Even in Hollywood movies, one could notice the importance of a fireplace to highlight such place called home. In the olden days, fireplace is known as hearth. A hearth is a brick- or stone-lined fireplace or oven used for cooking and/or heating. Having such glorious and rich history, the hearth was considered an integral part of a home, often its central or most important feature. Its Latin name is focus. In fireplace design, the hearth is often considered the visible elements of the fireplace, with emphasis upon the floor level extension of masonry associated with the fireplace mantel.It is advisable that the fireplace accessories are better selected with the thing in mind to have the materials and finish accentuate both the surrounding dcor as well as the other materials. The vital thing about fireplace accessories is that they are not just about protection and safety from sparks, but also to highlight and heighten surrounding dcor, hearth, and budget. The choice of fireplace accessories should also be in line with the budget and general character of a given home.

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Obsessive compulsive disorder is very tough, especially for someone to whom this is brand new. The first tough problem is the fact that we have a tendency to over complicate things we dont understand.
Its time to let go of all of the intricacies of the emotions and fears that occupy your brain . Focus on that which you are grateful for and watch and notice how this attitude of gratitude will save you from this mental malady.
Its hard to understand sometimes that emotions are just learned habits. We cant control what pops into our heads, but we sure can control what we dwell upon. We can change that which we think about if we have a strong enough burning desire to get rid of OCD, it will be done.
What then should you do this day so that you may be free from obsessive compulsive behavior? You should first observe that there are those in the world who do not suffer with obsessive compulsive thoughts. Is there something wrong with you? Do you have mental issues? No. You have a habit.
I have quit drugs, drinking, smoking and OCD by myself. These are not so easy to do. I have found that these things work, even with anxiety and I am living proof of that. I know that my fears are not real, not because a shrink or a book told me so, but because of my experience.
I would rather mentor with someone who has gone down the same road that I am heading that way they can tell me where the pitfalls are. You should learn from other peoples mistakes as you couldnt live long enough to make them all yourself anyway. I thank God that I was able to free myself from this mental malady.
So finally its time to decide to choose mental freedom having seen that its very possible. You too can enjoy the freedom of being OCD free! Make a mental decisions to take control of your thought life so that you can enjoy the OCD free lifestyle that youre always dreaming about!
What then, do we do to keep motivated. Every time you slack on trying to not perform rituals, think about how bad your OCD was, think about how bad it is and say to yourself, I am getting over it right now! No more OCD!
The third thing that I would consider is to practice what you preach. Be a man/woman of your word. Do what you know in your mind to be right. Do some self soul searching and think about the things that you know you should change. Ask yourself what it is that is holding you back. What are your constraints to becoming OCD free?
Tackle constraints that are stopping you from being mentally free. it could be fear or a lack of faith or both. You need to take these things on one by one as this will make everything easier for you to face and handle. When you do it this way, you will see fabulous results.
Take action: Observe that others have gotten out of a deep suffering with OCD, believe that you can to, resolve to make the change, create bite sized goals, and relentlessly and religiously complete your goals. If you do these things, its virtually impossible for you to fail, period! You can do it and I know this because I was in horrible shape and I did it! So I know you can.

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Long Term Care in Los Angeles and Orange County - Seal Beach - Long Beach - Call us today at (714) 827-7855. 
Why Save for Retirement?
• In order to meet your financial obligations and pay related bills
• To lead the lifestyle of your choice once you retire
• To help fund any long-term care requirements
About Long-Term Care Insurance
• Funds skilled nursing care or custodial care in a long-term care facility, nursing home, private residence, or adult-day care
• Why it may be required – should you need care for a prolonged illness (i.e. cancer), a degenerative condition (i.e. Parkinson’s or a stroke), a disability, or cognitive disorder (i.e.

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Aside from the fact that you are going to learn how to type with typing software programs, you will also be able to learn typing properly through fun typing games. Typing software helps people who want to Typing Games fast as they read. Touch typing is possible without looking down at the keyboard. Touch typing improves writing as they focus on what you have to say and type fast to get the job done quickly. If you opt to hire private tutorials from professionals to teach kids the art of typing, then you would have the advantage of intimate and very personal watch of the typing progress of kids. Opting to purchase, however, for typing software instead has so many advantages in store. Letting you to save lots of money, of course, is the top reason to Typing Games with software. On the average, it takes about 10 hours or so to learn how to type 70 words per minute. Once you Typing Games fast, you will wonder what really made you to type words longer before. Furthermore, with typing software, you can Typing Games by your own at home without the prying eyes of anyone.

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WHEN A CAREGIVER NEEDS TO STEP BACK
Home Instead Senior Care Southeast Houston provides resources that seniors need to remain independent at home, we hope that families can avoid some of the stress that goes with caring for an aging loved one - (281) 484-0200.
I’ve been my mother’s caregiver for over 10 years, since she suffered from a severe stroke in her late 70’s. Initially, I only cared for her on a part time basis, while I continued to manage my full time career and run a household consisting of 3 small children, and 1 husband who was frequently away from home on business trips.
When I began this process, the challenge was invigorating, but as time went on I started to cave under the pressure; with all my responsibilities compounded together, it was like working 3 full time jobs. When I started to have these feelings, I felt guilty; I knew my family needed me, and I didn’t want to disappoint them. So what did I do? I kept a stiff upper lip, and continued on. My immune system suffered from the stress I was feeling, and I seemed to have a constant illness I just couldn’t get away from; I wasn’t sleeping much, and I went through my daily routine in a daze.
It wasn’t until I stumbled in from my mother’s house late one evening, and collapsed into bed, only to be immediately disturbed by my 5 year old daughter, did I realize that something needed to change. I hadn’t even gone into my children’s bedrooms to kiss them goodnight, and instead of recognizing how much she missed my absence, I got upset because her appearance kept me from rest.
It was only later did I hear about the respite care Home Instead Senior Care in Southeast Houston delivers. If you are like me and need help, please call them at (281) 484-0200.

