Physical Aspects of Aging -- Part 1 of 4

Physical Changes of Aging 

It is important to recognize that people age differently, so what is presented here may not be exactly what you or your loved one experience. Also, even though there are many challenges of aging, these can often be addressed through simple steps that improve communication and make the environment safer and easier for the older person to navigate. These steps may also help to make it easier for the older person to live independently for as long as possible.

Sensory Changes

Humans receive and process information from the environment through hearing, vision, taste, smell, and touch. With aging, these senses are often diminished and incoming information may be distorted or difficult to understand. As a result, the older person may give up some enjoyable activities or lose contact with friends and family who are important sources of support. These problems can be reduced or overcome by following the suggestions described in the sections below.

Hearing

About 30% of people over 60 have a hearing impairment, but about 33% of those 75 to 84, and about half of those over 85, have a hearing loss. Hearing loss affects the older person's ability to talk easily with others. For example, older people often have trouble hearing higher pitched tones. They also may not be able to make out sounds or words when there is background noise. Conversations may be difficult to hear, especially if the speaker has a high voice or there is background interference.

Older persons may be frustrated or embarrassed about not being able to understand what is being said. They may have to ask people to repeat themselves, or endure shouting when a speaker tries to be heard. Older persons may hold back from conversation out of a fear of making inappropriate comments. They may tire from concentrating and straining to hear. As a result, the older person may withdraw from friends and family and outside activities.

Hearing loss doesn't have to cause social isolation and emotional distress. Simple changes in behavior and the home environment can increase the elder's ability to carry on a normal conversation.

• Speak clearly and in a normal tone of voice. Don't speak too fast or too slow. Hold your head still. Do not shout.
• Get the older person's attention before speaking.
• Look directly at her or his face and at the same level.
• Stand or sit with the light above or toward you, not behind you. Keep your hands away from your mouth.
• Eliminate background noise from radio and television.
• Try using different phrases with the same meaning if you are not getting your point across.
• Build breaks into your conversation.
• Use facial expressions or gestures to give useful clues.
• Repeat yourself if necessary, using different words.
• Ask how you can help.
• Include the hearing-impaired person when talking, do not exclude them.

There are many different devices that can be used in the home to help a hearing-impaired person. Special phones work with hearing aids and ring louder than a standard phone. There are alarm clocks, smoke detectors, and doorbells that have flashing lights and vibrations to alert the hearing-impaired.
Older adults need routine hearing exams by qualified professionals. Have hearing checked by an audiologist to be sure that another problem is not causing the hearing loss. If a hearing aid is needed, work with the audiologist to find the right brand and fit. If you are a caregiver, provide plenty of support and encouragement to the person who is adjusting to the hearing aid.

Learn more in our Restorative Aide course!  Click here for more info

An Excerpt From Our Social Service Designee Course

Elisabeth Kubler-Ross

Understanding Death and Dying

Preparing for death often means finishing a life's work, setting things right with family and friends, and making peace with the inevitable. Spiritual and religious issues are important to many dying people and their families. Members of the clergy are part of the care team in some hospice and hospital facilities, and professional caregivers can help people and their families find appropriate spiritual assistance if they do not have a relationship with a minister or other spiritual leader.

Grieving is a normal process that usually begins before an anticipated death. According to Elisabeth Kubler-Ross, a pioneer in death and dying, the dying person typically experiences five emotional stages, often in the following order: denial, anger, bargaining, depression, and acceptance. A person in denial may act as if, talk as if, or think that he is not dying. Denial is caused by fears about loss of control, separation from loved ones, an uncertain future, and suffering. Talking to a doctor or other health care member can help the dying person understand that he can remain in control and that his pain and other symptoms will be controlled. Anger may be expressed as a sense of injustice: "Why me?". Bargaining can be a sign of reasoning with death, that is, seeking more time. When the person realizes that bargaining and other strategies are not working, depression may develop. Acceptance, sometimes described as facing the inevitable, may come after discussions with family, friends, and care providers.

Preparing for death is hard work, with many emotional ups and downs. However, for most people, it is a time of new understanding and growth. By dealing with past hurts and mending relationships, a dying person and family members can achieve a profound sense of peace.

Preparing for approaching death can be terrifying if you have no idea what to expect both physically and emotionally. As the dying process enters its final stages there are two different dynamics at work.

The physical aspect concerns the body as it begins its final process of shutting down; this ends the physical systems' functioning.

