Thursday, July 15, 2010

Health Care Planning

One of the foremost challenges faced by health care professionals is to formulate a well-devised, well-thought out plan for assisting both the patients as well as the health care givers. Care planning is an essential part of health care, but is often misunderstood or regarded as a waste of time. Without a specific document delineating the plan of care, important issues are likely to be neglected. Care planning provides a sort of 'road map', to guide all who are involved with the patient's/resident's care. The health care plan has long been associated with nursing; however, all health care professionals need to be assisted in the care giving process. In today's world, highly expensive Health Insurance policies are not viable for most individuals. Therefore, the government needs to play a crucial part in ensuring that 'health care' is impartially and effectively provided to all citizens.

At the beginning of the 20th century, a new concept, the concept of 'health promotion' began to take shape. It was realized that public health had neglected the citizen as an individual and that the state had a direct responsibility for the health of the individual. Consequently, in addition to.disease control activities, one more goal was added to health-care planning- health promotion of individuals. It was initiated as personal health services such as mother and child health services, mental health and rehabilitation services. C.E.A.Winslow, one of the leading figures in the history of public health in 1920, defined public health care planning as: 'the science and art of preventing disease, prolonging life and promoting health and efficiency through organized community effort.'

The first step in the health care planning program is accurate and comprehensive assessment. Once the initial assessment is completed, a problem list should be generated. This may be as simple as a list of medical diagnosis. The problem list may include family/relationship problems,which are affecting the parent's overall well-being.

Following the problem list, the health-care professional must ask,' will I be able to solve this problem?If yes, then the goal of the health-care professional must be to solve that particular problem. Moreover, this goal should be specific, measurable and attainable. The approaches towards achieving that goal should also be measurable and realistic. An example of a problem that could improve, would be health-care deficit related to hip fracture. With rehab, this problem is likely to resolve.

In case a medical problem is irreversible- such as diabetes- the next step would be to eliminate further complications or possible health deterioration. In the case of such health problems, the goal should be to retain the level of health at an optimum level.

In case of an illness, where further health complications are inevitable, the goal should be to improve the quality of life. It is note-worthy that for all medical problems, approaches must be ordered by the physician. The health care planning process is never completed until the patient is discharged from the current care setting. Periodic schedule re-evaluation is also necessary once the patient is discharged.

In the final analysis, the ultimate purpose of the health care plan is to guide all who are involved in the care of the patient and to provide appropriate treatment.

What is an Advance Health Care Directive (or Living Will)?

Helping someone prepare for end-of-life medical decisions can be of great comfort to both the person and to others in his family. The document that helps you do this is an advance health care directive, or living will -- what it's called and what it includes depends on where the person lives -- sometimes paired with a power of attorney for health care. For information about how to set up an advance health care directive or living will, see Advance Health Care Directives and Living Wills: A Step-by-Step Guide.

Such a document is important because, given a medical situation in which someone can't speak for himself -- anything incapacitating, from a short, temporary condition to a long terminal illness -- it lets medical providers and other decision makers know his preferences, and it can authorize someone to speak on the person's behalf. Without an advance health care directive or living will, patients who can't communicate may be left to the confused decisions of squabbling family members or the mercy of doctors who might use artificial means to prolong life, or refuse to do so, regardless of what the patient would want.

An advance health care directive is the primary legal tool for protecting a person's healthcare wishes if and when he can't speak for himself. The health care directive applies any time the person is unable to communicate, whether or not the situation is life threatening, and for however long is necessary. Examples are a patient's temporary condition after an incapacitating stroke or his chronic state during the long-term, late stages of Alzheimer's disease.

An advance health care directive can set out the person's wishes regarding the specific care he does and doesn't want, and it can appoint someone -- usually a close family member -- to supervise that care or to make decisions for him when he's unable to do so. An advance health care directive would not override the person's direct control over his care as long as he can still speak for himself.

What is an advance health care directive supposed to accomplish?

Advance health care directives come in several varieties and go by several names, depending on the state where a person lives. Advance health care directive is the general name for all these documents. Some of the other names for particular documents are advance directive, living will, health care declaration, medical power of attorney, durable power of attorney for health care, and patient advocate designation.

