Three Four Letter Words No One Dares to Utter

"The good news is we are living longer and the bad news is....we are living longer."
Michael Aun, businessman, author, and nationally recognized motivational speaker

You have done all the right things. You lived within your means and saved diligently. You have maintained a properly diversified portfolio through all the ups and downs of the market, you kept an eye on investment costs and used a variety of strategies to minimize taxes on your gains. As a result, you have accumulated a sufficient nest egg to fund your retirement income and provide a decent legacy for your children. Unfortunately, you could lose it all if you don't make the right moves to protect your assets. No, I'm not talking about the prospects of continued market volatility or a double-dip recession that usually dominate the news and everyone's minds. I'm referring to the three four letter words almost no one dares to utter.... long-term care which includes the expense for a nursing home stay, assisted living care, or home health care.

Why should this be a concern?

• According to the US Department of Health and Human Services, 70% of people who reach age 65 will require some home long term care at some point in their lives> Of those who need the care, over 75% of them will need it for over a year


• Current Life Expectancy after age 65 is now 17.9 years, meaning that your chances of needing assistance due to chronic conditions is greater than it would have been ten or twenty years ago.


• The cost of nursing care is not cheap. According to American Association for Long Term Care Insurance, the average cost of nursing care is $73,000 a year. The cost of home health care can be considerably less or more depending upon on what services are needed and how often the patient needs care.


• The cost of care has been going up an average of 6% per year for a number of years. At that rate, in twelve years, the average cost of care will be twice as much of what it is today, which would bring it up to $146,000 per year. Assuming the cost of care continues to rise at the same rate, in another twelve years - twenty four years from now, the cost of care will be $292,000 a year.


• Medicare only covers the cost of the first twenty days of skilled nursing care that follows at least three days of hospitalization. Medicare and your supplement may pay for an additional eighty days of care but only if a medical professional says you need skilled care and again only after a three day period of hospitalization.

So, what should or can you do about it?

What you should do about it really depends on what you would want to happen if you needed any type of long-term care.

Would you want your spouse or your child to take care of you? If so, what impact would that have on their lives?

If you would rather have a professional provide you the care needed, how would you pay for the care?

• What assets would you liquidate?


• How much more in taxes would have to be paid?


• What affect would the loss of your assets and potential income have on your spouse's standard of living?

All of these questions must be answered before a plan of action can be drawn so you are not forced to make tough decisions under duress. Preparing such a plan can make sure that loved one's lives are not disrupted, family stress is minimized and the quality of all family members' lives are preserved.

The next question that needs to be addressed is what can you do to protect your assets from being depleted by long-term care.

If you do have substantial assets in addition to your home and you are in reasonably good health, one option that you should consider is long term care insurance. Claim proceeds are not taxable and in many cases a portion of the premium can be deducted from your federal income taxes..

The earlier you apply for coverage, the greater your chances of being approved for coverage will be. According to the American Association for Long Term Care Insurance, the odds of someone in their 50's being approved for coverage is 86%. but declines to 55%. if they wait until their 70's. Naturally, the earlier you apply for coverage the lower your annual premiums will be.

Most of these plans cover care provided in a nursing facility, a place that provides assisted living care, and in one's home. However, the insured must either have a cognitive impairment, been approved by their doctor for care that is medically necessary or be unable to perform two out of six activities of daily living. Activities are bathing, dressing, eating, continence, toileting or transferring - going from a bed to a chair. These plans also can include compound inflation protection so after your first year of coverage, your daily or monthly coverage will increase 5% on a compound basis.

Improving Staff Engagement at Your Site Will Improve Patient Outcomes and Your Bottom Line

It is an axiom of business that employee engagement produces many positive results, no matter what the setting-manufacturing or service. This is true for healthcare as well. Employee engagement produces a better product or service. In healthcare, engaged employees produce enhanced patient outcomes. When employees are engaged there is less turnover, which reduces training costs. Engaged employees are problem solvers. These are just a few of the many benefits from engaging employees.

How can management engage employees at healthcare sites? A recent study by Manpower's Right Management emphasized providing opportunities for advancement and opportunities for development. In a survey of a wide variety of organizations it found that in settings where employees felt that there were career opportunities for them, 54% were engaged. In settings where employees felt that there job was a dead end, only 9% were engaged. The same study also showed that employees who had career opportunities were likely to stay much longer than employees who did not think they had good career opportunities. For the former only 5% said they planned to leave their organization in less than one year. For the latter, 22% said they were likely to leave within a year.

Let me share an example of a primary care site which has engaged an employee through development. This site has found that the percent of collections from billed charges has drastically fallen from 75% to 60% in the past year. The practice administrator suspects that there may be several factors which have led to this, including poorer coding and physicians seeing fewer patients. Wanting to be objective, she decided to "go and see" what the real causes are. She talks to several of the staff to get their point of view. She reviews a recent external audit of billing and coding. She finds after a thorough analysis that the primary cause is coding; the percent of collections and reimbursement from first time coding has slipped. She talks to her coders and finds that the new codes are causing problems. With a team of physicians and coders she decides that the best strategy to solve this problem is provide online training to her coders. The coders in turn will instruct the physicians on how to better detail the patient visit so that the coding will be more accurate. This approach soon solves the problem. The coders believe that have played an important part in serving the practice and feel engaged.

Another way to engage employees is to provide them ways to identify and solve problems. The best healthcare sites do this by borrowing from the Lean model of Toyota. For simple problems, such as organizing a storage area that is continually disorganized, making it harder to find needed supplies, the administration has instructed the staff how to quickly form teams to provide simple solutions that can be carried out quickly and cheaply. Other sites, alternatively, may solve its simpler problems by having regular voluntary team meetings of staff in a work area, such as staff of a lab, in which problems are identified and solved in one setting.

For larger problems administration can assemble a team of those affected and use the kaizen approach that Toyota champions. This problem solving approach is carried out over a longer period and is based upon the Plan-Do-Check-Act approach. Before applying the PDCA though, the problem is thoroughly explored by "going and seeing." A detailed analysis of the problem is presented to the kaizen team and agreement is reached that this is the real problem. By doing so, a good solution is much easier to achieve.

An example of using this kaizen approach to engage employees in problem solving is found in a primary care setting that is implementing an electronic health record. Since EHR's are so complicated and multifunctional, it makes good sense to form an implementation team at a site, perhaps one with a leader who is an expert trained in Lean approaches and team building, a consultant if necessary, so implementation is less disruptive as new processes are created to fully make use of the EHR. Sites using such teams see a drop of only 3% or so in patient flow in the short term as implementation proceeds and income actually increases in a very short time. One site team decided to focus on using electronic prescribing features of EHR's first in order to realize benefits right away, both in safety and in freed up time. EHR's virtually eliminate the problems created by handwritten prescriptions-errors in dosing and drug names. This function freed up time for staff who were taking calls for refills and transmitting them to the physicians, time which could be better used for patient care. Interaction of drugs problems were also avoided.

Another example of positive results from engaged employees is my experience with the staff of Baylor Hospital in Dallas, Texas. My mother had to have a pacemaker inserted at Baylor to help with her ventricle electrical pulses. The nursing and support staff worked to make my mother as comfortable and anxiety free as possible. I was able to view this close-up as her room had a pull out bed and I stayed with her for two nights. The nurses were timely in their care and answered our questions with excellent detail. They demonstrated that the quality of her care was of utmost importance to them. They were obviously fully engaged. In fact, the Health Grades web site ranked them as providing excellent care overall.

I hope it is evident that engaged staff can provide superior quality for patients and dramatically improve the bottom line. Engaging staff by providing educational opportunities, by offering opportunities for advancement and by involving them in problem solving are just three ways to make good use of staff abilities. If such benefits are clear why aren't more healthcare sites making use of this approach? I believe one of the reasons lies in the inability of management to let go of the control they have, to trust in the abilities of their staff. I recall just such an occasion with one physician recently. The staff nurse was complaining to me that the office would run much more smoothly if the physician did not try to micromanage every detail and let the staff do its job.

As you can see staff engagement is a Win-Win for all, even though such a transition may be difficult for some management. Taking a gradual approach to integrating staff engagement as a policy at your site will be beneficial to staff, patients and management.

Know Your Rights If You Have An Accident At Work

Accidents can happen at any time, in any place. One place in particular where accidents can occur is an accident at work. It is the responsibility of every employer to ensure that their employees work in a safe environment. However, sometimes this is not the case, and can result in injury or worst-case scenario, a fatality.

Here are some common types of accident claims that are pursued following on from an accident or exposure to harmful chemicals in a workplace environment.

繚 Asbestos related illness - Exposure to high levels of asbestos fibres can lead to a variety of illnesses. These illnesses generally don't show themselves until later in life. They range in levels of severity, with Mesothelioma, an always fatal cancer, lung cancer, asbestosis and diffuse pleural thickening, which is not fatal but can be debilitating.

繚 Noise Induced Hearing Loss - caused by the constant use of loud machinery, prolific with those who have worked on building sites for most of their lives or other similar environments.

繚 Accidents in offices and shops

繚 Accidents in factories

繚 Slips, trips and falls

繚 Chemical contact

繚 Lack of training

If the accident was caused by another individual or organisation, and you weren't at fault then you can make a personal injury claim for compensation.

