Tuesday, September 29, 2015

Sunday, September 27, 2015

Rights & protections in a nursing home | Medicare.gov

Rights & protections in a nursing home | Medicare.gov: What are my rights & protections in a nursing home?

As a resident in a Medicare and/or Medicaid-certified nursing home, you have certain rights and protections under federal and state law that help ensure you get the care and services you need.

The nursing home must tell you about these rights and explain them in writing in a language you understand. They must also explain in writing how you should act and what you're responsible for while you're in the nursing home. This must be done before or at the time you're admitted, as well as during your stay. You must acknowledge in writing that you got this information.

Be treated with respect

You have the right to be treated with dignity and respect, as well as make your own schedule and participate in the activities you choose. You have the right to decide when you go to bed, rise in the morning, and eat your meals.

Participate in activities

You have the right to participate in an activities program designed to meet your needs and the needs of the other residents.
Be free from discrimination

Nursing homes don't have to accept all applicants, but they must comply with local, state, and federal civil rights laws.
Be free from abuse and neglect

You have the right to be free from verbal, sexual, physical, and mental abuse, as well as abuse of your money or property (called "misappropriation of property").

Nursing homes can't keep you apart from everyone else against your will. If you feel you've been mistreated (abused) or the nursing home isn't meeting your needs (neglect), report this to the nursing home administrator. Depending on your state, the agency that investigates abuse and neglect will be Adult Protective Services and/or the State Survey Agency. The nursing home must investigate and report all suspected violations and any injuries of unknown origin within 5 working days of the incident to the proper authorities. The Long-Term Care Ombudsman can also help by being your advocate and helping you resolve your concerns.

Be free from restraints

Nursing homes can't use any physical restraints (like side rails) or chemical restraints (like drugs) to discipline you or for the staff's own convenience.

Make complaints

You have the right to make a complaint to the staff of the nursing home or any other person without fear of being punished. The nursing home must address the issue promptly.
Get proper medical care

You have these rights regarding your medical care:

    To be fully informed about your total health status in a language you understand.
    To be fully informed about your medical condition, prescription and over-the-counter drugs, vitamins, and supplements.

    To be involved in the choice of your doctor.
    To participate in the decisions that affect your care.
To take part in developing your care plan.
By law, nursing homes must develop a care plan for each resident. You have the right to take part in this process. Family members can also help with your care plan with your permission.
    To access all your records and reports, including clinical records (medical records and reports) promptly during weekdays. Your legal guardian has the right to look at all your medical records and make important decisions on your behalf.
    To express any complaints (also called "grievances") you have about your care or treatment.
    To create advance directives in accordance with state law.
    To refuse to participate in experimental treatment.
    Have your representative notified. The nursing home must notify your doctor and, if known, your legal representative or an interested family member when:
        You're injured in an accident and/or need to see a doctor.
        Your physical, mental, or psychosocial status starts to get worse.
        You have a life threatening condition.
        You have medical complications.
        Your treatment needs to change significantly.

The nursing home decides to transfer or discharge you from the nursing home.
    Get information on services and fees. You have the right to be told in writing about all nursing home services and fees (those that are charged and not charged to you) before you move into the nursing home and at any time when services and fees change. In addition:
        The nursing home can't require a minimum entrance fee if your care is paid for by Medicare or Medicaid.
        For people seeking admission to the nursing home, the nursing home must tell you (both orally and in writing) and display written information about how to apply for and use Medicare and Medicaid benefits.
        The nursing home must also provide information on how to get a refund if you paid for an item or service, but because of Medicare and Medicaid eligibility rules, it's now considered covered.

    Manage your money. You have the right to manage your own money or choose someone you trust to do this for you. In addition:
        If you deposit your money with the nursing home or ask them to hold or account for your money, you must sign a written statement saying you want them to do this.
        The nursing home must allow you access to your bank accounts, cash, and other financial records.
        The nursing home must have a system that ensures full accounting for your funds and can't combine your funds with the nursing home's funds.
        The nursing home must protect your funds from any loss by providing an acceptable protection, like buying a surety bond.
        If a resident with a fund passes away, the nursing home must return the funds with a final accounting to the person or court handling the resident's estate within 30 days.
    Get proper privacy, property, and living arrangements. You have these rights:
        Keep and use your personal belongings and property as long as they don't interfere with the rights, health, or safety of others
        Have private visits.

        Make and get private phone calls.
        Have privacy in sending and getting mail and email.

        Have the nursing home protect your property from theft.
        Share a room with your spouse if you both live in the same nursing home (if you both agree to do so).
        Be notified by the nursing home before your room or your roommate is changed. They should take your preferences into account.
        Review the nursing home's health and fire safety inspection results.
    Spend time with visitors. You have these rights:
        Spend private time with visitors.

        Have visitors at any time, as long as you wish to see them, and as long as the visit doesn't interfere with the provision of care and privacy rights of other residents.

        See any person who gives you help with your health, social, legal, or other services at any time. This includes your doctor, a representative from the health department, and your Long-Term Care Ombudsman, among others.
    Get social services. The nursing home must provide you with any needed social services, including:
        Help solving problems with other residents.
        Help in contacting legal and financial professionals.
        Discharge planning.
    Leave the nursing home:

        Leaving for visits:
            If your health allows, and your doctor agrees, you can spend time away from the nursing home visiting family or friends during the day or overnight, called a "leave of absence." Talk to the nursing home staff a few days ahead of time so the staff has time to prepare your medicines and write your instructions.
            Caution: if your nursing home care is covered by certain health insurance, you may not be able to leave for visits without losing your coverage.
        Moving out:
            Nursing homes may have a policy that requires you to tell them before you plan to leave. If you don't, you may have to pay an extra fee.
    Have protections against unfair transfer or discharge:
        You can't be sent to another nursing home or made to leave the nursing home, unless any of these are true:
            It's necessary for the welfare, health, or safety of you or others.
            Your health has improved to the point that nursing home care is no longer necessary.
            The nursing home hasn't been paid for services you got.
            The nursing home closes.
        You have these rights:
            You have the right to appeal a transfer or discharge.
            The nursing home can't make you leave if you're waiting to get Medicaid.

            Except in emergencies, nursing homes must give a 30-day written notice of their plan and reason to discharge or transfer you.
            The nursing home has to safely and orderly transfer or discharge you and give you proper notice of bed-hold and readmission requirements.
    Form or participate in resident groups:
        You have a right to form or participate in a resident group to discuss issues and concerns about the nursing home's policies and operations. Most homes have such groups, often called "resident councils."
The home must give you meeting space and must listen to and act upon grievances and recommendations of the group.

