Nursing Homes|Nursing Home Abuse|Assisted Living Facilities

Most elderly people in nursing homes are unable to take care of their daily living needs without assistance, which is why their families have placed them in surroundings where that assistance is supposedly at hand.

While many, of not most, nursing homes are caring and conscientious, there are some where that assistance is negligently absent. And further, there are times when conscious or deliberate harm is done to elderly people. It can be physical or emotional harm, or both, but in either case it's personal injury and therefore potentially a legal matter.
If you have a loved one in a nursing home, it's important to be able to recognize signs of nursing home abuse or mistreatment. Here are some things to watch out for.

New wounds or scars on the skin
These could be from a fall, or from overly tight restraint, or from rough handling by the staff. As we age, our skin thins out and becomes delicate, easily bruising or tearing. Our elderly loved ones need gentle handling to avoid injury.

From Falls
Perhaps your loved one needs assistance sitting upright. There's a safe and appropriate way to do this, but sometimes it's forgotten, so the person could fall from the chair, or get up and wander around, sustaining a fall.

Our eyesight deteriorates as we age, but perhaps the glasses have been lost or broken.
The floors should be kept free of debris or obstacles, but perhaps someone left liquid or clutter where it could cause a fall.

From Overly tight restraint
Restraints are used to prevent falls, and to prevent a person with Alzheimer's, for instance, from wandering off the premises and becoming lost or hurt on the street. There's a correct way to use a restraint, but if it's put on too tightly, it can cause bruising, or break the skin.

From Rough handling
Sometimes nursing home staff are overworked and become too tired, or too impatient. That's a possible explanation for rough handling, but not a justification of it. A tight grip on an elderly person's arm can cause bruising and pain and even in more extreme cases a broken bone. But perhaps the elderly person is unable to speak well enough to object, or perhaps they feel intimidated.

Pressure sores
Some elderly people have difficulty turning themselves while in bed, or are entirely unable to do it because of having had a stroke, for instance. The staff is required to turn them at least every two hours and if this isn't done, the continual pressure on one place wears down the skin, causing an open sore known as a decubitus ulcer.

This is usually on a hip or near the coccyx. If it isn't treated immediately, it will enlarge and deepen and potentially become infected. It can even enter the bone tissue. These sores are preventable by good care.

Depression or anxiety
When you visit your loved one in the nursing home, you can gauge their mood each time, and if they appear to be more depressed, you can ask them what's troubling them. If their speech is intact you may learn at once what the problem is and be able to rectify it.
But if their speech is impaired, they may not be able to tell you. If their mood seems to be lower at each visit it may be time to discuss it with nursing home staff, and find out if any emotional abuse is happening. Sometimes there's even sexual abuse.

Weight loss
Many elderly people lose weight rather than gaining it, as a function of advancing age. But if you notice that your loved one starts losing weight more than you would expect, it could be that for some reason they've lost their appetite (see Depression or anxiety), or that food is being withheld. Why would food be withheld? Either from laziness and neglect, or as an inappropriate punishment. In either case, you'd be wise to check into what's happening.

Dehydration
Some harm doesn't give you obvious external signs. For instance, if a person is mildly or even moderately dehydrated, you might not notice it on a visit (although the nursing staff should notice it).

As we age, we tend to lose our sense of thirst, so your loved one might be thirsty but not reach for the nearby water. For that reason, nursing home staff is expected to offer drinking water at least every two hours. But you might notice extra dry lips, or eagerness for water to drink when you offer it, and if so, you could pay extra attention to that on each visit, or perhaps mention it to the staff. Severe dehydration is life-threatening and calls for quick action.

Helping someone you love find the proper elderly home can be a difficult process. There are many different options out there, so make sure that you understand the distinction between the types of homes offered.

If your loved one is entirely mobile and they do not need any type of medical assistance, they will probably feel most comfortable at a retirement home. These homes are largely apartment buildings for seniors that include various activities and amenities - almost like a resort for the elderly. Contrastingly, nursing homes are establishments that have been erected in order to help those that need constant medical attention. Right from the start, you should be able to determine what sort of home your loved one needs.

It is not a good idea to place a mobile person in a nursing home, since they will not be autonomous. This is precisely why most nursing homes will not accept any new people that do not require outside help. While those within these types of homes do not have to be completely bed stricken, they usually need help attending to daily tasks such as brushing their teeth, getting dressed, and going outside for a walk. The routine inside of a nursing home tends to be organized and scheduled every day - in short, there is no room for individual activities within this type of establishment. Since the staff that works at a nursing home provides around the clock attention, the cost of living at this type of home is generally higher than a retirement home.

Those elderly people that simply want to live in a smaller space will often seek out a retirement home. This type of home does not include any type of medical care, though it may include various extras such as transportation, senior services, and events that are planned with seniors in mind. Many seniors move to retirement homes when their own homes become too much to handle. Retirement homes charge a monthly rental fee that changes from home to home depending upon the type of services offered.

Now that you know the fundamental differences, you can begin to look around for the type of home that your loved one needs. Make sure to visit any kind of home unannounced during the afternoon hours - this way, you can see what the regular operations look like. Also, always bring your loved one with you to visit a home, so that you can be sure they like the atmosphere. Even though this process is never easy, it can be a lot easier if you know what type of home you are looking for.

Unfortunately, nursing home food is usually pretty lousy. Since budgets are tight, most nursing homes cannot afford to buy the best quality products. Buying food in bulk usually means sacrificing taste. Another reason why nursing home food is not great is because many people in the nursing homes are on restricted diets that limit the amount of sugar, salt, and fat they can have. This means flavor cannot be added to the food.

Many nursing homes rely on spices to give the food more flavor. But even then, they must be careful about how much they put and the kinds they use. Nursing homes cannot serve five-star meals. Most meals are prepared using simple recipes to produce meals that will feed sixty or more.

When visiting a nursing home, look at the food as it comes out. Presentation is very important when serving a meal. If the meal does not look appetizing, the elderly person will not eat it. Although the food will taste a little bland, there is little an elderly person can do except add a little salt if they are allowed to. As people age, their taste buds begin to lose their ability to distinguish flavors. This is made worse by the fact that the food served has very little taste.

In nursing homes, the dietary staff must also follow strict cooking guidelines such as cooked eggs, and temperatures for the meat. There are no rare steaks served in nursing homes. The elderly can get sick much more often and they can get more food borne illnesses than younger people. While the food may not be the greatest, it is usually healthy.

Many inventors and innovators come up with ideas and concepts that can be used by our military to become more efficient, protect our troops and help our nation. During wartime Americans wish to help their nation and thus, these innovators and small business entrepreneurs have their minds thinking for our country men in harms-way.

Now, how would one go about taking their invention to the US Military and why is that so difficult? Okay, let me talk off the record here for a moment and give you some thoughts from the entrepreneurial side of the game or from the innovator's or inventor's mindset, understanding both sides as you do, you might appreciate this dialogue; so here it goes:

With regards to the SBA and trying to get government contracts; I've often shaken my head at the way the various defense agencies fail to use the great resource of all the minds of the citizens. You see, when you contact a government website, or try to call in a suggestion, or an innovation or idea, they send you to some silly web form to fill out to get funding to start your own small business and then sell to the military. That is completely ridiculous.

Why you ask? Well, who says you want to start a business? Maybe you just want to give the idea and first, you need to know if anyone likes the idea. But if they are not allowed to talk with you, you cannot know. So, why would any entrepreneur bother to sign up to learn about an SBA loan to start a business, without any potential customer?