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Expert Home Care delivers elder care services to the home. We help seniors in New Jersey plan for long term care. Heres more information on whether you should consider a will or a living trust for your estate planning in NJ. We can be reached at  (800) 848-2336.
Wills
Wills are easier to set up. Wills can be less expensive to create and change. It allows you to name a guardian to care for minor children, something thats not possible with a living trust, unless you implement a supplemental document with the will.
If you have debts, creditors face a cutoff date for bringing claims against your estate. They cannot seek assets from beneficiaries once ownership is transferred.
Living Trusts
For smaller estates, the setup and maintenance costs for a living trust may outweigh any after death savings. Yet estate planning attorneys, may say that a living trust is a more economical route, especially for those having an estate over $2 million for the 2008 tax year.
A will speaks for you only after you die. A living trust can help you while youre alive a living trust can sometimes minimize probate at death.
Seniors in NJ should keep in mind when determing which to put in place that neither will change how property you own with another person is distributed at your death. And neither will affect assets with a designated beneficiary, such as individual retirement accounts or life insurance.
New Jersey Seniors - Beware of scams!
Beware of free lunch estate planning seminars and other scams that suggest that AARP endorses living trusts. AARP does not sell or endorse any living trust product. And trusts sold through these schemes often are more costly and dont comply with state law.

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    Editors: 
 Athina Lazakidou, Ph.D, University of Peloponnese, Department of Nursing, Sparti, Greece
Konstantinos Siassiakos, Ph.D, University of Piraeus, Department of Informatics, Piraeus, Greece
Konstantinos Ioannou, Ph.D, University of Patras, Department of Electrical and Computer Engineering, Patra, Greece
 
Introduction
Improving the quality of life for disabled and the increasing fraction of elderly people is becoming a more and more essential task for today’s European societies, as Europe and industrialized countries worldwide are confronted with a demographic shift. The consequence of increasing life expectancy and decreasing birth rates is an EU population that is becoming increasingly older. On the social side of this issue, it is important for all these people having the need to be supported in their daily-life-activities to remain integrated in social life - despite of their age and existing disabilities. On the economical side, ageing has enormous implications, since not only the income side of social schemes is affected but also expenditures: health care systems for instance, are concerned. Facing these challenges of ageing societies there exist areas of opportunity, where technological and social-economic innovation can enhance the quality of life of older and impaired people, mitigate the economic problems of an ageing population and create new economic and business opportunities.
Ambient Assisted Living (AAL) includes assistance to carry out daily activities, health and activity monitoring, enhancing safety and security, getting access to social, medical and emergency systems, and facilitating social contacts. Receiving social and/or medical support in various new intelligent ways consequently contributes to independent living and quality of life for many elderly and disabled people. Overall, AAL can improve the quality of life of elderly people at home and reduces the need of caretakers, personal nursing.
The proposed book focuses on emerging wireless technologies and innovative wireless solutions for smart home environments.
 
Overall Objectives and Mission
The proposed book will provide a compendium of terms, definitions and explanations of concepts, processes and acronyms. Additionally, this volume will feature chapters (each chapter consists of 7,000-10,000 words) authored by leading experts offering an in-depth description of key terms and concepts related to different areas, issues and trends in Wireless Technologies and Systems for Ambient Assisted Living.
The new book will be an excellent source of comprehensive knowledge and literature on the topic of Wireless Computing in the area of Health Care and Assisted Living.
 
Submission Procedure
Researchers and practitioners are invited to submit on or before November 30, 2008, a 2-page manuscript proposal clearly explaining the mission and concerns of the proposed chapter. Authors of accepted proposals will be notified by December 30, 2008  about the status of their proposals and sent chapter organizational guidelines. Full chapters are expected to be submitted by February 28, 2009. All submitted chapters will be reviewed on a double-blind review basis. The book is scheduled to be published by IGI Global, http://www.igi-pub.com/  in 2009.

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As I meet people in the community in my role as President/CEO for Ramona Visiting Nurse Association and Hospice, it is interesting to learn how few people understand the Medicare Hospice Benefit, and how even fewer understand that they have a “Choice” in selecting their hospice provider.

An analysis completed by United Government Services, LLC, the Medicare Regional Home Health and Hospice Intermediary for California and 8 other western states, demonstrated that this misunderstanding is not peculiar to our community.

A common misperception is that your physician must select the provider of your hospice care. It is important to remember that patients have a CHOICE in the selection of their hospice provider. While there are a number of hospice providers in our community, not all Hospice Providers are alike. The relationship between RVNA Hospice and Hemet Hospice Volunteers, Inc. (HHVI) is one of the things that set RVNA Hospice apart from other hospice providers.

This special relationship affords us the ability to provide special needs, education and necessities our patients might not otherwise receive during their hospice care. Some of the ways HHVI assists our patients include: payment for basic necessities (groceries, utility bills, special care products); payment for special needs items (caregiver at home, airline tickets to fulfill a last wish, Christmas gifts for children who have a parent receiving hospice care); free bereavement group services to families in the community; and hosting our annual Happy Hearts Kids Camp for children in the community who have suffered a personal loss.

Another common misperception is that hospice care is only for those persons with a terminal cancer condition. Although hospice care is commonly requested by physicians for their patients with cancer diagnoses, there are many other conditions also appropriate for hospice, and for which Ramona VNA Hospice provides care.

National data shows that 50.5% of hospice diagnoses are cancer. The top five non-cancer diagnoses that frequently receive hospice care are: end-stage heart disease, dementia, lung disease, end-stage kidney disease and end-stage liver disease. The common thread with each of these diagnoses is that the physicians feel that the patients are unlikely to survive more that 6 months if their disease runs its natural course.

However the 6 month figure is not absolute. Medicare recognizes that predicting life expectancy is very difficult. Many patients enter the program, leave the program and return to the program over the course of their illness. Many people enter hospice in the last few days or weeks of life, rather than earlier in the progression of their disease. As noted in a National Hospice and Palliative Care Organization (NHPCO) study, “There is an inaccurate perception throughout America that receiving hospice care means you have “given up”. Rather, patients or families who choose hospice care live an average of one month longer than similar patients who do not choose hospice care.

Remember, you have a CHOICE when it comes to hospice care. If you or a loved one needs hospice care, please tell your physician you would like Ramona Visiting Nurse Association and Hospice to be your hospice provider. As the premier hospice and home health providers in the valley for the past 25 years, we are proud to continue to provide this important service to our community.

