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Monday, January 30, 2012

Forgiveness: Letting go of grudges and bitterness

to be read AFTER the next entry

When someone you care about hurts you, you can hold on to anger, resentment and thoughts of revenge — or embrace forgiveness and move forward.

Nearly everyone has been hurt by the actions or words of another. Perhaps your mother criticized your parenting skills, your colleague sabotaged a project or your partner had an affair. These wounds can leave you with lasting feelings of anger, bitterness or even vengeance — but if you don't practice forgiveness, you might be the one who pays most dearly. By embracing forgiveness, you can also embrace peace, hope, gratitude and joy. Consider how forgiveness can lead you down the path of physical, emotional and spiritual well-being.

What is forgiveness?
Generally, forgiveness is a decision to let go of resentment and thoughts of revenge. The act that hurt or offended you might always remain a part of your life, but forgiveness can lessen its grip on you and help you focus on other, positive parts of your life. Forgiveness can even lead to feelings of understanding, empathy and compassion for the one who hurt you.

Forgiveness doesn't mean that you deny the other person's responsibility for hurting you, and it doesn't minimize or justify the wrong. You can forgive the person without excusing the act. Forgiveness brings a kind of peace that helps you go on with life.

What are the benefits of forgiving someone?
Letting go of grudges and bitterness can make way for compassion, kindness and peace. Forgiveness can lead to:

Healthier relationships
Greater spiritual and psychological well-being
Less anxiety, stress and hostility
Lower blood pressure
Fewer symptoms of depression
Lower risk of alcohol and substance abuse
Why is it so easy to hold a grudge?
When you're hurt by someone you love and trust, you might become angry, sad or confused. If you dwell on hurtful events or situations, grudges filled with resentment, vengeance and hostility can take root. If you allow negative feelings to crowd out positive feelings, you might find yourself swallowed up by your own bitterness or sense of injustice.

What are the effects of holding a grudge?
If you're unforgiving, you might pay the price repeatedly by bringing anger and bitterness into every relationship and new experience. Your life might become so wrapped up in the wrong that you can't enjoy the present. You might become depressed or anxious. You might feel that your life lacks meaning or purpose, or that you're at odds with your spiritual beliefs. You might lose valuable and enriching connectedness with others.

How do I reach a state of forgiveness?
Forgiveness is a commitment to a process of change. To begin, you might:

Consider the value of forgiveness and its importance in your life at a given time
Reflect on the facts of the situation, how you've reacted, and how this combination has affected your life, health and well-being
When you're ready, actively choose to forgive the person who's offended you
Move away from your role as victim and release the control and power the offending person and situation have had in your life
As you let go of grudges, you'll no longer define your life by how you've been hurt. You might even find compassion and understanding.

What happens if I can't forgive someone?
Forgiveness can be challenging, especially if the person who's hurt you doesn't admit wrong or doesn't speak of his or her sorrow. If you find yourself stuck, consider the situation from the other person's point of view. Ask yourself why he or she would behave in such a way. Paps you would have reacted similarly if you faced the same situation. In addition, consider broadening your view of the world. Expect occasional imperfections from the people in your life. You might want to reflect on times you've hurt others and on those who've forgiven you. It can also be helpful to write in a journal, pray or use guided meditation — or talk with a person you've found to be wise and compassionate, such as a spiritual leader, a mental health provider, or an impartial loved one or friend.

Does forgiveness guarantee reconciliation?
If the hurtful event involved someone whose relationship you otherwise value, forgiveness can lead to reconciliation. This isn't always the case, however. Reconciliation might be impossible if the offender has died or is unwilling to communicate with you. In other cases, reconciliation might not be appropriate. Still, forgiveness is possible — even if reconciliation isn't.

What if I have to interact with the person who hurt me but I don't want to?
If you haven't reached a state of forgiveness, being near the person who hurt you might be tense and stressful. To handle these situations, remember that you can choose to attend or avoid specific functions and gatherings. Respect yourself and do what seems best. If you choose to attend, don't be surprised by a certain amount of awkwardness and perhaps even more intense feelings. Do your best to keep an open heart and mind. You might find that the experience helps you to move forward with forgiveness.

What if the person I'm forgiving doesn't change?
Getting another person to change his or her actions, behavior or words isn't the point of forgiveness. Think of forgiveness more about how it can change your life — by bringing you peace, happiness, and emotional and spiritual healing. Forgiveness can take away the power the other person continues to wield in your life.

What if I'm the one who needs forgiveness?
The first step is to honestly assess and acknowledge the wrongs you've done and how those wrongs have affected others. At the same time, avoid judging yourself too harshly. You're human, and you'll make mistakes. If you're truly sorry for something you've said or done, consider admitting it to those you've harmed. Speak of your sincere sorrow or regret, and specifically ask for forgiveness — without making excuses. Remember, however, you can't force someone to forgive you. Others need to move to forgiveness in their own time. Whatever the outcome, commit to treating others with compassion, empathy and respect.


Source: www.mayoclinic.com

Anger and Resentment

It’s difficult not to feel occasional anger and resentment if you’re a primary caregiver who seems to be doing all the work caring for your parents – especially if other family members live nearby but are content to leave the details of such elderly care giving to you.

Or conversely, to be the caregiver of senior parents (determined solely by geographical location or because you’re ‘the oldest’) who is trying to do the best you can, but who must constantly listen to advice or criticism offered by other family members who may or may not be willing to offer actual help.

How do you deal with complaints, second-guessing and demands from senior parent siblings who want to offer advice, but can’t (or won’t) offer to help financially, physically or emotionally to help care for your senior Mom and Dad?

Dealing with Siblings


Care giving, especially when an elderly parent lives in your home, is a 24-an hour a day job. Many sons and daughters (mostly daughters) find themselves in the role of primary caretaker, whether they asked for the job or not. Often, this choice is delegated by unspoken agreement among other family members that you are “best suited to provide care for Mom”. You might work part-time, or be a stay-at-home Mom or run a home-based business. In such cases, other family members may feel you don’t “have a real job” so you have the time to care for your elderly parents. You may have been delegated to the role of primary caregiver because you live closest to Mom or Dad.

Disagreements about what should be done, what can be done and what has been done may crop up. Many caregivers must take on added financial responsibilities when caring for an elderly parent, (which Mom or Dad might not offer or be able to help pay for) and siblings often don’t realize or acknowledge that their sibling might need some extra help.

So how do you as a caregiver of elderly parents deal with the anger, frustration or resentment when it’s your life that’s suddenly been turned upside down, and you now have not only children, but also a husband and a job that needs your attention too? Care giving for elderly parents involves dozens of decisions, some that must be made immediately, and dealing with suggestions, complaints or second guessing from siblings is the last thing you need.


Get Everyone Involved


Whenever possible, try to keep all family members involved in the care giving process, even if they live far away and need to be updated by phone. Tell siblings and other family members what they can do to help. It doesn’t have to be physical help, but may involve a supportive phone call every week, an offer to help pay for a home care health aide, or help in making long-term decisions regarding senior medical care, legal issues, or finances.


Are You Completely Stressed Out?

Do you resent your siblings for not helping care for Mom and Dad? Are you being shut out of elderly care decisions? Are your elderly parents asking too much? Read What Others are Saying and let Us know What You Think...


Here are a few tips toward maintaining open communication with siblings:

* Update them frequently.

* If a sibling offers constant criticism but no help, gently but firmly explain that until he or she is willing to share in the responsibilities, you must continue doing the best you can with the tools you have.

* Let your siblings know what you are doing to provide elderly care – tell them everything – the nitty-gritty details that they probably aren’t even aware of.

* Be vocal in welcoming advice and help in your elderly parent’s care – this can be financial, legal, or medical.

* Be clear in telling siblings exactly what you would like them to do, or what you need them to do for you.

* Always use “I” and avoid accusations – for example, instead of saying “You never help,” say, “I feel stressed or overwhelmed.”

* Be willing to compromise when you ask for someone's help.



When Siblings Don't Help....

You feel resentful and angry that your freedom is gone. You work hard at your job, then rush home to take care of Dad, who’s suffering from mid-stage Alzheimer’s or a bedridden Mom who needs help with just about everything. It’s natural to feel anger and resentment over realizing that your life is no longer your own.

It’s also natural to feel guilty over such thoughts. We berate ourselves for being selfish, compassion less or self-centered. However, remember that this also is a natural process. Don’t beat yourself up over such thoughts.

Acknowledge them. Find someone to talk to about them - close friends, a sibling, or your pastor. People will understand, so don’t judge yourself too harshly. Accept the fact that you’re human and not super-woman.

Find a local support group for caregivers of elderly parents where you can freely express your stress and frustrations and you won’t be criticized or judged for voicing such feelings. Finding an outlet for anger and resentment is the best way to face it down and overcome it.



Source: www.boomers-with-elderly-parents.com

Safety in Nursing Homes

Nursing home facilities are expected to provide quality care and resources for their residents and in the process, create an environment that emphasizes safety and security. Nursing home safety involves taking adequate measures to provide a hazard free and protected environment by preventing sources, events or products that could lead to the physical, mental, and psychological injury of the facility's residents.

Both federal and state governments have enacted laws that set minimum standards regarding resident care and nursing home safety. Nursing home safety pertains to resident's personal safety and well being, their physical environment, and the other residents and staff they interact with.


Standards and Stipulations for Safe Practices:

The standards and stipulations of effective nursing home safety practices emphasize the following:

•Resident safety involves the care facility providing adequate nutrition and hydration for each resident.
•Nursing home safety also involves preventing a patient from deteriorating however and whenever possible.
•Nursing home professionals have a duty to help residents sustain their ability to complete daily living activities such as eating, general recreation, bathing etc.
•Nursing home safety must also ensure that residents receive proper medical care that is free of negligent or intentional error.
•Nursing home safety standards must be met in order to prevent any type of injury to a patient's physical, mental, and emotional well-being.
Nursing homes are responsible for the general well-being of their residents, and a main component of that responsibility lies in the promotion of a safe and secure living environment. Failure to comply with federal and state regulations regarding nursing home safety can often have tragic ramifications, and it is imperative to seek the aid of an experienced and understanding nursing home abuse lawyer should you or a loved one be exposed to such an unjust situation.



