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Advanced Directives

Advanced Directives

Advance directives are legal documents that allow control over decisions such as what care should be provided when capacity to make decisions is lost. There are two primary types. Firstly there is a Living Will and secondly a Durable Power of Attorney for health care. These are recognized and defined documents by statute with the aim of providing a legal tool by which people can express their wishes. However, they are not the exclusive means available to express wishes. Any authentic expression of a patient's wishes should be respected.

An advance directive cannot be completed after a patient becomes mentally incapacitated and it does not become effective until after incapacity has been determined. If an advance directive has been prepared, an authorized surrogate must be identified to make medical care decisions.

A living will expresses a patient's preferences for end-of-life medical care. State laws vary greatly regarding scope and applicability of living wills.

A living will allows people to express preferences for the amount and nature of their medical care, from no care to maximum care. Detailed treatment preferences are desirable because they provide more specific guidance to practitioners. A living will cannot compel health care practitioners to provide medical care that is medically or ethically unwarranted.

To be valid, a living will must comply with state law. The living wills should be written in a standardized way. It should be appropriately signed and witnessed. Living wills go into effect upon (1) the loss of ability to make health care decisions or (2) the existence of a medical condition specified in the directive—typically a terminal condition, permanent vegetative state, or the end-stage of a chronic condition. State law provides a process for confirming and documenting the loss of decisional capacity and the medical condition.

Durable power of attorney for health care is a document in which one person names another person to make decisions about health care and only health care.

While a living will states a person's specific preferences regarding medical treatment, a durable power of attorney for health care designates an agent to make health care decisions. People who have both a living will and a durable power of attorney for health care should stipulate which should be followed if the documents seem to conflict. Because predicting future circumstances in all of their complexity is virtually impossible and because the durable power of attorney for health care designates a decision maker who can respond to here-and-now circumstances, a durable power of attorney is far more practical and flexible than a living will. The agent is granted the power to discuss medical alternatives with the physicians and make decisions if an accident or illness incapacitates the person. In most states, a health care practitioner involved in the care of the patient cannot serve as agent for health care matters, unless the practitioner is a close relative. The durable power of attorney for health care can include a living will provision or any other specific instructions but, preferably, should do so only as guidance for the agent, rather than as a binding instruction.

The durable power of attorney for health care should name an alternate in case the first-named person is unable to proceed the role for certain reasons. Two or more people may be named to serve together or alone. The use of the durable power of attorney for health care is valuable for adults of all ages. It is especially critical for unmarried couples, same-sex partners, friends, or other individuals considered legally unrelated who wish to grant each other the legal authority to make health care decisions and to ensure rights of visitation and access to medical information.

Physicians should obtain a copy of a patient's living will and durable power of attorney for health care. The contents should be reviewed with the patient while the patient is still capable, and make it part of the medical record. A copy of the durable power of attorney for health care should also be given to the patient's appointed agent and another copy placed with important papers. The patient's attorney should hold a copy of all documents.

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Techniques Expected to Change Health Care

health care

Dr. Mache Seibel, a professor at the University of Massachusetts Medical School uses music to promote health education. HealthRock® uses contemporary songs to convey lessons on how people can live healthier lives. They are encouraged to make common sense lifestyle changes. The technique uses a variety of musical genres from gospel to pop, he said.

The musical technique has won recognition for its effectiveness from many publications and organizations. It is available in recordings and live performances at the Centers for Disease Control and Prevention and elementary schools. The technique is available at other locations too, Seibel added.

HealthRock Addresses Chronic Problems

According to the CDC, chronic health problems, such as cardiovascular disease, cancer and diabetes are among the most prevalent, costly and preventable health problems.

“The fundamental problem is that 90 million American adults and most American children are health illiterate. They don’t know how to keep themselves and their family members well,” he said.

