ATLANTA (Reuters) - Seniors, toddlers and others at high risk from the flu received almost two-thirds of the vaccine available in the United States during the 2004-2005 season, indicating that federal efforts to cope with an unexpected shortfall succeeded, officials said on Thursday.

The U.S. government urged millions of Americans last fall to forego a flu shot after a U.S. vaccine manufacturer announced that it would be unable to deliver about half of the 100 million doses needed in the nation.

Many people apparently heeded the government’s advice.

Vaccination rates for adults not at high risk for flu complications were about half historic levels, but those for high-risk groups were fairly similar to previous years, the Centers for Disease Control and Prevention said in a report.

People at highest risk from the flu, including those 65 years and older, pregnant women, children between the ages of 6 months and 23 months and people with chronic health conditions such as diabetes — accounted for about 40 million of the 61 million doses distributed, the Atlanta-based federal agency said.

“We know this was a challenging year for many patients and clinicians who patiently waited for influenza vaccine,” said Dr. Julie Gerberding, the director of the CDC, “but overall our extensive efforts paid off.”

Influenza, which is marked by respiratory inflammation, fever, muscular pain and intestinal tract irritation, is believed to kill about 36,000 people and hospitalize 114,000 in the United States every year.

Exact figures on flu-related deaths are difficult to get because U.S. doctors are not required to report such deaths.

Fears that the death toll could be higher this year surfaced in October, the outset of the flu season, when Chiron Corp. said it could not deliver any vaccine due to a contamination problem at its British plant.

The shortfall forced the CDC to scramble to find more vaccine and develop a plan for prioritizing existing supplies based on likely risk of health complications.

The agency said on Thursday that it has been working with vaccine manufacturers to improve distribution for the 2005-2006 flu season, adding that projected supplies appeared adequate to meet historical demand from people in high-risk groups.

The CDC also wants a system that would have those who administer vaccine order supplies based on a prioritized scale of high-risk groups.

I am surfing around all of Patti’s links here and found this. From Nursing Homes Magazine. I think bathrooms in every place I have worked are not designed for resident comfort.

Designing bathing rooms that comfort

Margaret P. Calkins, PhD, explains how using a sensory approach can help to create an elder-friendly bathing environment

Many caregivers find giving baths or showers one of the most difficult aspects of caregiving. It’s a time when residents with dementia are often most combative. But it doesn’t have to be that way. While both the caregiver approach and the design of the bathing room are important, this article focuses on the latter. Because the environment is experienced primarily through our senses, this article is organized by the different sensory modalities. The greatest emphasis is always given to how the resident is experiencing the setting, with a secondary focus on the ways the environment can support the caregiver.

Visual Environment
Bathing rooms in most long-term care settings are sterile, institutional, and frightening spaces filled with unfamiliar equipment—tubs with mechanical lifts or sides that open up and look like they might swallow you, chairs on wheels, or gurneys with arms that look like construction cranes. Soiled utility carts, lifts, scales, extra wheelchairs, and boxes of supplies may also be stored here and there. It’s not surprising that the person who needs some assistance with bathing resists.

The first step is to keep it simple. Find another location to store the extra equipment and supplies. If absolutely no other room is available for the carts and lifts—or if they are necessary for bathing purposes—find a way to hide those visual distractions behind a partition or curtain. They can still be physically accessible, just not visually accessible.

Read the whole page. They have pictures of cool tubs and other devices for bathing.

Here’s a really good article about training CNA’s…It’s in PDF format and a bit long, so print it out before reading.

The role of training in improving the recruitment and retention of direct-care workers in long-term care. Paraprofessional Healthcare Institute & The Institute for the Future of Aging Services. January 2005.
This paper provides a detailed overview of federal and state training requirements for direct-care workers, examines the costs involved, and examines what is known about the impact of training on retention and quality of care. The authors suggest questions that policymakers, educators, and other stakeholders may wish to explore when considering how to implement effective direct-care training programs.

Dear Nursing Assistants,

I want to thank Patti and everyone associated with NursingAssistants.net for providing such a wonderful resource!

I’d like to invite all of you to sign up for a free weekly email newsletter, LTC Nursing Assistant Trainer, published by HCPro, Inc. Each week we cover a relevant nursing topic; for example, last week we had a lesson on handling aggressive residents and the week before that we featured considerations for cleaning aging skin. The ezine offers a quick, helpful lesson for busy CNAs and, again, it’s free!

Check out our website too, where there is always news and information that you can use. If you want more in-depth education, try our online store.