    Have your family and friends involved:
        Family and friends can help make sure you get good quality care. They can visit and get to know the staff and the nursing home's rules. Family members and legal guardians may meet with the families of other residents and may participate in family councils, if one exists. With your permission, family members can help with your care plan. If a family member or friend is your legal guardian, he or she has the right to look at all medical records about you and make important decisions on your behalf

Thursday, September 24, 2015

Work Rules Exemption - Another View Published on Sun, 09/20/2015 - 8:30pm By Steve Moran

There are two tests when figuring out if an employee is exempt from overtime. The first is that, regardless of job duties, an employee has to be making more than a specified amount of money per year ($23,660) and they have to be doing certain kinds of job tasks. (In the case of senior living that's primarily supervising other employees.)
The big impact ..... is that the proposed rule change would increase the salary threshold to $50,400 per year.
It seems..............that we as a business sector, have to come a place where a 40 hour work week is no longer the real expected norm for anyone in a managerial or supervisorial role. As a provider and employer you may argue that this is just the new reality, but I find myself wondering if this is also why we see such high rates of dissatisfaction and turn-over in our team members?

Monday, September 21, 2015

Helping someone up from a fall

How to Get Up Off The Floor with a "Reach and Roll"

Lift for a patient on floor

Stop Digging By JoAnn Kunkle

"If You Find Yourself in a Hole, Stop Digging">

The quote is from Will Rogers, a simple talking philosopher, who just asked us to look honestly at ourselves, look around and appreciate what we see.
In preparing for a community course on interacting with a dependent loved one to keep them stimulated and positive, He  was struck by the many technical supports available and the real lack of hands on, relationship builders for caregivers and the person they love.


JoAnn Kunkle is a Volunteer Coordinator for the United Methodist Homes Elizabeth Church Campus in Binghamton, New York. She holds BS in Sociology, and graduated from SUNY at Brockport.  She has been a Social Worker at a Children’s’ Home, an Information Specialist in a library and a Director of Social Services. You can reach JoAnn at

Things You Can and Can't Do With POA - AgingCare.com

Things You Can and Can't Do With POA - AgingCare.com

IKOR of Greater Columbus: How to choose an aide/caregiver/unlicensed personnel

  • Who will be providing oversight? 

  • Who will conduct the background search to make sure this person does not have a criminal past? 

  • What happens if this person gets injured on the job? Are YOU willing

    to pay for workers comp insurance so the person does not try to sue you

    or your loved one if injured while caregiving? 

  • Will you document the care for tax reasons? Bills can add up quickly

    and can make a big difference during tax time if you can write off the

    expenses, or not write them off if you are not tracking expenses. 

  • What about other insurance and bonds to protect your loved one that is provided by reputable agencies. 

  • Again- not all agencies have these protections in place, make sure you do your due diligence!

Sunday, September 20, 2015

Sensible Coaching for Elderly Parents' Children | Endless Legacy

Sensible Coaching for Elderly Parents' Children | Endless Legacy

Is This You?

Worried Couple - Composite2
  • Are you suddenly burdened with care issues or other decisions for your elderly or aging parents?

  • Did you just receive that totally unexpected, out-of-the-blue phone call from some authority (doctor, police officer, emergency operator) advising you of the immediate help your aging elderly parent needs?


eCFR — Code of Federal Regulations
 Data is current as of June 4, 2014
TITLE 42—Public Health


Saturday, September 19, 2015

An Optometrist Explains Cataracts

An Optometrist Explains Cataracts
A cataract is a clouding on the lens of the eye that can impair vision. The disorder is commonly associated with aging. In fact, more than 50% of all Americans over the age of 65 suffer from cataracts. Advanced Eyecare Center, an optometrist clinic in Torrance knows that aging however, is not solely responsible for cataracts. While aging may be the principal factor behind cataracts, it is not the only factor that can lead to cataracts.

Friday, September 18, 2015

Gina Shaw, It Takes a Team: How to coordinate your loved one's care—and take care of yourself in the process. -- American Academy of Neurology

It Takes a Team: How to coordinate your loved one's care—and take care of yourself in the process. -- American Academy of Neurology

 You may have been thrust into the role of caregiver for a loved one with a neurologic condition suddenly—perhaps as the result of a traumatic brain injury or stroke. Or it may have happened more slowly, with the progression of multiple sclerosis, Alzheimer's disease, or Parkinson's disease. Either way, you will need a team of experts to help you coordinate your loved one's care. These professionals can be of enormous help, but sometimes just figuring out who is involved in your loved one's care, and what they do, can seem insurmountable.

To help you, we've identified some of the key healthcare professionals involved in caring for someone with a serious...... condition. Here's how you can work with them.

Skype lets you talk and video conference over the Internet

"Enjoy the World, hobbies, crafts, creative pastimes, e-mail,web based Conversations, Blogs, Articles"
Skype is a little piece of software that lets you talk and video conference over the Internet with anyone, anywhere in the world for free while viewing each other on your computer screens.

This Listen-Zone describes one of several ways to set up and use Skype

Basic Requirements for Skype
# A high speed Internet connection
# a personal computer (Your computer must have Windows 2000, XP or Vista to run Skype)
# a webcam, a microphone (some web cams have a built in microphone) and speakers attached to your computer). Many lap-tops have built in speakers, some have built in webcam. If you are concerned with the audio being overheard you can use a headset with microphone
# first install the camera's software on your computer
# Then Connect the camera with the USB cable to any of the the computer's USB sockets (ports).
Many computers will automatically recognize that you plugged the webcam in and it will tell you there is a new device on the computer
# With the webcam connected you have also connected the microphone that is built into the webcam to the computer. You can now adjust the audio settings using the webcam controls or wait until you have installed Skype.
# The Logitech installer will guide you through the con figuration of the audio. You may download from the Logitech site or from Skype.
# Skype provides the software free of charge. After you have Skype installed they have additional services that you buy into.
# This article is limited to free services over the Internet to anyone, anywhere in the world for free while viewing each other on your computer screens.
# You will be asked to choose a Skype name
This the name or nickname that people will use to call you (connect with you) on using Skype. The Skype Setup Wizard will appear and guide you through the rest of the installation.
# Make certain peakers are plugged in and volume turned up. (or if using a head set plug it in)
# Now call the Skype Test service. It is an automated service that you call and it calls you back so that you know you are ready to Skype.
# Make your first call
Select your friend's Skype Name and press the big green call button.
# Sign up for a Google Account and for a Google gmail account

What to do when the person with dementia asks the same questions

by Monica Heltemes on 9/24/2014 to Dementia Activities

new resource, "Ask the OT". Caregivers often have questions or situations that come up in dementia care. Although one answer never fits all situations, having different perspectives on the issue can help - in this case the perspective of an occupational therapist (OT).

Why does the person with dementia say the same things over and over?

The easy answer, but one that can be hard to keep in perspective, is that the person does not remember that he or she already told you that piece of information or story. Yes, in literally seconds, the person can have forgotten what was just discussed. The diseased brain is like a sieve with holes in it. The information just leaks right out instead of staying in the brain as it should.