To address these problems, he wrote songs that targeted specific health-related illnesses, such as obesity. “Phat Fat Rap,” “Exercise” and “Don’t Be Afraid of a Squash” are meant to encourage exercise and eating habits that fight obesity.

Guided Imagery Reduces Difficulties

Kathryn Farinholt, a Catonsville, Md., resident, developed a four-step technique that teachers, nurses, supervisors and human resource people can use to deal with difficult employees, students and patients.

Farinholt, who holds a doctorate, created the Defusing Difficulties course and began teaching it to her American clients. Now, she is ready to market the technique to health care providers, educators and stress management teams.

“Defusing Difficulties is a stress reduction technique known as guided imagery anyone can master in four simple steps,” said Farinholt. “Some of my clients who have mastered the technique tell me the problem was reduced or went away or like it never happened.”

On Sept. 10-11, 2009, Farinholt presented her technique to the Mid-Atlantic Association of Community Health Centers 2009 Annual Meeting and Conference. The technique was well received. Farinholt plans to teach the course Oct. 15, 2009, at the Howard County Community College in Maryland.

Although Farinholt does not have a health background, she does have an educator background and has had situations dealing with difficult people. She developed the technique to help her cope with those situations without causing additional problems. Those who have mastered the technique have reported their difficult problems disappeared once they applied the technique.

To master the technique, Farinholt said, health care providers must give it three weeks. They are taught to try it three times a day. She also recommends parents and spouses to use the technique in family situations that are usually highly emotionally charged.

These are two techniques that could revolutionize treatment for medical problems or stressful situations.

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The United States Nursing Shortage Crisis

nursing

In The Desperate United States Nursing Shortage, we examined the statistics that define the nursing shortage in the U.S., particularly in California. Here, we will go deeper into the issues and offer possible suggestions.

There are so few spots available in academic nursing programs because there are just not enough educators. To be a nurse educator, you must possess a bachelor's degree, at the very minimum. A master's prepared educator is ideal. Additionally, all nurse administrators in hospital settings must be bachelor's prepared or higher as well. Hospital administration pays more than education, so the candidates that are qualified for both, often pursue administration. As hospitals become more expansive and service-oriented - which they must do to survive in this precarious industry - they will have to increase salaries to draw highly qualified administrators. This, in turn, increases the salary gap between hospital administrators and nurse educators even more.

According to Diana Christiansen, president of The Atticus Group, a health care consultancy, "In California alone, enrollment must expand by 90 percent to meet the expected need for nurses. However, nursing schools are struggling to hire the faculty to meet the current 16 percent expansion in place. And 2010 this is predicted to be the biggest year for nursing faculty retirement in history."

Consider the pipeline behind those retiring nurses. There aren't enough BSNs to replace the retirees, much less support a large expansion, which will be necessary to replace the Baby Boomers. "We know the nursing doctoral programs are expanding," says Christiansen. "But 50 percent of the people in the programs do not plan to teach. So, this whole expansion effort on the part of the schools is a house of cards."

Ideas for Nursing Recruitment and Retention

In order to recruit new nurses, hospitals need to develop an expansion or recruitment partnership with their supporting schools. Riverside Community Hospital (www.rchc.org) in Riverside, California and Long Beach Memorial Hospital (www.memorialcare.com/long_beach/) in Long Beach, California created proprietary partnerships with their local colleges and universities with nursing programs, which allowed the institutions to double their enrollments.

The other storm brewing and gaining strength is the aging of nurse leaders. Have those nearing retirement had replacements identified and are they receiving the education and support they need to be ready? It is already extremely difficult for nursing schools to maintain enrollments, and this will occur at the time hospitals and colleges are losing staff to retirements. Meanwhile, part of hospital expansion efforts include adding more and more beds, which again expands the nurse-to-patient ratio into a greater, desperate deficit. And the cycle continues.