Soure:www.resource4nursingomeabuse.com

Wheel Chair Transfers




A wheelchair transfer means moving a person in to or out of a wheelchair. You may help a person move from their wheelchair to a bed, shower chair, commode (toilet) or into another chair. You may also help them move back into their wheelchair. You may be able to help a person transfer by yourself, or with another person helping you. You may use transfer aids such as a gait belt, a sliding board, or a mechanical lift to help move a person. These transfer aids can help make transfers safer and easier for you and the person that you are moving.

How do I prepare a person for a wheelchair transfer?
•Talk to the person about what will happen during the transfer. Speak slowly and clearly. Tell him what will happen at each step before you do it. Tell him that you must work together with him during the transfer.


•Learn about the person's condition, and if he is able to move, talk, and follow commands. Check for catheters, tubes, drainage bags and other items that might need to transfer with the person. Ask the person if he likes being transferred one way more than another way.


•Make sure that you and the person to be transferred are wearing shoes that will not slip on the floor.


•Make sure that the wheelchair and the transfer aids that you will be using are working right and not broken. Check material, stitching, straps, chains, and hooks. If the transfer aids look weak or broken, do not use them. Check the brakes on the wheelchair and on the bed to be sure they lock as they should. Make sure you have enough space to make a safe transfer.
What can I do to avoid getting hurt while transferring a person in and out of a wheelchair?
•Ask for help: Ask someone to help you do the transfer. The person may be heavy, or the place that you are transferring the person to may be too far away. A person may begin to fall while you are moving him. If you have another person with you, they can help you.


•Transfer the person correctly:


◦Bend your knees while transferring. Move from your hips. Do not move people using your back.


◦Do not leave your feet in place and twist your body at the waist during a transfer.


◦Keep your arms in close to your body rather than stretching them out during a transfer. Place your feet as wide apart as your hips.


◦Keep your back curved rather than holding it straight. Do not bend your head forward during a transfer.


◦Never let the person you are moving hold or hug you around your neck while you are moving them.


◦Stand very close to the person while transferring them.


◦Use your body's momentum (force gained by moving) to move the person.


•Train for the transfer:


◦Do stretching exercises before and after moving a person. This may prevent back strain or injury.


◦Learn how to correctly transfer a person in and out of a wheelchair.


◦Practice transfers with others who may be helping you.
What can happen to a person while I am transferring him?
People who are being transferred may get dizzy and faint. Have the person slowly sit up from lying down. Slowly move people from place to place to help avoid this. To help avoid slipping and falling on the floor, wear non-slip footwear, such as running shoes. Be sure the person that you are moving is also wearing non-slip footwear. Holding on to a person the wrong way can hurt their shoulders and other body areas. Hold on to people correctly as you move them. People can get skin bruises and their skin can tear as you are moving them. Transfer people carefully, watching that they do not bump into anything, or tear their skin as you move them.

What can I do to avoid hurting a person while transferring him in and out of a wheelchair?
•Learn which transfer aid is best for the person that you are moving, and learn how to use it correctly. Never leave a person alone while he is in a mechanical lift.


•Park the wheelchair as close as possible to the area where you will be transferring the person to or from. Park the wheelchair so that the person's stronger side of their body is the side that the transfer will be done on.


•Lock the wheels of the wheelchair to keep it from moving before doing every transfer. Lock the wheels on the bed before every transfer from or to the bed. When moving a person from a bed to a wheelchair raise the head of the bed as much as possible before moving the person out of the bed. Put the bed in the lowest position, so that it is as close to the floor as possible.


•Talk to the person who will be helping you with the transfer. Decide how to do the transfer, and talk about the transfer as you are doing it. Move together smoothly as you do the transfer. Ask the person that you are moving to help you do the transfer as much as they can. Explain each step before it happens.


•Before every transfer from or to a wheelchair, raise or remove the footrests. Have the persons feet set in the correct position, flat on the floor. Remove the armrest that is closest to the side that you are moving the person to, or moving him from. Be sure the patient will not fall out of the chair after you remove the footrests and arm rest, and before you do the transfer.


•Always put the footrests and armrest back on the wheelchair in the correct position after you have transferred a patient into the wheelchair. If the person cannot move an arm or leg, move it into the correct position for them after a transfer.


•If the person you are moving begins to fall during a transfer, bend your knees and lower him slowly to the nearest safe surface, or to the floor. Call for help. Never grab or hold on to a persons clothing while moving them.
How do I transfer a person using a gait belt?
A gait or transfer belt is a device that is placed around the person's waist or lower body. It may be used to help move a person to and from a wheelchair. It is used for persons who can stand, but need help getting up from a chair or bed to the standing position.

•Moving a person from a chair or bed into a wheelchair:


◦Prepare the wheelchair and the person for the transfer.


◦Fasten the gait belt securely around the person's waist. Ask the person to hold on to you if they can. Bend forward at the waist and bend your knees. Grab the belt or its handles around the back of the person.


◦Rock gently back and forth about three times with the person. On the third time, help the person up to a standing position.


◦Turn with small steps until the person's back is in front of the wheelchair. Ask the person to help by reaching for the wheelchair behind him. This may make it easier for the person to sit down in the wheelchair.


◦Bend forward while bending your knees, and lower the person so that he is sitting in the wheelchair.


◦Check that the wheelchair is safe, and the person is comfortable.


•To move a person out of his wheelchair using a gait belt, follow the same steps as when you moved him into the wheelchair.
How do I transfer a person using a mechanical lift?
A mechanical lift is equipment that is used to move a person. The lift has slings and straps, and can be electric or hand-powered. The lift can be attached to the floor, wall, or ceiling, or you may be able to move it from place to place where it is needed. A lift can be used for people who cannot stand up by themselves. A lift can be used for a person who is heavy and cannot be lifted easily. It may also be used for a person who cannot think clearly and are unable to help with the move. A lift is used to move a person over short distance, such as from a bed to a wheelchair.

•Moving a person into a wheelchair:


◦Roll the person onto their side. Slide the sling underneath him. Roll the person onto the other side and spread the sling evenly under him.


◦If the person is lying down, raise the head of the bed so he will be sitting up.


◦Correctly attach the sling's hooks, straps, or chains to the lift. Lift the person by pumping or plugging in the lift. Ask the person to keep still while he is being lifted up.


◦Move the lift until the person is over the wheelchair. Slowly lower him into it. Move the person into a position so that he is comfortable.


◦Unhook the sling from the lift. You may leave the sling under the person in case you need to transfer him again.


•Moving a person out of a wheelchair:


◦Lift one side of the person's body up slightly, or tilt him to one side. Slide the sling underneath his buttocks.


◦Lift or tilt the person to the other side, and spread the sling evenly under him.


◦Attach the sling to the mechanical lift. Raise the person by pumping the lift manually or by turning the lift on. Ask the person to stay still during the lift.


◦Move the lift until the person is over the bed, or the place where he is being transferred to. Slowly lower him down until he is seated. Move the person into a position so that he is comfortable.


◦Unhook the sling from the lift. Leave the sling under the person if you will need to transfer him again.
How do I transfer a person using a sliding board?
A sliding board is flat surface that can be used as a bridge between two areas. It is used when the person can move, but is too weak to transfer himself. It may also be used if the person is heavy. A sliding board may be used with a gait belt.

•Moving a person into a wheelchair:


◦Place the gait belt around the person's hips and buttocks, then place one end of the sliding board under his buttocks. The sliding board should form a bridge between the place he is transferring from (such as the bed), and the wheelchair.


◦Put one of your knees between the person's knees. Hold the gait belt or its handles. Slowly slide the patient across the board to the wheelchair. Ask the person to help by pushing his palms on the board and moving towards the wheelchair.


◦Remove the board once the person is seated in the wheelchair.


•To move a person out of his wheelchair using a sliding board, follow the same steps as when you moved him into the wheelchair.
How do I transfer a person using a sitting transfer?
You may use a sitting transfer if the person that you are moving cannot use his legs. This can also be used for people who cannot lift their body weight up using their arms.

•Moving a person into a wheelchair:


◦Place the gait or transfer belt around the person's hips and buttocks.


◦Slowly move the person to the edge of the bed or chair that he is transferring from. Ask the person to lean forward.


◦Hold the belt or its handles, then bend from your hips and knees. Holding the person close to your body, lift him up, and then lower him into the wheelchair. Move the person's arms and legs so that they are comfortable.


•To move a person out of his wheelchair using a sitting transfer, follow the same steps as when you moved him into the wheelchair.
How do I transfer a person using a pivot transfer?

This transfer is also called the assisted standing transfer. This transfer may be used for people who are weak on one side of their body, such as a person who has had a stroke.

◦Place the wheelchair at an angle on the person's strong side. Lock the brakes of the wheelchair. Raise or remove the footrests, and remove the armrest closer to him.


◦Put the transfer belt around the person's waist. Ask the person to put his arms on your hips or at his side. Put one of your knees between the person's knees.


◦Grip the belt or its handles. Bend your knees and rock using forward and backward motions. Ask the person to help by pushing up with his strong arm or leg.


◦Take small steps and turn both your body and the other person's body together. Have the person that you are moving take small steps with you. Step together until the person's back is in front of the wheelchair. If possible, ask the person to reach back for the armrest on the wheelchair behind him. This may bring the wheelchair closer and may make it easier for the person to sit down.


◦Bend forward to lower the person onto the wheelchair.


◦Put the wheelchair's footrests and armrest back to their place.


•To move a person out of his wheelchair using the pivot transfer, follow the same steps as when you moved him into the wheelchair.
How do I transfer a person using a scoot transfer?
•Supplies:


◦Place the wheelchair at an angle on the person's strong side. Lock the brakes of the wheelchair. Raise or remove the footrests, and remove the armrest closer to him.


◦Put the transfer belt around the person's waist. Ask the person to put his arms on your hips or at his side. Put one of your knees between the person's knees. Keep your shoulders and chest up, instead of leaning forward.


