Thursday, December 23, 2010

Thursday, October 28, 2010

AlfredHouse Eldercare



Baltimore, MD, October 21, 2010- This adorable two-level senior living home in Rockville, Maryland is close to Washington, D.C,, Baltimore and West Virginia. The home is well-staffed at a four-to-one ratio. Employees who work there are long-term staff who are committed to caring for you.

Alfred House Cashell Road is a licensed-nursing home with a light, family atmosphere, with spacial grounds and beautiful surroundings. Please call 301-460-6997 today, and ask us any questions about transitioning to a new home, overcoming challenges or any health concerns you or your senior-loved one may have and how we can help.

Online since 2001, Very Care Home Care and Assisted Living Directory has easily become the Nation’s #1 directory for nursing care facilities. Including Puerto Rico, Virgin Islands, Dubai, and Canada, Very Care is the most recognized, and most trusted, when it comes to finding care for loved ones.

We currently have 500,000 yearly, and come up in the top search-engines like Google, Bing and Yahoo. We are ranked 79,000 on, a website designed to provides information about websites including Top Sites, Internet Traffic Stats and Metrics, Related Links, Online Reviews, Contact Information, etc.

When compared to other directories, Very Care works because it strictly specializes in searching home care facilities, helping to maximize our search credentials. We currently work with over 44,000 facilities.

AlfredHouse Eldercare
AlfredHouse Cashell Road

Monday, September 13, 2010

Tuesday, April 20, 2010

When it comes to scoring the Activities-of-Daily-Living (ADL) measurement tool used in Nursing Homes and Assisted Living Facilities,

When it comes to scoring the Activities-of-Daily-Living (ADL) measurement tool used in Nursing Homes and Assisted Living Facilities, those who perform them without human assistance are known as Independent.

They (Nurses, Doctors, Administrators, Coordinators who assess), score the test based on the daily experience and not the ability to do it one time. This is also turned into documentation-evidence that is used in future decision-making meetings used to discuss the progress of the Elderly resident and if they need more or less care which means more or less dollars coming out-of-pocket.

The decision-making and ADL meeting can be a difficult one to discuss without getting defensive, but if we can remember to focus on the client/family member, it may help a little. A person who refuses to perform a function is still considered independent-based on the daily experience of the Elderly person.

These ratings are narrowed down to just 6 letters. Which letter are we?

A. Independent to feeding, bathroom control, transferring (getting up-and-down) and independent to dressing and bathing.

B. Independent in all categories but one.

C. Independent in all but bathing and one.

D. Independent in all but bathing, dressing and one.

E. Independent in all but bathing, dressing, going to bathroom and one

F. Independent in all but bathing, dressing, going to bathroom, transferring and one

G. Dependent in all functions.

Friday, April 09, 2010

how to pass the activities of daily living pt 1

The absence of a clear measurement tool between general health and type of long-term care required, specialist have focused their efforts on developing such tools. The most approached method is measuring the Activities of Daily Living or ADL’s.
The Katz ADL method is the one nursing homes and assisted living facilities use to determine how much assistance is needed for your senior-loved one. The better the Elderly person does in using this method, the LESS expensive the cost. The assessment instrument and classification method is the best-known and studied.

A Katz evaluation form will look like a checklist that covers 6 catergories.

Bathing-Sponge Bath, Tub Bath or Shower (pick one)

-receives no assistance in getting in and out

-receives assistance in bathing only one part of body (like a back or leg)

-receives assistance in bathing more than one part or not bathed

Dressing, getting clothes from closet and drawers, putting on undergarments, outer garments and using fasteners AND body braces if used (pick one)

-gets clothes and gets completely dressed with no assistance

-gets clothes and gets dressed without assistance except for assistance in tying shoes

-receives assistance in getting clothes or in getting dressed or stays partly or completely undressed

Toileting, going to the bathroom (pick one)

-goes to the bathroom, cleans self and arranges clothes without assistance but may support (cane, walker, wheelchair, can empty commode in morning)