We also publish CNA Training Advisor, which provides a complete inservice every month for just $119 a year. We also sell individual inservices.

Feel free to email me at aharding@hcpro.com if you have any training questions.

Thanks and keep up the good work!

Amy Harding

Editor

HCPro, Inc.

Decision to End Life Support a Common One

By DAVID B. CARUSO, Associated Press Writer

PHILADELPHIA - Hospitals and nursing homes don’t track how many Americans die each year after some level of life support is withdrawn, but the number is likely to be at least in the tens of thousands, doctors said Friday.

“I make at least one of these decisions daily,” said Dr. Sean Morrison, a palliative care physician and professor at the Mount Sinai School of Medicine in New York City.

“For a majority of people who die in this country, a decision is made at some point to either withhold or withdraw a medical treatment,” he said. “We ask the family what their goals are for the care, and we ask them to consider whether they believe that there is a fate worse than death. If the treatments meet the family’s goals, we continue it. If not, we don’t.”

Such end-of-life decisions are usually made quietly, without anything close to the turmoil or controversy that has marked the case involving Terri Schiavo.

The Florida woman has been in what some doctors describe as a persistent vegetative state for 15 years as her husband and parents have battled in court over whether to remove the feeding tube keeping her alive.

Doctors said her medical situation and the decision to withdraw life support is far from unusual.

Every day at hospitals and nursing homes, relatives of patients who have been rendered unresponsive by a stroke or Alzheimer’s disease (news - web sites) instruct doctors to detach their loved one from a ventilator or remove a feeding tube.

People with failed kidneys are taken off dialysis machines. Other patients stop getting chemotherapy or antibiotics, even though it will hasten their death.

“It’s so common, many hospitals don’t require these kinds of decisions to be brought before an ethics panel anymore,” said Laurie Zoloth, a professor of medical ethics Northwestern University.

American Medical Association guidelines bar doctors from performing euthanasia or participating in assisted suicide, but also require physicians to respect a patient’s wishes to forgo care, even if it is life sustaining.

In cases where the patient is unable to communicate, the association recommends a spouse or closest relative be given the power to decide whether to withdraw life support. The guidelines allow physicians to discontinue treatment, even if the patient is not terminally ill or permanently unconscious.

Family disputes do happen, said Arthur Caplan, chairman of the department of medical ethics at the University of Pennsylvania. Almost none winds up in court.

Most find a way to agree on whether their loved one would have wanted to be kept alive artificially.

“If there is one single lesson to take out of this, it is to fill out a living will, and discuss it with your family,” he said, referring to a document that specifies a person’s end-of-life wishes.

NURSE AIDE REGISTRIES: STATE COMPLIANCE AND PRACTICES OBJECTIVE To determine State compliance with Federal regulations for
(1) updating the nurse aide registry records of nurse aides who had substantiated findings of abuse, neglect, or misappropriation of property,
(2) removing the records of nurse aides who had not performed nursing or nursing-related services for 24 consecutive months, and (3) to review State nurse aide registry practices.
BACKGROUND
The Omnibus Budget Reconciliation Act of 1987 contained provisions designed to assure delivery of quality care to long-term care facility residents. Federal regulations (42 CFR § 483.156) require each State to establish and maintain a registry of individuals who have completed training and who the State finds to be competent to function as nurse aides. Nurse aide registries also must include information on any substantiated finding of abuse, neglect, or misappropriation of property made by the State survey agency related to an individual.
http://www.oig.hhs.gov/oei/reports/oei-07-03-00380.pdf

Aggressive residents are a large source of staff frustration and burnout. In addition, these residents suffer too, as their hygiene, grooming, toileting, and nutritional needs are often not fully met because staff tend to avoid them out of fear or irritation.

You can not always control the aggressive behavior of your residents, but you can control how you react to it. Often, if you know how, you can prevent or diffuse difficult situations. Aggressive acts by residents toward staff often go unreported and are not documented because staff members feel like they can’t do anything about it anyway. You need to tell your supervisor when a resident is aggressive. This way the care team can develop preventative measures and interventions to deal with the problem resident.

Here are some tips for protecting yourself when dealing with an aggressive resident:

Physical stance

Maintain a non-confrontational stance: Don’t cross your arms in front of you, as this can be interpreted as menacing.
Put one foot forward toward the resident and the other foot a step back at a 45 degree angle. This will allow you to move forward or backward quickly, if needed.
Keep your hands and arms at your sides, in the resident’s sight. When a person can’t see your hands, he or she may feel threatened.