Besides, I've done a ton of government contracting in my life and it's just amazing the "Slow Boat to China" approach to the solicitations process; bureaucracy at its worst. Further, the US Government, and yes the military too, pays its bills so slow, you have to be a bank to finance your own contract? So, in essence you are not getting a contract, you are buying one. Well, that is if you actually win the solicitation.

In fact, if you come up with an idea, the government has to send it out to bid with the specifications. So, you give them the "how to" and then you have to bid against a total low-baller to get the contract that was your idea, your innovation, your invention; that sounds rather silly. So who loses, when you do not get the contract? Well, the US Taxpayer, the small business garage "do'er" entrepreneur and the US Military. So, that's just a messed up process in an insider's game.

Perhaps, the procurement folks can tell us otherwise from their point-of-view. That might be interesting, and if not, it is certainly something to think about, as I believe we can do a lot better.

If you are at all concerned about losing your job - and today who isn't - it might be time to conduct a personal skills inventory, and rethink not only your job but your career. During the month of November 2008, over 500,000 Americans lost their jobs, driving unemployment levels to the highest point in 14 years, almost 7% of the population. These are staggering numbers, and something that everybody who works for a living should be concerned about.

The recession that we're currently in is here to stay and is building up to full force and effect. Most financial experts agree that the recession is going to get a lot worse before it gets any better. For that reason, people need to be thinking now about their financial future, and how they're going to deal with the coming hard times. Before we even discuss or think about the concepts of wealth preservation and wealth creation however, we first need to consider how we intend to generate an income in these difficult economic times.

As you think about your personal situation, a logical place to start is to reevaluate what you do for a living, and the joy and satisfaction you get from it. Many people find themselves working in a career or at a job that they initially got into out of necessity, graduating from school, and taking the first thing they could find. Over the years, their career has grown but not necessarily in a direction that they would prefer, or that they want. This is the reason why so many people undergo a midlife crisis-they find themselves in a situation that they no longer enjoy, and that is not fulfilling their personal needs. Due to the amount of time that you spend at work on a daily, weekly, and monthly basis, it's important that you enjoy what you do for a living in addition to making the money that you need to live.

A skills inventory can help you assess what you do well, as well as what you enjoy. Start by writing down the things you're good at, and be detailed. Follow that list of skills with a list of the things that you enjoy doing. If financial conditions dictate that you change your job and that you find a new source of income, you might as well take the time now to align what you do for work with what you enjoy doing.

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

Types of Physical Abuse

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

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

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

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

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

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

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

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

Why Physical Abuse Happens

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

Your Legal Rights

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

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

Summary

Complex intracellular inclusions were identified in brain cells of patients with non-inflammatory stealth virus encephalopathy. The cells showed extensive disruption of mitochondria leading to the suggestion that the inclusions were providing an alternative (non-mitochondria) source of cellular energy. Pigmented intracellular inclusions and extra-cellular materials were similarly identified in stealth virus cultures.

A characteristic feature of these cultures is the progressive lessening of the cytopathic (cell damaging) effect that coincides with, and is dependent upon, the accumulation of these pigmented materials. Tissue culture and direct patient derived materials exhibit various qualities consistent with their functioning as energy transducers. Specifically, they are composed of conglomerates of finer particles that can display fluorescent, electrostatic, sound resonating and variable magnetic activities. Individual particles contain various combinations of different minerals. They can act as both electron donors and electron acceptors in redox reactions and can also generate gas bubbles from water.

The viability of cells in cultures containing alternative cellular energy pigments (ACE-pigments) can be influenced by exposure to external electromagnetic, magnetic and sound frequencies that have no discernable effects on normal cell cultures. Enhanced cell growth and survival occurs upon exposure to relatively low intensities, while cell destruction occurs at higher intensity external energy exposure. Various natural products show ACE-pigment like activities, including a capacity of protecting cell cultures from the cytopathic effect of stealth viruses. These products are suitable for double blind clinical studies.

Introduction

Plants and certain bacteria derive energy in the form of sunlight to covalently link hydrogen and carbon atoms to form carbohydrates. This photosynthetic process is mediated by chlorophyll molecules that can specifically absorb photons corresponding to the blue and red components of sunlight. The photons elevate the energy levels of particular electrons within the chlorophyll molecules that can then be used in an electron donating (reducing) reaction between carbon dioxide and water to yield carbohydrates, such as glucose.

Electrons can subsequently be withdrawn from carbohydrates in the form of chemical energy for synthesis of other types of life sustaining organic molecules and for the generation heat. Protons typically accompany electrons in electron donating (reduction) and electron capturing (oxidation) reactions. The term oxidation is used since oxygen plays a major role as an electron acceptor to form water.

Chlorophyll utilizes only a minor fraction of the entire electromagnetic spectrum. Not only does this seem rather inefficient but the question can also be asked what was the energy used to synthesize the original chlorophyll molecules. Energy could conceivably be derived from other parts of the electromagnetic spectrum and/or from other less well understood forms of energy.

Viruses can cause cell damage by various mechanisms including simple competition for the metabolic resources available to the cell. I have defined a grouping of cytopathic (cell damaging) viruses, termed stealth viruses, that fail to evoke an immune mediated inflammatory reaction (please refer to http://www.s3support.com for a complete list of publications). The best characterized stealth virus originated from the cytomegalovirus of African green monkeys. The virus was isolated from a patient with the chronic fatigue syndrome, with a similar but not identical virus isolated from a patient with a manic depressive, bi-polar illness.

The virus induces a severe acute disease in cats followed by considerable clinical recovery in spite on an absent inflammatory response. Similarly, the cytopathic effect in tissue culture tends to abate over time, especially in infrequently fed cultures. The mechanism of this striking recovery process is attributed to materials that accumulate in tissue culture supernatants since reactivation occurs upon replacing the tissue culture medium with fresh medium. Reactivation can be prevented by including supernatant materials from repaired cultures into the re-feeding medium.

Unusual intracellular and extra-cellular materials were previously noted in the brains of stealth virus inoculated cats and in the brain biopsies of various patients with stealth virus encephalopathy. They were periodic acid Schiff (PAS) positive and also readily seen using the cationic Stains-all dye.

Irregularly shaped inclusions were also noted on electron microscopy of both animal and human brain biopsies. The highly ordered complex structures of some of these inclusions suggested that they were fulfilling some cellular function. Given the marked disruption of the cells' mitochondria, it seemed reasonable to postulate that the inclusions may be providing an alternative (non-mitochondria) energy source. The following data support such a conclusion.

Complex Inclusions in a Brain Biopsy from a Stealth Virus Infected Child

The child's illness evolved over seven months from what was initially considered to be a conduct and attention deficit disorder to an apparent neurological disease. In spite of markedly abnormal magnetic resonance imaging (MRI), his early neurological examination was essentially normal. A brain biopsy showed lipid accumulation within glial cells without accompanying inflammation, and was considered non-diagnostic by the attending and referral neuropathologists.

After extensive clinical reviews in major medical centers, a second brain biopsy was performed at Stanford University , this time with sections prepared for electron microscopy. Apart form the lipid vacuolization and mitochondria damage, the attending neuropathologist failed to report on any of the inclusions shown in Figures 1-8 of the article posted on the s3support.com web site.

Pigmented Particles, Threads and Ribbon-like Structures in Stealth Virus Cultures

Representative photographs of the cytopathic effect occurring in stealth virus cultures are also available on the web site. The repair and reactivation processes are illustrated in Figures 1 and 2 of the published article "Stealth virus culture pigments: a potential source of cellular energy." Exp Mol Pathol. 2003: 74:210-23 . Many of the cell clusters become pigmented and the pigmented material can coalesce into discrete particles, some of which are extruded into the tissue culture medium. Various threads and ribbon-like structures can also develop in stealth virus cultures.

