Saturday, January 28, 2012

CNA CLASS practice questions

* A Nurse Aid should wear gloves for which of the following duties?
A) Emptying a Catheter Bag
B) Combing the patient’s hair
C) Ambulating a patient
D) Feeding a patient

* Which of the following statements is accurate concerning caring for a patient who wears a hearing aid?

A) Hairspray should be applied after the hearing aid is put in place.
B) The hearing aid should be removed before the patient takes a shower.
C) Clean the hearing aid daily with water and allow it to air dry.
D) Replace the batteries in the hearing aid weekly.

1. A stroke has left the client’s left side paralyzed. When changing sweaters, which side do you put on first?

a. You put both sleeves on at once

b. Paralyzed (left) side first

c. The client tells you which side to put on first

d. Right sleeve (mobile side) first

2. You must wear gloves:

a. When feeding a patient

b. During peri-care

c. Giving back rubs or stimulating exercises

d. During range of motion exercises

3. A nurse tells a CNA to apply topical medication on a patient after morning care.

What should be the aide’s response?

a. “I will be happy to do it.”

b. “I shouldn’t be doing your job!”

c. “I am unable to comply because I cannot do this without a nurse in the room.”

d. “My training does not include the application or prescription of medication.”

4. Which of the following statements is true?

a. A slow heart rate is called tachycardia.

b. To determine an irregular heart rate, you must continue to take the pulse for at least 30 seconds.

c. Use the carotid site to take the pulse, the wrist vessel is unreliable.

d. A slow heart rate is known as bradycardia.

5. Which of the five senses will a dying client lose LAST?

a. Smell

b. Hearing

c. Taste

d. Sight

6. In order to prevent dehydration, a CNA must:

a. Keep the client hydrated with constant oral intake of fluid

b. Offer fluids during the night by waking the resident continually

c. Bathe the client frequently to rehydrate the skin

d. Increase sodium chloride rich food to keep the client thirsty

7. A formerly active patient has suddenly slipped into a lethargic state. Once talkative, he is now difficult to wake.

What should a Certified Nurse Assistant do?

a. Ask another CNA if incidents like this have occurred before?

b. Report any change in behaviour to the designated nurse in charge immediately.

c. Let him sleep, he is probably tired.

d. Place the resident in a recovery position.

8. A resident asks you to join him in his morning prayers, you

a. Decline but explain that you practice a different faith and that you would be happy to find a spiritual counselor for them

b. Join them*

c. Prevent them from finishing their prayers

d. Say that “I don’t think you should believe in God in your condition.”

Note: Joining a resident in prayer may be polite and appropriate but it is not required

9. How long should respirations be counted when observing a patient?

a. Approximately 1 minute

b. Only 20 seconds, then multiply by four

c. 30 seconds

d. At least 2 minutes

Answer Key:1)B; 2)B; 3)D; 4)D; 5)B; 6)A; 7)B; 8)B; 9)A,B; 10)A

Friday, January 27, 2012

So disturbing

Wonder why they released this guys name and not the nurses in Utah Valley who taped the woman's mouth shut?

Logan hospital worker arrested in alleged patient sex assault
Police • Victim was drunk and unconscious as staffer assaulted him.
By bob mims

The Salt Lake Tribune

Published: January 27, 2012 05:05PM
Updated: January 27, 2012 01:56PM

Hal Lavaun Weston. (Cache County Jail photo) Logan police thought they had safely secured a drunk and unconscious man in an exam room at Logan Regional Medical Center.

An officer even took up station outside the room while writing his report on the man’s alleged trespassing, intoxication and public urination.

But when the officer finished the report and went in to check up on his charge, he allegedly found a male medical staffer performing oral sex on the still-unconscious suspect instead of inserting a catheter.

“It’s one of those moments when you say to yourself, ‘Really? Wow,’” Logan Police Chief Gary Jensen said Friday. “It’s unsettling, to say the least.”

Jensen said that late on the night of Jan. 20, his officers had been dispatched to a residence near 1200 West and 200 North to deal with the drunken suspect, who was reportedly refusing to leave the home. Officers arrested the man, who passed out in the back seat of a cruiser en route to the Cache County Jail.

Neither officers nor paramedics were able to rouse the man, so he was transported to the hospital emergency unit and placed in the exam room to be monitored.

When the accompanying officer decided to check on the suspect, “He walked in the room and pulled the curtain back slightly. The officer observed the unconscious man laying on the hospital bed and the male caregiver performing a sexual act on the patient,” Jensen said.

The officer summoned hospital security personnel and just after midnight Jan. 21, Hal Lavaun Weston, 46, of Laketown, was detained, questioned by detectives and then arrested.

He was booked into Cache County Jail and later released on his promise to appear before a judge Feb. 13 in 1st District Court.

On Tuesday, Cache County prosecutors formally filed a first-degree felony forcible sodomy charge against Weston.

Calls to Weston’s Laketown home Friday seeking comment went unanswered.

© 2012 The Salt Lake Tribune
Logan hospital worker arrested in alleged patient sex assault
By bob mims

The Salt Lake Tribune

Wednesday, January 25, 2012

California Has 25% Fewer RNs Per 100,000 Than U.S. Average, According To California Institute For Nursing & Health Care

California Has 25% Fewer RNs Per 100,000 Than U.S. Average, According To California Institute For Nursing & Health Care

OAKLAND, Calif., Jan. 23, 2012 – California averages 644 nurses per 100,000 persons, compared to the U.S. national average of 859 nurses per 100,000, according to a study that graded 23 California regions on their nurse job to population ratio. More than half of these regions earned grades of “D” or “F” when compared to the national average. California earned an overall “C” grade, compared to the nation. An “A” would be a ratio of 1,257 or more RN jobs per 100,000, according to the analysis, which is based on U.S. Bureau of Labor Statistics data.

The California Institute for Nursing and Health Care (CINHC) study found that California’s RN job ratio per capita increased by 22 RN jobs between 2004 and 2010, but its national ranking did not change as nurses were added to the workforce across the county.

“This study supports the need to maintain capacity in nursing schools as a high priority since California lags behind most states in RN utilization. The report card is invaluable for regional planning efforts,” said Deloras Jones, RN, MSN, executive director of CINHC.

The San Francisco/San Mateo/Redwood City area earned a C+, the state’s highest mark. Other grades:
C: Redding
C-: Chico/Paradise; Sacramento; San Diego/Carlsbad/San Marcos; San Luis Obispo/Paso Robles; Santa Ana/Anaheim/Irvine; Santa Rosa/Petaluma; Vallejo/Fairfield
D: Los Angeles/Long Beach; Modesto; Oakland/Fremont/Hayward; Riverside/San Bernardino; Salinas; San Jose/Sunnyvale/Santa Clara; Santa Barbara/Santa Maria/Goleta; Santa Cruz/Watsonville; Stockton; Visalia/Tulare/Porterville.
F: Bakersfield; Fresno; Merced; Oxnard/Thousand Oaks/Ventura.
Ratios ranged from a low of 195.5 RNs per capita in Merced to a high of 960 in San Francisco/San Mateo/Redwood City.
Only the Redding and San Francisco areas were close to or exceeded the national average, with 960 and 857.7 RN jobs per 100,000 respectively.
Regions correspond to metropolitan statistical areas (MSA’s). Counties within each MSA are listed in the full report at Data for this study is from 2010. (The study was based on original work done in 2006 in cooperation with the VA Long Beach Healthcare System and UC Irvine School of Medicine.)

CINHC is a 501 (c)(3) non-profit organization that transforms the capacity of nurses to meet the evolving health needs of Californians by partnering with nurse leaders, educators, providers, payers, policy leaders, and consumers. For more information,

State Makes Universal Transfer Form Mandatory

State Makes Universal Transfer Form Mandatory
Stakeholders from all levels of the continuum developed a document specifically crafted to encourage widespread use.
January 2012

Theresa Edelstein and Daniel Moles, RN

​In New Jersey, transferring patients across the continuum of care has seen its share of problems regarding continuity and relaying accurate patient information. Developing and implementing a common transfer form to alleviate these issues was sorely needed to improve quality of care and reduce medical errors.

To address this need, health care facilities, home care providers, health care professionals, and other stakeholders worked with the state Department of Health and Senior Services (DHSS) to create and implement a mandatory Universal Transfer Form (UTF).
Getting Started
In late 2006, the UTF Task Force was launched with the New Jersey Hospital Association and the Health Care Association of New Jersey coordinating this statewide effort (see box, below).

The task force defined transfer as the handing off of responsibility for a patient from one facility or agency licensed by DHSS to another. The task force determined that it would be in the best interest of the patient if the receiving facility/agency had an up-to-date summary of essential information that was documented clearly on a standardized form to preserve continuity of care upon transfer.

This approach offered three advantages: All facilities would adjust their protocols for paper or electronic record systems to support the efficient capture of information needed to populate the mandatory form. Professionals receiving the new patient would know exactly where to look for the information needed to ensure continuity of care upon transfer. There would be a clear standard defining their duty to send accurate and complete information with patients upon transfer.

Exclusions included transfers between emergency departments; the return of an emergency department patient (who was not admitted to the hospital) back to his or her long term care facility; and special care needs patients, such as premature infants, newborns, and maternity care patients.

Voluntary compliance had failed in the past, so all stakeholders committed to using the UTF with the knowledge that the form would be mandated via state regulation.

All participants received numerous sample forms and transfer-of-care articles for review. The initial work concentrated on discussing and deciding what information was essential to include, as well as the degree of detail.
Keeping It Manageable
From the beginning, stakeholders were mindful of the concept that less is more. Too much information invited greater opportunities for errors of commission and omission. The task force decided to develop a form that captured essential information for continuity of care at the time of transfer and to encourage the sending provider to attach copies of relevant source documents appropriate to the needs of each patient.

Determining the best way to communicate medication information was especially challenging. Some stakeholders wanted a written list of current medications, while others wanted a copy of the physicians’ orders and medication administration records. Still others suggested that in accordance with The Joint Commission standards, a medication reconciliation document should be used.

Ultimately, the task force decided that the sending facility must include accurate information about current medications in a self-defined manner.

