Personal Injury Claims: The Blame Game

Personal injuries can happen for a number of reasons. They range from the smaller causes such as sprains as a result of a trip over uneven flooring to the more serious causes like car crashes, with many others in between.

A common query from those affected is how to ascertain whether they could potentially be eligible for a compensation claim. There is no absolute method of determining this as every situation is different. However one necessity required for personal injury compensation claims is liability.

In most circumstances, it will be mandatory to prove that your injury occurred as a result of another party's negligence. This is in order for the legal team to determine who can be held liable for your injury.

Who is liable for my injuries?

Unfortunately, the majority of personal injuries occur from situations that could have easily been prevented. There may not necessarily be one specific person wholly liable for the injury but a company or establishment.

For example, employers have a legal responsibility to protect their employees so if your personal injury at work occurred because you were provided with the incorrect protective equipment or unsafe tools then your employer could be to blame. When an accident at work is a direct result of an employer failing their duty to safeguard your well-being e.g. you were not given adequate training or made aware of the relevant emergency procedures in the result of fire or evacuation, a personal injury company may be able to assist you.

Of the 1.3 million work-related personal injury claims last year, just 550,000 were new cases. The rest reflected employees with existing illnesses or health issues which they felt were made worse by work. This could be anything from a back problem worsened by lifting without the correct equipment to psychological problems contributed to from work stress.

It is not just injuries at work which require the establishment of liability. In order for all personal injury claims to be processed, a defendant must be held liable. This can sometimes prove easier in certain scenarios than it does in others. For example, a car crash injury claim when a rear-end collision has occurred as a direct consequence of a car crashing into you.

Proving liability

Proving liability for other cases can be more complicated. In order to ascertain who can be held liable for compensation, there must be a full investigation into how the injury occurred. The injury firm will need to gather all the relevant information and as much evidence as possible to support your case. The length of time that this can take varies from case to case

In certain instances, a liability dispute may arise where the other party denies responsibility for the injury. In this situation, the personal injury lawyer would discuss with you additional information and evidence which could assist proceedings such as witness statements.

What information do I need to prove liability?

Again, each case differs so there are no set guidelines. However, if you have suffered an injury due to someone else's negligence then it is important to keep as much evidence and information as you possibly can. Did anyone see it happen? Are there witnesses who could support your story? Although it may be the last thing on your mind at the time, photographic evidence can also be very useful with regards to faulty equipment or facilities.

You will also need evidence of any financial losses which you hope to claim for whether these are medical expenses that you have incurred or periods of time which you have been unable to work due to injury. Essentially, the more detailed picture that you can illustrate to your personal injury lawyer, the better. They can then make the necessary enquiries for you.

It is always important to remember that with all personal injury claims there is no guarantee of being awarded any compensation if liability cannot be established.

If you would like some more information on liability or claims, speaking to a personal injury solicitor could prove beneficial.

Factors to Consider When Choosing Nursing Homes

There may be a time when you grow old and would need to acquire some professional care to help you live. When that time comes, nursing homes may become one of your top services to consider. If that is the case, here are some factors you should consider when choosing nursing homes, whether they are private nursing homes or not. Observe well and evaluate if they are up to par with the standards of these factors.

The first thing to consider would be the location of the home. You might want to look for a home that is located near your family, friends, or doctor. This allows them to easily pay a visit to you, or vice versa. You could also choose one that is situated at an appealing area to you, if you have always dreamed to stay in certain places. Regardless, the home should be located nearby a hospital in case of emergency. Do ask about visiting hours too because you would want people to find it convenient to visit you.

In the meantime, you should pay attention to the size of the home. There are typically more activities one can do at larger ones because they would need to serve the interest of many of their residents. However, there are people who prefer something smaller and personal. Decide on which would suit you better.

Of course, money is a very important issue to consider. You can check with the home to see what Medicaid or Medicare can cover to ease your costs. Check out how the different rooms cost differently, as you may prefer having smaller rooms, or do not mind sharing with others. Additional services such as helping with your daily tasks like bathing or eating would definitely incur additional costs, so if you do need such services, do ask because their rates can be significantly higher. Do note that private nursing homes would be more costly than non-private ones as well. There is another concern which is in the situation where you are hospitalized, will there be a bed reserved for you. Medicaid will pay for 7 days of the bedhold, but Medicare and private-pay residents will need to pay for each day of use of the bed, but their rates would not be more expensive than a regular daily rate on bedhold.

As you will be living in the home, you will definitely need to eat. Check what type of food is served and how often. One thing you can do is to visit during their meal ties to see if the food looks appealing or not, and if the residents there actually enjoy the food. You would not have a choice but to eat what is given if you start living at a home, so make sure you find one that is bearable to live with.

Lastly, find out how valuables are kept or protected. Theft does happen at nursing homes, so it is best to choose one that ensures most protection.

Understanding Elder Law and Nursing Home Issues: Rights of the Elderly

It's never an easy decision to place a parent or loved one in a nursing home, but in many cases it is the best possible solution for an elderly relative who wants to maintain some degree of independence but who can't live on his own. Many of today's facilities are respected places that provide exceptional care, but there is always the chance that your parent could end up as the victim of abuse or neglect. If this is the case that you're facing, learn when to contact litigation attorneys for help.

Elder Law Protects Nursing Home Residents

Fortunately, the government has put various elder law reforms into place as a means of protecting residents and their families. One of the most comprehensive is the 1987 Nursing Home Reform Law, which outlines the rights of residents, including:

• The availability of resources and services for the highest level of functioning

• Freedom from unnecessary restraints, including physical restraint or the use of drugs unless they are prescribed by a doctor for a limited and specific period of time

• Privacy, including privacy for visits and telephone conversations

• You have the right to have and use your own personal effects as long as they don't interfere with the rights or the safety of others

• The right to be notified in advance of any change in roommate or change in living arrangements such as being moved to a new room

• The right to consult with an elder law representative

• The opportunity to manage finances and have access to your own money

• The ability to set your own schedule for sleeping and rising, eating, choosing your own clothing, and other daily activities

• The right to leave at any time

• Freedom from coercion, intimidation or fear of reprisal from employees

There are additional rights outlined in the regulation that could pertain to your loved one. An elder law attorney can go into these with you in more detail and help you select a facility that conforms to all aspects of the Reform Law.

When Is A Litigation Attorney Needed?

If you suspect that your family member is the victim of nursing home abuse or neglect, you should immediately begin monitoring his activities closely. Keep track of his health, level of alertness and needs on a daily basis, including how and when staff members respond to those needs. If you believe that there is a problem, request a meeting with the director of the facility and clearly outline your concerns. The director should be able to resolve the issue to your satisfaction, but if you don't feel things have changed, contact the ombudsperson assigned to the nursing home. This is a patient advocate assigned by the state to handle these kinds of disputes.

If the situation still isn't resolved to your satisfaction, you should consult with a litigation attorney versed in elder law issues. While you may be able to resolve the problem without going to court, it is best to work with a litigation attorney so that your loved one is represented by a lawyer who can effectively make a case in the event you do have to sue the facility.

Protecting Your Parents From Nursing Home Abuse: When to Look for Attorneys

Nursing home abuse is something that the elderly are faced with daily and often the family needs to find a lawyer who is willing to step in and put a stop to it. The common abuse that the elderly suffer is negligence. Attorneys know that in Clarksville the increase of patients in nursing homes being neglected has had a steady increase. Most attorneys in the Clarksville area are fighting to get nursing home reform bills passed, but until they do it is up to the family to watch out how their family member is treated.

Many people who are elderly are unable to defend themselves, and some cannot even tell you when they are being abused or neglected. Clarksville attorneys who are familiar with such cases, will help you to recognize the signs that your family member is being abused or neglected. There are warning signs that indicate if an elder person is being abused or neglected. You should watch for some of these symptoms:

• When you recognize the fact that your parent has constant bedsores. This means that they are not being taken care of properly. They are probably being neglected while they are in bed. Some older people are not able to turn themselves in bed. This is the duty of a nurse or aid in order to help protect the elder person from bedsores.


• When you notice that an elderly person has cuts or bruises on a frequent basis. Then you should suspect abuse.


• When an elderly persons things are broken and torn, it is a sign that someone in the nursing home is abusing them. It could be another patient who does not know any better but, it is the responsibility of the nursing home to protect the elderly person and their personal belongings.


• When the elder person has a sudden weight loss with no formative reason, and they are not putting any weight back on, they are probably not being fed properly. This is a form of abuse.

There are several other signs that your elder person is being abused or neglected while they are staying in a nursing home, but you need to contact an attorney in the Chula Vista area. A Chula Vista attorney who handles nursing home abuse cases to find out all the details. You cannot accept a few bruises as abuse, instead it is best to get the advice of an attorney on how to track such things. The attorney will also help you to know what to do in order to remove your elder person from any type of abusive situation.

When you do see any of the warning signs that might indicate abuse, you should take action and not assume that the situation will get better or go away. This type of problem never resolves on its own, instead you must take action to help stop the abuse and protect the elder person. The Nursing Home Abuse Attorneys are more than willing to visit your elder person and see for themselves what maybe happening. You must make the initial contact with the lawyers and ask for their help. The Nursing Home Abuse lawyers will usually give you free consultation to discuss the problem and your legal options.

Nursing Homes and For-Profit Hospices: Potential Partners in Crime

When most people think of hospice care, they think of a person in the very last stages of life going home to die in peace and reflection with the comfort of family and friends around them - as the benefit was originally intended. The reality is that many hospice patients spend difficult and agonizing years "dying" in institutional nursing facilities under the profit-driven watch of dispassionate corporations.

Inspector General Warnings About Fraudulent Nursing Homes & Hospices

The Office of Inspector General of the Department of Health & Human Services (HHS-OIG) recognizes and warns that the intersection of nursing facilities and hospice care raises serious concern for fraud and elder abuse. According to a report by HHS-OIG a number of "potentially illegal practices" have been identified in "a hospice's access to nursing home patients," including circumstances where "nursing home operators or hospices may request or offer illegal inducements to influence the selection of a hospice."

Hospice Care in Nursing Homes: the Double-Billing Conundrum

While it may seem counterintuitive that federally and state-funded healthcare would pay a for-profit corporation simultaneously to provide institutional nursing care and hospice care - that is exactly what happens in many cases. For duel-eligible (Medicaid and Medicare) patients who are certified as terminally ill with less than six months to live, corporations are permitted to bill the taxpayers twice: first for 95% or more of the cost of staying in a nursing institution and second for a flat daily rate for hospice care - even on days where no hospice nurse visits the patient. The patients targeted by such arrangements comprise the nation's most disenfranchised and most vulnerable citizens: the elderly poor, the category of patients who qualify for both Medicare and Medicaid. The potential for profiteering upon such vulnerable patients is exacerbated when the nursing home and hospice are owned by the same company - one company potentially can multiply its payments by billing Medicare and Medicaid for both nursing care and hospice care without supplying any additional services or absorbing any additional costs, all on the taxpayer's dime and to the patient's potential detriment.