Another issue is that graduates of two-year RN programs have their choice of jobs unpon graduation. After spending at least two years of completing prerequisite classes and general education, and perhaps idling at least a year on a waiting list, they are eager to get out and get to work. They know that for future advancement they will need their Bachelor's of Science in Nursing (BSN), but they feel they need to work first and they can eventually go back. Many never do.

Once they begin working, the nurse to patient ratios are extremely high. Why? The nursing shortage. When nurses come in they are often extremely excited to begin the careers that they trained so hard and sacrificed so much for. However, because of hospital politics, the high nurse-to-patient ratio and the stereotypical dynamic that rookie nurses are often treated badly by their senior counterpoints and patronized by doctors frequently leads to disillusionment and then burnout.

Develop Academic Partnerships

So what can be done? For starters, adises Christiansen, hospitals need to be aggressively proactive. A head-in-the-sand approach simply will not do. In essence, this has what has brought us to this potentially catastrophic brink as it is. "Hospitals need to partner with their academic institutions and develop innovative programs that will increase enrollment and nurture their nurses once they have entered the workforce." Christiansen adds that the first year of a nurse's career is the most tenuous. Many dropout and never come back to the profession.

Next, employee mentoring programs must reverse the traditional hospital culture. Like the residency programs that are essentially a baptism-by-fire, it's a catchphrase in the industry that nurses "eat their young." In other words, the veterans had to endure strict treatment when breaking in, why shouldn't this generation of rookies do the same? Well, because in the situation the industry is in, they simply cannot afford to lose a single, qualified nursing professional to such treatment. Their jobs are difficult enough as it is, as they struggle to accomodate the needs of their patients, the demands of the doctors and the rigorous policies of the hospitals - talk about your perfect storms ...

Educating and nurturing baccalaureate-trained nurses should be the utmost priority for any hospital that expects to weather this storm that is already causing a deluge of debt and devastation in hospitals in many regions of the country. California is particularly vulnerable because of its enormous population. Offering nurse educators comparable salaries is another step. Or, perhaps balance the two by allowing hospital nurses to teach one or two days a week, alleviating their burnout, while maintaining their salaries and allowing them to educate the next generation of nursing professionals.

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Health Care Reform in the United States

health care reform

T.R. Reid, the author of "The Healing of America: A Global Quest for Better, Cheaper and Fairer Health Care" recently wrote about the five myths that are fueling the debate for Health Care Reform in the United States, but the most persistent myth of all, he says is that "America has the finest health care in the world".

Perhaps this is why there is such a strong reaction to the current debate that is going on in Congress and in the country. Americans like to be the best and questioning or examining the present health care system magnifies the problems within it which seems to bring a sense of fear and vulnerability to many Americans.

What is Vulnerability?

According to the Livestrong.com website, one definition of vulnerability fits well in regards to the health care struggles for change: Vulnerability is the fear of being trapped or imprisoned in a situation where feelings and rights are ignored.

It seems that Americans are fearful that if changes are put into place for different health care options they will be trapped in some system that is worse than what currently exists. Fear is overshadowing the dialogues that are essential in order to make changes that are wise and workable.

The Town Hall meetings that have been held in cities and in towns throughout the United States are great examples of how vulnerability and fear interrupt discussions. This is what fear and vulnerability look like--people fighting with any emotional or irrational weapons that they are able to find. They are scared that a way of life in the United States will soon be gone.

The Reality of Health Care in the U.S.

The current health care system of private insurance companies is built on capitalism which means these companies exist to provide health care, but also to make a profit. This means that decisions about insurance coverage and approved medical procedures are often viewed from a fiscal standpoint more than a health care perspective.

The costs for medical care not covered by insurance or beyond the allowable limitscontinue to increase and often leads to bankruptcy. Steffie Woolhandler, MD, of Harvard Medical School surveyed 2,314 people who filed for bankruptcy in 2007 and found that 62.1% of the bankruptcies were medically related. A similar survey in 2001 found only 46% of the bankruptcies filed were medically related.

