A newsbasket is on-line Internet publication containing comprehensive aggregated collections of information.

5 Steps for Dealing with Anticipatory Grief - Visiting Nurse Service of New York

5 Steps for Dealing with Anticipatory Grief - Visiting Nurse Service of New York: It might be the hardest part of caregiving: Watching your loved one slip away step by terrible step, knowing you can’t stop the decline and grieving the loss of the person you once knew, long before they’re actually gone. Psychologists call this process anticipatory grief, and it’s very common among caregivers and family members of those suffering from Alzheimer’s disease, cancer and other terminal illnesses.

“As a disease progresses, there is so much frustration and sadness associated with watching the person you once knew go away,” says Vince Corso, M.Div, LCSW, CT, Manager of Hospice Psychosocial Services, VNSNY. “It can be overwhelming.”

What Goes Into a Life Care Plan? | Hill Law Group, PA

Data gathering Forms  | Hill Law Group, PA

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

Dave M.

Personal Support Workers, or PSWs, are starting to fight back, but their wage increases equate to worry for clients, families and service provider agencies.

THE CAREGIVERS' LIVING ROOM A Blog by Donna Thomson: A Fight Between PSWs, Clients and Agency Service Providers Spells Trouble For All
an article by always erudite Howard Gleckman  He wrote in Forbes:

Should the aides who provide home care for frail elders and younger people with disabilities receive a living wage and decent benefits?  If they do, how can families, who often are unable to afford care today, be expected to pay those higher wages and benefits?  Should the market be allowed to set these prices, or should government intervene through minimum wage and mandatory overtime laws? …. These questions have set off an enormous, but largely unnoticed, political firestorm.  In some states, they have pit states against the federal government, people receiving care against their aides, and large home care agencies against independent direct care workers.

In Ontario, exactly the same questions are being asked. This time last year, the then Ontario Liberal Health Minister Deb Matthews and Finance Minister Charles Sousa announced an election promise of an increase in the minimum wage for 34,000 publicly paid Personal Support Workers to $16.50 an hour by April 1, 2016, up 32 per cent from the current rate of $12.50.  Implementation of that promise hasn’t been easy.   According to the Canadian Union of PublicEmployees (CUPE), some home and community care agencies have chosen not to implement the wage increase or they exclude sick leave, vacation and training hours in the new hourly wages.  The sum total effect, says a CUPE spokesperson, is that most Ontario PSWs have yet to receive a wage increase.

The real lives of personal care workers are documented in a new film titled CARE, due for release later this year.   The trailer is riveting and I recommend watching it HERE for a clear picture of the human side of our crisis in home and community care.

The care workers depicted in the film are all women.  They are mothers and daughters who have left their own families behind in more impoverished countries in order to care for more affluent strangers in the United States. 

Many care workers in Canada, the UK, Australia and New Zealand match this description.  Eva Kittay drills down into the issues surrounding immigrant care workers and the role they play in a larger, profit driven dynamic.

The migration of care workers is caused both by a pull, the need for care workers, and a push, the need of these women to provide for their families.

Eva Feder Kittay‘From the Ethics of Care to Global Justice

The truth is that people need care and care workers must be able to earn a living wage. 

New LinkedIn Group
Canadian Caregivers United is a new group on LinkedIn.

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

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

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

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

    Names of the individual, and relatives, employers or household members of the individual
    Geographic identifiers of the individual, including subdivisions smaller than a state, street addresses, city, country and precinct
    Zip code at any level less than the initial three digits; except if the initial 3 digits cover a geographic area of 20,000 or less people, then zip code is considered an identifier
    All elements of dates, except year, or dates directly related to an individual including birth date, admission date, discharge date, date of death and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older
    Telephone numbers
    Fax numbers
    Electronic mail addresses
    Social security numbers
    Medical record numbers
    Health plan beneficiary numbers
    Account numbers
    Certificate/license numbers
    Vehicle identifiers and serial numbers, including license plate numbers
    Device identifiers and serial numbers
    Web Universal Resource Locators (URLs)
    Internet Protocol (IP) address numbers
    Biometric identifiers, including finger and voice prints
    Full-face photographic images and any comparable images
    Any other unique identifying number, characteristic, or code

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

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

Palliative Care for Caregivers | Get Palliative Care

Palliative Care for Caregivers | Get Palliative Care
Mayo Clinic

Top 10 Things Palliative Care Clinicians Wished Everyone Knew About Palliative Care

August, 2013   By Jacob J. Strand, MD, Mihir M. Kamdar, MD , Elise C. Carey, MD

 Today, family caregivers provide about 80 percent of elder care, delivering meals, taking loved ones to doctor’s visits and managing medications and family conflicts. This results in lost work hours or lost jobs, high stress and serious declines in physical and mental health. Palliative care is a solution.

Get Palliative Care

Get Palliative Care

What Is Palliative Care

Learn more about adult and pediatric palliative care, refer to the glossary and get answers to some frequently asked questions.
How to Get Palliative Care

Talk to your doctor, find a hospital and meet with your palliative care team. Just two simple steps to get palliative care.
Is Palliative Care Right for You

Take a quiz to determine if palliative care is right for you or a loved one.

Home Health Aide Certification and Certificate Programs

Home Health Aide Certification and Certificate Programs

 Each state has its own requirements for home health aide certification. Some states only require that the employing agency be certified, while others require home health aides to pass a certification exam following completion of an educational program. Besides a skills assessment examination, certification may also require a state administered criminal background check. Some states maintain a registry database of certified home health aides that can be accessed by the public


Home Health Aide Training Requirements in MA

Massachusetts does not require a State issued certification, nor is there a State exam required to be eligible to work as a Home Health Aide.  Instead the State recommends national certification through the National Association for Home Care and Hospice. The NAHC requires a 75 hour training course and a competency test before you are eligible to apply for their certification.