Potential Patient Harm

It may seem beneficial to the patient to potentially get additional services while in the nursing home - but this is not always the case. If the patient is receiving adequate nursing care in the facility, then hospice care may be superfluous and even potentially dangerous. Because hospice patients must agree to forego any curative treatment, patients who are not truly terminal whom the corporation wrongly certifies as hospice-eligible may not get the important medications, treatments, therapy, and nutrition that they need - even though the taxpayers are being billed twice for the patient's care. Many hospices even consider dietary supplements like Ensure to be curative treatment and will withhold them from their patients. (It's no coincidence, though, that such dietary supplements are also expensive and cut into the corporation's bottom line). Conceivably, if a nursing home patient is inappropriately admitted to hospice, then the otherwise non-terminal patient could slowly starve to death while the company withholds dietary supplements and bills Medicare and Medicaid twice for the patient's care.

Illegal Kickbacks in Nursing Homes & Hospices

The profit motive for nursing homes and hospices to treat a patient as terminal rather than curative is obvious - it is also potentially criminal. Congress has made most quid pro quo arrangements between nursing homes and hospices and other cross-referring corporations a crime, and the reasons and policy served by outlawing such conduct has been expounded upon by HHS-OIG:

Because kickbacks can distort medical decision-making, result in overutilization, and have an adverse effect on the quality of care patients receive, they are prohibited under the Federal health care programs. Under the anti-kickback statute it is illegal to knowingly and willfully solicit, receive, offer, or pay anything of value to induce referrals of items or services payable by a Federal health care program.

Among the most troubling instances of potential kickbacks between hospice and nursing homes to influence the referral of patients observed by HHS-OIG are:

• hospices offering nursing homes remuneration for referrals in the form of: free goods and services or below market value goods and services to the nursing home or payments to the nursing home for "room and board" or other additional services above the normal Medicaid coverage


• hospices referring patients to nursing homes in exchange for the nursing homes referring other patients to hospice


• hospices providing free or below fair market care to skilled nursing facilities with the understanding that the patient will be referred to hospice after the skilled nursing benefit expires


• hospices offering free or below fair market nursing and support staff to nursing home

How to Avoid Being Victimized By Nursing Home and Hospice Fraud

Before agreeing to submit to hospice care in a nursing institution or to subject a loved one to institutionalized hospice care, proper assurances should be requested from both the hospice and nursing home provider that none of the above scenarios exist and that no other potentially improper relationship exists. If the hospice refuses to provide its service in the home and insists on an institutionalized setting, patients and their loved ones should consider an alternate provider. Red flags should rise over any hospice and nursing home that are owned or controlled by the same corporate entity. Ask about the corporate structure: if it seems complicated or complex or difficult to determine or if there is an obvious quid pro quo among the providers, then consider alternatives. Ideally, hospice should permit the patient to spend the last days among loved ones in the nurture of the home; while this is not always an option depending upon the patient's condition and home environment, it should never be the case that a patient or their loved one is forced to make a decision without knowing all of the facts.

Medicare Rewards Whistleblowers: Report Nursing Home and Hospice Fraud

If you have knowledge of an improper relationship between a hospice provider and a nursing facility, then you should seek the counsel of an attorney. You may have rights and remedies as a whistleblower under the federal or applicable state false claims act, which mandates that corporations submitting false claims for payment to Medicare or Medicaid repay three times the amount of the false claim plus penalties, attorneys' fees, and interest - including a reward of a percentage of the recovery to the whistleblower depending upon the extent of his or her involvement in prosecuting the case.

2011 James F. Barger, Jr

Nursing Tips - How to Organize and Prioritize Your Shift

To successfully and efficiently complete your daily tasks in your nursing shift, it is essential to organize and prioritize every time. The first thing that you have to understand is that things do not always go as planned. Rather, it is the exception when everything falls right into schedule. Because you are always expecting the unexpected, it will be easier for you to readjust your plans and not panic and get stressed out at the slightest changes. You will feel cooler and lighter in your discount landau scrubs. You should always have a Plan B even if it is just a vague plan.

Organizational and time management skills are invaluable skills for nurses and yet there are a lot of nursing schools that do not include these essential tools in their required courses, and only offer it as extension courses. Below are some ways to develop good organizational and time management skills.

Preparing at home

Being in the comfort of your home and away from the high intensity of your work environment, you will be able to think more clearly and objectively. While at home, you should already start organizing the basics of your shift. What you can do is try to map out a day in your life as a nurse. In a paper or word processor divide your shift into two hour increments and fill up the projected patient meal times, AM care, HS care, and so on. Include medication schedules such as ac, pc, and hs medications if there are any. Also put in when your patients are likely to go for therapy or tests and when MDs make their rounds. Also consider when new admits and discharges are likely to surge during the shift and what part of visiting hours gives you some time to catch up on tasks you left behind. The goal is to know when you will be busiest and when the tasks slow down so that you know how to readjust in any situation or circumstance.

Organizing at work

It is best to arrive early for your shift so that you have the time to assess the intensity of the previous shift and prepare yourself accordingly, whether for chaos or for downtime. So that you can anticipate what will ensue more or less in your shift, listen during rounds and reports on how busy the staff is going to be, the general level of acuity of that day's patients, who might have time to help you should you get overwhelmed, patients who require more of your time, what assessments, treatments and procedures you could learn from if you had the time, new patients and their diagnosis and treatments that you need to look into, time specific events such as meetings, things that you want to put off until the end of the shift or hope you don't need to do, and things that can be delegated to an LPN or nursing aide. Prioritize things that are difficult or you dislike so that you can get them out of the way. The more you put them off, the more they will be a burden for you for the rest of the day. Once you're done with the hard tasks, things will be generally lighter from there.

Guardianship Of A Parent: Elder Law Attorneys Can Help You Establish Boundaries

It's never easy to file for guardianship of one or both of your elderly parents, but there are many times when it has to be done because your parent is no longer able to care for himself or herself or make sound financial decisions. In either case, elder law attorneys can help you establish boundaries that are appropriate while still providing the oversight and additional care your loved one now needs. But what kinds of guardianship are there? Can you file to be a guardian while still giving him or her some autonomy? Elder lawyers can help you determine what path is best for your loved one and your family

Talk To A Guardianship Attorney

A guardianship attorney will explain the complexities of being a guardian and help you decide whether you need to have power over that individual or over his or her estate. If you gain guardianship of the person, you will be responsible for making medical decisions, making sure they are safe, properly clothed and taking care of themselves. On the other hand, control of their estate means you'll be making monetary decisions for them, including paying bills, making purchases and determining what is best for them financially. In some cases, you will need to become a guardian of both their finances and their person, particularly if they have advanced dementia or Alzheimer's. Regardless of whether your parent or loved one needs a guardian, they will probably fight you on this issue, fearing loss of autonomy and independence. There are ways, however, to maintain their dignity while taking care of crucial facets of their lives for them.

Don't Force The Issue: Elder Lawyers Offer Valuable Suggestions

Once the court has appointed you the guardian of your parent or loved one, you can make daily or financial decisions for them, but you will be held accountable for those decisions by the court. You can't arbitrarily make decisions that aren't in your ward's best interests. By talking to elder law specialists in your area or social service workers who are familiar with guardianship issues you will learn some tips that will make the transition easier for both your ward and your family. It's in everyone's best interests if you can oversee their health and their finances in a way that maximizes their independence while minimizing restrictions.

Encourage Their Participation

A guardianship attorney will tell you that the transition period can be extremely difficult if you don't handle your new position in regard to your parent or loved one with dignity and respect. Be sure to include your parent in any decisions you need to make such as choosing an assisted living facility or nursing home. You can certainly narrow down the choices to three or four locations that fit the estate's budget and your own sense of what your parent needs, but be sure to let your parent visit each of them and add his or her own input. If you force them into a location that they don't like, neither of you will be happy.

Giving Wards Autonomy Over Some Choices

For day-to-day living, elder lawyers advise that you let them make as many personal decisions as possible as long as they aren't endangering their health or that of others. If they can still make their own meals and are eating a balanced diet, let them. You should only step in when they have crossed that line between independence and self-neglect. A guardianship attorney may be able to illustrate some scenarios that help you understand which is which. Elder law recognizes that your parents may make choices that are unpleasant but not life-threatening or damaging to their well-being. For instance, if your father contributes a lot of money to a charity you don't approve of, as his guardian you don't need to take that choice away from him unless he is giving them most or all of his estate and leaving himself destitute.

It's crucial to understand the areas of elder law that influence guardianship of an ailing parent or loved one so that you don't cross a line and end up alienating them or taking away the little bit of independence and dignity that they need and deserve. An elder law attorney can explain the various elder law issues involved and help you navigate the uncertain landscape of guardianship.

Physical Abuse in Nursing Homes and Your Legal Rights

Sometimes we have to put our faith in others. In a nursing home environment, we take a big leap of faith that nurses and practitioners have the best interest of our loved ones in mind. Many times that's exactly what happens - conscientious care and attentiveness. But too often there are reports of physical abuse against the elderly. It's our job to pay attention to the signs and know our legal rights in this situation.

Types of Physical Abuse

Physical abuse comes in a wide variety. Although we general think of punching and kick, physical abuse actually encompasses all kinds of mishandling of the elderly. Here are some examples to keep in mind:

1. Cuts, scratches, and abrasions. These can occur from being hit with sharp objects or having things thrown at them.

2. Broken bones. Many times broken bones occur from falls, but its important to determine if the fall was accidental or caused.

3. Bruising and black eyes. Often physical strikes will manifest themselves as bruising. Furthermore, excessively tight gripping for come-along situations can show in the form of bruises.

4. Internal bleeding. Much harder to detect than the external injuries, internal bleeding can be caused much more easily in the elderly than in average individuals. Pay close attention to internal complaints by your loved ones.

5. Sexual injury. It's unpleasant to think about but sexual injuries can occur from caretakers taking advantage of helpless patients. Your loved one will likely be hesitant to discuss such an issue, so pay attention for unusual behavior or small hints at abuse.

6. Unnecessary restraint. It may not be as obvious as a broken bone, but excessive restraining can be seen as physical abuse. There is an important difference between restraining a patient for his/her own safety and restraining them for convenience.