They can show intricate patterning and can exist as either hollow tubes or flat bands. Both by scanning electron microscopy and auto-fluorescence microscopy, the particles can be seen as conglomerates of finer particles. The tread and ribbon-like structures are also auto-fluorescent with wide excitation and emission spectra. The particles can occasionally show magnetic activity which is characterized by a degree of variability in sensitivity and responsiveness that is not seen with inorganic metallic objects. Electron dispersive X-ray (EDX) analysis shows that the particles contain various minerals with individual particles displaying quite distinctive patterns of mineral composition.

The particles can show both electron donating (reducing) and electron accepting (oxidizing) reactions. The former is readily demonstrated using the chromogen MTT as an electron acceptor. It can also occur with reagents such as iodine in alcohol. Oxidation is seen with the appearance of calcium oxalate crystals following the addition of ascorbic acid to medium containing ACE pigments. The particles can also generate gas bubbles when placed in water. A remarkable feature is the variability seen over time with many of these properties. The particles appear to exist in both a "charged" and a "discharged" state. Individual particles will also commonly resonate when exposed to wide band sound frequencies.

Using a sound generator, each particle will commonly exhibit a rather narrow range of movement activating frequencies. Externally applied electromagnetic, fixed and pulsating magnetic energies, and sound waves can show effects on isolated ACE-pigments and on the viability of stealth virus cultures. It is easier to demonstrate cell destructive effects using light, X-ray and magnetic energies, but low intensity energy exposures have clearly benefited some cultures. Both sound and magnetic energies can induce considerable movement of freely floating cell clusters.

ACE Pigments Derived from Stealth Virus Infected Patients.

Similar mineral containing particles have been found in dried perspiration from stealth virus infected patients. They can exhibit rapidly reversible electrostatic properties suggesting internal movements of electrical charge. They are auto-fluorescent and can be both reducing (electron donating) and oxidizing (electron accepting). They can also generate gas bubbles from water.

Erratic movements of the particles in liquid suspensions may account for what earlier investigators have termed pleomorphic microorganisms. The occasional transformation of the particles into thread-like forms is also consistent with the mistaken belief that the supposed bacteria could transform into fungal forms. It is likely that ACE pigments are also responsible for so called delusional parasitosis or Ekbom's syndrome experienced by occasional patients with severe psychiatric illness. They may also explain mistaken reports of head lice in stealth virus infected patients.

Natural Products and Subtle Energies

An assay for the electron shuttling activity of ACE-pigments has been developed and applied to a number of natural products, including a Japanese plant extract and a material designated Enercell. Interesting patterns develop during these reactions that appear to be subject to environmental influences. These reactions are currently being used as a potential sensor for non-conventional forms of energy that may influence their physical and/or chemical properties. Other highly energized natural products can contain microscopic energy rich particles that show remarkable motility and that could easily be mistaken for bacteria.

Although not as well characterized as electromagnetic radiation, most physicists realize that other radiating forms of energy do exist. Included in this category are so called dark energy, phonons, biophotons (chi, orgone) and what is variously referred to as the ether, subtle energy, or zero-point energy. Understanding the potential reciprocal interactions of living organisms and the ether is rendered difficult because of the lack of suitable detection methods.

The restricted patterns of the minerals in individual ACE pigment particles suggested the existence of selective mineral affinity forces that favor the attraction of like substances. Minerals have mainly been studied in inorganic forms. Increasingly, it appears that minerals can exhibit quite different properties when either single atoms or small microclusters. Minerals can also behave differently when incorporated into organic and even silica based complex molecular lattices.

The concepts of orbitally-rearranged monoatomic element ( ORME ), molecular energy transduction with superconducting coherent energy emissions, and gravity defying elements, have been proposed to explain some of the unique features of these altered states of mineral existence. The field of biophysics is currently addressing the potential harmonization of energy patterns within living organisms and even between organisms separated by considerable distances. The experience of various healers would also suggest that conscious thought may be able to alter these harmonizing energy patterns.

Clinical and Agricultural Studies

Given their strong activity in the electron transferring assay system and testimonial evidence for efficacy in various disease states, a number of these natural products have been selected for detailed double blind, placebo controlled studies. Subjects with illnesses potentially attributable to stealth virus infections, and subjects who manifestly are lacking in energy production would be selected. Among the latter group plans are underway to test patients with various wasting syndromes (including cancer cachexia), children with severe diarrhea and asphyxiated newborn infants. Studies on both experimental and livestock animals can similarly be performed.

An advantage of the energy based approach to therapy is that it removes the focus away from using products as a means of enhancing the immune system. The new approach allows for a two way extension of studies to be conducted in an agricultural setting. Thus many products destined for evaluation in human and animal studies can be objectively assessed for their growth enhancement of various plants and crops. Conversely, natural materials that promote the quality of agricultural products may find usefulness in both animals and humans.

Co-ordination of Effort

It would be desirable to have an organizational structure that would encourage open communication among individuals contributing products, performing efficacy assessments and conducting basic research. Sound financial management and good public relations are also essential. The Government, Industry and Major Academic Institutions have, unfortunately, tended to put money-driven self interests above that of the public.

A fledgling non-profit organization termed S3Support has been joined by an Applied BioPhysics Foundation to form the Progressive University and BioPhysics Institute. Its primary goal is to develop and promote a nationwide endeavor to more rapidly bring the enormous benefits of energy based clinical and agricultural science to mankind. This effort can be assisted by increasing the membership of health care providers, farmers, researchers, administrators, public spokespersons, patients and their family members, etc., in the Applied BioPhysics Foundation.

• Estimated one adverse drug event occurs per patient per day


• Treating avoidable events conservatively cost $billions annually


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

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

Information Technology (IT) Opportunities

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

• Increased accessibility to and sharing of information


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


• Legible clinician documentation consistently compliant with regulatory language


• Enhanced systematic surveillance of disease/symptom/drug monitoring


• Updated drug information resources

Computerized Physician Order Entry (CPOE)

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

Clinical Decision Support Systems (CDSS)

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

• Better documentation for drug usage indications, allergies and interactions


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


• Improvements in therapeutic drug dosing adjustments


• Avoidance of preventable pharmacotherapeutic organ toxicity


• Improved clinician adherence to guideline-based care


• Positive influence on provider prescribing behavior


• Increased adherence to corollary orders

Cultural Changes

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

Raise the Bar

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

FHA Section 232 is the best financing available today to develop Nursing Homes or Assisted Living Facilities.

And the need is much greater today more then ever! Why?

With the aging of the baby boomer generation, there is currently a huge strain on existing nursing home and assisted living facilities. There aren't enough beds to meet the demand. Now is the time for developers to get in and begin developing these properties. And the FHA Section 232 financing program is the best way to finance these developments.

What Is This Program?

FHA Section 232 is a Federal mortgage insured program. It doesn't mean that FHA is providing the funding...they are insuring the actual lenders against defaults. Section 232 is a section under the National Housing Act. It allows the FHA (Federal Housing Administration) to provide mortgage insurance to HUD approved lenders. This is to assist in the development or substantial rehabilitation of assisted living facilities or nursing homes. The loan program allows for long-term mortgages (up to 40 years) that can be financed with Government National Mortgage Association (GNMA) Mortgage Backed Securities.

Who Can Use The FHA Section 232 Construction/Substantial Rehabilitation Financing?

This program is available for both non-profit and for-profit developers, public entities or investors. The maximum loan amount allowed with this type of financing is 95% of the estimated value of physical improvements and major movable equipment for non-profits and 90% for for-profit developers.

