Saturday, February 23, 2013

Bedsores and Nursing Home Abuse


When someone is bed-bound, it is necessary for them to change position periodically to prevent bed sores. Bedsores occur when a patient lies motionless for an extended period of time. Constant pressure on spots on that person's body can cause the skin underneath the contact point to die, creating a hole in the person's skin. If they are caught early, bedsores can be treated easily. But if they are overlooked, they can lead to massive infections and death.

Any spot the patient's body that experiences pressure while that person is motionless can develop a bed sore if the conditions are right. For example, if the person is lying in a position where part of the bed's frame is in constant contact with the person's knee, the sustained pressure of the frame on the leg can cut off blood supply to that small area of skin. If blood flow is cut off for too long, the skin underneath the contact point will die.

Unfortunately bed sores are especially common in nursing homes. Nursing homes are designed to care for patients who cannot take care of themselves, and patients often live there for years. A substantial portion of nursing home patients may be unable to leave their beds. Nurses are expected to regularly help patients reorient their bodies and to check for bedsores, but some facilities fail to safeguard their patients.

Early-stage bedsores, if they are detected, only cause damage to the upper layers of skin. Over time, the tissue death proceeds deeper and deeper. Beyond a certain point, the body cannot recover on its own. Treating a bed sore requires surgically removing the dead tissue and applying anti-microbial dressings to keep it covered. Severe wounds require skin grafts or similar surgery, as the body cannot close the hole on its own.

The causes, nature, and effects of bedsores are well known. Nursing homes, hospitals, and other care facilities have an obligation to ensure that bed-bound patients do not develop bedsores. If their negligence causes a patient great suffering, that person and their loved ones have the right to seek compensation for their suffering.

For more information on legal subjects related to medical malpractice and nursing home abuse, visit the website of the Kankakee nursing home abuse lawyers of Spiros Law, P.C.

Senior Friendly Homes - 21 Ideas & Tips on Adapting a Home For Senior Living


If you are thinking of moving into a home, building one that you can retire in, or wondering how you can make your elderly parent's home easier to live in - there are some things to look for to make living as a Senior Adult or a person with a disability easier. Here is a list of 21 proven helpful ideas and tips.

1. Rocker style light switches and lots of ways to turn lights on/off from different locations - commonly known as 2-way or 3-way. Plenty of natural lighting, overhead lights and electrical outlets. Ideally, electrical outlets should be higher off the floor than code says and many more in number, this makes placing of lights easier, cords are less likely to be in the way too. In large spaces, consider in-floor outlets which will eliminate cords and allow for furniture placement options. This also is very handy if you have a small bedroom and someone needs a hospital bed in a living or dining room area.

2. All doors - going inside/outside and doorways into rooms should be at least 36" for wheelchair, scooter, walker, etc. use. You need to have 18" wall space free of clutter on the latch side of the doorway (in & out of room) so if you are in a wheelchair you can get close enough to the handle to easily open/close the door. Watch out not to block the space with furniture. Look into pocket doors - you gain footage and ease.

3. Plenty of phone jacks so phones can be throughout the house, as you age, it takes longer to get to the phone. This also is safer in case of emergency situations.

4. Railings up/down stairs both sides, railings in the bathroom for balance getting up/down on the toilet and in/out of showers/tubs.

5. Think about a security system that include an emergency button that has a wrist or neck chain you can wear or put in your pocket. These are very affordable and can even be used outside within many feet of the home.

6. Hang a tennis ball on a string from the ceiling in the garage to hit your windshield at the right parking spot. Makes life easier. Make sure that if you have electric garage door openers, that if the power goes out, a "short" and not physically strong person can open the door to get the car out. Think about an on-demand generator... takes care of so many obstacles and dangers.

7. Have drawers for all of your under cabinets in the kitchen, makes finding things easy, less lifting and actually uses space more efficiently.

8. Washer/Dryer on floor near bedroom as this is where most laundry is generated.

9. Make sure house is one floor, or if two-story, has a staircase extra wide so a stair-chair climber can be installed. They now have home elevators at affordable prices that work like a bank air tube and thus they even work when there is no power coming downstairs.

10. Windows should be able to be cleaned from inside the house, both sides.

11. Really spend time looking at the bathroom and how you can make it usable if you broke your leg, if you had severe arthritis or if you were weak. Tub/shower/faucets/sprayers/slipping/room for equipment and mobility equipment.

12. Door knobs and faucet knobs should be lever type.

13. Maintenance free as much as you can, inside and outside of the home.

14. Is the home located near important resources such as grocery store, doctor/medical, pharmacy,
friends, and church/clubs/activities? Consider this in case you can't drive at night or very far or if you couldn't drive at all. How far to fire/rescue/police services too.

15. Open space vs. a house with many tiny rooms is best for flexibility as you age. Consider how far you have to walk in the home just to do daily living activities.

16. Think about a doggie or cat door, if appropriate and the animal will be safe. It could go into a fenced in area, they can be closed off at night and they make living much easier.

17. Re-think flooring. Does it have to be washed often, is it slippery, can a wheelchair go on it easily, and is it easy to care for and maintenance.

18. Stairs whether they are inside or outside the house can quickly become large obstacles, consider placement, width & rise, how often need to use, number, etc. for your future being to access areas of your home, getting in/out of your home and being safe.

19. Higher toilets are available and they make it easier to get up/down. There are now combo shower/tubs you walk into and they keep coming down in price too.

20. Having paved driveways and walkways is very helpful for safety, use of devices is necessary and in a snow climate, they melt faster. Consider fire escape plans too, we just don't move as quickly or as easily as we age or when you have limitations.

21. If you can just look at a home through aging eyes or have someone with a disability or who is a Senior Adult look at things for you, you can have a much happier, safer and easier life in your home.

Vocational Rehabilitation, which is in every state and usually located in the Department of Labor or Human Services, has at least one person fully trained in accessibility. (They are responsible for the Americans with Disabilities Act) and would be able to answer questions about your home in the sense of what can be done to make things easier. Some disability organizations may have a trained person in accommodations/adaptations too, or contact The Practical Expert.com for Tonia who is well trained in this area and who also lives it.

If you belong to a club, think about having it reviewed for suggestions of making it easier to access. This helps Senior Adults, people with disabilities and even people with a temporary injury (such as a person with a broken leg) to attend things like school graduations, belonging to civic organizations, for volunteering at places and going to many types of activities. Many accommodations/adaptations have no cost or little cost that can make a huge impact in people utilizing the place. Example, # of handicap spots at a school and how far to walk to the gym, etc.

Keeping your eye on how life can be more accessible and safer for senior adults, elderly parents and people with injuries or disabilities, means it is easier and safer for everyone, not just for today but for the future too.

The Secret Tax Treatment of Qualified Tuition Programs/529 Plans?


Families are having a tough time paying for college with rising costs pricing many out of a college education. Over the last 20 years public university tuition and fees have soared 30%. At the same time, middle class incomes have remained the same. Qualified Tuition Programs (QTP) or 529 Plans are the most popular savings vehicles to help pay for college because of their tax benefits. However, these plans may not be as great as you think because there are hidden tax liabilities that most families and CPA's are not aware of.

What is a QTP/529 Plan?

It is a state sponsored plan that allows families to pre-pay or either contribute to an account to pay for your child's qualified education expenses at an eligible educational institution.

Tax benefits of a QTP/529 Plan

As long as the withdrawal is less than or equal to the beneficiary's adjusted qualified education expenses, no tax is due. Stated another way, taxes will be due when the QTP/529 Plan withdrawal is greater than the beneficiary's adjusted qualified education expenses.

Who can withdraw?

First of all, withdrawals can only be taken by the account owner who is usually the parent or grandparent. The beneficiary is the other person who can also withdraw funds. When withdrawals are taken from the account a withdrawal form is submitted and the fund administrator will issue a 1099-Q (IRS reporting form) to the party that receives the funds. It is important to note that any tax consequence will not be stated on this form, taxes must be determined by the parent or an accountant.

What are the funds be used for?

The funds are designated for qualified education expenses (QEE) - tuition and fees, room and board, books and supplies, required equipment, computer and internet access, and special needs. The original contributions to a QTP/529 Plan are tax free but a portion of the earnings can be taxed even if the money was used to pay for QEE.

Taxable Withdrawal Example

Alyssa's parents opened a 529 college savings plan for her. Over the years they contributed $20,000 into the account. The balance on the date of the withdrawal was $29,000. In the fall, Alyssa enrolled in college and had the following QEE:

Tuition and Fees $11,000

Books and Supplies $ 1,000

Room and Board $ 6,000

Total QEE $18,000

She paid for her college expenses from the following sources:

Tax free education benefits

Scholarships/Grants $10,000

Lifetime Learning Credit $ 2,000

Total education benefits reduction $12,000

529 Plan $ 8,000

Before Alyssa can determine the taxable part of her withdrawal, she must reduce her total qualified expenses by any tax free education assistance.

