Assisted Living: Facing the Choice

There may come a time in your life when you will want to or have to care for an elderly parent or loved one at home. In moments like these, a senior's health can be uncertain and can turn downward quickly and deteriorate. You may not be able to manage the amount of care and attention that's now needed. That's when you will be at a crossroad not knowing which direction to take. Do you continue caring for them or do you find them an assisted living facility? When facing the choice where to move their loved one into an assisted living facility or skilled nursing facility certainly isn't a decision that should be made hastily. Because there is no certain age criteria, one must look at the actual their physical and emotional health of the person in consideration.

What Is an Assisted Living Facility?

The Department of Public Health in California licenses all assisted living facilities, also commonly known and licensed as Residential Care Facilities for the Elderly. Most of these assisted living facilities provide 24-hour guardian care and attention. Some facilities may have a certified RN nurse that can offer skilled nursing when and if needed. In many cases these facilities are Medi-Cal and are Medicare certified. Some only accept private funds.

Outside a medical facility, an assisted living facility offers the maximal level of care offered for elder adults. The staff assists the residents with meals, getting dressed, bathing, getting in and out of bed, as well as assistance with administering medication. The facilities often have a weekly calendar of planned activities and social gatherings.

Indicators of Possible Assisted Living Admission

If your loved one is moving out of their home for the first time, it can be very traumatic to the individual relocating. In either case, expect some opposition especially if there are some distinguished "warning signs" that it's time to consider the move. Please note that only a doctor can detect the correct indications of an assisted living facility. When uncertain, contact their primary physician right away:

• Disability: Seniors whom are physically disabled will benefit from this type of support. Ones who have limited mobility or that are utilizing wheelchairs will have more difficulty performing even simple tasks. Staff can help with taking care of personal needs, moving from one place to another and assist with walking without risking injury.


• Ill health: Frequent hospitalizations or requiring constant observation because of an affliction, then consider a skilled nursing facility rather than an assisted living facility. Other life-threatening health problems such as a stroke, heart attack or hip fracture are also indicators that your loved one needs the care available from a nursing home staff.


• Dementia and Alzheimer's Disease: a resident with Advanced stages of Alzheimer's Disease or type of dementia is better accommodated and at times, safer in a skilled nursing facility. Some of these "red flags" and warning signs may include; no longer being able to remember simple information or communicate clearly, unable to care for oneself, or the refusal to take prescribed medication.

In the end, you may not have a choice but to find a "home" for your senior. But as you can see, there are many benefits to choosing the best assisted living facility. Finding the "best" or actually the "right" facility doesn't come as an easy task. That's when Elder Care Referral agencies and services such as We Know A Place are useful resources. By finding an agency local to you, they will be familiar with the surrounding facilities. Once they have assessed the level of care needed, they in turn will help you determine which assisted living facility is the "best" one.

Choosing the Appropriate Senior Care Facility For Your Loved One

Does the responsibility of finding the ideal type of care for an elderly parent rest on your shoulders? If it does, it may seem to be a daunting task. You have to work through the horror stories about nursing home care, the innumerable different types of facilities available, and the cost. When you're working and have your own family to think about, there may not be enough hours in the day to decide on the appropriate care option. Each facility you consider needs to be researched and interviewed in order to determine where your parent would receive the best care and be the happiest. Even then, you're bound to have some doubts. Knowing what to look for will help simplify the situation for you.

Care services need to be adequate to give your loved one the specialized care that is needed. For instance, some centers have staff who are trained to care for someone with Alzheimer's or dementia. The training they have received has emphasized the need for patience and compassion while teaching them how best to care for those who have failing cognitive senses. Make sure that any facility your are considering has licensed, insured personnel, including registered nurses who are available 24 hours a day. A home that doesn't offer requisite services can be crossed off of your list.

Seniors today have a number of care options that weren't available until recent years. Assisted living facilities have been available to the well-to-do for a long time, but now many more people can afford to live in them and avail themselves of the services. Not every senior needs actual nursing care. Assisted living offers each person exactly what they need. Many older folks don't need care at all, but it gives them peace of mind to know that help is available if they experience problems. These centers offer them companionship with people their own age as well as a variety of social activities designed to help them build friendships. It is an ideal situation for many senior citizens.

Other types of shared housing include an independent living community, a skilled nursing facility, or a residential care home. All of these options are based on the concept of shared housing, and if you think about it, it makes a lot of sense. Moving from a house into one of them means that the senior no longer has to worry about such things as lawn upkeep, snow removal, navigating stairs, and routine home maintenance. Although most of the people who live there need little special care, just removing some of these responsibilities from them can make them feel much more carefree again. In addition, there is no need for your loved one to feel lonely when living in an active community such as these offer.

Affording a Good Nursing Home

Last year, the world's only Titanic survivor faced a quandary. Millvina Dean was only two months old when the great ship sunk, in 2008 she was in her mid-nineties and needed money to pay for a nursing home to live out the rest of her days in relative comfort. What to do?

Well, like many people the world over, Miss Dean took a long look at her assets - and decided to sell them. More precisely, she decided to sell the mementos she still had of the disaster, a suitcase full of clothes her family was given to help them begin a new life. The auction of the wicker case and clothes, along with rare prints of the ocean liner and letters her mother received from the Titanic Relief Fund, raised almost $54,000 - ten times more than she thought it would.

It's official: getting old is expensive. If you are lucky enough to live a long life, chances are you'll eventually be paying for it by the nose. Many people end up having to finance their own care near the end of their days, and it can cost a fortune. In fact, the New York Times reckons that an independent-living facility can cost up to $9,000 a month - that's about what a a New York penthouse could cost!

If you are looking into a nursing home - defined as a home that provides 24/7 care as well as administers medicines and even some medical procedures - for you or a loved one, here are some ways to pay...

Reverse Mortgage. This is a mortgage that allows homeowners to convert part of their assets into cash. Kind of like a home equity loan. Ask for professional advice if you are interested in going down this route, and only deal with a reputable lender. Be aware that the loan must be paid in full if you fail to have the home as your primary residence for one year or more, ie, if you stay in a nursing home for more than 12 months.

Long-Term Care Insurance. Most people do not have this type of insurance, but it can be very helpful if you do. The earlier you start to pay the more you will accrue - and the less you will pay initially. It is advised to take this route only to avoid burdening family members with bills for your care, and not if paying the premiums could become insurmountable. And remember you will not be sold a policy if you already have a health condition such as Parkinson's Disease or Alzheimer's.

Medicare or Medicaid. It's estimated that about 45 percent of all spending on long-term health care is covered by Medicaid, while about 11 percent is covered by Medicare and Social Security. The rest is paid for by the individual, by and large. Medicaid is both federal and state funded, and there are strict rules regarding who qualifies.

Win the Lottery. What could be better? Don't forget you need to buy a ticket first. And keep in mind that statistically, you have a better chance of walking up to a complete stranger and correctly guessing their telephone number than you have of winning any lottery at all. Still, every week there are winners!
繚Inherit a Fortune. Easy and simple, this is a fantastic way to afford a nursing home - as well as a new Porsche, a vacation in the Bahamas and a college education for all the grandkids. Great if you can get it. Most of us can't - even if we hire a treasure hunter to find out if we are a long-lost heir to some incredibly rich dead soul.