◦Ask the person to lean forward and put some of his weight on you. Lean back slightly. Grip the belt or its handles. Bend your knees and rock forward and backward. Lift the person slightly up and move him each time. Rock 2 to 4 more times, until you have moved (scooted) the person to the wheelchair.


•To move a person out of his wheelchair using the scoot transfer, follow the same steps as when you moved him into the wheelchair.
How do I transfer a person using a two-person transfer?
This transfer is done with another person helping you. If possible, choose someone who is near the same size and height as you to help. This transfer may be used if the person you are moving is heavy.

◦Put the transfer belt around the person's waist. Have the person cross his arms across his chest if possible.


◦Stand behind the person with your arms placed under the person's arms. Hold both of his wrists. Have your helper put his arms under the thighs of the person.


◦At the count of three, gently lift the person up, working together as a team.


◦Working together, carefully lower the person into the wheelchair.


•To move a person out of his wheelchair using the two-person transfer, follow the same steps as when you moved him into the wheelchair.
When should I call a caregiver?
Call caregivers if:

•The skin on the person that you are moving has torn.


•The shoulder, arm, or another body area on the person that you are moving looks out of place or different after you have moved him.


•The person that you have moved complains of new pain after you have moved him.


•You see one or more new sores on the skin of the person that you are moving.
When should I seek immediate help?
Seek care immediately or call 911 if:

•The person that you are moving has fainted and cannot be woken up.


•The person that you are moving has fallen down and looks like he is hurt.
Care Agreement
You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.



Source: www.drugs.com

How do wheelchair users transfer to and from the toilet?



The technique used to transfer from a wheelchair to the toilet and back varies according to factors such as: the size and design of the wheelchair; the level of function that the disabled person has (for example, strength in upper limbs); whether the transfer is independent or assisted; and personal preference. Here we describe a number of common transfer techniques:

Unassisted side (lateral) transfer
•the wheelchair is manoeuvred until it is more or less parallel with the WC, with the front of the wheelchair aligned with the front of the pan. Alternatively, the transfer maybe angled, with the wheelchair at about 45º to the WC (see diagram below)
•the wheelchair armrest nearest the toilet is removed
•the footrests are pushed out of the way
•the user slides him/herself from the wheelchair to the toilet (and back) using a rail, wheelchair and toilet pan for support

Unassisted angled (oblique) transfer
•the wheelchair is positioned facing the toilet at an angle
•the user stands or partially stands up and, using the vertical grabrail for support, swivels the feet to turn, and lowers him/herself down onto the WC pan using the horizontal wall rail and seat for support. The grabrails may be used as a support while rocking from side to side on the toilet seat to adjust clothing

Frontal transfer
This kind of transfer is only possible for users able to stand briefly and take some weight on their legs.

•the wheelchair is positioned facing the toilet head on (note: sufficient space is needed to allow this)
•the user stands and uses support rails on both sides of the toilet to shuffle around through 180º, and lowers him/herself onto the toilet or
•double lower-limb amputees and some other wheelchair users may choose to use the toilet facing the cistern by sliding forward from their wheelchair onto the toilet seat, using the rails on either side of the toilet

Rear transfer
•through zipped seat back of wheelchair

Assisted transfer
This may be done with the wheelchair in any of the transfer positions mentioned above. Assistance is needed when the wheelchair user has little or no functional use of the lower limbs and impaired upper limbs. He/she will need to be manually lifted or heaved from the wheelchair seat to the toilet seat and back. Clear, unobstructed space on both sides of the WC is important to allow the assistant (or assistants) to bend, turn and move freely when lifting a disabled person’s weight.


Source:www.independentlliving.cc.uk

Sunday, January 29, 2012

Nutrients for the elderly

Age-associated metabolic changes, inadequate intake, and environmental conditions associated with aging are some of the reasons why older adults and the elderly (individuals aged 51 and over) should follow dietary guidelines specific to their age. A decrease in physical activity and basal metabolic rate (due to loss of muscle mass) from early to late adulthood results in 20% fewer calories needed for weight maintenance. This means that foods consumed by the elderly need to be rich with vitamins and minerals so they can still get the nutrients they need while eating fewer calories.

Nutrients Affected by Age-Associated Metabolic Changes

Recommended Fiber Intake

A range of 21 to 30 grams (g) of dietary fiber per day or 14 g per 1000 calories consumed is recommended for older adults. Unfortunately, most people are short of this recommendation, with males eating about 18 g and females about 14 g daily. It is important for older adults to eat adequate fiber because it reduces the risk of diverticular and coronary heart disease in men, non insulin-dependent diabetes in women, and hypertension (high blood pressure) in both sexes. When fiber intake is increased, fluid intake must also be increased to aid in the processing of the additional fiber. It is recommended that fiber and fluid intake be increased slowly to allow the intestinal system to adapt and prevent unpleasant side effects such as cramping and bloating.

Recommended Vitamin D

With age, the body's ability to synthesize vitamin D from sunlight decreases. This decline may be compounded by limited sun exposure due to sunscreen, institutionalization or being homebound. Further, commonly used medications such as barbiturates and laxatives interfere with vitamin D metabolism. Key to healthy aging, the critical function of vitamin D is maintenance of blood calcium levels in order to prevent osteoporosis (decrease in bone mineral density) and osteomalacia (softening of the bones). The Recommended Dietary intake (RDA) established by the Institute of Medicine (IOM) for adults from age 51 to 70 years is 10 micrograms (mcg) per day of vitamin D, and 15 mcg for those aged 70 and older.
Here areome foods that contain Vitamin D:


Studies have shown that during the aging process, older adults lose their ability to split B12 from its protein carrier and therefore become unable to use this vitamin efficiently. It may take years to develop a deficiency, but a lack of B12 can cause neurological symptoms such as deterioration of mental function, change in personality and loss of physical coordination that are irreversible. Nutritionists will usually recommend consumption of foods to meet nutritional needs, however in the case of B12, the synthetic (purified form) is better absorbed. The synthetic form of B12 is found in fortified foods such as cereals and soy products and also in supplement form. It is recommended that older adults include these synthetic sources of B12 in their diet. The non-synthetic (protein-bound) form is found in animal products. The RDA for vitamin B12 is 2.4 mcg per day

Recommended Vitamin A

Older adults are actually more likely to overdose wit.
ih vitamin A than to be deficient of it. Not only do they tend to eat more than the recommended intake of 700 mcg for women and 900 mcg for men, but blood and liver stores of vitamin A increase with age. Therefore, older adults are more susceptible to vitamin A toxicity and possible liver damage than younger individuals are. Vitamin A toxicity symptoms include hair loss, dry skin, nausea, irritability, blurred vision and weakness. Beta carotene is the plant form (precursor) of vitamin A and can be found in carrots, spinach and broccoli. It is water soluble, and will therefore not cause liver damage or toxicity symptoms other than possibly causing a yellow-orange tint to the skin. To prevent toxicity, older adults should ensure their dietary intake of vitamin A is maintained equal to the recommended amount, but not above it.

Recommended Iron

For women, the need for iron decreases with aging after menopause. For all older adults, iron is stored more readily in their bodies than in the bodies of younger individuals, a similar situation to vitamin A. in addition, iron intake levels are generally above the recommended amount of 8 milligrams (mg) for older adults, and high intakes of vitamin C enhance iron absorption. Excess iron contributes to oxidative stress which increases the need for antioxidants to battle oxidant overload. However, it is important to note that there could be specific conditions causing an older adult to have inadequate iron stores such as antacid interference, decreased stomach acid secretion and low caloric intake. Doctors can administer a blood test to confirm adequate levels of iron storage. Iron deficiency can lead to anemia which includes symptoms such as weakness, fatigue and impaired cognitive function and immunity.

Typical Nutrient Deficiencies in the Elderly

Vitamin E, Folic Acid, Calcium, Magnesium and Zinc consumption tends to be below recommended intake levels. It is important for older adults to incorporate food sources of these nutrients into their diet, while keeping their caloric intake to approximately 1900 calories for women and 2300 calories for men (dependent upon body type). One of the best ways to do this is by limiting consumption of high calorie foods containing excess fat and sugar.

Citracal Calcium Citrate with Vitamin D 200 CapletsAmazon Price: $18.47


Nutritional Supplements for the Elderly

Although the best source of nutrients is food, older adults can benefit from supplements especially when their caloric intake is low, if they are vegetarian or vegan, or under the following additional conditions:

•Disinterest in food
•Chronic illness
•Lack of appetite
•Use of medications which affect absorption and/or metabolism of nutrients
When consuming supplements, it is important to remember that excess consumption of any nutrient can be harmful to the body. To avoid toxicity symptoms, intake should never exceed the tolerable upper limit established by the IOM.


Source: www.rmnutrition.hubpages.com

6 Vital Nutrition Tips for Your Elderly…

As people age, their diets may need to change, especially if their diets are not well-balanced. Generally, doctors will recommend a well-balanced diet for elders, meaning that they should eat a variety of fruits, vegetables, protein and whole grains to maintain and improve overall health. According to Ruth Frechman, registered dietitian and spokesperson for the American Dietetic Association, in addition to eating a healthful variety of foods, there are specific things a caregiver can incorporate into their parent's diet to boost his or her health.

Prepare meals rich in these nutrients

•Omega 3 fatty acids
The acids have been proven to reduce inflammation, which can cause heart disease, cancer and arthritis. They can be found in many different types of fish and in flaxseed oil. Your parent should have foods rich in this nutrient twice per week. If this is impossible, check with their doctor to see if an Omega 3 supplement would be beneficial.

•Calcium and Vitamin D
The need for calcium and vitamin D increases as people age. This is primarily to preserve bone health. One added benefit of calcium is that it helps to lower blood pressure. Adults over the age of 50 need at least 1200 milligrams per day of the nutrient – equal to about four cups of milk per day. Many people find it challenging to consume this much calcium per day by eating and drinking, so check with your parent's doctor to see if he or she should take a calcium supplement.