The initial draft was a two-page form. Page one contained essential information, and desired information was listed on page two. This allowed the sending facility to complete only the first page if the transfer out was an emergency, such as a nursing facility resident in need of immediate hospitalization.

Testing The Product
The draft form was pilot-tested in two phases. Phase one was a nonscientific, real-world mini pilot involving 10 facilities to determine if the draft form had major faults. The results of the pilot rendered minor suggestions to improve the form, which were adopted prior to the phase two trial.

Rutgers University was contracted to provide an objective, statewide phase two pilot test of the UTF.

The purposes of the phase two pilot were to gauge the acceptance of a UTF, identify ways to improve the form, highlight opportunities to effectively train staff in use of the UTF, and determine if the UTF was appropriate for a variety of facilities.

Five hospital systems and their referring and aftercare facilities participated in the phase two pilot.

The hospitals selected were in the northern, central, and southern areas of the state and were in both urban and suburban areas. The goal was to represent broadly the types of facilities that would be required to implement the UTF. Thirty-five facilities from these hospital systems participated in the pilot. This included assisted living facilities, home health care agencies, nursing homes, and rehabilitation hospitals. Some of these facilities offered multiple levels of care and specialized units, including mental health.

The 11-month field test yielded 546 UTF forms, 218 sender’s evaluation forms, and 10 receiver’s evaluation forms. Due to the low volume of receiver’s evaluations, Rutgers followed up by interviewing staff at receiving facilities.

In parallel during phase two, IGI Health created and pilot-tested an electronic version of the UTF with one hospital system and some of its post-acute partners. This was in anticipation of the expected development of and investment in more electronic health record applications in all care settings.
Form Still Too Long
Four themes emerged from the senders’ feedback: The form took too much time to fill out, the form was too long, staff members did not always have the information required, and there were various suggestions to omit or reduce specific areas. Receivers were pleased to have accurate and timely information on one form and offered ideas to reduce the length of the form.

Most importantly, the overwhelming majority of senders and receivers in the field were quick to recognize the inherent advantages of a standardized transfer form.

Based on their evaluation of the pilot, Rutgers made several recommendations that were adopted by the task force:
•Shorten the form while including the necessary information to ensure a safe and effective transfer;
•Include more staff members at future training sessions, incorporating a team approach rather than train-the-trainer;
•Address the individual organizational process needs of each specific facility and network, including the types of electronic or traditional medical filing systems; and
•Ensure that specialized facilities’ unique circumstances are addressed in the implementation of the UTF.
As a result, the form was reduced to a one-page document that captured the information needed at the time of transfer to ensure continuity of care. In addition, a comprehensive instruction sheet was developed to accompany the revised form.
The Final Transfer Document
In its final incarnation, information on page one included:
•Name and telephone number for physician and sending facility contact person in the event that the receiving professionals have questions
•Reason(s) for transfer
•Code status
•Pain along with other vital signs
•At-risk alerts
•Under-skin condition, identify if no wounds or the type of wounds
•Identify attached documents
•Require that the sending facility attach current medication information
In 2009, the final version of the UTF form and instructions were presented to DHSS. Following the administrative process for adopting regulations, in August 2011 the department finalized the rules for all 1,900 licensed health care providers and made the form and instructions available.

Electronic or paper completion of the UTF is permitted; considerable emphasis is being placed on electronic use of the form as a method to facilitate care transitions in concert with the goals of health care reform and the move toward health information exchanges.

Theresa Edelstein, MPH, LNHA, is vice president, post-acute care policy & special initiatives, for the New Jersey Hospital Association. She can be reached at Daniel Moles, RN, BBA, MPS, LNHA, is president of TRANSITION HealthCare Consultants and Nursing Home Expert Opinion Services, Monroe Township, N.J. He can be reached at

Study: Virtual Reality Trumps Traditional Exercise In Preventing Cognitive Impairment

Study: Virtual Reality Trumps Traditional Exercise In Preventing Cognitive Impairment

Meg LaPorte

Page Content
Exercise aided by virtual reality has cognitive benefits over traditional exercise for older adults, according to a new study published in the February issue of the American Journal of Preventive Medicine.

Virtual reality-enhanced exercise that combines physical exercise with computer-simulated environments and interactive video game features can produce greater cognitive benefits for older adults than traditional exercise alone, according to the study.

“We found that for older adults, virtual-reality enhanced interactive exercise, or ‘cybercycling,’ two to three times per week for three months yielded greater cognitive benefit, and perhaps added protection against mild cognitive impairment, than a similar dose of traditional exercise,” said Cay Anderson-Hanley, PhD, lead investigator of the study and professor at Union College in Schenectady, N.Y.

While research has traditionally shown that exercise may prevent or delay dementia and improve cognitive functioning in normal aging, only 14 percent of adults aged 65 to 74 and only 7 percent of those over 75 report regular exercise. According to the study’s authors, “exergames have the potential to increase exercise by shifting attention from aversive aspects toward motivating features such as competition and three-dimensional scenery, leading to greater frequency and intensity and enhanced health outcomes.”

The study included 101 volunteers aged 58 to 99 from independent living facilities with indoor access to an exercise bike. Sixty-three adults completed the study, some on a cybercycle and the remainder on a traditional stationary bike. Cybercycle participants experienced three-dimensional tours and raced against a “ghost rider,” an avatar based on their last best ride.

The results of the study revealed that cybercyclists had significantly better executive function than those who rode a traditional stationary bike. In addition, the cybercyclists experienced a 23 percent reduction in progression of mild cognitive impairment compared to traditional exercisers.

“No difference in exercise frequency, intensity, or duration was found between the two groups, indicating that factors other than effort and fitness were responsible for the cognitive benefit,” said co-principal investigator Paul Arciero, PhD, professor of health and exercise sciences at Skidmore College, Saratoga Springs, N.Y.

The investigators speculated that the benefits of cybercycling could be derived from navigating a three-dimensional landscape, anticipating turns, and competing with others, which requires additional focus, expanded divided attention, and enhanced decision making.

“These activities depend, in part, on executive function, which was significantly affected,” said Anderson-Hanley.

“The implication of our study is that older adults who choose exergaming with interactive physical and cognitive exercise over traditional exercise may garner added cognitive benefit, and perhaps prevent decline, all for the same exercise effort,” Anderson-Hanley said.

Thursday, January 19, 2012

Eagle Scout earns all 129 merit badges, saves grandpa

By Carol Lindsay

Special to The Tribune

Published: January 19, 2012 11:50AM
Updated: January 18, 2012 04:35PM

Courtesy of John Bill Eagle Scout John Bill — sitting with hid dog, Jake — earned every merit badge offered by the Boy Scouts of America. Clearfield • John Bills’ quest to earn every Boy Scout merit badge had an unexpected result: It saved his grandfather’s life.

It wasn’t the life-saving merit badge that did it. Or first aid. Or emergency preparedness. The badge the now-Eagle Scout credits with his grandfather’s rescue was actually dog care.

The story went something like this: During a visit to the Humane Society for his dog-care merit badge, John adopted a red Irish setter named Jake. It was an impulse decision. But on a freezing February night, just two days after bringing the dog home, it paid off.

It was 2 a.m. when Jake began to growl and fidget. The noise awoke Chris Bills, John’s father, who arose from bed to see what was the matter. After finding nothing amiss, he lay down again. But Jake refused to calm down. So Bills arose for a second time. It was then that he discovered John’s grandfather — an 84-year-old with Alzheimer’s — standing on the doorstep in 2-degree weather wearing nothing but pajamas. The ailing man had been locked out.

“I couldn’t believe it,” John said. “My dad and I rescued Jake as part of a merit badge, and Jake actually ended up saving my grandpa’s life.”

Serendipity is the word John’s father uses to describe many of the events that occurred during his son’s search for every merit badge offered by the Boy Scouts of America.

John — the 19-year-old son of father Chris Bills from Holladay and mother Diane Prince and stepfather Robert Prince from Centerville — decided shortly after earning his Eagle, at age 13, that he wanted to earn every merit badge. It was a lofty goal. Although it takes 21 merit badges to earn the Eagle rank, the Boy Scout organization offers 129 patches.

John met his goal, finishing his last merit badge on Oct. 29 — the night before 18th birthday.

“I tell people I have a whole flock of eagles,” John said.

Earning all the merit badges was a goal John couldn’t have achieved without his father. Because John’s parents are divorced, he spent every other weekend, every other holiday and a couple of weeks during his summer vacation at his father’s house. Most of that time was spent working on scouting.

“If we had more time,” John said, “I could have finished this by the time I was 15.”

John graduated from Viewmont High last spring. A court of honor, celebrating his accomplishment of earning every merit badge, was held late last month.

Early in his scouting career, John learned that pursuing merit badges opens doors. His second badge was in law. Dressed in full Scout uniform, John went to a criminal trial with his father. During a break in the proceedings, federal attorneys introduced themselves to John. Then they introduced John to the judge. Because of those connections, John soon found himself in another courtroom listening to goings-on of the high-profile Olympic bribery scandal. Before the day was done, he was invited onto the street for an interview by a journalist.

“These kind of experiences just kept happening over and over,” Chris Bills said. “It was almost like someone was opening doors all the way through this whole odyssey. It is amazing the number of places we’ve been and exciting experiences we have had. People have let us into their world and behind their curtains. We’ve seen things you wouldn’t see in a lifetime.”

When John went to earn his disability merit badge, he wanted to research blindness. So his dad opened the phone book and dialed a number. Ron Gardner, an attorney and president of the National Federation of the Blind of Utah, answered the phone. Not only was he willing to help John with his merit badge, he invited him to join him in Baltimore for a convention. John and his dad attended the convention and experienced being part of promoting legislation for the blind.

On the way back from Maryland, John had an unexpected experience.

“At the airport I was in my uniform and a huge plane landed,” John said. “Off came 80 Iraq soldiers with bags and luggage. One of the soldiers came over and started talking to me and he asked if I was an Eagle. I said no, but I would be soon. He asked if I collected coins and I said yes. He pulled out a campaign medallion he was given for his service in Iraq. … He said he grew up in the ghetto in L.A. If it wasn’t for his mom putting him in Scouts, he would be dead.”