-receives assistance in going to the bathroom, or in cleansing self or arranging


-doesn’t go to the bathroom for the elimination process

Transferring (pick one)

-moves in and out of bed and chair without assistance (may use support like a cane, walker, wheelchair)

-moves in and out of chair, bed with assistance

-doesn’t get out of bed

Continence Level (pick one)

-Controls urination and bowel movement completely by self

-has occasional accident

-supervision helps keep urine or bowel control, or a catheter is used or incontinent

Feeding (pick one)

-Feeds self without assistance

-feeds self except for assistance in cutting meat or buttering bread

-receives assistance in feeding or fed partly or using tubes

Tomorrow, how they score each of the six categories to determine assistance needed.

Friday, April 02, 2010

Ted Hose, what are they?

Ted Hose, What are they?
Compression socks, are also called Ted Hose. If your family member has ever had swollen feet, ankles or legs due to edema (when water swells), Ted Hose are the answer.
Ted Hose come in different compression settings and can come in High, Med or Low compression. High compression means the sock or tights will come very, very tight and are a bit more difficult to put on, than a low compression. A physician may also prescribe the compression setting depending on the swelling as well as other factors.
Putting on compression socks:

1. Do not tear the skin of the Elderly person you are putting the Ted Hose on.

2. If they are able to, have the person lay down on their back and put their feet on the bed. It’s easier to put the Ted Hose on before dressing.

3. When putting on the Ted Hose, make sure the skin is dry to avoid moisture against the skin.

4. Completely stick your thumbs into the sock and spread the sock as much as you can. As you get ready to place the Ted Hose on the foot, make sure you concentrate on getting the toes into the Ted Hose first and make sure you are pulling the sock up while you make sure the skin isn’t folded when pulling up the sock.

The sock is never loose but is very, very tight. Sometimes it helps to roll the sock over the foot and then roll the stocking up the leg as it hugs the foot or leg.

Thursday, March 25, 2010

the Why Technique

Why technique. A simple took used to analyze and approach problem solving. The Why Technique is used to ID potential and preventable root cause or a reoccurring problem

1. Focus on the problem

2. Ask “Why did this problem occur?” , to uncover first-level causes.

3. Repeat asking “Why did this problem occur?” for each cause to uncover a next layer cause.

4. Strive to uncover multiple causes for each level

5. Continue to ask “Why?”, until the root cause is identified

Thursday, March 11, 2010

If you are a non-planner or a risk-chooser, its very possible to end up in the worst nursing homes or become the greatest burden to your children.

The path to long-term care planning is the hardest issue you will face. The toughest and biggest boundary saved for the final days of our lives…tada it’s healthcare! But with proper life choices, it is very possible to position yourself for a fulfilling end-of-life.

End-of-life, if it seems far off, this article is not for you. If you are a non-planner or a risk-chooser, its very possible to end up in the worst nursing homes or become the greatest burden to your children.

Not very uplifting news? Here is one way to overcome healthcare obstacles during our end-of-life. The step to care planning begins with a label. Are you a non-planner, pre-planner, planner or risk-chooser?

First, could DEPENDENCY ever happen to you? Does your care-plan start with a perception of vulnerability?

Second, should you concern yourself now? Those who say yes, have a perception of timeliness.

Third, is it your responsibility? Will you place a burden on your family, others or the government?

Fourth, who has control of your healthcare? Who assumes responsibility for your future care? Is it you or is your fate in the control of others?

Do you have adequate information and is your perception of resources imagined or calculated? Do you have an understanding of options, programs or eligibility requirements?

Do you have the needed resources? Will your burden be shared by your family, church, insurance, government and medical? Or will you place the weight on one of these only?

Areas of planning involve financial, social and comprehensive. Perceiving that one might need long-term care is NECESSARY to begin planning according to Suzanne R Kunkel and Valerie Wellon et al.