MEAT - elders need meat and it's protein. We as a "modern" society are recommending to them a diet for a healthy 30 y.o. As the body ages elders eat less, process protein less well and lose muscle. This needs to be compensated with more meat in the diet. This includes meat soup stock, meatballs, chicken, pork, beef.

The trend of getting elders to cut out fat, cut out chickenskin, eat only lean meats, reduce the amount of meat, lower salt, reduce oils, take supplements, drink smoothies -- is a prescription for a road to mal-nutrition in the elderly. They land up eating nothing of substance.

I challenge any "advisor" out there to show me any studies, that for an otherwise healthy elder, that meat and in ample qualities has any negative effects.

Our teeth are flat, made for grinding. Not ripping and tearing. And to be "accurate" The top of the food chain "Meat Eaters" first devour every drop of blood in the prey. That is what keeps them alive, not the actual "Meat".
Before you "challenge" anyone- I suggest you not only read the back of the book- but the entire book. You might be surprised what you could learn.

PROTEIN - Hi Nutritionist. Can we first agree that elderly people need protein? If we can agree to this, then the next issue to address is sarcopenia (malnutrition in the elderly). In the elderly, the body changes and its ability to process protein reduces, creating a tendency toward frailty. Therefore, adequate protein intake and reduced ability to process protein requires an INCREASE in protein intake to maintain what the body needs. There are several clinical studies on this on the internet. Please familiarize yourself with the elderly, then I'd be happy to discuss further.

TEETH - regarding your flat teeth theory, please explain to me our 8 incisors? Your argument is that they are there to rip into leaves? Meatloaf is highly processable by the elderly and my dad loved it. NO reason to eliminate that from his diet. He loved chicken, NO reason to eliminate it.

The elderly DO NOT need to go on a vegan/vegetarian/weightloss/slim figure/media-hyped/low-calorie/flavorless diet. Unless they are obese.

You are confusing "Protein" with any type of "Meat" a cup of legumes has the same amount of Protein as 3 steaks. As with anyone "Aging" The body year after year has a harder time breaking down certain foods. Our "Incisors" are just what they are, for chewing and mulching- If we tried to take a bite into a live cat or dog they would not break skin- unlike the teeth of a kitten that could easily bite through your finger. I am not saying anyone from 2-200 needs "Protein" and if the only way you think you can have a solid meal that has flavor is with "Meat" of some kind- I wonder what part of the world you live? 98% of the "Meat" anyone in America eats today has been "Modified" it is not "pure" How do you think it can stay on a supermarket shelf for more then 24 hours(the time it would take fresh meat to spoil and turn rotten is actually 8 hours) hence why only a carrion feeder will eat anything left in the wild for more then the above time, and other animals even if starving will not feed off it.

If you raised your own cow, pig, or chicken, and made sure the soil was pure and the feed was grown yourself- and they were fed and taken care of - then fine- But anything beside that is sadly "altered" The average age of Menstration has gone down from the age of 16 to 8 in "Meat" eating countries. In the past 70 years. That is not natural. I'm sure your father can eat meat for the rest of his day's and hopefully it is well into his late 90's to 100+ But Meatloaf is not highly processable- no meat is- the purest form of Protein that is highly processable is an egg-white. And 3 Egg white's a day- is triple the protein eating "Meat" 7 nights a week. Now Fish- Or seafood- That is a efficient form of protein, that the body can actually use and need's (Vit D - Omega 3 acids) something no "Meat" has.

PROTEIN - Okay, as my own teeth are pretty functional when eating a T-bone, I won't argue with you on the evolutionary possibilities.

Since you seem open to my father continuing to eat his meat, then I think we're much in agreement. He also loves his eggs, be they scrambled, sunny side up, or in soup. He does not like vegetables or beans. Nuts he loves.

The remaining argument I have is that there is no need to "alter" an elderly person's diet in this way when they are old! My father, if a plate of "legumes" was placed in front of him, would - in his old fashioned way - politely decline to eat it, while saying they "taste great." In this way, if only presented with these sorts of options, he would slowly starve himself to death, or seek out candy and nuts.

Why do I assert this? Because it is exactly what happened to my father. He lost over 20 pounds when his wife took away the milk, skin of chicken, eggs, meat, butter, etc., from their diet in an attempt to "eat healthy" and because of her fear of diabetes. When they went to Souplantation, my father had nothing to eat and would woof down bowls of clam chowder, rather than the big plate of greenery. He was literally being starved to death.

When I saw this happening, I "forced" him to return to his old diet, and he was scarfing down steaks, beef bowls, buttered toast!, scrambled eggs. He put back on the weight, to a healthy level (not anywhere near obese) and much of his strength, vitality and yes, cognitive function. It was no easy struggle to counter the wife's "good" intentions as she had a mountain of newletters, recommendations, etc., though mostly geared toward middle-aged obese persons: which my father was not.

In my original comment, I was not so much against the "healthy" recommendations you suggested, it's great for me (middle-aged) to consider and likely adjustments and such are a beneifit.

But for an elderly person, and the super-elderly (80+) it can be a prescription for rapid decline and sarcopenia. Do you have some agreement with me on this aspect?

Fascinating dialogue. Keep it coming. I do nutrition coaching, with training from a 27-year cancer survivor. While we encourage large amounts of vegetable protein (I love to use mung beans, anasazi beans, garbanzos, etc) we also include fish and chicken. The one missing link here, IMHO, is digestive enzymes. Vegetable proteins may have enough on their own, while animal proteins require additional digestive enzymes to be consumed. I'm bringing a bottle to a client today, as a matter of fact. And the one source of bioavailable protein most readily received and utilized by the most elderly or frail of those with whom I work is undenatured whey protein with digestive enzymes in it. We utilize what I've come to view as one of the best available; able to be consumed in place of a meal if weight IS an issue, or appetite is low. As a drink accompanying a meal, or on its own, hands down the ONLY protein source that has provided noticable improvement in the strength and mood of these precious people. As it is a fact I have observed, it's offered only by way of a story, not "proof" of anything. When you get a 90 year old to happily show you how she is now able to stand up from bed on her own, and she hasn't done that for MONTHS, you know something is good. Then she cheerfully says "Honey, will you make me a shake?" Rewarding. Yep.

Limit sodium content
Most elders have hypertension – high blood pressure. One of the most important things caregivers can do to help reduce a parent's hypertension is to prepare foods with low sodium. Most people are surprised to know that table salt accounts for only a small percent of sodium content in food. Avoid giving your parent frozen, processed or restaurant food, as these are extremely high in sodium. The foods with the lowest sodium content are fruits and vegetables, so try and incorporate them as much as possible in their diet.

Hydrate
As people age, they do not get thirsty very often, even though their bodies still need the same amount of liquids. If you notice that your parent is not drinking liquids very often, make sure that you provide them with it. If they do not feel thirsty, chances are they may not think about drinking a glass of water.

If you are concerned that your parent may not be properly hydrated, check his or her urine. Urine is the surest sign of hydration or lack of it. If the urine is clear and light, then your parent is most likely properly hydrated. If, however, urine is dark and/or cloudy, your parent will need to start drinking more liquids.

MEAT - elders need meat and it's protein. We as a "modern" society are recommending to them a diet for a healthy 30 y.o. As the body ages elders eat less, process protein less well and lose muscle. This needs to be compensated with more meat in the diet. This includes meat soup stock, meatballs, chicken, pork, beef.

The trend of getting elders to cut out fat, cut out chickenskin, eat only lean meats, reduce the amount of meat, lower salt, reduce oils, take supplements, drink smoothies -- is a prescription for a road to mal-nutrition in the elderly. They land up eating nothing of substance.

I challenge any "advisor" out there to show me any studies, that for an otherwise healthy elder, that meat and in ample qualities has any negative effects.
PROTEIN - Hi Nutritionist. Can we first agree that elderly people need protein? If we can agree to this, then the next issue to address is sarcopenia (malnutrition in the elderly). In the elderly, the body changes and its ability to process protein reduces, creating a tendency toward frailty. Therefore, adequate protein intake and reduced ability to process protein requires an INCREASE in protein intake to maintain what the body needs. There are several clinical studies on this on the internet. Please familiarize yourself with the elderly, then I'd be happy to discuss further.

TEETH - regarding your flat teeth theory, please explain to me our 8 incisors? Your argument is that they are there to rip into leaves? Meatloaf is highly processable by the elderly and my dad loved it. NO reason to eliminate that from his diet. He loved chicken, NO reason to eliminate it.

The elderly DO NOT need to go on a vegan/vegetarian/weightloss/slim figure/media-hyped/low-calorie/flavorless diet. Unless they are obese.

PROTEIN - Okay, as my own teeth are pretty functional when eating a T-bone, I won't argue with you on the evolutionary possibilities.

Since you seem open to my father continuing to eat his meat, then I think we're much in agreement. He also loves his eggs, be they scrambled, sunny side up, or in soup. He does not like vegetables or beans. Nuts he loves.

The remaining argument I have is that there is no need to "alter" an elderly person's diet in this way when they are old! My father, if a plate of "legumes" was placed in front of him, would - in his old fashioned way - politely decline to eat it, while saying they "taste great." In this way, if only presented with these sorts of options, he would slowly starve himself to death, or seek out candy and nuts.

Why do I assert this? Because it is exactly what happened to my father. He lost over 20 pounds when his wife took away the milk, skin of chicken, eggs, meat, butter, etc., from their diet in an attempt to "eat healthy" and because of her fear of diabetes. When they went to Souplantation, my father had nothing to eat and would woof down bowls of clam chowder, rather than the big plate of greenery. He was literally being starved to death.

When I saw this happening, I "forced" him to return to his old diet, and he was scarfing down steaks, beef bowls, buttered toast!, scrambled eggs. He put back on the weight, to a healthy level (not anywhere near obese) and much of his strength, vitality and yes, cognitive function. It was no easy struggle to counter the wife's "good" intentions as she had a mountain of newletters, recommendations, etc., though mostly geared toward middle-aged obese persons: which my father was not.

In my original comment, I was not so much against the "healthy" recommendations you suggested, it's great for me (middle-aged) to consider and likely adjustments and such are a beneifit.