If you happen to have an accident in the workplace, then you need to inform your employers about it straight away. Make sure that the incident is recorded in the accident book. If there isn't an accident book available then make sure that the details of the accident are written down and formulate the details of the accident into a letter, which you will then need to send to your manager or HR department.

You should also go and see your GP straight away, even if your injuries don't seem that bad. This is important as your doctor will record your accident details and you can then use this to help win your case.

If you want to pursue a claim for an injury you have had through an accident at work then you will need to get in touch with a personal injury solicitor. They will talk in detail about the circumstances surrounding your injury and should be able to tell you relatively quickly whether or not you have a claim.

Remember that if you choose to make a claim against your employer then you won't have to pay anything whether you win or lose. This is due to the 'No win no fee' system, whereby legal fees are paid by your employers insurance company.

Nursing Home Abuse - Possible Signs Your Loved One is a Victim

The decision to place a family member into a nursing home is filled with all types of emotions. It is an extremely difficult decision to make.

Fortunately, most nursing homes are safe, clean, and offer a caring environment. Unfortunately, a small number of nursing homes exist which neglect their residents or treat them in an abusive manner. Families can only hope the home they choose will treat their loved one with dignity and respect. The last thing that anyone wants to see is their family member suffering from some type of abuse or neglect.

It is important to be aware of some signs that might be present if you believe your loved one is not being treated appropriately or that your loved one is suffering from physical or mental abuse.

Signs of mental abuse include a change in behavior in your loved one. Several months ago they were happy and seemingly enjoyed life. Now, you find they act in ways that are very different or unlike their previous, normal behavior.

You might find your loved one is upset most every time you visit. This might be expressed through agitation or a change in personality. If you try to discuss the matter with your loved one, this may cause them to become even more agitated upset.

Another sign is withdrawal. Your loved one previously enjoyed playing a game of cards with other residents. Or, they enjoyed going to different activities the nursing home offered such as exercise classes, singing classes, etc. Sometimes their withdrawal becomes so prevalent they often miss meals or ask to eat their meals alone in their room.

Any of these signs can be an indication something is not right. It is up to you to search and try to find what is wrong with your family member and determine if they are reacting to some sort of mental abuse.

Physical abuse may be easier to detect. Often you will see blatant signs of physical abuse. This can result from your loved one being kicked, shoved, beaten, struck, shaken, or even burned.

A less visible sign of physical abuse is sexual abuse. Sexual abuse can happen in the form of rape, inappropriate touching, the taking of sexually explicit photos, or many other ways. Since many residents living in a nursing home are very frail and weak this makes them a target for sexual abuse if there is a staff member who chooses to behave in such an inappropriate manner. Residents who have a difficult time talking are even more open to such abuse because it is difficult for them to tell anyone.

Neglect is another form of nursing home abuse. Sign of neglect can include bed injuries, falling and fractures, bed sores, and dehydration. If you notice any of these signs, it is imperative you try to discuss the matter with your loved one no matter how reluctant they may be. You should also discuss your concerns with representatives from the nursing home and your own lawyer so an investigation can take place.

It is important for residents, family members, and friends to realize all nursing homes have specific rules, laws, and regulations they must meet or they will be fined and potentially shut down. Do not let your loved ones suffer silently as a possible victim of nursing home abuse.

Article 81 Guardianships in New York

Introduction to Article 81

Guardianship[1] is the court proceeding by which one person (the guardian) is appointed to make decisions for another person (the ward) regarding personal, medical, and/or financial matters. In New York, the governing law is Article 81 of the New York Mental Hygiene Law (MHL), entitled "Proceedings for the Appointment of a Guardian for Personal Needs or Property Management", which went into effect April 1, 1993. It provides a mechanism[2] for the court to assist a person to meet his or her personal and/or financial needs, while at the same time limiting such assistance to the least intrusive means necessary.

The standard for appointment of a guardian under the statute focuses on the decision-making capacity and functional limitations of the person for whom the guardian is sought -- not any particular mental or physical medical condition. MHL 禮 81.02. In fact, New York courts have extended the scope of Article 81 beyond mental conditions such as dementia, mental illness, or mental impairment, to include other forms of impairment, such as blindness and other physical infirmity, drug or alcohol problems, and even gambling addiction.

Common scenarios where a guardianship can help

The following are situations where New York courts have appointed a guardian:

1. Where people seek to make decisions for their aging parent;

2. Where parents seek to make financial and personal decisions for their adult special needs or disabled child;

3. Where a guardian is needed to make decisions for someone who is unable to make responsible decisions because of cognitive impairment;

4. Where emergency medical decisions must be made for an incapacitated patient who does not have advance directives in place;

5. Where an elder is being unlawfully detained by a nursing home or other institution against his or her will, or is being abused or exploited, and emergency powers need to be given to a temporary guardian to act right away.

In one interesting example, a woman had recently won a great deal of money in the lottery and found that she could not help giving her money away to anyone who had a hard-luck story. For instance, she was talking to a friend that said she could really use a new car, so the woman bought her a new car. Although she could not resist this tendency, still the woman realized she needed help controlling the money she had just won.

This story highlights the difference between someone who is an Alleged Incapacitated Person (AIP), as opposed to a Person in Need of Guardian (PING). A person who is in a coma or otherwise allegedly incapacitated would be considered an AIP. Here, the woman who won the lottery was considered a PING -- that is, a person who is not incapacitated per se, but who nonetheless needs a guardian. She could actually self-petition to ask the court for the appointment of a property guardian (i.e., someone to make financial decisions only, and not personal or medical decisions) narrowly tailored to control her access to and use of the lottery proceeds.

The "Nuts-and-Bolts" of a Typical Proceeding

A guardianship proceeding begins with the filing of a petition which contains the required pertinent information about the proposed ward (i.e., the person for whom the guardian is sought), his or her assets and income, the proposed ward's family members and others who are entitled to notice of the proceeding, whether there is a Will and other advance directives, and other information about the circumstances. MHL 禮81.08.

The specific powers sought are set forth in considerable detail. In the event that this is an emergency, or some other circumstances warrant having immediate intervention, an Order to Show Cause asking for the appointment of a temporary guardian with particular immediate powers would be included. MHL 禮81.23.

A good example of this would be where an immediate decision has to be made as to whether or not surgery or some other urgent medical procedure should be performed on a comatose patient where no health care proxy is in place. This would be particularly true where the family members disagree on how to proceed. The guardianship court would appoint a temporary or special guardian who would investigate, talk to the doctors, and report to the court with a recommendation.

While it would appear to the layperson that the test for an Article 81 guardianship would require a medical diagnosis, actually the test is a functional one: The court must determine (1) if the person has functional limitations, and (2) whether he or she can understand the nature and consequences of those limitations, and (3) whether it is likely that the person will suffer harm if a guardian is not appointed. In other words, the observation of erratic or questionable behavior is more to the point in these proceedings than a medical diagnosis.

The court will often appoint a Court Evaluator to act as the "eyes and ears of the court" -- to investigate the circumstances, interview people, and report to the court. MHL 禮81.09.

The matter proceeds to a hearing at which testimony is taken. MHL 禮81.11. These proceedings can also be contested, with family members disagreeing as to who should be the guardian and what steps should actually be taken. The person for whom the guardianship is brought can even object to the appointment of a guardian, and can be represented by an attorney (court-appointed or of their own choosing). MHL 禮81.10.

Seeking The Least Restrictive Means

In enacting Article 81 of the Mental Hygiene Law, the intent of the legislature was to create a means of protecting individuals using the least restrictive means possible. In addition, the law gives the court the authority to tailor a guardianship to the ward's needs. Article 81 requires the court to consider alternatives to the appointment of a guardian, such as visiting nurses, home health aides, adult day care, and trusts, and allows the court to fashion remedies that may or may not include appointment of a guardian. See, e.g. MHL 禮81.01.

Conclusion

Article 81 is a versatile remedy that can provide useful or even life-saving solutions to a wide variety of situations. Because it is a complex proceeding with serious implications, and it requires a court hearing, it is imperative for anyone considering a guardianship to consult with an experienced elder law attorney knowledgeable in this area of the law.

_________________

[1] In some states, the proceeding is called conservatorship.

[2] In addition to Article 81 of the Mental Hygiene Law, which has arguably the broadest application and flexibility in such matters, other mechanisms exist. The main example is Article 17-A of the Surrogates Court Procedure Act. Originally designed for mentally retarded individuals who were newly discharged from mental institutions and needed a safety net, the law was later amended to include developmentally disabled individuals, and specifically those with cerebral palsy, autism, epilepsy, traumatic head injury and other neurological disorders. The disability must have originated before the age of 22 (except that no such age of origination applies to traumatic head injury). By contrast with Article 81, Article 17-A expressly requires that the mental retardation or developmental disability must be medically certified. Also, in the more extreme cases where a person may be a danger of harm to himself or others, a proceeding exists under Article 9 of the Mental Hygiene Law for involuntary commitment of the individual.

Honey, Fishing Makes Perfect Sense

OK, I admit it, I will go to almost any length to justify my love of fishing and to invent (if need be) reasons to indulge in my hobby. But, researchers may have just provided the perfect, iron-clad reason to wet hook and line and eat the catch. A recent article in the Journal of Neuroscience reports:

As people live longer their chances of developing Alzheimer's disease also grows - however, researchers from UCLA have found that fish oils can really reduce your chances of developing Alzheimer's. More importantly, they have found out why this is so.

