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About 'ari force'|...yang sememangnyer dah terlalu lama xupdate. Lagi lah ari nie ha dok dengar lagu 'BECAUSE OF YOU' nie berulang2...know that's weakness in your eyes I'm forced to fake A smile, laugh everyday of my life My...







About 'ari force'|...yang sememangnyer dah terlalu lama xupdate. Lagi lah ari nie ha dok dengar lagu 'BECAUSE OF YOU' nie berulang2...know that's weakness in your eyes I'm forced to fake A smile, laugh everyday of my life My...








Even               though               the               state               and               federal               governments               have               regulations               that               facilities               must               follow,               they               do               not               always               keep               a               close               watch.

A               great               number               of               nursing               homes               do               not               follow               many               of               these               policies,               though               it               seems               so,               on               paper.

Residents               suffer               from               abuse               in               many               nursing               facilities,               even               under               the               watchful               eye               of               the               government.

Most               forms               of               this               abuse               falls               under               the               category               of               neglect.

Federal               regulations               state               each               skilled               nursing               facility               should               have,               on               day-shift               one               aide               for               every               five               residents,               one               licensed               nurse               for               every               15               residents,               and               one               registered               nurse               for               every               25               residents.

A               Director               of               Nurses               should               also               be               on               duty               for               at               least               eight               hours.

On               the               evening               shift,               there               should               be               one               aide               for               every               ten               residents,               one               licensed               nurse               for               every               25               residents,               and               one               registered               nurse               for               every               35               residents.

Night               shift               should               have               one               aide               for               every               15               residents,               one               licensed               nurse               for               every               35               residents,               and               one               registered               nurse               for               every               50               residents.

The               registered               nurses               are               the               charge               nurses.

In               a               facility               with               59               or               less               residents,               one               registered               nurse               is               allowed.

(Report               to               Congress,               July               2000)
               Aides               should               have               at               least               120               hours               of               training,               should               be               certified               and               be               listed               in               the               state's               registry.

The               facility               should               conduct               a               thorough               background               check               on               applicants,               conduct               random               testing               for               drugs,               and               have               regular               orientation.

The               aide               must               be               motivated               to               do               this               kind               of               work.

They               should,               ideally,               be               kind               and               considerate,               have               a               love               of               the               elderly,               and               be               very               patient               people.

Unfortunately,               these               things               do               not               always               happen.

(Consensus               Statement               on               the               Staffing               Crisis               in               Nursing               Homes)
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               In               an               article               on               NewsRX.com,               Dr.

Charlene               Harrington,               PhD,               states:               "Low               staffing               and               high               turnover               rates               contribute               to               poor               quality               care.

Low               staffing               led               to               78%               of               nursing               homes               not               complying               with               federal               care               and               safety               regulations               during               mandatory               inspection."               Pay               is               less               in               nursing               homes               than               in               hospitals,               there               are               no               retirement               benefits,               and               the               insurance               is               unaffordable.

This               means               aides               are               assigned               too               many               residents,               because               the               facility               is               understaffed.

(Consensus               Statement               on               the               Staffing               Crisis               in               Nursing               Homes)
               Healthcare               administrators               tend               to               work               their               facilities               at               state               minimum,               which               is               often               not               nearly               enough,               and               cannot               afford               to               pay               their               aides               well,               because               the               budgets               are               too               low.

They               claim               Medicaid/Medicare               reimbursements               are               too               low               and               complain               about               the               recent               reductions               in               funding.

However,               in               a               Report               to               Congress,               in               December               2002,               the               United               States               General               Accounting               Office               states,               "Medicaid's               spending               for               skilled               nursing               facility               care               rose               at               an               average               annual               rate               of               30               %".
               Some               administrators               are               so               afraid               of               losing               money;               they               listen               to               what               the               family               wants,               over               the               needs               of               the               resident.

This               is               often               not               in               the               resident's               best               interests.

Many               families               tend               to               put               extra               pressure               on               aides,               to               take               better               care               of               certain               residents,               which,               in               turn,               puts               pressure               on               the               administrator               to               push               nurses               and               aides               harder.

(Administrative               Ethics,               Dec.

31,               1998)
               Sometimes               staff               does               not               do               in-service               training               properly,               because               the               facility               is               so               short-staffed.

Aides               and               nurses               do               not               learn               enough.

The               presentations               are               rushed               or               simply               overlooked.

