Nursing Homes|Nursing Home Abuse|Assisted Living Facilities

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

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

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

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

Calling a personal injury lawyer about nursing home abuse could be the first step to both a resolution to the situation as well as a settlement for the pain and damage that was caused. Unfortunately, these incidents have become far to commonplace and nursing home residents don't always have someone to turn to. Abuse and neglect of the elderly is an important problem that needs to be addressed sooner rather than later.

Contacting Legal Representation

It is important to find a personal injury lawyer with experience in this area. Each state has its own set of guidelines and regulations that need to be followed. Finding someone that has gone after nursing homes in the past and knows what it takes to pursue case will be beneficial to your situation. Choosing someone local gives you the benefit of someone that is already well versed in the local laws. If you have not already set up an initial consultation, now is the time to make an appointment.

Organize Your Information and Evidence

You want to walk into your personal injury lawyer and be able to give him or her details about the case that have been documented. You may have a notebook that lists different incidents that you have witnessed or evidence of issues and problems that took place while you were gone. If you can put this information into some type of order, by the date of the incident, it will help make things more efficient. With organized information, your legal representative can begin to research and look into the legal options you and your loved one have.

Find Out What You Need to Do

If you are not the Power of Attorney for your loved one, things might come to a stop without this person's help and consent. Talk to this person about arranging for a copy of all the medical records and information about your loved one from the nursing home. This information will be critical to your case.

You know the most about the situation. Your personal injury lawyer may ask you to go to friends and family members to talk to them about any evidence that they may have seen of the abuse or neglect. It is important that they consider testifying and sharing their information with the attorney. Before starting up these conversations, make sure that you talk to your legal representative. You want to make sure that you are following the right guidelines when it comes to these conversations.

Be Available

Throughout the process, your personal injury attorney may have questions about the case or need more information. In some cases, a law firm will have their own team of investigators. This will be beneficial to you in that they will be able to look into the situation and provide more information from an unbiased individual. When it comes to proving your case, having an investigator can be a huge advantage.

If you ever visited nursing homes as a child or teenager, perhaps what stayed with you the most was the smell. It is unfortunate that some care centers were unable to control that. Thankfully, care facilities today are much improved. They are often beautiful facilities where hurting people are cared for and loved. If your loved ones ever need full-time care, that is the type of home to consider.

If you do have relatives who need to move into a home, it is likely a very difficult time for you. You might feel like you are betraying them, especially if they are against the move. It is important to do what is best for them. What is often best for families who are having difficulty with the process is to be with nurses that know how to help your loved one's medical needs and everyday needs.

As you look at various nursing homes, it is important for you to go in as a visitor and look at the conditions. It should not have a strong odor, the area should look sanitary, and the residents should seem happy and comfortable. Of course, there are always exceptions as some of the residence will be sicker than others. You may want to go back on a few different days to see if anything changes.

Once you visit unannounced, you may want to make an appointment to meet with the administrator to have a tour. At that time, you could also ask if you could join the residents for a meal. By doing this, you will be able to see what the food is like. Something that you will not be able to experience by visiting is everyday life for your loved one. The only way to know anything about this before choosing a home is to read reviews that have been written about certain nursing homes.

Before sending your family member to a home, you should ask if you can stay the night. This might be completely out of the question, but it does not hurt to ask. You would, of course, have to stay in your assigned room, but you could at least experience a little of what night time would be like in a particular home.

Once you feel comfortable with a home, you can have your loved one admitted. It will probably only work to send them to a home if they are compliant. You cannot really force them to go anywhere unless you have Power of Attorney. It is best if they go to a home willingly anyway.

Nursing homes should make their residents feel comfortable. You should visit every day, especially at first to make sure that everything is going well. You are your loved one's advocate when they are in a home. It is important to make sure they are getting the care and comfort that is needed.

The vast majority of us conduct our lives often unaware of the principles that govern consequences. This often leads to us wondering why things go wrong and not understanding the results we achieve.

Obviously no one is perfect; however, truly successful individuals are masters at living principle centered lives.

So, what does it mean to live this way?

The goal of this article is to help define for you the meaning of living a life in alignment with principles and also to raise your awareness to its importance in your success.

The first thing to understand is that principles exist and operate in our lives whether we are aware of them or not or believe it or not. They are unbiased and impartial in nature and simply governs the results we achieve based completely upon our choices.

By definition, principles are natural laws - these are the rules of nature. They do not change, they simply are. In other words, although you might be able to cram for a test the night before and even pass it the next day; you couldn't possibly sustain a successful living in the field of this test if you only crammed the night before. Your success would be short-lived.

It's like a farm; you can't cram on a farm because it is a natural system. You must first plant the seeds and then pay the price day in and day out to water and fertilize the earth until the crops reach maturity. Then and only then can you reap the fruits of the farm. The farm then is like principles - no shortcuts - you have to pay the price otherwise the results you achieve will not be the best that they can be.

When you live a principle centered life, your choices are based on your core values and beliefs fueled by doing what is right. In so doing the consequences you reap will always be good.

Following are a few examples of what I mean by principles.

1. Do unto others as you would have them do unto you- this simply means that you treat other with the same type of love and respect you want others to treat you with. You do not judge and play "tit for tat", you behave the way you want others to behave - you set the example. By doing this you set things in motion that inevitably bring back to you the same treatment or better from others.


2. You have what you have and you are where you are because of the choices you've made- this means that if you were to examine the choices you've made thus far in your life and you were honest with yourself, you would easily see that the results you have achieved are directly related to the choices you've made. Sure, you can play the blame, shame and lame game; however, it won't change the fact that your choices got you where you are today with what you have and nothing else.


3. The more you show gratitude, the more you get to be grateful for - ever notice how the more up you are the more the universe fights to keep you up? The exact opposite is also true as you may have noticed; the more down you are the more the universe fights to keep you down. This is just a natural law - you can feel it when it's happening; however, most are powerless to do anything because they lack the awareness that they have options.

Think about these 3 concepts - principles - and you will begin to realize that they are not only true but unfailing in operation. They are not a matter of opinion or theory - they simply are and will continue to be so for eternity.

The later years in life don't always sound too appealing. There's a lot to being old that elderly people wouldn't recommend to their younger counterparts! But, as we all know it's an unavoidable fact of life; we'll all get old some day.

That doesn't mean that you'll have to stop doing things - granted, age can limit our physical and mental abilities to some extent, but this will vary from person to person. Being old is more of a mindset - some of the most senior people in my life are also some of the most active, healthy, sharp witted people I know and they show no signs of slowing down! But Those I know who have slowed down are still looking for challenges and enjoying life.

Retiring can leave some people feeling at a loss. At a stage in life where daily work is no longer available to you, what is there to do? Seniors often find themselves with much more time on their hands day to day than they used to have. Not working can leave a pretty big void - if you see it that way at least. The best way to see it is as opportunity - you can fill that time with something you've always wanted to learn, go places you've always wanted to go and do things you couldn't have done with the commitments of work holding you back.

Traveling the world is a journey many seniors embark on and for obvious reasons. Experiencing the beauty of the earth, it's countless peoples, cultures and delights is in amongst the most rewarding experiences that life can offer - and it's never too late to do it.

Moving into a care home later on in life can add to or bring back feelings of 'uselessness'. Don't feel that you've lost anything, in fact you're gaining a great deal by moving into a nursing home - proper care, comfort and access to new things, giving more time to pursue the things you love. Do you like playing an instrument? Maybe you and some other residents could play together, form a house band and put on shows for the whole community? Or how about writing and painting? Even if these are things that you don't do now, wouldn't you love to learn? Retirement can offer that opportunity.

Some of these activities can cost little or nothing to do, so you've got nothing to lose by trying. Retirement can be a financially difficult period - but still, it shouldn't stop you enjoying life and having new experiences. Being in a care home can offer you more time and opportunity to do the things you love, plus you get the benefits of care and a safe, welcoming environment, with all the support and help you'll need to get the very best out of life.

If you are feeling like Chicken Little, you have every right to feel this way. With seniors seeing all of their hard earned nest egg disappearing they are in a crisis and they are feel the pain? This article was taken from a noted person who deals with the senior's health issues on a Daily basis.