Greg Cole, professor of medicine and neurology, David Geffen School of Medicine, UCLA and associate director of UCLA's Alzheimer Disease Research Center, and team say that omega-3 fatty acid docosahexaenoic acid (DHA), which is found in fish oil, raises the production of LR11. LR11 is a protein which exists at excessively low levels among Alzheimer's disease patients. LR11 is known to destroy the protein that forms the plaques linked to the disease.

These plaques are deposits of beta amyloid, a protein that experts say is toxic to neurons in the brain - these deposits, as their numbers grow lead to Alzheimer's. If high levels of LR11 protect people from developing Alzheimer's, it is logical that levels that are too low will have the opposite effect. Medical News Today

Before you go out and drop a line in the nearest fishy-looking puddle, understand that researchers are talking about fish oil concentrate from cold water, ocean species, just don't tell my wife, please.

Contribution Of Nursing Programs In The Medical Field

In any hospital, you can witness that a patient will be attended by three nurses with different uniform. Basically these all have different job designation and perform separate tasks related to patient care. This will make it easy to understand that the tasks have been divided into different types of nurses. So they will be taking different trainings with certain level of education. There are many schools, colleges, nursing homes, hospitals and universities offering various nursing programs, they educate and train the students as per their caliber.

In order to get admission in any of the nursing programs, a person must possess a sympathetic personality and have the courage to serve the humanity. If you possess such qualities and want to start a career in health care profession then you can begin a new life as a Certified Nursing Assistant. You will be provided a few weeks training and after finishing the training, an exam will be conducted. On passing the exam you will be rewarded with a certificate so you can start working as a Certified Nursing Assistant, you will be working in hospitals or with the patients individually by visiting their homes.

Licensed Practical Nurse or LPN is a second stage in nursing. To become LPN, there are advanced nursing programs with time duration of 9 months to 18 months. A high school diploma is must for the entry in this training program. You will be getting theoretical training in the class rooms and for clinical training you will be taken to the ward and will be supervised. Once you finish the training, you have to pass a licensed exam NCLEX-PN. And after passing the exam, you will be given a license so you can start working as LPN. Registered Nurse is the top rank in nursing and to become a registered nurse you need to pass a four years degree called BSN. However there is another way to become a registered nurse, all you need is to complete 2 years associate degree from a hospital or from a school, college or any recognized university. There are many hospital diplomas that also allow students to pass the associate degree but then they have to pass a licensed exam called NCLEX-RN to become a registered nurse. After getting the license you can easily start working as a registered nurse in any renowned hospitals.

Certified nursing assistants are more focused on patient care by cleaning the patients, feeding them with special diet. They may also work with the patients in their homes where a patient can be a stroke patient, in this scenario they will be helping them with changing clothes and bathing as well. They will also be checking the patient's vital signs. The Licensed Practical nurses supervise nursing assistants and work in hospitals with the patients; they prepare the injections for the patients and perform some simple laboratory tests and also check the patient's vital signs just like a CNA. The Registered nurse however monitors every aspect relating with patient care, register nurses report directly to the doctor with the observations about a patient in order to change the treatment plan.

When Do I Need a Geriatric Consultant?

Most people do not even know what a Geriatric Care Consultant does let alone whether they need one. Geriatric Care Consultants can be very important under many different circumstances.

1. For many children who do not live in the same city or have extremely demanding schedules with little extra time, they may need an experienced Geriatric Consultant to help navigate their parents' needs. Some of those needs may be medical in nature such as: escorting them and being there for important doctor consultations; hiring caregivers or other supportive staff; supervising caregivers and directing them; determining medical needs and finding the appropriate doctors, physical therapists, occupational therapists, dentists etc. A Geriatric Consultant can provide accurate reports of vital information so that the children can make informed decisions with regards to their parents. Geriatric consultants can also give advice with regards to financial matters. They can direct children to lawyers and accountants who have the right expertise for each circumstance. If a nursing home or retirement home is necessary, a Geriatric Consultant can direct you to the right ones. If staying at home is the preferred option, a Geriatric Consultant can help with retrofitting the home to meet the physical challenges that have to be faced.

2. There are instances when an individual is asked or needs to be a Power of Attorney (POA) or guardian for a senior or disabled family or non family member. A Geriatric Consultant can direct them to the right professionals who can make sure that every aspect is executed properly.

3. Conflict resolution. Many times there are conflicts among family members as to the direction of care for their loved one. Other times there is resistance on the part of the person who needs care to accept care. An experienced Geriatric Care Consultant can help negotiate, arbitrate, and bring resolution and clarity to these dilemmas.

4. Advocacy. There are times when a loved one is in a facility such as a hospital or nursing home and needs someone to advocate for them and make sure that their need are being addressed especially if there are no family members or none in the same city. Dealing with insurance companies or other financial obligations may be difficult especially when a strong position has to be taken. A Geriatric Care Consultant can advocate effectively for the senior hopefully to a just conclusion.

5. General support and fellowship. Sometimes it is just comforting to have someone who is experienced and knowledgeable to talk to when making care decisions when it comes to a loved one.

Many care decisions are precipitated by a crisis or sudden change in the health of a loved one. That can be stressful enough. It is always a good thing to have a level headed, experienced professional working alongside you to advise, assist, co-ordinate and reassure you at those times.

Nursing Jobs Are Growing in Flexibility

Nurses are valuable contributors to the healthcare field. Their job is to care for those in times of medical distress. In recent years, the demands for qualified nursed have increased significantly. One of the main reasons for this growth is that nursing jobs are growing in flexibility.

Compared to most careers, the field of nursing is one of the most flexible fields. Nurses have the capability to work in any geographic location and in most medical areas. The work schedule is also very flexible. One can find a job that is either part-time or full-time. This is beneficial for nurses who have a family or other responsibilities such as furthering their education.

When it comes to work hours, there are flexible shifts available to nurses such as days, evenings, overnight, and weekend shifts. Hourly work shifts can vary from 4, 8, 10, or 12 hour shifts. This allows parents who both work to arrange time for raising their children.

The location of work for a nurse is also very flexible. One can work in urban medical facilities or in more rural or isolated regions. A nurse can work in any geographical area of the country and is not restricted by state. They can also work in countries around the world. If you have a spouse that gets a work transfer periodically, it will not be difficult to find work in the new location.

Career flexibility is also an important aspect of a career in nursing. There are many opportunities for nurses. They can specialize in such areas as surgery, pediatrics, critical care, emergency services, specific diseases or physical conditions, and much more. As well, a nurse has opportunities to further their education and move up the career ladder such as acquiring supervisor and management positions.

Nurses also have the flexibility to choose what medical department they want to work such as maternity, surgery, critical care...etc. If a nurse is suffering from burnout in a high stressed department, they have the ability to move to a less stressful department. Hospitals are not the only places where you will find a nurse. Nurses can be found working in community services, government departments such as health and human services, nursing homes, clinics, schools, out-patient care, home healthcare, rehabilitation facilities, and much more.

One area of nursing that is very flexible is Travel Nursing. Travel nurses provide short-term nursing assignments, about a 13 - 26 week period contracts, at medical facilities throughout the country, as well as in other countries. The pay is great and one gets to travel all over the country.

Flexibility with one's career is an essential aspect of a job that most workers value. Job flexibility helps maintain career satisfaction which leads to better productivity and a lower employee turn around rate. Because nurses are in such great demand, and the flexibility that comes with the career, it is a great time to become a nurse. One is nearly assured of finding their dream nursing job. Nursing is a highly lucrative, respected, and rewarding career.

Nursing Care Malpractice (Part II)

(Nursing Care Malpractice Part One discussed what is medical malpractice and the Indiana laws regarding medical malpractice. This article will discuss what happens if I get named in a lawsuit and should I have my own malpractice insurance. We all make mistakes just because we are human beings.)

What Happens If I Get Named In A Lawsuit?

There are two parties in a lawsuit, the plaintiff who is the patient initiating the suit and the second party is the defendant, who is the doctor or healthcare provider who is defending himself in the case. The plaintiff has the burden of proof to prove that there is medical malpractice. The burden of proof is that it is more likely than not that the defendant breached the standard of care.

The easiest example is by looking at the scales of justice. One side is for the plaintiff and the other is for the defendant. Plaintiff has met their burden of proof when the scale tips slightly to their side. It is unlikely for a nurse to get named individually. It is more likely that the employer will be named. As an employee of a healthcare entity such as a physician's office, hospital, nursing home or home healthcare service, the employer is responsible for the acts of negligence of its employees. The only exception where an employer will not be responsible for the acts of a nurses if the nurse is acting outside the scope of his/her responsibility. For example, if the nurse is ordering medication without a physician's order, the nurse is practicing medicine without a license and acting outside the scope of her responsibility.

Although it is unlikely that a nurse will get named as a defendant, it is possible that the defendant's attorney will ask to take the nurse's deposition. Even if a nurse is not directly named, this only affects payment and not the nurse's own accountability. The nurse should still be proactive to avoid any implication of malpractice.

What is A Deposition?

A deposition is simply a process where a witness is asked questions under oath. The court reporter takes everything down that the witness says. In a lawsuit, there should be no surprises. Both sides are entitled to get as much information as they can from anybody who has knowledge regarding the case.