Eligible Property Types?

The facility must have a minimum of 20 beds and the residents must require skilled nursing care or continuous care. The facilities must be properly licensed/regulated by the appropriate state or local agencies.

What Are The Benefits?

There are so many good benefits of using this program. In today's times of credit crunch and tighter lending criteria, many developers are finding it increasingly hard to obtain good financing that makes their projects work. FHA Section 232 financing is usually the only way that developers can make their projects work (from a numbers stand point). I would recommend this program as the best on the market.

Every year caregivers in nursing homes and assisted living facilities must deal with the challenge of gift ideas to their resident's. In an attempt to make this task a little easier for you, here are some ideas for gifts as well as a few ways in which you might consider distributing the gifts to the resident's in your facility.

Give each resident a paper cut out Christmas picture (tree, bell, angel, star) and ask them to write on the back, their name and a few items they might like to receive, maybe some things they need. These can then be put on a wall, bulletin board, or a Christmas tree and staff can pick them and use them to buy gifts for the residents.

You might want to have a dollar limit of $10 or so, or this could get quite expensive. A list should be kept as well, of the resident's names and the staff member who picked them. You don't want to find, at the last minute, that some residents were missed. It could be helpful to have the purchased gifts brought in a few days before you are handing them out, just to go through your list and be sure everyone is accounted for.

If there is a possibility that staff may not want to buy for some specific residents, for whatever personal reasons, maybe picking names anonymously would be better. They could draw names out of a hat. To take the anonymous idea one step further, you could simply have staff choose male or female and then each resident gets whatever is gifted for their gender, rather than items specific for them. It might also be an idea to have a few of these types of gifts available for new residents arriving to your facility who came after your lists were made up. You really don't want anyone missed.

If there are just too many residents for the staff to purchase for, consider asking local churches or organizations like Boy Scouts to participate.

Another gift idea is to put together some beautiful baskets that can be raffled off. The raffle tickets can be easy enough to make with a computer and printer, then stapled together. The baskets could be themed such as "Beauty" with lotions and soaps, or "Movies" with popcorn, candy, a movie DVD, etc. The tickets could be sold for a dollar or two to resident's families as they come to visit, or the boy scouts could sell them for you. The money could be used to help buy gifts for the residents as well, or pay for some of the Christmas party.

The gifts can be taken to each resident's room, or handed out by Santa at a Christmas Party.

You could also have some extra fun distributing the gifts at a party if you had a large plastic dice the residents could throw, taking turns. If they throw a number you have chosen specific for the game, such as a 4 for example, they can choose from the gift wrapped gifts under the tree. These should be labelled male or female. Then some time could be added after the gifts were all chosen and before they are unwrapped, for a swapping round. If another particular number is rolled on the dice, the resident can choose to swap with another person or keep what they have. Game over when the time is up.

Gift ideas

These are also good gift ideas for senior citizen's that are not in a care facility.

Inexpensive gift ideas:

• stuffed animals


• clothes


• pyjamas


• sweaters


• shoes


• socks


• slippers


• scarves


• hats


• gloves


• underwear


• nail polish


• books (fiction, history, hobby specific, large print, audio, picture)


• magazines


• puzzle books (word search/crossword)


• jigsaw puzzles


• box of greeting cards (they can use throughout the year to write to friends)


• stationary


• pens


• games


• music CD's


• craft items


• tissues


• lotions


• soap


• candy


• chocolate


• cookies


• coupons


• deck of cards


• plaques


• calendars


• grooming items


• personal photo album


• costume jewellery


• craft kit

Pricier gift ideas:

• disposable camera (and developing)


• audio books (if you can find or download inexpensive ones)


• DVD's (old TV series such as Gunsmoke, I Love Lucy, etc)


• CD's (nature sounds, old time radio shows like Jack Benny, Bob Hope, George Burns, etc)


• purse


• wallet


• Bible


• Robe


• lap robe


• jackets


• afghan or blanket


• magnifiers


• reading lights


• bird feeders


• Decorative or ornate box for special items or jewellery


• picture frames


• radio


• clocks

If you don't find the exact gift idea that works for the resident or senior you have in mind, these can be a help to get you started. Many of these gift ideas can also be personalized to make them a little more meaningful.

In my last article, we discussed what happens when someone over the age of 65 goes from the hospital to a rehab facility and also directly from home to a skilled nursing facility. We covered how and who pays for what services and for how long.

In this article, we will discuss payment choices once Medicare and Medicare supplement coverage runs out. As we learned, Medicare does not pay for long-term nursing home care.

Your three choices are: 1) Write a check each month to the nursing home for $6,000 or more (called Private Pay), 2) get reimbursed from your long-term care insurance policy, or 3) get qualified for Medi-Cal.

Most people have not planned for a long-term care event and are not prepared to pay the monthly nursing home cost of $6,000 or more. Most would go broke in a short period of time.

Also, it is estimated that 93% of seniors have not purchased long-term care insurance. This leads us to the only alternative left for the average person, getting qualified for Medi-Cal to help pay for the monthly nursing home cost.

There is general Medi-Cal (health insurance) and Medi-Cal for nursing home care. The qualifications are slightly different. We will be discussing Medi-Cal for nursing home care.

There is much confusion about Medi-Cal and Medicaid. They are the same program but in California, we have to be different so we call Medicaid, Medi-Cal. Medi-Cal is a means entitlement program created by Title XIX of the Social Security Act and is fifty percent funded by the federal government and fifty percent by the State. Even though our tax dollars fund the program, unlike Social Security, you have to qualify to receive benefits.

A nursing home Medi-Cal application is submitted only after someone is actually in a facility. You can gather documents and other materials and prepare the application, but the application is submitted to the county Medi-Cal LTC department only after admittance.

The department has 45 days to determine if you qualify for Medi-Cal benefits. For example, let's say that your application is submitted June 10, 2010 and your family member was admitted June 1, 2010. The department should have an answer back to you no later than July 25, 2010 and benefits would be retroactive for the entire month of June and July. There is no "you have been approved" letter that is received. If the application is approved, a Notice of Action form is sent detailing the month from which you are approved and your Share of Cost for the previous months and the subsequent months.

The Share of Cost is the amount that the Medi-Cal beneficiary must pay from their own income each month to the nursing home. Typically this will be the beneficiary's Social Security or pension income. There is an additional calculation if the Medi-Cal beneficiary is married as the well spouse is allowed to have a minimum monthly income of $2,739 for 2010.

Upon admittance to the facility, most will ask for the monthly private pay rate until the application is approved. Once approved, the facility will refund or credit any over payment above the Share of Cost.

Every year thereafter, the department will require an Annual Redetermination of Benefits. The redetermination process is not as paper intensive as the original application process but can be troublesome if you are not prepared for it.

After the original application is approved, there are post approval requirements that must be met within ninety days if the Medi-Cal beneficiary is married. This is also the time to consider Recovery Avoidance strategies as well as establish new estate planning documents. More on this in future articles.

It's heart wrenching - the look you see in your loved ones' eyes when they know they can no longer take care of themselves.? It's equally stressful for you as those who once cared for you now need your help in finding suitable nursing home care for them. ?

So how do you go about finding the right home?

How can you be sure of the quality of nursing homes?? Is the staff trained and experienced to provide the level of care you want for your loved one?? Do they understand his or her special needs?? Do staff members treat their residents with the dignity and respect they've earned and expect?