Without a perception of personal relevance, all relevant information, ideas and scare tactics, will be regarded as “stories about others.” Not all focus group participants demonstrate a sense of vulnerability to long-term care dependency, BUT ALL ACKNOWLEDGE THEIR OWN MORTALITY.

Non-planners never think about the possibility they might be vulnerable. Many nursing home residents find themselves “surprised” to need long-term care. A good-healthy, active lifestyle and history of family longevity of non-planners, contributes to a sense of invulnerable to dependency

What triggers a sense in pre-planners, planners and even risk choosers? Some planners have witnessed examples of planning now and some have witnessed consequences of waiting until it’s too late. Some think that the responsibility for their care is the family’s and they are unlikely to take personal responsibility. Some say that in OUR family, “every generation” we will never live with our children.

Participate in Pre-planning activities? More tomorrow.

Thursday, March 04, 2010

Bed sores come in stages and always start with a small-red skin breakdown of some type.

Bed sores are also call Decubitus or decubes. Bed sores come in stages and always start with a small-red skin breakdown of some type.

This small-red patch starts from low blood circulation, low activity levels with long periods of bed rest or wheel-chair bound with long periods of sitting. I do not know if medication can increase the chance of skin breakdown.
I do know this, when you see skin irritation on an Elderly person, when you see bright-red marks that resemble folds or pinches of skin, you MUST address the issue or it is guaranteed the skin will breakdown. You have 1-2 days to fix the problem to avoid the bed sore from breaking out or getting worse.


1. Massage the skin around the bed sore. Cream and air are necessary to heal. Air is necessary to dry the sore, since what caused the sore is most likely PRESSURE, DAMPNESS and DARKNESS.

2. Release the pressure, which means often moving the Elderly person and adjusting them to position every 1-2 hours and document. Release the pressure means moving the are or leg constantly to avoid resting directly on the bed sore.

3. Use pillows or foam to create a pocket of air used to alleviate any pressure on the wound.

4. Give the resident plenty of water and though they might not want it, they must continue to hydrate.

A bed sore can tear your skin down but it is also despairing to have a wound on your skin that shouldn’t be there. And too often, the Elderly person is battling many issues and just one small bed sore can take someone to the point of AMPUTATING a leg. It happens everyday. Do not neglect a wound or bed sore EVER EVER EVER.

Tuesday, March 02, 2010

Will YOUR choice be inflicted on you as in many Elderly lives today?

So I wrote an article on bedsores a few years ago and I can’t find it, so this is what I remember. Have you ever sat still while watching TV or a movie and your feet or leg falls asleep. One reason this occurs is due to the lack of blood circulation in the extremities.

Now when you go to bed, do you know why we shift during the night? Its our body telling us to reposition ourselves to better regulate blood-flow, adjusting when necessary.

Before I talk about bed sores, let’s talk about choice. You can choose to exercise or walk during the day more to better regulate the flow of blood. You can choose to drink more water when you have a headache (which sometimes helps).

Now what if your great-grandparent or grandparent was bed-ridden in bed 18 hours a day? How would you give them choice? When you are old, do you want choice? Will you get lucky and get someone like me to help you? Will YOUR choice be inflicted on you as in many Elderly lives today?  to be cont.....

Friday, February 26, 2010

Working for plenty of Elderly men and married couples who have retired, I learned a few practices....

Working for plenty of Elderly men and married couples who have retired, I learned a few practices that they do when couples are together.

Conversation: Mrs. W to her husband,” How did you sleep?” to which Mr. W replies,

”Morning dear, I slept horribly (by the way this is at 5am). Victor and I had to get up 4 times to use the bathroom and I almost fell the third time. Boy this aging thing is for the birds!”

Mrs. W asks,” What time is your doctor’s appointment?” Mr. W replies, ”It’s next Monday, but today I need to find an insurance paper I have somewhere in the office.”

Victor says, ”I can get that for you Mr. W!” To which Mr. W replies, “No thanks Vic, I can do it, but can you bring me some soup at noon so I can eat while I read?” Victor knowing very well Mr. W won’t eat in his office, much yet look for the paperwork.