If a nurse is asked to have his/her deposition taken, the attorney for the employer will properly prepare the nurse for the deposition.

Should I Have My Own Malpractice Insurance?

Whether or not to have your own malpractice insurance is a personal choice. The benefit of having your own is that it gives you a right to have your own attorney present at a deposition.

If you choose to have malpractice insurance, it is imperative that you become a qualified healthcare provider under the Indiana Patients Compensation Fund. In Part One of this article series we noted that, to have a healthcare provider's liability limited to $1,250,000.00, one must voluntarily participate and be qualified under the Indiana Patients Compensation Fund pursuant to the Indiana Medical Malpractice Act ("Act").

This requires that your insurance company pay an additional premium so as to qualify you under the Act. Nursing malpractice insurance is relatively inexpensive. However, it is more expensive to be covered by the Act. You must remember that it gives you certain benefits of limiting your liability so that there is no personal exposure. The Act also requires that your case must be presented to a medical review panel before it can proceed in court.

It is also advisable to have your own attorney if the hospital's interests are different from yours. If your position was terminated over this incident or you feel like the hospital will not support you in the care that you provided, it is advisable to have your own legal representation. In any event, it is advisable to seek the advice of an attorney should you get named in a suit or be asked to have your deposition taken because your testimony will be under oath and it can be given to the Indiana State Board of Nursing for further action if the Board deems necessary.

The best defense is a strong offense. By practicing defensive nursing care and charting thoroughly and being proactive with your care, it will save you a lot of time and trouble in the future.

After a long day it is difficult to have the energy to sit down and chart extensively, but imagine picking up a chart two to three years after the malpractice occurred and trying to remember what happened. I would challenge each one of you to pick up a chart that you wrote on six months ago and see how good your recollection is and see how well your notes protected you.

Over Crowding In The Emergency Room - Root Causes, Potential Liability And Preventive Action

Anyone who has ever visited a hospital emergency room has experienced over crowding and long waits to see a doctor. I have been on both sides of the fence as a patient and as an emergency nurse. It is a nasty situation that brings out the worst in all of us. Some years ago, the emergency department administrator in a hospital that I was working in had the bright idea to hire a magician to entertain the folks in the waiting room. This man was a clever entertainer, but he was playing to the wrong audience. While he was doing his rope trick one patient told him to hang himself. Another man told him where to shove his rabbit and a woman shouted, "Why don't you conjure me up a doctor so I can get treated for this lousy migraine?"

That administrator's goal was to find a way to get people to accept an unpleasant and dangerous situation rather than finding the route causes and implementing changes. Therein lays the answer to the mind boggling question, "Why does such a state of affairs that causes harm to the respective community and damages the providers' reputations persist in virtually every urban hospital in the country?"

Root Causes and Potential Liability

The harmful effects of prolonged E.R. waiting time as well as root causes and solutions are well documented in the medical literature (see references). Therefore, when medical and nursing errors occur in the emergency department the existence of certain conditions that administrators could have identified and resolved can be an issue of hospital liability. For example, recent headlines in South Florida revealed that a young man in his forties was found dead in a major hospital emergency waiting room. The initial investigation revealed that his body was stone cold when one of the nurses found him still seated in a chair with his head leaning against a wall. Apparently, he had been dead for several hours while his family was frantically looking for him.

Investigating a Death Related to Overcrowding

The underlying reason why this man was literally forgotten to death is obviously over crowding. There were so many people in the waiting room moaning, groaning, complaining, and making loud insulting comments that no one notice a quiet man in the back corner of the room who appeared to be sleeping. The next logical step is to examine the factors that contributed to the overloading of people in the treatment and waiting areas. Therefore, in conducting a proper investigation for corrective action the following questions need answers:

Does the hospital administration track waiting time?

What is the average waiting time as per the tracking reports?
Is the triage nurse located in a place where he or she can see what is going on in the waiting room?
Did the triage nurse periodically monitor the patients in the waiting room?
What is the average turn-over time for a bed on the floors (the time it takes for housekeepers to clean a bed between patients)?
How many emergency room gurneys are there and are they routinely returned to the E.R.?
What is the average turn around time for blood and urine tests (most take three minutes or less to perform while the doctors wait 3-4 hours for the reports)?
Does the administrator notify the 911 EMS dispatcher to divert ambulances to other hospitals when the hospital in question has no empty beds?

The Standards of Care and Corrective Action

In reviewing the literature for established standards, Spaite, et al reported that administrative focus on correcting such problems that cause slow downs and bottlenecks in patient flow have reduced average waiting time by one half (7). Additionally, Lambe, et al reported that a survey of emergency department administrators established that over crowding is defined as an average waiting time of more than one hour and the waiting time is the time of initial entry to the first physician contact (4).

1) This provides sufficient evidence that a general consensus exists as to what is good and proper:

2) That a hospital providing emergency care services must keep track of ED waiting time;

3) That administration must make every effort to keep average waiting time within one hour by eliminating correctable situations that cause delays in moving current patients, which in turn cause delays in treating new patients;

3) That there be enough nurses conducting triage and monitoring all patients who remain the waiting room for sudden changes in their condition.

Summary and Conclusion:

We know from the many studies that have been published that in most cases, prolonged waiting times in emergency departments can be reduced. We also know that over crowding can be ameliorated a significant degree by conducting a proper inquiry and making a few simple changes in administrative policy. Therefore, it is incumbent upon every hospital executive with command responsibility over the emergency department to take waiting time seriously and regard an average of more than one hour as unacceptable. Moreover, the hospital's cadre of board room denizens must take every reasonable action to find and correct such contributory factors as described above when emergency room over crowding (with the staff operating in disaster mode) has become the normal condition.

Curbless Shower Accessible Bathrooms and Senior Independent Living Sunrise Facilities

Assisted Living and its Benefits

Of the many ways we take care of our elderly, the concept of assisted living is one of the most popular. Assisted living offers the best of two worlds for the person served by the system. Independence is at a high while caregivers are available if they should need them. In essence, they are never really alone.

Assisted living facilities are not to be confused with nursing homes. This is a common misnomer. The term assisted living is exactly as it sounds. Facilities provide assistance with what are called ADL's or activities of daily living. This encompasses things such as bathing, eating, dressing and more.

While some assisted living facilities do offer medication assistance as allowed by the state it is located in. Medication assistance can mean anything from preparing the medication to simply reminding the individual that it is time to take it. These facilities do not provide any major medical services, which makes them a whole different type of facility from a nursing home.

The main attraction for assisted living facilities is the individual's independence. The elderly begin to feel that they have lost their independence if they cannot function on their own from day to day. This is where AL facilities play a major role in longevity and quality of life for residents.

The facilities themselves tend to be more attractive to the individual as well as the family. The types of units range from a standalone home to an apartment in a continued care community. However, it is not just the type of residence that appeals to the clients; it is the environment as well.

An environment that allows the individual to live a full life and receive the assistance of staff members only if needed. The staff is always there to watch and step in if they have to. Safety is the major function here. The individual is free to do whatever is available to do at will. Activities are on the schedule and always going on.

All of this freedom mixed with assistance gives the client a feeling of worth, value and security. That goes a long way towards the quality of life for these people. Additionally, the family can rest assured that their loved one is well cared for and happy. Therefore, the benefits are not ONLY for the client.

In the end, all of this needs to be paid for somehow. The usual way is private funding, but there are some exceptions to that rule. Many long-term care insurance policies will cover assisted living expenses if it is licensed. Check your loved one's policy to make sure.

In some states, Medicaid waivers and funds are available to help defer the costs. Check your local statutes and laws governing assisted living. Since AL facilities are regulated at the state level, you will need to check with the state for actual details pertaining to your situation.

The bottom line is that you can place your loved one in a nice assisted living facility. The cost can be deferred by several means and insurance may even cover it. Do a little research and see what your state has to offer. You may be surprised at what you discover.

The Top 10 Benefits of Getting Old, Including Elderly Care Facilities

Sure death is closer as you age, but once you deal with the reality of that you can start having fun. These 10 benefits make me look forward to my golden years.

1. Elderly Care Facilities: Senior assisted living is a great way to manage when getting older starts to take its toll on your body. Having someone provide your meals and manage your medicines takes the tedium out of aging.

2. Confidence: Ah, youth. It can be exciting for all of the uncertainty, but it can also be jarring and worrisome. Forget about being unconfident and self-conscious -- with age comes a self-righteousness well worth the wait.

3. Wisdom: As if being self assured isn't enough, you also get the benefits of having lived and seen a variety of things young whippersnappers haven't. That makes your experience all the more valuable. Pass it on whenever you get a chance, but because kids have little patience, it may be better to write it down as a memoir, so the future generations can have your stories too.

4. Discounts: From museums to early bird specials, seniors get tons of reduced fares. Take your pick and start enjoying.

5. Free Time: Without working you can easily begin a new hobby and focus on yourself. Try golf -- it's great exercise and it's nice to immerse yourself in nature.

6. Solitude: And speaking of nature, now that you've been around the block, chances are you can finally appreciate what it means to be alone. The quiet and relaxation of listening to birds chirp or streams burble; kids just want to see what's next.

7. Grandkids: The best aspects of having children without the worry of discipline and raising them properly. And with gray hair it's hard to be thought of as foolish, so you can act as silly as you want around kids (or anyone else, for that matter).

