Becoming a Care Home Owner

With people living for longer, the demand for care homes in the future will soar. Elderly people are often unable to look after themselves as they get older and whilst family and friends can help, it calls for a huge amount of responsibility to be taken up.

For those considering setting up their own care facility there are two categories that split the elderly care industry, nursing homes and residential care homes. Nursing homes are like private hospitals for elderly residents that require a high level of care. If opening this kind of facility, there needs to be managers and nursing staff with highly advanced levels of medical care and training.

Residential care homes are old people's homes, which provide accommodation for elderly people who may be unable to do everything for themselves. Residents such as these are still able to enjoy a degree of independence. Staff at such facilities are qualified carers whose level of training do not need to be as advanced as those in nursing homes.

The care industry is open to people from a wide range of backgrounds, although those with medical and care experience obviously feature strongly in the sector. There is more to owning a care home than your background, financial situation and ensuring you have all of the necessary care home supplies. You also need to have a certain type of personality.

You have to want to care for the elderly, there's no point opening a care facility if you yourself do not care. You need good management skills and must be able to organise staff and create a good working attitude and environment which will rub of on your residents. But remember, it is not a nine to five industry. If there's an emergency you may be contacted in the early hours of the morning- for example, if a client is ill.

However, caring alone isn't enough - it's still a business and it is worth bearing in mind that you will be inspected on a regular basis and there will also be unannounced inspections, which can be at any time of day or night.

Top 12 Things You Didn't Know About Adult Day Care

There are a number of options to consider when selecting a long term care solution for your aging loved one. Unfortunately, adult day care is one option which is often under-utilized and over-looked. In-home care and assisted living are some of the more popular care options; however adult day care should be considered for a number of different reasons. While awareness of the benefits is limited, trends do show that it is growing in popularity.

Below are the top 12 things you probably did not know about Adult Day Care.

1. Affordable: Most day programs cost a fraction of what other care services cost. Typically a day costs averages $60 per day including meals. In-home care costs average about $20 per hour or $160 for a full day of care (8 hours).

2. Socialization: Adult day care offers a great social opportunity. Studies show seniors who feel lonely have a significantly greater chance of developing dementia and heart conditions. Socialization is one of the key benefits.

3. Medical Support: Centers often have medical support services like nurses to help manage medications and other daily clinical needs.

4. Staff Continuity: The staff remains consistent allowing for better continuity of care. With in-home services, often the caregivers change daily or weekly creating gaps in the care.

5. Quality Care: Adult day cares are regulated and/or licensed by the county and/or state level assuring proper staffing ratio and qualifications.

6. Variety of Activities: Day center programs offer a wide variety of activities way beyond TV and Bingo. There is exercise, art, music, brain games, computers, current events, and so much more.

7. Alzheimer's/ Dementia support: Many centers have special programs designed specifically for older adults with dementia or Alzheimer's disease. Creating safe and engaging environments.

8. Family Activities: The family is included in special programs throughout the year creating a sense of community.

9. Caregiver Respite: Adult day care provides much needed respite to families who struggle daily with the pressures of full-time caregiving.

10. Caregiver Support: Most centers offer support groups where caregivers will find that they are not alone when having to manage the care of a loved one. The stress can be overwhelming, but finding others who share the experience can offer a great deal of relief.

11. Rehabilitation Services: Many centers have rehabilitation services to support individuals who are recovering from a fall or stroke. Services can include speech therapy, occupational therapy, and physical therapy.

12. Nutrition: Seniors often have challenges with their nutrition, at an adult day care program the meals are prepared by qualified nutritionists and are well balanced and nutritious.

13. Peace of Mind: One of the most important things that Adult Day Care can offer is the peace of mind to family caregivers who know that their aging loved one is in a safe, fun, socially-engaging setting where they are happy and well cared for, while not risking financial ruin.

For more information, contact SarahCare Adult Day Care Centers at info@sarahcare.com

Medicare Nursing Homes - Up To Date Information

The Medicare health care insurance plan does not cover long term nursing care, but the Medicare nursing homes section of the Medicare program does cover short term stays in these facilities. The coverage is dictated by the length of the stay and the type of? home care required.

In order to qualify, you must have spent at least three days in hospital prior to transfer to a Medicare certified nursing home facility and you must enter a? home within thirty days of your hospital stay to qualify.

The cost of a Medicare certified living facility is covered for up to twenty days. Thereafter, you are responsible for part payment for the next one hundred days of care per diagnosis and hospitalization. Medicare does not cover nursing home cover stays for duration of longer than one hundred days. Medicare coverage also ends if medical professionals document that you are failing to make progress towards independence.

If you reach the point where you are no longer able to be rehabilitated, but you still require nursing care, you will have to pay for your care. This might mean using your savings or selling your assets to cover the cost of care. If you reach the point where you have cashed in all your savings and assets and can no longer afford to pay for care, you can apply for Medicaid, which will then start paying for the long term nursing home care.

Once it is established that you will need to stay in a nursing home for a period of time, you will need to start looking for nursing homes in your area. The Medicare nursing homes compare tool can be found on the Medicare website. This is an informative guide to helping you find and compare nursing homes based on geographical criteria. Alternatively, you can ask for guidance from people you know and trust, for example friends or relatives who have used nursing homes, or medical personnel.

The Medicare Compare program helps you to make the right decision based on your needs by giving you information on how Medicare facilities are rated in your area. New guidance instigated in 2009 ensures that all nursing homes covered under the Medicare health care program are regularly inspected by nursing home surveyors to see that they maintain certain levels of care for the residents. These include ensuring the residents are able to live with dignity, they have choices in care and services, their environment is accommodated to their needs and preferences, and the home can offer a home-like environment that includes access for visitors. All of these guidelines are designed to ensure that the people who spend time in nursing homes can enjoy an improved quality of life.

There are many factors to consider before choosing a Medicare approved? home for you or your relative. If there is a possibility you might be in the home for a long duration, you need to be certain that the home is right for you. Once you have decided on the home that is suitable for your needs, the home is obligated to help you apply for and use the Medicare benefits available to you. They can also help you claim refunds on any payments already made that are covered by Medicare.

Our site has a huge amount of up to date information about medigap cost and important medicare issues. Stay informed on this important subject.

http://www.medigapcost.com

Veterans Aid and Attendance Pension Benefit - Long Term Care Benefits for Veterans

Veterans Aid and Attendance Pension Benefit -- Long Term Care Benefits for Veterans What Is the Aid and Attendance Benefit? The Veterans Benefits Administration offers a disability income available to veterans who served during a period of war or to their surviving spouses. This special benefit is officially called "pension" but is more popularly known as the "veterans aid and attendance pension benefit". For a pension benefit for veterans younger than 65, evidence of total of disability must be provided. Veterans 65 and older do not have to disabled.

The National Care Planning Council estimates that as much as 30% of the US population over the age of 65 would qualify for the aid and attendance pension benefit under the right circumstances. That's how many war veterans or surviving spouses of veterans there are. The benefit is such a well-kept secret that only a small fraction of these eligible veterans are actually receiving it. Death pension -- a benefit available to a surviving spouse-- is a lesser amount based on the same rules for applying for a living pension claim. In other words, the deceased veteran must have met the rules for pension -- with the exception of being totally disabled or over age 65 -- or have been receiving pension in order for his or her spouse to receive the lesser benefit. In addition, in order to be eligible or keep receiving the benefit, the surviving spouse must remain single.

Who can submit a claim? A claim is submitted by the veteran or by the veteran's single surviving spouse in the case of a death claim. A duly appointed service organization, an employee of the local regional VA office, or a VA approved agent may file a claim on behalf of the veteran or the spouse. A claim cannot be filed with a general or durable power of attorney. The application will be sent back requesting proper documentation for a VA power of attorney. The veteran must sign a document specifically authorizing a power of attorney for someone to submit an initial claim for him. Many chagrined children with a durable power of attorney have submitted claims on behalf of a parent only to have the claim rejected by VA.

What happens if the veteran is incompetent? If the veteran cannot submit the original application or sign a power of attorney for a surrogate to file an application, then a duly appointed guardian can complete the application. VA also allows the spouse, a parent or next of kin, or a friend to complete and submit an application on behalf of an incompetent veteran if that person submits the proper power of attorney request and indicates the applicant could be considered incompetent for financial affairs. Even though the veteran or surviving spouse may be incompetent for financial affairs, he or she should always sign the power of attorney request if he or she is competent to do so. VA may appoint a fiduciary to take over the claim and the affairs for the claimant if VA determines he or she is incompetent.

How does VA handle power of attorney? Employees of VA and veterans service organizations already have authorization for power of attorney to file an application on behalf of the veteran. They have forms for the veteran to sign to allow this to happen. An attorney representing the veteran in other affairs can also request a power of attorney in the proper format and on his or her letterhead. Any single individual may also submit a letter requesting power of attorney to submit an application if it is signed by the veteran and if the letter provides certain required information. There is also a VA form in the book support packet that can be submitted for power of attorney. All attorney requests submitted for power of attorney must state that the veteran is not paying a fee to file the application on his or her behalf.

What is an "aid and attendance" or "housebound" rating? A "rating" is granted by a veteran service representative where a condition exists that makes the disability more severe. Medical evidence is required unless someone is a patient in a nursing home, and then the requirement is waived. The rating allows VA to pay an additional monthly amount of pension or compensation to a veteran or a surviving spouse for additional costs associated with this disability.