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

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

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

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

Stephanie Z's link list

Stephanie D Zeman MSN RN
This is an updated list of links about information care givers will need. Most helpful will be "Understanding the dementia experience" which will give you an idea of what your LO is going through; and "Communication skills" Which will help you to communicate in ways which will avoid or decrease her negative behaviors.

It is also important for you to use the 800 number at the National Alz. Assoc. if you run into problems we can't help with. The 24/7 Helpline is: 1.800.272.3900

Here are some very helpful links on dementia care:

Guide to diagnosing and treating dementia


Anosognosia explains why dementia patients are unaware that they are ill:


Understanding the dementia experience


Communication Skills:


Selecting a home health caregiver:


Elder abuse and neglect:


Bathing and Showering


Help with dental care (PDF fine from Aust. Alz. Ass.)


How to determine if your LO has pain. Use the Pain Scale:


Picking at skin/scabs


Sexual Consent Guidelines Weinberg Center and Hebrew Home


Finding a Memory Care Unit:

When you start to look at nursing homes or ALFs, begin with a call to your local AD chapter and get a list in your area.

You can also go to: Guide to retirement living

http://www.retirement-living.com/ where you will get free information on nursing homes in your area.

Then go to the government site called Nursing Home Compare and get the results of their last surveys so you can get some idea of the quality of their care.


Also, when you select some, Google them along with the word lawsuit to see if there are or were any significant problems that crop up.

Do select at least 3 to look at. DO NOT expect them to look like an ALF. The decor will be less attractive, but in a good nursing home with a dementia unit, the care will be much better.

Once you have picked one, you will want to visit at least 3 times. Once during meals to see what the residents are eating (see if you can eat there as well), once on the evening shift, and once during activities to see how many people attend or have other things of interest available to do.


Twenty Common Nursing Home Problems and How to Solve Them.


Urinary infections in people with dementia


Eating problems


Caregiver kitchen


Australian Site: Nutrition Matters – Finger Foods:


Hope this helps Stephanie Z

Caregiving Criticism and Unsolicited Advice From Family - AARP

AARP Home » Home & Family » Caregiving »How to Handle Criticis...
How to Handle Criticism While Caregiving
Well-meaning advisers try to help but some can cause hurt
by Barry J. Jacobs, PsyD., AARP, December 29, 2014

Take it from whence it comes

Caregivers would be well-advised (there's that word again) to not
just react to the message being given but to consider the background and
intentions of the messenger. Advisers often have a sincere desire to
help, because they truly are caring and invested. They just don't have
enough information and understanding to know how to actually be helpful.
They are also unaware that their good ideas may come across as
critical. If you express appreciation for their caring, they will
usually feel satisfied that they are making a difference and stop
pressing specific recommendations.

Some people, though, use pieces of advice as thinly veiled barbs. Out
of competitiveness or their own misery, they consciously or
unconsciously mean to take caregivers down a peg. They should be kept at
arm's length. It is seldom worth debating them or giving them the
satisfaction of having caused hurt.

 Caregiving Criticism and Unsolicited Advice From Family - AARP

staff scheduling and labor management

OnShift  provides staff scheduling and labor management software

They are focused entirely on the long-term care and senior living industry, software and services are built upon an in-depth understanding of how providers work day-in and day-out, and how industry regulations and issues affect their every move.

{ staff scheduling and labor management is of interest to the world of Caregiving}

Jan 26, 2015 Mark Woodka posted the following to their  Long Term Care & Senior Living Blog

For some strange reason we encourage ourselves to prognosticate about the future annually as one year recedes and another begins.  These projections might not always be correct, but I think they nicely balance out our attempts at New Year’s resolutions and give us something to aim for. (I hope this list goes more smoothly than those resolutions usually do…)

I’d like to outline my predictions for long-term care and senior living in 2015 – the big things that may change how you run your communities and provide care for your residents.  So without further ado, here we go:

    Affordable Care Act Penalties: The Employer Mandate began January 1 after two years of delays, and we must now be very, very cautious in managing our workforces to ensure we do not get penalized.  There was a bill proposed to exclude certain industries from having to participate due to large populations of lower-wage hourly workers and low margins.  Guess what?  One of the original intents of the ACA was to get these very workers healthcare benefits.   Therefore, this bill is a non-starter, and we will not see our industry excluded.   The Affordable Care Act will remain the law of the land until and unless we have a new party in the White House in 2016, so tracking employee hours will be key.
    More Doc Fix Activity: The game of kick-the-can that has been the Doc Fix for the past decade will continue.  However, in an effort to kick the can as far as possible, Adam Vinatieri will be the kicker, and he will kick it 21 months into the future.  This will nicely coincide with the new administration taking office in January of 2017.  (I don’t think Congress will want to deal with this again in 12 months.)  Ideally, our friends at AHCA will be able to focus the pay-fors to other segments or maybe even help them find a permanent solution if in fact there is an appetite for one.

- See more at: http://www.onshift.com/blog/5-game-changing-predictions-senior-care-2015#sthash.36ZATwXG.dpuf


You may want to Visit >>

Next Generation Educators blog

Dealing with a “Code Brown”

Dealing with a “Code Brown” | Scrubs – The Leading Lifestyle Nursing Magazine Featuring Inspirational and Informational Nursing Articles
by Ani Burr, RN • October 22, 2010
When you are doing your best to get your client cleaned up, there is still that smell issue that can get in the way of your ability to focus and get in and out of there quickly! While it’s not guaranteed, you can try these tricks to protector your olfactory senses:

Caregiving MetroWest a program of BayPath Elder Services, Inc

Caregiving MetroWest is a program of BayPath Elder Services, Inc. for MetroWest caregivers.
The site offers Information on all aspects of caregiving; "Caregiving is a complex and demanding undertaking. There are many elements involved in the caregiving role, and we’ve assembled some helpful information on a variety of areas of importance to caregivers.

