Quality Assured Activity Programming

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

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

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

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

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

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

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

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

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

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

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

The Advantages of Home Care For the Elderly

Many seniors have trouble getting around their homes safely, leaving families with some tough decisions. Whether or not an elderly family member should move into an assisted living facility is often one of the key questions. However, home care is a viable option with many great benefits.

1. Homecare allows seniors to retain a sense of independence and freedom as they age. They can leave their home to go wherever they please whenever suits them best. Similarly, they can eat when they are hungry as opposed to when meals are served to them. Maintaining this sense of dignity is important, as it is something many seniors fear losing.

2. When the elderly live at home they are able to keep their physical possessions close at hand. The things they love do not have to be placed in storage as a result of moving into a smaller space. Many of these objects are tied to priceless memories, so it is understandable that a senior wouldn't want to part with them. Additionally, most retirement homes do not allow pets. At home, seniors can keep any pets they've grown attached to, which has been scientifically proven to reduce stress.

3. Those who live at home often have an easier time staying connected with friends and family. There aren't any visiting hours at home and the number of visitors allowed at any one time is not limited.

4. Living at home should help seniors stay healthier, as they won't be subjected to the all the germs that inevitably linger at a place where many people live. Those who are sick can simply be asked not visit until they are feeling better.

5. Home care allows the elderly to avoid the emotional stress of moving to a new place with new people and a new routine. Maintaining continuity leads to psychological wellbeing.

6. Assisted living facilities are costly and the location may be inconvenient, making it difficult for family members to visit. Many seniors have already paid off their mortgage, so moving to a retirement home is an added expense. With few exceptions, home care is a more fiscally responsible choice.

7. Finally, most seniors who live at home are far happier than they would be if they moved into an assisted living facility. The comforts of home are truly invaluable.

There are now many products and services that make living at home both feasible and affordable. Enhanced security systems, emergency panic buttons, and home delivered meals are just a few of the options to choose from. If your elderly family member wants to live at home, honoring that wish is now easier than ever before.

Senior Assisted Living Means Help When You Need It

At one time in our history, people that were getting on in years were just sent out to pasture to be all by themselves. That was extraordinarily inhumane.

And then it became the norm for families to care for the members of the older generation no matter what the consequences.

But nowadays, the world of senior assisted living has made this part of family life a little different than it used to be.

For some, the idea of moving into a retirement home is almost horrific. The tales we all hear, about elder abuse and the news stories that seem to flash on the TV screen from time to time make it seem like seniors are taken advantage of by almost everyone.

Nothing could be farther from the truth and the simple fact is that most retirement facilities whether they are communities like small villages or apartments for senior housing or even room settings like in a hospital, are staffed by great and caring human beings.

And the assisted lying places are at the top of the list for being full of personnel who take the time that every resident needs to manage his or her daily activities. The generation of today's seniors is the folks who went to Beatles concerts and war protests. The same people who organized sit ins and fought against the military industrial complex.

Those are today's older people, and the idea that any of them would settle for any second rate treatment in an assisted living facility is just ludicrous.

The term assisted means simply that. That if you live there, you can get help with the things you need help with. And your privacy is respected so that you can take care of things you can do on your own without interference.

Many times this kind of facility offers help with the giving of medications when needed, or providing meals or help in maintaining the living areas. Simple things like running the vacuum cleaner or help with dusting, things like that. But the hallmark of assisted living arrangement is independence.

The seniors deserve independence because they sure have earned it. And if someone only needs help with taking their medications a couple of times a day, then that's what they get. An offer to help with anything else, of course, but no bullying by the staff to make the senior more reliant on outside help.

If you are considering a senior assisted living type of arrangement for yourself or for someone you love, take few minutes and check out the offerings on the internet. You will be quite amazed at the high quality of what you find there.

Nursing Home CNA Training

Nursing home CNA training is training to become a nursing assistant that is offered at a nursing home facility. Continuing care communities often offer training for nursing assistants. The training is sometimes provided for people who have been hired to work for the facility but still need to take training to become certified.

There are times when a continuing care community will provide training for someone already working at the nursing home who wants to become a nursing assistant. This is an opportunity for an individual to change their career if they are interested in working as a nursing assistant.

If a healthcare provider offers you CNA training at no cost to you, they are like to require you to work for their facility for an agreed upon amount of time. It is not uncommon for them to ask you to work for them for at least one year.

You will receive excellent CNA training if you train in a continuing care community. The course will teach you the duties and responsibilities of a nursing assistant. You will learn about patient privacy rights and how to spot and report elder abuse. Your course will teach you some medical information. You will learn how to respond to an emergency situation.

There will be lecture and classroom portions of your CNA Training through a nursing home. You might also have some lab classes. Before you work with real patients, you might do some role playing with other students in order to practice procedures. You will probably also observe nurse and nursing assistants in action. Finally, you will get to work directly with some patients.

Most Nursing home CNA Training courses will last about somewhere between three and six weeks. You might find both full-time and part-time course opportunities in a nursing home setting. Of course, your training will last for a longer period of time if you are only studying a few hours each day.

You will be well prepared for the nursing certification exam upon completion of a nursing assistant training program at a nursing home. Once you have completed all your coursework, you will be able to take the examination. Your instructor will provide you with the details about when you will take your exam and how to prepare. You will also learn what you need to bring with you in order to take the test.

If you are not sure which nursing institutions in your area are offering nursing assistant training, you can contact a few directly. You can also contact the nursing aide registry in your area for information about nursing homes that offer CNA training. If an employer hires you to work as a nursing assistant and has state that they will provide you with all necessary training to become certified, they will provide you with the information you need.

You will be well on your way to a new career working as a nursing aide after completing nursing home CNA training.

How to Challenge Harm and Abuse in a Care Home

Nursing Home Abuse. Just the mention of the term makes people stomach turn. However it is more prevalent than most people think. This is not to say there are not quality nursing homes throughout the United States. But there are facilities that cover up and disregard abuse daily. So how do you as a family member challenge harm and abuse to your loved one behind the scenes at a nursing home? We have six tips that you can use.

1.Visit Daily
2.Take Pictures
3.Visit with the Ombudsman
4.Know Your Rights
5.Listen to your Loved One
6.Talk with Other Families

One of the best ways that you can challenge harm and abuse in the nursing home is to be consistent in coming to see your loved one. Nursing home staff know the families that are involved and tend to take better care of the residents that have family support. Not only must you go daily, but go at various time. This keeps the staff on their toes because they don't know when you will arrive.

Taking pictures upon admission of your loved one is another suggestion. This creates a "baseline" condition of your family member. You can use these pictures to compare to any injuries that you may encounter during your daily visits. If you do find any injuries, take pictures of this as well. A cell phone with photo taking ability makes this very easy to do.

The ombudsman is a person or agency that has been contracted by the state to visit nursing homes frequently and report about any conditions, good or bad, that might be encountered during their visit. The visit with families and residents as well as meet with the administrator of the facility. Get to know the ombudsman that is assigned to the facility that your loved one is in. Get their phone number and have it handy in the event there are abuse issues that come up.

Resident rights are a federally mandated list of obligations that the nursing home must adhere to. Such rights include a right to privacy, a right to respect, and freedom from abuse and neglect. Make sure that you are familiar with your loved ones rights in the nursing home. Upon admission, you should get a list of these rights. If not ask social services for a copy or find more information at the Medicare nursing home website.

Another important tip is to listen to your loved one. You may think that your loved one has dementia and doesn't make sense anymore. Listen anyway. There are often comments imbedded in their conversation that gives you clues to how they are being treated? Do they talk about the evil witch that chases them during a rainstorm? Maybe they are referring to the rude nursing aide that gives them their showers.

Finally, talk with other families that have loved ones in the nursing home. You can compare notes with them as well as talk about certain staff and problems that are encountered. Consider joining the family council that meets once a month to voice concerns to the nursing home administration.

Tips on Selecting Nursing Homes for Elderly People

Are you planning to place your grandparents or parents in nursing homes? Are you confused on how to choose the right facility for them? To gain insights and tips on how to select a suitable place for elderly people, read the article below.

Making a decision on whether to admit a loved one to a geriatric facility can be difficult because some elderly people are sensitive and they get upset by such decision. However, it is more daunting to choose the right facility for them.

With the busy and hectic schedules that we have everyday, seldom can we have time to care for our elderly grandparents and parents. No matter how much we love them, we have to make a decision on whether to place them in assisted living facility or not.

Some elderly individuals prefer to stay with their family as they grow old because they believed that nothing compares the quality of care given by family members than those they receive in assisted living facilities. More so, some of them like to live in long-term care homes because they do not want to become a burden to their loved ones.

Placing them in geriatric homes is not that easy because you have to consider several things to select the right facility for your loved one. Some families also experienced guilt, fear and regret when placing their loved ones in the hands of long-term care facilities.

