Many residents of nursing facilities and other long-term care settings are cognitively impaired and thus may be incapable of making decisions about their medical care. Clinicians providing care for these residents must rely on previously specified advance directives or on other designated decision-makers, usually called surrogates, for guidance in medical decision-making. Because advance directives can explicitly address only a limited number of situations, and because for each incapacitated patient there are usually many decisions to make over time, continuing communication between the medical providers and surrogates is often necessary. Understanding the nature of advance care planning and surrogate decision-making is thus crucial for both health care providers and surrogates.
8.) Later research confirmed that Social Security spend-through is almost half of nursing home out-of-pocket costs. (Nelda McCall, "Long Term Care: Definition, Demand, Cost, and Financing," in Nelda McCall, editor, , Health Administration Press, Chicago, Illinois, 2001, p.
California, which generally sets an example to the rest of the States, has adopted a new survey process to determine if facilities are in compliance with recently passed State statutes dealing with patient safety. They include: end of life care, brain death, hospital services, patient safety and infection control, discharge planning, dietary policy, immunizations and fair pricing.
In comparison with traditional planning, strategic planning is indeed, beneficial for educational institutions. One of the main aspects of defense for using strategic planning incorporates flexibility. Unlike traditional planning which is rigid, strategic planning is flexible. It allows educational institutions to be responsive to changes that occur within the external environment (Sevier, 2000). However, this is not possible for traditional planning since it coerces strategies to remain rigid regardless of the expected changes. Secondly, strategic planning provides a platform that allows institutions to develop comprehensive strategies that focus on achieving respective goals. This is separate from traditional planning, which mistakenly identifies goals or end-statements for strategies. As such, traditional planning does not focus on the long-term end of the organization. Thirdly, strategic planning puts into consideration the amount of reasonable goals that can be achieved within the plan’s allocated timeline. However, traditional planning concentrates on producing numerous goals that are unreasonable and thus, cannot be achieved. Additionally, traditional planning forces plans to adhere to an unbending timeline. Consequently, strategic planning incorporates the use of collaborative procedures and involvement steps that incorporate all stakeholders of the educational institution. As such, it facilitates inclusiveness in participation of planning among internal and external constituencies (Rowley & Sherman, 2001). However, traditional planning incorporates consensus building by using a limited group of individuals to focus on problem solving within a restricted period. Regardless of the fact that the traditional planning approach provides an opportunity for positive decision-making within educational institutions, it is closed to innovative approaches that can be utilized in developing efficient plans. As such, strategic planning surpasses this criterion since it facilitates, considers and includes effectual plans within educational institutions based on the type of approach used.
These primary English resources comprise a range of materials to support planning for each year group. These include menus of learning objectives/focuses pitched at the appropriate levels for each year. The medium-term English planning resources also include general progression papers, which map progression from foundation level through to beyond year 6. This will enable teachers to track back and look forward to identify expected outcomes to support differentiation. Progression is tracked within text types: six non-fiction, one narrative and one poetry.
Advance care planning by the guardian or other surrogate should also, in states where it is legal, result in a written advance directive, signed by the surrogate. Some states have standardized forms-- such as Oregon's Physician's Order for Life-Sustaining Treatment (POLST)20 and California's Physician Documentation of Preferred Intensity of Treatment - that ensure portability from facility to facility, e.g., from long-term care facility to hospital, of specific advance directives such as DNR orders. Surrogates should be familiar with about the regulations in their particular state.
The long history of heterogeneity in both terminology and theory about psychopathy continues. The modern era of thinking about psychopathy begins with Cleckley's work, originally done in 1941. Cleckley's emphasis of the psychopath as a constellation of various personality traits was essentially overturned by the American psychiatric establishment in revisions to the DSM, culminating in 1980 in a behaviorally based description and the use of the term antisocial personality disorder. Robert Hare, through his writing and widely popular testing initiatives, returned to a personality/trait approach derived from Cleckley's original factors. Hare's approach and tests have been particularly influential both in practical forensic settings and in academic research. Although a number of other tests of psychopathy have been developed and a number of authors have expressed reservations about Hare, Hare's approach has dominated. Hare has also been important in popularizing psychopathy in the lay public, especially via his 1993 book and by the 2006 a work he co-authored, examining the psychopath in a business context. This business/leadership theme was later followed up by Lawrence (2010). Hare's works have tended to be somewhat sensationalized and have co-mingled academic and lay (newspaper type) accounts. Despite much research on neurophysiological correlates of psychopathy, no clear consensus has developed yet concerning a neuropsychological theory of psychopathy. Many points of controversy are left unanswered and many key issues remain to be addressed.
Clear decisions about whether to use or forego specific diagnostic and therapeutic interventions are crucial to advance care planning in long-term care facilities. Such interventions include cardiopulmonary resuscitation, mechanical ventilation, artificial feeding, intravenous fluids, antibiotics, hospitalization, and dialysis. Surrogates should decide in advance in the event of acute illness whether it is appropriate, given the goals of care, to use these interventions, or opt for other approaches such as palliative care in the long-term care facility.
Hospitalization is not always the best method for managing infections or other acute conditions in nursing home residents.35 For example, hospitalization is not always necessary for optimal treatment of nursing home-acquired pneumonia. Immediate survival and mortality rates are comparable between patients treated in the long-term care facility and those treated in the hospital36,37,38, and 2-month survival is higher in patients treated in the nursing home compared with those treated in hospital (Fried JAGS 1997)
3- to 5-page evaluation of the benefits and challenges of implementing strategic planning within an organization. Your evaluation should include the following:•What are the steps of the strategic planning cycle? Be sure to include a condensed description of the value of each step to a professional organization.•What are the long-term business benefits of strategic planning?•What are the unique hurdles that companies need to be aware of when implementing the foundations of strategic planning? Explain with specific examples from scholarly sources.•Based on your research and/or personal experience, would there ever be a reason why an organization would benefit from not utilizing strategic planning? Provide a rationale for your answer with specific examples from scholarly sources.
Surrogate decision-making for long-term care facility residents will increase in frequency as the population ages. Decisions made by guardians and other surrogates should be ethically sound and based upon the best available clinical evidence. Health care providers have a responsibility to keep surrogates informed, to communicate information about prognosis and changes in condition, to provide guidance, and to work closely together with surrogates to foster decision-making in the best interest of the patient. Using all the available information from all involved persons, surrogates should be available to make decisions promptly, be willing to accept that treatment of some conditions may be ineffective or futile, be willing to forego ineffective treatments, and engage in advance care planning. Advance care planning may help to prevent delays in decision-making, and prevent undesired or futile treatments. Health care providers should familiarize themselves with the statutes and regulations pertaining to surrogate decision-making in their states.