Sometimes the person may be doing it to get attention. I don't mean to say that the person is purposely doing it to get attention, but rather the person may be bored or even frightened and may be seeking conversation or reassurance.

Another possibility is that the person is having a strong memory of a past event. The fact that the person is experiencing memories is a good thing, but perhaps it is not a happy memory or an unresolved memory, that is worrying the person. In either case, the caregiver understanding that the dementia illness is causing this behavior, is important.

Is there a way I can reduce the dementia behavior of repetitive questioning?

Yes, there are strategies to try. If one does not work, try another. The repeating may not go away completely, but it likely can be reduced.


ALZ Connected - Alzheimer's Association

ALZ Connected - Alzheimer's Association

Here's a

PDF brochure from the Alzheimer's Association that describes/discusses

legal planning and documents for the care of persons with AD/dementia.

It includes discussions on POAs and guardianships.


What Goes Into a Life Care Plan? | Data gathering Forms

Data gathering Forms  | Hill Law Group, PA

 These  planning questionnaires are worth their weight in gold! Everyone should, IMCO, have a family records notebook built from these forms.

Dave M.

Thursday, September 17, 2015

How To Use the Alzheimer's Reading Room Knowledge Base | Alzheimer's Reading Room

 Use the Alzheimer's Reading Room Knowledge Base

The Alzheimer's Reading Room Knowledge Base contains more than 4,000 articles. In the Alzheimer's Reading Room (ARR), we offer "real life" solutions to problems that Alzheimer's caregivers and their families encounter each day.
By Bob DeMarco
Alzheimer's Reading Room

The goal of the Alzheimer's Reading Room is to Educate, Empower, and sometimes Entertain Alzheimer's caregivers, their families, and the entire Alzheimer's community.

At its core the Alzheimer's Reading Room is about helping members of the Alzheimer's and Dementia Community understand, cope, and communicate with persons living with Alzheimer's and Dementia.

The Alzheimer's Reading Room is currently the number one source of information for Alzheimer's, dementia, memory loss, and related health and life news on the Internet.
Subscribe to the Alzheimer's Reading Room

You can access the Alzheimer's Reading Room Knowledge Base by using the search box that is available on every page on this website.

Bob DeMarco

Founder, Alzheimer's Reading Room

Wheelchair to Car Transfers - Getting your patient AND the wheelchair in the car


Wheelchair to Car Transfers - Getting your patient AND the wheelchair in the car: Wheelchair to car transfers and wheelchair management is not exactly what most people think of when they think of home safety or independence ... but...

One of the toughest obstacles patients and caregivers alike face is that of getting in and out of a vehicle and accomplishing this safely for both patient and caregiver. No doubt this IS part of a wise home safety checklist. If attempted without any forethought, disaster can lurk at any point in this sometimes tricky transfer.

Yet, mastering this wheelchair to car transfer can spell freedom and excitement for years to come for those otherwise "stuck" at home. It is my theory that those disabled by stroke or any any other means live longer lives when they can go out with a caregiver. And getting out means getting in the car, going, and getting back out of the car.

Of great importance next to seat belt use and the like is your planning for this essential ability.

You may master the car transfers without a hitch until you turn and see that ole wheelchair. Unless it's truly a window shopping ride, that wheelchair needs to come along too. With so many moving parts, though, it can be tougher than getting mom or dad to get in the car!

Do-It-Yourself Home Health Physical Therapy is a free e-zine that is sent to you when something happens here worth notifying you about. In the future, we will be sending this out on a monthly (and possible weekly) basis. Either way, your Do-It-Yourself Home Health Physical Therapy newsletter keeps you up to date on hot home health care topics that affect your rehabilitation at home.

Day Clock | Non traditional clock shows the periods of the day ( i.e particular part of the day)

Day Clock | Dementia Clock | Alzheimer’s Clock

The Day Clocks’ has a clear and simple display of “Now it’s Monday Morning” This clock is unlike any traditional clock you have seen. It does not
have one single number on its face, just the days of the week.  Non traditional clock shows the periods of the day ( i.e particular part of the day)

Help your loved ones who have Dementia or memory problems
In the US there are as many as 5.4 million people who have Dementia. If a loved one has dementia or any other memory loss problems, the DayClock will help remind them the time of day. Making dementia more manageable.

Understanding theDementia Experience

Jennifer Ghent-Fuller, B.A., R.N., M.Sc.N.

Smashwords Edition 2012

This ebook is licensed for your
personal enjoyment. This free ebook may be given away to other
people. If you would like to share this book with another person,
please send the entire book only, not a partial sampling. This book
may not be sold except if printed on paper in its entirety and only
for the exact cost of the materials only.
Thank you for respecting
the hard work of this author. Further information about sharing is in
'Note Written in 2002.'

Copyright Jennifer Ghent-Fuller 2002

Thoughtful Dementia Care TM

ISBN: 978-0-9881678-2-7

A Guide to Coping with Alzheimer's Disease - Harvard Health

A Guide to Coping with Alzheimer's Disease - Harvard Health

 This Special Health Report includes in-depth information on diagnosing
Alzheimer’s and treating its symptoms. Because caring for someone with
Alzheimer’s continues to be one of the toughest jobs in the world, the
report includes help for family members and caregivers, as well as for
the individuals with Alzheimer’s.

Prepared by the editors of Harvard Health Publications in collaboration with John H. Growdon, M.D., Professor of Neurology, Harvard Medical School, and Director, Memory and Movement Disorders Unit, Massachusetts General Hospital. 53 pages. (2015)

Wednesday, September 16, 2015

Alzheimer's Care Training - Help for Alzheimer's Families

Alzheimer's Care Training - Help for Alzheimer's Families: Free Family Caregiver Alzheimer’s Training

Learn how to better care for a loved one with Alzheimer’s by taking advantage of free family caregiver training opportunities available from Home Instead Senior Care.

The Difference Between Medicaid’s Lookback and Penalty Periods - AgingCare.com

The Difference Between Medicaid’s Lookback and Penalty Periods - AgingCare.com: The Difference Between Medicaid’s Lookback and Penalty Periods

Most people have heard that gifting an asset can cause problems if you later need to apply for Medicaid to cover a nursing home stay.

But what exactly are the rules you need to be aware of when helping an elderly loved one qualify for Medicaid?

New US Goverment organization, the Administration for Community Living (ACL). WE should be able to live at home

About ACL

All Americans—including people with disabilities and
older adults—should be able to live at home with the
supports they need, participating in communities that value their
contributions. To help meet these needs, the U.S. Department of
Health and Human Services (HHS) created a new organization, the
for Community Living (ACL)

ACL brings together the efforts and achievements of the
Administration on Aging, the Administration on Intellectual and
Developmental Disabilities, and the HHS Office on Disability to serve
as the Federal agency responsible for increasing access to community
supports, while focusing attention and resources on the unique needs
of older Americans and people with disabilities across the lifespan.