Factors to consider when choosing a nursing home center for your loved ones:

• Location - You must select a place where you can easily visit them during your spare time. Choose a convenient place where they are comfortable, reassured and at home. Select a good quality facility which is accessible to you so you can spend more time with them whenever you can.


• Costs - Pick a long-term care facility which is within your budgetary requirements. However, do not risk the quality of care they received on the amount you pay for the services they received.


• Care givers and care workers - Be sure to select a facility which employs experienced, certified, competent and credible employees. Before you pick one, do some research to find out the quality of care they give to elderly people. With the rising cases of abuse committed to elderly people, we should not risk their safety and security. Be sure to know that they have enough employees to provide quality services to these people and make sure that their care givers are thoroughly trained to give critical care, emergency care and elderly care. Before you sign in a contract, take time to inspect and to evaluate the place to see how they treat their patients. Look for traits like patience, politeness, empathy and compassion in their employees.


• Facility inspection - Visit the facility that you are considering and assess if they did not commit any violations with regards to healthy and safety inspections. Take a look and investigate if it has enough fire exits, smoke alarms, fire extinguishers and specially fitted comfort rooms for disabled elderly people.


• Conducive living environment - Make sure to look for a place which is not dreary and isolated. Consider nursing homes which offer plenty of entertainment and fun activities for elderly people to keep them productive and busy. Make sure that their employees are cheerful, positive and accommodating. Try to ask around and investigate the opinion of elderly people who stayed there for a long time.

By considering the tips and suggestions mentioned beforehand, you can choose the right nursing home facility for your loved ones.

Understanding the Threat of Nursing Home Abuse and Neglect

It is a difficult and often sad time when a person must make the decision to place their elderly loved one in a nursing home, but that decision is usually made with the expectation that their loved one will receive better medical attention and care than they can provide themselves. The unfortunate reality, however, is that nursing home residents oftentimes suffer from abuse and neglect, which not only causes illness and injury, but also significantly lowers their quality of life. In order to protect your loved ones from falling victim to such unacceptable practices, it is important to understand how often it occurs, what actually constitutes nursing home abuse and neglect, the signs of such abuse/neglect, and what you can do about it if it does happen.

Elder Neglect and Abuse Statistics
According to the Centers for Disease Control and Prevention (CDC), more than 500,000 adults over the age of 60 are neglected, abused or financially exploited every year in the U.S. In fact, the number is very likely much higher, considering only one in every 14 incidents of abuse is never followed up on by authorities. Other notable statistics, provided by the National Center on Elder Abuse (NCEA), claim that:

• More than 1 in 10 elders may suffer neglect and abuse, but only 1 in 5 are ever reported; and


• Between 1 and 2 million elders, aged 65 and older, have been exploited, injured or otherwise mistreated by someone they depended on for protection and/or care.

These statistics demonstrate that nursing home abuse and neglect are indeed a problem in need of resolution.

Types of Nursing Home Abuse
Different states may focus on different categories of elder abuse and neglect; however, generally, there are seven categories, as established by the NCEA:

• Physical Abuse - Using force to physically injure or threaten a vulnerable elder;


• Emotional Abuse - Using threats, isolation, verbal attacks, rejection, or other belittling actions to cause distress, pain or mental anguish to an elder;


• Sexual Abuse - Forced, tricked, threatened or otherwise coerced sexual contact on a vulnerable elder. This also includes any elder who is unable to give consent;


• Exploitation - Theft, fraud, use of undue influence and neglect or misuse of authority to gain control over an elder's money or property;


• Neglect- Refusing or failing to provide for a vulnerable older adult's safety and/or physical or emotional needs;


• Self-Neglect - Being unable to understand the consequences of one's own inaction or actions, which could lead to endangerment or harm; and


• Abandonment - Deserting a frail or vulnerable elder.

Common Signs of Nursing Home Neglect
Elders in nursing homes are dependent on other people for their medical attention and care and so when one of those people neglects or abuses them, it will likely never be reported. This is why it is important to be aware of the common signs of abuse and neglect, so that you can stop the abuse that your loved one is afraid to report. Some common signs of neglect and abuse include, but are not limited to:

• Dehydration;


• Unexplained bruising;


• Bed sores;


• Dirty and/or tattered clothing;


• Unexplained/sudden changes in finances;


• Altered wills;


• Poor or lack of personal hygiene;


• Fatigue and/or listlessness;


• Constant hunger, and even begging for food;


• Lack of dental or medical care;


• Malnutrition; and


• Left unattended for long periods of time.

If ignored, these signs may eventually result in serious illness, injury or even death. It is unacceptable that nursing homes, which should be run for the care and benefit of its residents, are instead often being run to benefit its owner and executives, who often cut corners in staffing and supplies in order to maximize profits for themselves.

Many Seniors Choose Home Monitoring Over Nursing Homes

To place an elderly family member in a nursing home or assisted care facility is not an easy decision. A large part of the decision process comes down to the amount of care the individual will require. The person's physical condition, ailments and level of fragility will dictate whether they will require round-the-clock attention, day care, regular rehabilitation or periodic check-ins by health care personnel. Transportation for things such as doctor visits and grocery shopping must also be taken into account.

Another large part of the equation is the expense. Medicare and Medicaid will help pay for some of the costs of assisted care and full-time care facilities. But certain conditions must be met - such as using Medicare-certified facilities and services - to qualify for these benefits.

Many elderly adults end up spending their personal savings in order to live in a nursing home or assisted care facility. Eventually they may become eligible for Medicare benefits, but by that time their savings have been significantly depleted. And if a qualified senior chooses a facility that is not Medicare-certified, the expenses can be prohibitive, especially on a fixed income. Even part-time home care costs can add up and become a financial burden over time.

Living at Home

Elderly adult or not, there's no place like home. But this is especially true for seniors. Living in the familiar surroundings of their own home or apartment helps seniors feel they are still in charge of their own lives.

This is where senior medical alert systems come into the picture. If an elderly individual is still able to function on their own to an acceptable degree, a reliable medical response system backed by a reputable company can be invaluable.

Most elderly home alarm systems have two-way communication capabilities. When the button is pushed on a medical alert bracelet or pendant, a responder at a monitoring center will immediately be alerted that there is a problem and will go into action. The responder will then attempt to speak to the occupant of the home, proceeding to send police and an EMS response team to the site if contact is not established.

As we age, we sometimes have a tendency to forget things. Medical alert companies have come up with ways to remind seniors to take their medications during certain times of the day. Additionally, there are mechanized dispensers available that help prevent seniors from skipping or double-dosing on medications.

Fall sensors and motion detectors are also very important devices in providing a secure and well-monitored environment for elderly individuals in their homes. These devices greatly diminish the chance that an elderly friend or loved one will have some kind of difficulty where they are unable to reach their alert button. These sensors and detectors provide an added level of security.

Living at home can perpetuate independence and foster self-esteem. If an elderly person is capable of living on their own, then home medical monitoring systems can ensure that their quality of life remains at a good level.

Arizona Nursing Home Abuse Lawyers

Nursing homes are on the rise due to the increase in the number of aged people. Along with the growing number of nursing homes, cases of nursing home abuse are also on the rise. Arizona, like any other state, is prone to this problem, which has led to an increase in the number of Arizona lawyers specializing in nursing home abuse. Arizona nursing home abuse lawyers help victims in all legal matters related to nursing home abuse and also advice them on a proper course of action.

Nursing home abuse and neglect in Arizona is on the rise and has become widespread. Most of the nursing home residents are dependent on the nursing homes for care and have no other place to go. The main reason for nursing home abuse is the lack of experienced and qualified staff at most nursing homes. Most nursing homes function as profit-making businesses, adding to the problem. When the treatment meted out by a nursing home is bad, the residents can take legal course. There are several strict laws enacted by the state of Arizona to deal with abuses in nursing homes. Since the nuances of the law cannot be understood by a common man, it is wise to take the advice of Arizona nursing home abuse lawyers.

Nursing home abuse can be physical, sexual, or financial. Depending on the type of abuse, a well-experienced Arizona nursing home abuse lawyer can file a case on the particular category. Almost all the Arizona nursing home abuse lawyers are members of the Association of Trial Lawyers of America, the Arizona Trial Lawyers Association, and the American Bar Association. It is wise to take the help of a lawyer who has specialized in the field of nursing home abuse.

The best place to hunt for Arizona nursing home abuse lawyers is the Internet. There are several websites providing information on nursing home abuse lawyers. Some of them even arrange for a free initial consultation.

Nursing Home Careers: What Are Your Options?

Facilities that provide care and service to the elderly, providing them with skilled care and rehabilitation services to help with injury, illness or functional disabilities. Nursing home careers are a rewarding way to make money while helping to improve elderly people's quality of life. There are several different areas in the retirement or convalescent home that people may desire to apply to and get involved with to achieve absolute the most rewarding job fulfillment experience!

