Communication

This is a great time to be working in the field of geriatrics, so much is going on in terms of research and available aids for senior citizens. I read about available grants for caregivers to allow them financial aid to return to school so they can get better paying jobs.

When developing a care plan for an individual remember to look into their native language. I spoke with an individual recently that earlier in her life spoke English and Spanish, however, now she pretty much speaks Spanish. Over half of the caregivers speak Spanish, for those who do not, to have available common phrases the individual would recognize and understand would be helpful. The effort put forth would pay double dividends, the resident would feel grateful and the caregivers would feel they were valued that their employer put forth the effort to improve communication so they could do a better job.

Definition of neglect

Wanted to pass along one of the many definitions of neglect. As professional nurses in long term care settings if you assess that a resident needs medical attention then get them to the hospital. Do not allow an administrator or family member to decline the services of an ambulance because they do not want the resident to go to the hospital. As a professional you can be held responsible for neglect when you do not advocate for the resident, especially when the facility's policies direct what action is to be taken. As a professional you are held to the regulations that operate in your state governing the operation of the facility and your nurse practice act including resident rights, and reporting requirements. Not knowing what the requirements are will not excuse you from legal and professional action when allegations of neglect are reported. You also can be held responsible if you fail to provide supervision to caregivers under your leadership and do not provide adequate training. Your best protection is knowing what your job description states, the facilities policies, your nurse practice act, regulations governing the type of facility for which you work and what must be reported to the state board of nursing.

Resident assessments

I wanted to talk about resident assessments. Identifying resident needs also should include an assessment of the skill set of the care staff that will be providing the care and services. Traumatic Brain Injury clients have a different set of needs than dementia or mental health clients. Staff need to receive training specific to the needs of residents with Traumatic Brain Injury. When care staff tell supervisors something is wrong they need to be listened to and the resident assessed. Nurses who complete assessments for residents need to access their resources to gather the necessary information they need. The internet is loaded with various resources from credible sources.

Blood pressure alerts

Monitoring a patient's or a resident's blood pressure is more than just taking the blood pressure recording the result and giving a pill. A facility should have parameters for when a resident's blood pressure reaches a specific parameter and the physician should be notified, including when a standard fax is adequate or when a phone call should be made to alert the doctor.

A person's blood pressure must be evaluated along with any other symptoms that are exhibited. A blood pressure of 77/36 is of grave concern because it the individual's vital organs such as kidneys, brain and lungs may not be getting adequate oxygen. If the resident is responding appropriately, the blood pressure should immediately be rechecked to determine if it is an accurate reading or if it is operator error or mechanical malfunction. If it is indeed an accurate result, the resident maybe exhibiting other symptoms such as non-responsiveness, confusion, dizziness, inability to speak. Medical intervention is necessary, the sooner the better. The resident needs to be evaluated/assessed.

Like wise if the blood pressure is high, the blood pressure needs to be evaluated. If the resident is responding appropriately, the blood pressure should immediately be rechecked to determine if it is an accurate reading. If is is indeed an accurate result, the resident maybe exhibiting other symptoms such as headache, dizziness, nausea, vomiting, slurred speech, inability to raise both arms, smile or other symptoms of stroke. The resident should immediately be transported to the hospital and the physician notified.

It is more helpful if the resident's physician determines the parameters for which he wishes to be notified.

New nurses

I did a visit at a facility today. I shared my concerns with the facility nurse and she responded as if her responsibility was to only send a fax to the doctor and failed to alert him to why he was receiving the fax. I could not determine if she did not have the scope of knowledge to realized that a blood pressure of 77/36 and/or a blood pressure of 211/114 was a serious medical problem. I would like to give her the benefit of the doubt I just don't think she gets it.

