Saturday, May 25, 2013

Understanding the Crucial Aspects of Basic Bedside Care


Most elder people would rather receive basic bedside care from the comfort of their homes than be confined to an assisted living facility. As a result, they hire specialized caregivers and nurses to take good care of them. In addition to these individuals there are also therapists and physicians who can provide at-home care services. Elderly people, especially the sick ones, require a lot of attention. Their bodies are frail as a result of terminal illnesses and the overall wear and tear on the body. Some may not be sick at all, but they do not have youthful energy to cook, clean and care for themselves. This is where you come in. You can't just watch and do nothing. Here are some basic things you need to know about becoming a bedside caregiver:

1. The basic bedside care activities for senior people are divided into two broad categories. On one hand are the Activities of Daily Living (ADL). The second category consists of what is termed as Instrumental Activities of Daily Living (IADL). Activities of daily living are those that you normally go though on a day-to-day basis. Examples include bathing, dressing, brushing your teeth, going to the restroom, movement from chair to bed, and vice versa. Examples of instrumental activities of daily living are cleaning the house, preparing meals, managing medication, shopping and managing money etc.

2. Frequency of basic bedside care. This is dependent on a number of factors. Of utmost importance is how independent the elderly person remains as you take care of their needs. For instance, a senior person is able to attend to activities of daily living on his or her own. Other activities like laundry and housekeeping require your input. You need to assign someone to perform these tasks on behalf of your elderly parent. There has to be a nurse or caregiver providing round the clock surveillance to ensure that the person is safe and comfortable. Medication is crucial especially to a very ill person. Make sure the correct dosage is followed. The meals have to be prepared at the right time while adhering to nutritional requirements.

3. Couples can take turns at providing basic bedside care. Caring for a sick person requires patience and understanding. You need to have a big heart. It can be inconvenience to your daily routine. You have to be at the person's side for long hours. It is your duty to ensure they have eaten well, have had a change of clothes and that they are generally okay. It means you have to stay awake most of the night. When you are not busy, you can relieve your spouse so that at least he or she can catch up on sleep and recoup some energy.

4. By taking care of your elderly parents from the comfort of your home, you can save a lot of money that could have otherwise been spent on caregivers. In some instances, it is not possible to do this. That is the time you hire a professional through a care giving agency. The rates vary depending on whether you want someone for the day, night or throughout. You can negotiate for a reasonable rate.

While seeking for a basic bedside care agency, ensure that you are dealing with a licensed firm. Some caregivers simply place ads in newspapers, yet they are not qualified or experienced for the task. Confirm that the caregiver has gone through training and is certified to provide elderly care to the sick and other indisposed seniors. Do a background check on all agencies you have short listed before making a final decision. There have been cases of caregivers mistreating the elderly. Always know who you are hiring to care for your loved ones!

The Tragic Effects of Nursing Home Abuse and Neglect


It isn't always easy to recognize when a patient at a nursing home is being abused or neglected. Many of the perpetrators of this type of behavior know full well the risks and will take active measures to abuse their victims in such a way that no noticeable damage is apparent, or, when it is, being sure to keep it hidden from concerned parties that might find them out. Even in the case of neglect, active precautions may be taken to ensure no red flags go up.

Not only that, but elderly people are often already insecure about the fact that they are so much more vulnerable later in life and may be so embarrassed by their inability to take care of or defend themselves that they just keep the abuse to themselves. But the effects of nursing home abuse on an elderly individual are extremely serious and for that reason it pays to always be curious and aware of what is going on.

Here are some of the effects that can manifest as a result.

1. Physical Injury and Suffering

Of course, any abuse, whether it be physical mistreatment, sexual abuse, or even rough handling, can lead to physical injuries or suffering. These can be bruises. They can be bedsores. They can even be broken bones or internal injuries.

These physical manifestations of abuse are obviously the easiest to notice, but most abusers will be sure to do their best to hide them, and since they are the ones in charge of the patient's care, they often have the power to do just that.

2. Emotional Wounds

Just as damaging can be the emotional scars created by a victim who is unable to defend themselves, and this is equally true when the abuse is more emotional than physical. Elderly people are often experiencing a lot of difficult emotions later in their lives, and anyone who is a victim of abuse will obviously suffer emotionally. In some cases, they will become extremely depressed if someone does not intervene.

3. Financial Losses and Theft

If the abuser is taking the elderly person's money and pocketing it or diverting it into their own bank account-possibly even just using it to purchase themselves expensive things-the end result can be severe financial damage to the elderly person's accounts or estate. In some cases, if enough money is taken, the victim can end up in a bad enough financial position that they can no longer take care of themselves in these later years of their life.

4. Sickness and Disease

Whether due to unsanitary conditions in the nursing home, neglect, or a lowered immune system stemming from emotional suffering, abuse can even lead to sickness and disease. As patients are often already physically weak in their old age, this can be a dangerous problem.

5. Premature Death

In a severe enough case, physical abuse can result in death. And even in other cases where the emotional effects of the abuse get bad enough, an elderly person may suffer declining health and premature death as a result of depression and an inability to cope with what is happening to them. It's tragic that we even have to think of such things in this day and age, but unfortunately, we cannot always trust the people who we depend on to keep our families safe and sound later in life. It's of utmost importance to always be aware of what's going on-most importantly, communicate with your aging loved ones as much as possible and inquire about their care.

And if anything is suspect, do not hesitate to contact legal help to get to the bottom of things.

Assisted Living Marketing Staff vs Ownership/Management?


Lots Of Responsibility, Little Authority

Some assisted living marketing directors and representatives get little support for their efforts - from management and/or staff. I really feel for them. Yes, I do realize that operations are critical. In the care business, you must provide great care. However, for a variety of reasons, the marketing personnel and plan are also vital elements in assisted living facility success.

Marketing, and its results, directly affect all the major players in assisted living - owners/management, residents/family members, staff members.

  • Enable the owner make a profit, and the management to meet their goals and responsibilities.

  • Drive (and increase) the revenue that enables the residents and family members to continue to get superior services.

  • Help the staff to keep their jobs and get paid fairly.

I feel ownership/management must give their marketing staff the freedom to make decisions and the resources to be successful. And why not? The return on investment (ROI) in assisted living is pretty good...in most cases the new revenue per move-in is more than $30,000/yr.

Management's Point Of View

On the other side of the coin, would I just give carte blanche to a marketing director or staff member? No way. Authority does not come until a professional shows me that they have a management mindset, a marketing philosophy and a work ethic that they believe in...and I am willing to support. They must prove to me they have a strategy, plan and systems that will get a good return on their time and talent, and on my money. Put bluntly, they must sell me on their ability to make me more successful.

It seems that the road between owner/management and marketing is a two way street.

Working Together, Building Trust

Here are recommendations for developing a business culture that allows ownership/management and marketing to respect and support one another, and work as a team to increase an assisted living census.

Owner/Management
  • Hire a person with:
    • The necessary marketing, organizational, communication and technical skills.

    • An ability to continue learning and to keep up with the trends, especially the technology trends.

    • The heart to care for seniors and to care for your business.

    Then trust them and let them do their job.

  • Require a strategy and a plan. If your trust level is low, then you should assist the marketing staff in developing their strategy and plan. However, do not micro-manage.

  • Set a budget and spending guidelines. Allow a certain amount of money to be spent without approval.
    Note: When a marketing director cannot spend $100 without permission, they lose credibility with their referral sources. In addition, their ability to act with confidence and at the right time is extremely limited.

  • Do not laden your marketing staff with serving you. It wastes their time and your money. It also creates stress that saps energy and hurts morale. Instead, support them. Ask "how can I help?" If you want a report, set it up so you can quickly grab the data and/or reports directly from the marketing database.

  • In general, put yourself in the marketing staff's place. Look through their eyes.

Marketing

  • Treat your responsibilities less like a job and more as an owner would. More support and freedom will come when an owner/management feels that you see their perspective, understand what they are risking (and can lose), and act in their best interest.

  • Develop and work a strategy and a plan. To gain trust and support, you may involve owner/management in the development process. Put systems in place that make you more effective and efficient. Update when necessary and keep management "in the loop". Remember, they are also a target market that has to be sold.

  • Prioritize and wisely allocate your budget. Show how monies are spent (and will be spent) and what business they generated. That means a good database with a tracking and reporting system that is easy to use and does not bog you (or anyone else) down.

  • It is my belief that management should be informed, yet not annoyed by trivial interruptions. To avoid bogging yourself down, set up a template/report in which you can easily update information they like to keep track of. You can "cc" and "forward" important e-mails. And you can even send them Google Analytics reports to show your website traffic.

  • In general, put yourself in ownership's and management's place. Look through their eyes.

Choose The Same Side

A lack of respect and/or support between ownership/management and the marketing staff creates tension. Each side wastes energy on their lack of trust and looking for how the "opposition" is messing up. The result - less move-ins.

When a client has a low census, this type of dysfunction is one of the first things I look for. I know that even proven strategies and systems will fall apart when there is internal tension. It is critical that there is only one side when it comes to filling an assisted living facility. Marketing must be integrated into the business and the care culture. Respect and support must flow back and forth between ownership/management and the marketing staff. The result - more move-ins.

Covering All of the Basics at CNA School


Are you the type of person who works hard, and loves to take care of people? If you are, then Cna School may be just the thing for you. A CNA is a 'certified nursing assistant', the men and women behind the front lines of modern medicine. If you have ever been hospitalized, you know, that you seldom see your nurse, and your doctor less often than that, maybe just as you are heading home. The person who has gotten to know you, and tried to make you feel welcome and cared for, is a Certified Nursing Assistant.