Eye contact

It is essential to maintain eye contact with an agitated resident.
Do not stare or scowl, as these expressions may be interpreted as a challenge.
Watch the resident’s eye movement. You may be given an advance warning that a resident is preparing to strike you. A blow is usually preceded by a glance to the area to be struck.

Release from a one-handed grip

The easiest way to pull out of an arm grip is to first make a fist.
Twist your arm toward the gripping thumb until the side of your wrist is between the resident’s thumb and fingers.
Back away from the resident as you pull your arm out of the grip.

Release from a hair pull

To release yourself from a hair pull, clasp your hands over your head.
Press down with your knuckles on your attacker’s hand. This relieves the pain cause by the grasp and provides leverage for the release of the hold.
While maintaining this pressure, when you feel the resident’s hold loosen, bend at the waist and turn away.

Release from a bite

If you are being bitten, try to avoid the urge to pull away. Pulling out of a bite can cause you increased pain and physical injury.
Instead, push toward the bite. Be careful not to apply too much pressure so you don’t hurt the resident.
Use your free hand to place your index finger in the pressure point just below the ear at the upper point of the jaw bone.
While pressing on the pressure point, extend the thumb of the same hand to the lower jaw.
The jaw will loosen and you can remove the injured area.
Note: Human bites need special medical attention. Report the bite immediately to a supervisor.

Always look for the causes of aggressive behavior and correct them if you can. Learn to recognize potentially dangerous situations and practice personal safety skills to protect yourself.

Source:
from LTC Nursing Assistant Trainer. Property of HcPro, Inc.

FDA orders killer hospital beds to be seized
Warns: Vail Products’ beds have trapped, killed patients LOS ANGELES, California (Reuters) — The U.S. Food and Drug Administration, citing a public health risk, said Tuesday it ordered the seizure of enclosed hospital beds made by Vail Products Inc. The FDA said it was aware of 30 people who became trapped in the beds, seven of whom died.
http://www.cnn.com/2005/HEALTH/03/22/fda.beds.reut/index.html

Toledo Bed Company Raided
Federal authorities are investigating Vail beds might be responsible for several deaths.
WASHINGTON (AP) - U.S. marshals seized three types of beds from a Toledo, Ohio, company on Tuesday that federal regulators blamed for seven deaths.
The Food and Drug Administration said it was aware of about 30 people who were entrapped by the Vail Enclosed Bed Systems made by Vail Products, Inc. “Use of these systems poses a public health risk because patients can become entrapped and suffocate, resulting in severe neurological damage or death,” the FDA said in a statement.
http://abclocal.go.com/wtvg/news/0323_VailBeds.html

U.S. seizes hospital beds from city firm Vail Products Inc., at 235 First St., is facing a $75,000 lawsuit over a child’s death the parents say was because of the company’s padded, mesh dome system that ‘encloses’ a bed.
Federal marshals yesterday raided an East Toledo manufacturer of enclosed hospital beds because a federal Food and Drug Administration investigation has determined that 30 patients became trapped in the bed and at least seven of them died.
http://toledoblade.com/apps/pbcs.dll/article?AID=/20050323/NEWS32/503230412

Posted on Fri, Feb. 25, 2005
Parents sue medical bed manufacturer after death of child WILMINGTON, Del. - The parents of a young girl with cerebral palsy who died in a specially designed bed have sued its maker, saying the company knew the bed had safety problems but didn’t inform them of a recall.
Victoria Flick, 7, suffocated in August 2004 in a bed made by Vail Products of Toledo, Ohio, according to the lawsuit filed in U.S. District Court in Wilmington by her parents, John and Deborah Flick of Bear.
http://www.miami.com/mld/miamiherald/business/national/10994626.htm

Family sues after child dies in bed
Parents say company was aware of dangers WILMINGTON — Five years ago, John and Deborah Flick of Bear bought a $6,350 enclosed bed that they thought would protect their daughter, born with cerebral palsy, while she slept. Instead, the family said, 7-year-old Victoria got stuck between the mattress and a railing and suffocated in August 2004.
http://www.delawareonline.com/newsjournal/local/2005/02/25familysuesafter.html

FDA Seizes Hazardous Hospital Beds
Neither the directions for use nor the warnings provided with the Vail 500, 1000, and 2000 Enclosed Bed Systems are adequate, the FDA charges, exposing patients to increased risk of entrapment and asphyxiation.
http://health.dailynewscentral.net/content/view/000540/42/

Aiding the aides

By Katherine Spitz

Genevieve “Jeni” Gipson has made a name for herself by speaking out for those who generally go unnoticed.