Victor says,” Yes sir, what would you like for breakfast?” When Mrs. W turns and says, “I’ll bring it to him Victor, you’re so kind, we will call for you when he’s ready to dress.” See at home health, people eat and then dress, but when you move to a home or facility, it’s dress then eat.

While Victor heads back to Mr. W’s office where he is set up to stay during his workshift, Mr. W, says, “So what else do we have to do today?” “Nothing” replied the wife, “now eat your breakfast dear, I’m to market to get some vegetables for dinner!” It’s 7am.

Thursday, February 25, 2010

Walkers, which are the best?

Walkers, which are the best fit? So if you ever need to use a walker, most likely a nurse or physician has diagnosed that you need some type of assistance with your gait. A walker gives the user the opportunity to maintain a straight gait (they way you walk) by allowing the user to hold on to the handlebars of the walker which is used to help you hold your head up by supporting your arms and taking weight off your foot.

The top of the walker should reach the users wrist when they are standing up. Most walkers can rise and lower by a release switch or metal push-in-buttons. Some walkers are made to sit on when you are not using the walker to ambulate. This fold-down chair is only used for short periods and is not used to sit on while transporting someone to get them somewhere faster.

Another helpful tool is the tennis ball which absorbs the vibration of the metal walkers and is used on the BACK of the walker by placing them over the back feet and used as sliders. You can also purchase hard-plastic sliders or you can also put wheels on the BACKS of the standard foldout walker which assist in getting over curbs and obstacles. Make sure a person who used a wheeled-walker is strong enough that the wheels won’t slide from underneath the resident.

They make 4-wheeled walkers but these are acceptable only if the person can use a hand-brake. All 4-wheeled walkers come with a hand-braking system. The best walkers are made in Sweden and are costly.

Tuesday, February 23, 2010

Remember, the more activities of daily living you can do alone, the lower your cost of entering a nursing home, assisted living or senior living.

Activities of Daily Living includes Ambulation, Pain Management, Alert to Person/Place/Time, Dressing, Eating and so forth.

Activities of Daily Living can be looked at in three ways. 1. Through the eyes of the actual person (the Elderly client/customer), 2. Through the eyes of the Nurse/Decision Maker, and 3. Through the eyes of the caregiver who assists the Elderly client.
What is an activity of daily living (ADL)? Imagine yourself in bed and only the left side of your body works and you are right-handed. You need to get up to go to work, so this usually means going to the bathroom, a shower and shave, right? You then need to get dressed and eat, before you drive to work.

-       To the caregiver, this is how we are to engage our Elderly client, as if every activity of daily living is important. Some residents will only be able to do one ADL on their own, and need assist with the rest of them. So lets say then can shower by themselves, well that is one ADL you can use to maintain their dignity. Instead of washing an Elderly client’s hair, verbally coach them and remind them how to do it themselves.

If they cannot, you an verbally tell them step by step what you are doing, I mean, don’t be weird about it, but let them know, “hey there, I’m about to wash your hair, wanna hold the bottle?” Engage them.

-       Through the eyes of the Nurse or Decision-Maker, aka management, an ADL is an opportunity to measure how much assistance this new client is going to need.

A functional assessment is necessary and the goal in providing care is the maintenance or promotion of ambulation(walking) and independence. Measuring the amount of ADL’s a client can do, assists in measuring cost from a management view and the amount of help necessary to meet those needs diagnosed by the nurse and team.

We must remember reimbursement for physicians who work with the Elderly is low.

-      Through the eyes of the ACTUAL RESIDENT, the person who we are responsible for in our duties, I cannot speak about. I can only say, it is our job (so that when we need healthcare) to make healthcare with the greatest quality, at a low cost, to serve the greatest numbers. But in truth, you only get two out of three.