Certified Nursing Assistants specialize in helping patients of all ages with their ADL's, or activities of daily living. These caring individuals complete a 6-12 week course, hands-on clinical practice, and final exam in order to hold the title of CNA. Although the qualifications vary from state to state, the basics remain the same. Standard CNA courses include basic nursing skills, anatomy and physiology, nutrition and infection control. Some online components are available for those students who do not have a local option.

Graduates of CNA schools can expect to earn between $20,000 to $30,000 per year, depending upon the facility where they work, and their levels of experience. Certified Nursing Assistants have many options available to them.

They can obtain employment in nursing homes, assisted living facilities, hospitals, mental health facilities, schools, and even in private homes. These professionals offer assistance in bathing, grooming and feeding their patients, as well as assisting nurses with medical equipment, and checking patient's vital signs.

Perhaps the most significant part of a CNA's job is the interpersonal connection which he or she develops with the patient. This is a two way street, as the patient receives the valuable one on one interaction, the CNA is able to relay vital information about that patient's condition to the nurses.

Cna School, a bargain at under $3,000 in most areas, can easily launch its graduates onto a very bright, rewarding, and lucrative future. Take your drive to learn, and combine it with a desire to nurture, and you will be well on your way to becoming a CNA.

Benefit Amounts on Institutional Care and Home-Based Care


Facility Care Benefit Amount

Daily nursing home benefit is the core of any long-term care insurance coverage. These policy benefits normally cover services related to custodial or nursing care that are incorporated in packages from its corresponding institution. Everything that is covered by Medicaid will be excluded from the policy; however, Medicaid can pay the services as adjunct to insurance coverage.

Licensed facilities include in its coverage the Alzheimer's facilities, skilled care, intermediate care, and custodial care facilities. Assisted living facilities or alternative care facilities are covered by most modern insurance policies. Assisted living facilities may be covered by either home and community policy or facilities policy. Nevertheless, the best policies offer it under facilities.

Many modern LTC policies pay the benefits acquired on a weekly or monthly basis instead of daily. For instance, the daily benefit amount may pay for $100 per day while monthly benefit amount may pay $3,000 per month. The total benefits paid by the policy are equivalent on either policy provided that there's no combination of claims happenedin any given day that exceeds $100. The policy paying weekly or monthly benefits more likely pay all the long term care costs unlike the daily policy benefit. The monthly paying benefit is an important windfall to your policy, and it can be purchased as additional rider. This extended benefit may be used in home care or nursing care or it may apply to all benefits offered under the policy,

The amount of the daily benefit should be determined to make the most out of LTC insurance. The amount of daily benefit is based on the sources of retirement income of the policyholder and the portion of that income to cover the long term care costs.

Home and Community Care Benefit Amount

All surveys and studies unveil that people choose home rather than institutional care and any other options available. Actually, 78% of long-term care is provided in the community. However, some policies are biased on facility care, making home-based care below the levels of institutional care. One concrete example is group plan. Most group plans are inclined to cut home care to about 50%, 75%, or 80% of the amount allocated for facilities. For instance, a $120 daily home care policy would only pay half or quarter, say $60, for home care, adult day care or hospice, and some poorly-designed policy would pay only $60 for assisted living.

Most insurance companies tell that home care costs less than institutional that's why nursing care is given much priority and importance. This idea may be true or not. To some strength, it's true because government shows statistics revealing that home care cost is only a fraction than that of nursing homes. Throughout the country, the family members take care of their sick loved ones primarily because they have insufficient budget to accommodate the costly services of nursing homes. Therefore, this reflects that home care is less expensive than nursing care. However, when the care giving family member has to end or limit his or her responsibilities to the sick/disabled loved one, paid services or institutional care comes in between.

Policies for home care normally cover the services of licensed nurses, aides, and therapists. Some companies, otherwise, include in the coverage the services of non-licensed providers and even the personal care-giving family. However, home care is usually limited to five or six daily living activities as defined in the policy. Several add-ons such as "homemaker" services should be stated in the policy before it takes effect.

Examining Assisted Living Costs


This article explains how examining the various components of assisted living costs can allow you to take advantage of what you previously thought was not possible. It is often thought that the fees required for assisted living residences are not affordable to many people. However, if they tried to analyze the different parts of these costs, they may be amazed to find that it might fit their budgets after all. Perhaps this misconception is due to the high costs of nursing home care, which was previously the only option available for retirees. Assisted living is a relatively new concept and is also known by various terms such as adult congregate living care, residential care, sheltered housing, adult foster care, enhanced care, adult living facilities, board and care, personal care, retirement residences, adult homes, community based retirement facilities, supported care, and domiciliary care. It should be pointed out that a substantial part of assisted living costs are normal living costs that you would incur if you stayed at home.

Let us check out those parts of assisted living costs that are standard components of living expenses. These include laundry service, housekeeping services, entertainment costs, social costs, transportation costs, medical expenses, garbage disposal services, meals, snacks, utility costs, home maintenance costs, emergency call system, and mortgage or monthly rent. And in contrast to independent living arrangements, there are no property taxes, insurance costs, or maintenance fees for condominiums. Therefore, the actual costs of assisted living programs are the nominal costs minus the above costs that you would have to spend whether you transfer to a retirement living community or not.

Assisted living arrangements are usually preferred by older people who need 24-hour assistance in key activities, such as meal preparation, cooking, toileting, bathing and dressing, but do not require the intensive care that is provided in nursing homes. An important advantage for residents of these communities is that it is easier for them to meet other people and socialize, thus eliminating the possibility that they would feel bored. This is quite possible for those who are alone in their homes because it is more difficult to leave the home to visit friends.

As discussed above, it is important to deduct from the assisted living costs the usual living expenses that would be eliminated if you transferred to a retirement community. If the resulting value is still substantial, you will need to convert some of your assets into cash flow. Of course, you can always ask your heirs to handle the costs or you can make use of a reverse mortgage in which you are able to convert a portion of your equity in the home into cash. There could be other assets to convert into cash like stocks and jewelry. As for those who are still planning for their retirement, it would be helpful to establish businesses that would provide the required cash flow when the time comes for you to retire. You may also purchase long term care insurance if retirement is still several years away.

Friday, May 24, 2013

Family Member Guide to Nursing Homes


Clients frequently tell us they trusted the nursing home or assisted living facility to take care of their loved one. We also hear clients say they assumed their regular visits to the nursing home or assisted living facility would encourage staff to provide better care for their family member. Well, that may be true but your presence in the room or down the hall is not enough.

Frustrated family members concerned about the level of care their loved one is receiving call often. Most of the time, their complaints cannot and should not be addressed by filing a lawsuit - so we provide more general advice. That advice is as follows:

Be Organized:

Keep a diary or a log of every visit to the nursing home or assisted living facility and include the following information:


  • Date / time of visit.

  • Location - where your loved one was upon arrival.

  • Complaints - stained clothes, sheets, food problems, no water? Write the complaints down.

  • Notify staff - make a written and verbal complaint to the charge nurse. Write down her name, and what she said would be done about the problem.

  • Follow up - next time you are there and ask the nurse what has been done. Ask to see the chart where the corrected action should have been documented.


Document Your Complaints:

If the problem continues take photographs; send a letter to the nursing home administrator requesting a conference. Ask that staff receive further training. Ask to see the facility's policies and procedures (you have this right under the Virginia Administrative Code) and compare what the staff is doing with what is required by the facility's policies and procedures.

Complain to State/Local Authorities:

If the problems get worse, or a single accident causes harm, call your local Department of Social Services (each County has one) and ask to speak to Adult Protective Services. File a complaint. You may call the Virginia Department of Health (1-800-955-1919) and file a complaint with them as well.

How to Work with Attending Physicians:

Many attending physicians also serve as Medical Directors to the facility. They are only obligated to review a resident's chart and or examine them, pursuant to Medicare requirements, and when a change in condition occurs. Ask to speak to the attending physician after each visit to determine whether there has been a change in condition. If it is a routine visit, contact the physician to find out what was examined. If medications are changed, ask why? Be curious, and write down the answers you receive. We have discovered in our cases where some nurses actually will draft the physician's orders and then call the physician after the fact, just to get their "ok".

What to do if a Fall Occurs:

If a fall occurs immediately go the facility. Ask for the name of individual who found your loved one. Where was the fall? What was he wearing? Was there medical equipment involved? Write all of this down. Who examined your family member to assess their status after the fall? Who determined that no injury occurred? Did a roommate witness the fall?

Follow up with the charge nurse - ask what is being done to prevent another fall. Ask to attend the Fall Committee's next conference when your family member is being discussed.

Also, consider the context of the fall - what time of day? Where were they going? Had they asked for help? Do they have the ability to ask for help? Is your family member taking any new medications which may cause dizziness?

What if Your Resident Stops Eating:

We hear staff say all the time - "we tried to get her to eat, but she refused." Is that true? What is the facility policy? I am certain the policy doesn't say, "if resident refuses to eat discontinue attempts." It likely requires staff to provide an alternative or supplement until the resident gets needed calories. Malnutrition can lead to the development of decubitus ulcers and prevents existing decubitus ulcers from healing.

Review the chart. Can your loved one see to eat? Can he or she feed themself? What about the food - will he eat what you bring? If so - tell the nurse and ask them to chart it. Patient refusal is a big excuse given by facilities when problems occur.

Discuss supplements, intravenous nutrition, energy bars - there are ways to get needed calories in. Is the physician aware? Make him aware.