A caregiver is anyone who provides help to another person in
need. In this section, we provide links to a wealth of information
on the Internet designed to assist family members and caregivers.

  • Alzheimers.gov

    site is the government’s resource for Alzheimer&rsqup;s and
    related dementias.

  • Alzheimer’s
    & Dementia Caregiver Center

    External Web Site Policy

    site provides information about day-to-day help and services in
    your community; getting support; or preparing for the future.

  • ARCH
    National Respite Network

    External Web Site Policy

    ARCH National Respite Network and Resource Center provides
    resources to help families locate respite and crisis care services.

  • Family
    Caregiver Alliance

    External Web Site Policy

    site contains a wide array of publications and services based on
    caregiver needs, including a Family Care Navigator.

  • National
    Alliance for Caregiving

    External Web Site Policy

    site contains publications and resources for caregivers, including
    the Family Care Resource Connection, where you can find reviews and
    ratings on over 1,000 books, videos, Web sites, and other materials
    on caregiving.

  • Caregiver
    Action Network

    External Web Site Policy

    site offers a virtual library of information and educational
    materials for family caregivers.

  • eXtension

    External Web Site Policy

    website was created by the United States Department of Agriculture
    (USDA), Cooperative Extension System. Here, caregivers and
    advocates can access a wide range of information and materials
    designed to help them learn about and provide supportive services
    to family and relative caregivers. Topics include disaster
    preparedness, military families, grandparents raising
    grandchildren, housing, and nutrition.

  • HHS
    Office of Women’s Health (OWH)

    The OWH website provides an
    extensive list of links of interest to caregivers.

Older Adults

  • Alzheimers.gov
    – This site is the government's resource for Alzheimer's and
    related dementias.

  • Eldercare
    – The ACL Eldercare Locator is a website and call
    center that links you to state and local agencies on aging and
    community-based organizations that serve older adults and their

  • Check
    for Benefits

    External Web Site Policy
    – The BenefitsCheckUp Website helps consumers find benefits
    programs that help them pay for prescription drugs, health care,
    rent, utilities, and other needs. The BenefitsCheckUp Website
    includes information from more than 1,650 public and private
    benefits programs from all 50 states and DC.

  • Find
    Helpful Publications and Website Resources
    – A part of the
    Eldercare Locator Website, here you will find useful topic-specific
    resources for older adults, caregivers and aging professionals.

  • Long-Term
    Care Planning
    – Long-term care includes a variety of services
    and supports to meet health or personal care needs over an extended
    period of time. The National Clearinghouse for Long-Term Care
    Information Website provides information and resources to help
    individuals plan for future long-term care.

Tuesday, September 15, 2015

Hearing Loss Web Home

Hearing Loss Web is dedicated to people who have hearing loss, but are not members of the traditional Deaf community. This includes people who consider themselves to be hearing impaired, hard of hearing, late deafened, and oral deaf. We provide information on issues, medical topics, resources, and technology related to hearing loss.

Gatekeepers | Safety Gates | Stair Gates | Customized, Removable Safety Gates - Gatekeepers, DeForest, WI

Gatekeepers | Safety Gates | Stair Gates | Customized, Removable Safety Gates - Gatekeepers, DeForest, WI

Gatekeepers was born out of the need to protect our child with a

durable and completely reliable baby gate. But over the years, as our

company has grown, we’ve realized there are several different reasons to

install a safety gate in a home or business.  In addition to Baby Gates and Pet Gates

we’ve found that caretakers of older adults or children with special

needs find safety gates of great benefit. We also make gates to protect

little ones from fireplaces, provide containment on decks and for

businesses looking to restrict access to certain areas.

Not only are our gates absolutely beautiful, but most importantly, our gates are safe. Our popular Swing Gate has successfully passed the ASTM F1004 Performance Test

and has been pressure tested to 500 pounds.  Too many safety gates
offer little more than a visual deterrent, while Gatekeepers safety
gates are made of solid wood, securely mounted and feature sturdy

Every Gatekeepers specialty safety gate offers the following features:

  • Custom-crafted to fit any size stairway, door opening or hallway

  • Mounted with safe, strong, minimally invasive hardware

  • Innovative slide rail system allows for easy removal

  • Unique latches that offer a level of difficulty for a child, yet are simple enough for an adult to open with one hand

  • Available in maple, oak or cherry wood with unlimited Sherwin Williams stain/paint colors
Not only will you be impressed with our products, you’ll also appreciate the service and support Gatekeepers provides. From initial measurements and consultation to final installation of your new gate, we guarantee your satisfaction.

Monday, September 14, 2015

▶ The Difference Between EMR & EHR - YouTube

▶ The Difference Between EMR & EHR - YouTube

 Quick Illustrated Video Differentiating EHR from EMR

shared by Matthew Smith on Wed, Jan 15, 2014 @ 01:28 PM

 previous post on the differences between EMR (Electronic Medical Records) and EHR (Electronic Health Records) really resonated with our readers.

Thank you to several HD Insights blog readers for sending along this concise, illustrated video detailing the differences between an EMR and an EHR. We felt that this video is too good not to share with everyone.

Matthew Smith  says Feel free to forward this post (and our previous post) as a simple explanation when someone in your department asks what the difference is between these two terms.

VNSNY Professionals - Healthcare in Transformation

VNSNY Professionals - Healthcare in Transformation

 At VNSNY, we consider care coordination our core expertise, precisely because it is the one practice designed to overcome fragmentation. Patient-centered, evidence-based and protocol-driven, the VNSNY model of care replaces fragmentation with continuity.  It knits together the patient experience across the care continuum–from setting to setting, from provider to provider, from transition to transition.

That is why it is called VNSNY CO•CARE–comprehensive, continuous, collaborative and community-based. VNSNY CO•CARE means care we manage together:
- See more at: http://professionals.vnsny.org/why-vnsny/healthcare-in-transformation/#sthash.6OPe7DfF.dpuf


VNSNY, we consider care coordination our core expertise, precisely

because it is the one practice designed to overcome fragmentation.

Patient-centered, evidence-based and protocol-driven, the VNSNY model of

care replaces fragmentation with continuity.  It knits together the

patient experience across the care continuum–from setting to setting,

from provider to provider, from transition to transition.

That is why it is called VNSNY CO•CARE–comprehensive, continuous,

collaborative and community-based. VNSNY CO•CARE means care we manage


- See more at: http://professionals.vnsny.org/why-vnsny/healthcare-in-transformation/#sthash.6OPe7DfF.dpuf

VNSNY, we consider care coordination our core expertise, precisely

because it is the one practice designed to overcome fragmentation.

Patient-centered, evidence-based and protocol-driven, the VNSNY model of

care replaces fragmentation with continuity.  It knits together the

patient experience across the care continuum–from setting to setting,

from provider to provider, from transition to transition.