8. Mental Strength: As we age, the brain grows stronger, having absorbed more. Philosophizing becomes easier and we don't take knowledge for granted the way young people often do.

9. Freedom: No one can really tell you what to do. You have age on your side, which goes a lot farther than any reasoning or "power."

10. Relaxation: With time to spare we don't have to rush or worry. That means you can breathe deeply and relax. Take a nap or a stroll, do whatever you want! You're retired!

Getting older is natural. Enjoy it as it occurs and you will be able to reflect on your youth without regret.

Long Term Care Insurance in Nursing Home Costs

Many people believe that long term care is only for elderly individuals. This is not the case. In fact, this type of insurance is often administered to individuals with disabilities and chronic illnesses. Many care services can include support with daily activities such as bathing, getting dressed and preparing meals. These services can be utilized in the individual's home or at nursing homes and assisted living facilities.

While you may not think so at this time, there is a very good chance you will eventually have to consider Medicare benefits. It has been estimated that by 2012, more than 12 million individuals will need this type of care. This means that those who reach the age of 65 will have a 40% chance of being placed in a nursing home. In addition, 10% of these individuals will stay in that facility for five years or longer. This is why it is so important to choose your medical care provider carefully.

Just as choosing a provider is important, so is planning your medical needs. Again, not many people think this far ahead in the future, but it is extremely important to plan for your future care needs . This planning is not always easy to do, so to make it a little easier, there are a few questions to answer. These questions and answers will help you make an informed decision. First, you should examine what types of care you may need. Next, consider how those needs may change over time. After that, determine your choices when it comes to insurance companies and providers. Finally, always be aware of the cost and how much you will be able to afford. After answering these questions, you will have a better idea how to plan for your nursing home needs and will give you knowledge about what kind of insurance coverage you will need when you retire.

When looking for insurance, there are many things to consider beyond the questions that were mentioned above. When comparing insurance, you want to find out what the protection from inflation is. Since many insurance companies only provide a fixed daily amount, you may opt to buy additional insurance for a Medicare supplement to offset the costs. You also want to consider the amount of coverage the insurance company offers. The cost of long term care varies, so you must think about where you may be residing when you are older. The length of coverage is also important. Some insurance companies offer coverage that will protect you anywhere from 2 years through the end of your life. Typically, nursing home costs will require 3 to 5 years of coverage. Finally, consider your insurance carrier's financial health. If you choose to buy lengthier care coverage, make sure that the insurance company will be around for a long time.

There are many online tools that can help you determine how much insurance you may need. These calculators will determine the estimated cost of coverage and will factor in what financial resources you already have available. They can be very useful in planning the amount of care time you need and choosing the right insurance coverage.

Most expenses for home care are not covered by Medicare, but some are covered by Medicaid. This is because the Medicaid program is based on the financial needs of the individual. You will need to pass an asset test to qualify for the Medicaid benefits. The end result would mean having to spend all of your assets before becoming eligible for Medicaid coverage. The government now allows policyholders of long term care insurance to exhaust their current benefits to receive financial assistance instead of using their life savings.

Under this program, if you purchase an insurance policy and your benefits run out, you will then qualify for Medicaid and be allowed to retain your assets, as long as they are equal to the value of the insurance you had purchased. Without this program, you would be required to spend all of your assets before you would be eligible for Medicaid coverage.

Unfortunately, only a few states have the above program in place, but 30 more states are taking the steps to get the program in place. You can find additional information at longtermcare.gov. This site will provide you with current information regarding your state's status on the program. You have one shot at submitting an application form to Medicaid. Do not submit it until it has been reviewed by an expert - it could cost you tens of thousands of dollars.

States typically offer online forms that you may download and print, however no states allow you to currently apply for Medicaid online.

DaVita Job Application for Lucrative Health Care Careers

DaVita is one of the operating divisions of a Fortune 500 company, DaVita HealthCare Partners Inc. On Nov. 1, 2012, DaVita closed the merger deal with HealthCare Partners, and the merged company is named DaVita HealthCare Partners Inc.

The medical centre is well known throughout the United States for offering competent and quality kidney care and dialysis services to patients throughout the United States. The patients with critical renal disease and chronic kidney disease (CKD) can expect high standard treatments from the division. There are 1,912 outpatient dialysis centres spread in the 43 states of the United States serving around 150,000 patients, as of September 30, 2012. The division also has its presence outside the United States with 24 centres, serving 1,000 patients. The division Headquarters at 1551 Wewatta St, Denver, CO.

Careers

The division serves the dialysis and renal disease patients with 41,000 teammates, who follow the core value of the organization for superior care through Service Excellence, Integrity, Team Work, Accountability, Common Goal, Continuous Improvement, Fulfilment and Work Enjoyment. The recruitment office of the division locates at The Lodge 5280,1627 Cole Blvd. Bldg 18, Lakewood, CO.

There are a number of employment opportunities available in DeVita. The applicants can build their careers in different fields such as Biomed, Corporate and Business Offices, DaVita Rx, Dialysis Healthcare Administrator (FA), Dietician, Regional Operations Director, IT, Laboratory services, Nursing, Patient care technician, Regional Operations Directors, Reuse Technician, Social Worker and Village Health Careers.

Benefits

The employees also enjoy a variety of Benefits together with salaries. They are offered Benefits in various categories such as For Your Growth, Your family's Growth, For Your Future, For Your Health, Change of Field and Career Advancement Options.

Application Process

The applicants can click on "Search Openings" on the Career Opportunity page of the division's website and select the field they are willing to apply online. All applications are accepted through online system only. You can find keywords, job type menu items, and/or location (by city/state), and modify search categories on the career page. If you are a returning user, you can search jobs with the existing log-in information and can also see the jobs already applied by you.

As a first step of your application process, you can upload your resume. The system will immediately extract the required information provided in the resume for the online submission. The applicants are offered an opportunity to review their application for any addition or deletion before final submission. If there is no vacant position, fitting your profile details or application, the HR team stores all your resume's relevant information and contact you when any job opening that suits your skills comes up.

It is also necessary to remember that the applicants receive a confirmation email once the company receives their online application, and the shortlisted candidates are contacted for phone or in person interviews.

Controversial 5 Star Nursing Home Ratings

The news recently buzzed about the Five Star Quality Ratings published for skilled nursing facilities. I was excited myself until I looked further into how the ratings were actually calculated. The ratings are based on three categories of data: health inspections, staffing and quality measures. To read the explanation regarding determination of quality ratings visit The Medicare website 5 Star Quality Ratings explanation page.

The category entitled Health Inspections is the ONLY category that provides information derived from trained teams of surveyors. However the category descriptor also mentions that there are "many differences in state licensing requirements that affect quality, and in state Medicaid programs that pay for much of the care in nursing homes." Additionally, "inspections do not identify nursing homes that give outstanding care. While reading these reports, keep in mind that the quality of a nursing home may get much better or much worse in a short period of time. These changes can occur when a nursing home's administrator or ownership changes or when a nursing home's finances suddenly change."

This statement says more about the care provided in a nursing home than most. Staff changes have significant ramifications on the care provided in a nursing home. Often when an administrator leaves many staff members also leave, resulting in significant gaps in patient care and coordination until new staff is up and running. I have personally experienced this myself when I have had clients in certain facilities, many of whom I would have previously recommended but would now not place my worst enemy. When looking for a good nursing home for a family member multiple factors should be considered including the annual survey which can serve as a starting point.

The second category Staffing, was based on "the overall number of staff compared to the number of residents and how many of the staff are trained nurses". This number was self-reported meaning that the rating relies on the integrity of the nursing home providing the information. Research shows that relying on numbers only is not a realistic measure of quality. After all how many times have we heard the joke "how many xyz does it take to change a light bulb?"

More relevant, an article in The Gerontologist related staffing levels and nursing home quality by focusing on staff stability, stating that "highly stable employees are likely to deliver consistent care and have a greater appreciation for care practices."

Staffing quality is not only a numbers game. Many times it depends on the care provided by individuals who have been with a facility for a number of years. Time indicates commitment to care as working for any length of time in a nursing home environment not only takes commitment but love of caring for others. The difficulty of the work is one of the reasons many facilities have high turnover especially if the employees do not receive sufficient support from supervisors and the company operating the facility.

Even more interesting is the category entitled Quality Measures which reports how well each nursing home performs on ten aspects of care such as dressing eating and preventing skin ulcers. These quality measures again are self-reported by each nursing home and I suspect the degree of quality is also self interpreted. How many individuals do you know that would purposely rate themselves as sub-standard giving only one or two stars.

This is the more important reason to visit several nursing homes. Meet with the staff. Are they responsive and do they have time for your questions? Pay attention to your first impressions. Ask other family members how they feel about the care. While there is a complaint outlet, called the ombudsman, few families proceed to file complaints about care. This often leads to individuals being placed in sub-standard homes because no family member wanted to complain.

Let me play devil's advocate. Thirty three percent of the star rating is provided by a trained team of surveyors and the remaining 66% self reported. I would say that the ratings are more questionable than not especially taking into consideration that the surveys are done during a "snapshot" of time when many nursing homes are on their best behavior and the survey itself mentions quality can change at the drop of a hat.

So how does one determine what makes a good nursing home? It is not easy, especially if you're a family member trying to make a choice and are held captive by an insurance company that dictates which nursing homes are covered by your insurance. When in doubt about your ability to investigate for appropriate care, seek expert advice.