Continuing to work at Scouts became a challenge in high school. Most of John’s friends had finished with Scouts in junior high.

“There were so many distractions, friends, school work, sports, girls, it was hard to keep myself motivated,” John said. “My friends had all stopped doing scouting and they wondered what I was doing. They would give me a hard time. I had to make decisions to work on this and not hang out with friends. So coming to my dad’s got me away from the distraction.”

So how often does a Boy Scout earn all the merit badges?

“About once a year in the country,” said Marte Green, program director for the Boy Scouts of America’s Trapper Trails Council. “It is pretty rare.”

Troop Committee Chairman Kent Toone conducted the boards of review for many of John’s awards.

“It was sure fun as a Scout leader to see John’s consistent enthusiasm,” he said. “He’s a fantastic example of how scouting creates men out of boys because I witnessed him develop his confidence, integrity and physical skills as he progressed and earned those merit badges.”

Now 19, John is preparing to serve an LDS mission.

“All the things I’ve learned in scouting — achieving goals, breaking them down into pieces — I can now put forth into my mission,” he said.

An Eagle’s path

John Bills didn’t stop his scouting career after reaching his Eagle Scout rank. Instead, here’s a look at his accomplishments, by the numbers:

235 • Hours devoted to his Eagle project

200 • Miles hiked

129 • Merit badges earned

60 • Campouts

50 • Miles biked

20 • Eagle palms earned

8 • Weeks of father/son summer camps

2 • Cross-country flights

1 • Train trip

An Eagle’s path

John Bills didn’t stop his scouting career after reaching his Eagle Scout rank. Instead, here’s a look at his accomplishments, by the numbers:

235 • Hours devoted to his Eagle project.

200 • Miles hiked.

129 • Merit badges earned.

60 • Campouts.

50 • Miles biked.

20 • Eagle palms earned.

8 • Weeks of father/son summer camps.

2 • Cross-country flights.

1 • Train trip.

© 2012 The Salt Lake Tribune
Eagle Scout earns all 129 merit badges, saves grandpa
By Carol Lindsay

Tuesday, January 17, 2012

Well, we had a good time at class!

The Saddest Days of the Year
Mark your calendars: January 16 may just be the gloomiest day of 2012. But that's not the only time to stock up on tissues.

By Chris Iliades, MDMedically reviewed by Farrokh Sohrabi, MD

“Sunday morning my head is bad, but it's worth it for the time that I had. But I got to get my rest … ‘Cause Monday’s a mess,” croons R&B legend Fats Domino in his 1957 tune “Blue Monday,” a song about the dreary doldrums of the work week.

And the singer may have been on to something: According to British psychologist Cliff Arnall, Monday is the bleakest day of the week. But what happens when you take a Monday smack-dab in the middle of winter, after the holidays? You may have just stumbled upon the most depressing day of the year.

Arnall has dubbed the third Monday in January “Blue Monday,” based on his theory that factors like the weather, post-holiday debt, and low motivational levels make it the gloomiest date on the calendar. But if you can make it past Blue Monday (which falls on January 16 this year) in one piece, you may want to beware of these other potentially gloomy periods that pop up throughout the year.

The Wearisome Winter Months
Blue Monday is just one day in a long, dark, and dreary season. Estimates vary, but some experts say that about 20 percent of Americans fall victim to winter blues.

Even more severe is seasonal affective disorder (SAD) — a form of depression that affects less than 5 percent of the U.S. population, typically during December, January, February, and March. This condition is thought to be caused by decreased exposure to sunlight during the winter months (which explains why it’s 10 times more common in Alaska than in sunny Florida).

"SAD is a serious problem for some people, but any type of depression can be made worse by short days, dreary weather, or stressful holidays," says Robert Rowney, DO, a psychiatrist and mood disorder expert and director of the Cleveland Clinic Center for Mood Disorders Treatment and Research at Lutheran Hospital. "The big difference between SAD and major depression is that SAD starts in the fall or winter and ends in the spring. Major depression may get worse in the winter, but it does not end in the spring."

In addition to sadness, anxiety, and social withdrawal, symptoms of SAD may include a lack of energy, a heightened need for sleep, weight gain, and cravings for sweets.

Lonely Valentine’s Day
If there’s one day of the year when many people feel blue, it’s Valentine’s Day — when roses and chocolates flow freely … if you’re in love. In fact, a recent study of more than 2,000 adults — orchestrated by the online dating site TRUEBeginnings — found high levels of psychological distress in singles on Valentine’s Day (and the weeks following). Another large survey from Meet Market Adventures discovered that more than 70 percent of unattached people stay home and wallow on Feb. 14.

To fight back, self-love proponent Christine Arylo, author of Choosing ME Before WE: Every Woman's Guide to Life and Love, has started a Feb. 13 celebration called “Madly In Love With Me Day” to encourage women to feel great about themselves, man or no man.

Troublesome Tax Day
Mark your calendars for mid-April: In a recent survey of more than 350,000 people from the polling agency Gallup, “tax day” topped the list as one of the most stressful days of the year. In fact, the only other nerve-wracking event in 2011 that was deemed more stressful than tax day was April 27 — when the outbreak of tornadoes devastated the southeastern United States, killing more than 300 people.

According to Gallup, about 15 percent of Americans experience extreme stress on this dreaded day on which taxes are due.

Serious Summer SADness
Sad when it’s sunny? For a small group of people, seasonal affective disorder may actually occur during the dog days of summer.

Summer SAD (or reverse seasonal affective disorder) accounts for only about one-tenth of SAD cases, according to the National Alliance on Mental Illness (NAMI), and it may be related to heat and humidity — some people get better if they visit a cooler climate. Symptoms include feelings of depression, anxiety, decreased appetite, and insomnia.

Dreary Daylight Savings Time
For people who experience season-induced sadness, the condition is closely related to the ticking of their biological internal clock (also called the circadian rhythm). Anything that alters that clock may throw it off enough to cause feelings of depression.

And even though you may be excited about that extra hour of sleep during November, daylight savings time may throw your emotions out of whack. "Daylight savings time may be a trigger for depression because it changes the sleeping and waking pattern and the hours of daylight exposure," says Dr. Rowney.

The Humdrum Holidays (Bah Humbug!)
The most wonderful time of the year? For some, the holidays and post-holidays can actually be the most depressing. Chalk it up to financial stress from holiday gifting and traveling, overindulgence in food (and, especially, alcohol), decreased amount of exercise, and resurfacing of old family tensions, says Rowney.

And once the holiday decorations are packed away, you might feel a huge letdown — and not just because Santa didn’t deliver on your list. "Holiday and post-holiday depression may be linked to changes in your routine and stress," he explains.

However, it’s not just the end-of-the-year holidays that make people blue: Just about any widely observed event can make some feel gloomy, he says. Mother's Day, for instance, can be a difficult day for women who've lost their mother or are struggling to become one. And Thanksgiving, so wrapped in the idea of family togetherness, can be a sad time of year for those who find themselves alone or battling family issues.

How to Keep Your Chin Up During the Gloomiest Days of the Year
The best way to avoid falling into a funk? Be prepared.

To avoid the winter blues or SAD, Rowney suggests getting out and soaking up as much morning sunshine as you can. To avoid the holiday blues — no matter what holiday most affects you — have reasonable expectations and try to spend the day (or days) with supportive friends and loved ones. Try to maintain your normal schedule as much as possible. Get plenty of sleep and exercise, and go easy on the eggnog.

"If you have depression at any time that lasts for more than a few weeks and significantly interferes with your ability to live your life, you need to ask for help," warns Rowney. You don't have to suffer through blue Mondays, Tuesdays — or any other days of the week for the matter.

Thursday, January 12, 2012

Utah health expert: No cure for the common cold, but common sense can prevent it

Health • Avoid infecting others, and get your flu shot.
By Patty Henetz

The Salt Lake Tribune

Published: January 12, 2012 01:01AM
Updated: January 12, 2012 01:01AM
One billion.

That’s the normal common-cold count each year in the United States. Broken down, that’s two to three colds per adult and six to nine per year for kids — a battle no amount of echinacea or zinc could ever win.

In fact, say public-health researchers and epidemiologists, there are only four ways to prevent colds, and none involve pharmaceuticals or supplements: Wash your hands, get enough sleep, exercise and don’t smoke. Beyond that, there is only mixed evidence that alternative medicines or home remedies can help.

Here are the basics.

Wash your hands often • Use soap and warm to hot water. Try singing “Happy Birthday” to yourself a couple of times to make sure you’re washing them long enough. Refrain from touching your face, eyes, nose and mouth, because they are the cold virus’s entry points. Cough or sneeze into your elbow rather than your hand to keep from spreading viruses to handrails, doorknobs, computer keyboards, your cellphone or any other surfaces, where they can live for three to five hours. If you don’t have soap, use alcohol-based hand disinfectant. Or both. Because other people probably haven’t sung “Happy Birthday” to themselves even once after using the bathroom or coughing.

Get your zzzzs • Research has shown that subjects deliberately dosed with a common cold virus were three times more likely to develop a cold if they slept seven hours instead of eight or more. Resting isn’t the same as sleeping.

Get moving • Teresa Garrett, director of disease control and prevention at the Utah Department of Health, says there is good evidence that regular exercise can stave off viruses. “We’re always telling people exercise is good for you,” she says. “It builds up your immune system, you are healthier, you drink more water, you do all the things you’re supposed to do.”

Thank you for not smoking • Even just being around others’ smoke dries out your nasal passages and paralyzes the cilia that sweep germs out of your lungs, a problem for people with chronic lung diseases and asthma. Yet a study by the National Institutes of Health of heavy smokers, which adjusted for chronic conditions, weight, physical activity, vitamin supplement intake and drinking alcohol, found no increase in the smokers’ cold frequency — they just lasted longer. And speaking of drinking: Alcohol dehydrates, which helps your body create a virus-friendly environment.

Worse, having a cold means a greater likelihood of developing the flu, viral bronchitis and viral pneumonia.

Flu season goes through March or April, so there’s still time to get a shot. “It’s really never too late,” Garrett says. “For the average person, getting the shot every year is a really good idea.”