Check Into a Veterans' Nursing Home. In theory, all veterans should have a place waiting for them when they need it. In practice, so many people need places that people on the lowest incomes usually get first priority. Check to see if you qualify before counting on this option.

Get Help from Other Family Members. Often family members will club together and pay what they can to insure that their parents or aging relatives are cared for when they need it most. Unfortunately, in many case family members simply don't have the funds - or have them earmarked for other priorities, such as Junior's college fund and Barb's new house in the 'burbs. Don't make the mistake of expecting a cash gift - you may be greatly disappointed. It's better to have an open talk in advance to learn whether any funds will be forthcoming, however uncomfortable this may be.

Top Tips for Paying for Care

Affordable long-term care will be a priority for many of us, but protecting our assets and savings should be a top priority as well. Here are some tips to do just that...

Don't give away all your assets. Remember the government can look back five years - if you gave away money that could make you ineligible to receive Medicaid for a period of time.

Avoid what is known as "spousal impoverishment," when the spouse who is left at home can also be left destitute as his or her assets are used to pay for the other person's nursing home care. You are allowed to opt out of having your assets count against you.

Read the fine print. It may sound like a fab idea to have a home equity loan or the equivalent, but know what you are getting into before you sign on the dotted line.

Hire a good, honest lawyer - if you can find one. Someone who specializes in Elder Law will be your best bet, as he or she will have years of experience in this type of thing.

Sadly, Millvina Dean died this May at the ripe old age of 97, in a private nursing home in the town of Ashurst, Hampshire in England. As the last survivor of the Titanic, her death was a memorable event. Three years earlier she had broken her hip and needed specialist care, and the sale of her historical memorabilia helped her through the most difficult times. We should all be so lucky!

The CNA Certification Test - Becoming a Certified Nursing Assistant!

In order to work as a Certified Nursing Assistant, you must complete a nurses aide training course, then pass the CNA certification test given by the State Board of Nursing. The test consists of two parts, a written exam and a hands-on or 'practical' CNA skills test. Licensing is done by the state, so you will want to register for testing in the state you expect to work in.

In most cases, you will be testing with a group. The written exam is usually given before the skills test, and everyone will take the test at the same time. You will have to answer approximately 100 multiple-choice questions, and are usually given up to two hours to complete them. The written test covers patient care and protocols, patient monitoring and record-keeping, laboratory and testing procedures.

Everything on the written portion will have been covered in your CNA classes. It is a good idea to review your class materials, handouts, and charts before the certification test, particularly if you won't be taking it right after completing the course. You can find some sample testing questions for the CNA exam online.

Following the written portion, the instructor takes the finished tests, and then individuals will be called on to perform their skills test one at a time. You may be asked to bring a "model" or helper with you to facilitate the skills testing. This person would act as your patient for you to demonstrate your skills on. The particulars of the skills test will vary, and may not be the same from person to person. You won't know which skills you will be asked to perform until the actual testing.

You can expect the practical exam to cover the most common skills you will encounter. This might include performing measurements of vital signs - blood pressure, pulse, and respiration; demonstrating the proper way make a bed, both with and without a patient in it; ambulating or moving your patient - helping them dress, moving them in to and out of a wheel chair, etc.; and responding to emergencies such as choking.

You won't know the outcome of your test right then and there; results will be mailed to you. However if you've been attentive in class and understand what you've been taught, and taken the time to study and review your materials prior to taking the test, you should have no problem passing. Once you have earned your certification, you are then free to work as a Certified Nursing Assistant, Home Health Aide, Nurse's Aide, or other similar position at any hospital, nursing home, or other facility in your state.

Signing a House Over To a Child? NOT a Good Idea!

I'm going to sign my house over to my eldest child. How many times have you heard someone make this statement? Every time it is said, it is said with great pride and joy. But it is far from being a clever thing to do. In fact it can have very serious consequences. Let me explain some of the potential threats. I am directing this article at those who believe that their home is their castle and their castle is their legacy to their children.

First of all, I would like to say that signing your house over to one of your children is a very kind and generous thing to do. However you may not be prepared for the Government's response. We must all agree that signing a house over to a child is done for a reason. I mean, you don't get out of bed one morning and announce to the world that you feel bit bored and so will sign your house over to one of your children because you have nothing better to do. NO! The Government takes the view that you have done this to evade taxation or to deny the Local Authority the ability to recover the costs of long-term care like the cost of nursing home fees. In fact they are so upset by you signing your house over to one of your children that they believe you may have committed a crime. They even give the crime a name: The Deliberate Deprivation of Assets. If you have done this within six months of going into care then your guilt is assumed. After that, the local authority must prove your guilt. This can be very upsetting particularly if you are of the opinion that the house is yours because you have paid off the mortgage. The house is not ring-fenced. It is your asset and thus subject to taxation and assessment. There are things you can do to protect your home from being used to pay nursing home fees etc. but advice on this is given on an individual basis.

Secondly, what if you sign your house over to a child and that child already has their own house. Now the child has two houses, one of which is their primary residence while the other (your former house) isn't. Should that child decide to sell the house at a later date then they could be subject to paying Capital Gains Tax (C.G.T.). In other words, you have taken a property on which there was no tax after sale, and placed it in an environment where there could be tax to pay. That is not much of a strategy.

Thirdly, by signing your house over to a child you are effectively homeless. That child can legally sell the house out from under you. The house that you spent so many years paying off is no longer yours.

So please don't be tempted to sign your house over to your child. Talk to someone before making any rash decisions.

Recognizing and Preventing Nursing Home Neglect

When our elderly friends and loved ones lose the ability to take care of themselves, we often do not have time to provide the loving care and attention that they need. Thus, many people turn to nursing homes and assisted living facilities as an alternative to home care. These facilities can be beneficial in providing a community for the elderly, but they can also become dangerous places if the staff neglects the residents.

While nursing home abuse is characterized by the staff going out of their way to physically, emotionally, and even financially torture the residents, neglect consists of the opposite. Residents who are neglected are ignored, and their needs go unrecognized and untreated. Sadly, the reason why most elderly are in assisted living in the first place is because they are unable to provide these needs for themselves. Thus, neglect can turn into life-threatening torment because residents may not be able to provide food and water for themselves.

Additionally, elderly neglect can also be financial abandonment. Older people at nursing homes are typically unable to work for themselves, which means that they may not have a steady source of income to pay for living in the facility. If a person agrees to pay for the assisted living, then refuses to do so, this can count as elderly neglect.

When an elderly person is neglected, he or she is restricted from access to life necessities. This can include food, water, shelter, safety, medical care, and clothing. Also, elderly often rely on other people to help them maintain their personal hygiene. Older people with mobility issues may not be able to get themselves out of bed, which keeps them from getting to the toilet. If nursing home attendants refuse to help the residents in and out of bed to go to the bathroom, they may be left laying in their own excrement. As gross as this sounds, it is also a safety issue since feces can carry diseases.

Other signs of nursing home neglect include:

Malnutrition

Dehydration

Bed sores

Unsafe living conditions

Presence of dirt, fleas, lice, etc.

Infections

Untreated illness

To help keep your loved ones safe, you should check out several different nursing homes before you settle on an assisted living center. Try to take tours of all of the facilities, and interview mentally capable residents about their experience there. Also, be sure to visit your elderly person regularly to check and see if they are being treated properly.