BayPath Elder Services, Inc
BayPath Elder Services, Inc. administers programs offering  home care and related services enabling people to live independently and comfortably in their homes while promoting their well-being and dignity.
Many BayPath services are free, others are based on one's ability to pay, and some are offered on a fee-for-service basis.

 “This non-profitcorporation is organized to plan, develop and implement the coordination and delivery of services and supportive programs   for persons sixty years of age and over unless otherwise restricted by conditions of grants or contracts, in the City of Marlborough, and the townships of Ashland, Holliston, Hopkinton, Dover, Sherborn, Natick, Framingham, Wayland, Sudbury, Hudson, Northborough , Southboro ugh and Westboro ugh , Massachusetts. The corporation shall endeavor to assist older persons to obtain services including but not limited to information and referral, homemaker and chore assistance, housing services, health maintenance and rehabilitation, nutritional services, legal and advocacy assistance, transportation, emergency assistance, and whatever medical or supportive services may be needed to prolong the life and well - being of older persons in the community and to prevent premature institutionalization."

Talking with a person with Alzheimer's guidelines: five basic ones

Marie Marley is the award-winning author of Come Back Early Today: A Memoir of Love, Alzheimer's and Joy. Her website  contains a wealth of information for Alzheimer's caregivers.

When relating to a person with Alzheimer's there are many guidelines to follow. 

five basic ones:
1) Don't tell them they are wrong about something,
2) Don't argue with them,
3) Don't ask if they remember something,
4) Don't remind them that their spouse, parent or other loved one is dead 
5) Don't bring up topics that may upset them.

Marie Marley author of Come Back Early Today

Dementia and Cognitive Impairment Diagnosis and Treatment Guideline

Dementia and Cognitive Impairment Diagnosis and ...
Group Health Cooperative
Dementia and Cognitive Impairment Diagnosis and Treatment Guideline. 1 ..... Guidelines are systematically developed statements to assist patients and providers in .... new and challenging mental activities, such as a language or musical instrument. .... Many different tools are available for assessing cognitive function.
 About Group Health
Group Health Cooperative is a member-governed, nonprofit health care system that coordinates care and coverage. Founded in 1947 and based in Seattle, Wash., Group Health and its subsidiary health carriers, Group Health Options, Inc. and KPS Health Plans, serve more than 600,000 residents of Washington and North Idaho.

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

Chronic Care Management Services:
Here's the deal...  Physicians are starting to be incentivized (and penalized) for their performance with respect to their chronic patients, but there's a reimbursement associated with it. The reimbursement is for patients with two or more chronic conditions in a practice with a certified EMR (Electronic Medical Record) system.  The reimbursement has two levels. The first level, reimbursed at $42/month, requires a 20 minute check-in (e.g., on the phone) with the patient.  The second, reimbursed at almost $100, requires telehealth.

Home care agencies can put a program in place where your best aides are paid $10 for a 20 minute check-in call. If you charge $32 for this service (leaving a $10 margin for the referring practice) and allocate some of the revenue to your staff nurses and for software, you can provide a great service  and make a reasonable margin. Care Transitions Services: You can provide services to help transition patients from hospital to home.  Most hospitals are now being penalized for excessive readmissions   These hospitals can use your help and there are many benefits to your agency.  We have a new white paper  to teach you about the numerous benefits that your home care agency can achieve.
 At Ankota, we love providing home care software, telephony, care plans, scheduling, billing, payroll and all the other basics, but we really love that we can enable your agency to play a broader role in the future oh health care.  We can make a difference together.  Please download our newest free white paper "Why Care Transitions is the Next Big Thing for the Home Care Industry."
About Ankota Ankota provides software to improve the delivery of care outside the hospital, focusing on efficiency and care coordination.

Hiring Home Care Workers: Why Work through an Agency? By Rona S. Bartelstone,

Hiring Private Duty Home Care Workers: Why Work through an Agency

One of the greatest long-term needs of older adults and those with
chronic illnesses is for in-home, custodial care services. These
workers are often referred to as home health aides, certified nursing
assistants and custodial care workers. These in-home workers make it
possible for people with functional limitations to remain at home in a
comfortable, familiar environment. Home health aides (as we will refer
to this class of workers) provide a wide range of assistance with
activities of daily living (ADLs), such as bathing, dressing, grooming,
assisting with ambulation or transferring, toileting, feeding and
providing medication reminders. In addition, home health aides help
with what professionals call, instrumental activities of daily living
(IADLs), such as shopping, meal preparation, making medical
appointments, transportation, laundry and companionship.

While it is true that most people would prefer to remain in their
own homes, there are circumstances in which care in a residential or
nursing facility is more appropriate and more cost-effective. For
example, the individual who needs round the clock care because of
treatments or behavioral issues will find a nursing facility or
residential setting likely to be more affordable.

The biggest proportion of people who utilize home health aide services are those
who need several hours per day of assistance, as opposed to those who need full-time care.

Due to the cost and the increasing shortage of home health
aides, many families seeking to hire in-home staff turn to private
individuals rather than working through an agency. While at first
glance this seems reasonable, it can also cause numerous problems and create unexpected liabilities for the family, who becomes the employer.

Great Big List of Caregiver Blogs | Caregiver's Corner July 14, 2010

Great Big List of Caregiver Blogs    

One of the best ways for a caregiver to find answers, reassurance,
and understanding is to connect with other caregivers. To help with
that, here is a list of blogs run by caregivers. If you know of any
blogs that should be added to this list, let us know!