Conclusion:

There are too many possible problems in a nursing home setting to anticipate or touch on here. However, it is important to be a diligent family member who takes notes and knows about the care provided, including who is providing the care. Also, VISIT, VISIT OFTEN - bring other family, ministers, anyone who will go. A supportive family can mean the difference between good care and poor care.

The Importance of Nursing Home Reviews


When you consider sending your loved one into a nursing home, reviews can be a life saver. You always hear about stories where the elderly get mistreated and often die in care homes because of mistreatment or neglect. This is why it is so important to read nursing home reviews before you commit to placing your loved one in a specific home.

Reviews can be found almost anywhere. One great place to find reviews on retirement homes is to simply ask around. Many of your friends or other family members may have experience in placing someone in a care home, and they will be more than happy to share their experiences with you. This is a great way to find out which nursing homes provide great care, and which other ones do not.

Another great resource for finding care homes is to read reviews online. There are many places on the World Wide Web, where you can go to read reviews on almost anything in existence, including retirement homes. Finding these sites and reading reviews can give you a lot of insight on which care homes have great service, and which ones could be putting your loved ones at risk. By reading the reviews on retirement homes in your local area, you can find a better placement for your family member.

Reviews are a great way to find out the true story about almost anything. By reading reviews, you can make an informed decision instead of a blind one.

Nursing home reviews can be found in many places, and if you need more advice on finding a great home for your loved one, you may want to check out Nursing Home Secrets Revealed. It's a great book that will take you step by step through the process of finding a great home for your loved one.

How to Become a Healthcare Administrator - A Comprehensive Guide to Help You Follow Your Dreams


Do you possess leadership qualities or look forward to an administrative oriented career? Then perhaps becoming a Health Care Administrator might be the right job for you. Here are some of the basic guidelines to help you start a successful career within this field

Length of Training/Requirements

In order to qualify as a Health Care Administrator, you must opt for at least a bachelor's degree from any good health care administration school. Most employers nowadays also ask for a master's degree in health care administration, health information technology, long term administration, health sciences, public health or even business administration.

Another aspect I must warn you about is that this is quite a competitive field. So, in order to enroll in an adequate graduate program, you must maintain your grades. Also make sure that your school is accredited by the Commission on Accreditation HealthCare Management Education (CAHME).

Skills Required

Apart from the educational requirements, some of the basic skills that are required for this job include:

  • Strong leadership qualities

  • Self-control

  • The ability to work under pressure

  • Tactfulness

  • Sympathy

  • Strong communication, negotiation and interpersonal skills

Duties and Responsibilities

As a Health Care Administrator, you will not only be required to coordinate day-to-day activities, but also develop and implement business strategies as well. Some of the most common duties and responsibilities expected from you include:

  • Coordinating and organizing finances as well as assisting in the management of health facilities

  • Managing overall policy directions as well as implementing them

  • Collecting up to date medical records

  • Overseeing compliance with government agencies and regulations

  • Assessing the need for different services, equipment and personnel

  • Making recommendations regarding the expansion or curtailment of services and the establishment of new or auxiliary facilities

  • Working closely with doctors and giving preventative care

  • Hiring, training, and supervising staff

Thus, your primary role is to represent your institution to outside organizations.

Certification and Licensing Requirements

A license is usually not required in this field, except for nursing home or long-term care administration. However, if your state does emphasize on it, then you must meet the educational criteria that has been set by the State Board of Nursing Home Administrators, which is regulated by the Department of Health. Moreover, you must also pass the state and national examinations, and continue education every two years to renew your license.

Career Outlook

This is a rapidly growing field which continues to evolve and expand with time. However, as a Health Care Administrator, you might have to begin your career either in a small hospital or as an assistant in a large medical institution. From there, you must put in all your efforts and gain as much experience as possible in order to advance as a Health Care Administrator. Thus, you will be able to move up the ladder towards a better job and higher paying positions.

Successfully Transfer Seniors to Assisted Living - Top 10 Tips


Realizing that your loved one can no longer live independently is stressful. Actually preparing for a move of this magnitude can be traumatic. These tips are provided to prepare your parents for an impending move, with hopes of making the transition to assisted living a more peaceful experience.

1. Involve your loved one in the discussion. Months before the impending move. Have them provide input about what services/amenities they need in their new home. Take them on tours of assisted living and nursing homes. Talk with them often about the move, using encouragement and positive reinforcement. Someone suffering from dementia might not be able to make important decisions regarding their care, but they would still appreciate being able to decide if their favorite chair will make the move too. Most seniors want to maintain their independence, so DON'T make all the decisions for them.

2. RESEARCH, put in the time to make sure it's the right long-term care option. Finding the right long term care facility is key to making the transition. Make sure you do a full background check on the facility you choose, including independent reviews and citation checks with the state. It's just as important to find a place that's safe as it is to find a place where the staff is loving. Most important, make sure the assisted living or nursing home you choose can provide them with the right level of care. Consider hiring a senior placement company to do the research and coordinate the entire transition to assisted living or a nursing home.

3. Take tours of many different long term care facilities. There is a negative stigma associated with assisted living and nursing homes, some people get the image of sterile hospital care with several patients in one room. Fortunately this care has been replaced with communities that promote independent living, wherever possible. To create a more comfortable image, take tours of many different types of communities and care facilities. These tours will give you insight to the priorities of the management and staff. Also try visiting them at different times during the day.

4. Tour the dining hall, have a meal or two. One of the biggest complaints of assisted living facilities is "the food is terrible". When you tour these facilities, also be sure to dine with them, maybe 2-3 times each, at different times of the day. This will give you a very clear indication of the quality of food being prepared.

5. Choose a location that is close enough to "home". You may have chosen a luxury assisted living facility, but if it's too far away from family, your loved one may still feel alone and isolated. Make sure the location is convenient to allow friends and family to visit easily. Consider throwing a house warming party, so that everyone knows the routine to visit, and is comfortable visiting on their own.

6. Decide what will happen to their home together. "I can't go because this is my home." Address this issue in advance by creating a plan of what will become of the family home. Consult a real estate agent who specializes in senior advisement. Sometimes just knowing the details are covered will alleviate the stress.

7. Help them sort through their things. Another concern is "I can't leave my things". Help alleviate these concerns by helping sort through their lifetime of memories, finding new places for their things, and assuring them they will be cherished by the new person. You can consider hiring a senior move manager who will pour over the memories with them, and help the senior sell the items that might be of value.

8. Create a warm, inviting and familiar environment in their new home. Make the new facility seem as much like home as possible, bringing in pictures, pets, even furniture from the last place. This can make the space feel more inviting. You'll need to check with the assisted living or nursing home on what items are allowed before moving things in.

9. Try to have the Senior keep the same routine. If the Senior has gone to coffee at the same place, with the same people for 10 years, try to make that appointment a priority. Often the concern is I have to "give up" my life to move into a long term care facility.

10. Provide a list of activities and transportation to them. Nearly all long term care facilities offer activities in house. Some even provide transportation to outside activities as well. When transportation is not provided by the long-term care provider, look into independent transportation companies that only service the elderly. Showing the many social opportunities available can give Seniors a greater sense of independence.

Medical Alert Systems


Medical alert systems save lives. A large percentage of adults are now responsible for looking after their aging parents. It is a difficult transition from child to caregiver; there is a delicate balance between support and interference. Many older folks resent that they are no longer capable of the activities they once took for granted and are not willing to ask for help. These personal systems can support seniors with health issues who do not yet require assisted living.

Medical alert systems, also known as Personal Emergency Response Systems, may consist of a built-in two-way voice communicator unit and a personal help button. If the wearer needs assistance they push the button. The system is monitored 24-hours a day and the person monitoring the system will make contact with the alarm wearer. Emergency response operators are trained to assess the situation and dispatch the appropriate emergency services. Personal Emergency Response Systems ease the minds of family members who may live in different, distant cities and who worry about their parents living alone.

Losing a driver's license or being unable to keep up with household maintenance are just two of the signs that older parents need some assistance and supervision. Medical alert systems can assist in granting continued independence to seniors who prefer to remain in their own homes. While activities such as getting groceries or yard work might have to be contracted out, senior emergency systems mean that support is available for falls and emergency medical situations within the home. Many seniors are frightened by the thought of leaving their homes, most have spent lifetimes there but having medical alert systems could mean the difference between remaining at home a while longer or having to move into an assisted living facility.

Seniors are not the only group who are at risk for falls and emergency medical situations in the home. Individuals with limited mobility and other physical challenges, people confined to wheelchairs, can also benefit from these systems. Living alone and falling on the floor can be life-threatening to someone who is physically challenged or critically ill. Medical alert systems can literally mean the difference between life and death. Medical emergencies are not the only situations where these systems make a difference. Home invasions have been stopped in progress because the homeowners activated their medical alert systems in time for police to come in and arrest the offenders.

Medical alert systems are designed to fit smoothly into an active lifestyle. If the subscriber is going away for a month and calls ahead, it is possible that the system can be set up in the vacation destination if it is within the country. If there is a change in residences, the medical alert system can be moved along with the subscriber. Medical alert systems are available for purchase through many companies. Most alarm systems are installed, tested, and monitored for an affordable monthly fee. In some cases, subsidies are available for seniors or consumers that need financial assistance.

There are many options available for medical alert systems, and choosing a system can be fraught with emotional perils for children and parents alike. Seniors have to come to terms with the fact that they need medical alert systems; they are no longer able to rely on themselves. Children must recognize their parents' limitations, and in some cases might also be financially responsible for the systems that ensure their parents' safety. Communication is especially important so that users know how to program and access their personal emergency systems. Buying medical alert systems will save lives.

