Reflective Essay on Dementia

Reflective Essay on Dementia My first administrative position in mental health was working on a Geriatric Psychiatric unit of the local hospital. Many of the patients were elderly patients with Alzheimers. This was my first experience with Alzheimers disease and the effects it has on their families. Alzheimers is the most common type of dementia and is incurable, degenerative, and terminal (Wikipedia) . Symptoms of Alzheimers begin slowly and become worse until they interfere with daily life and patients are unable to even carry on conversations. Families become caregivers for their loved ones who dont know who they are any more. The prognosis is not good for patients afflicted with this type of dementia but researchers continue to look for new treatments and possible preventions. A few of the Alzheimers patients I worked with on the Geriatric unit are very memorable. There was a gentleman who was in the moderate to severe stage of the disease. His job for most of his life was that of a hospital administrator. My office door was always open and some patients would wonder in time and again. My office must have triggered something in him because he would come in and need to sign papers. He would sit in my office for hours and sign papers. Another patient was a woman who had 12 children. She was always wondering the unit looking for her babies. The nurses bought her a baby doll and she carried it everywhere and it also calmed her down. Another aspect of Alzheimers is sundowners syndrome. Many of the Alzheimers patients would start to get agitated between 4:00 and 5:00 p.m. They would become more aggressive, oppositional and agitated. Sundowners syndrome is an increased time of memory loss, confusion, agitation, and even anger. For family members who care for Alzheimers patients, witnessing an increase in their loved ones symptoms of dementia at sunset can be nothing short of troubling, if not also painful, frightening, and exhausting (Sundowners Syndrome). Alzheimers is not a new disease. Alzheimers was first described by German psychiatrist and neuropathologist Alois Alzheimer in 1906. In 1901, Alzheimer observed a patient at the Frankfurt Asylum named Mrs. Auguste Deter. The 51-year-old patient had strange behavioral symptoms, including a loss of short-term memory. This patient would become his obsession over the coming years. In April 1906, Mrs. Deter died and Alzheimer had the patient records and the brain brought to Munich where he was working at Kraepelins lab. Together with two Italian physicians, he would use the staining techniques to identify amyloid plaques and neurofibrillary tangles (Wikipedia). Amyloid plagues are extracellular deposits that consist of a dense core of a protein known as B-amyloid, surrounded by degenerating axons and dendrites, along with activated microglia and reactive astrocytes, cells that are involved in destruction of damaged cells. Neurofibrillary tangles consist of dying neurons that contain intra cellular accumulations of twisted filaments of hyperphosphorylated tau protein (Carlson, 2008). These abnormal structures are also found in brains of patients with Down syndrome. Unlike Down syndrome, Alzheimers is a progressive degenerative disease that gradually destroys a persons memory and daily functioning. Currently Alzheimers is diagnosed by symptoms, and only confirmed by brain examination after death. There are warning sides of Alzheimers disease that include memory loss that disrupts daily life. Challenges in planning or solving problems when there were no problems before. Difficulty completing familiar tasks or leisure activities they a person used to do. Confusion with time and place, which is what most people know about Alzheimers. This is when family members forget where they are going or days of activities. Trouble understanding visual images and spatial relationships or new problems with words speaking or writing. Misplacing things and the inability to retrace steps. Decreased or poor judgment and withdrawal from work and social activities. Changes in mood and personality, which is another warning sign that most people are also familiar with from media, etc. Grandma turns from sweet to irritable (Stages and Warning Signs of Alzheimers). The Alzheimers Association is a strong national organization that supports and funds Alzheimers research. Their website has a vast amount o f information on symptoms, treatment, prevention and research of this disease. Taken from their website there are seven stages of Alzheimers. They include: Stage 1 where there is no impairment. Stage 2 there is very mild decline. Stage three there is mild decline. Stage four there is moderate decline. Stage five there is moderately severe decline and stage six and stage seven there is severe decline and very severe decline (Stages and Warning Signs of Alzheimers). The current major treatment for Alzheimers is medication management and each stage of Alzheimers requires a different medication. Mild to moderate Alzheimers is treated with cholinesterase inhibitors. These types of medications are prescribed because they may help delay or prevent the symptoms from becoming worse for a time and also help manage behaviors. The medications include: Razadyne (galantamine), Exelon (rivastigmine), and Aricept (donepezil). Another drug, Cognex (tacrine), was the first approved cholinesterase inhibitor but is rarely prescribed today due to safety concerns (Alzheimers Disease Medications Fact Sheet, 2010). Most people have heard of Aricept because is used often and advertised on the media more so than others. Moderate to severe Alzheimers is treated