Making a nursing home decision based only on literature, advice from others and TV and newspaper ads is not enough.? You need to visit each facility you're considering to get answers to the above questions as well as to get a "feel" for the quality of the staff and the level of care they provide as well as for the facility itself. There are also professionals you can ask:

•?? ?Social workers from your local hospital

•?? ?Your or your loved one's physician

•?? ?Area agencies

•?? ?Friends of your loved one who may be in nursing homes themselves

•?? ?Families and friends who have loved ones in nursing homes

•?? ?The Internet

Be sure you use these sources only for supporting information.? The ultimate decision must be yours.? A beautiful building and landscaping by itself should not be your deciding factor.? You need to know everything about the facility.? Visit the home a number of times (preferably at unscheduled times) and at different times of the day, such as at mealtimes. Observe the quality and quantity of the food served. Also check residents' reactions to the staff and whether or not the cleanliness of the facility is the same as you saw on your initial visit.

Most importantly and, if able, your loved one should be a major part of the decision process. The facility you choose will likely be home for the remainder of his or her life.

Once you've narrowed down your list of nursing homes, you should further investigate them through your state agency's inspection office.? This agency makes regular and thorough inspections of nursing homes, including residents' medical care, diet, condition of the facility, etc.? These reports are usually available for public review and, in some cases, can be found online.

You should also consider the following:

•?? ?Licensing - Be sure the facility is licensed and approved by your state's regulatory body.? If you don't see it, ask to see the license.? If one cannot be provided, cross the facility off your list.

•?? ?Facilities - Ask to be shown around the facility and take mental or written notes.? Is it easy for residents to move about within the facility?

•?? ?Activities - Are activities offered/scheduled for residents?? Physical and mental activities are important to the health and wellbeing of all and are especially important to seniors.

•?? ?Cleanliness - As mentioned above, be sure that the facility is clean at all times, not just during your scheduled visit. Stop in unannounced rather than making an appointment.

•?? ?Staff - One of the most important considerations you must make is the quality of the staff.? Observe how they treat the residents.? Are they friendly and attentive or distant?

•?? ?Language - If your loved one speaks a different language, is the staff able to speak and understand that language.

Although it may be difficult for both you and your loved one, it is important for you to begin the nursing home selection process as soon as you know care will be needed.? By doing so, your loved one will have time to adjust to the eventuality of nursing home living.? And you'll also benefit by having the time to choose a home that will provide the level of care you expect and at the cost you can afford.

Making the decision to place an elderly family member in a nursing home is never easy. If you do choose a facility, you of course expect it to be efficient, well run and safe and assume that your loved one will be treated well. Most of the approximately 16,000 nursing homes in the US are well run and they employ dedicated and reliable staff, although unfortunately nursing home abuse does occur. It can also be surprisingly difficult to identify and verify and only about 20 percent of cases actually get reported.

When choosing a nursing home, you will want to visit the facility before making a firm decision and just about every facility will give you a guided tour. There are certain 'red flags' that you should look for to try to determine signs of abuse in a nursing home. Signs of physical abuse are perhaps easiest to spot; these can include bruising, wounds or cuts, or lingering illnesses or injuries.

Residents who are forced to remain in their rooms for a long period of time should be a warning, as should any signs of residents fighting with each other. Look for unusual behavior such as rocking, nail biting or hugging oneself. If you get the chance, observe the staff interacting with a patient; the patient should appear to be relaxed and at ease when being cared for.

You should also look for an appropriate ratio of patients to staff, which is regulated by law and designed to ensure that patients are adequately cared for. It is estimated that as many as 50 percent of homes are short staffed, which of course means that patients are not being cared for. The work is also often demanding and unpleasant, leading to a high turnover of staff. Financial exploitation is also surprisingly common in some nursing homes, as of course many older people have little or no idea how much money they have.

It can also be surprisingly difficult to differentiate between actual abuse and neglect, the big difference is that neglect is generally unintentional and is more common than deliberate abuse. Many employees are simply over worked; in some cases, they have not received adequate training. Although most nursing home employees are caring and responsible, some see the job simply as a means to a paycheck and tend to neglect their patients, often without meaning to. In a nursing home, all accidents and injuries, however minor, must be investigated and reported and all too often, this does not happen.

If you do suspect signs of nursing home abuse, your first step should be to talk to the administrator, followed by your local authority. You also have the legal right to see a copy of the most recent report on the facility. In extreme cases, you may have to consult with an attorney, preferably one experienced and knowledgeable in this area. Of course, you can also talk to your loved one, although sadly many residents are unwilling or unable to identify abuse and talk about it.

Advances in medical technologies are enabling individuals to live longer and longer every year. As such, industries such as nursing homes and other long-term care facilities are experiencing booms in their business. Studies show that approximately 1.6 million Americans are cared for every year in nursing homes and other long-term care facilities. Additionally, a quarter of the US population will receive care in a long-term care facility at some point during their lives.

As such, one would hope that growing industries such as these would provide the quality care, respect, and comfort to the elderly and ailing individuals in our society that they need and deserve. Unfortunately, cases of nursing home abuse and negligence are increasingly prevalent. In recent years, the federal government has conducted extensive studies regarding the quality of nursing home care, and the results have been shocking and discouraging.

Occurrences of Nursing Home Malpractice

Government studies have revealed that approximately 30% of all nursing home facilities are guilty of some form of medical malpractice. The term nursing home malpractice can, in fact, encompass a number of different things, including physical, mental, or psychosocial harm.

Some of the most common examples of nursing home malpractice include

· Emotional abuse or negligence
· Patient dehydration or malnutrition
· Bedsores
· Pressure sores
· Infection
· Unexplained ailments
· Slip and fall accidents
· Medication errors
· Inappropriate physical restraint
· Financial malpractice
· Untreated pain

With regards to the last example listed above, studies have revealed that a shocking 50% of all nursing home patients suffer from untreated pain.

Reporting Nursing Home Abuse

Nursing home (and other long-term care facility) malpractice affects thousands of individuals and is a horrific crime, as it takes advantage of and abuses some of the most vulnerable members of our society. As such, it is critical that nursing home abuse and negligence is investigated and reported as soon as it is suspected in an attempt to try and end the cycle of malpractice.

As long as nursing home facilities go un-punished for malpractice, they will continue to abuse and neglect patients. If you suspect that a family member or loved one is being abused in a long-term care facility, there are a number of non-profit organizations that will investigate the institution to see if they are truly guilty of nursing home malpractice. It is important to contact these organizations as soon as possible to prevent the continued suffering of thousands of individuals.

If you would like more information on fighting nursing home malpractice, contact the Indianapolis nursing home malpractice attorneys of the Charles D. Hankey Law Office today.

Putting a loved one into care is an incredibly emotional and stressful experience; I know, we had to do make the decision on behalf of my mum when dad was suffering with Parkinsons and dementia.

In mum's case we were lucky, she could still afford to stay in their home even when paying for dad to be in a special care home. As mum's home was big enough to create a bedroom downstairs and we had a loo on the same level, eventually as dad's illness progressed, we were able to bring him home for the last few months.

However, not everyone is as lucky as we were so I've written a quick guide to different circumstances you may find yourself in so you know what options are available to you and you can try to work out what the best thing to do is.

Lone parent goes into a residential/nursing home or hospital temporarily

Firstly, despite some horror stories, if your loved one is in a home or nursing home for however long, no one can force you (or them) to sell the property. However, what will happen is if your parent is getting financial support to help for care at home, that money is likely to be stopped after four weeks of being in hospital.

It is important to remember if you have a loved one in temporary care and they are feeling poorly and frail, what happens to their home while they are away could be quite stressful. As a result, it is a good idea to put their mind at rest and either discuss a plan of action or let them know what you are going to do.

