Guilt, Sorrow and Pleasant Surprises in Nursing Homes

Do you remember the last time you visited your mother in that nursing home? You were worried because she was complaining about her next-door neighbour being too nosy and that kind of bothered her. You have talked to the director who said it was just a natural reaction of somebody who is yet getting accustomed to a new place.

You know your mother to be a very private person. She could be friendly but not to everybody. She is the discriminating type but far from being hostile. She doesn't dip her fingers into other people's affairs as she doesn't want them prying on hers. That is what worries you. She can't be happy in that nursing home.

Checking your calendar, you are surprised to discover it has been six months since you last visited her. You finally stopped making the vow to visit her every end of the month and resolved to do it the next day as it is a weekend. You have been too busy with work you even cannot properly be with your family as you work at home even on weekends. Tomorrow, the whole family will visit the nursing home.

On the way to the senior health care home, everybody is happily chattering and excited with the prospect of meeting your dear mom again. You couldn't wait to get there. The kids are so excited you had to admonish them as you enter the nursing home premises.

After going through the visitors' routine check you proceed to your mother's room passing through half-open doors with elderly people happily gossiping with their family although some barely participate. Growing old is such a mysteriously lonely phase. A few had no visitors at all and just stared blankly at the wall or to space through the window, not even noticing the manicured lawns and beautiful flowers blooming. Your heart skipped thinking of the months you haven't come to visit your mother. You are touched with guilt and a hint of sorrow.

You finally reach her room and got more worried not to find your mother there. Even the kids looked sad as they entered the room slowly wondering where their grandma was. Then you hear muffled laughter through the wall from the next room. As you passed by the slightly open door to ask about your mother's whereabouts, you see her excitedly chattering with her next-door neighbour who she said was "bothering" her. You tentatively knock at the door and your mother sees you. After a brief hello, you tell her that the family is waiting for her next door. But to your surprise, after a hint of pleasant surprise, she tells you to wait for her at her room. She just has a "little business" to finish.

Back in your mother's room it has been fifteen minutes but no grandma yet. You start to wonder if growing old and/or nursing homes will change you the same way.

Distracted Pedestrians at Higher Risk of Injury

Since the rise of the cell phone, distracted driving has been a huge area of concern. Attention is now turning to distracted pedestrians.

Pedestrian fatalities in the U.S. have increased for the first time in four years, focusing attention on the problems of pedestrians distracted by technology, including cell phones and iPods.

A recently published study in the online journal Injury Prevention found that pedestrians are at a higher risk of injury. Researchers found that the injury or death rate of pedestrians wearing headphones who are hit by moving vehicles has tripled in the United States since 2004 and 2005.

Just like drivers who can be distracted, pedestrians wearing headphones can be distracted and are at risk of getting hit by a car, truck, motorcyclist, bus, bicyclist or train.

Combing through data from 2004 through 2011, researchers identified 116 cases in which a pedestrian who was wearing headphones was killed or injured by a moving vehicle. 68% of the victims were male, and 67% were younger than 30. According to the study's lead author, Dr. Richard Lichenstein, the ages of the pedestrians killed mimic the demographic of users of MP3 players and iPods.

A phone app has even been developed to aid distracted pedestrians. Researchers at Dartmouth and the University of Bologna have developed a phone app for use by pedestrians who are talking on their cell phone. The Android app alerts the pedestrian if the system determines that an approaching vehicle is a threat to the pedestrian. Using a smartphone's camera, the app can detect cars moving 30 mph at more than 160 feet away. It alerts the distracted pedestrian via vibrations and auditory alerts.

Many state lawmakers are pushing legislation involving iPods and cell phones and how they affect traffic safety. In New York, a pending bill would ban the use of cell phones, iPods or other electronic devices while crossing streets. In Oregon, pending legislation would restrict bicyclists from using cell phone and music players. In Virginia, pending legislation would ban bicyclists from using a hand-held communication device.

California State Senator Joe Simitian is concerned that efforts to legislate against distraction outside the car could diminish the seriousness of laws designed to curb distracted driving. He believes there is a problem with distracted pedestrians, but the distracted driver poses a much greater hazard to the public, whereas distracted pedestrian poses a risk mainly to him or herself.

The Heartbreak of Elder Abuse Continues

I will continue to be amazed at the ludicrous actions of those in charge of protecting our citizens. This is the third installment of the blatant elder abuse case that my friend's mother, Dorothy, is a victim of. In this case, which is one of hundreds, if not thousands across the country, the judge decided to call for yet another conference to be held after listening to what seemed to be more lying and perjured testimony from the law guardian and healthcare manager, as relayed to me by witnesses who attended. An evaluation of Dorothy's health was requested from the current nursing home that she is incarcerated in.

This woman's health has spiraled down somewhat since she was forced into leaving her home of six decades. This was bound to happen after the law guardian made Dorothy move from one nursing home to a hospital to another nursing home within thirty days. It is ironic that in open court, one of the excuses submitted was that moving someone like her from place to place would be harmful to her mental and physical state. The "place" they were referring to was her daughter, Diane's, well-equipped home, where Dorothy has repeatedly stated she wants to go to if she is not allowed to stay in her own home. I must be clear that this is no indictment of any nursing home because they do serve a necessary and worthy function.

On the day of this latest hearing, Dorothy was not allowed to attend. Her law guardian failed to make arrangements to have her there. When Diane left several messages for the fourth party in this case, her mother's appointed attorney who is supposed to represent her, to ask her to make it happen, she did not get a timely response, so Diane called the nursing home. She was told by the social worker that the director of the nursing home stated, "It will not be safe for Dorothy to leave the nursing home." This woman went on to say that prior to being transported anywhere, Diane would need to be trained by the staff. A follow-up call to the correct department at the facility was made, where she was told it would take five to ten minutes. She was denied the right to have this done before the conference. Diane has been getting her Mom in and out of the car for a long time without incident, but suddenly she needed to be trained in how to do this. It was another blatant attempt to keep this elderly woman from having her own voice heard in the courtroom in front of a State Supreme Court judge who is responsible for this entire situation.

It must be noted that the following day, Dorothy's safety wasn't a concern for her to leave and go to a doctor appointment (not her own long-time physician) that is approximately the same distance as the court. While there was an original excuse that there were not enough funds to transport her, suddenly funding was not an issue. Dorothy and Diane are lied to on a consistent basis. I am not sharing anything that cannot be substantiated. The trail of evidence is pretty easy to follow, but the pompousness of the offending parties is such that it makes no difference to them.

There were several people who attended the latest conference to show support for Diane and her Mom. All of them appear to have gotten the same thing from the mockery of this judge's courtroom--that it is apparently legal to bleed the last of Dorothy's money out of her account while she waits dejectedly in a place that she did nothing to deserve to be put in. I can say this because the alternative to her own home would be to live in the home of Diane. The healthcare manager had sent a letter to the judge for the previous conference stating that the house met all of the standards needed to have someone handicapped live there safely. Dorothy, at age eighty-seven, has some knee problems that make it hard for her to walk, but she is able to do so pretty easily with the help of a walker. The renovation to the bathroom she would use all came out of Diane's own money.

According to sources, Dorothy's appointed attorney did little to fight to have her client at the hearing, nor fight to get her out of the nursing home. This entire alliance has given the appearance of some form of collusion, yet I am unable to state that with certainty until I receive more information. It does look like the "game" they play is to rant about things in the courtroom that are baseless, but once said, become part of the public record. It is yet another abuse of the legal system that has gone on unchecked by the judge handling this case. Until this latest hearing, he has consistently cut Diane off in most of her efforts to speak, but with this case gaining in national awareness amongst guardian abuse sites and more, he had no choice but to listen.

It must be noted that the main players in this abusive situation are all well-positioned. There are clear conflicts of interest; at least as viewed by most people. You have a law guardian who is the past vice president of one of the bar associations; a healthcare manager who sits on the boards of several groups who are supposed to protect the people who are being taken advantage of, and a judge who is a State Supreme Court justice. Their clout either intimidates or squashes all legitimate complaints against them. The appearance of wrongdoing is obvious to anyone who knows the about this case, including the people who have been at the hearings.

My life is about seeing everything from a higher perspective; one where I look at people from more of a soul basis. In addition, I am well aware of life lessons, both physically and on a more spiritual plateau. This causes me to see things in a different light than most. I will always try to give the benefit of the doubt to someone who makes poor judgments, improper decisions, or errors in attitude. The people involved in this guardian abuse case have given me reason to question much of what I have learned. It has happened gradually; first by thinking that all people are intrinsically good, then by looking at how greed can weaken the mind and erupt into having no commonsense. Had there been any, then the court would be able to see that there is only one truthfully loving child doing her best to make her mother's wishes be fulfilled.

I will leave you with the actual words from eighty-seven year old, Dorothy. She handwrote her plea to get out of the nursing home the night before the conference. There are several other letters written by her over the past two years, but Diane was always accused of dictating them. This one had an independent witness to validate that these words were not coerced or given to Dorothy in any way. Some of the letters are much more emotional in her pleading for release. As an aside, the healthcare manager, under oath, told the judge that Dorothy is acclimating well. The judge also assigned this woman and her company to handle Dorothy's healthcare. My efforts are to get all people to realize that there is a wreckless approach by many people who are designated to be helping, not hindering, our seniors and others who are incapacited in some manner. It does not mean they are incapable of making their own choices, nor that the loving members of their families cannot handle it.

