tag:blogger.com,1999:blog-56796685314593008702024-03-12T22:14:41.572-04:00Elder Care NotebookUnknownnoreply@blogger.comBlogger46125tag:blogger.com,1999:blog-5679668531459300870.post-28802715567942997142011-04-09T11:51:00.002-04:002011-04-10T01:33:24.511-04:00Hiring Privately - updated notes<div dir="ltr" style="text-align: left;" trbidi="on"><div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/-YlXGr_Bv3Qc/TaB9CBXbm0I/AAAAAAAAAUM/cYoTAQtecoo/s1600/helen-and-ann.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><br />
</a></div><a href="http://4.bp.blogspot.com/-YM_igScTjS8/TaB-ae10fQI/AAAAAAAAAUQ/jGyVy5bpaQ4/s1600/ann+sullivan.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-YM_igScTjS8/TaB-ae10fQI/AAAAAAAAAUQ/jGyVy5bpaQ4/s1600/ann+sullivan.jpg" /></a>If you are looking for home care for your loved one, whether through an agency, personal referrals, or especially through advertisements including free on-line ads, you should be sure to: <br />
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A.<b> Verify that the caregiver you are considering is Florida licensed. </b>Here is the link to the Florida database - check it out. <a href="http://ww2.doh.state.fl.us/irm00praes/PRASLIST.ASP" rel="nofollow">http://ww2.doh.state.fl.us/irm00praes/PRASLIST.ASP</a> <br />
<br />
--> You should do this regardless of the source, whether a friend, an <br />
<a name='more'></a>agency, newspaper ad, or especially a free internet ad. <br />
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--> Florida requires a background check in order to be licensed. <br />
<br />
--> Professionals listed on the database have had at least a 'Level 1' Florida State Police background check, and just more recently 'Level 2' screening, which includes fingerprinting and verification by the FBI. <br />
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--> The Florida healthcare professional database shows a record for any consumer complaints or disciplinary actions against caregivers. Again, check out the site. <br />
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B. I would recommend that caregivers in your home<b> have a Level 2 background check</b> (ask them), which as I noted includes fingerprinting and verification by the FBI. <br />
<br />
--> Older CNA licensing requirements were for Level 1. <br />
<br />
--> Unfortunately, the Florida database for Level 2 verification can currently only be accessed by registered institutions and agencies. <br />
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--> You would need to actually call the state for verification. <br />
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--> While you are at it, suggest that the state make Level 2 background check access available to individual consumers. <br />
<br />
C. Be aware that <b>while some states do have state-wide licensing for HHA's, Florida is not one of them</b>. <br />
<br />
--> For example, I have a state-issued HHA certificate from New York, which tested and licensed HHA's, much like Florida's CNA licensing. In Florida, only CNA's are state licensed. <br />
<br />
--> Individual agencies can and often do train caregivers they place, and award them 'HHA certificates'. <br />
<br />
--> Again this 'HHA certificate' is not regulated, and there is no record of background screening or consumer complaints. <br />
<br />
--> HHA certification is better than no training, but it is not equivalent to licensing. Be concerned if the HHA certification is advertised differently.<br />
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D. Make sure <b>your homecare CNA has a malpractice insurance policy</b>. <br />
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--> This is known as 'professional liability' insurance <br />
<br />
--> If you engage the CNA, get a record of the insurance carrier <br />
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--> Insurers will avoid caregivers with a risky history or those that they can't track. <br />
<br />
--> This is a must, even if the caregiver comes from a recommended agency, registry or other source <br />
<br />
E. Use caution, but also<b> avoid less than professional agencies, registries, or individuals who use scare tactics</b> to influence you. <br />
<br />
--> There are many caring and compassionate caregivers who are licensed and insured who are deserving of your trust. They will not disparage other professionals. <br />
<br />
--> Florida has good licensing and monitoring and a good public database compared to other states. Use those resources. <br />
<br />
F. Be aware that there are<b> IRS guidelines</b> regarding hiring 'employees' and 'independent contractors'. <br />
<br />
--> Don't be intimidated or discouraged by this. See my website for more information. <br />
<br />
--> Look for licensing and professional liability insurance, and operation as a 'business'<br />
<br />
G. If you have <b>Long Term Care insurance</b> especially, you can get more hours for your daily reimbursement rates from properly qualified independent contractors. <br />
<br />
--> Florida long-term care policies have standard provisions for using licensed private caregivers <br />
<br />
--> You can be reimbursed directly and then pay the caregiver, or you can designate that the caregiver be paid directly. Ask your insurer. <br />
<br />
H. Don't forget that professional caregivers are special people. The best truly love their work. <br />
<br />
--> At the same time, as much as we all like to cut costs, we can't expect something for nothing <br />
<br />
--> Qualified professionals generally won't be swayed by offers of 'room and board' in place of pay <br />
<br />
--> It usually does not cost any more on an hourly basis to hire a highly qualified person than an unqualified one <br />
<br />
--> With proper license checking, you can get higher quality people than you can get elsewhere, at affordable cost. <br />
<br />
There used to be a popular commercial that said educated consumers are our best customers. For more complete notes on 'hiring privately', see my short article: <a href="http://eldercarenotebook.blogspot.com/2009/08/hiring-privately.html" rel="nofollow">http://eldercarenotebook.blogspot.com/2009/08/hiring-privately.html</a> <br />
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<br />
</div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5679668531459300870.post-44440964735146649232011-03-07T11:57:00.003-05:002011-03-07T12:02:13.825-05:00Safety 'Chair Rails'<div dir="ltr" style="text-align: left;" trbidi="on"><div class="separator" style="clear: both; text-align: center;"><a href="https://lh6.googleusercontent.com/-P65ET4QyKBs/TXUILUw_REI/AAAAAAAAAR8/ehFj4Sf54HI/s1600/cottagerail.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://lh6.googleusercontent.com/-P65ET4QyKBs/TXUILUw_REI/AAAAAAAAAR8/ehFj4Sf54HI/s200/cottagerail.jpg" width="93" /></a></div>One client had an interesting idea for a chair rail. Rather than putting up decorative trim, the client had a more functional rail made, which was used on long stretches of wall around the house. <br />
<br />
In this case, the rail was used along the living room and in hall areas. Standing back, it looks like a substantial piece of woodworked trim, but up close it's much more functional. It serves as a sturdy hand-rail or banister, and also as wall protection against bumps by the wheelchair or walker.<br />
<br />
The idea was taken from the bumper rails used in some nursing homes and many hospitals, and is fairly simple to install. This rail was made from just 2-by-4's and smooth...<br />
<a name='more'></a><br />
1-by-6 lumber. The 2-by-4's were put up first, and then the smoothed 1-by-6's were firmly attached over them with their underside flush with the bottom of the 2-by-4. The 2-by-4 spacer provided enough distance from the wall so that fingers weren't pinched when grabbing the rail. <br />
<br />
The whole thing is solid, with the lumber fastened into wall studs. In the photo, the trim was ended at the corner, but it could easily be taken around corners. Just remember to sooth off or bevel everything so the corners aren't sharp. <br />
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</div>Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-5679668531459300870.post-16031837333882305112011-03-06T23:56:00.004-05:002011-03-07T00:26:46.565-05:00Helpful Furniture<div dir="ltr" style="text-align: left;" trbidi="on"><div class="separator" style="clear: both; text-align: center;"><a href="https://lh5.googleusercontent.com/-opU3zQYJxW8/TXRrs_Dxs8I/AAAAAAAAARw/32PUCY0nYfE/s1600/hosp+bed+small.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://lh5.googleusercontent.com/-opU3zQYJxW8/TXRrs_Dxs8I/AAAAAAAAARw/32PUCY0nYfE/s1600/hosp+bed+small.jpg" /></a></div><a href="https://lh6.googleusercontent.com/-Z4JxVm6Lt6w/TXRi8AaR_qI/AAAAAAAAARg/LLGEkEUFJf0/s1600/hosp+bed.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Sometimes the right furniture makes all the difference. </span><br />
<br />
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Caregivers may have clients who gradually have come to need a hospital bed or lift chair. However they might get some resistance to the idea, as people like their own familiar things. Clients can also be understandably.... <a name='more'></a>reluctant to replace things that still have many years of good use. Also, specialized care furniture can be a daily reminder of restricted mobility, much like a walker or wheelchair.</span><br />
<div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Caregivers, on the other hand, should have an eye to safety and practicality. While it can be a bit of a challenge to disguise, some special needs furniture, like hospital beds, clients may find that once they get used to them the benefits eventually win them over. A good, appropriate bed can make all the difference in safety, comfort, and even cleanliness. </span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><a href="https://lh6.googleusercontent.com/-FXZ6op3Kr2Q/TXRrOl87XkI/AAAAAAAAARs/tKC-MZ1ugJc/s1600/LiftChairs2small.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://lh6.googleusercontent.com/-FXZ6op3Kr2Q/TXRrOl87XkI/AAAAAAAAARs/tKC-MZ1ugJc/s1600/LiftChairs2small.jpg" /></a><a href="https://lh5.googleusercontent.com/-pcU0olHKmgw/TXRjnylBPiI/AAAAAAAAARk/C6hPE66AxWs/s1600/LiftChairs2.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Lift chairs can be a real help, also. Their main drawback is often their expense, but usually they at least look like regular recliners, and they can be a big aide to mobility, whether the client is assisted or more independent. Keep an eye on available materials, however. Where conditions dictate, some vinyl coverings are far easier to clean thoroughly than woven fabrics.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Caregivers can bring a fresh perspective to home furnishings, as well as to other aspects of living safely and comfortably at home. For clients concerned about affordability, it can be helpful to ask a reliable medical supply store to explore possibilities of reimbursement for prescribed items. While the reimbursement may not cover the full cost of desired items, sometimes it can help offset some of the cost. Lastly, for the adventurous, there are sometimes used items available in your care network. </span></div></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5679668531459300870.post-37244423121784985102011-03-06T13:57:00.001-05:002011-03-06T14:53:45.149-05:00Rehab Facilities - National Rankings<div dir="ltr" style="text-align: left;" trbidi="on"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">The US News and World Report has issued its listing of top rehabilitation hospitals. The following rehab hospitals are in the top tier in the national rankings. According to the survey, they have the highest reputations among the physicians polled. <br />