Total QEE $18,000 - tax free education benefits $12,000 = $6,000 Adjusted qualified education expenses (AQEE)

Since the AQEE $6,000 is lower than the 529 withdrawal, part of the earnings will be taxable.

Alyssa's 1099-Q form shows that $1,600 of her 529 withdrawal is earnings. Therefore, her parents or CPA figures the taxable part of the withdrawal as follows:

$1,600 earnings X $6,000 AQEE / $8,000 529 withdrawal = $1,200 tax free earnings

$1,600 earnings - $1,200 tax free earnings = $400 taxable earnings

Alyssa must claim $400 in income on her tax form as withdrawn 529 Plan earnings not used for AQEE.

QTP/529 Plan withdrawals are not as simple as you might think. The process is quite complicated and without the help of an expert on your side - saving for college could be costly if you are not aware of the tax consequences and how they apply to your circumstances. But you don't have to navigate the system alone, seek the assistance of a college planning professional. For more information on other education tax benefits consult IRS Publication 970.

5 Safety Measures to Put in Place Before Implementing in Home Care


In home care can be a blessing, when elderly home health care is started in a home and done right. We all hear the horror stories of the individuals that took advantage of that aging senior while providing care for them. Many times, this occurred right under the noses of the family.

There are many safety measures you can take to protect yourself before you begin in home health care. If you are reading this, and have not taken these steps, it is not too late. I will address five of them today.

There are many good people in health care. But I am an individual that believes you should not tempt fate. You cannot put a price tag on preventing something disastrous from happening to your family. In home health care means bring strangers into your home. Many of these strangers, over time, will grow to be like your own family. Minor problems with any situation are not uncommon. There is always an adjustment period, for the aging senior family member as well as the health care workers.

The more serious problems, fraud, theft and abuse are rare. But, it does occur. So it is my goal to help you not to become a victim. I have had the opportunity of compiling a list of things that family members have shared with me. Many have had had some very unpleasant experiences and do not want others to have the same things happen to them.

The most simple advice is to use common sense and do not make anything of value easily available to anyone that is coming and going from the house. Sounds simple enough, but you do not think about keeping alcohol or narcotics locked up.

More on in home care and safety

Do not allow anyone to bring in the mail or make the mail available to anyone in the house. Credit card statements and bank account numbers make an individual a target for easy prey.

It is important that you take the time to make a room that you can lock up the valuable knick knacks, jewelry, credit cards, checkbooks etc. You may feel like these are extreme measures, but when you put things away and make them inaccessible it protects the health care worker as much as it does you and your family member from theft. It not only removes the temptation to take things it also protects the in home health care worker from being accused of taking something if it comes up missing. And I will tell from personal experience that things do get lost, or misplaced and even stolen by other family members.

Do not allow the wallet or the credit cards of the aging senior to be available to any outside help. Remove money, social security anything that can be used to steal an identity or obtain credit. If you have an aging senior that is adamant about keeping their wallet and having a credit card, get one with a very low limit, as in a few hundred dollars. Be sure to monitor the activity on this card online or monthly if not more often.

If you have a senior that is at home and uses a computer, make sure that their personal information or areas where they pay bills etc is password protected. It is important to make the computer off limits as a house rule. If you are not going to be able to monitor the activity when you are not there, just be on the safe side and make certain areas on the computer password protected just in case.

In home care allows caregivers freedom and the ability to carry on their lives while trying to honor the wishes of their loved one and keep them at home. The individuals that work and provide care for elderly home health care are very special people, kind and caring. When you find a good employee, treat them like gold, because they are priceless. Just use common sense and protect yourself and give yourself peace of mind.

Creating an Accessible Home - Assisted Modifications For the Elderly, Disabled, Or Handicapped


As promised, this is a second of a series of articles discussing ways to make a home more accessible. My first article talked about general construction of a barrier free home. The related articles will address specific tweaks to make it easier to overcome environmental problems.

What I have observed is that people without physical limitations often do not appreciate how difficult simple everyday tasks can be to someone who is physically compromised. Many times a small modification can remove an obstacle. By presenting these examples of problems and solutions, I hope to raise awareness of problems and inspire people to look for answers.

Problems/Solutions:

Doorways openings are too small/Offset Door Hinges - The obvious answer is through construction - widen doorways. There is a cheaper, less disruptive approach. Offset door hinges will give you an extra 2 inches with very little effort and cost.

Turning round doorknobs/Levered Doorknobs - Round doorknobs can be difficult for people with limited grasp. With a lever, all you need to do to open a door is to push down on the lever. You can replace all the doorknobs in the house with levered ones but this means changing locks and that can get expensive. An alternative approach would be to put conversion lever attachments over existing round knobs. Locks would not need to be changed and the cost would be less with this problem solver.

Standing from a seated position/Furniture Risers or a Lift Chair - Standing from a low level can create problems for someone with limited leg strength. By raising the seat to a higher level, it takes less effort to stand, possibly making the task achievable. Furniture Riser can raise the whole chair from 2" to 5". Another option would be a Lift Chair. These chairs automatically lift the chair seat with the push of a button. Chairs online begin at about $600 and go up. My online purchase saved me about $300; I paid $600 when the suggested retail was $900. Shipping was free. An additional feature in many of these electronically operated chairs is that they also can recline with the push of a button.

Turning Faucets/Automatic Faucets - Normal aging, a stroke, arthritis, or some other medical problem may cause the simple, everyday activity of turning a faucet to be frustrating. An automatic faucet can be mounted to your existing faucet. Simply run an object under the faucet and your water comes on automatically. It will then stay on until you move from under the sensor. Online prices start at around $50.

Grasping and turning a small switch/Touch Lamps - Limited grasp caused by arthritis or other health problems can make the activity of holding a small object like a light switch and turning it difficult. A touch lamp can be operated by coming in contact with a metal surface on the lamp. You can buy new touch lamps or just put a Touch Lamp Converter into your existing lamps.

Opening widow coverings/Motorized Window Blinds - Do you, a friend or relative have a dark house because the blinds were never opened? Sunlight can work wonders on a person's psyche making this an important problem to fix. The inability to reach the controls to operate window coverings is a very common problem. It is not unusual for furniture to block access. With motorized blinds, you use a remote to point and click to open or close blinds. A cheaper fix for those who can reach controls but find it difficult to turn wand controllers is to buy blinds where pulling a cord opens or closes the blinds.

Getting over thresholds when using a wheelchair/Wheelchair friendly threshold - Your normal door threshold has a small hump so there is not a gap between the bottom of the door and the floor. Unfortunately, a wheelchair user must be very careful that both wheels hit the hump at the same time or the chair will rock, threatening a collision with the door frame. You can replace the raised threshold plate with a flat one but then must put a weather proofing strip on the bottom of the door to close the gap. This item is available at most hardware stores.

Getting out of bed/Bed Handle - For people with the problem of getting out of bed independently, a bed handle may be the solution. This bedrail gives a person something to pull up with, helps them turn in bed, or can provide support when standing. It is only about 1 1/2 feet long which is shorter than a normal bedrail. This short rail is not effective for keeping someone in bed, however, it provides something to grasp while being short enough to allow someone to swing their legs over the side to stand.

Many times only minor changes are necessary to bring an obstacle down to size. The first step to problem solving is to recognize the actual stumbling block. Once identified, consider whether an alternative approaches would help you reach the goal.

Friday, February 22, 2013

Residential and Nursing Home Care


Sometimes, people find it difficult to look after themselves. This can happen slowly or as a result of an illness or accident. In most cases, this happens once they have stayed for sometime in a hospital.

Many people may be able to stay home with the help and assistance of their families or friends as well as with the help and support from social care services like the NHS or home care visits from the district nurse. However, for some people, a move to a sheltered housing or some other type of accommodation would help meet their needs.

A few other may still find it difficult that they cannot cope and considers taking the step into moving to a home care. This could be a residential care home providing meals and personal care or even a nursing home having qualified nurses on the area. Sometimes people needing to move into a care home are able to arrange the transfer themselves and cover the costs. For those who cannot, the local authorities can help them in the transition.

Selecting a nursing home
The first move to make when considering a move to a nursing home is to contact your local social care team. These people will be able to give you information about the different local homes and help you decide which care homes will suit your needs, including the content of the inspection reports of homes you are considering.

Your social care team will also organize an assessment of your needs to see what level of care you really require.

Residential care homes inspections
The Commission for Social Care Inspection conducts registration and inspection of residential care homes twice a year.

All resident in that certain care home are given the opportunity to share their views about the home to the Commission during an inspection and may also address their complaints to the Commission for Social Care Inspection if they cannot derive satisfactory responses on their complaints from the home.

If you are interested in converting your home into a registered care home, you need to get in touch with the Commission for Social Care Inspection and they will assist you through the registration process

Resolving problems with your care home or service
If you are having problems with a care home or service it is best to try resolving the problem with your care provider first. You may do this by making them aware of your concerns. Only if you feel that the matter is not being handled to your satisfaction, should you contact your care manager if the care is being paid for either full or in part by the county council or the local authorities. If you are not able to contact your care manager directly, you should directly call your local social care team.