These documents -- either one document alone, or two in combination -- are meant to protect a person in two ways if and when he can't communicate:

The person can set out the specific types of healthcare -- usually including artificial life-prolonging care, artificially administered food and water, and comfort care -- that he does and doesn't want. In most states, this care can be specified if the person is either close to death from a terminal condition or considered permanently comatose. This clarifies things not only for family but also for medical providers, who are bound by law to follow the patient's wishes or find another provider who will agree to follow them.

The person can name someone to act on his behalf in making healthcare decisions when he can't do so himself. This designated agent, who's given legal power to act by the document, can make sure that the patient's wishes are carried out and can make any other healthcare decision that wasn't specified in the document.

Which documents does someone need to ensure his medical wishes are followed when he's incapacitated?

Ideally, a person will achieve two separate goals, no matter what documents are used. He can spell out specific instructions and name someone to speak on his behalf. This might be accomplished in one document, or it might take two.

The possible need for extra paperwork is that some documents, usually those called living wills or health care declarations, just set out the individual's specific instructions. They spell out the care he does or doesn't want if he's terminally ill or permanently unconscious, usually with particular attention to end-of-life decisions such as resuscitation and artificial prolonging of life. The problem with relying solely on such a document is that it can't anticipate every possible medical scenario. Also, it doesn't grant any particular person the authority and responsibility to make sure that the person's wishes are actually followed.

Another type of document, variously called a medical power of attorney, power of attorney for health care, patient advocate designation, or something similar, names a specific person to act as the patient's "agent," "proxy," or "attorney-in-fact." This person will have legal authority to make sure the patient's wishes are followed and can make all other decisions related to his medical care, including:

Consenting to or refusing any medical treatment or diagnostic procedure related to physical or mental health, including artificial nutrition and hydration.
Hiring and firing medical providers.
Admitting to and discharging from hospitals and long-term care facilities.
Accessing all medical records.
Giving directions regarding organ donation.

However, these power-of-attorney documents don't always include descriptions of what specific medical care someone does and doesn't want. This leaves room for arguments among family members and doctors, even though the person named in the document has the last word. In most states, an advance health care directive permits the patient to accomplish both goals in a single document. In other states, he might need two separate documents.

Choosing an agent for end-of-life decisions

What if the patient can't decide on an agent?

Perhaps the person has a very clear idea of what type of life-prolonging or comfort care he would want toward the end of life, but he's hard-pressed to come up with a trusted person to name to supervise that care. In such a case, encourage him to go ahead with expressing his wishes for care in writing in a directive -- even if he has to forgo naming an agent.

While this method isn't optimal, in such a case medical personnel would still be legally bound to follow the written wishes for care -- or find another doctor or hospital willing to carry them out.

On the other hand, the patient may not be sure, right now, exactly what medical procedures he would or would not want to undergo in the future. But he is ready to name an individual to oversee his medical care if he becomes unable to express his wishes -- someone who knows his mind and will lobby for that care even when up against an unwilling medical establishment.

In such a situation, encourage him to take the step of naming the healthcare agent while skipping the other step of setting out detailed wishes for medical care. That will ensure that one specific person will be authorized to supervise his care, rather than leaving medical decisions up to the whims of a particular doctor or hospital policy.

How should someone choose an agent?

First, know the rules. In many states, the patient's doctor can't be named the patient's agent in an advance health care directive. In any case, it's a bad idea to name a doctor. Instead, the patient should select someone trustworthy and loyal who, above all else, knows his wishes and can discuss them with him and with others. This, of course, requires that person's willingness and ability to talk openly with the patient about dying and death.

Ideally, the agent should be someone who can be physically present or easy to reach when the patient needs to have healthcare decisions made. And the agent should have a strong enough personality to make sure that the patient's wishes are followed -- someone who can't be bulldozed by family members or by doctors.

The patient should name only one agent, not two. This avoids disputes. But he should name a successor or alternative agent, particularly if the agent is also elderly -- for example, if a husband chooses his wife as the initial agent. The alternative agent will serve if the first-named agent also becomes incapacitated, dies, or is otherwise unable to serve.

Union Organizing in the Health Care Industry - New Unions and Alliances Among Rivals

Though our nation's economy has recently lost millions of jobs, the health care industry has continued to add them. Not surprisingly, unions are eager to sign up health care workers. In the last 10 years, the rate of union wins in the health care industry has grown faster than the national average. Unions are uniting to lobby for labor-friendly legislation to promote increased union membership in the health care sector.