How does one qualify for aid and attendance or housebound rating? The application form has a block allowing for a request for either rating. Submitting medical evidence in advance instead of waiting for a request from VA can help expedite the process of getting this rating. We have provided in the book support packet, a sample form that might be used for this purpose. This form is also designed around information that VA is looking for and may be a more effective presentation of the facts than typical medical records from the doctor.

What is the effective date? The effective date is generally the day VA receives an original application. If it takes three months for the process of approval or six months, it doesn't matter. The effective date still reverts to receipt of the original application.

When does payment begin? Generally, payments start on the first day of the month following the month of the effective date. This means that if it took six months to get approval, at least five months of benefit will be paid retroactively. VA requires automatic deposit of awards in a checking or savings account.

What happens if the veteran dies during the period of application? If the veteran dies during the period of application and the application was not approved prior to the death, there may be accrued benefits. If the regional office had all of the information in its possession that would have led to an approval, then there is an accrued benefit payable. Otherwise there is none. The full benefit is available for the month of death of the veteran and to a surviving spouse through an application on Form 21-534. This is the same form a surviving spouse uses for a death benefit claim for himself or herself. VA will award either an accrued benefit or death benefit to the surviving spouse whichever is larger. If there is no surviving spouse or dependent child, VA will pay the unreimbursed costs of last illness and burial to the person who paid those costs. A special claim must be submitted for these costs, not Form 21-534.

What is a veteran's federal fiduciary, and does that affect the application? For a veteran who is considered incompetent to handle his own financial affairs, VA will appoint a fiduciary to receive the money and pay the bills. A federal fiduciary is an individual appointed for this purpose, usually a spouse or a family member. In most cases -- except for the spouse living with the veteran -- there is an interview required and mounds of paperwork. This process can take a long time, and it is to the advantage of the person filing an original claim to request the appointment of himself or herself as a fiduciary or for some other appropriate person or organization to help expedite the process. VA always makes the final decision on whom it appoints as a fiduciary. In fact, the agency might well ignore court appointed fiduciaries. In general, the decision favors declaring the veteran competent and avoiding a fiduciary where at all possible.

What is the income test for pension? If the household income adjusted for unreimbursed medical expenses and a deductible is greater than the maximum allowable pension rate -- MAPR -- there is no benefit. In 2007, the maximum allowable rate for a couple with aid and attendance allowance is $21,615 a year. For a single it is $18,234 a year. Without aid and attendance or housebound allowance the maximum couple's rate is $14,313 a year and for a single it is $10,929 a year. Death pension rates are lower. People seeking a benefit with adjusted incomes greater than these levels will be denied.

Can a household with income above the maximum limit qualify for pension? A quirk in the way benefits are calculated can allow individuals and couples earning between $24,000 to $60,000 a year to still qualify for a benefit. It has to do with the treatment by VA of the very large recurring medical costs associated with home care, assisted living, or nursing home care.

What is the pension household asset test, and what can be done if the asset test is not met? As a general rule assets cannot exceed $80,000. A veteran or spouse occupied-house, a reasonable amount of land upon which it sits and a vehicle are exempt from the asset test. In reality there is no specific test in the regulations. Veterans service representatives are required to file paperwork justifying their decision if they allow assets greater than $80,000. Thus this amount has become a traditional ceiling. The service representative is encouraged to analyze the veteran's household needs for maintenance and weigh those needs against assets that can be readily converted to cash. In the end, the decision as to allowable assets is a subjective decision made by a service representative. In certain cases a benefit award could be denied even if assets are below $20,000 or $10,000 or even zero dollars. There are legal ways to get around the asset test if assets are too high. These are described in our book.

What proofs and documents are required with the pension claim? We have already discussed the requirements for power of attorney and fiduciary if they apply. In addition, an original copy of the discharge from service -- typically DD 214 or form WD -- is required and the discharge must have been honorable. If there is a question about the marriage relationship, a marriage certificate or other proof may be necessary. Birth certificates of dependent children are usually not required but may be necessary under certain conditions. A dependent child is a minor, a dependent student under age 23, or a totally dependent adult child. There are certain documents that need to be submitted to prove future recurring medical expenses and to prove need for aid and attendance or housebound allowances. VA does not furnish these documents nor provide any information that they are required. Sample documents that could be used for these purposes are included in our book.

Can someone charge to help fill out the form? Federal code and VA regulations prohibit an agent, advisor or attorney from charging a fee to fill out and file a claim for pension. Most practitioners or providers help their clients for free, sometimes in the context of solving other retirement issues or providing long term care services. Some practitioners offer application advice for a fee (which is legal) but will send their clients to a veterans' service organization to complete the application. Some assisted living facilities or home care providers also offer free advice or help and this seems to be an acceptable practice. An agent or attorney can also be paid by a disinterested third party under certain conditions to complete an application. However, a home care agency, assisted living facility or nursing home that pays an agent or attorney to complete an application on behalf of a resident or client does not meet the definition of a disinterested third party is in violation of the prohibition for charging a fee

How are assets, income and unreimbursed medical expenses determined? The applicant must submit details on the application of all income and all assets including retirement savings accounts such as IRAs. Almost any type of money received or anything received that can be converted into money is income. The only exclusions for assets are a personal residence (occupied by the veteran or spouse) and a reasonable amount of land it sits on as well as vehicles and other personal possessions. Personal possessions used as an investment such as a coin collection are counted as assets. Unreimbursed medical expenses can be almost any expense related to medical needs.

Are there any other reporting requirements? VA requires that any change in income or assets be reported immediately. The award is calculated for 12 months in advance, but at the beginning of each calendar year, a formal report called an EVR (Eligibility Verification Report) must be filed detailing all income, assets and unreimbursed medical expenses for the coming calendar year. For example if the award is granted in April for 12 months in advance, an EVR must be submitted in January of the next year that could affect the award amount for the remaining four months of the initial 12 month period. The EVR will be used for determining benefits for the calendar year on which it is based.

What is a veteran's federal fiduciary, and does that affect the application? VA can appoint a number of different types of fiduciaries to manage the funds on behalf of an incompetent veteran. A federal fiduciary is typically an individual such as the spouse or a child whom the VA is most likely to appoint. If VA is not notified with the application that the veteran may be incompetent and that a fiduciary appointment is requested, this could slow down the application and approval process.

Will the pension benefit pay a nonlicensed homecare provider? VA does not pay providers directly but provides extra income to make up for the cost of licensed medical care. Medical conditions or injuries or diseases that require a need for ongoing licensed homecare will allow the applicant to reduce household income by the cost of homecare making it possible to receive the additional income from a pension award. If the beneficiary has an aid and attendance or housebound allowance, VA will allow deductions for nonlicensed providers as well.

Will the pension benefit pay a member of the family to provide care at home? As explained above, VA will not pay providers directly but only indirectly through extra income. If the beneficiary receiving care in the home has received a rating for aid and attendance or housebound, VA will allow expenses paid to a family member for care to be counted as unreimbursed medical expenses to qualify for the benefit. The care arrangement must be legitimate and appropriate evidence must be provided.

Does the pension benefit pay the costs of a nursing home? The application form has provision for indicating residency in a nursing home and whether or not the applicant is eligible for Medicaid. VA will automatically apply the monthly cost of the nursing home in determining the pension benefit. If the applicant is single with no dependent children at home and is eligible for Medicaid, VA is required to stop any payment of full benefits and only provide the veteran with $90 a month.

Does the pension benefit pay the costs of assisted living? As explained above, VA will not pay providers directly but only indirectly through extra income. If the beneficiary receiving care in assisted living has received a rating for aid and attendance or housebound, VA will allow expenses paid to assisted living for aid and attendance or housebound ratings -- including room and board -- to be counted as unreimbursed medical expenses. The cost of assisted living being used as a retirement residence is not considered a medical expense. It does not warrant a rating and cannot be deducted.

What are the requirements to receive a death pension benefit? The applicant must be a surviving spouse or a dependent child of an eligible veteran. VA form 21-534 is used to apply for death pension, death compensation, accrued benefits, or dependency and indemnity compensation (DIC). The surviving spouse must be single. A surviving spouse of any age is eligible as long as the deceased veteran served at least 90 days during a period of war. They had to be married at least a year prior to death or have a child as a result of the marriage. There is no requirement for total disability for the surviving spouse nor for the deceased veteran to have been totally disabled or older than age 65.

How does one prove that unreimbursed medical expenses will recur every month? VA has specific rules for proving future recurring medical expenses. Information in our book outlines the type of paperwork that must be submitted for each type of long term care service. The book also contains appropriate forms for this purpose. Neither the claims form nor information from the regional office provides any guidance on the rules for proving future recurring medical expenses for home care or assisted living. One simply has to know how to do it. This one crucial step often makes the difference between a successful claim and a denial.

What if the veteran or spouse is currently receiving Medicaid? Our interpretation of the rules leads us to believe that VA will not consider Medicaid payments as income. However, Medicaid will consider the nonallowance portion of the pension to be income. This could affect Medicaid eligibility in income test states. There is evidence that some income test states count the entire pension benefit including the allowance as income. According to federal Medicaid rules this should not happen.