Once you get a cold, you may be able to take the edge off your symptoms with vitamin D3, zinc acetate, echinacea and vitamin C, all of which have been subject to research and shown sporadic effectiveness.

Honey can soothe sore throats and suppress coughing but should never be given to children less than a year old. Massage can make you feel better because it releases oxytocin, the contentment hormone that counters stress, a known contributor to multiple illnesses including the common cold. Chicken soup can help because it is hot, liquid and usually contains garlic, which may boost your immune system.

But, as Garrett points out, a cold — caused by any one of more than 200 viruses — will be with you for seven to 14 days. You are contagious for those first seven days.

“You’re a hazard to others,” she says, especially to people with compromised immune systems due to diabetes, cancer, HIV, high blood pressure, arthritis or any other chronic illness.

“Staying home when you don’t feel good is important,” she says. “We don’t do enough of that in our culture.”

Cold season

R Defend yourself and others from cold viruses with common-sense health practices, which are far more effective than any other remedy.

© 2012 The Salt Lake Tribune
Utah health expert: No cure for the common cold, but common sense can prevent it
By Patty Henetz

The Salt Lake Tribune

Johnson & Johnson may be fined for selling bad insulin pumps

Safety • FDA also says company delayed reporting failures of device.

The Associated Press

Published: January 11, 2012 04:51PM
Updated: January 11, 2012 05:45PM
Trenton, N.J. • Federal regulators have warned Johnson & Johnson that it could face fines and other sanctions for selling faulty insulin pumps and delaying disclosures of serious injuries to diabetics who were using its OneTouch Ping and 2020 pumps.

The Food and Drug Administration ordered J&J’s Animas Corp. unit to explain why it kept selling pumps known to fail and also to submit a plan to rectify its failure to promptly report cases in which its device might have caused or contributed to death or serious injury.

In a Dec. 27 warning letter posted online by the FDA Tuesday, the agency wrote to Animas and J&J CEO Bill Weldon that inspectors found Animas, which is based in West Chester, Pa., never reported on one complaint about serious patient injury and delayed reporting on two others. Those patients were hospitalized with dangerously high blood sugar, respiratory failure and coma, and a life-threatening complication called diabetic ketoacidosis caused by lack of insulin to break down blood sugar.

Insulin pumps, which are about the size of a cellphone, automatically inject small amounts of insulin through a tiny needle under the skin throughout the day to keep diabetics’ blood sugar at a safe level. Patients program the device to inject additional insulin right before a meal or snack, according to the amount of carbohydrates about to be eaten.

Animas spokeswoman Caroline Pavis said the company did not report the three patient incidents to FDA as required within 30 days because each involved patients not using the pumps according to directions. In one case, she said, the patient ignored an alarm signaling the cap had come off the insulin cartridge inside the device, preventing insulin from being pumped into the body. She said Animas will now report all patient complaints promptly.

In a separate issue, some pump keypads for controlling how much insulin is injected were deteriorating prematurely, leading to failures. “We decided to go with a new keypad because it’s more durable,” Pavis said.

While Animas was lining up the new keypad supplier, it was still selling the older ones. The FDA demanded documents about the company’s decision to do that.

David Rosen, a former FDA staff member who’s now an attorney at Foley & Lardner LLP advising clients on FDA regulatory issues, said companies must continuously evaluate a product’s safety over its life span.

“A company the size of J&J should have infrastructure in place to process, review and classify complaints, because they could be indicative of a larger issue with the product,” he said. “It’s a little disconcerting that they didn’t have their act together in that regard.”

The problems follow a string of nearly 30 product recalls announced by New Brunswick, N.J.-based Johnson & Johnson from September 2009 through last month. They have included millions of bottles of Tylenol, Motrin and other nonprescription medicines for children and adults, prescription drugs for seizures and HIV, faulty hip implants and contact lenses that stung the eyes. Reasons for the recalls ranged from contamination with metal shards and glass particles, to nauseating odors and inaccurate levels of active drug ingredients.

“Any company can have one of these things pop up and smack them, and you can have a bad coincidence when two of them come and smack you three weeks apart. But it’s not bad luck when you have” this many, said Erik Gordon, a professor and analyst at the University of Michigan’s Ross School of Business. “The amazing thing is that Bill Weldon still has a job.”

The recalls cost J&J $900 million in 2010 alone in lost revenue from products not being in stores, plus millions more for factory upgrades and legal expenses. The FDA and Congress have been investigating the handling of the manufacturing problems and the recalls by a company that stresses in its corporate credo its responsibility to the doctors, patients and parents who use its products.

J&J has said there have been no reports of serious patient harm from the recalled products, although it’s now being sued by a couple alleging their toddler died from taking a “super dose” of defective Children’s Tylenol.

The FDA’s warning letter states that the initial Animas response to the problems cited in the August inspection report was not adequate. Pavis said Animas hopes to respond before the Jan. 20 deadline.

The letter states that if the company doesn’t promptly correct the violations, it could face seizure, injunction, and fines, and could be denied future contracts from federal agencies. Pavis could not say how much business Animas does with the Medicare and Medicaid programs.

On Wednesday, Johnson & Johnson shares fell 7 cents to close at $65.13.

© 2012 The Salt Lake Tribune
Johnson & Johnson may be fined for selling bad insulin pumps

The Associated Press

Sunday, January 8, 2012

Nurse's suicide highlights twin tragedies of medical errors

By JoNel Aleccia
Health writer
For registered nurse Kimberly Hiatt, the horror began last Sept. 14, the moment she realized she’d overdosed a fragile baby with 10 times too much medication.

Stunned, she told nearby staff at the Cardiac Intensive Care Unit at Seattle Children’s Hospital what had happened. “It was in the line of, ‘Oh my God, I have given too much calcium,’” recalled a fellow nurse, Michelle Asplin, in a statement to state investigators.

In Hiatt’s 24-year career, all of it at Seattle Children’s, dispensing 1.4 grams of calcium chloride — instead of the correct dose of 140 milligrams — was the only serious medical mistake she’d ever made, public investigation records show.

“She was devastated, just devastated,” said Lyn Hiatt, 49, of Seattle, Kim’s partner and co-parent of their two children, Eli, 18, and Sydney, 16.

That mistake turned out to be the beginning of an unraveled life, contributing not only to the death of the child, 8-month-old Kaia Zautner, but also to Hiatt’s firing, a state nursing commission investigation — and Hiatt's suicide on April 3 at age 50.

Hiatt’s dismissal — and her death — raise larger questions about the impact of errors on providers, the so-called “second victims” of medical mistakes. That’s a phrase coined a decade ago by Dr. Albert Wu, a professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health.

It’s meant to describe the twin casualties caused by a serious medical mistake: The first victim is the patient, the person hurt or killed by a preventable error — but the second victim is the person who has to live with the aftermath of making it.

No question, the patients are the top concern in a nation where 1 in 7 Medicare patients experiences serious harm because of medical errors and hospital infections each year, and 180,000 patients die, according to a November 2010 study by the Department of Health and Human Services’ Office of Inspector General.

That’s nearly double the 98,000 deaths attributed to preventable errors in the pivotal 2000 report “To Err is Human,” by the Institute of Medicine, which galvanized the nation's patient safety movement.

In reality, though, the doctors, nurses and other medical workers who commit errors are often traumatized as well, with reactions that range from anxiety and sleeping problems to doubt about their professional abilities — and thoughts of suicide, according to two recent studies.

Surgeons who believed they made medical errors were more than three times as likely to have considered suicide as those who didn’t, according to a January survey of more nearly 8,000 participants published in the Archives of Surgery.

Even when they don’t think of killing themselves, medical workers who make errors are often shaken to their core, said Amy Waterman, an assistant professor of medicine at Washington University in St. Louis, who studied the issue in a 2007 survey of more than 3,100 practicing doctors in the U.S. and Canada. Ironically, the survey included doctors at Seattle Children’s Hospital.

“It really affects their confidence as physicians and it affects their ability in the future,” Waterman said.

Longtime caregiver
Records show that Hiatt had cared for Kaia Zautner many times since her birth, when the baby with severe heart problems was first brought to Seattle Children’s. She was close to the child’s family, who sought out her care, records show. She was Facebook friends with Alana Zautner, Kaia’s mom, hospital officials said.

After the overdose, the child’s parents asked that Hiatt not care directly for their baby, but they did not appear to seek retribution, according to an investigation report by Cathie Rea, the hospital’s director of ICU.

“Very calm and reasonable people — understandably upset, but continued to say they ‘didn’t want us to cut off anyone’s head over this,’” Rea wrote. Reached by, Alana Zautner declined to comment publicly.

It’s not clear whether Hiatt’s mistake actually caused the death of the child, who was critically ill. The mistake “exacerbated cardiac dysfunction” in the baby and led to her decline, according to a statement by cardiologist Dr. Harris P. Baden, who cared for Kaia. However, state lawyers said the child’s fragile condition and poor prognosis would have made it difficult to prove legally that the overdose caused her death five days later, records show.

Still, Hiatt was escorted from the hospital after the mistake, immediately put on administrative leave and then fired within weeks.

After the incident, Hiatt "was a wreck,” recalled Julie Stenger, 39, of Seattle, a critical care nurse who worked with Hiatt at the hospital. “No one needed to punish Kim. She was doing a good job of that herself.”

Officials at Seattle Children’s Hospital declined to discuss specifics about Hiatt’s termination, although they said there is “more behind Kim’s case than can be made public” because of personnel and privacy policies.

They said the hospital has since 2007 followed a so-called “Just Culture” model, which recognizes the need to use errors to identify and correct systemic problems, rather than focusing on penalizing individuals.

“The circumstances that led to Kim’s departure from Children’s were tragic on many levels and our heart goes out to the patient’s family and to Kim’s family,” said hospital officials, who responded to only in written statements. “Within Just Culture, staff are not terminated for simple human error.”

Experts in patient safety say terminating an individual worker is rarely the answer to even the worst mistakes, unless they’re the result of repeated, willful flouting of established procedures or intentional harm.

