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More and more people are choosing home health care as an alternative to entering assisted living facilities. There are different levels of care available to individuals who wish to remain in their homes but who need a little extra help. Having these options make it possible for lots of folks to stay in their houses longer and live their own lives. There are several compelling reasons families are choosing this for their loved ones.

Better for the Well-Being of the Patient

Studies have shown that being allowed to stay at home and to maintain some level of independence is better for the patient’s overall health. Feeling “put away” can cause feelings of depression or hopelessness, which in turn may cause increased health problems. If a patient has a say in their own care, they feel much better and their body can recover and heal more efficiently. This is true even if they do decide to enter a nursing home, but simply having the option is a big help.

Comfortable and Convenient

When the time comes when someone needs a little special attention or care, it is important for them to be as comfortable as possible. A big change in their health condition is stressful enough. Sometimes, the best decision is to make sure they can stay in their own home where everything is familiar, so that there aren’t as many drastic changes all at once.

Not having to pack a bag or decide what can stay or go is another benefit to home health care. Everything is as it always was, but now there is someone there to help with the details.

Affordable

The old stereotype about home health care is that it is not affordable except for the super-rich. This is not at all the case. An ever increasing number of health insurance providers are covering this type of care, and certain government programs can offer financial assistance.

Easier on Families

Home health care is a wonderful blessing for couples who need help for one person but not the other. The couple can stay together in their own home, but without the pressure of one person having to provide constant assistance to the other. The strain is off the partner, and the couple can simply enjoy being together. This also has health benefits for the partner.

Kids, grandkids, brothers and sisters might be helping out with the health care needs of an individual just so they can stay at home. With a home health care provider, the patient will receive professional assistance. The family members also benefit, because when they come to visit they can just spend quality time together instead of concerning themselves with all the health issues.

Home health care is a welcome option for many folks who are trying to decide how to plan for the future in light of their physical requirements. While a nursing home is still a very good option for many people, it is reassuring that there are choices out there to fit everyone’s individual needs.

With all the new information concerning HIPAA, which is scheduled to be fully implemented by April of 2005. you need to be aware of the confidentiality laws that govern your practice. One aspect of confidentiality concerns employment law. There are federal and state guidelines that address employment and discrimination laws.

The common law governs the relationship between employer and employees in terms of tort and contract duties. These rules are a part of agency law and the relationship between Principle (employer) and Agent (employee). In some instances, but not all, this law has been replaced by statutory enactments, principally on the Federal level. The balance and working relationship between employer and employee is greatly affected by government regulations. The terms of employment between management and the employee is regulated by federal statute designed to promote employer management and welfare of the employee. Federal law also controls and prohibits discrimination in employment based upon race, sex, religion, age, handicap or national origin. In addition, Congress has also mandated that employers provide their employees a safe and healthy environment to work in. All states have adopted Worker’s Compensation Acts that provide compensation to employees that have been injured during the course of their duties for the employer.

As I mentioned above, a relationship that is closely related to agency is the employee. and principle-independent contractor. In the employer-employee relationship, also called the (master-servant relationship), the employer has the right to control the physical conduct of the employee. A person who engages an independent contractor to do a specific job does not have the right to control the conduct of the independent contractor in the performance of his or her contract. The contract time to complete the job depends upon the employer’s time frame to complete the desired task(s), or job. Keep in mind that the employer may still be held liable for the torts committed by an employee within the scope of his or her employment. In contrast an employer ordinarily is not liable for torts committed by an independent contractor, but there are instances when the employer can be held liable for the acts of the independent contractor. Know your laws governing hiring a person as an independent contractor.

Labor law is not really applicable to your practice of Chiropractic in a practice setting. We will concentrate on employment and discrimination law. There are a number of Federal Statutes that prohibit discrimination in employment based upon race, sex, religion, national origin, age and handicap. The main framework of Federal employment discrimination law is Title VII of the 1964 Civil Rights Act, but also the Equal Pay Act, Discrimination in Employment Act of 1973, the Rehabilitation Act of 1973, and many Executive Orders. In all cases each state has enacted laws prohibiting the same discriminations as Federal Statutes.

