Saturday, April 27, 2013

Assisted Living Facilities - Things to Consider Before Making a Decision


What indications are there that will determine the need to look for Assisted Living facilities?

- It is ideal for those who may require help with meal preparations, doing their housekeeping, showering, and remembering to take their medications.

- Not eating properly as my mother did by having pork 'n' beans or canned tomatoes over toast or soup.

- Falling frequently is another indication. When my mother fell in the bathroom, pulling the towel rod off the wall and hitting her shoulder on the tub, we knew we had to think of other options. She had had other falls but this was the worst. Bruising will be a tell-tale sign.

- When minimal housekeeping is not being done.

- Forgetting to take medications. This is usually a result of memory loss.

- Confusion and strange behavior. On one visit to my mother's place, she had a pot on the stove with the burner turned on beneath it. She said she was drying the pot. My mother was an extremely intelligent woman so this was definitely strange behavior for her.

- When isolation and loneliness become a factor and help is required, an Assisted Living facility becomes the ideal choice because they can receive the help they need but are still able to retain their independence.

What are some of the things to do when choosing this type of facility?

- Visit several in the area of your choice to get a feel for the place. Is it homey? Does it feel comfortable? Is it close to friends and family?

- Assess how the staff interacts with the residents. Do they take the time to talk to them or are they rushed? Are they warm and friendly?

- Is there enough staff, especially at busy times such as meals and when medications are given out.

- Speak to as many residents as possible to determine whether they are happy living there.

- Ask a lot of questions of both the residents and the staff to get as much information as possible before making a decision.

- Check to see if there have been any complaints about the facility.

- Ask to see certification inspection reports.

- Ask to see the Resident Agreement which outlines services, prices, staffing, extra charges and house rules. Do they charge extra for assistance with showers, toilet needs or giving medications? Determine what their obligation is as well as your own.

- Are there extra services available such as a manicurist, hairdresser or podiatrist?

- Is there a 24 hour response system in each unit?

- Is there a nurse available on staff 24 hours a day?

- Is there security on the doors?

- Are there handrails in the hallways and bathrooms, and are the hallways and elevators wide enough to allow for walkers and wheelchairs?

- Do they clean the rooms and do laundry? Is the facility, in general, clean and well maintained?

- Do they have cable and telephone hook-up in each unit and if so, is there an additional cost?

- Do they consider and accommodate dietary needs?

- Do they allow overnight guests and are residents allowed to keep their pets?

- What activities are available for the residents? Do they have regular bus trips?

- Eat a meal there to determine the quality of food and whether staff give assistance if necessary.

- Is there another level of care provided when more care is required than what is offered in the Assisted Living facility? My mother lived in a place that offered three levels of care.

- Try to determine by talking to residents what the staff turnover rate is.

There is a lot to consider when looking for an Assisted Living facility. It is a stressful change for elderly people. None of us like changes so it is important to make the best choice at the beginning before a move is made.

How Home Care Can Help the Elderly to Be More Independent - Mary's Story


For many people ageing means the loss of health and independence. People who choose to remain in their own homes are often faced with still needing to rely on others to do the things they once did for themselves. Losing this independence is very hard, but there are ways in which people living at home can be assisted to regain their independence. This approach to eldercare is based on an Enabling philosophy.

This means that the aim is to 'do with' rather then 'do for'. You are never "too old" to do things for yourself.

Sometimes people can lose confidence in their own abilities after having a fall or a serious illness. The enabling approach allows for a gradual re-introduction of tasks with support to ensure you are safe while you build your skills up again.

Mary's story highlights this process: *names changed

Mary was 78 when she slipped on her front step on a rainy afternoon in Sydney. She fractured her hip and spent several months in hospital recovering. Whilst in hospital, Mary had nurses to help her shower and did not have to cook or clean. She was worried about how she would do these things when she returned home as she lives alone. Mary's children all lived far away and she did not want to burden her friends. Mary was frightened that she would fall again and have to move into a nursing home. Mary was introduced to a home care service when she decided that she wanted to return home to live rather then move into a nursing home.

Mary then met with a care manager- David, and together they arranged services to help her with her daily activities and build her confidence. Mary's goal was to be fully independent again. She was introduced to her community worker, Joan. Joan would pop around every morning to help Mary have a shower, do some housework and any shopping that Mary needed. Initially Mary wanted Joan to help quite a bit- she told David that she was especially worried she would fall over in the shower. David then organized a chair for her in the shower and Mary was able to shower herself with Joan standing by in case she needed her.

Joan encouraged Mary to participate in the housework tasks- Mary would wipe the bench tops while Joan used the vacuum. Over the next few months Mary gradually started doing more of the housework tasks herself with Joan standing by for support. David would check in every few weeks to see how Mary was progressing with her goal and adjust the services if necessary. Soon Mary built her confidence up and Joan was no longer needed at all: Mary regained her independence.

Mary's story highlights how a bit of help can go along way. If applied with an enabling focus, in-home elder care can assist a person to become more independent. It doesn't have to mean the end of independence.

I Am A Dog Bite Victim: Should I Sue Or Settle?


Dog Bite Incidents and how the law can protect you.

If you have been bitten by a dog you may be able to sue the dog owner in a personal injury lawsuit. Different states may have different laws and the amount of money you can get can vary. Therefore consider hiring a local attorney who is familiar with the state laws.

The dog owner may be liable for almost any injury their dog was involved in. There could be exceptions, however. If the victim was on private property trespassing or caused a dog to upset into attacking, then the dog owner might not be at fault.

You may be able to file a lawsuit for negligence if dog owners actions caused the accident. For example if the owner was aware of the fact that the dog was dangerous and did not take appropriate steps to prevent the dog bite accident.

Another example of negligence could be for example, if the dog's owner disregards public safety and leaves the fence door, gate, or door open or does not use leash where required by law.

If you have been injured, you may need to consult a personal injury attorney who is experienced in your state laws and has experience representing other victims of dog bite incident.

After you hire a lawyer, he or she will gather all the facts, any evidence and will draft a demand letter. The demand letter includes details of your dog bite injuries. It will also include a state that you intend to file a lawsuit. Your lawyer can write up arguments as to why the lawsuit is justified. He or she can also specify any settlement amount you may be requesting from the other party in order to avoid a trial in the court. It is probably best to avoid trial and settle for an agreed upon amount for a dog bite incident if this is acceptable by the victim. A lawsuit can be a very expensive, lengthy, and stressful endeavor.

If the dog owner agrees and accepts the settlement figure offer without further negotiation, it may be a good idea to not to proceed further to the trial and take the settlement if that is what the dog bite victim wants. If the dog owner offers a counter-offer then options are to litigate, negotiate further, or accept the counter offer.

If the settlement negotiations fail, it may be necessary to go to trial.

The Problem of Multitasking While Driving a Car


Driving distractions are widely considered as one of the main causes of vehicle accidents in the United States that ultimately result to injuries, deaths and millions worth of damages every year. While many drivers argue that they still drive safely all the time, they are not aware that combining other activities while behind the wheel is a recipe for disaster.

The lifestyle of today's people can be described as fast and demanding. Almost everyone can do two or more things at the same time. This is called multitasking-an act of doing several things simultaneously in an aim to be productive and to save precious time.

Multitasking is usually related to the workplace and most of the time produces favorable results; however, doing so while behind the wheel could be dangerous. With this activity, drivers do tasks that require them to take their eyes off the road and their hands off the steering wheel.

Multitasking while driving a vehicle is dangerous because of two factors:

• Technology. The use of wireless communication devices such as mobile phones became even more popular in today's society. However, using such devices contributed to the occurrence of road accidents in the United States. According to the Nationwide Insurance, in 2007, eighty percent of drivers admit that they multitask while driving. Out of this percentage, nineteen percent of them use their phones to type, send or read text messages.

• Car's interior design. Believe it or not, even the interior design of a vehicle has been linked to multitasking. Car features that focus more on comfort and convenience have engage drivers to become more distracted when driving. Examples of such are drink holders, trays, and compartments for gadgets such as mobile phones and laptops.

Examples of multitasking activities

The abovementioned factors somehow contribute to the causes of vehicular accidents in the United States. Given those factors, here are some activities that drivers do while driving their vehicles:

• Drinking
• Fidgeting on the car stereo, shuffling through radio stations, putting on a CD, or finding a song on the playlist on music players connected through an auxiliary outlet
• Grooming activities such as combing the hair and applying makeup.
• Dealing with meddling children inside the car
• Eating a snack or a full meal

A pedestrian or another motorist who gets injured because of someone else's distracted driving can receive compensation from the damages suffered. The victim can hire a Los Angeles injury lawyer to know if the liable party indeed exercised distracted driving. That way, the jury may award the victim the exact amount of damages he or she suffered because of the accident.

Medicaid Home Exemption May Become Limited Under New Law


President Bush has included a provision in his 2008 Budget Proposal that would eliminate the ability of states to exempt more than $500,000 of a home's equity.

Prior to the enactment of the Deficit Reduction Act of 2005 (DRA) on February 8, 2006, a single or married individual applying for Medicaid nursing home coverage could exclude a house of unlimited value. Since that law was passed, however, a limit of $500,000 was imposed: if a single individual's home equity exceeded $500,000, even by one dollar, the entire value of the home would be a countable asset for Medicaid eligibility purposes. (For an individual whose spouse resides in the house, there is still no limitation on value.) However, the DRA permitted the states to increase that $500,000 limit to as much as $750,000, if they passed a state law that did so.

Under the new Budget Proposal, however, that ability of states to increase the exemption would be taken away. With modest middle class housing values in many parts of the country routinely surpassing $500,000, that $500,000 limit can be a real problem.

One suggestion of how to deal with this would be for the potential Medicaid applicant to create an irrevocable trust and deed the house into that trust. If the trust is drafted correctly, then after 5 years have passed, the house will no longer be a countable asset, regardless of its value! An additional benefit: while a house not in trust can be attached by the state after the death of the owner/Medicaid recipient, if the house is in this type of trust it cannot be attached. So, it protects the house both during life and after death!

To decide if the above trust technique will work for your situation, you will need to sit down with an experienced elder law attorney in the state where the potential Medicaid applicant lives. Because this works best when there is sufficient time for the 5-year period to run, it is best to do this as soon as possible!

A number of additional options for dealing with the home both during life and after death are discussed in my book, "How to Protect Your Family's Assets from Devastating Nursing Home Costs: Medicaid Secrets."

Pork Rinds Are Healthy and Other Lies We Tell


This week an administrator in one of my buildings asked me to talk to a female resident about her diet. I will call this resident "Ethel". Ethel chronically complains to me and the staff about her food. She said the food from the nursing home kitchen is too "greasy" and "spicy". She also stated she had two strokes and it was because of the nursing home food. What she did not tell me on my prior visits was she had a staff member buying her food. The staff member provided me Ethel's shopping list. The list included Pepper Jack cheese, Vienna sausage and fried pork rinds. When I approached Ethel about her shopping list, Ethel responded, "Pork Rinds are healthy. Besides, I only started eating them with the colored gal here. She's my friend" I shot back with my usual dry humor, "Ethel what color is she"? Ethel yelled, "You know what color she is, she's your color!" I did not want to upset her so I asked if I could also explain the situation to her friend. Ethel told me her friend died six months ago from a stroke. I realized at that point Ethel was not exactly "connecting the dots."