"Time is a great teacher, but unfortunately it kills all its pupils." - Louis Hector Berlioz

Informal Vs Formal Care and 2 Recommendations to Transition Between the Two


Many questions arise once you or perhaps your loved ones start to get older and require extra care as compared with earlier. One significant one is should we facilitate formal proper care or even informal care? Informal proper care may be thought of as proper care that is not being offered from a paid for caregiver, or charity organization. This form of care is nearly always provided through a spouse or family member at the same time they attempt to accommodate a full-time position, a spouse and children, in addition to several other activities. Formal care is at any time care is granted by means of a paid caregiver or facility such as a nursing home or even assisted living home.

The benefits of informal care is which care is typically provided free or perhaps at a affordable fee, and the care is given by means of a loved one so the individual feels further comfortable. Even so, with the busy agendas people have nowadays, plus additional duties, full time informal proper care is quite often not doable. What will often arise is a part time formal caregiver will have to be hired to pick up the slack. But as the individual begins to need to have additional care, a formal option is required.

As soon as informal care no longer is attainable, a transition to formal care ought to take area. This might be assisted living, a nursing home, or even retirement community.

We have two guidelines for making this transition as smooth as possible:

1. It is no secret that care facilities can be quite highly-priced. Whether proper care is delivered in an assisted living facility, adult family home, or nursing home, financial plans need to be made a head of time to assure the individual will receive the proper care required along with the family will continue to be supported. There have been experiences where because the charge of proper care was so high, the wife or husband of the patient ended up in a position where they important food stamps and also subsidized housing to get by. So our advice is to begin planning early. Get a financial adviser to look at the figures with you. Draw out a 10-20 year program so there are no surprises along the way.

2. Transitioning to a new environment might be a shock for countless patients. It is crucial to provide them with confidence early on which they are getting the most beneficial care possible. For this, it is crucial which various other members of the family are present and also providing support. Ensure that the belongs of the patient are moved to their new room, so the individual feels right at home. A few jokes as well as laughs along the way don't help either.

Fellow these two recommendations, as well as your transition from informal to formal proper care will be a good deal smoother.

Thursday, May 23, 2013

Malnutrition in Nursing Homes


Nursing homes are responsible for the well being of their residents since they assist their elderly patients with all aspects of their lives. As such, nursing homes are responsible for ensuring that their patients receive proper nourishment.

When these establishments try to cut back on costs, they may buy inferior food products or significantly lower portions. Unfortunately, this may come at the expense of your loved one's health. When assisted living facilities buy poor qualities of food or underfeed their patients, your loved one may suffer malnourishment, which can lead to significant problems.

You may be able to tell if your loved one has suffered from malnutrition. In general, he or she may appear weaker or frailer than usual, and he or she may not have the same amount of energy as before. Many elderly individuals will also suffer significant weight loss without any discernable reason.

When an individual is underfed or eats foods that are low in nutrients for long periods of time, he or she may eventually pass away from malnutrition. In the meantime, though, an individual may suffer any number of medical problems.

Individuals who suffer harm in nursing homes from malnutrition or other forms of physical abuse may be entitled to financial compensation for their unnecessary suffering. These individuals will likely need to file personal injury lawsuits to pursue this compensation.

Before filing a lawsuit, individuals are advised to first seek out an experienced personal injury lawyer to help them build and fight their cases. Though hiring a lawyer does not guarantee victory, many individuals may increase their chances of winning their lawsuits when they employ the help of experienced lawyers.

If your loved one suffered malnutrition while living in an assisted living facility, discuss your legal rights and options with the New Jersey nursing home abuse attorneys of Levinson Axelrod, P.A., today.

Getting Along With Your Boss


No matter how you earn a living, one occupational skill you would do well to cultivate is the knack for getting along with the boss; that dispenser of raises and promotions is probably the key person in your working life. In most facilities, it's your boss's opinion of you that determines your future in the company. A staff person in constant conflict with his/her supervisor, even if he or she is a virtuoso performer on the job can find his/her prospects considerably dimmed.

Short of marrying his or her daughter, what can you do to get into the boss's good graces and stay there? Fortunately, most bosses aren't monsters, so they respond to efforts to improve relationships with their staff members.

Here are some suggestions for making yourself more valuable to the man or woman you work for, based upon the observations of managers and job counselors.

Help him or her to do his/her job. You can accomplish this by doing your job as best you can - an important piece of advice. It is probably the most frequently forgotten; keep in mind how your job ties in with your boss's. He or she is responsible for seeing that a certain set of tasks is accomplished, be it writing insurance policies, directives, memorandums, health care policies, assembling machine parts or selling dresses. Your job is to tend to some detail of his or her task. The better you hold up your end, the easier his or her job is, which is bound to make him or her look more kindly on you and your endeavors.

Get to know his/her standards. Your performance is judged by him/her. By noting your boss's reactions to different ways things are done, you learn what is especially important to him or her. For example, a secretary who prides herself on her shorthand and typing speed may be surprised to find herself passed up for a promotion if she ignores her boss's frequent complaints about her spelling errors and likewise a supervisor of nursing or nursing assistant whose supervisors have to remind him/her to turn reports in on time, may not be considered for promotion or for a new job within the facility.

If you were a boss, would you promote someone who has to be hounded again and again about the same old mistakes or shortcomings?

Keep him or her informed. When the boss gives you an assignment, especially a long-term one, he/she will want to be kept informed about how you're coming along. You can keep him/her up-to-date with short memos now and then, and by mentioning your progress during informal conversations with him or her. If it's a complicated report, better put it in writing. It is especially important if you work with relatively little supervision to let your supervisors know, periodically, what you're doing. Tell him/her about any ideas you may get for streamlining the way you do your job, (not the way he/she does his or hers) only if you've carefully thought them through and can explain them clearly.

Don't take too much of his/her time. Spare the boss the details of your weekend camping trip unless he or she expresses a definite interest. There is a time and place for swapping stories, and if your boss wants to pass some time that way, he or she will take the initiative. Be careful also about bending his/her ear every time a minor problem comes up within the facility or office. True, he or she is there to help solve problems, but you can often find the answers without bothering him/her. You want the boss to notice you for the problems you solve, not the ones you toss in his/her lap.

Be reliable. Get to work on time, finish your assignments when you are supposed to, show the boss that when he or she needs something done in hurry, you are the one who will give it that extra effort needed. If he/she knows he/she can depend on you, he/she will, and that's a real feather in your cap.

Be enthusiastic about your work. One of the most difficult problems the boss faces is motivating a worker who sees his or her job as little more than a necessary evil in the pursuit of a paycheck. Bosses know they can't teach enthusiasm, and they can't buy it no matter how high the wage is, but they place much value on it.

If your enthusiasm is genuine, it will show. Do you take pride in your work? Are you willing to come early and stay late when necessary? Are you optimistic about the future of the company you work for? Do you tackle assignments cheerfully, without trying to think up reasons why they just can't be done? If your answers to these questions are completely negative, maybe you are in the wrong job.

Learn to take criticism. Inability to accept constructive criticism or advice from supervisors and co-workers alike is a serious handicap. If you do a slow burn every time the boss points out your mistakes, he/she is bound to feel uncomfortable about it, and is likely to resent your attitude. After all, guiding and correcting your work is part of his/her job. Listen to what he or she tells you, apply his/her suggestions to what you are doing. Temperamental workers, no matter how brilliant, are something most bosses would rather do without.

Don't play office politics. Few things can destroy morale faster than the presence of gossipers and other thoughtless workers who start or pass along uncomplimentary and embarrassing stories about fellow workers. Ignore rumors and tend to your business. Don't take sides in disputes between other workers, or you may end up a part of the gossip yourself. Resist the temptation to grumble about minor inconveniences caused by management decisions; if you have a legitimate complaint take it to your boss privately. He or she will appreciate hearing it from you before he/she hears it via the grapevine.

Don't compete with the boss. Everybody wants to get ahead on the job, of course, but if you aim to do it by demonstrating to everybody else that you know more about the business than your boss does, watch out. In the first place, you probably don't, and in the second place, you'll find that no one, including your boss's boss, appreciates a worker who constantly goes over his/her supervisor's head or tries to show him or her up. If you buck your boss at every turn, downgrade his confidence and generally make his/her life miserable, be prepared to lose when the showdown comes.

Remember bosses are human too. Chances are your boss isn't the world's foremost authority in his or her field, so don't expect him or her to be. He/she will make mistakes occasionally. He/she may be abrupt or grouchy from time to time just as you are, and when he/she really applies the heat, it's often because his/her boss or some other authority is putting the heat or pressure on him or her.

You'll probably never find the perfect boss, just as he or she will never find the perfect employee, but in general, you've probably got the nearest perfect boss you've ever had in your life, and he/she undoubtedly has the most perfect employee as well. Your ability to get along with the person you report to can enhance your prospects at every step on the job ladder.

It you are experiencing fear about deciding to be a leader, laugh your fears away by following this simple plan. Kenneth E. Strong, Jr, and Professor John DiCicco can help you eliminate those fears and give you the confidence to lead. Feel free to use this article, in your publications; in its entirety provided you include the following notice: Copyright 2011, Kenneth E Strong, Jr, Columbus, Ohio. I'll see you in the front row of success. To learn more about Leadership Is A Choice visit http://www.kenneth-e-strong-jr.com/leadership-choice

2010 Long Term Care Costs


Long term care in America has been a growing concern for millions of adults and aging baby boomers these days. Its cost poses tremendous threats to the person's health and finance as well. Seven in ten Americans believe they will need long term care services in the future.