Equal Pay Act: This act prohibits an employer from discriminating between employees on the basis of sex by paying unequal wages for the same work. The act also forbids the employer from paying wages at a rate less than the rate at which he pays for equal work at the same establishment. Once the employee has demonstrated that the employer pays unequal wages for equal work to members of the opposite sex, the burden of proof shifts to the employer to prove that the pay difference is based upon the following:

1. Seniority system
2. Merit system
3. A system that measures earnings by quantity or quality of production
4. Or any factor except sex.

Remedies may include recovery of back pay and enjoining the employer from further unlawful conduct and or sizeable fines.
Civil Rights Act of 1964: Title VII of the Civil Rights Act prohibits discrimination on the basis of race, color, sex, religion, or national origin in hiring, firing, compensating, promoting, training or employees. Each of the following could constitute a violation prohibited by the Act:

1. Employer utilizing a proscribed criteria in making an employment decision. Prima Facie evidence would show, if the employee was within a protected class, applied for an open position and was qualified for the position, was denied the job and the employed continued to try to fill the position. Once these criteria’s are established, the burden of proof shifts to the employer to justify a nondiscriminatory reason for the person’s rejection for the job.

2. An employer engages in conduct which appears to be neutral or non-discriminatory, but continues to continue past discriminatory practices.

3. The employer adopts rules, which are adverse to protected classes, which are not justified as being necessary to the practice business. The enforcement agency is the Equal Employment Opportunity Commission (EEOC). It has the right to file legal actions, resolve action through mediation, or other means prior to filing suit. Investigate all charges of discrimination and issue guidelines and regulations concerning the enforcement policy of discrimination law.

The Act provides three defenses: A bona fide seniority or merit system, an occupational qualification or a professionally developed ability test. Violations of this act include: enjoining the employer from engaging in unlawful conduct, or behavior. Affirmative action and reinstatement of employees and back wages from a date not more than two years prior to the filing of the charge with the EEOC.

Age Discrimination in Employment Act of 1976: This Act prohibits discrimination in hiring, firing, salaries, on the basis of age. Under Title VII it address all these areas and ages, but it is especially benefits individuals between the ages of 40-70 years. The language in this act is substantive for individuals between 40-70 years of age. The defenses and remedies are the same as the Civil Rights Act of 1964.

Employee Safety: In 1970 Congress enacted the Occupational Safety and Health Act. This Act ensured that every worker have a safe and healthful working environment. This Act established that OSHA develop standard, conduct inspections, monitor compliance and institute and enforce actions against non-compliance.

The Act makes each employer to provide a work environment that is free from recognized hazards that can cause or likely to cause death or serious physical harm to the employees. In addition, employers are required to comply with specific safety risks outlined by OSHA in their rules and regulations.

The Act also prohibits any employer from discharging or discriminating against an employee who exercises his rights under this Act.
The enforcement of this Act involves inspections and citations for the following:

1. Breach of general duty obligations
2. Breach of specific safety and health standards
3. Failure to keep proper records, make reports or post notices required under this Act

When a violation is discovered, a written citation, proposed penalty, and corrective date are given to the employer. Citations may be contested and heard by an administrative judge at a hearing. The Occupational Safety and Health Review Commission can grant a review of an administrative law judge’s decision. If not, than the decision of the judge becomes final. The affected party may appeal the decision to the US Circuit Court of Appeals.

Penalties for violations are both civil and criminal and may be as high as $1000.00 per violation per day, while criminal penalty be imposed as well for unlawful violations. OSHA may shut down a business for violations that create dangers of death or serious injury.

Worker’s Compensation: Most actions by injured employees against an employer are due to failure of the employer to use reasonable care under the circumstances for the safety of the employee. In such actions the employer has several well-established defenses available to him. They include defenses of the fellow servant rule. This rule does not make an employer liable for injuries sustained by an employee caused by the negligence of a fellow employee. If an employer establishes that the negligence of an employee contributed to the injury he sustained in the course of his employment, in many jurisdictions the employee cannot recover damages from the employer. Voluntary assumption of risk is the third defense. An employer in most jurisdictions is not liable to the employee for harm or injury caused by unsafe conditions of the premises if the employee, with knowledge of the facts and understanding the risks involved, voluntary inters into or continues in the employment of the employer.