9/18/11

To Whom it May Concern,

I want to go home more then [sic] anything else in the world. There is nothing wrong with me. Being home will make me the happiest person in the world. You never realize how precious your home is until you are not in it.

Please help me. I want to go home.

Sincerely,
Dorothy

The ABC's of Medicaid For the Elderly

Medicaid is one of the most complicated, confusing areas of the law, and I often think it is deliberately made so in order to keep people from qualifying or to discourage them from attempting to qualify. It is the government medical program for the poor.

Medicaid is often confused with Medicare, which is the federal government medical program for the elderly. Almost all senior citizens qualify for Medicare, so long as they have contributed to the system over their working lives. For those seniors who do not qualify, they have an opportunity to "buy into" the system by paying premiums set by the federal government. Benefits under Medicare are limited; thus, seniors may purchase "Medigap" or Medicare supplement insurance policies that pay benefits where Medicare leaves off.

Medicaid, on the other hand, is a joint program between the federal government and the states to provide medical care for the poor. As such, it is regulated first by Congress, then by state Legislatures. Those lawmakers have set the standards by which Americans and permanent residents (and only those classes of individuals, not "illegal aliens", to dispel a rumor) can qualify for government-paid medical care. While qualifications can vary from state to state, there are several concepts that apply across-the-board.

Although Medicaid has programs for poor people of all ages, my law practice concentrates on the elderly and those are the programs upon which I focus. Depending on the state, Medicaid can offer nursing home care and/or at-home care for seniors in need. Most people are aware of nursing home care programs, but at-home care programs, if they exist in your state, can offer a great alternative to nursing home care. New York, for example, offers nursing home care and also has an ambitious "community", or at-home, Medicaid program; Florida, on the other hand, offers nursing home care and leaves it to the individual counties to provide whatever type of at-home care they can afford.

The program most people are aware of is nursing home care, referred to in New York as "chronic care Medicaid" and referred to in Florida as "institutional care Medicaid". If a person becomes so infirm that they cannot perform certain Activities of Daily Living (ADLs), they are unsafe living at home, and they need medical assistance, they may need permanent nursing home care. Contrary to popular belief, Medicare (the program for seniors) does NOT pay for nursing home care; it only pays for limited "skilled nursing care", which often takes place in a nursing home with rehabilitation facilities. A good "Medigap" policy will pick up where Medicare leaves off, paying up to 100 days in full for skilled nursing care.

If a senior needs permanent nursing home care, however, they are either going to have to pay for it out of their own pocket, with long-term care insurance, or by qualifying for Medicaid. For those who can afford to pay for their own nursing home care, kudos to you. For those who own or are contemplating purchasing long-term care insurance policies, be a smart shopper: Those policies usually pay a set daily rate (a fraction of the full daily rate, especially over time) for nursing home care for a set period of time (usually only a couple of years), and frequently do not go into effect until the individual is in the nursing home for so many days. It is important to read those policies carefully and understand them

The last option, Medicaid, is for the poor or those who have modest assets. Whether an infirm senior citizen will qualify for Medicaid to pay for nursing home care depends on whether they did advance Medicaid planning or whether their current financial status immediately qualifies them. Sometimes an individual has to "spend down" some of their assets before they qualify, although there are certain ways in which some assets can be shielded.

If you or your loved one is interested in learning more about Medicaid and proper planning for future qualification, make an appointment to see an elder lawyer who can review your financial picture and devise a strategy to help you meet your future needs.

On Death and Dying - Ten Things You Need to Know About Hospice Care

Your family doctor and your neighbor have both suggested you call hospice for your ill loved one but you continue to be reluctant. You fear that accepting hospice is "giving up" and that your loved one will no longer receive state of the art medical care. This article will help you to sort through many of your spoken and unspoken concerns about hospice care.

1. Isn't hospice a place where people go? No, hospice is a service, not a place. Hospice brings care into your own home, be it a private residence, an assisted living facility or a nursing home. Most people want to and can stay at home but if your care becomes too complex to manage at home, hospices also provide short term inpatient care to control symptoms in a hospice unit, a hospital or a skilled nursing facility.

2. What does hospice provide? Hospice provides a lot of professional services. Hospices are mandated to provide both routine and after hours nursing visits. This means that the nurse will visit regularly, assess for changes and arrange for medicines and medical supplies as they are needed. She/he will put emergency medications and oxygen in your home in advance of a crisis. The nurse will spend a great deal of time answering your questions and preparing you for what comes next. Where in the past, you brought your ill loved one to the doctor's office or to the emergency room, now the services will come to you. Should you need help or direction on a Saturday or Sunday, a nurse will visit. You are no longer alone; help is just a phone call away. Other services that the hospice provides include an aide to help with bathing, counselors to help meet emotional needs and volunteers. Some hospices provide physician visits. Some hospices even provide music therapy, massage therapy, aroma therapy, pet therapy and art therapy.

3. When do you qualify for hospice care? Unfortunately most people get hospice care too late, in the final days or weeks of life. They qualify for it as much as six months earlier. Getting hospice care earlier reduces the family's stress, avoids burnout and guarantees an improved quality of life. It keeps the patient well, which allows for special moments and memories to be shared. It affords both you and your loved one the opportunity to say "thank you" and "good bye."

4. Don't most people die at home? While is true that 90% of Americans want to die at home, in actuality, very few do. Currently, 75-80% of Americans die in facilities (hospitals and nursing homes) and less than 25% of them die at home. In contrast, hospice patients almost always get their wish to die at home as their families are well prepared and supported to care for them at home. Hospice patients rarely die in the hospital.

5. Can hospice patients die in a hospital? Of course. If they choose to die in the hospital, the patient will need to be discharged from the hospice, a simple matter of signing a paper.

6. Will entering a hospice make you die sooner? There is a great deal of unfounded concern about the use of medications like Morphine and the fear that its use will shorten life. There are several studies that show that Morphine eases pain but does not shorten life even in the most debilitated and ill patients. Another unfounded fear is that someone will die sooner if they find out that they are terminally ill. Family members sometimes insist that no one mention the word "hospice" to their loved one out of fear that their loved one will give up on life. The reality is, being ill and in failing health is a lonely experience. Most patients know on some level how ill they are. Many want to talk about it and put plans in place. Sometimes they don't bring it up because they see how painful it is for you and they are trying to protect you. This conspiracy of silence robs both parties of opportunities. Many patients want to ask questions about what will happen to them. They look for reassurance that their symptoms will be controlled and that they will remain in control and comfortable. You also may want to ask them questions. Questions about their funeral and how they want issues handled after their death.

7. Do patients admitted to hospice ever improve? Yes, some patients admitted to hospice actually improve and in time, they are discharged from hospice. This makes sense that when you improve someone's pain and ease their loneliness, they will eat and sleep better and regain some health.

8. Will hospice make me give up treatments that are currently benefiting me? You don't have to give up treatments or medications that are benefiting you. The hospice focus is on quality of life. Medications that promote quality of life are usually covered by the hospice. If you find a new treatment that may prolong your life (but not improve your quality of life), you can sign off the hospice benefit and return at a later date.

9. Is hospice care expensive? Hospice care is covered by most insurance. Medicare and most Medicaid insurances cover hospice care at 100%. Many private insurances have modeled themselves after these federal and state programs and also cover hospice care at 100%.

10. Hospice care is a necessary service that many people never receive.

Sometimes it is never offered and other times, the patient or family is reluctant to accept hospice care. Most families who did receive hospice care say that they could have benefited from hospice much earlier. Ask you doctor about hospice care. If your doctor is not sure that you qualify, most hospices will send a nurse to the home to evaluate your appropriateness for hospice. Don't allow your fear to prevent you from getting the help that you need.

How to Assess a Senior Adult's Independent Living Ability - Part 1 of 3

As they age, people may have more difficulty performing the daily tasks we all do in order to live. To be able to assess a person's ability, or rather, where there is difficulty so changes, accommodations, or adaptations can be made, requires the assessor to be able to look at the details or steps it takes to do each task.

For instance, it usually will require 40 or more steps to actually brush your teeth. If you miss some steps, it is no big deal but some steps if missed, can have serious consequences. Most people will create their own adaptations or accommodations to problems they are having. Like not being able to see well at night, they do all of their appointments and errands during the day - thus no problem in continuing to live independently but there is actually a problem. Most accommodations and adaptations can be made easily and inexpensively and creativity goes a long way. Many catalogs now, cost effectively, offer products that can help an elderly person continue to function independently.

To assess a person's independent living skills, you will need to record your findings and then, several months later, go back and do it again to see if there has been a change. It is important too that your aging parent or senior adult is honest in what they report to you and/or you see or they demonstrate how they do a particular activity. Please you good judgment and good communication skills in how you approach doing an assessment.

Activities of Daily Living Guide/List

• Laundry:

• Flooring/carpeting clean, how often done:

• Counter tops clean in kitchen and bathrooms? How often, with what?