What happens when the veteran or spouse wants to receive pension & Medicaid together? Federal law requires that a single veteran receiving Medicaid with no spouse or dependent children can receive no more than $90 a month from VA. Veterans in state veterans homes are exempt from this requirement. The veteran with a spouse can receive the benefit to help defray the costs of a nursing home. As a general rule, the pension benefit would probably not work if Medicaid were paying the bill. But the benefit does work well for non-Medicaid nursing home beds and while the recipient is going through the Medicaid spend down.

This article is an excerpt from the book -- "VETERANS AID AND ATTENDANCE BENEFIT -- LONG TERM CARE BENEFITS FOR VETERANS" -- published by the National Care Planning Council and written and edited by Thomas Day, Council Director. This first-of-its-kind book is available in two editions -- the Standard Edition (209 pages) for the general public and the Professional Edition (443 pages) to be used as a handbook for advisors and care providers. Both books contain the necessary information and forms to complete an application for the benefit. The Professional Edition also includes citations from rules and regulations, hypothetical planning cases, asset reduction strategies and a software CD with benefit estimate software, all applicable forms and planning sheets. To review and purchase the book go to http://www.longtermcarelink.net/a16veterans_books.htm or type in your browser window www.veteranbook.com.

Assisted Living in Alberta and Saskatchewan

Canadian provinces are each unique in whether or not seniors' facilities and communities are regulated or funded. Therefore it's important to do the research into what your options are, whether there are regulations in place set at the government level and who the seniors' advocates are in the province where you will need Assisted Living.

Designated Assisted Living Facilities in Alberta

Since April 2007, under the Provincial Government of Alberta department ASCS - Alberta Seniors and Community Support, Alberta has had legislation in place to protect seniors that live in supportive living facilities. The standards set by the ASCS apply to both private and public supportive living scenarios in Alberta; they have designated a Supportive Living Framework to define the types of homes that may be defined as a supportive living facility. Designated Assisted Living Facilities or DALs are under the protective umbrella of the ASCS. A Designated Assisted Living residence is one that has been accepted by the ASCS and the regional health authority okays residents on the basis of their health needs.

The Alberta Senior Citizen' Housing Association (ASCHA)

The ASCHA represents retirement communities in the province of Alberta and acts as an advocate for its members. The ASCHA represents more than 100 organizations operating more than 24,000 seniors housing units in Alberta. That translates to approximately 70% of the seniors housing sector. Members of the ASCHA include private not-for-profit, private for-profit, and public not-for-profit community operators. Stakeholders and corporate members are also vital to the ASCHA.

In the province of Saskatchewan, the Minister of Health advocates on behalf of seniors to ensure that issues of importance are heard at the Provincial Government level. As well as providing a voice in Cabinet the Minister of Health communicates with and takes advice from seniors' organizations in the province.

Provincial Advisory Committee of Older Persons

In June 2000 the Provincial Advisory Committee of Older Persons was established by the Saskatchewan Provincial Government to monitor public and private housing programs for seniors. Under the Personal Care Homes Act, privately owned homes may be licensed to provide the level of care similar to Assisted Living, where seniors may live at home, retaining their independence while requesting assistance in certain areas of their daily lives.

Finding Assisted Living in Saskatchewan

There are many providers of retirement communities in Saskatchewan whose philosophy is all about the excellent level of service they provide to their residents. In doing an Internet search for Assisted Living in Saskatchewan, pay special attention to the management company. Learn about the history of the company, their values and their mission statement. Make an appointment to visit the community that you may be considering and ask questions. Two examples of retirement community providers are Hawthorn Retirement Group in Regina and Riverside Terrace in Saskatoon. Both have Assisted Living as an option within their communities and both have established reputations.

Saskatchewan Seniors Mechanism

There are influential groups and organizations in the province of Saskatchewan that strive to keep seniors up to date about programs and services and provide a voice for seniors. The Saskatchewan Seniors Mechanism is one such influential organization. Established in 1990, they have been developing partnerships with groups throughout the province their goals being to act as on behalf of member organizations and create awareness of programs and services available to seniors. They are the umbrella organization for seniors' groups throughout the province and these groups collectively represent more than 100,000 Saskatchewan seniors. The SSM is recognized for their ongoing dedication to the betterment of their members.

8 Disadvantages of a Nursing Home

During this time of change these people are experiencing one of the most difficult periods of their lives. Not only is it difficult for the person making the move, but also for that person's family and friends.

Here are more disadvantages:

1. The person is usually very sad. This is quite justified since they are usually leaving the only home they have known for years -- including all the memories.

2. Most fear a nursing home because they consider it the final step before death. This is usually true since once there, they usually do not return to their own home.

3. Loneliness is a continuing problem with many. For some visits from their loved ones are few and far in-between.

4. Once in a home, you lose your independence. This in itself gives the feeling that their life is over. Along with loss of independence, they lose their self-esteem too. Now, anything they do is part of a scheduled activity.

5. Freedom is missed. They now have to eat what is served or do not eat at all. The following freedoms no longer exist:

a. To cook for their family or friends
b. Showering can only be done with the help of nurses on the nurse's schedule
c. Laundry is done with everyone else's laundry
d. TV watching is done only when allowed.

6. No longer can they attend their own church; but, instead attend the service provided by the home.

7. Lose their own personal doctor; and, instead one is provided by the home.

8. They may become very angry at their child or children for putting them there. This causes all kinds of heartache in the family.

Sometimes there is no choice and a loved one must enter a nursing home. That is understandable; however, all situations are different. If I had to do it all over again for my mom, I would definitely consider at home care.

Aspects of Spirituality For Caregivers Responsible For End-of-Life Care

Spirituality can also be described as a vigorous process of looking within oneself to reflect on your own life and at the same time turning outward to seek what is actually beyond what is being experience on a daily basis. For many people, spirituality is found in religion but for others spirituality can be found in nature, art or music. There are also those who will reflect on spirituality as being what occurs in everyday life through their association with friends and family.

For anyone facing an end to their physical life, religion and spirituality are two causes of deep apprehension and pain. Sometimes these two subjects may never have even been previously considered, let alone talked openly about. The sudden sharp focus on either or both of them, are not only reasons for apprehension and pain in the person facing end of life, but also for the caregiver and other family members.

In discussing this area of care it is difficult to separate spirituality in the terms relating to carers and that which relates to the person who is coming to the end of their physical life, so the two need to be intertwined.

Religion and spirituality are often blended together, but they are in fact not the same and it is possible to have either a secular spirituality or a religious spirituality.

Spirituality and spiritual care are acknowledged as central topics when professional carers are responsible in the delivery of a high quality end of life care. Spirituality, however, is difficult to define and many health care professionals themselves feel ill at ease in their attempts to provide spiritual care for those who are dying and/or bereaved. These challenges seem to emerge out of a number of issues concerning the diverse meanings of spirituality in a culturally diverse society, as well as the complexities of our current day, contemporary health-care delivery systems. Even those health-care providers who are the most sensitive to including all aspects of spiritual care in their caring role are often very daunted by the thought of engaging such a vague or ill-defined expression of need.

Over recent years many studies have been conducted into aspects of spiritual care in both the home and health facility setting and a study that was conducted by KE Steinhauser, NA Christakis, EC Clipp (and others) considered several factors that were pointed out to be highly important at the end of life by patients, family, physicians and other care providers. This study was reported on in the Journal of American Medical Association in 2000, and indicated that both the person dying and their families considered spiritual care to be important. The range of expectations expressed and the desire for spiritual care was found to be very expansive, but the emotionally sensitive indicators that were paramount, were the ability to be listened to and be cared for with love and trust.

Yet to be able to just listen with intent and show unconditional love and care is often the hardest aspect of providing end-of-life care.

Once one grasps the concepts and skills to listening with intent they develop a better understanding of what the person is really saying. The spiritual aspect of terminal care becomes a journey which is then more emotionally satisfying and healing for all concerned.

Spiritual pain can be the result of a past experience that has been filed away in their subconscious mind. Perhaps it was an experience that totally traumatized them and may have for a period of time, left them in a state of helplessness, and now with their death looming this past memory resurfaces and becomes the center of their being; it is how they are viewing their life, once again in a state of devastation and hopelessness. This is often expressed by the person continually saying thing like - 'Why?' or 'Why me?' or 'I am lost and lonely.' They feel that their life is devoid of all hope and if they used a religious term it probably would be "dark night of the soul". As with any pain, spiritual pain does present with known symptoms. A fear of dying is very widespread and deep and the following seven fears represent the major symptoms of spiritual pain:

Fear of the dying process "what will it be like?" Will it be painful?
Fear of loss of control "will I be dependent on others? Will I be unable to care for myself?
Fear of loss of loved ones "How will they manage without me?
Fear of others reaction to them "How will people cope with seeing me like this?
Fear of isolation "Will people stop coming to see me?
Fear of the unknown "what happens after you die?
Fear that life will have been meaningless.

By being aware and responding appropriately to what these questions represent, caregivers can reduce the person's fear and alleviate their spiritual pain.

Spiritual pain does not require a dose of pharmaceutical medication, it requires all those delivering care to be able to let go of their ideas, roles and agendas, to listen intently, to provide encouragement and to acknowledge as necessary. Put simply those experiencing this pain require their carers to listen with their heart.

By listening with your heart, there is no need to respond, the love and feeling are passed through your looks and your touch, their spiritual pain is only healed from within.

Improved VA Disability Pension Benefit With Aid and Attendance Entitlement

Attention WWII and Korean War Veterans - The VA will provide you financial assistance to help you or the widowed surviving spouse pay for long-term care.