Keep in mind that all states have enacted Worker’s Compensation Acts. These statutes create commissions or boards to determine whether an injured worker is entitled to receive compensation. Defenses above are not available in most jurisdictions to employers in proceeding under these statutes. The only requirement is that the employee be injured in the course of his employment.

Fair Labor and Standards Act: This act regulates the employment of child labor outside of agriculture. This act prohibits the employment of anyone less than 14 years of age in non-farm work. Fourteen and Fifteen years old may be employed for a limited number for hours outside of school hours, under specific conditions of non-hazardous occupations. Sixteen and seventeen year olds may work any non-hazardous jobs. Eighteen and older person may work in any job. This Act imposes wage and hour requirements upon covered employers. This act provides for a minimum hourly wage and overtime pay.

The world today has become surrounded by drug abuse as well as drug addiction. This escalating disorder has become so common, that its truth is based on misconceptions that people have concerning drug abuse as well as addiction. This paper briefly provides an overview of drug abuse as well as addiction, and at the same time looks at the aspects of epidemiology, social problems, pathophysiology, as well as ethical issues that might arise with medical emergency responders.

Drug abuse and drug addiction; exactly what does that mean and who is affected by it? There is a confusion between drug addiction and abuse. Drug abuse happens when there is usage of a substance, generally illicit drugs or alcohol, while drug addiction takes place in a broad variety of substances and activities. Addiction can be termed as the compulsive need for usage of substance forming habits, such as alcohol, nicotine and heroin, of which is eventually characterized by obviously physiological signs upon withdrawal as well as tolerance; widely: insistent compulsive use of known substances that are harmful to the user. Drug addiction is usually not a substance forming habit, it also includes things such as gambling, sex, video gaming, and even internet. All the same, the primary focus of society is still to do with drugs, tobacco and alcohol. Several characteristics of pathophysiology and epidemiology will be discussed together with the social implications that addiction causes as well as any ethical problems that lie with addiction and medical emergency service providers.

The addictive behavioral study is relatively new. Science just started to study behavioral addictiveness in the 1930. Prior to this, studies were being carried out by scientist on drug abuse that were plagued by misconception shadows as well as nature addiction. But with present day discoveries as well as information on how brain chemicals work and the methods of alteration, there is now a deeper understanding of alcohol and drug addiction. Drug addiction, according to Dr. Dryden-Edwards also referred to as chemical dependency or substance dependence, is an illness that is described by a destructive drug abuse pattern that leads to major problems which involve tolerance towards or substance withdrawal and other problems arising from substance use that could have implications to the sufferer, either by school performance, socially or in terms of work. More than 2.5% of humanity suffer from drug addiction at some point in their lives. Some of the commonly abused addictive substances are alcohol, anabolic steroids, amphetamines, cannabis, caffeine, ecstasy, cocaine, inhalants, hallucinogens, nicotine, phencyclidine, opiates, sedatives, anti-anxiety drugs, and or hypnotic. Despite the fact that alcohol and drug addiction is viewed as a mental health issue, there is no one particular determinant cause. However, several people believe that drug addiction and abuse is a genetic disease of which is a false fact. A person’s environment is cause for the development of a predisposition dependency drug.

Epidemiology

The socially associated risk factors of drug addiction and drug abuse encompass the male gender, between the age ranges of 18 and 44 years, heritage of Native American persons, low socioeconomic status as well as the marital status of the unmarried. State statistics reveal that residents from the western U.S are more at risk to substance dependency as well as abuse. While males are very prone to alcoholism development, females seem more vulnerable to alcoholism at fairly lower amounts of alcohol consumption, this is because females have a much lower body mass as compared to males. The combined medical, criminal, economical, as well as the social implications costs American taxpayer more than half a trillion dollars annually. Each year drug and alcohol abuses contributes to 100,000 American deaths, with tobacco contributes approximately 440,000 deaths annually. Individuals of all ages suffer the damaging consequences of drug as well as alcohol addiction and abuse. Babies can get affected while within the mother’s womb if the mother is to engage in drug or alcohol use, which as a result causes defects in birth as well as slows down the intellectual development in the later years of the child. As for Adolescents, they usually perform poorly in school and usually drop out while they are abusing drugs. Adolescent girls stand the risk of having unwanted pregnancies, sexually transmitted diseases, and violence. In addition, parents and adults are also affected, usually by having their cognitive abilities clouded. With all the vast exposure, the stage has easily been set for the next generation to simply step into the addictive lifestyle.