Top 10 Codes You Aren’t Meant To Know - Listverse

Top 10 Codes You Aren’t Meant To Know - Listverse
Stores, hospitals, entertainment venues, and other places where the public are together in large numbers, use secret codes to pass information between store employees. These are meant to be a secret as they don’t want to alarm the non-staff members or alert someone (like a thief) to the fact that they have been noticed. Many stores have their own codes – for example WalMart, but there are a number that are nearly universal in application. This is a list of ten secret codes that may prove useful to you in future, or at least dispel any curiosity you may have if you hear them.

Strategies to Protect Your Money from Medicaid - AgingCare.com

AgingCare.com is not simply a website, but a community of caregivers facing the challenge of caring for an elderly loved one.
They provide a comfortable meeting place for the free exchange of ideas with knowledgeable professionals, responsive experts, and people just like you. They provide an excellent knowledge network, use it.

The following is extracted from AgingCare.com
Too few older adults know and understand their rights and options regarding health care, particularly long-term care, which, to quote the New York Court of Appeals, is "ruinously expensive."

A Caregiver Agreement is an excellent strategy in many cases where extra services are needed or desired that would not be covered by Medicaid, and are outside the scope of what a nursing facility or home care attendants would provide.

The caregiver can be a son, a daughter or other family member, a friend, a geriatric care manager or a home care agency. The services can be paid for in advance, and the payment will then reduce countable resources, helping the person in need of care gain Medicaid eligibility. A family member can render these services, providing income for that person (who may have given up a job or taken time off from work), and reducing conflict with other family members who are unable or unwilling to help out.

If the caregiver is to be paid in advance, the keys to creating an agreement that will be accepted by Medicaid are:

    The contract must specifically define the services provided and hours to be worked by the caregiver.
    The lump sum payment must be calculated using a reasonable life expectancy and legitimate market rates for the services.
    A daily log of actual services rendered and hours worked must be maintained, along with written invoices.
    Upon the death of the patient, any unearned amounts must be paid to Medicaid, up to the amount that Medicaid paid on behalf of the patient.

Spousal Transfers and Spousal Refusal

An important feature of the Medicaid laws is that transfers between spouses are permitted, are not subject to the "look back," and thus do not result in any penalty. In the case of a married couple, one of the basic strategies is to transfer any assets that are in the name of the spouse who needs care to the name of the well spouse (also called the "community spouse" where the spouse who needs care is in a nursing home).

New York and some other states permit something called "spousal refusal." In these scenarios, the well (or community) spouse will refuse to provide support for the spouse who needs care.As a result, the spouse who needs care will be immediately eligible for Medicaid, and will receive services.

Once Medicaid provides services, it has the right to seek contribution from the well spouse. In some cases, however, Medicaid does not pursue its rights, and in other cases it is willing to settle at a discount. At a minimum, the well spouse will receive a significant benefit because any reimbursement to Medicaid will be at Medicaid's discounted rates, rather than at the private pay rates that the providers would have charged.

Unfortunately, the majority of states are "spousal share" states that do not permit spousal refusal. In these states, the resources of both spouses are counted towards the Medicaid eligibility amount, and the above strategy is therefore ineffective.

Elder Law attorneys are able to work within the Medicaid laws to produce favorable outcomes for their clients. Bear in mind that every case has its unique facts, and these strategies might or might not be the top five for you, given your circumstances. In any case, it's hardly ever too late to develop an effective strategy to obtain benefits, and protect at least some of your assets or income at the same time.

David Cutner is a former family caregiver and co-founder of Lamson & Cutner, a boutique elder law firm in Manhattan, known for its successful strategic planning and insights into the issues of today's elder law maze.

{End of Quoting}

I have no connection with  David Cutner the following contact information is my thanks to him.

Lamson & Cutner, P.C.
9 East 40th Street
New York, New York 10016
Contact Information:
Phone: (888) 618-3701

Fax: (212) 486-1600 Web Site: www.elder-law-lawyer.com
    BLOG The Best Elder Law Blog

800AgeInfo - Information on Programs - Caregiver Support Page

800AgeInfo - Information on Programs - Caregiver Support Page

Caregiver Support

(caring for an individual)

The Massachusetts Family Caregiver Support Program (MFCSP) is
administered through a partnership with local Area Agencies on Aging
(AAAs) and Aging Service Access Points (ASAPs). MFCSP provides family
caregivers guidance, support, and attention that often is unavailable or
overlooked.  Caregivers receive individual attention to:

  • discuss their caregiving situation
  • increase knowledge of and access to resources
  • make informed decisions and solve problems related to their caregiver role
  • increase their own personal well-being including reduced stress

Family caregivers are individuals who:

  • Care for a spouse, parent, other relative or friend who is age 60 or older, or who has Alzheimer’s disease.
  • Are grandparents age 55 or older who are caring for grandchildren who are 18 years of age or younger, or who are disabled.
  • Are over the age of 55 and caring for a disabled individual who is not their child.
Caring for a loved one can be overwhelming and at times stressful,
even isolating; yet it can be meaningful and rewarding as well.  It is
critical that caregivers are aware of available services. Through the
MFCSP compassionate and knowledgeable professionals work directly with
caregivers offering a range of services that may include:

  • One-on-one Counseling
  • Family Meeting
  • In-home Assessment
  • In-home Services
  • Respite (a break for caregivers)
  • Nutrition Services
  • Transportation Services
  • Caregiver Training
  • Support Groups
  • Supplemental Services (such as assistive devices, emergency response system)
  • Financial Counseling
  • Legal Referral

