Sunday, July 29, 2018

History of schools

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In the 1800s children were dressed like little adults and, in fact, treated like adults in that they were (in the lower classes) expected to go to work as early as 5 or 6. They were probably more serious than our children; working in a dangerous factory will knock lots of foolishness out of a child. There was no such thing as a teenager and no cult of children who need to be spoiled and entertained. Girls were often married at 15 or 16 and, in the middle to lower classes, boys were expected to decide at about 10 what trade they wanted to go into, so they could be apprenticed.
There was no standard or requirement for literacy; the boys in the upper classes were fluent in Latin, Greek, often French, with some Italian. They were heavily versed in the literary classics. Their less fortunate peers went to school when they could and often taught themselves after work.
Girls in the upper classes were literate and probably knowledgeable in light literature (poetry, novels, etc.) but were discouraged from learning anything more than "feminine accomplishments": playing the pianoforte, drawing, fine needlework.
Poor girls were lucky to be able to read, but often knew something the "better" girls did not: how to run a household.
These children were also raised with a greater presence of death. Dying in childbirth was fairly common and, since birth control was illegal and unreliable, childbirth was tough to avoid. It was rare for a mother, of any class, to raise all her children without one fatality.
Fathers were often killed in factory accidents--with no OSHA to monitor working conditions. The Victorians' repulsive methods of disposing of waste generated many of the fatal illnesses they suffered.
And many people died at their doctor's hands, being bled or "cupped" for all sorts of illnesses and complaints, or treated inappropriately for under-diagnosed symptoms.
I think this climate, in which responsibility was ever-present and mourning was big business, had to have a melancholy affect on children that, luckily, our children don't have.

In the early 1900s, the wealthy children attended private academies.  The schools were houses with a few rooms in them set aside for classrooms.  They were small, with only about three or four pupils in each grade.  One teacher taught several grades in just one room.  In the private schools, girls and boys were not together. They went to separate academies.
Some of the subjects the girls learned were reading, spelling, history, arithmetic, geography and penmanship or handwriting. Sometimes they learned manners and dancing, French, drawing and how to walk and act like a young lady.
The public schools, on the other hand, were free and mostly attended by the kids who were not rich.  Boys and girls were at the same school. There was a class for each grade level with about 20 to 30 kids in each class.
n 1904, children were supposed to go to school until the age of 16; however, most kids never finished the 8th grade.  They went to work in factories, farms and coalmines to help their families.  Some went to high school and a few went to college.  In those days, very few women went to college. Even the rich girls didn't all get to go to college.
From 1910 to 1940, high schools grew in number and size, reaching out to a broader clientele. In 1910, for example, 9% of Americans had a high school diploma; in 1935, the rate was 40%. By 1940, the number had increased to 50%.[ This phenomenon was uniquely American; no other nation attempted such widespread coverage. The fastest growth came in states with greater wealth, more homogeneity of wealth, and less manufacturing activity than others. The high schools provided necessary skill sets for youth planning to teach school, and essential skills for those planning careers in white collar work and some high-paying blue collar jobs. Economist Claudia Goldin argues this rapid growth was facilitated by public funding, openness, gender neutrality, local (and also state) control, separation of church and state, and an academic curriculum. The wealthiest European nations such as Germany and Britain had far more exclusivity to their education system and few youth attended past age 14. Apart from technical training schools, European secondary schooling was dominated by children of the wealthy and the social elites.
The United States chose a type of post-elementary schooling consistent with its particular features — stressing flexible, general and widely applicable skills that were not tied to particular occupations and geographic places had great value in giving students options in their lives. Skills had to survive transport across firms, industries, occupations, and geography in the dynamic American economy.
Public schools were funded and supervised by independent districts that depended on taxpayer support. In dramatic contrast to the centralized systems in Europe, where national agencies made the major decisions, the American districts designed their own rules and curricula
In 1975 Congress passed Public Law 94-142, Education for All Handicapped Children Act. One of the most comprehensive laws in the history of education in the United States, this Act brought together several pieces of state and federal legislation, making free, appropriate education available to all eligible students with a disability. The law was amended in 1986 to extend its coverage to include younger children. In 1990 the Individuals with Disabilities Education Act (IDEA) extended its definitions and changed the label "handicap" to "disabilities". Further procedural changes were amended to IDEA in 1997
No Child Left Behind, passed by a bipartisan coalition in Congress in 2002, marked a new direction. In exchange for more federal aid the states were required to measure progress and punish schools that were not meeting the goals as measured by standardized state exams in math and language skills.  By 2012 half the states were given waivers because the original goal that 100% students by 2014 be deemed "proficient" prov ed unrealistic
The education and job world that young people are entering is so different from just 15 or 20 years ago, it’s not even comparable. For the first time in history we have a truly global economy and global competition. It’s completely the opposite of the Baby Boomers’ experience. Then, America was the center of the world. The Second World War had made the U.S. the most advanced and powerful nation ever seen, while our most capable competition was buried in ash and rubble. Now, not only has the world caught up, it’s educated, connected and competing for U.S. jobs that were the exclusive right of U.S. workers just a couple of decades ago.
People are all over the map with blame — bad teachers, lazy students, distracted parents, video games, junk food — which tells me no one has any real answer. I just know what I keep telling my kids: keep your eyes, ears and options open and your priorities straight because the only living you deserve is the one you earn.