I want to thank them for bring this issue out so many can get the help they need. If and when you are felling like you have no options think about this. You work you entire life to pay for your home, let it pay you now and not worry about what you are going to leave your family. Think about how they will feel if you are financially doing well, and can afford to live without being a burden on them.

You can accomplish this by receiving a Reverse Mortgage. It often is at the moment when an elderly patient is about to be discharged from the hospital that he or she first faces the prospect of having to pay the total long-term expenses of either nursing-home or home care services.

This easily can come to $50,000 or more a year -- at a time when the primary objective for any patient and family should be excellent care and emotional support, not a desperate fight to preserve one's income and savings. It widely is known among older Americans, their families and their friends that a long-term illness could wipe out a patient's savings. Long-term care includes many different support services aimed at helping chronically ill patients either in their homes or in a nursing home.

Medicare does not pay for long-term care. The only government assistance for the expense of long-term care is the health insurance for the poor, Medicaid. Tragically, some families would rather risk substandard facilities for their loved ones rather than choose the Medicaid option. As a former investigator for the New York State Attorney General's Medicaid Fraud Control Unit, I have seen firsthand many victims of the system.

One elderly woman, who was not poor enough to qualify for Medicaid, was exhumed from her final resting place to determine whether she had been starved to death by the operator of an illegal nursing home whose monthly fees were less than half of its licensed competitors. Unfortunately, this case is not an isolated example of a family under duress resorting to underground providers of care to shield a loved one's assets. Long-term care, whether at home or in a nursing home, often can wipe out the life savings of a chronically ill patient in one year or less.

Under current eligibility rules for Medicaid coverage of long-term nursing care, a recipient usually may not have assets in excess of $2,000. This has led many Americans to manipulate the Medicaid system by transferring assets to heirs and beneficiaries in an effort to avoid spending their life savings on nursing-home care. Some Americans, desperate to preserve an estate, have taken extreme measures such as divorce or spousal refusal, whereby one spouse refuses to pay for the long-term care needs of the other.

Some have been able to use loopholes in the Medicaid system to transfer part of their life savings before they apply for Medicaid. Others have stopped saving and simply spend all of their income without regard for the future. In effect, some people are using Medicaid as their long-term care insurer, while others who do not game the system are systematically impoverished as they pay privately for their own care.

Then, having finally qualified, these people are reduced to a state of humiliating poverty and dependence on government support. Many cannot afford to pay the transportation costs of visits from their relatives or to upgrade their living quarters. This perverse system rewards deception and punishes law-abiding citizens. Financing long-term care is supposed to be the responsibility of the patient.

In reality, the burden falls on the taxpayer, because the payments for almost 70 percent of the long-term care needs of older patients are paid for by Medicare and Medicaid. Many hardworking and independent older Americans in need of long-term care have contributed a lifetime of energy and dedication to their communities and the country. These people and their families do not want to be on medical welfare. The optimal solution for improving long-term care is a dramatic increase in the number of private payers.

The Institute for Social Economic Studies has developed a proposal to solve this problem. Under the institute's plan, every dollar paid out by the patient would protect a dollar's worth of assets from the draconian requirements of Medicaid eligibility. For example, if a patient with life savings and property totaling $100,000 spent $50,000 for long-term care, the remaining $50,000 of assets would be protected from eligibility rules, providing the patient would otherwise qualify for Medicaid. Although some of a patient's assets would be protected, all of a patient's income would be used to pay for long-term care under this plan.

In addition, to further promote private funding, this plan would protect all of a patient's remaining assets (not income) after he or she pays for three years of nursing-home care or six years of full-time home care. Under this arrangement; elderly patient not their relatives would have control over their hard earned savings and could use them to purchase personal items and luxuries currently out of reach to many. The numbers of older Americans will more than double in the next 32 years. By year 2030, the elderly will account for 20 percent of the population and number more than 80 million. It is urgent that we develop a solution for long-term care now.

If we don't act, everyone -- workers, our children, our parents and our grandparents could pay a severe price. Let's avoid this tragedy while time is still on our side by older seniors who own homes receiving proceed from a Reverse Mortgage they can shield themselves from financial disaster.

Some are having trouble sleeping, she says, others are not eating well, and a few have taken up smoking again. But most say they no longer feel in control of their financial future and well-being after the wild market swings of the past few weeks. Constant news reports on home foreclosures, bank failures, the credit crunch, a $700 billion bailout for the financial industry and the steady erosion of retirement savings have jolted anxious and easygoing types alike. But for those nearer to retirement, or living on fixed incomes, the stakes are higher-and so are stress levels. According to an American Psychological Association (APA) poll released in October, the miserable economy "significantly stressed" a whopping 80 percent of Americans in September, up from 66 percent in April. The survey compared the stress levels of more than 2,500 adults nationwide.

Among the respondents, women reportedly felt more anguish about declining economic conditions than men did-84 percent compared with 75 percent. And those over age 63 reported more stress (86 percent) than boomers ages 44 to 62 (83 percent) and those ages 18 to 29 (71 percent). However, when it came to day-to-day pocketbook issues, the youngest age group (83 percent) reported being more worried than boomers (79 percent) and those 63-plus (73 percent). A separate survey of working adults, released Oct. 27, found that 92 percent said financial worries were keeping them up at night.

The poll of 1,137 people, conducted by Com Psych, a provider of employee assistance programs, said the biggest concern for respondents was the high cost of living (30 percent),credit card debt (29 percent), mortgage payments (14 percent) and declining retirement accounts (13 percent). Alan Keck, a psychologist in Altamonte Springs, Fla., says the mounting stress his clients are carrying has "complicated their treatment." He hears growing complaints about sleep disturbances, unintended weight loss, depressed mood and obsessive thoughts. "I can tell you that the economy has played havoc with the plans of a few of my clients-everything from delaying the completion of the divorce process because of inability to sell a jointly owned house, to full-blown anxiety and depression syndromes over threatened loss of retirement savings," he says.

For older workers, a declining portfolio can be enough to provoke fear and panic. One woman in her 60s, who is planning to retire in two years, says she gave in to that fear two weeks ago when she bailed out of the stock market and opted for safer investments in money market funds and CDs. "I was constantly worried that I might lose what I've built up," says the woman, a publishing industry professional who asked to remain anonymous. "I don't know if I did the right thing by pulling out of the market; we'll see how things shake out.

I just wanted to preserve what I had. Uncertainty when you're nearing retirement is very stressful." So in closing I want to again thank them for posting this article to help seniors around the world know that they are not alone. To find out how you can increase the money you need for retirement and how a Reverse Mortgage can help stabilize your future see the facts.

Advantages Choosing Residential Assisted Living over Nursing Homes

Making the leap from living at home to living elsewhere is a decision that shouldn't be taken lightly. Most people will eventually face the dilemma of having to move either to a nursing home facility or an assisted living facility - and there is a big difference between the two. There are many advantages to choosing residential care homes over nursing homes or other facilities.

Home Environment

The biggest advantage that care homes have over nursing facilities is the home environment that residents experience. Not to impugn the nursing home industry as a whole, nursing homes provide a hospital type of setting that is clinical and not very much like living at home. Care homes offer a home-like environment that is very much like living in your own home; in fact, some residential care homes feature resident apartments, or at the very least, private rooms. In a nursing facility you will likely have a roommate and not very much space for your personal belongings.

Quality of Life

The quality of life for those who choose assisted living is typically greater than what is experienced in most nursing homes. Because the assisted living resident is encouraged to maintain their independence and remain active, these residents can enjoy their senior years to the fullest. There are activities planned for group fun or individual entertainment - and residents are further encouraged to run errands and keep appointments, entertain guests and more. Nursing facilities cannot offer this freedom.

Cost

The cost of a nursing home stay is around $4,000 each month; assisted living costs around $2,400, although it can be far less, depending on the facility that you choose. Because adult care homes usually charge a flat rate that encompasses rent, utilities, care, meals, and more - the cost of assisted living is a good value for most seniors that are covered by many private insurance companies and long term care insurance. Many nursing facilities will eventually seize and sell your home or other valuables to pay the cost of care after you have been admitted to their facilities for a certain period of time. Adult care homes do not follow those same guidelines.