Sadly, nursing home abuse is all too real. If you or someone you love has been mistreated by nursing home attendants, you should speak with a personal injury lawyer today about your rights. For more information, contact an experienced personal injury attorney at the firm of Habush Habush & Rottier, S.C., today.

Home Care Explained - Everything You Need to Know About Home Care

Homecare - Who needs it?

Everyone needs care at some point in their lives; from little babies to centenarians and everyone in between. Most of the time when we need care, our families and friends provide it. However some people require more care than family and friends are able to provide. Often in these instances the person requiring the care (care recipient) may be a new mother, have a disability, be frail aged, have a severe illness or a mental health issue. Depending on the needs of the person, particular home care supports will be put in place to assist them to live or manage at home. Many people who receive home care would need to live in a nursing home, hospital or institution if that support was not available. Other terms such as 'home health care' and 'domiciliary care' are often used interchangeably with home care - but can refer also to care provided by a health professional.

Homecare - What is it?

There is a wide range of services and supports that fall under the banner of home care. In short, the type of care provided is what the person is unable to do for themselves. Listed below are some of the main ones with a brief description:

• Personal Care - Refers to all care that addresses the personal hygiene of the care recipient. Personal care support can include; assistance to shower or bath, to dress, to use the toilet, to change continence aids, to shave, apply lotions and cosmetics, brush hair and brush teeth.
• Domestic Assistance - refers to all housekeeping and cleaning tasks. Services can include; cleaning the house, doing the dishes and laundry.
• Transportation- This can be driving the person to appointments and can also include accompanying them if required.
• Shopping- This can involve driving the person to the store and assisting them to do their own shopping, or the home care worker can do the shopping with a list.
• Respite- This type of support involves remaining with the care recipient while the usual carer has a break.
• Nursing Care- refers to the home care that needs to be provided by a registered nurse. Can include: medication monitoring, wound dressing, injections and nursing assessments.
• Case management - Case management involves a comprehensive assessment and the development of a care plan in conjunction with a case manager. Case management can be short or long term depending on the needs and requirements of the care recipient.
• Social Support - refers to services that focus of the social needs of the client. This type of service can include companionship, visiting and community access.

Homecare - Who pays?

Depending on the country you live in there may be government funded programs that assist in paying home care costs. Some health insurance can cover some of these costs - check with your insurer for more information.

There is also a wide variety of home care agencies that can provide you with a home care worker for a fee.

Homecare - Who provides it?

In most instances friends and family of the care recipient are able to provide them with home care. However in those cases where family and friends cannot do so, or where the care recipient prefers; a professional care giver will provide the care. Professional care givers can also be referred to as: support workers, carers, community workers, personal care aides and assistants and nursing assistants. The terminology will vary between countries. The level of skill and qualifications required for professional care work will also vary depending on country. It's best to check with your care provider to find out the minimum requirements in your area.

How to Find the Best Nursing Home

Even at a well-known, fully licensed nursing home, there is the possibility of abuse or neglect. That is why you need to make sure that a facility will provide your loved one with quality care.

Touring a facility is only the first step, because a scheduled visit is unlikely to reveal everything that is happening beneath the surface or when no one is visiting. Certainly, your goal is to assure quality care for your loved one, as well as peace of mind for your family. To accomplish this, it's helpful for you to take the following steps before selecting a nursing home:

• Talk with other residents at the nursing home that you are considering. You can simply walk the corridors of the facility, and speak with residents, including those who are bedridden.



• In addition, your own physical observations are extremely important. Do the residents appear well groomed? Do any of them have visible wounds or sores? How is their oral care? If you find several residents who seem confused and disoriented, you may be witnessing signs of neglect.



• Federal regulations require that all nursing homes have the latest state survey of the facility readily available for review. Ask the management for this survey, read it carefully, and ask questions. Be on the lookout for signs of any problems with basic care.



• Ask questions about the staff at the facility. What is the size of the staff during the different hours of the day and night? How many staff members are nurses? How many are nursing assistants? Are there social workers and clergy on the staff? Consider how the staffing of that facility compares to other nursing homes with a similar number of patients.



• Speak with the relatives of other residents at the facility. Have they observed any problems? Do they have any issues with the management or staff at the facility? You may wish to find out whether any of the residents' families use of web cameras (sometimes called "granny cams"). Although this cyber visitation is a new practice, some families who cannot visit their loved ones every day are placing special internet cameras in relatives' rooms to allow them to see what is happening at any time. If you see a "granny cam" at a facility, ask to speak with the family of that resident, to learn what they have observed. If possible, inquire if the facility would mind if you used this kind of device.



• When walking the halls of the facility, use your senses. One of the most effective methods of inspecting a facility may be your sense of smell. A nursing home should not smell of urine or feces. If it does smell, residents may not be receiving adequate toileting care. Often, this basic care is essential to preventing life-threatening illnesses, like urinary tract infections or bedsores.



• Watch as residents are being fed. Do many residents look underweight? How much of the food are they eating? Is staff helping residents who have problems feeding themselves? Do the aides who assist with the food seem overwhelmed? Are the aides spending enough time working with each resident during mealtime?



• If at all possible, visit the potential nursing home more that once and plan your visits at different times of the day and week. If you can only visit the nursing home once, go at night or on a weekend afternoon. Staff levels may be lowest during these "off" times.



• Is water easily available to all residents at the facility? If some residents are incapable of helping themselves to a drink, is staff offering assistance at regular intervals?



• When you attempt to look at the facility, are you deliberately steered to certain rooms or residents? If you feel that you are being denied full access to the facility, you should find out if there is a good reason.



• Ask to meet all of the key executive personnel at the facility. Speak with the administrative head, the medical staff administrator, and the nursing staff administrator. Ask how often physicians actually examine residents. Find out about the facility's staff turnover rate, including the average length of employment for nursing assistants and other primary caregivers.

Nursing Home Evaluation Checklist

You should be alert whenever you visit your loved one's nursing home. The following are questions to ask yourself during each visit:

• Do you notice signs that your loved one is suffering from dehydration (lack of water) or malnutrition (lack of food)?


• Have you noticed the resident is less active or less able to move about?


• Have you noticed emotional changes, mood swings, withdrawal, anxiety, or other fears?


• Are residents dressed appropriately for the season and time of day?


• Are the resident's living quarters clean?


• Are the resident's medical conditions being treated in a timely manner?


• Does the resident seem to suffer from chronic viruses and/or infections?


• Are all medications administered in a timely and appropriate fashion?


• Has the nursing home staff delayed reporting an injury or incident to a doctor or to the resident's family or guardian?


• Has the resident suffered frequent falls or broken bones?


• Does there seem to be adequate staff and supervision?


• Are the caregivers ignoring the resident or describing him or her as a burden?


• Does any caregiver react defensively to routine questions about the resident's care?