7. Food and drink deprivation. It's understood that nursing homes get busy, but that is no excuse for extended food or drink deprivation. Watch for signs of malnourishment.

Why Physical Abuse Happens

There are a few reasons nursing home abuse can occur. The first is frustration. It can be extremely difficult handling ornery and resistant older patients. Frustration can easily set in for nurses and practitioners, resulting in a decision to resort to violence or abuse. The second reason is dominance. In order to achieve compliance and obedience, nursing home workers could use sheer physical superiority. Furthermore, there can be a subtle, psychological thrill at dominating or bullying others. The third reason is sexual gratification. Forced compliance can allow workers to take sexual advantage of patients. Of course every situation is unique and it's important to pay attention to small details that give you hints at the possibility and causes of physical abuse.

Your Legal Rights

Sometimes if families believe their loved one is being abused they will simply move that person to a different nursing home. This may stop the short term damage, but it doesn't provide any legal or financial recourse for the abuse. Furthermore, future families are likely to fall into the same situation. For the livelihood of your family and the safety of future patients, it is important that you figure out what you can do to get legal satisfaction for the wrongs done to your loved one.

If you suspect there is physical abuse happening, do your best to document the time of complaints, details of complaints, and potentially pictures of the physical damage done. From there, get in touch with a qualified elder-abuse attorney in your area who knows how to handle the ins and outs of the industry.

Medical Malpractice - How to Deal With It

So, you think you are a victim of medical malpractice. It has been done and what you need to do is to act the right way in order to get a just compensation for the casualty or injury incurred. What you do right after a malpractice case is important so make sure that you read this entire article about what medical malpractice is all about and what you should do in order to deal with it properly.

Before we delve into what things a victim should do, let us first know what medical malpractice is all about. Medical malpractice is one of the leading causes of death in the US. This is next to cancer and heart-related disease. This is defined using the prism of law as an act of negligence on the part of medical personnel or health care provider that resulted in the injury or casualty of a patient. Medical malpractice often involves simple misdiagnosis of cancer, dental malpractice, errors in administering drugs or anesthesia and birth injury. Nursing home abuse falls under this type of malpractice.

So, what should you do if you are victim of this form of malpractice involving medical personnel? Before you take your case to the jury, make sure that you have a lot of evidence to establish negligence on the part of the defendant which is the institution where the alleged malpractice case took place. Evidences play a hard role in this type of legal case. Take note that the more you have documented evidence, the more credible and strong your claim is before the jury.

A very important thing to do is to write down all the circumstances of the event before and after the patient is receiving medical attention. Making a journal is important. If the victim knows what he is saying and not just fabricating stories to make his claim credible, the jury will be on his side.

To give you a good example of documentation, the victim or his relative should take note of specific deviations from what is accepted as medical standard. For instance, take note if the nurse or physician forgets to administer drugs to the patient. Wrong dose of medication should also be noted.

These are just few examples how to deal with medical malpractice. If you think you have a valid claim for personal injury compensation, hiring an experience personal injury lawyer is very important.

CNA Training In Nursing Homes

CNA training in nursing homes is just one way to get the training you need to pursue a career as a nursing assistant. CNAs working in nursing homes provide the elderly with the care needed to go about their daily lives when they are unable to take care of themselves.

Training that is available in nursing homes is often available for those individuals who wish to enter this area of medicine. All of the training takes place at a nursing home facility and becomes part of on the job training. One of the greatest benefits to students who are being trained in such facilities is that they are getting paid while they are learning how to care for clients. Students also gain much needed experience so that they are ready to go to work anywhere.

Part of CNA training in nursing homes has to do with theory which is done in a classroom setting onsite. The practical portion is completed while working alongside other students and CNAs. This is the perfect way to get the right kind of training to provide proper care to patients in the home as well as to be ready to work in other medical settings as well.

Working as a certified CNA requires some physical strength and durability as well as psychological acumen since they are going to be on their feet for long stretches of time and have to remain mentally sharp throughout their shift. Here are just some of the tasks that aspiring CNAs can look forward to.

• Bathe, dress and feed patients

• Move patients from one place to another such as from room to dining room

• Cleanse and sanitize equipment after use

• Take vital signs and log them in patient reports

• Patiently listen to concerns of patients and engage in conversation

• Make sure that medications are given on schedule

• Monitor and control visitors

Prerequisites for becoming an effective CNA are that individuals should be loving and caring. Patients need a lot of understanding when they are in a hospital or nursing home. It is important that those wishing to work in this medical field have a desire to make a difference in the lives of those they are caring for. It is not everyone who will be successful in this field, but the select few who are change the lives of those they touch every day.

Anyone with a desire to serve as part of the health care profession should first take a look at becoming a CNA in nursing homes. This is the best way to take a closer look at something that may end up being a life's work.

Bachelor of Science in Nursing - The Next Step

A bachelor of science in nursing (BSN) is perfect for people looking to start a medical career. Individuals currently working as nurses find the BSN helps to enhance potential career options and serves as a precursor to graduate studies. More schools than ever offer online BSN courses, making the degree accessible to a wider range of students.

The BSN program lasts a total of four years, with early graduation possible due to credits earned from employment and other applicable life experiences. Candidates receive training in standard patient procedures, but the curriculum also grooms them for work in non-bedside occupations including research and supervisory positions.

Students take a wide range of classes, each lasting approximately eight weeks. First and second year curriculum focuses on liberal arts and sciences. Students take nursing courses during the third and fourth years. Degree candidates also work under a licensed supervisor at this time, called the clinical period. Most online BSN degrees only accept registered nurses (RNs) who have previously completed at least two years of training. This eliminates the need for clinical requirements and reduces program completion time to a total of two years.

Sample general courses include:

- Mammalian anatomy

- Psychology

- Elementary statistics

Sample nursing courses include:

- Nursing care of the elderly

- Introduction to wellness

Additional courses include:

- Data management for nurse managers

- Ethical challenges in health care informatics

Successful degree candidates have a strong background in mathematics and sciences. Students interested in pursuing a BSN program online should have a strong internet connection. Teachers provide instruction in the form of web seminars, or webinars. Mp3 and mp4 downloads turn workout rooms or long drives into a learning experience. Chat rooms allow students to share their experiences and discuss problems with classmates from around the country.

According to the United States Department of Labor Statistics (BLS), employment opportunities are excellent for BSN degree holders. Some areas are desperate for new talent as current staff retire from the system. Also, this flexible field, hospital and clinics may not be the only option for degree recipients. Book publishers and law firms sometimes have a place for individuals who possess a bachelor of science in nursing.

Some career paths can include:

• Primary care nurse manager

• Nursing staff development director

• Nurse case manager

• General registered nurse

• Clinical nursing manager

• Clinical audit manager

• Hospice care program administrator

• Nurse manager

• Nursing director

• Behavioral health program manager

Seniors Advocates and Assisted Living in Manitoba

In the province of Manitoba there is no authorization or screening required to operate an Assisted Living facility or community. They are privately owned facilities and are not licensed or government regulated. The Manitoba Home Care Program provides professional services to Assisted Living residents based upon their individual eligibility.

Manitoba Home Care
The Manitoba Home Care Program is the oldest program of its kind in Canada and was established in September 1974. In 2009 - 10 Home Care provided services to more than 35,000 individuals in Manitoba, most being seniors. The Regional Health Authorities (RHAs) are responsible for Home Care operations in each of the eleven regions covering the province of Manitoba.

Healthy Living
The Manitoba Government's 'Department of Healthy Living, Youth and Seniors' focus is on wellness and illness prevention. In partnership with the communities, the schools and the workplaces in the province, the Healthy Living department promotes health and wellness in every stage of life from infants to seniors and their goal is that healthy choices are easier and more accessible to everyone. The Minister of the Department of Healthy Living, Jim Rondeau is dedicated to the goals and initiatives that his department supports.

Seniors and Healthy Aging
Seniors and Healthy Aging is a part of the Department of Healthy Living, Youth and Seniors. The Seniors and Healthy Aging Secretariat acts as a point of contact to seniors and organizations ensuring that government policies and programs reflect the needs of Manitoba seniors. The Secretariat works to promote independence, health and well being to older Manitoba residents by being a source of information and providing research support to the Manitoba Council on Aging and an advisory body to the Minister of Healthy Living.

The Manitoba Council on Aging
The Manitoba Council on Aging is an advisory body to the Minister of Healthy Living, Youth and Seniors. It is the responsibility of the Council to ensure that the seniors' perspective is provided and reflected in government policies and programs that relate directly to seniors. A complete description of the roles and responsibilities of the Manitoba Council on Aging can be found on the Manitoba Government Website.

Age-Friendly Manitoba Initiative
Another important initiative is the Age-Friendly Manitoba Initiative led by the Seniors and Healthy Aging Secretariat. The Initiative works to create environments that value their seniors within the communities of Manitoba. Their mission statement is built around community values including celebrating the diversity of all Manitoba residents and to make Manitoba the most age-friendly province in Canada. The goals and resources of Age-Friendly Manitoba are explained in greater detail on their website.

Finding Assisted Living Communities in Manitoba
The definition of Assisted Living in Manitoba is similar to that of the other Canadian provinces. Assisted Living facilities combine independent living with services such as housekeeping, laundry, transportation and meals and are customized according to the requirements or needs of the individual. The Manitoba government does not subsidize daily fees for living in an Assisted Living facility or community but seniors may qualify for Home Care Services or the Manitoba Shelter Benefit Program.

Homestead Manitoba
Homestead Manitoba is one example of Assisted Living in Manitoba. They have been established in Manitoba since 2003 and they take great pride in providing the best possible services to their residents. Their communities include Kildonan House in North Kildonan, MB, Sterling House in Winnipeg, Dakota House located in the heart of St.Vital, MB, and Devonshire House in Winnipeg.

Great Benefit for Annuity Owners - Nursing Home Waiver

Almost all newer annuity contracts have a provision in them to allow access to all or most of your funds in the event of a need for a nursing home. The greatest fear of most senior adults is being confined to a nursing home and not being able to live in dignity. Annuity products have a rider that allows for access to your funds to finance this need and almost no one knows they have it in their contract.

For a long time insurance companies have been looked on as insensitive and having all that small print in the contract. But this addition to annuity contracts provides an enormous benefit. And guess what...? There is no extra charge. The benefit is built into the pricing and crediting rate of your annuity!

The language that determines if this benefit is available to you is very straight forward. In the event you are placed in a nursing home for a period of six months and meet the other simple standards which a doctor will attest, the rider comes into effect.