Skilled Nursing Facilities Careers Option #1 - Front Office Administration

It takes many people to run a skilled nursing facility. Engaging careers in administration can range from answering the phone at the front desk to the chief financial officer of the company. Accountants, secretaries, nursing home coordinators and facility manager are all nursing home careers that fall under the umbrella of administration. While many of these positions involve an advanced degree, many people in convalescent home employment start out as a receptionist and work their way up to management.

Convalescent Home Careers Option #2 - Nursing

Nursing is a large part of the available nursing home careers. There are many levels of nursing in this setting. The certified nursing assistants help patients with activities of daily living such as eating, bathing and hygiene care. Licensed practical nurses administer patient medications as well as provide skilled care. While registered nurses do commonly have convalescent home careers, their positions are mostly supervisory positions that oversee the activity on the floor or in the entire facility.

Retirement Communities Employment Option #3 - Pharmacy

Most facilities have an on-site pharmacy that allows patients to receive their medications within hours of a physician writing prescriptions. This opens up a number of rewarding and lucrative careers in the pharmacy arena. Pharmacy technicians help pharmacists fill orders and help with paperwork. Pharmacists review orders, answer medical staff questions regarding prescriptions, and mix and dispense medications. A pharmacist must have a minimum of six year's post high school education in pharmaceuticals, achieve a Doctor of Pharmacy degree and become licensed to practice as a pharmacist.

Retirement Home Careers Option #4 - Social Services

Other relevant and related employment options include those in the social services. These facilities require a number of people who specialize in social services such as psychologists and social workers. Psychologists and licensed clinical social workers help work with patients with psychological issues as well as help create care plans. Psychologists and social workers both commonly require a four-year degree.

Retirement Community Employment Option #5 - Physical and Occupational Therapists

Skilled facilities and rehabilitation facilities often staff licensed therapists to work in a number of different fields. This opens up a number of types of therapy as a viable career option. Physical therapists and physical therapy assistants often work with patients to help restore function, improve mobility, prevent and limit disabilities and relieve pain. Occupational therapists create treatment plans to help elderly patients restore functions common in daily living such as vocational, homemaking and general independence. Speech therapists often work with patients following a stroke or illness that affects speech or the part of the brain that affects speech.

Employers, Medical Staffing Agencies, Hospitals and Retirement Communities can Hire for all types of Nursing Home Careers and Post a Job for every Job Type - CLICK HERE: Nursing Home Careers. Job Seekers can Also search for Nursing Home Jobs Needed or Available.

10 Things You Should Know About Assisted Living

Moving into an assisted living home is a big life change. Anyone making this move is sure to feel uneasy and have many questions. The first step is to make sure you are fully informed about assisted living facilities so you can make the right choice for you or your loved one.

Here is a list of 10 things you should know or ask yourself before picking an assisted living facility:

1. Is Assisted Living Right For Me? This is the first, and most important, question you should be asking yourself. However chances are, if you’re asking yourself this, the answer is yes. Assisted living covers a wide variety of needs and can work for just about anyone. Right now it is estimated that more then a million Americans live in approximately 20,000 assisted living facilities. And no two of them are alike. Some residents need some help cooking for themselves, or taking daily medication. This can be a concern for their family while they love and worry about them, assisted living is a perfect solution for you both. While other residents move to a facility just to enjoy the social life!

2. Will I Be Taken Care Of? Of course! Everyone is different and has different needs, so no two guests will have the same situation. However, your specific needs will be met. When you meet with the facility in advance let them know your needs and they will inform you of what they can and can’t do for you. Chances are your day to day needs will be no problem.

3. Will It Be Fun? Yes, assisted living can and will be FUN! Most facilities offer a wide variety of activities to fit the personal preference of all their guests. Everything from movies, fishing and shopping to enjoying the great outdoors and having a cocktail at the bar! There’s something for everyone to enjoy.

4. Privacy Is Key A main concern of new guests is privacy. But not to worry, assisted living facilities pay a great deal of attention to your privacy wants and needs. Unlike a nursing home, which is much less private, assisted living will give you all the private time you require, whether it be to sit alone in your room and enjoy a good book or visit with your family.

5. What Are ADL’s And IADL’s? [http://www.lakeshoreli.com/faq/what-are-adls-and-iadls.htm] These are two abbreviations you may start to hear about a lot while doing your research and visit different locations. They both refer to the kinds of needs an individual has, and what kind of day to day care they will need when they move into the facility. ADL’s are Activities of Daily Living, such as bathing, dressing and eating. IADL’s are Instrumental Activities of Daily Living, such as paying bills, cleaning, and doing laundry. These activities, by nature, are less time sensitive.

6. What To Pack Packing for you move is very important, but what you need to bring heavily depends on the facility you select. Some offer fully furnished rooms, where others you’ll have to provide yourself with any furniture you’d like. Visit the room in advance. Stop by the apartment you’ll be moving into and take a look around, what is provided, what will you need, take some measurements so you’ll know what fits and what doesn’t.

7. Location, Location, Location! Make sure you are picking a location you are happy with. Think about what’s most important to you to have near by. Some may want to visit somewhere new and enjoy a new and exciting atmosphere. For example, assisted living in New York [http://www.lakeshoreli.com/faq/assisted-living-new-york.htm] can offer you some amazingly beautiful landscapes to enjoy, fishing, shopping, and the general peace and beauty of the great New York outdoors! However most feel that there is no place like home and want to have their family and friends near by. So if your family is in the New York area you’ve really hit the jackpot! The best thing for you to do is check out the surrounding towns and cities, your family will want to visit you and you want to make sure there are places to stay near by and fun things to do together!

8. Who Foots The Bill? Unfortunately, in most cases you will be. Residents and their families typically pay the entire, or at least the bulk, of the assisted living expenses themselves. However, before you start paying the bills out of your own pocket don’t forget to check your health insurance long term care policy, some or all costs may be reimbursed. Regrettably, there has been very limited government aid for assisted living, so you should look to our insurance coverage for financial assistance.

9. Emotional Transition Although chances are you will eventually be very pleased with your decision to move into assisted living, the initial transition will probably be a struggle for most. When you first arrive you may not know anyone, or only a few, but remember that everyone there once went through exactly what you are going through right now. These people are your allies not your enemies! They can help you adjust and get a feel for your new home. You may feel compelled to stay in your room and keep to yourself, however getting out and making new friends and getting involved will make the transition much smoother and is said to be the very best way to assimilate into your new home.

10. Have A Good Attitude It’s important to stay positive and upbeat during the decision making and moving process, for both the individual and immediate family and friends. It can be emotional to let go of your home and some possessions you’ve enjoyed for many years, giving up your total independence and admitting you may need a little help here or there is a tough uphill battle for some. But don’t focus on the things you are giving up, think of all the fun you are about to have! The adventure you’re embarking on! You will be surprised how much you’ll have in common with your new neighbors and friends.

Tips on How To Get Rich

Even though today's economy is not ripe for investment options to get rich, there are still more than a few ways to gain wealth. The following are but a few examples of ways to get rich:

1. Find a company that has a product that will reduce energy costs. Do some research to ensure the product is viable and in a price range that the general public will purchase. Buy as many shares as you can afford and then check into becoming a distributor for the product. Find the right market and sell as many units as it takes to get rich. Or invest in Emerging Markets. Many foreign lands have viable resources that have not been tapped into yet. Take China for example, there are thousands of natural resources and mines there that have not be found. Research companies that are mining or have just found a big ore and invest in them

2. Real estate is still a good investment in the right location. Many, many expensive homes are selling for forty percent or less of their value a few years ago. The price may never get back to 2004 levels but, you should be able to make twenty to thirty percent profit on each piece of property. Foreclosures are a great place to start. If you have 70,000 or 80,000 thousand already saved, then foreclosures could be a gold mine for you. Buying and flipping houses is one of the best ways to make a good living.

3. We as a population are living longer and longer. A good investment would be in anything having to do with any health care or living item seniors will need as they continue to grow older. Most seniors have a fair amount of cash they are willing to make their life more comfortable with. An assisted living facility would be a great investment.

4. Creating a home business that provides a product that makes the daily life of working parents easier to manage will reap great rewards. Think of something you would love to have to make your life easier. Chances are others would feel the same. You can enjoy the comfort of your own home while making money. Many businesses offer ways to make money, but it is hard to find the right one. Many times you may feel that they are scams, but actually many of them really work if you give them a chance. You will have to work on them a good bit, but you can follow guidelines that the business shows you, and I guarantee you will be working less than if you stayed at a business for your whole life. In addition you will have much less stress in your life.