According to study conducted by Prudential Life, the costs of care rose to 2% to 14% (depending on the type of care) over the past two years. However, the price soared rapidly in 2010 with 14% from 2008 and 47% from 2004. It is also said that as home health care becomes more preferred, then the costs start to increase to meet the demands.

Below is an overview of long term care costs by state based on the type of care:

Home Health Care
Here are the average hourly rates for home health care as of 2010

Alaska - $32
Wyoming - $31
Connecticut - $27
Colorado - $27
Oregon - $27
Utah - $26
Rhode Island - $26
Mississippi - $26
Minnesota - $25
California - $25
Texas - $12
Louisiana - $15
Missouri - $15
Alabama - $16
Arizona - $16
Washington - $17
Arkansas - $18
Hawaii - $18
Florida - $18
South Carolina - $18
Missouri - $18

The national average hourly rate for home health aide is $21, or 4168 daily - this rate has remained constant since 2008. However, the hourly rates for private licensed practical nurses have soared to $17% since 2008.

Assisted Living Facility

The national average monthly cost for assisted living is $2,930 per month or $36, 160 annually. Its rate has increased 2% in the past two years, much lower than any other types of care.

Here are the annual monthly costs for assisted living facility as of 2010:
Delaware - $ 63,000
Maine - $58,400
Connecticut - $54,000
Massachusetts - $48,300
Illinois - $46,600
New Hampshire - $45,600
Alaska - $43,360
Hawaii - $42,000
New Jersey - $40,400
Vermont -$40,300
Indiana - $25,600
Florida - $26,400
Nebraska - $27,300
Missouri - $27,600
Arkansas - $27,700
South Dakota - $27,800
Pennsylvania - $28,000
South Carolina - $28,200
Mississippi - $28,300
Alabama - $28,700

The rates increase together with the size of the facility. The average monthly base rate for the smallest assisted living facilities is $2,500, while a larger facility costs about $3,500. The typical length of stay in assisted living facility is 42 months or nearly four years. States in the metropolitan areas are obviously the highest rates for nursing home care.

Nursing Home Care

Nursing home care is seriously the most expensive type of care, averaging to $90,000 in 2010 or 14 percent increase since 2008. The average daily cost for private room in a nursing home is $247 or $90,155 annually, while semi-private room's average to $215 daily is $78, 475 annually.

Here's the annual breakdown of costs for nursing home care as of 2010:
Alaska - $ 232,100
Connecticut - $143,800
New York - $138,300
Massachusetts - $127,400
New Jersey - $123,000
Hawaii - $109,000
Washington, DC - $108,400
Delaware - $108,300
Pennsylvania - $102,600
Washington - $102,500
Louisiana - $55,900
Arkansas - $55,800
Missouri - $57,700
South Dakota - $61,000
Oklahoma - $61,300
Kansas - $62,400
Mississippi - $65,700
Alabama - $66,000
Iowa - $67,900
North Dakota - $68,400

How I Chose the Perfect Assisted Living Facility for My Mom


I did not know how much my mom had deteriorated until my dad went into the hospital. Mom had seemed forgetful for awhile, but when dad was suddenly hospitalized one evening I learned that Mom's problem was more than just a little forgetfulness. I went down to stay with her and for the first week dad was sick, I thought that she was just sad and frazzled because he was not around. However, when he passed away the next week, I learned that she had been relying on my dad to remember everything for years -- even for little things like whether she remembered to put the groceries away and whether she had her glasses on.

My brothers are not the most reliable pair, so it became my responsibility to arrange everything for my dad's funeral, administer his estate and take care of my mom. I thought about moving her into my house, but I could not be home all day to watch her. She would often forget that she could not remember things and I feared that she would turn the bath on and forget, or even something worse like a gas burner on the stove. I have to admit that I am also not a senior care expert who is able to take care of all of her needs. As much as I did not like the idea, it was time to find a retirement home for my mom. Of course, my brothers could not be counted on to help with that either.

I was not sure what type of retirement home to put mom in. The last experience I had with one had been decades before when my husband's great aunt lived in dreadfully stale state nursing home. I knew that was not the type of place that I wanted for my mom. Other than that, however, I did not know what I was looking for.

After a little research online, I discovered that there were a many different types of retirement homes, but that did not tell me what was the best choice for my mom. With everything going on after my dad's death, I just did not have the time to visit a bunch of different facilities and talk to all of the people, so the next time I took Mom to a doctor's appointment, I asked the nurse if she had a few minutes to spare to talk to me about retirement homes.

Fortunately, the nurse knew my mom and exactly what was needed. After a short conversation lasting only a few minutes, I learned that my mom needed an assisted living facility. The nurse told me that with assisted living, a trained senior care staff would take care of my mom's daily tasks and make sure that she did not forget anything important.

With that information, I was able to go back online and find assisted living facilities in my town. The one that intrigued me the most said that it was both an independent living facility and an assisted living facility. After a short phone call to the place, I arranged a visit with the retirement home's director.

The director gave me a tour and told me all about how they handled their assisted living residents. It seemed like a great deal for my mom because he said that the senior care staff only help their residents with things that the residents actually need help with. For everything else they let the residents have the freedom to live on their own. He also told me that the senior care staff continuously monitor the assisted living residents' situations and offer more assistance when the residents deteriorate more.

Of course, I had to ask what the residents do during the day. I did not want my mom to be bored sitting in a room all day like my husband's great aunt was. The director showed me a lot of different rooms with seniors doing all sorts of things. At first, I was nervous because he showed me things that I knew my mom would not like very much, such as billiards and bowling. But, when he showed me the cooking class, I knew that I had found the perfect retirement home for my mom.

I wish that I had never had to put my mom into assisted living at all. When her forgetfulness worsened and became full-blown Alzheimer's, I was glad I did and I was equally glad that I chose the right assisted living facility for her with the right senior care staff. How the staff helped mom through that awful disease is a story for another day though.

Should You Get Nursing Home Insurance at a Young Age?


Thinking that you are too young, can mean you avoid getting the protection provided by nursing home insurance policies. Some may think that it is only for retirement-age people and that less mature adults shouldn't worry about buying this important coverage.

There are several advantages to purchasing long term care insurance at an early age. You may need to be in a long term care facility long before you reach normal retirement age. You may develop a health condition later in life that will keep you from buying a nursing home insurance policy in the future. You be able to lock in a lower monthly premium if you purchase a long term care policy at a younger age.

Planning ahead and buying a long term care policy can mean that not only are you prepared for your golden years, you are better protected today. Skilled care in a custodial facility is needed by both the old and the young who are unable to live in at home due to a sickness or injury that causes disability.

Although it is true that one is more likely to need nursing home insurance (long term care insurance) the older one gets. Not everyone in a nursing home is elderly. Eighty-eight percent of the people in a nursing home are over age 65. This means that twelve percent of nursing home residents are not of retirement age.

Other types of policies will not cover a nursing home stay or won't cover it well. Health insurance and disability insurance plans can provide some coverage, but the coverage can be quite limited.

A medical insurance policy may cover you well in the hospital and the doctor's office. However your policy probably only covers the expenses of the first one hundred days in a skilled care nursing home. Most residents are in custodial care facilities or intermediate care facilities.

A disability income policy may pay you a percentage of your lost wages when you are disabled. Even if this does provide you with enough income to cover the cost of your care, you will have less income left over to cover your mortgage or any other expenses that you may have.

Long term care insurance requires applicants to be medically underwritten. This means that if you have a medical condition you may not qualify or you may be charged a higher insurance premium. This means that if you are healthy today, you may qualify for a low cost long term care insurance policy. However, since you cannot guarantee that you will just as healthy a year from now procrastination can mean that you will be unable to own this important protection.

The prices for nursing home insurance policies tend to be based on the age you purchased your policy. This means that you can pay the price only forty-year-old applicants qualify for when you are in your sixties and seventies. This can mean a huge cost savings when your income is more limited.

If you add an inflation rider to your coverage, you may only not even need to supplement your coverage as you get older. An inflation rider is recommended for any long term care insurance purchase.

Buying long-term care insurance at as as a younger man or woman has significant advantages. You get insurance protection right away. You are more likely to medically qualify for a policy. You will probably be able to lock in much lower insurance premium than you would if you waited, since rates go up as you age.

Assisted Living Statistics Are an Economic Pointer


Assisted living statistics helps understand how things are changing with regards to senior citizen assisted care. The change is something to look into as it does not merely give figures on this niche area but also gives us a peek into the changed environment that senior citizens today live in.

In the 1990s, when this concept began there was just a handful of these emerging service providers in the market. And the rules were yet to be laid. Today, however one of the studies show that capital invested in this sector in 2030 will be around USD490 billion. Compared to a mere USD 86 billion that was invested in 1996.

Increasingly people, entrepreneurs and speculators are looking closely at these assisted living statistics because they see growth beyond just senior care. It is a growth that is also economical.

Today, it is being seen as an industry that needs a lot of attention.

The Benefits

The upside of this changed perception is two-fold. One with people treating it as a full fledged industry there will be an inevitable rise in the standard of service provided. Better services, more organized efforts and consensus will do wonder for this sector. At least that is what the assisted living statistics tell us now.

The other factor is an economic one. A current estimate of target people is about 1.78 million which is projected to double to 3.7 million by 2030. This is significant because with increased demand will be greater spread of these assisted living facilities. In 2002 alone, American Housing Association gave us a figure of 7150 assisted facilities that were home to 500,000 seniors in the United States. That works out at an average of 74 residents per facility. Being labor intensive, just imagine the huge employment potential.

