Regulations RESIDENTIAL CARE FACILITIES FOR THE ELDERLY 87621
87621 COLOSTOMY/ILEOSTOMY 87621
(a) Except as specified in Section 87611(a), the licensee shall be permitted to accept or retain a resident who has a colostomy or ileostomy under the following circumstances:
(1) If the resident is mentally and physically capable of providing all routine care for his/her ostomy, and the physician has documented that the ostomy is completely healed.
(2) If assistance in the care of the ostomy is provided by an appropriately skilled professional.
(b) In addition to Section 87611(b), the licensees shall be responsible for the following:
(1) Ensuring that ostomy care is provided by an appropriately skilled professional.
(A) The ostomy bag and adhesive may be changed by facility staff who have been instructed by the professional.
(B) There shall be written documentation by an appropriately skilled professional outlining the instruction of the procedures delegated and the names of the facility staff who have been instructed.
(C) The professional shall review the procedures and techniques no less than twice a month.
(2) Ensuring that used bags are discarded as specified in Section 87303(f)(1).
(3) Privacy shall be afforded when ostomy care is provided.
NOTE: Authority cited: Section 1569.30, Health and Safety Code. Reference: Sections 1569.2 and 1569.312, Health and Safety Code.
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Regulations RESIDENTIAL CARE FACILITIES FOR THE ELDERLY 87621
PacifiCare Faces $1.3 Billion in Penalties for Over 130,000 Violations
California Insurance Commissioner Steven Poizner and the Director of the California Department of Managed Care (DMHC), Cindy Ehnes, announced that they are seeking $1.3 billion for over 130,000 alleged claim violations made by PacifiCare. It is the first action ever taken by both departments against a single health care provider.
Details of the violations
The Department of Insurance conducted market examinations that reviewed PacifiCare files between July 1, 2005 and May 31, 2007. It identified over 130,000 violations – each subject to penalties of $5,000 for non-willful violations and up to $10,000 for willful violations. When you add those numbers up, PacifiCare faces fines of between $650,000 to a staggering $1.3 billion (and this is not a typo – that’s billion, with a ‘B’.) The examinations were conducted in response to hundreds of complaints received from both consumers and providers.
The alleged violations include:
Other violations / recoveries
According to a joint press release, the DMHC has already assessed the company, which was acquired by United Healthcare in 2005, a $3.5 million penalty for its practices – the largest fine it has ever imposed. The Department of Insurance also directed a self-audit of the company for unfairly denying coverage for pre-existing conditions. That audit resulted in over $750,000 in claims recoveries.
Putting an end to unfair claims practices
According to Poizner, this joint effort is meant to put an end to unfair claims practices in California. In a press release, he said:
To view the press release, go to: http://www.dmhc.ca.gov/library/reports/news/prpchbcp.pdf.
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Why was the Dakim BrainFitness invented?
A: The Dakim BrainFitness is the product of inventor, founder, and CEO Dan Michel’s experience with his father’s thirteen-year struggle with Alzheimer’s disease. Dan’s participation in cognitively stimulating activities with his father over the course of several years made him recognize the therapeutic and emotional value of mental stimulation. He also saw a pressing need for a more effective means of providing brain fitness exercise to help seniors use rigorous cognitive stimulation, long-term to defend their brain health-to prevent or slow the development of dementia. Dakim’s team has spent the last eight years developing, testing and refining what senior living providers consider to be the most advanced, effective, user-friendly and entertaining way to help virtually all seniors enhance their quality of life.
How does the Dakim BrainFitness improve seniors’ quality of life?
A: Experts have found that brain health is a ‘use it or lose it’ proposition. Dakim BrainFitness engages the brain with challenging exercises across six cognitive domains, and turns rigorous cognitive exercise (based on standardized neurological tests and exercises) into a compelling and entertaining experience. The Dakim BrainFitness makes the entire experience so much fun for seniors, they’ll want to use it again and again! At Dakim, we believe fun and enjoyment enhance everyone’s quality of life!
Who is Dakim BrainFitness for?
A: Virtually all seniors can benefit from the Dakim BrainFitness cognitive fitness system, from those with normal brain function to those with mild cognitive impairment and even moderate dementia. Dakim BrainFitness is designed to enable seniors to use rigorous cognitive stimulation to prevent or slow the development of dementia. As Gary Small, M.D. says, ‘It’s never too early or too late to start a brain fitness program.’
How many cognitive domains does the system exercise?
A: The Dakim BrainFitness exercises six cognitive domains, including memory (short-term and long-term), language, calculation, visuospatial-orientation and critical thinking.
How long does a Dakim BrainFitness session last?