5. The easiest way to get rich is marry someone with tons of money and treat them well.

Assisted Living Facilities For All

Many elderly people dread going to nursing homes because of the bad reputation that nursing homes have in our society. Nursing homes have had some problems over the past several decades, but there are still good, reputable homes. Even so, being placed in a home will force your loved one to give up their personal freedom, privacy, and independence. If your loved one does not yet need constant medical care, there isn't a necessity to place them in a nursing home. Try considering another option.

The alternative to a nursing home is Assisted Living Facilities, popularly known as ALF. These facilities are for people needing assistance with daily living activities, but who want to live as independently as possible for as long as possible. The goal is to bridge the gap between independent living and nursing homes.

Level of Freedom

Residents in assisted living centers are not able to live by themselves, yet do not require constant care either. Such facilities offer help with eating, bathing, dressing, laundry, housekeeping, and assistance with medications. Many facilities also have centers for medical care; although, the care offered may not be as intensive as the care offered at a nursing home.

Understanding the Differences

The decision on whether to send your loved one to an assisted living facility or a nursing home rests on many factors:

* Cost: Assisted living is rather costly because individuals live in apartment-like settings. Nursing homes are cheaper because the elderly live in a more communal space, with little private space.

* Medicare is frequently available for someone in a nursing home, but may not be for someone in an Assisted Living Facility.

* Facilities: ALFs are focused on individuals. Nursing homes are focused on the collective group.

* Place: While assisted living facility is a place for a few seniors at a time, a nursing home houses many patients. The former house an individual who is given all the help and assistance he or she needs, while the nursing home gives far less individual care.

* Nursing homes are meant to care for people who have a number of health care requirements, and cannot care for themselves. ALFs are meant to assist elderly persons who can basically care for many of their personal needs themselves.

* In an assisted living facility, skilled nursing care is not usually available except on an as-needed basis. A nursing home is more similar to a hospital environment and provides full-scale, skilled nursing care.

* Assisted living facilities are meant to assist people in preparing meals, bathing, dressing or performing household chores. If your loved one is often confused or experiencing memory problems, this might be the answer. If they have a debilitating disease or condition, they might need a nursing home.

Consider Their Welfare

When deciding on either a nursing home or an assisted living facility, your major concern should be the welfare of your loved one. It may be necessary to factor in the reality of costs, but there are ways of obtaining financial aid and in the long run, you'll rest easier knowing your loved one is being well cared for. Just keep in mind that if you end up with a situation that is fraught with problems, the effort and stress you invest in resolving the situation may not be worth the dollars you thought you might save.

Veteran's Administration Program Helps Vets With Senior Living Expenses

It may be one of the U.S. Department of Veterans Affairs' best kept secrets - and it helps veterans pay their senior living expenses! If you are a retired wartime veteran looking for ways to help pay for senior living care, the Veteran's Aid & Attendance Pension Benefit (also called 'A&A') may be for you.

A&A is classified as a special pension benefit which is paid in addition to other VA benefits. It is available to wartime veterans and their spouses, and helps defray the cost of senior living care whether you live at home or in a nursing, assisted living or senior care facility. A&A is also available to the veteran's spouse or widow, as well. Because it is considered financial assistance rather than VA compensation, it remains largely unknown and underutilized.

Not everyone qualifies for A&A, and the amounts provided to veterans vary according to financial need. Here are five common questions about the A&A benefit:

1. How Much Does A&A Contribute?
The Veteran's Aid & Attendance Pension Benefit is a needs-based program that provides up to $1,703 each month for a veteran. A surviving spouse is eligible to receive up to $1,094 monthly, and a couple is eligible to receive $2,019 monthly.

2. What is a Wartime Veteran?
The A&A benefit is only available to wartime veterans. That means the veteran needs to have served at least one day of his service during a time of war (World Wars I and II, Korea, Vietnam and the Persian Gulf wars all qualify). The veteran does not need to have seen combat or served overseas, but must have received an honorable discharge.

3. Do I Qualify For Needs-Based Assistance?
Eligibility is based on need. The veteran or spouse must have limited assets. Limited assets is generally defined as less than $80,000, but remember - homes, vehicles and life insurance policies don't count toward the total asset amount.

4. How Do I Establish a Need for A&A?
The veteran or surviving spouse need must have a doctor establish their need for assistance. Typically, a doctor must document a need for daily assistance by others in order to complete tasks such as feeding, bathing, getting dressed, cooking or remove or placing prosthetics devices. Bedridden vets and spouses - as well as those suffering from mental or physical incapacitation - also qualify.

5. What if I Don't Need Constant Help? Do I Still Qualify?
It isn't necessary that the veteran or spouse require assistance with all of their everyday tasks. It is only necessary to provide medical evidence that the veteran or spouse cannot function entirely by themselves.

The VA's A&A program allows society to give back and provide for our country's heroes in the autumn of their lives, beyond Medicaid and a Veteran's Administration nursing home.

Don't Forget Your Parents

Who are Parents? The people who raised us, took care of all our needs as we grew up, making sure that we turned into good young men and women, ready to go out into the world, and make our own way. For the most part, they were successful. Most of us are on our own, making at least enough money to survive (which I admit is getting harder to do in today's economy). In some ways, they are still raising us, even after we enter middle-age, and are raising our own kids.

We still see them during the Holidays, and, if we still live close enough to them, we may see them every week. But, if you're like me, you may have slacked off a bit on keeping in touch with them. Maybe the every-day stresses of life are weighing so hard on your shoulders that you just don't even have time to think about how they are doing.

My Dad has remarried after my parent's divorce, and he and his wife have two homes; one in Gainesville, Florida (about 160 miles away from me), and one in Roscommon, Michigan (1800 miles away). They make the trip every spring and fall, taking 2 to 3 days to travel. I don't see them much, maybe a couple of times a year, including Christmas, even though it's only a three hour drive. I did make 3 weekend trips to Gainesville last spring, while Dad was recovering from some major surgery, but haven't seen them since then. We occasionally talk on the phone, but definitely not often enough.

My Mom lives just across town from me. I rarely see her either. She lives alone in a mobile home park, but has a lot of friends that she sees almost daily. She is there year-round, and she used to travel quite a bit, but not so much anymore.

I don't know why I don't visit with her more often. It's not a question of whether or not I love her. My work has me on-call 24/7, but I don't get that many after-hours calls, maybe 3 or 4 a month, so that's not it. I live with one of my sons, and work out of his garage, where I have an office set up. I have good transportation since I bought my boss's '99 Suburban. It only takes about 8 minutes to drive to her house. So, why don't I go see her more often? I really don't know. I know that I should.

So, how many of you are like me? How many of you have slacked off, even if your parent(s) live(s) close by.

How many of you have placed your Mom or Dad in an assisted living facility and don't go to see them? I should point out that this is the biggest fear of Seniors, when they are faced with the possibility of having to go live in a facility. They are afraid that you will put them in there, and then forget them. Sure, they'll have new friends to meet and play cards with, but they'll miss the people they love.

Would you take away from them the joy of watching their grand-kids grow up? Would you let them think that they are useless, and have been thrown away? Ask yourself if you would like your kids to treat you like that.  Ask yourself how much invaluable wisdom your parents could share with you.  And you shouldn't deny your children from having interaction with their grandparents.  The ties of the family have made this country strong for a couple of hundred years, and if we totally lose that, I think this country will fall apart.

There has been a lot of talk about how we can keep our Senior Loved-Ones at home longer, and there are some in-home systems out there now that can help. These systems can provide valuable information to you about how Mom and Dad are doing. One of the best ones out there uses small, wireless motion sensors placed around the home, that keep track of their activity levels. This system was created for use in Assisted Living Facilities, but when they tried it in a residential setting, it actually proved itself invaluable in tracking the senior's activity levels, posting the info on a secure website, and automatically sensing problems early; notifying the sons and daughters when a problem first starts. This is very valuable, and much more accurate than waiting for Mom or Dad to finally admit that they're not sleeping much, or haven't been feeling too well. You can actually know about the problem before they do, in some cases.

Now, this system doesn't relieve you from visiting with your Loved-One. There is absolutely no excuse for you (or me) to not visit with them once in a while. It merely presents information to you, so you can assess what they may need. You can even give their Doctor access to the system, so that he/she can look at it for themselves.

Well, we are all going to grow old eventually. It's inevitable; a fact of life. So, let's employ the Golden Rule right now. Treat your Parents the way that you are going to want to be treated by your children. Your kids will see how you treat your Parents, and will learn from your example. 

So long, for now. I'm going to call my Dad and then head over to visit with my Mom.

My Spouse Has to Go Into a Nursing Home - How Much Can I Keep?