But for an elderly person, and the super-elderly (80+) it can be a prescription for rapid decline and sarcopenia. Do you have some agreement with me on this aspect?
Fascinating dialogue. Keep it coming. I do nutrition coaching, with training from a 27-year cancer survivor. While we encourage large amounts of vegetable protein (I love to use mung beans, anasazi beans, garbanzos, etc) we also include fish and chicken. The one missing link here, IMHO, is digestive enzymes. Vegetable proteins may have enough on their own, while animal proteins require additional digestive enzymes to be consumed. I'm bringing a bottle to a client today, as a matter of fact. And the one source of bioavailable protein most readily received and utilized by the most elderly or frail of those with whom I work is undenatured whey protein with digestive enzymes in it. We utilize what I've come to view as one of the best available; able to be consumed in place of a meal if weight IS an issue, or appetite is low. As a drink accompanying a meal, or on its own, hands down the ONLY protein source that has provided noticable improvement in the strength and mood of these precious people. As it is a fact I have observed, it's offered only by way of a story, not "proof" of anything. When you get a 90 year old to happily show you how she is now able to stand up from bed on her own, and she hasn't done that for MONTHS, you know something is good. Then she cheerfully says "Honey, will you make me a shake?" Rewarding. Yep.


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6 Vital Nutrition Tips for Your Elderly Parents
Page 2: More Nutritional Guidelines for Elders
By Emilee Seltzer
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Limit sodium content
Most elders have hypertension – high blood pressure. One of the most important things caregivers can do to help reduce a parent's hypertension is to prepare foods with low sodium. Most people are surprised to know that table salt accounts for only a small percent of sodium content in food. Avoid giving your parent frozen, processed or restaurant food, as these are extremely high in sodium. The foods with the lowest sodium content are fruits and vegetables, so try and incorporate them as much as possible in their diet.

Hydrate
As people age, they do not get thirsty very often, even though their bodies still need the same amount of liquids. If you notice that your parent is not drinking liquids very often, make sure that you provide them with it. If they do not feel thirsty, chances are they may not think about drinking a glass of water.

If you are concerned that your parent may not be properly hydrated, check his or her urine. Urine is the surest sign of hydration or lack of it. If the urine is clear and light, then your parent is most likely properly hydrated. If, however, urine is dark and/or cloudy, your parent will need to start drinking more liquids.

Source: unknown. Pls report it to me if this is yours.

Food for the elders and sick

Taking on the responsibility to care for the sick and elderly is a large commitment time wise, financially and emotionally. You are assuming the responsibility of care for another person, one who likely cannot do much on her own. Make sure that you take the time to plan for the care, and choose the necessary help, medical care and type of care that you'll be giving. With the right support and attitude about caring for the sick and elderly, you can have a fulfilling experience.

Step 1
Make a care plan with the elderly person's family. If you are the family, talk to your siblings and parents about what should be done, and who can help. Taking on all of the care for the sick and elderly is a big responsibility, and you may be able to take shifts with other family members. Map out how much care should be given, and what can be done to make the sickly person's life easier and more comfortable.

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Sponsored Links Step 2
Arrange the home for comfort. If you are caring for the sick and elderly person in his own home, you may need to remove some of his furniture or move his bedroom to the main floor for ease and comfort. Make sure that he is still surrounded by his favorite things, and that you've done what you can to make the house safer and more comfortable, suggests "U.S. News and World Report."

Step 3
Allow for as much independence as humanly possible. If the sick person you are caring for is bedridden, but still likes to take her own baths, do what you can to make that possible. You'll find that she is much more agreeable and easy to deal with when she doesn't feel like you are taking over her entire life.

Step 4
Visit with the individual's doctor and take him to doctor visits so that you stay up to date on his condition and what should be done. If you are not a family member, you may need permission from a family member to attend doctor's visits and medical consultations first. Keep your own file on the sick and elderly person so you remember which medications need to be administered, rehabilitation tactics and warning signs to bring him to the hospital or call a doctor.

Step 5
Ask for help if you need it, the AARP recommends. The 24-hour care of another person is a huge commitment, and there are services that make it easier. Elderly day care, home hospice services and even meal services can all be employed to lighten your load so that you're able to care for the elderly person and yourself simultaneously.



Sorce: www.liovestrong.com

What Is Physical Therapy?




Physical therapy helps people get back to full strength and movement in key parts of the body after an illness or injury. Physical therapy doesn't just help a person rebuild strength and range of motion, though — it also can help someone manage pain, whether that pain is caused by bad posture, an injury, or a disease like arthritis. When done properly and consistently, physical therapy can help prevent permanent damage and recurring problems.

Most physical therapy uses a combination of techniques to relieve pain and boost coordination, strength, endurance, flexibility, and range of motion. Physical therapists (PTs) often ask patients to use exercise equipment like bikes and treadmills.

In addition to exercising the affected area, a PT also may treat it with heat or cold, electrical stimulation, ultrasound, massage, and water or whirlpool baths. In many cases, PTs massage injured areas and oversee the patient during stretching routines.

Most of the time (but not always), physical therapists give their patients exercises to do at home. These at-home exercises work with the treatments and exercises done in the PT's office to help a person heal better, faster, and safely.

Continue
ListenWhat to Look for in a Physical TherapistYou'll want to be sure a physical therapist is qualified to treat you. All PTs must have an advanced degree in physical therapy and be licensed by the state to practice. As of 2010, the entry-level degree for a physical therapist is a doctoral degree (DPT).
Like doctors, some physical therapists can specialize in different areas: A particular therapist might work mostly with sports injuries, for example. Others may be experts in head injuries or in caring for wound and muscle damage in people with burns or skin injuries. Some PTs focus specifically on athletes, children, babies, the elderly, or the very ill.
Your doctor may recommend the right PT for you — but you also need to be sure you feel comfortable with that PT. Don't be afraid to ask questions. Some good ones are:
How much experience do you have treating people with my condition?How will you decide which treatment program I need?What equipment will you use to treat my condition? (This prepares you for when the PT suggests a particular piece of equipment.)How long will each treatment session last?How long do you think I will need to come for treatment?If you don't feel comfortable (for example, the PT doesn't answer your questions or can't explain your routine in a way that you understand), let your doctor know and ask for another recommendation. The doctor will probably appreciate your feedback!
If your doctor doesn't have a recommendation, contact your state's physical therapy association for names of licensed PTs in your area. The coach at your school may also be able to recommend a PT.

ListenThe First VisitMany, but not all, states require a prescription from your doctor before you can be evaluated and treated by a PT. If you're going to a hospital or clinic, it's a good idea to take someone like a parent or older brother or sister with you the first time, even if you can drive yourself. Not only will you have support and someone to talk to about the experience, but you'll also have someone to help with your exercises at home — and maybe even give you a gentle nudge when you're feeling unmotivated!
Most likely you'll see a PT in a clinic or office. But some PTs work in schools, helping children with injuries, disabilities, or chronic (long-lasting) conditions. When you go to your physical therapy appointments, try to wear loose-fitting clothing and sneakers so your PT can accurately measure your strength and range of motion.
During your first visit, the PT will evaluate your needs and may ask questions about how you're feeling, if you have any pain, and where that pain falls on a scale of 1 to 10. It's important to be straight with your PT, so he or she can treat your condition properly.
Using the results of the examination and your doctor's recommendations, the PT will design a treatment plan. Many times, a PT will start treatment during a first visit — including giving a patient exercises to do at home.
The PT will probably ask you to go through these at-home exercises while you're there to make sure you know how to do them on your own. Many PTs give their patients a piece of paper with the exercises written on them as a reminder of what to do and in which order (if any). Be sure to follow the plan exactly — most of the benefit of PT comes from the routines a person does at home.
Don't be afraid to ask for another explanation if you don't completely understand an exercise that you're going to be doing at home. It's easy to feel confused or overwhelmed with information during a first treatment session — lots of people (adults included) feel this way.
It's talk with the PT about how the exercises should feel when you do them — for example, if you're supposed to feel any pain or unusual sensations, and whether you need to stop if you do.
Some people like to keep track of their progress during PT by taking notes on how often they do the exercises, how they feel, and how sensations change — this will help you and your PT monitor your treatment.

ListenAfter the First VisitMost physical therapy sessions last 30-60 minutes each depending on what you are receiving therapy for. As you make progress, your visits may change in length and frequency. You'll learn new techniques to help continue your healing.
In big offices, you may meet with different PTs during the course of your treatment. Alex lives in Washington, DC, and he visited an office shared by five PTs and lots of assistants. He usually saw the same physical therapist, but not always.
Don't worry if you see a new face — but make sure each PT working with you knows your condition, and that you're comfortable asking questions of each therapist. Remember: If you don't like the treatment, or something feels wrong, speak up.
Although the long-term goal is pain relief and recovery, physical therapy itself won't always feel good. Depending on your injury, you may feel uncomfortable or not used to moving the area. It's important to stick to the routine — and to breathe, be kind to yourself, and ask your PT for other hints on getting through. It's also important not to put yourself through too much or to overdo it.
If you feel pain, make sure to talk to your PT about it. "No pain, no gain" is no way to approach physical therapy. Pain is a warning signal, and by pushing yourself through too much pain, you can do more damage.
Practice Perfectly & Other Things to Keep in MindFollowing a few simple steps can help you make your PT treatment a success:
Stick to the plan. It's important to follow the PT's instructions. Do your exercises at home in the number, order, and frequency noted. Don't skip any, and don't do extra exercises — following the directions will help you heal faster and get moving again.Know your body. It helps to know what's going on and why. Ask questions and pay attention when the PT explains the injury and the treatment. You'll probably be amazed by the way your body heals itself. And you'll want to know how the affected area functions so you can spot problems or avoid further injury in the future.Talk to your PT if you have problems. If things hurt, if you have questions, or if you're not making progress the way you thought you would: ask. The PT is there to help you.Celebrate your successes. When you follow the plan, you should start to see a difference in a few weeks or months. Bouncing back from more serious surgeries may take many months or a year, but there will be milestones along the way. Take a moment to appreciate the difference from where you started! Sometimes, recovery can feel frustrating and slow — but it helps to stop and enjoy the successes, no matter how small they may seem.