</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div><span style="font-family: "Courier New"; font-size: 12pt;">o<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><a href="http://health.usnews.com/best-hospitals/rehabilitation-institute-of-chicago-6431012"><span style="color: blue;">Rehabilitation Institute of Chicago</span></a> Chicago, IL</span><br />
<span style="font-family: "Courier New"; font-size: 12pt;">o<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><a href="http://health.usnews.com/best-hospitals/kessler-institute-for-rehabilitation-6220253"><span style="color: blue;">Kessler Institute for Rehabilitation</span></a> West Orange, NJ</span><br />
<span style="font-family: "Courier New"; font-size: 12pt;">o<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><a href="http://health.usnews.com/best-hospitals/university-of-washington-medical-center-6910750"><span style="color: blue;">University of Washington Medical Center</span></a> Seattle, WA</span><br />
<span style="font-family: "Courier New"; font-size: 12pt;">o<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><a href="http://health.usnews.com/best-hospitals/massachusetts-general-hospital-6140430"><span style="color: blue;">Spaulding Rehabilitation Hospital</span></a> Boston, MA</span><br />
<a name='more'></a><span style="font-family: "Courier New"; font-size: 12pt;">o<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><a href="http://health.usnews.com/best-hospitals/tirr-memorial-hermann-6742020"><span style="color: blue;">TIRR Memorial Hermann</span></a> Houston, TX</span><br />
<span style="font-family: "Courier New"; font-size: 12pt;">o<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><a href="http://health.usnews.com/best-hospitals/mayo-clinic-5000000"><span style="color: blue;">Mayo Clinic</span></a> Rochester, MN</span><br />
<span style="font-family: "Courier New"; font-size: 12pt;">o<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><a href="http://health.usnews.com/best-hospitals/craig-hospital-6840740"><span style="color: blue;">Craig Hospital</span></a> Englewood, CO</span><br />
<span style="font-family: "Courier New"; font-size: 12pt;">o<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><a href="http://health.usnews.com/best-hospitals/nyu-langone-medical-center-6212925"><span style="color: blue;">Rusk Institute, NYU Langone Medical Center</span></a> New York, NY</span><br />
<span style="font-family: "Courier New"; font-size: 12pt;">o<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><a href="http://health.usnews.com/best-hospitals/shepherd-center-6380225"><span style="color: blue;">Shepherd Center</span></a> Atlanta, GA</span><br />
<span style="font-family: "Courier New"; font-size: 12pt;">o<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><a href="http://health.usnews.com/best-hospitals/moss-rehab-einstein-at-elkins-park-6230715"><span style="color: blue;">Moss Rehab</span></a> Elkins Park, PA</span><br />
<span style="font-family: "Courier New"; font-size: 12pt;">o<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><a href="http://health.usnews.com/best-hospitals/ohio-state-university-medical-center-6411100"><span style="color: blue;">Ohio State University Hospital</span></a> Columbus, OH</span><br />
<span style="font-family: "Courier New"; font-size: 12pt;">o<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><a href="http://health.usnews.com/best-hospitals/thomas-jefferson-university-hospital-6230043"><span style="color: blue;">Thomas Jefferson University Hospital</span></a> Philadelphia, PA</span><br />
<span style="font-family: "Courier New"; font-size: 12pt;">o<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><a href="http://health.usnews.com/best-hospitals/national-rehabilitation-hospital-6330170"><span style="color: blue;">National Rehabilitation Hospital</span></a> Washington, DC</span><br />
<span style="font-family: "Courier New"; font-size: 12pt;">o<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><a href="http://health.usnews.com/best-hospitals/johns-hopkins-hospital-6320180"><span style="color: blue;">Johns Hopkins Hospital</span></a> Baltimore, MD</span><br />
<span style="font-family: "Courier New"; font-size: 12pt;">o<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><a href="http://health.usnews.com/best-hospitals/upmc-presbyterian-6230029"><span style="color: blue;">UPMC-University of Pittsburgh Medical Center</span></a> Pittsburgh, PA</span><br />
<span style="font-family: "Courier New"; font-size: 12pt;">o<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><a href="http://health.usnews.com/best-hospitals/mount-sinai-hospital-6213140"><span style="color: blue;">Mount Sinai Medical Center</span></a> New York, NY</span><br />
<span style="font-family: "Courier New"; font-size: 12pt;">o<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><a href="http://health.usnews.com/best-hospitals/rancho-los-amigos-national-rehabilitation-center-6930990"><span style="color: blue;">Rancho Los Amigos National Rehabilitation Center</span></a> Downey, CA</span><br />
<span style="font-family: "Courier New"; font-size: 12pt;">o<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><a href="http://health.usnews.com/best-hospitals/baylor-institute-for-rehabilitation-6740915"><span style="color: blue;">Baylor Institute for Rehabilitation</span></a> Dallas, TX</span><br />
<span style="font-family: "Courier New"; font-size: 12pt;">o<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><a href="http://health.usnews.com/best-hospitals/university-of-michigan-hospitals-and-health-centers-6440110"><span style="color: blue;">University of Michigan Hospitals and Health Centers</span></a> Ann Arbor, MI</span><br />
<span style="font-family: "Courier New"; font-size: 12pt;">o<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><a href="http://health.usnews.com/best-hospitals/vcu-health-system-6340860"><span style="color: blue;">Virginia Commonwealth University Medical Center</span></a> Richmond, VA</span><br />
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;"> </span> <br />
<div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Here is a <a href="http://www.blogger.com/The%20US%20News%20and%20World%20Reports%20listing%20of%20top%20rehabilitation%20hospitals.%20%20Besides%20high%20scores%20in%20its%20measurements,%20this%20group%20also%20has%20the%20highest%20ranking%20for%20reputation%20among%20physicians:%20%20%20%20o%09Rehabilitation%20Institute%20of%20Chicago%20%20%20Chicago,%20IL%20o%09Kessler%20Institute%20for%20Rehabilitation%20%20West%20Orange,%20NJ%20o%09University%20of%20Washington%20Medical%20Center%20%20Seattle,%20WA%20o%09Spaulding%20Rehabilitation%20Hospital%20%20%20Boston,%20MA%20o%09TIRR%20Memorial%20Hermann%20%20%20Houston,%20TX%20o%09Mayo%20Clinic%20%20Rochester,%20MN%20o%09Craig%20Hospital%20%20Englewood,%20CO%20o%09Rusk%20Institute,%20NYU%20Langone%20Medical%20Center%20%20%20New%20York,%20NY%20o%09Shepherd%20Center%20%20%20Atlanta,%20GA%20o%09Moss%20Rehab%20%20%20Elkins%20Park,%20PA%20o%09Ohio%20State%20University%20Hospital%20%20%20Columbus,%20OH%20o%09Thomas%20Jefferson%20University%20Hospital%20%20%20Philadelphia,%20PA%20o%09National%20Rehabilitation%20Hospital%20%20Washington,%20DC%20o%09Johns%20Hopkins%20Hospital%20%20Baltimore,%20MD%20o%09UPMC-University%20of%20Pittsburgh%20Medical%20Center%20%20%20Pittsburgh,%20PA%20o%09Mount%20Sinai%20Medical%20Center%20%20New%20York,%20NY%20o%09Rancho%20Los%20Amigos%20National%20Rehabilitation%20Center%20%20Downey,%20CA%20o%09Baylor%20Institute%20for%20Rehabilitation%20%20%20Dallas,%20TX%20o%09University%20of%20Michigan%20Hospitals%20and%20Health%20Centers%20%20%20Ann%20Arbor,%20MI%20o%09Virginia%20Commonwealth%20University%20Medical%20Center%20%20%20Richmond,%20VA%20%20Here%20is%20a%20link%20to%20the%20full%20search%20list%20for%20hospitals,%20include%20%E2%80%98rehab%E2%80%99%20hospitals,%20by%20state.%20%20http://health.usnews.com/best-hospitals/search?hospital_name=Hospital+name&specialty_id=REPREHA&service_offered=All&city=City&state=FL&zip=ZIP+Code">link to the full search list for hospitals, include rehab hospitals,</a> by state.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><br />
</span></div></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5679668531459300870.post-50580181385555767582011-03-06T02:51:00.001-05:002011-03-06T19:53:46.498-05:00Nursing Home 'Honor Roll' listing<div dir="ltr" style="text-align: left;" trbidi="on">US News & World Report has issued an updated list of <a href="http://health.usnews.com/health-news/best-nursing-homes/articles/2011/02/07/best-nursing-homes-the-us-news-honor-roll-2011">'best nursing homes</a>' based on government rankings. A few were designated as 'honor roll' facilities, meaning they received top scores in each ranking category over the past year. Theses are listed below. The honor roll selection is based on scoring, meaning the list is just a starting point for selection.<br />
<div class="MsoNormal">- CA: <a href="http://health.usnews.com/senior-housing/nursing-homes/ca/mary-health-of-the-sick-convalescent---nursing-hos-055022">Mary Health of the Sick Convalescent and Nursing Hospital</a>, <a href="http://health.usnews.com/senior-housing/nursing-homes/ca/rady-childrens-convalescent-hospital-d-p-snf-05A292/ratings">Rady Children’s Hospital Bernardy Center</a><br />
- CT: <a href="http://health.usnews.com/senior-housing/nursing-homes/ct/alzheimers-resource-center-of-connecticut-075378">Alzheimer's Resource Center of Connecticut</a>, <a href="http://health.usnews.com/senior-housing/nursing-homes/ct/lourdes-health-care-center--in-075426/ratings">Lourdes Health Care Center</a>, <a href="http://health.usnews.com/senior-housing/nursing-homes/ct/matulaitis-nursing-home-075411">Matulaitis Nursing Home</a>, <a href="http://health.usnews.com/senior-housing/nursing-homes/ct/westview-nursing-care---rehab-075078/ratings">Westview Nursing Care and Rehabilitation</a><br />