Most people know that in order to qualify for Medicaid coverage of a long-term stay in a nursing home, the nursing home resident cannot own more than $2,000 in cash or other "countable" assets. But if you're married, and one spouse is going into a nursing home and the other is remaining "in the community" (i.e., continuing to reside at home), how much can the so-called "Community Spouse" retain? That amount is determined by a combination of both federal and state Medicaid laws. (Note that for these purposes it doesn't matter whether assets are titled in the sole name of the nursing home spouse, the Community Spouse, or jointly in both names.)

The basic rule is that the Community Spouse can retain 50% of all of the countable assets of both spouses, based on what they own when the other spouse first enters the nursing home for a continuous period of at least 30 days.

Most of the states only permit the at-home spouse to protect one-half of the total amount of the couple's assets, up to $109,560, but with a minimum of $21,912. So if the couple's total assets are under $21,912, the Community Spouse can retain it all; if their total assets are between $21,912 and twice that amount (i.e., $43,824), the Community Spouse retains $21,912; if between $43,824 and $219,120, the Community Spouse retains half; and if over $219,120, the Community Spouse is limited to protecting $109,560.
Here are some additional examples:

Examples:

1. Assume a couple has total assets of $30,000. Half of that is $15,000, which is less than the "floor" amount, so the at-home spouse can protect $21,912; the balance must be "spent down" before the nursing home spouse can qualify for Medicaid.

2. If the couple's assets total $100,000, then the Community Spouse can protect the full 50% amount: $50,000.

3. If the couple's assets total $300,000, the Community Spouse's protected amount is limited to $109,560.

States following the above rule are known as "50% states." However, the most lenient states ("100% states") permit the at-home spouse to retain 100% of the couple's combined assets, but never more than $109,560. So if the couple's total assets are, say $150,000, the Community Spouse can protect not just 50% ($75,000) but $109,560. (The $109,560 figure changes annually, to keep up with inflation; this is the 2009 amount.)

In all states, once the Community Spouse's share is set aside, the nursing home spouse can keep up to $2,000 in cash, but the balance of the couple's assets must be eliminated somehow before the nursing home spouse can qualify for Medicaid.

So what do you do with the "excess" assets over the limits discussed above? The state Medicaid administration department will tell you that you must "spend down" the excess assets, and if it's a small amount, that's certainly the simplest way to qualify.

Another alternative is for the couple to simply give away the excess, but that will cause a period of disqualification from Medicaid eligibility for the nursing home spouse.

The couple could convert some or all of the excess from "countable" to "non-countable," e.g., buying a new car, improving the house, purchasing a Medicaid annuity, etc.

Finally, many of these options are quite technical and require the skills and advice of an experienced elder law attorney. Unless you're an attorney "in the trenches" on a daily basis, it's easy to miss a recent state Regulation or Agency Letter and make a mistake that will wind up costing you $1,000s!

Information Technology Career Preparation Training Options

When looking to obtain a higher education in information technology there are many options available. You can pursue a career that meets you individual goals by choosing from a variety of specialized areas of study. Training can be completed at different levels to allow you to receive the educational career preparation that is right for you. Enrollment in an accredited school or college will help you to obtain the higher education that is necessary for you to pursue a career in information technology. With numerous opportunities available, you can start by learning more information technology career preparation training options.

Professionals in this field are trained to carry out a number of tasks based on the career that they have chosen. You can learn to work with various computer systems for a number of reasons. Training will allow you to pursue the degree and career that meets your individual needs and goals. You can look into:

• Associate


• Bachelor


• Master


• Doctoral

...degree training programs in information technology. Studies can last anywhere from two to eight years depending on the level of education needed to enter into the career you desire. Accredited career preparation can give you the skills and knowledge to enter into a variety of careers.

There are numerous professions available in information technology. You can select the level of education that allows you to enter the career of your dreams. You can specialize in areas such as:

• Computer Information Science


• Information Security


• Computer Information Systems


• Information Systems

...and more. Accredited higher education training in these areas will cover a variety of topics to help you gain the skills you need to enter into a successful career. The area of specialty will decide the courses that must be studied.

Coursework will be different for each level of degree and the area of study that is selected. You can obtain the accredited education that will help you succeed by completing training in web development, databases, systems analysis, hardware components, and computer software. You can also complete computer security training, as well as telecommunications, user interface design, application testing, and many other subjects related to the career and specialized area you wish to enter. There are a variety of professions that can be pursued once an accredited higher education is obtained in information technology. Possible career opportunities can include working as a:

• Software Developer


• Support Specialist


• Systems Analyst


• LAN Administrator


• Computer Programmer


• Certified Information Systems Security Professional (CISSP)

...and other related professions. Obtain the accredited educational training you need to pursue the career of your dreams by enrolling in an information technology school or college today.

Full accredited programs offer you the best quality education available. You can ensure this by making sure the program you choose carries full accreditation from an agency like the Accrediting Commission of Career Schools and Colleges of Technology ( http://www.accsc.org/ ). Start by researching information technology schools and colleges to find the one that's right for you and enrolling in the degree program that meets your individual needs and goals.

DISCLAIMER: Above is a GENERIC OUTLINE and may or may not depict precise methods, courses and/or focuses related to ANY ONE specific school(s) that may or may not be advertised at PETAP.org.

Copyright 2010 - All rights reserved by PETAP.org.

Long Distance Caregiving and the Role of the Geriatric Care Manager

Long distance caregiver is a new role that is thrust upon children and younger family members these days. After all, families used to live closer together, with children residing and working near their parents, but these days family members are more distant from each other.

According to a report by the Alzheimer's Association, 7 million Americans provide 80% of the care to ailing family members, there are approximately 3.3 million long-distance caregivers in this country with an average distance of 480 miles from the people they assist, and the number of long distance caregivers will double over the next 15 years. The report also states that 15 million days are missed from work each year because of long distance care giving.

Professional care managers (also known as geriatric-, elder-, or aging- care managers) represent a growing trend to help employed and/or distant family caregivers provide care for loved ones. Such experts assist caregivers, friends or family members provide care, make decisions, and find governmental and private resources. They are professionals who are trained to assess the abilities and needs of the elderly, and to evaluate and recommend care for them. Their backgrounds include fields such as nursing, social work, psychology, and gerontology.

These professionals are becoming extremely popular as the liaison between long-distance family members and their aging loved ones. That's why it is important to find a geriatric care manager where your loved one lives, since he or she will have knowledge of the resources in the area and can serve as your eyes and ears when it comes to your distant loved one.

The following is a partial list of what a care manager might do:

• Assess the level and type of care needed and develop a care plan.


• Put the care plan in place and keep it functioning.


• Make sure care is in a safe and disability-friendly environment.


• Resolve family conflicts and other issues.


• Become an advocate for the care recipient and the caregiver.


• Implement and manage long distance care.


• Conduct ongoing assessments to implement changes in care.


• Oversee and direct care provided at home.


• Coordinate the efforts of key support systems.


• Provide personal counseling.


• Arrange for services by legal and financial advisors.


• Arrange placement in assisted living facilities or nursing homes.


• Monitor the care received in a nursing home or in assisted living.


• Assist with the monitoring of medications.


• Coordinate medical appointments and medical information.


• Arrange or provide transportation to medical appointments.


• Assist families in their decision-making.

Services offered will depend on the educational and professional background of the care manager, but most are qualified to cover items in the list above or can recommend a professional who can. Fees vary. There is often an initial consultation fee that is followed by hourly or flat fees for services. Medical insurance usually does not cover these fees, but long-term care insurance might.

When you take into account the time absent from work and time to find the right care resources for your loved ones, along with the cost of travel expenses to monitor their care, you will probably agree that using a caregiver is money well spent. Add to this the stress of handling your own life circumstances combined with being a caregiver, and you will probably wonder how you could have ever done without the care manager.

How To Properly Handle a Car Accident

No one ever wants to be in a car accident but they happen and when they do, you better know what to do. In case that you were not the one who caused the accident, then I have listed here some guidelines that you can follow when it comes to handling the situation. It would surely help a lot to know these things:

• The first thing for you to do after you have made sure that no one was hurt is to gather information that you are going to need afterwards. You need to take note of the plate number of the car, its make, and the model. If you can not write it down for the moment, you should just keep on saying it out loud until you can.

• If the accident happened at night, you better turn your hazard lights on. You don't want to cause another traffic accident.

• It does not matter how minor an accident it is, the police should still be called in right away. The police report is going to be needed by the insurance company and you might need the police officers to officially determine what actually happened. So, be sure to call the police right away and don't leave that to others.

• Try to look for witnesses in the area. If the accident happened in a crowded area, then that might not be a problem, but if it happened in an isolated location, where there are no other vehicles, then that might complicate things. Still a witness' testimony could help you out a lot.

• If there are no arguments as to what had happened, then you should exchange information with the other driver. You should get their name, driver's license number and their car insurance company - and you should provide the same. That information would be needed in the processing of the claim.