These assisted living statistics also help us understand how much we can expect out of this niche segment in terms of employment. In times of economic uncertainty, those working in the assisted living segment have observed that there were only minor changes to their income and prospects.

In 2003, State Senior's Housing report also put forth a median figure of USD 2050 per month as service fee paid by seniors. This clearly states that there is spending power and so it as an industry is actually waiting to be tapped. What we now need is a better understanding of how to stream line our efforts to optimize economic benefits. It is only right to note that in such a line of work EQ will be as critical as IQ and professional skills. Else the whole concept will collapse if people do not love what they do and use it merely as a stop gap solution.

Imagine an elderly person being pushed around on a daily basis. It would be the end of the industry even before we started making sense of these assisted living statistics.

Wednesday, May 22, 2013

How Maritime Lawyers Evaluate Cruise Ship Crew Member Injury Cases Under the Jones Act


When a cruise ship crew member is injured while working aboard a vessel, they may and often do qualify for Jones Act compensation for their maritime injuries.? For a cruise boat crew member to qualify for compensation under the Jones Act, either the injured party must be American, or the vessel must be an American-flagged vessel. When our cruise injury lawyers first speak with an injured cruise employee, we will need to know the following information:? ? ? ? ? ? ? ? ?



  • The name of the cruise ship on board which the crew member was injured



  • The date of injury and the details of how you were injured



  • The name of the employer



  • How many contracts the crew member has worked for this employer



  • The position/title of the injured party while working aboard the vessel



  • The home country of the employee



  • If the injured employee is currently receiving medical care and if so, where



  • Whether or not the injured party is receiving maintenance and cure



  • In your own words, please tell our cruise ship injury lawyers what was the negligence of the cruise boat that caused your accident

An injured crew member?is entitled under maritime law to receive both maintenance and cure.? Maintenance is a daily amount paid to an injured seaman for cost of living including food and lodging.? Cure is payment of?reasonable medical expenses result in from the injury.? An injured cruise ship worker is also entitled to receive unearned wages to the end of their contracted sea voyage or contract for employment.?

General maritime law also provides the tort remedy of unseaworthiness, strict liability for the ship owner with regard to its non-delegable duty to insure its cruise ship is reasonably safe and fit for its intended purpose.? To recover under this theory of liability, an injured crew member must prove the cruise line failed to provide a "seaworthy" cruise ship.?

Each year, cruise ship employees are injured or killed due to cruise ship negligence. Inadequate vessel maintenance and failure to inspect equipment on board the vessel that the crew might use frequently contribute to serious injury and death. The Jones Act , a federal statute encompassing a considerable portion of maritime law, is the applicable law for the maritime law personal injury claims of ship crew members injured while working on the ship. ?Jones Act claims are a very complicated and?specialized field of law.? When you speak with injury lawyers, please be sure to ask them how many maritime cases they have handled in their career. ??Experienced maritime lawyers will have handled hundreds, if not thousands of cruise ship crew member injury cases.?

Home Based Business - Healthcare Products Are Always in Demand


A home based business that caters to healthcare needs can achieve strong growth. The growth of personalized healthcare and round the clock medical services has not been impacted by recession.

Healthcare offers high business potential as it can render wellness products and services to millions of people. It can provide financial security through a successful business model.

Demand for Medical Services:

The current healthcare system is under tremendous stress to meet the increasing demands for primary geriatric care. A high percentage of the baby boomer generation is expected to head to retirement this decade. The increasing preference for primary care at home among the elderly has further pushed up demand for medical services. It is said that more than 10 million people in developed nations are to become seniors by the year 2020.

The medical expertise provided can vary from non medical for assisted living services. Non medical services provide assistance for comfortable stay at home for the seniors. An assisted living facility provides passage for shift in stay for those unable to live at homes. The profit margins with the above business opportunity are growing tremendously.

Healthcare Products and Profits:

Healthcare products of home based business can extend beyond vitamin supplements. Antiaging products, calorie drinks and cosmetics find strong appeal with the health conscious population. Natural health beverages with ayurvedic products that work against stress and general ailments are popular. Certain healthcare companies offer opportunities for executives and franchises to sell their product.

Low cost home based business can be initiated by taking advantage of the opportunities offered by many such companies. Product information can be gained for a nominal amount through coaching centres and teleconferences.

Business and Marketing Potentials:

Neighbourhood networking can help identify the potential distributors for healthcare products and you can strategically join hands with them and earn regular commissions. Sales training and lead generation skills can be learnt though business training programs offered by product companies.

An independent distributor program can be undertaken for wellness products which are developed by professionals. Enrolment as a dealer for new calorie drinks and herbal products can negate the difficulty of working in a saturated environment.

Dealers can promote and place orders for their products from home though a provided back office URL. Consumers can place orders through the dealer's website to earn reward points and bonuses with discounts. Marketing needs of a healthcare business can be attended through distribution of wellness information, press release and educational data.

Comparison in the Role of a Licensed Vocational Nurse (LVN) And Psychiatric Technician (PT)


Licensed Vocational Nurse

The title "nurse" can refer to individuals with varying degrees of education and licensure. Job titles to which individuals may refer to themselves as "nurses" include the following: Certified Nursing Assistant (CNA), Licensed Vocational Nurse (LVN) / Licensed Practical Nurse (LPN), Registered Nurse (RN) of Nurse Practitioner (NP). LVN's and LPN's have the same training, licensure and scope of practice. The title Licensed Vocational Nurse is used only in California and Texas, while the title Licensed Practical Nurse is used throughout the rest of the United States. The job title used in Australia and New Zealand is Enrolled Nurse, while in the United Kingdom the job title is State Enrolled Nurse. In the United States, it is compulsory for a prospective LVN/LPN to have completed high school. Internationally, the scope of practice and title of the LVN/LPN may vary, depending upon country-specific criteria.

LVN's/LPN's work in hospitals, clinics (pediatric, geriatric, women's health, psychiatric) as well as skilled nursing facilities, assisted living facilities, correctional facilities and dental offices. LVN's/LPN's may perform specific nursing skills and procedures under the supervision of an RN, NP, Physician Assistant (PA), Physician (MD), or Dentist (DDS). They also may work collaboratively with RN's, and are licensed to delegate to CNA's or other non-licensed assistants. The LVN/LPN scope of practice includes performance and documentation of the following duties: basic patient care; vital signs; data collection on all body systems; carrying out wound care orders; preparing patients for diagnostic testing, including collection of urine, sputum, and fecal specimens; insertion and care of urinary catheters; insertion and care of naso-gastric tubes; and administration of medications, except intravenous medication (IV). In order to draw blood, or to initiate or administer IV medications, LVN's/LPN's must pass an additional post-licensure IV certification course. Even with successful passage of an IV certification course, LVN's/LPN's may not administer IV push medications. IV push medications are under the scope of practice of the RN.

Psychiatric Technician

Psychiatric Technicians (PT's) are trained and licensed to work in psychiatric facilities under the supervision of RN's or physicians. In preparation for licensure, there is some didactic coursework in common for PT's and LVN's/LPN's. These courses include Anatomy and Physiology, Nursing Fundamentals, Nutrition and Pharmacology. However, because their client base specifically includes individuals with developmental disabilities or those with psychiatric diagnoses such as (but not limited to) schizophrenia, bi-polar disorder, or depression, PT's require additional study in the area of psychotropic medications. Also, their clinical training is focused solely in psychiatric facilities.

Probate of Will


What is Probate?

Probate is the process where after death the instructions of the Will are carried out. Will is admitted to "Probate" in the County Surrogate. Some people refer to the Surrogate as the Will Clerk. Upon the death of the testator or testatrix (maker of the Will), the probate procedure can begin. This is the legal process which establishes the genuineness of the Will. It is done by the Surrogate in the county where the testator or testatrix resided at the time of death.

The probate application must contain the following information:

1. the applicant's residence;
2. the name, domicile and date of death of the decedent;
3. the names and addresses of the decedent's spouse, heirs (those entitled to take under the laws of interstate succession), and any person named to serve as Executor;
4. the ages of any minor heirs; and
5. the names of the testator's children when the Will was made and the names of children born and adopted after the Will was made, or their children, if any.

To minimize time spent in the Surrogate, it is recommended, and in some counties required, that before an Executor submits the Will for probate the executor's attorney or executor send the Court:

1) a "data sheet" (referred to in some counties as an "information sheet" or a "fact sheet") containing the information needed by the Surrogate to complete the application;
2) a copy of the Will; and
3) a copy of the death certificate.

FILING A PROBATE APPLICATION

Upon the death of a person, a probate proceeding may be commenced by offering the decedent's (the dead person's ) last Will for probate in the Surrogate's Court of the county in which the decedent was domiciled at death. R. 4:80-1(a). Generally, the Executor nominated in the Will brings the proceeding by filing a verified application with the Court.

When the applicant files the original Will for probate, the applicant must also file a death certificate (and original with a raised seal). A filing fee of approximately $150 must be paid. Once the Will, application and death certificate are filed, the Surrogate will review the papers, and if there are no irregularities or objections, admit the Will to probate. Although New Jersey law prohibits admission of a Will to probate within 10 days of the testator's death, an applicant may submit the application prior to expiration of the 10-day period. If the Will is filed after the 10-day waiting period, many Courts will issue a judgment for probate contemporaneously with the filing of the probate papers.