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The Industrial Revolution ushered in an era of technological change, leading to better standards of living for us today. Yet this progress has taken a toll on the non-renewable resources of our planet. Given the accelerated rate at which developing nations now follow in our footsteps in the exploitation of natural resources, how long will our planet be able to sustain such growth? Panelists Harriet Babbitt, Nancy Birdsall, Lawrence Summers and Cameron Sinclair discuss the meaning of, and ways to achieve, sustainable development.

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Moms Loving Home Care provides your elder loved one in Delaware and Chester Counties Pennsylvannia homemaker personal care help at home - located in Villanova, St. Davids, Radnor, Devon Strafford, Berwyn please call 610-624-4534.
MEAL PLANNING WITH DIABETES 
The best way to ensure you are properly maintaining your diabetic diet is to consult a dietician with experience in diabetic meal planning. A handy tool to help you make wise choices is the Diabetes Pyramid. It is similar to the USDA Food guide, however, rather than grouping foods based on their classification, it groups them based on their carbohydrate and protein content. It provides ranges for serving size in each category, which results in a daily caloric intake between 1600 to 2800.
• Grains Starches – 6 to 11 servings per day (1 slice of bread; ¼ of a bagel, ½ an english muffin or pita bread; ¾ cup of dry cereal; ½ cup hot cereal;  ½ cup potato, yam, peas, corn or cooked beans; 1/3 cup rice or pasta).
• Vegetables – 3 to 5 servings per day (1 cup raw, ½ cup cooked).
• Fruit – 2 to 4 servings per day (1/2 cup canned fruit; 1 piece of small fresh fruit; 2 tbs dried fruit; 1 cup melon or raspberries; 1 ¼ cup of whole strawberries).
• Milk – 2 to 3 servings per day (1 cup non-fat or low fat milk; 1 cup yogurt).
• Meat Meat Substitutes – 4 to 6 oz per day (1oz of meat/fish; ¼ cup cottage cheese, 1 egg, 1 tbsp peanut butter, ½ cup tofu).
• Fats, sweets and alcohol – (1/2 cup ice cream, 1 small cupcake or muffin, 2 small cookies).
Eating a well-balanced diet of 3 meals and light snacks every day at the same time, coupled with your exercise routine and medication regiment should help to keep your glucose levels under control with minimal impact to the activities and lifestyle that you enjoy.

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High cholesterol levels are the cause of increased risk for many diseases, such as cardiovascular disease, as well as increasing risk for heart attacks. About one in two American has high cholesterol, that’s saying a lot about what we eat and the way that we take care of our bodies. Maintaining a healthy weigh and diet is one of the best ways to keep cholesterol under control. Though there are prescription drugs that can also lower cholesterol, it is best not to depend on treatments like this, or to double this medicine up with healthy practices.
There are a few things that you can do daily in order to help you cholesterol levels drop to a more healthy level.
- The first thing that you can do is to reduce the saturated fat that you intake everyday to no more than 7% of your total calories. Read labels as much as possible and try to track your typical intake to see where you stand, then start making the necessary adjustments.
- Add 5 to 10 grams of fiber a day. You can do this by eating oats, beans, fruits and vegetables.
- Make sure that, if you are overweight, you start working towards your ideal body weight. The extra weight on your body also increases your blood cholesterol level, so it is important to exercise in order to cut this back.
With these few things you can start to cut down on your cholesterol levels and decrease the risk for heart attack and other diseases.
DFW Urgent Care - is located in Texas in the Dallas/Fort Worth area. For more information please visit the DFW Urgent Care website.

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Five Reasons We Should All Be Concerned about Global Warning
If you pay any attention at all to current news, it’s hard to escape the debate over global climate change, also known as global warming.  Many human activities are taking materials out of the earth and putting them into the atmosphere.  Most of what is released are greenhouse gases like carbon dioxide.  Scientists believe this is causing a change in temperature patterns.  While some areas will get colder, they think there is an overall warming trend over the globe.  Here are just a few of the many ways global warming will affect us all.
1. Animals
Lately, there’s been a lot of talk about polar bears and how global climate change will affect them, but the truth is that there are thousands of species that will be affected by changing temperatures and sea levels.  Like the polar bears, many Arctic and Antarctic animals will lose their habitat from ice caps melting.  Others will simply not be able to survive with temperature, humidity, and precipitation patterns and will have to adapt, move, or die.
2.  Sea Level Rise
With a global temperature rise, mountain glaciers will melt and eventually run into oceans.  The additional water could raise sea levels by several feet.  We’ve all seen the kind of devastation flooding can cause in major cities, but what most people don’t realize is how many of the world’s major cities and rural populations are within just a few feet of current sea levels.  A rise of a few feet would put millions of homes and businesses underwater.  While this may not be a huge problem for more affluent nations, people in third world countries could be left without homes and with few other options.
3.  Disease
Changing temperatures could also affect the spread of certain diseases.  Most diseases have a certain temperature range they survive best in.  As the temperature pattern changes, so will the areas where a disease can survive and spread.  While some areas may see a decrease in certain illnesses, others will see a dramatic rise.  This is especially true for illnesses spread by insects such as mosquitoes, whose breeding and survival are affected by temperature and the availability of water.
4,  Severe Storms
Not only will weather and temperature patterns change, but many scientists think it will increase the instance of severe weather.  Severe thunderstorms, hurricanes, and even tornadoes could become more common and harder to predict.  Many areas of the world are not equipped to deal with storms at current levels, let alone if they increase.
5.  Crops
In most cases, higher temperatures mean less snow and more rain, especially in cold weather farming areas.  Even if these areas get the same amount of total precipitation, they will get more during the winter, and less from spring snowmelt.  This will affect the growth of many crop varieties that rely on this spring wet period.  Many areas will simply get more or less rain, which also affects what crops can be successfully grown there.
Many people are skeptical about whether global warming actually exists and if it does, if it is caused by human actions.  No matter what scientists, politicians, and anyone else says, the real answer is that we don’t know for sure.  We can guess and speculate, but there’s no 100% sure way of knowing.  However, does that mean we should sit around and do nothing.