• This is the part where you tell the police officer what actually happened. Be sure that you tell things exactly as it happened and do not exaggerate, which might cause the other party to disagree. If the damage was minor and there were no injuries then you should not try to complicate things further.

• File a claim with your company in order to cover for the expenses of the damage that was caused to your vehicle. There are cases though when the damage is too slight that it would actually be wiser for you not to file a claim at all.

• When the damage is too small, you might just file an insurance notification with your company. This is when you tell them that an accident has happened but you're not seeking compensation for it. That might have some long term benefits for you.

These are the steps that you can follow when the accident that you were involved in was just a minor one. In cases where there are some serious damage and the amount of the claim involved is rather large then it might make sense for you to hire a personal accident or personal injury attorney.

Homecare Makes Caring For Elderly Parents Convenient and Affordable

Many adult children find caring for elderly parents to be a challenging, worrisome, and often exhausting experience. They wonder if their elderly parents are able to maintain their personal hygiene, whether they're taking their medications properly, and if they're safe in their homes.

Homecare agencies can remove the anxiety and burden of caring for elderly parents from afar. Homecare enables seniors to continue to live independently in their homes by receiving assistance with their basic needs. This can include help with:
• Eating, bathing, getting dressed, and going to the bathroom
• Getting to the pharmacy, the doctor's office, and other appointments
• Shopping and household chores
• Making home modifications like installing grab bars in the bathroom
• Identifying opportunities to socialize with other seniors

According to the Family Caregiver Alliance, between five and seven million Americans are caring for elderly parents from afar (defined as living at least one hour away from an older relative). This trend will continue to grow as more and more of the baby-boomer generation gets older and opts for homecare instead of nursing homes or assisted living facilities.

For people living in our area, homecare services from reputable homecare agencies promote independence, provide dignity, and encourage peer interaction (which is proven to improve brain function). Caring for elderly parents does require you to make some important decisions. You shouldn't hire a company to care for your elderly loved one from afar until you know what they offer and why they're the best agency to care for your elderly loved one.

Make sure to ask the following questions when you meet with homecare agencies:

• Who is the employer? It may sound like a strange question to ask, but homecare agencies come in all shapes and sizes. From a safety and liability perspective, you want to hire a company that manages everything from payroll to taxes to worker's compensation insurance. If you don't, you will be considered the employer and will ultimately be responsible for handling the many legal and financial issues involved with homecare.

• What is their experience? It may go without saying, but experience matters. How long has the homecare agency been in business? Has the agency provided similar services to other clients in the past? What do its past and current clients have to say about the quality of the services?

• Do they offer a free consultation? Most reputable homecare agencies offer a free consultation to provide a comprehensive assessment of your elderly parent's needs.

• Do they have a rigorous employee screening process? It's important that the Orange County homecare agency conduct thorough background checks on all employees. Checking criminal, professional, and personal references is critical to make sure your loved one is being cared for by a qualified caregiver.

• What is the plan of care? Developing a plan for caring for elderly parents is important because it enables you to clarify expectations about what and how much care is going to be provided. From personal care to cooking meals to attending doctor visits, everyone is involved in determining the best course of homecare.

• How accessible are they? How easy or difficult will it be to reach the people in charge? This is especially important on nights and weekends. Will you be able to speak with a person when you call the agency or will you reach an answering machine if you call after normal business hours?

If you're caring for elderly parents and want to learn more about homecare services, visit http://www.CambrianHomecare.com or call 877.422.2270.

An Old Coach Offers a Simple Solution to Childhood Obesity

Obesity is a huge and growing problem in America and around the world. And the childhood edition of this problem is a 21st century tragedy that's not only costing our nation billions of dollars, but it's costing millions of kids their confidence, their self esteem, their willingness to try something new in public for fear of failure, and consequently their capacity to live full and productive lives.

While scientists are busy studying body chemistry, body composition, nutrition, and exercise physiology, pharmaceutical companies are busy developing the latest weight loss pill, the diet industry is designing a new diet strategies, infomercials are crowing about new exercise devices, health clubs are hustling fitness, insurance companies are cutting benefits, and McDonald's is pushing salads, all in an effort to commercially take part in the multi billion dollar obesity industry. In the mean time, the problem continues to grow unabated, like a forest fire raging out of control.

An Old Coach's Reaction

In light of that raging forest fire I'd like to introduce you to the wisdom of a retired coach who I've known for over three decades. In the words of this old coach (he prefers to remain anonymous, and back in the shadows), "I taught physical education for most of my adult life and during that time I made the following observation. I noticed that kids who could perform pull-ups were never obese," he said. "And kids who were obese could never perform pull-ups. Pull-ups and obesity are mutually exclusive, and are never found in the same kids," he added.

Without Pills, Shots, or Magic Diets

The old coach's conclusion was that if you start 'em young, before they've had a chance to pick up much weight, teach them the ability to perform pull-ups, and teach them to never lose that ability, you can immunize kids against obesity for a lifetime, without pills, shots, magic diets, or much in the way of expense. "The more kids you can teach to physically pull their own weight," he said, "the closer you'll come to whipping the childhood obesity epidemic."

But Kids Hate Pull-Ups

I told the coach that I thought his logic was impeccable, but in my view he had one problem. According to my recollection, most kids hated pull-ups with a passion. And if they hate doing it, how can you teach them to perform pull-ups? They'll drag their feet all the way to the gym, won't they?

Using A Height Adjustable Pull-Up Bar

"Kids hate doing anything where they fail in public," the coach replied. "The trick is to start them young before they learned to fail on the pull-up bar. Start them out on a height adjustable bar that allows them all to succeed immediately with leg- assisted pull-ups, jumping and pulling at the same time. With this inexpensive tool you'll eliminate failure, and build regular success into the experience for all participants."

How High Do You Set The Bar

A couple of more questions popped into my mind immediately. First, how high do you set the bar when you're starting a youngster out? And secondly, how do you adjust the level of difficulty in order to insure progress? I could tell however, the wise old coach had an answer on the tip of his tongue.

The Progression

"You start the bar out low enough that the child can do at least 8 leg assisted pull-ups, but no more than 12. You allow them to work out twice a week and expect them to improve every time for a number of weeks, consecutively. In other words, in the second workout they should do 9, in the third 10, in the fourth 11, and in the fifth 12 leg assisted pull-ups. When they hit 12 repetitions you raise the bar one inch and they begin the 8-12 process all over again. This strategy allows a child to make a little progress every time he or she works out, and after several weeks they learn to EXPECT TO SUCCEED IN PUBLIC, which in turn teaches them to love instead of hate pull-ups."

They've Immunized Themselves Naturally

So if I understand it right Coach, the kids literally inch their way upward until they eventually run out of leg assistance, at which point they've not only learned to perform pull-ups, but they've also learned to love doing them, and in the process they've immunized themselves naturally against obesity for a lifetime as long as they maintain the ability. Does that sound about right, I asked?

They May Want To Be Bad, But

"Mechanically speaking that's correct," the coach said. But there are a few other things that go into the strategy that you need to understand. One thing is that you're tapping into a child's natural desire to be strong and not weak. In my years of teaching I met lots of kids who wanted to be bad, but I never met a kid who wants to be weak. And that goes for the boys as well as the girls. We all want to be strong. All kids know that the ability to do pull-ups requires you to be strong. And when you work in a group, they're getting stronger in public, and kids love to succeed in public," he said. "They inevitably finish off by giving each other high fives, and they love every second of it."

I asked the coach what other things are built into his strategy. He said kids learn that three things make them strong, including regular work, good eating habits, and getting enough rest at night and in between workouts. They also learn that fooling around with tobacco, alcohol, and drugs makes them weak. And no kid ever wants to be weak. "They also learn these concepts in a very hands-on, and concrete way," he said.

Taking Responsibility For Yourself

I knew the coach could have talked on this subject all day but I wanted to finish on one other related point. The phrase pull your own weight has responsibility taking connotations that are very appealing to most people these days. What role does taking responsibility for oneself play in this childhood obesity prevention strategy?

After congratulating me on all the good questions the old coach said, "One of the big lessons that kids learn from working on the pull-up bar is that nobody else can do it for you," he said. "I mean in reading, writing, and arithmetic you may get away with having somebody else do your homework for awhile. But the pull-up bar knows immediately if you've done the work, it knows if you're eating right, it knows if you got enough rest recently, and it pays you for doing these things with additional success.

On the other hand, it also knows if you fail to do these things, and it can just as easily deny the public success that all kids crave. So this strategy absolutely encourages kids to take responsibility for themselves in all kinds of ways," the coach said.

A Web Site Dedicated to The Old Coach's Strategy

I confessed that he'd sold me. I agreed that teaching kids to pull their own weight would go a long ways towards solving the childhood obesity epidemic, it could save our nation billions of dollars, and do all kinds of wonderful things for the individuals who learned the lessons that are built into this simple, practical, affordable, and infinitely measurable strategy. In fact I was so impressed that I offered to build an informational web site dedicated to the old coach's naturalistic vision. He took me up on the offer, and as I write this sentence you can now check out "pull your own weight dot net" if you'd like to learn more about the old coach's simple childhood obesity prevention strategy.