- DE: <a href="http://health.usnews.com/senior-housing/nursing-homes/de/jeanne-jugan-residence-08A006/ratings">Jeanne Jugan Residence</a><br />
- MA: <a href="http://health.usnews.com/senior-housing/nursing-homes/ma/bethany-skilled-nursing-facility-225535/ratings">Bethany Skilled Nursing Facility</a><br />
- ME: <a href="http://health.usnews.com/senior-housing/nursing-homes/me/charles-a-dean-memorial-hospital-205152">Charles A. Dean Memorial Hospital<a name='more'></a></a> </div><div class="MsoNormal">- MO: <a href="http://health.usnews.com/senior-housing/nursing-homes/mo/ssm-depaul-health-center-26A489">SSM Depaul Health Center</a><br />
- MT: <a href="http://health.usnews.com/senior-housing/nursing-homes/mt/wibaux-county-n-h-275079">Wibaux County Nursing Home</a><br />
- ND: <a href="http://health.usnews.com/senior-housing/nursing-homes/nd/dakota--alpha-355101">Dakota Alpha</a><br />
- NM: <a href="http://health.usnews.com/senior-housing/nursing-homes/nm/miners-colfax-medical-center-32E027">Miners' Colfax Medical Center</a><br />
- NY: <a href="http://health.usnews.com/senior-housing/nursing-homes/ny/orzac-center-for-extended-care---rehabilitation-335700">Orzac Center for Extended Care and Rehabilitation</a>, <a href="http://health.usnews.com/senior-housing/nursing-homes/ny/peconic-landing-at-southold-inc-335842">Peconic Landing at Southold</a> , <a href="http://health.usnews.com/senior-housing/nursing-homes/ny/westchester-meadows-335844">Westchester Meadows</a><br />
- PA: <a href="http://health.usnews.com/senior-housing/nursing-homes/pa/south-mountain-restoration-cen-395583/ratings">South Mountain Restoration Center</a><br />
- WA: <a href="http://health.usnews.com/senior-housing/nursing-homes/wa/riverview-lutheran-care-center-505291">Riverview Lutheran Care Center</a></div><div class="MsoNormal"><br />
Going past this list, there are still many facilities that are very highly rated in the rankings, but without perfect scores in every category. The three major categories of scoring in the rankings are health inspections, nurse staffing, and quality measures. The inspection information is from annual inspections. The nurse data is based on RN, LPN, and CNA coverage per resident. The quality measures include rates of infections and sores.<br />
<br />
I would not recommend making compromises on the 'health' category. Contracting C-diff or MRSA, or the development of a bedsores, can turn even a rehabilitation stay into a long-term stay or even a one-way trip.<br />
<br />
Some sample lists by state:<br />
- FL <a href="http://health.usnews.com/senior-housing/nursing-homes/fl">http://health.usnews.com/senior-housing/nursing-homes/fl </a><br />
- MA <a href="http://health.usnews.com/senior-housing/nursing-homes/ma">http://health.usnews.com/senior-housing/nursing-homes/ma </a><br />
- ME <a href="http://health.usnews.com/senior-housing/nursing-homes/me"> http://health.usnews.com/senior-housing/nursing-homes/me</a><br />
<a href="http://health.usnews.com/senior-housing/nursing-homes/me"></a><br />
This list is just based on statistical rankings. In making any selection, be sure to read '<a href="http://eldercarenotebook.blogspot.com/2009/11/nursing-home-selection-notes.html">Nursing Home Selection Notes</a>' for additional considerations.</div><div class="MsoNormal"> </div></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5679668531459300870.post-9621980652570223552010-04-19T10:32:00.003-04:002011-03-07T00:30:54.167-05:00Disaster Preparedness<div dir="ltr" style="text-align: left;" trbidi="on"><div class="separator" style="clear: both; text-align: center;"><a href="https://lh5.googleusercontent.com/-_Cozsspn4I4/TXRtE0GxphI/AAAAAAAAAR0/oAEUUb_1fV8/s1600/hurricane__florida_smaller.gif" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://lh5.googleusercontent.com/-_Cozsspn4I4/TXRtE0GxphI/AAAAAAAAAR0/oAEUUb_1fV8/s1600/hurricane__florida_smaller.gif" /></a></div>Here in Florida we are concerned about hurricanes, but most parts of the country have their own natural disaster threats. The county where I live has an excellent <a href="http://www.co.palm-beach.fl.us/hurricane/pdf/Hurricane_Guide.pdf">Hurricane Guide</a> on line with safety advice and preparedness checklists that might be helpful wherever you happen to be.<br />
<br />
Among other items, the guide recommends that you know in advance where your nearest emergency shelters are located. If you have a 'special needs' person...<br />
<a name='more'></a> under your care, find out where an appropriate shelter for the person might be located. Our county has several shelters, but only a couple that are specifically equipped for 'special needs' residents, and only those who have <a href="http://www.ci.highland-beach.fl.us/DocumentView.aspx?DID=212">registered in advance</a>. Registration is a precaution, whether you will need to use the shelter or not. Just as importantly, the county has instruction on how to register for<b> transporation</b> to shelters, including 'special needs' transportation.<br />
<br />
Our county accepts physician approved <a href="http://www.ci.highland-beach.fl.us/DocumentView.aspx?DID=212">special needs registrations</a> <b>up until</b> the hurricane warning is issued, so you don't want to wait until there's actually a problem to start thinking about this. <br />
<br />
Also, <a href="http://eldercarenotebook.blogspot.com/2009/07/disaster-preparedness-for-diabetics.html">prepare emergency medicines and foods in advance, especially if the person under your care has diabetic</a> or other considerations.</div>Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-5679668531459300870.post-565112186950711202009-11-17T11:00:00.008-05:002011-03-06T00:51:00.312-05:00The Caregiver's Notebook<div dir="ltr" style="text-align: left;" trbidi="on"><div style="text-align: left;"><a href="http://2.bp.blogspot.com/_N8dTnoY_HCA/Sv15GqCkB8I/AAAAAAAAAQ4/fWNuda9OnU0/s1600-h/notebook.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="77" src="http://2.bp.blogspot.com/_N8dTnoY_HCA/Sv15GqCkB8I/AAAAAAAAAQ4/fWNuda9OnU0/s200/notebook.jpg" width="77" /></a>Imagine this. A well credentialed caregiver shows up at a new client and is briefed at length by the previous caregiver, who is leaving. This new caregiver listens to everything without making any notes at all on this complex case. She is there, her first day, without the thought of keeping a notebook! I actually recommend....</div><a name='more'></a>keeping two books. One, a professional diary of client vital signs, medications, exercise, therapy, and other relevant information. The data included should be specific to that client's condition. Notes should be professional and factual. So often, caregiver diaries are either irregular and disorganized, or interesting to read but not particularly useful.<br />
<br />
This notebook is for professional use, and should be treated as confidential for the client. In keeping it, though, we should consider that if there is an emergency of some kind, we would want to be able to retrace everything that might be relevant for the attending physicians.<br />
<br />
Secondly, a condensed notebook to bring to routine doctors' appointments. Ask the client's doctors what they would like to see in this book, and remember that they will want to scan it easily from the previous appointment for <span id="SPELLING_ERROR_0">pertinent</span> data. They won't want a lot of commentary. Some specialists have their own format that they like to see used.<br />
<br />
Don't forget. Update the notebooks on a regular daily schedule, while the day's activities are still fresh.</div>Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-5679668531459300870.post-4126265492760777942009-11-16T10:08:00.047-05:002009-11-16T10:08:00.262-05:00Expiration Dates<a href="http://3.bp.blogspot.com/_N8dTnoY_HCA/Svs7Meh0l0I/AAAAAAAAAQo/X6LgYfXuuiQ/s1600-h/expiredate.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" height="62" id="BLOGGER_PHOTO_ID_5402977263500433218" src="http://3.bp.blogspot.com/_N8dTnoY_HCA/Svs7Meh0l0I/AAAAAAAAAQo/X6LgYfXuuiQ/s200/expiredate.jpg" style="float: right; margin: 0pt 0pt 10px 10px;" width="131" /></a>When taking on any new home care case, don't forget to check expiration dates on all food as well as, of course, medicine. This point was also mentioned briefly in the earlier <a href="http://eldercarenotebook.blogspot.com/2009/07/disaster-preparedness-for-diabetics.html">Disaster Preparedness</a> post, however the discovery of some very old cans of food in an elderly client's cupboards suggest that this is worth highlighting.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5679668531459300870.post-30136735125044558492009-11-13T07:58:00.013-05:002011-03-06T00:18:10.571-05:00Nursing Home Selection Notes<div dir="ltr" style="text-align: left;" trbidi="on"><a href="http://1.bp.blogspot.com/_N8dTnoY_HCA/SvtXpduKs9I/AAAAAAAAAQw/Lz7cVAxFK7s/s1600-h/dice.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5403008547825562578" src="http://1.bp.blogspot.com/_N8dTnoY_HCA/SvtXpduKs9I/AAAAAAAAAQw/Lz7cVAxFK7s/s200/dice.jpg" style="cursor: pointer; float: right; height: 75px; margin: 0pt 0pt 10px 10px; width: 101px;" /></a>There are certainly plenty of guides and checklists published on the internet and elsewhere for selecting a nursing home. Medicare has an <a href="http://www.medicare.gov/Publications/Pubs/pdf/02174.pdf">on-line pamphlet</a>, and also a <a href="http://www.medicare.gov/nursing/checklist.pdf">checklist</a>. Here are some of my own notes:<br />
<br />
1. As I have suggested previously, check out the government websites of nursing homes, and specifically the<a href="http://www.medicare.gov/NHCompare/Include/DataSection/Questions/ProximitySearch.asp?bhcp=1"> '5 Star ranking' </a>score of the ones you are considering. As you narrow down your choices you may want to look into the factors behind the rankings. As an example, I see my son's employer received only a mediocre ranking. That nursing home.....<br />
<a name='more'></a> received 5 stars for "Quality Measures" and 1 star for staffing levels, factors that didn't surprise Martin.<br />
Remember also that the rankings are averages of only selected measurements, during certain times. Critics of the ranking complain that things like patient satisfaction surveys are ignored. In any case, you won't want a place that <a href="http://allnurses.com/ltc-directors-nursing/survey-preparation-267843.html">puts more effort into 'passing the test'</a> than in improving overall quality.<br />
<br />