Comfort Care DNR protocol

When a patient is in a non-hospital setting, Emergency Medical Technicians (EMTs) are required to provide emergency medical care and to transport patients to appropriate health care facilities. Emergency Medical Services (EMS) personnel are required by law to provide treatment to the fullest extent possible, subject to their level of training.
Comfort Care DNR Order Verification Protocol (Comfort and Care DNR)
  1. The Comfort Care DNR is designed to allow EMTs and first responders to honor a DNR order in an out-of-hospital setting.
  2. Before 1999, when Massachusetts implemented its Comfort Care DNR protocol, there was no mechanism to enable EMT’s and other first responders to recognize DNR orders in a non-hospital setting. So EMT personnel were always obligated to perform full resuscitation measures when they encountered a patient unable to convey directions regarding medical treatment.
  3. The Comfort Care DNR protocol provides for a statewide, uniform DNR verification protocol.
  4. The purpose of the Comfort Care DNR is to: (a) provide a verification of DNR orders to enable EMTs and first responders to honor DNR orders, (b) clarify the role and responsibilities of EMTs and first responders at the scene and/or during transport of patients who have a valid current DNR order, (c) avoid resuscitation of patients who have a current and valid DNR, (d) provide for palliative/comfort care measures for patients with a current Comfort Care DNR order verification form.
  5. Comfort Care DNR order verification forms must be completed and signed by the patient’s physician, authorized Physician’s Assistant or Nurse Practitioner.
  6. The patient must post the Comfort Care DNR where any EMT or first responder can easily find it. (Usually the patient’s refrigerator, or taped to the patients bedroom door. The Department of Public Health stopped issuing Comfort Care DNR bracelets in 2007, but the Department’s approved form contains bracelet inserts that can be used in generic wrist bracelets.
  7. The Comfort Care DNR Order Verification form can be accessed by anyone, in downloadable format from the Massachusetts Department of Public Health/Office of Emergency Medical Services website, at: http://www.mass.gov/eohhs/gov/departments/dph/programs/hcq/oems/comfort-care/public-health-oems-comfort-care-verification.html. But the form must be fully completed and signed by the attending physician, authorized nurse practitioner or authorized physician assistant as proscribed by the regulations.

Comfort Care Order (CCO-DNR) program Plus MOLST

EMS Comfort Care Order Do Not Resuscitate Program | doh

Comfort Care - Do Not Resuscitate
Emergency Medical Services (EMS) Comfort Care Order-Do Not Resuscitate
(CCO-DNR) program allows patients diagnosed with a specific medical or
terminal condition to express their wishes regarding end of life
resuscitation in the pre or post-hospital setting.

The program requires that a patient’s attending physician certify and sign a Comfort Care Order
(CCO) that states the patient (adult or child) has a specific medical
or terminal condition. The patient, or his or her authorized decision
maker or surrogate, must also consent and sign the CCO (verbal orders
are not valid). The physician then places a Comfort Care bracelet on the

Resources | Novant Health | Choices and Champions

Resources | Novant Health | Choices and Champions
Novant Health is a integrated system of physician practices, hospitals, outpatient centers, and more – each element committed to delivering a remarkable healthcare experience for you and your family. Code Comfort is for patients with a DNR order who desire comfort measures. Use of the order set will promote comfort for patients at risk for symptom crisis nearing end of life. Code Comfort Order Set Code Comfort Policy (draft)

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

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

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

As is true for CPR efforts, we know teamwork matters to relieve the
suffering of dying patients. Code Comfort protocols include an
algorithm-driven method for assessing and addressing symptoms such as
pain, agitation and dyspnea. For example, a patient suffering from
severe, acute dyspnea would be given morphine and increased oxygen, her
head would be elevated, a fan might be used to provide a comforting
breeze, and she’d receive other measures to reduce anxiety. Importantly,
Code Comfort ensures that no patient or family suffers alone. Nurses
are present during the code, actively treating the patient’s symptoms
and calling in other team members as needed, all of which provides
essential emotional support and reassurance

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

In the hospital? Are you a hospital inpatient or outpatient?

In the hospital? Are you a hospital inpatient or outpatient?     May 21, 2014 by Wendy Shane
May 21, 2014 by
May 21, 2014 by
 Why does this matter to patients?
When hospital patients are classified as outpatients on Observation Status, they may be charged for services that Medicare would have paid if they were properly admitted as inpatients (for example, medications, so you may want to bring medications with you). Most significantly, patients will not be able to obtain any Medicare coverage if they need nursing home care after their hospital stay. Medicare only covers nursing home care for patients who have a minimum 3-day inpatient hospital stay. Observation Status doesn’t count towards the 3-day stay.

Why does this matter to patients?

When hospital patients are classified as outpatients on Observation
Status, they may be charged for services that Medicare would have paid
if they were properly admitted as inpatients (for example, medications,
so you may want to bring medications with you). Most significantly,
patients will not be able to obtain any Medicare coverage if they need
nursing home care after their hospital stay. Medicare only covers
nursing home care for patients who have a minimum 3-day inpatient
hospital stay. Observation Status doesn’t count towards the 3-day stay.

- See more at: http://lcdne.com/aging/are-you-a-hospital-inpatient-or-outpatient#sthash.pcIuTJej.dpuf

Why does this matter to patients?

When hospital patients are classified as outpatients on Observation
Status, they may be charged for services that Medicare would have paid
if they were properly admitted as inpatients (for example, medications,
so you may want to bring medications with you). Most significantly,
patients will not be able to obtain any Medicare coverage if they need
nursing home care after their hospital stay. Medicare only covers
nursing home care for patients who have a minimum 3-day inpatient
hospital stay. Observation Status doesn’t count towards the 3-day stay.

- See more at: http://lcdne.com/aging/are-you-a-hospital-inpatient-or-outpatient#sthash.pcIuTJej.dpuf

Why does this matter to patients?

When hospital patients are classified as outpatients on Observation
Status, they may be charged for services that Medicare would have paid
if they were properly admitted as inpatients (for example, medications,
so you may want to bring medications with you). Most significantly,
patients will not be able to obtain any Medicare coverage if they need
nursing home care after their hospital stay. Medicare only covers
nursing home care for patients who have a minimum 3-day inpatient
hospital stay. Observation Status doesn’t count towards the 3-day stay.