That is why it is called VNSNY CO•CARE–comprehensive, continuous,

collaborative and community-based. VNSNY CO•CARE means care we manage


- See more at: http://professionals.vnsny.org/why-vnsny/healthcare-in-transformation/#sthash.6OPe7DfF.dpuf


VNSNY, we consider care coordination our core expertise, precisely

because it is the one practice designed to overcome fragmentation.

Patient-centered, evidence-based and protocol-driven, the VNSNY model of

care replaces fragmentation with continuity.  It knits together the

patient experience across the care continuum–from setting to setting,

from provider to provider, from transition to transition.

That is why it is called VNSNY CO•CARE–comprehensive, continuous,

collaborative and community-based. VNSNY CO•CARE means care we manage


- See more at: http://professionals.vnsny.org/why-vnsny/healthcare-in-transformation/#sthash.6OPe7DfF.dpuf

VNSNY, we consider care coordination our core expertise, precisely

because it is the one practice designed to overcome fragmentation.

Patient-centered, evidence-based and protocol-driven, the VNSNY model of

care replaces fragmentation with continuity.  It knits together the

patient experience across the care continuum–from setting to setting,

from provider to provider, from transition to transition.

That is why it is called VNSNY CO•CARE–comprehensive, continuous,

collaborative and community-based. VNSNY CO•CARE means care we manage


- See more at: http://professionals.vnsny.org/why-vnsny/healthcare-in-transformation/#sthash.6OPe7DfF.dpuf

Vendor Risk Management:

Vendor Risk Management: Business Associate Agreements: Vendor Risk Management: Business Associate Agreements

by Russ Cornwall on Fri, Dec 20, 2013 @ 09:26 AM

Healthcare organizations can give third-parties (“business associates”) access to patient data, including an independent medical transcriptionist hired by a physician, outsourced claims services, a consultant, or a CPA firm whose services require access to protected patient information.

 Patients are protected by HIPPA privacy rules in the following ways:

    Patients may ask to see all medial records

    Patients may have health records corrected

    Patients may request and receive information about how their health records are used and/or shared

    Patients may decide how their information is shared for certain purposes (i.e. for marketing)

    Patients may have access to information about when or where their information was shared

    Patients may file a complaint if they believe their information has been misused or compromised

Beoynd the Video: Home Care—Lifting and Moving Your Loved One

Beoynd the Video: Home Care—Lifting and Moving Your Loved One: beyond the video
Home Care—Lifting and Moving Your Loved One

This video demonstrates basic techniques for moving a person with limited mobility, such as after a stroke, from bed to wheelchair and back again.

The steps for each maneuver are simply stated, but these are the things you need to know first:

Help the person to work with you by placing yourself so that his stronger side is on the edge closest to the bed or chair.

Tell the person what you are going to do and that the move will take place when you say "Now" so that he is prepared and can work with you.

Always bend your knees and keep your feet spread about shoulder-width apart so that you can lift with your legs, not your back.

Use a transfer belt that is fastened around the person's waist with room for you to get your fingers underneath it for each lift. You will be reaching both arms around his waist (closer to his back) and putting your fingers underneath the bottom of the belt, with your thumbs at the top of the belt. This makes the transfer easier for you and also helps the person feel more secure.

Alzheimer's {A CareGiver's compilation} Goods and Services Blog

Alzheimer's {A CareGiver's compilation} Goods and Services | Things To Do Together, Safety Devices & related Equipment, On-line Discussions – Forums and support sites, caregivers' Organizations, Associations | Government: Local, State, Federal, International; Medical Centers, Hospitals, Schools and University's

Family Caregiver Stress Relief | Caregiver Stress Ask Dr. Amy

Family Caregiver Stress Relief | Caregiver Stress

 There are ways to make personal care tasks easier, though. As a senior care professional, you’ve likely learned to overcome those awkward situations with your patients as well. Here are seven suggestions you can recommend to family caregivers. {end quote}
Ask Dr. Amy

Dr. Amy D'Aprix, MSW, PhD, CSA, is  Executive Director of the DAI Foundation on Caregiving.

Dr. D'Aprix's focus on providing service for seniors and their caregivers started at the State University of New York at Albany, where she concentrated on Aging Studies in both her BS and MSW programs. During her doctorial program at Case Western Reserve University in Cleveland Ohio, Dr. D'Aprix received a Doctoral Fellowship from the Mandel Alzheimer's Caregiving Institute. In addition to her university degrees, Dr. D'Aprix holds the designation of Certified Senior Advisor and is currently on the International Faculty for the Society of Certified Senior Advisors and the Canadian Academy of Senior Advisors.

Sunday, September 13, 2015

A guide on how to cut out cable television

A guide on how to cut out cable television: Cable bundle bills that include phone, Internet, and TV can range from a $60 per month deal to upwards of $200 a month. But decreasing that cost is easily achieved by cutting cable out completely. Your bill has the possibility of going from $150 to $30 a month. But how do you still watch major network shows? With an antenna.

Saturday, September 12, 2015

One of the world's largest knowledge networks

 LINKEDIN The world's largest professional network:300 million strong.
                                              It's free.

Members-only group discussions can only be seen by other group members.

Open group discussions can be seen by anyone on the web and can be shared on other social networking platforms.

Elder Care Professionals; Created: May 27, 2008
Type: Professional Group, Members: 30,465
Owner: Scott Williamson 
"A group for people working in elder care - in PACE programs, traditional nursing homes, hospice, assisted living, social workers, educators, CMS personnel, etc. It also has a number of subgroups for specialties or specific topics within the elder care community."

 Advancing Alzheimer's DayCare at Night {evening} Programs
Created: April 19, 2013 Type: Networking Group
Owner: Dave Mainwaring
Discussions and networking for individuals and organizations providing  adult day-care activities during evening for  individuals with Alzheimer's Disease
Website: http://caregiversnewsbasket.blogspot.com

Alzheimer's Reading Room:     Created: March 5, 2009
Networking Group, Members: 2,674
Owner: Bob DeMarco
The goal of the Alzheimer's Reading Room is to Educate and Empower Alzheimer's caregivers, their families, and the entire Alzheimer's and dementia community worldwide.
 Website: http://www.alzheimersreadingroom.com

Alzheimer's Caregivers Peer to Peer Connector
Created: January 28, 2012, Type: Networking Group
Members: 46
owner: Dave Mainwaring
Connecting carers/caregivers providing in-home care to clients having Alzheimer's and their families.
Website: http://caregiversnewsbasket.blogspot.com...

Alzheimer's Association MA/NH Chapter
Background: The Alzheimer's Association opened its doors in 1980 as one of the founding Chapters of our national association.
the Chapter assumed responsibility for providing services to families and professionals living and working in New Hampshire.

Alzheimer's Care at Home,  Created: August 13, 2011
Type: Professional Group. Members: 1,267
Owner: Elayne Forgie
The purpose of this group is to share information and engage in discussions that focus on the care of the Alzheimer's/dementia patient in their own home.