• Are the sinks, drains, shower/tub and toilets clean? How often, equipment used and cleaner? Check the back top of the toilet and around the base (for urine especially), look at the faucets and spouts (many times toothpaste and soap scum accumulate there and may not get cleaned).

• Closets, drawers and cabinet organized or has it changed?

• How often are dishes done, cleanliness and with what?

• Any maintenance needs to be done and if so, how long has it been in its current state?

• Is anything missing from the house?

• Trash containers clean, emptied or overflowing?

• Magazines/newspapers - organized or piled up, a fire hazard? Can the person get them outside for trash?

• Are devices such as walker/wheel chair/scooter/cane clean? How often? Repair needed?

• Overall bathing? Cleanliness? Safety in doing it?

• Oral care? Cleanliness? Are dentures/plates worn?

• Toilet? How often are hands washed throughout the day? Are they washed such as after going to the bathroom, touching raw meat, cleaning the litter box, etc.?

• Are finger nails and toe nails cut and clean? Any signs of infection in the toes?

• Is shaving done regularly (male and female), well and safely?

• Urinary incontinence (bladder control)? Are they up several times a night? Are there loose bowel movements or uncontrollable ones? Constipation, or urinary or yeast infections?

• Any skin redness or problems? Hair care & maintenance: Does the person continue to put on deodorant, perfume, shaving cologne, make-up, etc.?

• Are eyeglasses (or contact lenses) worn as prescribed, kept clean? Are regular eye appointments made and kept? Are eye drops taken as prescribed?

• Is clothing appropriate, clean, fit correctly, neatness, no rips/buttons missing or stains/holes?

• Do shoes fit properly, in good condition, comfortable, easy to put on/off and clean? Are weather appropriate coats/shoes available, do they fit, are they in good condition and clean?

• Is the pocket book or wallet a mess, too heavy, in need of cleaning, or need to be replaced?

• Is the person able to list out the pros and cons or options of the decision they are trying to make? Do they need a little or a lot of help, do they even want help, do they ask for help and if so, in what areas usually? What areas do family members see that there are problems in or with what decisions were made?

• Are appointments made when needed, are they kept, and are recommendations followed? Is the person sleeping through the night, if not, how often are they waking up & why?

• How many hours do they sleep at night? What time do they usually go to bed and get up?

• Are they taking naps during the day? If so, how often and for how long? Where do they take their naps - in bed, in the chair sitting up, in a recliner? Is there any particular task that makes taking a nap necessary?

• Even after a good night's sleep, are they still tired?

• How much energy does the person have - slight decline or more of decline than anticipated?

• How many typical daily tasks can the person do before they are winded or tired and have to sit down or take a nap?

• How is the person's ability to use utensils properly and safely? Are they messy, cutting pieces too large, eating with fingers, is food coming out of their mouth?

You will want to add this list to Parts 2 & 3, in order to have a complete ADL assessment tool to use.

Asking the right questions, listening, observation and trying different ways of doing things, while having meaningful conversations with your elderly parent, is key to really getting an accurate picture how well a person is functioning in their home.

If you have concerns or questions, there are several agencies who provide information - such as Elder Care, Senior Caregiving and The Practical Expert (which is the only certified coach specialist on aging parent issues & trained in home assessment and accommodations). Getting some assistance, can save you time, energy and help with making the assessment process smoother and more thorough and thus getting the information you need easier.

Marketing to Senior Citizens - Assume Nothing!

Once upon a time, senior citizens were old people. They were assumed to be suffering from ill health and in need of care. They sold their homes so they could move in with children or move to a care facility. Not any more.

Now senior citizens exhibit the same variety of health and fitness as people much younger. In fact, those who have actively taken care of themselves are probably more fit than those in their teens and 20's who shun exercise and live on junk food.

So, assume nothing, because senior citizens come in many varieties, with many different goals.

Many choose to remain in their homes, while others want a change of scenery. But even those want to sell have different reasons.

Some want to get away from excessive maintenance chores. They'll choose a smaller home with a smaller yard - or perhaps a condo. They may be in failing health, but don't assume so. They may just want to pursue hobbies or take up volunteer work or be free to travel. Many have something they want to do that they couldn't do before, and they don't want to be tied down by a high maintenance home.

Others want to find a new home with a large yard, or even acreage, so they can take up gardening or buy a horse or raise dogs.

Some just want to get away! They'll sell the old homestead and move into a motor home so they can see the places they've been dreaming about for all those years when they were tied to work.

Some want to move to a more temperate climate - they're tired of the cold and snow and want to get outdoors and play all year. Some have always dreamed of living on a lake or in the mountains or on the desert. Some wanted to get away to a small town with a slower pace - or to move to a city with opera houses and art galleries and the theater. But until now, they were stuck because they were afraid to move away from their work. Now they can go where they want.

Of course, there still are those seniors who are selling because they do need to move in with the kids or to an assisted living facility.

Your job as an agent is to not assume anything. If you want to sort your lists, set up a capture on your website with information about downsizing to a smaller home, and a separate capture with information about transitioning to assisted living. You could even have different pages on your site - just like you might have different pages and different information for first time buyers and move-up buyers.

When you get a call to list a home for a senior citizen, go with no pre-set ideas. Wait and talk to the homeowner before you try to anticipate just what kind of assistance they need. Otherwise, you'll risk alienating a new client before you get a chance to show your stuff!

Increase In-House Nursing Homes Collections

The following nursing home collections report outlines 11 guidelines you can follow to increase the amount of in-house long term care collections your facility collects.

1] Have A Defined Long Term Care Collection Policy

One of the major causes of delinquent nursing home receivables is that the facility has not clearly defined to its residents/responsible parties and business office staff when the accounts are to be paid. If you are currently 'playing-it-by-ear', and have no consistent guidelines for your business office to follow - you are inviting bad debt. These guidelines should be made clear to both your business office and admissions staff. If you consistently apply your collection policy to every nursing home account, you will enjoy a large decrease in delinquent accounts.

2] Educate Residents/Responsible Parties On Your Policy Before Admission

If residents/responsible parties are not educated that their nursing home accounts need to be paid on time - then chances are they'll pay late or sometimes not at all. Make it crystal clear what day of the month that you bill, and when their payment is expected. Let them know the consequences of non-payment up front - not after they become delinquent. This eliminates potential future misunderstandings from your residents/responsible parties. Statement of your payment policy when payment is overdue is a strong first step in facilitating payment.

3] Invoice Promptly and Bill Regularly

If you don't have a systematic invoicing and billing system - get one. Many times the resident/ responsible party hasn't been re-billed or reminded to pay in a timely manner. This situation regularly occurs in homes where there isn't enough billing staff in your business office, or the staff is spread to thin to invoice or bill on a timely basis. It is amazing how much money is often left uncollected because the resident/ responsible party was never billed or contacted a second time.

4] Keep Accurate And Timely Payment Records

Once a resident is admitted, it is vitally important to maintain accurate and timely records on their payment history. If you see any deviation from past payment patterns, and especially if payments become unusually slow, immediate follow-up is warranted. This not only gives you an early alert to impending payment problems, it also gives you the chance for early intervention if there is an outside influence (i.e. responsible party withholding payment, etc...)

5] Contact Past Due Accounts More Frequently

There is no law prohibiting you from contacting a resident/responsible party more than a month. The old adage 'The squeaky wheel gets the oil' has a great deal of merit when it comes to collecting delinquent accounts. It is an excellent idea to contact late payers every 14 days. Doing so will enable you to diplomatically remind the resident/responsible party about your terms of payment and give you more chances to discover the real reason why they are late.

6] Develop A Systematic Plan To Follow Up On Past Due Accounts

Determine ahead of time what actions you will take and a defined time frame when the actions will take place. For example, at 15 days delinquent - make a phone call. Your business office can start with a 'courtesy' call to make sure the statement was received. At 30 days delinquent - send another statement with a message, "This balance is 30 days delinquent, please remit immediately." At 45 days your business office can call and make a stronger demand for payment. Having a plan and adhering to it makes both you and your residents/ responsible parties aware of the fact you expect to be paid on a timely basis.

7] Use Your Aging Report - Not Your "Feelings"

Many well meaning business offices have let an nursing home account age beyond the point of ever being collected because they 'felt' that the resident/responsible party would eventually pay. While there certainly are a few isolated cases of unusual payment situations, the truth is that if you aren't being paid, usually someone else is. So stick to your systematic plan of follow up. You'll soon know who intends to really pay and who does not. You can then take appropriate measures once you know where you stand.

8] Make Sure Your Business Office Is Trained

Even experienced business office members can sometimes become jaded when dealing with debtors. This usually occurs when the residents or responsible parties: have made and broken promises for payment, did not file information at the county office, avoided your attempts to make contact, moved with no forwarding address, or just flat out declared they have no intention of paying. Make sure your business office is firm yet courteous when dealing with the residents/responsible parties. Your business office could benefit from customer service training because they must 'sell' the residents/responsible parties on the idea that you expect to be paid. Make sure your business office is trained to not only bring the nursing home account current, but to also maintain good will with your residents/responsible parties.