This financial assistance provides needed money to help these elderly war-time veterans (and their widowed surviving spouse) receive in-home care or offset the costs of an assisted living facility.

And the best part, you don't need to use official VA care or facilities. This financial assistance can be used to pay independent home care agencies and non-government run assisted living facilities. Many families also can get this VA financial assistance to pay a family member to provide the care.

This little-known veterans' benefit is commonly called the "Aid and Attendance" benefit. It is officially called an "Improved Disability Pension Benefit with Aid and Attendance Entitlement" that provides a tax-free monthly amount up to $1,644 for a veteran or $1,949 for a veteran and spouse.

Widowed surviving spouses who have not re-married are eligible for this same benefit but by a different name. The official name of the surviving spouse benefit is "Improved Death Pension Benefit with Aid and Attendance Entitlement". This benefit also provides a tax-free benefit equal to $1,057 monthly.

This "improved" VA disability pension benefit can be used to pay for in-home care, assisted living facility costs or nursing home care. In addition other qualified uses include medical expenses, prescription drugs, incontinence supplies and more.

Five Steps of Qualification
1. To qualify for time of service, the WWII or Korean veteran must have served at least 90 days of active duty with at least one day of service between December 7, 1941 and December 31, 1946 for WWII or between June 27, 1950 and January 31, 1955 for the Korean War.

It does not matter if the veteran's active duty was stateside or overseas. Discharge from military service also must not have been under dishonorably conditions.

Note: Surviving spouses who remarried a non-eligible individual or whose marriage to the veteran ended in divorce are not eligible.

2. To qualify physically, the veteran (or eligible surviving spouse) must be age 65 or older (to not have to prove they can no longer work) and need help with basic activities of daily living tasks such as eating, dressing, grooming, proper hygiene, bathing or going to the bathroom.

Being blind or use of a wheelchair for mobility also physically qualifies the claimant. The claimant must also be no longer able to safely drive to be considered home-bound.

Physical qualifications should be documented by your private physician. You do not have to use or visit a VA doctor.

3. To qualify financially, the veteran (or eligible surviving spouse) must have limited assets (typically under $80,000) excluding the primary home and a single vehicle. Note: The claimant cannot be driving or they will be ineligible for the benefit.

The amount of benefit that the claimant can receive is based on a two-step calculation.

a. Add up all annual income from social security, retirement pensions, interest, dividends, annuities, etc.
b. Subtract from this income total the annual recurring out-of-pocket medical and prescription costs, the cost of private supplemental health care insurance, any long-term care insurance, and long-term care expenses from in-home care or an assisted living facility.

The resulting amount is called the "adjusted countable household income". This amount is then compared to the maximum VA disability pension benefit. The difference is the benefit amount you will receive - paid in 12 equal payments.

4. The maximum VA disability pension benefit for 2009 is as follows:

Single or widowed veteran = $19,736 paid $1,644 monthly
Veteran with a dependent (typically spouse) = $23,396 paid $1,949 monthly
Un-remarried widowed surviving spouse = $12,681 paid $1,057 monthly

Let's look at an example:

• Sam is an honorably discharged Korean War veteran who lost his wife 6 months ago.


• He suffers from dementia and can no longer drive or live alone. His family has moved him to the Great Home Assisted Living facility where many of his friends also now live.


• His adjusted countable household income is a negative $-1,000 (Social security and a small pension from his work at the Tool & Die Company less his qualified medical costs of assisted living, prescriptions and medical insurance premium).


• He has less than $10,000 in savings and after the reverse mortgage is paid off from the sale of his home he will net $50,000.

Since Sam's qualified medical costs exceeds his income he qualifies for the maximum VA disability pension benefit, or $1,644 per month.
This means that Sam now has $644 in income each month after paying his qualified expenses instead of having to take $1,000 from savings each month for his care.

5. How to Apply

To learn more or to understand how to successfully apply for the Aid and Attendance benefit from the VA, visit www dot VeteransCareAdvisors dot com. The Aid and Attendance Handbook will walk you through the process and help you better understand the paper work, required documentation and what to expect during the claim processing.

Why to Choose a Special Dementia Focused Nursing Home For Your Relative With Alzheimers

Alzheimer's can affect anyone at any age from any part of the world. Dementia comes in many forms and can start with little signs of memory loss, to confusion of where the person is or what the person is doing. If you have a relative with Alzheimer's then caring for them at home can become a safety issue and even a life threatening issue.

Why To Choose a Special Dementia Focused Nursing Home For Your Relative with Alzheimers

When you have a relative that has Dementia it is vital that when you look at Nursing Homes that you can find one that suits the special needs of your relative with Alzheimers based care. There are many different aspect to their care that not every Nursing Home can give. Safety is the number one issue, with carers providing an environment filled with love, understanding, compassion, patience and willing to give care that is above and beyond what will be expected

Five Reasons Why You Need To Choose A Special Care Unit

1. Dementia People become very confused very easily, and forget where they are and what they are doing.


2. Your Relative may be at the early stages so sometimes appears as if ever thing is normal on the outside but on the inside their brain is no longer working, so finding a SCU that is secure is vital


3. A normal nursing home is not able to give close care like a SCU


4. The Relative may become aggressive so will need to have access to teams in the SCU that can help the Alzheimer person


5. Looking after your relative can become too draining so you may need to take time to look after yourself with choosing a SCU

What Does A Special Dementia Focused Nursing Home Offer Your Relative?

A Special Dementia Focused Nursing Home is set up with Alzheimers needs taken into account. The SCU are places with doors that are secure, and usually take a pin code to enter and exit through the door or gate. They are buildings that are built especially for Alzheimer's people with their best interest at heart. When you are looking for a Nursing Home for your relative its important to take a good look at the atmosphere in the SCU and to see how well the residents are cared for by the Assistant in Nursing. Because you can not ask the residents if they are happy, its best to pop into the Nursing home and see if other Relatives are there visiting and then ask if the family are satisfied with the level of care provided to their Dementia Relative.

Remember These Points When Looking For A Special Dementia Focused Nursing Home

• Is there a gate or door with a secure lock?


• What happens if an incident occurs with your loved one, who and when will you be informed?


• What about visiting hours - when can you visit your relative?


• Are you able to take your loved one out for day trips or over night trips?


• What are the qualifications of the aged care Nurses? Have they had training for Alzheimers Residents?


• Is there a program where the Dementia people are asked to join in - like Music, Art, Singing, Dancing, Mind games etc?


• Who will caring for your Dementia Relative? Is there any religious views that you want to have respected?


• Is there a Doctor on call if the residents needs do change?


• Will there be any therapy provided for your Dementia Relative that will aid with their health? What about their spiritual needs? Will there be any extra activities offered to your relative?

Choosing A Special Dementia Focused Nursing Home For Your Relative with Alzheimers is important because you need to know that your loved one will be looked after, and cared for in a way that shows them love, respect, and to feel like they are worthwhile.

Things to Expect at Assisted Living Facilities

Entering into a new environment create a cocktail of feelings. One might feel anxious, scared, or excited, especially when they do not know what to expect. It is no different with introducing one's self to an assisted living facility, even more so that their life would take a change to creating a new family outside of home. However, knowing what to expect would help ease some of that anxiety. Here are some of the things one can expect from an assisted living facility.

While each facility varies from one another in the package offered, there are some common things that each package should at least offer. For one, they should be provided three nutritious meals a day, and their room and laundry are maintained for them. There would be minimal amount of supervision on the elderly if they have able bodies, and they will be allowed to participate in the facility's social-recreational activities. The overall environment will be safe with the presence of 24-hour staff watching over the premises, while the bathrooms are designed and equipped for handicapped, ensuring that the bathrooms are ergonomic for the elderly.

Other services may also be provided, and would usually cost extra. For example, you could get assistance with the daily medications by a registered nurse to help the elderly be reminded or prepare the medication. Some elderly may also need assistance with bathing as they may not be able to do it on their own. Apart from that, there can be services to help with daily living tasks, such as dressing up, walking, using the toilet, and even eating for the elderly who have trouble doing them on their own. If there is a need to transport the elderly from the facility to the doctor's office, physiotherapy centre, or other places, this service is also provided.

Although the daily necessities are provided for the elderly, one should visit their elderly frequently as no one can replace the company of their own relatives and friends. No elderly person would want to feel left behind.

How Medical Alert for Seniors Protects the Elderly From Accidental Falls

The absolute importance of having a reliable medical alert system in place can be understood in the context of a leading killer among the elderly: accidental elderly falls. There is a convoluted explanation why more and more elderly people seem to be dying from falls, but the understanding of many scientists and medical researchers boils down to a simple proposition: the longer we live, the frailer we get. This frailty means that one single, very small mistake-a miscalculated step on the stairs perhaps, or failing to notice that the floor is wet and slippery-can be fatal. Less and less older people are dying from chronic diseases such as heart disease or cancer, thanks to continuing improvements in health care. However, this longevity exposes the elderly to the said "quicker" cause of death.

At 65 years of age or older, an individual stepping on a banana peel is no longer funny-in fact, it takes on a deadly character. A simple accident like that could be catastrophically destructive to aged bones and tissue. The prognosis worsens in the presence of underlying medical conditions, such as osteoporosis. Indeed, if we check out the statistical data from the past decade or so, thousands of older adults died as a direct result of an accidental fall, than from any other type of injury.

