wears his/her identification bracelet. My father used to wear a Safe Return bracelet. Once in the nursing home he wore their identification bracelet.


7. Keep important phone numbers handy or in your smart phone.

These seven tips will give you a solid start in preventing neglect in any care facility.

What Is a Nursing Home Rehabilitation Center

Senior citizens often require specialized health services. When they undergo surgery, suffered an injury, or show signs of losing their memories, seniors may need the specialized services offered at a nursing home rehabilitation center. At this facility, seniors can regain their mobility, improve their memories, and overcome challenges to their health.

The staff at a nursing home rehabilitation center caters a patient's care according to the needs of that specific individual. A person who has had surgery on a knee or hip may need physical therapy to improve his or her balance and strength in that part of the body. Physical therapy often includes working out with weights, walking around an indoor track, or bending the affected part of the body in rhythmic exercise routines. Most patients work directly with a therapist as they build up their strength and resistance to the exercises.

On the other hand, a patient who is suffering from memory loss may benefit from occupational therapy. A therapist uses flash cards, puzzles, and games to assist that person in remembering basic skills, such as placing puzzle pieces together or pronouncing words. This therapy is most often used for patients who have suffered strokes or who have been diagnosed with Alzheimer's disease or dementia.

Staff at a nursing home rehabilitation center also assists people who suffer from physical conditions that interfere with basic daily activities. For example, dysphagia tends to be a common condition among the elderly; this condition makes it difficult for seniors to swallow food, water, and medication. People with this affliction feel that they are choking or unable to swallow these substances. In worst case scenarios, sufferers lose weight, choke on their food or medication, or develop pneumonia by aspirating substances into their lungs. Therapists assist these individuals by teaching techniques that make swallowing easier. They may also position patients differently in their beds or at their tables to facilitate eating and drinking. If all else fails, therapists can discuss remedies that include feeding tubes or intravenous hydration.

Patients at this facility may be surprised that their therapies are not dull and lack entertainment. In fact, a nursing home rehabilitation center may use a Wii game system as part of people's daily therapies. Playing a virtual game of bowling, tennis, baseball, basketball, and more lets people work out while having fun. Even more, playing video games has proven to be beneficial for those who suffer from anxiety and depression. Patients often look forward to playing the Wii as part of their rehabilitation processes. This approach and others like it allow senior citizens to regain their mobility, improve their health, and overcome challenges to their wellbeing. They can benefit from staying at this facility.

Incompetence Means You Pay More!

During a recent property tax appeal case we were shocked to hear the local property tax assessor make the statement, "Have him close the business and I'll consider lowering the taxes". We looked at one another in sheer amazement and before I could inform the assessor that he had just admitted to taxing the business enterprise as opposed to strictly the real estate, Clay had taken out a legal pad and said "Wait! Let me quote you on that!" The confident assessor gladly made the statement once again unaware of the fact Clay was actually documenting the quote to be utilized later during a formal appeals board hearing. Real Estate Taxes are just that, a tax that is attributable to the real estate only. This assessor made it quite clear that this personal care facility was being taxed, not only on its real estate, land plus improvements, but on the business enterprise (intangible assets) associated with the business occupying the improved property.

Appraisal literature features an abundance of articles addressing the valuation of various properties with a focus on the segregation of intangible components from the tangible assets. Most state laws hold only real property and other tangible assets subject to taxation so the importance of separating these components of value is most apparent in property tax assessment. Intangible assets, though they may enhance the value of the total operating enterprise, are not subject to ad valorem taxes.

Commercial property, especially nursing homes, personal care centers, assisted living center and hospitality owners should analyze their ad valorem tax obligation immediately. We continue to find that most assessors are incorrect in the way they are assessing these specialized types of properties. Many times these properties sell and transfer including not only the real estate but the businesses themselves. The majority of the assessing officials will simply assess the property at this sale price, which often times not only include the real estate but also the personal property and business enterprise value (BEV) which is also referred to as going-concern value.

Valuing the going concern is fairly straightforward using discounted cash flow techniques or an income capitalization approach. The difficulty arises when there is a need to decompose the going concern value into the various elements as required for assessment and condemnation assignments.

