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insiders guide to south dakota s black hills badlands insidersIf you continue browsing the site, you agree to the use of cookies on this website. See our User Agreement and Privacy Policy.If you continue browsing the site, you agree to the use of cookies on this website. See our Privacy Policy and User Agreement for details.You can change your ad preferences anytime. Release Date:Download HereNow customize the name of a clipboard to store your clips. The Decline In Nursing Home Use, 1985 And 1995 Christine E. Bishop Affiliations Christine Bishop is a research professor at the Heller Graduate School, Brandeis University, and a staff member at Brandeis's Institute for Health Policy.The numbers reflect a change in the role of the nursing home, as defined in this survey. By 1995 nursing facilities were increasingly focusing on patients with greater disability and postacute care needs. Preferred alternatives, most notably home-delivered care and assisted living, were likely filling the gap left by declining nursing home use. Better population-based studies are needed to track emerging trends and ascertain whether elders with disabilities are receiving the care they need. Such data could inform development of better public and private financing strategies for long-term care. TOPICS Nursing homes Disabilities Nursing Elderly care Access to care Long-term services and supports Medicare savings programs Elderly patients Balanced Budget Act of 1997 Medicaid The views presented here are those of the author and should not be attributed to the Commonwealth Fund or its staff, officers, or directors. The author is grateful to Stanley Wallack, Judith Feder, Joshua Wiener, William Scanlon, Christopher Murtaugh, Brenda Spillman, and several anonymous reviewers for helpful comments. Effects of nursing home eligibility on costs, hospitalizations and survival Journal of Health Economics, Vol. 73 Containing or shifting.Health Affairs gratefully acknowledges the support of many funders.Project HOPE has published Health Affairs since 1981.http://medpressa.ru/files/hot2000-manual.xml
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They worry it may be months before they can hug each other again. Many families are debating whether to move their frail loved ones out altogether and care for them at home. Thousands of nursing homes and assisted-living centers across the United States are becoming islands of isolation as health care administrators take unprecedented steps to lock them down, hoping to protect some of the nation’s most vulnerable residents from the threat posed by the coronavirus. On Tuesday, industry leaders recommended curtailing all but essential visits at homes across the country, calling the challenge posed by the novel coronavirus “one of the most significant, if not the most significant” issues the industry has ever faced. Five long-term care facilities in Washington State have been hit, but officials worry the virus could already have spread to far more facilities with still-undetected cases. “The mortality rate is shocking,” said Mark Parkinson, president and chief executive of the American Health Care Association. He said the death rate might well exceed the 15 percent that had been reported in China for people aged 80 and older. In Washington State, where 18 residents from a single facility in Kirkland have died, families are getting increasingly desperate. “I’m concerned that the loneliness and helplessness will kill her quicker than the virus,” said Melissa West, whose 95-year-old mother-in-law lives in a nursing home in Seattle that has remained untouched by the virus. “I just think of her being there by herself. Just sitting in her wheelchair all day. Being trapped and waiting.” Long-term care centers across the country are already curbing outside visits. One nursing home in Oklahoma is trimming back visiting hours and prohibiting anyone who has recently traveled internationally. Another in Maryland shut its doors after a resident developed symptoms of the coronavirus. Some families have decided they cannot risk being cut off from their loved ones.http://ashrayacharity.org/userfiles/hotel-accounting-manual-download.xml Veronique Littlefield said she and her family moved her 86-year-old mother home two weeks ago after she was potentially exposed to the coronavirus at the Kirkland facility, Life Care Center, which has become the center of the outbreak in the United States. Ms. Littlefield said that her mother had been transferred to a nearby hospital, and that as they discussed where to take her next, the family had to weigh the risks of exposing themselves to the virus if they elected to care for her. With the aid of a hospice service, the family set up a hospital bed in the downstairs of their home, quarantined themselves from the outside world and became round-the-clock caregivers. They wear gloves to serve her red wine. None of them, including her mother, has developed any symptoms. “She sacrificed so much to be the most loving and caring person we could ever know,” Ms. Littlefield said. “This is why we’re doing this for her.” The new guidance on curtailing visits calls for nursing homes to screen all visitors — family, staff members, contractors and government workers — at reception and turn away anyone with signs of illness. According to the new guidelines, which have been endorsed by the federal government, only essential visits should be conducted — and that generally means no families. News of a death at another nursing home in Washington State, made public on Tuesday, underscored the perils facing older residents. The facility, which announced last week that it was prohibiting visitors, was in the process of contacting everyone who has visited since early February. Meanwhile, in