with a drug that regulates glutamate, an important brain chemical. The medication known as Namenda (memantine), an N-methyl D-aspartate (NMDA) antagonist. Aricept has also been approved by the FDA to treat modera te to severe Alzheimers. These drugs main effect is to delay progression of some of the symptoms and they may allow patients to maintain certain daily functions a little longer than they would without the medication. The medication may help a patient in the later stages of the disease maintain his or her ability to use the bathroom independently for several more months, a benefit for both patients and caregivers (Alzheimers Disease Medications Fact Sheet, 2010). There is research going on to provide diagnosis by a simple blood test, this was reported by American researchers just last month. Also, other researchers have shown spinal fluid tests, which require a spinal tap, can detect early changes that signal the onset of Alzheimers. Imaging companies such as privately held Avid Radiopharmaceuticals, General Electrics GE Healthcare and Germanys Bayer are racing to finish clinical trials on new agents that can make brain lesions called plaques visible on positron emission tomography o r PET scanners (Anonymous, 2010). Researchers also are looking at any possible prevention or slow down of the disease. Currently at Rush University is leading a nationwide clinical trial of a nutritional drink to determine whether it can improve cognitive performance in people with mild to moderate Alzheimers. The study follows recently released results from an earlier trial conducted in Europe showing that the drink, called Souvenaid, improved verbal recall in people with mild disease who were followed for three months (Anonymous., 2010). Alzheimers affects approximately 10 percent of the population above the age of 65 and almost 50 percent of people over the age of 85 years (Carlson, 2008). The number of Americans age 65 and older who have this condition will increase from the 5.1 million today to 13.5 million by mid-century. A recent report from the Alzheimers Association states that the cost of Alzheimers to the United States will be $20 trillion over the next 40 years. Changing the Trajectory of Alzheimers Disease: A National Imperative shows that in the absence of disease-modifying treatments, the cumulative costs of care for people with Alzheimers from 2010 to 2050 will exceed $20 trillion, in todays dollars (Report: Alzheimers disease to cost United States $20 trillion over next 40 years, 2010). Statistics taken from the Alzheimers Association break it down as follows; Alzheimers disease costs business $24.6 billion in health care. In the US 7 out of 10 people with Alzheimers live at home where 75% of costs are absorbed by the family. The remaining 25% of care costs cost an average $19,000 a year. It is estimated that Alzheimers caregivers cost business $36.5 bill ion. This includes the costs of absenteeism and lost productivity. The average cost of a nursing home in the US is $42,000 a year. However in some areas those costs can be at least $70,000. Medicare costs for beneficiaries with Alzheimers disease were $91 billion in 2005. Medicare costs are expected to increase by 75% to $160 billion in 2010. Medicaid expenditures on residential dementia care were $21 billion in 2005. These costs are estimated to rise by 14% to $24 billion in 2010( (Kennard, 2010). The stress of caregivers for loved ones with Alzheimers is high. The frustration and challenges of caring for an adult who no longer complies with reasonable requests is a daily consequence of a loved one with Alzheimers. There are many support groups and resources for caregivers. Some tips for managing an Alzheimers patient is to have patience, be flexible, reduce frustration, reduce choices, reduce distractions to create a safe environment (Research, 1998-2010). Patience and flexibility are easy to figure out. Patience because a patient with Alzheimers will be oppositional at times, will not know their caregiver at times as well as not remember family members. The Alzheimer patients mood and reactions to daily tasks will change sometimes daily as the disease progresses. Flexibility with caring for Alzheimers patients is tied into their changing needs and abilities from day to day. Reducing frustration, choices and distractions would be like raising a toddler. Not too many choices or distractions for them to be overwhelmed with. A safe environment is pretty clear and we hear about Alzheimers patients wandering off reported on the news more often. Alzheimers patients who have been left in an unsecured house or got into a unlocked car. Doors should always be locked so the Alzheimers patient is unable open or figure out how to open. The car is easy to figure out, keep it locked! Take the car keys are keep them on you or hidden. There was a poem on the Geriatric unit w all where I worked. The author is unknown and it is taken from Coach Frank Broyles Playbook for Alzheimers Caregivers.  Ãƒâ€šÃ‚  Ãƒâ€šÃ‚  The poem is a good reminder of what Alzheimers is all about and a good conclusion to this report.   Ãƒâ€šÃ‚  Ãƒâ€šÃ‚  Ãƒâ€šÃ‚  Ãƒâ€šÃ‚   Do not ask me to remember. Dont try to make me understand. Let me rest and know youre with me. Kiss my cheek and hold my hand. Im confused beyond your concept. I  am sad and sick and lost. All I know is that I need you, to be with me at all cost.   Do not lose your patience with me. Do not scold or curse or cry. I cant help the way Im acting, cant be different though I try. Just remember that I need you,  that the best of me is gone. Please dont fail to stand beside me, love me till my life is done.