9] Admit And Correct Any Mistakes On Your Part

Sometimes residents/responsible parties do not pay because they feel you have made a mistake. If the basis of the non-payment is a dispute over the quality of care, a mutually agreeable settlement between you and the resident/responsible party should be arrived at promptly. The resident/responsible party may use a minor dispute to withhold substantial payment. Insist that the undisputed portion get paid immediately, indicating the balance will be negotiated. This will not only help to collect payment payment, it shows the resident/responsible party that you are listening to his or her concerns.

10] Use Third Party Nursing Home Collections Intervention Sooner

If you have systematically pursued your delinquent nursing home accounts for 60 to 90 days from the due date, and they still have not paid, you are being delivered a message from your resident/responsible party. If you have implemented a good collections policy, you have requested payment four to six times in the form of statements, letters, phone calls and possibly personal visits. Statistics show that after 90 days, the effect of in-house collection efforts wear of 80%". That means that the time and resources of your business office should be focused within the first 90 days of delinquency where you have the best chance to collect the delinquent nursing home balances. From that point on, a third party can motivate a resident/responsible party to pay in ways you cannot, because of both the perceived and real consequences of dealing with a collection agency or attorney.

11] Remember That Nobody Collects Every Account

Even by setting up and adhering to a specific long term care collection plan, there are always some accounts that will never bee collected. By identifying these nursing home accounts early your billing staff a great deal of time and money. Even though a few may slip by, you will find that the overall number of slow pay and nonpaying accounts will greatly diminish, and that's a victory in itself!

Education Specialist Degree Online

According to the United States Department of Education, 92 million adults took part in some type of formal education to accommodate new job requirements, earn an advanced degree, keep their skills current or simply to attain a higher education. The education specialist degree program is intended for teachers, supervisors, administrators and counselors in elementary and secondary schools. This degree program offers specialization for teachers who have completed their master's degree, along with in-depth opportunities for enhanced professional growth.

The minimum educational requirement to pursue an education specialist degree is 60 hours of graduate credit, which might include a master's degree. A candidate for the program should have a minimum 3.0 grade point average on their previous graduate work. Furthermore, many educational specialist programs require at least three years of successful teaching in the field, standardized test scores, writing samples and recommendations. Since a specialist level teacher is considered an instructional leader, the education specialist degree program builds upon the teacher's prior education and professional experiences to accomplish this. The specialist program ensures that a teacher who completes the course is particularly knowledgeable about current theory and practice in education.

Specific areas of study can be pursued within the education specialist degree program. Such areas of include curriculum and instruction, administration and counseling.

Curriculum and instruction: Teachers pursuing an education specialist degree with a concentration in curriculum and instruction are involved with the teaching, supervision and curriculum of discipline-centered areas of study.

Administration: Those educators seeking an education specialist degree with a concentration in administration can seek licenses for advanced administrative positions within public and private schools, such as building administrator, administrative specialist, vocational director and district administrator.

Counseling: Teachers taking the education specialist degree program with a concentration in counseling have the opportunity for advanced training and study in specialized areas of interest, such as individual, group or family clinical counseling.

Specializations within each of the three segments of the education specialist degree include literature, art, English, foreign language, science, social education, mathematics and special education. The education specialist degree program encompasses 30 semester hours.

An education specialist degree is intended to develop proficiency and professional among teachers already in service. By earning an education specialist degree online, working teachers are afforded the flexibility to attend classes around their own schedule. Online education makes it easier for teachers to pursue higher education while keeping their current positions and maintaining tenure. Thus, attending an education specialist degree program online enables teachers to remain in the classroom with students while they learn how to enhance the educational experience. Teachers who attain an education specialist degree are useful in imparting leadership skills to other teachers, administrators, colleagues and students. Many such teachers implement school improvement plans, developing and using unique teaching practices right in their own classroom.

So are the longterm benefits of pursuing an education specialist degree online worth balancing time between earning and learning? The U.S. Department of Labor, Career Guide to Industries, 2006-07 Edition states that 1 in 4 Americans are enrolled in educational institutions; this makes the educational services the second largest industry in America. About 13 million jobs exist in education services today and most of them require at least a bachelor's degree. The Guide further offers that, "Wage and salary employment growth of 17 percent is expected in the educational services industry over the 2004-14 period, higher than the 14 percent increase projected for all industries combined. The number of teachers retiring is expected to remain a record high over the 2004-2014 period, so there may be a lack of students graduating with education degrees to meet this growing industry's needs. This makes job opportunities for graduates in many education fields good to excellent."

Education remains an important part of life and school attendance is compulsory the United States, so there are numerous educational establishments to teach at. As technology expands and the economy changes, there will be an increased need for skilled teachers with an innovative approach to dynamic classroom situations. People holding an education specialist degree will have increased opportunities to advance into positions as administrators, specialized counselors or even assist in developing cutting edge curriculum for students. In a Report released in July 2006, The U.S. Department of Labor reveals that school districts report difficulties in recruiting qualified administrators and teachers, especially in urban and rural areas.

According to the Distance Education and Training Council, over 4 million students are enrolled in online universities and schools and that number is growing by 30 percent each year. The convenience of pursuing an education specialist degree online enables teachers to learn while they earn, as well implement the skills they attain in their own classrooms as they go. Thus, education specialist degree online programs are beneficial to both teachers and their students.

Reduce Hospital Re-Admissions by Discharging to Better Nursing Homes

A common cause of hospital readmission is urinary tract infection (UTI) associated with catheter placement. This is especially true in the elderly and stroke populations discharged to nursing homes.

The belief is that a hospital treats a patient, sends her back to the nursing home from which she came, only for that nursing home to leave her catheter in too long which subsequently causes a UTI and associated symptoms such as "dizziness and giddiness" that look like they could be stroke related. Thus, the patient is admitted to the hospital, treated and the cycle continues.

Meanwhile, the hospital is unable to cover the cost of the admissions for various reasons: failure to document "present on admission," too many resources were used to diagnose the problem and rule out a stroke, the patient didn't meet admission criteria or payment for the billing DRG simply was less than the cost of the admission.

You can prevent these admissions quite simply by knowing more about the nursing homes to which you're discharging patients. We recommend looking at two pieces of quality information and sharing with families when choosing a nursing home:

1. Percent of long-stay residents who have/had a catheter inserted and left in their bladder (the national average is 5%)
2. Percent of long stay patients who had a UTI (the national average is 9%)

A quick search on nursing homes in the Detroit area yielded surprising results. We found one home in Taylor, MI where 20% of long stay patients had a UTI. That's 11% above the national average! One might find that hospitals in that area discharging to this nursing home have higher than average readmission rates and are losing needless amounts of money.

If that is the case, these hospitals should quickly implement a procedure to present these simple pieces of information to families as they are making long term care choices. Armed with the right information, families can find better care for their loved ones and help you improve your bottom line.

Using Skype Creatively to Stay Connected

For many, Skype is more than an opportunity to video chat. It's an opportunity to bring those most special to us into the rhythms of our daily life. Here are some creative ways people are using Skype to connect.

Using Skype to Connect With Children:

Show and Tell - scan the camera to different parts of your home, showing your collections or gifts and drawings sent by them; aim your camera outside the window to show your view?

Play games - e.g. Simon Says or children's board games such as Candyland, etc.

Sing songs together - use a children's?CD or be brave and sing without?

Use puppets to entertain?

Read a book together - send the book in advance?

Celebrate birthdays - arrange for cake in both places and choose games can do over Skype

Use flash cards - see how many the child can answer?

Draw or paint together?

Do science projects - e.g. plant a seed and watch it grow??

Using Skype to Connect With Teens or Adults:

Facilitate a family book club

Organize a family fantasy sports league

Cook together - send recipe in advance, buy ingredients and make dish simultaneously

Play board games - e.g. chess, checkers

Conduct a regular family teleconference with extended family - e.g., aunts, uncles, nieces, nephews etc.

Have a baby or wedding shower - eat together and watch new bride or mom open gifts sent in advance

Eat holiday meals together

Continue the rhythm of daily life - keep camera on while go about daily life. ?Until a family could be reunited with a parent who was transferred to another part of the country, each left their Skype connection open. They ate dinner at the same time and each then went about their normal routine knowing the other was on the other end of the line.??

With seniors in assisted living or with dementia - Use Skype to connect with?those in assisted living who often have difficulty talking on the phone.? Many assisted living facilities are discovering the value of Skype and now offer it.

There are numerous ways others?are using Skype to stay connected. But whatever way people use to help make the connection, it's the connection that's valued. ?Said one user, "I record the sessions just to listen to family members when I'm alone."?????

Why Granny Flats Are Better Than a Nursing Home

There comes a time in our lives when we have to think about things like retirement and nest eggs. While being old slows us down, it shouldn't stop us from continuing to enjoy our lives, long after we've hung up our working gloves. If anything, this should be a time when we begin to enjoy ourselves, including the fruits of a lifetime of hard work.

Many of those approaching retirement age first consider a place to live. These days, nursing homes or special care homes are not the only alternatives a senior citizen has when they decide to move out of their family homes, which may have grown too big or proven to become a little unmanageable. Granny flats, also known as "mother-in-law-apartments," "granny suites" or "accessory apartments" are fast becoming a more appealing prospect for senior citizens who would rather use their hard-earned money traveling abroad.