Monday, July 23, 2018

Help those with high blood pressure naturally

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Over 70 million Americans suffer from high blood pressure and a further 30 percent have prehypertension, making this condition extremely crucial to control.
“While health is important at any age, chronic insults to the arteries such as elevated blood pressure can certainly take their toll over time leading to increased risk for heart disease,” says Felicia Stoler, M.S., R.D., an expert consultant in healthy living who specializes in integrating behavior and nutritional modification to influence positive health outcomes.
“It’s important to schedule regular doctors visits, especially if you know you have a genetic predisposition to hypertension and monitor your blood pressure regularly with a home device,” she tells Newsmax Health.
While physicians are quick to prescribe medication to lower blood pressure, Stoler cautions that any medication can have side effects.
“Some people taking ACE inhibitors, for example, can have a dry cough while others suffer from dizziness and have an upset stomach. It’s important to try natural remedies first before diving into drugs.”
Stoler warns that high blood pressure is often called “the silent killer” because it rarely shows symptoms, so monitoring your numbers regularly can be life-saving. According to the American Heart Association, ideal blood pressure should be less than 120/80.
Here are some suggestions on how to lower or stabilize hypertension naturally:
  1. Choose foods low in saturated fat, trans fat, and sodium. Eat plenty of fruits and vegetables, fiber-rich grains, oily fish, nuts, legumes and seeds.
  2. Daily activity is important, says Stoler. “You don’t have to sweat or get out of breath in order to reap the benefits. Take a five-minute walk every hour at work, which can add up to 40 minutes of activity during an 8 hour day.”
  3. Fish oil supplementation. Fish oil omega-3 fatty acids have been shown to lower cardiovascular risk by reducing inflammation in the body and also reduce clotting time.
  4. Meditate. The American Heart Association released a recent scientific statement endorsing the practice of Transcendental Meditation as a valid technique to lower blood pressure. The report also said that the method was safe and had no side effects.
  5. Hawthorn. This herb is commonly used in Europe to lower blood pressure, says Ellen Kamhi, Ph.D, author of “The Natural Medicine Chest.”  “It improves blood flow and strengthens the contractions of the heart muscle.” In a British trial, this herb showed significant health benefits with a 1,200 milligram daily dose.
  6. Coenzyme Q10. This supplement lowers both the systolic pressure, when the heart is beating, and the diastolic pressure, when the heart is relaxed, says Kamhi. University of Western Australia research shows that taking 60 to 100 milligrams daily lowers blood pressure by up to 17 points.
  7. Aged garlic extract. A Brown University study showed that taking daily capsules of aged garlic extract lowers high blood pressure by 6 percent.
  8. Beet juice. Scientists at Wake Forest Baptist Medical Center found that a daily dose of beetroot juice significantly improved blood pressure in elderly patients with heart failure. It also boosted their exercise endurance levels by 24 percent after one week.

Saturday, July 21, 2018

Hearing aids can help those with dementia

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Chicago Tribune Health

Hearing aids might help increase memory, reduce anxiety and increase social interaction among dementia patients, local health experts say.

"Whether you have dementia or not, you need to hear," said Ronna Fisher, audiologist and founder and president of Hearing Health Center in Chicago and three suburbs. "It's not normal not to hear. Hearing is what makes us happy in our relationships. If you can't hear, you stop talking."

Improved sensory perception won't stop the progression of dementia caused by Alzheimer's disease, experts said, but increasing the ability to hear will help reduce a patient's loneliness and confusion.

The staff at Smith Village, a continuing-care retirement community in Chicago's Beverlyneighborhood, said it has noticed increased participation among residents who address their hearing problems.

"Getting hearing aids does help them," said Diane Morgan, memory support coordinator. "When their hearing is down, they experience paranoia or anxiety because they can't hear what's being said to them."

Fisher, whose father suffered hearing loss at an early age, said she began noticing in 2008 that when her dementia patients were fitted with hearing aids –– especially deep-insert hearing devices that remain in the ear for three months at a time –– they socialized more and their memories improved.

In a study released this year, researchers at Johns Hopkins Medicine and the National Institute on Aging found that seniors suffering from hearing loss were more likely to develop dementia over time than those who retain their hearing. Among other things, the research suggests that hearing loss could lead to social isolation, a risk factor for dementia.

The research should offer hope to physicians treating dementia patients, said Dr. Marsel Mesulam, director of th Cognitive Neurology and Alzheimer's Disease Center at Northwestern Memorial Hospital and Northwestern's medical school.
"Doctors and health care providers treating elderly patients should not throw up theirhands treating dementia," Mesulam said. "They can look at other factors that are treatable, like hearing loss or vision."