It’s far better to identify and address the problems in the system that contributed to the error, said Mary Z. Taylor, director of patient safety at the Washington University School of Medicine in St. Louis.

“To eliminate them is futile; you will make errors,” said Taylor, who recently launched one of the nation’s few peer coaching program aimed at helping providers cope with the aftermath of mistakes.

“You may think things are safer if you’ve gotten rid of that person, but that’s not necessarily so,” Taylor said.

The problem is not an isolated issue by any means. Waterman, the Washington University researcher, found that 92 percent of the doctors she surveyed said they’d experienced a near miss, a minor error or a serious error — and 57 percent confessed to a serious mistake.

Of those, two-thirds reported anxiety about future errors and half reported decreased job confidence and satisfaction, the study found. Although the survey focused on doctors, researchers said they believed the results could apply broadly to nurses and other health care workers as well.

That’s because medical workers invariably go into the profession to help people. When harm occurs, the providers are haunted by every detail of the mistakes, often for years, said Susan D. Scott, a registered nurse and patient safety director at the University of Missouri Health Care. That hospital is among a handful in the country to have established a formal support system to help providers cope with difficult patient outcomes or errors.

There are other options to punitive actions, including education, supervision, reparations to the patient or family — and allowing the person who made the mistake to help craft specific systems to make sure it can't happen again, Scott said.

In some ways, however, those who’ve made mistakes might be even safer than those who haven’t, she added.

“If my mom got an insulin overdose from a nurse in a hospital, I would want that nurse to give her that insulin tomorrow,” Scott said.

On the day of Hiatt’s error, she admitted the mistake in a report submitted on the hospital’s electronic feedback system — and vowed not to repeat it.

“I messed up,” she wrote. “I’ve been giving CaCI [calcium chloride] for years. I was talking to someone while drawing it up. Miscalculated in my head the correct mls according to the mg/ml. First med error in 25 yrs. of working here. I am simply sick about it. Will be more careful in the future.”

Other factors in the firing?
There’s some question about whether other factors contributed to Hiatt's firing. Hospital officials said that Hiatt should have recognized that the dose was far too large for such a small child, and that Hiatt violated other dosing protocols. Investigation records show that officials worried that Hiatt didn't fully recognize her role in the error.

"Kim has not shown an understanding of how her deviation from policy in medication administration was in any way responsible for this error," wrote ICU Director Cathie Rea. "Her attention to detail and her precision is not what I would expect it to be at this point in her career."

However, investigators also said they had concerns about “Patterns of behavior re: Boundaries, Authority, Relationships.”

A co-worker had filed a sexual harassment claim against Hiatt, who was a lesbian, in 2008, alleging Hiatt acted inappropriately by hugging her and kissing her on the cheek. In a letter, Hiatt denied there was anything sexual about the action, which she said was meant to comfort the co-worker during a tough time, and described the investigation as a “witch hunt.” She said the Human Resources department had a history of discriminating against her because of her sexual orientation with one document dating to 1994.

Seattle Children’s officials denied that Hiatt’s personal life had anything to do with her dismissal. “Our strong support for the diversity of our staff and the community we serve is well-established,” officials wrote. “Kim’s departure from Children’s was unrelated to her sexual orientation.”

Records show that Hiatt was stunned to be terminated for what she believed was a single medical error in nearly a quarter-century of service. Investigation records reveal multiple glowing reviews. Just two weeks before the overdose, an Aug. 30, 2010 evaluation identified her as a “leading performer,” earning a mark of 4 on a 5-point scale, records show.

"Kim's nursing practice was incredible," Lyn Hiatt said. "She was smart, she was quick."

A storm of media attention followed news of the error, spurring state nursing commission officials to open an investigation into whether Hiatt’s license should be revoked. Ultimately, the agency imposed sanctions instead, including a $3,000 fine, 80 hours of new coursework on medication administration and four years of probation in which any supervisor would be required to report on Hiatt's work every 90 days.

After fighting to keep her license, Hiatt didn’t think she’d find another position in Seattle, family members said.

“She said, ‘Who’s going to touch me? I’ve made a mistake,’” said Sharon Crum, 73, Hiatt’s mother and a retired nurse herself. “When she lost this job, it wasn’t just the job she lost, it was her future.”

‘She ran out of coping skills’
Faced with the prospect of not working again as a nurse, Hiatt was overcome with despair, family members said. On April 3, a Sunday, Kimberly Hiatt hanged herself in her family’s home, records show. Nearly 500 people, including many nurses, attended her memorial ceremony a week later.

“She was in such anguish,” Crum says. “She ran out of coping skills.”

Hiatt’s death has unleashed a storm of reaction from her family, her colleagues — and from fellow nurses. After Hiatt's firing, the Washington State Nurses Association, which represents nurses at Seattle Children's, grieved her dismissal and negotiated a confidential settlement with the hospital on her behalf. Since then, WSNA officials have heard from many nurses worried about making mistakes themselves.

“It certainly has heightened that fear factor,” said Sally Watkins, assistant executive director of nursing practice, education and research for the WSNA.

A survey of WSNA nurses in the months after Hiatt’s case became public found that half of respondents believe their mistakes will be held against them personally. Even more worrisome, nearly a third say they would hesitate to report an error or patient safety concern because they’re afraid of retaliation or harsh discipline.

“Punitive actions are actually counterproductive. Everything in the literature points to that not being the right step to take,” Watkins said. “Nurses in that unit or hospital will not report things. There’s this heightened awareness: It could be me.”

Across the country, patient safety advocates — speaking both generally and about public reports of Hiatt's case — worry that firing providers after they make mistakes leaves patients at greater risk.

Hospital disputes safety experts
Officials at Seattle Children’s say armchair safety experts don’t know the details of Hiatt’s case. They indicated they changed the way calcium chloride is dispensed in response to Hiatt’s error to make it safer, even though a state investigation found that appropriate safeguards were already in place. They say critics haven't contacted them to ask about procedures for reporting and correcting errors, or for supporting staff when mistakes occur.

For Hiatt’s friends and family, all the debate in the world is useless unless it actually serves to change the circumstances that led to two tragedies: the loss of a fragile baby and the death of a nurse who loved her job.

“I promised Kim I’d do whatever I could to help,” said Stenger, Hiatt's colleague and friend, who said she left her job at Seattle Children’s in part because of how Hiatt was treated. “I thought it was sending the exact wrong message: If you make a mistake, you better keep your mouth shut about it.”

Only 1 in 7 hospital errors reported, study finds

By Robert Pear

Hospital employees recognize and report only one out of seven errors, accidents and other events that harm Medicare patients while they are hospitalized, federal investigators say in a new report.

Yet even after hospitals investigate preventable injuries and infections that have been reported, they rarely change their practices to prevent repetition of the “adverse events,” according to the study, from Daniel R. Levinson, inspector general of the Department of Health and Human Services.

In the report, being issued on Friday, Mr. Levinson notes that as a condition of being paid under Medicare, hospitals are to “track medical errors and adverse patient events, analyze their causes” and improve care.

Nearly all hospitals have some type of system for employees to inform hospital managers of adverse events, defined as significant harm experienced by patients as a result of medical care.

“Despite the existence of incident reporting systems,” Mr. Levinson said, “hospital staff did not report most events that harmed Medicare beneficiaries.” Indeed, he said, some of the most serious problems, including some that caused patients to die, were not reported.

Adverse events include medication errors, severe bedsores, infections that patients acquire in hospitals, delirium resulting from overuse of painkillers and excessive bleeding linked to improper use of blood thinners.

Federal investigators identified many unreported events by having independent doctors review patients’ records.

.The inspector general estimated that more than 130,000 Medicare beneficiaries experienced one or more adverse events in hospitals in a single month.

Many hospital administrators acknowledged that their employees were underreporting injuries and infections that occurred in the hospital, he said.

When the National Academy of Sciences issued a landmark report on patient safety in 1999, many experts said that hospital employees were often afraid to admit mistakes. But that no longer appears to be the main obstacle to reporting, federal investigators said.

More often, Mr. Levinson said, the problem is that hospital employees do not recognize “what constitutes patient harm” or do not realize that particular events harmed patients and should be reported.

In some cases, he said, employees assumed someone else would report the episode, or they thought it was so common that it did not need to be reported, or “suspected that the events were isolated incidents unlikely to recur.”

To clear up confusion, Medicare officials said they would develop a list of “reportable events” that hospitals and their employees could use. In addition, the Medicare agency said, hospitals should give employees “detailed, unambiguous instructions on the types of events that should be reported.”

The Obama administration and hospital industry leaders have placed a high priority on reducing medical errors. But, the report said, at many hospitals, this high-level commitment has not been translated into practice.

The inspector general found that “hospitals made few changes to policies or practices” after employees reported harm to patients. In many cases, hospital executives told federal investigators that the events did not reveal any “systemic quality problems.”

Organizations that inspect and accredit hospitals generally “do not scrutinize” how hospitals keep track of medical errors and other adverse events, the study said.

The federal investigators did an in-depth review of 293 cases in which patients had been harmed. Forty of those cases were reported to hospital managers, and 28 were investigated by the hospitals, but only five led to changes in policies or practices, the study said.

More than 2,900 hospitals have joined the administration in a “partnership for patients” intended to reduce errors and save 60,000 lives in three years.

At least 27 states have laws that require hospitals to report publicly on infections that patients develop in the hospital, according to the National Conference of State Legislatures, up from 6 at the end of 2005.

In view of the state laws, Obama administration officials said they were not proposing new federal requirements for the public reporting of adverse events.

Do Utahns have the right to choose how they die?

By Patty Henetz

The Salt Lake Tribune

First published Jan 07 2012 11:12PM
Updated Jan 7, 2012 11:25PM
Helmuth and Frances Fluehe died peacefully in their late 90s. But the journey to their final breaths involved agonizing pain, indignity and great expense, common death experiences in America that the couple’s two sons hope fervently to avoid.

“I was lucky to have my parents as healthy as they were for as long as they were,” says Paul Fluehe.

Yet near the end, he says, both his parents said they prayed to go to sleep and not wake up. And while both had signed documents guiding their medical care called advance directives, he says, “they didn’t feel they had the right to choose their own time.”