Sorce: www.kidshealth.org

Lifting & Moving Patients

Thousands of patients are lifted and moved by EMTs and many EMTs are injured because they attempt to lift or move a patient improperly. A wide variety of patient conditions as well as circumstances affect how the patient is "packaged" for transport.

The expression "Lift with your legs and not your back." is a very important part of proper body mechanics. Always get as close to the patient as you can when lifting. Keep your arms and patient as close to your body as you can to help create leverage and maintain balance. Bend at the knees while keeping your back as straight as possible. Recognize your limitations and call for back-up when needed to lift patient.

Guidelines for Safe Lifting

1. Consider the weight of the patient together with the weight of the stretcher or other equipment being carried and determine if additional help is needed.

2. Know your physical ability and limitations. Know your combined ability with your partner. If absolutely necessary, you can ask bystanders to help. You or your partner must be in charge and give the orders, not the bystander.

3. Lift without twisting. Avoid any kind of swinging motion when lifting as well.

4. Position your feet shoulder width apart with one foot slightly in front of the other. Wear proper boots that go above the ankle to protect your feet and help keep a firm footing. Boots should have nonskid soles.

5. Communicate clearly and frequently with your partner. Decide ahead of time how you will move the patient and what verbal commands will be used. Also, tell the patient what you will be doing ahead of time. A startled patient may reach out or grab something and cause a loss of balance.

Guidelines for Lifting Cots and Stretchers

Most back injuries to EMTs can be avoided by following the following guidelines:

Know or find out the weight to be lifted.
Use a minimum of two people to lift, even if a one-person stretcher is being used.
Use an even number of people to maintain balance during the lift.
Know the weight limitations of the equipment you use. Know what to do if the patient exceeds the weight limitations of the equipment.
Use the power lift or squat lift position. Feet are shoulder width apart. Back is tight and the abdominal muscles lock the lower back in a slight inward curve. Distribute weight to the balls of the feet. Keep both feet in full contact with floor or ground. While standing, keep the back locked in, as the upper body comes up before the hips.
Use a power grip to get maximum force from the hands. Hands should be at least 10 inches apart. Palms face up and fingers in complete contact with the stretcher bar.
Lift while keeping your back in the locked-in position.
When lowering the cot or stretcher, reverse the steps.
Avoid bending at the waist.
Avoid twisting. "Feed" the stretcher into the ambulance while face across the patient.
Guidelines for Carrying Patients and Equipment

Whenever possible, move patients on devices that can be rolled.
Minimize the distance needed to carry patients
Know the weight to be carried.
Work in a coordinated manner with your partner.
Keep the weight as close to your body as possible.
Keep your back in a locked-in position and refrain from twisting.
Flex at the hips, NOT the waist, and bend at the knees.
Do not hyperextend your back (do not lean back from the waist).
Try to lift with a partner that has similar height and strength.
Guidelines for Safe Carrying on Stairs

One of the most difficult carries an EMT must do is carry a patient backwards up a stairway. Try to carry heavy patients up a stairway with two people at the top, shoulder to shoulder, and two at the bottom of the stretcher.

Always carry patients head first up the stairs and feet first down the stairs.
Try to use a stair chair if the patient's condition allows it. If a stair chair is not available, use a light but sturdy kitchen chair. If neither are available, use the extremity lift.
Keep you back in the locked-in position.
Flex at the hips, NOT the waist, and bend at the knees.
Keep the weight and your arms as close to your body as possible.
Guidelines for Reaching

Keep your back in locked-in position.
Avoid stretching or overreaching when reaching overhead.
Avoid twisting.
Keep your back straight when leaning over patients.
Lean from the hips.
Use shoulder muscles with log rolls.
Avoid reaching more than 15-20" in front of your body.
Avoid reaching and strenuous activity for more than 1 minute.
Guidelines for Pushing and Pulling

Push whenever possible rather than pull.
Keep your back locked-in.
Keep elbows bent with arms close to sides.
Keep the line of pull through the center of your body by bending your knees.
Keep weight close to body.
Push at a level between your waist and shoulders.
Use kneeling position if weight is below waist level.
Avoid pushing and pulling from overhead position.
Principles for Moving Patients

Emergency Moves

A patient should be moved immediately by an emergency move only when there is an immediate danger to the paitnet or the EMTs including:

Fire or danger of fire.
Danger of explosives or other hazardous materials.
Inability to protect patient from other hazards at the scene.
Inability to gain access to other patients who need lifesaving care.
Inability to provide care due to location or position.
Clothing Drag

1. Tie the patient's wrists together if you have something quickly available. If nothing is available, tuck the hands into the waist band to prevent them from being pulled upwards.

2. Clutch the patient's clothing on both sides of the neck to provide a support for the head.

3. Pull the patient towards you as you back up, watching the patient at all times. The pulling force should be concentrated under the armpits and NOT the neck.

Sheet Drag

1. Fold or twist a sheet or large towel lengthwise.

2. Place the narrowed sheet across the chest at the level of the armpits.

3. Tuck the sheet ends under the armpits and behind the patient's head.

4. Grasp the two ends behind the head to form a support and a means for pulling.

5. Pull the patient toward you while observing the patient at all times.

Blanket Drag

1. Lay a blanket lengthwise beside the patient.

2. Kneel on the opposite side of the patient and roll the patient toward you.

3. As the patient lies on their side while resting against you, reach across and grab the blanket.

4. Tightly tuck half of the blanket lengthwise under the patient and leave the other half lying flat.

5. Gently roll the patient onto their back.

6. Pull the tucked portion of the blanket out from under the patient and wrap it around the body.

7. Grasp the blanket under the patient's head to form a support and means for pulling.

8. Pull while backing up and while observing the patient at all times.

Bent Arm Drag

1. Reach under the patient's armpits from behind and grasp the forearms or wrists.

2. Use your arms as a cradle for the patient's head and keep the arms locked in a bent position by your grasp.

3. Drag the patient towards you as you walk backwards, observing the patient at all times.

Urgent Moves

Sometimes a patient must be moved more quickly than usual due to reasons of an urgent nature. Weather conditions, hostile bystanders, uncontrolled traffic, and rapidly rising flood waters are some examples of situations requiring an urgent move.

Procedure for Rapid Extrication

One EMT should be stationed behind the patient. Place one hand on each side of the patient's head to stabilize the neck in a neutral position. It is done as you begin evaluation of the airway.
The second EMT quickly applies a cervical spine immobilization device while doing a rapid primary survey.
A third EMT simultaneously places the long backboard onto the seat and, if possible, slightly under the patient's buttocks.
The second EMT supports the chest and back as the third EMT frees the patient's legs from the pedals and floor panel.
The patient is rotated in several short coordinated moves until the patient's back is in the open doorway and feet are on the backboard.
Another EMT supports the patient's head until the first EMT gets out and takes control of the cervical spine immobilization device from outside the vehicle.
The EMT team lowers the patient and slides the patient onto the board in short coordinated movements. Straighten the patient's legs and make sure the neck and back do not bend. Secure patient to backboard after the patient is brought back to the ambulance.
Nonurgent Moves

This is the most frequent type of move and the best way to make the move depends on the illness or injury, factors at the scene, and equipment and personnel resources available.

Direct Ground Lift

2-3 EMTs line up on the same side of a supine patient.
The EMTs all kneel on one knee.
Cross the patient's arms on the chest if injuries don't prevent it.
The EMT at the head places one arm under the patient's head and shoulders, cradling the head. The other arm is placed under the patient's lower back.
The second EMT places one arm directly below the first EMT's arm in the small of the patient's back. The second arm is placed under the patient's knees.
The third EMT (if available) slides both arms under the patient's waist. The other EMTs adjust their arms accordingly.
On signal, the EMTs lift the patient to their knees and roll the patient in toward their chests.
On signal, the EMTs stand and move the patient to the stretcher.
On signal, the patient is lowered onto the stretcher, which has been positioned at waist level.
Extremity Lift

This is only used when a spinal injury is not suspected. It is best used for short distances.

One EMT kneels at the patient's head and the other EMT kneels at the patient's side by the knees.
The EMT at the head reaches under the patient arms at the shoulders and grasps the patient's wrists. If the patient is unresponsive or uncooperative, the other EMT may assist by lifting the patient's wrists to within the reach of the partner. To improve stability, the patient's left wrist may be grasped by your right hand and their right wrist by your left hand. This crosses the patient's arms over their chest creating a more secure hold with less give.
The second EMT reaches under both knees with one arm and under the buttocks with the other arm.
The EMT's rise to a crouching position, then simultaneously stand and move with the patient to the stretcher.
Transfer of Supine Patient from Bed to Stretcher

Direct Carry

Position the stretcher at a right angle to the patient's bed with the head end of the stretcher at the foot of the bed.
Prepare the stretcher by unbuckling the straps, removing other items, and lowering the closest railing.
Both EMTs stand between the stretcher and the bed, facing the patient.
The EMT at the head end of the stretcher slides one arm under the patient's neck and shoulders, cupping the far shoulder with his or her hand and cradling the head.
The second EMT slides one arm under the small of the patient's back, slides the arm under the buttocks and lifts slightly to allow the first EMT to slide an arm under the waist.
The second EMT reaches under the patient's lower legs.
The patient is pulled to the edge of the bed, then lifted and curled toward the EMT's chest.
The EMTs rotate to be in line with the stretcher, then place the patient gently on to it.
Draw Sheet Method

Loosen the bottom sheet on patient's bed.
Adjust stretcher to height of bed, unbuckle straps, lower both rails, and remove all items from stretcher.
Place the stretcher against the side of the bed.
Both EMTs reach across the stretcher and grasp the sheet firmly beside the patient's head, chest, hips and knees.
Slide the patient gently across and onto the stretcher. If enough personnel are available, the patient may be lifted by grasping the sheet on both sides of the patient at the chest and hip simultanously.
Equipment for Moving Patients

Wheeled Stretcher

Two basic types of stretchers are used: the two-person and the one-person. The two-person requires two EMTs to lift and load in the ambulance, whereas, the one-person stretcher has special loading wheels at the head that allows one EMT to load it into the ambulance. Stretchers are usually adjustable to different heights and different angles. Some can be adjusted to elevate the legs (Trendelenberg position). Additional equipment may be attached to the stretchers including oxygen, IV lines, and cardiac monitors or defibrillators.