However, if you are paying for the care services of home care services fully, you may contact the Commission for Social Care Inspection to voice out your concerns, dissatisfactions or complaints.

Nursing Homes and Necessity - Has the Time Come?


No one welcomes the day that they have to start looking at nursing homes for themselves or a family member. But if an elderly parent has reached the point where living alone is impossible, this may be the best option for the future.

If you have an aging parent who is frail, forgets to eat, is accident prone or is physically unhealthy, full-time care might be the only viable. This is especially the case if the individual's family does not live close by. Sometimes a move to a home is the best thing for the person, as it will ensure that their needs will be met.

You want your elderly loved one to be well taken care of in every way. You want them to receive compassionate and qualified care from people who are skilled at their jobs and really care about the human side of the work they do. Before you start scouting out nursing homes in the area, your family member should have a thorough evaluation done. A geriatric assessment needs to be conducted by a doctor or nurse practitioner to evaluate the individual's mental and physical status.

It is important that the medical professional that does the evaluation is in-depth and as thorough as can be. In particular you want to know how well your family member can perform activities of daily living, such as getting up out of a chair without help, walking, eating and dressing themselves. The person's balance also needs to be checked, as does such things as signs of anxiety or depression, memory problems or any indications of Alzheimer's or dementia.

Identifying any physical or psychological problems that the person is living with can help with the planning stage of which facility would be best suited to the senior. It is important though to not let the person get lost in the planning. After all, this is their life so do not act as if they are not a part of their own future.

However, you might be able to put off the day when you have to start researching nursing homes if there are good local resources in your community from which to draw upon. For example, for a senior who is depressed and sits alone, an adult day program can provide the opportunity to get out of the house and talk with others.

A person who only needs help once in awhile or a couple of hours a day is different than a person who needs 24-hour care. If your parent falls into the former group, find out what your community has to offer. There should be a listing of local services in your area for companies that provide in-home nursing care. You should also research to find out if there are volunteer groups that arrange rides for older individuals to get to and from their appointments and to do their shopping. Check online, your telephone book or the local newspaper for the information you seek.

Signs You Need a Nursing Home Neglect Attorney


Even if you merely suspect that something is not right with an elderly loved one, consider contacting a nursing home neglect attorney. Because the signs are not always obvious, many people struggle with the decision to take legal action. Even suspicion is worth talking over with a lawyer. He or she will be able to guide you to the right decision and help you figure out if you have a case. As you visit a loved one, look for signs that they are not being taken care of properly.

Falls

As a person gets older, the chance of falling tends to increase. For many elderly individuals, a fall results in more than just a few scrapes or bruises. Instead, if left on the floor for an extended amount of time, the trauma of the injury as well as the emotional trauma can take their toll. If a loved one has fallen, it may be time to talk to a nursing home neglect attorney to find out if there is anything that can be done. Listen to your loved one describe what happened and how long it took for someone to come and care for the problem. Facilities should be offering the proper care and observation for patients who have limited mobility.

Bedsores

It may not be unusual for a resident to spend a majority of his or her time in bed. However, if a loved one has started to get bedsores, it is time to talk to a nursing home neglect attorney. Bedsores are often caused by pressure on a certain part of the body for an extended amount of time. It may be several hours or in severe cases, it could be a few days. Because residents should be cleaned regularly if they are unable to handle the task on their own, someone should notice any bedsores before they get out of hand. In severe cases, bedsores can become infected and cause a series of different physical ailments.

Dehydration or Malnutrition

Not being provided with the right amount of nourishment can border on abuse. If a loved one seems to be dropping considerable weight without any medical explanation or you notice that he or she is not getting enough water, it is important to bring this to the attention of a nursing home neglect attorney. The lawyer will help you determine whether or not this is happening as a result of incompetent care of if this is a physical or medical issue that needs to be addressed.

In any of these situations, be sure to take note of anything your loved one is trying to tell you. Even with patients suffering from dementia, it is important to listen carefully and attempt to figure out if there is cause for concern. Once you feel like you need assistance, contact a local nursing home neglect attorney for more information.

The Problem With Acquiring Assisted Living Leads and the Solution You Need


You are about to learn more about the problem with acquiring assisted living leads and how you can go about solving that problem. When purchasing assisted living leads you are lining yourself up to work with prospects who may have been treated with a lack of emotional concern during the prospect gathering process. Marketers who gather generic leads for a large variety of industries lack the attention to detail needed to generate quality interest in your assisted living business. In many cases the assisted living leads you are purchasing are being provided to over 6 of your competitors. Who is going to call the prospect first? Tag, you are it!

As a marketer or owner of an Assisted Living business you understand that the majority of your prospective clients are shopping for your services in an emotional state. This is a tough decision. They need to be treated delicately and with care to their needs. In order to best align yourself as the authority in their area of need you should be presented as an experienced provider of care. A 3rd party cannot do that for you as their focus is on lead volume and profit.

Knowledge is key. Any company whose focus is to generate and sell as many leads as many times as possible will simply not be providing a quality product. Your time is much better served creating content on the web that points to you and you alone. The longer you remain loyal to a source of prospective assisted living leads the more likely you are to experience stagnation in the pool of leads you are using.

When placing an ad in the newspaper, industry publications, radio, print or other main stream markets you do so with the understanding that your competition is right there with you following the same steps and exposing themselves to the same market. You pay less for this kind of marketing as a result. However, when purchasing assisted living leads an expectation of exclusivity is rarely if ever met even though that is one of the primary reasons for going this way.

Take hold of the reigns of assisted living leads generation and develop your very own strategies. If you go to work and really learn to understand your prospects search patterns and then cater to them, not only will you save money in your marketing but you will increase volume and quality of service. Learn how to do keyword research, article marketing and use videos for your marketing. If you don't have time to do this our simply don't wish to, find someone to operate this for you. You will have a much more focused marketing campaign as a result but best of all, clients will come to you knowing what to expect: Quality.

Help! I Am Locked In A Bad Rehabilitation And Care Center Formerly Known As A Nursing Home


This article might be a little shock to you. After you are shocked, the best thing that you can do for you and for your family is to prepare them and prepare yourself for the future and cover any what ifs that could or might happen.

After doing extensive research on the topic and after being a somewhat-constant visitor to many hospitals, medical centers, nursing homes and a rehabilitation and care center, I have come to the conclusion that nursing homes are not meant for human beings. The only human beings that most nursing homes can benefit are those humans that have absolutely no family, friends, co-workers or connections. And even then, those patients are not helped either but might be the ones that are most taken advantage of.

These are statements in general about various things that can, did and will happen in your local nursing homes, rehab centers and medical centers and hospitals.


  1. Nursing homes and rehab centers and some hospitals will insist that patients wear diapers --even when they do not medically need diapers.

  2. Nursing homes and rehab centers will present some patients with contracts/policy admissions or enrollment papers that gives the facility practically complete control over all the assets, money an d real estate of the patient. The documents will give mass permission to the facility to investigage into the patient's entire life, financial, social, psychiatric, medical and more circumstances without even asking the patients' permission again. (They get the signature when the patient enrolls and most time the patient has no clue what the enrollment agreement /contract is.

  3. Nursing homes and rehab centers, in some and lots of cases, will try to isolate the family members and co workers and friends from their relatives, patients so that the family members and friends are not witnesses to the nursing home lacks and neglects. The really bad nursing homes are those that want the patient to be separate from their immediate family members even from those family members that have been helpful, beneficial and good towards the patient or family member.

  4. Nursing Homes and rehab centers, once they get your signature on Medicaid or Medicare applications, and once they get your application almost processed will ignore your requests to go home, to visit out of the nursing homes and your requests to be connected with people.

  5. Rehabilitation and care centers that are bad or going bad will keep their public phones -- on the long term floors -- broken or out of order most times. THey know that is the connection with family members, yet the phones are always either busy, broken or both.

  6. They will let patients sit for hours and hours in their own urine and excrement, ignoring their pleas for help and assistance.

  7. They will let patients wait for hours on toilet bowls, having them wait to have assistance to come off the toilet bowl.

  8. They will medicate patients that are witnesses and medicate patients who complain about conditions.

  9. They will lie to families consistently and continuously. There was one case where they told the family member that a patient could walk 90 feet, yet when the family member went to watch the patient, the patient could walk only a few feet at one time and no where near 90 feet. They have lied to other patients about whether patients came out of the bed. For example, a nurse will say, yes she had breakfast in the dining room, but the truth is that she had breakfast in bed in her own room, still isolated from the rest of the population in the facility.

  10. They will consistently lose patients' clothing, all the time. There are patients wearing other patients' clothing and there are tons of clothing lost for each year.