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Moms Loving Care provides non-medical companion/ homemaker services to seniors, those recovering from surgery, new and expectant mothers, and others. Options include 24 hour live-in care or hourly care. Located in Pennsylvania, Moms Loving Care is a locally owned and operated business. We serve all of Delaware County and parts of Chester, Montgomery, and Philadelphia Counties.  Call us today (610) 624-4534.
What do you need to know as family caregivers?  You may be in position to evaluate information on the right time to seek caregiving for a spouse or aging parent or relative. How to evaluate whether a senior needs home caregiving assistance, when you are with them - observe what is going on how they are able to move around without assistance, care for themselves, cook, clean, etc. Ask them questions that can give you important feedback, and pay attention to telltale signs.
Providing care for a family member in need is an old act of kindness, love, and loyalty. Most of the population will participate in the caregiving process, as the caregiver, the recipient of care, and most likely both. The demand for caregiving services has increased dramatically and will continue to rise with increased life expectancies and medical advances.

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In the ten months that I have served on the Massachusetts Public Health Council, no issue has been more contentious than “limited service clinics,” quickie drop-in offices offering treatment of minor illnesses that will be located primarily in pharmacies and staffed by nurse practitioners. The 15-member council, which is empowered to help shape health care policy in Massachusetts, has approved expensive new scanners, multi-million dollar outpatient buildings, and the creation of additional hospital beds with scarcely a whimper of protest. Many of these capital expenditures will predictably drive up health care costs in the state of Massachusetts, potentially threatening outlays for services essential to the health and well-being of the citizens of the Commonwealth. The benefit accruing from these capital investments is not subject to scrutiny.

The regulations that will permit the introduction of limited service clinics in Massachusetts, by contrast, provoked a storm of protest. Council members were deluged with petitions from interested parties—primarily physician groups arguing against this form of medical practice. The Council spent the better part of two of its monthly meetings debating the issue. But was the issue really the regulations—the Department of Public Health did an admirable job of developing detailed regulations that conformed to the proposed regulations developed by the American Academy of Family Physicians—or rather the belief of a variety of interest groups that mini-clinics are dangerous because they offer episodic care rather than coordinated care, they will be staffed by nurse practitioners rather than physicians, they will tend to be for-profit, and many will be located in drug stores, which sell cigarettes. Do any of these concerns hold up?

Nothing but the best…
Ideally, if you live in Massachusetts, you have your own primary care physician. Not only that, but you have ready access to that physician—no week-long waits for an appointment, no 2-hour waits to be seen even if you have an appointment. In the best all of all worlds, if you are elderly and have multiple chronic illnesses, you have coordinated care, facilitated by a case manager (see R. Bernabei et al, “Randomised Trial of Impact of Model of Integrated Care and Case Management for Older People Living in Community,” British Medical Journal 1998; 316: 1348-1352). You also have health insurance coverage to pay for your visit to the physician. And if you happen not to be a resident, but merely visiting the state, you are able to find a primary care practice ready and willing to accommodate you if you happen to get sick while you’re here.

The reality is very different. Massachusetts has a shortage of primary care doctors. Generalists don’t want to move to the state, where salaries are below the national average and the cost of living is well above the national average. Despite the recent initiative to require health insurance for all residents, not everyone has coverage. “Coverage” may include substantial co-payments and deductibles. Thousands of patients throng to emergency rooms for care every day—where the wait to be seen is usually measured in hours, not minutes.

The fix for these problems is complex. And it’s not a problem that Massachusetts can solve alone—nation-wide, primary care is in a slump. The number of young physicians going into primary care is declining every year, and the reasons range from high student loans to fear of litigation, with a dozen other factors in between that adversely affect physicians’ willingness to practice general medicine.

Over the short term, limited service clinics can help. They provide an alternative way for patients to get treatment for straightforward problems such as sore throats and sprained ankles. They can administer flu shots and help tourists with a rash or a stomach bug. With suitable regulatory oversight, mini-clinics can improve the public’s health.

The NP/Physician Wars
Physicians have been suspicious of the care provided by nurse practitioners for years. But the evidence is that in the arenas where NPs work, they often do at least as good a job as physicians. A study by Mary Mundinger et al (“Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians: A Randomized Trial,” Journal of the American Medical Association 2000; 283: 59-68), found no differences in outcomes or satisfaction among over 3000 adults, some of whom received care from NPs and some from MDs—except in the case of management of high blood pressure, where NPs performed better. In data specifically on limited service clinics released as part of the Minnesota Health Care Quality Report, the NP-run clinics received a 100% rating for the treatment of sore throat in the pediatric population in 2006. When I randomly chose a not-for-profit clinic operating in the same Minnesota county to compare to Minute Clinic, I found it had a 72% rating on the sore throat treatment indicator (see mnhealthcare.org).

NPs always have MD back-up and supervision. It’s a condition of their licensure. But that doesn’t mean a doctor must be on the premises. NPs have been providing high quality care in nursing homes (where doctors often fear to tread) for years, as well as in hospices and in patients’ homes. There is no reason to worry they will misdiagnose or mistreat the routine ailments that will come to their attention in mini-clinics.

Big bad for-profit health care…
Many health care institutions throughout the United States are for-profit. There are for-profit HMOs, for-profit hospitals, and for-profit physician group practices, among others. The data on the effect of for-profit status on the quality of care is mixed. A National Bureau of Economic Research Conference Report comparing for-profit hospitals to not-for-profit hospitals found evidence that in some situations, for-profit hospitals are higher quality than not for profit hospitals (David Cutler, ed, The Changing Hospital Industry: Comparing Not-for-Profit and For-Profit Institutions, Chicago: University of Chicago Press, 2000). On the other hand, a study comparing health plans found for-profit plans performed less well than not-for-profit plans on 3 out of 4 quality indicators (EL Schneider et al, “Quality of Care in For-Profit and Not-for-Profit Health Plans Enrolling Medicare Beneficiaries,” American Journal of Medicine 2005; 118: 1392-1400).

For-profit health care is no stranger to Massachusetts. We have for-profit nursing homes. We have for-profit hospices. There is no justification for dismissing limited service clinics simply because many of them will be owned and operated by CVS.