If you are still independent enough to provide a certain level of self-care, but are just struggling with particular aspects of maintaining your ability to live on your own, residential assisted living or adult care homes may be for you.

Assisted Living and Nursing Homes are two terms often used interchangeably, however this is a mistake. The two are actually very different, and a candidate for one is not a candidate for the other. The following are some differences between the two:

Assisted Living Facilities:

o Individuals in assisted living are more independent and can usually get through most of the day by themselves. They only need general help with daily activities like bathing, dressing, grooming and preparing food.

o Candidates still enjoy social activities with other people and make autonomous decisions about their day. Someone who belongs in an assisted living facility would be downright miserable in a nursing home.

o These living facilities require limited to no medical care. An ideal assisted living facility candidate would be in good health both mentally and physically.

o These facilities focus on personal privacy and self-sufficiency more so than a nursing home. Residents are able to maintain their independence in a more secure atmosphere.

o These facilities offer their clients a comfortable apartment that is luxurious and comfortable. Meals and light housekeeping are available.

o Assisted living facilities offer mature adults an alternative with care when needed and would prefer not to manage their large house anymore.

Nursing Homes:

o Those in nursing homes need a great deal more care. They usually require 24-hour nursing supervision and are generally not in good health. Nursing homes are equipped to handle patients who are not mentally or physically well.

o Nursing home patients require help with much more than three or more daily tasks - such as walking or being pushed in wheel chairs, eating, and regular medical tests.

o A nursing home is a place for someone who is unable to be cared for at home, but is not a candidate for hospital care. Although, some nursing homes are set up like hospitals to meet state requirements.

o Nursing homes also provide rehabilitation to help people gain back their independence after a serious health problem, i.e. a stroke or fall.

o Similar to hospitals, nursing home patients have little to no privacy and quite often share rooms.

o Nursing home clients are viewed as patients, not clients. They are there for the sole purpose to get well. If you or your parent is well, a nursing home would not be the ideal place. Perhaps you should investigate an assisted living facility near you.

It is certainly possible for a parent to sign a deed transferring complete title of the parent's home to a child. However, the parent should be very sure he or she understands the ramifications of signing such a deed.

First of all, this is a taxable gift. However, in most states there is no state gift tax to worry about, and if your total gifts during life will never exceed $1 million, you'll have no federal gift tax to worry about, either.

Second, and more importantly, you no longer own the house. That means that you're at the mercy of your child who now owns it. But you're not worried about your child kicking you out, you say? That's not necessarily the issue. What you should be concerned about is if your child gets sued because of a business deal gone bad or a car crash where the injuries exceed your child's auto insurance policy limits. You should also be concerned if your child gets divorced, with the divorce rate being as high as it is. You see, although even after you've signed the deed you may still think of your home as "your" house, it is now really an asset of your child's, and those creditors will have no problem foreclosing on "your" house and booting you out.

Third, there is the impact on Medicaid eligibility. If you or your spouse deed your home to one or more of your children, that transfer will cause a period of disqualification from Medicaid. This is called a "penalty period." The length of the penalty period depends on the value of your house. The formula the states use is this: amount of gift [divided by] penalty divisor = # of months penalty. The "penalty divisor" is a figure set by each state, roughly equivalent to the average cost of a nursing home in your state.

Example: You deed your house worth $150,000 when your state's "penalty divisor" is $5,000. $150,000/$5,000 = 30. Thus, if you applied for Medicaid the next day--or anytime prior to five years from now--you would be disqualified for the next 30 months. The only way around that is if you waited at least 5 years and then applied for Medicaid. At that point, the gift of the house would be ignored, since it is outside of the 5-year "lookback" period.

If in the above example your house were worth $350,000, the penalty period increases to 70 months! Of course, in that case, you would definitely want to wait to apply for Medicaid until after the expiration of the 5-year lookback period. If for some reason you forgot and actually did apply before the 5 years were up, you would be faced with a 70-month penalty period. There is no upper limit to the length of the penalty.

There are exceptions to the above rule that allow a transfer of the house without it causing a penalty. These exceptions will be discussed in future blogs. Stay tuned!

There are many veterans and surviving spouses of veterans who are currently either in assisted living or are looking to move into an assisted living community; however, the costs become such a burden on the resident and often times, the family has to keep their loved one at home due to the high costs of moving their loved one into an assisted living community. What many people don't know is that there is a benefit for veterans and surviving spouses of veterans. The benefit is called Aid and Attendance and is provided by the VA. For the actual veteran, he/she can receive up to nearly $2,000.00 each month as a reimbursement for his/her expenses in assisted living.

Now, I'm not the expert on getting you the benefit, but I am the expert on giving you enough information to know if it's something that you should be looking into and where you can get more information. For the surviving spouse, he/she may be eligible for close to $1,000.00 each month as a reimbursement for his/her expenses in assisted living. Now, you or your loved one is living in a skilled nursing facility and you're wondering if the benefit will help pay for those costs. The answer is, absolutely. Most (if not all) medical expenses in fact, are reimbursable up to the cap amount that was mentioned previously.

How do you know if you qualify? Here are a few tips. The veteran will have had to be on active duty at least one day during one of the major wars such as Vietnam, World War II, or the Korean War, etc. The VA will look at your current income also. If your income is less than your medical costs (and yes, every penny of the cost of assisted living is considered a medical cost), you will be eligible to be reimbursed up to the full amount of the benefit. For example, say your income is $1,500 per month and your medical expenses are $3,000 per month. You will be eligible for a reimbursement of up to $1500 each month. This amount is paid to the veteran directly and not to the facility. Will they take into consideration that the veteran still owns a home and has other assets? Yes, however, there are legal ways to move these assets around to become eligible for the benefit. I would use the professionals to help you do this to make sure you're doing it right.

Now, how do you get the benefit? There are two ways. You can either go to the VA yourself and do all of the paperwork yourself or you can have a company help you in the process. There are pros and cons to each. If you do the paperwork yourself and work directly with the VA, it may take a while as there are several forms to be completed and if you don't submit them just right, it may delay the reimbursement. If you use a company that specializes in this process, they'll know exactly what needs to be submitted and they'll help you submit it correctly the first time (allowing you to start getting the maximum benefit). These types of companies typically charge anywhere from $500-800 to help you complete the paperwork, but that will pay off after one month of reimbursement potentially. http://va.gov is the site where you can find more information about this benefit. Put in the key word "aid and attendance."

So how do you find a company that will help you in this process? I would call an assisted living community near your home and ask them. In Utah there is a company in Salt Lake County call Senior Care Associates that does a pretty good job at this.

One final and very important piece of information. With this benefit, it's not retro-active in one sense; however, there is a form called Statement in Support of Claim found at va.gov/vaforms/form_detail.asp?FormNo=21-4138. THIS IS SO IMPORTANT! Get this form in first. From the time that the VA receives this form from you, you will be reimbursed back to the date they received this (while you're taking some time to gather all of the other necessary forms and documents to get the benefit).

After jumping through all of the hoops, you'll be grateful to have know about this benefit. Now you need to share this valuable information with others who could benefit from it.

As with any other field, nurses should look into what their short and long term goals are, in order to advance themselves career-wise. Nurses may be considering these objectives if they're already in school, or are planning to enroll in advanced education. Factors to consider when goal-planning as a nurse include:

1. The Desired Position:

Planning for a general nurse in health care settings? A Bachelor's is well-suited for this position.

If you have goals as a nurse practitioner, midwife, clinical nurse specialist, anesthetist nurse, administrator or educator, then a higher education requirement will be needed, which is detailed below in the article.

2. The Working Environment:

Would you like to work in a hospital, a nursing home or a medical office? Industries with the highest nursing employment concentrations as per the Bureau of Labor Statistics, include general medical and surgical hospitals, home health care services, offices of physicians, nursing care facilities and outpatient care centers. There are also opportunities to work as a visitation nurse, or in niches such as travel and cruising, or in schools.

3. The Compensation Package:

In any career plan, the compensation package will be one of the top things to consider, and whether this salary meets the lifestyle preferences of the individual. According to the Bureau of Labor Statistics, the mean annual salary for registered nurses in the year 2011 was $69,110. Think about whether or not the package includes benefits like a health plan, 401K and other popular perks.