Nursing homes must provide good nutrition and hydration to residents. Poor diet and lack of water are among the most common forms of nursing home abuse and neglect. Some of the health problems associated with malnutrition and/or dehydration include:

• Increased risk of infections


• Confusion


• Muscle weakness (possible immobility and increased risk of falls)


• Pressure ulcers or bedsores


• Pneumonia


• Increased risk of becoming ill from exposure to bacteria or viruses

The Importance of Proper Nutrition and Hydration

Nursing homes should conduct regular nutritional assessments and provide residents with well-balanced, palatable meals. When you consider a nursing home for a loved one, you may wish to ask to sample a random meal at the facility. Also, ask to speak to the staff dietitian about the factors they use to develop meal plans for the facility. The following is a list of reasons why an individual may suffer from malnutrition and/or dehydration:

Personal causes of malnutrition:

• Illness


• Adverse drug effects such as nausea, vomiting, diarrhea, cognitive disturbances, or sleepiness


• Food and drug interactions that decrease the ability of the body to absorb vitamins and minerals


• Depression


• Swallowing disorders


• Mouth problems such as tooth loss, dentures that do not fit properly, mouth sores, and mouth pain


• Tremors or shakiness, which affect residents' ability to feed themselves

Environmental causes of malnutrition:

• Inadequate staff attention for residents who need help to eat


• Staff who lack training about malnutrition and the proper ways to feed residents who need help


• Reliance on liquid supplements


• Special diets

Signs that a resident is malnourished:

• Clothes fitting more loosely than usual


• Cracks around the mouth


• Pale looking lips or mouth


• Dentures that no longer fit


• Hair thinning or getting sparser


• Wounds that take longer to heal


• Confusion (which is unusual for that individual)


• Skin breaking down


• Sunken eyes


• Weight loss

The following questions may help you pinpoint the reason for a particular person's problems with nutrition or hydration:

• Can the resident feed him/herself?


• What is the resident's favorite meal of the day


• When and where does the resident prefer to have meals serve


• Does it take a long time for the resident to eat?


• Is the resident rushed through meals?


• Is the resident unable to finish meals?


• Does the resident seem to eat more when someone is there to help with the meal?


• Does the resident seem uninterested in food?


• Has the resident lost his/her appetite?


• Does the resident like the food at the facility?


• Can the resident choose from a menu?


• Are snacks readily available to the resident?


• Is the resident on a special diet?


• Has the resident started taking any new medications?


• Is the resident's weight monitored on a regular basis?


• Has the staff informed family members of weight loss?


• Has staff asked family members for assistance?

Parents' Medicaid Application May Be Affected by Gifts to Kids

As your parents get older, they may decide that keeping the large house is too much work and they may desire a change of lifestyle. They may sell their house and then they decide to give some of the net proceeds to their children. As time goes on, if their health declines, they may need nursing home care. Can the gift that mom and dad made be spent or must it be held for a certain number of years? How does this gift impact mom and dad qualifying for Medicaid in the event that they need nursing home care?

The gift that you received from mom and dad can be used by you in any manner that you wish. However, if your parents enter a nursing home, they could be left in a bind. This is due to the Deficit Reduction Act, which was enacted last February, which tightened the rules for qualifying for Medicaid help with their long-term care after making gifts to family members.

The basic rules for applying for Medicaid to assist in the payment of the bills for long term care are that an individual must typically use up all but $2,000 of their cash and investments. One way to accomplish this is for the parents to make gifts to someone else, usually to their children. There were limitations on this practice in the past, which included a three-year "look-back" period, in which any gifts made within three years of the date that the individual tries to qualify for Medicaid assistance may be used to determine if they have met the threshold. Under the past laws, a government regulator could examine gifts made in the past three years and assess a penalty. (If a parent spends down the amount for their regular living or medical expenses, the rules set forth in this article do not apply).

Under the new rules, this "look-back" period has been extended to five years. The regulators now can examine any gifts made within that five-year period and then determine if a penalty should be assessed.

What kind of penalty can be assessed? The penalty is a number of months that Medicaid will not pay for the long-term care that is necessary, such as nursing home care. If a gift was made of $18,000 about a year prior to the date of application for Medicaid and assuming that nursing home care is about $6,000 per month, the penalty period would be a three-month window in which Medicaid would not cover the nursing home care. Under the old rules, the penalty began from the date that the gift was made. Under the new rules, however, the penalty begins on the date of application for Medicaid assistance. This application date may be at a time when your parents are already in a nursing home and your parents do not have the funds to pay for the nursing home care.

One way to handle the penalty period is to have the recipients of the gifts pay for the nursing home care for the penalty period. While no one can force the kids to return the money by paying the amount of the nursing home care, this may be the only way under current law to have a parent cared for in a nursing home setting. Alternatively, while waiting out the penalty period, the kids may have to care for mom and dad in their own home. If your parents had thought ahead, they may have purchased long term care insurance, which may help in offsetting the heavy cost of nursing home care.

In making later life decisions, it is always good to plan far ahead. Now, you just need to plan even further ahead in making the decisions that will be right for you and your family.

Nursing Home Owners: Top Reasons Why You Should Hire a Nursing Expert Witness

Nursing Malpractice and Nursing Expert Witnesses

Registered nurses are professionals who have sworn to provide their patients with utmost care until their recovery. But due to several reasons, a registered nurse can sometimes deviate from the medical standards. This deviation can sometimes be classified under nursing malpractice or negligence.

If you think that your nurse has turned away from the standard of care, hiring a nursing expert can help you determine whether your suspicion is correct. The expert will take his time to review the necessary medical documents, reports, and records to check if your claim has bearing. And if, according to the expert, your claim is valid, you can file a complaint and take the case to court.

Top Reasons Why You Should Hire a Nursing Expert Witness

But aside from providing a solid testimony to support your claim in court, a nursing expert witness can help you in a lot of other ways. These ways are related to the prevention of litigation cases that may be filed against you because of your nurse's negligence.

A nursing expert witness can help you determine whether your nursing home is malpractice-proof or not. He does this by making a thorough examination of all the equipment present in your nursing home, and all the procedures done to help your patients recover. He serves as an objective third-party auditor to check whether or not your practices are at par with the state's and the industry's standards. He will tell you what you need to work on and what kind of equipment need to be upgraded.

As a result, you will have proof that everything in your nursing home has been checked by a highly qualified individual. And in case one of your patients decides to file a case against you, you can confidently walk into the courtroom with a winning smile.

Hire Only an Experienced Nursing Expert Witness

When choosing your expert, set aside some time to do your research. When you flip the witness directory, you can find a lot of highly qualified nurses so it's tempting to pick the first person that appears on the list.

But you want to look for someone who has years of experience as an expert witness and as a practicing nurse. A highly experienced medical expert knows what the court needs including all the documents that needs to be prepared and submitted. He knows which of your practices will get you in trouble, and he knows which ones will get you rewarded.

Recourse and Non-Recourse Nurse Staffing Accounts Receivable Factoring: What's the Difference?

What is nurse staffing recourse factoring?

For the most part, recourse factoring is the most common and the most affordable nurse staffing financial help available to business owners. In this type of factoring arrangements, the accounts receivable factoring company will require an agency owner to buy an invoice back if the client does not pay within a specified amount of time. Moreover, the nurse staffing agency owner accepts full credit risk for any and all accounts receivables that it sells to the factoring company.

What is nurse staffing non-recourse factoring?

The other accounts receivable factoring option that owners have is non-recourse factoring. In a nutshell, non-recourse nurse staffing financing agreements hold the factor entirely responsible for an unpaid invoices if the following is true:

• If the hospital, nursing home or vendor management system (VMS) goes bankrupt during the time an agency owner's invoice was factored.


• If the hospital, nursing home or VMS goes out of business during the time an agency owner's invoice was factored.