In addition to traditional organizing, health care union organizers are using more radical corporate campaigns that target hospital donors, shareholders, community groups, and even patients. The unions push these target groups to put pressure on hospital owners to allow unions to organize their employees. Many critics have argued that some of these agreements with employers have greatly limited workers' power and emphasized the union's cooperation with management.

The following article provides an overview of the major unions involved in the health care industry, as well as strategies to ensure your organization is prepared and remains successful.

Service Employees International Union
The Service Employees International Union (SEIU) began in 1921 primarily as a janitor's union and branched out to include government, security, and health care workers. By 2000, it was the largest, fastest-growing union in the United States, with much of that growth stemming from a series of strategic mergers with smaller unions. In June 2005, the SEIU and six other unions left the American Federation of Labor and Congress of Industrial Organizations (AFL-CIO) to form the Change to Win coalition. Citing the need for a renewed effort to organize workers, Change to Win purports to be focused on achieving fair wages, health care benefits, and secure retirement for all employees. The coalition also encourages workers to unionize on an industry-wide basis, consolidating smaller unions within larger unions.

SEIU Healthcare
In 2007, the SEIU announced plans to launch a new health care union to serve approximately one million members, such as nurses and service workers at hospitals and nursing homes. SEIU Healthcare combined financial and personnel resources from the 38 local SEIU Healthcare unions. Of the SEIU's 1.9 million members, 900,000 work in health care. In September 2008, the SEIU reported it would begin several high-profile projects to bring business leaders, health care providers, community organizations, and elected officials together to work on the nation's health care system. SEIU leaders were part of a May meeting held by President Obama to discuss a health care overhaul. More recently, SEIU members attended town hall meetings to speak out in support of the proposed health care reform. In August, the SEIU was part of a group-largely funded by the pharmaceutical industry's lobby-that launched $12 million in television advertisements to support Obama's health care proposal. This group, the Americans for Stable Quality Care, could spend tens of millions more this fall.

SEIU and NUHW
The SEIU attempted to consolidate three local units representing home health care workers into one unit last December, taking authority away from the local units. The SEIU accused the local unit officials of financial misconduct, and in response, the leaders of the local units criticized the SEIU's practice of centralizing power at its Washington headquarters and making corrupt deals with employers. In January, a 150,000-member SEIU local unit in Oakland was put under trusteeship by the SEIU, and the local officials of that unit were dismissed. The ousted officials formed a new union, the National Union of Healthcare Workers (NUHW).

The NUHW announced the first workers had cast votes in favor of representation by the new union in March. A majority of 350 union-represented workers at four nursing homes in northern California managed by North American Health Care wanted to end their labor relationship with SEIU and join the NUHW. The day after this announcement, the SEIU filed unfair labor practice charges against the four nursing homes, charging that administrators of the facilities had illegally withdrawn union recognition and colluded with a competing labor union. In that same month, a National Labor Relations Board regional director ruled against the NUHW, saying that the contract between the SEIU and the hospital chain prevented the effort by a new labor union to represent 14,000 Catholic Healthcare West workers. Despite the ruling, the founding convention to formally launch the NUHW took place in April 2009. According to the NUHW, approximately 91,000 California health care workers have signed petitions filed at the labor board, stating they would like be members of the new union.

The NUHW also claims that, in response to these decertification drives, the SEIU has resorted to harassment and intimidation and tactics similar to union prevention. The SEIU argues that the new group has unfairly restrained and coerced workers, as well as complained to the National Labor Relations Board. A decisive battle between the two unions will come in 2010, when the SEIU-UHW contract with Kaiser Permanente expires and the opportunity for decertification elections reopens. Kaiser, the largest health care provider in California, has 50,000 workers that could potentially become members of NUHW.

Health Care Reform is Not Healthy

HEALTH CARE REFORM IS NOT HEALTHY!

LET'S CALL IT WHAT IT Is - HEALTH INSURANCE MONEY ALLOCATION AND RE-DISTRICTING

Health insurance premiums are driven by the success or failure of actual health recovery maintenance and the costs required to deliver of service. Harris L. Coulter, Ph.D., of Washington, DC, and editor of the 8th edition of the HPUS,is an internationally renowned medical historian and author of over 30 books and essays, which include: THE DIVIDED LEGACY, a four volume epochal history of medicine, which covers its origins to present day.