1) Castle, Nicholas G et. al. Further Examination of the Influence of Caregiver Staffing Levels on Nursing Home Quality. Vol. 48, No. 4, 464-476.

Senior Citizen Housing - A Growing Trend in the Society

Everyone approaches aging differently. For senior citizens, emotions differ from individual to individual. Some consider the retirement days as the best days of their lives whereas some feel insecure about their future. At this age, senior citizen housing is an ideal residential care option for the elderly who feel alone and insecure about their future life. As revealed by the recent study, senior independent living is the top choice of most seniors as it allows them to be independent and at the same time relieve the burden of staying alone and managing the daily chores. It has been found that many seniors are technology freaks and want it to be part of their old age. This new need has resulted in the formation of unique senior living facilities which offer state-of-the-art systems for the computer savvy senior people.

Some who have just left the job would like to spend the rest of their lives around computers because they are accustomed to such a lifestyle. Senior citizen housing is provides an environment where elderly people can live with their peers and can take part in a variety of activities. This kind of housing facility ranges from single family homes to large apartment-style living facilities. The senior housing facility can be categorized into three basic types including independent living, assisted living and nursing home care. The choice can be highly personal depending upon the lifestyle and the health condition of the senior citizen. For healthy seniors who want their own space and freedom, senior independent living is an ideal residential option.

In the last 2 decades, the arena of senior housing has expanded, with multiple options available for the senior citizens. While selecting senior living facilities, it is essential to ask several questions to yourself including those pertaining to personal care, medical care, privacy, temporary or long term care and the cost. In case of senior independent living, the houses or apartments are well equipped with kitchens and a central dining area. However, the laundry services are available on a special request. Some of the activities which can be enjoyed in senior citizen housing include recreational, educational and social events, along with health and exercise programs, religious services, golf courses and clubhouses.

Certain complexities are attached to some types of senior citizen housing. Therefore, in some instances it is better to seek a professional advisor so the right kind of facility is chosen for the rest of the life. If the elderly person is unhealthy it may be wise to seek the advice of a doctor. According to a recent survey, certain trends have been found that reveals that independence, technology, health, environment and education will keep the members of senior independent living communities occupied, challenged and productive for years to come. In the case of independent living, no assistance is provided to the senior citizens as it offers maximum freedom to the elderly people. The senior living facilities are known by several names like senior apartments, senior housing, retirement homes, retirement communities and independent living communities. Regardless of the type of independent living you choose, it is important to keep certain considerations in mind.

Great Activities for Seniors

When caring for senior citizens and the elderly, keeping their minds and bodies active is very important. Staying physically active can help prevent or maintain different chronic diseases like heart disease. Doing different mental activities can help with memory for seniors who suffer from Alzheimer's or dementia. The only thing is making sure the activities are fun and don't seem like a chore. Here are some fun activities for seniors.

Playing cards can be a great way to stimulate the mind. There are so many different card games that can work. Games like UNO or Dirty Neighbor can be fun and stimulating. Not only does the person need to remember the rules, but they have to plan and strategize what their next move will be. This helps the brain get a work out by triggering different parts of it. You could even play poker, with fake money, and whoever wins gets a prize. Poker will help when it comes to rationalizing as well as planning.

Arts and crafts can be very helpful when it comes to dexterity and hand eye coordination. For those who have arthritis, this can become difficult depending on when the activity is. These can be anything from sewing or cross stitching to painting or playing an instrument. Depending on whether or not the person has arthritis and/or how far advance it is, the crafts that require steadiness of the hand, or completing small details may be difficult. On the other hand this keeps the mind relaying messages to their hands.

Doing yoga or tai-chi can be a very helpful activity that doubles as exercise. These activities help keep joints healthy by stretching and working out different joints and muscle groups. As stated before, exercise can help prevent control different diseases that are common in senior citizens. Also, by making it a group activity, seniors can be more social while doing something good for their mind and body. Many people, not just the elderly, find activities like yoga and tai-chi to be very relaxing.

If the person is in a senior citizen care facility or a nursing home, having movie nights can be quite beneficial. Instead of serving snacks like pop corn, you can serve healthy alternatives like grapes, or carrots. Or, if they are on a good diet and can splurge, you can bring in nostalgic candy and then pop some popcorn as well. A movie night may not seem like exercise in any way, shape or form, but happiness is a major part of being healthy. As they say, laughter is the best medicine, and what is a better way to laugh than at a familiar movie with friends and/or family.

There are so many different activities that senior citizens can get involved that will be beneficial in more ways than you may think. Many nursing homes and elderly care facilities already have activity schedules set in place, but if there is something else that you think of, ask and see if it can be put on your activity list. Living happy and healthy doesn't have to be a chore, simply get involved in some of your favorite activities and you will be well on your way.

Successfully Approaching Marketing Professionals - How to Market a New Consumer Product or Idea

Many inventors and entrepreneurs are so excited about their concept that they neglect to learn, or practice proper business etiquette when soliciting marketing or investment assistance. This can ruin their opportunity, or at the least set prospects back sharply. The following are some simple rules to follow when making initial contact or presentation of your exciting new product or marketing concept.

Never Utilize Mindless Platitudes
My Company has been developing consumer products and marketing consulting for almost four decades. There is no bigger turn-off than to just meet a potential new client and hear something like: "I am going to put the Mattel Toy Company out of business with this new plush toy (or board game, or articulated doll, etc.)".

Another golden oldie cold shower is, "This is a multi-billion dollar opportunity".

We see this tried every day and it is a disqualifier.

Be realistic, humble and factual about the opportunity you present. Professional marketers and venture capitalists will appreciate and are more likely to reward the sober tone.

Always Tell the Truth, Never Embellish
The marketplace of ideas and new product ideas is huge, uber-competitive and non-forgiving. If you stretch the truth, embellish facts, or omit important facts that will affect your proposition two things will surely occur, they always do: You will be discovered. You will be dismissed.

Be absolutely clear and truthful about everything you represent as factual. I cannot tell you how many times we have met entrepreneurs with great product ideas and we dismiss them out of hand because of obvious methane in their story. It is far better to detail a competitive disadvantage your product might possess and offer a solution to overcoming the handicap than to gloss over and try to mitigate the flaw.

You Get One Chance to Make a Great First Impression!
I interview entrepreneurs for a living. I have certain screening questions that I use to separate the wheat from the chafe. Every venture capital firm, investment banker, consumer product marketing professional and licensing agent I know utilizes the same verbal qualifiers, or disqualifiers depending on how they are answered. The goal of your first contact is to get a face to face meeting with decision makers.

Do not try to close a deal on the first call. Do not hard or over-sell. Never attempt any type of sale or screening technique on an e-mail if you wish to be considered serious. Present yourself as a professional person who has a project that is well-vetted, serious, offers unique product features and benefits that will benefit consumers and retailers and that you would be appreciative of a meeting that should be of interest to all parties.

Do Not Detail Your Perceived Value of Your Project
Why? Because you do not have a clue what the REAL value of your project is. I have never read a non-professionally written business plan that offered an inkling of an iota of the true value, if any, ensconced in the project. You may have a wonderful idea. But without Execution, Cost of Goods balance, a customized Marketing Strategy that employ's unique Branding concepts and Consumer Product Features and Benefits that can easily be conveyed to consumers in a cluttered marketplace even the best product will not succeed.

Have a Great Elevator Speech
You will need to be able to excite decision makers in a brief few minutes of time. An initial call is always cold. This is the time to plant seeds of interest, not reap a harvest from a virgin field. The same principles that apply to the Executive Summary section of your Business Plan should apply to the Elevator Speech. Respect the time of the decision maker. Interest him (or her) with product features and benefits, a very brief summary of your due diligence and be prepared to answer questions, hopefully, if you have excited a level of interest from you target these will come. Remember, your goal should be to meet.

Ask Questions
After an introduction and a short, tight Elevator Speech, you will be asked questions if there is any level of interest from your target. Assuming you have done your homework and pass the screening exam you will have the opportunity to ask questions of your target. Do not get too detailed and specific. Save that for the time when negotiations commence, and that is still a long way off.

These are only a few of the most egregious flaws and shortcomings we see every day as our Marketing Consulting firm reviews projects. We get very interested in unique products. We only get truly excited when the entrepreneur is as good, or better, than the product they present.

by: Geoff Ficke

How to Protect Yourself With a Tractor Trailer Accident Attorney

Driving a tractor trailer can be a very dangerous job. Driving this type of vehicle is not as easy as it is to drive a regular car or even a motorcycle. A tractor trailer is a motor vehicle that weighs quite a few tons and requires quite a bit of skill since you will be maneuvering an extremely heavy vehicle on humongous wheels. Since these vehicles are driven on the same roads as any other vehicle, it is important for you to exercise extreme caution, while staying focused on the road. Everyone knows that accidents are bound to happen at any point in time, and if you find yourself in a fender bender with another vehicle while you were on the big rig, you need to hire a tractor trailer accident attorney right away.

Since most people are real quick to point the fingers of blame on the bigger vehicles, it is important for you to protect yourself from any potential lawsuits that may arise. While driving a big rig vehicle, accidents can happen in a split second and since the accident involves such a large vehicle, some severe injuries and damages can occur. Most people know that a tractor trailer cannot maneuver as sharply as an average vehicle can, which is why many drivers tend to give them a wide berth while they are on the road. There are some drivers who do not care much about their safety or the safety of others. Their single mindlessness is a result of them either being in a rush or not paying proper attention to the task at hand. It is many times due to their own fault, that they and many others often have to deal with a vehicle crash that involves a big rig.