4. The Educational Requirements:

Once you've determined the position, compensation and environment you want to work for, consider what educational requirements are needed for that goal. A supervisory nursing position for instance, will require a Bachelor's in Nursing Education. A master's degree is able to propel a general nurse into a supervisory role within a year or two, depending on the school's course length. The good news for nurses is that they are able to pursue higher education while working by going to school online, on weekends or in the evenings.

These are some of the most important factors to consider when planning for nursing goals. One surefire way to meet objectives more easily is with a plan. While there will certainly be uncontrolled variables, having a step-guide will help planners move from entry-level employment into more professional roles.

After a assessing, planning and implementing long and short term goals, nurses can then go on to periodically evaluate their own personal fulfillment in the field, and decide what needs work. Nursing one's career with goal planning, as most will find out, is the best way to succeed.

As the population of the world increases the basic needs of the population (food and shelter) are met with increasing ease. One result of this is that less of the population is employed in providing these basic needs. At the same time more and more people are living longer and in better health. A great majority of these people want or must work to keep pace with the ever-increasing cost of living.

More people living on less disposable income with less essential work for them to do coupled with more purchasing options from producers located all over the world selling through the internet adds up to the following:

1. More people are providing goods and services that do not fill needs; they fill "wants" which skillful marketing has transformed into necessary for us to be happy. Does any man go even one day longer between shaves when he uses a razor with five blades instead of one? So when we shop for any of these non-essential "wants" (dinning out, vacations, clothing, entertainment, etc.) we tend to look more closely at the perceived value - which means we shop for the best price.

2. The "new" products and services brought into the market are largely variations of goods and services, which already exist. For them to be successful they depend more on presentation than meaningful features. This translates into skillful marketing concepts (zero down payments, extended warranties, longer payment terms, more style changes, more meaningless features.)

3. The intermediary in the distribution process has changed from "mom and pop" stores to major retailers with revolving door clerks and the manufacturer has done away with its dealer or representative network, and moved into direct selling. And the purchase and the guarantee are no longer covered by a handshake but by a multi-page series of documents. (Has anyone seen an unconditional guarantee recently?)

The backbone of the small businessperson, the relationship they could establish between their business and their customer has been systematically removed from the marketplace. The transaction has become the buyer's highest priority.

What can the entrepreneur do? Where should he or she concentrate their efforts to make their business successful?

Without a truly unique product or service one must concentrate on controlling costs. One way to do that is to vertically integrate.

If you create a low cost culture in your business you can bring the goods and services you provide to the customer by providing "real" value, not perceived value. When you focus on continuing to lower costs and passing on the results through lower prices, you can effectively compete and win.

How do you lower costs?

Do a cost analysis on everything you make or provide. This effort will show you where you make the most money and where you make the least. If you must continue to provide the low profit item, start looking to buy it from somebody else or start offering it to your competitors who may be in your same situation. Higher volume may enable you buy it cheaper than you can make it or sell it cheaper than the other guy can make it.

This same analysis may help you find high-cost elements in a complex product or service that you could farm out to a specialist for less cost.

This all comes under the label "outsourcing." You may not have to send your work to a third world country; you may accomplish your objectives by shopping harder in your own backyard.

The Big Three fell on hard times for a number of reasons, but a major contributor was the fact that they never adopted a low cost culture where it counted. They beat up their suppliers who were free to make decisions every day as to which of their customers they would service the best and which they put lower on the priority list. But they rolled over on the demands from the unions whose members had far fewer alternatives for a paycheck.

When you bring an attitude of lowest cost processes, and resources into your business, you are in control, you will be working with costs you can measure in terms of productivity

Marketing is important, but it is difficult to evaluate. As some business person once said, "I know that 50% of my advertising dollars work, I just don't know which 50%."

We all know there are different professions working in medical field and the most we interact with is the healthcare profession. When we talk about the health care profession nurses are the one working day and night in wards, homes, medical centers and in nursing homes. There are different types of nurses, if a person claim to be a nurse then we cannot say that the person can perform all the nursing tasks. Nurses are divided into different categories for some specific tasks and they get trainings and education accordingly. A certified nurse assistant is the basic nursing and there is a certification exam students need to pass in order to become a nurse. Then there are licensed nurses who supervise the certified nursing assistants and perform some major tasks as well. The highest rank in nursing profession is a Registered Nurse who monitors the entire characteristics relating patient care.

These three are the major types of nursing, now if we talk about the trainings and education; these nurses need to start working in healthcare profession. Certified Nursing assistant gets a few weeks training which qualify them to pass the exam for the certification. The Certified Nursing Assistant trainings are provided by almost every school and college in country.

The American Red Cross is also facilitating students with training in approximately 38 cities. Students can also take their classes online by registering with the websites providing the training classes. The duration for the training varies according to the states rules. Then the licensed Practical Nurse training duration for a practical nurse is from 9 to 18 months depending on the institute. The training entry requirement is high school Diploma however some institutes have a requirement of a prerequisite training. There is an entry test for the admission to check the student's skills. Once the training is finished, students are required to pass the exam for license. After getting the license they can work as licensed Practical nurses. Now how to become a registered Nurse? You have to pass four years bachelor degree BSN bachelors of sciences in nursing or you can also get an associate two years degree which is cost effective and saves time as well. If you do hospital diploma for four years you can also become a RN but then you have to pass the license exam and have to apply for a RN license.

All types of nurses work in same ward either in cardiac or in general ward they will be helping patients but with different responsibilities. Certified nursing assistants help Licensed Nurses with their daily routine work and also help patients with feeding, cleaning and grooming. The licensed Practical Nurses check the vital signs for the patients, help them with the medicines and also give them the injections, they also perform some simple laboratory tests and supervise the Nursing Assistants. The responsibilities of a Registered Nurse are to maintain the records for the patient's medical and vital signs amend the treatment procedure by examining their symptoms and changes in patient's conditions and also report them to the doctors.

Let's admit that we are humans and we are not robots. Therefore, we can get exhausted or tired and we can't ensure that we'll always be able to do everything on our own. When you have a senior at home or anyone who has a condition that needs constant care and at the same time you have your own family and a job on the side, I tell you, you need help. You won't be able to attend to all your responsibilities without battling stress and breaking down when you're almost fed up. So, I'd like to let you know that the best help you can get is that from a private home caregiver. Why?

Hiring private home caregivers allow for the flexibility of responsibilities that clients would like them to have compared to those in nursing homes. There are a lot of tasks that private care providers can do. They can provide life assistance services like bathing, grooming, dressing, etc. Caregivers who have medical backgrounds can also provide medical assistance like first aid, checking vital signs like blood pressure and they can ensure that patients are taking the right medications in right amounts. The best thing about this is that we can actually customize their tasks according to what we need as clients or what the patient needs. Just make sure that the tasks are clear right before the carer starts to work to prevent any misunderstanding. It is also advisable to have everything in paper to make sure everything is accounted for.

Secondly, let's face that we can't always be at home with our elderly loved ones. We need to attend to our own responsibilities, own families, own jobs and the list just goes on. And during these busy times, private home caregivers can actually serve as our loved ones' company. It will be good to have them around so that our seniors will have someone to chat with, watch the TV with or just go through everyday life without feeling lonely or bored.

Aside from the fact that it's really sad to leave our seniors unaccompanied at home, we also need to remember that they need someone who can be with them in case there's an emergency. We'll never know when will an accident or a medical mishap occur and we need to be ready for that. Having a private home caregiver ensures that our loved ones will not be left uncared for and unattended.

Another reality is that sometimes, even if we are at home, something just suddenly comes up. We can receive a call from a friend or a colleague and we just have to leave the house again for hours. So who's the best person to call in cases like this? Of course, it's your private home caregiver! I know that there are specific working days specified when they sign contracts with clients. But then again, they're always our options. If we ask them if they can be on duty even if it's not scheduled and they decline, then find another person who can be there at the moment or better yet, don't leave the house. But knowing how understanding most caregivers are, most of them might actually show up and help. We just need to make sure that we can pay them extra when this sort of thing happens.