  11. They will ignore your requests for help. They will make fun of patients, mimicking them when they want to do so.

  12. They will take money from residents so that they can purchase cigarettes and other health-harming items for patients who are on oxygen, patients who are sick, and for patients who are not allowed out of the building.

  13. Some will take your clothing and not issue any receipts.

  14. Some will lose ALL the pants and some of the clothing. The method to their madness about them losing the pants, is this: If the resident has many pairs of pants then the resident can tell the place that he does not want to wear diapers. So, those facilities that want to keep residents isolated, will lose the residents pants so that the resident cannot leave his room. YOu are not permitted to leave your room without pants, of course, and it the place consistently loses their pants, the resident becomes more isolated and more unhappy.


How can you protect yourself and your family?


  • Put everything in writing. Yes, write all about it. This way no one can say that you said this or said that. Keep documented records of everything that happened or did or will happen.


These are just some of the ways that these facilities are harming people. I will write more articles about this topic, at a future date,

I created this article on May 20, 2007.

Characteristics of Good Senior Home Care Providers


Home care providers and home health care are a unique breed. While training is needed to meet job requirements, home health care providers must also possess other innate qualities that enable them to compassionately perform job functions, as per patient wishes and the wishes of their families.These special qualities are what make all the difference between average home care and excellent senior care providers. This article examines caregiver characteristics that are necessary for providing invaluable services within homes and communities everywhere.

Senior home health care providers must be able to perform all of the following job functions, including:

  • Assisting clients, seniors, and care recipients with daily living activities.

  • Preparing meals for clients.

  • Any necessary assistance with ambulation.

  • Light housekeeping tasks, cleaning, laundry, trash removal, tidying up.

  • Attending to all safety needs, ensuring a safe environment for patients and care recipients.

  • Effective and compassionate communication with patients, family, coworkers, and all interested parties.

  • Confidentiality, as per the wishes of family and patients.

  • Understanding and following through on all requirements for the care of the patient or senior loved one, including special needs and patient wishes.

Beyond those basic functions and responsibilities lie the real substance of a home health care provider's role; that of the compassionate personal attendant. Caregivers must go beyond handling the needs of care recipients and responding appropriately to certain job situations, but demonstrate compassion, love, caring, and thoughtfulness. When those qualities are present, you'll know you have a caregiver who not only loves their job, but love those they provide care for. Caregivers, home health care providers, and senior caregivers are dedicated individuals who have a passion for helping people, and are selfless in their desire to improve the quality of life for senior loved ones. Home health providers work as facilitators to achieve a better quality of life for elders in need of support.

Other characteristics of exceptional home care providers include:

Commitment and dedication. Families and elderly individuals in need of home care should rely on workers to be available when needed, honor their commitments, and carry out all job related responsibilities in a highly professional manner. When a family chooses to bring a home health care provider into their environment, the caregiver should be respectful of the situation, as well as any hardships the family or patient faces on an everyday basis.

Creativity. Great home care providers are always thinking of new activities and ideas to introduce to clients, designed to better their quality of life or improve a situation, helping them gain comfort and independence. Additionally, they should focus on creating new ways elderly individuals can carry out tasks and learn new skills.

Judgment. Home health caregivers should always exercise good judgment, and maintain confidentiality, but not when a patient or client is in danger.

Senior home care find their careers very rewarding, and perform invaluable services in homes and communities everywhere. A home health care provider with willingness to help elderly patients and loved ones in need and a caregiving individual who chooses to make themselves available as relief for families is invaluable.

Home care is an excellent option for seniors who wish to continue living in their community and home to feel secure, despite difficulties they may be experiencing. Home care and assisted living providers work with you and your loved one to create a specially tailored plan to meet the personalized needs and services required-and this plan can be adjusted at any point in time to ensure the proper care is provided, as conditions can change. Learn more about home health care services and find out if that type of support would benefit your loved one and improve their safety, health, and well being.

Thursday, February 21, 2013

Recognizing Nursing Home Abuse and Neglect


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

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


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

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

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

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

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

  • Poor handwashing techniques -- which leads to infection;

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

  • Ignoring call bells or cries for help.


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

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

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

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

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

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


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

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

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

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


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

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

Make Your Report To:


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

  • The state or local Ombudsman

  • The local police or State law enforcement

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

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

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

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


AFTER THE REPORT:

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

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

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

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

3 Tips for Preventing Isolation in Nursing Home Patients


There are plenty of instances of nursing home patients who never get visitors. Perhaps they are in a facility that is far away from any of their family members, or maybe they have no one left. Whatever the particular situation, it is important for the patient's health and well-being to avoid feelings of isolation. Fortunately, there are a number of things the staff and community members can do to alleviate this problem. Using the available resources as well as getting creative and coming up with additional ways to keep all residents as involved and engaged as possible can play a vital role in their overall wellbeing and sense of pride and happiness.

Encouraging patients to engage with other residents, both at meal times and during social activities, is an important way for them to maintain friendships and keep from isolating themselves. By gently encouraging patients who tend to want to be alone to leave their room, you can help them bring a sense of hope and enjoyment to their life. Whether it is a simple encouragement for them to share meal times with other residents, or enticing them to join in on a game or some entertainment, such as a television program or movie night, getting out amongst others can be extremely beneficial in eliminating feelings of isolation and loneliness.

There are often community groups, such as churches and day are centers that are willing to come in to a nursing home and provide some entertainment and social interaction for the residents. Young children can be a wonderful enjoyment for seniors and their innocence and exuberance are often a welcome addition to the daily routine of nursing home care. Inviting these groups in to share some music, cookies and an hour or two of visiting with the residents can be an excellent way to prevent isolation, especially for residents who normally do not receive visitors.

In addition to community groups that are willing to come in and provide entertainment for the nursing home residents, there are often individuals or families who would welcome a chance to come and visit with a particular resident. This one-on-one interaction allows the resident and visiting family or individual to forge an on-going relationship. In fact, families who are far from their own grandparents often enjoy adopting one of these seniors as a grandparent figure for their children. It can turn into a very mutually rewarding relationship that everyone can benefit from. This type of arrangement is particularly effective in preventing isolation in nursing home patients because it gives them meaningful relationships and a sense of belonging. This is an excellent way to help isolated seniors become more involved in the world around them.

Regardless of why a particular nursing home resident is becoming isolated, it is important for those people around them to do what they can to bring enriching and stimulating opportunities to help draw them out. Residents who become isolated are at a greater risk of depression and other health related issues.

Discussing Elder Care With a Senior


When it comes time to decide on elder care arrangements for you or your loved one, it's best to get the family involved in the process. Besides giving advice and understanding the situation, they can also provide moral support to the individual who is moving. Family meetings give everyone a chance to get together to air thoughts and share information.

Calling a Family Meeting

If you or a loved one has concerns about an elderly family member, it is time to call a family meeting to discuss his or her situation and future. The best time to call a family meeting is before the situation turns critical and quick decisions must be made. The aging individual has more input at this stage and more options available in terms of elder care. It's smart to put a plan in place even if it is not immediately needed. Hold a family meeting when:

  • There a decline in health

  • Finances are a concern

  • There is medical emergency

  • The primary caregiver needs help

  • The aging individual asks for help

  • There are concerns about him or her living alone

Who Should Attend?

It doesn't matter who calls the family meeting. It could be a caregiver who provides day-to-day support, or an adult child who lives out-of-town and wants an update about what's going on. The importance is communication and making sure that everyone involved is on the same page so that there are no misunderstandings in the end.

Family meetings typically include adult children or grandchildren, siblings, and other close family members or caregivers affected by the situation. Depending on the elderly individual's current physical and emotional being, he or she may attend the family meeting. However, these meetings are for family members to speak candidly about the elderly relative. Therefore, you may not want him or her to attend as to avoid hurting feelings or being offended. Typically, after an initial plan is in place, the affected individual joins the meeting.

What Should Be Discussed

Whoever plans the meeting, should make up an agenda of concerns that can include:

  • Information about the individual's health

  • Feelings about the situation

  • Daily care giving needs (in-homecare vs. assisted living)

  • Financial concerns

  • Who will make all decisions or given power of attorney

  • What roles do family members want to take

Schedule subsequent meetings if all the topics aren't covered. Follow-up meetings are also good to discuss how things are going at that time.

Problems The Elderly Face Living At Home Alone


For the elderly, living alone can be a tough thing. With children grown up and moved out and increasing problems that come with age like loss of mobility, maintaining independence can be a struggle. There are a number of common, everyday obstacles that the elderly face, each requiring a solution or attention. Family who are worried about older relatives living on their own should task themselves with creating a more comfortable and safe environment for them.

Trips and Falls

Physical limitation is one of the most common problems that the elderly face. Older individuals are always at risk of injury from even a minor trip or fall - with nobody there to tend to them afterward, any accident can be a serious one. Alert necklaces and watches are one of the top selling safety solutions to at-home accidents by providing the individual with simple, one press alarm that calls for an ambulance in the event of a serious accident.

