Sunday, November 29, 2015

Vascular dementia: What you need to know about this common disease

Vascular dementia: What you need to know about this common disease : Vascular dementia: What you need to know about this common disease
By Susan Griffi September 2015, 17:37 BST stanfieldnursing.co.uk

The word dementia describes a set of symptoms that can include memory loss and difficulties with thinking, problem-solving or language. In vascular dementia, these symptoms occur “when there is a reduced blood supply to the brain due to diseased blood vessels,” explains Kathryn Smith, director of operations at Alzheimer’s Society.

To be healthy and function properly, brain cells need a constant supply of blood, which is delivered through a network of vessels called the vascular system. If the blood vessels leak or become blocked, then blood can’t reach the brain cells and they’ll eventually die. It’s the death of brain cells which causes problems with memory, thinking or reasoning (collectively known as cognition). When these cognitive problems are bad enough to have a significant impact on daily life, it’s known as vascular dementia.

Who gets vascular dementia? There are a number of factors that put someone at risk of developing vascular dementia, including:

• Age - The risk of developing the condition doubles approximately every five years over the age of 65.

• History of cardiovascular disease - A person who’s had a stroke, or has diabetes or heart disease, is approximately twice as likely to develop vascular dementia.

• Sleep apnoea - A condition where breathing stops for a few seconds or minutes during sleep is a possible risk factor.

• Depression - According to the Alzheimer’s Society, there is some evidence that a history of depression also increases the risk of vascular dementia.

• Genetic factors - Someone with a family history of stroke, heart disease or diabetes has an increased risk of developing these conditions, although the role of genes in the common types of vascular dementia is small.

• Ethnicity - Those from an Indian, Bangladeshi, Pakistani or Sri Lankan backgrounds living in the UK have significantly higher rates of stroke, diabetes and heart disease than white Europeans. Among people of African-Caribbean descent, the risk of diabetes and stroke – but not heart disease – is also higher


Monday, November 16, 2015

Money Follows the Person Waivers

Money Follows the Person Waivers: Money Follows the Person Waivers

MassHealth offers two Home- and Community-Based Services (HCBS) waivers called the Money Follows the Person Waivers (MFP Waivers), which will help individuals who are qualified for the MFP Demonstration to move from a nursing home or long-stay hospital to an MFP-qualified residence in the community and obtain community-based services.

The two MFP Waivers are:

MFP Residential Supports (MFP-RS) waiver – for individuals who need supervision and staffing 24 hours a day, seven days a week.
MFP Community Living (MFP-CL) waiver – for individuals who can move to their own home or apartment or to the home of someone else and receive services in the community.

Eligibility Criteria for MFP Waivers

To qualify for one of these waivers, you as an applicant must:

be living in a nursing home or long-stay hospital for at least 90 consecutive days, excluding Medicare rehabilitation days
be 18 years old or older and have a disability, or be age 65 or older;
meet the clinical requirements for and be in need of MFP waiver services;
be able to be safely served in the community within the terms of the MFP waivers;
meet the financial requirements to qualify for MassHealth. Special financial rules exist for waivers participants;
meet the requirements for participation in the MFP Demonstration; and
transition to an a MFP qualified residence in the community. A qualified residence includes:
a home owned or leased by the applicant or family member;
an apartment with an individual lease or a community-based residential setting in which no more than four unrelated individuals reside; or
an assisted-living residence that has an apartment with separate living, sleeping, bathing and cooking areas, lockable entrance and exit doors, and meets other criteria.

In addition to the above, to qualify for the MFP-RS waiver, you as an applicant must need residential support services with staff supervision 24 hours a day, seven days a week.
Services Offered to Waiver Participants

All waiver participants will work with a case manager to develop their individual service plan that will reflect their goals and the waiver services and supports the waiver participant needs in the community.