Alzheimer's is the most common form of dementia, a term used to describe the common symptoms of memory loss and declining cognitive abilities that interfere with daily life, according to the Alzheimer's Association. The disease accounts for 50 to 80 percent of dementia cases. Other causes of dementia include brain injuries, infections and tumors, and vascular, Parkinson's and other diseases that affect neurological function.

Nancy Rainwater, a spokeswoman for the Greater Illinois Chapter of the Alzheimer's Association, said that at the very least, a person's hearing loss might cause caregivers to assume there is dementia when there is not.

"Each patient is different," Rainwater said. "Get a formal diagnosis."

Naperville resident Debby Berger began taking her 86-year-old mother to Hearing Health Center last year. At the time, her mother's memory had declined. Since she has been fitted with deep-insert hearing devices, her memory has improved.

"Now that she can hear, if you tell her something, she remembers it," Berger said.

Thursday, July 19, 2018

Safety & Quality Pay Off

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Advance for long term care

By Sanjaya Kumar, MD

Safe, high-quality care is an imperative in the evolution of health care. Everyone involved in the care process, from patients to providers to payors agree on this point.
No matter what payment system, billing process or reimbursement policy is implemented, top-notch care is becoming the focus. At the core of a superior care environment is a consistent experience based on best practices and actionable knowledge.
Yet, as the entire industry is rapidly moving from process to outcomes-based metrics, most health care executives and senior staff are still ill equipped to make prudent decisions that help improve care while ensuring their efforts are operationally and fiscally sound.
Today providers make these decisions using a combination of partial data, past experience and trial and error. However, with technological advancement, better methods of decision-making are coming to the forefront. If implemented appropriately, these methods can rapidly change the paradigm of care and the overall performance of the health care enterprise.
One main barrier to this is that performance-enhancing, actionable knowledge resides within silos of data scattered throughout the health care IT environment. Integration of this information through business intelligence systems will enable health care executives to more effectively direct resources to improve patient safety and care based on hard evidence.

Out of Functional Silos, Integration of Clinical and Financial MetricsToday, clinically relevant data can more easily be associated with financial metrics. For example, pressure ulcers have always been considered a drain on resources, but proving this was cumbersome. Software enables patient populations to be easily separated into different cohorts (e.g., various stages of pressure ulcers). Likewise, analytics built into software enables length of stay (LOS) and costs incurred by each group to be analyzed.
The differences between the groups are typically wide, with extended stays and higher costs associated with those who have stage III and IV pressure ulcers. And if these are acquired while in the hospital, Medicare reimbursement is at risk. This of course is in addition to the burden on the patient, many of whom must subsequently be cared for in a rehab or skilled nursing facility.
There are many other examples of how integrated data can clarify and "prove up" where and to what extent investments in patient safety and quality should be allocated. High-risk, problem-prone activities, as well as those that are covered under accreditation standards, can be used as variables in the prioritization process. Research can also support decision-making regarding investment decisions.
An analysis of insurance claims data completed by the consulting firm Milliman for the Schaumburg, IL-based Society of Actuaries (SOA) revealed that five common medical errors accounted for 55 percent of total medical error costs in 2008:
  • Pressure ulcers, $3.86 billion ($10,288 total cost per error)
  • Postoperative infections, $3.66 billion ($14,548 per error)
  • Mechanical complications of devices, implants, or grafts, $1.13 billion ($18,771 per error)
  • Postlaminectomy syndrome, $1.12 billion ($9,863 per error)
  • Hemorrhages complicating a procedure, $960 million (12,272 per error)
Access to cross-domain, interrelated information on demand, with presentation in a context that makes sense based on the decision-maker's roles and responsibilities, is critical to supporting executive decision-making, the launch of improvement goals and the measurement of results. Analytics and reporting support teams as they delve into the processes and systems that need to be revised or redesigned.
In addition, the quality effort must be applied consistently across the entire organization to allow performance improvement to be measured enterprise-wide and across all domains.

Understanding the Technological FundamentalsHealthcare executives have long dealt with large budgets for IT systems, software and hardware. Today's newer technologies will support not just an individual organization, but also the healthcare continuum. To be prepared to review and evaluate these technologies, leaders must be have a basic understanding of the following concepts:
  • Cloud computing: this term refers to hosted services over the Internet and is broadly divided into three categories: platform-as-a-service (PaaS), infrastructure-as-a-service (IaaS), and software-as-a-service (SaaS). Among many advantages, these services provide access to a wide variety of service options and applications, the latest advanced application developments at a fraction of the cost of in-house development, and hosting on the most advanced platforms with the greatest computing power.
  • Integration and its complexities: With cloud computing services and their new, flexible and highly sophisticated technologies, the time-consuming and expensive task of integrating data across multiple tasks becomes considerably easier. This scheme provides match data types for the business owner with a map in place across all data types.