Private home caregivers are trained and certified. They have excellent nursing skills that qualify them in assisting patients at home. Most of them are either Registered Nurses or Licensed Practical Nurses while some have taken vocational caregiving courses. We can all be rest assured that they know what they are doing and that we can entrust our loved ones' lives to them. Before practicing in the field, they have undergone classroom lectures and several written and practical examinations that evaluated their performances. If they have passed, then that means they are capable enough to be practicing in the field. So again, make sure that your private home caregivers have accreditation or licenses duly recognized by authorized agencies before hiring them.

In addition to monitoring food and liquid intake of nursing home patients, the staff needs to pay attention to the elimination of the wastes. When urine and feces are not produced on a regular basis, the nursing home staff must bring these problems to the attention of physicians.

One of the more obvious cases of nursing home neglect my office is working on involves a patient who went at least 10 days without a bowel movement. Shift after shift of nursing home staff tended to our client-- yet no one cared enough to look at his medical chart to see when the last bowel movement occurred. It was not until the man was taken to a local hospital, was it determined that the man's bowel had become impacted with feces. Within 24-hours of his admission to the hospital, the man died from complications related to sepsis.

What is an impacted bowel?

An impacted bowel is the condition where feces are trapped in the lower part of the large intestine, causing a waste obstruction. The stool collects in the bowel and becomes hardened. This hard stool can irritate the rectum, resulting in the production of mucus and fluid which can leak, causing fecal incontinence.

One of the most common symptoms is lack of appetite, caused by pressure on the abdomen. Hemorrhoids (a mass of dilated veins in swollen tissue around the anus) are a common sign of impacted bowels because it is more difficult to rid your body of fecal matter. Other symptoms include: a constant feeling of fullness; diarrhea; hardened feces; cramping and pain; vomiting; constipation; bad breathe; and bloating. If left untreated, the waste obstruction can cause a rectal infection that can lead to sepsis or death.

The most common cause of impacted bowel symptoms is Crohn's disease. In a nursing home setting, causes of impacted bowel include: not drinking enough water; not eating a diet with adequate fiber; lack of activity; certain prescription medications and generally unhealthy diet with high fat and processed foods.

When timely identified, impacted bowels can be treated with a higher fiber diet, increased hydration, exercise, laxatives, enemas, suppositories, or manually removing the hardened feces.

Unfortunately, many nursing home patients are highly susceptible to impacted bowels due to a combination of inattentive staff and an unhealthy lifestyle. In order to minimize the chances of impacted bowels among patients, nursing homes should:

Provide the residents with proper nutrition (sufficient fiber, water, and healthy foods), the residents can suffer from painful constipation.

Provide as much physical activity as feasible for patients.

Monitor each patients bowel movements (time, quantity, consistency)

Pay special attention to patients complaining of stomach pain or cramping

Jonathan Rosenfeld is an attorney based in Chicago and handles elder abuse and neglect cases in the Midwest and across the country. Mr. Rosenfeld works on the following types of cases:

Bed Sores, Pressure Sores, Decubitus Ulcers
Falls
Dehydration / Malnutrition
Medication Errors
Impacted bowels
Sex Abuse
Medical Errors

Feel free to contact Jonathan for a free case evaluation.

One of the unique aspects of the human race which has set us apart over the ages is our willingness to honor and to provide for our "seniors". Even Neanderthals seem to have cared and provided for those older adults who could no longer sustain themselves. During the second half of the 20th century, though - at least in the "developed" countries - we achieved a level of prosperity which has largely enabled senior citizens to remain independent. In many cases, retired senior citizens have enjoyed a level of luxury which would have been unimaginable, even incomprehensible to our ancestors.

A Life of Luxury

A surprising number of well heeled senior citizens have elected to move into retirement communities which were designed and are operated to cater to their every need, desire, and whim. Across the United States, there are many such retirement villages and retirement homes, some of which are sponsored and / or operated by church organizations, offering church services, prayer times, and Bible studies on a wide variety of Christian devotional topics. Many of these communities even have multiple levels of care, beginning with independent living in a community of like minded individuals, advancing to assisted living, and eventually to clinical care, as their needs change.

Finding New Purpose

In many cases, Christian seniors have seen fit to spend a portion of their time and resources for mission projects, which have blessed the impoverished, the handicapped, and others whose lot in life is less pleasant. By participating in such benevolent activities, many seniors who might otherwise have felt useless have found new purpose in life. Some have even reported that they finally - after a lifetime of self focused labor - have a sense of a higher purpose, and of true achievement.

For those seniors who were not quite so fortunate, government sponsored programs such as Social Security, Medicare, and Food Stamps have made it possible for many retired seniors to at least manage a subsistence level of independent living. There is no doubt that these benefits and privileges have been a great blessing to many people. Even the government programs are in place, at least in part, because of the influence of godly people. We can rightly take pride in the influence which the church has wielded to improve the lives of those who can't provide for themselves.

Multi-Generational Homes Used to Be the Norm

There is another side, though, to this story. Down through human history, multi-generational living has been "the norm", with families adding a room or two as needed in order to accommodate growing families. (Have you heard the term, "Mother in Law Suite"?) Seniors who could no longer handle the rigors of manual labor were accommodated, and their presence in the home with their children and grandchildren was a blessing in its own way. Their experience, wisdom, and spiritual maturity blessed and guided families in ways that extend far beyond the value of earning power and physical labor.

With seniors in the home, the standards of faith and family values were reinforced and stabilized. Such values guided and shaped society, providing the children with role models, and at the same time giving parents an opportunity to "get away" occasionally without the cost and disruption of paid child care.

That's right! Even if Grandma can't do the strenuous housework, she can many times assist with childcare. Grandpa, too! It seems that the prosperity of the late 20th and early 21st centuries has largely swept such blessings from modern homes.

The Cost of Independence

Our society has come to expect that seniors will remain independent. Young people often move far from their parents, so that there is little interaction. When situations arise in which the older generation might have been able to help, they are too far away. Even if the younger generation remains in the same community, families with children rarely share space with grandparents. In fact, in many cases, such an arrangement would be considered unusual, even abnormal.

The worldwide financial difficulties of this decade may force us, as a society, to reevaluate these concepts. This experience, although painful, offers a unique opportunity for the church to lead the way to renewed family values. It may not be feasible for every church to support elder-care facilities, but it is certainly reasonable and achievable for us to promote responsible blending of multi-generational families. In fact, this may be exactly what God intends that we do.

A Biblical Perspective

Does this sound a bit radical to you? Consider the words of our Lord, concerning how "senior citizens" should be treated by their families. (This text is from the "Good News Bible", because it seems to offer the greatest clarity on this particular issue.)

"But you teach that if people have something they could use to help their father or mother, but say, 'This belongs to God,' they do not need to honor their father. In this way you disregard God's command, in order to follow your own teaching. You hypocrites!" - Matthew 15:5-7(a) "Good News Bible"

Ouch! Was that a bit too close for comfort? Think - and pray - about it. Are we, the Church, willing to accept God's direction, even when it differs from prevailing practices of our society? Is He calling His Church, during the present fiscal crisis, to lead in restoring the Home to its' former level of inter-generational love, interaction, and mutual cooperation?

Over the past year I have observed an increasing number of Medicare and Medicaid audits being initiated against psychologists and other mental health professionals.

I have recently seen a number of audits initiated against psychologists and mental health professionals who treat assisted living facility (ALF) and skilled nursing facility (SNF) residents. Most often these are audits by the Medicare Administrative Contractor (MAC), because this area of medical practice has been identified as one fraught with fraud and abuse. Sometimes these are only "probe" audits, initial audits requesting one (1) to five (5) medical records. Other times the MAC has been requesting anywhere from 120 to 375 records.

Zone Program Integrity Contractors (ZPICs).

Zone Program Integrity Contracts (ZPICs), are the primary Medicare fraud detection contractors. If a probe audit, MAC audit or other investigation of audit suspected fraudulent billing, the ZPIC may come in. The ZPIC also identifies and target various CPT codes, areas of medical practice, services and equipment that are highly susceptible to fraud. It will then initiate a ZPIC audit on its own. ZPICs receive bonuses based on amounts they recover for the Medicare program.