2. Have a look at the short list of USNews<a href="http://www.blogger.com/goog_1258040621836"> </a><a href="http://health.usnews.com/articles/health/best-nursing-homes/2009/10/05/best-nursing-homes-rankings-honor-roll.html">'Honor Roll' nursing homes</a>. Also, watch for other articles and news reports that identify other noteworthy facilities, like <a href="http://www.nytimes.com/2009/10/06/health/06brod.html?scp=5&sq=nursing%20homes&st=cse">Miami Jewish Health Systems and Hebrew Home of Riverdale</a>. Be aware that the Honor Roll list is based on the government 5-star ranking mentioned above. These are nursing homes that scored a "5" in all three categories measured, and the list has the same drawbacks as the ranking itself. Even if you don't select one of these nursing homes, just visiting them probably gives you a good reference for comparison.<br />
<br />
3. See what the CNA's who are actually providing hands-on care are saying, in <a href="http://www.indeed.com/forum/job/nursing-assistant/is-considered-normal-Patient-CNA-Ratio-work-24-patients/t7824/p2">their own forums</a>. While they won't name employer names, you can get an idea of their issues and frustrations. Try to get an idea if the concerns you read about on-line, like inadequate coverage and unrealistic expectations, might be concerns in the places you visit.<br />
<br />
4. Before visiting any home, take just a little time to learn some of the <a href="http://eldercarenotebook.blogspot.com/2009/08/saw-horses-and-quality-of-care.html">tell-tale signs of quality care</a>. Also, remember to <a href="http://eldercarenotebook.blogspot.com/2009/06/trust-your-nose.html">trust your nose</a>. You won't always find bad news. In one nursing home I visited, for example, the cleanliness standards and disciplines were so impressive that I had immediate respect for the staff. In another fancier place I was dissappointed. <br />
<br />
5. Check out <a href="http://www.nursinghomesabuseblog.com/">Elder Abuse Attorney websites</a>, and avoid any nursing home owned by companies with frequent problems in their other facilities. You may have to do some research, because ownership is sometimes not clear. One national operator of 200 homes, many of which have been cited by elder attorneys and the AARP, operates under many different local names.<br />
<br />
6. While this is not a critical factor in itself, you might check to see if the nursing home is for-profit or non-profit. Although individual institutions vary, <a href="http://eldercarenotebook.blogspot.com/2009/07/cdc-on-nursing-homes-cnas.html">staff salaries are typically higher in non-profits</a>. In the past, most 'honor roll' facilities were non-profit, though that may be changing.<br />
<br />
7. As with any care provider, check references. Besides families, <a href="http://www.caremanager.org/">professional care managers</a> can be a help. Also, many states have ombudsmen that look into complaints about nursing homes. For example, <a href="http://ombudsman.myflorida.com/resfam.php">Florida has regional ombudsmen</a> who take consumer complaints. While they usually get involved after there is a problem, it may be worthwhile to check with them during the selection process. <br />
<br />
Once you or your loved ones make your selection, consider having your own private CNA, RN, or care manager visit. Ideally, it should be someone who will not only give personal care and attention on a regular basis, but will be thorough and able to identify possible problems, signs of infection or developing sores for example, as well as observe general conditions and care. Even with regular visits by family members, you will want to <a href="http://eldercarenotebook.blogspot.com/2009/06/trust-but-verify.html">verify</a> that all is really well.</div>Unknownnoreply@blogger.com2tag:blogger.com,1999:blog-5679668531459300870.post-76897066194630110222009-11-12T11:00:00.003-05:002011-03-06T00:49:41.052-05:00CNA Continuing Education<div dir="ltr" style="text-align: left;" trbidi="on"><a href="http://3.bp.blogspot.com/_N8dTnoY_HCA/SsuDIRfowfI/AAAAAAAAAP4/7kQsqcbRq0Q/s1600-h/bored+kid.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5389545557237219826" src="http://3.bp.blogspot.com/_N8dTnoY_HCA/SsuDIRfowfI/AAAAAAAAAP4/7kQsqcbRq0Q/s200/bored+kid.jpg" style="cursor: pointer; float: left; height: 100px; margin: 0pt 10px 10px 0pt; width: 125px;" /></a>As we know, CNA's have continuing education (CE) requirements similar to those of other licensed professionals.<br />
<br />
Self-employed CNA's sometimes have challenges in meeting this requirement, but they also have some interesting opportunities. There is no....<br />
<a name='more'></a> need to be bored. For example, there are professional conferences. Here in South Florida, the annual <a href="http://www.alzcare.org/pdfs/Brochure_04_01_09_FINAL.pdf">Alzheimer's conference</a> provides that kind of opportunity. The conference lectures are the types of things that you would certainly want to attend anyway. Attendees can meet recognized leaders in their subjects, and get updated on the latest research and developments. As a bonus, licensed providers can get CE credit for attending.<br />
<br />
For those who just can't get away from their client commitments, professional organizations can help. In Florida, for example, there's the <a href="http://www.flana.org/">Florida Association of Professional Caregivers</a>. They provide coursework for home study at a reasonable cost. Just complete the course materials at your convenience and mail them in for grading and credit. Sometimes these organizations also have no-cost lectures for credit.<br />
<br />
Why shouldn't meeting CE requirements be really interesting?</div>Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-5679668531459300870.post-75071358368983681472009-10-06T17:00:00.023-04:002011-06-03T20:29:40.776-04:00Men With Hammers<div dir="ltr" style="text-align: left;" trbidi="on"><a href="http://3.bp.blogspot.com/_N8dTnoY_HCA/SsukhMgt3dI/AAAAAAAAAQA/QppvMWBnmQo/s1600-h/twain.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5389582269280017874" src="http://3.bp.blogspot.com/_N8dTnoY_HCA/SsukhMgt3dI/AAAAAAAAAQA/QppvMWBnmQo/s200/twain.jpg" style="cursor: pointer; float: left; height: 144px; margin: 0pt 10px 10px 0pt; width: 104px;" /></a>A famous writer supposedly said, "to a man with a hammer, everything looks like a nail."<br />
<br />
That saying may be appropriate in the elder care field. The challenge for clients and their families is to understand the best course of action or treatment, instead of just the best choice services that are being offered by an individual or agency.<br />
<br />
Sometimes the best care for the client involves several different approaches or disciplines. Perhaps it includes a combination of appropriate therapies, medicines, and counseling. Some providers may have good short-term solutions, but do not have the tools or experience needed to<br />
<a name='more'></a> achieve long-term improvement. Be cautious when the solution offered for a difficult condition or situation is simply more hammering, meaning increased dosages - of prescriptions, sessions, care providers, and the like.<br />
<br />
Sometimes it's helpful to step back and re-evaluate. For those too close to a situation, or too emotionally involved, there are geriatric care professionals who will help clients and their families consider alternatives. Even within that group, though, you have to be careful that the professional is actually independent, and is not promoting their own care-giving services, or those of a related business. <br />
<br />
In selecting a visiting nurse, geriatric care manager, or other professional, you would want to go through the same level of screening and reference-checking that you would with any other provider. For those with big budgets, there are the <a href="http://eldercarenotebook.blogspot.com/2009/07/concierge-advocate-service.html">high-end concierge services.</a> What one of my clients found was that they can work wonders with major medical issues, but their service and knowledge in a particular geographic area was not as strong as the best local providers.<br />
<br />
In researching care managers, the <a href="http://www.caremanager.org/">National Association of Geriatric Care Managers</a> might be a good place to start.</div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5679668531459300870.post-74639004392099909732009-10-05T18:58:00.015-04:002011-03-06T00:19:49.962-05:00CNA Report Card<div dir="ltr" style="text-align: left;" trbidi="on"><a href="http://4.bp.blogspot.com/_N8dTnoY_HCA/Sss0tYBlOuI/AAAAAAAAAPw/F0W9tNsCxOo/s1600-h/reportcard.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5389459333226773218" src="http://4.bp.blogspot.com/_N8dTnoY_HCA/Sss0tYBlOuI/AAAAAAAAAPw/F0W9tNsCxOo/s200/reportcard.jpg" style="cursor: pointer; float: right; height: 151px; margin: 0pt 0pt 10px 10px; width: 110px;" /></a>So often, impressions of caregiver performance are subjective. As with any medical provider, a home caregiver's <span style="font-style: italic;">bedside manner</span> is important. Just as with others providing treatment and care, however, we must not forget that actual, measured results do count.<br />
<br />
As a caregiver, you should be aware of whether the client has improved or not under your care, even if the change has been gradual. This is not something you get from......<br />
<a name='more'></a> impressions, but from your actual daily records. <br />
<br />
If you have been keeping a good record you will have the information you need. Key measurements depend on the client. These might be progress in vent weaning, weaning from certain medications, limb flexibility, body mass index, blood pressure, blood sugar, or any other specifically relevant measurement.<br />
<br />
While clients and their families may not be attuned to this, the physicians and other professional providers will be. Ask them how the client, and you, are doing. Make sure you understand what they see as the important measurements of progress. Don't hesitate to have them evaluate your results.<br />
<br />
As you go along, use the measurements that the physician and other medical providers are reviewing to grade your own performance.</div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5679668531459300870.post-38681842622694072412009-09-15T12:02:00.012-04:002011-03-05T23:45:57.713-05:00Stretching your LTC claim dollars<div dir="ltr" style="text-align: left;" trbidi="on"><a href="http://3.bp.blogspot.com/_N8dTnoY_HCA/SrDie_fB1GI/AAAAAAAAAPY/sFUay1uYXRU/s1600-h/stretchdollar.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5382050576773272674" src="http://3.bp.blogspot.com/_N8dTnoY_HCA/SrDie_fB1GI/AAAAAAAAAPY/sFUay1uYXRU/s200/stretchdollar.jpg" style="cursor: pointer; float: left; height: 39px; margin: 0pt 10px 10px 0pt; width: 116px;" /></a>I sometimes work for clients who have Long Term Care insurance policies. Often, these policies have dollar limits to payouts, rather than specific time limits.<br />
<br />
One of my clients, a couple, did some research into this, and found that their policy covered care by state-licensed individuals - meaning CNA's like myself.....<br />