Qualifying the Executor

Once the Will is admitted to probate, the Court will issue letters testamentary to an Executor who has properly qualified to serve. An Executor named in a Will qualifies to serve by filing a form affidavit in which the Executor agrees to perform his or her duties. The nominated Executor must also provide a power of attorney to the Surrogate empowering the Surrogate to accept service of process of claims against the estate. Once the Executor qualifies, the Court then issues letters testamentary.

How is an administrator appointed when there is no Will?

When there is no Will, an administrator, administratrix or personal representative is appointed by the Surrogate's Court. The surviving spouse has the first right to apply for the position of administrator; however, any heir of the decedent may be appointed. When one of several heirs seeks to be appointed administrator, all other heirs must renounce their right to be appointed administrator. In most cases, a surety bond must be furnished to cover the value of the real and personal property in the estate.

Mailing Probate Notices

After a Will is admitted to probate, the Executor's Attorney or Executor must mail within 60 days a notice of probate to the decedent's spouse, heirs and all beneficiaries under the Will. The notice of probate should contain the executor's name and address, place and date that the Will was probated, and an offer to furnish a copy of the Will upon request. Within 10 days of mailing the notice the Executor's Attorney or Executor should file proof of service of the notice with the Surrogate's Court. Once notice of probate has been sent and proof of mailing has been filed the probate process is essentially completed.

Completing the probate process should cause only minimal delay, perhaps a few weeks, in administering a decedent's affairs. The cost of admitting a Will to probate should be limited. Unlike in some other states, the Surrogate's filing fee in New Jersey is the same regardless of the size of the estate. See Zimiles "Probate is not a Dirty word in New Jersey" N.J. Lawyer pg. 14 (July/August 1992)

How do I begin the probate procedure?

The Executor or personal representative can be appointed and the Will admitted to probate in most cases by going to the Surrogate's Court with the original Will, certified death certificate, and, if the Will is not self-proven, at least one of the witnesses who signed the Will must prove the signature on the Will.

What kind of information should I collect?

The decedent's personal representative should make a list of all of the next of kin of the person who died, along with their degree of relationship, addresses and ages.

What if the Will is not properly executed?

The Surrogate will advise the personal representative as to the proper procedure in order to allow the Will to be admitted to probate. This procedure normally involves a formal hearing before a Judge of the Superior Court.

Are unpaid inheritance taxes a lien on property?

Yes, to sell real estate, you Will need to obtain "tax waivers" from the State Transfer Inheritance 'Tax Bureau, and the waivers must be filed with the County Clerk in the county where the land is located. Land held by husband and wife as "tenants by the entirety" need not be reported and may be transferred without a waiver. Other property may be subject to a lien for unpaid inheritance taxes such as bank accounts and certificates of deposit.

How about federal estate taxes?

In 2009 there is no federal tax due unless the estate exceeds $3,500,000. However, there is a New Jersey Estate tax for estates over $675,000.

There is also an unlimited federal marital deduction, which means unlimited amounts of property can be transferred between spouses without estate of gift taxes.

How many Surrogate's Certificates ("Shorts") Will I need?

When is the Will admitted to probate?

After all the proper forms are filed with the probate clerk, the clerk will prepare a judgment which admits the Will to probate. The Surrogate then signs the judgment and issues "Letters Testamentary."

What are Surrogate's Certificates used for?

Surrogate's Certificates act as evidence of the authority of the personal representative (Executor, Administrator, Trustee ) to act. These certificates are necessary to accomplish certain tasks such as transferring stocks, closing bank accounts, etc.

Is it necessary to send copies of the Will to the beneficiaries?

From the time the Will is probated, the Executer has 60 days to mail all beneficiaries a notice that they can be provided with a copy of the Will, along with a notice giving the specific date and place the Will was entered into probate. See Zimiles "Probate is not a Dirty word in New Jersey" N.J. Lawyer

Basically, what is the Executor/Administrator required to do?

The Executor or Administrator is, in general, required to collect and safeguard all of the assets of the estate and eventually to pay the debts of the decedent, as well as any taxes due, and be able to provide an accounting of his actions to the beneficiaries or heirs. An Executor or Administrator must obtain the necessary legal documents, called either LETTERS TESTAMENTARY (for an Executor) or LETTERS OF ADMINISTRATION (for an Administrator), are obtained through the Surrogate in the county in which the DECEDENT (the deceased person) resided at the time of death.

The duties of the personal representative include:

* - finding the Will and having it PROBATED. Probate is the legal procedure used to establish the validity of a Will.* - locating and protecting the assets of the estate.* - finding and notifying the heirs.* - paying the debts, expenses, and taxes of the estate from the assets of the estate.* - complying with the requirements of state and federal law.* - distributing property to the heirs after all proper procedures have been followed.

Is an attorney necessary in estate administration?

As a practical matter, it is very difficulty for a nonlawyer to correctly follow the required procedures in administering an estate without the assistance of an attorney. The personal representative selects the attorney for the estate. You may wish to call your attorney to give you further advice as to specific duties and obligations.

Where does the Executor/Administrator obtain the funds to pay debts?

The Executor may, in most cases, withdraw up to one-half of the funds in the decedent's bank accounts. Generally, the Executor should open an estate checking account which can be used to receive and disburse funds.

Edited by Craig Renitsky, Dickinson College

Sudan and One Tourist - Me.


In 1985 the Sudan was in considerable trouble. Sudan had been in trouble before but this time the country was almost on its knees. I had been invited to visit relatives of a dear friend of mine, a Sudanese girl I shared an apartment with, and I was hoping to be met by her cousin Zuba.

I arrived in Khartoum at the exact moment the Sudanese decided to sack their incumbent President, Gaafar Muhammad Nimeri. From the first moment of my arrival I could sense the tension; it was an almost tangible thing, raw and exciting. I arrived late at night, tiptoeing over the sleeping bundles of rags propped against scant furniture in the weirdly utility building rumored to be the arrivals hall. At least I was assured it was the arrivals hall.

There were piles of unclaimed baggage strewn in every direction, with locks hanging loosely; obviously having been tampered with by a series of looters. In my innocence and inexperience of life in Khartoum, I had worn a rather smart white dress and jacket for my journey, rather like selecting a wedding gown to explore a coal pit really, although I was unaware of my idiocy at the time.

I was sitting in what can only described as ultimate chaos. The aircraft I had just alighted from had disgorged over two hundred shell shocked passengers into a room only slightly larger and considerably dustier than a scout hut. Floating sand was everywhere, in the air, on the seats, settled into drifts along the counters and over the Perspex barriers which separated the passengers from barely visible immigration officials. Children were crying, some strange Arabian anthem was crackling across a loudspeaker, and outside the building cars and taxis were honking their horns.

As I sat, fine yellowish brown sand floated down onto the shoulders and lapels of my crisp, white dress and coat and onto the black leather of my dressing case and handbag which I carried, terrified to lose sight of my personal belongings in this bedlam.

A cluster of ragged bodies seemed to be pawing at a pile of baggage just in front of me. On closer inspection I managed to read the back of the tee shirt nearest me. ‘Baggage Handling’ it said. The wearer had on only a pair of worn out Speedo shorts, and flip flops. He was puffing away on an evil smelling clove cigarette and he and his friends had already opened a suitcase further along the line.

They had also opened a bird cage for some reason, and the occupant, an African parrot, had flown out in search of refuge. The parrot was now perched on one of the slowly turning blades of the most enormous ceiling fan I had ever seen, and was hurling selections from his considerable repertoire of phrases at everyone who went near him. Each sentence was couched in the most obscene terms and he had collected a group of admirers who were throwing him peanuts to coax him from his perch. I gathered from one of his young admirers that his name was Maxwell.

The collection of rags was now searching through one of my suitcases so I decided the time had come to assert ownership. Just as I arose from my seat, Zuba arrived. I should explain at this point that Zuba, as we affectionately called her, was 36 years old and, as yet, unmarried. In the Sudan, to be this great age and not yet betrothed or married was an unforgivable sin. She was not unattractive in a strange, Zuba sort of way. By that I mean she was of medium height, huge brown eyes with heavy fringes of lashes, smooth skin of a coffee complexion, and dainty hands and feet. Her voice, however, would cut through steel. Most of her remarks were quickly followed by raucous laughter, usually mistaken for male origin.

Zuba was ungainly in the extreme; she walked as a farmer might, when striding through a pig pen, with feet well apart, taking large strides and swinging her arms as she went. Zuba adored Bob Marley, Peter Sellers and going to parties. She had joined the army upon leaving school and had risen through the ranks, training as a medical officer and then as a Psychologist, until by 1985 she had reached the rank of Colonel.

Wherever Zuba went, so her entourage followed. There were two uniformed private soldiers she informed me were her bodyguards, both of whom were of considerably slighter build than she and terrified of her. A further four soldiers just seemed to trail behind the first two and try to look interested in everything Zuba said, or did. The seventh member of her little band was her driver, whom she pummeled with her handbag whenever he misbehaved.

She came toward me through the arrivals hall at Khartoum airport, dressed in her khaki uniform, pips and eagles adorning each shoulder, a gold lanyard swinging from her tunic, looking extremely official and parting the crowds of people by waving her service revolver at everybody who dared to get in her way. She threw her arms around me and lifted me off my feet, kissing me on both cheeks several times over. By the time she had finished planting kisses all over my face her emotions had overcome her and she began to actually cry. Her driver handed her a handkerchief and she blew her nose noisily before shouting to one of her troop to grab my suitcases.

Zuba led us through immigration in a flurry of handshakes and toothy smiles, introducing me to everyone and explaining that I was a VIP from diplomatic circles. I actually was a lowly administrator from Leeds so nothing could be further from the truth and it was very obvious none of them believed her, but they seemed not to care and we were soon outside the terminal doors.