Impact of the Affordable Care Act Essay

The Affordable Care Act (ACA) was signed into law by President Barack Obama early in 2010. The ACA was introduced into law to help provide access to affordable and quality health insurance to more Americans than ever before. The goal was to reduce health care cost for individuals and government. It has allowed more adults to be eligible for Medicaid by increasing income eligibility to 138 percent of the Federal Poverty Level (FPL). (Milstead, 2013) However, by ruling of the Supreme Court in June of 2012, states had the option to implement the expansion of Medicaid eligibility to cover more low-income adults. As of January 2014, North Carolina (NC) was one of the states that chose not to implement the expansion of Medicaid making the eligibility for Medicaid for low-income adults very limited. How does this affect the population, economy, cost, and quality of health care? North Carolina’s Right to Refuse According to Knickman and Kovner (2011, p. 110), â€Å"the 10th Amendment to the U.S. Constitution gives states the primary responsibility for public health. Medicaid is administered and overseen by each state but governed by various federal guidelines with the federal government contributing 50%-78% of its costs. (2011) After long debate and review of advantages and disadvantages to implementing the new laws, the North Carolina’s government elected not to adopt the new legislation. Caroll (2013) indicated the decision was based on NC’s current Medicaid system, indicating that is was broken and needing to be revised. There was concern the ACA would cause an increase in taxpayer’s contribution due to the long term costs. As of September 2014, there are 21 states that are following North Carolina’s decision not to adopt the new health care reform. This would leave millions of Americans that would be eligible for Medicaid under the ACA without access to health care.  (StateReforum, 2014) Impact on the Population One of the initiatives of the ACA was to provide more than 32 million uninsured Americans with insurance coverage. This was to be done by increasing the FPL to 138 percent and lifting or altering certain limitations for eligibility to Medicaid. This meant that all Americans whose income was at or below the FPL would be eligible for Medicaid. For example, an unemployed, single, 26-year-old male without any other income would be eligible for Medicaid. Medicaid would no longer be limited to specific categories such as the disabled, children and their parents, or pregnant women whose income was below the FPL. North Carolina’s current Medicaid program â€Å"eligibility for non-disabled adults is limited to parents with incomes below 43% of poverty, or about $10,000 a year for a family of four, and adults without dependent children remain ineligible regardless of their income† (How Will the Uninsured, 2014). Currently, there are over 319,000 uninsured adults in NC that are not eligible for Medicaid, by the current NC guidelines, which would be eligible under the Affordable Care Act. This can lead to increased health care costs and weighs heavily on the economy. Who is to take up the slack? Economic Effects of Doing Nothing Dorgan (2009), Chairman of the Democratic Policy Committee, indicates that the current health care system in NC has â€Å"led to higher health care costs, reduced access to care, and inconsistent quality of care†. The Gross Domestic Product in 2013 for North Carolina, based on millions of dollars spent, was $471,365 million, an increase of over $50,000 million since 2010. (Department of Labor and Workforce, 2013) In 2013, North Carolina’s State Auditor Beth Wood indicated that the state’s Medicaid program had gone over budget for the past three years, costing taxpayers about $1.2 billion. (Hoban, 2013) This leaves businesses and the working population to cover health care costs by paying higher taxes. With unemployment soaring over the last decade, and North Carolina having one of the highest unemployment rates in the United States (Hoban, 2013), less is paid into taxes. This leads to less to cover health care costs. The Affordable Care Act was implemented to decrease the costs of health care for all Americans. According to the White House website (2014) â€Å"the Congressional Budget Office found that health  insurance reform will reduce the deficit by $210 billion in this decade and by more than $1 trillion over the following 10 years. A family of four would save as much as $2,300 on their premiums in 2014 compared to what they would have paid without reform†. Will the decreased costs affect the quality of care being provided? Quality of Care The implementation of the ACA will require a higher standard for quality of care. The ACA promotes the use of accountable care organizations (ACO), which is a type of managed care that includes at least primary physicians, specialists, and hospitals that would be held accountable for the quality of care provided. (Kovener and Knickman, 2011, p. 196) The ACA works to move away from a fee-for-service approach to an accountable care organization (ACO) model