"Society today is paying a heavy price in disease and death for the monopoly granted the medical profession in the 1920's. In fact, the situation peculiarly resembles that of the 1830s when physicians relied on bloodletting, mercurial medicines, and quinine, even though knowing them to be intrinsically harmful. And precisely the same arguments were made in defense of these medicines as are employed today, namely, that the benefits outweigh the risks. In truth, the benefits accrue to the physician, while the patient runs the risks."-Harris Coulter, Ph.D., (Divided Legacy Vol 3)

There is no question we need reform in the areas of disease elimination improvements in Health, better delivery of health care when it is needed and health insurance parity. Personally, am all for reform, but let those reforms ring with the clarity of Truth and illuminate our way through the fog obfuscation.

Overall chemo-therapy and radiation are documented to be an absolute failure in the so-called war against cancer. The long-term survival rate of cancer patients using orthodox therapies remains abysmal and the statistical reportage is obfuscated.

Refer to: New England Journal of Medicine, "Progress Against Cancer," May 8, 1986 by John C. Bailar, III and Elaine M. Smith, and a ten-year follow-up "The War on Cancer" which appeared in Lancet, May 18th, 1996, by Michael B. Spoorn. Therein is published in leading medical journals, but they remain as the only therapies and pharmaceutical companies enjoy federal mandate.
Stated simply you cannot poison a sick person well.

HEALTH CARE REFORM is a meme used to numb the mind and sway political process but has little or nothing to do with health and certainly is neither, reform in the ways the public perceives, nor what they dearly need.

Merely by changing who and how much they profit for health services is only a small fraction of the underlying problem and ultimately it's you who pay. Current Congressional debates will not offer true reform of our systemic disease CARE, but strengthen insurance profits and control.

The fruit of the healthcare tree, while certainly abundant, is altogether rotten, because the roots are corrupted by disease. If the Food and Drug Administration which regulates both FOOD and drugs while having far reaching powers that are beyond the Constitution of the United States of America, is powerless to effectuate the genuine change required to modify the so-called health industry.

Nor can the FDA provide the reforms by its far reaching power and control, then how can we expect it to come from mandates from an under educated over lobbied congress?

Give credit where due, the FDA has been effective in causing millions of tones of ground meat and spinach. A little too late perhaps as the FDA has done nothing to stop chemical companies from pouring oceans of deadly toxic, and known carcinogens on our crops.

"Water and air, the two essential fluids on which all life depends, have become global garbage cans" ~ Jacques Cousteau

HOW CAN YOU HAVE HEALTH IF WE DON'T HAVE CLEAN WATER AND AIR?

We must stop poisoning our earth with unnecessary toxic chemicals, which leaches out the elements and minerals building blocks of the cells of our bodies, and support and teach the farmers on bio-dynamic farming.

Why is there no respect for and replication of how the Hunzas and several other tribes on earth, wholive to be well over 120, and disease free.

These tribes drink the water which comes off of the slow grinding of the glacier across mountain terrain and gives minute quantities of every element and every mineral. Their cells have
access to all the natural building blocks of life and therefore remain impervious to invasion and disease.

Health and Old Age Places with High Longevity: Hunza Pakistan the area of Hunza in Pakistan which has a high level of longevity. A Guide to Shangri-La: The Leading Longevity Sites on Earth

For Americans and the world at large where the crop land is awash in chemicals the minerals and elements are leached out of the soil and the roots of our food crops are have no way to chelate them so that we can digest them into our bodies.

What follows is a well known symptom called pica, and we are constantly looking for something to eat to satisfy the hunger of the cells and this leads to obesity and disease on a national scale.

There are solutions, but the FOOD administration, has done nothing to listen to, study, implement, nor promote the use of Bio-Dynamic Farming, which is proven to produce greater volumes of crops far healthier and do not poison our water aquifers.

One fairly recent proactive move; the FDA and the FTC have enforced the little known Federal Law under USC Title 21 Part 56, INFORMED CONSENT. This activity is evidenced by the too frequent drug commercials and advertisements. To name one example the anti depressant drug, ABILIFY, is known to cause death and suicide.