  • Role-based application architecture: Operating on the many-to-many principle, this architecture distributes data to many individuals from multiple sources. Each individual develops specific profiles with data access and permissions. To monitor metrics important to their role across clinical, operational and financial domains, users have the ability to customize their environment. This empowers and guides healthcare executives to make the most financially prudent and clinically sound decisions.
Next Steps for a Creating Clinical Business Intelligence EnvironmentNavigating the ever-changing tides of the health care environment and making driving a profitable, high-quality end result is not an easy task. Yet health care organizations have the data required to optimize performance and manage a financially and operationally efficient enterprise. As health care providers look to harness the power of business intelligence there are some key factors that deserve consideration. They include:
  1. Start with the end in mind. Setting a concrete vision for how a health care organization plans to implement and use a business intelligence system is critical to its success. Lack of vision will lead to numerous missteps and poor investment decisions.
  2. Choose the right technology platform. Health care providers need to review their environment and make sure the technology supports the overall vision. Technology for technology's sake will not yield the results desired from a business intelligence and decision support system.
  3. Drive cultural change. Ultimately, business intelligence solutions are used by staff to make critical decisions. Health care organizations need to ensure their organizations are prepared to take action with this knowledge. Clarity of roles and responsibilities and a supportive environment that encourages responsibility and accountability accelerate adoption and usage of this newfound intelligence.
  4. Implement checks and balances. Any decision support system needs constant monitoring to validate the use of the system and the decisions being made. Business intelligence is not a magic bullet to solve all your organizational issues. It is a systematic means of making informed decisions that should be monitored in terms of financial and clinical outcomes.
  5. Expect to fine-tune as you go. Implementing a business intelligence system is the start of a journey. Once the initial implementation takes place, health care providers will see a hundred other areas where business intelligence can be applied. They should expect this and make sure the technology used has the ability adapt and evolve with the needs of the organization.
Health care is at a crossroads. The intersections are safe, high-quality care, efficient operations and financially prudent decisions. Business intelligence, the technology, people and processes deployed will determine the level of organizational success in this endeavor. Every day health care providers wait to get moving is another day where profits and quality care are at risk.
1. Davis, C. (2010). Medical errors: Pressure ulcers and postop infections 

Tuesday, July 17, 2018

Using gratitude

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Use this information about gratitude is important and will have a positive impact on the people you serve

Gratitude is an appreciation of someone who has done something desirable, helped us, and done a good deed. Giving thanks to somebody gives them a good feeling of being appreciated.
There is no need to wait until somebody does something that we want for us in order to say thank you. This wonderful and enchanting phrase, "thank you", can be used every day, to express gratitude for the wonderful world that illuminates our morning with beautiful rays of the sun, gratitude for our loving and supportive family, and so on. Our awareness of the wonderful things that happen in our life will only become greater and more powerful and enable us to continue to receive more of what we already have.

Expressing gratitude calms the emotions. Expressing gratitude brings us into harmony and is good for the heart and soul. Expressing gratitude opens many doors to happiness, serenity and good health.
Sometimes we give thanks in our heart - very quietly.
The effective way to feel a sense of gratitude is to change our focus towards the positive things around us that are already taking place in our lives.
Expressing gratitude as a way of coping with bad moods
Sometimes we feel depressed and out of sorts. The circumstances can be many and varied, and sometimes there may be no real reason, just that we "got out of bed on the wrong side".
There are many beautiful catchphrases: "it is all in our own hands", or "don`t take any notice of what they say about you, know your own value". These things are good and true, but people who are in a black mood are not capable of hearing advice from others. When they feel that their situation is dark and gloomy, it is hard to persuade them by means of such slogans.

We all experience a wide range of emotions, we all fall sometimes into the pit of anger, hatred, competitiveness, jealousy and fear. One of the strongest tools for getting out of this maelstrom and letting go of these difficult emotions is to express gratitude.

Being thankful is a practical action, with the power to heal body and soul. It has a magical power that can bring us out of our state of "emotional emergency".
We have to find time during the day to give thanks for all the good things in our lives, from our functional limbs to the external environment in which we live. Expressing gratitude works like a magic broom: if said wholeheartedly, it will free us from the shackles of sadness and discontent. After we give thanks for everything that exists in our lives, we will certainly reach a place of emotional serenity and balance.
Even if somebody has, for example, insulted and hurt me, I have to make the effort to find something positive. It always exists. Sometimes awareness helps to improve things or to understand new directions.
Expressing gratitude and appreciation opens many doors.
When we thank others for their actions, they immediately feel like doing more for us. Expressing gratitude is one of our tools for enhancing and increasing good things in our lives.
In fact, it works like a formula:

the more we give thanks, the more we will receive of the things we are asking for.