Ethel's lack of understanding is justifiable. She has a diagnosis of schizophrenia and a limited amount of education. Anyone in the 21st century who refers to another grown woman as a "colored gal" is not obviously receptive to change. Furthermore, pork rinds are advertised as low carbohydrate food and we all know low carbohydrate food equals healthy food, right? Now, I would like to discuss some other lies we tell:

1. Size does not matter.

Let me explain my position. You should feel good about yourself no matter how much you weigh. I have no problem if you want to wear a bikini on the beach and weigh 400 pounds. This is not a matter of your self-esteem; it is a matter of your health. If you have a BMI (body mass index) greater than 25, you are at risk of developing type II diabetes. If you already have type II diabetes, losing 5% to 7% of your body weight (10 to 14 pounds if you weigh 200 pounds) can improve your blood sugar. You do not have to look like Kate Moss to control your diabetes.

2. Only people who go to the gym get proper exercise.

The National Weight Control Registry is an organization that monitors individuals who have lost at least 30 pounds and kept the weight off longer than one year. The average weight loss of the participants is 66 pounds and the average time of maintaining their weight is five years. According to the registry, walking is the number one exercise. Most of the participants walk daily. You can start slowly by walking for 10 minutes several times a day. You can also burn calories by cleaning your house, gardening or washing your car. You can even exercise in your chair. Just move!

3. Eating at restaurants is cheaper than cooking.

Eating at McDonald's or the nearest buffet may be more convenient than cooking at home but it is definitely not cheaper. In addition, processed food is not cheaper than whole food. You can make more chips from a bag of potatoes as opposed to buying a bag of potato chips; however I would not recommend it. The old credo "time is money" does not apply either. Think of how much time and money are wasted with extra doctor visits or medications because you did not take control of your health. Plus, think of time lost because you die earlier than you intended.

Broken Bones and Elderly Adults


Breaking a bone can be a traumatic experience at any age, but the health concerns are often far greater when an elderly adult breaks a bone. The ability of an elderly adult to heal from a broken bone may not be nearly as great as that of a younger person. Often, accidents that result in broken bones are avoidable. This is especially true if a caretaker's negligence results in a broken bone or other serious injury. These situations cannot be overlooked or taken lightly because of the real impact that this type of injury can have on the health of an elderly adult.

Broken bones are a serious concern for many adults living in nursing home facilities. Often these homes do not properly facilitate preventative health practices like proper exercise and diet that could protect a resident against injury. Proper diet and exercise are crucial for muscle strength and bone strength at any age.

If a caretaker is negligent or even abusive in how they provide for the clients in their care, their inattention could result in painful injuries. Also, if a caretaker is not attentive or observant in their care of an elderly adult, accidents can occur. Even a low-level drop or fall can cause serious bone damage for a nursing home resident. If a caretaker fails to properly supervise his or her clients, he or she may not be able to stop a preventable accident.

Broken bones can be a serious health concern for elderly adults in nursing home facilities. If your loved one has been the victim of one of these accidents due to caretaker negligence, he or she may be able to secure compensation for his or her unnecessary and avoidable pain and suffering.

Friday, April 26, 2013

Medicare and Medicaid Audits of Psychologists and Other Mental Health Professionals


Over the past year I have observed an increasing number of Medicare and Medicaid audits being initiated against psychologists and other mental health professionals.

I have recently seen a number of audits initiated against psychologists and mental health professionals who treat assisted living facility (ALF) and skilled nursing facility (SNF) residents. Most often these are audits by the Medicare Administrative Contractor (MAC), because this area of medical practice has been identified as one fraught with fraud and abuse. Sometimes these are only "probe" audits, initial audits requesting one (1) to five (5) medical records. Other times the MAC has been requesting anywhere from 120 to 375 records.

Zone Program Integrity Contractors (ZPICs).

Zone Program Integrity Contracts (ZPICs), are the primary Medicare fraud detection contractors. If a probe audit, MAC audit or other investigation of audit suspected fraudulent billing, the ZPIC may come in. The ZPIC also identifies and target various CPT codes, areas of medical practice, services and equipment that are highly susceptible to fraud. It will then initiate a ZPIC audit on its own. ZPICs receive bonuses based on amounts they recover for the Medicare program.

OIG Annual Work Plan.

The Office of Inspector General (OIG) publishes a work plan each year which discusses the areas, types of medical services, CPT codes, equipment and tests it considers to be most susceptible to fraud and abuse. The new plan is usually published in the fall for the work year. It is available online.

Psychiatrists, psychologists and mental health counselors, as well as facility administrators, compliance officers, attorneys and billing and coding experts should review this work plan each year to learn what the OIG considers to be fraud and abuse and why. Measures should be immediately implemented to remedy any problems in your practice or facility that are identified.

Qui Tam or Whistle Blower Cases.

In many cases an audit or investigation may be convened against a facility, individual or group, based on the filing of a qui tam or whistle blower's case. You won't know this, however, because these cases are filed under seal and stay sealed, often for years. These suits are based on false claims that have been filed for Medicare, Medicaid, Tricare, Veterans Administration (VA) or any other federal or state program. They are usually filed by disgruntled, former employees. These may cause the initiation of any of the types of audits discussed above.

If you suspect that this has happened, you should immediately retain legal counsel to represent you or your organization. If OIG special agents (S/As) or Federal Bureau of Investigation (FBI) agents are involved, it would be foolish not to retain an experience health law attorney before you speak to anyone.

Medicaid Audits.

I have also seen an increase in Medicaid audits by state agencies, as well.

Ordinarily, Medicaid audits are initiated by the program integrity section or division of the state agency that administers the Medicaid program, or one of the agency's contractors. The states are under increasing pressure from the federal government to be much more aggressive in identifying Medicaid fraud and recovering the overpayments.

If Medicare or any of its contractors recover an overpayment from a provider, they will also notify the state Medicaid program and Tricare program. These will them initiate audits and collection actions.

State ZPICs.

States are now contracting with ZPICs to help detect fraud and make recoveries of large overpayments from Medicaid providers. Additionally, the Medicare ZPICs may also detect and recover Medicaid overpayments, as well.

Areas Being Targeted.

In state Medicaid audits, I have recently seen increased scrutiny in the following areas:


1. Pediatric care

2. Therapy (speech therapy, physical therapy, occupational therapy) especially to pediatric patients and developmentally disabled patients.

3. Small assisted living facilities (ALFs), group homes, homes for the developmentally disabled (DD) and other small facilities.

4. Home health agencies.

5. Pediatric dentistry.

6. Optometry care, especially if delivered in a nursing home or assisted living facility (ALF).

7. Ambulance and medical transportation services, especially of nursing homes.

8. Psychiatric psychological and mental health.

Use of Statistical Sampling and Extrapolation Formulas to Multiply Repayment Amounts.

In both state Medicaid audits and in Medicare audits, I have experience increased reliance by the auditing agency on use of mathematical extrapolation formulas to estimate the amount that should be repaid. The formula used usually takes the overpayment that has actually been found and, based on several factors, multiplies it out to many times the actual overpayment amount. Thus, a found overpayment of $2,800 may become a demand for repayment of $280,000, based on the statistical extrapolation.

Things you should know about this are as follows.

1. Neither the Medicare program nor the state Medicaid programs should use an extrapolation formula, unless:

a. There is a "high" error rate in the claims that have been submitted; or

b. There have been prior educational efforts or prior audits of the provider, and the provider

has failed to correct the problems in claims submission previously found.
2. The states each have different guidelines, rules or regulations on when they will apply the statistical formula. Some do not use it. Some use a higher percentage error rate to prompt use of the formula and some lower. North Carolina is one of the lowest we have encountered; an error rate of more than five percent (5%) will prompt its Medicaid agency to apply the statistical extrapolation to the recovery amount.

Problems Psychologists and Mental Health Professionals May Encounter Producing Records for Audits.

Many psychologists, therapists and health professionals are being audited because they are treating patients in a nursing facility or assisted living facility.

In most cases, a history, physical, comprehensive assessment, physician orders, diagnosis, medication list, medication administration records, consultations, social service notes and other medial documents being relied upon by the therapist are reviewed and assessed in connection with treatment of the patient. The big problem here is that these usually stay in the facility. When an audit occurs, these may not all be available.

The biggest issue that Medicare and Medicaid seem to be targeting is lack of documented "medical necessity." The auditors take the position that the audited therapist must produce copies of the documents listed above, in part, to show "medical necessity" for the services provided.

Additionally, most physicians who treat patients in nursing facilities place their own assessments, plans and notes into the facility's chart and do not retain a copy themselves. When the audit comes, they may not be able to produce copies of their own notes and evaluations.

I recommend that any provider treating residents of nursing homes and assisted living facilities (ALFs):


1. Review the local coverage decision (LCD) applicable to the code(s) you bill so you know what requirements must be met and what documentation is required.

2. Review the Medicaid provider handbook or state regulations for the services you provide if you are a Medicaid provider.

3. Obtain and keep copies of all applicable histories, physicals, care plans, physician orders, physician consults, etc. This is best done by obtaining and using a portable scanner. You can then keep the copies electronically in a properly secured, protected server in your office (backed-up, off site, of course).

4. Sign all of your evaluations, prepare your reports, evaluations progress notes and consultations on your laptop or other computer and sign it electronically before you print it out. Alternatively, if you still use paper, scan the paper copy (after signed) and maintain it electronically.

5. Do not use unusual or non-standard terms and abbreviations. If you do, you must keep an "abbreviations and definitions" list and produce it with your records in any audit response.

6. In your reports, evaluations and notes, use the terminology from the LCD and Medicaid provider handbook. Also, always include the start time, stop time and total time spent with any resident in your report, evaluation and notes.

7. Be sure the patient, patient's next of kin/surrogate, patient's physician or nursing home administrator signs off as having received the services each time. The patient's signature is preferred.

Contact Health Law Attorneys Experienced in Handling Medicaid or Medicare Audits.

Medicaid and Medicare fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Healthcare Administration (AHCA), the Zone Program Integrity Contractors (ZPICs), the FBI, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS). Often other state and federal agencies, including the U.S. Postal Service (USPS), and other law enforcement agencies participate. Don't wait until it's too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today. Often Medicaid and Medicare fraud criminal charges arise out of routine Medicaid and Medicare audits, probe audits, or patient complaints.

The Health Law Firm's attorneys routinely represent physicians, medical groups, clinics, pharmacies, assisted living facilities (AFLs), home health care agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.

Disclaimer: Please note this article is for general education and information purposes only and does not constitute legal advice or solicitation for clients. Our opinions stated herein are just that, our opinions.

"The Health Law Firm" is a registered fictitious business name of George F. Indest III, P.A. - The Health Law Firm, a Florida professional service corporation, since 1999.

Copyright 穢 1996-2012 The Health Law Firm. All rights reserved.

Gift Ideas for Seniors Living in Nursing Homes


There are some gift ideas that you can use if you want to buy a great gift for a friend or loved one who is currently living in a nursing home. Everyone can benefit from receiving a gift from family or friends to remind them that they are loved and appreciated. You want to provide your loved one with a gift that is practical and safe for him or her.

If you have a loved one in a nursing home who is able to get out and about every once in awhile, you might consider giving them the gift of an afternoon out with you. Of course, you will need to check with the staff to make sure your loved one is able to leave the nursing home and to have them approve the locations where you will be taking the resident. You can plan to take them shopping for a little while or even to a nice restaurant.

Purchase some good books for a nursing home resident if you know he or she loves to read. Perhaps you can buy him or her some books from their favorite author. You might even want to consider buying audio books for your loved one. Many residents also enjoy reading or skimming through magazines. Take a couple magazines with you for your friend or loved one when you go to visit. You might even want to consider purchasing him or her a magazine subscription.

Bring your loved one some crayons and coloring books. Sometimes individuals in a nursing home are not able to communicate as well as they once could. This does not mean that they still do not want to spend quality time with you. Bring some coloring books in so that you can color together for the afternoon. Your family member might be able to express him or herself well though the pictures they color.