As if death-related data are not enough to push our thesis, there is also statistics from emergency departments: in a single year alone, millions of people in the USA were treated for "luckier" nonfatal injuries related to an accidental elderly fall. The significance of such data can be further understood with the fact that more and more senior citizens opt to stay and live in their own homes rather than in a special home for the aged. It appears that we still value our autonomy and the comfort of familiar surroundings and will gladly choose them over having to live in a special home for seniors.

That is why getting the services of a reliable medical alert system is more than necessary to complement the choice of staying and living at home. Senior citizens who live alone are at a particularly greater risk for elderly falls, and with no one around to immediately attend to them in case such an accident occurs, the chances of survival dips to zero.

Against this backdrop, the invention of the medical alert system can perhaps be considered a "Godsend" for many senior citizens. In the event of a fall, especially when there's no one else around to witness it, the medical alert can instantly notify the relevant medical response teams to come to the elderly person's aid. Most wearable medical alert systems have sensors that detect if a fall has taken place.

Well, aside from getting a reliable medical alert system to ensure the round-the-clock monitoring of an elderly person's whereabouts and other health-related concerns, there are also several proactive measures the elderly can perform to avoid accidental falls. The most obvious, of course, is maintaining physical fitness. The less frail you are, the less likely you might slip or fall. The usual prescription of exercising regularly applies to this: choose exercise programs whose specific fitness targets include enhancing your sense of balance, improving your agility, and restores your alertness and strength. Exercise programs that involve deep breathing exercises are also good.

If the elderly person is taking maintenance medication, have their doctor review the medication for possible replacement with alternatives that cause minimal side-effects. Most medications taken by the elderly may cause dizziness and the occasional nausea.

And most importantly, you should "fall-proof" your home. Reassess the layout of your house and try to identify accident-prone turns or areas, and do something to make such areas safer for the elderly. Improve the lighting conditions, for instance. Or increase the friction of the floors.

In the end, an efficient medical alert can give a senior citizen and their loved ones peace of mind. Although no one can entirely eliminate the possibility of elderly falls, at least we should exhaust all measures to prevent it from occurring. And if such an unfortunate accident does occur, you can maintain your peace of mind with a medical alert for seniors.

Caring For Elderly Parents - In-Home Care Decisions

Caring for Elderly Parents

There comes a time in most of our lives when adult children find themselves responsible for their parent's well being. This usually happens when the parents have exhibited behavior that proves they can no longer able to take care of themselves.

Nursing Homes

For some people, the care of an elderly parent means selecting the best possible nursing home. The advantage to putting a parent in a nursing home is that they will receive round the clock professional care, and that the nursing home will have everything they could possibly need.

The disadvantage to nursing homes is that the facilities and people are unfamiliar which can sometime stress the elderly to the point that their overall health deteriorates. Also, nursing homes are very expensive and many families simply can't afford them.

In Home Care

For people who don't feel a nursing home is a viable choice, they can choose to move their elderly parent into their own home.

A great deal of preparation, both mentally and environmentally must be done before a family brings their elderly parent to live with them. Families need to prepare for is arguments. By nature people tend to resist being taken care of, and most people really don't like the idea of their children being burdened by them. This often leads to outburst and arguments that can leave everyone feeling hurt and helpless. The best thing a family can do is try to stay calm. It doesn't hurt to find tasks that the parents can do so that they can still feel like they are a help rather than a hindrance. Most people are healthier, mentally and physically, when they have something to keep their mind active.

Before moving their parent into their home, adult children need to spend some time researching their parent's condition. The more they know about what to expect as their parent's mental and/or physical state deteriorates, the better able everyone will be able to prepare for things.

Another thing adult children need to consider before moving an elderly parent into their home is how much care the parent is going to need, and whether or not the adult children will be able to provide it. If the parent needs round the clock care, the family might need to consider hiring a part-time, in-home nurse.

One of the things that many people learn after moving their elderly parent into their home, is that caring for the parent often involves a great deal more than making sure they get enough to eat. Most of the elderly have mobility problems and need to be helped out of bed and off of chairs. At first this doesn't seem like it will be a problem, but after a while it can become tiresome. Lift chairs are products that can help the entire family retain their humor and mobility. Lift chairs are a step beyond the average household recliner. The seat of the chair tips to a 45 degree angle, making it easier to stand the person on their own feet.

Lift chairs have been beneficial to people who have been diagnosed with Parkinson's, Alzheimer disease, poor circulation, arthritis, and numerous other ailments and conditions.

Picking the Scab

This article is about picking at the past, memories of that unwanted experience, and at any undesirable present condition. We all have this propensity to pick at the unwanted memory, experience or condition. Like the scab on your body from a previous experience. We don't like that it's there and are uncomfortable with it, we don't like how it looks and feels and know that doesn't reveal who we really are; divine, beautiful and perfect. We want the scab gone, like the past unwanted experience and the feelings that accompany them, so we pick at the scab. But picking at a scab, an old wound, only irritates it, reopens it and brings it back into our present experience.

It reminds me of a funny thing that happened a couple of years ago. I went to the doctor, here in Germany before I learned any German. I had injured my knee slipping on an icy sidewalk and I went to the doctor because the swelling was not going down. First of before I continue, all over the same leg I have a birthmark and it looks like someone beat me.

Well the doctor, a sweet woman, didn't speak a lot of English. I didn't speak any German. She took a look at my leg, after we tried to discuss the problem with an English/German dictionary, and said, "Uh, um, you have angered your knee" I understood that she was saying that I have irritated my knee, but got a giggle out of it non-the-less. From then on my husband and I referred to irritation of any body part as angering it.

This is what we do to scabs, to memories and conditions, we anger them. We rile them; reopen them to harm us again. It is the same thing as resentment.

Resentment can be triggered by an emotionally disturbing experience that is being felt again or relived in the mind. When the person feeling resentment is directing the emotion at their self it appears as remorse.

Resentment is reliving the same experience over and over and over again. And of course it's always reliving something undesirable and painful; picking at the scab reviving it to its original pain and condition; often to a worse state getting infected. In this action we are reigniting the thoughts and emotions, previously experienced and in turn keeping it active until it manifests something similar to the original experience. The wounds from the past, like a scab, left alone or put out of your mind heals and falls away.

Often the scab we are picking at is the wound that we carry about something someone else said about us. We carry the wounds of abandonment, criticism, guilt and rejection like a sack of rocks; carried heavy upon our back and it doesn't occur to us to just drop the bag of rocks and move on. Some might call it our baggage.

Put the sack of rocks down. Replace the thoughts of the past with new and better thoughts. It is almost impossible to make yourself stop thinking about something in order to rid yourself of the thoughts. It's much easier to just decide on something else better and grand to think about; and eventually, like the scab, the old thoughts fall away and are replaced with the new and better thoughts.

Why do we pick at the past, the scab of previous wounds or the unwanted memories; usually because the person that inflicted said wound had been deemed as an authority. We had given that person a lot of power. We had decided long ago that we should care about what others think and gave them the authority on us our lives. We considered what others thought of us as true. So each time we come upon a thought or experience, that reminded us of that past experience, we brought to mind the scenario of the past experience, relive it and continue to conduct our lives in the same way; because we believed the person we gave the authority to; be it a lover who decided we were not enough, the parent who decided we were inadequate, or the so called friend who criticized.

It's time to lay the past to rest, "the you called" authority figures to their own business and let the scab heal. That Resentment, according to popular belief, hurts the other person is not true. Resentment only hurts you.

I am reminded of a scab/resentment I picked at for a long time, keeping it alive and active; my mother's life long romance with being a victim and self hatred. Her constant manifestation of illness and constant attempted suicide's preyed on my mind as often as she felt sorry for herself. I was consistently angry over the calls to rescue her, her threats of abandonment (suicide) even when I was a child, and the guilt I allowed myself to feel through it all. When my anger culminated into a rage, speaking and thinking of her behavior often I realized that I was reopening the scab and keeping it alive. I realized that in my expectation of her behavior I was co-creating, with her, the same experience over and over. I was participating and perpetuating her behavior. I was really just afraid. In my fear I drew her experience into mine. I expected she delivered. I so often worried that at any moment I would get another call, about her negative manifestations, that I did.

She, in her believed inability to create a happy life, thrived on the attention she got when ill in a hospital or recovering from a suicide attempt. She could only feel good about herself when others ran to her side, which to her meant they cared. She didn't know how to feel good any other way. So when she felt bad she recalled how she was able to feel good, siting the past as proof, and re-created the situation. Don't believe for a minute that I didn't, almost every day since I was able to reach the kitchen cabinets that I did not try to help her. It encouraged, cared for her and was her cheerleader for as long as I could remember. Ultimately it stole my childhood and much of my adulthood.

I finally made a decision to no longer entertain her negative possibilities. I made a decision to focus on my life and think of only that which I desired. I also visualized my mother healthy and happy. I did not talk to my mother for a period of time in order that I not focus on her unhappiness and get re-centered. I told her that I would no longer take care of her, I would no longer RSVP to her shows of illness or attempted suicides and until she made the decision to enter a hospital and get help I would not talk to her. It was difficult and I received much disdain from family members. One family member passed onto me from another family member who actually said, "That's blackmail" I told the messenger, "You bet it is"

Within months, my mom who had landed herself in a nursing home at age sixty after an attempted suicide took charge. She decided she would not die in a nursing home and made calls from her hospital room until she found a government assisted apartment complex that welcomed her. She arranged to enter a psychiatric hospital and received help. She recovered physically, started her mental recovery and moved into her own apartment, after years of being taken care of by her family, and is moving towards, little by little, a new way of thinking and living. She still struggles with her long ago physical illness that she manifested, but is ever moving closer and closer to becoming happy, healthy and self-reliant. She practices often thinking only of that which she desires and with all her might avoids picking the scab.