The other dynamic is the emotional/mental and spiritual area which is a different process. This is where the spirit of the dying individual begins to slip away from its immediate environment and attachments. This release tends to follow its own priorities when it comes to letting go; of family members, unfinished business of a personal nature and/or unreconciled problems. You have all heard people tell how someone on their death bed refused to let go until a certain member of the family was able to get there. Even when the body is trying to shut down the spirit hangs on until a resolution is reached. It is as though the dying person needs permission to go; needs to feel that he has achieved the support and acceptance of his fate by those he leaves behind. This way he can slip into the next dimension of life with grace and dignity.

Acceptance is coming to terms with reality. It is accepting that the world will still go on without you. Death is after all, just a part of life.

The EKR Foundation: Click Here

Elisabeth Kübler-Ross: Click Here

As a Social Service Designee, you may spend one on one time with dying residents. You may just want to read aloud or hold their hands. Some residents enjoy reading a passages from the Bible (or their preferred holy book) that are comforting (Psalm 23, in particular). Know your residents’ likes and dislikes. This will help you to know what residents would want you to do during this time. You can also get information from family members.

Move To Improve Residents' Quality of Life a Welcome Development

As growing numbers of Americans age and need extended care, long-term care organizations have sought to better meet both the healthcare and social needs of their residents. Those who reach the point in life where nursing home care is necessary do not want to live in an environment that feels like a hospital instead of a home.

Over the past several years, alternatives to institutional environments such as the Green House Project, the Pioneer Network and the Eden Alternative have all aimed to encourage genuine homes for the disabled elderly. And, with the Centers for Medicare & Medicaid Services' recent call for a culture change in nursing homes, the focus on resident-centered care places a priority on residents' rights.

CMS' new rules will encourage long-term care organizations to improve the quality of residents' lives by moving away from the institutional environment. For example, a resident's preferences for a daily schedule should be respected. Also, institutional overhead paging systems, alarms and large nursing stations, and meals served on institutional trays, should be eliminated..

Read more here:  http://www.mcknights.com/move-to-improve-residents-quality-of-life-a-welcome-development/article/141159/

Working Women's Wardrobe Guide

Understanding the rules and etiquette that applies to business attire can be the difference between success in a job interview or job placement and failure. Women's business attire should be understated, good quality, body-appropriate and comfortable. Tight-fitting, translucent, bright and worn-looking clothes are not acceptable business attire and will translate badly in a business environment.

Suits for all Seasons

Suits are the staple of proper business attire. The Pasadena Independent School District business etiquette website states that for women, wool suits are the best choice in winter, fall and spring. Summer suits can be made from cotton or linen. Proper fitting is essential for business attire, so suits should be professionally fitted, if possible--this will give the most professional look to business attire and will also provide optimum comfort. Avoid tight suits, bright colors and bold patterns that may be too distracting--black, gray, navy, taupe, dark green and burgundy are colors that work in a business environment. Pinstripe and, to a lesser degree, houndstooth patterns are acceptable.

Read more: Working Women's Wardrobe Guide | eHow.com http://www.ehow.com/list_6331441_women_s-business-attire_-rules-etiquette.html#ixzz1QgP7L6pa

What Is A Social Service Designee?

The Social Service Designee usually works in a Long Term Care environment. They work under a Social Worker. Social Service Designees are the voice of the resident when the resident has lost the capacity to speak for his or herself.

An SSD should:

• Express a philosophy of person-centered, long-term care based on individual resident needs, preferences and choices.
• Demonstrate a basic knowledge of the aging process, including misconceptions, physical changes and psychosocial aspects.
• Demonstrate knowledge of applicable state and federal regulations.
• Show understanding of the rights of individuals who reside in long-term care facilities.
• Demonstrate knowledge of the admission and discharge process.
• Demonstrate an understanding of the principles of documentation.
• Demonstrate ability in basic performance skills, such as teamwork, communication skills and working with administrative staff and other disciplines.
• Discuss issues involved in the management of internal support staff, budgeting, supplies, and outside resources.
• Show understanding of methods of identifying resident interests and needs and the use of assessment in care plan development.
• Evaluate a care plan for effectiveness.

Sign up for We Care Online's Social Service Designee class - Click Here!

Celebrate Residents' Rights - National Residents' Rights Month 2011 Packet of Materials Available Online

From the National Long Term Care Ombudsmen Resource Center:

May 3, 2011

We are pleased to announce Residents' Rights Week has been expanded to Residents' Rights Month. This gives us the entire month of October to call attention to the very important topic of residents' rights.
Residents' Rights Month is an annual event designated by the National Consumer Voice for Quality Long-Term Care and is celebrated in October to honor residents living in all long-term care facilities, including nursing homes, sub acute units, assisted living, board and care and retirement communities. It is a time for celebration and recognition offering an opportunity for every facility to focus on and celebrate awareness of dignity, respect and the value of each individual resident. The theme for Residents' Rights Month 2011 is, "Welcome Home: Creating Connections Between Residents and the Community" with the goal of educating the community about residents' rights and to increase community involvement with residents.