that would incorporate a coordinated approach to provide high quality of care. This type of system rewards physicians and health care facilities through how they are paid for the quality of care they provide. The ACA reforms the way health care is delivered to the population by â€Å"creating high-performing organizations of physicians and hospitals that use systems of care and information technology to prevent illness, improve access to care, improve safety, and coordinate services† (What is an Accountable Care, 2011) making them more accountable for the care they provide. Incentives are provided to physicians and healthcare organizations that have shown they can provide quality care and improve patient satisfaction. Ethical Implications How can the government provide quality health care to so many without sacrificing the rights of a few? The ACA was enacted to help provide health care to more adults between the ages of 19-64 years of age that otherwise would not have access to or afford health care. According to Sorrell (2012), Americans want a health care system that will provide quality care, have freedom of choice, be affordable, and allow the costs to be shared among all. There is worry the ACO will lead to cost-shifting. Medicare and Medicaid pay much less for reimbursement for health care treatment. To re-coop their costs, hospitals and health care providers participate in the unethical practice of shifting these losses to patients with insurance by charging more for the same services. Insurance companies then shift these  costs to members by increasing their premiums and out-of-pocket costs. With such an increase in the number of people eligible for Medicaid, providers will be receiving much less for the services they provide. Another concern is for the Americans that do not qualify for Medicaid. Income levels can qualify some for decrease in premiums for health insurance from private companies. However, there will be those that do not qualify in either category and do not have access to health insurance through their employer and cannot afford the high premiums of private insurance. The new health reform requires those that do not have some type of health insurance to have to pay penalties for not having insurance. Conclusion The Affordable Care Act was developed to provide health care to an additional 32 million Americans with the goal of reducing health care costs. Even though there are millions that will now have access to health care, there will be millions that do not qualify for the programs and will remain uninsured. There is much concern and debate the ACA with hurt the economy, increase health care costs, and add to the United States’ deficit. North Carolina, along with 21 other states, have chosen not to adopt the new law and either continue with current guidelines or choose to restructure their current health care policies. Concerns also arise about causing a decrease in quality of health care provided. The development of ACO’s through the ACA implies that quality of health care will be improved. However, there is question that ACO’s will lead to cost-shifting to re-coop lost costs from the influx of American’s now eligible for Medicaid and Medicare. References Caroll, B. (2013). North Carolina Thumbs its Nose at Obamacare. Retrieved from http://watchdogwire.com/northcarolina/2013/02/12/north-carolina-thumbs-its-nose-at-obamacare/ Dorgan, B. (2009). Health Care Reform: The Cost of Doing Nothing in North Carolina. Democratic Policy Committee. Retrieved from http://www.dpc.senate.gov/docs/states-fs-111-1-87/nc.pdf Hoban, R. (April, 2013). Cost of Care: How ‘Broken’ is NC Medicaid?. North Carolina Health News. Retrieved from http://www.northcarolinahealthnews.org/2013/04/15/how-broken-is-nc-medicaid/

Equal Opportunity Essay

In this short story, Equal Opportunity, written by Walter Mosely, Minority Socrates Furtlow, faces the dilemma of getting a job. Socrates is an ex-con, having served 27 years in prison. While drunken, he killed two of his good friends, and now lives life as a bumb who goes around collecting bottles and cans for a living. This story tells his struggle to find honorable work as a black man in society because of his background. Because there were no jobs in Socrates neighborhood that would hire him, knowing of his background, finding a job was a complicated task for this African-American, 58 year-old man who hadn’t worked in 37 years. As Socrates travels approximately 14 miles, 3 bus transfers from his apartment in Watts, South Central, Los Angeles, he arrives at Bounty Supermarket to try and get a job. As he enters the store, he wondered what the workers would think of him working there surrounded by money because of his prison background. Socrates, though was a murderer, not a thief! During his job search at Bounty Supermarket, he attempted to retrieve an application. Being a man of his stance, he had already practiced how he would attempt to ask for â€Å"an application. Anton Crier, assistant store manager of Bounty Supermarket, was a young white male who Socrates interacted with during his first visit. Anton