Pathophysiology

Drug addiction primarily affects the brain, but also affects the flow of a person’s organ systems. Drugs as well as mind changing substances which can be abused usually target the body’s natural system of reward either willingly or unwillingly causing entire euphoric effects for the drug user. These effects arise from the dopamine, which is a regulated neurotransmitter movement, emotion, cognition, motivation and pleasure feelings. The release of Dopamine is naturally rewarded to the body for natural behaviors as well as initiations for the cycle to repeat the behavior all over. The dopamine neurotransmitter fills the reward system that is often concealed in restricted amounts from routine activities such as sex or eating. The brain perceives this as a life-sustaining action as a result of the activated reward system. On introducing the chemical substance within a person’s system and the euphoric effects are realized, a person’s brain takes note of several significant happening events and teaches itself to do this action repeatedly until it is a habit. The consumption of illicit drugs can cause an individual to impulsively act when the brain’s reasoning system would normally delay or prevent a form of given action.

This reasoning system is circumvented, hence leading to the undesired action that can possibly have negative consequences on the drug user’s life. However, several drug effects as well as chemical substances are at times euphoric, and other times the substance causes depression, suicidal thoughts, and paranoia. Continuation of the drug causes the brain to become acclimatized to the surplus of dopamine within the reward system. This then leads to the decrease of dopamine release as well as the dopamine receptors numbers within the system itself. In turn, this affects the user’s ability to attain the desired effects of the drug usage. This response from the person’s brain causes the person to try and reactivate the receptors by adding the dosage or amount of the drug in order to attain the same dopamine high. This effect process is referred to as a tolerance. Long term drug abuse causes changes to occur to other systems parts within the brain. The neurotransmitter glutamate of which is a part of the reward systems can be changed and hence cause learning inability. When the brain reaches the maximum level of glutamate, it causes an off balance and the brain tries to compensate, of which as a result affects the drug user’s cognitive ability. Once the brain accustoms to the drug effects, dependence is made and drug abuse cessation causes a result known as withdrawal. While most withdrawal signs are very uncomfortable for the drug addict, there are several serious signs such as seizures, strokes, myocardial infraction, delirium tremens, and hallucinations.

Social, Ethical issues as well as the impact on emergency medical services (EMS)

The consequences of drug abuse and addiction are very evident in an individual social life. The addictions destructive behavior affects every area of their personal life, right from the genesis of the drug abuse. The addictions symptoms from a physical perspective include alteration of sleeping patterns as well as eating habits, which in turn contribute to both weight gain as well as loss. Frequent drug abuse tends to lead to failure in meeting important responsibilities at work, school or even home. Other drug addiction effects include domestic violence, family disintegration, child abuse, employment loss, and failure in school. People with addiction engage in risk taking, and with alterations in the reward system within the brain, the drug users expect positive reactions prior to them taking the substance that would satisfy their needs for the risks they take. Impulse control is difficult when drug choice is available to people with addiction. As a result this fuels the addiction even more.

The effect of the emergency medical service is immense. The calls from addiction range from medical overdosage to trauma. The emergency medical provider’s obligation in response to overdosed patients requires paramedics to find out how much as well as what the patients took, and what is the correct medication to give in order to reverse the condition that is being experienced by the patient or drug user. With the various emergency responses comes danger, with the possibility of violent outbreaks by the addicts or users. Therefore, paramedics must be aware of their surroundings while handling the patients. In addition, patients who experience withdrawals tend to hallucinate a complete event as well as incorporate the paramedics, thus causing the patient to react violently towards the care provider. Drug addiction is a very serious condition that can be considered as a psychiatric problem, of which needs to be treated with a sure diligence as well as suspicion.