2011 Residents' Rights Month Packet of Materials

Each year, the Consumer Voice develops a packet to help you plan your Residents’ Rights events. The packet is completely downloadable and features ready-to-use items, including promotional materials, activities to celebrate Residents' Rights Month, training tools and resources. Access the packet online.

A Few Great Links for Activity Directors

If you're like me, you're constantly online Googling different ideas to make your job more fun and interesting.  Here are a few good links with great activity ideas that came across our Activity Director course Discussion Board last month.

Have fun!

http://www.notjustbingo.com/

http://www.theactivitydirectorsoffice.com/Gina_ActivityIdeasThatWork_Home.html

http://www.birdsandblooms.com/

http://www.funtrivia.com/

Gardening Leads to Better Eating Habits and Quality of Life

Older adults who spend time gardening are more likely to eat healthier foods, and report better quality of life and higher energy levels than other seniors who don't garden.

Texas A&M and Texas State University conducted a survey of nearly 300 adults age 50 and over. 

• Respondents who spent time gardening were more likely to be energetic, healthy and optimistic about the future.
• 84% said they had made plans for things they will be doing in one month or one year, while only 68% of non-gardeners had made similar plans

Read more:  Click Here

Tips and Time Savers For CNA's

So, you’re brand new and a little nervous? Thats ok and natural. Being a CNA is a rewarding career, but there are LOTS to learn and lots of cover in those first few days at work! Don’t be surprised if you feel a bit overwhelmed and anxious. Someday–soon- you will be an “old pro” at this stuff. The first part of this is for the new CNA…

The Basics
I remember my first few weeks as a CNA- it was hard to get to know all the residents as well as staff as well as the facility policies and procedures. I was very overwhelmed and looking back now- there were certain things I should have done that would have made my life much easier then! Live and learn….

First, it is a good idea to bring a little notebook to work with you. In here you can write down info you need about everything from phone numbers to resident issues. Jotting down info is a way to remember it! At periodic times during the day check the little book to see if there are things you still need info about. When you think of questions and no one is around to answer them- write them down. Later you can refer back to the book.

See the rest - Click Here

The Social Service Designee

This week, we continue our look at career options for students of our classes, we're taking a closer look at the Social Service Designee class this week.

Social Service Designees work to make sure that the social, spiritual, and emotional needs of long term care residents are being met. In a large facility with a social worker on staff, the Social Service Designee will assist the social worker. In a small facility the Social Service Designee may fill all the social work roles. The first
priority of the SSD is to do an assessment of incoming residents, and to work with residents and their families to develop a plan of care for each resident. SSDs also work as advocates for residents, especially when cognitive or emotional issues prevent residents from representing themselves.

SSDs learn to apply the principles of "person centered care", and need to understand the aging process and the cognitive and physical issues that long-term care residents can face. An SSD's work also involves budgeting, staff management, admission and discharge processes, and a great deal of interaction with families, residents, staff, and social service agencies. SSDs need to have good time management skills, be comfortable working with people, and know how to balance compassion with efficiency.

The WeCareOnline Social Service Designee class is currently available in 13 states, and more are coming soon. Students have four weeks to complete the class, and must accomplish 45 hours of work in that time.
Since the class is available 24/7, many students finish before the four weeks are up, and all appreciate being able to study on their own schedule. The class consists of four units which cover the basics of person-centered care, the aging process, cognitive issues, and psychosocial needs. The class also covers the business end of an SSD's job. In four weeks or less, students are ready with the skills they need to work as a facility's Social Service Designee. There is no other required training or certification needed to work in the states
where this class is approved.

Job prospects for Social Service Designees are excellent and the US Department of Labor reports that this is a field that is growing much faster than average. They anticipate 20% or more growth in this field between now and 2018. Need for long term care is also on the rise as Americans are living longer and often need managed care in their later years. If you love working with people, and enjoy the challenge of assessing needs and working to fulfill those needs, this is the career for you.

The Activity Director

This is the first of an ongoing series that explores the career options for students of our classes. To begin, we'll take a closer look at the Activity Director class.