Uses of mint

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Many residents love mint

Mother Earth News

MINT SPLASH Mint leaves (peppermint is especially good) in a pint of hot water for about ten minutes ... then strain through a sieve, let cool, and chill. When you need a lift, sprinkle yourself with this solution. You'll perk up! (The liquid is usable for several days.)
MINT RINSE. Prepare mint-water as above and add it to your bath water for a tingly wash, or use the solution as a final rinse after shampooing. It's also good as a mouthwash, an after-shave lotion, and a soak for tired feet.
BREATH PURIFIER. Simply chew a sprig of your favorite mint.
TEA. Steep 1 1/2 teaspoons of dried (or 3 teaspoons of fresh) chopped mint leaves in a cup of hot water. Sweeten to taste with honey, then sip slowly, breathing in the fragrance. (Think of green fields warmed by the summer sun.) For iced tea, simply serve hot mint tea "on the rocks."
MINTED VEGETABLES. During the last two minutes of cooking, add two tablespoons of fresh chopped mint (or one tablespoon of dried chopped mint) to each quart of peas, green beans, carrots, or cauliflower.
ZESTY SALAD. Toss together two cups of lettuce, two cups of lamb's-quarters (the herb, not the animal), two or three scallions (green leaves and all), a couple of sprigs of fresh marjoram or lemon thyme (chopped), and three tablespoons of fresh, chopped mint (more if you want, but be careful not to overpower the salad with mintiness). Serve with your favorite oil-and-vinegar dressing. (Yield: 4 servings.)
MINT-CHEESE SPREAD. Add a few minced mint leaves to cream or cottage cheese, mix well, and spread on wholegrain crackers or rounds.
MINTED FRUITS. Add chopped mint to applesauce, baked apples, or fruit compotes. (For a morning eye-opener, blend chopped mint with orange juice.)
Finally, you might want to try what I call "mint sniff." Bruise a mint leaf, raise it to your nose, and inhale. Do this whenever you've forgotten the beauty in the world ... and — believe me — you'll remember.

Sunday, July 15, 2018

How to prevent falls

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Every second of the day in the United States an older adult falls, making falls the number one cause of injuries and deaths from injury for this segment of the population.
According to the Centers for Disease Control and Prevention (CDC), in 2014 alone, older Americans experienced 29 million falls causing seven million injuries and costing $31 billion in annual Medicare costs.
Falling — the unexpected collapse to the floor or other surfaces —has been called the “next tsunami of health care problems” by leading podiatrist and fall prevention expert Dr. David Griffin of Kaiser Permanente Medical Group.

Falls are also the leading reason for emergency room visits by people aged 45 to 64 as well as older adults, Trevor Meyerowitz, PT, director of Rehabilitation for Preferred Physical Associates in Florida tells Newsmax. That results in 1.6 million ER admissions each year. And as Baby Boomers age, that number, too, will increase.

“There are many reasons that older adults are more prone to falling unexpectedly,” says Meyerowitz. “They develop muscle weakness, especially in the legs. Often the problem is poor balance when the brain fails to get the correct sensory input from the ocular system or the eyes, the vestibular system or the inner ears or the somatosensory system which involves the feet, muscles and ligaments relaying information back to the brain.”
Often seniors develop slower reflexes that cause them to trip over something and are unable to catch their fall in time, he says.
Surprisingly, closets are the number one location for falls.

“People can’t take their walkers in because the door is often too narrow, the lighting is poor and if they do lose their balance they put out their hand to catch themselves but can only grab onto hanging clothes,” he explains.
So the number one suggestion to prevent potentially deadly falls is to improve lighting throughout the house, adding nightlights especially on the way to the bathroom, he says. “Many of my patients fall at night on the way to the bathroom.”

  • Remove all clutter from the floor including towels in the bathroom, phone cords, and area rugs.
  • Use non-slip bath mats outside the shower or tub, and place non-slip strips on the floor of the shower or tub.
  • Install grab bars in the shower and toilet and use a shower chair to wash one’s feet.
  • Rearrange furniture in the home so that you can walk safely and unobstructed from room to room.
  • Do not use a footstool to reach items in the home. Place frequently used items within easy reach to reduce the risk of falling.
  • Some medications can increase your risk of falling. According to Harvard Medical School, these include antidepressants, blood pressure meds, anti-anxiety drugs, pain relievers and sleep aids. Don’t try to get up out of bed too quickly. Sit up and make sure you aren’t’ too dizzy to rise.
Meyerowitz says that you can improve your balance training with a physical therapist to increase muscle strength, flexibility, and reflexes. You can also do simple exercises such as standing on one foot and then the other for 30 seconds when brushing your teeth. Or sit on a chair and get up and down several times to build muscle strength and balance.
“You need to do your homework every day to reduce your risk of falling,” says Meyerowitz.

Monday, July 9, 2018

Brain Exercises for Dementia

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The Dementia Caregiver's Little Book of Hope [Kindle Edition]


Dementia, a condition affecting the brain, causes loss in memory and thinking skills. Dementia gets worse over time. The key is slowing down the progression of this condition. One way to do this is to engage those with dementia in mentally stimulating brain exercises. Exercising your brain throughout your life is beneficial if you succumb to dementia. After your loved one has dementia, the trick is finding the right activities so your loved one keeps functioning at the highest possible level.

According to a study published in the August 4, 2009, issue of Neurology, people who devote effort to activities that exercise the brain, such as reading, writing, and playing card games, may delay the rapid memory decline that occurs if they later develop dementia. The study found that for every activity a person participated in, the onset of rapid memory loss in dementia was delayed by 0.18 years.