It's important to keep in mind that non-recourse accounts receivable factoring does not cover the following situations:

• Very late payments when there is no insolvency


• Disputes/challenges with nurse staffing services


• General collections issues

Naturally, both options have pros and cons that an owner should consider before choosing which type of agreement to make. Typically, they will receive lower factoring fees and/or higher advance rates if they choose to enter into a recourse factoring relationship. On the other hand, a non-recourse accounts receivable factoring arrangement buys nurse staffing business owners' protection if a hospital nursing home or VMS goes bankrupt. Ultimately, agency owners need to review their accounts receivable factoring contract in detail with a lawyer to determine which type of arrangement, recourse or non-recourse, is the best fit for their agency.

Registered Nuts - A Night in the Life of an ER Nurse

I've ceased with the pre-shift ritual of meditating in my parked truck along with a soothing piece of music. No more prayers to God en route to work asking for more patience, more humanity, more understanding. I have accepted the fact that it will be no different than any other night in the Emergency Department, no matter if I blare Yanni's rancid piano etudes or make a promise to God to pass out my own body parts to the discharged patients as they leave. Nothing will change. I use to look forward to making a difference in someone's life, helping a poor soul whose body has given out. Those moments are few and far between now. Instead, I resign myself to the fact that the next 12 hours will be spent pasting a fake smile on a tired body, going through the motions of caring, repeating ready-made lines of false concern and giving out medical advice that fall on deaf ears. I use to feel important in my role as Charge Nurse at a major ER of an inner-city charity hospital. Now, as I sit in my truck at 6:45 in the evening, gangster rap blaring, I send out a quick impromptu message to God..... "Please God, allow me the opportunity to be gainfully employed 12 hours from now."

7:02 PM-

I receive a quick report of the clingons and leftovers who haven't made it out of the department by change of shift and to no surprise to myself and the night crew, a few names are all too familiar and the reports of their latest "illness" easily recitable from memory. The usual apologies from the day crew for not getting them out before we arrived go unnoticed. A shrill screech from one of the psych beds startles no one. We all just look up from within the "safe" confines of the nursing station, confirm that our overweight security force is camped out beside the room, shake our heads briefly and go on about our business. We go through the ritual of taking our own baseline vital signs, popping a few Xanax and removing sharp objects from our pockets. Patient safety is important and we wouldn't want to accidentally stab one of them repeatedly in the chest.

7:17 PM-

My primary job aside from direct patient care is triage. Initial interview, vital signs, brief medical history, current medical problem, current medications, height, weight etc etc. My first of 35 or so fits the typical profile of this or any other ER in the country. 40 year old, female, morbidly obese, diabetic, hypertensive, multiple psych meds, very little English, less common sense, no means to pay. She complains of the usual nausea, vomiting, diarrhea and generalized abdominal pain. She's already spent thousands of dollars of other people's money last week for the same complaint. She didn't fill her scripts, didn't follow up with her Gastroenterologist as requested and by no means was this 300 + lb, truffle hunting leech going to alter her diet one iota in order to prevent another attack of diverticulitis. Her idea of a "Clear Liquid Diet" was a bucket of chicken and bowl of menudo an hour prior to her arrival. So here she is, totally oblivious as to why she is still sick. Non-compliant with her meds, non-compliant with the discharge instructions, follow up or diet instructions, which included a bland, low-fat, liquid diet for a few days until she was able to tolerate semi-solid/or solid food.

She bitches profusely when she is not brought straight back and put into a bed, instead she is sent back out to the waiting area for a lengthy wait. We are full and busy with the truly "emergent" patients but she can't seem to fathom this. She barrels through the exit door, into the waiting area calling me every name in the book (in Spanish) and swearing to never come back again. "PENDEJO!", she mutters. Oh, she'll be back.

"NEXT"!

7:31 PM-

My 3rd patient is a 23-year-old mother of 3, the oldest being 10. She has somehow mistaken our "EMERGENCY DEPARTMENT" for a pediatric clinic and wants her brood "checked out" because they feel "hot." No temperature ever taken at home, no Tylenol or Motrin given before the decision was made to spend $1500.00 of other people's money and to waste our time babysitting 3 snot-nosed, unkempt ankle-biters who are no more sicker than the man in the moon. I usher them one at a time onto a scale for weights and am not surprised that each is twice the size they should be at their particular ages. One, I have to pry finger foods and a "Big Gulp" from their obstinate little mitts prior to the weight so as not to inadvertently add 5 lbs to his already triple digit reading. The electronic scale beeps incessantly and reads, "ONE AT A TIME, PLEASE."(Ok, not really) With all their vitals being normal they are ushered out into the waiting area where they eagerly pounce on the furniture and run around like the defensive line for the Attention Deficits.

I am verbally attacked by my obese belly pain lady, who has "been waiting for hours" (uh, how about 20 minutes). I instantly notice the "positive Cheetos sign" on her fingers and around her lips and remind her that the sickest are seen first and to have a seat. She tosses me a "Pincha Pendejo" and rumbles back to her seat. I sneak in a quick call to God asking that he makes sure she looks before she plops back down in her chair(s). I can hear the intercom announcer now, "CODE BLUE TRAUMA, ER WAITING ROOM." I mentally picture the scenario of the code team spending the next hour removing baby Julio from the rectum of a 300-lb verbally abusive Hispanic woman.
"NEXT"!!

9:21 PM-

I've survived the dinner crowd with my job intact and make my way back to the treatment area to assist the rest of my team in the treatment of the patients who were lucky enough to make it back ahead of the non-emergent riff-raff. I make my way to the EMS radio station when I hear....."Unit 842 code 2 patient report"....we have a 102 year old nursing home patient,....found unresponsive on the floor....no IV....she's now awake, combative, confused, covered in stool, incontinent of urine, blah, blah, blah..." The report from the nursing home prior to her EMS transport reveals that this patient had a tendency to "dig out stool from her rectum when constipated." "Oh, that's just friggin lovely"

9:25 PM-

The waiting room intercom a buzz......"I beeen waiting for 10 hours, you pendejo...you piece of...." Click!

9:33 PM

Our lovely elderly finger painter arrives, covered in poop from head to toe. EMS personnel smirk as they wheel her by, updating us as to any changes en route. Nope, no changes, except that now she's given up the fight and is again unresponsive and her breathing more shallow. In an instant her breathing stops and is immediately rushed to trauma 1 where CPR is initiated. "CODE BLUE ER-1, CODE BLUE ER-1."

9:57 PM-

"Time of death, 9:55" is belted out by the code team leader. "She never stood a chance." "It was her time." "She had a long and good life." Blah Blah Blah Blah. She had a horrendous death. Born covered in amniotic fluid, but certainly a proud moment for her parents one can be sure. She died, however, covered in shit, piss and bedsores. The nursing home where she spent her remaining days in agony and perpetual loneliness should be burned to the ground. No family, no attention, nowhere near as prominent and proud as she once was. Left to waste while the understaffed workers at Our Lady of the Perpetual Petri Dish took their extended breaks and pillaged through her personal belongings. A courtesy call to the nursing home is placed telling them that Mrs. Mullins will not be coming back and has been transferred to the ECU (Eternal Care Unit). I hear, "Whew, thank God.....CLICK."