Activity Directors are the people who plan group and solo activities for residents of nursing homes and long term care facilities. State licensing requirements for nursing homes almost always require a facility to have an Activity Director on staff, or at least available to the residents part-time. An Activity Director must be able to plan and run a variety of activities that will appeal to residents of all ages and cognitive/physical abilities--no easy task! He or she must also be able to budget, direct staff, and coordinate events both inside and outside of a facility. The job requires skills in many areas, but most of all, a person must truly love working with people.

The WeCareOnline Activity Director class is currently available in nine states, and more are coming soon. Students have four weeks to complete the class, and must accomplish 45 hours of work in that time. Since the class is available 24/7, many students finish before the four weeks are up, and all appreciate being able to study on their own schedule. The class consists of four units which cover the basics of person-centered care, the aging process, cognitive issues, and psychosocial needs. The class also covers the business end of an Activity Director's job, and students learn how to work with facility budgets, how to manage internal and external resources, and how to plan and provide activities to best meet the residents' needs. In four weeks or less, students are ready with the skills they need to work as a facility's Activity Director. There is no other required training or certification needed to work in the states where this class is approved.

Job prospects for Activity Directors are good, and the US Department of Labor reports that this is a field that's growing faster than average. They anticipate 14-19% growth in this field between now and 2018. Need for long term care is also on the rise as Americans are living longer and often need managed care in their later years. If you love working with people, and enjoy the challenge of planning activities to meet a diverse set of needs, this is the career for you.

WeCareOnlineClasses.com

Is It Depression, Or Just The Blues?

There are many factors that can cause depression. Moving from an independent setting to managed care is a big step, and despite the best efforts of staff and family members, the change of circumstance can bring on a strong case of the blues. Seniors are also more prone to experience the loss of close friends or family members (due to age and illness), deal with chronic pain, and be faced with some loss of independence and mobility. A period of adjustment is to be expected, but if those blues stick around, depression could be to blame. Depression differs from sadness in that it is persistent, long-lasting, and can be far more than just a state of mind.

There are many clues that a person may be suffering from depression. Some of the most obvious are a loss of interest in activities, lethargy, and a general disinterest in things going on around the person. Depressions symptoms are long-lasting and strong enough to interfere w/ daily life. Take a moment and get to Know the signs: http://www.caring.com/articles/depression-signs

How is depression different from general sadness or grief? It's more serious. Don't assume a depressed person can or will snap out of it. As a friend or caregiver, it's up to you to intervene and be proactive. Depression can affect a person's immunity, stress body systems, and cause physical pain. Unfortunately, depression is still misunderstood by many people, and carries a strong negative stigma. People are taught to hide their feelings and mask symptoms, so it can be hard to address the issue before it becomes severe and interferes with a person's daily functioning.

As a caregiver, you might need to go above and beyond to help a resident cope with depression. It's not so simple as telling someone to cheer up and smile. In fact, that can be one of the most frustrating and insulting things you can say. What can you do? If possible, involve the resident's family or friends. A depressed person is often too down to ask for help or realize how far his or her condition has progressed. Support from friends and family can help a person pull out of the crippling sadness and start to participate in social activities again. If a person in your care makes any mention of suicide, seek help from your facility's social worker, or the resident's doctor, immediately. Even without the risk of suicide, it is essential that family members, a social worker, or a doctor be alerted to the resident's condition.

Treatment options

In many cases, simply getting the depressed person out of isolation and into social activities can make a big difference. The change of scenery from a residential room to a facility's common areas (or outdoors, if possible) can pull a person out of dwelling on sadness. Group therapy and support can make a difference. Cognitive or "talk" therapy is a common first step in addressing depression. In Cognitive Behavioral Therapy (CBT), the depressed person is taught how to break the cycle of negative thoughts and learns coping skills. Sometimes it's enough to talk with a family member or trusted friend, but it might be beneficial to bring in a professional counselor. Your facility's Social Service Designee should be able to arrange for counseling or therapy, if it's needed.

If a resident has a religious affiliation, it could help to bring in members of that person's faith to visit or pray with them, or make it possible for the resident to attend religious services with others of the same faith. Fellowship is a strong way to combat the loneliness and isolation that can lead to depression.

Some medications can cause or exacerbate depression, so get in touch with the resident's doctor, or the person overseeing his or her care, and ask them to review medications for possible negative interactions or side effects. Hormonal issues could also be to blame, so bring up that possible cause when speaking with the doctor.

No matter what the causes, it's important to take depression seriously, and learn to spot the signs before they get out of control. Even though a person's reasons for being sad might sound silly or petty to you, please remember that they are significant to the depressed person and should be respected. Try not to judge, and do what you can to be a good listener and get the resident the help he or she needs.