A: A typical session usually lasts about 20 to 30 minutes, but this can be adjusted-by home users or by care providers in senior living communities, to suit the specific needs of the community and/or its residents.
Does Dakim provide new exercises?
A: Yes! New content is downloaded and automatically installed, via the Internet regularly, as often as every day or two. Our fresh, entertaining content, which is constantly being created and customized for our users, is the key to making the Dakim BrainFitness fun and beneficial!
Irene G. Methe of Belchertown bowls every Monday. But she doesn’t have to don soft-soled shoes or make a trip to the local bowling alley.
Instead, Methe, 78, heads over to the Belchertown Senior Center where she and a few other seniors compete in a “virtual” bowling competition using Wii Sports, a video game system produced by Nintendo in which players use a remote control device to mimic actions performed in real-life sports. In addition to bowling, Wii users also can play simulated golf, tennis, baseball and boxing.
Wii Sports, Wii Play and Wii Fit programs have swept the nation, with Nintendo reporting that by March 2009, some 50 million units have been sold worldwide, making Wii the most popular video game system in the world.
The Wii craze has taken hold in retirement communities and senior citizen centers across the country, and locally, many facilities are beginning to offer Wii programs.
At the Belchertown Senior Center, for example, people have been playing Wii bowling, golf and tennis for the past couple of months and there’s a weekly Wii bowling league. The Easthampton Senior Center has a program they call “Say Oui to Wii,” and seniors have formed a Wii bowling league. The Hadley Council on Aging recently held an orientation program for seniors to learn how to use a new Wii system, while at the Lathrop Retirement Community in Easthampton, seniors also are playing Wii golf and bowling. The Northampton Senior Center is trying to raise money to buy a Wii system. A new Wii console, that includes Wii Sports games, costs about $250.
“I’d never done Wii bowling before we got it set up at the senior center,” Methe said. “We are having such a ball with it. I like it a lot. It makes you move and gets you some exercise and it’s fun to be able to get up and participate with different people at all different skill levels. We are all learning together.”
Methe, the mother of six children, bowled as a young woman in a mother’s bowling league, but hasn’t played the sport in many years. She said the Wii program is very similar to real bowling.
“The whole thing keeps score and does everything for you,” she said. “All you have to do is aim the remote straight and release it.” Methe said she would like to bowl at an actual bowling alley, but said it would be difficult to find transportation and people to play with. “This is all right here at the senior center for us,” she said. “We don’t have to go anywhere.”
Methe said the Wii system allows many people at the center with physical limitations to bowl. Methe is the center’s top bowler, with a score of 181, the highest score bowled so far. “That’s better than I did in my normal bowling,” she said. “And there were witnesses!”
Local health experts say any form of exercise is good for seniors, including Wii.
“Exercise is extremely important for elderly folks and there is so much new information now on how beneficial it is,” said Dr. H. Jon Schiller, a family practitioner with Valley Medical Center in Amherst. “If Wii fosters participation in exercise, then I am all for it,” he said.
At the VA Medical Center, Wii is used in all the in-patient units for recreation as well as for physical therapy, says Sandra Diamond, the center’s rehabilitation supervisor. Diamond says she particularly likes the features that track participants’ fitness levels, body-mass index, balance reactions, and other areas, and appreciates the ability to modify the games to accommodate different abilities, including for people who must be seated. Ankle and leg weights can be used for added difficulty, she noted. The Wii is especially popular among young veterans returning from Iraq and Afghanistan, she said, but also is used by older veterans.
“Wii is such a great distraction,” she said. “Everyone likes to stare at TV and now you can combine that with some fun exercise.”
For many seniors, like Methe, the Wii games provide an opportunity to participate in sports in the “virtual” world that they once enjoyed in their everyday lives. Some of these seniors do not have the mobility to get out to a golf course or bowling alley any longer. Inclement winter weather keeps those who are mobile stuck indoors.
“Wii is something you can do inside and it’s easily accessible if you are not as physically able as you were once were,” said Kim Jensen, activity coordinator at the Easthampton Council on Aging and Senior Center. The center just launched a weekly Wii bowling league and plans to offer golf and other Wii games in the future.
For example, Jensen said, bowling is inaccessible to many elderly people because the balls weigh between 5 and 15 pounds or so. In Wii bowling, the player “bowls” with a remote device that “weighs no more than a tissue box.” The game can even be played while seated by those who have trouble standing for long periods or who are confined to wheelchairs.
“If you are sitting in a chair, you can still swing your arm and you don’t even need to have a full range of the arm to play,” Jensen said.