<a name='more'></a><br />
Many other LTC policies, including those offered through the AARP, also have that same provision that covers the direct use of licensed CNA's.<br />
<br />
For reimbursement, the client simply submitted a claim form indicating my license number. The insurance company paid the couple directly, and from that payment they then paid me our negotiated rate. That rate was lower than they would have paid through an agency or other corporate provider.<br />
<br />
They would not be able to do this with unlicensed caregivers, but since CNA pay rates are usually the same as those paid to unlicensed providers, and considerably less than rates paid to corporate providers of these services, there was an opportunity for them to greatly stretch coverage.<br />
<br />
I would add some points:<br />
<br />
1. Clients should use legitimately<a href="http://eldercarenotebook.blogspot.com/2009/07/cna-or-hha.html"> licensed</a>, self-employed caregivers to prevent 'employer liability' issues.<br />
<br />
2. Clients should check that the CNA they use has her <a href="http://eldercarenotebook.blogspot.com/2009/08/finding-that-throat-to-choke.html">own malpractice insurance policy.</a><br />
<br />
<br />
3. Follow the <a href="http://eldercarenotebook.blogspot.com/2009/08/hiring-privately.html">normal safe-guards</a> that would apply to any home care agency or individual, including reference checks.<br />
<br />
4. Whether considering licensed caregivers, agencies, nursing homes, or assisted living facilities, clients should educate themselves as to <a href="http://eldercarenotebook.blogspot.com/2009/08/saw-horses-and-quality-of-care.html">signs of quality care</a>.<br />
<br />
By checking into their actual LTC policies, clients may find simple ways to stretch their benefit dollars.</div>Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-5679668531459300870.post-33693526816699826112009-08-27T06:10:00.013-04:002011-03-06T00:23:44.067-05:00Saw Horses and Quality of Care<div dir="ltr" style="text-align: left;" trbidi="on"><a href="http://3.bp.blogspot.com/_N8dTnoY_HCA/SpVfoVR60EI/AAAAAAAAAPQ/c3LfS_mRCnA/s1600-h/sawhorse.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5374306876848263234" src="http://3.bp.blogspot.com/_N8dTnoY_HCA/SpVfoVR60EI/AAAAAAAAAPQ/c3LfS_mRCnA/s200/sawhorse.jpg" style="cursor: pointer; float: right; height: 131px; margin: 0pt 0pt 10px 10px; width: 131px;" /></a><span style="font-family: georgia; font-size: 100%;">The Wisconsin technical colleges have a series of </span><span style="font-family: georgia; font-size: 100%;"><a href="http://deptets.fvtc.edu/nursing/" onclick="externalLink('externalLinkOverlay', 'http://deptets.fvtc.edu/nursing/'); return false;" rel="nofollow"><b>80 training videos online (Lessons 1 - 80)</b></a> that can be useful for caregivers. The series is geared towards training aides in hospitals and the like, but the techniques and precautions apply to home care as well. </span><br />
<span style="font-family: georgia; font-size: 100%;"> </span> <br />
<div style="font-family: georgia;"><span style="font-size: 100%;"> These are classroom-type lessons, so the style might be a bit tedious for casual viewers. Even so....<a name='more'></a> the lessons are organized well, and you can pick your subjects.</span><br />
<br />
</div><div style="font-family: georgia;"><span style="font-size: 100%;"> Several of them can be especially informative for those who have loved ones in care facilities. So often, I am discouraged by the actual practices in nursing homes or even hospitals that seem wonderful to the casual observer. They remind me of a friendly, personable mechanic who shouldn't be touching your car.</span><br />
<br />
</div><div style="font-family: georgia;"><span style="font-size: 100%;"> I'm not alone in this. A recent Consumer Report magazine issue includes a survey of patients in hospitals, and of nurses in those same hospitals. The survey highlighted the differences between what patients <b><i>were</i></b> concerned about - with the care level, facility, and all - compared to what their nurses thought they<b><i> should have been</i></b><i> </i>concerned about. The nurses considered the lack of <b>coordination</b> among the providers (communication) and deficiencies in <b>hand-washing discipline </b>to be the two most significant things that the patients should have been worried about. Very few of the patients picked up on these, especially the hand-washing. </span><br />
<br />
</div><div style="font-family: georgia;"><span style="font-size: 100%;"> All this leads to a seemingly simple video topic - </span><span style="font-size: 100%;"><a href="http://deptets.fvtc.edu/nursing/l22_Bedmaking.WMV" onclick="externalLink('externalLinkOverlay', 'http://deptets.fvtc.edu/nursing/l22_Bedmaking.WMV'); return false;" rel="nofollow"><b>Lesson 22 Bed Making.</b> </a> If you watch the video, at least the first half, you can't help but notice the emphasis on sanitary practices necessary for even this ordinary task. Next time you are in a hospital or long term care facility, observe the bed making. Watch the details. This is one, just one, small indication of the quality of care and attention to safe practices in the facility.</span><br />
<span style="font-size: 100%;"> </span><span style="font-size: 100%;"> </span></div><div style="font-family: georgia;"><span style="font-size: 100%;"> I'm impressed when I see tasks like this being done to proper standards. You should be, too. If you see that the staff attends to every detail, as these lessons will explain, compliment them and their supervisor. If you see short-cuts, however, be concerned. Friendly faces (at least in your presence) don't make up for lack of good practices. </span><br />
<br />
</div><div style="font-family: georgia;"><span style="font-size: 100%;"> Again, the Bed Making procedures are just an example. All the procedures laid out are important, of course. A carpenter friend once said that his boss had job applicants make a quick set of saw horses in the interview. The boss could tell all he needed to know from that. Bed making is something like that. Watch the video, and you'll see what I mean.</span></div></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5679668531459300870.post-54559179896807778372009-08-19T05:59:00.006-04:002011-03-05T23:48:10.865-05:00Hiring Privately<div dir="ltr" style="text-align: left;" trbidi="on"><a href="http://1.bp.blogspot.com/_N8dTnoY_HCA/SooYJ00F4HI/AAAAAAAAAPA/iA1GXINpRh8/s1600-h/HelenAnne.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5371132062667759730" src="http://1.bp.blogspot.com/_N8dTnoY_HCA/SooYJ00F4HI/AAAAAAAAAPA/iA1GXINpRh8/s200/HelenAnne.jpg" style="cursor: pointer; float: right; height: 200px; margin: 0pt 0pt 10px 10px; width: 163px;" /></a>By engaging a private caregiver, you can often get a highly qualified professional at affordable rates. With the latest developments in licensing, insurance, and on-line resources, you might consider using a licensed CNA.<br />
<br />
When considering a CNA, ask for the caregiver's license number, and check it out with your state's Department of Health, either on-line or by phone.<br />
<br />
<i><b>Licensing.</b></i> Exams for CNA's have become standardized across many states. State licensing also includes law enforcement checks, with FBI checks....<br />
<a name='more'></a> as appropriate. Many states maintain easily accessible databases of licensees. License holders also have continuing education (CE) requirements.<br />
<br />
<i><b>Insurance</b></i>. Professional liability insurance is now available for individual caregivers. Check that the person you engage has a professional liability policy. If your favorite caregiver doesn't have a policy, you might suggest that she obtain one.<br />
<br />
<i><b>Self-employed contractor.</b></i> Much has been made about the risks of being an 'employer.' To stay clear of problems, use a licensed professional who offers services to the public as an independent contractor. Quoting the IRS: "the general rule is that an individual is an independent contractor if (the person for whom the services are performed) has the right to control or direct only the result of the work, and not what will be done and how it will be done or method of accomplishing the result<b><i>." </i></b>Use a licensed professional who has the necessary training and experience to do the job.<br />
<br />
<i><b>Internet resources</b></i>. Most states have on-line databases of licensed professionals, which provide the licensee's status. For those who want a more current background check than provided by the state licensing board, there are numerous on-line services. These typically charge nominal search fees.<br />
<br />
<span style="font-style: italic;"><span style="font-weight: bold;"><span style="font-style: italic;"></span></span></span><span style="font-style: italic; font-weight: bold;">Spot-checking</span>. One of my clients' families had a motion-sensor video security system installed in the foyer. If desired, comings and goings could be monitored, spot-checked, or even communicated by email. The added advantage of that system was that, combined with cell-phones, it could be an entertaining form of communication. Of course this is only appropriate if used with discretion.<br />
<br />
<i><b>Affiliations</b></i>. If you are planning to use a CNA extensively, check that she has back-up resources available. Many independent CNA's have good networks, including caregivers with prior hospital or other institutional experience. Some private caregivers have close affiliations with RN's. This can be especially helpful in complex cases. As a further back-up, you could also research some local agencies for possible short-term coverage needs.<br />
<br />
<br />
<i><b>Long Term Care insurance eligibility.</b></i> Licensed caregivers are eligible providers under many LTC policies (including the AARP-affiliated provider). Check with your agent or refer to your policy. Since the policy may have dollar limits, you may be able to get more 'bang for your buck' hiring directly.<br />
<br />
<i><b>Financial & Quality advantage</b></i>. By engaging a caregiver directly you can sometimes get professionals of caliber that you might not have access to through an agency, and at significantly lower cost.<br />
<br />