Restricted Mobility Around the Home

Physical limitations and disability can also restrict basic movement around the home. Stairs, entranceways and ledges can become difficult to navigate with disability and poor mobility - especially if the person in question relies on a wheelchair. Nobody wants to have to move home to keep their independence, especially if they have lived there for years.

There are many solutions to breaking down the barriers that poor mobility can cause. Stair lifts are a fantastic way to make all levels of the home accessible while platform lifts can make wheelchair access easy both inside and outside the home. These new technologies are fantastic alternatives to concrete ramps and often a lot more affordable than expensive construction work.

Difficulty Getting Out of the House

Maintaining independence in the home also means successfully completing day-to-day activities and errands like grocery shopping. Physical and mental impairment can cause issues, especially poor mobility, hearing and vision loss. Mobility scooters are one solution that makes travelling to the store a breeze while some carers offer errand running and shopping services to take the stress out of day-to-day life. Those who are a bit more tech savvy might be able to find solutions online through internet grocery shopping - a service that many supermarkets offer - or with a simple food box delivery set up by a family member.

Maintaining independence is incredibly important for a lot of elderly people. Age can bring with it all kinds of problems, but most of these obstacles are easy to overcome. Create a more friendly home life for your relative by seeing to these issues as they develop.

Deficit Reduction Act Changes the Way We Think About Medicaid - Nursing Homes


I'm still dumbfounded that Congress determined it was necessary to take away much of the Medicaid Planning that was available to the public.

What is Medicaid you ask? Well, it's complicated.

This is a federal and state funded and state administered medical benefit program which can pay for the cost of the nursing home if certain asset and income tests are met.

There are basically four ways to pay for nursing home care:

1. Private Pay. This is the method many people are required to use at first. Quite simply, it means paying for the cost of a nursing home out of your own pocket. Unfortunately, with nursing home bills averaging between $4,000 and $4,500 per month in our area, few people can afford a long term stay in a nursing home.

2. Long Term Care Insurance. If you are fortunate enough to have this type of coverage, it may go a long way toward paying the cost of the nursing home. Unfortunately, long term care insurance has only started to become popular in the last few years and most people facing a nursing home stay do not have this coverage

The first two methods of private pay (i.e. using your own funds) and long term care insurance are self-explanatory, our discussion will concentrate on Medicare and Medicaid.

3. Medicare - This is the national health insurance program primarily for people 65 years of age and older, certain younger disabled people, and people with kidney failure. Medicare provides short term assistance with nursing home costs, but only if you meet the strict qualification rules.

4. Medicaid - This is a federal and state funded and state administered medical benefit program which can pay for the cost of the nursing home if certain asset and income tests are met. Since the first two methods of private pay (i.e. using your own funds) and long term care insurance are self-explanatory, our discussion will concentrate on Medicare and Medicaid.

Medicaid has traditionally been the way many people paid for long term stays in skilled nursing facilities. For instance, if a loved on is facing a nursing home stay due to an illness such as Alzheimer's, Medicaid may pay for these costs. But the rules are much tougher now than they have ever been, due to changes in the law that occurred in 2006 under the Deficit Reduction Act (DRA)

The main thing to note is that there are many ways to still qualify for Medicaid paid nursing home care, and many planning techniques that may still be available, even under these tough new laws. But you need a qualified Elder Law Attorney to help you navigate through the ever rising riptides.

4 Design Secrets From the Best Builders


Building design is both a science and an art form. Some of the world's most technically advanced homes and projects are also works of art. Designs are conceived and developed using both aesthetic and innovative ideas based on talent and years of experience.

Design concepts: Where the beautiful and the practical come together

Design concepts are the heart and soul of the building industry. Modern building design is a far cry from old style building. Computer Assisted Design is one of the reasons for this quantum jump in design. It's now possible to plan with levels of complexity, accuracy and style which were simply impossible in the past.

New design concepts have exploded with new technology and innovation. Designs can be tailored to suit the most demanding tastes and bring to life the most beautiful ideas with a few clicks on a computer. Add to this the brilliant new architectural concepts and modern building methods, and you have design capacity which is unparalleled in history.

Modern culture and building design: How the market drives design and innovation

The building industry is very much market driven. New home builders are very design conscious, and highly literate. They know what they want, and can search the internet for designs. This very well informed market has helped to promote new building ideas, and has been extremely quick to take up innovative designs

Most importantly, there's no longer a huge technical gap in knowledge between home builders and designers. The absolute latest in building design is now straightforward and easy to understand, with hyperlinks and detailed analyses from experts. This situation has let builders off the leash and given them the ability to create and promote brilliant creative new building concepts.

Designs for living

Custom design has completely changed even the basic idea of building a home. Living standards are now the working basis of industry design quality standards. Top professional builders now incorporate the latest living concepts in their standard designs.

The huge demand for living quality has been a win-win situation for builders and consumers. "Luxury living" has become a high volume commercial proposition, which has reduced basic costs and drastically increased the range of choices for consumers. It's become a self developing process, with design driving demand, which drives a new range of building options. Today's best building designs are the basis of tomorrow's standards.

Designs for environments and personal tastes

Home builders have helped create an entirely new market idiom, where personal tastes are no longer ultra expensive and difficult to achieve. New home designs are a joint effort between builders and home buyers, working with the site and its environment.

If you live by the sea, or in a beautiful forested area, or want a smart new modern city home, you can build to your preferences and get top quality construction with proven best practice building options. Wherever you want to live, your builder can create a perfect match for your tastes.

Wednesday, February 20, 2013

How To Prevent Elder Abuse


As our population ages and more stress is placed on families to care or both parents and children at the same time, there is a potential for Elder Abuse by caregivers whether family members or service providers. To understand how Elder Abuse happens we must first define what Elder Abuse is, what are the indicators, who are the perpetrators, what the signs of elder abuse and who is at risk of being a victim.

Elder abuse is defined as any form of mistreatment that results in harm or loss to an older person. It is generally divided into the following categories:

Physical Abuse

Physical abuse is physical force or violence that results in bodily injury, pain, or impairment. It includes assault, battery, and inappropriate restraint.

Who are the perpetrators?

Perpetrators may be acquaintances, sons, daughters, grandchildren, or others. Perpetrators are likely to be unmarried, to live with their victims, and to be unemployed. Some perpetrators have alcohol or substance abuse problems. Some are caregivers for those they abuse.

Who is at risk?

As a group, victims of physical abuse do not differ significantly from seniors who are not abused.

What are the indicators?

Indicators are signs or clues that abuse has occurred. Physical indicators may include injuries or bruises, while behavioral indicators are ways victims and abusers act or interact with each other. Many of the indicators listed below can be explained by other causes (e.g. a bruise may be the result of an accidental fall) and no single indicator can be taken as conclusive proof. Rather, one should look for patterns or clusters of indicators that suggest a problem.

Physical indicators

* Sprains, dislocations, fractures, or broken bones

* Burns from cigarettes, appliances, or hot water

* Abrasions on arms, legs, or torso that resemble rope or strap marks

* Internal injuries evidenced by pain, difficulty with normal functioning of organs, and bleeding from body orifices

* Bruises. The following types of bruises are rarely accidental:

o Bilateral bruising to the arms (may indicate that the person has been shaken, grabbed, or restrained)

o Bilateral bruising of the inner thighs (may indicate sexual abuse)

o "Wrap around" bruises that encircle an older person's arms, legs, or torso (may indicate that the person has been physically restrained)

o Multicolored bruises (indicating that they were sustained over time)

o Injuries healing through "secondary intention" (indicating that they did not receive appropriate care)

o Signs of traumatic hair and tooth loss

Behavioral indicators

* Injuries are unexplained or explanations are implausible (they do not "fit" with the injuries observed)

* Family members provide different explanations of how injuries were sustained

* A history of similar injuries, and/or numerous or suspicious hospitalizations

* Victims are brought to different medical facilities for treatment to prevent medical practitioners from observing a pattern of abuse

* Delay between onset of injury and seeking medical care

Sexual Abuse

Sexual abuse is any form of non-consensual physical contact. It includes rape, molestation, or any sexual conduct with a person who lacks the mental capacity to exercise consent.

Who are the perpetrators?

Perpetrators of sexual abuse include attendants, employees of care facilities, family members (including spouses), and others. Facility residents sometimes assault fellow residents.

Who is at risk?

* The majority of identified victims are women, however older men have been sexually abused in both domestic and institutional settings.

* Persons with physical or cognitive disabilities

* Persons who lack social support and are isolated

What are the indicators?

Indicators are signs or clues that abuse has occurred. Physical indicators may include injuries or bruises, while behavioral indicators are ways victims and abusers act or interact with each other. Some of the indicators listed below can be explained by other causes (e.g. inappropriate or unusual behavior may signal dementia or drug interactions) and no single indicator can be taken as conclusive proof. Rather, one should look for patterns or clusters of indicators that suggest a problem.