To our detriment and demise, the FDA has a tunnel vision partisan perspective and always reactive, rarely proactive when a patient actually dies from using an FDA approved drug, they routinely avoid any blame and state "there is no conclusive evidence to prove it was because of the drug." No drug company is ever charged with a crime and no executives, nor doctors, are criminally charged for manufacturing, nor for prescribing the drugs.

WHY? Because the drugs are FDA approved so it would mean they are culpable.

However, when a substance derived and used by another Healing Art, i.e. Homeopathy, is found to be highly effective in combating and eliminating a disease such as cancer, or reversing the side effects of AIDS, a stroke, or Cystic Fibrosis, to name a few, the FDA routinely states there is no scientific evidence to support the claims moves swiftly to prosecute to the fullest extent of the law.

We must continue to strengthen the education of the public on sound fundamentals of health maintenance.

We must allow for access and coverage to all branches of the Healing Arts. This is known as the ECLECTIC. The allopathic cartel are not the arbiters of truth, nor have they proven to be honorable stewards, nor have they provided viable solutions where other forms of healing arts have been successful, in some cases thousands of years.

Making the Choice to Execute a Health Care Power of Attorney and Living Will

Advances in medical technology, recent court rulings and emerging political trends have brought with them a number of life-and-death choices which many have never before considered. The looming prospect of legalized physician-assisted suicide is one such choice which severely erodes the inherent value and dignity of human life. The much-publicized efforts of certain doctors to provide carbon monoxide poisoning or prescribe lethal drugs for their terminally ill patients constitute euthanasia. So may the removal of certain life-sustaining treatments from a patient who is not in a terminal condition. Euthanasia and willful suicide, in any form, are offenses against life; they must be and are rejected by the vast majority of U.S. states.

However, people faced with these difficult dilemmas should be made aware that there are morally-appropriate, life-affirming legal options available to them. One such option, for Catholics and others, can be a "health care power of attorney" and "living will." South Carolina State law allows you to appoint someone as your agent to make health care decisions for you in the event you lose the ability to decide for yourself. This appointment is executed by means of a "health care power of attorney" form, a model for which can be obtained from your attorney.

A health care power of attorney can be a morally and legally acceptable means of protecting your wishes, values and religious beliefs when faced with a serious illness or debilitating accident. Accordingly, for persons wishing to execute health care powers of attorney, see the following instructions and guidance from the authoritative teachings and traditions of various religious faiths.

The intent of the health care power of attorney law is to allow adults to delegate their God-given, legally-recognized right to make health care decisions to a designated and trusted agent. The law does not intend to encourage or discourage any particular health care treatment. Nor does it legalize or promote euthanasia, suicide or assisted suicide. The health care power of attorney law allows you, or any competent adult, to designate an "agent," such as a family member or close friend, to make health care decisions for you if you lose the ability to decide for yourself in the future. This is done by completing a health care power of attorney form.

You...

o Have the right to make all of your own health care decisions while capable of doing so. The health care power of attorney only becomes effective when and if you become incapacitated through illness or accident.

o Have the right to challenge your doctor's determination that you are not capable of making your own medical decisions.

o CAN give special instructions about your medical treatment to your agent and can forbid your agent from making certain treatment decisions. To do so, you simply need to communicate your wishes, beliefs and instructions to your agent. Instructions about any specific treatments or procedures which you desire or do not desire under special conditions can also be written in your health care power of attorney and/or provided in a separate living will.

o Can revoke your health care power of attorney or the appointment of your agent at any time while competent.

o May not designate as your agent an administrator or employee of the hospital, nursing home or mental hygiene facility to which you are admitted, unless they are related by blood, marriage or adoption. 1996

Your agent...

o Can begin making decisions for you only when your doctor determines that you are no longer able to make health care decisions for yourself.

o May make any and all health care decisions for you, including treatments for physical or mental conditions and decisions regarding life-sustaining procedures, unless you limit the power of your agent.

o Will not have authority to make decisions about the artificial provision of nutrition and hydration (nourishment and water through feeding tubes) unless he or she clearly knows that these decisions are in accord with your wishes about those measures.

o Is protected from legal liability when acting in good faith.

o Must base his or her decisions on your wishes or, if your wishes cannot be reasonably ascertained, in your "best interests." The agent's decisions will take precedence over the decisions of all other persons, regardless of family relationships.

o May have his or her decision challenged if your family, health care provider or close friend believes the agent is acting in bad faith or is not acting in accord with your wishes, including your religious/moral beliefs, or is not acting in your best interests.