<i><b>The result. </b></i>For short-term needs, or in transitional situations, using an agency may make more sense. For longer-term situations, the key relationship is between the actual caregiver and the care recipient. With the developments in licensing, the availability of professional insurance, and advanced technologies, private hiring can be a rewarding alternative.</div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5679668531459300870.post-25460357590996579742009-08-03T06:13:00.007-04:002011-06-03T18:38:25.523-04:00Finding that "Throat to Choke"<div dir="ltr" style="text-align: left;" trbidi="on"><a href="http://3.bp.blogspot.com/_N8dTnoY_HCA/SnWDPPqTsYI/AAAAAAAAAOg/BUMM61D7Bm8/s1600-h/Choke.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5365338829007073666" src="http://3.bp.blogspot.com/_N8dTnoY_HCA/SnWDPPqTsYI/AAAAAAAAAOg/BUMM61D7Bm8/s200/Choke.jpg" style="cursor: pointer; float: left; height: 164px; margin: 0pt 10px 10px 0pt; width: 119px;" /></a>A recent post by an elder care adviser: <span style="color: #663300; font-style: italic; font-weight: bold;">"Important point:With an agency- you have someone with money to sue if need be!"</span><br />
<br />
Seconded by the franchise owner(?) of a new home health care agency: <span style="color: #663300; font-style: italic; font-weight: bold;">"you have an agency to sue when you hire an agency (I call it a "throat to choke")"</span><span style="color: #663300; font-weight: bold;">.</span><br />
<br />
In case we don't get the point, they are both saying you had better arrange for your home health care worker through an agency, and not deal directly with the caregiver. After all, throttling is banned in most places, and suing for money only works if there is some to be found. And home care agencies have insurance policies. Therefore, their logic goes,....<br />
<a name='more'></a><br />
<br />
Well, good news! Your caregiver can, and increasingly does, have a <a href="http://www.cmfgroup.com/insurance_products/professional_liability_individual/nurses_aides.html?state=FL&login=GO">professional liability policy</a><a href="http://www.cmfgroup.com/insurance_products/professional_liability_individual/allied_healthcare_professional.html">.</a><br />
<br />
These policies are easy to obtain and affordable for the caregiver. With this insurance, you can still directly engage your caregiver, and have the peace of mind of being able to legally throttle her some day, if you choose. And actually get paid when you do the deed.<br />
<br />
So, make sure she has a liability policy. From one provider's site:<br />
<span style="font-style: italic;"><br />
The policy is specially designed for home healthcare providers, giving you protection from lawsuits arising out of any mistake, real or perceived, during your care as a home healthcare provider. Here are just a few of the benefits: </span><br />
<ul style="font-style: italic;"><li>Professional malpractice insurance that protects and defends</li>
<li>24 Hour a day coverage - 365 days a year</li>
<li>Up to $1 million per incident/ $6 million maximum policy period</li>
<li>Policy travels with you no matter where you work</li>
</ul></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5679668531459300870.post-75794238517706293332009-07-25T05:46:00.005-04:002011-03-05T23:16:50.425-05:00Agencies, Nurse Registries, Companions<div dir="ltr" style="text-align: left;" trbidi="on"><a href="http://3.bp.blogspot.com/_N8dTnoY_HCA/Smkjm3GYqkI/AAAAAAAAAMo/XnUpQ6att64/s1600-h/pinkpanther.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5361855981894019650" src="http://3.bp.blogspot.com/_N8dTnoY_HCA/Smkjm3GYqkI/AAAAAAAAAMo/XnUpQ6att64/s200/pinkpanther.jpg" style="cursor: pointer; float: left; height: 137px; margin: 0pt 10px 10px 0pt; width: 73px;" /></a>Florida has three kinds of licensed or registered home care companies.<br />
<br />
- <span style="font-style: italic; font-weight: bold;">Nurse Registries</span> (recruiters)<br />
<br />
- <span style="font-style: italic; font-weight: bold;">Home companions</span> (sitters and non-health)<br />
<br />
- <span style="font-style: italic; font-weight: bold;">Home care agencies</span><br />
<br />
Only the last group is technically a <span style="font-style: italic; font-weight: bold;">home care agency</span>, but all..... <br />
<a name='more'></a>compete for mostly the same clients. Clients are often unaware of the distinctions and most of us, myself included, usually refer to any of the three groups as <span style="font-style: italic; font-weight: bold;">agencies</span> despite the actual differences. <br />
<br />
<span style="color: #000066; font-weight: bold;">Online search:</span><br />
<br />
When considering a Florida "agency" you should check out their licensing status on the <a href="http://www.floridahealthfinder.gov/facilitylocator/FacilitySearch.aspx" style="color: #660000; font-weight: bold;">FloridaHealthFinder.gov</a><span style="color: #660000; font-weight: bold;"><a href="http://www.floridahealthfinder.gov/facilitylocator/FacilitySearch.aspx"> search site</a></span><span style="font-style: italic; font-weight: bold;"><span style="color: #660000;">.</span> </span> Using the drop-down menu, select <span style="font-style: italic; font-weight: bold;">Home Health Agency, Nurse Registry, </span>or<span style="font-style: italic; font-weight: bold;"> Homeaker and Companion Service. </span>Unfortunately, the categories must be searched separately. If you don't see your "agency" listed in one, try the others.<span style="font-style: italic; font-weight: bold;"><br />
</span><span style="color: #000066; font-weight: bold;">The differences:</span><br />
<span style="font-style: italic; font-weight: bold;"><br />
Registries</span> generally are not eligible for Medicare-covered work, and neither are <span style="font-style: italic; font-weight: bold;">home companion companies</span>. Agencies may be eligible Medicare requirements if they meet certain licensing requirements.<br />
<br />
Placement through a <span style="font-style: italic; font-weight: bold;">home companion</span> service means the caregiver should not be providing the actual personal care, such as bathing. Adding to the confusion, local offices of national franchise chains like Comfort Keepers may qualify as <span style="font-style: italic; font-weight: bold;">home care agencies</span> in many states, but not necessarily in Florida, where the local branch might only qualify as a <span style="font-style: italic; font-weight: bold;">companion service.</span><br />
<br />
<span style="font-style: italic; font-weight: bold;">Nurse registries</span> do not actually hire the nurse or CNA. They arrange for the professionals registered with them to work for clients on a contract basis. Hospitals, especially those in areas with skilled nurse shortages, often use registries to fill specialized or temporary needs. I register with nurse registries, and have found that the assignments that some have access to can be interesting.<br />
<br />
<span style="font-style: italic; font-weight: bold;">R</span><span style="font-style: italic; font-weight: bold;">egistries</span>, and any <span style="font-style: italic; font-weight: bold;">agencies</span> that place caregivers like myself on a contract basis, are not paying any portion of social security or withholding taxes. Contract caregivers report and pay taxes themselves, just as any other contractor would (despite the articles we read that imply otherwise), and often have their own liability coverage.<span style="font-style: italic; font-weight: bold;"><br />
<br />
In Florida, licensed CNA's are 'eligible providers' under Long Term Care policies, whether they are hired directly or placed through agencies or registries.</span></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5679668531459300870.post-42701652320394242552009-07-19T05:04:00.006-04:002011-03-05T23:48:54.785-05:00DNR's<div dir="ltr" style="text-align: left;" trbidi="on"><a href="http://4.bp.blogspot.com/_N8dTnoY_HCA/SlxfI_OSn_I/AAAAAAAAAJ4/HmVIyVTkF4M/s1600-h/DNRtags.gif" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5358262264679014386" src="http://4.bp.blogspot.com/_N8dTnoY_HCA/SlxfI_OSn_I/AAAAAAAAAJ4/HmVIyVTkF4M/s200/DNRtags.gif" style="cursor: pointer; float: right; height: 131px; margin: 0pt 0pt 10px 10px; width: 160px;" /></a>DNR, "do not <span class="blsp-spelling-corrected" id="SPELLING_ERROR_1">resuscitate</span>". As some politicians have put it, this subject is above my pay grade. Or is it?<br />
<br />
As aides or family members, we are advocates for the client, and for the best care possible. I am naturally suspicious of DNR's because ...<br />
<a name='more'></a>I don't want an excuse for anything but the best safety measures and care.<br />
<br />
The argument for DNR's is frequently that they may be appropriate where the act of resuscitation is likely to be painful or unreasonably traumatic for what will be a poor outcome anyway. For example, a terminally ill patient might want to pass away peacefully rather than have his last experience be a powerful and painful shock in a hopeless attempt at revival. Subsequent 'quality of life' issues are sometimes mentioned as reasons, too.<br />
<span style="font-family: helvetica;"><br />
</span><br />
But actual end of life situations are often complicated. For example, if a client or family member on a respirator and with a weak heart is suddenly suffocating, you would want fast action to enable breathing. However, it might not be appropriate to try to shock his heart into beating again if it came to that. DNR instructions should be specific and appropriate. If you are considering one, be very careful and very specific. Don't let a DNR be an 'out' for anyone responsible for care.<br />
<br />
From a CNA/HHA point of view, and for that matter, for anyone but the physician, a DNR instruction should make no difference in the level of care. Actually, that's not quite correct. Caregivers should be more vigilant than ever when there is a DNR instruction, because a DNR could very well mean that the caregiver is the last line of a client's (or loved one's) defense for their life.</div>Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-5679668531459300870.post-7913634203930811342009-07-10T05:41:00.004-04:002011-03-05T23:21:01.755-05:00CNA? or HHA?<div dir="ltr" style="text-align: left;" trbidi="on"><a href="http://3.bp.blogspot.com/_N8dTnoY_HCA/SkPvJYQcDGI/AAAAAAAAAGw/Ywcfbq2yYg8/s1600-h/diplomadraw.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5351383726655540322" src="http://3.bp.blogspot.com/_N8dTnoY_HCA/SkPvJYQcDGI/AAAAAAAAAGw/Ywcfbq2yYg8/s200/diplomadraw.jpg" style="cursor: pointer; float: left; height: 81px; margin: 0pt 10px 10px 0pt; width: 160px;" /></a><span style="color: #660000; font-weight: bold;">Certified Nursing Assistant</span> or <span style="color: #660000; font-weight: bold;">Home Health Aide</span>? Which is more appropriate? It depends.<br />
<br />
When I worked in home care in a different state, I was trained and certified as a Home Health Aide. Since I was not 'assisting nurses' but rather providing private care, a CNA designation seemed less relevant.<br />
<br />
Florida, where I live, recognizes that there are HHA's in the workforce, but it does not test or license them. Florida only requires that some appropriate but unregulated training be given, by agencies themselves, for HHA's that they place.<br />