Guidelines for Moving Stretchers

Stretchers should be handled by two EMTs with both hands on the stretcher. Other personnel or bystanders may be asked to help carry additional equipment if necessary.
Never leave the patient alone on the stretcher.
Load the stretcher with the foot end first or going upstairs.
Position one EMT at the foot and one EMT at the head of the stretcher when rolling it. The EMT at the foot should pull while the EMT at the head should push.
Always maintain a firm grip on the stretcher when rolling to prevent a tipover.
Lower the stretcher and carry end to end if the ground is to rough to roll the stretcher safely.
Use four EMTs, one at each corner, when moving a stretcher across extremely rough terrain.
Turn corners slowly and squarely, avoiding sideways movements that might make the patient dizzy.
Lift the stretcher over rugs, grates, door jams, and other such obstacles on the ground or floor.
Keep the patient secured with belts at all times while on stretcher even if the stretcher is not being moved.
Loading the Ambulance

Place the head end of the two-person stretcher close to the bumper of the ambulance, and make certain it is locked at its lowest level.
The EMTs stand on opposite sides of the stretcher, bend at the knees while keeping their backs straight, and grasp the lowest bar of the stretcher.
Hands are positioned at each end of the lowest bar with both palms facing up.
On signal, both EMTs stand and move toward the rear of the ambulance until the front wheels rest on the floor at the back of the ambulance.
Roll the stretcher forward and guide it into the front of the stretcher catch. Then the foot end of the stretcher is locked into place.
NOTE: Load hanging and portable stretchers before the wheeled stretcher. Obstetrics patients may be loaded feet first so that it is easier to manage an impending delivery. Make sure that all patients and stretchers are secure before moving the ambulance.
Unloading the Ambulance

Unlock the latch at the foot end of the stretcher catch and pull the stretcher until the rear wheels are at the lowest end of the floor.
Grasp the lowest bar on each side of the stretcher with palms facing upwards as it is rolled out.
Once the head end of the stretcher is clear of the ambulance, keep the stretcher level and lower it to the ground by bending at the knees while keeping the back straight. The stretcher may then be raised by triggering the appropriate release handle.
Alternative. Once the head end of the stretcher is level and clear of the ambulance, the driver's side EMT may trigger the handle release and allow the base of the stretcher to slide down the legs of the EMTs. This method avoids the extra lift from the ground but requires the use of the main stretcher bar for lifting and simultaneous release of the handle.
Portable stretchers, or "folding stretchers" weigh 8-15 pounds and can carry a patient up to 350 pounds. They are more easy to use when carrying patients down stairs, down hill, or over rough terrain. It can be suspended from the ceiling with special brackets, placed on the floor, or secured to the squad bench.
Stair Chair

These are designed for patients that can sit up while being carried. They are useful for taking patients up or down stairs, or through narrow passageways. The patient must be transferred to the stretcher once back at the ambulance.

The extremity lift is used to place the patient in the stair chair. All belts and straps must be secured before moving patient. The patients wrists may be loosely tied to prevent grabbing onto fixtures and causing loss of balance when moving them. The chair is tilted slightly backwards to allow movement with the wheels on the chair.

Long Backboard

There are several styles of backboards:

Ohio is coffin-shaped to fit easily into a basket stretcher or helicopter.
Farrington is rectangular with rounded corners.
Aluminum are usually foldable but they can be uncomfortable in cold weather and prevent x-rays from being taken.
Miller is made of molded plastic and is strong and buoyant.
Vacuum molds to the patient once they are positioned in it.
The importance of a backboard is in spinal immobilization and moving the patient, especially during rapid extrication, and providing secondary support when using a short spineboard.

Short Backboard

This is used when a spinal injury is suspected and the patient is in a seated position. They made be made from wood, aluminum, or plastic. A vest type is also used when a patient is found inside a small car or place. It wraps around the patient and has all the straps attached or enclosed.

Scoop (Orthopedic) Stretcher

This is designed to easily lift supine patients. The stretcher is made of a rectangular aluminum tube with V-shaped lifts to "scoop" patients from the floor or ground without changing their position. Its greatest advantage is that it can be used in confined spaces where other stretchers cannot fit.

The scoop may be used to initially lift the patient with a suspected spine injury. The patient should then be placed immediately on a long backboard for immobilization. If no spine injury is suspected, the scoop can then be placed with patient onto the stretcher for transport.

The following steps are used with the scoop stretcher:

Adjust the length of the scoop stretcher on the ground beside the patient to accommodate the patient.
Separate the stretcher halves and place one half on each side of the patient. Do not lift equipment over patient.
Slightly lift the clothing on one side of the patient while another EMT slides one half of the scoop under the patient's side. Repeat on the other side. If a spine injury is suspected, another EMT must maintain cervical spine support at all times.
Lock the head end of the scoop in place, then bring the foot end together until the assembly is locked. If any resistance is met, have an EMT gently lift one side of the patient. This move prevents the patient's clothing from being caught or their skin from being pinched.
Attach the padded head strap. Use at least three straps to secure the patient to the scoop stretcher before lifting.
Flexible Stretcher

Do not use the flexible, or "pole" stretcher if spine injury is suspected. It is designed for the following uses:

limited access space
on stairs or around cramped corners
when other equipment is not available
Patient Positioning

EMTs should consider not only the best equipment to use but the position of the patient. The following general rules apply:

Unresponsive patients without suspected spine injury should be placed in the recovery position on their left side.
Patients with chest pain or difficulty breathing should NOT be walked to the ambulance.
Patients with suspected spine injury should be fully immobilized on a long backboard.
Patients with signs and symptoms of shock should have their legs elevated 8-12 inches.
Place the pregnant patient with hypotension on her left side.
Load the pregnant patient whose delivery is imminent feet first into the ambulance to allow for more room to work.
An infant's own car seat should be used if possible. It can be secured to the stretcher with the straps. It can also serve as an immobilization device with padding and taping.
Patients with head injury and no suspected spine injury should be transported in a semi-sitting position at about a 45 degree angle. This reduces pressure inside the skull and risk for increased bleeding.
Trauma patients with multiple injuries should always be transported on the long backboard to provide full body immobilization.
Use discretion when moving and positioning a disabled patient. Increased communication is necessary with visually or hearing impaired patients. Take extra care when securing patients with physical deformities. Use pillows, rolled towels, or other supports and padding to create a more comfortable position.
Elderly patients should be placed in a position that will be as comfortable as possible for their condition. Extra time and care with patients with conditions such as arthritis, osteoporosis, or other conditions is important to reduce risk of body injury.

Source:www.happerinstitute.com

Caregiving Skills

Helping to balance a checkbook or helping with grocery shopping are tasks most caregivers can easily do, but there are other, more difficult tasks that caregivers may not be prepared for. Learning the correct way to transfer a loved one from a bed to a wheelchair can help you avoid serious injury to yourself and the person you're caring for. Learning how to properly bathe someone with mobility problems can reduce the risk of hospitalization for chronic sores and infections. Unfortunately, family caregivers often do not receive the training they need, but there are resources available that can help.

How to Communicate Your Needs
Time Management Skills
Communicate with Insurance Company Personnel
Communicate in the Hospital Setting

In addition to the resources below, you should also talk to a doctor, nurse, or social worker about any caregiving tasks that you are uncomfortable performing or find difficult to perform.

The American Red Cross has developed a training program for family caregivers that covers the following topics:

Home Safety
General Caregiving Skills
Positioning and Helping Your Loved One Move
Assisting with Personal Care
Healthy Eating
Caring for the Caregiver
Legal and Financial Issues
Caring for a Loved One with Alzheimer's Disease or Dementia
Caring for a Loved One with HIV/AIDS
Contact your local Red Cross chapter for more information on this program.

Mather LifeWays, a Chicago-area company that provides community-based services and residential services for the elderly, offers a program entitled Powerful Tools for Caregivers. The program is designed to enable family caregivers to better care for their older relatives with chronic illnesses by improving their own self-confidence and self-care. Currently the program is only available in the Chicago area.

The Family Caregiver Alliance provides an overview of the day-to-day skills family caregivers need to care for the frail elderly or individuals with chronic conditions. It is available at http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=954.

The Center for Caregiver Training is developing a free online training course for family caregivers. The first three modules are currently available at http://caregiving101.org/LessonContent/html/introduction.asp.

The Arc of the United States has created a handbook entitled Family Handbook on Future Planning. The handbook focuses on planning for the future care needs of children with cognitive, intellectual, or developmental disabilities. The Arc also provides a Family Resource Guide with information on resources available in several states for families raising children with mental retardation and related developmental disabilities.



Source:www.familycaregiving101.org

A Guide to Nursing Homes

Skilled Nursing Facilities and Convalescent Homes


As the population ages, more and more of us are faced with the prospect of moving either ourselves or an older family member into a nursing home. It may be a decision that arrives suddenly after a recent hospitalization or you may have gradually noticed more and more needs becoming difficult to manage in other types of housing. The decision can be a stressful one for both the older adult and their family. Additionally, there are many misconceptions about nursing homes. It’s important to learn all you can about how nursing homes work, when a nursing home is the best option, and how to find the nursing home that is best for you or a loved one.

What is a Nursing Home (Skilled Nursing Facility)?
A nursing home is normally the highest level of care for older adults outside of a hospital. Nursing homes provide what is called custodial care, including getting in and out of bed, and providing assistance with feeding, bathing and dressing. However, nursing homes differ from other senior housing facilities in that they also provide a high level of medical care. A licensed physician supervises each patient’s care and a nurse or other medical professional is almost always on the premises. Skilled nursing care is available on site, usually 24 hours a day. Other medical professionals such as occupational or physical therapists are also available. This allows the delivery of medical procedures and therapies on site that would not be possible in other housing.