Physical indicators

* Genital or anal pain, irritation, or bleeding

* Bruises on external genitalia or inner thighs

* Difficulty walking or sitting

* Torn, stained, or bloody underclothing

* Sexually transmitted diseases

Behavioral indicators

* Inappropriate sex-role relationship between victim and suspect

* Inappropriate, unusual, or aggressive sexual behavior

Domestic violence

Domestic violence is an escalating pattern of violence or intimidation by an intimate partner, which is used to gain power and control. Several categories of domestic violence against the elderly have been identified:

"Domestic violence grown old" is when domestic violence started earlier in life and persists into old age

"Late onset domestic violence" begins in old age. There may have been a strained relationship or emotional abuse earlier that got worse as the partners aged. When abuse begins or is exacerbated in old age, it is likely to be linked to:

* Retirement

* Disability

* Changing roles of family members

* Sexual changes

Some older people enter into abusive relationships late in life

Who are the perpetrators?

* Perpetrators are spouses or intimate partners

* The majority are men

* Some perpetrators abuse drugs or alcohol.

Who is at risk?

* Older women whose relationships with their spouses or intimate partners were abusive or strained when they were younger.

* Older women who enter into intimate relationships late in life

What are the indicators?

Indicators of domestic violence are similar to those associated with physical abuse and/or sexual abuse (see physical abuse and sexual abuse). The following additional patterns are also characteristic:

* The frequency and severity of injuries are likely to increase over time

* Victims often experience intense confusion and disassociation

* Violent incidents are often preceded by periods of intensifying tension and followed by periods of apparent contrition on the part of perpetrators

Psychological abuse

Psychological abuse is the willful infliction of mental or emotional anguish by threat, humiliation, or other verbal or nonverbal conduct.

Cultural values and expectations play a significant role in how psychological abuse is manifested and how it affects its victims.

Who are the perpetrators?

Perpetrators may be family members, caregivers, or acquaintances.

Who is at risk?

Persons who are isolated and lack social or emotional support are particularly vulnerable.

What are the indicators?

Indicators are signs or clues that abuse has occurred. Physical indicators may include somatic changes or decline, while behavioral indicators are ways victims and abusers act or interact. Some of the indicators listed below can be explained by other causes and no single indicator can be taken as conclusive proof. Rather, one should look for patterns or clusters of indicators that suggest a problem.

Physical indicators

* Significant weight loss or gain that is not attributed to other causes

* Stress-related conditions, including elevated blood pressure

Behavioral indicators

The perpetrator:

* Isolates the elder emotionally by not speaking to, touching, or comforting him or her

The elder:

* Has problems sleeping

* Exhibits depression and confusion

* Cowers in the presence of abuser

* Is emotionally upset, agitated, withdrawn, and non responsive

* Exhibits unusual behavior usually attributed to dementia (e.g., sucking, biting, rocking)

Financial Abuse

Elder financial abuse spans a broad spectrum of conduct, including:

* Taking money or property

* Forging an older person's signature

* Getting an older person to sign a deed, will, or power of attorney through deception, coercion, or undue influence

* Using the older person's property or possessions without permission

* Promising lifelong care in exchange for money or property and not following through on the promise

* Confidence crimes ("cons") are the use of deception to gain victims' confidence

* Scams are fraudulent or deceptive acts

* Fraud is the use of deception, trickery, false pretense, or dishonest acts or statements for financial gain

* Telemarketing scams. Perpetrators call victims and use deception, scare tactics, or exaggerated claims to get them to send money. They may also make charges against victims' credit cards without authorization

Who are the perpetrators?

1. Family members, including sons, daughters, grandchildren, or spouses. They may:

* Have substance abuse, gambling, or financial problems

* Stand to inherit and feel justified in taking what they believe is "almost" or "rightfully" theirs

* Fear that their older family member will get sick and use up their savings, depriving the abuser of an inheritance

* Have had a negative relationship with the older person and feel a sense of "entitlement"

* Have negative feelings toward siblings or other family members whom they want to prevent from acquiring or inheriting the older person's assets

2. Predatory individuals who seek out vulnerable seniors with the intent of exploiting them. They may:

* Profess to love the older person ("sweetheart scams")

* Seek employment as personal care attendants, counselors, etc. to gain access

* Identify vulnerable persons by driving through neighborhoods (to find persons who are alone and isolated) or contact recently widowed persons they find through newspaper death announcements

* Move from community to community to avoid being apprehended (transient criminals)

3. Unscrupulous professionals or business persons, or persons posing as such. They may:

* Overcharge for services or products

* Use deceptive or unfair business practices

* Use their positions of trust or respect to gain compliance

Who is at risk?

The following conditions or factors increase an older person's risk of being victimized:

* Isolation

* Loneliness

* Recent losses

* Physical or mental disabilities

* Lack of familiarity with financial matters

* Have family members who are unemployed and/or have substance abusers problems

Why are the elderly attractive targets?

* Persons over the age of 50 control over 70% of the nation's wealth

* Many seniors do not realize the value of their assets (particularly homes that have appreciated markedly)

* The elderly are likely to have disabilities that make them dependent on others for help. These "helpers" may have access to homes and assets, and may exercise significant influence over the older person

* They may have predictable patterns (e.g. because older people are likely to receive monthly checks, abusers can predict when an older people will have money on hand or need to go to the bank)

* Severely impaired individuals are also less likely to take action against their abusers as a result of illness or embarrassment

* Abusers may assume that frail victims will not survive long enough to follow through on legal interventions, or that they will not make convincing witnesses

* Some older people are unsophisticated about financial matters

* Advances in technology have made managing finances more complicated

What are the indicators?

Indicators are signs or clues that abuse has occurred. Some of the indicators listed below can be explained by other causes or factors and no single indicator can be taken as conclusive proof. Rather, one should look for patterns or clusters of indicators that suggest a problem.

* Unpaid bills, eviction notices, or notices to discontinue utilities

* Withdrawals from bank accounts or transfers between accounts that the older person cannot explain

* Bank statements and canceled checks no longer come to the elder's home

* New "best friends"

* Legal documents, such as powers of attorney, which the older person didn't understand at the time he or she signed them

* Unusual activity in the older person's bank accounts including large, unexplained withdrawals, frequent transfers between accounts, or ATM withdrawals

* The care of the elder is not commensurate with the size of his/her estate

* A caregiver expresses excessive interest in the amount of money being spent on the older person

* Belongings or property are missing

* Suspicious signatures on checks or other documents

* Absence of documentation about financial arrangements

* Implausible explanations given about the elderly person's finances by the elder or the caregiver

* The elder is unaware of or does not understand financial arrangements that have been made for him or her

Neglect and Self-Neglect

"Active" neglect refers to behavior that is willful - that is, the caregiver intentionally withholds care or necessities. The neglect may be motivated by financial gain (e.g. the caregiver stands to inherit) or reflect interpersonal conflicts.

"Passive" neglect refers to situations in which the caregiver is unable to fulfill his or her care giving responsibilities as a result of illness, disability, stress, ignorance, lack of maturity, or lack of resources.

"Self neglect" refers to situations in which there is no perpetrator and neglect is the result of the older person refusing care.

Who are the perpetrators?

* Perpetrators may be paid attendants, family members, employees of long- term care facilities, or others

* Caregivers who lack adequate skills, training, time, or energy

* Caregivers who are mentally ill, or who have alcohol, substance abuse or other mental health problems

* In self-neglect cases, there are no perpetrators

Who is at risk?

* Persons with physical or mental disabilities who depend on others for care

* Persons with high care needs. The literature on care giving suggests that certain conditions are particularly stressful to caregivers. These include fluctuations in the older person's need for care, disturbed sleep, incontinence, and lack of support from other family members.

* Self-neglect is often associated with mental health problems, including substance abuse, dementia, and depression.

What are the indicators?