Waiver services available in the MFP Residential Supports (MFP-RS) Waiver include:

Residential Habilitation (group home)
Shared Living – 24-Hour Supports
Assisted Living Services
Day Services
Home Accessibility Adaptations
Individual Support and Community Habilitation
Occupational Therapy
Peer Support
Physical Therapy
Prevocational Services
Residential Family Training
Skilled Nursing
Specialized Medical Equipment
Speech Therapy
Supported Employment
Transportation

Waiver services available in the MFP Community Living (MFP-CL) Waiver include:

Adult Companion
Chore Service
Community Family Training
Day Services
Home Accessibility Adaptations
Home Health Aide
Homemaker
Independent Living Supports
Individual Support and Community Habilitation
Occupational Therapy
Peer Support
Personal Care
Physical Therapy
Prevocational Services
Respite
Shared Home Supports
Skilled Nursing
Specialized Medical Equipment
Speech Therapy
Supported Employment
Supportive Home Care Aide
Transportation
Vehicle Modification

In addition, if you are enrolled in one of the MFP waivers and need behavioral health services (mental health or substance abuse services), you will receive your behavioral health services through the Massachusetts Behavioral Health Partnership (MBHP). MBHP is the MassHealth behavioral health managed-care contractor that will work with you and your waiver case manager to help you get the behavioral health care you need.
MFP Waiver Application Process and Brochures

You may submit MFP waiver applications any time on or after April 1, 2013. A link to the waiver applications is found below.

Application for Home- and Community-Based Services Waivers for Money Follows the Person (MFP) Residential Supports Waiver (MFP-RS) pdf format of Application for MFP Residential Supports Waiver txt format of Application for MFP Residential Supports Waiver

Solicitud de exenciones para servicios basados en el hogar y la comunidad de El dinero sigue a la persona (MFP) Exención de apoyo residencial (MFP-RS) pdf format of mfp-rs-sp.pdf txt format of mfp-rs-sp.txt
Application for Home- and Community-Based Services Waivers for Money Follows the Person (MFP) Community Living Waiver (MFP-CL) pdf format of Application for MFP Community Living Waiver txt format of Application for MFP Community Living Waiver

Solicitud de exenciones para servicios basados en el hogar y la comunidad de El dinero sigue a la persona (MFP) Exención de vivienda comunitaria pdf format of mfp-cl-sp.pdf txt format of MFP-CL-SP

A brochure with more information about the waivers is also available. Below is a link to the MFP Waiver brochure and a brochure with information about Self-directed Services in the MFP waivers.

Sunday, November 15, 2015

Ramps.org - How to Choose a Ramp

Ramps.org - How to Choose a Ramp: Home

How to Choose a Ramp
Layout Considerations
Ramps for Homes
Ramps for Businesses
Ramps for Vehicles
Specialty Ramps

Build a Wooden Ramp

Where to Get a Ramp

Contractor Corner  www.RAMPS.org
FAQ  
Ask a Question
Resource Links
Accessible Homes
Free Ramp Programs

{Q}Choosing a ramp is a lot simpler when you have some basic information. Click on the links below to learn some terminology and familiarize yourself with the kinds of ramps available, what they are made out of and what types of features are commonly offered.{EQ}

Terms to Know
Basic Types of Ramps
Materials

www.RAMPS.org

Tuesday, November 10, 2015

Hospice and Nursing Homes Blog: Afterlife: Patients’ Cultural Beliefs (Research, Video 2:27)

Hospice and Nursing Homes Blog: Afterlife: Patients’ Cultural Beliefs (Research, Video 2:27): Death has different meanings for different people. Some may choose how to respond based on cultural influences.

 Of course, basic cultural influences can differ even within a particular cultural group. Patients and their loved ones may want to share these beliefs with healthcare caregivers, so they can better understand their personal death experiences.

Their responses to patients can be very helpful to patients.

This research on the soul and afterlife was done from a cultural perspective with older adult Mexican American (MA), European American (EA), and African American (AA) participants.

These were the results:

1) Most participants said that the soul lives on after physical death, leaves the body immediately at death, and eventually reaches heaven.
2) Many participants also said death ends physical suffering.
3) More AAs than MAs or EAs said that they believed that the soul after physical death exists in the world or interacts with the living.
4) In every ethnic group, more women than men said they believed that the soul exists in the world.