Talk to the nursing home staff to determine if you can bring your loved one some candy or one of their favorite treats. You must check first to make sure they can safely eat these items. If the individual can only have one or two pieces of candy at a time, the staff might be able to give the treats to your loved one as they are able.

Purchase some stationary for your favorite nursing home resident if they are still able and still enjoy to write. They will love having the opportunity to drop a line to friends and loved ones. Make the gifts even better by including some postage stamps and a new pack of pens or pencils with the stationary or note cards.

One of the best things you can give to a loved one who is in a nursing home is your time. They will not care if you bring them a present as long as you bring yourself for a visit as often as possible. Take the time to spend a couple hours each week with your loved one. There is no greater joy that you could give your loved one than your love and attention in person.

ADA and Senior Living - Legislative Updates For the Workplace


The Americans with Disabilities Act (ADA) underwent substantial revisions when the ADA Amendments Act of 2008 (ADAAA) took effect on January 1, 2009. The stated purpose of the ADAAA was to redress court decisions that "created an inappropriately high level of limitation necessary to obtain coverage under the ADA." The clear upshot of the ADAAA was to substantially broaden the scope of disabilities covered under the ADA, making more individuals eligible for the provision of employer-provided reasonable accommodations.

On September 23, 2009, the Equal Employment Opportunity Commission (EEOC) issued a Notice of Proposed Rule Making (NPRM), which issued proposed revisions to the ADA regulations and accompanying interpretive guidance to bring them into compliance with the ADAAA. These regulations and guidelines will be finalized shortly. Senior living communities, which rely heavily on able staff to care for residents, should be aware of the ADAAA and NPRM developments.

Defining Disability

The revised legislation provides that, in general, the definition of "disability" should be broadened to the maximum extent permitted by the terms of the ADA. The ADA defines disability as: (1) a physical or mental impairment that substantially limits one or more major life activities; (2) a record of such an impairment; or (3) being regarded as having such an impairment. The Act maintains this definition of disability, but clarifies each prong of the definition and regards each as more expansive.

The definition of "major life activity" is expanded under the Act and NPRM. The Act rejects Supreme Court precedent holding that major life activities are limited to those of "central importance to a person's life." As explained in the NPRM, major life activities are to be construed as basic activities, including major bodily functions, that most people in the general population can perform with little or no difficulty. The Act sets forth a specific non-exhaustive list of major life activities, including caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping, walking, standing, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking, communicating, and working. The NPRM adds three additional major life activities not included in the text of the Act: reaching, interacting with others, and sitting.

The ADAAA also includes a non-exhaustive list of major bodily functions, including normal cell growth and regular functions of the immune, endocrine, digestive, neurological, circulatory, respiratory, and reproductive systems. The NPRM also adds special sense organs and skin, genitourinary, cardiovascular, hemic, lymphatic, and musculoskeletal functions to the list. The ADAAA makes clear that an impairment need only substantially limit one major life activity to be considered a disability.

Interpreting Key Phrases

The Act rejects the Supreme Court's holding in Toyota Motor Mfg., Kentucky Inc. v. Williams, which held that the phrase "substantially limits" should be strictly construed, and that a disability must severely restrict or prevent the individual from doing activities that are of central importance to most people's lives. The Act also rejects the regulations promulgated by the EEOC that define "substantially limits" as "significantly restricted." Specifically, the ADAAA says the EEOC's definition of "substantially limits" is "inconsistent with congressional intent, by expressing too high a standard."

In response to this, the NPRM removes the factors that are currently considered in determining whether an impairment is "substantially limiting"- specifically, the nature, severity, and duration of the impairment and the permanent or long-term impact of the condition. Instead, the NPRM proposes several rules of construction, including: The focus should be on whether discrimination occurred rather than whether the individual meets the definition of disability; the individual does not have to demonstrate the limitation is in an activity of "central importance to daily life"; and the term "substantially limits" should not require extensive analysis.

The NPRM provides that an impairment is a disability if it substantially limits an individual's ability to perform a major life activity as compared to "most people in the general population," as opposed to the prior standard, which focused on "an average person in the general population."

And finally, under the ADAAA and echoed by the NPRM, a determination of whether an individual is substantially limited in a major life activity shall be made without regard to mitigating measures. With the exception of common eyeglasses and contact lenses, the ADAAA prohibits the consideration of measures such as medication, medical supplies, equipment, prosthetic devices, hearing aids, mobility devices, and others when determining whether an employee is substantially limited in a major life activity.

Adapting New Standards

The NPRM proposes that to be substantially limited in the major life activity of working, an individual must be unable to perform a type of work, taking into account the nature of the individual's work and job-related requirements. This new standard replaces the prior standard of needing to determine whether an individual is substantially limited from working a "class" or "broad range" of jobs.

The NPRM reiterates the text of the ADAAA by providing that impairments that are episodic (e.g., epilepsy) or in remission (e.g., cancer) would constitute disabilities if they would be substantially limiting "when active."

The ADAAA says that the expansive definition of disability will be categorical for certain types of conditions-in contrast with the prior view that all impairments were subject to individualized assessments as to whether they were disabling. The ADAAA provides that certain impairments (e.g., autism, cancer, cerebral palsy, diabetes) would consistently meet the definition of disability. For specified conditions, the individualized assessment should be conducted "quickly and easily." The NPRM adds a list of impairments that may be disabling for some individuals (e.g., asthma, high blood pressure, learning disabilities). With respect to these types of conditions, the NPRM proposes that the individualized analysis should be slightly more comprehensive.

Interpreting Repercussions

The number of individuals covered under the ADA will increase as a result of the ADAAA and NPRM. Employers should expect to receive a greater number of requests for accommodations and be mindful of the new and broadened scope of the ADA's coverage. Employers should also review their guidelines for determining disability and, in a close case, contact counsel to review how the Act's expansion may impact the determination of a disability that will require reasonable accommodation.

While many state/local laws, such as in New York, New Jersey, and California, have long defined disability more broadly-thereby including many individuals who did not qualify for protection under the ADA-in certain respects, the Act's expanded "regarded as" standard may be broader than even the most employee-friendly state or local law.

Key Points for Employers

The ADA Amendments Act of 2008 (ADAAA) and accompanying Notice of Proposed Rule Making (NPRM) include exhaustive details about how disabilities are defined, and senior living providers should become familiar with all the changes affecting their business. However, here are some quick points to keep in mind. Under the ADAAA and NPRM:

o An individual satisfies the definition of disability if he establishes that he has been subjected to prohibited action based on an actual or perceived physical or mental impairment.

o An individual no longer needs to establish that the impairment substantially limits a major life activity. However, employers are not required to make reasonable accommodations in all cases.

o A "transitory and minor impairment" (i.e., an impairment with an actual or expected duration of six months or less) does not satisfy the "regarded as" prong of the definition of disability.

Sexual Abuse And Police Brutality - Two Difficult Personal Injury Case Types


Personal injury attorneys sometimes find that it is easier to take on cases that involve product liability, such as malfunctioning equipment, or even automotive accidents. Expert witnesses in these cases can provide information about how the interactions between roads, traffic control signals and other elements function. On the other hand, personal injury cases can be difficult when allegations of police brutality or sexual abuse arise.

In the case of some ten women who Los Angeles County law enforcement agencies say were assaulted at residential care centers in the California area, they may not even be able to speak for themselves. After all, they are severely disabled, and the sole current record of the attacks are grainy surveillance videos recovered by an anonymous computer technician. So if you are involved in such a personal injury case, how can you be sure that you have the best chance of it reaching a satisfactory conclusion?

Sexual Abuse Personal Injury Cases

Many plaintiffs in personal injury cases revolving around sexual assault or sexual abuse are those who have been attacked by a person in a position of authority, whether a superior or an aide in a healthcare situation. So the danger in these cases is first, to provide an atmosphere where the victim feels comfortable admitting that an attack has taken place. Qualified personal injury attorneys who take on these cases understand the difficulty in offering solace while allowing victims to speak about these tragic events.

They also understand that it's not just the assailant that may be at fault. A California sexual assault case that returned a judgment of more than $2 million on behalf of two sexually assaulted students found that the school district could have been at fault, were it not for the statute of limitations running out. It means that based on case-by-case evaluations, employers of assaulters or those who did not create a safe environment may also potentially be at fault. It's important for assault victims and their guardians or families to understand this fact.

Police Brutality Personal Injury Cases

Police officers have guidelines for the amount of force that they can use in a given situation, it's commonly called a matrix, and is set by their department's policies. In many cases, the force is only that needed to either minimize a violent situation, or restrain a suspect long enough to apprehend him or her. But police officers make mistakes and use excessive force, and personal injury attorneys recognize how difficult it can be to establish claims and reach a jury award or satisfactory financial settlement.

The closed society behind police departments may means that it takes substantial effort to get departmental records or video of alleged events. Potential personal injury lawsuit plaintiffs need to understand that those with experience know how to press for information, how to best use prior medical records to establish the amount of damage that a police brutality case caused for a victim, and more. The right attorney can help find the evidence, find witnesses, and ensure the best possible result. It can result in millions of dollars in settlements, as a California personal injury case concerning police brutality found.

Advantages of Taking Online LPN Nursing Classes


Many people are inspired by Florence Nightingale who gave her services to mankind selflessly. You can also be another Florence Nightingale by enrolling into the nursing profession via an appropriate nursing course.

Online LPN nursing classes

There are many nursing classes which you can get on to start your nursing career. There is the nursing degree that qualifies you to be a registered nurse (RN) and further degrees as in Masters in nursing. There is also the Licensed Practical Nursing (LPN) nursing degree which you can take online today due to the high demand of nursing specialists.

It is easy to register for an online LPN nursing classes program today through the Internet as there are many providers of such courses. There are many advantages in undergoing an online LPN nursing classes program instead of going through an on-campus course.

Advantages

Registration for the online LPN nursing classes program is easy. The registration is simple and valid without the need to make a trip to the campus as your registration details onscreen will be accepted as you sent through the Internet. All fee payments can also be made online through online credit facilities.
You can run through the course lectures in your free time and send your completed assignments through the Internet. It is fast and secure. You are helping the environment by sending a soft copy than a printed copy.

The online LPN nursing classes program is the same as the one offered on campus; but you can complete the online program in a shorter duration as you exercise good time management on your learning. Hence, your career can start sooner than you expected.

It only takes 1-2 years for a successful completion of an online LPN nursing classes program with good time management and discipline.

There are online tutors to assist you whenever you require further help with your course. Online chats and discussions on the course are available with tutors and other course mates to enhance your learning experience.

Further Career Pathways

When you have successfully completed the online LPN nursing classes program, you can pursue a national certification or be engaged in a practical session with some approved nursing facility to add value to your acquired knowledge, unless you are already in regular time nursing employment. You can also consider an area of specialization to acquire some specific skills and knowledge to move your career forward. You can work in most medical environments such as hospitals, clinics, hospices, nursing homes and medical private practices.

Getting Your First Job As a New Nurse - Hope and Hints for Graduate Nurses


How do you get that first job at nursing? It can be so daunting, sending in application after application, always applying and hearing little back.Keep at it! I have been a nurse for 30 years, and it is a wonderful and versatile career. Stay open to education as you progress in your career - but first you have to get that first job.

When I started nursing school hospitals were begging for nurses. I even saw a hospital offering the use of a car in exchange for nurses who made contracts. When I graduated that had changed. That time it was because of a change in insurance - there were new "diagnostic related groupings" as a way of diagnosing and getting reimbursed and hospitals responded by freezing jobs. I have also worked in Canada, and experienced a period of time where they were experiencing layoffs. It was very hard for nurses, especially as they might have worked many years in a specialty like labor and delivery to be forced to go to another area. During that time it was almost impossible for new nurses. Two years later, both situations had turned around again - but getting that first job can still be tough. It is highly probable that changes in national health care will open up jobs to nurses, but for right now - how to get that first job is the major challenge. Here are some helpful hints:

  • Consider a nationwide search. Some states are more open than others - California new grads are having a particularly hard time, but just over the border in Arizona or New Mexico it is much better. The South and the Midwest are doing well also. I helped some of my Canadian nurses consider relocating to the States, as the cultures and language are so similar. (Although I did have to retake my boards in Canada, and the situation might be the same in the US - dependent on the States.