We talk now all the time. She appreciates that I insisted she stand on her own two feet. We talk all of the time about Law of Attraction and manifesting, she embraces the concepts, and is manifesting a life experience she desires. And she absolutely loves and watches the video I produced for her. Her Fantastic Life Video where she can see herself doing, being and having all that she desires.

And I am focusing on that which I desire for my experience. I no longer pick at the scab of my mother's previous behavior. Truly until this moment that I translate to you the story of my mother I had not given thought or attention to the way it was for many years now.

In conclusion; pay attention to, only give thought to the now. Decide on what you will think about, how you want to feel and what you prefer as your life experience. Leave the scab alone and it will heal. Replace previous negative thoughts with new and exciting thoughts. Dwell in the possibilities, the visions of a beautiful joyful healthy abundant life.

The possibilities are unlimited, the experiences boundless and the joy is yours. You are divine energy in physical form. You are full of astounding ideas, magical inventions, and craftiness creations.

Nursing Homes and Elder Abuse

Elder abuse in assisted living homes is a horrible thing, yet it still occurs today. Most recently, the Florida state government has responded to help eliminate this practice. Because of "rampant" abuse across the entire state, Florida's lawmakers have proposed two bills that will crack down on elder abuse. More specifically, if a patient dies because of poor care, these bills would enforce mandatory penalties that would cause the home to shut down. In other cases, individual caretakers would be banned from their profession.

Florida lawmakers claim that the state was not doing its job properly, as exposed by a series of articles written in the Miami Herald. Now, Florida is looking to go from one of the most lenient states regarding care all the way up to one of the strictest states in the U.S.

It's about time. Elder abuse is something that many people believe does not go on anymore, but it is still a rampant practice; the most common type of abuse being neglect. In Florida, a lot of the attention has been on the elderly folks who have died because of their mismanagement, but elder abuse takes on many different forms. These can range from missed medications to infected bed sores. Whatever the form that the neglectful abuse takes its shape in it is a practice that needs to be more closely monitored. If a home or a worker is found to be abusing patients, mandatory punishments, such as those proposed by Florida lawmakers, need to be enforced.

This marks the biggest overhaul of this type within Florida in over four decades. With the protection measures for assisted living facility patients slowly being stripped away over the last few decades, it is high time for a new mandatory set of regulations.

The proposed laws would take away a home's license if a patient dies from "shoddy" care. They would also avoid settlements in cases of neglectful deaths. The maximum penalty would automatically be imposed upon these offenders. The minimum qualifications of workers would also be increased. Instead of just having a high school diploma, a caretaker would be required to have a college diploma with at least some course work in health fields. There would also be severe criminal penalties for fraudulently altering assisted living facility paperwork regarding patient care.

Florida is finally taking steps in the right direction. The care that elders receive often is taken for granted, but as the case in Florida suggests, this should no longer be the case. Elder abuse needs to be looked out for and it needs to be reported to the authorities when it does happen. There is no excuse for shoddy care, our parents and grandparents deserve the best care possible.

Become a CNA - Certified Nurse Assistant Job Description

Do you have compassion and a desire to help people? Would you love to have a rewarding career in the healthcare industry? If you answered yes to these questions, then becoming a Certified Nurse Assistant may be just the job for you. With a shortage of caregivers and a growing elderly population, nurse aides have never been in more demand than they are right now. Though this is certainty not an easy job, and it is definitely not for everyone, there will always be a need for qualified nursing assistants.

Certified Nurse Assistants (CNA) are the nurses that provide direct patient care, both medical and non-medical, in places such as hospitals, outpatient facilities, long-term care facilities, nursing homes, and through home care. They are responsible for a wide range of daily patient care duties and work directly under the supervision of a Registered Nurse (RN), Licensed Practical Nurse (LPN), or other licensed medical professional. They may assist patients while getting dressed or undressed, with general hygiene tasks (such as bathing or brushing their teeth), or when eating, among many other job duties. The CNA may also be responsible for collecting simple body fluid specimens or taking a patient's vital signs (blood pressure, heart rate, temperature) but does not make any decisions based on this data. They can help physicians or nursing staff members with patient procedures as needed. And they are typically responsible for documenting a patient's activities throughout the day.

The following list is a general CNA job description and are some of the duties you could expect to perform as a certified nurse assistant:

- Moving the patient from a bed to a wheelchair (and vice versa)
- Moving the patient from a bed to stretcher (and vice versa)
- Moving the patient with a mechanical lift
- Moving the patient up in bed (to the side of the bed, raising head and shoulders, or onto his or her side)
- Making an occupied or unoccupied bed
- Measuring temperature (oral, rectal, and auxiliary)
- Taking radial or apical pulse
- Counting the patient's respirations
- Measuring blood pressure
- Measuring height & weight
- Brushing & flossing the patient's teeth or providing oral care for dentures
- Providing perineal care
- Assisting with a tub bath or a partial bath in bed
- Assisting the patient with hand and foot care
- Assisting the patient with dressing or undressing
- Shampooing or combing the patient's hair
- Shaving the patient's face
- Assisting with feeding
- Assisting with a bedpan (or male with using a urinal)
- Collecting a urine or stool specimen
- Providing catheter care / emptying a urine drainage bag
- Assisting the nurse with a wound dressing change

If you want to become a valuable member of a healthcare team who makes a huge difference in the lives of patients and their families every single day, then becoming a certified nurse assistant is a great place for you to break into the medical field.

Senior Citizens and Alcoholism

Compared to alcoholism among young adults, alcohol abuse among elderly people is rarely discussed. However, addiction experts have known about this problem for a long time. Studies over the last three decades show that alcoholism among elderly people is alarmingly high in the United States. Unfortunately, very few rehabilitation clinics have created specialized treatment programs to address the issue. Whether they developed their addictions at a younger age or didn't begin heavy drinking until they were older, many seniors abuse alcohol for the latter ten, twenty, or even thirty years of their lives. It is critical that society understands and addresses this problem, especially since baby boomers are beginning to retire in massive numbers.

Though people rarely associate addictions with elderly people, alcoholism is quite common among senior citizens. One possible reason why so few recognize this problem is that older, more experienced alcoholics may be more adept at concealing their problems. According to a 2000 study by Sally K Rigler of the KU School of Medicine, heavy drinking was reported in thirteen percent of men and two percent of women ages sixty to ninety-four. She writes that on average, six percent of elderly people consume three or more drinks per day.

This figure may be inaccurately low, however. Many senior citizens lie about their alcohol use because they fear having their rights taken away or being put into nursing homes against their wills. The problem could also be worse than statistics suggest because senior citizens who abuse alcohol are likely to abuse other substances, as well. They may develop addictions to their prescription medications, but older alcoholics are also believed to be more likely to abuse tobacco and even illegal drugs. This could further skew statistics, since anyone using illicit substances might lie to avoid legal penalties. Overall, the current body of evidence does not provide a clear understanding of the problem at hand.

Addiction specialists do understand that senior citizens tend to be less socially active than younger people. They have fewer close relationships, and their slower lifestyles often make them feel isolated from younger family members. Elderly people also tend to suffer the losses of friends quite often as they grow older, further shrinking their social circles. These diminishing personal connections can easily lead to depression, antisocial behaviors, and self-medication. Because of elderly people's heightened risk for substance abuse, society must learn to recognize the warning signs of alcoholism. They include:

Obsessive behavior:

Alcoholics young and old often talk constantly about drinking. They discuss new bars or liquor stores, people they drink with, and their favorite drinks. They may even shamelessly talk about the large amounts of alcohol they regularly consume. Without realizing it, many alcoholics glorify the behaviors that are consuming and destroying their lives.

Lack of Self-Control:

It is common for people with substance abuse problems to utterly lose their ability to control their consumption. Alcoholics may forget when in the day they started drinking, whether or not they drank the previous few days, or how many drinks are currently in their bodies. They often exhibit extremely inappropriate or outrageous behavior while drunk. However, some alcoholics can also disguise their lack of self-control by drinking alone or moderating their drinking when around other people.

Recklessness:

The clearest sign of any addiction is the continuation of harmful behaviors in the face of large and obvious consequences. Alcoholics will continue to drink obsessively as their personal relationships, careers, and families fall apart. An additional consequence for elderly alcoholics is mental degradation. Studies have shown that older people who drink heavily are more likely to experience memory loss and other cognitive difficulties.

Although these signs are typical of alcoholics, many people are able to conceal their drinking problems and maintain orderly lives. This is one reason why so few people recognize the problem of alcohol abuse in elderly people. Older alcoholics may have developed their problems when they were younger and become adept at managing or hiding their addictions.

Overall, the combination of senior citizens' heightened risks for alcoholism and the public's lack of awareness about elderly alcohol abuse is a serious national problem. If you know a senior citizen who is currently struggling with this addiction, or if you need help with your own substance abuse problems, use the links below to get help now. Our dedicated addiction specialists are standing by for your free, no-obligation consultation. Get your life back on track today.