Senior Care Services Companies   Created: April 25, 2008
Type: Networking Group, Members: 9,969
Owner: Johnny Wilkinson
Private group. Networking group of companies and professionals in all types of industries who target their services to the seniors market.

Advocates for Person Centered Care     Created: July 25, 2009
Type: Networking Group, Members: 2,417
Owner: Lorraine T.
Private group.  for anyone who is an advocate for Person Centered Care in our senior population. If you are willing to share ideas for creating such an environment in existing settings such as in-home care, assisted living, dementia care facilities and skilled nursing homes, Instead of expecting our seniors to "fit" into our structured environments called care facilities, let's strive for Person Centered Care. They deserve it.

Caregiving in the USA Network, Created: June 23, 2008
 Type: Networking Group, Members: 3,020
Owner: Margarete Hermanson
 Managers: Donahue Vanderhider and Susan Baida,
Private group. Are you a caregiver? Have you been a caregiver? Will you become a caregiver? Do you work in the field of caregiving? Do you care about someone who is giving care? ...
Website: http://www.aarp.org/issues/dividedwefail...

Elder Care Issue Resolutions Group:   Created: November 9, 2008
Type: Professional Group, Members: 2,909
Owner: Jill Srebnick, SPSM
Private group.  for those who are in the Elder Care industry and for those dealing with Elder Care issues and need help finding answers to their questions. Need help wiht medicare or medicaid, nursing homes, rehabilitation facilities, home nursing, etc..

Client Focused Health Care Providers: Physicians, Hospitals, Nursing Homes, and Other Care Services, Created: November 12, 2013
Type: Networking Group
Owner: Dave Mainwaring
All-inclusive discussions about patient safety and the needs of people who are strangers to Health Care Providers (i.e.Physicians, Hospitals, Nursing Homes, Rehab, and Other Care Services). "Patient Friendly Healthcare it is client focused VS organization focused". Help develop patient focused policies and provider practices. Patients and visitors who are strangers to Nursing Homes hospitals, emergency departments, emergency rooms and the mind boggling array of titles not to mention inpatient and outpatient organization.

Healthcare professionals can't respond with patient focused care unless they are trained and their organization has a common guidelines how to manage patient confusion, fear, cognitive issues and inform clients of what to expect.
    Managers: UncleDave Mainwaring

Created: April 21, 2008, Type: Professional Group
Members: 48,630
Owner: Austin Giltus
    Managers: Karen Close, Victoria Brewster, MSW, Sini Thomson, Marina Richardson, Sreemol S,
Network of Professional Social Workers(NPSW) is an International Association of professional Social Workers. NPSW connects with Social Workers across the globe beyond national and regional boundaries.
Social Workers from any part of the world, working with any population, organizations, and settings are welcome to join hands with this global network.

Patient Centered Medical Home (2919120)   Created: April 1, 2010
Type: Other... Members: 2,206
Owner: Julie F. Schwab, MSNA, MMGT
this is a forum for discussions relating to providing patient centered care. Those interested in the patient centered medical home concept and team approaches to providing patient centered care are welcome to join this group.

Senior Housing Forum   Created: October 30, 2011
Type: Networking Group, Members: 2,893
Owner: Steve Moran
This group has been formed to compliment
www.seniorhousingforum.net the fastest growing senior housing blog.

Alzheimer's Caregivers   Private group.
being a caregiver to someone with Alzheimer's owner wants to share the things learned in the hope that owner can help others through the challenges they are facing. No one can understand the day to day struggles unless they are living it.

The Elder Care Network:   Private group.  Created: August 22, 2008
Type: Professional Group, Members: 20,001
Owner: Bob Andrews
   where Professionals, Service Providers and Vendors come together to partner in providing resources, products, services and refferals for families in need of Elder Care / Senior Care solutions for loved ones.
Including but not limited to assisted living communities, Alzheimer's care, nursing homes, respite care, retirement communities, residential care homes, home care, hospice care, Attorneys,

A Guide to Durable Medical Equipment And Medical Supplies - AgingCare.com

A Guide to Durable Medical Equipment And Medical Supplies - AgingCare.com

Urine in carpet, cleaning tip from Arm and Hammer

Mix equal parts water to vinegar and pour the mixture over the affected area to saturate and let it dry
Liberally sprinkle the baking soda over the spot. Then stir up a mixture of hydrogen peroxide and dish liquid (four parts hydrogen peroxide to one part detergent) and lightly rub the mixture onto the area. Use a brush (old toothbrushes work wonders), gloved fingers, or whatever else you have on hand to get the job done. After it dries, vacuum the area. If the smell remains, repeat the process.

Thursday, September 10, 2015

The Validity of Online Contracts

The Validity of Online Contracts      

 It is basic, black letter, first week in law school law
that in order to have a valid contract, there must be at least 3
essential elements.   These elements are an offer, acceptance and

        The concept of “offer” is simple: a web site offers goods,
services, software, membership in the site etc. etc. and that offer is
contained, for the sake of this article, in some sort of agreement
posted on the site.

        “Consideration” for the sake of extreme simplicity and
because it is not germane to this article, involves something of value
being exchanged between the parties.  Let’s just leave it at that.

  This article deals with how, in the context of the Internet, the element of “acceptance” can be satisfied so that, assuming the validity of a given offer and a valid consideration, a binding
obligation can be created.

HIPAA - Individually Identifiable Information: Know the Rules! ,,,,,, from Harmony Healthcare International, Inc.

 Privacy Rule. One such policy includes incidental use and disclosure of confidential health information (also known as Protected Health Information or “PHI”). Per the requirements in the HIPAA Privacy Rule (See 45 CFR 164.530), protect the confidentiality of individually identifiable patient health and financial information from any unauthorized intentional or unintentional use or disclosure.

For clarity,  Protected Health Information (PHI) is defined as any information in the medical record or designated record set that can be used to identify an individual and that was created, used, or disclosed in the course of providing a health care service such as diagnosis or treatment.

The HIPAA Privacy Rule specifies the following pieces of “Individually Identifiable Information” that, when linked with health or medical information, constitute PHI (45 CFR 164.514):

    Names of the individual, and relatives, employers or household members of the individual

    Geographic identifiers of the individual, including subdivisions smaller than a state, street addresses, city, country and precinct

    Zip code at any level less than the initial three digits; except if the initial 3 digits cover a geographic area of 20,000 or less people, then zip code is considered an identifier

    All elements of dates, except year, or dates directly related to an individual including birth date, admission date, discharge date, date of death and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older

    Telephone numbers

    Fax numbers

    Electronic mail addresses

    Social security numbers

    Medical record numbers

    Health plan beneficiary numbers

    Account numbers

    Certificate/license numbers

    Vehicle identifiers and serial numbers, including license plate numbers

    Device identifiers and serial numbers

    Web Universal Resource Locators (URLs)

    Internet Protocol (IP) address numbers

    Biometric identifiers, including finger and voice prints

    Full-face photographic images and any comparable images

    Any other unique identifying number, characteristic, or code

Failure to comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) can result in Civil and Criminal penalties. These civil and criminal penalties can apply to both Covered Entities and Individuals.