It’s an outrage to have a health care clinic within a facility that sells cigarettes…
Cigarettes are one of the leading causes of some of the major killers: coronary heart disease, emphysema, and lung cancer. Clearly, the Massachusetts Department of Public Health needs to be concerned with strategies to decrease cigarette smoking and to prevent young people from starting to smoke in the first place. But we do not ban the sale of cigarettes outright. We do not tax cigarettes enough to make them unaffordable to all but the very rich. And we do not prevent drug stores that sell prescription drugs for the treatment of coronary heart disease, emphysema, and lung cancer from also selling cigarettes. I fail to see why we should prevent those same drug stores from housing a health clinic.

The bottom line
I hope that some day all patients in Massachusetts have access to top notch primary care. In particular, I hope that frail geriatric patients will have the kind of integrated care that I believe is best achieved through a case-managed, capitated health plan. In fact, I hope that there will be so little demand for mini-clinics that they disappear. But for the moment, I suspect they will provide a valuable service for many sick people in Massachusetts.

It is time for policy makers to pay at least as much attention to the rising cost of health care and its potentially dire consequences as to mini-clinics. Just this morning the Boston Globe reported that Governor Patrick has proposed a $28.2 billion budget that includes a 1.3 billion dollar budget gap, “created mainly by rising health care costs and decreased revenues.” The Congressional Budget Office recently released statistics indicating that barring any changes in policy, total spending on health care, which currently accounts for 16% of the Gross Domestic Project, will rise to 25% in 2025 and 37% in 2050. Federal spending on Medicare and Medicaid alone (net of beneficiaries’ premiums) is now 4% of GDP and will rise to 7% in 2025 and 12% in 2050 (see www.cbo.gov). Medicaid is a joint federal/state program: for every dollar spent by the federal government on Medicaid in Massachusetts, the state spends another dollar. And over the long run, as Medicare costs soar, the federal government will have less and less to spend on other programs that affect everyone, including Massachusetts residents.

The leading engine behind this unsustainable growth in spending is technology (See James Lubitz, “Health, Technology, and Medical Care Spending,” Health Affairs 2005; W5: R81-R85). While some forms of technology contribute much to health, others simply contribute to costs. Hospital beds, once built, will be used. But more is not always better. In a major study, Medicare enrollees living in high spending regions of the country received more care but did not have better health outcomes or greater satisfaction with their care (Elliott Fisher et al, “The Implications of Regional Variations in Medicare Spending: Health Outcomes and Satisfaction with Care,” Annals of Internal Medicine 2003; 138: 288-298).

The Public Health Council can do little more than rubber-stamp most of the requests it receives for substantial capital expansion. Massachusetts Determination of Need law does not permit the Public Health Council to do much other than review whether health care facilities submitting requests for substantial capital expenditures have engaged in the recommended planning process, whether they have developed the requisite community health services initiatives, and whether the proposed construction complies with existing standards. Ostensibly, the law is intended to “promote availability and accessibility of cost effective quality health care.” But the current statute promotes the evaluation of cost effectiveness without the ability to consider effectiveness. If Massachusetts is to have sound health policies, and if the PHC is to devote its time to the critical issues facing the state, the legislature will have to revamp the Determination of Need law of the Commonwealth.

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DIANNE KOHLER BARNARD, MP
DA SPOKESPERSON ON SAFETY SECURITY


Today the Justice and Safety and Security Portfolio Committees met to discuss whether or not to allow Members of Parliament implicated in the Travelgate saga to vote on the closure of the Scorpions.  There are currently 12 MPs working in Parliament who admitted guilt in this matter, and are paying back the amounts fraudulently obtained. One MP is currently in court defending the case against him, and a further 13 had charges against them drawn up by the National Prosecuting Authority, and then subsequently declared de minimus non curat lex (the law does not involve itself with small matters).  The cases were then handed over to the Parliamentary Disciplinary Committee for further action.