Claiming Negligence After a Car Accident

Although car accidents in a few states can still be considered "no fault," in many other states, the authorities and insurance companies specifically require that the blame for any accident be placed somewhere - usually on the party determined to have been negligent.

If, after a car accident in an at-fault state like Colorado, you are determined to have been negligent, your car insurance company will likely end up paying the bill and employing any attorneys necessary, while you stand a good chance of seeing your rates go up. If, on the other hand, the other driver's negligence caused the wreck, you may find yourself in need of a good car accident attorney to help you collect the damages you are owed from the responsible insurance company.

What constitutes negligence in car accident claims

There are a few different ways to show a driver was legally negligent, and proof of these behaviors can help bolster your claim should you have difficulty collecting from the other driver's car insurance company. What you are essentially trying to show is that while you were exercising due care on the roadways, the other driver was not.

Driving distractions, for example, often cause drivers to act in ways that would be considered negligent. Talking on a cell phone while driving or even taking a sip of coffee can take a driver's attention away from the road and endanger other drivers. Driving under the influence also constitutes negligence, because it shows that the driver was not living up to the legal "duty of reasonable care", we all commit to when accepting our drivers' licenses.

Negligence itself does not guarantee a successful outcome

Not only must you prove that the other driver was negligent in his or her duty to pay attention and keep the roads safe, you must also prove that this negligence has resulted in financial loss for which you are owed restitution.

The first element of this is tricky because unless there was a witness to the negligence, admittance by the driver, or some physical proof of the negligence, the other driver - or rather the other driver's insurance company - will do everything possible to deny that negligence caused the car accident.

Assuming you have proof, though, you still need to prove your own loss in order to show the court that you deserve reimbursement. With physical damage to an automobile this is usually not an issue. In cases of injury, especially an injury which requires long-term treatment, you will likely require the assistance of a skilled car accident attorney to help show the extent of your current and future medical bills.

Do all car accidents require attorneys?

No, every car accident does not require the assistance of an attorney, but the number is probably higher than most people realize. Car insurance companies don't happily pay claims in most cases. If they see any opportunity to avoid paying, they will fight the claim with all of the resources they have available - and that's a lot of resources.

If you are preparing to go up against an insurance company to try to collect your claim from their army of lawyers, you'll be better suited to handle what's to come with the help of a car accident attorney of your own.

Senior Living - The Top 4 Elderly Aids That Make Life Easier

As seniors age they should know that there are elderly aids available that are intended to make senior living easier. These tools are easy to use and designed for everyone as they age. Here are the top 4 elderly aids that make life easier for senior living.

When we age our bodies begin to slow down. We get tired quicker, our vision and hearing is not what it used to be, muscles ache more and for many mobility challenges begin to set in. But that doesn't mean life is over. With all the advances in medical science today we will be living much longer lives than our grandparents and even parents.

There has also been some pretty neat advancement in the design of tools to aid seniors. All of these keep in mind the declining condition that faces the elderly.

Phones for Hard of Hearing

There are a number of different styles of phones available today that work well for those that are hard of hearing and have vision challenges. Some of the phones have extra loud ringers and volume control settings. Some have very numbered keypads that are even back lit so they can be seen easily at night.

Large Print Keyboards

More seniors than ever are connecting and communicating with each other and their families on the Internet these days. They are learning to use computers and finding how beneficial a computer can be. However with dexterity problems from arthritis and low declining vision inputting letters on a traditional keyboard can be somewhat difficult.

That is where a large print keywords can prove very helpful. These special keyboards have over sized letters and are often back lit so they can used and seen with ease.

Walkers With Wheels

Slip and fall accidents is a huge concern for the elderly. That is because their mobility is often something that begins to decline as they age. Their ability to walk, keep proper balance and avoid stepping on objects within their path becomes a real challenge. The newest walkers have seats and even wheels. Walkers with wheels allow seniors the ability to stay mobile and move around safely, minimizing the risk of falling.

Electric Lift Chair

This is by far the best invention ever for seniors. Many seniors like to relax in their living room watching TV or even to take naps during the afternoon. But the problem can be getting in and out of a traditional recliner or chair. Well that problem has been overcome with the design of the electric lift chair.

These are recliners that operate with a remote, hand-held controller. At the touch of a button the chair lifts up and out so it can be sat upon from a standing position. At the touch of a button, the chair lowers into a normal seating position. These recliner are big and very comfortable chairs, nothing has been sacrificed in their features. When the senior is ready to exit the chair the same controller is pushed and the chair rises again so it can be exited in a standing position.

The Pricing Problem - Game Theory Used to Determine Optimal Rates For Assisted Living Facilities

When aging seniors begin to need basic assistance with daily living, they can essentially choose from one of the following to get the long-term care they need:

(1) receiving assistance at home from a loved one;
(2) hiring a caregiver from a homecare agency; or
(3) moving into an assisted living facility. While approximately 70% of seniors over 75 years of age obtain help from a loved one in the US, home care agencies (HC) and assisted living facilities (ALF) are growing, lucrative industries. ALFs and HC services provide quality senior care and assistance for those in the aging elderly US population who have the ability to lessen the burden on their children by paying for expert long-term care services with their home equity, pensions, retirement savings, and/or government funding.

ALFs naturally compete with HC agencies for seniors and it is typically the adult daughter who decides if her aging parent will either move into an ALF or hire an in-home caregiver. Presumably, an adult daughter will choose the option that cultivates the most health and happiness to her aging parent at the lowest cost (especially in the current economic climate), and the goal of an ALF is to maximize revenue while keeping occupancy rates high by not losing seniors to HC companies. However, ALFs (known in signaling games as the sender (Source 1), since they send a price signal to the adult daughter) can vary greatly in quality (i.e. 'good' or 'bad') and HC quality is more stable (See Note). Ideally, operators of 'good' ALFs would signal their high quality to adult daughters with high prices, but because HC is a valuable alternative and there are 'bad' ALF that could raise their prices to falsely signal quality, the 'good' ALF operator has to carefully set its rates. This uncertain price-quality signaling between high revenue for the ALF and optimal benefit to the senior resident can be analyzed using game theory, particularly an extensive form signaling model, to help owners and operators of ALFs answer the question:

How should I price my assisted living facility to profit and show high quality, while still attracting residents?

As with any theoretical model, many assumptions about the 'game' must be made in order to solve. First, we will presume that there is uncertainty for the adult daughter regarding the quality of ALFs and a facility can be either 'good' (G) (higher benefit), with a probability of (p), or 'bad' (B) (lower benefit), with probability (1-p). Moreover, the benefit a senior receives from an in-home caregiver is more constant and simply provides a benefit of (HC). Second, ALFs can charge a high monthly rate (H) or a low monthly rate (L) and HC companies charge a constant amount, (K). The following values will be used as a numerical example to represent the costs and benefits of various senior living choices:

(G) = 6 (arbitrary benefit value of a 'good' ALF)
(B)= 3 (half of the benefit value of a 'good' ALF because of lower quality care levels)
(HC)=6.5 (highest benefit value option, assuming seniors would rather stay at home at receive care)
(H)= goal to solve for (H); typical high priced ALFs in the US charge $3,000-$6,000/month)
(L)= 1.5 (represents the cost of typical low priced ALFs charging $1,500/ month)
(K)= 5.5 (represents typical monthly caregiver costs charged by HC companies of $5,500/month)
(p)= 0.5 (assume that 1/2 of ALF are 'good' regarding the health and happiness provided to the senior)

Consequently, a set of parameters and a graphical representation of this game can be created from these assumptions. Therefore, the adult daughter who wishes to maximize her aging parents utility (benefit minus cost) would order her preferences for care options (highest to lowest utility) as follows:

(G - L) > (G - H) > (B - L) > (HC - K) > (B - H)

Thus, the adult daughter would first like a 'good' ALF at a low cost, second, a 'good' ALF at a high cost, third, a 'bad' ALF at a low cost, fourth a HC agency at the typical cost (K), and lastly, a 'bad' facility at a high cost.

There exists a specific price at which the adult daughter may choose a high priced ALF in hopes that it is 'good' (G - H), in spite of the risk that the ALF is 'bad' (1 - p) and gets (B - H). Subsequently, the total utility is: (p)(G - H) + (1 - p)(B - H). The adult daughter will then only choose a high priced ALF if the utility is greater than the utility from a HC agency, illustrated by the equation:

(p)(G - H) + (1 - p)(B - H) > (HC - K)

For a numerical application, assume the values from above to solve for (H) (See Figure 2 for detailed calculations) and the resulting highest price an adult daughter is willing to pay for the potential benefit of a 'good' ALF at high price, with the risk of that the ALF could be 'bad' factored in, calculates to H

Assisted Living - Why it is So Popular With Seniors?

As we age into our golden years, we face a bit of a quandary. As much as we hate to admit it, we could use some help with some basic daily tasks. At the same time, we want to maintain our independence as much as possible. More and more people are finding that assisted living is a great option because it allows both of these goals to be met.

What Is Assisted Living?

Assisted living is a compromise between completely independent living and a nursing home. It is designed to provide seniors with help with daily tasks like meals and cleaning, while allowing them their total independence when it comes to daily tasks and such. Although different facilities offer different services, most assisted living facilities do not offer medical care.