A granny flat is a separate dwelling unit built on properties that are normally for one dwelling unit only and has its own entrance, living area, kitchen and bathroom. It is usually built over a rear detached garage, above or below the main floor of a single-detached dwelling, attached to a single-detached dwelling at grade or detached from the principal dwelling, very much like a guesthouse.

For senior citizens and their families who've found nursing homes too impersonal and expensive, for sons and daughters who've found they really can't bear to have Mom living so far away, the granny flat is the best option. Not only will it keep your family together, but your elderly relatives will also be able to enjoy a sense of privacy and independence that they are loath to lose. They, as well are assured that they have someone close by they can turn to for emergencies like driving to and from the doctor's office for check-ups or grocery shopping.

For the families of senior citizens, another reason why granny flats are better than nursing homes is the fact that energy bills are considerately lower since this occupies a smaller space. One of the main reasons senior citizens are forced to move out of their family homes is because they can no longer manage the bills that large houses incur.

Granny flats can also be built according to your personal preferences. With many home designs available ranging from single to five bedrooms, you will surely find a granny flat that will suit you and your elderly parents' requirements. Going online will yield a lot of the information you need, as well as the laws and regulations concerning the construction of granny flats in your area. Take note that there may be some council areas that prohibit construction due to zoning laws so again, the importance of doing research is being stressed to avoid any future complications.

But the biggest benefit of granny flats for most people is that it can also be a great investment. When you do your research and plan everything right, not only will you be able to have your elderly parents close, you will also be able to manage your finances more effectively. Thanks to the SEPP (State Environmental Planning Policy) you will be able to build granny flats on your property and rent it out for increased yield and good depreciation benefits. They could also help you significantly if you are struggling with loan repayments on your property.

The Seven Primary Types of Personal Injury Cases

There are at least seven primary types of personal injury cases, as follows:

1. Intentional Torts. A tort is a civil wrongdoing. Intentional torts include intentional acts which result in personal injury to a victim. Common examples of intentional torts include battery and assault. The victim of an intentional tort has a legal cause of action against the at-fault party who committed the intentional tort.

2. General Negligence. Negligence is also a tort. However, unlike intentional torts, negligence occurs when a person or entity causes an accident by failing to act reasonably under the circumstances, despite whether they intentionally caused an accident. This broad category of torts includes many specific subcategories and consists of the vast majority of legal claims made by personal injury victims, such as car accidents.

3. Car accidents. Car accidents generally involve a claim for the tort of negligence. That said, this subcategory of negligence is unique in that the federal government and most states have enacted special statutes governing drivers, vehicles, and car insurance. Said statutes create so many unique legal issues that car accident litigation is generally considered a unique subcategory of personal injury claims.

4. Premises liability. Premises liability laws cover the duty of a landowner, landlord, tenant, property manager, and similar entities to persons on the property. Landowners owe persons on the property unique duties dependent upon whether the person is an invitee, licensee, or trespasser. Again, while the vast majority of premises liability cases involve the general tort of negligence, these unique legal issues in premises liability cases are such that this area of the law is generally considered a separate subcategory of personal injury claims.

5. Professional malpractice. Professional malpractice is another specific type of negligence claim involving the negligent acts of a professional, such as a doctor or lawyer. Most states have enacted special statutes applicable only to professional malpractice claims. This specific area a negligence is again, a separate subcategory of personal injury claims.

6. Product liability. Product liability involves the duty of product manufacturers, distributors, and retailers to product purchasers and users. While many product liability claims involve negligence claims, they also usually involve claims specific to this area of the law, such as strict liability and failure to warn. Again, this is a unique subcategory of personal injury claims.

7. Wrongful death. Each state has enacted wrongful death statutes governing the claims that can be made and the damages which can be recovered when a tort causes a victim's death. A wrongful death claim can be made in conjunction with any of the foregoing categories and subcategories of torts; however, the uniqueness of these claims warrants a separate subcategory of personal injury claims.

While there are many other types and subtypes, the foregoing are at least seven of the primary types of personal injury cases.

Nursing Home Doctors Should Heed Drug Warning

Reglan is a brand name of the generic drug metoclopramide and has some serious side effects that can cause permanent damage. Reglan is used to treat gastroesophageal reflux disease (GERD) and as a prokinetic drug to improve gastric motility of a gut that has digestive impairment due to nerve damage. With its effect on dopamine receptors, Reglan is also prescribed as an anti-nausea drug after some surgeries or prior to some procedures. As with many other drugs it is intended for short-term use as labeled for 4-12 weeks. However, many patients have been prescribed the drug for much longer periods of time.

The serious side effects of Reglan cause what is known as Tardive Dyskinesia which is involuntary muscle movements that can debilitate a person who takes it. Not all patients prescribed Reglan suffer from the more serious side effects, and some do fully recover after discontinuing use of the drug. However, for some patients who have been prescribed Reglan the involuntary muscle movements that are a serious neurological disorder do not go away.

The involuntary muscle movements of Tardive dyskinesia may be exacerbated in those who are diagnosed with Parkinson's disease. Facial grimacing movements, rapid eye blinking, uncontrolled movements of the tongue, lips or jaw, uncontrolled finger, hand and arm movements are some of the side effects, and they can even involve the arms, shoulder, trunk of the body and legs.

If the muscle movements did not exist prior to taking Reglan, and if there is no other definitive cause, Reglan should be suspected. For some patients the neurological condition will not go away due to there not being any effective methods of treatment for Tardive Dyskinesia thus making their condition permanent.

It has been found that physicians have had a tendency to over prescribe Reglan when other drugs that are known to produce less serious side effects could have been used. In the U.S. there is no other drug available that is as effective as prokinetic for nerve-damaged gastric systems thus Reglan is the sole drug for this prescribed use. However, it has been found that physicians do not explain the potential serious side effects of Reglan before prescribing it, and with the condition of Tardive Dyskinesia being irreversible this is an issue.

Seniors in nursing homes are at more risk for the overuse of Reglan to treat symptoms. As well, seniors with varying levels of dementia are not able to understand the risks of the drug or may not be in a position to say no to treatment with the drug. With the possibility of adding the serious neurological disorder of Tardive Dyskinesia to senior patients in nursing homes who obviously already have a long list of health issues, it is of major concern to get physicians to quit over prescribing a drug known to have serious side effects.

Cases of patients suffering permanent serious side effects of Reglan use are now under review with attorneys all over the U.S. Law firms all over the U.S. are open to representing clients who believe they have suffered irreversible neurological symptoms due to taking the prescription drug Reglan or the generic metoclopramide.

Common Tricks Insurance Companies Play Claiming Pre-Existing Injuries

One common trick played by insurance companies is to claim that a personal injury victim's injuries were "pre-existing" and therefore, their insured is not responsible for any damages. In truth, there are seldom any true cases involving "pre-existing injuries" when that term is given its plain and ordinary meaning.

A true "pre-existing injury" is one that already exists and was not affected by a new occurrence. Thus, if I already had a fractured leg and was involved in a serious car accident, my lawyer could not claim the fractured leg was caused in the car accident. This is so obvious that it almost never occurs.

Rather, consumers need to understand that simply because they have a past injury it does NOT prevent them from retaining a personal injury lawyer and filing a claim for a personal injury. In fact, it is their right to do so.

Every first year law student learns about the "eggshell plaintiff doctrine" in his or her Torts class. The law recognizes that a pre-existing injury could make you more likely to suffer from an additional injury, even from a relatively mild collision. By law, the victim of an automobile collision must be accepted in the condition they were at the time of the collision. This means the person or people responsible for an automobile collision are fully liable for all injuries sustained by the victim, no matter how unforeseeable such injuries might be. Car accident attorneys refer to this as the "Eggshell Plaintiff" or "Eggshell Skull" principle, based on the idea that a theoretical victim's condition may be so fragile that the slightest contact caused substantial injury to the victim. This concept applies to mental as well as physical injuries such as considering impact of an assault on Vietnam veteran's post-traumatic stress syndrome.

Thus, consumers should know that insurance companies are fully liable for their insured's negligence that causes an aggravation or exacerbation of a pre-existing injury.

Also, the Eggshell Plaintiff principle only pertains to the damages a personal injury victim may recover. The Eggshell Plaintiff principle does not affect the standards for liability when determining fault for the automobile accident.

It is important for your injury attorney to understand your complete medical history to overcome these tricks played by the insurance companies and accurately present your case. Otherwise, insurance company defense lawyers will attempt to distort the record, distort the truth, and avoid taking responsibility for the injuries caused by their clients.

Pharmacy Technician Job Description

To put it simply, a pharmacy technician job description consists of receiving and filling prescription requests for patients. These requests can come directly from the patient, nurses, physicians or hospitals, and must be carried out under the supervision of licensed pharmacists.

Prescription preparation can take the form of several tasks, including:

-Retrieving prescription orders
-Counting, measuring, mixing and weighing medications
-Making sure the correct prescription container is chosen
-Creating prescription labels

After having filled the prescription, a technician must price and file the medication. The licensed pharmacist, who supervises pharmacy technicians, then checks the prescription before a patient is able to receive it.