One other benefit that annuities provide is the forfeiture of surrender fees at death. In the event the annuitant passed away prior to the end of a surrender period the full account value of the annuity is paid to the beneficiary. There are a few companies who do not provide this benefit so it is important to ask and to fully understand how the death benefit is calculated. Occasionally contracts are issued with a front end premium bonus and to protect itself the insurance company will require the policy to be kept for the entire surrender period.

These contacts are rare and can be avoided by asking questions prior to purchase. Always be informed prior to purchasing an annuity.

Employ Yourself With a Business Administration Diploma

Did you ever build and work a lemonade stand when you were young? If you did, and although you probably didn't think about it at the time, but you were a self-employed entrepreneur who handled almost every aspect of business administration yourself. In terms of financing, you asked your parents for enough money for lemons. For production, you squeezed the lemon juice and mixed it with water and sugar. For marketing, you set up your table and made a sign, maybe posted signs around the neighborhood and told your family and friends to come by. In operations and sales, you sat behind the table for hours and helped refresh your customers. Even for human resources, you perhaps get some friends to help you out and then compensated them with a cut of the share, or by giving them unlimited access to your freshly squeezed lemonade.

Operating a lemonade stand is easy, despite having to multi-task almost every single aspect of running a business on your own. This is not to say that it is impossible to be self-employed as you get older and move into more competitive markets, but it takes more than relying on your parents and the community to get your business rolling. You may not want to spend years getting a university degree and memorizing business theories before you set out to work. And you may not be interested in choosing a specific field of business if you want to run the whole show. Getting a business administration diploma is a speedy way to getting the know-how and training to having your own business.

Studying business administration is like a fast-track through every aspect of running a business from financing to production to marketing and beyond. While this education is also perfectly suited for someone wanting to enter a large company, for those interested in working for themselves, here are a few examples of self-employed work, with examples of the many aspects of business administration training required:

• Language instructor or translator - learn how to set competitive rates, advertise your services, and do proper customer feedback.


• Management consultant - use your business administrative skills to help companies be more efficient and profitable, while managing your own business as a consultant.


• Talent agent - for models, actors or musicians, bridge the financial and contractual gap between the artistic and creative types and the business side of the industries they are trying to break into.


• Physiotherapist - acquire the space and equipment needed, get clients through advertising and industry referrals.


• Custom furniture maker - balance the cost of materials with the time and energy required to produce furniture and the individual costing for each customer.


• Videographer and video editor - figure out overhead costs of equipment computer software against individual client costs when quoting a job.

This is just the beginning of the list of self-employed work, but in reality almost anyone in any industry can work for themselves. The point is to demonstrate how some of these professions use different aspects of general business administration. What is important about the right training overall is knowing how to balance your own time, financial means and physical capabilities with your ambitions.

Assisted Living: Benefits Of In-Home Senior Care

When it comes time to face the important family decision of how to care for an aging cherished one, the choices are limited. You can either place them in a nursing home, move them in with you, or hire an in home elder care company to take care of their day to day needs. Many people are only aware of the first 2 options, and often choose one of the two, despite the well-known challenges to each.

Most people are aware of the common problems with putting an elderly family member in a nursing home. They get lonely there and the quality of care is often sub-standard. After all, it's hard for someone to be comfortable in a strange place where they don't get to see their family members very often.

Moving your loved one in with you has its own set of challenges. Unless you and/or your spouse are not working and have no kids to care for, there is often very little time to care for their growing health concerns. Add to that the fact that most people are not health care professionals and do not specialize in elder care, so even if you had the time, you may not have the capability to properly care for your loved one.

This brings us to in home care. Many people have heard of it, but it is a developing service and few are familiar with how it works and how it may benefit your loved one. Here are 3 of the biggest benefits to hiring an in home senior care agency to look after your loved one:

1. Reduced stress and anxiety on your family member

It is well known that moving to a nursing home can put a lot of stress on your aging loved one. This can often exacerbate the health issues they are facing and lead to further medical problems. Allowing your family member to receive elder care in the comfort of their own home will take away that stress and allow them to enjoy the same independence and quality of life they have become accustomed to.

2. Care is customized to the needs of the individual

Unlike large institutions such as hospitals and nursing homes, an in home senior care agency offers one on one support and care for your loved one. This allows them to tailor a health care plan to fit their needs. This insures that your loved one receives personalized care from a nursing professional who has a passion to serve the elderly.

3. In home care is a cost effective option

Since your aging family member receives their senior care at home, they will not be stuck with the outrageous hospital or nursing home bills that eat up all their savings and many times cause the state to take ownership of their house. In home elder care can be had at a fraction of the cost of these other options, saving your loved one and the entire family a fortune in medical bills.

These are just a few of the many benefits to hiring an in home senior care agency to look after your aging loved one. If you are facing the difficult decision of how to care for an elderly family member, in home care is an option well worth considering.

Financial Assistance For Elderly Veterans and Their Widows is a Well Kept Secret

Ask an elderly Veteran if they are aware they may be eligible for a pension from the Veteran's Administration and they will tell you "I'm not eligible because I was not injured in the War." This is a common misconception which keeps many Veterans from tapping into a benefit they well earned by serving our country. The fact is elderly, disabled Veterans and their widows may very well qualify for large sums of money, but they have to apply for the funds. There are several Veteran pensions, but the pension designed to help elderly Veterans and Veteran's Widows pay for costly Home Health Care, Assisted Living Facility or Nursing Home fees (if the Veteran is not covered by Medicaid) is called Special Monthly Pension with Aid and Attendance. The pension can pay a married Veteran up to $1,949.00 per month, an unmarried Veteran up to $1,644.00 per month and a Veteran's Widow can receive up to $1,056.00 per month. The amount one receives is based upon their medical expenses and their current financial and medical status. The pension is paid by check directly to the Veteran or Veteran's Widow every month as long as they meet the criteria.

The Special Monthly Pension with Aid and Attendance is the government's best kept secret. I cannot tell you how many seniors have told me that they called Veterans Affairs and were actually told that this pension does not exist or that they do not qualify. For thirteen years, I have assisted Veterans and Veteran's Widows in obtaining these funds - they really do exist.

To get the maximum pension amount, a Veteran must qualify medically and financially and must have served their country for at least one day during "War Time". Also the Veteran must have been honorably discharged. Every case is considered individually. If a Veteran or Veteran's Widow feels they may qualify, they can apply for the pension. The pension can take many months to actually be approved. The average waiting period is three to eight months. The first check will be retroactive to the month the application arrived at the Veterans' Affairs, therefore the first check may be for thousands of dollars. Subsequent checks will arrive monthly for the approved amount. This pension money can mean the difference between affording adequate care for an aging Veteran/ Widow or having no care at all.

As with any governmental program, success is all in the paperwork. The pension application is many pages long and some of it is in essay form. It is the exact wording used in the essay areas that mean the difference between approval and denial. Also, Veteran's Affairs does not tell Veterans about all the supporting documents that they would like to see. The better the medical and financial records, the better the chances are of approval. Including the right medical forms signed by a doctor is very important for approval. Also typical of governmental red tape is the frustrating lack of communication. Once the application is filed and in the process of being reviewed, it is nearly impossible to get an update or check on the status of the application unless the Veteran/ Widow make the call themselves. For most of our clients, they are too ill or too confused to make a call like that.

In a perfect world, financial assistance for those who qualify should be easily accessible and easy to get. But the reality is that government agencies are inherently complicated and their application processes are never self explanatory or simple. Ignorance of the rules is no excuse and no one will tell you the rules. The rules are written in a handbook, but the Veterans Affairs is not allowed to give them to you. Seasoned Eldercare professionals can often navigate these processes for you. They may charge for their services, but to attempt to do it yourself and have your application denied, will cost much more money. The Department of Veterans' Affairs supposedly employs staff to help Veterans and their Widows apply for these pensions for free, but it is these very people who have told so many seniors that they do not qualify, when in fact they could qualify if they made one small change. Perhaps Veteran's Affairs is afraid that if they made it easy for every Veteran to apply, the pension fund would go broke. Given that War Time includes the Gulf War Era which began in 1990 and has not ended yet, I anticipate the pension fund will one day be either broke or impossible to get. For now, the money is very much available and attainable.

Here are the Special Monthly Pension with Aid and Attendance eligibility criteria for the year 2008.

1) Veteran served in the Military for at least one day during War Time or had a spouse who served at that time. Spouses are people whom you never divorced.
2) Honorably Discharged from the Military.
3) Currently has medical or psychological condition which make the Veteran or Veteran widow dependent on the aid or assistance of a non- family member in order to meet their daily care needs or they reside in an Assisted Living Facility or Nursing Home ( not on Medicaid). This claim must be supported by physician signed forms, financial data and medical records.
4) Veteran Financial Criteria: Have assets in their own name below $80,000 (if married) or below $50,000 (if single). The car and house does not count as an asset. Annual income below $19,736,.00 (if single) or $ 23,396.00 (if married) after all medical expenses such as insurance premiums/copays, assisted living facility fees, paid caregiver salary, medications, medical transportation/ supplies, certain housing expenses, etc.
5) Veteran Widow Financial Criteria: Assets below $50,000 and income less than $12,681 per year (after medical expenses listed above).
6) Note: Income figures are AFTER MEDICAL EXPENSES. VA may require someone of advanced age to have fewer assets than quoted above. We have seen this when applicants are near 100 years old.

In many cases, if a person has a paid care giver, such as a nurse's aide, or they pay an assisted living facility, or they pay out of pocket for a nursing home, those expenses impact so greatly on a person's net income, that they will meet the criteria for the income level.

If a Veteran or Veteran Widow has cash assets above the limit, they are allowed to place those assets into certain investments in order to have them "sheltered". This sheltering does not have a penalty or "look back period" associated with it. Proper asset sheltering for Special Monthly Pension with Aid and Attendance should be done under the supervision of an elder care professional or attorney well versed in Medicaid planning because one could easily ruin the chances of ever getting Medicaid if the V.A. pension planning was done incorrectly.

With a little professional planning, many Veterans and Veteran Widows can receive pensions that make a significant difference in the amount of care they receive. After all, the reason for this particular pension is to assure that a Veteran or Veteran Widow does not live in a substandard environment in their old age. It takes a little work to apply for this pension, but anything worth having usually does.

Care Giving Secrets - Ways to Encourage Clients and Prevent Caregiver Burnout

"The world we have created is a product of our thinking; it cannot be changed without changing our thinking." ~Albert Einstein

The Heart of Caregiving is basically, part of the important discipline of nursing; caring in a loving and professional way. The principles that guide this discipline are dignity, independence, communication, safety, infection control, and privacy. These bottom line principles of DISCIP-LINE may be applied in any situation and be easily remembered:

Dignity, Independence, Safety, Communication, Infection, Control Privacy, bottom LINE.