was reluctant to give Socrates the time of day, mainly because of his appearance. Anton’s first question to Socrates was â€Å"Uh. How old are you sir? † As an ex-convict, with the stereotype of knowing the law, Socrates knew that this question was a violation of is rights for Equal Opportunity, and he surely informed Anton. Socrates stated to him the law of discrimination, equal opportunity, and his right to basically be given a chance and to at least to turn an application. Determination allowed Socrates to â€Å"demand† his right to fill out the application and wait for a reply, based on the information submitted on the application and simply not his race! After he turned in the application with a borrowed pencil Anton loaned him, he informed Anton and the store manager Halley Grimes of his dilemma of not having a phone, but an address where they could write to him he results of his application. He had to explain to them his address was valid because they were already going trying not accept it based on the fact he did not have a phone . He also questioned them about an information section on the application about his ability to travel to work. The question asked if he had a car? Although he didn’t, he didn’t mind using the public transportation (RTD -Rapid Transportaion District) bus route. Over a five day period, Socrates proved to them both his willingness to work and get there on time even if he was using the bus. He arrived at the supermarket for those five days straight on time, and before 9:30am. On the fourth day, Halley informed him his application had not been accepted and that she had thrown the fax away stating his denial. Unable to produce proof, Socrates called the main office himself, finding out his application was never submitted. In the midst of all this, Halley had also reported that Socrates was a threat to her and was afraid that he would do her harm because of him coming in all the time demanding his application results, knowing that she hadn’t submitted them. So that fifth day when Socrates came to the supermarket for an answer, he was approached by two gentlemen in lieu of his business there. He was called into the manager’s office and then was asked explained to the men, Mr. Parker and Mr. Weems his situation. Surely as they thought about his rights, end up offering Socrates a job at one of their other locations. As Socrates faces dilemma in his position as a black man during the Harlem Renaissance period, he ultimately succeeds in doing what he set out to do†¦.. find a job. As honorable as Socrates claimed he would be while trying to get this job, he ended up lying in the end about another question on the application he had missed. That question is the one who would identify him as a felon for his past mishaps. As appreciation for Mosely’s short story, one must believe that Socrates and many other African-Americans struggled to be successful, and to survive during this time period. This story tells the struggle of a man who just wanted to work to survive, and that knowing his rights and acting on them with patience and non-violence helped him get what he wanted eventually!

The Path Goal Theory And Its Limitations - 1560 Words

The Path-Goal Theory and its Limitations The Contingency Theory states that leaders have dominant behavioral tendencies that cannot be changed. Leaders should not adjust their behavior to each situation presented to them, and their effectiveness is based on how well a situation fits their leadership style. The theory has received a lot of complaints that it lacks flexibility, and fails to explain what organizations should do if there were a mismatch between the leader and the situation. A newer style, the path-goal theory is an updated and more flexible leadership style. Path-goal is a style of leadership where the leaders help and support their subordinates to reach their personal or organizational goals. A leadership style is selected†¦show more content†¦The leader must choose a behavior that supplements or complements what is missing from the work environment (Abolrous, 2010). Supportive leadership is where the leader is very focused on the well being and personal needs of the subordinate. (This style may describe the leader as being open, friendly, and they will try to make a comfortable work environment for the subordinate.) The leader may be described as being open and friendly and tries to make work comfortable for the subordinate. The leader much be approachable and show concern for their followers (Clark, 2004). Increasing the follower’s self-esteem and making the job more interesting is a part of this approach (Staker, 2004). A main focus of this approach is stress reduction and avoiding frustration, especially in highly demanding work environments (Writer, 2011). If tasks are intrinsically motivating, this behavior will have no effect on the subordinate (Gupta, 2009). The directive approach is simply when the leader tells the follower exactly what to do. This can include how to perform a task, scheduling and coordinating work. 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