By hiring a tractor trailer accident attorney, not only are you protecting yourself, you are protecting the business that you work for. When you are involved in an accident, you become a liability for your employer. If you don't want to end up losing your job, you need a tractor trailer accident attorney to protect your interests. You need a lawyer that has represented hundreds of tractor trailer clients who have been in your same predicament. This lets you know that they have ample experience in defending clients like you. They are more willing to listen to your side of the story and help protect you against claims from the other parties that are involved.

Since you will have a tractor trailer accident attorney defending you, you don't have to worry about whether or not you are going to be without a job or have to pay out any money because of the other party's claims. If you are not sure of how to handle the situation, then it is important for you to contact a good tractor trailer accident attorney so they provide you with the legal guidance you need.

Negligence and Intentional Tort Law

In general, personal injury law can be separated in to two categories: negligent acts or intentional acts.  They may also be referred to as "torts" an old english term meaning "legal cause of action" for which an individual can seek compensation for through the legal system.

Negligent Acts

A negligent act occurs when one individual damages the person or property of another without any "intent" to injure.  This may occur due to the carelessness of the first individual.  For example, a driver who is careless, and causes an auto accident by failing to obey the traffic laws may be considered negligent and would be responsible for any damages caused to any person or property.

In order to prevail in a negligence action, the injured party needs to prove that the other party had a duty of reasonable care, did not maintain reasonable care, and that the failure to maintain such reasonable care resulted in injuries to the aggrieved party.  For example, referring to the auto accident mentioned above, all drivers have the duty to operate their vehicle safely.  If they fail to do so, and this failure injures any other person, or THEIR property, then they would meet all of the criteria to be held negligent and therefore accountable for and damages caused to the injured party.

The majority of negligent actions include slip and fall situations, motor vehicle accidents, products liability cases, and injuries resulting from the malpractice of a medical professional or institution.

Intentional Actions or Torts

An intentional tort occurs when an individual intentionally acts to injure another or their property.  In most cases, is does not matter whether the party intended that an injury occur, only that he or she intended to commit the act which led to the injury.  In some states an intentional tort may also be defined as an act which a reasonable person knew or should have known would have led to an injury to a person or property.

Intentional torts include such acts as, kidnapping, assault, and spousal abuse.  In fact many intentional tort actions are brought as the result of the commission of a criminal act.

Information About Nursing Home Abuse and What to Do

Aging is a natural part of life and is inevitable. When a person gets to the point that they cannot care for themselves they may need to be placed into a nursing home. Many will tell you that the nursing homes they have seen are nice and cozy. Unfortunately, that is not true for all nursing homes out there. Some homes are a place where your loved ones are enduring physical, mental or emotional, and sexual abuse.

Physical Abuse
It is natural for the body to become weak with years of aging. Unfortunately, this makes it all the more easier for a nursing home worker to physically abuse their patients. Many people do not realize that it can become quite difficult to handle taking care of an elderly person. While this does not justify abuse in a nursing home, it should be a question you want to address to your nursing home candidates to see whether or not they can handle your loved one. Examples of physical abuse include:

o Pushing- this is quite common because the patients tend to move slower due to their age. Workers can become impatient and push or shove their patients to get them to hurry up.

o Hitting or Shaking- it is not uncommon for a patient to get violent or act out, but that does not give the worker a right to retaliate. There have been instances where workers try to "teach the patient a lesson" by pinching, hitting, kicking, or shaking.

o Restraining- while restraining a hostile patient may be necessary, some workers over sedate or restrain a patient which is uncalled for.

o Neglect- some elderly workers get tired of running back and forth to a patients room, but that is a part of the job. When a worker neglects a patient and fails to change or bathe them in a timely manner, it can result in bed sores infections, and rashes.

Mental Or Emotional Abuse
Elderly people deserve the same amount of respect as any other individual. Belittling a patient who is reliant on your care is an abuse of power. It is inappropriate to exploit the patient's feelings of embarrassment to make yourself fell better. Unfortunately this happens all the time. Comments such as geezer, senile, lazy, fat, etc. are harmful to the patient's already fragile state.

Sexual Abuse
Unfortunately sexual abuse in nursing homes has happened. The inability of the patient to defend themselves leaves them vulnerable to this abuse. Forms of sexual abuse that have occurred in nursing homes include rape, assault, nudity, and sodomy.

Financial Abuse
Caretakers have been known to steal or threaten their patients to obtain money. They have also violated the law and forged a patient's signature to obtain their assets, property, and any other money available.

Caregivers: Ten Important Questions to Ask Before a Hospital Discharge

Do you have a loved one, parent, child, friend or even yourself who is about to be discharged from a hospital stay?

Read before you proceed. Ten important questions to ask before you take your loved one home that could be a life saver.

1. What is the Prospective Discharge Date?

When a loved one is admitted to the hospital, the last thing on the mind of a caregiver or family member are concerns about them being discharged. Initially, all of the caregiver's or family's concerns are focused on the present. For example, concerns of what is wrong with the patient, what kinds of treatment the patient will undergo, and whether or not they will be fine are all commonplace during this time. The caregiver and family members of the patient realize that, unless the untimely happens, the patient will be discharged from the hospital at some point. The discharge most likely will happen sooner than expected. Based on today's statistics, the average hospital stay for a non-complicated patient is 1.5 days. Due to Medicare, Medicaid and private insurance regulations, hospitals and institutions are discharging their patients sooner than expected and utilizing other available resources such as rehabilitation centers, assisted living facilities, nursing homes, and course, the patient's family.

Technically, the discharge planning for the patient starts at the time of admission. As soon as a patient is registered into the hospital system, a team is ready to plan the discharge. The caregiver and family of the loved one are part of the discharge planning team that includes the physicians, nurses, social workers, case managers, and all other medical personnel involved in the patient's care. With this information on hand, the caregiver and or family of the patient must understand that they are an important part of the discharge planning team. Therefore, they must be informed, assertive, and proactive to obtain the best possible outcome for their loved one.

2. Who are Your Teammates?

It is imperative that the patient's caregiver or family meet with the discharge planning team, in order to understand their role and what to expect from them. Know them on a first name basis, meet with them, and collect their phone numbers.

a) The Patient

The patient is the most important member of the discharge planning team. It is easy for all those involved with the patient's care, as well as the patient's family, to assume that once a person is lying on a hospital bed all decisions are made by somebody else. However, it will ultimately be the patient, depending on their age and condition, who will make the decision of their care following discharge.

b) All Physicians and Specialists Involved

Keep in mind that the physician that provided care during the patient's hospital stay is not necessarily the one that will continue care after discharge. Today, more and more, hospitals have what is called a Hospitalist. A Hospitalist's involvement with the patient is limited to treatment and care required while in the hospital. Upon discharge, the patient must follow-up with their primary care physician. In other words, after discharge you may not be able to contact the discharging physician or Hospitalist for follow-up orders, refills or consultations. It will be very difficult and frustrating for you to try to contact him or her and ultimately they will refer you to the primary care physician. Obtain all prescriptions and services that the patient needs to continue after discharge. This includes equipment such as a hospital bed, wheelchair, oxygen, supplies, and home care services. Ask for these orders/prescriptions before the patient is discharged. If your loved one received care from any kind of Specialist, make sure that you have their names, specialty, addresses, phone numbers and their office manager's name. Ask if your patient must follow-up with them and make an appointment as soon as possible.

c) Clinical Personnel

This includes nurses, therapists, clinical managers and others involved in the patient's care. As well as the other team members, know them by name and obtain phone numbers where they could be contacted in case of questions or concerns. Learn what their responsibilities are when the patient is admitted and how you could get in contact with them if needed after discharge. Make sure that you get the name and phone number of the Nurse Manager of the unit where your patient was admitted.

d) Case Manager

Every patient admitted in a hospital or institution is assigned a case manager. This person plays a key role in the discharge planning process. Get to know her or him well. This individual is your line to sanity during the first few hours after discharge. The Case Manager is the one that coordinates the whole process. When a strong, positive relation is developed between the patient, caregiver, family, and case manager, the process is usually easier and less stressful for all those involved. The case manager will arrange for the equipment needed after discharge, home care services or hospice, referrals or placement to other health care facilities such as assisted living facilities, nursing homes or rehabilitation centers and transportation if needed.

e) Caregiver and Family Members of the Patient

Another extremely important team member in the discharge planning process, and most of the time the most difficult to coordinate, is the caregiver and family. It is important to identify, without a doubt, exactly who is in charge. Call for a family meeting and designate who will be taking the responsibility of coordinating the patient's care after discharge. Keep clear in mind that the caregiver position cannot be an assumed or imposed one. There are options available to be considered before making this decision. Caregiving - whether at home or outside the home - is one of the most stressful, life disturbing experiences anyone could ever live. I recommend that the person that is considering taking this responsibility take the Caregiver Assessment Test. This will provided some insight of the potential caregiver's strengths and weaknesses before undertaking the task.