OIG Annual Work Plan.

The Office of Inspector General (OIG) publishes a work plan each year which discusses the areas, types of medical services, CPT codes, equipment and tests it considers to be most susceptible to fraud and abuse. The new plan is usually published in the fall for the work year. It is available online.

Psychiatrists, psychologists and mental health counselors, as well as facility administrators, compliance officers, attorneys and billing and coding experts should review this work plan each year to learn what the OIG considers to be fraud and abuse and why. Measures should be immediately implemented to remedy any problems in your practice or facility that are identified.

Qui Tam or Whistle Blower Cases.

In many cases an audit or investigation may be convened against a facility, individual or group, based on the filing of a qui tam or whistle blower's case. You won't know this, however, because these cases are filed under seal and stay sealed, often for years. These suits are based on false claims that have been filed for Medicare, Medicaid, Tricare, Veterans Administration (VA) or any other federal or state program. They are usually filed by disgruntled, former employees. These may cause the initiation of any of the types of audits discussed above.

If you suspect that this has happened, you should immediately retain legal counsel to represent you or your organization. If OIG special agents (S/As) or Federal Bureau of Investigation (FBI) agents are involved, it would be foolish not to retain an experience health law attorney before you speak to anyone.

Medicaid Audits.

I have also seen an increase in Medicaid audits by state agencies, as well.

Ordinarily, Medicaid audits are initiated by the program integrity section or division of the state agency that administers the Medicaid program, or one of the agency's contractors. The states are under increasing pressure from the federal government to be much more aggressive in identifying Medicaid fraud and recovering the overpayments.

If Medicare or any of its contractors recover an overpayment from a provider, they will also notify the state Medicaid program and Tricare program. These will them initiate audits and collection actions.

State ZPICs.

States are now contracting with ZPICs to help detect fraud and make recoveries of large overpayments from Medicaid providers. Additionally, the Medicare ZPICs may also detect and recover Medicaid overpayments, as well.

Areas Being Targeted.

In state Medicaid audits, I have recently seen increased scrutiny in the following areas:

1. Pediatric care

2. Therapy (speech therapy, physical therapy, occupational therapy) especially to pediatric patients and developmentally disabled patients.

3. Small assisted living facilities (ALFs), group homes, homes for the developmentally disabled (DD) and other small facilities.

4. Home health agencies.

5. Pediatric dentistry.

6. Optometry care, especially if delivered in a nursing home or assisted living facility (ALF).

7. Ambulance and medical transportation services, especially of nursing homes.

8. Psychiatric psychological and mental health.

Use of Statistical Sampling and Extrapolation Formulas to Multiply Repayment Amounts.

In both state Medicaid audits and in Medicare audits, I have experience increased reliance by the auditing agency on use of mathematical extrapolation formulas to estimate the amount that should be repaid. The formula used usually takes the overpayment that has actually been found and, based on several factors, multiplies it out to many times the actual overpayment amount. Thus, a found overpayment of $2,800 may become a demand for repayment of $280,000, based on the statistical extrapolation.

Things you should know about this are as follows.

1. Neither the Medicare program nor the state Medicaid programs should use an extrapolation formula, unless:

a. There is a "high" error rate in the claims that have been submitted; or

b. There have been prior educational efforts or prior audits of the provider, and the provider

has failed to correct the problems in claims submission previously found.
2. The states each have different guidelines, rules or regulations on when they will apply the statistical formula. Some do not use it. Some use a higher percentage error rate to prompt use of the formula and some lower. North Carolina is one of the lowest we have encountered; an error rate of more than five percent (5%) will prompt its Medicaid agency to apply the statistical extrapolation to the recovery amount.

Problems Psychologists and Mental Health Professionals May Encounter Producing Records for Audits.

Many psychologists, therapists and health professionals are being audited because they are treating patients in a nursing facility or assisted living facility.

In most cases, a history, physical, comprehensive assessment, physician orders, diagnosis, medication list, medication administration records, consultations, social service notes and other medial documents being relied upon by the therapist are reviewed and assessed in connection with treatment of the patient. The big problem here is that these usually stay in the facility. When an audit occurs, these may not all be available.

The biggest issue that Medicare and Medicaid seem to be targeting is lack of documented "medical necessity." The auditors take the position that the audited therapist must produce copies of the documents listed above, in part, to show "medical necessity" for the services provided.

Additionally, most physicians who treat patients in nursing facilities place their own assessments, plans and notes into the facility's chart and do not retain a copy themselves. When the audit comes, they may not be able to produce copies of their own notes and evaluations.

I recommend that any provider treating residents of nursing homes and assisted living facilities (ALFs):

1. Review the local coverage decision (LCD) applicable to the code(s) you bill so you know what requirements must be met and what documentation is required.

2. Review the Medicaid provider handbook or state regulations for the services you provide if you are a Medicaid provider.

3. Obtain and keep copies of all applicable histories, physicals, care plans, physician orders, physician consults, etc. This is best done by obtaining and using a portable scanner. You can then keep the copies electronically in a properly secured, protected server in your office (backed-up, off site, of course).

4. Sign all of your evaluations, prepare your reports, evaluations progress notes and consultations on your laptop or other computer and sign it electronically before you print it out. Alternatively, if you still use paper, scan the paper copy (after signed) and maintain it electronically.

5. Do not use unusual or non-standard terms and abbreviations. If you do, you must keep an "abbreviations and definitions" list and produce it with your records in any audit response.

6. In your reports, evaluations and notes, use the terminology from the LCD and Medicaid provider handbook. Also, always include the start time, stop time and total time spent with any resident in your report, evaluation and notes.

7. Be sure the patient, patient's next of kin/surrogate, patient's physician or nursing home administrator signs off as having received the services each time. The patient's signature is preferred.

Contact Health Law Attorneys Experienced in Handling Medicaid or Medicare Audits.

Medicaid and Medicare fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Healthcare Administration (AHCA), the Zone Program Integrity Contractors (ZPICs), the FBI, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS). Often other state and federal agencies, including the U.S. Postal Service (USPS), and other law enforcement agencies participate. Don't wait until it's too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today. Often Medicaid and Medicare fraud criminal charges arise out of routine Medicaid and Medicare audits, probe audits, or patient complaints.

The Health Law Firm's attorneys routinely represent physicians, medical groups, clinics, pharmacies, assisted living facilities (AFLs), home health care agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.

Disclaimer: Please note this article is for general education and information purposes only and does not constitute legal advice or solicitation for clients. Our opinions stated herein are just that, our opinions.

"The Health Law Firm" is a registered fictitious business name of George F. Indest III, P.A. - The Health Law Firm, a Florida professional service corporation, since 1999.

Copyright 穢 1996-2012 The Health Law Firm. All rights reserved.

A Licensed Practical Nurse or LPN is a nurse who has completed a basic nursing degree and works under the direct supervision of a medical doctor or a registered nurse. They are also called Licensed Vocational Nurses, and although the LPN job description may differ slightly depending on where they work, their basic task is to see to the comfort of the patient.

Licensed Practical Nurses are employed in a variety of institutions, such as residential care facilities, nursing homes, hospitals, clinics, and also in private abodes, which is one of the reasons why the LPN job description can vary a bit. They take a lot of the strain off of registered nurses, of which there is a shortage, freeing the RN up to attend to the administrative side of her duties. There is a huge demand for good Licensed Practical Nurses, especially because people are living longer due to the advances that are made in the medical fraternity every day.

The general LPN job description includes some of the more mundane tasks such as making patients more comfortable in their beds by straightening the bedding and fluffing the pillows; helping patients to perform their ablutions and get dressed, and helping them to get about such as to the toilet and to appointments they may have in other parts of the hospital. An LPN also collects samples for lab tests, records solid and fluid intake and output, maintains the health charts, assists with the patient's physical therapy and records vital signs such as respiration, pulse, temperature, weight and height, and blood pressure.