Had they been interested, the Fluehes didn’t have the option to legally obtain a lethal dose of sedative drugs through a doctor. Only Oregon, Washington and Montana allow doctors to legally write such prescriptions for the terminally ill, under certain circumstances. Patients decide when or whether to take the drugs.

Activists and lawmakers in several other states are pursuing similar laws. But the organization most active in getting Oregon’s law passed is also focusing on a method it says is legal everywhere: VSED, or voluntarily stopping eating and drinking.

Compassion & Choices maintains that forgoing food and water while receiving comfort care and pain medication is a natural way to die at home, says Barbara Coombs Lee, the group’s president. A former nurse and physician’s assistant, Coombs Lee became an attorney and guided Oregon’s Death With Dignity Act through the courts.

But lawyer Maureen Henry, executive director of the Utah Commission on Aging and author of Utah’s advance-directive statute, says VSED is neither legal nor illegal in the Beehive State.

“It’s not correct to say that anyone can stop eating and drinking,” she says. “It’s more complicated than that.”

The catalyst » Compassion & Choices took up its VSED campaign, “Peace at Life’s End. Anywhere,” after a New Mexico assisted-living facility early this year evicted a dying elderly couple. Armond and Dorothy Rudolph had decided they would refuse food and water at the end of their lives, and they did so in their early 90s when their pain and frailty became unacceptable to them.

The Rudolphs, who learned of VSED from Compassion & Choices, were on the fourth day of their fast when facility administrators called 911 to report suicide attempts. After two emergency squads responded, an emergency room doctor interviewed the lucid couple and decided they didn’t need his services.

Dorothy Rudolph died 10 days after starting her fast, and Armond Rudolph died the next day in a New Mexico house their son rented for them, according to The New York Times and other news reports.

Coombs Lee said Compassion & Choices, based in Portland, Ore., often gets calls from people who are thinking about the end of their lives.

“Everybody has a worst nightmare. A lot of people are comforted by having a frank discussion,” she says. “We are candid. We are nonjudgmental.”

Multiple court tests have found a dying patient’s choice to stop eating and drinking can be ethical and legal. The argument rests on the premise that any unwanted touching is battery. Supreme Court rulings have found constitutional guarantees for a person’s right to refuse life-sustaining treatment.

Yet not all patients fit neatly into this analysis, Henry warns.
Making the decision » What if a mentally ill person thinks God is telling him not to eat or drink?

Or what if an elderly woman becomes delirious when she has a urinary tract infection? If she refuses food or water, do you comply or do you treat the infection?

“[If] you cure her,” Henry says, “she may well say she does want food and water.”

It is difficult for people to predict what they will want in the future, Henry adds.

“They get a diagnosis and say, ‘I never want to be kept alive if someone has to bathe me, if someone has to spoon-feed me,’ ” she says. But as time goes by, “they tend to want more care than they did at their diagnosis.”

Debbie Thorpe, an advance-practice nurse who specializes in pain and palliative care at the Huntsman Cancer Institute in Salt Lake City, says many patients ask for a speedy death but change their minds when they get comfort care.

When Michael Galindo, a physician and director of palliative care for LDS Hospital and Intermountain Medical Center, considers the Rudolphs, he finds overtones of a suicide pact. If people actively decide to stop eating and drinking, he says, “the first thing I would be concerned with would be depression.”

Such a deliberate decision should be made as part of a doctor-patient relationship that includes advance directives and orders that spell out a patient’s end-of-life choices, Galindo says. Without that context, Galindo says, it is suicide.

Coombs Lee says otherwise. “Suicide is impulsive,” she says. “It’s usually done in isolation and anger. It’s a manifestation of pathology.”

Suicide is rightly illegal, she adds. That is why death with dignity advocates in Oregon, Washington and Montana don’t use the term “assisted suicide” because that implies a direct killing, such as the injections Michigan physician Jack Kevorkian administered to his patients. But she agrees that long before people are terminally ill, they should make sure their doctor knows what they want when they are dying.

“That knowledge frees us to enjoy life to the fullest every day,” she says. “That’s our goal.”

Henry says every adult from age 18 on should craft advance directives. The single most important step, she says, is to find someone you would want to make decisions for you if you were unable to speak for yourself.

“They stop eating.” » From a medical standpoint, there are times when it is reasonable to honor a patient’s choice to decline food and drink, Galindo says.

And a very ill 90-year-old may simply find eating and drinking too burdensome. “That’s what people do when they are terminal,” Galindo says. “They stop eating.”

Conversations with hospice patients about nutrition and hydration are common, especially what professionals call “breakpoint” talks — specifics about the physical process of dying, including what it’s like to stop taking sustenance.

In her experience, Thorpe says, patients don’t specifically say they want to stop eating and drinking — they just do.

“That’s such a natural thing; it’s not usually an intentional withdrawal,” she says. And sometimes, patients want food in their mouths just so they can taste it — ice cream, a tortilla — even though they can’t swallow it.

There also is the fact, Galindo says, that pushing nutrition at the end of life doesn’t do much good anyway.

“It ends up being a couple of cans of Boost. It really isn’t enough,” he says. “The disease really is in the driver’s seat. From food preparation all the way to elimination, [eating] can be so burdensome it’s no longer worth it.”

This is where hospice comes in, to keep patients comfortable and let them manage their lives as well as they can.

Life at the end » Here is what happens when a terminal patient goes without food and water.

She dies not of starvation, but dehydration. Her kidneys most likely shut down. Her lungs and tissues fill with fluid and toxins the body no longer can excrete; this severe edema is painful.

“If someone has problems with nausea, having food in the stomach is going to make that worse,” Galindo says.

The patient typically loses consciousness in two or three days and dies within one to two weeks when the lungs and heart cease working.

Thirst, dry mouth and cracked lips can be alleviated with mouth swabs or small sips of water. One of the body’s compensatory reactions when a person nears death is endorphin release. Pneumonia may speed the end.

“This isn’t something that should be done in a back bedroom of an apartment without help,” Galindo says. “Nobody should ever stop eating and drinking without hospice.”

Compassion & Choices says “success” with VSED requires support from family or other caregivers, plus palliative care for pain. Rarely are pain and other symptoms so unmanageable a patient can’t get relief, Coombs Lee says.

Studies have shown hospice patients end up living longer than those who continue to fight — an attitude Dan Hull, executive director of the Utah Hospice & Palliative Care Organization, finds very American.

“Our whole life is a struggle to keep doing it. Always winning, always achieving, always being first in the world,” he says. When someone says he wants to die, “society doesn’t like that,” Hull says. “We don’t want to let them have control. If dying is only a matter of weeks, then choice is really critical. I think we have to figure that out a little better.”

Patients have asked Hull if he could give them a blessing to die. Patients, relatives and loved ones have asked for ways to make the end come faster.

He once had a patient who lived two weeks without any food or water, and her daughters asked how to help her die. Hull told them to leave their mother alone for an hour. She died.

Compassion & Choices’ VSED campaign may be “the outlier that pushes us along,” Hull says. “[Patients] may never use the choice, but it gives them one. If one says, ‘I don’t want more chemotherapy,’ and one says, ‘I don’t want to eat or drink,’ if they both have terminal illness, what’s the difference?”

Dying and dignity » Helmuth Fluehe died at age 97 in September 2009.

His legs failed and he had severe dementia. A man who hadn’t ever in his life feared anything “lost his capacity to deal with any adversity at all,” Richard Fluehe says. “To watch this guy disintegrate was really tough. He had intestinal blockage, his intestines tied up in knots, in tremendous agony.”

Frances Fluehe died at 98 in September 2010. She endured painful care for a prolapsed rectum. “It was kind of horrendous to be out in the hallway and hear her screaming while they were taking care of that,” Paul Fluehe says.

Both parents received hospice care in their last days; both died of sepsis.

They had not made end-of-life plans with their sons or anyone else, though their advance directives included do-not-resuscitate orders. The brothers say their parents suffered and wish they had died sooner.

Now, Paul Fluehe says the right to die with dignity is on his mind all the time.

“I just don’t think people ought to suffer,” he says.

The brothers expect to choose their deaths. “There’s going to be no heroics with either of us,” Richard Fluehe says.

Both say they mean to write valid advance directives. Neither has.

Well that's depressing: From CNN

Sorry, Boomers, but a new study suggests that memory, reasoning and comprehension can start to slip as early as age 45.

"It is widely believed that cognitive ability does not decline before the age of 60. We were able to show robust cognitive decline even in individuals aged 45 to 49 years," said Singh-Manoux.

"It is widely believed that cognitive ability does not decline before the age of 60. We were able to show robust cognitive decline even in individuals aged 45 to 49 years," said Singh-Manoux.

This finding runs counter to conventional wisdom that mental decline doesn't begin before 60, the researchers added.

"Cognitive function in normal, healthy adults begins to decline earlier than previously thought," said study author Archana Singh-Manoux.

"It is widely believed that cognitive ability does not decline before the age of 60. We were able to show robust cognitive decline even in individuals aged 45 to 49 years," added Singh-Manoux, research director at INSERM's Center for Research in Epidemiology & Population Health at the Paul-Brousse Hospital in Paris.

These findings should be put in context of the link between cognitive function and the dementia, Singh-Manoux said.

"Previous research shows small differences in cognitive performance in earlier life to predict larger differences in risk of dementia in later life," she said.

Understanding cognitive aging might enable early identification of those at risk for dementia, Singh-Manoux said.

The report was published in the Jan. 5 issue of BMJ.

For the study, Singh-Manoux and colleagues collected data on nearly 5,200 men and 2,200 women who took part in the Whitehall II cohort study. The study, which began in 1985, followed British civil servants from the age of 45 to 70.

Over 10 years, starting in 1997, the participants' cognitive function was tested three times. The researchers assessed memory, vocabulary, hearing and vision.

Singh-Manoux's group found that over time, test scores for memory, reasoning and vocabulary skills all dropped. The decline was faster among the older participants, they added.

Among men aged 45 to 49, reasoning skills declined by nearly 4 percent, and for those aged 65 to 70 those skills dropped by about nearly 10 percent.