In distinguishing between BEV and real estate value, it is fundamental to recognize that income generated from a business conducted within the real estate is not the appropriate measure of real estate value. Instead, that income is the value of the going concern. For many special purpose properties, the business enterprise component is substantial, so the potential for error is large if going concern value and real estate value are confused.

In using the Income Approach, it must be kept in mind that the proprietary nursing home is more than a real estate entity consisting of land and buildings. It is a facility equipped and staffed for providing personal services. Recognition must be given to this factor in the form of a "business profit" to the owner of operator.

The real estate alone (land and buildings) is not the preponderant income-producing factor as in a facility such as an apartment building. A nursing home provides many personal services to its occupants as part of the charge for occupying a room or a bed. These include food, nursing care on a 24-hour basis, and a limited amount of entertainment....The proprietary nursing home is a "special use" property. As such, the market is quite limited. Furthermore, the special design limits the alternate uses for the real estate.

During a recently settled case of a property containing both a personal care facility and an assisted living center, we argued that the personal care facility added no value and in fact was a determent to the overall property. This was based upon the KY required payment arrangement of $37.80 per bed per day and that no prudent investor would even attempt to buy the property and continue this center based on that income. This is attributed to the going-concern and was provided to the assessor to demonstrate the lack of current success of the business within the real estate. In addition this property suffered an immeasurable amount of functional obsolescence as it was constructed in 1969. The assessor agreed and explored alternative uses for the assisted living center and was also of the opinion it did not represent the highest and best use of the property. The total assessment was lowered from $6,087,100 to $4,000,000 with an annual tax saving of $29,267 or $146,337 over the next five years. The total savings are immeasurable as they are carried into perpetuity due to the fact there is a new starting point ($4,000,000) in which the assessment may be raised in the future.

The land and buildings are not the chief income-producing factors in a nursing home......The value of a nursing home is enhanced by its reputation and good will in the medical and nursing field and in the community at large.

If a firm is prosperous it does not want to sell except for a bonus; if it is bankrupt, it often sells at a bargain upset price; and in neither case is true value measured. When Dodge Bros., automobile manufactures was purchased by capitalists, it was reported that an allowance of many millions of dollars in stock was paid for goodwill.

It is therefore readily understood that a law requiring property to be assessed at its actual value, its real value, its cash value, its market cash value or its full cash value does not mean its "transaction value" where cash paid represents but a fraction of the sales price, nor does it mean the all cash price paid at a forced sale.

This intangible value is not generally taxable. A tax assessor is often confused when an industrial property sells at a figure greatly above the assessed value. He has not the information at hand from which to fathom the intricacies of patent rights, goodwill, etc., and often the problem is left unsolved.

Ad valorem tax is one of the only taxes one pays that is based upon someone's opinion of value. Incompetence means you pay more! Don't let an incompetent assessor cost you thousands of dollars by making you pay more than your fair share by including BEV!

By Bryan S. Reynolds and Clay J. Wells

Those Wanting To Pursue A Career In The Health Care Or Medical Field Should Plan Their Education

Have you often thought that you would like to be working in some capacity in the health or medical field? Does the idea of providing some level of comfort and assistance to someone in need sound like a good day's work? If you have aspirations of working in this "in demand" industry, then it is time to plan your education as different occupations require different degrees.

This seems to be the optimum time to consider a career in health or medicine as an aging population has increased the demand for qualified professionals. There are numerous career choices in the health care industry so you will need to determine what your goals are in order to think about degree programs. Whether you want to work with patients or deal with the billing for services, a program exists to meet your educational needs.

Let's start at the bottom rung and work upward by first looking at some occupations you might consider if you are a high school graduate. Depending on your interests, you might want to consider a program for dental assistants, fitness trainers, or medical assistants. You can be any one of these right out of high school by enrolling in a training program.

You might want to consider an associate's degree program, especially if you are interested in dentistry because you could be a dental hygienist by extending your education. Also, some folks attend associate's degree programs to become radiologic technicians, respiratory therapists or LPN's. Perhaps you prefer a more "hands-on job" and want an associate's degree in message therapy.