Has the first evidence of life after death been found? In the largest study ever done on this topic, researchers at the University of Southhampton, England examined 2,000 cases of patients who suffered cardiac arrest and were later brought back to life. During the time when their brains had no measurable activity, as many as 40% recalled experiencing some sort of awareness.

Sunday, November 8, 2015

Home Accessibility Ramps

step-by-step manual titled How to Build Ramps for Home Accessibility is available from the Metropolitan Center for Independent Living (MCIL) in St. Paul, Minnesota.

Your ramp project may need a permit from your town.

Take a copy of your plans to the officials

Be certain to tell them if the ramp is temporary so you get the correct permit.

Advice can be obtained from your rehabilitation commission:

help is available from http://www.ramps.org/contact-us.php

Information regarding ramps; https://www.google.com/search?q=access+ramps+for+the+elderly

Thursday, November 5, 2015

How to use Windows 10’s Reliability Monitor to fix and fine-tune your PC | PCWorld

How to use Windows 10’s Reliability Monitor to fix and fine-tune your PC | PCWorld: Ed Tittel | @@EdTittel
Oct 29, 2015 6:47 AM Kim Lindros

Reliability Monitor is a built-in part of Windows that’s been around since the introduction of Windows Vista back in January 2007. It’s always been a somewhat hidden feature of the Windows operating system, and therefore easy for users and admins alike to overlook. Nevertheless, it’s a great tool that provides all kinds of interesting insight into system history and stability (see Figure 1). Reliability Monitor is particularly useful when troubleshooting glitchy systems, and can provide insights into possible causes as well as important clues to fixing things.
Understanding Reliability Monitor

Reliability Monitor is part and parcel of the Reliability & Performance Monitor snap-in for the Microsoft Management Console (MMC). That said, Reliability Monitor comes pre-defined with all modern Windows versions, so there’s no need to launch MMC, and then to start adding and configuring snap-ins to make Reliability Monitor work.

Instead, Reliability Monitor taps into the Windows Event Manager to elicit data about your system, with a focus on events that impact reliability, as well as performance counters and configuration data. Reliability monitor tracks five different categories of information, namely:

Application failures: Tracks application failures or errors (e.g., “MS Outlook … stopped working”)
Windows failures: Tracks OS failures or errors (e.g., “Windows hardware error”)
Miscellaneous failures: Tracks other failures or errors, typically peripherals (e.g., “Disk failure”)
Warnings: Tracks failures or errors that don’t necessary impact system behavior (e.g., “Unsuccessful driver installation”)
Information: Tracks system changes and updates (e.g., “Successful Windows Update” and “Successful driver installation”)

Tuesday, November 3, 2015

The Alzheimer's Association has many resources to help you as you provide care

24/7 Helpline: A free resource for reliable information and support, day or night, at 800.272.3900.
Healthy caregiver: An online resource with tips and resources about caring for yourself.
ALZConnected®: An online community that enables you to connect with other caregivers.
Educational resources: Our educational workshops and online Caregiver Center offer strategies and proactive advice.
Community Resource Finder: A comprehensive listing of Alzheimer's and dementia resources and local community programs and services.
Alzheimer's Navigator®: A powerful online tool to help caregivers like you identify needs and local community programs and services.

Legal Rights of Nursing Home Residents

Legal Rights of Nursing Home Residents
 See 
http://injury.findlaw.com/torts-and-personal-injuries/legal-rights-of-nursing-home-residents.html#sthash.WJdkqBnJ.dpuf

{quoted}
Nursing
homes have been defined as private institutions that furnish shelter,
feeding and care for sick, aged, or infirm persons. They are not
strictly considered hospitals, in that they do not necessarily render
actual medical treatment, but may be considered hospitals for certain
purposes, depending on various statutes that may govern their operation.