Indicators are signs or clues that neglect has occurred. Indicators of neglect include the condition of the older person's home (environmental indicators), physical signs of poor care, and behavioral characteristics of the caregiver and/or older person. Some of the indicators listed below may not signal neglect but rather reflect lifestyle choices, lack of resources, or mental health problems, etc. One should look for patterns or clusters of indicators that suggest a problem. Signs of neglect observed in the home

* Absence of necessities including food, water, heat

* Inadequate living environment evidenced by lack of utilities, sufficient space, and ventilation

* Animal or insect infestations

* Signs of medication mismanagement, including empty or unmarked bottles or outdated prescriptions

* Housing is unsafe as a result of disrepair, faulty wiring, inadequate sanitation, substandard cleanliness, or architectural barriers

Physical indicators:

* Poor personal hygiene including soiled clothing, dirty nails and skin, matted or lice infested hair, odors, and the presence of feces or urine

* Unclothed, or improperly clothed for weather

* Decubiti (bedsores)

* Skin rashes

* Dehydration, evidenced by low urinary output, dry fragile skin, dry sore mouth, apathy, lack of energy, and mental confusion

* Untreated medical or mental conditions including infections, soiled bandages, and unattended fractures

* Absence of needed dentures, eyeglasses, hearing aids, walkers, wheelchairs, braces, or commodes

* Exacerbation of chronic diseases despite a care plan

* Worsening dementia

Behavioral indicators:

Observed in the caregiver/abuser

* Expresses anger, frustration, or exhaustion

* Isolates the elder from the outside world, friends, or relatives

* Obviously lacks care giving skills

* Is unreasonably critical and/or dissatisfied with social and health care providers and changes providers frequently

* Refuses to apply for economic aid or services for the elder and resists outside help

Observed in the victim:

* Exhibits emotional distress such as crying, depression, or despair

* Has nightmares or difficulty sleeping

* Has had a sudden loss of appetite that is unrelated to a medical condition

* Is confused and disoriented (this may be the result of malnutrition)

* Is emotionally numb, withdrawn, or detached

* Exhibits regressive behavior

* Exhibits self-destructive behavior

* Exhibits fear toward the caregiver

* Expresses unrealistic expectations about their care (e.g. claiming that their care is adequate when it is not or insisting that the situation will improve)

Senior-Friendly Housing in Canada


As the Baby Boomer generation ages, the need for senior-friendly housing is on the rise. Josh Crabb of CTV Edmonton reported that currently seniors make up about 15% of Canadian population. By 2036 this number is expected to skyrocket to nearly 24% (CMHC, "2011 Canadian Housing Observer"). It's been noted that a large portion of seniors prefer giving up their family homes in favor of condo living for its convenience, but much consideration and weighting of pros and cons should be done before opting in for a condo lifestyle.

Condo living is attractive to seniors due to perceived convenience and ease of maintenance. In fact, many seniors choose to sell family homes and relocate to condos before they reach the age, when such a move becomes very difficult. Despite a wide variety of retirement homes, home care facilities and other times of senior housing readily available across all Canadian provinces, independent condo living is something a staggering number of seniors opt in for.

The CMHC report says that condominium projects accounted for one-third of housing start-ups in Canadian cities in 2010 and that's up from 29 percent in 2009. It's been predicted that the rapidly aging population will translate into a growing demand for smaller homes.

The CMHC report further estimates that as the population ages across the country, its needs are changing, thus even smaller communities will need proper facilities to accommodate seniors with disabilities and other medical conditions.

While both large cities and smaller towns hold appeal for seniors, its small communities where shopping and social amenities are more convenient and easily accessible; they are expected to be largely affected by the aging population. This is why smaller urban centers will need to become more senior-friendly, and urban planners will have to take their needs into consideration.

Still, Canada's largest cities have a multitude of retirement homes, assisted living facilities, home care options, as well as senior housing communities already available, and the cost of living there is often more affordable. In addition, city living translates into a wider range of social activities, community groups and entertainment to choose from.

The despite the general trend for condo and assisted living, the CMHC also projects a lot of activity in the home renovations market. Seniors who choose to remain in their family homes will often choose to undertake serious renovations projects in order to make their living space more convenient and easily accessible. Among other adjustments, seniors are becoming proactive by installing ramps and elevators, widening doorways to fit wheelchairs, upgrading bathrooms to include grab bars and senior-friendly bathtubs. Some seniors who live with adult children go as far as adding suite extensions to their homes.

The aging of Canadian population means that there is an increasing need to accommodate the needs and requirements of Canadian seniors both in areas of housing and urban planning.

Medicaid Estate Planning: Maximize Your Results


For those of you not familiar with the 2005 Tax Reduction Act, some of the provisions address specific transfers by seniors under the new Medicaid nursing home provisions. Under the new provisions, before seniors qualify for Medicare assistance into a nursing home, they must spend-down their assets. These new restriction have a 5-year look-back. The look-back used to be 3 years.

By a vote of 216-214, the U.S. House of Representatives passed budget legislation that will impose punitive new restrictions on the ability of the elderly to transfer assets before qualifying for Medicaid coverage of nursing home care. You can link to the new law Deficit Reduction Act of 2005 in PDF format, click on: http://www.rules.house.gov/109/text/s1932cr/109s1932_text.pdf. The section on the transfer provisions begins on page 222.

WHAT'S MEDICAID?

What's Medicaid? Medicaid is a government assistance program for people over the age of 65 or who are disabled. Medicaid assistance was designed for those who could not afford medical expenses (for the poor) but Medicaid has become the default for the middle class. The middle class has become the new poor.

Medicaid planning and Medicaid rules are complicated. The government is mandating a 5-year look-back on any transfers you may have made to disqualify you from entering the nursing home. Before the 2005 Tax Reduction Act it was 3 years. The transfer of any assets by the elderly has taken a notation of a "fraudulent conveyance" or in government parlance "deprivation of resources."

These new rules are spousal impoverishment programs designed to punish the healthy spouse. If one of the spouses gets sick, all resources have to be spent before you can qualify for government assistance. These new restrictive rules punish the healthy spouse leaving the healthy spouse at the mercy of welfare or her children. It's very humiliating when seniors have planned their retirement based on their ability to keep their home.

ASSETS YOU MUST SPEND DOWN

Assets that you must spend down before you can qualify for nursing home assistance. Anything you own in your name or together with your spouse. Cash, savings, checking, certificate of deposits, U.S. Savings bonds, credit union shares, Individual Retirement Accounts (IRA), nursing home trust funds, annuities, living revocable trust assets, any revocable Medicaid estate planning trust, real property occupied as a home, other real estate you hold as investment property or income producing property, cash surrender value of your life insurance policy, face value of your life insurance policy, household goods and effects, artwork, burial spaces, burial funds, prepaid burial if they can be canceled, motor vehicles, land contracts, life estate in real property, trailer, mobile home, business and business property, and anything else in your name or your possession.

WHAT DO YOU MEAN "FRAUDULENT CONVEYANCE"?

What do you mean by "fraudulent conveyance" or "deprivation of resources." If you give away your assets and you do not receive an equal amount (value) in return, the transfer is a deprivation of resources and you have committed a fraudulent transfer, (you give your house to your children for $100.00 when the fair cash value of your home is i.e. $150,000). If you gave your house to your children for $100 sixty months (5 years) before you entered the nursing home, you "deprived your resources" from the nursing home expenses. Unwittingly, you also incurred a gift tax on the difference between the $100.00 and the $150,000 and in addition you may have cheated the government out of Estate Taxes.

HOW FEDERAL GIFT TAX APPLIES?

The gift tax rules apply to the transfer by gift of any property. You make a gift if you give property (including money), or give the use of property, or give the income from property without expecting to receive something of at least equal value in return. If you sell something at less than its full value or if you make an interest-free or reduced-interest loan, you may be making a gift.

The general gift tax rules are that any gift is a taxable gift. However, there are many exceptions to this rule. Generally, the following gifts are not taxable gifts:

- Gifts that are not more than the annual $12,000 exclusion for the calendar year beginning in 2006 (This is called the Annual exclusion for any 12 month period, see below).

- Tuition or medical expenses you pay directly to a medical or educational institution for someone,

- Gifts to your spouse,

- Gifts to a political organization for its use, and

- Gifts to charities.

- Annual gift tax exclusion. A separate annual gift tax exclusion applies to each person to whom you make a gift. For 2007, the annual gift tax exclusion is $12,000. Therefore, you generally can give up to $12,000 each to any number of people in 2007 and none of the gifts will be taxable. However, gifts of future interests cannot be excluded under the annual exclusion provisions. A gift of a future interest is a gift that is limited so that its use, possession, or enjoyment will begin at some point in the future. A federal Gift Tax return is filed on form 709 for taxable gifts in excess of the annual exclusion.

FILING A GIFT TAX RETURN

Generally, you must file a gift tax return on Form 709 if any of the following apply:

- You gave gifts to at least one person (other than your spouse) that have a fair "cash" value of more than the annual exclusion of $12,000 for the tax year 2007.

- You and your spouse are splitting a gift.

- You gave someone (other than your spouse) a gift of a future interest that he or she cannot actually possess, enjoy, or receive income from until some time in the future.

- You gave your spouse an interest in property that will be ended by some future event.

- Your entire interest in property, if no other interest has been transferred for less than adequate consideration (less than its fair "cash" value) or for other than a charitable use; or

- A qualified conservation contribution that is a restriction (granted forever) on the use of real property

HOW ESTATE TAX APPLIES?

Estate tax may apply to your taxable estate at your death. Your taxable estate is your gross estate less allowable deductions. On the date of your death, everything in your name is taxable. Take inventory of what you own: Cash, Savings and checking accounts, CDs, Stocks, Mutual Funds, Bonds, Treasuries, Exempts, Jewelry, Cars, Stamps, Boats, Paintings, and other collectibles, Real Estate ... main home, vacation spot, investment realty, your Business, Interests in other businesses, Limited Partnerships, Partnerships, Mortgages and notes receivable you hold, Retirement plan benefits, IRAs, or any amounts that you expect to inherit from others.