5 Simple Steps To Help A Lonely Resident

As we move into the holiday season, and the days grow shorter and grayer, many residents may find themselves feeling a bit down an lonely. Here are five simple things you can do to brighten a resident's day and keep the loneliness at bay.

1. Take the resident on an outing.
Something as simple as a trip to a coffee shop, going to see a matinee movie, or taking a short drive in the country can do so much to lift a person's mood. Ask questions and encourage your guest to share stories from his or her life. Be a good listener and you can really make someone's day. If a resident is not able to leave the facility, bring the outing to him or her. Get a take-out treat from a favorite local restaurant, or have a meal wrapped take-out style from your facility's cafeteria. Pick up a red and white checked tablecloth at the discount store to add a festive, picnic element. Brightly colored plates, cups, or utensils add a nice touch, too.

2. Be a friend.
As caregivers, we do the best we can for each of our residents, but some days a resident needs you to go above and beyond. There are those awful days when pain is worse than usual, or they're just feeling blue. Maybe personal issues are getting them down. See if you can free up a few moments in your schedule and sit down and visit with the resident. Let them know that, sure, you have other things you could be doing, but you choose to spend time with them. It could be as simple as chatting about the weather, or as involved as being a sounding board for whatever is worrying or bothering the resident. Think about a time when you were lonely, and how nice it would have been if someone had come along and said "I'm here for you." Schedule a regular visiting time, or give the resident a specific time when you'll be back to visit again. The lonely times go a lot faster if you've got something to look forward to.

3. Help your resident connect with others.
Arthritis and failing eyesight can make it hard for seniors to do things we take for granted, like writing a letter or making a phone call. Help a resident write a letter or email. Is your resident having trouble with a phone or cell phone? Offer to help w/ dialing, or write or type up a list of important phone numbers in large numbers.

4. Small gifts
Bring the resident a small gift like fresh flowers or a small potted plant. A little gesture can both brighten up their room and make their day. But--and this is important--Don't just gift and run. Take a few minutes to visit with the resident. Let them know you were thinking of them and that you genuinely care about them. Then, when they look up and see your gift, they'll remember your visit with a smile, and look forward to the next time you're able to stop by.

5. Make contact
This suggestion takes a little more care and effort than the previous ones. If you can do so without violating HIPPA or your resident's privacy, reach out to others on behalf of the resident, and see if you can arrange for friends or family to visit. Some residents are too proud to ask for help, or too upset or distracted to take the initiative on their own. Ask your facility's SSD to contact the resident's family or friends. Arrange a surprise visit. No family? Drum up a volunteer, pet visit, or something w/ local scouting troop or school. Sometimes it's not so important who is visiting, but that the resident has visitors, period.

Finally, If you have several residents who are dealing with loneliness, try arranging a group activity. A movie night (or ongoing movie club) is a great way to bring people together and get them talking. Invite family members and volunteers, if possible, too. Get the group together and watch a classic movie with an upbeat theme like Singin' in the Rain. Musicals are great because of the lively music and lavish dance scenes! Provide snacks, dim the lights, and let everyone enjoy a movie together. Afterward, lead a discussion about the movie. Encourage everyone to talk about their favorite songs or scenes, or reminisce about other favorite movies and actors from that time period. If the movie had dancing, bring in a volunteer to teach everyone a simple dance based on a song from the movie. Or lead a sing-a-long or karaoke with songs from famous movie musicals.

Sometimes the smallest gestures can have the biggest impact. If you see someone looking down, or who hasn't had visitors in a while, a little attention from you can make a huge difference.

You're a CNA, Now What?

Americans are living longer than any previous generation and the need for long-term and nursing care is growing by leaps and bounds. This is the perfect time to enter a health care career, and achieving Certified Nurse Aide (Assistant) certification is a great start. We've had thousands of students in our Nurse Aide classes. If you really want a competitive edge in the jobs marketplace, though, your best bet is to broaden your skills and make yourself even more appealing to an employer. Many students use the CNA class as a stepping stone to Registered Nurse training, but there are several other options for additional skills.

So, where do you go from CNA?

One good starting point is to train as a Restorative Aide. RAs assist with physical, occupational and speech therapy under the supervision of a specialist. RAs work with individuals recovering from injuries or operations, and are not limited to elder care. Jobs are available in facilities and with outside agencies, so having RA skills can be a great option for people who like to work in a variety of settings. Our Restorative Aide class is offered every month and involves 32 hours of coursework. It's a two week course and it can mean an extra $0.50 an hour (or more!) in your paycheck, according to payscale.com.