Sadly another fact of life is that if your parent hasn't been very well, and especially if they are suffering with any dementia related illnesses, that they have managed to keep up to speed with all their bills such as phone/gas and electricity/TV licence etc. Check with each service what you can do to keep the power/line active while keeping the bills as low as possible.

Whatever you decide, the first thing to check is your parent's home insurance. If the property is going to be unoccupied for more than 30 days and you do not advise your insurance company, the insurance may be invalid. Speak to the insurance company to see what you can do or go to specialist companies such as Towergate who will insure the property cost effectively.

Once you've sorted the insurance, then it's important to decide whether you are going to leave the property empty or whether another family member might stay there (who your parent will trust) or you can consider renting the property out.

Leaving a Property Empty Long Term

If you leave the property empty, then follow our 'empty property checklist' to make sure that you keep it as safe as possible for when your parent returns:-

Empty Property Checklist

1. Make sure the property is insured for being empty for more than 30 days (or whatever the current home insurance covers).

2. Turn off the gas, water and all plugs so the property is kept safe.

3. Cancel or redirect as many deliveries as you can, such as milk, newspapers or other mail.

4. Ensure you have an alarm or something that would alert YOU or neighbours if they are around, that the property was being broken into.

5. Either ask a neighbour/friend to visit the property a couple of times a week or do it yourself and ensure all post is read and throw away (or cancel) anything that is no longer needed.

6. Make sure that the curtains or blinds are closed/opened regularly.

7. Enhance security by having lights/radio etc coming on at different times of the day.

8. Ensure that the garden is kept in as good an order as possible. Contact 'Help the Aged' as they may be able to suggest a good value gardener that's been checked by them.

9. In summer months, be on the lookout for unwanted visitors such as ants.

10. In the winter, check that the boiler still works.

Finally, when your mum or dad does come home, check the place over thoroughly a few weeks or so beforehand, especially if your parent may need some help or changes to the property post nursing/hospital care.

Renting an Owned Property

If you want to rent a property out, you are likely to have to do this for six months or more. You will also need to incur costs to let the property legally such as:-

• Energy Performance Certificate


• Gas Safety Certificate


• Electrical Safety Certificate OR self certifying that the electrics are safe

You also need to bear in mind that if you take a tenant on, you will need:-

1. An up to date tenancy agreement.
2. To protect deposits in a tenancy deposit scheme.
3. To carry out credit checks on the tenant.

You can legally do all this yourself, but if it's your first time, it's wise to use a recognised service as otherwise you may fall foul of the law or end up with a tenant that causes more hassle than it's worth.

When the tenant moves in, you'll need to:-

1. Make sure all furniture and appliances are checked independently to meet fire safety legislation.
2. Have an inventory, ideally from a member of the The AIIC.
3. Secure specialist buy to let insurance to protect the property from rogue tenants and any damage.

Finally, remember that any excess rental income versus allowable costs your parent receives could be taxable, so you'll need to check this out too!

What to do if a lone parent is moved into a residential/nursing home permanently

This is such a tough time for everyone. Sometimes it's a relief all round, other times it can be very tense. Depending on your circumstances, you have two courses of action: to sell the property or rent it out.

Whether you decide to rent out the property or sell it often depends on three factors:-

1. Is your parent 'happy' to let go of the property or do they still think they will come home at some stage? This can be the case especially if people have dementia.

2. The state of the market. If the market isn't particularly buoyant, for example at the moment, then it might not be the ideal time to sell.

3. Whether you and your parent want to sell the 'family' home.

Essentially, if you haven't already, you'll need to deal with issues such as 'Power of Attorney' to allow you to take over your parent's affairs. The Alzheimer's Society explains this quite well, although your parent doesn't need to have dementia to have a Power of Attorney, but you will need their consent.

It is important to speak to your parent on a 'good day' and ask them what they would like to do, explaining all the different options and the pros and cons of each of them.

Pros and Cons of Different Options

Buying your Parent's Home
You might decide to rent out your own home (or sell) and buy your parent's home instead as it might be bigger, and just what you are after. Before you do this, you need to talk to a legal expert and an inheritance tax expert to find the best way for you to do this, for your circumstances.

Sometimes this option can be a real bonus to a parent as when they come to visit they are still coming back to their own home. However, it's more complicated if there is more than one sibling.

Pros
Your parent can come back for visits to their own 'home'.
May mean you secure the property you want for your family.

Cons
Difficult option if you have brothers/sisters as you might not be able to agree on a fair settlement.
Need to seek tax and legal advice which will cost several hundred pounds.

Equity Release
If you don't want to sell your parent's home now and renting it out won't cover care fees, then you could consider releasing some equity until you decide what you want to do longer term.

For more information about equity release, read our Equity Release guide. Make sure that any company you contact about equity release is a member of SHIP.

Pros
Relatively easy and quick to secure funds
Can help if money is tight during a stressful time

Cons
Can be more costly than selling up or renting
It's not an instant solution, so will take some weeks to set up

Selling your Parent's Home
In some cases you may have little choice but to sell the home to help fund your parent's costs of being in residential/nursing care. There have been some media reports of people having to sell their homes to fund their hospital care.

Pros
Makes a clean break with the home so your parent can move on.
The money can help support your parent while in care, helping to choose which home they go into.

Cons
May be too stressful for your parent to let go of the property.
If selling in a poor market, it may mean that it takes a while to sell the property and you have to sell at a discount to find a buyer.

Renting out your Parent's Home
This might be a good option if your parent hasn't yet accepted that they need to sell their home, or it's the right thing for them. It may also be helpful if the market isn't very good and it's taking some time to sell a property.

Pros
Leaves your options open so you have some time to decide what to do with the property.
Can help fund care costs if required.

Cons
Renting a home requires checks and changes to the property and will incur costs prior to renting.
Tenants could cause problems or damage the property.

What are your options if you have one poorly parent and one well parent?

On the one hand this can make things easier, as often, the parent who is well will be able to help make the decisions and they will often want to either stay in the home or move, so it takes renting out of the equation.

Ideally you'll need to discuss with both parents what they want to do, but it's important not to rush into anything. Many people making decisions at times like this when stress levels are high, end up making the wrong decision and then incurring more cost later on as they 'change their mind'.

As a result, it's important to consider lots of questions and then decide on some options which, ideally, can be trialled.

For example, when you have two parents, one of whom is ill either temporarily or long term, it's important to think through not only the next few months and the next year, but also what happens when only one parent is left. A hard thought I know, but it's often what people don't think through and the consequences of not working this out can incur further unnecessary costs later on. I know this is hard to do, but some may be better off staying in their own home, others may be better off downsizing and some may be better off moving close to a family member.

Top 10 Things to Consider when one parent is poorly or needs care

1. How 'attached' to the area are your parents? Are all their friends there? Do they have hobbies such as bowling/theatre nearby that they would miss if moved?

2. How adaptable is the home they are in? Does a downstairs bedroom/bathroom facility exist or can it be created?

3. Is it possible or practical to have care at home in the short or long term? How much would this cost?

4. Are there people nearby that can help in an emergency?

5. If one of your parent's is a carer of the other, how would you manage if they became ill?

6. If your parents do trade down, what equity would be left over after the sale to buy another home?

7. Would an ordinary property be OK or would your parents benefit from retirement living in specially built properties or warden aided facilities? What would be the additional costs of this type of property?

8. What facilities would the new property need to have? What is it likely to cost?

9. If a parent needs regular hospital/residential care, what transport facilities would be required long term? A car may be fine now, but can your parents get their easily by public transport/taxi?