One Final Question

My final question to parents and educators (or anyone who works with kids) is, why wait for the experts to come up with a high tech solution when you can turn the tide naturally with your own kids right now by simply teaching them to pull their own weight? As they always say, there's no time like the present. Carpe diem.

Baby Boomers' Addiction & Alcoholism May Take Down Medicare & Social Security Programs

There is a relatively new group to be treated for addiction and alcoholism that is growing very quickly, and which is causing some in the field great concern: It is the retiring "baby-boomer" population.

There are several reasons that the "boomer" generation may potentially be home to many more addicts and alcoholics than the rest of the population. Some of these reasons are that the boomers were (1) the first generation to engage in wide-spread recreational use of a variety of addictive drugs (including cocaine, marijuana, and methamphetamines); (2) the first generation for which a wide variety of prescription medications and painkillers were readily available; and (3) the last generation for which treatment and recovery were not culturally acceptable. For these and other reasons, some are calling it, " America's hidden epidemic". [1]

According to some studies, it is expected that, by 2020, the number of seniors with alcohol and other drug problems will leap 150 percent to 4.4 million older people - up from only 1.7 million in 2001. [2]

Deborah Trunzo, research coordinator for the SAMHSA (Substance Abuse and Mental Health Services Administration), has said that, by 2020, the number of older people who will have drug problems, and be seeking treatment, will be "likely to swamp the system".

It is the baby-boomer generation, or the "young old" - those born between 1946 and 1964 - that are at the heart of this possible epidemic. Unlike their predecessors, those in the baby-boom generation are more comfortable taking medications for a wide range of problems, including pain, insomnia, depression, and anxiety.

In addition, the baby boomers are the first generation to widely experiment with recreational drug use. Yet along with all of these "firsts", they are also the last group born before it became somewhat permissible to admit to addiction or alcoholism, or to seek help or treatment.

One of the big concerns is that the boomers are much more vulnerable to late-life manifestation of alcoholism, addiction, and drug abuse.

In addition, in more recent years, this group has been prescribed with far more painkillers, as well as newer "designer drugs" including potentially addictive psychotropics.

A. Rush Limbaugh: The Poster-Child for Late-Onset Addiction

For example, in October 2003, at the age of 55, well-known political talk-show host, Rush Limbaugh, was charged with prescription drug fraud, and admitted to being addicted to painkillers - primarily oxycodone. With Mr. Limbaugh's admission to his addiction, he became the poster child (or poster "senior") of the new type of patient showing up in treatment centers, and emergency rooms. [3]

This "late onset" substance abuse is often linked to other medical problems, and the emotional traumas that can accompany old age, which arise from isolation, injuries and accidents, the death of friends and family, and the natural aging and dysfunction of the body.

As the boomers move into retirement, and leave the work force, they may find it more difficult to maintain their drug supply of choice: On the one hand, those who obtain drugs through legal means will have less medical coverage and less money to spend on prescription drugs. On the other hand, those who rely upon illegal drugs will no longer have as much money to pay for those drugs after retirement, and many will lose "access" to those drugs from their professional vocation (think of the dentist, nurse, or paramedic, for example, who has easy access during work). Retirement may simply mean a loss of supply, the attendant consequences of withdrawal, and the need for medical treatment.

A new legion of addicts is coming, and they require a far different approach to treatment, as well as a much higher level of medical intervention and support.

B. The Need for Greater and More Specialized Treatment

In general, older adults have different needs than younger adults; and, when it comes to the treatment of addiction and alcoholism in older adults, these differences are magnified.

Typically, younger adults are more resilient, and have abused themselves for a shorter period of time, and therefore, have a much better chance of living in recovery. On the other hand, senior citizens are much more likely to drop into a long decline toward death following any significant medical event (such as detoxification).

The aged are a very vulnerable group, and are noted to have the highest rate of suicide and other complications in relation to alcoholism. [4] Older adults are also showing an increase in seeking treatment for methamphetamine use. These are just some examples of the differences and trends which make the boomers such a widely diverse group, with different histories and backgrounds, giving the group the need for a wider variety of treatment plans and responses. [5]

Also, boomers are more likely to have dual diagnosis, with untreated long-standing co-morbid mental health problems, such as ADHD, anxiety disorder, and other personality disorders, that were simply not recognized by the medical community back in the day when the boomers were younger.

Finally, the aging abused human body in retirement will require more medical attention, more care-giving, more nursing homes, more medications, and more money, on average, than one who has led a relatively healthy life.

Macroeconomics: Medicare and Social Security Programs

The greater monetary and social costs associated with older adult treatment, recovery, and medical support could be substantial. If we significantly under-estimate the number of baby-boomers that are or will be addicts and alcoholics in their retirement years, we may have greatly misjudged the overall costs to our healthcare systems.

The Social Security and Medicare Boards of Trustees just this week released the 2008 Annual Report on the Status of the Social Security and Medicare Programs. [6]

The Summary Report begins as follows:

"A MESSAGE TO THE PUBLIC:

Each year the Trustees of the Social Security and Medicare trust funds report on the current and projected financial status of the two programs. This message summarizes our 2008 Annual Reports.

"The financial condition of the Social Security and Medicare programs remains problematic. Projected long run program costs are not sustainable under current financing arrangements. Social Security's current annual surpluses of tax income over expenditures will begin to decline in 2011 and then turn into rapidly growing deficits as the baby boom generation retires. Medicare's financial status is even worse. This year Medicare's Hospital Insurance (HI) Trust Fund is expected to pay out more in hospital benefits and other expenditures than it receives in taxes and other dedicated revenues. The difference will be made up from general revenues which pay for interest credits to the Trust Fund. Growing annual deficits are projected to exhaust HI reserves in 2019 and Social Security reserves in 2041. In addition, the Medicare Supplementary Medical Insurance (SMI) Trust Fund that pays for physician services and the prescription drug benefit will continue to require general revenue financing and charges on beneficiaries that grow substantially faster than the economy and beneficiary incomes over time.

"The drawdown of Social Security and HI Trust Fund reserves and the general revenue transfers into SMI will result in mounting pressure on the Federal budget. In fact, pressure is already evident. For the second consecutive year, a "Medicare funding warning" is being triggered, signaling that non-dedicated sources of revenues-primarily general revenues-will soon account for more than 45 percent of Medicare's outlays. The President recently proposed remedial action pursuant to the warning in last year's report and, in accordance with Medicare statute, a Presidential proposal will be needed in response to the latest warning.

We are increasingly concerned about inaction on the financial challenges facing the Social Security and Medicare programs. The longer action is delayed, the greater will be the required adjustments, the larger the burden on future generations, and the more severe the detrimental economic impact on our nation."

The actuarial assumptions underlying the Annual Report are based upon the intermediate range of projected costs. As also stated in the Summary Report:

"How Are Estimates of the Trust Funds' Future Status Made? Short-range (10-year) and long-range (75-year) projections are reported for all funds. Estimates are based on current law and assumptions about factors that affect the income and outgo of each trust fund. Assumptions include economic growth, wage growth, inflation, unemployment, fertility, immigration, and mortality, as well as factors relating to disability incidence and the cost of hospital, medical, and prescription drug services. [Emphasis added.]

Because the future is inherently uncertain, three alternative sets of economic, demographic, and programmatic assumptions are used to show a range of possibilities. The intermediate assumptions (alternative II) reflect the Trustees' best estimate of future experience. The low-cost alternative I is more optimistic for trust fund financing, and the high-cost alternative III is more pessimistic; they show trust fund projections for more and less favorable conditions for trust fund financing than the best estimate. The assumptions are reexamined each year in light of recent experience and new information about future trends, and are revised as warranted. In general, greater confidence can be placed in the assumptions and estimates for earlier projection years than for later years. The statistics and analysis presented in this Summary are based on the intermediate assumptions." [Emphasis added.]

Therefore, it is possible that the current Reports significantly under-estimate the number of addicts and alcoholics in the boomer generation, the wide diversity of addiction types, and the overall health problems and medical needs of the boomers as they enter the Social Security and Medicare systems in the years ahead.

If so, the impact on the financial outlook of the systems could be catastrophic:

"What is the Long-Range (2008-2082) Outlook for Social Security and Medicare Costs? An instructive way to view the projected cost of Social Security and Medicare is to compare the financing required to pay all scheduled benefits for the two programs with the gross domestic product (GDP), the most frequently used measure of the total output of the U.S. economy. Costs for both programs rise steeply between 2010 and 2030 because the number of people receiving benefits will increase rapidly as the large baby-boom generation retires (Chart B). During those years, cost growth for Medicare is higher than for Social Security because of the rising cost of health services, increasing utilization rates, and anticipated increases in the complexity of services. [Emphasis added.]