If you have questions regarding HIPAA or need help maintaining compliance, please click here to contact Harmony Healthcare International or call them at (800) 530-4413.

Bedside monitor, motion detectorm, 16886

sensor type: infra red
mounting location:multiple options
detector power: batteries ac adaptr
remote receiver
receiver/alarm power: batteries, ac adapter

Name: 16886
Colonial Medical alarm 16886
Infrared Motion Detector Bedside Monitor

Tuesday, September 8, 2015

Barton patient transfer system is covered under Medicare and private insurances

play video

Barton Chair Transfer Video 40 Second Clip






When Cognition & Hearing Loss Collide

When Cognition & Hearing Loss Collide: When Cognition & Hearing Loss Collide
By Jennifer Bradley, Staff Write

If you find a loved one asking repetitive questions, becoming more confused and forgetful, you may assume they have dementia, but the cause could be hearing loss.

While it’s not “new” news, study results reported in the January 2013 Journal of the Medical Association Internal Medicine are confirming what many professionals have believed: that cognitive loss and hearing loss collide on a large scale.

The study, from the John Hopkins University School of Medicine, is the first of its kind and is viewing long-term brain function impacted by hearing loss. When the study began in 2001, the 1,984 participants (in the age range of 75 to 84) were in good health and had no cognitive impairment. Over a period of six years, hearing and brain cognition tests were administered. Study researchers determined that brain ability was in direct correlation to hearing loss. Those who did have hearing loss suffered more substantial cognitive impairment more than three years sooner than others with normal hearing levels.

mobile tool helps non-physician health workers, such as Accredited Social Healthcare Activists (ASHA), and doctors make evidence-based management decisions to lower their patients’ CVD risk

George Clinical, a research organization, Posted to federaltelemedicine.com | Cardiovascular Disease (CVD) risk
SMARTHealth – Provides Rural Areas with Better Access to Healthcare through a Mobile-Based Tool
Gender, age, systolic BP, cholesterol level, and behavioral risks are entered into the mobile system to estimate the patient’s risk of developing CVD. Knowing this information can encourage patients to adhere to their medication and change behavioral risk factors that may result in CVD, such as drinking or smoking.
Seventy percent of India’s population live in rural areas, where the doctor to patient ratio stands at 1 doctor to 1700 patients. A mobile-based system called SMARTHealth, was developed as a point-of-care, Clinical Decision Support (CDS) tool. The mobile system assists local healthcare workers assess and manage Cardiovascular Disease (CVD) risk, and helps to expand the capabilities of current healthcare workers by providing them with proper equipment to monitor and measure CVD risk within these rural communities.
The CDS tool operating with a mobile health system is able to generate a risk-based prediction and management system along with a server side electronic medical record system.
This mobile tool helps non-physician health workers, such as Accredited Social Healthcare Activists (ASHA), and doctors make evidence-based management decisions to lower their patients’ CVD risk. This helps to prevent severe diseases that may occur later.
The mobile system is able to provide information on the risk of CVD to the patient through a visual projection meter built within the app. Through this projection meter, the cause and effect risk factor for each patient can be visually expressed in an easy to understand format. Gender, age, systolic BP, cholesterol level, and behavioral risks are entered into the mobile system to estimate the patient’s risk of developing CVD. Knowing this information can encourage patients to adhere to their medication and change behavioral risk factors that may result in CVD, such as drinking or smoking.

How Joint Bank Accounts and Property Affect Medicaid Eligibility - AgingCare.com

How Joint Bank Accounts and Property Affect Medicaid Eligibility - AgingCare.com

When considering trying to qualify for Medicaid, many questions about jointly-held assets arise:

Should I re-title my house from joint names with my spouse into my name alone?

If I add my son's name to my bank account, will that affect my ability to qualify for Medicaid?

What do POD, TOD and JTWROS mean?


the purposes of Medicaid, there are two different instances when the

exact way an asset is titled can affect a family's finances: when a

family member applies for Medicaid, and following the death of a family

member who was covered by Medicaid.

Alzheimer's Association list of safety services


The information is based on the provider’s description of their own services
We cannot guarantee, endorse, or recommend any provider listed and the information may change without notice. This is an informational list only and we update it regularly. Through our 24-hour Helpline

St. Louis Chapter
24/7 Helpline: 800.272.3900

Monday, September 7, 2015

Code Comfort: A Code Blue Alternative for Patients with DNRs - HBR

Code Comfort: A Code Blue Alternative for Patients with DNRs - HBR

Code Comfort provides a response for patients whose code status is DNR and who desire comfort measures only. It is a compassionate way to manage pain and suffering — including emotional suffering — during an acute crisis without providing unwanted care. Hospital staff responding to a Code Comfort may include palliative care physicians, nurses, respiratory therapists, chaplains and others who are prepared to rapidly address the patient’s physical symptoms, as well as the suffering and concerns of family members.

As is true for CPR efforts, we know teamwork matters to relieve the suffering of dying patients. Code Comfort protocols include an algorithm-driven method for assessing and addressing symptoms such as pain, agitation and dyspnea. For example, a patient suffering from severe, acute dyspnea would be given morphine and increased oxygen, her head would be elevated, a fan might be used to provide a comforting breeze, and she’d receive other measures to reduce anxiety.

Importantly, Code Comfort ensures that no patient or family suffers alone. Nurses are present during the code, actively treating the patient’s symptoms and calling in other team members as needed, all of which provides essential emotional support and reassurance

 Code Comfort: A Code Blue Alternative for Patients with DNRs
Melissa P. Phipps, John D. Phipps; December 9, 2014

"Care Transitions for the Home Care Industry." Ankota software

Chronic Care Management Services:

Here's the
deal...  Physicians are starting to be incentivized (and penalized) for
their performance with respect to their chronic patients, but there's a
reimbursement associated with it.

The reimbursement is for patients with two or more chronic conditions in a practice with a certified EMR
(Electronic Medical Record) system.  The reimbursement has two levels.

The first level, reimbursed at $42/month, requires a 20 minute check-in
(e.g., on the phone) with the patient.  The second, reimbursed at almost
$100, requires telehealth.

Home care agencies can put a program in
place where your best aides are paid $10 for a 20 minute check-in call.
If you charge $32 for this service (leaving a $10 margin for the
referring practice) and allocate some of the revenue to your staff
nurses and for software, you can provide a great service  and make a
reasonable margin.
Care Transitions Services: You can provide services
to help transition patients from hospital to home.  Most hospitals are
now being penalized for excessive readmissions
These hospitals can use your help and there are many benefits to your
agency.  We have a new white paper  to teach you about the
numerous benefits that your home care agency can achieve.