For women, the decline in reasoning approached 5 percent for those aged 45 to 49 and about 7 percent for those 65 to 70, the researchers found.

"Greater awareness of the fact that our cognitive status is not intact until deep old age might lead individuals to make changes in their lifestyle and improve [their] cardiovascular health, to reduce risk of adverse cognitive outcomes in old age," Singh-Manoux said.

Research shows that "what is good for the heart is good for the head," which makes living a healthy lifestyle a part of slowing cognitive decline, she said.

Targeting patients who have risk factors for heart disease such as obesity, high blood pressure and high cholesterol might not only protect their hearts but also prevent dementia in old age, the researchers said.

"Understanding cognitive aging will be one of the challenges of this century," especially as people are living longer, they added.

In addition, knowing when cognitive decline is likely to start can help in treatment, because the earlier treatment starts the more likely it is to be effective, the researchers noted.

Francine Grodstein, an associate professor of medicine at Brigham and Women's Hospital in Boston and author of an accompanying editorial, said more research is needed into how to prevent early cognitive decline.

"If cognitive decline may start at younger ages, then efforts to prevent cognitive decline may need to start at younger ages," she said.

"New research should focus on understanding what factors may contribute to cognitive decline in younger persons," Grodstein added.

"This is consistent with what we have seen in other studies and the cognitive changes that occur as we age," said Heather M. Snyder, senior associate director of medical & scientific relations at the Alzheimer's Association.

These changes do not mean that all these people will go on to develop Alzheimer's disease or another dementia, Snyder noted. "It is important to remember that the cognitive changes associated with aging are very different from the cognitive changes that are associated with Alzheimer's disease," she stressed.

Although some of these people may go on to develop Alzheimer's disease there is currently no way to tell who is at risk, Snyder said. "This is why it is so important to continue to investigate biological changes that occur in the earliest stages, because it is difficult to [determine] the cognitive changes that are associated with Alzheimer's disease," she said.

Snyder noted that Alzheimer's disease can start 15 to 20 years before symptoms are apparent, which makes finding a biological marker so important. "If a therapeutic is available, we can intervene at that point," she said

Thursday, January 5, 2012

Bed injuries

Between January 1, 1985 and January 1, 2010, the FDA received 828 incidents of patients caught, trapped, entangled, or strangled in hospital beds. The reports included 493 deaths, 141 nonfatal injuries, and 194 cases where staff needed to intervene to prevent injuries.

Some siderails extend the full length of the bed; others, called half rails, are about 2-1/2 feet long. Some are metal, others plastic. Most can be raised or lowered.

Siderails are divided, either vertically or horizontally, with slats spaced about six or more inches apart. This space can trap an elderly person's head, causing him or her to strangle; or, to allow a thin, frail person to squeeze between the rails and fall to the floor.

Often mattresses fit loosely in the frame, leaving gaps large enough to trap the resident between the mattress and siderail, also leading to suffocation.

“Rails decrease your risk of falling by 10 to 15 percent, but they increase the risk of injury by about 20 percent because they change the geometry of the fall,” says Steven Miles, geriatrician and bioethicist at the University of Minnesota, in a 2010 article published in The New York Times.

Signs of Nursing Home Abuse

Physical abuse
Some of the more commonly observed types and signs include:
Sexual Assault
Sexual Battery
Unreasonable physical restraint
Prolonged or continual deprivation of food or water
Use of a physical or chemical restraint or psychotropic medication for any purpose not consistent with that authorized by the physician
Giving too much medication
Not giving needed medication
Unexplained injuries
Caretaker cannot adequately explain condition
Open wounds, cuts, bruises or welts
Elder reports of being slapped or mistreated
Slapping, pushing, shaking, beating
Forcing an older person to stay in a room

Some of the more commonly observed types include:
Physical neglect: disregard for the necessities of daily living
Medical neglect: lack of care for existing medical problems
Failure to prevent dehydration, malnutrition, and bed sores
Failure to assist in personal hygiene, or in the provision of food, clothing, or shelter
Unsanitary and unclean conditions
Failure to protect from health and safety hazards
Poor access to medical services

Verbal and emotional abuse
Creating situations harmful to the resident's self-esteem.

Possible signs of verbal or emotional abuse may include resident behavior such as:
Emotionally upset or agitated
Extremely withdrawn and non-communicative
Unusual behavior (sucking, biting, rocking)
Humiliating, insulting, frightening, threatening or ignoring behavior towards family and friends
Wanting to be isolated from other people

Other warning signs
Other signs to look for if you think nursing home abuse or negligence has occurred include the following:
Injuries requiring emergency treatment or hospitalization
Any incident involving broken bones, especially a fractured hip
Any injury or death occurring during or shortly after an episode of wandering (including outside the facility) when the staff is not aware that the resident is missing for some period of time
Heavy medication or sedation
Rapid weight loss or weight gain without physician or family notification and a change in treatment being provided
Unexplained or unexpected death of the resident
One nursing home resident injures another resident
Resident is frequently ill, and the illnesses are not promptly reported to the physician and family

See Me

What do you see, nurses, what do you see?
Are you thinking, when you look at me --
A crabby old woman, not very wise,
Uncertain of habit, with far-away eyes,
Who dribbles her food and makes no reply,
When you say in a loud voice -- "I do wish you'd try."

Who seems not to notice the things that you do,
And forever is losing a stocking or shoe,
Who unresisting or not, lets you do as you will,
With bathing and feeding, the long day to fill.

Is that what you're thinking, is that what you see?
Then open your eyes, nurse, you're looking at ME...
I'll tell you who I am, as I sit here so still;
As I rise at your bidding, as I eat at your will.

I'm a small child of ten with a father and mother,
Brothers and sisters, who love one another,
A young girl of sixteen with wings on her feet.
Dreaming that soon now a lover she'll meet;
A bride soon at twenty -- my heart gives a leap,
Remembering the vows that I promised to keep;
At twenty-five now I have young of my own,
Who need me to build a secure, happy home;
A woman of thirty, my young now grow fast,
Bound to each other with ties that should last;
At forty, my young sons have grown and are gone,
But my man's beside me to see I don't mourn;
At fifty once more babies play 'round my knee,
Again we know children, my loved one and me.

Dark days are upon me, my husband is dead,
I look at the future, I shudder with dread,
For my young are all rearing young of their own,
And I think of the years and the love that I've known;
I'm an old woman now and nature is cruel --
'Tis her jest to make old age look like a fool.

The body is crumbled, grace and vigor depart,
There is now a stone where once I had a heart,
But inside this old carcass a young girl still dwells,
And now and again my battered heart swells.

I remember the joys, I remember the pain,
And I'm loving and living life over again,
I think of the years, all too few -- gone too fast,
And accept the stark fact that nothing can last --
So I open your eyes, nurses, open and see,
Not a crabby old woman, look closer, nurses -- see ME!

This poem was found among the possessions of an elderly lady who died in the geriatric ward of a hospital. No information is available concerning her -- who she was or when she died.

CNA CLASS practice questions

1. While applying a binder, it becomes loose or wrinkled. What does the nursing assistant do?

A. Secure pins so they face the incisional area.
B. Reapply the binder so that firm, even pressure is exerted over the area.
C. Make sure the binder is always warm and dry.
D. Only reapply binder if it becomes soiled.

2. During a 24 hour urine specimen collection, Mrs. Jones flushes her own urine. What must the nursing assistant do?

A. Report to the nurse and continue collection.
B. Report to the nurse and start test over.
C. Scold Mrs. Jones for flushing the urine.
D. Call the doctor.

3. Mrs. Black has returned to her room from the hospital by stretcher. The nursing assistant uses a three person lift to transfer her to bed. What type of resident would require this type of transfer?

A. Resident with dysphasia
B. Resident with diabetes
C. Resident with hypertension
D. Resident on complete bed rest

4. The nursing assistant will lift and move the resident onto the stretcher on the count of:

A. 4
B. 3
C. 2
D. 1

5. Fred puts on his call light and requests help to the bathroom. The nursing assistant is walking in the hall to go on break. What action should the nursing assistant take?

A. Tell Fred he has to wait until break is over.
B. Tell Fred another nursing assistant will help him.
C. Let the light ring until someone else responds.
D. Take Fred to the bathroom and then go on break.

6. Mrs. Potts goes to the bathroom to void. When the nursing assistant empties the urine, what would be MOST important to report to the nurse?

A. Light yellow color
B. Large volume
C. Reddened color
D. Amber color

7. Mr. Halo states, "I feel constipated." The nursing assistant knows this means:

A. the passage of hard, dry stool.
B. the passage of liquid stool.
C. the passage of gas (flatus) through the anus.
D. a fecal impaction.

8. What attitude should a nursing assistant display when dealing with a terminally ill resident?

A. Compassion
B. Distance
C. Negligence
D. Enthusiasm

9. The nursing assistant finds the terminally ill resident crying in bed. What is the nursing assistant's best response to this situation?

A. Encourage the resident to stop crying.
B. Offer to stay with resident and discuss the situation.
C. Assure the resident it will be okay.
D. Leave the room to provide privacy.

10. Which of the following is true about fecal impaction?

A. Lubricant is not needed for unresponsive resident.
B. Fecal impaction is an emergency. The doctor should be notified immediately.
C. Fecal impaction can cause abdominal pain and cramping.
D. A resident with loose, watery stool cannot have an impaction.

1. B
Q3: CORRECT! Only Response D indicates a physical situation that requires a stretcher transport. Mosby 7th ed pages 268 and 269
CNA TASK: Transport resident by stretcher.

Q4: CORRECT! Common protocol dictates using a 1-2-3 count. Mosby 7th ed page 269 Procedure Box: Moving the Person to a Stretcher
CNA TASK: Transport resident by stretcher.

Q5: CORRECT! Because caring for the patient’s toileting needs is imperative, the nursing assistant should assist the resident to the bathroom then take their break Mosby 7th ed page 364 Box 21-3 Nursing Measures for Persons With Urinary Incontinence
CNA TASK: Maintain resident's right to quality care.

Q6: CORRECT! Red tinged urine indicates the presence of blood and should be reported immediately. Mosby 7th ed page 356
CNA TASK: Calculate, report and record output.