If you are looking to provide a higher level of health or medical service to the public, then you would be wise to find a bachelor's degree program. With a bachelor's degree you might work as a physician's assistant or a registered nurse, or if working with patients is not your cup of tea, you may choose to be a health educator. Whatever your aspirations are, you will find a myriad of bachelor's degree programs to choose from in the health and medical fields.

We all know that more money means more responsibility and higher education. Those students looking to rise to the top in their chosen careers will surely need to enroll in a master's degree program. If you want to work as a social worker, mental health therapist, or health administrator, you will need an advanced degree. Be sure to research thoroughly to find the program that best meets your educational and financial needs.

Of course, the pinnacle of degrees in health and medical field is the doctorate degree. Graduates of Ph.D. programs usually work as researchers in areas of oncology or other research areas. Another example of a Ph.D. at work is a psychologist, while other Ph.D.'s work as policy makers or professors in colleges or universities.

Leaders Communication Takes Effort

We must never forget that the most powerful communication isn't what you say, it's what you do. What counts, in the final analysis, is not what people are told but what they accept. It is this concept of the role of communication in industry that characterizes effective leadership. - Frank E. Fischer

The majority of people who are considered excellent conversationalists will tell you that they spend far more time listening than speaking. They also ask questions of clarification, making sure they fully understand what is being said before contributing their own thoughts about the topic. This as you may know is easier said than done. It takes practice, practice and more practice.

Chances are when you are participating in a conversation you are listening from a defensive posture to interject you views at the expense of the other individual. Part of the reason for this is that we are emotionally bonded to our views. Believing in your views is a good thing except when the evidence suggests that they are not correct. Don't be so possessive of your views that you will not change them in a heart beat when presented with contrary evidence.

The best way to ensure that you are listening completely is to imagine that your mind's inner voice is a tape recorder. As the person speaks repeat everything that is said in your mind's inner voice. This process helps you in a variety of ways: you are not going to interrupt the conversation prematurely because you are repeating what is said in your mind, you are increasing you understanding of the issue because you first hear it, then repeat it.

The next step is to ask questions of clarification or check for understanding. Once the question is asked start the process all over again. Continue this process until the other person has finished. Once you fully understand the other person's position or point of view you can begin to present your view.

This process takes time however the long term benefits are that you will be considered a leader who is trustworthy, understanding, supportive and accepted by the people who you supervise and your supervisors. You will immediately distinguish yourself as a leader worthy of being followed.

There will be times, when it is not possible to have a two way conversation, to gather ideas, suggestions and options. One way communication should be reserved for emergencies, deadlines, directives and after you have considered all the views, options, and suggestions of your team to make the final decision.

The final outcome is to make far more good decisions than poor judgments. If things do go wrong, bring your team together to review how the poor outcome could have been avoided and prevent it from occurring next time. Some may call this process quality improvement and others call it an after action report. It doesn't matter what you call it; the process is what is important.

Your success as a leader depends on how good a listener you are and the quality of your questions. You may think that as a leader you should control the conversation and wonder how that can be done when you are repeating everything that is said in your mind and asking clarification questions. Think of it this way when you ask an informed question based upon what you have heard and repeated aren't you really determining the direction of the conversation?

Active listening, mentally repeating what is said and asking clarification questions is a win, win process for everyone involved.

Feel free to use this article, in your publications; in its entirety provided you include the following notice: 穢 Copyright 2011, Kenneth E Strong, Jr, Columbus, Ohio.

Senior Safety - Quick Fixes For Yard, Entryway, and Living Room Hazards

Did you know that falls are the leading cause of injury deaths for people 65 years of age and older, per The National Safety Council? Do you worry that your parents have physical or judgment deficits which impact their safety? Do they open the front door for anyone who rings the doorbell? In this article, I will show you how to identify and reduce safety hazards in the living room, yard and entryways of an elderly persons home.

1) Yard and entryways into home:

• Are walkways level and clear of debris and plant overgrowth?


• Is there enough light to see obstacles? A simple motion sensor light makes it easier to insert the key into the lock.


• You may want to install a railing on both sides if there are stairs up to the door.


• Post a No Soliciting sign outside the front door to minimize trips to the door and to lessen the risk of intruders.