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Long Term Care Health Insurance Terms
Accelerated Death Benefit. This is when a consumer can use a feature in their life insurance police allowing them to use some of their policy's benefits before dying.
Activities of Daily/Selected Living (ADLs). A scale that measures disability or the ability to perform functions of daily living. Often three out of six or two out of five activities. ADLs usually include bathing, moving from one location to another, eating, dressing, going to the toilet, and sometimes cognitive ability.
Adult Day Care. Adult day care provides care during the day for adults, usually at senior or community centers to relieve caregivers. It may be purely recreational or may include occupational and physical therapy. Programs may include meals, transportation, health, and related support services.
Area Agencies on Aging (AAA's). A local (city or county) agency, funded under the federal Older Americans Act, that plans and coordinates various social and health service programs for persons 60 years of age or more. The network of AAA offices consists of more than 600 approved agencies. Call your city or county government for the name, address, and telephone number of the AAA in your community.
Assisted Living Facility. This is a place where consumers can live in a residential living environment when they require and receive assistance with their activities of daily living such as individual personal care and health services.
Board and care homes. Are typically privately operated facilities that provide a room, meals, personal care services, and 24-hour protective oversight.
Care management services. A service provided by a professional, typically a nurse or social worker, who arranges, monitors, and coordinates long-term care services, including health and social services, from multiple providers for an extended period of time.
Cash value (Cash surrender value). The amount available in cash to be borrowed against or obtained in cash if a life insurance policy is canceled.
Chronic illness. An illness marked by long duration or frequent reoccurrence such as arthritis, diabetes, heart disease, asthma, and hypertension. These conditions are also considered permanent, sometimes with disabilities, may require rehabilitation instruction, or long period of supervision and care.
Community-based services. Those services that are designed to help older people remain independent and in their own homes; can include senior centers, transportation, delivered meals or congregate meal sites, visiting nurses or home health aides, adult day care, and homemaker services.
Congregate housing. Operated by many different groups, congregate homes offer independent living with some central facilities and services that can include transportation, recreation, social, and health services.
Conditionally renewable. Policies with this provision are no longer sold, but older policies may still be in force. When a policy is conditionally renewable, an insurance company agrees to continue insurance for an individual policyholder as long as it continues to insure everyone in the same state holding the same kind of policy. This is not a guarantee of continued coverage, and policyholders have better protection with a policy that is guaranteed renewable.
Continuing care communities. Offer housing and a range of health care, social, and other services for substantial initial costs plus monthly fees.
Custodial care. Assistance with bathing, dressing, eating, taking medicine, and similar personal needs. Custodial care can be provided by people without medical skills or training.
Daily benefit. This is a certain amount of insurance benefit dollars that consumers can purchase for long-term care insurance expenses.
Elimination period. The period of time before insurance benefits begin. Friendly visitor. Volunteers who visit the homebound to sit and talk or sometimes to run errands and shop for them.
Guaranteed renewable. A policy that is always renewable as long as premiums are paid. A company may raise premiums for all policyholders within a particular group.
Health Insurance Portability and Accountability Act (HIPPA). This is a federal law that became effective on July 1, 1997 that provides consumers certain protection insurance wise when they have pre-existing medical conditions. It also helps long-term care insurance policies to be qualified for some federal tax advantages or benefits.
Home health care. Includes a wide variety of services that bring care to the home: skilled nursing care, physical and occupational therapy, speech therapy, personal care, and the assistance of home health aides (sometimes referred to as homemakers) with chore services.
Homemaker services. This is a trained professional offering interior home services to a consumer who can no longer complete household tasks themselves such as cleaning, preparing meals, or doing laundry.
Inflation protection. This is when a policy has a built in feature where you are provided more benefit money to help pay for the increased costs of long-term care services.
Long-term care insurance. Insurance that pays for medical and personal services for a chronically ill or disabled person; covered services may include nursing home care, home health care, adult care, and respite care.
Lapsed policy. A policy terminated for non-payment of premiums.
Medicaid. A medical insurance program for low-income individuals that is paid by federal and state funds.
Medicare. A federal government health program available to people over 65 and some other citizens meeting specified requirements.
Medigap insurance or Medicare supplement. Medicare supplement insurance, or Medigap (sometimes called MedSup), is private insurance that supplements or fills in many of the gaps in Medicare coverage. While MedSup policies typically cover Medicare's deductibles and co-insurance amounts, they do not pay benefits for long-term care.
National Association of Insurance Commissioners (NAIC). NAIC is a national organization of the 50 state insurance commissioners for exchanging ideas, information, and coordinating regulatory activities. NAIC has no legal power but exerts a strong influence through its recommendations.
Noncancelable policy. A policy that guarantees the premium will remain the same and the policy stay in force as long as the premium is paid.
Non-forfeiture Benefits. It is a policy feature that gives you partial reimbursement of your premiums when you cancel your policy or you are lapsed in paying the premium.
Nursing home - levels of care.
1. Skilled Nursing is for persons who need intensive care, 24-hours-a-day supervision and treatment by a registered nurse, under the direction of a doctor.
2. Intermediate Care is suitable for persons who do not require around-the-clock nursing, but are not able to live alone.
3. Custodial Care is suitable for many persons who do not need skilled nursing care, but require supervision (for example, help with eating or personal hygiene). Insurance companies' definitions may differ somewhat from the above so check the policy.
Older Americans Act. Federal legislation enacted in 1965, and since amended, to set up a network of state and area agencies on aging which plan, coordinate, and fund local programs of services for persons aged 60 or older.
Period of confinement. The time during which you receive care for a covered illness. The period ends when you have been discharged from care for a specified period of time, usually six months.
Personal care. Assistance given people who need help with ADLs such as dressing, bathing, personal hygiene, grooming, or eating.
Rescind. The insurance company cancels a policy.
Respite care. Offers a few hours to several days of help to family members caring for a homebound person. The care may be provided by volunteers, an institution, or an adult care center.
Rider. An amendment to a policy that modifies the policy by expanding or restricting its benefits or excluding certain conditions from coverage.
Skilled nursing care. Daily nursing and rehabilitative care that can be performed only by, or under the supervision of, skilled medical personnel.
Social Services Block Grant. A federal program established under Title XX of the Social Security Act to fund non-medical services for low-income persons.
Spend Down. When individuals deplete their income and assets and thereby meet Medicaid financial eligibility requirements.
Spousal Impoverishment Act. Rules, which allow the at-home spouse of a Medicaid-eligible nursing home resident to keep a minimum of joint income and assets as, determined by the state.
State Health Insurance Program. Usually you see the acronym of SHIP for this word. It is a federally funded program that trains volunteers to help provide health insurance counseling to senior citizens.
Tax-Qualified Long-Term Care Insurance Policy. This is a long-term care insurance policy that conforms to the federal laws and provides some positive federal tax advantages.
Term life insurance. Insurance protection that pays death benefits to survivors but no cash value buildup.
Third Party Notice. This is when a third person such as a relative, friend, lawyer, or accountant is notified when a relative's, friend's, or client's insurance policy is about to stop due to the lack of premium non-payment.
Underwriting. Classifying applicants for insurance according to their degrees of insurability so that the appropriate premium rates may be charged.
Universal life insurance. A flexible premium life insurance policy under which the policyholder may change the death benefit from time to time (with satisfactory evidence of insurability for increases) and vary the amount or timing of premium payments. Premiums (less expense charges) are credited to a policy account from which mortality charges are deducted and to which interest is credited at rates that may change from time to time.
Waiver of premium clause. A policy provision that continues the policy without premium payment while the subscriber is ill or disabled. Whole life insurance. A cash value life insurance policy that provides level protection for a level premium as long as premiums are paid and includes a savings feature.
Viatical settlement. A transaction in which a life insurance policyholder who is terminally ill sells his or her rights to the policy in exchange for immediate payment of a portion of the death benefits.
Contact http://www.pillarmortgage.com/ to find out more about putting together long-term care provisions to best meet your particular needs.