Federal
regulations distinguish among four types of health care facilities,
starting with those that offer the lowest level of nursing care, "adult
boarding facilities," then "residential care facilities," "intermediate
care facilities," and finally, those that offer the highest level of
nursing care -- "skilled nursing facilities." Different standards apply
depending on how an institution is classified. State and federal
governments regulate skilled nursing facilities and intermediate care
facilities, particularly with respect to their participation in Medicare
and Medicaid. National standards for nursing homes serving as "extended
care facilities" are contained in the Federal Medicare Health Insurance
Program for the Aged.

Under federal guidelines, each nursing
facility must develop and implement written policies and procedures
prohibiting mistreatment, neglect, or abuse of residents. A resident in
such a nursing facility is entitled to receive verbal and written notice
of the rights and services to which he or she is entitled during
his/her stay in the facility. This notice must be give prior to or upon
admission, and periodically throughout the resident's stay, in a
language the resident understands. The resident must acknowledge his or
her receipt of such notice in writing.

- See more at:
http://injury.findlaw.com/torts-and-personal-injuries/legal-rights-of-nursing-home-residents.html#sthash.WJdkqBnJ.dpuf
Nursing
homes have been defined as private institutions that furnish shelter,
feeding and care for sick, aged, or infirm persons. They are not
strictly considered hospitals, in that they do not necessarily render
actual medical treatment, but may be considered hospitals for certain
purposes, depending on various statutes that may govern their operation.

Federal
regulations distinguish among four types of health care facilities,
starting with those that offer the lowest level of nursing care, "adult
boarding facilities," then "residential care facilities," "intermediate
care facilities," and finally, those that offer the highest level of
nursing care -- "skilled nursing facilities." Different standards apply
depending on how an institution is classified. State and federal
governments regulate skilled nursing facilities and intermediate care
facilities, particularly with respect to their participation in Medicare
and Medicaid. National standards for nursing homes serving as "extended
care facilities" are contained in the Federal Medicare Health Insurance
Program for the Aged.

Under federal guidelines, each nursing
facility must develop and implement written policies and procedures
prohibiting mistreatment, neglect, or abuse of residents. A resident in
such a nursing facility is entitled to receive verbal and written notice
of the rights and services to which he or she is entitled during
his/her stay in the facility. This notice must be give prior to or upon
admission, and periodically throughout the resident's stay, in a
language the resident understands. The resident must acknowledge his or
her receipt of such notice in writing.

- See more at:
http://injury.findlaw.com/torts-and-personal-injuries/legal-rights-of-nursing-home-residents.html#sthash.WJdkqBnJ.dpuf
 Nursing homes have been defined as private institutions that furnish shelter, feeding and care for sick, aged, or infirm persons. They are not strictly considered hospitals, in that they do not necessarily render actual medical treatment, but may be considered hospitals for certain purposes, depending on various statutes that may govern their operation.

Federal regulations distinguish among four types of health care facilities, starting with those that offer the lowest level of nursing care, "adult boarding facilities," then "residential care facilities," "intermediate care facilities," and finally, those that offer the highest level of nursing care -- "skilled nursing facilities." Different standards apply depending on how an institution is classified. State and federal governments regulate skilled nursing facilities and intermediate care facilities, particularly with respect to their participation in Medicare and Medicaid. National standards for nursing homes serving as "extended care facilities" are contained in the Federal Medicare Health Insurance Program for the Aged.

Under federal guidelines, each nursing facility must develop and implement written policies and procedures prohibiting mistreatment, neglect, or abuse of residents. A resident in such a nursing facility is entitled to receive verbal and written notice of the rights and services to which he or she is entitled during his/her stay in the facility. This notice must be give prior to or upon admission, and periodically throughout the resident's stay, in a language the resident understands. The resident must acknowledge his or her receipt of such notice in writing.
- See more at: http://injury.findlaw.com/torts-and-personal-injuries/legal-rights-of-nursing-home-residents.html#sthash.WJdkqBnJ.dpuf

Nursing
homes have been defined as private institutions that furnish shelter,
feeding and care for sick, aged, or infirm persons. They are not
strictly considered hospitals, in that they do not necessarily render
actual medical treatment, but may be considered hospitals for certain
purposes, depending on various statutes that may govern their operation.