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  External doors and windows: Be sure that all windows can lock when fully closed and when partially opened. Have deadbolt locks on all external doors and install wide-angle peep-holes. This is a good opportunity for the "avoid opening the door to strangers", "always lock the doors", and "don't give strangers any personal information on the phone" discussions with your elderly loved ones.

2) Living Room Safety:

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  Clutter: This may sound like a no-brainer, but it is often overlooked. Clear away unwanted items, especially from all pathways in the home. Besides reducing tripping hazards, this will help lessen fire risks.


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  Floors and floor coverings: Don't use cleaning products and floor waxes that leave the surface slippery. Check for loose carpet and tighten it to avoid tripping. Loose rugs should be attached to the floor with double-sided tape. Be sure to move electrical and phone cords out of all pathways. If a walker or cane is used, it is important to remove all throw rugs.


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  Lighting: Check all light bulbs to be sure they are working. Light switches need to be within easy reach. There should not be any areas inside the home that can not be illuminated. Use night lights in all pathways, especially from bedroom. Light timers work well for an elderly person who keeps a fairly regular schedule; program to automatically turn off an hour after bedtime, so that they leave the room while still lighted.


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  Furniture: All furniture should be sturdy and in good repair. Elderly people tend to grab on to furniture as they walk by; not recommended, but frequently done, so the sturdier the better. Chairs with arms and higher seats are easier and safer to access.


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  Emergency plan. Be sure there is a working smoke detector and fire extinguisher on each level of the home. Attach an easy-to-read list of emergency phone numbers near every phone and review emergency procedures with your elderly family members. Since many seniors spend lots of time in the living room, installing a phone in this room is a great idea. You may want to consider a mobile safety alarm which is worn on the wrist or as a pendant, to automatically summon help with the push of a button.

Most elderly people cherish their independence and will do just about anything to keep it. Because many older adults have mild to moderate sensory deficits, balance issues, memory loss or other cognitive deficits, it is important to evaluate their safety at home. Sometimes a simple device or two in the home is all that is needed to keep them safe and independent. If you still are not sure whether your senior loved ones are safe at home, you may want to obtain a safety evaluation performed by a Physical or Occupational Therapist specializing in geriatric care. They are experts in determining safety and judgment while performing activities of daily living and also can recommend appropriate assistive devices and environmental modifications.

Preventing Occurrences of Elder Abuse

Elder abuse is a worrisome activity that occurs all throughout the country both in nursing homes and at outpatient care facilities, such as in the home of an elderly person. It involves the physical, emotional, sexual, or financial abuse of an elderly person. Oftentimes, the abuser may be the very person that is relied on to provide care for the elderly person. When something such as this occurs, the elderly person is afraid to voice their opinion in fear of retaliation or the refusal of the care that they need. If you believe that your elderly family member is suffering from some form of abuse or neglect, there are several legal actions you can take.

Some of the signs that are associated with physical elder abuse include unexplained bruising, cuts, broken bones, complaints of pain, and other types of unexplained injuries. Signs of emotional or financial elder abuse can include agitation, exaggerated emotions, anger, withdrawal from public settings, unexplained and unusual behavior towards friends or family, and unexplained withdrawals or purchases from bank accounts. Sexual abuse, a very serious type of abuse seen in nursing home facilities, is signaled by unexplained bruising near the genitals or breasts, complaints of sexual abuse, and many of the other signs that indicate physical abuse. If you believe that your family member may be exposed to instances of neglect, they may be exhibiting signs such as malnutrition, wandering, dehydration, poor hygiene, and more. No matter what type of abuse or neglect you believe your family member to be suffering from, there is something you can do about it!

By bringing the situation, or potential situation, to light, you may stop the abuse in its tracks and possibly prevent a future event from taking place. An attorney will be able to thoroughly review the case, evaluate the potential danger that your family member and others are in, and investigate the situation. If it is found that nursing home abuse or any form of elder abuse is present, including an incorrect dosage of medication being prescribed by a facility's pharmacist or medication usage for off-label purposes, the facility will be held accountable for the damage that they have caused.

This legal action will hold the abuser or abusers responsible for their wrongful actions. In turn, it may also prevent future outbreaks of physical, emotional or verbal, sexual, or financial abuse from taking place. It is very important to your loved one to get the legal help that you need and deserve in a troubling time such as this.