Remember, the more activities of daily living you can do alone, the lower your cost of entering a nursing home, assisted living or senior living.  Thank you to Quality Care in Geriatrics Settings by Paul R Katz, Robert L Kane and Mathy D Mezey whom I used 2 sentences from their book!

Monday, February 22, 2010

Alzheimer’s Unit, Memory Unit and Reminiscence Hall or neighborhood...

Alzheimer’s Unit, Memory Unit and Reminiscence Hall or neighborhood are some of the terms you will see and hear when shopping for a retirement home, assisted living or nursing home. Many residents who have stage-one Alzheimer’s, will still function very well and need minimal if any, verbal cues (reminders).

What type of people will you see in a memory-impaired, reminiscence or Alzheimer’s unit? In a Reminiscence unit, you will see a variety of races, both genders with varying backgrounds. A Reminiscence unit will have people who are not alert to either person, place or time or any combination thereof.

Being alert to person means if you ask someone who they are, they do not struggle to remember their first and last name. Being alert to place means you ask someone where they are, the person can tell you what location they are at or what city they are in currently.

Last, being alert to time means if you ask someone what time it is and they can tell you the date, another way to determine is someone is struggling with time is to ask them who is the current President of the United States?

Being alert to person, place and time is only an indicator used to measure what type of assistance best serves the Elderly person. There are many people with Alzheimer’s who are not alert to person, place or time, but still live flourishing lives.

Friday, February 19, 2010

king kong john barry remix i did during the storm

king kong john barry remix i did during the storm.

The alien and the administrator

“But I don’t want to go among mad people,” Alice remarked.
“Oh, you can’t help that,” said the Cat: “we’re all mad here. I’m mad. You’re mad.”
“How do you know that I am mad?” said Alice.
“You must be,” said the Cat, “ or you wouldn’t have come here.”
-Lewis Carroll

Thanks to the Gardner Report for the premise:

Imagine a strange alien from Planet Mars, intelligent but unfamiliar with our ways, walks into a hospital and starts a conversation with the Administrator.

“Greetings! I am new here, what happens in this fine institution?” asked the Space Traveler. The Administrator explains that people who are disabled by illness or injury come here for skilled examinations and judgments to determine PRECISELY what is wrong.

“This often requires great delicacy and wisdom to combat the disability.” Said the Administrator. “Wowzers!” Exclaims the Alien, ” And as the Administrator, the man in charge here, you make all the judgments and order these procedures yourself?”

“Uhh, No,” replied the Administrator, “That is the function of people we call Physicians, who qualify for these roles by long periods of intensive training and observation.”

The Alien visitor stated, “I see, the Physician then, must make many decisions that determine how your resources are used and what work your people do.”

If anything, the Physican also decides which patients to admit and when to dismiss them, thought the Administrator. “So, these Physicians,” said the Alien, “ where do these important people stand in your organization?”

Administrator-“Actually, they stand outside the organization, they are engaged and paid by our customers and a 3rd party, but they must observe our organizational rule and we, by tradition, must not interfere or seek to influence their decisions, and they must pay to insure themselves from lawsuits from those they serve.”

“But you must be joking!” said the Alien, “As anyone can plainly see, such an arrangement would be impossible to manage.”

The Administrator acknowledged it wasn’t easy as the Alien left it said. “Impossible!”

Thursday, February 18, 2010

Senior Day Centers

Senior Day Centers play a vital role to the senior community. A senior day center is more than a place where you go to watch TV. The ideal Day Center is not the solution to your family problems. You are the solution to your family problems.

You are the solution.

A Senior Day Center is a business where profit margins are low and caring hearts are plentiful. The Senior Day Center is not the solution to your problems. Very often the staff may or may not have a high school degree and the management may be a new graduate or it may be someone who has worked there 20 years.

The Senior Day Center will focus on your parent or loved one with the greatest possible resources allowed, but it will never compensate for the guilt of the family who leaves a family member there. No one wants to be at a Day Center, other than the staff, who are paid to be there by a non-profit, for profit or the rare individual who owns their Elderly-Serving Business.