Other Responsibilities

Apart from preparing prescriptions, technicians may also need to look after the pharmacy itself, including interactions with patients and hospitals. Some of the other duties one can expect to perform may include:

-Preparing insurance claim forms
-Keeping patient profiles up-to-date
-Answering the phone
-Undertaking cash register transactions
-Keeping up-to-date with the latest medicines and their availability
-Inventorying over-the-counter medications
-Measuring liquid medicines
-Verifying prescriptions

Duties may also include advising patients on health and diet requirements. Therefore, the majority of employers require pharmacy technicians to gain this knowledge through certification.

Working Environment

Pharmacy techs work in organized, clean environments, and spend much of their working day on their feet. They can work in a range of facilities, including:

-Pharmacies
-Hospitals
-Nursing Homes
-Health & Personal Care Stores
-Retail or Mail-Order Pharmacies
-Assisted Living Facilities

While those working in this field typically work a standard 9-5, working on weekends or evenings may also be required, although this depends on the environment worked in and what is demanded from the employer. Pharmacy techs can also work part-time or full-time, again depending on the employer.

Other Skills

There are a few traits that aspiring technicians should possess. While possessing all of the following traits is not a requirement to work in the field, they are useful to have as it maximises the chances of job being found as soon as possible.

Customer Service

As a pharmacy technician spends much of his day interacting with other people, he or she must be able to provide a high level of customer service. One should be able to give his full attention to people and should be able to understand and take on board the points and opinions made by patients.

Communication

Being able to communicate effectively is an important trait to possess, as technicians must interact with colleagues and patients on a daily basis. Therefore, the ability to convey the information patients/colleagues need to know in an easy to understand manner is needed.

Reading Skills

As the job is focused on preparing prescriptions, a person must be able to easily read doctor's handwriting - which as we all know - can be very difficult for the majority of the population.

Math Skills

While an advanced understanding of math is not required, a basic understanding of solving math problems is. However, this can vary by employer, therefore, solving math problems is not always part of a pharmacy technician job description.

A Review of the Best Rated Assisted Living Homes

There are a handful of assisted living homes in each state but some stand out than others because of their excellent services and impeccable facilities. Reading nursing home reviews and client feedbacks of different retirement homes can help other potential clients choose the best assisted living home for them or for a loved one going on retirement.

Senior homes can have multiple services that range from independent living, assisted care for seniors to the more comprehensive medical programs for persons who are ill with Alzheimer's, Parkinson's or any medical condition. Choosing the best facility is very vital and the needs loved ones should be the primary concern. There is no better way to give a retiree the comfort and caring he deserves than a superior facility that is devoted to achieving great customer satisfaction.

Before making a choice of the most appropriate senior facility for your family member, it is best to do an extensive research of the candidate facilities to pick the right choice. The easiest and most convenient way to do this is online where nursing home reviews and customer feedback about retirement facilities are available in many websites, as well as contact information and virtual tours for those who want to assess the spaces and design of the apartments or rooms.

Below are some nursing home reviews of the top rated facilities in the country.

• The Hearth Castle Gardens in Vestal, NY - this senior home offers assisted living care for seniors and at the same time offers Alzheimer's and Dementia care. The program for assisted living offers independence for active retirees minus the hassle of maintaining a home. The facility also offers comprehensive personal care for patients who need more support and caring such as those with Alzheimer's and Dementia by providing them with more specialized assistance such as personal aides and an individualized health program. The Hearth Castle Gardens provides plenty of space for activities and is fully equipped with resort-style amenities for the entertainment and leisure of the retirees.


• Seirra Oaks of Redding in Redding, California - This facility offers only country-style assisted living and has received good reviews from clients they have served. The location of the home is perfect with oak trees spanning the entire community and a great outdoor view. The facility has a licensed nurse and a number of care-givers to assist in all the in-house medical care needed. Service is superior because it is tailored to the individual needs of the residents from the meals, activities and up to the personal and medical care. The staffs are friendly and very professional; it is easy to feel at home with the warm company and the great services in the facility.


• Elsa's Adult Care Home in Tucson, Arizona - This home specializes in assisted living care and holds a license from the Arizona Department of Health as an Adult Care Home and Assisted Living Facility. The facility boasts of personalized service and health care for the residents in an environment that is homey, safe and ideal for retirees.

Take time to ask for specific program services and quotes from assisted living communities before jumping to a particular choice. The internet provides clients with information on various senior retirement homes as well as nursing home reviews for those who need specialized personal and medical care for patients who are ill with Alzheimer's, dementia or other medical conditions. Pick the assisted living facility that offers the basic services for you or your loved ones at a very reasonable price.

Common Personal Injury Claim Mistakes

Personal injury claims are often difficult and complicated. But, still there are many people who choose to pursue their own claims. While it is true that making an injury claim all by yourself is possible, it must also be noted that not all types of injury claims can be handled without specialist help. Injury claims where the victim has been severely injured may require specialist legal representation. The reason is that an experienced injury lawyer can help you achieve a better outcome and substantial compensation for your damages.

If you have been injured in an accident, you can choose to seek legal help or handle your claim on your own. If you choose the second option, then it is also important that you avoid the common mistakes that most people make when handling their own claims. In this article, we will look at what these common mistakes are.

You provide a recorded statement - insurance adjusters will tell you that they need a recorded statement before they could make you an offer. This is not right. The fact is that these insurance adjusters can use anything you say against you. When making an injury claim, it is essential to avoid making this mistake. In fact, you must seek legal help and make any statements after you have consulted with your injury lawyers so that they ensure that you do not say anything that can affect your claim in a negative way.

You demand too little or too much - if this is the first time you are making a claim or if you don't have much knowledge about injury claims, then it is highly likely that you don't know how much to ask for. It is always important to understand the value of your injury claim before you demand. If your demand is too little or too much, then your opponent's insurers will know that you don't know how much your claim is worth and this can impact your claim and the compensation you receive.

Accepting the insurance company's offer - if it is clear that another person was at fault, their insurers will make an offer. If you receive an offer from the opponent before you start a claim, don't think that you are lucky. Insurance companies are very clever and they will often try to offer less than what you deserve. If you accept their offer without seeking legal advice, then you will be settling your claim for a fraction of what it is actually worth.

Nursing Degree Programs Are Implementing Geriatric Care Courses Into Curriculum

The Pew Research Center in December described them as "perched on the front stoop of old age." The oldest of the baby boom generation this year begin turning 65, the Pew Research Center article noted, a milestone that only 13 percent of the American population has presently reached. Seymour Butts is one of the "patients," virtually speaking, that has been helping students in nursing degree programs learn to care for an increasingly aged population.

Butts, afflicted stress-related buttocks sores at a private Indiana university's virtual learning lab, is a part of what some consider innovative programming in geriatrics. It wasn't until fairly recently, however, that students working toward their nursing degrees had much training in this subject area.

Studies in 1997 and 2003 have suggested that geriatric education was a part of nursing degree programs that were lacking in one way or another. According to the American Association of Colleges of Nursing, the studies found that educational programming was inadequate, instructor experience was lacking and few nursing degree programs included individual courses in geriatric nursing. The association stepped in and provided nursing schools with grants for enhancing geriatric nursing education as part of their nursing degree programs.

The grants, provided with help from $3.99 million from the John A. Hartford Foundation, were provided as part of an Enhancing Geriatric Nursing Education in Undergraduate and Advanced Practice Nursing Programs. With this money, 20 nursing degree programs at the undergraduate level and 10 at the graduate level made strides towards developing faculty knowledge in the area, adding gerontology courses and coursework, establishing clinical programs and more, the association website shows.

The private university in Indiana, for example, redesigned its nursing degree program, making an elective course on The Aging Process a required course, began more intense promotions for a Human Aging minor, established partnerships with senior centers and assisted living facilities, added a gerontology certificate program and more. The virtual learning lab with Butts is a part of The Aging Process course, as is a service learning project requirement whereby students provide group presentations at churches, assisted living facilities and senior day care centers in the area.

At a public university in Florida, gerontology was integrated into all courses, including pharmacology, where students can learn about medications considered inadvisable for older adults. A course in gerontology was also made available to new students and professional nurses, information on the American Association of Colleges of Nursing website shows. The course, Nursing Care of Older Adults, began as an elective and as of the 2005-2006 academic year was scheduled to become a requirement. As part of it, the instructor included a Facts on Aging quiz as well as Into Aging and Walk in My Shoes, interactive games that simulated aging.

There are nearly 80 million men and women who are considered baby boomers, which equates to about 26 percent of the American population, according to the Pew Research Center article. If that article is any indication, baby boomers themselves, however, might not yet care about how nursing degree programs are preparing students to tend to them. That's because many baby boomers not only consider old age to be 72 and older - they also feel nine years younger than they actually are, the article noted.

Ways to Deal With Elder Abuse

Not everyone is equipped with the patience to be a nurse, yet many Americans find themselves caring for a senior at home. As a result, there are roughly 2 million cases of elder abuse each year that include emotional, physical, sexual and financial abuse, as well as neglect. Since 3/5 of the cases of domestic violence committed against seniors are from family members, it is important that you look into finding a senior care facility if you feel your stress levels and patience wearing thin.

Chances are you have already made the decision to put your mother or father into an institution that can best care for their later life needs. Perhaps you felt guilty about it, but deep down knew you couldn't handle the stress and time-consumption of being an at-home caregiver.