Lots of changes happening at the state level. Our state government expanded the definition of financial exploitation of the elderly which was a good start. Training for individuals in the financial institutions, family members and facilities is paramount to preventing the exploitation of our senior citizens. It is very unfortunate when exploitation occurs and the ramifications for the senior involved is wide spread. This past week a news paper had a story where a gentleman was robbed of over 2 million dollars by a woman who promised marriage and companionship. Although the courts said she will pay the money back the reality is that probably will not happen as scamming elderly men was how she made her living. Keeping in contact and having frank discussions about financial matters with loved ones is the most effective means of protection against financial exploitation from crooks.

emergency preparedness

Every facility needs to have an emergency plan because disaster does not schedule their events. We had a facility with a fire in which residents were evacuated. The facility staff were prompt in responding and the facility nurse developed a care plan to address resident needs related to being moved. Some of the issues she addressed included watching the residents for respiratory stress due to potential exposure to smoke, stress of moving from familiar surrounding to a different location, how to provide a calm safe environment and respond to potential behaviors. This professional nurse also included directives on how to deal with questions from family members and the media. Resident were found to be calm and dealing with the changes.

My a year goes by pretty fast. There have been multiple changes to state resources and staff reassignments. We continue to have the 1-800 number for the complaint resolution hot line and for individuals to report abuse. This year appears to be gearing up to spotlight financial exploitation of seniors and what it looks like. Please return to this blog for additional information. Changes have settled down for the time being so hopefully posts will be more regular and timely.

Elder Abuse Prevention Conference review

This is the third Elder Abuse Prevention Conference I have attended. Each year it improves dramatically. The Keynote speaker Paul Greenwood, San Diego County Deputy District Attorney delivered an educated, dynamic heartfelt presentation. He was engaging, humorous and passionate about his topic. He spoke about the myths and misconceptions surrounding the investigation and prosecution of criminal elder abuse cases. He also addressed financial exploitation and how to best recognize, investigate and prosecute allegations of elder abuse. Dr. Mindy Schaffner addressed the unique considerations of mental health and aging. The audience was very diverse and Dr. Schaffner answered questions and took comments providing a lively interactive session. I believe the group could have continued on for another hour we were sad to have to call a halt so conference participants and attendees could have lunch. After lunch, Therese Murphy, Yakima County Prosecuting Attorney, discussed what we are doing locally to combat elder abuse and discussed locally prosecuted cases. She identified specific pieces of information that are needed to conduct a successful prosecution of an abuse case. Ms. Murphy stated financial institutions are now able to report suspicious activity on a clients account to Adult protective services. Another breakout session included a presentation by a secret service agent, John Lowry. He spoke about scams and fraud targeted to vulnerable adults and how to avoid identity theft. Mr. Lowry was very knowledgeable, interesting and invited questions from the audience. The conference ended with the panel of experts answering questions from the attendees. The conference was time well spent.

Elder Abuse Conference

This week on 5/19/2010 the Elder Abuse Conference will be held at the Clarion Hotel. One of the guest speakers is Dr. Mindy Schaffner. I am looking forward to attending.

Assessments of residents in Assisted Living Centers

The position of the licensed nurse in an Assisted Living Center comes with a lot of autonomy and requires the discipline of a self starter. How to integrate assessment skills with the requirements of an assisted living is challenging for nurses who enter the field without the experience of well developed critical thinking. Assessment of a resident needs to include information from family members, the resident, the resident's physician, case manager and the licensed nurse. The assessment is pivoted around what makes up the resident's life, not just a head to toe physical assessment. The question that needs to be answered is "Can the facility meet the needs of the resident in a manner that provides the highest quality of life for that resident?" Combining all the information regarding a resident and developing a service plan that identifies what services the resident needs and wants, at the time he or she wants, in the manner he or she wants, determines if the resident's needs will just be met or if the needs will be met in an atmosphere that validates the person and supports their rights.

Making a connection

Elderly clients are so intriguing. I was a guest at a facility this week in which I was privileged to observe the activity staff engaging residents with music. A number of the residents were unable to follow a conversation due to advanced dementia, however, they responded with enthusiasm, clapping of hands and a few even joined in with the singing. Although the pathways for verbal communication due to dementia are not accessible, music seems to be able to connect residents with even the most advanced dementia to those around them. A young man shared with me that his grandmother, who he was very close to when growing up, no longer recognizes him however when he plays the guitar for her she lights up and smiles. He said this is a gift he is able to give her when he visits every week. This facility plays music for the residents through out the day that includes music from their era, gospel and soothing sounds. Staff are constantly observing the reactions of the residents so they are available when a moment happens and a door opens for just a little while, they are there to connect with the resident. Each resident was acknowledged, validated and spoken to respectfully several times during my visit.