10. How much can you as a family help with the care, what's practical, what other help and support can you secure?

There are lots of organisations that can help you with these decisions, for example 'Help the Aged'. Alternatively, your local social worker should be able to help and you should be allocated one during your loved ones stay in hospital or care. It's important to liaise with social workers as they understand the rules and regulations of funding short and long term care, and what other financial or home support help you are entitled to.

As we get older, we start thinking about how our lives will change in the years to come. It can be hard to face up to the facts sometimes - you or someone you care about can't go on living at home because it's just too hard. Moving into a nursing home or care home can be the result of numerous factors, but commonly it's down to the difficulty of living with health problems.

Ill health and disabilities that come with age can make life at home too hard without help. Having live-in care or carers at home is an option but usually this is too expensive for most people to afford. Plus there are modifications that need to be made to the home in order to make it easier to navigate and to help with washing and getting into bed. Family might not be able to provide the full scope of care, despite their best efforts. Sadly, some people might not have any family or loved ones to help.

Nursing care homes offer an opportunity to be cared for in a safe and comfortable environment. But the process of moving from your family home and into a new, strange environment can be upsetting. It can be very hard to leave the place where you raised a family and that you have so many wonderful memories of. That's why choosing a nursing care home that feels like home is so important. Meeting the people who you'll be spending time with, seeing the grounds and getting a feel for what life might be like in any particular nursing home is as important as the services provided.

Try to focus on the good things that living in a care home can bring. It can bring relief from the stresses that accompany old age and give you more time for enjoyment. You'll be part of a community of people, many with similar experiences to you. You'll have freedom to come and go, see friends and family and importantly, you will be cared for. Genuinely cared for. Staff in nursing homes not only have to be qualified in delivering care, they are required to be caring people. Forget the horror stories you may have heard or seen on TV. These nursing/care homes staff represent a tiny, almost immeasurable fraction of an otherwise dedicated, loving and brilliant workforce. If all the good deeds of care homes staff were reported on as much as the bad, there wouldn't be enough hours in a day to report them all!

All good nursing care homes provide round the clock care and provide some of the services that a hospital might normally provide, which distinguishes them from traditional retirement homes. Specialist nursing care can be accommodated for in some circumstances, so if you need any particular treatments or medication, speak to staff and nurses - they'll be able to arrange the best way forward for you.

Even if you merely suspect that something is not right with an elderly loved one, consider contacting a nursing home neglect attorney. Because the signs are not always obvious, many people struggle with the decision to take legal action. Even suspicion is worth talking over with a lawyer. He or she will be able to guide you to the right decision and help you figure out if you have a case. As you visit a loved one, look for signs that they are not being taken care of properly.

Falls

As a person gets older, the chance of falling tends to increase. For many elderly individuals, a fall results in more than just a few scrapes or bruises. Instead, if left on the floor for an extended amount of time, the trauma of the injury as well as the emotional trauma can take their toll. If a loved one has fallen, it may be time to talk to a nursing home neglect attorney to find out if there is anything that can be done. Listen to your loved one describe what happened and how long it took for someone to come and care for the problem. Facilities should be offering the proper care and observation for patients who have limited mobility.

Bedsores

It may not be unusual for a resident to spend a majority of his or her time in bed. However, if a loved one has started to get bedsores, it is time to talk to a nursing home neglect attorney. Bedsores are often caused by pressure on a certain part of the body for an extended amount of time. It may be several hours or in severe cases, it could be a few days. Because residents should be cleaned regularly if they are unable to handle the task on their own, someone should notice any bedsores before they get out of hand. In severe cases, bedsores can become infected and cause a series of different physical ailments.

Dehydration or Malnutrition

Not being provided with the right amount of nourishment can border on abuse. If a loved one seems to be dropping considerable weight without any medical explanation or you notice that he or she is not getting enough water, it is important to bring this to the attention of a nursing home neglect attorney. The lawyer will help you determine whether or not this is happening as a result of incompetent care of if this is a physical or medical issue that needs to be addressed.

In any of these situations, be sure to take note of anything your loved one is trying to tell you. Even with patients suffering from dementia, it is important to listen carefully and attempt to figure out if there is cause for concern. Once you feel like you need assistance, contact a local nursing home neglect attorney for more information.

Most people see long term care insurance as nursing home insurance when if fact it is the opposite. Long term care insurance provides options to avoid nursing home placement, unless a nursing home is where an individual prefers to live. And please do not misunderstand, nursing homes have changed significantly over time and many are now very clean and nice facilities. However, a nursing home is usually not where an individual would choose to remain for the final days or months of their life unless there are no other options.

Long term care insurance is becoming more popular as consumers realize it provides options for independence. Many studies indicate that two thirds of individuals over age 65 will require a long term care stay. A long term care stay is a nice way of saying nursing home or skilled facility stay. And over forty percent individuals over age 65 will experience a long term care stay lasting two or more years. This is a long time if you are in a facility in a shared room -- not a private room, with a roommate you dislike. Think back to those college years and consider how you might like to be in a similar situation at age eighty.

And surprise, Medicare will not pay for a long term stay. Medicare usually covers days 1-20 if medically necessary and progress for rehabilitation occurs. On days 21-100 the individual pays an insurance co-pay of $128 per day (in 2008) and after 100 days, the individual is totally responsible for one hundred percent of the cost which averages between $175-220 per day (in 2008). As with anything these costs are expected to increase each year by 3-5% percent.

Long term care insurance not only will pay for these long term care stays, it will pay for care to be provided at home, which is where most individuals prefer to live as long as possible. It also pays for day care, assisted living, home modifications and other services depending on the policy.

Many individuals mistakenly think that long term care is too expensive. As opposed to what I ask you? As opposed to $6,000 per month in a long term care facility? Compare a monthly premium of $200 to the cost of $200 PER DAY in a long term care facility and tell me if long term care is too expensive?

Many are shocked when the cost of one year in a long term care facility at $75,000 eats up most of their retirement savings. Or when they have to "spend down" to qualify for public assistance called Medicaid. The government has determined that with the increasing numbers of baby boomers who will require medical care in the future that there is no possible way that the government can fund this care.

Thus the Debt Reduction Act of 2005. This Act states that individuals wishing to qualify for Medicaid assistance will need to spend all of their assets prior to qualifying for Medicaid. And there is a five year look back period to ensure that assets like homes and money were NOT given away to family members in an attempt to avoid the government receiving these funds. When money or resources are given away, the government imposes a penalty equal to the financial amount given away divided by the cost of one month in a long term care facility. So for example, if your parents gave away $60,000 today and wish to qualify for Medicaid in 2009, Medicaid will accept the application and penalize them for ten months of care. This means that they cannot receive services through Medicaid for a period of ten months from the date of their Medicaid application. Which means that if the care is truly necessary, children and other family members will pay personally for the care.

Even more reason to consider long term care insurance not only for yourself, but purchasing a policy for your parents if they cannot afford the premiums. The question is will they pay now or will you pay later for your parent's care. Caring for parents and the emotional and financial stressors significantly impact the retirement prospects of children. Parents always assume that their children will take care of them but do not consider the impact on employment, retirement income and even marriages and children.

Don't put yourself, your parents or your children in a situation of requiring care and not having a back up plan on paying for care. Because we will all pay for care one way or another when we are older. It's inevitable. We will pay because of our ability to have long term care insurance that ensures we decide about our care. We will pay because our parents require care and they have not prepared financially for the cost. We will pay because we did not prepare financially for the cost by having to receive care through public assistance called Medicaid.

Unfortunately the probability that we will all die is one hundred percent absolute. The question is how do you want to spend the last years of your life? In a manner you choose or in a manner chosen for you?