Another great option is to train as a Home Health Aide. Not only will this make you more employable, it will greatly increase your employment options. While CNAs generally work in long term care facilities, a CNA with HHA training can work with a Home Health Care agency and have the opportunity to work with clients in their own homes. The current trend is to keep elders in their homes with assisted care rather than moving them into facilities, so demand for qualified Home Health Aides is growing rapidly. As a Home Health Aide, you will help people live comfortably and with dignity in their own homes. HHA is the perfect option for working parents, or people who need flexible hours since you can sometimes schedule home visits around your other commitments. Our Home Health Aide class involves 20 hours of coursework, and is offered quarterly. Is it worth 20-32 hours of your time to boost your earning potential?

Ready To Run Away When The Surveyors Come?

Work in a long term care facility is filled with hundreds of little stresses, but every now and then one comes along that throws you into a panic. For many employees, survey time can be the worst. You know the drill: A state employee shows up with a clipboard and puts your facility under the microscope. Suddenly you're worried about every little thing, and unable to concentrate on your work. Is your paperwork in order? Did you remember to wash your hands after helping Ms. Jones with her eyedrops? Did Mr. Morris get his lunch in a timely manner?

Ok, stop. Take a deep breath. I'm going to let you in on a secret about surveys. Ready?

Survey days are the same as ANY OTHER DAY.

That's right. Whether you're the DON, a CNA, or facility's Activities Director, it's up to you to do you very best for your residents every day you come to work. If you're doing your job properly, everything will run smoothly and survey day won't be any different than any other day on the job.

Want to make survey as painless as possible? Do a mental run-down of everything the surveyors look for and make sure you could pass inspection with flying colors. Is your workflow in order, or are you always scrambling to take care of things when they pop up? Checklists can be a great help for both directors and employees. Rather than having to juggle everything in your head--and deal with interruptions and distractions--you can just refer to your checklist and keep things running smoothly. It's the easiest way to make sure you never forget something important, and it'll help you get back on track when all those little distractions pop up. If your records are up-to-date and neatly organized, you'll sail right through that part of the survey.

Next, take a moment to pretend that you're visiting your facility for the first time. Look around you and take note of what you see. Are the residents happy and involved with activities, or are they sitting alone in silence? Does everyone look well groomed, or is hygiene lacking? How does the air smell? When you work in a place day after day, you can get accustomed to smells, but it's important to take a moment to pay attention. If anything seems off, or if there are issues with the residents, take care of them now. That way, when it's survey time, you can relax and be confident that everything is in order.

Stand in the entrance to the dining hall, or in the facility's entry. How would your coworkers appear to a stranger? Are people stressed and short tempered, or do you see lots of smiles and pleasant interactions? Are residents addressed by name? If there is anything discourteous or disrespectful occurring, take care of it immediately. It might require a staff meeting or a memo, but clearing up any issues now will make survey a breeze.

Finally, remember that surveyors are just people doing their jobs, like you. They aren't there to cause trouble or make your life difficult. Yes, a lot of things are riding on a survey, but if you're working safely and conscientiously already, you have nothing to worry about. Help inspectors get their work done and get the information they need, and you'll be able to get back to your work that much more quickly. If you're doing a good job every day, survey day will be a breeze. Smile, take a deep breath, and go about your business without worrying.

 https://www.cms.gov/manuals/downloads/som107c07.pdf

 

How to Be a Good Online Student

In my last post, I gave an overview of whether or not online learning is for you. Now I'd like to focus on what it takes to succeed in online learning. If you've decided that an online class sounds just right for you, this list can help you not only survive, but thrive in your class.

1. Take care of all the required busywork up front. If the class requires a book or workbook, make sure you leave plenty of time to get it. If you're ordering the book from an online store (or even a regular bookstore), the book might be out of stock or backordered. Leave enough time for the post office to get your book to you before class starts, or you could find yourself falling behind. Also, make sure you have submitted all the required paperwork for your class. Here at We Care Online, several of our Kansas classes require students to include a copy of a Nurse Aide or Social Security card as part of the registration. If your class has a clinical component, make sure you know where and when the class will meet, and make any arrangements for transportation or child care.

2. Get familiar with your computer. If you only use your computer for checking email or watching videos, take some time to play around online and get comfortable with how your web browser works. Ask your questions and get familiar with how the computer works before you're under the pressure of class deadlines. It's much easier to get over nerves when you're just surfing for yourself versus when you're in the middle of a class and assignments are due.

3. Start your class promptly and stay on track. If possible, get a little bit ahead on assignments so you'll have a cushion of time later on in the class. A lot of people assume that online classes are easier and take less time than traditional classes, but this is rarely the case. Don't assume you can take it easy in the beginning and make up for lost time at the end.