10:22 PM-

Our usually bevy of drug-seeking, bipolar, depressed, suicidal, Xanax, Vicodin, Demerol hounds arrive as scheduled with multiple and varied complaints of, migraine headaches, chronic back pain, stress, anxiety, fibromyalgia, blah, blah, blah....!
They are easy to spot, almost always familiar, with the same ole' story. Most we know on a first name basis. They are all, coincidentally, allergic to the same medications; Tylenol, Motrin, Vistaril, Toradol, Aspirin or any other non narcotic or harmless placebo we've attempted to quell their "pain" with in the past. The only thing that works is "Demerol" and they must have a large supply of Vicodin in the form of a prescription when they leave. (Vicodin has Tylenol in it but apparently doesn't cause a severe allergic reaction when mixed with euphoria,....go figure!)

Security is usually called, for to tell them "no drugs tonight" is just asking for a fight. $1000.00 later of other peoples money and they usually leave with their buzz on and their script for Vicodin. But usually not before asking for a "shot for the road" or additional scripts for anxiety (preferably Xanax) or sleep aids. 30 pills are often the number of pills given, depending on the frequency of the prescribed dose. This usually last a few days for the typical drug seeker and then they'll usually return with more "pain" and a hungry monkey.

In the age when Doctors are sued for both under treating pain OR for prescribing too many narcotics and "getting them addicted", we medical personal are caught up in the proverbial "catch 22". More often than not I have been written up and on several occasions was at a point where my job was in jeopardy because I challenged their pathetic lies whenever these low-life drug addicts invaded our ER's. Now I just shut up, shake my head and pray for an overdose.

11:12 PM

Waiting Room intercom is ringing off the wall. "...how long will I.......can you tell me where I am on the list......Donde esta su Doctor.......I can't find my child........the dingo ate my baby.....PINCHE PEDEJO, I BEEN HEER FER TWO DAYS AND MY ASS FEELS LIKE SOMEONE POURED SALSA RIGHT UP MY..........click.

Midnight in the garden of good (for nothings) and the evil (doers)-

After a flurry of non emergent triages, (sore toe, "the shakes", anal abscess, foreign bodies in the nose, ears and stomach of a 2 year old, blah blah, blah) I call in an astute, well dressed, middle aged white male, who is walking quite gingerly and refusing to sit. Differential diagnoses race through my head, back pain, abdominal pain, rectal abscess,. or perhaps....no!....NO!......NOOOOOOOOOOO!

Yes!

The story goes (and it is a common one) that he and the Mrs. were "experimenting" in bed (against his wishes, no doubt) when a vibrator was jammed in his keester and is now painfully out of reach. Given the nature of the "injury" he is whisked back to a private room, placed on his side, lubed up like a 57 Chevy, and a valiant effort is made to retrieve the 12 inch "perpetrator with ribs" from his large bowel. All to no avail. At one point we had a hold of the foreign body (actually, it was made in the US) but the colon wouldn't let go of it's new found cylindrical friend. We tugged, twisted, yanked, pulled, all efforts proving futile. Finally the physician stopped, exhausted from the tug-o-war match, with the forceps, commonly used to removed big headed babies, protruding from the prominent lawyers butt, he made the decision to call in the surgical team. All efforts to remain professional, however, fell by the wayside when, during a moment of silence, a low buzz was detected in the room. Had the blood pressure cuff inflated? Were the incandescent lights buzzing? Was the TV on?

No, no and no. We looked at the forceps and noticed they were vibrating uncontrollably, instantly realizing at that point that this thing was STILL ON. A mad rush by the scant crew to the exit door of the private room was attempted as to not embarrass this local professional with our boisterous laughter. No dice.

We will all eventually be written up and apologies made for our "unprofessionalism and disregard for the patient's privacy and mental well being".
That's ok. We needed that to preserve our own mental well being. Still proving that laughter is still the best medicine.

1:02 AM

Ten triages later and its dinner time for this mentally worn crew. We retrieve our food, locate it to the middle of the nursing station and we eat. Not all at once, mind you but usually a bite at a time. Eat a French fry, go wipe an ass in ER-1, a bite of a Big Mac, go clean up cherry cool-aid flavored vomit in ER-4, a sip of Dr Pepper, then physically restrain a combative Scitzo-effective patient. By 2:15 we have polished off the last bite of a hardened burger, ate our last stale French fry and sucked down the last gulp of our watered-down soda. A soda that is now as warm as fresh urine and food that is as cold as Mrs. Mullins in ER13.

2:30 AM-

Ahhh, my favorite time during the entire shift is upon us. The "Last Call at the local bar crowd" (LCLBC) start to pour in to the front entrance, while EMS brings the ones who got the shit kicked out of them through the back ambulance entrance. "Santa Rosa, this is unit 842....we are coming code 2 trauma with a 19 year old male.....closed head injury....intoxicated...combative....soiled....bloody.....no insurance.....blah, blah,blah.

The same ole song and dance spews from this patients bloodied spout as he is wheeled into Trauma-2......"I was just minding my own business"......"I only had two beers"....."I don't do drugs"..... "Can I get something to eat?" "RAALLLLLLPHHH!" "Housekeeping to ER Trauma-2, Housekeeping...."

2:31 AM-

"Dear Lord, If ANYONE can make time travel possible, it's you, God." "Pleeeese, send me forward to 7 AM.

3:03 AM-

Patient waiting room intercom is screaming..........."CLICK"......."BANG, BANG, BANG".

3:15 AM-

I am ushered into the staff break room for a "time out" and reminded by the night supervisor that the cost of the intercom will be deducted from my paycheck.

4:18 AM-

Our portly female beast of a woman is finally ushered back to a room but not before mumbling under her breath as she brushes past me, "Pendejo"! A major "abdominal work-up" is ordered. 40 lab tests, urine tests, stool cultures, abdominal x-rays, Cat Scans, blah, blah, blah......She's placed in a gown that looks like curtains stolen from the Grand Ole Opry, and given the reminder "Opening to the back, please," tossed in for good measure. ("Lord, give me the strength to...........Oh forget it, never mind")

She's given a URINE cup as she bounces her way to the bathroom. She fills it with STOOL. "Housekeeping to ER, STAT."

Can't find a blood pressure cuff large enough so we must take a chance at an erroneous reading by placing it around her calf or forearm. The hydraulic bed grunts and groans with ever twitch and shift from this woman of substances. She continues to bitch and moan and will eventually file a complaint with (in) human resources, I am sure. Multiple attempts at IV access finally yields a vein that hasn't been choked off by the mass of arm fat and IV fluids are initiated. After a quick assessment by the ER physician she is off to radiology, with a little 120 lb tech pushing 600 lbs of patient and bed up to the 3rd floor for a series of $3000.00 radiologic exams. X-rays that were done just last week and that she has no intention or means to pay for. It would have been easier (and cheaper) had she driven to Sea World instead. Certainly more accommodating for a woman of her stature.

5:57 AM-

Multiple early morning stragglers are triaged and sent to wait. The foul odor of urine, poop, BO, booze, vomit, etc, permeates the air. "One Hour Left", I thought. We get all the results of the voluptuous Ms. Hinojosa's tests back and surprise, surprise...."Diverticulitis." Perhaps this time she will be compliant with her meds, compliant with her diet, compliant with her follow up, compliant with life. "Fat chance,"I thought. (Pun intended).