  • Open to other kinds of facilities such as nursing homes, doctors offices and home health agencies.

  • If you are still in school, try hard to get into a hospital or nursing home that you would be interested in working at as a Medical Secretary or Certified Nursing Assistant. The skills that you develop in these professions translate directly into nursing and you make yourself seen by doing these jobs.

  • Don't get stuck into believing that just because the Internet exists there are no ways to use personal contact! Go to any nursing event that remotely interests you - even if you don't feel qualified to be in the room. Try to contact the head nurse of an area that interests you directly - even if you are just able to volunteer.

  • Look into hospitals that offer internships.

  • Consider enlisting in the military. There are sweet deals for nurses here. However, they much prefer BSN nurses, so talk to your recruiter to make sure you are getting all the details. They are available nationwide.

  • If at all possible get a union job. Ralph Nader once said that the California Nurses Union is the strongest union in the United States, and other states are unionized as well. If you have a choice, a unionized job will give you the strongest protection.

  • Don't give up! Every nurse had to start somewhere - and you will find that first job.

Thursday, April 25, 2013

AvMed Health Insurance - What You Should Know


AvMed medical insurance is a small company based in Florida, offering medical insurance for all residents of the state. In 1969, the company was initially founded to offer health insurance for pilots. AvMed actually stands for 'aviation medicine'. Today, the company is the largest non-profit healthcare organization available in the state of Florida. They have had HMO licensing since 1973 and have been federally qualified as a health insurance company since 1977. The company has more than 300,000 customers, along with offices throughout the state to make sure that all customers are taken care of.

AvMed provides a variety of different insurance options to its customers. There are group plans that are ideal for large and small employers alike, as well as Medicare Advantage plans and even individual health services. However, it is important to note that not all services are available everywhere. Throughout the state of Florida, here is what you can get with AvMed medical insurance:

Miami-Dade and Broward County residents can obtain Medicare Advantage plans.

Miami-Dade residents can obtain individual health insurance plans.

All Florida businesses can purchase group medical insurance plans for large and small groups.

AvMed is owned by parent company SantaFe Healthcare, Inc., which is a company that is comprised of non-profit companies that are located all over the nation. The parent company also operates a variety of assisted living facilities throughout the state of Florida. When it comes to choosing a medical insurance organization that is committed to its customers and providing the best insurance options possible, AvMed is definitely a company worth checking out. In the state of Florida, there are so many different medical insurance plans and it is hard for people to find the right insurance right away, but this company is definitely worth checking into.

While AvMed's offerings might seem quite limited when compared to other Florida insurance companies, they actually have quite a great deal to give to the people who can use their services. If you live in Miami-Dade county and need individual medical insurance, or even if you're a Florida business looking for a group medical insurance plan, AvMed is sure to have something to suit your needs. Take the time to check out their various comprehensive health plans and see what you can find to suit your needs. Whether you need POS, HMO, or other health insurance plans or services, AvMed has something for just about everyone in their service area.

If you need assistance in locating particular coverages at a pre-determined price, we can help you save up to 50% on your health insurance monthly premium.

Choosing Between Assisted Living and Nursing Homes


There are numerous options for senior care currently available, ranging from home care and independent living to full nursing homes. Choosing the type of senior care that's right for your loved one is a challenging task, and much research needs to be undertaken to find the type of care that would best suit their needs. When looking for the right type of care, keep the wishes of your loved ones at the forefront, but also keep in mind their health needs, personal preferences, as well as likes and dislikes. Knowing the difference between different types of senior care will help you make the right decision.

Nursing Homes

Nursing Homes are otherwise known as Long-Term Care or Skilled Nursing Facilities or Homes for the Aged. Nursing homes are for elderly individuals who require assistance and care 24/7. Seniors with debilitating medical problems or cognitive impairments, who require professional assistance, opt for this type of care option. The distinguishing feature of nursing homes is that they provide professional medical assistance, convenience of access to physical therapists, many kinds of healthcare practitioners, as well as nutritional meals and personal care amenities.

Assisted Living Facilities

Assisted living combines independent living with assistance from professionals when necessary. Support services are available when needed.

In these types of communities, seniors receive help with certain daily activities, such personal care, medication reminders, or other activities, all dependent on individual needs.

Here, seniors' living space usually has his/her own furnishings and decorations; staff are required to be accommodating to the privacy and independence of each resident.

Thus, the main difference between nursing homes and assisted living communities is that the former offer professional and on-going medical services, while in the latter, assistance is offered largely with regular daily activities.

Which is more appropriate at each stage in the life of a senior?

Assisted living residences and communities can look like single-family dwellings or apartment buildings including common visiting and dining areas. The atmosphere of the suites and studios in an assisted living community are usually home-like including kitchenettes offering the resident the choice to dine alone or in a community dining room.

Seniors that have experienced a decline in health and require assistance with one or more daily life activities may be perfectly suited to an assisted living environment. Many Assisted Living arrangements and communities allow the individual to age in place rather than relocate to a facility that provides additional levels of care and the way to find out whether the residence of your loved one qualifies for the option to age in place is to contact the division of government, usually the Ministry of Health, in your province.

Nursing Homes employ health care professionals that are available to their residents as needed and they also offer most of the same options that an assisted living community offers. For example, social get togethers and excursions, physical therapy and exercise classes. The bottom line is to assess the needs of your loved one and match them to the type of care and the options provided at each level.

Caring For Our Elderly Parents and Relatives


Years ago the choice was simple, everyone chipped in to help. There was never a shortage of resources and parents lived with their children when they could no longer care for themselves. To assist in the matter, most women were stay-at-home Moms who took care of their children and parents. Those were the days when people had large families, a support system that all lived in the same city or town. Today, however, things have changed dramatically. We have stopped having the large families; if there are siblings, they frequently live far apart due to the strain of finding sufficient employment. Society has become mobile, here today, somewhere else tomorrow. So how do we care for our elderly? Off to a nursing home or assisted care living, the burden and responsibility has shifted to unrelated people to care for our elderly. It is no wonder we have lost respect for our elderly, out of sight out of mind. Old age was once thought of as the "Golden Years," but not any more. Nursing homes and assisted care living is extremely expensive. How do we plan for these costs with house payments, car expenses, college tuition, insurance fees and every day living costs? Long-term care policies only pay a fixed amount per year and have caps. So what are we to do? The bubble is going to burst at some point with the baby boomers approaching retirement age.

Doing the right thing for your Parents or elderly relatives can be daunting, demanding and stressful. The situation can be magnified if your parents have health issues e.g. Alzheimer's. My family was faced with this dilemma a year ago. My Mom's Alzheimer's was progressing and she lived in her house alone. Additionally, she lived on the East Coast, my brother in the Midwest and I in the West. We choose not to place her in a nursing home because she had severe sun-downing symptoms, i.e. paranoia, hallucinations, delusions. We were concerned that she would be highly medicated and confined to a wheel chair if placed in a facility. Our Mom has two good legs and enjoys walking and being active. Keeping an eye on her in a nursing environment would be challenging. Attention provided to patients is based on a facility's staff to patient ratio which is generally one staff member to many patients, mandated by law. Finding a good facility requires establishing a criteria checklist. Some factors to consider when searching for a facility are:

  1. Facility Reputation

  2. Pending Lawsuits, prior lawsuits

  3. References

  4. Certifications

  5. Site Inspection - Visual observation

  6. Are patients happy?

  7. Are patients clean, dressed appropriately for the temperature and weather?

  8. Does the staff know each patient's name?

  9. Noise Level?

  10. Facility cleanliness?

  11. Is temperature controlled within each patient's room?

  12. Security, Wander bracelets, anklets?

  13. Wheelchair access and handicap showers?

  14. Staff to patient ratio - What nursing level, i.e. RN, LPN, CNA per shift and how many?

  15. Does Facility offer future and on-going training for all staff members?

  16. Programs, Activities, Recreation, calendar of events for residents?

  17. Emergency procedures, working fire detectors and sprinkler system?

  18. Meals, Nutritionist on board, special diets for patients with food allergies or diabetes or other health issues?

  19. Price, Price increases how often, historically, how much advance notice?

  20. Furnished/Unfurnished?

If you decide to go the nursing facility route, make sure to visit your parent and facility on a regular basis to ensure your family member is being treated and cared for appropriately. Don't ever convey when you will be there to visit, show up at different times. Inquire immediately about any bruises, odor and request to see medication reports to review times administered. Visit with the nurse on duty to obtain daily information. If nursing home costs exceed available funds and you are over the Medicaid threshold, see if there are additional funds under Medicaid's Medically Needy Program. In some states, Medicaid will pay the difference between what you can pay and the facility's cost even if available funds exceed Medicaid's threshold.

If you are thinking about caring for your parent at home, your home will need many features similar to those found in a nursing environment i.e. safety features, shower accommodations, wheelchair/walker accessibility, door latches and i.d. bracelets for wanderers. A major difference for at home care is that you become the around-the-clock nurse, housekeeper and cook, 24/7. You will need the following skills and/or knowledge

  1. Lifting skills.

  2. Bathing/showering skills.

  3. Toilet cleaning skills.

  4. Dressing skills.

  5. Denture care skills, make sure to clean and remove while sleeping.

  6. Knowledge on administering medication timely with or without food, medication side effects.

  7. Food preparation skills, i.e. how to prepare appropriate balanced meals, soft foods for chewing and swallowing, no tough steak or sticky chewy candy.

  8. Provide mental and physical stimulation. Flash cards, puzzles, card games and walking are good activities. Ask them to write sentences and their name is a good memory exercise.

  9. CPR skills so you can recognize life threatening symptoms and be well prepared for the unexpected. Knowing what signs to look for with the elderly can be life saving when time may be of the essence, e.g. stroke signs.

  10. Calming skills when someone is confused and doesn't recognize you. Go with the flow and try not to get them upset, create a soothing story. My Mom wanted to know where her young children were; she thought my brother and I were still kids. Instead of explaining the truth, I said they were at their friend's home playing and they would be back later.

  11. Don't leave them alone.

My brother and I decided to keep my Mom at home with us. I took her for several months and established a good treatment plan with the assistance of several specialized doctors. My brother then took over the care of her at his home. His home is more suited for elderly care, i.e. minimum stairs, bedrooms and bathroom on main floor, large, wide hallways for walker access and our Mom was accepted into a clinical study research program with a major pharmaceutical company. The company is in the last year testing a new drug for Alzheimer's before going to market.

Caring for the elderly at home, there are common symptoms to be mindful of. Dehydration with the elderly is common. When you pinch skin on the back of their hand, it should snap right back in place, if it stays pinched together, they are dehydrated. Make sure they drink plenty of fluid, water is best. Another common feature with elderly people is that they tend to have dry skin. Assist them with moisturizing their skin with a hypoallergenic moisturizing lotion. Elderly people also tend to be colder since they move around less, keep a sweater, jacket or blanket handy. Elderly may have incontinence issues so keep a change of clothes, bed pads, wipes, etc. in a diaper/travel bag, be prepared at all times for the inevitable. Keep sunglasses and tissues in the car. Pack whatever is necessary to keep them comfortable, snacks and water is also a good idea if you are away from home for a long period. Elderly can be like children. You have to do all the thinking.