The label “nursing home” has negative connotations for many people. Yet nursing homes provide an important component of senior housing options. It's important to separate nursing home myth from fact.

Myths about nursing homes
If I can’t take care of myself at home, a nursing home is the only option. Today, there are many options to help older adults to stay at home, ranging from help with shopping and laundry to caregiving and visiting home health services. If home care options are no longer possible, other options, such as assisted living, may be a better fit if the primary need is custodial care rather than skilled medical care. Even if hospice care is being considered, home care is also often a possibility.

Nursing homes are for people whose families don’t care about them. Many cultures have strong beliefs that it is family duty to care for elders. However, in today’s world of smaller families living farther apart, work conflicts, and people living longer with more chronic illness, it simply may not be possible. Considering a nursing home does not mean you don’t care about your family. If you cannot provide the necessary care, it is the responsible decision to find a place where your family member’s needs will be met.

Nursing homes are poorly run, and I or my family member will get awful care. While it is key to research homes thoroughly and visit frequently, it is not true that all nursing homes provide poor care. There are more and more safeguards in place, and a facility’s staffing information and any previous violations are available to the public to help you make your decision.

Once I’m in a nursing home, I’ll never leave. Some illnesses or injuries have progressed to the point where both ongoing medical and custodial care may be necessary through the end of life. However, many people encounter a nursing home for the first time after a sudden hospitalization, such as from a fall or stroke. After rehabilitative care, either home or other housing options may be a better fit.

Living arrangements in a nursing home
The ambience and layout varies from nursing home to nursing home. For example, some rooms may be private and others shared. Rooms may have their own bathroom, or they may need to be shared with others. Some meals may be provided in the room, while others may be in a centralized dining area.

While nursing homes have traditionally been set up in a medically-oriented design, with ease of patient care being the primary goal, some homes are now moving to a newer design model. This features smaller communities of 10 to 30 people within a home, private kitchens, communal areas and continuity of staff.

When should I or a loved one consider a nursing home?
Whether you and your family are facing a quick decision about a nursing home due to a recent event, or have been coping with a worsening progressive disease such as Alzheimer’s or Parkinson’s, considering a nursing home is not an easy decision. Emotions such as guilt, sadness, frustration and anger are normal. Working through the possibilities of housing, finances, and medical needs can help you and your family make an informed decision.

Here are some questions to ask when considering a nursing home:

Has the senior been assessed recently? If a nursing home is being considered as the next step from a hospitalization, this probably has already been done. However, if a senior is considering a move from home or another facility, a more formal assessment by a medical team can help clarify the senior’s needs and see if other housing options may be a possibility.
Can the senior’s needs be met safely in other housing situations? The risk of falls may be too great, or the senior’s medical needs may no longer be able to be met at home or in another facility. If the senior needs 24-hour supervision, or is in danger of wandering off or forgetting about a hot stove, for example, a skilled nursing facility may be the best option. If the senior’s needs are solely custodial, though, an assisted living facility may be a better fit.
Can the primary caregiver meet the senior’s needs? Caregivers are often juggling the needs of work, other family, and their own health. It’s not possible for one person to be awake and responsive 24 hours a day. Sometimes other family members can help fill in the gap. Day programs, home care services, and respite care, where a senior temporarily stays in a nursing home, may also provide the support a caregiver needs. However, there may come a point where medical needs become too great and home care services are unable to bridge the gap or become too expensive.
Would the need for a nursing home be temporary or permanent? Sometimes, a temporary situation may be covered through home care, or family members might be able to rotate care on a short-term basis. However, if the level of care is expected to be permanent, this may be too expensive or coverage might not be enough.
Nursing home vs. other types of senior housing
Nursing homes provide some of the highest levels of care, both medical and custodial. If you’re not sure that you or your loved one need that level of care for the long term, learn more about other types of senior housing, including home care, to see what will best fit your needs.

Read: Choosing Senior Housing: A Guide to Senior Living Choices and Residential Care

Choosing a nursing home
Finding a nursing home
Finding the right nursing home is not easy, and you may be under pressure to move fast due to a recent hospitalization or deterioration in condition. The more information you have, the greater your chances of finding the right fit for you or a loved one. Here are some tips on narrowing down your options:

Start with referrals. Does your family physician or specialist have any recommendations? Or do you know any friends or family who have used different homes? Knowing someone with first-hand experience with a home can help you narrow your choices. However, remember your needs may differ: one size does not fit all.
Educate yourself. Online resources for nursing homes include ranking sites that utilize existing state data to rate nursing homes. Every state has what is called a long term care ombudsman, which can be a valuable resource about the current condition of a nursing home. Advocacy groups can also provide hints on searching for the right facility. See the resources section below for more information.
Consider your medical needs. Different nursing homes may have more expertise in different areas. Are they experienced in handling your condition of interest, such as for Alzheimer’s or a stroke? Or are you looking for more short term rehabilitation?
Factor in distance. In general, the more convenient the home, the easier it is for family and friends to visit.
Planning a visit
Once you’ve narrowed down your list of homes, it’s time to plan a visit. Visiting is key to understanding if a home is right for you. As with other senior housing options, it’s the people that make the place, both the residents and staff. In a nursing home, you’ll also need to make sure that the medical care is delivered appropriately and promptly.

What to look for in staff:

How is the staff turnover? What is the staffing level on weekdays, weekends and evenings?
Do they have time to speak with you or does it feel rushed?
How would they manage your health condition? How are medications and procedures arranged? And how do they handle emergencies or accidents such as falls?
Do they appear genuinely interested in you, and do you see them interacting warmly with current residents?
What to look for in current residents and their families:

Do the residents appear happy, engaged? Or excessively groggy and overmedicated? Do they seem clean and well groomed? Do they seem like people you’d enjoy getting to know? How do they respond to you? Try to observe social gatherings such as meals or other activities. If needed, are residents getting timely help to eat, and with getting to and from the gathering areas?
If you see a family visiting, you can ask them their impressions of the home and how their loved one has been treated. Ask if there is a family council and if you could attend.
What to look for in the facility:

Cleanliness. Does the facility appear clean? Do you smell urine or strong deodorizers that may be covering up the smell of urine?
Food. What kinds of meals are normally served? Does it look nutritious and appetizing? How are special diets handled? What kind of help is available with meals, and do they have to be eaten at the same time or in a common area?
Arrangement. Traditionally nursing homes have been run like a medical facility, including a centralized nursing station and set medication and mealtimes. Some nursing homes are now moving to a different model, with smaller communities and communal areas. If this type is available in your area, it may provide a more homely feel.
Activities. What quality of life activities are available for residents? Are outside activities also arranged as well, health permitting?
Experience with your condition. If a loved one has Alzheimer’s, for example, is there a special care unit or specialized staff and activities? How does staff handle behavioral problems like agitation, or wandering?
Understanding Nursing Home/Skilled Nursing Facility Costs
Nursing home costs are a big part of nursing home care and can vary widely depending on the state you live in. Average costs are around $70,000 per year so you need to know how you’re going to pay for nursing home care. It’s important to understand the limitations of insurance in covering costs:

Medicare only covers limited stays in nursing homes. Skilled nursing or rehabilitation services are covered for a period of about 100 days after a hospitalization. Medicare does not cover custodial care (such as assistance with feeding, bathing and dressing) if that is the only care needed.
If your income and assets are limited, you may qualify for Medicaid, which does cover most of the costs of nursing home care. However, not all nursing homes accept Medicaid. If you suspect that you may need extended nursing home care in the future, you may want to contact an elder law attorney to learn more about which assets are protected and to what extent. For example, if you have a spouse living at home, your home is normally not considered in eligibility for Medicaid for nursing home purposes, and some of your savings may be partially protected as well.
If you have long term care insurance, check the provisions of your plan to see what portion of nursing home coverage is protected.
The Resources section provides more information on managing and planning for nursing home costs.

What you may be feeling as you go through the process
Moving is a stressful transition, even at the best of times, and moving to a nursing home brings with it a whole host of different emotions.

If you are the one moving, you are leaving behind a familiar place and memories. If the nursing home move was due to a hospitalization, the transition may have been abrupt and you may not have had time to even process what has happened. Add to that increased medical needs and decreased mobility, and it’s no wonder moving to a nursing home can be so stressful. You may even feel angry and abandoned by family members, even if you realize that they can’t provide the required level of care. Anger and grief are perfectly normal emotions.

If a loved one is moving, you may feel guilty for being unable to provide care, or sad that your loved one has to go through this transition. You may feel relief that your loved one is getting the care they need, tempered with guilt if caregiving has been particularly intense. Family members may have been arguing about whether a nursing home is necessary, where it should be located, and who should be the point of contact.

Easing the transition
Everyone needs time. Both the older adult and his or her loved ones need time to adjust to this transition and come to terms with their own their feelings. Trying to sweep anger and grief under the rug or refusing to acknowledge the difficulties of the transition will only intensify these feelings.

The older adult takes the lead. As much as possible, the older adult should be the one making the decisions about which nursing home is best. Whenever possible he or she should come along on visits when making a nursing home decision, and make the choices about what to take along and how to personalize the room. If the older adult is unable, loved ones should try to think about what his or her wishes might have been. A familiar blanket or favorite music, for example, may provide comfort even if the older adult is unable to verbalize it.

Tips for loved ones
Keep in regular contact.ou live far away, frequent calls, letters and emails make a big difference. Regular visits by family and friends help ease the transition. Keep your loved one in the loop about family events as much as possible.

Stay involved. Regular contact not only reassures your loved one, but allows you to serve as an advocate for your loved one’s needs. Even if you’ve chosen the finest facility, you want to make sure your loved one’s care continues to be of the highest standard, so visit at irregular hours to make spot checks, and get to know the staff. The more engaged they feel you are, the more attentive they are likely to be towards your loved one. If the nursing home has a family council, a group of relatives and friends who meet on a regular basis to discuss concerns and issues, consider joining.

SourceP www.helpguide.org