"The point of accelerated decline was delayed by 1.29 years for the person who participated in 11 activities per week compared to the person who participated in only four activities per week," said study author Charles B. Hall, PhD, of Albert Einstein College of Medicine in Bronx, N.Y. This means start engaging in activities that exercise your brain.
Best Exercises
It is best to involve yourself all of Brain Exercises for Dementia

Saturday, July 7, 2018

Good news for activity directors

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Here is a great dementia resource for caregivers and healthcare professionals,

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Skilled Nursing News
Activity directors and non-certified nurse aides enjoyed the largest pay raises — on a percentage basis — of all skilled nursing employees between 2016 and 2017, according to the latest data set from the Hospital & Healthcare Compensation Service.
Among salaried employees, activity directors took the crown with a bump of 3.44%, or a rise from $39,520 to $40,878. Nurse aides saw the biggest increase of any hourly employees, with wages rising from $10.53 to $10.90 per hour, or 3.50%. Staff registered nurses had a bump of 3.33%, for comparison, while certified nurse aides only took home 1.47% more in hourly wages.
These are just a few of the takeaways from the report, which the Oakland, N.J.-based service compiles annually in conjunction with the American Health Care Association (AHCA). Using data from 1,970 participating providers across the United States, the report paints a detailed picture of skilled nursing wages and staffing in a variety of settings, from continuing care retirement communities (CCRCs) to traditional SNFs to independent and assisted living facilities.
Certified nursing assistants logged the highest turnover of any type of SNF staffer, with respondents reporting a rate of 38.8% — defined as the total number of vacancies, terminations, and resignations divided by actual positions. Registered nurses followed close behind with a rate of 35.7%, while dining services workers turned over at a rate of 35.1%. Top-level executives, meanwhile, had a rate of just 17.6%.
The data also show the gulf between compensation at nursing homes and pay at CCRCs: For instance, executive directors at CCRCs take in a full $40,000 more per year on average than their nursing-home counterparts, while hourly employees from licensed practical nurses and CNAs to dining staff routinely make less at nursing homes than in CCRCs: A cook can expect to bring in about $13.54 per hour at a CCRC, for example, as opposed to just $12 at a nursing home.
Written by Alex Spanko

Thursday, July 5, 2018

Changing your dementia unit

Activities directors and other healthcare professionals here is a great dementia resource for caregivers and healthcare professionals.

Here is information on being the best caregiver you can be

Here is a way for nurses administrators, social workers and other health care  professionals to get an easyceu or two

Follow alzheimersideas on twitter

Canada's Peel Region took a big risk, with a plan to transform its long-term dementia-care home, hoping that residents - and staff - could find joy and a purpose. Watch what happened! 

Here is the dramatic journey of a nursing home dementia unit that tries to transform itself from a cold, clinical warehouse for seniors to a home of laughter, warmth and love. Peel Region’s Redstone unit could serve as a blueprint for Ontario nursing homes at the same crucial time as baby boomers move into their vulnerable years.


Kenroy Foxe leaves his basement apartment in north Brampton, hops into his beat-up Honda and drives south for an afternoon shift at the nursing home where he will inevitably get punched in the head.

Kenroy is tired of being a human punching bag, taking jabs from residents. It’s a job hazard, for sure, but as he weaves his car through traffic, Kenroy starts thinking about the visiting dementia guru from England. His ideas seemed subversive at first but now Kenroy wonders, could they work?

By the time he arrives at the dementia unit, Kenroy has a plan for Fred, the 89-year-old whose fists hit hard. Kenroy does something that could get him fired in another home. It works so well that word of his success grabs the attention of the home’s senior medical director, upending his long-held notions of care.

(Kenroy Foxe works in Malton Village’s Redstone unit, the site of a year-long pilot program called the Butterfly program, which aims to transform care in nursing homes.) 

Kenroy’s epiphany is one of hundreds of small but momentous changes inside the Redstone unit at Peel Region’s Malton Village long-term care home. They could transform the way Ontario cares for its aging population, proving that a warm, lively nursing home is not that difficult to create.

Kenroy just doesn’t want to get hit. The fastest jab belongs to Fred, who doesn’t understand why Kenroy wants to pull down his pants and change his briefs. He gets scared and defensive. His tough side emerges, maybe from his years as a civilian mechanic with the Pakistani military, and he punches Kenroy.

Kenroy has been listening and learning. He decides there’s a better way. So one day in late August, he does what his original training forbids.

He hugs Fred. A big bear hug. Fred hugs him back. “Let’s go to the toilet Fred,” he says. They walk down the hallway, arm in arm.

“He hasn’t hit me since,” Kenroy says.

In September, before a council meeting, Peel's long-term care director Cathy Granger shows a note describing Kenroy's hugging solution to Dr. Sudip Saha, Peel's senior medical director of its five long term care homes. Dr. Saha also holds senior positions within the William Osler Health System, including medical director, division chief of seniors and senior medical director of long-term care.

...Now, Cathy watches Dr. Saha as she reads aloud from the note about Kenroy’s story. His face shifts. The next day, Saha tells her that the Kenroy-and-Fred solution could help people with dementia in Peel’s other homes and hospitals.