The potential for amplified costs of treatment for a much larger population of addicts and alcoholics would rest upon the shoulders of an already absurdly large set of projected healthcare costs.

C. Conclusion

In conclusion, if the actual addiction and alcoholism rates of the retiring baby-boomers is significantly higher that our current estimate of those rates, then the overall medical and related costs to be borne by the Medicare and Social Security Programs could be substantially higher than our current predictions. This, in addition to the already high projected costs of healthcare for that group, could, in turn, impact all of us by way of the significant long-term financial impact on the United States Government.

As the Summary Report concludes:

"The combined difference grows each year, so that by 2017, net revenue flows from the general fund will total $449 billion (2.0 percent of GDP). The positive amounts that begin in 2017 for OASDI, and in 2008 for HI, initially represent payments the Treasury must make to the trust funds when assets are redeemed to help pay benefits in years prior to exhaustion of the funds. Note that neither the redemption of trust fund bonds, nor interest paid on those bonds, provides any new net income to the Treasury, which must finance redemptions and interest payments through some combination of increased taxation, reductions in other government spending, or additional borrowing from the public.

"Chart E shows that the difference between outgo and dedicated payroll tax and premium income will grow rapidly in the 2010-30 period as the baby-boom generation reaches retirement age. Beyond 2030, the difference continues to increase nearly as rapidly due primarily to health care costs that grow faster than GDP. After the trust fund exhaustion dates (2041 for OASDI, 2019 for HI), the increasing positive amounts for OASDI and HI depict the excess of scheduled benefits over projected program income. When the statutory SMI general fund revenue requirements are added in, the projected combined Social Security and Medicare deficits and statutory general fund revenues in 2082 equal 9.3 percent of GDP, indicating the magnitude of the potential effect on the Federal budget if general revenues were used to ensure payment of all scheduled program benefits. A similar burden today would require nearly 80 percent of all Federal income tax revenues, which amounted to 11.7 percent of GDP in 2007.

"To put these magnitudes into historical perspective, in 2007 the combined annual cost of HI, SMI, and OASDI amounted to 38 percent of total Federal revenues, or about 7 percent of GDP. That cost (as a percentage of GDP) is projected to double by 2060, and then to increase further to nearly 17 percent of GDP in 2082. It is noteworthy that over the past four decades, the average amount of total Federal revenue as a percentage of GDP has been 18 percent, and has not exceeded 21 percent in a given year. Assuming the continued need to fund a wide range of other government functions, the projected growth in Social Security and Medicare costs would require that the total Federal revenue share of GDP increase to wholly unprecedented levels."

While the financial outlook for the Programs is bleak, the failure to address a potentially larger problem of addiction and alcoholism in the next generation to retire could have amplified consequences for everyone.

References

(1) Jointogether.org; "Addiction Among Seniors Called 'Hidden Epidemic'; News Summary, July 21, 2003.

(2) The New York Times; "Addicts of A Certain Age: Baby Boomers Need Help." March 6, 2008.

(3) CNN.Com; "Limbaugh admits addiction to pain medication"; Oct. 10, 2003.

(4) National Institute on Alcohol Abuse and Alcoholism. Alcohol Alert. Alcohol and Aging.

(5) Hughes, Mary Elizabeth; O'Rand, Angela; "The Lives and Times of the Baby Boomers", part of "The American People" series. http://www.aginghipsters.com/blog/archives/1/000346.php; 12/16/04.

(6) Actuarial Publications; "Status of the Social Security and Medicare Programs/Summary of the 2008 Annual Reports"; Social Security and Medicare Boards of Trustees; http://www.ssa.gov/OACT/TRSUM/trsummary.html

A Nursing Home at Christmas Time

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

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

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

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

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

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

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

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

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

California Registered Nurses With Out-of-State Disciplinary Records at Risk of License Revocation

A recent newspaper expos矇 of California-licensed nurses who have been disciplined for professional misconduct in other states has resulted in a California-wide effort to revoke all of those nurses' California licenses. So committed is California's Governor to this agenda, that he recently fired the head administrator and replaced all of the members of the Board of Registered Nursing. The new appointees have been given their marching orders, and more than 2,000 Registered Nurses are slated for license revocation on the basis of prior conduct in other states. It seems clear that Licensed Vocational Nurses will face similar issues soon.

Obviously, some nurses should not be practicing anywhere. But California apparently assumes that all nurses with license issues in other states should also be barred here. And nurses who are now on California's hit-list might assume that loss of their California licenses is inevitable. Neither of these assumptions is supported by logic or law.

License Discipline and Revocation in California

A nursing license-RN or LVN-once earned, is the property of the nurse. And, like any other property, such as real estate (think foreclosure) or money (think of fines imposed by courts), the nursing license cannot be taken away (revoked), even for a short time (suspension), and cannot be diminished or restricted in any way (probationary conditions) without two things: good cause and due process.

There is a vast body of law as to what constitutes good cause. But here's the take-away you need to remember: the mere fact that in the past some other state revoked or disciplined a nursing license issued by that state does not, by itself, constitute good cause for California to discipline a current California nursing license.

As for due process, that means that California cannot simply unilaterally revoke or discipline the license based on what State officials believe to be good cause. Instead, California must first notify the nurse of the State's intention to discipline or revoke the license. Then the State must offer the nurse an opportunity to deny that the license should be disciplined, and an opportunity to demonstrate why. The demonstration of why the license should not be disciplined takes place at an administrative hearing where the nurse's advocate can challenge all or any of the State's reasons and evidence in front of an impartial administrative law judge.

Also at the hearing, the nurse's advocate will introduce evidence that the nurse is competent and that there presently exists no reason to deny the right to practice nursing in California. The judge will give due consideration to the evidence put before him or her and issue (1) findings of fact that explain what evidence the judge finds credible, (2) conclusions of law that explain what laws the judge thinks apply to the case, and (3) a proposed decision. The proposed decision is then forwarded to the Board for action, and the nurse and the nurse's advocate can appear before the Board to argue in favor of or in opposition to the Administrative Law Judge's proposed decision.

Opportunities to Defeat Discipline at the Administrative Hearing

Anyone who is not familiar with the hearing process might not realize that the hearing offers many opportunities to the nurse to avoid or reduce the discipline against the license that is proposed by the State. For example, the records of prior discipline in another state may not be available. Or the out-of-state records may not meet the standards of admissible evidence set forth in the California Evidence Code (California law will apply at the hearing.) The discipline imposed by the prior state may have been based on conduct that is lawful in California. Many procedural defects may exist in the out-of-state disciplinary process.

Many more reasons exist for invalidating or reducing the State's claims. The out-of-state discipline may have occurred a number of years ago, and the nurse may have current relevant work experience that demonstrates that any previous performance problems have been addressed and resolved. The nurse may have evidence of further professional training since the time of the out-of-state discipline, or the nurse may have completed rehabilitation or received effective counseling. The nurse may be able to demonstrate a new maturity, significant changes based on life experiences (parenthood, military service, successful employment, religious enlightenment) and improvements in professional competence. Any similar facts would be compelling evidence where the State's only basis to discipline the nursing license is out-of-state prior misconduct.

These are only a few of the more obvious kinds of evidence that may be utilized to defend a nursing license in an administrative hearing. Countless others exist.

The Economics of Defending Against Discipline of the Nursing License

Some nurses (and other professional and occupational licensees) believe that they cannot "afford" to invoke the fair hearing process and defend their license against the State. But consider: what do you earn in a year from nursing? In two years? In three? A license revocation will prohibit re-application for a new license for at least three years and probably longer. You do the math: can you afford not to defend your right to earn your living?

How to Begin to Defend Against Discipline of a California Nursing License

The one certain way to lose your California nursing license on the basis of prior out-of-state professional discipline is to do nothing when you receive a notice of proposed action from the State of California. Do not let this happen to you!

Read the notice. It will give you a very short window of time in which to provide written notice of denial of the charges and your demand for hearing. Do not let this deadline pass! It is critical to submit your denial/demand before the time expires. Then, get a lawyer.

As the State will tell you, you are not required to have an attorney to defend against discipline of an occupational license, or to obtain one after the State has denied the application. But you should. The State will be represented by an experienced and specialized attorney. Because the coming R.N. cases will feature out-of-state records that may be subject to challenge on the basis of California evidentiary standards, these are not the kind of cases where it will be okay if the only party without an attorney is the nurse with everything to lose.

Your nursing license is your asset. It has value: real, quantifiable, actual value. Protect it by exercising of all of the legal rights it carries.

California may be at war with its dual- and multi-state licensed nurses, but you need not be one of the casualties.