The center offers private one-on-one training sessions for seniors who may find the technology of Wii unfamiliar and intimidating, Jensen added. Once they get the basics, players can join their friends for the weekly Wii bowling league.
“Some people need time to get used to the idea of playing a Wii game,” Jensen said. “They may have seen their grandchildren or great-grandchildren play with Wii and they think of it as just a video game. I tell them it’s a lot more than that. It’s a whole-body game that will get them up and moving.”
Schiller, of Valley Medical Center, said regular exercise, like that provided by the Wii Sports games, can improve balance, stability and coordination for senior citizens and help them retain muscle strength.
“Research shows that seniors who exercise regularly have a 30 percent decrease in falls and a 20 to 40 percent decrease in hip fractures,” he said. Exercise also lowers blood pressure and benefits the heart, increases endurance and prevents osteoporosis and bone loss – all of which are significant concerns for elderly people. Schiller noted the latest research also indicates that exercise can have a beneficial effect on lifting depression, which many senior citizens grapple with, particularly those who are more isolated.
“Sweat is the new antidepressant,” Schiller said. “Exercise improves sleep, reduces anxiety and depression and helps us cope with stress. The news that is exciting us lately is that exercise actually increases the ability of the brain to function and some studies show that new brain cells are formed with regular exercise. … It’s like Miracle Grow for the brain. Exercise improves the functioning of the frontal lobe and literally can help stave off Alzheimer’s disease.”
While Bill Korzenowski, director of the Belchertown Senior Center, says it is too soon to know whether the Wii games are improving the health of seniors there, he said it is clear that people are having fun.
“The people who are using it really enjoy it,” Korzenowski said.
That enjoyment may be part of the key to Wii’s success, says Dr. Beth Warner, an osteopath and hospitalist at Cooley Dickinson Hospital in Northampton.
“It’s always good for exercise programs to be fun and I could see that being a motivating factor for people to use Wii,” Warner said. For elderly people with “reasonable” balance, she says, Wii Sports games are a good option for exercise. “Most efforts at exercise programs among older adults should incorporate a blend of strength training, endurance and balance,” she said, adding that regular exercise helps senior citizens maintain independence and prevents falls. Once an elderly person falls, she said, they often become anxious about the next fall and may be afraid to go out. Frequently, they become increasingly housebound and immobile, relying on caregivers.
Warner cautioned that elderly people with balance issues should see a physical therapist before participating in Wii Fit, which uses a balance board; players must be able to safely step on and off the board. A simple exam by a physician to screen for joint pains, high blood pressure, cardiovascular problems, or dizziness should suffice for most elderly patients in good health, she says.
Senior center directors stress that their facilities still offer traditional exercise classes such as yoga, Tai Chi, and osteoporosis prevention, and the Wii is not meant to replace those activities.
Wii has been especially appealing to people who once bowled or golfed or played tennis, but cannot any longer. In most cases, the games are projected on a large screen television, which makes it easier for seniors to see and participate in the action.
“It’s accessible on so many different levels,” Jensen, of the Easthampton Senior Center, said. “People say, ¿Oh those days are over for me,’ and I say, ¿no they are not.’ ”
Once people see others playing, they often become curious and want to join in on the fun. “It’s exciting for people to say, ¿Hey, I can still get up and bowl, no matter what age or physical condition I am in,’ ” Jensen said. “Wii encourages the body to have some body memory and do what they used to do, but on a smaller scale.”
Fun and games
Whether or not they are drawn to the exercise aspect, many senior citizens are getting hooked on Wii.
“I would say that part of it is just the fun and games of it,” said John Clobridge, activities coordinator at Lathrop. “It’s more of a social event. People like playing Wii with other people. Kids like to sit alone and play video games ad infinitum, but it’s not like that with seniors. They enjoy seeing other people do it. It’s even become a spectator sport here.” Several seniors have been golfing on the Wii system at Lathrop and the retirement community is planning a Wii golf tournament this spring.
Ann Hess, 71, who plays on the Wii bowling league at the Belchertown Senior Center, said, “It’s definitely a lot of fun. … It seems like it’s real bowling and you can get a little bit of exercise with it. I think people have found it easy to use. I’d recommend it for seniors everywhere.”
Jensen said it’s been a pleasure to see some previously inactive seniors participate in the Wii bowling.
“For older people who have closed the box on physical activity, the Wii helps open that box back up and takes the lid off,” Jensen said. “When we do the Wii bowling, people are cheering each other on. Someone makes a gutter ball and everyone laughs and they try again and finally get a few pins down. It’s wonderful watching their faces light up.”
Sandra Dias is a freelance writer based in Holyoke.