There are many myths regarding health and aging, for example, memory loss is not a normal symptom for healthy aging. The reality is there are more than 1/10 Americans who are 65 years or older. Most men are married and women are twice as likely to live alone and widowed. Common with aging are loss of important people and meaningful things, such as height, sight, taste, teeth strength and hearing, in 1/3 of elders over 65 years old. Attentive Caregivers put their personal thoughts, feelings, troubles second to the person they are caring for.

Caregivers may avoid negative feelings by being balanced and focused, while understanding older people and the disease process. Practicing the six principles of care allows caregivers to understand how to participate as part of a team and offer emotional support while providing direct care. Being balanced within allows caregivers to do focused care flexibly and creatively, while enjoying the celebration of life and caring. Dignity is being treated with respect at all times.

Clients heal and function best when they are treated as individuals and are allowed to direct their care. Each person's beliefs affect their health and attitude. Caregivers are best able to provide care to clients when they are balanced and focused in the present moment. Many caregivers are overwhelmed by the tasks involved in care giving. Below are some basic concepts and tools that can combine with the principles of care for self care and care giving, to combat this pattern of overwhelm.

For example, when we treat ourselves with DIGNITY, it is a natural process to extend this behavior to those in our care. How do we treat ourselves with dignity? A simple adjustment to BEING instead of DOING makes an amazing difference. What we focus on expands, so we can choose to focus on what we want. By acknowledging what we want within ourselves, we will create more of this value in our lives. For example, the daily 6 principles of care giving may be balanced with the six principles of self care. Decide on one value (such as; clarity, courage, creativity, focus, fun, being consistent, flexible or generous) to focus on and one of the six principles of care giving and Self care, each day. Think about how this relates to the person we care for. "How can I have fun with my client and dignity, today?"

Be thoughtful and do insist on CONNECTION and invite what you hate. Many things influence a person's behavior and there is always a reason behind the behavior, even if you do not understand what it is. What are your experiences of someone doing something they wouldn't normally do, or that seems inappropriate or unnecessary? What have you done to put yourself in danger of harm, embarrassment or another kind of risk?

A caregiver's responsibility is to provide care with kindness, no matter what the client's behavior is. UNDERSTANDING basic needs and the life cycles can be useful. From the time we are born, we search for closeness and connection. Peekaboo, tag and hide & seek are all games that play with connection. Sometimes our clients do not connect or reconnect so easily. They may feel so isolated that they come out swinging both arms aggressively or retreat to a corner. This is a signal that more connection is needed, even if it feels annoying, obnoxious or infuriating. Hyperactivity or inability to calm down and depression may be other symptoms of this need for connection. No value comes from punishing or leaving the client isolated. Setting relaxed expectations and eye contact can be useful for breaking the ice. Playful physical and verbal bumbling attempts to be close (beg & plead, close your eyes and kiss the air, wall or chair instead-open eyes), can bring laughter and a softening of the stuck feelings. Deep within, the client may have a feeling of something being wrong with themselves. Pay attention to how near or far, from the client, brings the most laughter or tenseness and repeat for more laughter. A few minutes of eye contact and laughter can make all the difference in feeling connected while providing direct care. When you are finished say, "Great! I got no hugs. no kisses. But someday, someday, someday, I'll get one! I'll just have to try again next time! Thanks for a good run around the house!"

Be on SAME PHYSICAL LEVEL level: Do remember that you are delivering care in a balanced way for the client and yourself. Your right hand represents giving and the left hand represents receiving. Keep them both together at your heart level, near your mind. Keep your body within one foot of your client, keeping your elbows at your waist whenever delivering direct care. Being aware of your hands together at your heart level, connected to your mind, allows you to be balanced and focused, preventing you from injuring your back, while creating closeness and safety with the client. Keep your body within one foot of your client, keeping your elbows at your waist whenever delivering direct care. Communicate what action you want before doing. Cradle with palms only to assist movement. Do not grasp with your fingers.

Be aware of GENDER DIFFERENCES Respectful of the male hunter's one track focus and the female as gatherer of information and pleasing others roles. Knowledge of the instinct for direct immediate relation of the hunter versus diffuse awareness of "hostess head" gatherer can save many hours of frustration. Key differences and helpful generalization tools for gender communication: For him; don't interrupt, simply wait, do not rephrase or give options. For her; state the obvious in a thoughtful tone. Use questions to help talk about feelings and see chapter three for further communication tips.

Be willing to lose your own dignity, in order to protect the RIGHTS of your client. Individual rights are guaranteed by law and no one can take them away. A person's rights are protected by law because rights are crucial to a person's freedom. People have a right to competent, compassionate care that is delivered with respect. A person in your care should not be expected to give up any of their rights. Which rights would you give up? Caregivers have an obligation to be ethical and do the right thing.

Celebrate POWER versus Powerlessness. What are your Daily personal six principles of care? Because inner creates outer and roots create the fruit, these are my six principles of care and may or may not work for you.

1) Daily Be GRATEFUL for ten things in your life.

2) Daily Be APPRECIATIVE of ten things about yourself.

3) Do daily EXERCISE; bounce on the balls of your feet, elbows in, chopping at waist level to be grounded, then chest level to be focused and above your head to the heavens, to release any stinking thinking.

3) Do the RIGHT thing.

4) ASK for what you want.

5) Be willing to RECEIVE it.

6) CELEBRATE every small and large success, immediately. The celebration will energize you for the next task and could be any joyful action; a statement of well done, a hooray, pat on the back, jump for joy, cup of tea, garden, phone call to share, reading, writing, listening to music or an inspiring bit of information.

TIP: Use a ten minute timer, a buddy and a journal as allies. Remember to provide balanced and focused care in a loving and professional manner, by keeping your giving and receiving hands close to your heart and mind, while using DISCIP-LINE: Dignity, Independence, Communication, Infection Control and Privacy.

We would love to hear your comments about this guide, so if you prefer to email rather than blog, send your comments to sonia.morrison@gmail.com For additional information regarding these tools and principles of care visit http://www.soniamorrison.com or order the book, The Heart of Caregiving.

Kings and cabbages go back to compost but good deeds stay green forever. ~ Rick DeMartinis

The shorter way to do many things is to do only one thing at a time. ~Wolfgang Amadeus Mozart

Kites rise highest against the wind, not with it. ~Winston Churchill

Emergency Room Errors

Emergency Rooms, or ER's, at hospitals all over the country are the most stressful worksites in the healthcare profession. The standard of care in United States hospitals is high quality. Doctors, nurses, surgeons, and all other healthcare professionals take pride in this. However, the fact remains that malpractice occurs in the medical profession and today's hospitals need to improve the care provided in their Emergency Departments.

Errors in hospital Emergency Rooms are a common occurrence infrequently talked about and rarely reported to the media. That is why you don't hear about these types of cases on the news. Understaffed hospitals, ill-equipped emergency rooms, and poorly trained staff may lead to fatal errors when dealing with patients requiring emergency treatment. Let's face it - when you arrive at your local hospital ER you know absolutely nothing about who will be taking care of you and there is no time to research the competency and track record of the ER staff.

There are many ways that errors or malpractice may occur in Emergency Rooms. The following is a partial list of some of the Emergency Room medical negligence cases we have handled:

• Medication Errors


• Prescription Errors


• Failing to diagnose impending heart attacks and strokes


• Diagnosis Errors


• Errors in interpreting x-rays, CT scans, and MRI studies


• Discharging patients who are critically ill

Over 225,000 people die from medical malpractice related injuries in a single year and nearly half of these deaths are from emergency room errors.

The following is a partial list of the more common medical errors which arise in the Emergency Department:

Failing to administer prophylactic antibiotics in patients with open fractures. An open fracture is one in which the bone has broken through the skin, and as such, these fractures present an increased likelihood of infection. The best outcome for these patients is dependent upon prevention of infection and obtaining a quick union of the fracture. Prophylactic antibiotics reduce the risk of infection and should be given as soon as possible.

Failing to diagnose compartment syndrome in patients with tibial fractures. The tibia is the larger of the two bones of the lower leg and is the weight-bearing bone of the shin. A compartment syndrome is a serious complication which occurs when the pressure in a closed fascial compartment rises sufficiently high to cause nerve and tissue injuries. Without timely diagnosis and treatment, compartment syndrome can cause permanent loss of use or function in the involved extremity (legs or arms). The clinical signs of compartment syndrome include pain out of proportion to the injury, pain on passive range of motion, and loss of distal pulses. Immediate consultation with a surgeon is the preferred course of treatment.

Failing to treat a perirectal abscess in a diabetic patient as an emergency. Patients who are diabetic present many unique challenges to their health care providers. A perirectal or perianal abscess is a pool of pus that forms next to the anus, often causing considerable tenderness and swelling in that area and pain on sitting down and on defecating. These abscesses or infections have a tendency to rapidly progress to deeper, more serious infections in diabetic patients. The abscess can develop into Fournier's gangrene, a life-threatening infections with a reported mortality rate of 9% - 43%. Again, prompt consultation with a surgeon is the preferred course of action.

Failing to provide the proper airway for patients with facial or skull fractures. Establishing and securing an airway is one of the first steps addressed by all Emergency Departments. There are several ways to accomplish this goal but the main techniques are tracheal intubation (either oral or nasal), bag and mask, or a surgical procedure known as a cricothyroidotomy. Emergency physicians should almost never attempt a nasal tracheal intubation in patients with facial or skull fractures due to the possibility of passing the tube into the cranial vault and thereby cause even more serious injuries.

Failing to admit unstable patients or patients with unclear diagnoses to the hospital. Remember, the Emergency Room doctor's first responsibility is to stabilize the patient and then make appropriate decisions about the patient's continuing care needs. Most ER doctors do not have admitting privileges at the hospital - they must contact the patient's regular doctor or the hospital admitting doctor for permission to admit the patient directly from the ER into the hospital. Almost everyone has a story about a friend or family member who was discharged from the Emergency Room returned to their home and within hours or a couple of days suffered a disastrous outcome. Make sure your friend or family member is stable, and with a plan of treatment, before discharge from the ER.

If you or anyone you know has experienced an emergency room error, or any other kind of medical malpractice, please contact us. We are here to help.

Elder Abuse - How Can I Protect My Aging Parent Against Financial Abuse?

Elder abuse is something I don't like to think about. It's a tough subject to write about. But, each of us needs to raise our level of awareness so we can protect our aging parents. Elder abuse can take many forms. When I hear the term, I think about physical abuse and neglect of the elderly by hired employees in a nursing home. But, it encompasses so much more. The National Center on Elder Abuse (NCEA) lists these other forms: emotional or psychological abuse; verbal abuse and threats; financial abuse and exploitation, sexual abuse, and abandonment. It can happen anywhere: nursing home, private home and other institutions. Surprisingly, it affects the elderly across all socio-economic classes. Dementia is an especially strong risk factor.