Taking care of the elderly can be emotionally and physically draining, make sure to give yourself a daily/weekly breaks, don't burn out the caregiver. There are many support groups that can assist with stress. There are nursing agencies that provide per diem nurses for $18 per hour and up. Your religious institution may have volunteer services which could provide you relief for free. There are also adult daycare centers sometimes run by your hospital or city. Social interaction is good for the elderly especially those with Alzheimer's. Ask friends and relatives if they could assist for a few hours a week. For additional resources, consult your doctor and city offices. Good luck with your decision. If you have any questions, please email me. Thank you, Kathryn Alexander. www.herocardsinc.com.

Workplace Risk Assessments - What Do They Involve?


Workplaces such as construction sites and factories can be dangerous environments. Even workplaces such as offices and schools which are considered to be generally safe can be home to a number of potential hazards such as unsupportive chairs, trailing computer wires, etc. According to the HSE, which is also known as the Health and Safety Executive, an estimated thirty five million working days are lost as a result of injuries caused in workplace accidents each year.

Workplace risk assessments are quite important when it comes to ensuring the health and safety of employees at the workplace. It is the duty of every employer to carry out regular risk assessments so that they are able to provide a safe working environment to the workers. Risk assessments are quite easy to carry out and when they are carried out, they reduce the likelihood of workplace accidents and injuries. They also reduce the likelihood of work injury claims and the pain and suffering that work injuries and accidents cause to the workers.

Employers have a strong legal duty to carry out risk assessments, but some companies, especially the smaller ones are not fully compliant with the legal requirements. Workplace risk assessments are important because they can help protect workers from harm and they can also reduce the likelihood of work injury claims being made against the employer.

When employers fail to undertake risk assessments and adopt preventative measures, they put the health and safety of their employees at risk. If a workplace accident has occurred because the employer failed to conduct risk assessments and identify the potential hazards, then the employer could face penalties for not taking reasonable safety measures.

Workplace risk assessments include performing a thorough assessment of all the areas where workers have access to. In addition, it should include assessment of all the procedures which workers are required to undertake and which could prove hazardous such as manual handling.

If workers are required to lift heavy objects, the employers must provide them training as well as mechanical assistance. Employers must take reasonable measures to reduce the risk of workers getting involved in manual handling accidents. Noise regulations must also be followed at the workplace if workers are exposed to excessive noise such as in the case of nightclubs, airports and construction sites.

Failure of the employer to carry out workplace risk assessments could result in injuries to the workers. Anyone who has been hurt at work because of the negligence of their employer may be entitled to make work injury claims.

Elder Abuse And The Effect On Families


Elder mistreatment or senior abuse is the term used by the American Psychological Association to describe the mental, psychological, physical or financial abuse of an elderly person or senior citizen. As aging makes the elderly physically weak and vulnerable to ill treatment, it is imperative that people are educated about the signs of elder abuse.

Significance
Senior abuse can take place in the senior's own home, the caregiver's home, or a nursing facility. As per the National Center on Elder Abuse (NCEA) in the US about 10 per cent of senior citizens are ill-treated, but hardly 20 per cent of these cases get reported. This is the reason that there is very little awareness on this topic.

Features
According to the Helpguide.org, 500,000 cases of elder abuse are reported every year. It has been found that caregivers or other family members are often perpetrators of abuse or are witnesses to the abuse of an elderly person. More often than not caregivers become abusers as they may find the task of looking after an elderly person exhausting, stressful and demanding.

Signs
Senior citizens hardly if ever speak about their abuse or ill-treatment to others. That is why it is all the more imperative that their relatives are aware of the signs of abuse. Some of these signs are strained relationship with the caregiver, weight loss, social withdrawal, inadequate hygiene, and untreated physical injuries, bruises and abrasions. Use of threats, ridicule and abusive language to keep control over an elderly person by a caregiver is another main sign of elder abuse.

Effects
The effects of ill-treatment of an elderly person on their relatives can be seen at two levels. People, who are both caregivers and abusers, are often torn between remorse, regret, anger and guilt. Abusers often feel guilt because they are unable to control their abusive tendencies despite the knowledge that they are wrong. At the second level are the other relatives, who later learn of the abuse after an injury or sometimes death of the elderly person. It is generally a feeling of grief or anger at the mishap.

Prevention
Elderly abuse can be prevented if both the elderly citizens and their family members follow a few preventive measures. The NCEA suggests that senior citizens should ensure that they begin thinking about a health plan early on to prevent incidences of abuse. Furthermore, taking part in social activities in senior centers will prevent social isolation, and reduce the possibility of abuse. At the same time, family members are advised to get involved in the lives of their elderly relatives. It is also advisable that they get educated about elder abuse, so that they are equipped to handle the issue should the need arise.

Planning for Your Parents' Future Needs


For many aging seniors who are starting to need extra help, moving in with your children is not a viable or desired option. Unfortunately, sometimes parents and children do not want to think about the inevitable and do not talk about what plans the parents have or have not made. Whether your parents are in good health, on the brink of needing additional care or need immediate assistance, it is never too early to start or act on planning discussions. And if they need immediate care, take heart, there are still options available to them.

If your parents' finances are in good condition, the planning process is important to focus on protecting their assets and setting funds aside for their long-term care. Long-term care insurance can help provide resources for obtaining care both at home or in a care facility. However, LTC insurance can be quite expensive and gets more so as you age. Getting advice is critical, and lawyers who specialize in elder care laws can provide valuable guidance, even if used just for a consultation. For a fee, they can help set up trusts to protect assets, and some offices provide medicaid application assistance as well.

If your parents have limited resources, there are still options available to them. Many county offices have an Office/Department of the Aging that provides information regarding a variety of services in their areas, like home health care agencies, meal programs and senior centers. Many home health care agencies can provide both skilled nursing or aides who can assist with daily living activities, like getting dressed, preparing meals, etc. If your parent only needs a little assistance a few times a week, home health care agencies are a good option. Many locations provide transportation to senior centers that can also help provide activities like exercise or other social events.

If your parent needs more round-the-clock care, there are assisted living facilities and nursing home facilities. Assisted living facilities allow for more independence, typically in apartment-style surroundings where support staff is readily available if help is needed. Some facilities have both assisted living and nursing home wings so that as conditions progress, residents can be moved between facilities and remain close to more self-sufficient spouses. These facilities are usually private pay and require that your parents have the resources to pay for rent.

When your parent doesn't have those resources, you can look at facilities that accept Medicaid patients. Medicaid is used for long-term care, after Medicare has been exhausted. Medicaid applications can take months to be approved, so you want to start the process as soon as you think it may be needed. The application does not have to be approved prior to your parent moving in, as nursing home facilities will accept "Medicaid pending" patients, but the application should be in progress.

Medicaid laws vary from state to state, so you should look for assistance in understanding your state's requirements, either from an elder law attorney or from the state social services department. All will require that your parents funds, except those protected by a trust, or allowed by the state, for example, to support the spouse, be exhausted. Look back periods exist, e.g. in New York, five years, in which the state will review any financial statements to see if funds were transferred, that may be asked to be returned. Once again these rules and exceptions vary based upon state so you want to check them out way in advance if possible.

Tremendous amounts of information exist to help seniors if you know where to look for it. Even if your parents seem to be in perfect health, it's never too early to have a serious discussion about what they would like to have happen, and positioning them to better be able to achieve that. The earlier you start, the more likely you will be able to accommodate their wishes. But even if you need to act quickly, make sure you stay calm and explore your different options, as well as the different providers that exist within each option. These will be some of the most important decisions you can help your parent make, and you don't want to rush through them or feel pressured to make just any choice. Knowing your options will put you in a much better position to help take care of the people who have always taken care of you.

Wednesday, April 24, 2013

Seattle Assisted Living Info


Residents of Seattle senior living communities can take advantage of all the trappings of a thriving city: world-class shopping and dining, natural scenic beauty, exciting cultural events, all the while maintaining the intimacy of a close-knit community.

Seattle Recreation & Activities

Many assisted living facilities in Seattle are conveniently clustered around shopping and recreational facilities in any one of the many residential neighborhoods throughout the city. Here are a few of the more popular recreational activities that Seattle senior living residents and their families can take advantage of:

North Seattle

Assisted living facilities in Seattle, north of the ship canal, are a short distance away from one of the most popular and scenic recreation centers in Seattle, Greenlake Park, which boasts ADA compliant pedestrian paths and a public theater. It is a great place to read a book, set up a fishing rod or people watch from a shaded bench.

During the winter months or to escape the rain, assisted living seniors can take a trip to Northgate Mall. When the weather turns nicer, University Village, an outdoor shopping center with retail, restaurants, and adjacent grocery and drugstores, is a another great option.

North Seattle senior living residents can also participate in activities at Senior activity centers in Ballard, Wallingford or Greenwood.

Central Seattle/Downtown

Seattle assisted living seniors who live downtown or in the First Hill neighborhood are located a short distance from the Downtown retail corridor which houses most major retailers, Seattle's theater district, world-renowned restaurants and two major cinemas: AMC Pacific Place 11 and Regal Meridian 16.

Assisted living facilities in the Capitol Hill neighborhood are a short distance from an assortment of cultural, recreational and dining activities. A stroll along Broadway, the main commercial thoroughfare, offers an array of local eateries and entertainment such as the Harvard Exit and Egyptian theaters located at either end of boulevard.

All these residents are a short distance from the Central Area Senior Center.

West Seattle

West Seattle assisted living complexes boast convenient access to Alki Beach, which features a pedestrian friendly boardwalk and stunning views of Puget Sound. The West Seattle Junction retail district is packed with restaurants and specialty stores along Main Street, great for window shopping or grabbing a cup of coffee. Residents can also opt for a more conventional mall experience at the recently renovated Westwood Village shopping center.

Open to all is the Senior Center of West Seattle specifically geared for senior activities.

South Seattle

South Seattle assisted living communities are clustered in the Rainier Beach, Columbia City and Beacon Hill neighborhoods. Residents enjoy easy access to some of Lake Washington's most pristine views, especially form Seward Park, a 277-acre peninsula at the southeast edge of Seattle. There are great activities to be found at the Southeast Seattle Senior Center.

Seattle Medical Facilities

Seattle has become a biomedical research hub, and attracts some of the greatest doctors and healthcare providers in the country. Residents of assisted living facilities can get preventative and emergency care at a variety of high-quality, local hospitals and medical centers:

North Seattle

North Seattle is home to the University of Washington Medical Center, a nationally-recognized, state-of-the-art medical research facility. It is the teaching and research hospital of the University of Washington.

Central Seattle/Downtown/West Seattle

The following are all large, modern hospital centers that serve the entire Seattle community: Virginia Mason Medical Center, Swedish/First Hill Medical Center, and Harborview Medical Center.

Seattle Transportation

Many Seattle assisted living facilities employ their own fleet of handicap accessible shuttles for shopping, medical appointments and other activities. King County (which includes Seattle), provides the Senior Services Transportation Program, which is free to any King County resident 60 years or older, who are able to enter and exit vehicles with minimal assistance.

Seniors with limited mobility may be able to use for Seattle Metro's Access transportation service or ADA Paratransit Program. The Access shuttles are specially equipped to handle wheelchairs and provide shared ride service along existing Seattle bus routes. Personal care attendants and service animals can accompany the senior for no additional charge.

You can find assisted living in Seattle at our Seattle Assisted Living page.

Are Your Nursing Assistants in the Know About Hospice?


Do your nursing assistants know that hospice care focuses on comfort and dignity? And that it promotes the best possible quality of life for dying clients and their families? Unfortunately, not enough people (even those who work in health care) know what hospice care is all about. Because they are the "front line" workers, it is important for every CNA to understand that hospice is an available choice. Here is some basic information that you can share with your nurse aides:

What Is Hospice?