Her IV is removed and a half gallon of fat globules ooze from the harpoon hole. She is hoisted off the bed with the help of several departments within the hospital; half of who will call in sick tomorrow with severe back spasms. The battered stretcher which now resembles a low-rider after a major accident is towed to the back for repair. Ms Hinojosa is discharged but not before requesting a breakfast tray. Request denied.

Off she goes to the local "Taco Cabana" for a flurry of assorted breakfast tacos and a bowl of menudo. "She you in a few days, Ms Hinojosa."

"Pinche Pendejo!"

6:47 AM-

The dismal faces of the morning crew are evident as they reluctantly make there way in, some still in mid-prayer, the newer nurses with walkman's on, listening to ocean waves or cricket noises saturated with Muzac. A quick report is given to the mentally exhausted night crew and apologies made for the missing bed in ER 3 and the dead body in ER-12.

7:07 AM-

Each member of the night crew, each with a phone in hand, are awaiting the instant the clock strikes 7:08 where, with lightning speed, a flurry of buttons will be punched to clock out, ending another horrendous but typical night in the ER.

7:47 AM-

I pull up to my apartment and sit quietly in my truck. I recall the night's events and wonder if I had made any critical errors in care or judgment. I mentally prepare for the answers to the complaints made the night before by this unique ER culture of ignorant, non-compliant, abusive, poor, helpless, drugged-up, psychotic, dregs of society.

I say a prayer for Mrs. Mullins and her family and curse all those who've abused the system in the last 12 hours, spending thousands upon thousands of dollars of other people's money but contributing nothing to society what-so-ever. Once I deem that I will have a job come 6:45 that evening, I ease my tired body and shattered mind out of my vehicle, meander up to my apartment and into bed, hungry, frustrated, angry. Where I will fight the demons for an hour or so until I am able to fall asleep. I don't. I am woken by a dream whereby the ER staff are all patients in the waiting room on a busy night. I am called into the back where a 500-lb female nurse is ripping my clothes off with one hand and swinging a 6 foot rectal scope in the other like a pair of numchucks in a Bruce Lee movie. The alarm clock sounds and I immediately spring up and grab my ass, praying that a 6-foot proctoscope isn't dangling precariously from it. It's not. I breathe a sigh of relief and make my way to the shower and into another fateful night of chaos and mayhem.

6:43 PM-

I pull up to the ER, park my truck and sit. I clip on my name badge, giggle as I read our "Mission statement" tattooed on the back. "To extend the healing ministry of Christ," it reads, and I take a minute to ponder that statement. I smile, acknowledge it's powerful and profound meaning and bow my head to pray.
"Lord, today, give me your divine power to accept my responsibilities within this ministry. I pray that..."

Just then a beat up delta 88 rolls by on two wheels, with a definite lean to one side. I watch as they take up two parking spaces in the "staff" lot and out pops Ms Hinojosa. I cringe. She leaves a trail of urped-up fajita and menudo through the patient parking lot, into the physicians parking area, towards the ER entrance. Anger churns inside me and I hang my head, looking down at my badge and the mission statement on the back. I try desperately to find the peace and pride I felt just 2 minutes earlier and I resume my prayer......"Lord,....I just.......If you could only find it in your heart to............OH FORGET IT!!!!!....... NEVER MIND."

CNA Job Description Varies With Employed Position And Health Care Facility

You may have completed your nurse aide training program and earned CNA Certification, and now you must be aiming to start your career in the health care field. But, are you aware that as a certified nurse aide your CNA Job Description varies with the type of job you are employed and your job position.

As a certified nurse aide, you can get employment in a hospital, long term care unit, nursing home, adult homes, rehabilitation center, hospice, psychiatric care center or health clinics. It is also possible that you may work as a private duty CNA, home health aide, travel nurse aide, military nurse aide or school nurse aide.

Different types of Job Description need execution of specific nurse aide duties that are essential for that particular job. CNA Programs must have trained you for executing common and basic everyday routine cares, but the skill and knowledge gained from the training program needs to be executed differently for separate jobs. For example, if you work in a physicians office, you will have to perform separate set of duties than working as a home health aide.

Again, the position you are employed also needs execution of duties more related to that work. In same facility also you may be employed in different departments where your responsibilities also vary. Working in an OPD of a hospital needs performance of separate set of duties than working in an operation theater or intensive care unit.

Hospital Nurse Aide

If you work in a hospital, your job description is divided among different units of the hospital. You may work in the opd, intensive-care unit, operation room, neo natal center, neurology department, post-anesthesia care unit, neo natal intensive care unit, emergency department, pediatric intensive-care unit, cardiology or coronary care unit or hospital stores looking after medication and other hospital inventory supplies.

In an operation room of the hospital, your duties are more concentrated in assisting surgeons and specialized nurses during surgical operations. You may also have to sterilize operating knives, scissors and other equipments. It is also your duty to prepare the patient for operation and counsel him/her about the treatment and operation procedures.

If you are employed in an OPD of a hospital, you are required to attend incoming and outgoing patients, provide them medications as directed by the physician and perform other duties.

You must also remember that in a hospital, you are required to execute your duties and responsibilities under the direct supervision of a physician, registered nurse or licensed practical nurse.

But, suppose if you are working as a home health aide, your job description shows that you will have to offer care to patients who are recovering at home from long treatments or patients that are released from the hospital after certain period of time.

Home Health Aide

In the home of the patient, you may have to execute duties, such as count, measure and record vital signs, measure intake and output of fluids, measure height and weight, proper use of bed pan, dressing and undressing patients, cleaning and dressing wounds, clean the room and change bed linens.

In addition, you may also have to perform some house keeping, cook for the patient, assist in movements through wheel chairs and walking, supervise exercises, answer light calls and execute numerous other duties.

Therefore, your CNA duties are specified to units and positions you are employed. Even your CNA salary also depends on these factors and as a certified nurse aide working in an Operating room or Intensive care unit you earn much higher than working as a home health aide.

CNA License Offers Eligibility to Work in a Health Care Center

In the United States of America, if it is your desire to get employed in a health care facility, you must earn a CNA License (or Certification) that offers you permission to work in a Health Care Setting. The federal OBRA-87 also mandates that a candidate aiming to get employed in a hospital, nursing home and long term care unit must be thoroughly trained through the approved nurse aide training program. The OBRA legislation further directs every state authority to evaluate the competency of the aspiring nurse aide candidate through the CNA Licensing test.

Steps Essential for Earning CNA License

• Complete the state and OBRA approved CNA Training Program, comprising of minimum 75 hours of classroom course instructions and clinical hands-on experience.

• Appear and pass the Certification Exam, which consists of the Written/Oral Test and Skill Test.

Once, the candidates clear the Licensing Exam, they are awarded with the CNA License and listing with the Nurse Aide Registry. The registration with the registry also awards these candidates a License No., which permits them to work legally in any type of the health care facility.

Validity of Nurse Aide Certification

The Nurse Aide Certification is valid for two years and you must get it renewed within 2 years, before it gets expired. You are required to submit a Completed Application and Renewal Fees to your state Nurse Aide Registry for the renewal.

CNA License Verification

On few occasions, working certified nurse aides forget to renew their certification and they are not sure if their current license is valid or expired. The Nurse Assistants are offered Online License Verification by the state Board of Nursing. You are required to provide your Serial Number to the Licensing authority and verify your certification online or by visiting the concerned authorities on their street address.