You want to be sure all of your parent's needs are being met and that he or she is happy, although seniors aren't always candid about being abused; perhaps out of fear, humiliation, ignorance of the signs, deep depression or the normalization of violence. Therefore, it's up to you to watch out for symptoms of abusive relationships within the nursing home.

While you are visiting your family member in the care facility, take a look around and be sure you know the people who are regularly caring for your loved one. Perpetrators of elder abuse may callously minimize the victim's complaints or sudden injuries. They may refer to the victim as "crazy," "clumsy" or "off their medication."

When you ask your loved one a question, the abusive caregiver may try to answer everything, speaking on behalf of the victim. They often forbid the victims from contacting family or friends and withhold gifts from being sent to their rooms. They might try to cover up the abuse by canceling medical appointments or taking the victim to different doctors. They may stalk, threaten or harass the victim, or they may act overly attentive or unnecessarily touch the victim often in your presence.

If you suspect a family friend is a victim of emotional, physical, financial or neglectful elder abuse, then you should call your local Adult Protective Services agency. Victims often suddenly "sign over the power of attorney" and have their homes sold for quick cash or have all their possessions given away while they are still in a care facility. Seniors may have bed sores, be malnourished or act withdrawn.

They may forget medication or miss their doctor's appointments. The abuser will try to speak for your friend and try to prevent you from speaking with him or her. Isolation is the leading factor contributing to abuse of the elderly, so play an active role in your friend's life and don't be afraid to call for help or advice.

How to Choose the Right Nursing Home For Your Loved One

Below is a list of variables to consider when making your choice. Review the list and mark which are important to you.

Is this facility covered by your insurance? For how long? Under what circumstances?

Location- is it close to family and friends? Proximity to friends and family is one of the most important pieces of the decision.

Meals: do you have an option of an alternate at each meal? Are there considerations made for alternative menus such as: cardiac/renal/diabetic diets, vegetarian/vegan; kosher, weight loss/gain?

Do they offer transportation to out-of-the-facility appointments? Is this free or for an extra fee? Do they have rehabilitation available? Occupational, Physical and Speech Therapy 5, 6 or 7 days a week?

Do they offer other medical services: podiatry, dental, ophthalmologist/optometrist? Do they have an activities department and what activities are available and how often: music, games, exercise groups?

Is there a chapel and/or minister available, how often? What is the staff to resident ratio?

Are there separate units for short term rehab versus long term care? Do they offer salon services? How often in the week? Do you like the general appearance: colors, lighting, and cleanliness?

Are there private or semi private rooms? Do they provide a TV and phone? Can you bring in your own furniture such as a recliner chair? Can you have pet visits?

A state regulatory agency evaluates all facilities regularly in numerous categories from food preparation to medication errors. You may consider looking at the summary to see how well they performed compared with their competition.

List all the nursing homes in your area. You can find listings in your yellow pages, online using your search engines, in your local Senior Resource guides, asking for referrals from friends, or by asking your primary care physician.

Call to schedule a visit, take a tour, and talk to some of the residents and staff.

After exploring all the options you can feel more confident in your decision.

Tips:

--Definitely take the time to visit. Being in the building and seeing the residents and staff will influence your decision.

-- Proximity is important in choosing a facility, the closer it is to friends/family, the more frequently friends and family will visit.

-- It's important to remember the old adage "there's no place like home", but you can find facilities that mirror the feelings of home.

-- Choosing a nursing home is not an exact science, you want to visit & tour your options to get the feel of the facility before making your decision.

-- You still have options- even after checking in, if you are not satisfied with your care or service, you have options and can transfer to another facility.

Warnings:

- Some facilities have been rated poorly by state regulatory agencies, the reports are available but you will have to request it.

Everyday Zen

Zen can be a difficult concept to understand. Translated by many as meaning "meditation" or "a state of mind", Zen can be perceived as a new understanding on how to live one's life. Demanding persistence, patience and discipline, living a life of Zen everyday is not an easy process but can ultimately prove to be extremely meaningful and worthwhile.

Zen is not a religion. Zen does not tell you what to do. Zen is an approach that has been refined through many years that can be practiced everyday by anyone. The main aim of Zen is to develop self-awareness and an understanding of everything around you. Through the course of one's life, people are conditioned into believing things without thinking about them too deeply. Zen encourages you to release lifelong conditioning and preconceptions and enables you to find a deeper understanding of yourself and reality. Zen frees your mind to live a life of heightened awareness which in turn enriches and improves your daily life experiences.

Achieving complete Zen is known as the process of enlightenment. As mentioned above, it is the process of discovering a new viewpoint on life and discovering ones inner truth. Discovering this complete inner truth comes from persistent practice and getting to know the true you. This can be achieved through daily meditation as well as through trying to live a life of deep respect and compassion for all things around you.

Zen meditation is one of the techniques that have assisted many in the Zen path. Setting time aside daily to meditate aids in allowing one to focus and receive clarity on the world and oneself. This clarity comes with practice and patience and there are numerous meditation techniques that can be used to assist you in this process. It has been mentioned countless times by many how the way one sees the world is often very similar to how one sees oneself.

Consequently, Zen living is to live a life with respect for all living things and can be utilized in every aspect of one's life. Zen deals with the present and things that have practical relevance in one's life and ignores concepts of things that do not have an effect on ones daily experiences. Zen encourages one to live for the moment and to look at things in different ways in order to make them take on more meaning and in turn provide greater enjoyment.

Practiced for thousands of years and an approach that is available to everyone. Zen can either be practiced daily or its ideas can be incorporated into one's lifestyle, to assist in encouraging a more fulfilled and pleasure filled life.

Stockton Assisted Living Info

Stockton is one of the largest cities in the Central Valley, and the county seat of San Joaquin County. This former gold mining town enjoys traditional California summers, yet cools down during the winter months.

Stockton residents can expect a lower cost of living as compared to other large cities in the state. While still peaceful and out-of-the-way, Stockton is well-connected to the rest of California by extensive highway systems.

Stockton assisted living is the perfect way for seniors to enjoy a California climate without the bustle of big city tourism.

Stockton Recreation

Active Stockton senior living residents can experience a taste of nature while spending the day on the banks of Stockton's popular Lake McLeod, the city's link to the 1,000 miles of navigable waterways which span across the California Delta.

Enthusiasts of healthful eating will be delighted by Stockton's annual Asparagus Festival, one of San Joaquin county's biggest spring events.

Stockton Activities

Stockton seniors are provided with an abundance of services and activities through the city's four senior centers. Seniors can take classes, travel and socialize with other seniors at the Arnold Rue Center, the Oak Park Senior Center, the Stribley Center and at the soon-to-open Van Buskirk Center.

The Stockton Arena is the area's top venue for sporting events and big-name performers, but Stockton senior living residents can also view concerts, Broadway musicals and even classic movies at the Bob Hope Theatre or the Stockton Civic Center.

Stockton shopping opportunities can be found at Sherwood and Weberstown Malls, while art appreciators will enjoy The Haggin Musuem.

Stockton Medical Facilities

There are two major San Joaquin County medical facilities located within easy accessibility of Stockton assisted living residents. The non-profit, state-of-the-art Dameron Hospital exists solely to serve the healthcare needs of the community. San Joaquin General Hospital operates a string of specialty clinics to provide all types of medical assistance. In addition, Stockton is home to St. Joseph's Medical Center, which employs specialists in cardiovascular and cancer care.

Stockton Transportation

Stockton senior living residents can travel beyond the city by land or by sea from the Port of Stockton or the Stockton Metropolitan Airport.

For more localized trips, seniors receive discounted rates when riding buses operated by the San Joaquin Regional Transit District (RTD). The Metro Hopper is designed to deviate from its normal route to serve the needs of ADA certified riders. The company also offers Dial-A-Ride services for residents who cannot otherwise be accommodated. The Altamont Commuter Express train (ACE) is ideal transportation for longer trips or weekend getaways.

The dynamic city of Stockton is close to everything, yet far enough out-of-the-way to offer your senior loved one peace and tranquility in a beautiful Northern California setting. Find assisted living for your loved on by browsing our Stockton Assisted Living page.

Inside Mental Hospitals and Behavioral Units: A Bipolar Patient's Point-Of-View

Popular media portrayals of mental institutions often depict unflattering prison-like facilities staffed by stern attendants trying to manage patients as if they were small children in constant need of severe whippings and isolation. Except for government-run facilities for the indigent and criminally insane, today's hospital settings are much more benign and peaceful. This fact is not due to the oft-portrayed result of overmedication needed to keep patients from being too active and unmanageable as found in nursing homes; rather, it stems from today's empirical knowledge that a serene and comfortable environment is key to a patient's mental and emotional healing.

When an individual experiencing a mental disorder episode is either violent or not determines whether he or she is taken to either an emergency room (ER), a private mental hospital, or public hospital behavioral unit for assessment. The out-of-control ER patient typically receives a sedative medication upon admission to prepare him or her for transport to a mental health facility. Both they and non-violent individuals who enter a psychiatric unit are first assessed in order to discover their underlying condition(s). With the patient safely inside a secure facility, a psychiatrist prescribes an initial mix of psychotropic drugs to arrest and stabilize the patient's presenting condition and immediate symptoms' presentations. A lengthy hospital stay is often required because most psychiatric drugs require 2 to 4 weeks administration before behaviorally affecting the patient.