<br />
CNA licensing, however, includes coursework and hands-on training that generally includes an internship in a nursing home, a law enforcement background check, and a state licensing exam....<br />
<a name='more'></a> The exam includes both a written section plus a hands-on test of patient care activities. There are also annual continuing education and training requirements. For those applicants that don't have a long enough residency in Florida, the background check also includes an FBI check.<br />
<br />
<br />
Florida also provides useful information about each currently licensed CNA on its Department of Health website, including expiration date of the license and whether there are any disciplinary actions against the CNA. If you are hiring a CNA, ask for their license number and check them out through the website. Those in other states should see if their state has a similar online database of CNA's, and if not, phone the state licensing board with the inquiry, instead.<br />
<br />
Since CNA license holders can work as HHA's in Florida, but not the other way around, it is helpful for caregivers to maintain a CNA license. It's useful because interested employers can quickly and easily check on us and be assured that we have been trained, tested, and have undergone the background check.<a href="http://4.bp.blogspot.com/_N8dTnoY_HCA/SkPu5mHo6pI/AAAAAAAAAGo/1yotCDY-gWk/s1600-h/diplom2.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><br />
</a></div>Unknownnoreply@blogger.com2tag:blogger.com,1999:blog-5679668531459300870.post-88105330570382228342009-07-03T15:54:00.002-04:002011-03-05T23:25:12.902-05:00Nursing Home "Honor Roll"<div dir="ltr" style="text-align: left;" trbidi="on"><a href="http://1.bp.blogspot.com/_N8dTnoY_HCA/SmnOeB_9MFI/AAAAAAAAANA/DKQmkaMLA8c/s1600-h/honor_roll+visitingangels+bocanursingservices+kellysangelseldercare.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5362043846689370194" src="http://1.bp.blogspot.com/_N8dTnoY_HCA/SmnOeB_9MFI/AAAAAAAAANA/DKQmkaMLA8c/s200/honor_roll+visitingangels+bocanursingservices+kellysangelseldercare.jpg" style="cursor: pointer; float: right; height: 99px; margin: 0pt 0pt 10px 10px; width: 99px;" /></a>US News & World Report's honor roll of <a href="http://health.usnews.com/articles/health/best-nursing-homes/2009/07/02/best-nursing-homes-the-us-news-honor-roll.html">nursing homes</a>.<br />
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<div class="MsoNormal" style="font-family: times new roman; margin-bottom: 0.0001pt;"><span style="font-size: 85%; line-height: 115%;">Arkansas:</span><span style="font-size: 85%; line-height: 115%;"> <a href="http://www.usnews.com/listings/nursing-homes/ar/045320/health">St. Mary's Regional</a><o:p></o:p></span></div><div class="MsoNormal" style="font-family: times new roman; margin-bottom: 0.0001pt;"><span style="font-size: 85%; line-height: 115%;">California</span><span style="font-size: 85%; line-height: 115%;">: <a href="http://www.usnews.com/listings/nursing-homes/ca/05A091/health">Golden LivingCenter-Fresno</a> / <a href="http://www.usnews.com/listings/nursing-homes/ca/05A292/health">Rady Children's Convalescent</a><o:p></o:p></span></div><div class="MsoNormal" style="font-family: times new roman; margin-bottom: 0.0001pt;"><span style="font-size: 85%; line-height: 115%;">Connecticut</span><span style="font-size: 85%; line-height: 115%;"> <a href="http://www.usnews.com/listings/nursing-homes/ct/075096/health">Grove Manor</a> / <a href="http://www.usnews.com/listings/nursing-homes/ct/075411/health">Matulaitis </a> / <a href="http://www.usnews.com/listings/nursing-homes/ct/075426/health">Lourdes </a> <o:p></o:p></span></div><div class="MsoNormal" style="font-family: times new roman; margin-bottom: 0.0001pt;"><span style="font-size: 85%; line-height: 115%;">Delaware</span><span style="font-size: 85%; line-height: 115%;"> <a href="http://www.usnews.com/listings/nursing-homes/de/085017/health">Cokesbury Village</a> <a href="http://www.usnews.com/listings/nursing-homes/de/08A006/health">/ Jeanne Jugan </a> <o:p></o:p></span></div><div class="MsoNormal" style="font-family: times new roman; margin-bottom: 0.0001pt;"><span style="font-size: 85%; line-height: 115%;">Florida</span><span style="font-size: 85%; line-height: 115%;"> <a href="http://www.usnews.com/listings/nursing-homes/fl/105297/health">Brooksville Healthcare<a name='more'></a></a> <o:p></o:p></span></div><div class="MsoNormal" style="font-family: times new roman; margin-bottom: 0.0001pt;"><span style="font-size: 85%; line-height: 115%;"><span style="color: black;">Illinois</span> <a href="http://www.usnews.com/listings/nursing-homes/il/145102/health">Memorial Convalescent</a> / <a href="http://www.usnews.com/listings/nursing-homes/il/146009/health">Selfhelp Home of Chicago</a> / <a href="http://www.usnews.com/listings/nursing-homes/il/146118/health">Prairieview Nursing</a> <o:p></o:p></span></div><div class="MsoNormal" style="font-family: times new roman; margin-bottom: 0.0001pt;"><span style="font-size: 85%; line-height: 115%;"><span style="color: black;">Kansas</span> <a href="http://www.usnews.com/listings/nursing-homes/ks/17E011/health">Wichita County </a><a href="http://www.usnews.com/listings/nursing-homes/ks/17E015/health">/ Grisell Memorial </a> / <a href="http://www.usnews.com/listings/nursing-homes/ks/17E585/health">Dooley</a><o:p></o:p></span></div><div class="MsoNormal" style="font-family: times new roman; margin-bottom: 0.0001pt;"><span style="font-size: 85%; line-height: 115%;"><span style="color: #330000;">Kentucky</span><span style="color: #330000;"> </span><a href="http://www.usnews.com/listings/nursing-homes/ky/185154/health">Home of the Innocents</a> <o:p></o:p></span></div><div class="MsoNormal" style="font-family: times new roman; margin-bottom: 0.0001pt;"><span style="font-size: 85%; line-height: 115%;">Louisiana <a href="http://www.usnews.com/listings/nursing-homes/la/195276/health">Lane Regional</a> <o:p></o:p></span></div><div class="MsoNormal" style="font-family: times new roman; margin-bottom: 0.0001pt;"><span style="font-size: 85%; line-height: 115%;">Maine <a href="http://www.usnews.com/listings/nursing-homes/me/205147/health">Oceanview / </a> <a href="http://www.usnews.com/listings/nursing-homes/me/205152/health">Charles A. Dean Memorial</a><o:p></o:p></span></div><div class="MsoNormal" style="font-family: times new roman; margin-bottom: 0.0001pt;"><span style="font-size: 85%; line-height: 115%;">Maryland <a href="http://www.usnews.com/listings/nursing-homes/md/21E041/health">Crawford </a> <a href="http://www.usnews.com/listings/nursing-homes/md/215228/health">/ Althea / Woodland</a><o:p></o:p></span></div><div class="MsoNormal" style="font-family: times new roman; margin-bottom: 0.0001pt;"><span style="font-size: 85%; line-height: 115%;">Massachusetts <a href="http://www.usnews.com/listings/nursing-homes/ma/225535/health">Bethany</a> <a href="http://www.usnews.com/listings/nursing-homes/ma/225547/health">/ Hannah B.G. Shaw</a> / <a href="http://www.usnews.com/listings/nursing-homes/ma/22A091/health">Seven Hills Pediatric</a><o:p></o:p></span></div><div class="MsoNormal" style="font-family: times new roman; margin-bottom: 0.0001pt;"><span style="font-size: 85%; line-height: 115%;">Michigan <a href="http://www.usnews.com/listings/nursing-homes/mi/235530/health">Marywood</a><o:p></o:p></span></div><div class="MsoNormal" style="font-family: times new roman; margin-bottom: 0.0001pt;"><span style="font-size: 85%; line-height: 115%;">Missouri <a href="http://www.usnews.com/listings/nursing-homes/mo/265767/health">Lutheran at Breeze Park</a> <o:p></o:p></span></div><div class="MsoNormal" style="font-family: times new roman; margin-bottom: 0.0001pt;"><span style="font-size: 85%; line-height: 115%;">Montana <a href="http://www.usnews.com/listings/nursing-homes/mt/275079/health">Wibaux County</a><o:p></o:p></span></div><div class="MsoNormal" style="font-family: times new roman; margin-bottom: 0.0001pt;"><span style="font-size: 85%; line-height: 115%;">Nevada <a href="http://www.usnews.com/listings/nursing-homes/nv/295081/health">Nevada State Veterans</a> <o:p></o:p></span></div><div class="MsoNormal" style="font-family: times new roman; margin-bottom: 0.0001pt;"><span style="font-size: 85%; line-height: 115%;">New Jersey <a href="http://www.usnews.com/listings/nursing-homes/nj/315343/health">Broadway House </a><a href="http://www.usnews.com/listings/nursing-homes/nj/315441/health">/ Holy Name Friary</a> <o:p></o:p></span></div><div class="MsoNormal" style="font-family: times new roman; margin-bottom: 0.0001pt;"><span style="font-size: 85%; line-height: 115%;">New Mexico <a href="http://www.usnews.com/listings/nursing-homes/nm/325092/health">New Mexico State Veterans</a><o:p></o:p></span></div><div class="MsoNormal" style="font-family: times new roman; margin-bottom: 0.0001pt;"><span style="font-size: 85%; line-height: 115%;">New York <a href="http://www.usnews.com/listings/nursing-homes/ny/335553/health">Our Lady of Hope / </a><a href="http://www.usnews.com/listings/nursing-homes/ny/335776/health">Mapplethorpe Residential / </a> <a href="http://www.usnews.com/listings/nursing-homes/ny/335849/health">Jeanne Jugan</a> <o:p></o:p></span></div><div class="MsoNormal" style="font-family: times new roman; margin-bottom: 0.0001pt;"><span style="font-size: 85%; line-height: 115%;">North Carolina <a href="http://www.usnews.com/listings/nursing-homes/nc/345009/health">Mayview Convalescent </a><o:p></o:p></span></div><div class="MsoNormal" style="font-family: times new roman; margin-bottom: 0.0001pt;"><span style="font-size: 85%; line-height: 115%;">Pennsylvania <a href="http://www.usnews.com/listings/nursing-homes/pa/395583/health">South Mountain Restoration</a> <o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="font-family: "; font-size: 10pt; line-height: 115%;"><span style="font-family: times new roman; font-size: 85%;">Texas <a href="http://www.usnews.com/listings/nursing-homes/tx/676168/health">Rambling Oaks Courtyard</a> <o:p></o:p><br />
</span></span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="font-family: "; font-size: 10pt; line-height: 115%;"><span style="font-family: times new roman; font-size: 85%;">Vermont <a href="http://www.usnews.com/listings/nursing-homes/vt/475056/health">Wake Robin-Linden</a></span></span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="font-family: "; font-size: 10pt; line-height: 115%;"><span style="font-family: times new roman; font-size: 85%;"><o:p></o:p></span><span style="font-family: times new roman; font-size: 85%;">Virginia <a href="http://www.usnews.com/listings/nursing-homes/va/495106/health">Central Virginia Training </a><a href="http://www.usnews.com/listings/nursing-homes/va/49A008/health">/ King's Grant Retirement </a> <a href="http://www.usnews.com/listings/nursing-homes/va/49E076/health">/ Snyder</a></span></span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><br />