Medicare does provide care for those over 65 and those that are found to be disabled, but many people who are elderly, pay for supplemental insurance to be sure that they have more options and better coverage. Health Insurance costs for self-employed people is very expensive and if a pre-existing medical condition is present, it may not be an option at all.

The present health care system in the United States is not a model for other countries, because it is a system that is need of change. Fear of the unknown and a sense of vulnerability is overshadowing the realities of health care in America. The need for honest, open, rational dialogue about the present health care system is needed, but right now it may be too frightening for too many people for that to occur.

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About Medicare Gov and Healthcare Gov Open Enrollment Periods

Medicare gov’s OEP:

Medicare is a polity removed upbeat shelter information exclusive for grouping older 65 and over. The Medicare Gov information includes quaternary removed programs. The options feature same an ABC soup, including Part A and B (original Medicare), Part C (Medicare Advantage), and Part D (Drug Coverage). People crapper opt some organisation they like. The Medicare Open Enrollment Period is a punctuation when grouping crapper modify their Medicare Advantage and/or Part D prescription-drug plans. If you hit Original Medicare with a Medigap added organisation and are bright with it, you crapper ease verify a countenance at effort a newborn Medicare Part D. It is discreet to class around for deciding plans in your area.

Elaine Wong Eakin, Executive administrator of Calif. Health Advocates in Sacramento says, “People crapper tie a Medicare Advantage organisation or Part D medication take organisation for the prototypal time. If they are already in digit of these plans, they crapper switch. If they don’t poverty [the plans they currently have], they crapper un-enroll and go backwards to Original Medicare.” solon than 14.5 meg grouping or most 28% of the Medicare accumulation are registered in Medicare Advantage plans.

These plans unstoppered doors to seniors to obtain both Medicare Part A and B benefits though clannish upbeat insurers which contracts with Medicare. Part A organisation covers hospitalization, outpatient tending etc. Part D plans counterbalance the outlay of medication drugs that Original Medicare doesn’t clear for. In preceding years, unstoppered entering has been held from Nov 15 to the modify of December. In 2015 the OEP is Oct 15 to Dec 7, 2014. The modify was prefabricated in the assemblage 2011 to attain trusty that Medicare has sufficiency instance to impact beneficiaries organisation choices in time.

Medicare’s organisation D is a rattling favourite Medicare Supplemental Insurance Plan. So if you are eligible, then you crapper class for - and acquire a added Medicare policy.

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Healthcare gov’s OEP:

Like Medicare, Healthcare also has an entering punctuation to acquire upbeat shelter from clannish insurers. OEP for aid gov’s Healthcare Market Place in 2015 is between Nov 15, 2014 and Feb 15, 2015. If a mortal can’t acquire some organisation within this period, he or she won’t be healthy to acquire some organisation or renewed until the incoming OEP. NOTE: You crapper ease acquire upbeat shelter direct from clannish insurers at some instance during the year. Click on the unification at the modify of this article to study upbeat shelter rates. If a mortal is registered in 2014, his or her organisation module be modify on 31 December, 2014. In visit to move the underway plan, he or she has to restore or modify the organisation for 2015 during the instance of unstoppered enrollment. If digit decides to recruit between the 1st and 15th of a month, his news module move from the 1st period of the ordinal month. As for example, if you recruit on March 17, your upbeat shelter news module move from Apr 1st. A mortal haw recruit in the Children’s upbeat Insurance Program- CHIP or Medicaid at anytime. There are no instance barriers for these digit programs.

The mass dates are essential to recruit or acquire Healthcare Marketplace shelter during the OEP:

November 15, 2014: 2015 Healthcare Gov Open Enrollment module begin.

December 31, 2014: Coverage for 2014 Marketplace Insurance module end.

January 1, 2015: 2015 Coverage module begin.

February 15, 2015: 2015 Health Insurance Marketplace Open Enrollment module end.
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