Federal
regulations distinguish among four types of health care facilities,
starting with those that offer the lowest level of nursing care, "adult
boarding facilities," then "residential care facilities," "intermediate
care facilities," and finally, those that offer the highest level of
nursing care -- "skilled nursing facilities." Different standards apply
depending on how an institution is classified. State and federal
governments regulate skilled nursing facilities and intermediate care
facilities, particularly with respect to their participation in Medicare
and Medicaid. National standards for nursing homes serving as "extended
care facilities" are contained in the Federal Medicare Health Insurance
Program for the Aged.

Under federal guidelines, each nursing
facility must develop and implement written policies and procedures
prohibiting mistreatment, neglect, or abuse of residents. A resident in
such a nursing facility is entitled to receive verbal and written notice
of the rights and services to which he or she is entitled during
his/her stay in the facility. This notice must be give prior to or upon
admission, and periodically throughout the resident's stay, in a
language the resident understands. The resident must acknowledge his or
her receipt of such notice in writing.

- See more at:
http://injury.findlaw.com/torts-and-personal-injuries/legal-rights-of-nursing-home-residents.html#sthash.WJdkqBnJ.dpuf
Nursing
homes have been defined as private institutions that furnish shelter,
feeding and care for sick, aged, or infirm persons. They are not
strictly considered hospitals, in that they do not necessarily render
actual medical treatment, but may be considered hospitals for certain
purposes, depending on various statutes that may govern their operation.

Federal
regulations distinguish among four types of health care facilities,
starting with those that offer the lowest level of nursing care, "adult
boarding facilities," then "residential care facilities," "intermediate
care facilities," and finally, those that offer the highest level of
nursing care -- "skilled nursing facilities." Different standards apply
depending on how an institution is classified. State and federal
governments regulate skilled nursing facilities and intermediate care
facilities, particularly with respect to their participation in Medicare
and Medicaid. National standards for nursing homes serving as "extended
care facilities" are contained in the Federal Medicare Health Insurance
Program for the Aged.

Under federal guidelines, each nursing
facility must develop and implement written policies and procedures
prohibiting mistreatment, neglect, or abuse of residents. A resident in
such a nursing facility is entitled to receive verbal and written notice
of the rights and services to which he or she is entitled during
his/her stay in the facility. This notice must be give prior to or upon
admission, and periodically throughout the resident's stay, in a
language the resident understands. The resident must acknowledge his or
her receipt of such notice in writing.

- See more at:
http://injury.findlaw.com/torts-and-personal-injuries/legal-rights-of-nursing-home-residents.html#sthash.WJdkqBnJ.dpuf

Sunday, November 1, 2015

Defining Elder Abuse and Neglect

Stephanie Z posted this on https://www.alzconnected.org

Defining Elder Abuse and Neglect

Care-giving for people with dementia is stressful to say the least. This is true for both family members and professionals working in long term care settings.

Abuse in the home setting

Add a variety of sometimes problematic family relationships and perhaps the personal stressors of the caregiver or other family members and the potential for neglect and abuse can increase. The problem is that most families don?t understand the potential for abuse or the fact that the most loving caregiver can be guilty of neglect. Most reported family situations appear to involve abuse or neglect which is has not been recognized until the person with dementia has a crisis.

Abuse in long term care

Abuse can also occur in a facility. Even the best of facilities occasionally find an employee who is abusive verbally, physically, even sexually, although that is relatively rare. Residents belongings are also at risk from abusive staff. Therefore families must always monitor what is going on with their LO and immediately report anything suspicious.

The Omnibus Reconciliation Act, which was put into law in 1989 and still in effect today, defines the rights of the elderly in long term care settings, including the right to be free from verbal, physical, and financial abuse. This extends to the inappropriate use of chemical and physical restraints (which can only be used in an emergency and for short periods of time)

Medical professionals are mandated to report suspected abuse. (and so are families and other non professionals in many states) Failure to report can result in loss of professional license, fines and even jail time.

Here is information on what to observe when looking for signs of abuse. (These come from the Elder Assessment Instrument which was created for this purpose. This information may be helpful if you suspect abuse of your LO either by a family member or the staff at a long term care facility.)