Assisted living is by far the most popular senior housing option. Why is this? Well, think the issue through. Most people prefer to live independent and do so. As we age, we might need help with a few things, but it is fairly rare that we suddenly need help with everything! This is where assisted living comes in. We don't have to worry about making meals. We don't have to worry about keeping our living area clean and so on. The staff of the assisted living facility takes care of those annoying issues.

Another reason assisted living is popular has to do with the people occupying the communities. Simply put, they are all seniors who are active. It is not a gathering of really sick people one finds in a nursing home. This collection of active individuals of the same general age gives us chances to meet others with similar attitudes and the same interests. For many seniors, moving into an assisted living facility is one of the best things that can happen to them.

For the longest period of time, the only real option for seniors was to transition from independent living to a nursing home. That constituted a major change in lifestyle and was one reason many seniors viewed nursing homes with such despair. Fortunately, assisted living has created a transition between the two and today provides seniors with a housing option that not only meets their needs, but represents an idyllic living situation in many cases.

Holiday Blues: Depression in the Elderly

We who are involved in Elder Law have to be vigilant about recognizing the symptoms of depression in our older clients. For one thing, it can affect the care we put in place. This concern becomes even more acute during the holiday season, when the symptoms of depression can become heightened. This is often referred to as the "Holiday Blues".

As we spend time with the older people in our families and communities, we should all be on the look out for signs of depression. It is, it turns out, more common than generally believed. According to the National Institutes of Health, of the 35 million Americans age 65 years or older, about 2 million suffer from full-blown depression, and another 5 million suffer from less severe forms of the illness. This represents about 20% of the senior population.

Exacerbating the problem is that depression in the elderly is frequently misdiagnosed and often goes untreated. The symptoms may be confused with a medical illness, dementia, or malnutrition due to a poor diet. Another factor is that many older people will not accept the idea that they have depression and refuse to seek treatment.

What causes depression in the elderly?

The holidays tend to bring memories of earlier, perhaps happier, times. Additional contributing factors that bring on depression may be the loss of a spouse or close friend, or a move from a home to an assisted living facility, or a change in an older person's routine.

Depression may also be a sign of a medical problem. Chronic pain or complications of an illness or memory loss can also cause depression. In addition, diet can also be a factor when proper nutrition and vitamins are lacking. Often, there are both mental and physical reasons for depression.

Symptoms to look for in depression might include:

• Depressed or irritable mood


• Feelings of worthlessness or sadness


• Expressions of helplessness


• Anxiety


• Loss of interest in daily activities


• Loss of appetite


• Weight loss


• Fatigue


• Lack of attending to personal care and hygiene


• Difficulty concentrating


• Irresponsible behavior


• Obsessive thoughts about death


• Talk about suicide

How do you know if it is depression or dementia?

Depression and dementia share similar symptoms, but here is a guide to some differences that might help to distinguish between the two:

In depression there is a rapid mental decline, but memory of time, date and awareness of the environment remains. Motor skills are slow but normal in depression. Concern with concentration and worry about impaired memory may occur.

On the other hand, dementia symptoms reveal a slow mental decline with confusion and loss of recognizing familiar locations. Writing, speaking and motor skills are impaired, and memory loss is not acknowledged as being a problem by the person suffering dementia.

Whether it is depression or dementia, prompt treatment is recommended. A physical examination will help determine if there is a medical cause for depression. A geriatric medical practitioner is skilled in diagnosing depression and illnesses in the elderly. If you are the caregiver of an elderly person it may be beneficial for you to seek out a geriatric health care specialist.

Treating depression in older people

Once the cause of the depression is identified, a treatment program can be implemented. Treatment may be as simple as relieving loneliness through visitations, outings and involvement in family activities. In more severe cases antidepressant drugs have been known to improve the quality of life in depressed elderly people. Cognitive therapy sessions with a counselor may also be effective.

As a caregiver or family member of a depressed elderly person, it is important to take the initiative. The elderly person will generally deny any problems; they may fear being labelled as mentally ill. Your intervention can make the difference and alleviate the depression and Holiday Blues of a senior in your family or community.
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Disclaimer: The foregoing is not medical advice, and no action or refraining from action should be based on it. Anyone who is dealing with the issues discussed above should immediately consult their physician or other health care provider.

Medication Errors in Nursing Homes - Part 2

• Estimated one adverse drug event occurs per patient per day


• Treating avoidable events conservatively cost $billions annually


• Information technology plays a key role in improving resident medication safety

Nursing home residents take an average of eight medications per month. One-third of them take nine or more. Despite the excellent care provided to these residents, one avoidable adverse drug related event is estimated to occur per resident per day at an annual healthcare cost of billions. Many events are caused by inefficient information systems offering incomplete or inaccurate information to the clinician. Increasing access to accurate resident specific information empowers physicians in perhaps their most important role in long-term care facilities; that of monitoring for inevitable drug interactions between diseases, symptoms and other drugs in the medication use process. Three emerging technologies (EMRs, CPOE and CDSS) actively enlist clinician participation in this ongoing process.

Information Technology (IT) Opportunities

Electronic medical records (EMRs) store resident specific information electronically thus centralizing information and enhancing operational efficiencies for clinicians and the interdisciplinary team. Other benefits include:

• Increased accessibility to and sharing of information


• Ongoing clinician maintenance and review of the resident specific medication list


• Legible clinician documentation consistently compliant with regulatory language


• Enhanced systematic surveillance of disease/symptom/drug monitoring


• Updated drug information resources

Computerized Physician Order Entry (CPOE)

CPOE enables electronic entry of clinician orders. Prescribing medications electronically with an EMR is safer and more reliable than paper based prescribing and reduces medication error rates.

Clinical Decision Support Systems (CDSS)

Clinical decision support systems provide care guidelines to clinicians and promotes resident safety, education and communication. Diagnosis specific treatment guidelines (e.g., myocardial infarction plus aspirin or atrial fibrillation plus warfarin) support optimal health through proactive disease management. Automated resident-specific reminders for drug allergies, interactions, dosing adjustments and evidence-based interventions prevent errors of omission. The reminders become a reliably consistent surrogate for resources inefficiently spent in retrospective, individual chart reviews. When combined with clinical decision support systems CPOE reduce medication errors by 80 percent. Benefits of CPOE and CDSS include:

• Better documentation for drug usage indications, allergies and interactions


• Warning messages triggered by incomplete, incorrect or excessive dosing orders


• Improvements in therapeutic drug dosing adjustments


• Avoidance of preventable pharmacotherapeutic organ toxicity


• Improved clinician adherence to guideline-based care


• Positive influence on provider prescribing behavior


• Increased adherence to corollary orders

Cultural Changes

Residents and families, institutional partners and third party payers now expect system approaches to ensure policies and procedures follow evolving standards of care. Cost related quicker and sicker hospital discharges into nursing facilities and lawsuits involving adverse drug events are a few of the change drivers for using these integrated information systems to improve communication efficiency and quality of care. Despite demonstrated improvements using an EMR, CPOE and CDSS, the long term care industry has been slow to voluntarily adopt these technologies. The government is considering mandating e-prescribing as requisite for physician Medicare participation with all prescriptions being written electronically by 2010.

Raise the Bar

Specialty EMR, CPOE and CDSS give institutions and clinicians the ability to revolutionize healthcare quality with accurate, comprehensive information systems. The time has come for us to use electronic medical records and embrace a higher standard of resident safety and advocacy in long term care by integrating these systems into the disease and medication monitoring process. This ensures clinicians and facilities deliver the best care they are capable of and that residents receive the excellent care they deserve.

Guide to Making a Personal Injury Claim

Making a personal injury claim can be a very daunting process. Many people do not even consider fighting for compensation because they think it is not justified, will cost them a lot of money, take a lot of time or effort or simply because they do not know who to turn to. And some think that compensation claims are only made by those who want to get something for nothing and take advantage of the system, after all, an accident is an accident, right?

But getting compensation for an injury that was caused by another person's negligence or irresponsible or illegal behaviour is your legal right and you are 100% justified in finding out about making a claim.

If you do not find out about making a claim you could be missing out on the money you deserve to help you get the treatment you need and ease the stress of being unable to work.

Here are three key things you should address when you think you have a personal injury claim. They will help the process go smoothly and give you the best chance of getting the maximum amount you are entitled to in order to help you get back on your feet financially.

1. Keep written records

Your legal expert will get full witness statements and medical reports, but you should keep notes on what happened, your injury, any costs you have incurred as a result, treatment and advice you have been given and general thoughts on how your daily life has been affected.

These sorts of statements could be hugely beneficial in showing how you have been hurt financially and give vital information in proving the extent and impact of your injury.

Take photos too and keep everything safe in a folder so you have easy access to all the information when your attorney needs it.

2. Show how you have been affected

As well as physical injury, be prepared to show how your life has been impacted by the accident. This could mean giving a sense of any negative effects on your lifestyle, such as friends and family having to make trips to hospital or care for you or not being able to work and therefore struggling to pay the bills.

The compensation you are awarded will take these effects into account, as well as the nature of your injury, how it happened and how it should have been prevented by those responsible.

3. Take professional advice

Speaking to an expert legal team is vital when making a compensation claim. Only a trained, professional attorney with experience in making personal injury claims with insurers and the courts will be able to get you the justified payout you are owed.

Having an expert on your side to deal with all the proper procedures and regulations will give you the best chance of getting the highest possible amount of compensation, so it is well worth finding a legal team you can trust.