 At Ankota, we love providing home care software, telephony, care
plans, scheduling, billing, payroll and all the other basics, but we
really love that we can enable your agency to play a broader role in the
future oh health care.  We can make a difference together.  Please
download our newest free white paper "Why Care Transitions is the Next Big Thing for the Home Care Industry."

About Ankota Ankota provides software to improve the delivery of care outside
the hospital, focusing on efficiency and care coordination.

Sunday, September 6, 2015

How to Find a Lost Bank Account | eHow.com

How to Find a Lost Bank Account | eHow.com

Comfort Care DNR protocol

When a patient is in a non-hospital setting, Emergency Medical
Technicians (EMTs) are required to provide emergency medical care and to
transport patients to appropriate health care facilities. Emergency
Medical Services (EMS) personnel are required by law to provide
treatment to the fullest extent possible, subject to their level of

Comfort Care DNR Order Verification Protocol (Comfort and Care DNR)

  1. The Comfort Care DNR is designed to allow EMTs and first responders to honor a DNR order in an out-of-hospital setting.

  2. Before 1999, when Massachusetts implemented its Comfort Care DNR
    protocol, there was no mechanism to enable EMT’s and other first
    responders to recognize DNR orders in a non-hospital setting. So EMT
    personnel were always obligated to perform full resuscitation measures
    when they encountered a patient unable to convey directions regarding
    medical treatment.

  3. The Comfort Care DNR protocol provides for a statewide, uniform DNR verification protocol.

  4. The purpose of the Comfort Care DNR is to: (a) provide a
    verification of DNR orders to enable EMTs and first responders to honor
    DNR orders, (b) clarify the role and responsibilities of EMTs and first
    responders at the scene and/or during transport of patients who have a
    valid current DNR order, (c) avoid resuscitation of patients who have a
    current and valid DNR, (d) provide for palliative/comfort care measures
    for patients with a current Comfort Care DNR order verification form.

  5. Comfort Care DNR order verification forms must be completed and
    signed by the patient’s physician, authorized Physician’s Assistant or
    Nurse Practitioner.

  6. The patient must post the Comfort Care DNR where any EMT or first
    responder can easily find it. (Usually the patient’s refrigerator, or
    taped to the patients bedroom door. The Department of Public Health
    stopped issuing Comfort Care DNR bracelets in 2007, but the Department’s
    approved form contains bracelet inserts that can be used in generic
    wrist bracelets.

  7. The Comfort Care DNR Order Verification form can be accessed by
    anyone, in downloadable format from the Massachusetts Department of
    Public Health/Office of Emergency Medical Services website, at:
    But the form must be fully completed and signed by the attending
    physician, authorized nurse practitioner or authorized physician
    assistant as proscribed by the regulations.

Delirium or Dementia - Do you know the difference?

From   http://www.alz.org/norcal/in_my_community_17590.asp from Northern California and Northern Nevada Chapter Home > Delirium or Dementia - Do you know the difference?

What do we mean by delirium?

Also called the acute confusional state, delirium is a medical condition that results in confusion and other disruptions in thinking and behavior,

including changes in perception, attention, mood and activity level.

Individuals living with dementia are highly susceptible to delirium. Unfortunately, it can easily go unrecognized even by healthcare professionals

because many symptoms are shared by delirium and dementia. Sudden changes in behavior, such as increased agitation or confusion in the late evening, may be labeled as “sundowning” and dismissed as the unfortunate natural progression of one’s dementia.

When is a change in behavior delirium and not part of dementia?

In dementia, changes in memory and intellect are slowly evident over months or years. Delirium is a more abrupt confusion, emerging over days or weeks, and represents a sudden change from the person’s previous course of dementia.

** Unlike the subtle decline of Alzheimer’s disease, the confusion of delirium fluctuates over the day, at times dramatically. Thinking becomes more

disorganized, and maintaining a coherent conversation may not be possible. Alertness may vary from a “hyperalert” or easily startled state to drowsiness and lethargy. The hallmark separating delirium from underlying dementia is inattention. The individual simply cannot focus on one idea or task.

What if you suspect delirium? ..... Secondly, create a safe and soothing environment to help improve the course of delirium: keep the room softly lit at night, turn off the television and remove other sources of excess noise and stimulation. The reassuring presence of a family member, friend, or a professional often prevents the need to medicate.
And lastly, tread lightly with medications. Sedatives, sleeping medications and other minor tranquilizers play a very limited role in delirium management unless a patient is experiencing drug withdrawals.
Prevention of Delirium
 Avoid illness through smoking cessation, a balanced diet, regular exercise, adequate hydration and vaccinations to prevent influenza and pneumonia.
 Avoid alcohol in any amount.
  Exercise caution with medication, especially sleep aids, and periodically ask the physician for a “medication review.”

  Eliminate or reduce the use of the following medications:
  Antihistamines (e.g., diphenhydramine)
  Bladder relaxants
  Intestinal antispasmodic
  Centrally-acting blood pressure medicines (e.g., clonidine, methyldopa)
  Muscle relaxants
Anticholinergics (drugs with atropine-like effects)
  Opioids (e.g., codeine, hydrocodone, morphine)
Anti-nausea medication
 Benzodiazepine type sedatives

The following interventions appear to reduce the risk of delirium during hospitalization:

 Early mobilization after surgery (e.g., walking, getting up in a chair)

  Assisting the individual with eating

Round-the-clock acetaminophen for surgical pain (may lessen the need for stronger drugs)

 Minimizing bladder catheter use
  Avoiding physical restraints
  Avoiding multiple new medications
  Hydration – encourage and assist with fluids
  Normalizing the environment (e.g., pictures from home, familiar objects, cognitively stimulating activities and reminders, visits from family members)

  Providing sensory devices if needed (glasses, hearing and visual aides from home)
Overview of Delirium and Dementia
by Juebin Huang, MD, PhD

Delirium (sometimes called acute confusional state) and dementia are the most common causes of cognitive impairment, although affective disorders (eg,

depression) can also disrupt cognition.

Delirium and dementia are separate disorders but are sometimes difficult to distinguish. In both, cognition is disordered; however,

dementia affects mainly memory, and delirium affects mainly attention

 Matching the environment to patients with delirium: lessons learned from the delirium room, a restraint-free environment for older hospitalized adults with delirium.
Flaherty JH1, Little MO.


Delirium is associated with several negative outcomes and is not always preventable. Current practices for the management of older hospitalized adults with delirium, such as one-on-one sitters, antipsychotic medications, and physical restraints, have limited effectiveness or potential health risks. 

{snipped} The authors have found that a restraint-free environment can be achieved; "tolerate, anticipate, and don't agitate" (the T-A-DA method) are the core principles of the nonpharmacological approach that go beyond the traditional strategies of management (such as reorientation); based on observational data,