This particular article focuses on Elder financial abuse. The elderly can be financially abused by mail fraud, phone fraud, business fraud and stealing by a family member or hired caregiver, or visitor. Today, I heard yet another instance of a trusted caregiver stealing a large sum of money, $20,000, from an elderly man.

Here are some key ways we can prevent financial abuse from happening to our elderly loved ones.

• Stay in frequent contact with elderly relatives, and keep lines of communication open.


• Be observant and perceptive about any physical or behavioral change.


• Choose any caregiver carefully. Never select one through an ad. Use a licensed, bonded agency. Hire an investigator to ensure the potential caregiver is not a convicted felon.


• Keep a photographed inventory of all jewelry in a locked box.


• Use a criss-cross shredder on any paperwork containing identifying information.


• Protect incoming and outgoing mail. Getting a Post Office box is a good preventive measure.


• Obtain a credit search for your parent 2-3 times a year.


• Have Caller Id on the phone. Teach your parents to not answer "unknown" or "out of area". Tell them that scam artists use the phone as a weapon, and it is OK to hang up on someone.


• Tell them "You will NEVER win a foreign lottery".


• Have a duplicate copy of their banking account statements sent to a trusted family member.


• Tell them to not assume a handyman is to be trusted, even if he has a wonderful name and is charming. Check the Better Business Bureau and state licensing. Always get 3 estimates. Obtain a written contract. And, never pay more than 10% or $1,000 up-front, whichever is less.


• Have a second line of defense at their front door (a peephole or locked screen door).

Report any suspected mistreatment immediately. Contact the Helpline for your state at http://www.ncea.aoa.gov/NCEAroot/Main_Site/Find_Help/State_Resources.aspx

Value of the Pre Nursing Home Admission Visit

The Pre-Admissions Visit Does Have Critical Value Before Nursing Home Admissions

If you talk to Diana Waugh, a registered nurse from Ohio, long-term care quality advocate and former director of nursing she would tell you she believes in the value of the pre-admission visit. What is that? It is when nursing home personnel visit a hospital and gain an in-depth understanding of a referred patient's needs before accepting this person for admission.

Of course this typically does not happen in our age of electronic referrals and stiff competition among skilled nursing facilities. Plus hospitals are gun-shy, afraid that facility reps will come in and try to market to other patients.

Unfortunately post admission many skilled facilities are finding there may be a financial and clinical incompatibility with this new admission and it becomes almost impossible to undo the process without infringing upon the patient's and their family's comfort level and dignity. Typically the discharge, whenever it is time for it to occur is a complicated one.

Of course there is also the convenience factor. Many nursing home personnel rarely leave the building for anything, except for business development staff. Many are simply in a rut and that can be hard to break away from.

However, Diana's concerns are very legitimate. Accepting certain admissions without really feeling confident this patient is an appropriate behavioral, clinical and psychological fit can open a can of worms that can be hard to manage and hard to close.

Further, when the dominant pre-admission questions center around insurance coverage and skilled days already consumed that calendar year, it is easy to slip into that "cattle herding" mode where we start to move away from the human side of care delivery and care management and focus solely on reimbursement.

Of course location plays a role since the hospital referring the patient may be 30 miles away and even if the pre-admission visit became an industry wide rule we still cannot escape the reality that no admission is perfect. Additionally this can never become a system wide practice unless everyone gets on board or the more aggressive marketers will keep accepting anyone who can pay regardless of the lack of person-centeredness involved.

Maybe there is another solution. If you have it we hope you will share. Let's talk about it. In the meantime may families and patients take a more active role in ensuring that every admission is as close a match as possible in order to ensure quality care delivery remains the priority.

Thanks for allowing us to share.

What Is an Adult Family Care Home?

An adult family care home is in the assisted living category of retirement living. The services are the same and they have to abide by the same laws as an assisted living facility. The only difference is that an adult family care home can only have up to 5 residents.

True to the name, these types of homes provide family-style living in a private home. The 5 full time residents are elderly or disabled adults who are not related to the owner of the home. The residents can either share a room with another resident or they can have a room all to themselves.

The owner who lives in the home provides-by way of a contracted nurse or outsourced caregiver- the same services that are provided in a larger assisted living facility and include but are not limited to:

• Social and recreational activities
• Daily health monitoring
• Residential supervision
• Medication disbursement and/or assistance by a nurse or contracted caregiver
• Respite care (short term care of a senior meant to provide relief to a caregiver)
• Transportation arrangement and escorting to doctors' appointments
• Assistance with daily activities like walking, bathing, housekeeping, eating, and moving from one room to another, etc.
• Healthcare planning and organization

Just like and assisted living facility, an adult family care home may contract an independent skilled nurse or employ a skilled nurse to take vital signs such as blood pressure, temperature, respiration and pulse. Keep in mind however, you are allowed to bring in your own home healthcare provider to administer these services.

These homes are licensed by the Agency for Health Care Administration and require that residents must be able to perform with assistance, daily activities like bathing, dressing, and eating. The residents are not allowed to live in an AFCH if they are bedridden or if they need 24-hour supervision. They also can not have stage 3 or 4 pressure sores. These are minimum requirements and residents must meet other conditions as outlined in the Florida regulations.
Like a larger assisted living facility, if you end up needing more health care than allowed by law for an adult family care home, you may be asked to move on to a nursing home.

There are pros and cons associated with both assisted living facilities and adult family care homes. It would seem that one of the benefits of living in an AFCH would be that there is more of an intimate family-style atmosphere. In addition to that, these homes are typically more affordable than an assisted living facility.

Once you decide exactly which type of assisted living situation you want your loved one to settle into, it might be a good idea to talk to an elder law attorney. There is usually a bunch of paperwork to fill out before you can move in.

Assisted Living Centers Make the Golden Years Fun!

An assisted living facility can provide the best in care and services to your loved ones as they age. These facilities make independent living not only possible, but enjoyable as well. Senior living has never been better at one of these terrific assisted living facilities!

Assisted living facilities provide round the clock care for your loved one by trained professionals, with medical care provided during regular hours and for emergencies. Caring nurse and staff can assist with activities of daily living including medications, bathing and grooming, and other things. In most circumstances, residents have their own spacious studio or 1-bedroom apartment in which to live. These often resemble college dorm rooms!

The goal of these facilities, is to make your loved one feel as much at home as possible. Many of the facilities will have on-site beauty parlors and provide assistance with transportation needs. In order to promote healthy and social lifestyles, senior centers feature a large common area for socializing, reading, watching televisions, and other activities. A dining hall will also serve three nutritious meals each day.

The average assisted living facility resident is 86 years of age. Both male and female residents opt for these type of living arrangements when living alone is no longer feasible yet they are still independent. Female patients living in these communities are slightly higher than males.

Choosing an assisted living facility is a great way to ensure the senior years will be truly golden. Your loved one will always have special friends and staff by their side with planned activities and plenty of social interactions and outings. Carefully look at several facilities to select the facility you are most comfortable with to make the transition easier for everyone. There are both small and large facilities and several centers located in most U.S.cities.

Abuse in the Nursing Home

In the U.S. there are over 16,000 nursing homes caring for the elderly citizens of the country. Some older individuals may choose to live with their family members who will watch over them and provide what care they can. Others may move in to senior housing where they can maintain much of their independent living. Nursing homes on the other hand offer a closer eye as well as other benefits for those that are aging and no longer able to sufficiently care for themselves alone. They provide live in facilities for their patients, including basic housing amenities and prepared meals. One of the greatest benefits of a nursing home for many is the medical attention and treatment that is on hand at the location. Nurses and other medical staff are either their daily or are called in to treat the needs of the patients living in the home. While these facilities can be a great blessing to the elderly and their families that cannot meet the level of care that they need, there can also be downfalls to them. Reports of nursing home abuse occur every year with estimates ranging between one and two million. While many accounts go unnoticed and unresolved, many are brought to the attention of authorities to handle legally.

Abuse suffered by nursing home patients can be physical abuse. Slapping, hitting, shoving, blocking and restraining are all examples of what can occur. In some cases the physical harm may be so severe that it leads to a personal injury. It can also be comprised of neglecting the patient. When staff leaves a person in their bed that cannot move about on their own, they may harm themselves trying to get up or they may be forced to remain in their bed, unable to go to the bathroom or feed themselves. Neglect can also involve not treating a person that is in need of medical attention and even ignoring their basic hygiene. Psychological or emotional abuse is also a common problem. It can incorporate yelling, threatening or humiliating them, as well as belittling or ignoring them. Others may suffer from workers that take advantage of their finances, stealing money, overcharging them or providing healthcare measures they did not actually need. One other appalling form of abuse is sexual abuse. It can include actual sexual acts, forcing them to view pornographic material, forcing them to undress and more. If the elderly person was against any of the actions or they were not in the right mind to express their opinion it is considered abuse.

The reasons for elder abuse will never all be known. Each case has its own circumstances that lead to the outcome. In many instances a nursing home worker may have a shorter tolerance for the people they are working with. The elderly person may not be as quick or capable as they would like. As an outlet of their frustration, they take it out on their patient, failing to provide the quality care they are meant to. This can include harsh treatment physically, when they are moving them about or talking down to them when they are explaining something to them. Other times it may be that the staff was not properly trained in techniques to deal with the patient both physically or in their bedside manner. Without knowing the correct procedure, they are more likely to make errors. Many nursing homes are understaffed and as a result the caretakers that are there cannot handle the overload of patients to the sufficient standards. They may be unable to turn them as often as they should, increasing the number of decubitus ulcers. They may not have the time required to properly asses their needs as well as carrying out those necessities. As a result of the lack of staff, the patients and the home will suffer.

About 1 out of every 14 cases of domestic elder abuse is reported to police, while one out of every five cases of all types of elder abuse is never brought to their attention. Various circumstances may be the reasons why no one ever notices an elderly person is being abused or the individual themselves does not call attention to it. There may be a fear of the consequences if they do or they may worry that no one will believe them. Those that interact with them should always take notice of any changes to see if there is an issue of abuse they are just not willing to mention. To detect elder abuse, be on the lookout for any physical warning signs. If there is bruising or other personal injuries, inquire as to how they sustained them. Also take note of their behavior. While some may conclude that unusual behavior of the elderly person is a case of dementia or just getting older, it could also be the effects of the abuse they are sustaining. If there are any changes in their actions or personality, question to see if there is something more extensive going on. Notice how they interact with their caregivers; if it is in a gentle loving manner or if there is clear friction between the two.