The word "hospice" comes from a Latin word that means "guesthouse". However, in today's world, hospice is not a location. It's a special way of caring for terminally ill clients and their families. Hospice gives people control over their end-of-live care and keeps families together during the difficult time of losing a loved one.

In addition:


  • Hospice care tends to save money. (It usually costs less for people to receive hospice care than for them to be in a hospital.)

  • Modern hospices began in England in the 1940's. The first hospice in the U.S. opened in 1974. Today, hospices combine the comforting power of modern medicine with the "old fashioned" support of caring hospice workers and loving families.

  • The majority of hospice clients are dying from some form of cancer. Heart disease is the second most common diagnosis. However, the focus of hospice is not the disease-it's the client and family.

  • Hospice care is provided by a team of people who have chosen hospice as their specialty and who have been trained to work with dying clients. That doesn't mean that hospice is all about grief and sadness! The main goal of hospice is to help clients live meaningful lives-with comfort and dignity-for the time that's left them.

  • The hospice team includes nursing assistants (usually called home health aides or hospice aides). In fact, aides are very important to the team, especially since they spend so much time with clients and their families.

Where Can Clients Receive Hospice Care?

Hospice services are available to people wherever they choose to spend their final days. This includes:

Private Homes. A hospice client may live at home or a friend or family member's home.

Freestanding Hospice Facilities. Many large hospices have their own facilities where clients come for care. These facilities tend to be located in cities.

Hospitals. Some hospitals provide hospice care. They may devote a special floor or wing to hospice clients-and have a specially trained hospice team.

Nursing & Assisted Living Homes. Hospice care is also provided at some skilled nursing and assisted living facilities. (The facility is considered the client's home.) There may be an "in house" hospice team or a visiting team.

Who Receives Hospice Care?

Before a client receives hospice care, nurses and physicians review the client's disease history, current symptoms and life expectancy. Then, they meet with the client and the family to discuss hospice philosophy and services, pain management and equipment needs.

People who receive hospice care:


  • Are usually in the last six months of their lives.

  • Can be any age...from a child to a senior citizen.

  • Can be of any religion...or of no religion.

  • Have terminal illnesses such as cancer, AIDS, lung diseases, heart disease, nerve disorders and Alzheimer's Disease.

  • Often have a friend or family member who helps care for them.

  • Can be wealthy, poor or in between!

Remember...it is possible for doctors to be wrong about how long a person has to live. There have been cases of people "graduating" from the hospice program by getting better! There are also cases of people who live longer than six months while receiving hospice care. Their care doesn't stop just because they've survived longer than expected!

People have the right to change their minds. If they begin hospice care and don't like it or want to try some new "cure" for their disease, they can be discharged from hospice. Most insurance plans allow people to start hospice again at a later time.

Hospice care is paid for by Medicare, Medicaid, some private insurance companies and through charitable foundations. Most hospice organizations work hard to find funds to pay for the care of clients without health insurance.

What Makes Hospice Care Different?

There are a number of factors that distinguish hospice care from traditional home care or care given at a facility.


  • When people are admitted to hospice, the staff comes and goes as needed. (However, they are available 24 hours a day, 7 days a week.) If a client feels better, the staff visits less often-but the client is not discharged.

  • Hospice care provides palliative care rather than trying to "cure" a disease. Palliative care focuses on making people comfortable by reducing or taking away unpleasant symptoms such as shortness of breath or pain.

  • The hospice team has special training that helps them deal with a client's emotional pain, too.

  • Hospice care provides services to clients and their families.

  • Hospice care is less expensive than most other types of care...costing under $150.00 per day.

  • Most hospice clients remain at home with their friends and family. Hospice clients have already decided not to be kept alive by machines.

  • Hospice care for the family continues for up to one year after the client dies. This is known as bereavement care.

  • Many home care clients are required to be homebound. Hospice clients are not! They may leave their homes as much as they like.

  • If a hospice client lives in a facility, hospice provides grief counseling for the staff of the facility-just like they do for the family.

Most people wait too long before transitioning to hospice. This means that they don't live long enough to benefit fully from the scope of hospice services. If one of your clients mentions an interest in hospice care, please notify your supervisor.

Eight Questions You Should Ask Before Buying a Nursing Agency or Nursing Home for Sale


If you are looking for a recession-proof investment, buying a nursing home or nursing agency for sale currently makes a lot of sense. While consumers tighten their budgets in many areas, the need for independent healthcare provision isn't going to go away any time soon. Indeed, the demographics of baby boomers coming up to retirement and ever increasing life expectancy means that the potential client base for nursing homes and agencies is steadily rising. In addition, government cutbacks are reported to be already impacting on waiting times for NHS provided treatment, driving many people to look at private medical options. This in turn is creating more business for private healthcare firms, and an increase in demand for nursing staff of all kinds in the private sector - supplied, of course, by nursing agencies.

But although the top level business case for buying a nursing agency or nursing home may be solid, choosing a specific nursing agency for sale is not so simple. Every nursing agency and nursing home for sale is different in terms of its client base, its funding sources, its premises, its management and its staff. So it is important to understand the particular features of any home or agency you may be considering buying, to ensure it will be a good fit for your requirements. Here are the eight questions you must ask before buying a nursing home or nursing agency for sale.

Why is This Nursing Home or Nursing Agency for Sale?

Knowing what is motivating the vendors to place their nursing home or nursing agency for sale right now can give you a lot of clues about the current state of the business. Just as you are interested in nursing agencies or nursing homes as a business investment, so will the vendors before you. (Even owners motivated by the desire to provide excellent care will need to have made sure that the business is sustainable and can provide a living income.) Motivation to sell can be of three main types:

The business is doing well and the vendor wants to realise the increase in value.

The business is doing badly and the vendor needs to sell.

The vendor wants to retire and use the proceeds from the sale to fund their retirement.

All other things being equal, a business which is performing well will be a more attractive investment than one which is not. But it is not necessarily bad for you if a particular nursing agency or nursing home for sale isn't performing well financially. Sometimes this can represent a bargain investment, provided you fully understand why the business is struggling and have the ability and vision to turn things around. From an investment point of view, this type of sale can represent the biggest opportunity for value increase - but it will require experience and expertise to know what needs fixing. If you are a hands-off investor with no experience of nursing homes and agencies, an underperforming business should be avoided in favour of one which is already financially successful.

What Are its Income Sources?

Nursing homes and agencies in the UK can receive income from three main sources:

Direct from the NHS (e.g. an NHS hospital pays for temporary nursing cover)

Local Authority (e.g. a local authority assesses someone as requiring care in a nursing home and pays for that care directly)

Privately (e.g. an individual arranges for domiciliary care to be provided in their home, or a private health company wants to recruit nursing staff)

As a business investor you need to know the current mix of income sources and whether there is over-reliance on one type. For instance, many nursing homes flourished over the past decade or so based on local authorities' legal obligation to provide residential care. Many local authorities are now reassessing people against new criteria and withdrawing funding, as a way of cutting expenditure. Nursing homes which have not also built up a healthy private client base, with associated marketing to support it, may find their funding position looking shaky as a result.

What is its Reputation with Clients?

What do clients and their families think about the agency or home? When it comes to personal care services such as residential care or domiciliary care, families place considerable importance on the experience their relative is getting, at least as much as the technical quality of medical care or the cost of the service. Put simply, even when changes in the economic landscape may be creating funding uncertainties for nursing homes and agencies, businesses which are loved by customers will have the easiest time in attracting new clients and maintaining a healthy business.

What is its Client Base?

Apart from income sources, what type of customer does the nursing home or nursing agency cater for? This will indicate the likely size of your potential customer base (important if you have plans for growing the business) as well as funding stability. It may also affect how well the new acquisition fits into an existing portfolio. For instance, if you already own a chain of residential homes for the elderly, a home currently catering for young adults with learning disabilities may not fit the current brand as well a home specialising in dementia care. The client base will also determine the skills needed to run it successfully - so if you intend to be an owner-manager it's important to choose a nursing home for sale which matches your background and skills.

Is it Profitable, and if so Why / Why Not?

You must find out the turnover and profits of the current business, before and after tax. This is normally disclosed as a matter of course by the vendor and is usually verified prior to completion of a sale. But it is more important to find out why the business is or is not profitable, than to look just at the bottom line. For instance, a lack of profits may occur in a well run home or agency but where financial management has been weak (this might occur in an independently run home where the owner is more focused on care issues than running a sound business). Equally, a profitable business may be the result of a vendor having an eye to selling and minimising investment in care and maximising profits.

How Vendor-Dependent Is It?

How well could the business continue to run when the vendor is no longer there? Does the business have a strong management team in place who can continue to run the business in the absence of the owner? If you want to be a hands-on owner, taking over the day to day running of the business, then this factor may not matter so much. But if you want to be a hands-off investor, you will either need a team already in place, or you will need to appoint a manager on your behalf.

What Development / Expansion Potential Does it Have?

Assuming you are look at nursing agencies and nursing homes for sale as an investment opportunity, you will want to know what scope there is for adding value to the business after you have bought it. In the case of a nursing home, can the value of the premises themselves be increased through refurbishment, or is there scope to increase capacity? In the case of a nursing agency, could business be increased by bringing in new clients? Or could the range of services be expanded (e.g. a nursing agency deciding to also provide non-medical domiciliary care)?

Is it Independent or Franchise?

Some nursing agencies and homes are fully independent, while others operate as part of a franchise. Buying a franchise will be less expensive, and may appeal to those with appropriate nursing background and skills but with less cash to invest - but the scope for adding value or increasing personal income will be strictly limited. Buying an independent business will cost more - often including the price of the premises - but you will own everything and will have a far greater degree of control over how the business is run. Perhaps more importantly from an investment point of view, you will benefit from any increase in income and value you are able to generate.

Using a Business Broker to Assess Businesses for Sale

Finding out this level of detail about a nursing home or nursing agency for sale can be difficult, and may not be completely revealed until negotiations are well advanced. It is therefore useful to use the services of a business broker who is better placed to know these details or to find them out on your behalf. A broker who is representing a nursing agency or nursing home for sale (i.e. the home or agency has asked the broker to find a buyer) should have determined this type of information already in order to understand the business and find a suitable buyer.

But where information is not yet known, it is often far easier to make enquiries via a broker than to ask a vendor directly. Being able to ask these questions and to trust the information that comes back can help prevent time being wasted on unsuitable businesses. More importantly, it should prevent you from completing a deal only to find out later the true position of the business.

The General Philosophical Framework of Rosenzweig's Thought


The unique framework of Franz Rosenzweig

The philosophy of Franz Rosenzweig is one of the most interesting and surprising innovations of modern thought, both general and Jewish. There exists a background of distinguished modern Jewish philosophers from Moses Mendelssohn, the first philosopher of modem thought who systematically defined the essence of Judaism, to Hermann Cohen and Martin Buber. However, Rosenzweig was the first to inject existential philosophy into Jewish thought and give it direction, both theologically Jewish and original.

Rosenzweig coined a terminological system whose terms were taken from Jewish usage. He provided its own guidelines and created a unique philosophical weave containing an interpretation of the struggle of Judaism with the other monotheistic religions.
Rosenzweig emphasizes a unique and orderly conception of life. In his epistle "On Education," he wrote: "The Judaism to which I refer is not 'literary' and is not grasped by the writing or reading of books. Even - forgive me all modern thinkers - it is not to be 'experienced' or 'cultivated'. One may only live it. And not even this - one is simply a Jew, and nothing more" (His Life 159).