- See more at: http://lcdne.com/aging/are-you-a-hospital-inpatient-or-outpatient#sthash.pcIuTJej.dpuf

Why does this matter to patients?

When hospital patients are classified as outpatients on Observation
Status, they may be charged for services that Medicare would have paid
if they were properly admitted as inpatients (for example, medications,
so you may want to bring medications with you). Most significantly,
patients will not be able to obtain any Medicare coverage if they need
nursing home care after their hospital stay. Medicare only covers
nursing home care for patients who have a minimum 3-day inpatient
hospital stay. Observation Status doesn’t count towards the 3-day stay.

- See more at: http://lcdne.com/aging/are-you-a-hospital-inpatient-or-outpatient#sthash.pcIuTJej.dpuf

Why are caregiver spouses so relectant to hire help? | LinkedIn

Brett Frankenberg Brett Frankenberg 2nd Founder at The Institute for Quality in Senior
Living, Greater San Diego Area participated in  an interesting discussion on
Home Care and Healthcare Advocacy  concerning "Why are caregiver spouses so
reluctant to hire help?

" I am paraphrasing from his discussion:”

One cannot stress enough the need for caregiver education. The problem
is many family members think they learn by watching caregivers in the

Brett: Have you ever worked an overnight shift in a hospital with a
Senior who has dementia?

Brett If you have, I doubt you would assert that observing highly
trained professionals who care for patients in the hospital would
suffice as sufficient training.

Brett has managed home health and clinically based staff for years and
the amount of times needed to train caregivers on the most simple
activities - transfers, bathing, safety risks -blood glucose testing,
sliding scale insulin, specific diet instructions  such as chopped or
puree and you get an overwhelmed caregiver pretty darn quickly.

Brett believes the biggest mistake is assuming that a caregiver is
absorbing the necessary information simply by observing the clinical
activities that take place when the patient is an inpatient. Further,
we have no idea what the baseline of the caregiver is most of the

Brett: Do they have some aspect of dementia themselves to the point
they can't learn?

Do they have physical limitations that would prevent them from
performing all the activities that daily caregiving demands?


Exploring the Potential of Digital Technology to link AHPs and People in Remote, Rural Hubs

Let's Talk about Dementia | Never in the history of mankind did not talking about something scary make it disappear.

Living it Up Creatively

Exploring the Potential of Digital Technology to link AHPs and People in Remote, Rural Hubs


Since June 2014, a group made up of people living with disabilities
and health problems, carers and Allied Health Professionals (AHP’s) have
been actively learning about the benefits of digital inclusion. In
August, we established a steering group to drive forward a Living it Up Creatively
digital project that links Helmsdale, a remote rural community in East
Sutherland, to New Craigs, the main Mental Health Hospital supporting
the Highlands from Inverness.

How will we use digital technology to connect professionals and people in the future?

For further information contact Sarah Muir (AHP Lead NHS Highlands) at sarah.muir2@nhs.net or Ann Pascoe (Dementia Friendly Communities, East Sutherland) on ann@dementia-friendly.com .

And follow us on twitter: @sarahahpmh and @a_carers_voice.

Addressing Unmet Palliative and Geriatric Needs of Zombies | GeriPal - Geriatrics and Palliative Care Blog

Addressing Unmet Palliative and Geriatric Needs of Zombies | GeriPal - Geriatrics and Palliative Care Blog
{Q{ Considerable evidence indicates that zombies do not receive optimal palliative or geriatric care.

Advance Care Planning 
The subject of advance care planning pertains to end-of-life decisions, which may seem unimportant for zombies as they are past the end of life. However, understanding the values and preferences of zombies around “dead-decisions” is just as important as asking the living about end-of-life decisions. Given the high rates of traumatic injuries, having stated values of what is most important to zombies in their deaths, what brings them enjoyment while being dead, and what are the biggest worries and concerns would appear to be just as important to the undead as to the living.

by: Eric Widera (@ewidera)  {EQ}

Quality of U.S. hospices varies, patients left in dark - The Washington Post

Quality of U.S. hospices varies, patients left in dark - The Washington Post

{Q}A boom in the industry allows patients to choose from an array of
hospice outfits, some of them excellent. More than a thousand new
hospices have opened in the United States in the past decade. But the
absence of public information about their quality, a void that is
unusual even within the health-care industry, leaves consumers at a loss
to distinguish the good from the bad.

Though the federal government publishes consumer data about the quality of other
health-care companies, including hospitals, nursing homes and home
health agencies, it provides no such information about hospices.

 The reasons that some hospices stint on care may be at least partly
financial. Medicare, the chief source of industry revenue, pays hospice
companies per day of care — about $155 for a “routine” day — regardless
of how much care is actually provided. That means that the less a
hospice spends on nursing and other services, the more it can profit.

 http://www.washingtonpost.com/wp-srv/special/business/hospice-quality  This database shows, among other things, whether the hospice has provided more intense levels of care for patients suffering a crisis; how much it spends on nursing visits per patient; and whether it has won approval from one of three outside accrediting agencies, the Joint Commission, the Accreditation Commission for Health Care and Community Health Accreditation Program, or CHAP

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

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

{Q}First, the basic needs of elderly or ill people must be addressed before they or their family members can think about more abstract or long-term issues.
Second, it is very difficult to obtain information about meeting these basic needs, especially when it comes to finding the right products or supplies. The policies and practices of third-party payers - whether private insurance, Medicare or Medicaid - are often confusing and inconsistent. 

Nevertheless, with a little persistence and some basic information, you can become a more  knowledgeable and satisfied consumer. The reward will be an improved  quality of life for both the elderly person and the caregiver. {EQ}

Read the article from end to end.Good information for caregivers, seniors, and families.