Taking belongings away violation of resident rights

An incident that I became aware of recently where caregivers had decided to remove a resident's belongings because he would make a mess of his room was disturbing. To take and with hold a person's belongings is a violation of their right to property. The caregivers needed to explore options that protected and ensured the resident's rights. Options possible could have included increased supervision, providing activities that interested the client, request a family member to visit during that particular time or exploration of why the resident was agitated and remove the cause. Did the agitation occur frequently or at the same time during the day or night? Did the resident need to be toileted, was the resident in pain, did the resident have gastric upset or was ill or possibly hunger? Putting residents in front of a television without monitoring what is being viewed could possibly be the problem. Residents with dementia lose the ability to process stimuli in the same manner that individuals who do not have dementia. Providing care to individuals with dementia is challenging because often they are unable to verbalize what is bothering them. Providing a safe environment with a high quality of life requires all the skills of observation, reasoning and critical thinking of the caregivers.

Elder Abuse Awareness Day June 15, 2009

Monday 6/15/09 is Elder Abuse Awareness Day. I wanted to share 'What are the signs of Elder abuse?'
* Unexplained injuries, bruises, burns, puncture wounds, cuts, sunken eyes and/or welts.
* Excessive fears, withdrawal, agitation.
* Changes in appetite or unusual weight gain or loss.
* Poor personal hygiene.
* Unexplained changes in health, personality or behavior.
* Frequent arguments or tension between the elder and his/her caregiver.
* Unsanitary or unsafe living conditions.
* Unnecessary services. goods or subscriptions.
* Sudden inability to pay bills, buy food or personal items.
* Financial activity the elder could not have done.
* suspicious changes in wills, POA, titles and policies.

What can you do as a concerned friend or family member?
* If you suspect abuse, REPORT IT!
* Monitor the elder's medication
* Ask the elder if someone they trust could review their bank statements, credit card statements for unauthorized transactions.
* Pay attention to "new" friends
* Offer to assist the elder with household needs (lawn care, repair work, etc.)
* Call and visit as often as possible
* Get acquainted with the elder's neighbors-enlist their help.

Exploitation

What does exploitation mean? According to the Washington Administrative Code (WAC) exploitation is defined as: an act of forcing, compelling or exerting undue influence over a resident causing the resident to act in a way that is inconsistent with relevant past behavior or causing the resident to perform services for the benefit of another (not their usual behavior). Because our elderly are often lonely or isolated due to inability to get out anyone extending a friendly hand is often welcomed. To help an elderly person not be a victim of exploitation when asking how they are doing be specific. Ask them how they are getting their groceries, assist them to utilize community available transport or locate grocery stores that offer a delivery service. When there is a scam reported in the news let the elderly people in your life know about the scam and how to protect themselves. The most important safeguard is to have frequent contact and if possible visit often. If you believe someone has been the victim of exploitation call the complaint resolution unit or Adult protective services for your area.

Elder Abuse conference

I was fortunate to be able to attend the Elder Abuse Conference last week. There were several excellent speakers. The conference covered what constitutes abuse, how to recognize abuse, where to report abuse and some strategies to prevent abuse. Several case studies were shared and talked about how a perpetrator was able to swindle several thousand dollars out of unsuspecting elderly ladies in a senior mobile home park. One important point that was emphasized was to learn who your neighbors are or learn who the neighbors are of the elders you care about. Neighbors can be invaluable in terms of keeping an eye out and letting a family member know when when someone has been in the neighborhood that normally isn't. One of the attorney's that presented stated that had it not been for a neighbor who had written down the license plate number of the car of the perpetrator, the perpetrator may never have been caught and prosecuted.

I will include in the next several posts more information that was shared at the conference.
Have a great week.

Mesothelioma

Mesothelioma: A Quiet Killer

Many of us are aware that lung cancer is the United States leading cause of death behind heart disease and that other cancers, such as breast cancer and prostate cancer are receiving a great deal of attention in recent years. But I wish to touch upon a type of cancer that very few people are aware of-mesothelioma. Mesothelioma accounts for only one percent of cancers in the United States each year, but nevertheless is likely the most devastating of all malignancies.