Nursing home abuse can lead to effects that are physical as well as emotional. The victim may be emotionally damaged by the terrible acts that were committed against them. They may suffer through a change in their personality; becoming quitter or more easily agitated. They may also have to deal with a personal injury. As a result of negligence they may have had a slip and fall accident. For the elderly, injuries and falls can have a much greater effect. They may have broken a bone or ruined a hip replacement. Since the immune system of older citizens becomes compromised the older they get, any illnesses or injuries may not heal as they otherwise would. An injury to them can shorten their life span or hinder their quality of life. In no way should this atrocious treatment ever be tolerated. Those that are injured should speak to an attorney who can defend them; fighting to secure the financial earnings they need to pay for medical expenses and live the best life possible they can in spite of their emotional and physical grievances.

Evaluating the Social Needs of the Elderly

Life leads everyone to the Golden Years. In the past, reaching old age was a time to sit on the rocking chair in the balcony and watch the world go by. Those days are gone. Today's older generation, the elderly, are learning to be proactive. Many elderly are wired and marvel at the wonders of technology.

This is a promising era for the elderly. With the advent of information technology, into the 21st century, health of mind, body and spirit are as important as our careers. The Elixir of Youth has not been discovered, but technology has made advances in the battle against aging---delays the aging process for a while.

Realistically, the aches and pains of getting old come nagging in the quiet of the night, or in the wee hours of the morning, or just about at anytime. Add skeletal and muscular aches and pains and a list of medical conditions that creep up as we get older. Should this condition limit one's activities? This needs a serious thought. It is proven that keeping active is good for physical, mental and emotional health.

While we all need a quiet time, for the elderly, days can be very long if they are inactive. It is easy for an elderly person to feel alone and isolated, or feel guilty of being a burden. This feeling gets more serious if there is no social life to give a semblance of balance between action and inaction. Interaction helps to keep the elderly in touch with current events. Social contacts add value to their lives, encourages them to stay connected with people and keep abreast of current events. Simple social activities add sparkle to their days. There is always something to look forward to tomorrow.

There is a lot the younger generation can learn from their elderly relatives or friends. It is said that society have the tools needed to age gracefully. But there are many cases where the mobility of the elderly relative is limited.This does not mean that they should be confined to the four walls of their home. Families should discuss how to share in the responsibility of visitation and a day out for their elders. It warms the heart of the elderly to know someone cares. Emotionally, this is very important. There are community services that are dedicated to take care of the needs of the elderly. But some attention from a caring family member or friend lifts their spirits and feel that yes, they are loved, and there is more to life than counting the hours go by.

Geography separates families and friends. We live in a highly mobile world. Even with the advent of travel, visiting relatives is not that easy. Career and family responsibilities contribute to infrequent family gatherings. It is up to the younger members of the family to show more concern for their elders.
Surely, you have pleasant memories of yesteryears.

Encourage them to nurture their friendships. Open discussions about accessibility to services, keeping in contact with friends and neighbors is critical. Someone in the family should volunteer to be the contact in case of emergency. There are social activities in most communities meant for the elderly population. Encourage your elder to check into these and find a buddy who will enjoy these with them. Attending church services is a way to keep in touch with the community. There are exercise classes for seniors, this is not only healthy, it can be fun. A trip to the library with a friend can be interesting, and make a side trip for coffee. Take them out shopping, make a social event of it. An occasional dining out can be interesting.

With time on their hands, social activities keep life interesting, healthier and meaningful. Keeping active makes each sunrise brighter and welcome each day with happy thoughts. It is important to be out there socially and be an active member of society. It takes the mind off the aches and pains and the loneliness of old age.

Small Space Sectionals With Storage Provide Seniors With Space-Saving, Movable Seating Options

There may come a time in later life when the big, beautiful house that sheltered a family must be traded for something smaller and easier to maneuver in, like an assisted living community. With the nest empty and bigger space simply not necessary, a pared down condominium or apartment-style home is often the best financial solution. Sectional couches designed for smaller spaces are an ideal furniture option when downsizing to a smaller living space in our later years.

For intimate moments of reflection or snuggling, small space sectionals are warm and inviting, yet extend plentiful seating when the grandkids come to visit. Cuddling with a blanket and a book, or even stretching out for a nap, can be done in comfort and style. And, when family or friends stop by, your small space sectional can be rearranged to accommodate your guests. When you choose a small sectional with pieces that can be separated or grouped together, you will also benefit from the ability to easily move these lightweight sectional pieces around, creating the ideal seating option for any occasion. For example, arranging your sectional sofa in an L shape or U shape makes a fantastic atmosphere in which to share memories or discuss current events.

To add even more functionality and space-saving options to your smaller living area, select a small sectional couch that features storage under each seat and in the ottomans. These ample storage compartments can be used to keep scrapbooks and photo albums safe and close at hand, stow children's toys between visits or keep seasonal clothing organized throughout the year. The storage areas offered by small space sectionals are also perfect for storing movies, receipts, magazines, extra linens or greeting cards.

Those who choose ready-to-assemble sectional couches will find that they are not bulky and clumsy like pre-fabricated, traditional couches. They arrive in boxes, allowing them to be easily moved to the room where they will be assembled, even if there is a narrow doorway or hallway that would be an issue with other sofa options. Once assembled, these sectionals are easy to arrange or disassemble if you need to move to a new living situation. They fit well in small spaces, offer extra built-in storage, and travel well.

Ready-to-assemble sectionals are available with a variety of color and fabric options, allowing you to find just the right look to fit your style. This allows you to turn your new, smaller condo or apartment into a welcoming, warm home.

How to Keep Control of Your Elderly Parent's or Spouse's Assets

Often, an elderly parent or spouse may have always solely owned and controlled his assets for the benefit of himself or a spouse. But his sudden death or incapacity can prevent those assets from being used by the very people he wanted to help. This article explores what's in jeopardy and how to quickly remedy the situation.

-Loss of control comes from sole ownership

Suppose you're caring for your aging parent who owns everything in his or her name only. If he dies, his assets become part of his estate. You can't access any of his bank accounts to pay for the funeral expenses. And this is especially true if he has no valid will.

Or suppose your spouse who likewise controls everything in his name becomes seriously ill and unable to communicate. You can't access his account because it's solely under his name.

Or, suppose you can't afford to take care of an aging parent and put him in a nursing home. The funds deposited in his bank accounts - which you don't have access to - will be taken by the nursing home as payment for providing shelter and healthcare services. There's little one can do once your parent is in a nursing home to protect assets in his name. They and the income they generate will be used to pay for the nursing home facility before Medicaid will pick up the cost for free.

So, under sole ownership, the control of your disabled or dead parent's or spouse's assets is in someone else's hands. And that's probably not what your parent or spouse would have wished.

-Prevent Loss of Control through legal access

For emotional reasons, it's common to want to put off making even simple financial arrangements for the protection of a loved one's assets. But delaying to do so is unwise. Begin today to eliminate the jeopardy that assets and accounts solely in your love one's name are subject to.

Here are things you can do to prevent loss of control:

* Explain the jeopardy of leaving assets solely in your love one's name to your loved one, then
* Add your name to any bank account that your elderly parent or spouse has
* Have an attorney draw up a durable power of attorney for the finances of your loved one
* Initiate a durable power of attorney for health care of your loved one in case he or she becomes incapacitated.

Doing the above will keep the control of your love one's assets in the family should he become ill or die. That's because you'll be able to use and control those assets yourself to handle those situations that will inevitably arise.

Setting up a living trust will keep your loved one in charge, but allow you to take over in case of death or illness.

Private Practice Strategies: How to Develop Multiple Streams of Psychology Income

Mental health professionals have a wealth of valuable, even crucial, information and expertise in which many people are in need.

One-on-one therapy is only one way we can deliver this expertise and help.

There are a number of possible ways therapists can create revenue streams while sharing their talents, expertise and skills with people in need.

Some of these ways are traditional and common, but others are rather innovative ways therapists are beginning to put their abilities to good use. In doing so, they are creating revenue streams.

Traditional Services

Although its time for therapists to think out of the box and develop new services that creatively meet the felt needs of niche markets, there is a place for the traditional therapeutic services.

These include psychotherapy for the DSM diagnoses, psychological testing and evaluation, marriage and family therapy and behavioral health care.

And, yes, people will forgo managed-care reimbursement and pay out of pocket for services that are of higher value because they are higher quality, offer real privacy and are truly customized for the individual needs.

One of the frustrations I hear from mental health care service consumers is that they can't find a specialized therapist in their managed-care insurance network.

It's as if managed care's philosophy is, "We'll help you obtain access to psychotherapy, but we don't care whether the therapist we connect you with is a specialist. A generalist is fine."

Set yourself apart and demonstrate your true value in the marketplace through specialization. Many people in the market for therapy value specialization.

Getting Published

A book is a powerful way to affect lives. It is also a good way to establish credibility, highlight your practice and services and position yourself in your niche.

And, it's easier than you think if you self-publish. It has become very affordable to do so, and it puts you in charge of the content, price and reprints.

It can actually be more profitable, too. You keep every dollar above your costs. If you went through a major publisher who sells a few thousand books, you would only receive the author's fee. You can make as much selling a few hundred copies of a self-published book yourself.

If your book is successful, you may even attract a large publisher to take over your book.

Writing a book opens doors to speaking engagements, media opportunities and a reputation in your niche market.

It also helps you to crystallize your thinking and enhances your effectiveness as a practitioner; it's a great exercise in that sense. You will learn a lot both in breadth and depth.

Take the opportunity now to brainstorm ideas for a book that's inside you.

It doesn't have to be long. One hundred pages is plenty.

Teaching

Teaching courses part-time at a local college or university can be an attractive stream of income.

I have been teaching as adjunct faculty in the Doctor of Psychology (Psy.D.) program at Widener University outside Philadelphia for several years and find it both rewarding and enjoyable.

Think about areas of special interest on which you could teach a course. Courses that adjunct faculty teach can be core curriculum in a graduate program, an undergraduate course or an elective.

I find that part-time professors who are practitioners have a lot to offer because they are immersed in what they teach. Students seem to appreciate this as well.

E-books

E-books are another medium in which you can package and share specialized information.

And e-book is a written piece of information that is distributed via the internet electronically. It is offered free or for a cost (typically $10 to $30) on a web site.

You can also submit an e-book to web sites that list hundreds of e-books to make them available to the public.

Tens of thousands of e-books are downloaded each year, and are changing lives for the better.

Perhaps you can make yours one of them.

Do you have a solution to a specific problem or can you research the answers?

The best e-books share answers to a specific problem.