Q7: CORRECT! Constipation is defined as the "passage of hard, dry stool" as described in Response A. Mosby 7th ed page 380
CNA TASK: Recognize and report abnormal signs and symptoms in common diseases and conditions.

Q8: CORRECT! The resident dealing with terminal illness needs the nursing assistant to approach them with compassion as they carry out their duties. Mosby 7th ed page 772
CNA TASK: Provide care for terminally ill resident.

Q9: CORRECT! Response B offers the resident compassionate support. Mosby 7th ed page 772
CNA TASK: Provide care for terminally ill resident.

Q10: CORRECT! Fecal impaction can cause symptoms as described in Response C. Mosby 7th ed page 381
CNA TASK: Recognize and report abnormal signs and symptoms in common diseases and conditions.

Wednesday, January 4, 2012

UTAH CNA TEACHER pictures of my vacation

Carol and family in Costa Rica

Florida Nursing Facilities Rise Above Challenging Times

January 2012

Patrick Connole

Page Content
Florida has suffered deeply from the effects of the Great Recession and its aftermath, with once booming housing and construction markets gone bust and even the 12-month-a-year tourism trade unable to prop up an otherwise weak economy that has left nearly 1 million without work.

In a state known for its older-skewing populace, along with Disney World, space launches, and the beach, the economy has left another mark on Florida. The Sunshine State is now thought of as a leading foreclosure market in a country full of depressing stories about lost real estate dreams.

The gloomy economic scene has put intense pressure on state lawmakers to find ways to eliminate huge budget deficits. Fiscal year (FY) 2011-2012 saw the need to bridge a $4.6 billion deficit, and FY 2012-2013 could see a $2 billion hole. As Provider went to press, Florida Gov. Rick Scott (R) was preparing to release his 2012-2013 budget recommendations, which long term care providers anticipate will include another round of Medicaid reimbursement reductions.

Medicaid costs rose to $20.3 billion projected for this fiscal year in Florida, from about $19.8 billion in 2011, with the state’s share surging 23 percent, to $9.48 billion, from $7.7 billion, Florida legislature reports said. The state’s share of Medicaid is forecast to rise 2.7 percent, to $9.74 billion, in 2013, and total costs may rise 15 percent by 2015.

Florida’s legislature last year also passed a proposal to shift almost all Medicaid beneficiaries into managed care plans to reduce costs, but the state has not received a waiver from the federal government to start the process of making the change.

Overall, the short-term picture is clear in Florida: Medicaid reimbursement dollars will decline while beneficiary rolls rise and the economy lags behind in keeping up with rising costs.
Medicaid Under The Spotlight
Gov. Scott specifically pointed to the growing costs of the Medicaid program as a main drag on the rosier state income picture for 2011.

The governor told the media in late November that when he releases his proposed budget, it will have recommendations to deal with rising Medicaid costs. Beyond immediate measures to help balance the budget, Scott would like the federal government to let states run the Medicaid program, a popular notion among many in his party who call for “block granting” Medicaid dollars as opposed to managing the federal-state partnership that currently exists.

Talk of what could be in the offing for next year has J. Emmett Reed, executive director of the Florida Health Care Association (FHCA), working hard to limit what will certainly be another reduction in reimbursement dollars for long term care providers.

“It was bad last year, but then you’re dealing with a $4.6 billion budget hole. We weren’t happy but it could have been worse, and it was worse for other providers,” Reed says.

Things didn’t look so bleak for FY 2012 about six months ago, he says, but things took a turn for the worse by end of summer, and now the negative reports project the aforementioned $2 billion budget hole.
Double Whammy
At the same time the state has hit health care providers hard in the Medicaid program, the federal government has reduced Medicare reimbursement for nursing care providers, a virtual tsunami of cuts, as Reed puts it.

“Seventy percent of our costs are our people [staff], and the residual effects go to the vendor level,” he says.

A lot of FHCA members are assessing their bottom lines anew with the reimbursement uncertainty now a seemingly constant reality, with some likely in line to reduce staffing while many more try to figure out ways to avoid such steps, Reed says.

“We have a lot of members who are not cutting. They are working with frontline caregivers to manage hours,” he says. “Caregivers working at facilities have knowledge of the residents, they work with residents.”

Reed notes that all the work being done to creatively work around the 2011-2012 reductions could be a mere footnote to what lies ahead. “If there is another round of cuts, all bets are off,” Reed says. “But providers are bending over backwards to make it work and keep caregivers there to serve residents.”
Greek For Caring
Against this backdrop of mostly negative economic news, nursing and assisted living facilities conduct the day-in day-out work of caring for the state’s frail and elderly, a job Marilyn Wood, president and chief executive officer (CEO) of Opis Management Resources, Tampa, Fla., has embraced for 40 years. She worked first as a nurse and rose through the ranks to lead Opis, a word that comes from the Greek language and translates to “caring.”

Opis was founded in 2003, assuming control of properties owned by Kennett Square, Pa.-based Genesis HealthCare, which departed the state because of concerns about the business climate. Florida is not an easy state to do business in, with its high litigation costs tied to a friendly environment for trial lawyers.

Opis runs 10 skilled nursing and one assisted living facility across the state and prides itself on strict attention to quality, having won top honors from the state of Florida four times for its efforts to make a positive difference in elder care.

Wood sees long term care as a business prone to defined cycles, with the current one being as challenging as any one that has presented itself in the past. She has also seen how the acuity level of residents has shifted, transforming the work to a higher level of care at all settings.
Florida A Tough Market
As providers across the country face the challenges of reimbursement reductions and marketing their services in a down economy, Wood says Florida remains a unique case with its plentiful number of seniors and other factors.

“The litigation we have in our state is still a problem for us,” she notes. Also a challenge is the fact that Florida is a pacesetter in regulation. “I think this comes because of the scrutiny generated by the large population of seniors in our state,” Wood says.

The Medicaid issue is, of course, a leading challenge as well, but one she grasps. “The reality is the government has only so many resources; there are pressures to fund education and transportation beyond health care, for example,” Wood says.

All sectors have had to sacrifice, but the goal for long term care is to do so without compromising quality care. The jobs inside her facilities are all tied to making residents safe and as healthy as possible, so each is valuable to the overall operation.

Opis employs 2,300 people, and these workers are part of a family as well, putting food on their own tables and paying mortgages. “That’s what people have to understand. We take our staffing issues seriously and care for them passionately. Legislators need to understand that,” Wood says.
CCRC Attracts Residents Despite Economy
Tom Kelly, CEO of Village On The Isle in Venice, Fla., thinks his operation is getting it right in how to care for every long term care need within his continuing care retirement community (CCRC) just a few minutes from the Gulf of Mexico. Located south of Sarasota, the CCRC offers seniors skilled nursing, assisted living, and independent living options in a high-tech community wired with the latest technology to improve care quality and make living as comfortable as possible for residents.
A not-for-profit, faith-based provider, Village On The Isle is affiliated with the Evangelical Lutheran Church in America and strives to meets its commitments beyond the daily care of residents in a 100 percent ecumenical fashion, Kelly says. This effort includes catering a Meals on Wheels program to the local community, serving 180 meals per day all week.

“All of it is done out of our own pocket with volunteers,” Kelly says.

With a staff of 275 serving the 415 seniors in the CCRC, the breakdown of the living options are 210 residential apartment homes, 100 assisted living accommodations, and a 60-bed skilled nursing facility. Again, as part of the faith-based effort, 10 percent of the 100 assisted living spots are reserved for a special program for those who cannot afford to pay full freight. The maximum cost is $1,500 a month for the affordable care program, compared with the regular rate of $3,695, he says.

“There are no Medicaid waiver dollars involved,” Kelly says.
Technology Vital To The Mission
Village On The Isle takes technology seriously. The entire complex is wired for Wi-Fi, which is free for residents and guests as well as mobile Skype videophones that residents can use to video chat with their families and loved ones. Dining areas are equipped with digital signage for easy representation of daily menus, and health care facilities employ Electronic Medication Observation Systems to reduce medication errors.

Other tools include the Nurse Rosie system, which provides state-of-the-art equipment for gathering vital signs such as pulse oximetry, blood pressure, temperature, and blood glucose levels. The system interfaces with CareTracker to eliminate human error in the recording and transcription of vital signs.

Kelly praises the CCRC’s staff for devising new ways to make technology more than just software and hardware, but part of the resident’s experience and part of the staff’s care plan. The move to keep abreast of the latest tools for pleasing residents and their families is a strategy to maintain quality care and attract business even in the rough economy.
Jobs, Jobs, Jobs
Over the years, Kelly has built up a strong business that had a 20 percent vacancy rate when he took over. Now, the facilities have added and saved jobs with an attention to detail and made staff more capable with the use of technology.

With the high occupancy rate near 100 percent, Village On The Isle is a job beacon for the Venice community. “We have very high staff retention, and that is good because long-term employees are your best assets. This translates to consistent quality care, no lawsuits, and few worker comp issues,” Kelly says.

Kelly’s staff have 80 percent of their health insurance paid for, and there is a 20 percent employer match in a retirement plan with no vesting.

Village On The Isle also works with the local high school to attract young workers who often make the care community their first job.

“It’s $8.75 to start, and they can eat whatever they want,” Kelly says.

Some of the younger workers stay on for years to come, he says, noting his director of food services came out of the high school recruitment effort.

When the state Medicaid reimbursement reductions took effect July 1, 2011, and were followed in October by the federal cutbacks of more than 11 percent in Medicare payments, assessments had to take place on how to deal with the loss of funding, Kelly says.

“We expected the problem to occur, and we built operational budgets accordingly,” he says. This preparation resulted in no wage cuts or a job freeze for employees, even though the final Medicare percent rollback was on the high end of expectations coming in one fell swoop.

To combat the effect of the governmental reductions, Village On The Isle has sought to bolster its outpatient business, diversifying its services by providing potential clients with the latest low-gravity treadmill system for rehabilitation purposes.

By getting away in some respects from the unpredictable nature of Medicaid and Medicare reimbursement, the system of overall care across the CCRC can flourish, starting with the core mission of serving others, both the ones paying for care and the entire community surrounding the site.