LPNs are generalists and as such are required to be able to take up the slack in various areas of healthcare. Their general duties are the same, but the LPN job description can change a bit depending on whether they work in a home for the aged, a doctor's office, a private nursing home, a private residence or a hospital or clinic. No matter where they work though, the characteristics that are required of an LPN are the same, and include a caring personality, compassion, patience, professionalism, good team work and excellent communication skills.

<p>An LPN working in a nursing facility could also be involved in developing care-plans for patients, supervising nurse-aides, and monitoring and reporting adverse reactions to medication. Those in doctor's clinics would also be involved in taking down a patient's medical history and other particulars, complete insurance forms, and various other administrative tasks. LPNs who work in homes for the aged could find themselves assisting the elderly with physical exercises, writing letters for them or reading to them, and accompanying them on outings, or to do shopping. Those working in private homes will often find that their duties include cooking, shopping, doing laundry and various other personal tasks; they also very often form a strong bond with their charge as they spend a lot of one-on-one time together.

So, as you can see, the LPN job description is really basic caring for a patient, but can include many other little personal tasks and duties dependent on where one is employed. Many LPNs do not work full-time but register with home-care agencies through which they can do part-time weekend or short-term caring. Many LPNs prefer to work in private homes rather than in hospitals, doctor's offices or clinics.

It is one's state of evolution and consciousness that determines what sort of afterlife one finds one's self in after the crossing from this world into the realms beyond it. One's spiritual progress or development is largely dependent on the degree of one's personal illumination, love, understanding and forgiveness. We will explore what happens to souls who are overly steeped in materialism or dogmatic beliefs and to those that commit suicide. Also we will try to solve the problem of reincarnation.

Why Some Souls Start Out Earthbound

Search and rescue of earthbound souls is a common and very much needed occupation as many materialistic souls (not knowing anything about the astral planes or life after death) still cling to the earth for days, weeks, even months after they die simply because they know of nothing better and would often try to get the attention of their physical relatives and friends or take free rides up and down the streets on a bus! The only real problems encountered are those souls with very strong misconceptions (such as deep religious and old, life-long dogmatic convictions) about the afterlife. They are very hard to reach and often stay earthbound much longer than most souls and usually end up in a colony on one of the "belief system territories" of the lower astral worlds along with many other souls of that same very limiting religion or belief system. They are in most cases quite happy there, so might as well leave them well enough alone!

The Problem with Suicide

Well, after knowing just how wonderful death really is, why don't we all just kill ourselves and go back to paradise? One would think, especially if one is in a terrible predicament or suffering or pain or some other severe hardship that one might as well take one's own life and get it over with. After all, so many of the souls who come through can't help but say how extremely happy they are to be free from all the miseries and complexities of physical living and that death was the best thing that ever happened to them. However, the spirits warn that to go before one's time would be detrimental to spiritual wholeness.

Would suicide ever be justified? An assisted suicide might make sense for those patients who are on the life support, in intensive care, who are being forced to hang around in a "vegetable" state of total or extreme disability and/or who are only suffering and having no chance whatsoever of any future purpose, convalescence, joy, healing or happiness while still on Earth. If the physical body is very old, completely worn out, completely useless, in a coma, etc. then why on Earth prolong the suffering? Why not allow the soul its freedom of choice so that it can go on if it wants to? To deliberately force the soul to stay stuck in a painful, agonizing existence in a completely worn-out body and non-functioning brain would not make any sense whatsoever.

On the other hand, if one is still young, healthy, and can still in any way shape or form do some sort of good or service to humanity while still on Earth, it could be hazardous to one's spiritual progress or development to commit suicide, which would rather be like quitting school before one graduates or cutting "Earth" classes before the course is over. There is no such thing as a "shortcut" to paradise. To enter paradise, one's self-concept must be very upright or full of certainty or knowing that one has done only the best thing possible while on Earth with whatever hardship or seeming injustices thrown at one and has not overindulged in too much selfish behavior to the detriment of others. One must face one's self and that is the catch. Those who selfishly commit suicide will have to "live" with all the consequences of that decision, and face all the people hurt by or affected in any way by the taking of one's own life. It is universal law that when one causes pain in others, one never gets away with it.

Regarding life on Earth, no matter how difficult, suicide is never advisable, and death is not intended or designed to solve all one's problems, which are trying to teach one some very important lessons, not to mention all the very important reasons for being on Earth in the first place. Ask any soul who had committed suicide while still in the prime of life and they will lament at all the grief and sadness they had caused others to go through, lost opportunities to love, grow, experience and really become the person they always wanted to be. Every incarnated soul has a mission of some sort to accomplish, and from what I've learned, heard and read about suicide, to find one's self back "at home" without having first accomplished all that one has intended to do on Earth could result in having to go back to Earth and start all over again in a new body. Life, whether here or hereafter is a responsibility, and that responsibility can never be escaped from without great sacrifice to one's spiritual evolution and progress toward finer levels of happiness, fulfillment and salvation.

The Problem With Reincarnation (Not My Favorite Subject)

Very few souls ever want to go back to live (reincarnate) on Earth again. Some souls say reincarnation is possible, and there are many proven cases of reincarnation. According to a video of Betty Jean Eadie, author of Embraced by the Light there might be a form of reincarnation but nothing like what common eastern and popular western "New Age" concepts portray. According to the medium Robert James Lees (1849-1931), author of The Life Elysian, his spirit author (or ghost writer-ha! ha!), Aphraar states that the concept that one dies and reincarnates again and again is a distortion, in other words, there is usually no personal spirit that enters the body after its conception. He also states that there are many misled souls both on Earth and in the hereafter who will say that reincarnation is essential for spiritual and evolutionary progress, just as there are many who pass over still believing in old religious philosophies or dogmas, because no one suddenly becomes all-knowing wise and perfect just because they died.

William Charles Cadwell who is direct voice medium David Thompson's main spirit convener at the Circle of the Silver Cord, stated in one of the seances that half of the souls born onto the "Earth plane" have lived at least once before, while the other half are new souls with no past except as pure "God" energy. Getting exact, scientific knowledge of reincarnation even while in direct communication with spirits is still quite a challenge. Even though knowledge in the afterlife is so much easier to obtain and retain, the spirits can still carry with them many misconceptions and contradictions just as they had while on Earth. Other than for a great soul to come back as a teacher (like Yogananda or Jesus Christ), I would have to seriously question the reasoning of anyone who would want to come back and live on Earth again! My official view on reincarnation: it not only is possible, it is constantly occurring and is, unfortunately, essential for all souls who are still tied up with the Earth vibration. However, I personally dislike the idea of becoming physically restricted again after any period of heavenly freedom!

Anyway, I am still wondering about the sanity of those few souls on the other side who say they want to reincarnate! For example there is a Leslie Flint tape where the spirit of Annie Besant, a famous Theosophist talks for a while about reincarnation and spiritual development followed by an Italian lady named Estell (near end of tape) who wants to reincarnate so she could get married and have children which was not possible for her during her recent lifetime on Earth. (Why can't she do this on the astral plane where everyone's desire is provided for?) Annie Besant, who believed she herself would reincarnate right away (but speaking through Leslie Flint's ectoplasm 55 years after her death obviously did not!) states that there are group souls who reincarnate together to express truth and to uplift humanity. However I am a little uncomfortable and worried about what she says about reincarnation as if the time spent on Earth was so insignificant which may be true from the cosmic perspective, but from my viewpoint, just my present lifetime on Earth alone has been a rather traumatic, tiresome, unpleasant experience.

My concern with reincarnation is why do we souls seem to be such gluttons for punishment supposedly having had so many past lives many of which were quite tragic and then not even remembered by the vast majority? To willingly get reborn into a new body and forgetting everything previously learned to me is simply awful! Living lives on Earth compared to living lives in the heavenly spheres is usually much harder, often terrifying, and extremely frustrating!

At least it has been for me in both this lifetime in England and the U.S. and in previous lifetimes in Turkey and other parts of the Middle East where I was kidnapped, buried alive for several years, and then murdered while trying to escape, and in another life, I died by crashing through the top of a catacomb or abandoned well while riding a camel (along with several others in a caravan) over a desert hill which gave me nightmares for years while young and seemed to lead to severe problems in my present lifetime. I also remember a vivid nightmare where saw a man in very primitive clothing running across a barren, rocky plain so fast right in front of my range of vision that it made me laugh until the next thing I knew my head was being crushed within the mouth of a sabertooth tiger! Glad I woke up right away!