Questions to Ask About Durable Medical Equipment and Medical Supplies - AgingCare.com

Questions to Ask About Durable Medical Equipment and Medical Supplies - AgingCare.com

 An article full of very helpful advice and information. A long article and you need to read from end to end to get full benefit

Questions to Ask About Medical Equipment and Supplies

Sample for disucssion:

  • Are the senior's needs and comfort periodically assessed?
  • Handling a dispute with the insurer or vendor:
  • Has the caregiver made frequent and careful inquiries?
  • Has all communication (in person, phone, mail, email) been well documented?
  • If the insurer disputes the need for particular equipment or
    supplies or rejects a claim for a more costly but medically justified
    item, will an appeal be necessary?
  • Does the caregiver know how to file an appeal? 

Developed by, and made available with the permission of John J.
Connolly, Ed.D., President and CEO of Castle Connolly Medical Ltd.,
America's "trusted" source for information on top doctors and quality



6 Questions To Ask Before Hiring An In-Home Caregiver

 What is the cost, and how will the bills be paid? “Be certain to understand the whole payment package,” McVicker advises. For example, does the agency tack on extra charges for billing, taxes and worker’s compensation or include them in a single fee for services? Some agencies will send you a bill that includes the hourly rate for services plus additional itemized charges for taxes and administrative costs. Other agencies will simply charge you an hourly amount that encompasses all costs.

Code of Federal Regulations Resident rights (§483.10) Admission, transfer, and discharge rights (§483.12) Resident behavior and facility practices (§483.13) Quality of life (§483.15) Quality of care (§483.25)

Quoted from:http://tinyurl.com/pmmrher December 14, 2013 Long Term Care Facilities: Are You Being Treated Right? By CzepigaDalyPope LLC

The Code of Federal Regulations (herein either “the Code” or “CFR”) is a codification of rules published in the Federal Register by the departments and agencies of the Federal Government. Title 42 of the Code, Part 483, addresses public health requirements for long term care facilities.

Part 483 specifically addresses, among many other issues, the following:

Resident rights (§483.10) Admission, transfer, and discharge rights (§483.12) Resident behavior and facility practices (§483.13) Quality of life (§483.15) Quality of care (§483.25)

Most of the fundamental questions you have will be addressed, at least in part, in the sections cited above. Section 483.10, as one example, addresses resident rights and specifically provides for what a facility must do regarding issues that range from providing, for inspection, a resident with his or her medical records within twenty four hours of request, to prominently displaying information about how to apply for and use Medicare and Medicaid benefits.

Section 483.12, as one other example, lists the six permissible reasons to discharge a resident from a long term care facility. It is important to note, there are no other reasons for discharge beyond these six, any other purported reason for discharge that is not listed in §483.12 (a)(2) is a violation of Federal law.

6 Reasons for Discharge

The transfer or discharge is necessary for the resident’s welfare and the resident’s needs cannot be met in the facility
the transfer or discharge is appropriate because the resident’s health has improved sufficiently so the resident no longer needs the services provided by the facility
The safety of individuals in the facility is endangered
The health of individuals in the facility would otherwise be endangered
The resident has failed, after reasonable and appropriate notice, to pay for (or to have paid under Medicare or Medicaid) a stay at the facility.
The facility ceases to operate

For those who live in long term care facilities, it is your home and you are entitled to certain rights within it. For those of you who visit a loved one in a long term care facility, if you begin to question whether your loved one is being treated appropriately, simply go online, type into Google “42 CFR 483,” and start getting your questions answered.

A trial attorney who handles these types of matters, can give you lots of help,
you would be surprised how effective Federal law is when properly cited during discussions with facility administrators and staff.

Posted in: Elder Law and Nursing Home Litigation

Create A Better Day Café Marlborough , MA USA

Create A Better Day Café Are you caring for someone with Alzheimer’s or other dementia? Create

A Better Day Café encourages socialization with other caregivers and loved ones where you can just be yourself. This is a wonderful opportunity to get out with your loved one and have an enjoyable afternoon.

It’s a time to step out of the daily routine, leave the disease at the door, and enjoy a positive experience in a supportive environment. The afternoon will consist of conversation, music, arts, games, refreshments, and most importantly, laughter.

There is no cost.

It is open to anyone at any stage of the disease process accompanied by friends, family, and loved ones. The café is held the 4th Sunday of each month Please attend our next Café on Sunday, October 26th 1:00pm to 3:00pm at Pleasantries Adult Day and Consulting Services 195 Reservoir Street, Marlborough

Please contact Tammy for more information at 508-481-0809 Due to the possibility of cancellation please call prior to attending and listen to voice message

Hospice and Nursing Homes Blog: Death Rattle, Families, Signs of Dying (Research, ...

Hospice and Nursing Homes Blog: Death Rattle, Families, Signs of Dying (Research, ...:

{quote}A crackling, gurgling sound emanating from a dying person’s throat can distress onlookers who have not been prepared for this  occurre...

  Caregivers and loved ones should be educated regarding the death rattle experience and reassured about the unlikelihood of patients’ pain.

Supporting this need for more education is additional death rattle family research focused on bereaved family members who had witnessed the anxiety of watching a death rattle experience. This study involved 663 questionnaire surveys conducted in 95 palliative care units, Among family members who participated, 46% of respondents had witnessed the death rattle. Of these participants, 66% reported high distress levels, and 53% perceived a strong need for improved death rattle care.

This research concluded that family distress could be reduced by having medical staff lessen patients' symptoms with comprehensive and supportive care strategies. These strategies would include decreasing secretions and uncomfortable smells along with alleviating torment of family members through education.

{end quote}

Some Basic basics for caregivers | Compiled from aggregated information on the Net

Learning about and accepting Confabulating and Confabulations is
essential and not easy to accept.

In psychology, confabulation (verb: confabulate) is a memory
disturbance, defined as the production of fabricated, distorted or
misinterpreted memories about oneself or the world, without the
conscious intention to deceive.