There               just               would               not               be               enough               people               on               the               floor               to               conduct               a               proper               training               session.
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               The               state               inspectors               do               not               see               these               things.

It               is               all               on               paper               that               these               things               are               done,               when,               in               fact,               the               documents               have               been               "doctored".

Staffing               requirements               are               often               overlooked,               if               things               appear               to               be               running               smoothly,               in               a               facility.
               Federal               regulations               require               state               inspectors               to               do               a               standard               survey               at               least               every               nine               months,               and               not               longer               than               15               months.

This               is               the               simple               survey               to               see               if               residents               are               comfortable,               happy,               and               well               cared               for.

This               standard               survey               is               completed,               within               four               days.

Because               these               inspections               are               so               regular,               most               facilities               know               approximately               when               they               will               be               there               and               can               prepare               for               them.

(Nursing               Homes:               Overview               of               State               Regulations)               They               will               hire               extra               workers               for               a               temporary               staff,               to               make               it               appear               they               are               working               at               full               staff               requirements.

This               is               when               these               facilities               put               out               the               "good"               sheets,               and               ensure               the               linen               closets               are               fully               stocked.

The               bedpans               and               bath               pans               are               thrown               out,               and               replaced               with               new               ones.

Aides               and               other               workers               are               encouraged               to               avoid               inspectors.

Usually,               they               are               told               what               to               say,               if               approached.
               Federal               Nursing               Staff               Requirements               states:
               "Surveyors               do               not               collect               any               information               on               nursing               staff               levels               as               part               of               off-site               preparation               for               the               survey.

More               detailed               review               of               nursing               staff               sufficiency               does               not               occur               under               the               federal               protocol               unless               serious               quality-of               care               problems               are               identified               prior               to               or               during               the               annual               survey               process,               of               it               a               complaint               about               inadequate               nursing               staff               is               received."
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               If,               by               chance,               the               inspectors               find               that               the               quality               of               care               is               below               standard,               they               fine               the               facility.

The               inspectors               send               a               report               on               the               problems               found,               and               give               the               facility               a               chance               to               correct               the               deficiencies.

The               facility               is               watched               more               closely,               at               this               point,               and               then               the               inspectors               do               an               extended               survey.

This               is               a               more               detailed               inspection.

All               records               are               thoroughly               reviewed,               and               families,               as               well               as               the               residents               are               interviewed.

(Nursing               Homes:               Overview               of               State               Regulations)               This               can               sometimes               cycle               many               times               through.

A               facility               can               be               found,               many               times               over,               to               produce               substandard               quality               of               care;               but,               as               long               as               they               pay               the               fines,               and               correct               the               deficiencies,               they               can               continue               doing               business               for               another               year.

This               continues,               year               after               year,               with               so               many               facilities.

As               long               as               they               continue               to               pay               the               fines               and               continue               to               seem               to               "clean               up               their               act",               they               stay               in               business.
               The               results               of               all               this               are               the               serious               health               risks               to               the               residents.

If               they               are               not               properly               turned               and               positioned,               there               is               the               risk               of               pressure               ulcers,               more               commonly               called               "bed               sores".

Sometimes,               the               facility               is               so               short-staffed,               there               is               no               time               to               pass               out               the               ice               water,               which               these               people               desperately               need.

This               should               be               done               at               the               beginning               of               each               shift.

Aides               can               actually               be               told,               at               these               times,               not               to               pass               the               ice.

There               is               the               risk               of               dehydration,               especially               if               the               caretakers               do               not               take               the               time               to               encourage               them               to               drink               the               water.

Some               caregivers               tend               to               force-feed               residents,               to               hurry               through               mealtimes,               risking               aspiration               pneumonia,               for               those               residents               who               have               problems               swallowing.

The               residents               are               pressured               into               eating               faster,               or               not               allowed               to               finish               the               food               on               their               plates.
               There               is               also               the               serious               risk               of               spread               of               infectious               diseases.

Caregivers,               who               are               hurried,               tend               to               hurry               through               or               skip               residents'               showers.

The               best               time               to               check               a               resident               for               skin               tears               and               new               bruises               is               lost,               because               rushing               through               reduces               the               chances               of               catching               these.

An               open               wound               is               a               magnet               for               bacteria.

Some               aides               tend               to               skip               oral               care,               as               well.