Twenty-eight years ago, the Norton resident formally started the Career Nurse Assistants Program Inc., the nation’s first organization focused on the unsung workers who perform the nitty-gritty work of caring for a frail, often elderly person.

Gipson, a registered nurse who holds a master’s degree in education, has devoted her long career to issues related to nurse assistants, a term she prefers to use instead of the more common term of nurse aide.

Her achievements are many. Gipson has consulted in nursing homes in Beijing, China, testified at U.S. Senate Health Subcommittee meetings on nurse assistant issues, ran the Long Term Care Education Center formerly at the University of Akron for 17 years, and has conducted nurse assistant-training programs for the Ohio Department of Health.

At age 68, Gipson is still in the middle of her career. She gives speeches across the country — she plans to speak at meetings in Nevada, Indiana and Florida and New York this spring — and publishes widely. Her latest project: studying ways in which nursing assistants use their voices to soothe patients.

Taking care of caregivers

All of her work is toward one goal: to make things better for nursing assistants, with the goal of improving care for those they help.

“I guess my philosophy early on is: If you want to have good care for the residents, you’ve got to take care of the people who are doing it,” said Gipson, who began her work in the 1960s.

When it comes to salaries, nurse assistants are low on the health care rung, earning between $8 and $9.50 an hour, often with no benefits. At the same time, nurse assistants provide the majority of direct patient care, whether in a person’s home, or in a long-term-care facility. In addition to feeding and bathing a frail patient, the nurse assistant is often the first person to notice a change in a patient’s condition, experts say.

Currently, there are 2.5 million nurse assistants in the nation, Gipson said. Within two years, an additional 750,000 workers will be needed, she said.

“We’re already in crisis around the country,” she said.

Annual conference

Gipson’s organization now has a board of directors with members throughout the country. It hosts an annual two-day Akron conference for nurse assistants, which draws 300 to 400 people; this year’s meeting is slated for mid-June. The program also gives 20-year service awards to nurse assistants, and publishes articles by nursing assistants.

“She’s been an advocate for recognition, training and professionalism of nurse assistants,” said Dr. Harvey Sterns, a psychologist who directs the Institute for Life-Span Development and Gerontology at the University of Akron and a longtime colleague of Gipson’s. “She’s been a very important national voice.”

Gipson also wants those she advocates for to have their own voice. The program’s Web site — www.cna-network.org — offers nine message boards and list services for nursing assistants, which gives those in the field the chance to talk to others in similar situations.

“It gives us a voice to let us know what our brothers and sisters in the field are doing,” said M.D. Garrett of Akron, a nursing assistant who works in both elder day care and at area nursing homes. “We also can communicate with newcomers in the field.” Garrett, 45, became a nurse’s aide after a stint in the Army. He said he is also active in the organization’s work group, formed to attract more males to the field.

Gipson said her interest in the needs of older adults started as a child who lived in a multigenerational home. A Norton High School graduate, she was awarded a scholarship to the University of Akron, where she majored in nursing.

Gipson did a stint at the former Summit County Home for the indigent frail elderly, an experience that she said galvanized her to want to change conditions for both staff and patients.

Before the 1980s, Gipson said, there wasn’t even a legal definition of a nursing assistant.

“Back then, they didn’t call them anything. They called them, `Hey, girl,’ ” she said.

To find out more about the Career Nurse Assistants Program Inc., go to the organization’s site at www.cna-network.org To contact Genevieve Gipson, e-mail her at cnajeni@aol.com

Virginia is about to see new rules and regulations govern assisted living facilities.

Key Changes

Among the changes affecting Virginia’s assisted living industry:

• Administrators at facilities must be licensed by the state’s Department of Health Professionals.

• Staff members who administer medication must be registered with the state’s Board of Nursing and receive more training.

• Applicants seeking licenses to operate facilities must undergo background checks.

• Facilities unable to meet minimum state standards must display a copy of their “provisional” licenses.

• Regulators can more quickly suspend operations at a troubled facility.

• Maximum penalties for infractions increase from $500 to $10,000. Homes with unpaid fines cannot get their licenses renewed.

• Facilities “substantially out of compliance” with licensing requirements may be prohibited from receiving public funds.

• New regulations and training requirements for “direct care” staff will be developed.

Go read the rest if you live there. It’s about time AL came under some regualtions, I hate to say. Far too many issues have arisen, life and death problems and poor care.