I would never, ever want to reincarnate ever again! I mean to go through all that forgetting who we really are, birthing trauma, diapers, growing up, learning how to communicate, making the same mistakes over and over, working hard for almost nothing, choking on physical food, hunger, searching for a mate, loneliness, uncertainty, suffering, disease, and dying etc. over and over again--who in their right mind would want to reincarnate?! It's a wonder I didn't crawl back inside whenever I was born! The frustrating and humiliating limitations and sufferings of physical living is this main concern that has driven me nearly insane and then to yoga, meditation and afterlife research in the first place--I really need to know for sure that I won't have to leave paradise and forget my true self again through another rudely disrupting reincarnation! This is the problem of reincarnation I have been concerned about and that has prompted much of my spiritual research in the hopes of finding a way out of this rather frightening cycle of birth, suffering and death.

Another serious problem regarding reincarnation one would have to acknowledge is the fact that with the ever growing population of the earth there could never be enough reincarnating human souls to occupy all those new bodies unless perhaps they come from either nature spirits (elemental thought forces or creations), fragments of one's Oversoul and/or animal spirits, Source Energy (as Abraham-Hicks would say) or simply nothing at all except some self-aware fragment of the Universal Spirit, Prana or Shakti. The recent massive surge to nearly seven billion people proves that there can't possibly be enough reincarnations from past human lives from past history to go around unless they came from some other source or even no source at all.

According to Robert A. Monroe's Ultimate Journey it is the numerous separate fragments of an Oversoul who reincarnate and never one soul reincarnating over and over. When tuning in through meditation or through dream states, these past lives of those fragments of one's Oversoul could easily be experienced or interpreted as one's own. These fragments often exist as members of like minded individuals living together in a group or community in the afterlife. I like that explanation and prefer to stick with it rather than feel I must go on and on reincarnating! This explanation is quite realistic because Robert actually met his other "soul fragments" quite frequently throughout his out-of-body adventures who were often in all sorts of states, stages and lifetimes. So have I experienced similar encounters in my dream states including fragmentary experiences of simultaneous lives in different planets, places and times as portrayed in Jane Robert's The Oversoul 7 Trilogy.

The physical reality is really only a very tiny, rather backwards and insignificant part of the "rainbow universe." In the higher levels of the vibrational spheres or universal spectrum of existence, most souls seem to enjoy centuries and centuries of very idealistic living while gradually evolving into ever higher and higher spheres and expanding into ever new dimensions of great love, understanding, experience, creativity and beauty indefinitely.

The spirits say that salvation should come naturally, and to never expect it to come from some other "God," guru, or person, but only through the direct experience of their teachings, and through one's own inner growth, meditation and evolution of the soul. Just as one can never reach the horizon, absolute perfection can never be reached, only approached. One can never actually become God, one can and does however get ever closer and closer to becoming like God (perfect love, freedom, joy and wholeness).

From the Leslie Flint tapes, it is now confirmed that souls on the lowest level of development either come back to reincarnate right away after passing over or remain in either an unconscious (sleep) state, or are earthbound (shadow being), or remain stuck in an inferior low astral vibration or state. However, most souls, and those who are more spiritually advanced live more consciously, much more pleasantly and much longer on the astral spheres before returning to Earth again. The great Christ-like yogi, Sri Yukteswar said in Chapter 43 "The Resurrection of Sri Yukteswar" of Autobiography of a Yogi by Paramhansa Yogananda that the average soul, after some 150 to 600 years of astral living must either move on to higher planes (spheres) of consciousness beyond the astral plane (the causal and celestial planes or spheres which are said to be the real heavens) or if not evolved enough to remain conscious in such a refined state of being, must return back to Earth or some other sphere, and repeat this cycle until the soul is in fact advanced enough to consciously exist on the causal plane after which point it will simply manifest back and forth between the causal and astral spheres until it remains permanently on the causal and finally celestial levels of consciousness as a "freed soul."

Here again is more confirmation of why it is so essential to dedicate one's life to the search for truth, meditate on Spirit for long hours, evolve spiritually, become as selfless as possible, and to free one's self from all material (earthly) desires and attachments forever. From all of the most authoritative material that I have read and listened to so far, most of us will have to come back again and again to reincarnate many more lifetimes on Earth! Even Jesus (according to Dr. Marshall as "Lucillius") will reincarnate eventually but only as an extremely advanced "helper" of humanity and only as a "freed soul" or "avatar" as described in Autobiography of a Yogi by Paramhansa Yogananda.

An alternative to reincarnation on Earth is the possibility of reincarnation on a much "easier" sphere such as Bashar's world, Essassani mentioned in some of my other articles. A very physical reincarnation can be experienced on that planet, except it is still subtle enough to not be such a traumatic limitation to the soul nor have to force one to go through any other sort of unpleasantness so often typical of life's struggles on Earth.

Interesting to see in many instances how the system of yogic knowledge and experienced astral travelers confirm all that has come through Leslie Flint and how all the more important it is to evolve spiritually or remain stuck in the quandary of spiritual ignorance and suffering of reincarnation!

Your family member, sick and in pain, is in a hospital or nursing home and no one is available to help because the person is the next room is in critical condition and the entire floor staff is rushing around to help this person. You empathize thinking that if you were in a similar situation you would want everyone rushing around to save you. What you really do not know is that this emergency is due in some cases to financial self interest or lack of staff education regarding critical or end of life care. Most individuals do not fear death as much as the experience of a painful death and many nursing homes and assisted living facility staff do not have the training or desire to educate family members about hospice and palliative care services.

How can we make the stress of having a sick loved one, piled on top of daily stress easier for all involved when hospitals, nursing homes and assisted living locations often provide end of life care? Whether you recently experienced the loss of someone you know or are currently experiencing the decline of a loved one there are steps that can be taken to ease the journey but you must be the one to ask questions because many facility staff lack training in hospice and palliative care.

According to research by Lisa Welch, Ph.D. few nursing homes or assisted living facilities have written procedures for regularly assessing residents' terminal disease status or eligibility for hospice care. Instead, many staff members base their timing and referral of hospice based on their ability to recognize decline, their personal beliefs about hospice services and their initiative in raising hospice as an option. What happens when facility staffs have little or no education relative to palliative or hospice care and family members rely on their level of experience to help their loved ones? The result is often family frustration, little or no pain assessment or management for the loved one and a painful death.

In my work, I have been personally told by facility staff that their administration does not want them recommending outside hospice services because that means that money leaves the building. Or, as the research mentions, if there is no family requiring support, hospice is not recommended and is instead provided by their own staff, lacking hospice background. In these cases, offering hospice becomes a territorial issue founded by concerns over money and staffing. How can family members trust health care providers when the concern for money and self interest overrides the care needs of their family members at an especially critical time of life? This choice should not be a decision made by facility staff but the decision of the individual or family member involved.

"Additionally, timing of hospice referrals is often delayed because staff members believe that hospice is appropriate only for the very end of life. There was often a discrepancy of weeks or months between when staff reported recognizing terminal decline and when referral to hospice occurred." It is clear that training needs exist for staff relative to recognizing declines and understanding the benefits of hospice services. In defense of facility staff, I have experienced instances where fear of breaking rules or regulations or chastisement by a superior prevents staff from doing the right thing. However in these cases mysteriously a phone call or recommendation is made and I become involved to help families navigate the situation.

Until the level of palliative and hospice care education catches up with the need, family members will have a greater level of responsibility navigating the care of loved ones experiencing declines in health. It's never too early to ask about palliative or hospice care; however it can be too late. Too late is when a loved one is days away from passing and has already likely experienced a high degree of pain and discomfort. In the instance you ask and it is not quite time for palliative or hospice care, at least you have been proactive in your own education and when the time does come you'll be more prepared and less reliant on others to recognize the signs or request assistance.

Welch, Lisa C. Ph.D. et. al. Referral and Timing of Referral to Hospice Care in Nursing Homes: The Significant Role of Staff Members. The Gerontologist. Vol 48, No. 4, 477-484.