The Star of Redemption, Rosenzweig's masterpiece, is written in a remarkable, ordered, dialectical singularity. In The Star of Redemption, Rosenzweig made one of the few attempts to formulate methodically religious existential philosophy (MiMytos 262-273), This attempt makes the book unconventional, an exceptional work among the philosophical works of our time.
Rosenzweig, contrary to the great classical philosopher, stresses the lack of identity between thought and reality. Instead, the book is based on three elements - God, the world and man - which preface all logical action and may be conceived only by means of faith The Star of Redemption also strays from the accepted line in the existential philosophy of Kierkegaard and Sartre, in that Rosenzweig attempts to prepare a philosophical method par excellence.

Rosenzweig's life and personality also uniquely reflect his philosophy of life: "Man thinks that he philosophizes, but in actuality he writes his autobiography ("From Revelation" 162). Although raised in an assimilated environment, educated at the knees of the classical German idealism and philosophy of the Enlightenment so distant from that of religious belief, he suddenly turned sharply to faith. Author of the philosophical treatise Hegel and the State, Rosinzweig subsequently became the author of the theological book The Star of Redemption and translator of Hebrew poetry of the middle Ages and the Bible to German. He stood at the threshold of converting to Christianity and returned to Judaism to become one of its most profound thinkers. Intellectually acute, probing and exhilarating, his essays frequently contained irony and humor though written during the last eight years of his life while he was critically ill and in agony, paralyzed throughout his body and unable to speak (His Life).

Notwithstanding the uniqueness of the man and his method, Rosenzweig's philosophy is a not a singular phenomenon, but is a total spiritual process which characterizes post-Hegelian philosophy. This process places in the center of thought not understanding or an abstract method but rather existential man, real, vital man, with all his existential problems, emotion and agonies of soul.

The philosophic path leading to Hegel

In the approximately two hundred years which preceded Hegel, a direction in philosophical thought had commenced and developed which led inexorably t Hegelian thought. Among the significant philosophers of this developmental period was Francis Bacon (1561-1626), the father of English empiricism, who maintained that the source of understanding o knowledge is the experience we acquire by means of our senses. Bacon developed the scientific method, which was adopted and adapted by, among others, political philosophers different one from the other as Thomas Hobbes (1588-1679) and John Locke (1632-1701).

Man's dependence on his perception developed from a scientific method to a philosophical concept. George Berkeley (1685-1753) set forth the rule: "to be" is to "be perceived" in the mind of man. He further asserted that the one thing, which exists for certain, is Spiritual reality, thought, the result at which the senses arrive. The skepticism of Berkeley was buttressed by David Hume (1711-1771), who denied the possibility to understand via our intellect any truth of reality. Immanuel Kant (1724-1804) neither accepted the skepticism of Hume nor the earlier empiricism, and he suggested a synthesis, which transferred the center of gravity from the object to the "I." We know, claimed Kant, by means of our senses as shaped by our intellect and not by the world surrounding us.

Kant was not the only philosopher who nourished the "I". Ren矇 Descartes (1596-1650) based consciousness on one fundamental element "Cogito ergo Sum." Gottfried Wilhelm Leibnitz's (1646-1716) theory of monadology strengthened the "I" of Descartes, and the monism and natural determinism of Baruch Spinoza (1632-1677) found in the "I" total unity of spirit and the entirely natural.
Thus, the broad spectrum of philosophical doctrines in the approximately two hundred years which preceded Hegel Began to emphasize deliberation on man's place in the world. Following Hegel, there occurred significant and distinctive movement in philosophical thought, one which properly, as described by Rosinzweig, could be called "the new thinking."

The immense significance of "the new thinking" will become apparent following a brief review of the theories and teachings of Hegel.

Hegelian theory and reaction to it as background to "The New Thinking"

Georg Wilhelm Friedrich Hegel (1770-1831) contributed to philosophy in the two following ways:

1. He established the history of philosophy as a central authority and integral part of philosophical education. The dialectic observes things in motion, flowing, and knows that not everything, which was true yesterday, will be true also tomorrow. By its nature, the dialectic is likely to accustom man to greater tolerance.

2. He made the initial determination that the previous various philosophical methods are expressed in terms of the development of cognition towards one idealistic philosophy, which strives towards an absolute and exclusive truth, that is, to the "worldly spirit" - the divine orientation which aspires to bring the human world to complete fulfillment of spiritual freedom. Hegel saw in the history of philosophy a steady march towards "absolute knowledge". Philosophy was not only a matter of understanding history but rather was the force and the best means to direct the course of history ("die absalute Macht" ), to make the cognitive path bring about events. However, the striving of Hegel towards one total and complete philosophy, the one philosophy, which strived for absolute truth, conflicted with the many philosophical doctrines of earlier philosophers.

Hegel solved this conflict with his dialectic. Philosophical conceptions based on theses, that is, On assumptions of only partial perception of verity of the concept. Become in the course of thought anti-theses. These anti-theses are also partial in their perception of the verity of the concept, however their fusion engenders mutual completion, synthesis, realization of one philosophical truth ("die Tatalit?"t"). In other words, one must recognize any philosophy only via its conflict with other philosophies, but one must recognize also its veritable elements.

Philosophy absorbs within it the fruits of the spirit of the earlier period, which opposes it, and that spirit completes and improves it and creates the Hegelian synthesis.

"That philosophy which is the last chronologically embodies the result of all the previous philosophies, and therefore it must contain the principles of all of them; thus, as philosophy, it is the most advanced, fertile and explicit" (Enzyklop?"die, sec, 13, 47).Each philosopher, then, represents a specific stage of partial truth on the way to the entirety.

A similar idea was recently proposed by Natan Rotenstreich, born in 1914, approximately 150 years after Hegel ( Al Hakiyum 25-28). According to Rotenstreich, every person must feel himself a necessary link in the development of custom, which is the complex of connections, which are transferred in each and every generation. The consciousness senses that one is a participant in an enterprise of giants that will never be completed. The I-myself is turned, then, by one's modest original contribution to a part of some infinite thing. Man is not the initiator of processes; he knows that the world does not begin with him. Similarly, he cannot put a to the enterprise with which he is associated, and he is, therefore, a part of it forever. Rotenstreich emphasizes the personal, subjective element, but there is no moment of philosophy perfecting itself, as there is according to Hegel.

Rosenzeig utilized the systematic and methodical concept of Hegel, perceiving him as "the great inheritor of two thousand years of the history o philosophy" (Star 61), but did not conclude therefore that Hegel was the sole possessor of philosophical truth or that his predecessors propounded false conceptions. Hegel's dialectic resolution was not a conclusion after which no advancement of thought, which opposes the essence of his dialectic vision, could be drawn. Philosophical weaponry of a fresh and innovative type was necessary to resolve philosophical problems as they continued to arise.

This yearning for a new type of philosophical thinking that will function in the real world perceived the existence of man as he is rather than in terms of Hegel's "worldly spirit." This longing was expressed, for example, in Nietzsche's "changing the scale of all values" and in the materialistic philosophical thought of Karl Marx (1818-1883) and Ludwig Andreas Feuerbach (1804-1872).

Not only was Hegel's metaphysics being critically analyzed, his "philosophy of nature" also was revealed as being false. His attempts to perceive the phenomena of nature from abstract assumptions and not from experimental science was mocked by expert researchers such as Carl Friedrich Gauss in his research on geometry and Hermann Ludwig Ferdinand von Helmholtz in his work on the consciousness (Lectures).

Hegel observed the world from the aspect of the absolute spirit, the "perfect" consciousness of abstract thought and did not consider the existence of real man as he is, living in the concrete world of his direct experiences and his real problems. Hegel perceived the world as consolidated and united, as an infinite ideal, forever unattainable by science, a world which does not bring man to concrete actuality at the depths of his soul.

Hegel enclosed man in a world of abstract concepts, seeing man as a world in miniature, which loses its connection with the true and vital reality and is forever incapable of finding it. Man became, instead, a part of the method, a part of a speculative, magical, worldly system - the world and man are "one flesh" - united and linked one with the other. Consciousness does not bring one to true and real cognition, rather it results from the elemental and specific experience, maintained Hegel's opponents.

Contrary to Hegel's opinion, Hegelian thought was not complete. Bacon, who two hundred years earlier distrusted thought in and of itself and favored knowledge based on phenomena of nature and experiment, and Hans Vaihinger, who asserted two generations after Hegel that thought is unable to recognize the "absolute truth, " were only two of many philosophers who disputed Hegel's claim. There were also other doctrines, which were inconsistent with Hegelians thought. Among these doctrines are phenomenology, founded by Edmund Husserl (1859-1938), which currently dominates in Germany and France. Phenomenology seeks to light the true position of man's consciousness by spiritual or external data ("phenomena") without any ontological- a priori determination.

Another dissident vis -獺 - visa Hegelian thought is Hermann Cohen (1842-1918), considered one of the fathers of the neo -Kantian "Marburg School." Cohen asserts that the "logic of the inception" ("Logik des Ursprungs") or transcendental ontology seeks the "true reality" or the final essence in thought, meaning that examination of the spiritual a priori creation, exposure of the data from the beginning as an infinite process, is that which determines the programmatic status of the consciousness of man. Cohen seeks to realize society organized on the principles of ethics and the safeguarding of man's honor.

The philosophers who followed Hegel were dissatisfied with idealistic philosophy; they did not agree with Hegel that consciousness does not bring one to true and real cognition and began to develop philosophic thought that would not be restricted to the abstract and traditional method of Hegel. They sought, furthermore, to use philosophy to find resolutions to the problems bothering real people in the concrete world.

"The essential tendency of philosophic activity must bring the philosopher to man...the special symbol of recognition of man turns his independent essence to a unique personality which exists for itself..." (Principles of the Philosophy 60). In his book The Essence of Christianity ( Das Wesen Der Christentums), Feuerbach maintains that the existential reality in the life of man is in his belief in human nature and in good deeds in this world. Marxian and Nietzschian thought similarly conflicted with that of Hegel on the essential point set forth by Feuerbach.

The difference, then, between Hegel and those who opposed his thought is in the view of the relationship of the man-philosopher and philosophy, Hegel considered each philosopher as an instrument of philosophy, a representative of partial truth at a certain stage of the development of philosophy, That idea about which the philosopher thinks becomes an idea, external to the philosopher, abstract and "perfect, " on which the philosopher speculates and is not a part of him.

Form the perspective of his opponents, not only was there a new concept of philosophy; there was also a new brand of philosopher. Man is now the determining factor; he is no longer enclosed in a world of concepts, but is tied to vital. Concrete and direct, experiential reality. Man has, in the words of Rosenzweig, a "world view," he "takes a position " (Star 143). He is not an instrument of philosophy; rather philosophy is an instrument of the philosopher, of man. "The philosopher lowers himself humbly to his experimental. Existing "I," and then his doctrine will be more veritable, concrete and closer to the truth" (Dialogical Philosophy 173).

Another conflict with Hegelian thought was led by the non-rationalists, those philosophers who opposed a philosophy in which man acts according to the intellect alone, leaving no place for the demands of the heart and feeling. S繪ren Kierdegaard (1813-1855) claimed, for example, that Hegel changed religion to an absolute, conceptual-cognitive idealistic philosophy, which prevents man from attaining the possibility of direct connection with God. He declared that "truth is subjective and that the principal element in philosophy is 'the subjective philosopher'" (post-Scriptum, sec. 2).

Hegelian thought monistic idealism, which solves everything by one principle, the idea the "spirit" - prevented man from making the connection of faith. The world is, Hegel claimed, only an idea of God without a theistic undertone; rather, it is pantheistic, since things are not created by the idea: they are the idea itself. Nature, science and the arts are all accomplishments of consciousness individual man also is the fulfillment of consciousness, and there is only the conscious, so the private "I" has no place in this method. The "I" is similar, as in the theory of Spinoza, to a "light wave rolling along the waves of the ocean." The object ("substantia") according to Spinoza is the spirit according to Hegel, each engulfing everything within it. Thus, the solitary "I" cannot face God, as one who stands before God whether in prayer or as sinner or as a thinker.