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The Glycemic Index is a nutrition concept that can help you sort out the pros and cons of carbohydrates. It is a comparative guide to the rise in insulin levels that occurs after eating carbohydrates.
Low to moderate glycemic index carbs produce a small but steady rise in insulin levels (healthy) as opposed to high glycemic index carbs that produce a large and rapid rise in insulin levels (unhealthy).
Low to moderate glycemic index carbohydrates provide slow release of energy that supplies continuous fuel for the body and brain and for the working muscles. Their slow rate of digestion and absorption puts less stress on the insulin producing cells in the pancreas.
Misconceptions about the Glycemic Index abound and people often have a hard time putting the principles into daily dietary practice.
A glycemic rating over 70 is high. Medium runs from 70- 56. Under 55 is considered low.
Many factors affect the glycemic index of a carbohydrate. In general, carbohydrates that are more processed and ground more finely with the bran separated out will have a higher glycemic index.
Guidelines for choosing lower glycemic index breads, cereals, crackers, chips and other carbohydrate packaged products:
Limit your intake of finely ground, soft, puffed and flaky products. Finely ground flour products – both 100% whole wheat and white flour such as soft whole wheat or white flour bread, crackers, breakfast cereals will have a high glycemic index. If you can mush it together and form a ball out of it– the glycemic index is high.
Anything such as puffed wheat, rice or corn cereals – even whole wheat ones – will usually have a high glycemic index. If something has been processed into small fine particles that can be crushed into crunchy crackers and cereals – the glycemic index is probably going to be high –even those made out of good whole grains. Most crackers, packaged cold cereals and chips have a glycemic index in the 70s, 80s and 90s.
Instead, choose dense, grainy, chewy products. Foods with intact fiber will be more and chewy and less flaky and light. If the fiber is intact the product will have a lower glycemic index. Grainy, dense breads are more likely to have a lower glycemic index. Choose coarse breads with at least 50% intact kernels.
Sourdough breads, because of the acids produced by the fermentation of their yeast starter culture, have much slower rates of digestion and absorption.
You can also eat whole grains in their natural state. Whole intact grains that have been softened by soaking and cooking will have a low GI value. For example, cooked barley has a GI value of only 25. Cooked whole wheat has a GI value of 41. But choose old fashion whole grains and not the varieties – any thing that has been is probably going to have a higher glycemic index.
Fruits and Vegetables:
Choose barely ripe fruits and vegetables for a lower glycemic index. Overly ripe fruits and vegetables have higher sugar content and a higher glycemic effect than just ripe foods.
Tropical fruits, such as mango, papaya, pineapple, and cantaloupe tend to have higher values than temperate fruits such as apples and oranges. But all fruits are OK. Even the higher glycemic index fruits like pineapple will usually have a GI rating in the 60s. Just dont eat only watermelon (GI 72).
Almost all vegetables are low to moderate glycemic index and are great to eat. The poor carrot has been greatly maligned as having too much sugar but actually has an average glycemic index of only 47.
Potatoes:
Most potato varieties have a high glycemic index due to the presence of high amounts of amyl pectin that is quickly digested.
Tiny new white and red bliss potatoes have a lower GI value than normal varieties. Russet baked potatoes have the highest glycemic index (an average of 85) and mashed potatoes an average of 92.
The glycemic impact of potatoes can be lessened by eating smaller portions and varying your diet with alternatives such as sweet potato (GI- average 61 - the starch in sweet potatoes is amylose – more slowly digested and absorbed) or yams (GI average 37).
Rice vs. Pasta:
Pasta gets a bad rap. Pasta gets blamed for all sorts of maladies because it routinely gets categorized as a bad carbohydrate. say to cut out the pasta and eat rice.
Well, it just so happens that pasta has a low to moderate glycemic index (30-55) that results in a slow, steady release of energy in your body.
Pasta made with semolina is made from cracked wheat and not finely ground flour so it has a moderate glycemic index. Furthermore, pasta is unique in its physical make up. The reason for its slow digestion and steady release of energy is the physical entrapment of ungelatinized starch granules in a sponge-like network of protein molecules in the pasta dough. That is something you dont need to understand to get the good news that pasta can be good for your energy. Yippee!
But always serve pasta al dente. If you overcook pasta it gets soft and swollen and you have fully those starch granules and turned pasta into an energy drainer.
Almost all kinds of pasta have a lower glycemic index than most varieties of rice - even brown rice (a glycemic index over 70 is typical because almost complete of rice starch takes place during cooking). And pasta has more protein than rice or potatoes. Overall semolina pasta is a good energy food and can be part of a high-energy diet. Remember though – a serving is just 1/2 cup and keep variety in your diet by not eating pasta any more that once every four days.
Rice varieties such as Jasmine and short grain varieties (even short grain brown rice) that have a lot of amylopectin tend to have higher glycemic index GI (high 70s to 139). You will know these higher amylopectin rice varieties because they tend to stick together after cooking (an example of the if you can mush it into a ball and it sticks test).
High amylose content rice varieties such as Basmati, Uncle Bens converted rice and long grain brown rice have a low glycemic index. If the rice grains stay separate after cooking it is more likely to have a lower glycemic index (GI 50s and 60s)
Great alternatives to rice include pearled barley, buckwheat, bulgur, couscous, or noodles - all moderate to low GI.
Simple steps to lower the glycemic effect of your diet:
To get good glycemic control you dont have to eliminate all high glycemic index foods – just be sure and have at least one low glycemic carbohydrate at each meal.
Overly cooked foods are predigested have higher sugar content and a higher glycemic index. Avoid over cooking your foods.
Fats slow down the digestion of starches. The higher the fat content of a food the lower its glycemic index. This is why the glycemic index of potato chips is lower than that of a baked potato. To lower the glycemic effect of a high glycemic food such as a French baguette add a little fat such as olive oil, good quality organic butter or some nut butter.
When you do eat a high GI index carbohydrate include protein with it. The protein will slow down the rate of digestion and can cut the glycemic index effect by about one third.
The higher the acid content of a food the lower its glycemic index. Acids in foods slow down stomach emptying, thereby slowing the rate at which the starch can be digested. Include some acidic foods in your meals like vinegar, lemon juice, limejuice, some salad dressings, and pickled vegetables. A side salad with your meal will help to keep blood glucose levels under control. Four teaspoons of vinegar in a salad dressing or about four teaspoons of lemon on your food or in your water reduces the glycemic effect by about one-third.
Include more legumes in your diet. Legumes are super nutritious, high fiber low glycemic index foods (GI ranging from 13 to 59). If you want to ensure stable long lasting blood sugar control legumes are your friends.
The glycemic index is only one of many markers you can use to choose nutritious foods. It is not the only marker to use. Often it is better to have a higher glycemic index food such as baked potato than a lower glycemic index food such as potato chips. Consider not only the glycemic index of a carbohydrate but also the nutrient value of the food when making your choice.
Even with these guidelines it can sometimes be hard to tell the glycemic effect of a carbohydrate. But when you are not carrying a reference book around with you these guidelines will help you take better care of your health and well-being.