4. Manage your time. When your class starts, take a look at the class outline, and at the assignments for all chapters or units. Get a feel for how long it will take you to work through each section and set up a schedule for yourself so you'll stay on track. There can be a lot of variation in the length of individual learning units, so don't assume that each one will take the same amount of time to complete.

5. Be sociable. Online classes have a discussion board when you can talk to your fellow students. There are generally some assigned questions related to the class material, but don't be afraid to start a new topic or to stray a little off topic to get to know your classmates better. You're all just names on a screen to each other until you write a message and let your personality come through. Share experiences you have had in your working life that might help your other students, such as how a technique is performed at your facility, or something you have learned on the job.  But always be mindful of patient confidentiality issues! It's ok to change names or details to protect someone's privacy.

Unfortunately, it's easy to get too comfortable online and share more than you should. Always be mindful of over-sharing. It's fine to mention if you have kids, or where you work, but be wary of giving out personal information like phone numbers or birthdates. Think of it this way: if you're chatting with someone in line at the grocery store, you might tell a funny story about your toddler, but you're not going to tell that person where you live or where your kids go to school. If you're not comfortable sharing it with that person in the grocery store line, you probably shouldn't share it online either. Be open with your knowledge of class topics--you're here to learn, and learn from others--but keep the personal information personal.

Finally, always be mindful of the fact that when you're online, humor and sarcasm are not always obvious, so jokes can fall flat and people might misunderstand what you are trying to say. Always take a moment to pause and read over your discussion board comments, or email messages, before sending them. Do your best to use good grammar and proper spelling, and to project a professional image at all times. Leave a good impression on your classmates--you never know when you might bump into them in your working life. A student might someday be your co-worker, boss, or employee, or a reference on a job application. Make sure your words reflect the best you have to offer.

The Virginia Adult Learning Resource Center has a wonderful tutorial about online learning. Some of the items are specific to VALRC students, but the majority of the information applies to any online class. The sections on time management and internet terms are particularly good. If you are new to computers, or hesitant online, this tutorial could set your mind at ease.

Start here: http://www.valrc.org/tutorials/onlinelearner/introduction.htm

How To Keep Your Cool When Dealing With a Difficult Resident

You don't have to work in long term care for long before you encounter a difficult person. Sometimes it's a resident, other times a coworker, or even someone outside the facility like a resident's family member or doctor. Beyond the golden rule, what can you, as a health worker, do to improve these encounters? To simplify things, I'm going to address issues with residents here. A lot of these tips are universal and can help with any difficult person, but some are very specific to long term care residents.

First off, no matter how difficult it is, keep your temper in check. It's easy to get your hackles up when people are being belligerent - moreso when you know you're right and they're wrong - but nothing will
ruin the encounter faster than a lost temper. If you need to leave the room or turn away to regain your composure, do so. Taking a deep breath and letting it out slowly, or counting to ten in your head,
really does help.

Composed and ready to face the situation now? Great. It's important to remember that many residents are adjusting to many changes in their lives. It is very rarely about you, and almost always about something
else that's bothering the resident, so don't take outbursts personally. The loss of health and independence can be very hard to face. Fear, anger, sadness, and pain can pervade almost every aspect of a person's life when they first transition to assisted care. Keep in mind that any of these things might be behind a resident's rudeness or inappropriate behavior. Instead of scolding the resident, or getting your feathers ruffled, use your empathy skills to gently encourage a resident to share what is bothering him or her. A leading question like, "I hear a lot of tension in your voice. Is your pain worse today?"  can give the resident the chance to tell his or her side of the story. Let your residents know that you're on their side
and will do everything in your power to help address their issues.

Now, with a belligerent resident, this might be an invitation to carry on about problems and pains, whether real or imagined. Do your best to get to the heart of their issues and offer solutions. Is Mr. Smith's wheelchair pad worn and causing discomfort? Is Ms. Jones' robe aggravating her skin condition? It's often the simple fix that can diffuse the litany of complaints. If fear is the root of the problem,
demonstrating empathy and sharing your knowledge might be all it takes to set a resident's mind at ease. Perhaps a resident is balking at taking medication because he or she doesn't fully understand why it is
necessary. Telling the resident to "take it because the doctor said so" won't help the situation. Use your knowledge to explain, as best you can, what a medication does or doesn't do, and set the resident's mind at ease. A resident might also lash out due to loneliness. Do whatever you can to be a friend to your residents. Sometimes all they need is someone to listen. Talk to your facility's Activity Director or Social Services representative and arrange for the resident to attend a group activity or have a volunteer stop by and visit with the resident.