Key factors in confabulations are there is no intent to deceive,
second the person being unaware that the information is blatantly
false. Confabulating is distinct from lying because there is no intent
to deceive, and the person being unaware that the information is
blatantly false. Carers challenge: is what they say true?
Confabulations become a far greater concern in the later stages,
because confabulations are much more likely to be acted upon.

It is difficult for everyone to accept a mind is damaged by
Alzheimer's Disease. Not only is memory damaged their ability to
process thoughts and conversations is impaired.

Confabulations are a major annoyance and can be dangerous- when we take everything in a discussion at face value. Confabulating is very frequently observed in people with Alzheimer's.

We all Confabulate when we make..verbal statements and/or actions that
inaccurately describe history, background and present situations
unintentionally. We must be aware of information that is blatantly
false yet are coherent, internally consistent, and appear relatively

Understand the similarities between confabulation and delusions; e.g.,
both involve the production of unintentional false statements, both
are resistant to contradictory evidence.

Recognize Sunrise Syndrome delusions that are frequently observed in
Alzheimer's patients include beliefs about theft, the patient's house
not being his home, a spouse, is an impostor, belief an intruder is in
the house,abandonment, spousal infidelity, and paranoia.

It seems that Alzheimer's world is fraught with confabulation speak.
The general public doesn't understand Alzheimer's they certainly need
to be educated regarding Confabulation.

{Quoting http://tinyurl.com/qfutbn4 Nature Reviews Neuroscience }

"Most patients with spontaneous confabulation eventually stop

"Confabulators may occasionally act upon their confabulation."
("Occasionally"? Later-stage Alzheimer's patients persistently and
repeatedly act upon the belief their childhood memories are relevant
to their present circumstances.)

"Confabulations are usually limited in time; they relate to the recent
past, the present, and the future."

{End Quoting http://tinyurl.com/qfutbn4 Nature Reviews Neuroscience }

An aide/caregiver must understand the individual has Alzheimer's
Disease, be aware of the danger, and treat the person with patience.
Also, Confabulation is common. Conversing with someone who has
Alzheimer's is often like talking with your cat.

Acknowledge, respond, be affectionate, develop boundless patience.
Forget about rational responses. Show respect, your therapeutic
fictional responses are allowed. ~{quoting}DLMifm}

To cope with spontaneous confabulation, and ease the confusion,
frustration, and fear for the loved one, use resources such as:

By far, the most serious danger posed by Alzheimer's disease is when
the individual may decide they want to go for a walk, go searching for
"home," or maybe just walk outside to get the paper. In a restaurant
they may go to a rest-room. When they turn around, the place they
expect to see is gone. Their assurance they are Ok and can go on their
own ?. may be a example of confabulation.


Alzheimer Society of Canada, http://tinyurl.com/oujghvy Toronto,
Ontario, M4R 1K8

Hallucinations and delusions are symptoms of Alzheimer's disease and
other dementias. With hallucinations or delusions, people do not
experience things as they really are.

Delusions are false beliefs. Even if you give evidence about something
to the person with dementia, she will not change her belief. For
example, a person with dementia may have a delusion in which she
believes someone else is living in her house when she actually lives
alone. Delusions can also be experienced in the form of paranoid
beliefs, or accusing others for things that have not happened. For
example, the person with dementia may misplace an item and blame
others for stealing it. Some people with dementia may have the
delusion that others are "out to get them." For example, he
may believe that his food is being poisoned.

Hallucinations are incorrect perceptions of objects or events
involving the senses. They seem real to the person experiencing them
but cannot be verified by anyone else. Hallucinations are a false
perception that can result in either positive or negative experiences.
Hallucinations experienced by people with dementia can involve any of
the senses, but are most often either visual (seeing something that
isn't really there) or auditory (hearing noises or voices that do not
actually exist). For example, a visual hallucination could be seeing
bugs crawling over the bed that aren't actually there. Of course,
people also make “visual mistakes,� mistaking a housecoat hanging
up for a person, for example, because they can’t see the object
clearly. This can happen to anyone, and is not considered a


Definition of Alzheimer's Sunrise Syndrome

Internet description: cognitive instability on arising from sleep.

Sunrise Syndrome,(sun?riz) a condition in which a person with
Alzheimer's wakes up rising in the morning and their mind is filled
with delusions which include include beliefs about theft, the
patient's house not being their home, a spouse is an impostor, belief
an intruder is in the house, abandonment, spousal and paranoia, people
eavesdropping. Sometimes the person may carry over content of a dream.

One observation is that Sunrise Syndrome is different from Sundowning
because the person may wake up in a confabulation mind set. During a
Sunrise Syndrome conversation with the content may filled with
confabulations; verbal statements and/or actions that inaccurately
describe history, background and present situations.

Sundowning in contrast displays as confusion, disorientation,
wandering, searching, escape behaviors, tapping or banging,
vocalization, combativeness; the demons of anxiety, anger, fear,
hallucinations and paranoia come out.

When I became a caregiver for my wife with Alzheimer's I had no
clue to the tasks ahead. I started to read and search the Internet for

Now retired I enjoy blogging and networking. I am an Aggregator to
Ishmael's Knowledge Network, I frequently collect content from various
Internet sources and consolidate it on Ish's Knowledge Network
Knowledge networking is a pastime / hobby. BTW I have no
commercial ties to the linked information.

Suggested reading Jennifer Ghent-Fuller's article,
"Understanding the Dementia Experience"

I really need to say this: The blog is for informational purposes only. I assume no responsibility for its accuracy. The information is subject to change without notice. Any actions you take based on information from the podcast or from this website are entirely at your own risk. Products and services are mentioned for informational purposes only and their various trademarks and service marks are the property of their respective owners. Fair Use:  is not an infringement of copyright