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In my work I spend a lot of time gathering information about professionals my clients may want to know about. Vision Loss Resources is fantastic resource for anyone with aging parents who might be struggling with some loss of vision. This article is submitted by Vision Loss Resources.
Today more than 6.5 million Americans over age 65 have a severe visual impairment. According to a recent study, the National Eye Institute found that the risk of low vision and blindness increases significantly with age, particularly in those over the age of 65. This, combined with an aging population, means that rates of vision loss from diseases like age-related macular degeneration, glaucoma, and cataracts are expected to double by the year 2030, as the nation’s 78 million baby boomers reach retirement age. Like many other issues of aging, vision loss will present challenges for keeping seniors independent and connected to their communities.
So what do you do when you or a loved one begins to lose their vision?
For many seniors, normal age-related vision loss can be corrected or stopped with glasses, medication or surgery. For others, vision aids and making changes to their homes and routines help them stay safe and independent. The important thing to know is that many services and supports are available through MN State Services for the Blind and several non-profit organizations. One local non-profit resource is Vision Loss Resources. In 1993, two of Minnesota's leading providers of services for the blind (Minneapolis Society for the Blind and Saint Paul Society for the Blind), merged to create what is now Vision Loss Resources. The mission of Vision Loss Resources is to assist people who are blind or visually impaired in achieving their full potential and to enrich the lives of all persons affected by blindness or vision loss.
Staff at VLR work daily to educate and inform clients and family members about the options available to them, the emotional aspects associated with vision loss and what programs might be beneficial to help maintain independence. Staff are available for in home consultations, ongoing support, classes and referrals to services other agencies provide. VLR’s programs are carefully designed to help clients learn new techniques and skills for living independently which can include: meal preparation, household chores, laundry, clothing organization, managing finances, correspondence and more.
Most programs and services are available free of charge. Vision Loss Resources is an independent, nonprofit 501C(3) agency with offices in both Minneapolis and St. Paul. Our programs serve the 11-county Twin City Metro area. To learn more please feel welcome to visit our website at
www.visionlossresources.org or call 612-871-2222.By – Ellen Morrow, M.A.

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Were watching the first day of the Democratic National Convention on C-SPAN over cable this evening. This is the first time in my life I can say I know people on the convention floor; its the first time I can reasonably expect to see faces I recognize amidst the waving signs and clapping hands and crazy hats. It may be a long way from here, but this time its personal.

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Connecticut Nurses Associations annual convention on Thursday, October 23, 2008 at the Hartford Marriott/Farmington, Farmington, CT
CNAs POSTER PRESENTATION GUIDE
POSTER CONCEPT: The intent of a Poster Session is to provide a forum for presenting well thought out information to conference attendees. This mechanism may be the preferred method where it allows more opportunity for the poster presenter to directly interface with the attendees as opposed to giving a formal presentation during the convention. The poster presentation can also serve as an alternate means for sharing the information when time is not available on the convention program. At a minimum, poster presenters should be with their posters during those times that are designated in the convention program as Break Vendors.
Poster presenters should bring a horizontal poster board (usually 4 x 8). A table will be provided, if needed. The poster presenter will post to the poster board using appropriate visual information and data that can be viewed at leisure by the convention attendees. The poster presenter is responsible for providing the allowed mounting materials for their poster (i.e., push pins, thumb tacks, Velcro, etc.).
REQUIREMENTS:To enhance the quality of the Poster Session, and in keeping with practices of other organizations regarding poster presentations, the following is the CNA process for poster presentations:
All proposals for posters to be presented at the Connecticut Nurses Association annual convention must be submitted to the Poster Review Committee. The CNA president and executive director are members of the Poster Review Committee.
Submit the poster proposal to the Poster Review Committee no later than September 30th.
Poster proposals are to include the concept, ideas, and structure layout.
Approval will be made within two weeks of submission. The poster presenter will be notified of the decision. (Note: If space is available, the Poster Review Committee can approve posters as late as two weeks prior to the convention.)
Once approval is received, and at least 30 days prior to the convention, the author is to advise Virginia Malerba at 203-238-1207 x11 or Virginia@ctnurses.org, of any requirements needed such as a table, electricity, audio visual, etc. There will be a $20 charge for electricity and for any audio visual equipment provided by the hotel.
Poster presentation material may consist of PowerPoint slides including notes, or a detailed summary of the poster material. This information is needed electronically for publishing on the Connecticut Nurses Association website.
GUIDELINES
Posters are educational and cannot promote a product, service or organization.
Posters will focus on research, a case study, project, or program.
To ensure an effective poster presentation:
1. Keep a sharp focus - Establish your objective at the outset. Define it with a simple, non-ambiguous title and stick to it throughout your presentation. Avoid extraneous details that do not relate to your main point.
2. Present points in logical sequence - Avoid placing items out of sequence just to achieve attractive design. Haphazard arrangement is a frequent cause of confusion.
3. Avoid complexity - If you are working with a complicated subject, your poster objective should be to make it as simple and straight forward as possible with good organization.
4. Use your space effectively - A poster that is too large for its assigned space will be crowded and unattractive.
5. Make it self-explanatory - Despite the fact that there will be someone on hand to discuss the poster with viewers at designated times, the poster should include sufficient test and captions to carry its message.
6. A poster presentation should be easily read by the attendees. The information may include text from a prepared paper and should include graphs and data supporting the concepts being presented.
7. It is recommended that graphs and charts that support the text generally be made larger and placed at higher elevations with the text being placed below the graphs and charts.
8. All headings should be at least ½ inch in height (36 point) or larger.
9. If electronic media such as a laptop, is used to supplement the poster, it should be arranged so the projections will not interfere with any individuals who desire to read the poster.
10. If audio is used, we recommend the volume of sound be kept low so the sound does not interfere with individuals desiring to read the information on the poster.
11. We recommend that handout material be available and located in a place where it does not interfere with the individuals desiring to read the information on the poster.
QUESTIONS:If you have questions regarding these criteria or the submission of your material, please contact Carolyn Squires via e-mail: membership@ctnurses.org or phone at 203-238-1207 x10.
Presentation should be sent to membership@ctnurses.org. For more information visit www.ctnurses.

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