E-book topics I have heard of recently include: how to write a eulogy, how to cope with a hysterectomy and the topic of recovering from fibromyalgia.

These are e-books written by non-mental health professionals. Imagine what information psychotherapists can offer in this just-in-time format.

E-books cost very little to produce and nothing to distribute. You can attach the file for an e-book to an email or make it downloadable from a web site.

A great e-book is not long. Many of the best are 10 to 35 pages long.

E-books offer short answers to problems readers want to solve, and are available to people quickly.

Good e-books are specific and do not contain general information. The key to marketability is communicating your precise answer to a specific problem.

E-Courses

E-Courses are similar to e-books, but they may be lengthier and delivered to readers one segment at a time. As the name implies, these can be formatted as guided self-study programs.

E-courses allow for the content to be integrated over a specific period of time. Each lesson can be a simple article or more in-depth with guided self-study. Write between five and 10 lessons, and you have a good e-course.

Written by a professional, a good e-course can bridge the gap between a reader learning new information and the reader applying that information to his/her life and making a behavioral change.

Personal Coaching

In sports, coaching is important to help an athlete develop a winning strategy, develop skills and execute the plan. The coach knows how the athlete can progress and move forward. He/she urges the athlete to set high goals and provides motivation, support, focus and encouragement.

Over the past 10 years, the field of professional coaching in personal development and business arenas has grown tremendously.

What is coaching? Personal coaching is a one-on-one professional relationship in which a client is assisted in achieving a personal, business or career goal.

What is the difference between coaching and therapy? Although coaches sometimes assist people with challenges and problems of various kinds, they do not try to help people overcome problems related to diagnosable conditions as found in the DSM.

Rather, coaches assist well-functioning people to attain greater levels of achievement and satisfaction in their personal lives, businesses or careers.

While therapy is remedial and restorative, coaching is developmental and growth-oriented.

Therapy heals mental and emotional infirmities, while coaching helps healthy individuals achieve more or reach important goals.

Personal coaches work with clients on a wide range of issues, such as coping with a problem or crisis, focusing their efforts on achievement, making career transitions, living more fulfilled lives, achieving life goals and building better relationships.

Other coaches assist people with business development or managerial or leadership development. These coaches are called business coaches or executive coaches.

While coaching is not always based on psychology, it often is. And many of the skills a coach uses are the skills in which therapists are trained. So, there is considerable overlap between coaching and therapy.

This is why many psychologists, counselors and therapists have found coaching attractive and transitioned into coaching either entirely or as a part of their practice mix. I am one of them.
In many ways, therapists have an ideal background to be coaches. But the differences between coaching and therapy are significant and important to keep in mind.

Therapists can make great coaches because of their insights into human motivation and behavior, their understanding of human development and life transitions, their communication and relationship skill and their sense of professional ethics, knowledge base and experience in helping people.

Live Workshops, Retreats, Trainings

Presenting live events such as seminars, workshops, retreats and training programs can be a very lucrative stream of income.

And, it can be a powerful way to affect peoples' lives.

The group setting allows learners to engage with your material and benefit from the collective knowledge and experience of the group.

Live programs can also be an introduction to your other services. Brief programs, such as a "lunch and learn," can be delivered for free as a solid marketing vehicle for your practice.

As a therapist, if you have developed and packaged your message into a program as recommended earlier, you have the makings of a great seminar or workshop.

Why not kill two birds with one stone?

Promoting a workshop or retreat is promoting your practice at the same time -- and may be psychologically easier to do.

Consider adding a post-training element to your program. It could be a follow-up mini-workshop, a series of workshops or one-on-one work.

You can leverage the energy of a live event in many ways for additional revenue streams.

And, it is likely that some participants will choose to work with you after the event is over.

You will want to casually present your other offerings at the event. You may make it easier for them by having a sign-up sheet.

Teleseminars

A teleseminar (also called a teleclass) is a seminar held over the telephone, like a conference call.

The advantage of a teleseminar is the convenience. No one has to commute and the consumers dial to a bridge line at the specified time. No physical accommodations need be arranged; you only need to rent a telephone bridgeline.

Teleseminars can include people from all over the country, even internationally, at the same time.

Classes are typically 60 minutes long, but can vary. Often teleseminars are offered in a multi-class series.

Teleseminars are another way to offer your packaged content and introduce people to your services. Teleseminars can be offered for free to attract prospective clients and let them sample your services.

See [http://www.teleclass.com] for examples of what various professionals are offering. Or, do a search on Google for teleseminars or teleclasses. There are hundreds to browse and attend.

To get a better feel for how to conduct a teleseminar, attend some yourself.

Consulting

The goal of this book is to help mental health practitioners build thriving managed-care free private practices.
One of the themes I hope I have conveyed is that psychology is not just for DSM diagnoses.
While we have discussed ways to market traditional services, diversification is important, as it increases the chances we can generate sufficient income to operate outside of managed care.
Multiple streams of psychotherapy income can be developed in one's practice.

When I decided to build a manage-care free practice, I gave considerable thought to how

I could provide private-pay services. I explored how I could use my skills in ways that people would readily pay.

Many psychologists and other mental health professionals are successful in consulting in the workplace for the benefit of employees and employers. Business consulting can be a very lucrative income stream.

Like many practitioners, I found my skills could be applied in the business arena. Today, through a business I started called Leadership Concepts, I offer services in the areas of business consulting, executive, business and career coaching and seminars and workshops for businesses. This has proven to be a solid and growing income stream for me, and it is work I really enjoy.

Other ways to diversify into consulting include behavioral medicine, forensics and sports psychology.

Consulting is a very broad and diverse area, so I won't scrape the surface of the possibilities here. But perhaps I can give you good directions for exploration.

If this area is new for you, you will be surprised to find out the many valuable ways our psychology and mental health expertise can be of benefit to people in the workplace.
Our background makes us capable of assisting businesses with many different barriers to productivity.

To familiarize yourself with this terrain, I suggest you do a Google search using the keywords "business," "consulting" and "psychologist" and browse the web sites that come up.

Forensic Consulting

Another specific type of consulting is worth considering separately.

Forensic consulting has to do with psychological or mental health service specifically related to the court system.

Often times, a court has to deal with issues that impinge on mental health issues.

Some of these include:

Criminal cases

• Competency to stand trial


• Mental status at time of offense


• Mitigating factors in offenses


• Risk assessments, violence

Civil cases

• Emotional damages in personal injuries


• Assessments for malingering

Family cases and other

• Child custody evaluations


• Court-ordered psychological evaluations

In addition, attorneys often need help sorting out the issues when questions of a psychological nature occur in their cases. They retain psychologists and other experts to review files and help them prepare for depositions or cross-examination of experts.

Psychologists and other professionals can inform the court on issues, perform assessments and testify as experts.

Consultants in this area testifying as experts typically receive $1,000 to $2,000 for their testimony.

I find that this niche is an attractive one for several reasons:

• It is completely managed-care free


• It is interesting work


• It makes good use of our background


• It is lucrative


• It is a specialized area that many professionals find intimidating,
  which means less competition

If you find this an interesting prospect as a part of your practice, then I encourage you to begin taking some training workshops to familiarize yourself with the terrain.

Web sites

Revenue streams can be active or passive. Therapy sessions, therapy groups, workshops and consulting services are all active forms of revenue streams. You exchange your time and skills for a fee.

Passive revenue is revenue from streams that do not involve service delivery, but once set up, occur automatically 24/7. A common form of passive revenue is income from products sold on a web site.

Can you see the advantages of passive revenue? Can therapists develop passive revenue streams? You bet!

Therapists can productize their most useful expertise and offer information products to benefit others.

Some of these we already looked at, like books, e-books and e-courses. These can all be offered on a web site for web seekers to obtain and utilize to fill their needs.

There are other possibilities as well, such as licensing programs.

As an example of a passive revenue web site effectively offering information products to a specific niche, see TeachMeTeamwork.com.

Passive income streams utilizing the internet via web sites are a burgeoning area for many service professionals, but few mental health professionals are taking advantage of the potential so far.

This will be changing soon.

Active income streams can also be marketed on the internet.

Web sites can also be effectively used as a marketing tool for your fee-for-service practice. More and more therapists are putting up web sites and for good reasons.

A web site is your practice brochure, available any time, day or night, to seekers on the internet. People you meet, people who hear you give a presentation and people referred to you by another professional, can be directed to view your web site, find out more about you and, hopefully, be stimulated to contact you.

A simple, attractive, intriguing postcard sent to a mailing list can direct your niche market to your web site. Or, your yellow page ad in the phone book can include your web address.

A web site is much more than a brochure. It is also a potentially powerful marketing vehicle, when combined with internet marketing strategies.

If you decide to have a web site for your practice, or for a particular niche service, make it full of resources (articles and free information) that will attract people to it and make them want to spread the word.

Although beyond the scope of this article, internet marketing strategies can be developed to drive people to your web site.

Increasingly, people are beginning their search for products and services on the internet.

The yellow pages are not the first choice for many.

Are you effectively represented on the Internet?

Licensing Programs

After you have developed effective structured programs for your niches, you can license the use of these programs to other professionals.

Other therapists have been doing this for years. Psychologist Dr. Daniel Dana, a conflict resolution specialist, certifies mediators and licenses his program at MediationWorks.com.

Another example can be found at DifficultChild.com, as we mentioned previously. Howard Glasser, M.A. offers a parenting approach and program, as well as other materials, for ADHD children. His program involves a book, a training program for parents and a training and certification program for therapists.

His program is called "Transforming the Difficult Child: The Nurtured Heart Approach."

One of my coaching clients is certified in this program and speaks highly of it.

Howard Glasser's web site actually models several streams of income, including a book, workshops, training other professionals, licensing or certification and internet marketing for all the above including his practice.

These "programs in a box" are typically complete turnkey therapy, counseling or consulting programs that therapists can purchase. They are usually complete, including the structured program itself, instructor materials, workbooks and also include marketing pieces you can use to generate business.

For those of you who want to do niche marketing but prefer not to do the creating part, you may want to find out whether someone has developed a program you can utilize to serve your niche.

Someone may have done the work for you.

If you can find a program suitable for your niche market, you could be a few days away from having a marketable service in your repertoire.

Training Other Professionals

When you have developed an effective program, you can leverage it by training others in your approach and methods.

Innovators in therapy have been training others for years. If you develop a specialization, program or niche service in a growing area, you may find many other therapists would like to learn from you.

Sometimes the innovation is mainly in how a service is packaged.

You can train other professionals via live workshops, self-study program packages and teleseminars.

Diversification by developing a number of streams of psychotherapy income increases the chances you can create sustainable income and can be rewarding in other ways too.