Within the realm of the emergency medical service, the response rate of addiction is not considered an emergency condition. The incident will arise if an addict is experiencing withdrawal violent signs or has substance overdose, and the patient would appear in a state of agitation or even unconsciousness. There is no prearranged method in handling a patient that is experiencing problems related to addiction. The key element is in treating the symptoms of the patient. All patients require supplementary oxygen through non rebreathe if tolerance is acceptable. To assist in flushing out a normal saline of infusion, obtaining of intravenous access is a must. Should a patient or addict be in a state of agitation or seizure, administration of a sedative is required, such as versed or valium. Caution must be taken when administrating benzodiazepines because of the risks regarding failure or respiratory depression is present. Should a patient experiencing an opiate overdose as well as low breathing, Narcan 0.4 – 2 milligrams must be administered, but caution must be observed when administering the drug of which is done slowly in order for the patient to breathe sufficiently so as to sustain life. Should breathing and airway problems continue then intubation must be considered in order to secure the airway of the patient. Quick transport with due concern is suggested in order for the patient to be evaluated so as to have the hospital staff commence detoxification.

Conclusion

The drug abuse and addiction world is unforgiving and harsh, especially if an addict or user is unwilling to leave it behind. A number of people claim that the addiction is all within the head, and research has verified this notion. The brain effects from a formed learned pattern is similarly rewarded to such activities like drinking or eating.

A lot of people do not comprehend as to how and why other people become drug addicts. It is wrongfully presumed that drug users have no willpower or moral principles and cannot stop using drugs simply by choosing to alter their behavior. The reality is, drug addiction and abuse is a complex illness, and quitting it requires lots of good intentions. In actual fact, because drugs alter the brain in ways that raise drug abuse compulsiveness, quitting becomes hard, even for the willing addicts.

A lot of drug users also believe that they can control their drug abuse and addiction. Having a drug habit is a costly affair that leads to loss of belongings, money and even self-esteem. Curiosity is what drives some people abuse drugs, while others it is peer pressure, and another group of people become addicts of prescription drugs. While drug abuse normally leads to drug addiction, overcoming drug addiction is no easy task. So the question begs, is this drug abuse or is this drug addiction? These are two completely separate paths that lead to the same depressing outcome. In addition, the consequences of drug abuse as well as drug addiction become noticeable after a given period of time whereby compulsiveness and violence take over, furthermore, the physical toll which includes illness and depression at times could be debilitating. Therefore, the only method to reducing drug abuse as well as addiction is through educating or sensitizing the public. Avoidance is viewed as the best prevention.

Anyone in need of home health care deserves non-medical care or in home medical care that is compassionate whether the patient is a child, adult or elder. Home health care services are provided anywhere except for in nursing homes or a hospital. These services may even be provided at an assisted living facility, a school, apartment or house.

As far as care plans go, there are a wide variety of personal care and nursing services that are not just available, they are tailored for the needs of each individual recipient. Customized care plans and follow up assessments should be provided by a registered nurse.

Nursing Supervision and Case Management

The care that is provided by personal care assistants and home health aides is typically supervised by a registered nurse. One of these registered nurses should be on call at all times in order to assist the caregivers as well as to provide medical training and oversight and to implement the plans of care.

Elder or Adult Care

Are you aware of the fact that 75% of the health care costs in the US are incurred by only 12% of Americans? These people generally have some type of chronic illness. The benefits of this type of individualized home care include much more than just being able to keep someone at home for their illness as opposed to being institutionalized or put in a long term care facility. As far as cost goes, home care visits are roughly only 10% of what a single day in the hospital will cost.

Additionally, home health care has a track record that has been proven when it comes to things such as reducing readmissions to the hospital, expensive visits to the emergency room and in managing chronic illnesses. In addition, there is scientific evidence that has proven that patients are able to heal faster when they are in their own homes. Both morbidity and mortality rates are reduced in patients who take advantage of home health care. In fact, 90% of seniors facing long term care in nursing homes prefer to stay home and get the services of a home health care provider.

Private Elder Care Coordination, Planning and Management

This involves both advising and then assisting families when it comes to determining the necessities of an aging adult. These caregivers are able to navigate many of the long term type of care resources that are available in your area. The goal here is to educate and inform the family of what the options are and them to assist them with the implementation of their decision. Typically this is done by an RN who has been certified and specially trained in the area of geriatrics who can provide:

The services of being a liaison for family members who may live a great distance away
Educating and advocating for the patient
Assisting with paperwork and forms that are related to insurance, medical assistant and Medicare
Screening, arranging for and then monitoring any in home help or options for institutional or residential care options
Care planning that is tailored to the patient
In the long run home health care is a compassionate and caring choice for anyone who needs care and wishes to remain in their own home.