<span style="font-family: "; font-size: 10pt; line-height: 115%;"><o:p></o:p></span></div>The ranking appears to rely mostly on the government's <a href="http://eldercarenotebook.blogspot.com/2009/07/nursing-home-rating-system.html">5-star rating system</a>.</div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5679668531459300870.post-92090933826301168262009-06-24T14:00:00.005-04:002011-03-05T23:50:05.316-05:00Trust Your Nose<div dir="ltr" style="text-align: left;" trbidi="on"><a href="http://1.bp.blogspot.com/_N8dTnoY_HCA/SkL12ZGDEoI/AAAAAAAAAFY/5uOfueivVzA/s1600-h/bloodhound.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5351109622067565186" src="http://1.bp.blogspot.com/_N8dTnoY_HCA/SkL12ZGDEoI/AAAAAAAAAFY/5uOfueivVzA/s200/bloodhound.jpg" style="cursor: pointer; float: right; height: 117px; margin: 0pt 0pt 10px 10px; width: 160px;" /></a>If it doesn't smell right, it probably isn't.<br />
<br />
<span style="color: #660000; font-weight: bold;">Faci</span><span style="color: #660000; font-weight: bold;">lities</span><br />
<br />
When visiting care facilities, including acute care hospitals, nursing homes, rehab units and even assisted living homes, trust your sense of smell as you check out conditions. A sanitary place will smell sanitary. Odors won't be covered up with...<br />
<a name='more'></a><br />
cleaning sprays. You will find that even within one facility, the odors in wings can vary. At one highly respected rehab center in the Midwest, one wing didn't pass the the smell test, while the rest of the building was ok. If you come across anything like that, have your client moved to an area that is acceptable. Aside from the sanitation aspects, if the odors bother you, why subject your client to them?<br />
<br />
<span style="color: #660000; font-weight: bold;">Bathing </span><br />
<br />
After your client has been bathed, he or she should smell fresh. If you detect any sour smell or anything less than fresh, see that the job is done over again, properly.<br />
<br />
<span style="color: #660000; font-weight: bold;">Infections</span><br />
<br />
Infections will often cause odors, and you should be familiar with those and attuned to them. I once detected a foot sore on a patient in an acute care hospital by its odor. The patient's foot had been wedged at the bottom of the bed. He had no feeling at all in his legs and was unaware of the developing sore. Meanwhile, the staff assigned to him had missed the warning signs.<br />
<br />
<div style="text-align: left;"><a href="http://3.bp.blogspot.com/_N8dTnoY_HCA/SkLyWyJDkjI/AAAAAAAAAFI/UllpZAJo7bA/s1600-h/bloodhound.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"></a><br />
<div style="text-align: left;">If you discover a sore, what do you do? If a doctor isn't available right away, arrange for a Wound Care Nurse to treat the wound immediately.</div></div></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5679668531459300870.post-57111939841721390772009-06-18T06:16:00.003-04:002011-03-06T00:43:41.875-05:00Hand washing<div dir="ltr" style="text-align: left;" trbidi="on">Please excuse me if I seem upset about this.<br />
<br />
We've all see the headlines like "Inadequate hospital hand hygiene is spreading MRSA."<br />
<br />
<a class="taggedlink" href="http://www.news-medical.net/news/2006/07/24/19018.aspx"> </a>CNA's in most states are even tested on hand washing. Hospitals are increasing enforcement of the procedures. Is it working? Or do we still see situations where the staff wash their hands when they enter the room, put on the latex gloves, then.....<br />
<a name='more'></a> go about their duties in the room touching one patient, then the next? When they leave, they throw out the gloves, then do the same in the next room? At least the staff... is protected from MRSA, right?<br />
<br />
We won't win friends when we point this out. I certainly don't make many. But we need to speak up.<br />
<br />
Too many of our clients have contracted MRSA and other infections unnecessarily.<br />
<br />
<object data="http://www.cdc.gov/CDCTV/HandsTogether/HandsTogether_emb.swf" height="415" id="cdc" type="application/x-shockwave-flash" width="500" wmode="transparent"> <img src="http://www.cdc.gov/CDCTV/HandsTogether/HandsTogether.jpg" alt="Put Your Hands Together. Flash Player 9 is required." width="66" height="66" /><param name="movie" value="http://www.cdc.gov/CDCTV/HandsTogether/HandsTogether_emb.swf"><param name="quality" value="high"><param value="transparent" name="wmode"></object></div>Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-5679668531459300870.post-60797534466499697722009-05-26T06:02:00.002-04:002011-03-05T23:56:27.019-05:00Bedsores - Prevention Summary<div dir="ltr" style="text-align: left;" trbidi="on"><br />
<div style="text-align: left;"><a href="http://3.bp.blogspot.com/_N8dTnoY_HCA/SkIpPZOxsSI/AAAAAAAAAEA/buA65N3WG9E/s1600-h/P1010195c.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5350884651717210402" src="http://3.bp.blogspot.com/_N8dTnoY_HCA/SkIpPZOxsSI/AAAAAAAAAEA/buA65N3WG9E/s200/P1010195c.jpg" style="cursor: pointer; height: 51px; width: 35px;" /></a><a href="http://4.bp.blogspot.com/_N8dTnoY_HCA/SkIpPwpAR4I/AAAAAAAAAEI/aMqXVLx_dy0/s1600-h/CoreRoll_COR141.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5350884658001233794" src="http://4.bp.blogspot.com/_N8dTnoY_HCA/SkIpPwpAR4I/AAAAAAAAAEI/aMqXVLx_dy0/s200/CoreRoll_COR141.jpg" style="cursor: pointer; height: 24px; width: 32px;" /></a><a href="http://2.bp.blogspot.com/_N8dTnoY_HCA/SkIpPGXVkeI/AAAAAAAAAD4/gF96oyibgDA/s1600-h/Aloe+Vesta.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5350884646652842466" src="http://2.bp.blogspot.com/_N8dTnoY_HCA/SkIpPGXVkeI/AAAAAAAAAD4/gF96oyibgDA/s200/Aloe+Vesta.jpg" style="cursor: pointer; height: 48px; width: 21px;" /></a><a href="http://3.bp.blogspot.com/_N8dTnoY_HCA/SkIpO0WXQkI/AAAAAAAAADo/cjC3cheOJW8/s1600-h/thumbnail.aspx.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5350884641816920642" src="http://3.bp.blogspot.com/_N8dTnoY_HCA/SkIpO0WXQkI/AAAAAAAAADo/cjC3cheOJW8/s200/thumbnail.aspx.jpg" style="cursor: pointer; height: 48px; width: 65px;" /></a><a href="http://4.bp.blogspot.com/_N8dTnoY_HCA/SkIpPIjbaGI/AAAAAAAAADw/-O0GPqQtrS4/s1600-h/sheepskin.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5350884647240427618" src="http://4.bp.blogspot.com/_N8dTnoY_HCA/SkIpPIjbaGI/AAAAAAAAADw/-O0GPqQtrS4/s200/sheepskin.jpg" style="cursor: pointer; height: 48px; width: 67px;" /></a></div><br />
There are a number of things that can be done for prevention of sores:<br />
<ul><li>Help the person shift frequently, at least every couple of hours. If the person can't move at all.....<a name='more'></a> consider getting a bed that can shift their position automatically.</li>
</ul><ul><li>Be careful of pressure on bony areas, like the heel or lower spine. Pay special attention to those areas<br />
</li>
</ul><ul><li>For people who can't move their feet, I always try to place a sheepskin pad under their heels. The elbows can also be protected by pads.</li>
</ul><ul><li>If the bed tilts up, put padding or a roll pillow at the foot of the bed so that feet don't get wedged against a hard surface. Be careful of sliding.</li>
</ul><ul><li>Be careful not to allow friction burns from sliding on the bed. This can happen accidentally when tilting the bed up, when changing the linen, or when sliding the person off or on the bed.</li>
</ul><ul><li>Bathe daily, and more frequently as needed, using appropriate products.</li>
</ul><ul><li>Don't allow the skin to get too dry. After bathing or cleaning, use a good moisturizing lotion all over. Thoroughly massage the lotion into the skin.</li>
</ul><ul><li>Keep bedding clean and dry, and be careful of wet or damp linen or bedding.</li>
</ul><ul><li>If using a wheelchair, be careful of prolonged contact with hard surfaces. Use high quality pads.</li>
</ul><br />
<br />
<br />
</div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5679668531459300870.post-10384606415049181482009-05-25T05:43:00.002-04:002011-03-06T00:13:11.208-05:00Bedsore prevention - lotions<div dir="ltr" style="text-align: left;" trbidi="on"><a href="http://4.bp.blogspot.com/_N8dTnoY_HCA/SjmdAVWrSPI/AAAAAAAAACw/FI6lhQDCL9o/s1600-h/P1010194.JPG" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5348478661536991474" src="http://4.bp.blogspot.com/_N8dTnoY_HCA/SjmdAVWrSPI/AAAAAAAAACw/FI6lhQDCL9o/s200/P1010194.JPG" style="cursor: pointer; float: right; height: 84px; margin: 0pt 0pt 10px 10px; width: 200px;" /></a>I recommend using the best cleansers and lotions you can get. These are often only available at medical supply stores or from online medical suppliers, and are usually expensive. I believe in being frugal, but this is one area where you don't want to save pennies.<br />
<br />
Even if your client or loved one is in a long-term care facility, you will still want to look into this. There is a good chance that even acute care hospitals....<br />
<a name='more'></a> might not be using high quality products. Find out what is being used, and if necessary, bring in samples of your favorites. Be prepared to ask your client's physician directly for prescriptions for the most appropriate products, and then make sure the care facility actually gets them. If a lotion is prescribed for your client, you will want to be sure it is kept aside for his or her use and not put with the general supplies.<br />
<br />
You may have to insist, but it's worth it. Of course these only work if used daily, and properly.<br />
<br />
Bathing should be performed at least daily, with additional follow-up bathing as necessary. Prosducts for rinse-less bathing are available at some pharmacies and most medical supply stores. After the bath, lotion should be applied, and thoroughly massaged into the skin so there is no residue. You should be checking for the possible development of sores while doing this.</div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5679668531459300870.post-18714073223661230932009-05-24T18:01:00.000-04:002009-09-27T05:04:11.254-04:00NIH's Wound (bedsore) Treatment Chart<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://4.bp.blogspot.com/_N8dTnoY_HCA/SkKjHD8DjhI/AAAAAAAAAEQ/P34rmRBhbiI/s1600-h/WoundChart.jpg"><img style="margin: 0pt 10px 10px 0pt; float: left; cursor: pointer; width: 258px; height: 341px;" src="http://4.bp.blogspot.com/_N8dTnoY_HCA/SkKjHD8DjhI/AAAAAAAAAEQ/P34rmRBhbiI/s320/WoundChart.jpg" alt="" id="BLOGGER_PHOTO_ID_5351018648981179922" border="0" /></a><br />This chart from the NIH's website is just a reminder that the treatment of bedsores is not "do it yourself." Wound care is complex, and important.<br /><br />See your physician or Wound Care Nurse.Unknownnoreply@blogger.com0