“I was pleased,” he says later, smiling. “Very, very pleased.”

See the complete article:
The Fix
One Peel nursing home took a gamble on fun, life and love. The most dangerous story we can tell is how simple it was to change.


Tuesday, July 3, 2018

Here it is New CMS Tag 679 Activities for Long-Term Care Facilities

Activities directors and other healthcare professionals here is a great dementia resource for caregivers and healthcare professionals.

Here is information on being the best caregiver you can be

Here is a way for nurses administrators, social workers and other health care  professionals to get an easyceu or two

Follow alzheimersideas on twitter


§483.24(c)(1) The facility must provide, based on the comprehensive assessment and care plan and the preferences of each resident, an ongoing program to support residents in their choice of activities, both facility-sponsored group and individual activities and independent activities, designed to meet the interests of and support the physical, mental, and psychosocial well-being of each resident, encouraging both independence and interaction in the community.]]

INTENT §483.24(c) To ensure that facilities implement an ongoing resident centered activities program that incorporates the resident’s interests, hobbies and cultural preferences which is integral to maintaining and/or improving a resident’s physical, mental, and psychosocial well-being and independence. To create opportunities for each resident to have a meaningful life by supporting his/her domains of wellness (security, autonomy, growth, connectedness, identity, joy and meaning). 

DEFINITIONS §483.24(c) “Activities” refer to any endeavor, other than routine ADLs, in which a resident participates that is intended to enhance her/his sense of well-being and to promote or enhance physical, cognitive, and emotional health. These include, but are not limited to, activities that promote self-esteem, pleasure, comfort, education, creativity, success, and independence. NOTE: 

ADL-related activities, such as manicures/pedicures, hair styling, 

GUIDANCE §483.24(c) Research findings and the observations of positive resident outcomes confirm that activities are an integral component of residents’ lives. Residents have indicated that daily life and involvement should be meaningful. Activities are meaningful when they reflect a person’s interests and lifestyle, are enjoyable to the person, help the person to feel useful, and provide a sense of belonging. 

Maintaining contact and interaction with the community is an important aspect of a person’s wellbeing and facilitates feelings of connectedness and self- esteem. Involvement in community includes interactions such as assisting the resident to maintain his/her ability to independently shop, attend the community theater, local concerts, library, and participate in community groups. 

©2018. F-TAG 679 ACTIVITIES. Fax# 757-552-0143. 2 Activity Approaches for Residents with Dementia 

All residents have a need for engagement in meaningful activities. 

For residents with dementia, the lack of engaging activities can cause boredom, loneliness and frustration, resulting in distress and agitation. 

Activities must be individualized and customized based on the resident’s previous lifestyle (occupation, family, hobbies), preferences and comforts.

PalliativeCareGuidelines.pdf NOTE: References to non-CMS/HHS sources or sites on the Internet included above or later in this document are provided as a services and do not constitute or imply endorsement of these organizations or their programs by CMS or the U.S. Department of Health and Human Services. 

CMS is not responsible for the content of pages found at these sites. URL addresses were current at the date of this publication. The facility may have identified a resident’s pattern of behavioral symptoms and may offer activity interventions, whenever possible, prior to the behavior occurring. 

Once a behavior escalates, activities may be less effective or may even cause further stress to the resident (some behaviors may be appropriate reactions to feelings of discomfort, pain, or embarrassment, such as aggressive behaviors exhibited by some residents with dementia during bathing16). 

Examples of activities related interventions that a facility may provide to try to minimize distressed behavior may include, but are not limited, to the following: 

For the resident who exhibits unusual amounts of energy or walking without purpose: 

• Providing a space and environmental cues that encourage physical exercise, decreases exit-seeking behavior and reduces extraneous stimulation (such as seating areas spaced along a walking path or garden; a setting in which the resident may manipulate objects; or a room with a calming atmosphere, for example, using music, light, and rocking chairs); 

• Providing aroma(s)/aromatherapy that is/are pleasing and calming to the resident; and • Validating the resident’s feelings and words; engaging the resident in conversation about who or what they are seeking; and using one-to-one activities, such as reading to the resident or looking at familiar pictures and photo albums. 

For the resident who engages in behaviors not conducive with a therapeutic home like environment:

• Providing a calm, non-rushed environment, with structured, familiar activities such as folding, sorting, and matching; using one-to-one activities or small group activities that comfort the resident, such as their preferred music, walking quietly with the staff, a family member, or a friend; eating a favorite snack; looking at familiar pictures; 

• Engaging in exercise and movement activities; and 

• Exchanging self-stimulatory activity for a more socially-appropriate activity that uses the hands, if in a public space. For the resident who exhibits behavior that require a less ©2018. F-TAG 679 ACTIVITIES. Fax# 757-552-0143. 3 stimulating environment to discontinue behaviors not welcomed by others sharing their social space:

 • Offering activities in which the resident can succeed, that are broken into simple steps, that involve small groups or are one-to-one activities such as using the computer, that are short and repetitive, and that are stopped if the resident becomes overwhelmed (reducing excessive noise such as from the television); 