Observe the general condition of your LO.

Is their clothing clean and are they dressed according to the environment?

Are your LO?s hygiene needs being met? (Bathing, dental care, incontinence care?} Please consider that some people with dementia resist bathing and families need to learn how to address this.

Are their nutritional needs being met? Needs will change according to stage of the disease. The key is to observe for weight, hydration, redness or irritation on boney prominences as inadequate protein can add to the risk of decubitus ulcers. In the later stages of dementia when a person becomes bedridden and has problems swallowing, weight loss is expected but there should be an assessment of swallowing and adjustment of the diet to accommodate their needs (perhaps finger foods or puree foods and thickened liquids)

Skin integrity ? Are there decubitus ulcers? Were they avoidable? (Ask a professional to assess this) Are there contractures of the arms and legs and fingers? (Unable to straighten out due to lack of range of motion exercises) Contractures are very preventable, when they occur they are painful to the person and are usually permanent.

Possible Abuse Indicators:

Bruising. Occasional bruises and skin tears will happen in the older adult, especially in the later stages of dementia. However bruises in unusual places (like the middle of the back or stomach, inner thigh, upper arms, etc.) and unexplained bruises that occur regularly, are red flags. These MAY be coming from rough handling or even hitting. These need investigation by the staff and if the explanation is not satisfactory, call APS and let them assess it.

Lacerations and fractures can occur with falls. When this happens, or especially if there is no explanation (ie: no one saw it happen) an investigation should be done by the facility. If an adequate explanation is not given, or this happens more than once, or you are not satisfied with the explanation, call APS and let them assess it.

Evidence of sexual abuse:

The following signs may indicate that your loved one is the victim of sexual abuse in a nursing home:

    Unexplained difficulty with walking or sitting
    Bruising and/or thumbprints on the inner thighs, genital area, buttocks, and/or breasts
    Unexplained vaginal and/or anal bleeding
    Unexplained sexually transmitted disease or genital infection
    Unexplained genital irritation, injury, and/or redness
    Torn, stained, or bloody underclothing
    Stained or bloody sheets
    Fear, stress, anxiety, or a another strong reaction when a particular person approaches to help with bathing, dressing, or toileting

Please note that sexual abuse can even happen if a spouse is coerceing a partner into unwanted sex.

Statements by your LO that indicate abuse may be taking place. Always investigate even if you believe nothing has happened. It doesn?t hurt to be sure.

Possible Neglect Indicators

The presence of the following may indicate neglect:

Decubitus Contractures Dehydration

Untreated diarrhea Impaction Depression Malnutrition Urine Burns (diaper rash)

Who to notify:

If someone is in immediate danger, call 911 or the local police for immediate help.

If the danger is not immediate, but you suspect that abuse has occurred or is occurring, please tell someone. To report elder abuse, contact the Adult Protective Services (APS) agency in the state where the elder resides. You can find the APS reporting number for each state by visiting:

    The State Resources section of the National Center on Elder Abuse website
    http://www.ncea.aoa.gov/Stop_Abuse/Get_Help/State/index.aspx
    The Eldercare Locator website http://www.eldercare.gov/Eldercare.NET/Public/Index.aspx
    or calling 1-800-677-1116.

If the abuse takes place in a long term care facility, let the administration know, call your Ombudsman and Adult Protective Services.

family safety profile designating "senior at risk" for police, hospitals emergency responders

I have proactively registered with Smart911
I Establish a family safety profile with Smart911 to give emergency responders information before they respond. Smart911 is a national database that gives your 9-1-1 dispatchers and first responders critical-care and rescue information The information is entered through the Smart911 website and if you call 9-1-1 from a Smart911 registered and verified phone, Smart911 automatically makes your information available to your 9-1-1 operator and first responders where the service is installed.
Register at www.smart911.com and follow the prompts for creating for Smart Safety Profile.
The prompts/questions are terrific for writing a file of life document to place on you refrigerator or place where the members of the med response team can find the document and take it with them to the hospital.