Another issue that faces residents as they transition to a nursing facility is the feeling of a loss of  responsibility. Many resent going from being parents and caretakers to being dependent on others. Refusing to take medicine, or not wanting to attend meals in the dining room can point to a deeper issue. Residents are going from being in control of their own schedules to being forced into a facility's schedule, and that can be tough. You can help by offering residents choices and allowing them to exercise independence and judgment on their own. Instead of offering water with pills, let the resident chose between water, milk and juice (according to the diet plan). Ask residents what time they like to eat meals, and if the time is different from your facility's dining hours, see if it would be possible to arrange for an
in-room meal at a time more fitting for the resident.

In all encounters, focus on the positive. If you need to get through an awkward or unpleasant activity (like a sponge bath) chat about a TV show coming on later that day, or about the facility-wide Bingo game
that evening. If a resident is fighting you as you try to change a wound dressing, remind them that the sooner you finish, the sooner the resident can go back to doing something he or she enjoys. Let them see that by sitting quietly and letting you do your work, they can move on to more pleasant things more quickly.

Finally, be on the lookout for residents who suffer in silence. Most people are taught to keep a stiff upper lip, or to remain stoic in the face of troubles, so it can be very hard for your residents to admit they are hurting and need help. Use your skill at reading body language to help see beyond the surface behavior to what might be going on under the surface. Stiff posture or fidgeting might indicate a person is in pain. Staring into space or frequent sighing can clue you in that your resident's mind is on something other than the here and now. It might be too embarrassing for residents to discuss medical problems with you at first, but if you demonstrate an air of trust and make your residents feel safe, you can help them to express what's really behind "bad" behavior.

Want to read more on this topic? Check out these articles.
http://nursinglink.monster.com/careers/articles/5771-difficult-patients-why-theyre-that-way-and-how-to-handle-them

http://ezinearticles.com/?Elder-Care-Solutions---Dealing-With-Difficult-Aging-Parents&id=3901872

Elder Abuse and Neglect

Every year, tens of thousands of elderly Americans are abused in their own homes, in relatives’ homes, and even in  facilities responsible for their care. You may suspect that an elderly person you know is being harmed physically or emotionally by a neglectful or overwhelmed caregiver or being preyed upon financially. By learning the signs and symptoms of elder abuse and how to act on behalf of an elderly person who is being abused, you’ll not only be helping someone else but strengthening your own defenses against elder abuse in the future.

It’s difficult to take care of a senior when he or she has many different needs, and it’s difficult to be elderly when age brings with it infirmities and dependence. Both the demands of caregiving and the needs of the elder can create situations in which abuse is more likely to occur.

Many nonprofessional caregivers, spouses, adult children, other relatives and friends find taking care of an elder to be satisfying and enriching. But the responsibilities and demands of elder care giving, which escalate as the elder's condition deteriorates, can also be extremely stressful. The stress of elder care can lead to mental and physical health problems that make caregivers burned out, impatient, and unable to keep from lashing out against elders in their care.

Among caregivers, significant risk factors for elder abuse are

• Inability to cope with stress (lack of resilience)
• Depression, which is common among caregivers
• Lack of support from other potential caregivers
• The caregiver's perception that taking care of the elder is burdensome and without psychological reward

Substance abuse

Even caregivers in institutional settings can experience stress at levels that lead to elder abuse. Nursing home staff may be prone to elder abuse if they lack training, have too many responsibilities, are unsuited to care giving, or work under poor conditions.

The elder's condition and history

Several factors concerning elders themselves, while they don't excuse abuse, influence whether they are at greater risk for abuse:

• The intensity of an elderly person's illness or dementia
• Social isolation; i.e., the elder and caregiver are alone together almost all the time
• The elder's role, at an earlier time, as an abusive parent or spouse
• A history of domestic violence in the home

The elder's own tendency toward verbal or physical aggression

In many cases, elder abuse, though real, is unintentional. Caregivers pushed beyond their capabilities or psychological resources may not mean to yell at, strike, or ignore the needs of the elders in their care. (The preceding is an excerpt from helpguide.org.  Click HERE for the full article.)

Below is  presentation with more information on Elder Abuse.

Music Brings Memory

The aide who answered the phone in the Alzheimer's unit shouted, "Woody, you've got a phone call!" I heard the clattering as he grasped the handset, followed by his whistle, a nervous habit he acquired over the past few years. "It's Mary Ellen, your daughter," I said. Then I hummed him a note, as if I were giving him a cue from the pitch pipe--and began to sing Henry Mancini's "Moon River." By the second note, he was...read the rest of the story.