Our transport was an open army jeep complete with flags and hooters. We raced through the hot, dusty trails, you could certainly not call them roads, and after what seemed like hours, we arrived at Zuba’s family home on the outskirts of Omdurman. Tired, caked with dust and filth, I entered the ruined splendor of Zuba’s home.

It was easy to see how in the old days her family had considerable wealth and influence. Now, the marble floors beneath my feet were gritty from sand, brown at the edges where the floors met the walls, bare light bulbs hanging from light fittings, threadbare rugs scattered everywhere. Zuba brought two young girls forward and introduced them as servants. ‘It’s okay Jan, you don’t have to kiss them, they are very black!’ she said! Shocked, I started to scold her about talking of the girls in that manner but she laughed loudly and began dragging me upstairs to unpack.

Zuba’s bedroom had not been decorated since she was nine years old and still had pink painted furniture and posters of pop stars of the sixties adorning the walls. A very young Donny Osmond grinned down at me from above a bed I assumed to be Zubas; cotton throws in bright colors were draped over the chairs to hide the childish Disney transfers of Snow White pasted to the backs. Zuba explained that her bedroom had been left in this state by her mother as a punishment for not getting married at a respectable age. I murmured something sympathetic and she continued to show me around her private quarters.

There was a heavy metal door at one end of the room which turned out to be the door to the flat roof. I stepped through the door, looking forward to seeing a roof garden with perhaps a dining area. Instead I was greeted by a collection of discarded cardboard boxes, some of which still had the smelly remains of fruit adhering to the sides. Beyond the boxes was another door, this time to a bathroom, containing a tap high up on the wall which was the only means of showering, and a toilet, the smell from which was beginning to make me gag. Everything up here was coated in brown dust. The rest of the roof was just an open space with a low wall.

A drunken washing line was strung between the bathroom wall and a hook on the parapet, and obviously it would be impossible to peg washing from it except at its highest point. At the far end of the roof was a plastic chair and table with a suspicious looking object trailing a wire through the wall.‘Here, Jan you can ring your family and tell them you are in Zuba’s wonderful house,’ she said, pointing to the object which I now recognized as a telephone without is plastic cover.

Zuba discreetly retired to the ground floor, leaving me to phone home. It was then I realized there was no dial on the object either, therefore there were no numbers to choose from. I sat on the plastic chair and laughed.

I stayed with Zuba and her family for six wonderful months. I was 31 and had been working as a secretary in the service branch of an engineering company for the past two years. I had been suffering from boredom for so long I was now beginning to accustom myself to the perpetual ennui of my set routine and I was terrified of waking up one morning on the wrong side of fifty and wondering where my life had gone. Sudan was exactly the kind of adventure I needed and I launched myself into the business of living on a knife edge with passionate abandon. I found a job as a temporary secretary with a local oil company and agreed to attend every single function I was invited to for the next three months.

Khartoum was overrun by American pilots who were there to train the local air force. They invited me to their parties and barbecues and treated me like royalty. I joined the Sudan Club, the last relic of British occupation and still inhabited by one or two live-in residents left over from the fifties when the Sudan still had roads and pavements.

At first I was content to stay with Zuba and learn about the way Sudanese families lived. After a few weeks though, I began to understand that I must be a drain on the family resources, in a city where food shortages were becoming more and more worrying each day.

Bread was queued for, sometimes for hours. The two servant girls were sent to wait for hours in the sun outside the bread shop, the grocery shop, and the worst of all, the gas depot, where gas bottles were rationed to those residents who had enough money to bribe the depot officials, thus enabling them to cook and to light their houses. The gas depot was a long walk away, no shelter from the sun when you got there, and no guarantee of coming home with gas.

One of Zuba’s cousins, Ozzy, was a regular visitor to the house. He would arrive late morning and greet Zuba politely, then retire to the front patio with her brothers, to smoke and drink ‘Sid’ – a disgusting concoction of ninety proof alcohol which passed for cocktails in these difficult times. The entire family was devout Moslem I must point out and therefore strictly forbidden to consume alcohol. As in all things, the consumption of alcohol was overlooked and deemed a necessary evil to help overcome the daily tiresomeness of living in reduced circumstances.

One evening about a week after my arrival, Ozzy invited me to visit his mother. I was delighted to be invited as Ozzy’s mother was reputed to be a great beauty of her generation and a highly sophisticated woman. We set out just before dinner and I was fascinated at how Ozzy could find his way around the sandy wasteland of Khartoum. There were no street signs, no signposts, and no stop signs. The sands of time had covered a once beautiful city. Ozzy informed me that long ago, when the British were in residence, the city had fire hydrants, post boxes, beautifully paved sidewalks, shops and taxi ranks and post offices. Now there were just tired, dusty houses facing other tired, dusty houses with a desert wasteland between. You had to use a compass to get around.

We stopped suddenly outside a house with a locked metal gate. There was a Mercedes parked outside the house and Ozzy got out of the car, opened the trunk and took out a plastic canister and a hose pipe. To my horror and disbelief, he began the process of siphoning petrol out of the parked Mercedes into our car! I objected strenuously to this blatant theft but Ozzy just smiled, ignored me and continued to his destination.

My visit to Ozzy’s mother, Una, was the first of a series of visits, each one more enjoyable than the last, and we became close friends. She helped me to find an apartment in Khartoum and I managed to furnish it with donated furniture from a collection of concerned friends.

I felt more comfortable now that I was not draining Zuba’s family’s limited supplies and in fact I was now able to supply them with a few luxuries such as shampoo and toothpaste which I bought at the American commissary, a perk of working for an American oil company. Some days were good and some were unspeakably bad.

One morning I woke to find my apartment flooded. There had been no water for three days and I stupidly left the taps turned to the on position. The water supply had been restored in the middle of the night and overflowed everywhere. On arriving in the street I found my driver, Khamis, busy under the bonnet of the company car allocated to me. After recruiting the assistance of a series of passersby it was concluded there was no petrol in the car.

It was stifling hot in the back seat and I demanded to know why I could not open the windows. Khamis informed me solemnly that he had super glued the windows shut to deter thieves. The front windows were not glued, I pointed out. No, he said, that was because he found it too hot with them shut.

Arriving at my office it would be quite normal to find the telephones did not work, the electricity had been cut off, the water was off, or the caretakers had not shown up to open the building, resulting in a mass adjournment to the cafes for endless cups of coffee until lunchtime. The Sudan Club supplied food most days. It would not do to be too fussy, you had to eat whatever was on the menu for the day. My lunch on some days consisted of a curious collection of pickles and a slice of bread, at other times there would be a veritable feast due to the arrival of a consignment of food which was then distributed by the resourceful characters in charge of imported goods through the ports.

Zuba was a regular visitor to my apartment and she made herself at home, arranging herself on the sofa with her feet on the coffee table and viewing my collection of library videos which I borrowed weekly from the American commissary shop. She would tuck into a large bowl of cereal, her latest fad, glue herself to the television and refuse to talk until she had come to the end of her movie.

I was amazed one morning to spy Zuba alighting from her staff car outside my apartment, in full dress uniform complete with white gloves and sunglasses, looking like a female version of Idi Amin, accompanied by her feckless driver who failed to catch her when she stepped off the sill of her jeep and she stumbled into a hole in the road, slapping him over the head with her handbag and screaming abuse at him top volume. She had been to the hairdresser, and her shoulder length hair had been braided into hundreds of tiny plaits, and secured at the end with multi colored beads; very attractive for party wear, but hardly suitable to accessorize an army uniform. Over the top of her uniform cap she had jammed a set of headphones, and she proceeded to dance up the stairs of the building to the tune of Bob Marley.

Zuba casually asked me what I did at work, and when I told her I typed, processed papers, made coffee, etc, she froze in shock. What did I mean by ‘make coffee?’ I explained that in the modern world secretaries make coffee for their bosses, it was no big deal. The next day she showed up at my office complete with entourage and service revolver, which she waved at my boss and warned him darkly that he was not to ask her friend to make his coffee again if he wanted to survive his term of service in the Sudan. I assured him after she had gone that he did not have to worry, I was quite happy to make his coffee. Nonetheless he never asked me to again.

During my time in Khartoum I explored the seam where the blue and the white Niles meet, helped in a crocodile hunt, survived the onslaught of numerous haboobs (sand storms) and flew into the wilderness near El Obaid, courtesy of the World Bank to meet the field Geologists studying desert life in isolated camps with their families; two years in the desert without any contact with the outside world made them very pleased to see us.

I experienced the discomfort of tear gas during the coup and had to bath in bottled soda water when water supplies completely dried up, and I watched with delight when Nimeri was finally ousted from power, joining the dancing and celebrations in the streets which went on for days. I visited the camps where my friend Marguerita was in charge of vaccines, nursing the children with so many famine connected diseases, and eventually nursed Marguerita while she died of cholera in my little apartment. She was so brave and strong, it seemed unthinkable she should end her days in such horrible circumstances.

My stay in Sudan came to an end when I had the opportunity to visit Dubai over a year later. I found modern desert life fascinating and a new platform for adventure. The Sudan and Dubai were at opposite ends of the spectrum of civilization. Whereas Sudan was poor, underprivileged and shabby, Dubai was sleek, rich and super efficient. I needed the change and went into my new life in the modern Emirates with the same rush of enthusiasm I had felt when I first stepped off the plane in Khartoum. I will always remember them; the Sudan, Khartoum, Marguerita, and Zuba.