• Involving in familiar occupation-related activities. (A resident, if they desire, can do paid or volunteer work and the type of work would be included in the resident’s plan of care, such as working outside the facility, sorting supplies, delivering resident mail, passing juice and snacks, refer to §483.10(e)(8) Resident Right to Work); 

• Involving in physical activities such as walking, exercise or dancing, games or projects requiring strategy, planning, and concentration, such as model building, and creative programs such as music, art, dance or physically resistive activities, such as kneading clay, hammering, scrubbing, sanding, using a punching bag, using stretch bands, or lifting weights; and 

• Slow exercises (e.g., slow tapping, clapping or drumming); rocking or swinging motions (including a rocking chair). For the resident who goes through others’ belongings: 

• Using normalizing life activities such as stacking canned food onto shelves, folding laundry; offering sorting activities (e.g., sorting socks, ties or buttons); involving in organizing tasks (e.g., putting activity supplies away); providing rummage areas in plain sight, such as a dresser; and 

• Using non-entry cues, such as “Do not disturb” signs or removable sashes, at the doors of other residents’ rooms; providing locks to secure other resident’s belongings (if requested). For the resident who has withdrawn from previous activity interests/customary routines and isolates self in room/bed most of the day: 

• Providing activities just before or after meal time and where the meal is being served (out of the room); 

• Providing in-room volunteer visits, music or videos of choice; 

• Encouraging volunteer-type work that begins in the room and needs to be completed outside of the room, or a small group activity in the resident’s room, if the resident agrees; working on failure-free activities, such as simple structured crafts or other activity with a friend; having the resident assist another person; • 

Inviting to special events with a trusted peer or family/friend; • Engaging in activities that give the resident a sense of value (e.g., intergenerational activities that emphasize the resident's oral history knowledge); 

• Inviting resident to participate on facility committees; ©2018. F-TAG 679 ACTIVITIES. Fax# 757-552-0143. 4 • Inviting the resident outdoors; and • Involving in gross motor exercises (e.g., aerobics, light weight training) to increase energy and uplift mood. 

For the resident who excessively seeks attention from staff and/or peers: Including in social programs, small group activities, service projects, with opportunities for leadership.

 For the resident who lacks awareness of personal safety, such as putting foreign objects in her/his mouth or who is self-destructive and tries to harm self by cutting or hitting self, head banging, or causing other injuries to self: 

• Observing closely during activities, taking precautions with materials (e.g., avoiding sharp objects and small items that can be put into the mouth); 

• Involving in smaller groups or one-to-one activities that use the hands (e.g., folding towels, putting together PVC tubing); • 

Focusing attention on activities that are emotionally soothing, such as listening to music or talking about personal strengths and skills, followed by participation in related activities; and 

• Focusing attention on physical activities, such as exercise. For the resident who has delusional and hallucinatory behavior that is stressful to her/him: 

• Focusing the resident on activities that decrease stress and increase awareness of actual surroundings, such as familiar activities and physical activities; offering verbal reassurance, especially in terms of keeping the resident safe; and acknowledging that the resident’s experience is real to her/him. 

The outcome for the resident, the decrease or elimination of the behavior, either validates the activity intervention or suggests the need for a new approach.

 The facility may use, but need not duplicate, information from other sources, such as the RAI/MDS assessment, including the CAAs, assessments by other disciplines, observation, and resident and family interviews. 

Other sources of relevant information include the resident’s lifelong interests, spirituality, life roles, goals, strengths, needs and activity pursuit patterns and preferences. 

This assessment should be completed by or under the supervision of a qualified professional.

 NOTE: Some residents may be independently capable of pursuing their own activities without intervention from the facility. 

This information should be noted in the assessment and identified in the plan of care. Surveyors need to be aware that some facilities may take a non-traditional approach to activities. 

In nursing homes where culture change philosophy has been adopted, all staff may be trained as nurse aides or “universal workers,” (workers with primary role but multiple duties outside of primary role)and may be responsible to provide activities, which may resemble those of a private home. 

The provision of activities should not be confined to a department, but rather may involve ©2018. F-TAG 679 ACTIVITIES. Fax# 757-552-0143. 5 all staff interacting with residents. 

Residents, staff, and families should interact in ways that reflect daily life, instead of in formal activities programs. 

Residents may be more involved in the ongoing activities in their living area, such as care-planned approaches including chores, preparing foods, meeting with other residents to choose spontaneous activities, and leading an activity. 

It has been reported that, “some culture changed homes might not have a traditional activities calendar, and instead focus on community life to include activities.

” Instead of an “activities director,” some homes have a Community Life Coordinator, a Community Developer, or other title for the individual directing the activities program. 

For more information on activities in homes changing to a resident-directed culture, the following websites are available as resources:;; and 

INVESTIGATIVE SUMMARY Use the Activities Critical Element pathway and the guidance above to investigate concerns related to activities which are based on the resident’s comprehensive assessment and care plan, and meet the resident’s interests and preferences, and support his or her physical, mental, and psychosocial well-being.