The Day Center in your neighborhood is a resource; golden and fresh. EXPECT them to share your burden and they will. They are healthcare at its purest form, they meet a need with the greatest resources available to them. Have patience with the Senior Day Center, they are the mother Theresa of our particular healthcare industry.

They will share your burden but they are not the solution. You are the solution.

Wednesday, February 17, 2010

Nursing Homes

The term nursing home is a broad term and means many things to many different people. Nursing homes, to many people are perceived as places where one goes to die. “As institutions, they were properly seen as the choice of last resort” (Pratt: 2004 70). The National Center for Health Statistics (NCHS) defines a nursing home as a “facility with three beds or more that is either licensed as a nursing home by its state, certified as a nursing facility under Medicare or Medicaid, identified as a nursing care unit of a retirement center, or determined to provide nursing or medical care” (Evashwick 1996: 44).

As the years have gone by, nursing home care, the facilities and the quality of care has greatly improved. Nursing homes are now commonly referred to as rehabilitation centers, skilled nursing facilities, health care centers, etc. according to Nancy Ferrone (2010). However, while much has changed over the years, there will always be issues that need to be addressed regarding nursing homes.

Nursing homes have evolved greatly since the beginning of the 20th century. According to Linda Zinn (1999), there were many fortunate elderly during the early 20th century who had families who were able to care for them. Others may have been cared for by religious or ethnic communities. However, those who were less fortunate often found themselves in poorhouses. “And poor it was in every way: poor (if any) sanitation, poor food, poor clothing, poor sleeping arrangements, no nursing care and little, if any, medical care” (Zinn 1999: 22).

The non-profit homes which were sponsored by churches and other services for the communities did offer more quality care to those who were in need of housing and other services, but they (like the poorhouses) did not provide nursing care in the very early years according to Zinn (1999). As the years went on, these “nursing homes” evolved and grew out of the early charity-based forms of care. “They really came into their own, however, when the federal government became involved with assisting the needy, beginning with passage of the Social Security Act in 1935” (Pratt 2004: 70).

Nursing homes provided an institutional alternative to extended hospitalization. Hospital stays began to increase in price and therefore there became a need for less expensive places of care. “Nursing homes also served (and continue to serve) as homes away from home for the elderly and others needing assistance with daily activities and some level of medical care merely to survive” (Pratt 2004: 70). “Today, they are filling a greater and ever expanding role in the community.

The objectives of the modern nursing home are of a positive and challenging nature” (McQuillan 1974: 3). According to McQuillan (1974) the objectives are:

1. To provide continuing care for those recovering from surgical or medical disorders.
2. To assist patients in reaching optimal physical and emotional health.
3. To provide for the total needs of patients- physical, emotional, and spiritual.
4. To assist the aging toward an active participation in life.
5. To provide for rehabilitation services when the need exists.
6. To work cooperatively with other community and social agencies.

Tuesday, February 16, 2010

Assisted Living

Assisted Living Facilities began as an alternative to retirement homes and came about in the 90's. Assisted Livings were the first to use the "Aging-In_Place model. This model is meant to keep the resident in the Assisted Living for the rest of their life. Aging in place is a model that meets the needs of the resident as more and more assistance is needed.

Though it is honorable to want to keep a resident in an assisted living, very often, after a fall, heart attack, stroke and so forth, you will find that a resident is still placed in a nursing home until that resident is deemed able to fulfill their activities of daily living with little or no assistance.

If more care is needed for a resident in an assisted living, a re-assessment is usually done every 6 months or after a life changing incident such as a fall, memory impairmenent worsens, a stroke, heart attack. At this assessment, the nurse, the assisted living director and a staff member may gather all the notes, charts and doctor's orders together and decide if a resident is in need for more care.

If more care is needed in an assisted living after a major incident occurs, the level of care may be bumped up to a level two, or ++ which are ways of determining a resident is in need of more assistance then before therefore causing a rise in care and a rise in cost.

Tomorrow, Nursing Homes.