When choosing an elderly care facility, it is important to know the difference between a nursing home and a senior citizens' residence. Barbados nursing homes usually provide short or long term nursing care in private or semi-private rooms, including, meals, activities, and personal care. Barbados nursing homes must have a registered nurse on duty at all times. Barbados Senior citizen residences provide short or long term nursing care (assisted living) in private or semi-private rooms, including, meals, activities, and personal care but do not require a registered nurse at all times. However, a registered nurse must be on call when required at a senior citizens' residence. The differences between a nursing home and a senior citizens' residence do not necessarily define the quality of care but basically helps you to identify the level of care you or your family member may require.

Choosing either a senior citizen residence or a nursing home may be stressful for you and your loved ones. It is helpful to plan ahead and understand the level of care that may be required. You should visit and compare a range of nursing care facilities or have someone visit and compare them for you. Make good financial plans early. Planning ahead gives you and your family more control and can help ensure that your short or long-term care needs are met. Both Barbados nursing homes and Barbados Senior citizen residences provides care for the elderly who can no longer care for themselves at home due to physical or other health related issues.

Steps to choosing a Barbados nursing home or senior citizens' residence that meet your needs:

1. Find out about the various services provided by the facility.
2. Find out how facility compare in quality.
3. Visit the facility you are interested in, or have one of their registered nurses visit your family member for an assessment.
4. Choose the facility that best meets the need of your family member and you.
5. Ask other people you know who have a friend or family member in the facility you are evaluating, if they are or were satisfied with the quality of care they received at the senior citizens' residence or nursing home.

Although you or your loved one may consider the clean appearance of a nursing home or senior citizens' residence, new paint, sparkling floors or lush surroundings, is no indicator of quality care. Quality care comes from people who work in the facility. You will recognize a well run senior citizens' residence or nursing home by the way you are greeted at the entrance and the way management expresses compassion towards your needs. If you cannot visit the facility yourself, you may want a family member or friend to visit for you.

Take a formal tour:

• Make an appointment and visit the senior citizens' residence or nursing home.
• Trust your senses. If there is an icy atmosphere as you enter or it does not have the homely, welcoming feeling you would expect in such an environment; then reconsider.
• Take a formal tour of the senior citizens' residence or nursing home with the supervisory staff member.
• Look around to get a better picture of the services, activities available, and the level of personal care of the residents.
• Look for safety rails in hallways, bed rails, and grab bars in bathrooms
• Do the nursing assistants seem genuinely fond of the residents?
• Do you see staff smiling or conversing with the residents?
• Is the living environment noisy and confusing or is it pleasant to the eyes and ears?
• Do you hear any laughter?
• Do you hear anyone singing?
• Is a TV blasting or are the call bells annoyingly loud?
• Are pathways and bathrooms kept clear of clutter?
• Are lunch dishes still noticeable unclean after 4PM?
• Is the kitchen screened to maintain a clean environment
• Does the temperature of the room/s feel too hot?
• Are there air conditioned or fan cooled areas?
• Use your sense of smell to detect any unpleasant odors bearing in mind that at any time some of the residents may be incontinent.

Ask questions during your tour:

• Ask questions that can help you compare the senior citizens' residence or nursing home.
• What services does the care facility provide?
• Ask the nursing assistants how long they have worked at the facility.
• Does the care facility have a current license issued by the Ministry of Health?
• Are staff members certified by The Nursing Council of Barbados?
• Do they charge a basic fee for room, meals, and personal care?
• Do they charge extra for other services or care for special medical needs?
• Ask about the length of time the care facility has been in business
• Ask to see residents' living spaces (private or multiple occupancies), hallway, stairs, lounge, bathrooms, dining area, menus, laundry services, activities plan and personal care plan.
• Is there use of a computer, fax machine or email available for quick transmission and receipt of important information?
• Are Admission Forms, Resident Personal Appliance Forms, Resident Valuables and Personal Forms, Leave of Absence Forms, Nursing Care Plan, Medication Charts and Resident Bed-Hold Agreement Forms etc., available?
• Is there a contract that clearly spells out the terms and conditions of the services offered?
• Ask where medications are stored to ensure that they are kept safely.
• Ask about emergency plans and procedures for patients who are ill
• Ask about emergency plans and procedures as it applies to hurricane preparedness.

The most important factor is the staff. The director of nursing or administrator sets the tone for the facility. She or he must demonstrate a sense of compassion, good organizational and interpersonal skills. Those with poor people skills cause high employee turnover. Talk to the nursing assistants to determine if they like working with management and residents. A skilled, friendly nursing staff is the key to good care.

Current Licenses and insurances (property and liability)

Although a current License from the Barbados Ministry of Health may not reflect the true nature of the care facility, ask to see it. By law the institution should operate with current License issued by the Ministry of Health, as well as property and liability insurances. If you receive excuses about why it is not available you may want to reconsider.

Quality of Life

Does the staff treat residents in a respectful way? Are there a variety of social, recreational, religious, or cultural activities? Do the residents have choices about their schedule and living space? Do the residents have privacy for visits or personal care?

Quality of Care

Is there enough staff to ensure that residents are getting the care they need? Can residents still see their personal doctors? Can you visit as often as you wish? Having visitors can make the transition to the senior citizens' residence or nursing home easier for you and your family member.

Preventive Care: Does the nursing home make sure that residents get preventive care to help keep them healthy?

Your informed choice will help you or your loved one in making an agreeable change from living at home to living in a senior citizens' residence or a nursing home. You can be your loved ones' advocate by observing their potential care and living conditions and discussing them with your family or family member.

Remember, there is more to choosing a senior citizens' residence or nursing home that just the price. It is the quality of care that counts.

A 1986 study conducted by the Institute of Medicine concluded many residents of nursing homes were being subject to ill treatment. This study fueled the efforts for reforms which became law in 1987. The Nursing Home Reform Act was passed as a portion of the Omnibus Budget Reconciliation Act of 1987.

The objective of the reforms was to ensure patients received the highest practical care to foster their mental, physical, and psychosocial well-being. The act established a Resident's Bill of Rights and specifies services which should be given. Medicare and Medicaid payments will be halted if the facility does not comply with the reforms. As nursing homes rely on the majority of their expenses to be funded from these sources, the facilities are forced to make sure their care is up to standards.

Required resident services include: comprehensive care plans for each individual resident, periodic assessments by professional, nursing services, rehabilitation services, social services, pharmaceutical services, dietary services, and if the facility houses more than 120 patients, it must employ a social worker full time.

The Residents' Bill of Rights gives patients the following:

-The right to freedom from abuse, mistreatment, and neglect;

-The right to freedom from physical restraints;

-The right to privacy;

-The right to accommodation of medical, physical, psychological, and social needs;

-The right to participate in resident and family groups;

-The right to be treated with dignity;

-The right to participate in the review of one's care plan, and to be fully informed in advance about any changes in care, treatment, or change of status in the facility; and

-The right to voice grievances without discrimination or reprisal

To asses whether nursing homes meet the criteria as designated by the Nursing Home Reform Act, the law established a certification process. It requires the state to conduct unannounced surveys and resident interviews at random times. However, the government did not issue regulations for the process until 1995. If there are specific complaints filed against a nursing home, the residents will often be surveyed accordingly so if a problem exists it can be detected.

If a nursing home is found in violation, it might have the opportunity to correct deficiencies before discipline is imposed. However, the following sanctions have been imposed for facilities which do not pass: directed in-service training of staff, directed plan of correction, state monitoring, civil monetary penalties, denial of payment for all new Medicare or Medicaid admissions, Denial of payment for all Medicaid or Medicare patients, temporary management, and termination of the provider agreement.