CNA License Transfer to another State

If you are moving from one state to another state for the CNA employment, you are not allowed to work in that state with your home state CNA License. You are required to complete certain basic requirements as needed by the state including:

• Reciprocity Arrangement between the states may exempt you from reappearing in the nurse aide exam and your licensing procedure continues in the same fashion as your License Renewal.

• If the states do not have Reciprocity Arrangement with each other, you may have to re-complete the state Nurse Assistant Training Program and reappear for the state CNA Certification exam once again.

CNA License Transfer to another State

If you are moving from one state to another state for working in a facility, you are not allowed to work in that state with your home state CNA License. You are required to complete certain basic requirements as desired by the state and these necessities include:

• Reciprocity Arrangement between states may exempt you from reappearing in the nurse aide exam, and your licensing procedure continues in the same fashion as your License Renewal.

• If the states do not have Reciprocity Arrangement with each other, you may have to complete state Nurse Assistant Training Program and appear for the state CNA Certification exam once again.

The Role and Responsibilities of Nurse Managers

Managing a staff of nurses is a challenging career that requires nursing and managerial skills. A nursing management career starts with being a licensed practical nurse and working your way up through years of clinical practice and advanced education. They also participate in management training that addresses specific issues that deals with employees, behavioral standards, and handling of legal issues that is associated with the supervision of the people working in the hospital environment. Nurse Managers or what used to be called as head nurses handle specific departments such as the intensive care unit or pediatrics.

Duties of a nurse manager

• Nurse Managers are responsible for planning, organizing, and directing health services in their department to ensure that the goals and objectives are performed consistently and that the services provided to the patients is of the highest quality and standard.
  
  


• They select, mentor, motivate, and direct the development and evaluation of the staff nurses. They are responsible for establishing and keeping track of quality improvement indicators and other information that concerns the patient care and services. They ensure that resources are available in order to provide high quality service and the on-time performance that is consistent with the facility's standards. At times, they devise educational programs that are health related for the facility's non-professional and professional staff.
  
  


• They participate, consult and collaborate with other units and healthcare providers in developing long term plans for health care programs. They interpret and communicate policies and procedures that the agency or facility puts in place to establish areas of responsibility and assignments among departments and staff.
  
  


• They are also responsible for developing budget estimates and handle other information pertaining to financial concerns and requirements. They approve and monitor expenditures and purchases to ensure that the budget guidelines are complied to.
  
  


• They are responsible in the staff maintenance. They assign nurses to particular cases and oversee the patient care to ensure that it remains at a high standard. They are also involved in creating treatment plans for patients and to coordinate the efforts of the medical team. This is to keep everyone up to date of the progress in the medical care and condition of the patient.

Key challenges in nursing management

• Increasing nursing staff satisfaction and retention. One of the most challenging aspects of being a nurse manager is how to effectively address or reduce the effects of the continuing shortage of nurses especially in their respective facility or department.
  
  


• Planning and managing the unit's finances and resources. This requires proper planning and management on a shift to shift basis and in between shifts.
  
  


• Handling of labor and union issues. Labor unions are becoming more demanding in their efforts to affect the hospital's management decisions. Nurse Managers need to have the sophistication, skill and diplomacy in order to effectively address such concerns and issues.
  
  


• Creating a positive and performance oriented culture. A nurse manager has a great influence in establishing a positive and performance oriented culture by building an open communication with the staff and establish the standards of care, build an alliance with her staff and other members of the multi-disciplinary team and assure that each one feels valued and committed to organizational goals.

How to Detect & Prevent Nursing Home Abuse With a Hidden Spy Camera

Millions and millions of the baby boom generation are becoming parents to our aging parents. As our parents get older, it is possible that they require a lot of care. Thus the proliferation of assisted care and long term care facilities. And it will grow quickly as the population ages.

Even though our parents may live longer than ever it is not necessarily better. These facilities house 2.6 million residents. Abuse happens in 44% of nursing homes according to one study. Elder abuse is an under recognized problem with life threatening consequences.

Every day, headlines throughout the U.S. show seniors who have been abused, neglected, and exploited, by people they trust the most. Abusers may be spouses, family members, personal acquaintances, professionals in positions of trust or opportunistic strangers who prey on the vulnerable.

That is only one part of the problem. The other is the millions of seniors live at home by themselves who have home health care and domestic assistance. Many of these folks have dementia and are targets of unscrupulous caregivers and domestics.

Back to the issue at hand: how to detect/prevent nursing home abuse with a hidden spy camera. If you suspect exploitation, verbal, emotional or physical abuse, neglect or even abandonment make sure you make your suspicions known immediately and demand that the issue be investigated.

No one really knows for sure how big the problem actually is because relatively few cases are identified since elders often are reluctant to report the mistreatment. Based on available information, women and "older" elders are more likely to be victimized. Dementia is a significant risk factor. Mental health and substance abuse issues - of both abusers and victims - are risk factors too as well as isolation.

One way to keep an eye on things when you can't be there is to install a hidden camera with built in DVR in their room. There are many hidden cameras with camera and DVR all in one neat looking package. Aim it in the direction you want, set the recording speed and record.

They are disguised as common devices like wall clocks, boom boxes, alarm clocks, tower fans, et. al. The camera is motion activated so a minimum of down time. When you are ready to playback remove the SD card and insert it into your computer or alternatively use the RCA cable to your TV for easy no brainer playback.

It may not be a perfect solution to all situations but it can offer a viable way to keep an eye on aging parents and others to keep them safe.

Finding the Right Nursing Home for Your Loved One

No one enjoys the process of finding a nursing home for their loved one, but when their health is deteriorating before their eyes, the time may have come to find the right nursing home for them. There are four steps that you may want to follow when considering nursing homes for the ones you love:

The first step that you need to take when deciding on the best nursing home is simply determining whether or not one is necessary. If you notice that your loved one is losing weight or experiencing memory loss, you should have him or her evaluated by a geriatrician. The doctor will assess whether or not they can dress themselves, eat, without assistance, or if they falls frequently. The physician will also check for early signs of dementia.

If the evaluation determines that a home is necessary, you need to compile a list of nursing homes to consider.

Some things you should look for are:

- Distance from you. You don't want your loved one to feel isolated from their family, and you can check on the quality of care they are receiving.

- History of care quality. You want to check for nursing homes that have a higher ranking, while keeping in mind that these will be the most sought after, and will likely have a waiting list. You can find this information on state health department websites.

- Keep count of the caregivers and their schedules. The more caregivers that a home has, the greater the likelihood that it will have better care.

- Find an advocate. This person will know about the various nursing homes, and may also help you get into the better ones. They will also know where to go to find the necessary information on each nursing home's care and safety.

The next thing you should do is visit each of the finalists. While you are visiting, the administrators questions that are tailored to the needs of your loved one. You should also vary your visits to different days and times. Things to look for are a full parking lot, the sounds of visitors, how the staff relates to the patients, how the residents play and eat, and unpleasant smells.

Finally, once you have moved your loved one into his or her new home, you need to visit occasionally so that you can monitor their care. You should expect an adjustment period while your loved one gets used to the new surroundings. During these visits make note of any changes to your loved one's health, disposition, and appearance. If you notice any problems, calmly bring it to the attention of the administrators, as it may be something that they were not aware of.

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.

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[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.

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 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.