3. What are the Patient's Diagnosis or Diagnoses, Prognosis and Life Expectancy?

Be very clear and specific about this. Ask for the specific name of the diagnosis or diagnoses. If unknown or difficult to understand, ask the person providing the information to explain it in simple words or to write it down for you. Research and educate yourself on the matter. The caregiver and/or family must be fully aware on what to expect after the patient is discharged. Ask about prognosis and life expectancy. This will be a difficult subject to deal with. Healthcare professionals sometimes have difficulty dealing with this topic themselves, and could be very evasive about it. The caregiver has the right to know, contingent with privacy regulations, the patient's condition to be able to make the best decision regarding the patient's after care.

4. What are the Best Options for After Discharge Care?

There are as many answers to this question as there are patients, diagnosis and conditions. It all depends on the patient's specific condition, prognosis, life expectancy, age, availability of caregiver and family support system. The options include but are not limited to; the patient's own home, family and friend's homes, nursing home facilities, rehabilitation centers and assisted living facilities. The caregiver or family must make a self-assessment to determine the best options for their loved, as well as themselves. If you, a family member or friend decides to undertake this task, I have created a simple tool that the caregiver could use to determine if care giving at home is an option. Take this simple test before you make any decision.

Talk with the patient's physician, case manager and other members of the discharge planning team, including other family members. Reach out! This will be your salvation once you start this journey of caring for someone at home.

5. What Treatments and Procedures will have to be Continued After Discharge?

Now more and more it happens that patients are being discharged from the hospital in need of continued care such as therapy, treatment or procedures. Even if the patient will receive home care services, usually these services are provided for a limited amount of time and the caregiver is expected to continue to perform them after the services are terminated. From insulin injections, tracheostomy care, colostomy care, wound care or dressing changes and everything in between. Many of these procedures do not require a professional to perform them but the caregiver must be instructed on how to perform them. Educate yourself, observe the healthcare provider performing these procedures while in the hospital, request a one on one, hands on instruction session. Plain and simple, get ready! It is up to the caregiver to get ready for the task. Clinical personnel will not volunteer to instruct the caregiver on certain procedures unless the caregiver demonstrates an interest in learning or it is specifically ordered by the physician.

6. Will My Patient Continue the Same Medications and Treatments Before They Were Admitted?

I wanted to list this question as a serious issue that needs to be addressed independently. In my experience as a nurse and caregiver, medication non-compliance is one of the most frequent reasons for the patient to be readmitted to the hospital. Most of the time, the patient and/or caregiver assume that a medication or medications are to be continued or discontinued without understanding the consequences. It is standard practice that when a patient is admitted into the hospital all of the medications that are taken at home are reconciled. The same procedure applies at discharge time. Make sure that a list of medications taken at home is brought in upon admission of the patient or shortly after. At the time of discharge, request to speak with the clinician in charge of your patient's care. Go over each one of the medications in the patient medication profile. Ask for indications, dosages, frequency and route as well as possible side effects and or allergic reactions. If a new medication has been indicated during the hospital stay, ask if it is to be continued after discharge. Be certain to request prescriptions for all those new medications. You do not want to find yourself in the situation of needing a medication, not having a prescription from discharge and it is a holiday. Good luck!

7. What are Possible Signs and Symptoms I should be Aware of?

It is here where the absolute understanding of the patient's diagnosis and prognosis comes into play. Signs, symptoms and actions to take depend on the patient's condition and vary with them. Request a conference with all those involved in the patient's care i.e. physicians, specialists, clinical personnel, and case manager or social worker. Ask all the questions that you think are pertinent to your patient's condition and prognosis. The ideal situation will be that the conference is held with all participants at once; however, most likely that will not be the situation. One thing is certain; you must have a face-to-face conversation with all the disciplines mentioned if you want to survive the first 24 hours after discharge. Get educated, be assertive and proactive, request, demand and expect. Most hospital personnel welcome the caregiver interested on a fast recovery or the best outcome possible of their loved one, but in today's fast environment the caregiver should assume a very assertive position.

8. Who is Responsible for the Patient's Financial Obligations?

This should be asked right up front. Do not assume that the caregiver is responsible for this obligation. Have an honest talk with the patient, if possible, on how he or she plans to meet their financial obligation with the hospital or institution. Request an appointment with the office of financial affairs at the hospital or institution to discuss the patient's bill status. Familiarize yourself with all medical insurance policies that the patient might have. Bring with you all of the identification cards, copies of insurance policies including any supplemental health insurance policies. Request an itemized bill. Obtain the name and phone number of the person you are dealing with. You will need to call back regarding this issue and you need a person that knows you. This will prevent the aggravation of having to tell your story to several people repeatedly.

9. What do I do During the Days Just Before Discharge?

The panic is overtaking you. Reality is sinking in. Your loved one is coming home tomorrow. You have accepted the responsibility of taking care of him or her at home. Welcome to the club. There are millions of members in this club. Hopefully, you took the Caregiver Assessment Tool Test before you assumed this responsibility.

Today you will collect the patient's belongings that will not be needed for the rest of the hospital stay. Make sure you go over every item that was brought with the patient at the time of admission. This includes eyeglasses, dentures, any equipment such as wheelchairs or walkers. If possible, ask the patient if there is anything else that was brought in that you are not aware of. If anything is missing, this is the time to speak with the personnel that took care of the patient and start a search. Do not wait until the day of discharge.

Make sure that before discharge, care is already coordinated and in place. This is equipment, supplies and services such as home care. Contact the home care agency that is supposed to service your loved one and inform them of the prospective discharge date. Get a contact person's name and phone number. Contact the case manager and inform him or her of any discrepancies in the coordination of services.

10. Today is the Day, What do I do?

Today is the day. Discharge day. Emotions are running high. Make sure that you are available at the time of discharge. It is imperative that you are there during this process. On this day, you will take last inventory of the patient's belongings. Get prescriptions from the hospitalist. Talk with the nurse that is in charge of the patient's care and request all medications that remained unused. Ensure these medications are on the list of medications that the patient is supposed to continue after discharge, as well as all supplies. These medications and supplies were already charged to the patient. Request a last-minute conference with the hospitalist to be clear on instructions that were already discussed. Clarify any doubts and ask questions. Avoid the feeling that you are taking their time or interfering with their schedule. They are there for you and your patient. Now, it is time to go home.

Welcome aboard.

The journey has begun.

Abuse and Neglect in Older Persons, How Can We Prevent It?

Older people abuse is common in many societies, including some health institutions. Older peoples become victims of abuse because society see them as intellectually handicapped, frail and have nothing to contribute.

Old people are more vulnerable and easier to be abused by family members,relatives and caregivers.

There are different types of abuse that are commonly practiced either in homes or residential facilities.

1.Physical abuse

This is when the abuser uses physical pain, injury or force on the elderly person for example,rough handling, slapping,pushing shaking the poor person and restricting freedom of movement by either confining them into a small space or not letting them associate with others. In some cases care givers withhold pain relief or prescribed medications at the right time.

Signs of physical abuse include: grip marks on the skin,abrasions, burns,bleeding, bruises, punctured wounds, welts,dislocations especially hips, dehydration and over-sedation.

2.Sexual abuse

This is when an elderly person is forced into unwanted sexual activity such as rape,inappropriate fondling of private parts, lack of respect for privacy and lack of recognizing sexuality.

Signs of sexual abuse could be bruising or bleeding to private parts,pain or itching to genital area,difficulty in walking,may develop infection and decline to have a bath.

3.Emotional abuse.

This includes threats,insults,harassment,withholding affection,talking to older person like a child,lack of respect for privacy,limiting their social contacts or affiliations, exposing them to noisy or brighter lights or darkness.

Most often,older people express fear,become withdrawn,depression may set in. In extreme cases, they may become angry,lack sleep,and mental confusion may set in.

4.Material abuse.

This is most practiced in societies with low economic status.
Family members,care givers illegally take or use money or other possessions.The frail poor person will be forced to hand over money,possession and property to family members pretending to keep it for safety, mean while use it for themselves.

Signs of Material abuse will be noticed when the abusers fail to pay rent, bills on behalf of the older person, lack of money to buy food,pay for electricity, sale of property,the savings account become depleted. Often the signatures on some documents and cheques are forged.

5.Self neglect

With the advent of modern society where young people migrate to cities looking for employment, older people have no one to look after them. A self neglect may be reported by a concerned neighbor who may notice a strange behavior.Most of the times, older people may be demented,requiring a supervised care in a health institution.

Signs of Self-Neglect

They are malnourished,dehydrated,filthy and unhealthy surroundings. They be develop a hobby of collecting and hoarding rubbish,unkempt, fearful and do not trust anyone.

The other general signs of abuse that needs to be observed in the older people are loss of interest in personal grooming do appear depressed and withdrawn. The sleep may be disturbed, there may be alteration in eating habits and always wishing to commit suicide or die. Find out why they are afraid of particular persons and if they are avoiding physical,eye or verbal contact with the carer or service provider.

How to Prevent Abuse

Members of the community must be observant and report to local authorities if they suspect abuse or neglect of older persons.
Health providers must put in place adequate training,supervision and support to management and staff members.
There should be proper policies and procedures to ensure that the safety of older persons in the institution is upheld.

The institution should provide information for public members, family and visitors about whom they are free to approach and the help available if they are concerned about their relative that he or she is being abused or not receiving the proper care.

Any form of abuse by any person is a serious offense and should not be entertained at all!