Given the recent advancements and investments in cancer research over the past 25 years, it is rare that patients are told by their physicians that there is nothing they can do to help them. Unfortunately, with mesothelioma patients, this is too often the norm. Mesothelioma forms in the lining of the body’s internal organs, most often in the cell wall that lines the lungs. As the tumor grows around the lung and chest wall, it begins to collapse chest expansion and limit breathing. Untreated disease often results in suffocation of the patient.

Mesothelioma is known only to be caused by asbestos exposure. Asbestos was an industrial insulation material used throughout different industries until it was found to be carcinogenic. Studies indicate that while mesothelioma is relatively rare at the present, incidence will increase in the next decade as the disease will often not manifest for 40-50 years after initial exposure to asbestos, meaning many are living right now who have the devastation of terminal cancer in their future.

What we need is more research into new therapies to treat mesothelioma, particularly given the expected rise in incidence. We need more physicians like Dr. David Jablons of the UCSF School of Medicine, who is experimenting with multi-faceted approaches and immunotoxin therapies for advanced disease. We need more national investment not only in cancers like lung and breast malignancies, but also rare cancers like mesothelioma. Progress we have made in recent years in the treatment of cancer in general can be attributed to this type of research and investment. Let’s extend that to all cancers, so that we may finally eradicate disease like mesothelioma.

Mesothelioma

What is it?

Malignant mesothelioma is a rare type of cancer that occurs in the thin layer of cells lining the body's internal organs, known as the mesothelium. There are three recognized types of mesothelioma. Pleural mesothelioma is the most common form of the disease, accounting for roughly 70% of cases, and occurs in the lining of the lung known as the pleura. Peritoneal mesothelioma occurs in the lining of the abdominal cavity, known as the peritoneum and pericardial mesothelioma originates in the pericardium, which lines the heart.

Who is at risk for Mesothelioma?

The only recognized cause of mesothelioma is exposure to asbestos, though other factors such as smoking can make the disease more or less likely in some individuals. Industrial laborers were widely subjected to asbestos exposure on the job, as the material was widely used throughout the 20th century. Few of these workers knew they were being exposed to asbestos, however, despite the fact that many manufacturers were aware the material was hazardous. In most cases, mesothelioma symptoms will not appear in an individual exposed to asbestos until many years after the exposure has occurred. Those who believe they may have been exposed to asbestos should fill out our form to receive a free mesothelioma information packet, detailing treatment options, emerging therapies, and jobsite exposure information.

Mesothelioma Treatment

Once an individual has been diagnosed with mesothelioma, the next step is to discuss mesothelioma treatment options with his/her physician. Recent scientific research has produced significant breakthroughs with regard to treatment protocols for mesothelioma patients and more options are now available for managing the disease and supporting improved quality of life. Newly diagnosed patients always have many questions about the treatment options that would be most effective for them, including those about new treatment therapies like Alimta and Cisplatin and other chemotherapy drugs. In addition to these newer drugs that are being used to treat asbestos cancer, mesothelioma patients also have a number of "conventional" treatment options to consider, including chemotherapy, radiation therapy and surgery.

Clinical trials and experimental treatments are still other options that some mesothelioma patients may be eligible to participate in. Our site features a comprehensive mesothelioma cancer treatment section that includes important information for patients and families. We've included resources on top mesothelioma doctors such as Dr. Sugarbaker, as well as a comprehensive list of questions that you may wish to discuss with your personal physician when preparing a treatment plan. We are always providing new and informative resources regarding mesothelioma treatment including: Clinical Trials, conventional treatments, experimental therapies, and more. Check back often for the most recent advances in mesothelioma treatments.

Harvey Pass, M.D., NYU Medical Center

Dr. Harvey Pass is a top mesothelioma doctor and expert in the diagnosis and treatment of pleural mesothelioma, a type of lung cancer that is often related to asbestos exposure.

Asbestos Exposure

Asbestos exposure is the single known cause of mesothelioma. Inhaled or ingested asbestos fibers may cause an inflammation of internal tissue and disrupt organ function which leads to the development of the disease. Asbestos products were used extensively throughout the 20th century in a wide variety of applications. Many of these products were responsible for asbestos exposure sustained by both the individuals who manufactured the products as well as those who used them at commercial and industrial jobsites including shipyards, refineries, power plants, steel plants and more. Several asbestos companies continued to produce these products even after they were known to be hazardous and harmful to workers and their families. Those who have become sick because of exposure to these products may now be eligible for financial compensation if they were wrongfully exposed.