This               can               lead               to               many               problems.
               Silent               Abuse               6
               A               caregiver               in               a               hurry               will               throw               dirty               linens               on               the               floor,               while               changing               the               beds.

This               causes               many               germs               to               be               spread.

The               most               problematic               is               not               following               Universal               Precautions.

Caregivers               in               such               a               hurry               they               do               not               wear               gloves,               do               not               change               gloves               between               patients,               do               not               wash               their               hands               after               every               patient.

Nearly               all               infectious               diseases               spread               in               a               facility               is               spread               from               this               simple               problem.

(Centers               for               Disease               Control               and               Prevention)
               It               all               goes               back               to               overworked               and               underpaid               staff.

When               a               facility               is               understaffed,               there               is               no               teamwork.

One               shift               works               against               the               next,               instead               of               working               together               for               the               sake               of               the               residents.

Aides               do               not               work               together               as               a               team,               and               must               lift               residents               alone,               sometimes               without               proper               mechanical               lifts.

This               leads               to               many               on-the-job               injuries,               as               well               as               injuries               to               the               resident.

In               the               end,               these               cost               a               facility               more               money               than               if               they               had               simply               hired               workers               that               are               more               qualified.
               There               are               many               very               good               facilities               out               there,               but               there               are               so               many               that               are               not.

They               just               appear               to               be,               on               paper,               and               to               those               who               are               watching.

Many               workers               are               not               as               kind               and               caring               as               they               appear               to               be,               when               they               are               being               watched.

There               are               so               many               stories               in               the               news,               today,               about               the               obvious               abuse:               the               physical,               sexual,               emotional.

It               is               what               is               not               seen               that               can               also               seriously               affect               these               residents:               neglect.

It               is               the               silent               abuse.

It               can               be               things               most               overlook,               because               they               do               not               know               it               is               abuse.

Sometimes,               in               nursing               homes,               things               are               not               what               they               seem               to               be,               to               the               uninformed.
               More               people               need               to               get               involved               and               learn               what               really               goes               on               in               some               of               these               places,               learn               what               steps               can               be               taken               to               prevent               the               neglect               of               the               elderly.

Learn               the               standards               a               facility               uses               to               hire               employees.

Contact               the               state               and               federal               government,               to               help               stop               the               Medicaid/Medicare               cutbacks,               which               prevent               facilities               from               hiring               qualified               employees.
               Silent               Abuse               7
               References
               Aroskar,               Mila               Ann,               RN,               EdD,               FAAN               (Dec.

31,               1998).
               Administrative               Ethics:               Perspectives               on               Patients               and               Community-Based               Care.

Online               Journal               of               Issues               in               Nursing.

Retrieved               August               06,               2004,               from               http://www.nursingworld.org/ojin/topic8/topic8_4.htm
               Centers               for               Disease               Control               and               Prevention.

Perspectives               in               Disease               Prevention               and               Health               Promotion               Update:               Universal               Precautions               for               Prevention               of               Transmission               of               Human               Immunodeficiency               Virus,               Hepatitis               B               Virus,               and               Other               Blood               borne               Pathogens               in               Health-Care               Settings.

Retrieved               on               August               16,               2004               from               http://www.cdc.gov/mmwr/preview/mmwrhtml/00000039.htm
               Harrington,               Charlene,               PhD.

Retrieved               on               August               05,               2004               from               http://www.NewsRX.com
               HCFA,               Appropriateness               of               Minimum               Nurse               Staffing               Ratios               in               Nursing               Homes,
               Report               to               Congress,               July               2000.

Retrieved               August               05,               2004,               from               http://www.cga.state.ct.us/pri/archives/2000sireportchap2.htm
               Markinson,               Ari               J.

(November/December               2003).
               Nursing               Homes:               Overview               of               State               Regulation.

State               Bar               News.
               Retrieved               August               07,               2004,               from               http://ebglaw.com/article_924.html
               National               Citizen's               Coalition               for               Nursing               Home               Reform.

Consensus               Statement               on               the               Staffing               Crisis               in               Nursing               Homes.

Retrieved               August               06,               2004,               from               http://www.nccnhr.org/govpolicy/51_162_701.cfm
               Office               of               Inspector               General.

Publication               of               the               OIG               Compliance               Program               Guidance               for               Nursing               Facilities.

(March               16,               2000).

Notice.

Federal               Register,               Vol.

65,               No.

52.






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