A violent or unruly patient is sometimes taken to a locked and padded isolation room for observation before his or her initial dosing of meds wears off. A psychiatrist, psychotherapist and case manager are assigned to the patient. The "in-control" patient in either a private hospital or general hospital behavioral unit is quickly assessed to determine the nature of the current episode. A patient history is also cobbled together. He or she is asked a battery of questions concerning moods, thoughts, actions and beliefs by a psychologist or trained psychiatric nurse, caseworker or licensed social worker (LSW). However, the patient is primarily scrutinized according to his or her "body language," as 65% of all human communication is non-verbal.

Medical care is often limited, constrained by government regulations, sub-standard facilities and medical professionals' unions found in state and federal (e.g., veteran) hospitals. There is even a lack of basic janitorial services at some of these locales. Additionally, "drug lists" used within these institutions are narrow and limit the physicians' use of the latest, most-efficacious and commonly prescribed psychotropic medications available in the marketplace.

Complicating adequate patient care in many of these facilities is the fact they are mandatory repositories for both criminally insane and indigent patients. As with prison facilities, dangerous contraband including drugs and sharp objects often find their way into the patient population and constitute an existential threat to all in-house staff and patients. Basic equipment, as can be found in most hospitals, is either non-existent or broken. A padded crutch or fully functional wheelchair may be non-existent or broken. A lone wheelchair may exhibit an undersized seat, loose armrest, pinch-points, missing footrests or broken brake lever. Group and individual counseling are pedestrian at best and absent at worst. Occupational and physical therapies often do not exist. Food is often substandard.

Standard procedure in all hospitals is having all items except for the textile portions of patients' clothing bagged and safely stowed to prevent theft and injury to the patient by items like pocket knives, belt-buckles and other items known as "sharps." Disposable slippers or cotton socks with non-slip rubber soles are issued in lieu of the patient's original footwear. Meal service is either smooth-edged metal spoons or plastic flatware accompanied by either unbreakable smooth-rimmed melamine or non-injurious paper or styrofoam plates. Styrofoam drink-ware is also used. Meals are of above-average quality and quantity. This stems from patient dietary needs due to disorder-caused eating issues that have deprived most patients of both nutritious and adequate amounts of food. Meals are served in either buffet lines or catered-style metal food warmers. The latter usually contain meals selected by patients the previous day from menus offering a choice of entrees, beverages and desserts. Much light-hearted trading of food takes place around the tables during mealtimes.

More women than men occupy a psychiatric unit at all times. Although an equal number of men and women are bipolar, women suffer depression twice as much as men do. Hence the patient census typically exhibits 15%-25% more women than men on any given day. With the wide variation of patients, their personalities, and manifold states of their drug therapies, arguments between and among them are not uncommon, as are physical confrontations. Psychiatric technicians and nurses are always on guard to immediately quash these encounters.

Psychiatric facilities focus on both mental (including emotional) and physical health for patients. Spiritual needs are not addressed except for an occasional, optional 15-minute non-denominational session on a Sunday morning, for example. The goal of a restored circadian rhythm in patients explains the strict observance of scheduled morning wake-up calls, meals, group therapy sessions, physical and occupational therapies, other activities and bedtimes. Occupational therapy consisting of small construction and art projects provide for patient relaxation, sense of accomplishment and success in meeting small goals. Sometimes batteries of mental and physical tests are administered to gauge the overall status or health of the patient. An Intelligence Quotient (IQ) test is but one of these exams.

Mood patient anxiety, mania and depression slowly subside in response to a varying drug "cocktail" in an attempt to discover the best course for the patient. Also, a physical, emotional and social activity regimen is instituted to achieve a patient's overall goal of mental stability. "Level" or "stable" moods, not joy or happiness, are the goal, as is commonly misunderstood by the layman, for achieving mental recovery. Outpatient therapies and counseling may be administered before ultimate patient release. When a lack progress is evidenced after treatment with various pharmaceutical therapies, bipolar I and severe cases of clinically depressed patients may undergo Electro-Convulsive-Therapy (ECT or "electroshock therapy") to relieve the pain and damage done during episodes of mania, deep depression and catatonia. Although these procedures produce tremendous restoration of patient moods, they are performed at the expense of varying degrees of either or both temporary and permanent loss of patient memory.

As in-patients, a holistic approach to healing takes place due to the coordinated efforts of psychiatrists, psychologists, psychiatric nurses, psychiatric technicians, physical therapists, occupational therapists, dieticians, case managers and social workers. This advantage to the patient is abruptly interrupted upon release and can cause varying levels of anxiety and perhaps a relapse. There may be only psychiatric visits after leaving hospital and perhaps some psychological counseling. Sadly, these two professionals, psychiatrist and psychologist, are usually not in communication with one another and the resultant disconnect results in a patient's issues being poorly addressed. While the psychiatrist is primarily concerned with drug therapies, the psychologist is more concerned with talk, thought, emotional, and behavioral therapies. This scenario often, when combined with the patient's continuing poor domestic environment and poor responses to life challenges, will often require another visit to his or her hospital alma mater, or result in injury or death.

Once stabilized to the satisfaction of one's psychiatrist and other staff, the patient is readied for release. A strange feeling creeps into the patient's psyche as his or her release date and time draw near. He or she has been "ready to leave" for days on end and cannot wait for release. Nonetheless, immediately prior to walking out the door, anxiety strikes the patient with full force. The realization of having been in a peaceful, nurturing environment contrasts with having to confront the stigma of having mental illness, their home environments, and former (sometimes toxic) relationships with others and having no outside help. Fortunately, for most patients, they are usually referred to a counselor or licensed social worker with whom they can continue their recovery back in the "real world." Either an out-patient program or support group meetings can provide other avenues for recovery and maintenance of their mental health.

Because mental healthcare is a specialization and therefore more costly than general medicine, medical insurance usually covers a relatively small portion of both in-patient and out-patient mental health expenses or none at all. Lifetime total in-patient hours are often limited despite high premiums. And, as with any medical hospitalization, the mental hospital facility and doctors each bill the patient separately.

Identifying the Health Care Market Segments For Your Small Business

The first step in a small business selling to the hospital market space is being able to identify the different segments that they will approach. This is one of the essential building blocks for them to craft their method to and match the correct messages to their potential clients. There are five major segments in institutional hospital selling for small businesses to focus on.

The largest in size of the segments is the Integrated Delivery Networks (IDN) which is, at its basic level, a multi-hospital system that can cover a large geographical area. The groups have come together to share resources in an attempt to provide better continuity of care for their patients, but for small business vendors the main item of note is that they have consolidated a lot of their purchasing power.

As a general rule, the larger the group the longer it will take to penetrate these types of accounts. Furthermore, it is critical to understand that even when a small business gets under contract with the IDN, it does not guarantee orders, but rather just simply provides a streamlined vehicle for participating facilities to purchase the businesses products or services.

IDNs are definitely part of the marketing mix of a small business, but absolutely not the only part.

The next level segment is the slightly smaller hospital systems, which is a group of two or more hospitals (sometimes referred to as sister facilities) that are commonly found in the same geographical area. These groups normally have system wide directors that have heavy influence on the choice of vendors. Similar to IDNs, this level generally takes longer to secure a relationship with, but delivers a tremendous amount of value once established as a vendor.

Hospital systems would be one of the foundational pillars of a small companies business develop plan.

Individual hospitals are the next segment in the order of size. This is the number one penetration point for small businesses developing their foray into health care. Individual hospitals have directors that are reachable, large enough to provide small businesses a substantial transaction size with repeatable orders and are the ultimate internal referral to escalate to their related hospital system or even the larger IDN the facility belongs to.

Individual hospitals are the centerpiece of a small businesses plan of attack into health care.

At the next level are the facilities that cover long term care such as nursing homes and assisted living. The long term care segment can provide quicker sales as their transaction sizes are usually smaller. The area of concern in creating an approach to these places is determining the decision maker that authorizes purchases. Some facilities are tied to a hospital and some are not, some are part of a group and some are standalone. This will take investigation, but it is well worth it as sales coming in the door will keep momentum going for a small business while simultaneously pursuing the larger accounts.

Nursing homes and assisted living are the section of a small business plan that generates small deposits in between the larger sales at hospitals.

The final focus of the health care market space is the clinics and surgery centers. Just like long term care facilities, they have the same challenges in locating the purse strings in becoming a vendor, but will yield faster smaller sales.

Clinics and surgery centers also are part of generating cash flow for a small company and smaller jobs to fill a fulfillment schedule or technicians calendar.

There is a sixth segment made up of Group Purchasing Organizations (GPO). They combine many facilities purchasing power, negotiate lower prices from vendors and take a fee from both sides (hospitals and vendors) for this service. Often these are very large and cover the entire country so they look for vendors that have the capacity to handle national accounts.

Small businesses should avoid these GPOs until later stages of their companies growth.

A business development plan for a small business that blends a simultaneous approach to IDNs, hospital systems, long term care, clinics and surgery centers around a main thrust into individual hospitals will have a strong foundation to build a successful business for years to come.