Asbestos was also used at many New York jobsites including Ground Zero and the former World Trade Center site. Common asbestos exposure sites in New York include the Brooklyn Navy Yard, Todd Shipyard, and the Con Edison power plant in New York City.

Veteran Support

Navy veterans who worked in navy shipyards and or served on our nation’s warships and submarine’s from WWII through the Vietnam War were exposed to high concentrations of deadly asbestos. Boiler rooms, engine rooms, sleeping quarters, and other areas of naval vessels were the most common areas where asbestos was present. As a result, Navy veterans are at a greater risk of developing mesothelioma. Veterans who were exposed should fill out the brief form on this page to receive a free mesothelioma and asbestos exposure information kit. Support systems are in place to make sure you receive the assistance you deserve.

News Alerts

Mesothelioma Treatment Option Found Effective

Lugano, Switzerland - May 23, 2009

A type of surgery used as part of a treatment plan for mesothelioma has recently been assessed by a major medical conference, and has been found to be very effective.

Firehouse Project Pushed Back Due to Asbestos Discovery

Vineland, New Jersey - May 22, 2009

Plans to demolish buildings to make way for a new firehouse have run into a snag: asbestos cleanup will be needed at the site.

Sixty-three Countries Approve United Nations Convention on Ship Recycling

Bangkok, Thailand - May 21, 2009

A new convention related to safety issues and the global shipbreaking industry has been approved by 63 world governments, according the United Nations. The goal is to update safety regulations within the shipbreaking industry in an effort to better protect workers.

Last modified: May 22 2009

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Elder abuse

Abuse comes in all forms. This past week I learned of an elderly lady who was financially exploited by the caregivers she hired. She was progressing rapidly in her dementia and the caregivers were writing out checks to themselves forging her name. A bank teller picked up on something was not right; however this happened after several thousand dollars were taken.

One of the recommendations for aging deliberately is for all individuals who reach retirement age or before, decide how they wish their estate to be handled and make arrangements with someone they trust to follow their wishes. If there is no family there are means of setting up accounts at banks or through an attorney to establish a plan for one's estate.

Guest Post: Mesothelioma A quiet Killer

Mesothelioma: A Quiet Killer
Many of us are aware that lung cancer is the United States leading cause of death behind heart disease and that other cancers, such as breast cancer and prostate cancer are receiving a great deal of attention in recent years. But I wish to touch upon a type of cancer that very few people are aware of-mesothelioma. Mesothelioma accounts for only one percent of cancers in the United States each year, but nevertheless is likely the most devastating of all malignancies.
Given the recent advancements and investments in cancer research over the past 25 years, it is rare that patients are told by their physicians that there is nothing they can do to help them. Unfortunately, with mesothelioma patients, this is too often the norm. Mesothelioma forms in the lining of the body’s internal organs, most often in the cell wall that lines the lungs. As the tumor grows around the lung and chest wall, it begins to collapse chest expansion and limit breathing. Untreated disease often results in suffocation of the patient.
Mesothelioma is known only to be caused by asbestos exposure. Asbestos was an industrial insulation material used throughout different industries until it was found to be carcinogenic. Studies indicate that while mesothelioma is relatively rare at the present, incidence will increase in the next decade as the disease will often not manifest for 40-50 years after initial exposure to asbestos, meaning many are living right now who have the devastation of terminal cancer in their future.
What we need is more research into new therapies to treat mesothelioma, particularly given the expected rise in incidence. We need more physicians like Dr. David Jablons of the UCSF School of Medicine, who is experimenting with multi-faceted approaches and immunotoxin therapies for advanced disease. We need more national investment not only in cancers like lung and breast malignancies, but also rare cancers like mesothelioma. Progress we have made in recent years in the treatment of cancer in general can be attributed to this type of research and investment. Let’s extend that to all cancers, so that we may finally eradicate disease like mesothelioma.

I would like to extend a thank you to Jack Bleaker for providing the guest post.