The basic assumption of belief is that man can stand and present his essence before God, that God can speak with him and he can speak with God, or in the words of the German historian, Leopold von Ranke (1795-1886): "Here every age is really immediate to God" (Star 225). Ranke depicts the events of the past "as they were when they occurred." That is, the events are depicted b means of the revelation of God in the metaphysical ideal image, which gave significance to the occurrences, and not by means of the intellect ("The Significance").

In refuting Hegel, the non-rationalist Friedrich Wilhelm Joseph von Schelling (1775-1854) claimed that in rationalistic systems we can attain only knowledge of the possible and general laws knowledge of the real is always individualistic, it requires an act of the will which results from a personal need which can not be supplied by possibilities or general laws. Against the "negative" rationalistic philosophy Schelling placed a "positive philosophy," based on faith and will, which philosophy created the powerful and innovative basis for existential, religious philosophy, from which philosophy Franz Rosenzweig was influenced greatly.

Arthur Schopenhauer (1788-1860) and Friedrich Nietzsche (1844-1900) raised the "will" above "consciousness" ("ratio") (The World). Schopenhauer claimed that the will resembles a thing which itself is outside our ken, beyond the ability of our consciousness to understand; the will is the singular reality in us and in the entire world. Man's consciousness serves the power of blind will, which lacks purpose and proof and will never be satisfied (compare Star 47, 49 and 57). Nietzsche holds that only the will to govern and be powerful exists in all beings. Will is the active element in natural and human phenomena; our mental consciousness distorts and opposes life, and science is of value but is not veritable.

Among other non-rationalists who contested Hegel's monastic idealism were Theodor Lessing (1872-1933) and Solomon Ludwig Steinheim (1789-1866). Lessing argued that truth is not revealed by consciousness, that it is hidden from consciousness and found among the silent forces, which activate and direct the consciousness in its action (Einmal). Steinheim (1789-1866) asserted that one does not reach religious truth (creation of the world, revelation) by mental deliberation since this truth is subject to revelation only. He "denies speculative philosophy because of its rationalistic nature and makes faith itself a type of consciousness, not identifying it with the rationalistic consciousness" (Al Hakiyum2: 168).

Philosophy's two separate paths

Rosenzweig's thought has a special place among the thinking which disputed Hegel. Although he belongs to the non-rationalist stream of thought, continuing the line of Schelling, Kierkegaard, Schopenhauer and Nietzche, Rosenzweig relies heavily on the anthropological motifs of Feuerbach which are "the first revelation of renewal of thought" (Naharayim 232). However, there is also an interlacing of rationalism and anti-rationalism, as is evidenced by the following:

"Revelation remembers back to its past, while at the same time remaining of the present; it recognizes its past as part of a world passed by...for in the world of things it recognizes the substantive ground of its belief in the immovable factuality of a historical event" (Star 215). "There is something in consciousness which is beyond consciousness...consciousness is the basis for reality, but consciousness in its very essence is also reality" (Naharayim 207).

Thus, Rosenzweig's philosophy follows two paths: One road philosophical theology chose for itself, in which the intellect is the nourishing factor. The philosophy of religion trekked the second path, revelation serving as its basis. These two paths, according to Rosenzweig, complement each other, one nourishing the other, and neither can exist independently. This conception is comparable to Thomas Aquinas (1225-1274), who also created a great synthesis between science or limited consciousness and the perfection of belief.

However, while Aquinas derived belief from Christian revelation (Basic Writings), Rosenzweig derived it from the soul of man, according to which the relationship between philosophy and theology is determined. Rosenzweig, contrary to Steinheim, noted that he was assisted by intellectual, philosophical means to prove its substance. Rosenzweig opposed forcefully any existence-belief doctrine, which is itself based on his conscious investigations. His anti-rationalist doctrine resulted from faith, but this faith was drawn from the rationalistic history of creation (Star 213), and in this aspect, his doctrine is not different from others constructed on logical, rationalistic concepts.

Rosenzweig opposed Hegel zealously. Instead of the dated abstract thought of Hegel came concrete "new thinking" connected to words, men and real experiences.

Man is free - he is own master

The act of transferring the center of gravity from philosophy to the philosopher created not only a responsibility for man, but also emphasized that man is free. He is his own master; the entire responsibility for his existence rests on his shoulders alone. Man inhales his freedom from the will and imagination. He does not breathe freedom from the advancement and attainments of science as propounded by materialism, nor does he find it I the creative spirit of man as propounded by idealism nor from intellectual knowledge of the world pursuant to rationalism. Nietzsche, for example, perceived a new form through whose strength of will exposes the subjective values which condition thought and human conduct on the freedom of his choice.

Rosenzweig proclaims a "very personal type, a type of philosopher of world view, one who takes a position" (Star 143), who rises and flourishes on the pedestals of freedom, responsibility and ability at the time of the meeting of man, God and the world and, in regard to a Jew, during his struggle with the Jewish way of life of practical commandments.

The philosophic "I" of Kierkegaard and Rosenzweig is not the solitary "I" of Immanuel Kant, an "I" which knows nothing about the world, with which it has no contact. Similarly, Descartes, in stating "Cogito ergo Sum" did not speak of his private "I" but of the abstract thinking "I". Yet Kant speaks incessantly about the "I." Which is the center of a methodical system, but as Kierkegaard says, insofar as one speaks persistently about the "I," that "I" becomes thinner and thinner until it becomes ultimately the actual spirit of the dead (Dialogical Philosophy 17).

According to "the new thinking," freedom of choice is not a matter of obligation or compulsion which comes to man from without by command or decree. This freedom is man himself - existence - "existence for itself" ("F羹rsichselbstsein"), according to the German philosopher, Karl Jaspers (1883-1969) or "being itself" ("sich zu eigenist") in the words of Martin Heidegger. Therefore, he cannot flee from himself except by suicide and death.

Man has no choice but to be free. Thus, in every circumstance we are responsible, since responsibility rises from the ground of freedom (L'Existentialisme 64). One errs if he thinks he can pack and flee from himself via the Kantian Or Hegelian abstract dogma. Thus, man has two available courses: the way of favoring freedom and the way of opposing it. Life for the sake of freedom is true life, authentic life. One who utilizes freedom in order to fight it or to limit its domain in the world lives an insubstantial, inauthentic life. Such a life is not consistent with the nature of man (Portrait 75).

Man is free to create good and evil, truth and falsehood. He approves or negates the world and proclaims his presence and nothingness. Man who chose freedom chose well, and not only for himself but for all humanity (L'Etre 143). The individual is the source of freedom. There is no freedom other than the freedom of the individual. For this reason, each man must create and develop the truth of the test of the values as well as the values themselves. In respect of our lives and experiences, there is no world other than the world of man. Even values are nothing other than values as they relate to individual man. Thus, the individual must create values. Without the individual, they would not have arisen and there would be no values (L'Existentialisme 34-35). Man by nature is neither good nor evil. He is good or evil to the extent that he increases freedom in the world.

Freedom, then, is neither a priori nor objective. It is the being of man who lives it every day and every moment. It is the true existence since it exists for itself (L'Etre 641).

On the difficulties which gave birth to existentialism

Rosenzweig sought refuge from extreme subjectivism when he abandoned in 1913 the idealistic philosophy and the historicism of Friedrich Meinecke (1862-1954), his teacher (see Die Entstehung). He returned to theology, to the non-rational faith philosophy, while deliberating on "the clear brightness" (Star 143) of subjectivism, which Heidegger rooted in his creation of pure subjectivist philosophy.

Rosenzweig's explanation indicates the lack of clarity that existed in the world of philosophy. Each philosopher, religious or not, aspired frankly to nullify the being of man as object, desiring to see man as subject only. However, in perceiving the "I" as subject alone and turning their back on the objective element in their philosophical thinking, these philosophers exposed themselves to significant difficulties. Nikolai Aleksandrovich Berdiaev (1874-1948) spoke of the decline of freedom, of freedoms lack of candor and man's subordination to freedom. Jaspers saw in subjectivism a prison, comparable to the snail who builds its house and is forever tied to it. It is not surprising that in this attempt the real freedom withdrew upon the presentation of an imaginary freedom.

The freedom represented is abstract, a vague freedom. Indeed, there is no true freedom of choice since our options are always limited a d dependent on factors upon which we have no, or inconsequential, control. Man did not pray for simple, corporeal or metaphysical freedom. He wanted real freedom in thought, economics, religion and throughout his personal life. Man wanted freedom to lift stumbling blocks from the path of life, control disease and catastrophes, master the environment and improve generally that which exists. Such a freedom is expressed in action innovation, creation, and revelation of the clandestine and knowledge o the hidden. Existential freedom is not turned toward the external world of the real and vital meeting with God and the world; instead, it is turned to the abstract, to the intangible.
Freedom of choice, then, is minuscule. According to existentialist thinking, we are not free and independent people, but rather each of us is made gradually "a man of the multitude," one among many, one who lives by the doctrine of "sit and do not act.":

1. The lack of knowledge.

We live our life without understanding it, without knowing anything about our purpose and what we must do. Even if man has a conscious nature, he cannot conceive reality. As a result, he cannot be at home in the world, and he is "thrown" into an adversarial environment. This alienation is apparent in Sartre's novels and plays, the dramatis personae being uprooted from their societal environment and removed from their past, each lacking internal spiritual unity. What determines the character of the confrontation of man with his world is not the intellect; instead it is a certain essence, which is described as nausea or anguish at the finality and fragmentation of human existence.

In respect of life and death, existence is nothing other than passing from nothing to nothing. Being, in its generality, is not understandable and cannot be known since it is connected, on the one hand, to human consciousness and, on the other, it is given to us forever fragmented so that man perceives always his limitations, the fragmentation of his being and consciousness. Franz Kafka (1883-1924) stresses that without knowledge, minuscule man is lost I the modern world, which is arranged with no way out. There is no other possible way for the hero of The Trial (Der Proze? ) other than to accept the judgment of death, though he does not know for what, why nor by whom he is accused, tried and sentenced.

Modern society is mysterious, a sort of blind and evil force which prevents the individual from exercising free choice and the joy of life, permitting him only to yield to his uncomprehended fate. Without knowledge, one can not know the expected, and the lack of this knowledge leads to fear of the unknown, and this fear leads to uncertainty, confusion and helplessness.

2. The fear of death.

Martin Heidegger, the extreme and heartless realist, presents an authentic being, founded o the possibility of a race toward (the fear of) death. One must live, Heidegger claims, though the sole reason for his life is his death. From the moment one enters the world, we accept the sentence of death. One has no choice in this matter. If so, how can man function with this ever-present active and tragic obsession? For fear is a strong emotional reaction with physiological consequences such as paleness, trembling, accelerated pulse and breathing and dryness of mouth which can ultimately result in the cessation of all hope and total paralysis of creation caused by the entire waste of one's energy.

3. The lack of purpose.

Existentialism will never perceive purpose in man since man is not yet defined inexorably. The objective of a priori good disappeared since there is not now any compete and infinite consciousness that will calculate it. Fyodor Dostoyevsky (1821-1881) wrote: "If God does not exist, then everything is permitted" (The Brothers Karamazov). Sartre and Nietzsche ignored the existence of God, and Heidegger stated that all existence is man and nothing more. Man abandons the world of values and the a priori commandments, which can justify his behavior because he is unable to find something to rest upon his world has no purpose and therefore also no ethical values.

Such is the dismal condition of man. He is comparable to one who walks on a tightrope above the abyss whose bottom disappears from sight. Is there no exit from this fearful vision?