CONSIDERATIONS FOR ALL PEOPLE FROM CHRISTIAN/CATHOLIC TEACHING

The following is an attempt to gather information from the doctrines of Christianity, Catholicism, and Judaism to see if there are any commonalities with regard to health care agencies and living wills. We will see that all three religions have placed a value on dying with dignity and the right of the person to direct how their dying process will occur.

A major tenet of the faith is that it is unethical to take a life. It is not the highest of all values to stay alive, but you cannot affirmatively take steps to kill someone. The church is strongly against euthanasia and suicide. But often if the patient and medical care providers permit nature to take its course without heroic intervention, the person's life may be taken by God.

This is a narrow path. Taking a life is inappropriate; on the other hand, using heroic medical measures to keep a body biologically functioning would not be appropriate either. Mere biological existence is not considered a value. It is not a sin to allow someone to die peacefully and with dignity. We see death as an evil to be transformed into a victory by faith in God. The difficulty is discussing these issues in abstraction; they must be addressed on a case-by-case basis. The Christian church's view of life-and-death issues should ideally be reflected in the living will and health-care proxy.

Roman Catholic teaching celebrates life as a gift of a loving God and respects each human life because each is created in the image and likeness of God. It is consistent with Church teaching that each person has a right to make his or her own health care decisions. Further, a person's family or trusted delegate may have to assume that responsibility for someone who has become incapable of making their decisions. Accordingly, it is morally acceptable to appoint a health care agent by executing a health care power of attorney, provided it conforms to the teachings and traditions of the Catholic faith.

While the health care power of attorney law allows us to designate someone to make health care decisions for us, we must bear in mind that life is a sacred trust over which we have been given stewardship. We have a duty to preserve it, while recognizing that we have no unlimited power over it. Therefore, the Catholic Church encourages us to keep the following considerations in mind if we decide to sign a health care power of attorney.

1. As Christians, we believe that our physical life is sacred but that our ultimate goal is everlasting life with God. We are called to accept death as a part of the human condition. Death need not be avoided at all costs.

2. Suffering is "a fact of human life, and has special significance for the Christian as an opportunity to share in Christ's redemptive suffering. Nevertheless there is nothing wrong in trying to relieve someone's suffering as long as this does not interfere with other moral and religious duties. For example, it is permissible in the case of terminal illness to use pain killers which carry the risk of shortening life, so long as the intent is to relieve pain effectively rather than to cause death."

3. Euthanasia is "an action or omission which of itself or by intention causes death, in order that all suffering may in this way be eliminated." "[Euthanasia] is an attack on human life which no one has a right to make or request."

4. "Everyone has the duty to care for his or her own health and to seek necessary medical care from others, but this does not mean that all possible remedies must be used in all circumstances. One is not obliged to use 'extraordinary' means - that is, means which offer no reasonable hope of benefit or which involve excessive hardship.

5. No health care agent may be authorized to deny personal services which every patient can rightfully expect, such as appropriate food, water, bed rest, room temperature and hygiene.

6. The patient's condition, however, may affect the moral obligation of providing food and water when they are being administered artificially. Factors that must be weighed in making this judgment include: the patient's ability to assimilate the artificially provided nutrition and hydration, the imminence of death and the risks of the procedures for the patient. While medically-administered food and water pose unique questions, especially for patients who are permanently unconscious, decisions about these measures should be guided by a presumption in favor of their use. Food and water must never be withdrawn in order to cause death. They may be withdrawn if they offer no reasonable hope of maintaining life or if they pose excessive risks or burdens.

7. Life-sustaining treatment must be maintained for a pregnant patient if continued treatment may benefit her unborn child.

Such principles and guidelines from the Christian heritage may guide Catholics and others as they strive to make responsible health care decisions and execute health care proxies. They may also guide Catholic health care facilities and providers in deciding when to accept and when to refuse to honor an agent's decision.

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