Many people prefer not to think about what will happen on their death, but none of us are immortal and failure to make proper plans can mean that we leave behind is a mess which has to be sorted out by our nearest and dearest, at great expense and inconvenience, at a time when they are emotionally bankrupt.

Your federal death (estate) tax, up to 55%, is based on the "fair cash value" of your property on the date of your death, not what you originally paid. State probate and death taxes are based on the "location" of your property. Thus, if you own property in different states, each state has to be probated and each will want their fair share. The only real alternative to a will arrangement is to set up a trust structure during lifetime which, with careful planning, can operate to eradicate probate delays, administration costs, and taxes as well as giving a large number of additional benefits. For these reasons the use of trusts has increased dramatically.

WHAT IS YOUR GROSS ESTATE?

Your gross estate includes the value of all property in which you had an interest at the time of death. Your gross estate also will include the following:

- Life insurance proceeds payable to your estate or, if you owned the policy, to your heirs;

- The value of certain annuities payable to your estate or your heirs; and

- The value of certain property you transferred within 3 years before your death.

WHAT IS YOUR TAXABLE ESTATE?

The allowable deductions used in determining your taxable estate include:

- Funeral expenses paid out of your estate,

- Debts you owed at the time of death,

- The marital deduction (generally, the value of the property that passes from your estate to your surviving spouse), and

- The charitable deduction (generally, the value of the property that passes from your estate to the United States, any state, a political subdivision of a state, or to a qualifying charity for exclusively charitable purposes).

HOW GIFT TAXES & ESTATE TAXES APPLY TO MY ESTATE:

If you die in the tax year of 2007, your "taxable estate exemption" is $2,000,000, your "gift tax exemption" is $1,000,000 and you have a maximum estate tax of 45%.

If you die in the tax year of 2008, your "taxable estate exemption" is $2,000,000, your "gift tax exemption" is $1,000,000 and you have a maximum estate tax of 45%.

If you die in the tax year of 2009, your "taxable estate exemption" is $3,500,000, your "gift tax exemption" is $1,000,000 and you have a maximum estate tax of 45%.

If you die in the tax year of 2010, your "taxable estate exemption" is $0.00 (i.e. it's repealed), your "gift tax exemption" is $0.00 (i.e. it's repealed as well) and you have a maximum estate tax of 55%.

13 times in 32 years, congress has changed the rules. Congress is always tinkering with the "Death Transfer Tax." For more information on what is included in your gross estate and the allowable deductions, see Form 706.

HOW TO AVOID THESE UNPLEASANT RESULTS?

You can avoid all of the above unpleasant results and filing requirements with an irrevocable trust implemented 60 months before you plan to qualify for the nursing home.

By repositioning your assets (transferring your assets) from you to an irrevocable trust, you will NO longer own the assets:

- you don't qualify for the probate process, and

- you do not have to file an estate tax return,

- because on the date you qualify for the nursing home you do NOT own any assets,

- at the time of your death you do NOT own any assets for the probate process,

- and at the date of your death you do NOT own any assets to report on your estate tax return.

Things We Learn From Being A Nurse


As nurses, there are many things that we learn from what we do. The experiences and learning we get from our job change our lives and the way we view life and even death. For most nurses, these are the most common things that we often learn from our profession.

1. We may not always hear our patients say "thank you" but that doesn't mean we should treat them differently. Every patient is fighting his own battle and we don't know exactly how he feels. The best thing we can do to make that person feel better is to do our tasks and responsibilities to the best of our abilities. From time to time, we may meet patients who are not as cheery as the others. This only goes to show that patients did not choose to be in the hospital. But for nurse, we chose to be there and assist every patient assigned to us. That's why it is us nurses who should be more patient and understanding.

2. Being understanding to patients does not mean being a doormat. Just because we need to be more understanding of patients does not give them the right to verbally or physically abuse us. When this happens, we need to inform our leaders or superiors about it.

3. We know the importance of life and health. We have seen so many deaths in our profession that these moments give us a chance to take better care of ourselves and the people around us. We have also seen people who have been given another shot at life or being given the miracle of life. This makes us feel how precious life is.

4. We know that the amount of responsibility we have is immense. We are responsible for administering medicines to patients, checking their stats and giving physical and emotional assistance to them. We are accountable for our actions towards them and so it is essential to provide the right nursing care.

5. We do not know everything. While we may hold a nursing license, this does not equate us to being omniscient medical professionals. We need guidance and we need to ask for help when we are unsure of what actions and steps to take. When we look back at the time when we were still new to the profession, we always ask questions to people who are more knowledgeable- our mentors, superiors and experienced coworkers.

The Job Outlook for Nursing Careers


Although the economy is sluggish, the job outlook for nursing careers still looks pretty good especially compared with many other careers that are experiencing hiring freezes at the moment. We will always need nurses, and even if hospitals are enacting some hiring freezes, travel nurses and other nursing positions are always going to be available. In fact, the Bureau of Labor Statistics foresees a much faster job growth for nurses compared to other careers through the year 2016.

It is expected that the employment of nurses will grow by more than approximately 20 percent over the next decade, and there is a variety of reasons for this. The elderly population continues to grow, technologies that require well-trained medical professionals continue to advance, older nurses continue to retire and patient care continues to progress. This expected growth will translate to more than half a million jobs for registered nurses if it plays out the way most experts think it will.

Although hospitals always need nurses, the most rapid growth for nursing careers can be found outside the traditional healthcare facility. The biggest growth of nursing jobs will be in home health care organizations, private physicians' offices and outpatient care centers. This does not seem to apply, however, to mental health and substance abuse care centers. Other areas of growth will be in employment services, particularly traveling nurse agencies, and in nursing homes for the elderly and disabled. There will also be job growth in hospitals.

Physicians' offices should experience the biggest growth due to the increased number of procedures being performed on an outpatient basis, which do not require any hospital stay. Home health care is a growing field because more and more elderly people are staying in their homes longer, opting for advanced home treatment rather than moving into nursing homes. It takes a specially trained nurse to administer the kind of care these elderly patients often need later in their lives. With such a good job outlook for nursing careers, it seems like as good a time as ever to get into this continuously growing field.

Getting Rid of Dad's Boredom By Finding the Right Assisted Living Facility


If there is any state of being that my dad absolutely can not stand, it is boredom. All other emotions are perfectly acceptable, but not boredom. The man was always active. Growing up in my family, we did not just watch TV. Dad had to constantly talk about what was happening on the screen. I missed a lot of TV shows as a child because my dad was talking about them rather than watching them. Even if he was just reading the morning paper, Dad had to talk about the news. It did not seem to bother him that we had no idea what he was talking about as we had not read the paper.

That's what made me so sad after my dad had his hip replacement. He was bored. The only time he got out of the house was for physical therapy sessions. The doctor said the therapy would never be able to give him back his full mobility, not at his age and in his health. As cliche as it sounds, my dad really did become one of those old people who sit around all day blankly watching reruns of Matlock and Wheel of Fortune. He was bored. Things might have been different it was football season, but it was spring. I could not stand to see my dad bored.

I had to work so I could not be there all the time to talk to him, not that he wanted to talk to me at that point. With his hip being the way it was, he needed help with little things like putting his pants on too. I hated to do it, but I decided that I needed to find an assisted living facility for my dad. I just hoped that I could find one where he wasn't bored all the time.

I toured what seemed like hundreds of facilities. The residents in most seemed either as bored as my dad or way too active for him. Sure, before his hip replacement, he might have loved an independent living facility that was full of other seniors taking dance classes and going on long walks, but that would not work now. Even though I told my them about my dad's situation, so many facilities insisted on telling me how active all of their residents were.

Finally, after a long search -- it seemed endless -- I found an assisted living facility that got my dad's unique situation. Sure, they showed me lots of seniors dancing and bowling and doing all sorts of other extremely active things. It was also an independent living facility so that was to be expected. However, they also took the time to show me their assisted living residents who were in similar situations as my dad's. What really got me was the movie screening room where a group of residents were watching some old John Wayne film and talking about it just like my dad used to do. They even let me talk to the assisted living and the independent living residents to see how they liked the place. Turns out they all loved it.

Now, I just had to convince my dad to go into a retirement home. As you might expect, he resisted and threw a fit. I think I heard him say, "No, retirement home" at least one hundred times in the space of two weeks. I'm not sure how I did it, maybe it was the nagging, but I finally got him to just go with me to visit the place. He started the visit in a bad mood and was predictably determined to hate the place. Then, something happened. The same group of residents that I had seen in the movie room, whisked my dad away from me and the tour guide.

To this day, I do not know what those residents said to my dad or what they all did. All that I know is dad returned a couple of hours later and said, "I'm staying." Of course, it was not that easy and it took a couple of weeks to get everything arranged for dad to move in. But once he did, that assisted living facility became his new home and I got my old dad back. He wasn't bored any more.