Seattle, the Ida Culver House Ravenna senior living complex was also rushing to prevent an outbreak after one of its residents tested positive and later died. And health officials in Snohomish County announced that three people from the Josephine Caring Community center in Stanwood, Wash., had tested positive for coronavirus.http://dev.pb-adcon.de/node/20160 On Tuesday, Terry Robertson, the chief executive of the Stanwood center, said that the doors had been locked and that every staff member was being screened for fever or cough upon arriving to work. The parking lot of the facility was quiet on Tuesday morning, and the closed front doors included signs saying, “DUE TO CDC RECOMMENDATIONS NO VISITORS AT THIS TIME.” “That’s incredibly tough for family,” Mr. Robertson said. “We’re very sorry, but we can’t spread this. We have to isolate.” Gov. Jay Inslee on Tuesday announced new requirements for nursing homes and assisted living facilities, requiring that residents be limited to one visitor per day. He also ordered that employees and volunteers be screened for symptoms at the start of each shift. “We know that this is a fatal disease — all too frequently — for those particularly of age, and those with chronic conditions,” Mr. Inslee said. The federal government has dispatched inspectors to try to understand why the germ is spreading in this community. Candace Goehring, who oversees Washington State’s inspectors as director of residential care services, said the investigations were not far enough along to yield results, but said Life Care Centers of Kirkland has had good inspection reports for overall quality in the past. Image A worker sanitizes a hand rail at the South Shore Rehabilitation and Skilled Care Center in Rockland, Mass. But the facility received three stars out of five for health inspections, which according to the rankings would mean a higher level of “health risks” than a four- or five-star rating. In Brooklyn, an employee of the King David Center for Nursing and Rehabilitation has tested positive for the virus, and officials in Sacramento County said on Tuesday that a resident of an assisted-living facility in Elk Grove had tested positive and was being treated. Ms. Goehring said one factor leading to the spread of the coronavirus in these facilities may be that “the virus has reacted somewhat differently than what we heard about in other locations.” She said that early reports from countries in Asia and Europe had not pointed to nursing homes as a particular problem, possibly catching the United States off guard, and that it may also be that the virus somehow “changed in this population” to become more virulent. A variety of factors make nursing homes especially at risk to an epidemic: older residents often have weakened immune systems, and many facilities are poorly staffed and have lax infection prevention — partly because visitors are constantly coming and going — which allows germs to spread. On top of that, residents, who live in proximity, often move back and forth to hospitals when they become acutely ill, making them potential carriers of infection. The Covid-19 coronavirus appears to pose a significantly greater risk to the nursing-home population than a typical seasonal flu — although the two illnesses share some similarities and are often compared. Both can spread easily and attack the lungs. With the flu, nursing homes vaccinate their staff and patients, but no vaccine exists for the novel coronavirus. When the flu hits a nursing home, patients are given prophylactic anti-viral medicine; no such prophylaxis exists for the new coronavirus. The death rate from the flu varies widely, depending on how strong the strain, but its potential lethality is sharply curbed by the built-in immunity created by vaccinations and some people’s immune defenses. No herd immunity, no vaccine and no treatment,” said Dr. David Dosa, a geriatrician and expert in emergency preparedness medicine at Brown University. “What is going to happen in each of these cases is the virus will get in, and presuming it’s not easily stopped once it gets in, everybody in the building will get it,” he said. “Then you’ll see mortality and morbidity rates that are very significant.” That prospect has left Washington State officials scrambling to understand not only how to stop the spread in these facilities but how it appears to be jumping from one place to the next. Dr. Kevin Kavanagh, an expert in infection control who has been critical of lax practices at nursing homes, lauded the new guidance that restricts social visits. This extreme level of quarantine is sometimes known as “reverse isolation” and was used to effect during the Spanish Flu epidemic, Dr. Kavanagh said. “As evidenced by the Life Care Center in Kirkland, once the virus starts to spread in the facility it ravages its residents,” he said. He said that “the importance is in delay.” Some relatives of Life Care residents said they were still frustrated by the pace of testing and the facility’s response. Vanessa Phelps said she got a call on Monday telling her that her 90-year-old mother, a former opera singer, had tested positive for the coronavirus, one of 31 newly reported cases at the nursing facility. Ms. Phelps said that she desperately wanted her mother transferred to a hospital and felt that she was being left to die by remaining at Life Care. Ms. Phelps said her mother, who has developed a cough, still had not yet learned about her own test results. “I keep telling her we’re going to take her to the park when the quarantine’s done,” Ms. Phelps said. “That’s not happening.” Jack Healy reported from Stanwood, Matt Richtel from San Francisco and Mike Baker from Seattle. Image Signage on the front doors of Genesis HealthCare’s Ballard Center in Seattle informs visitors about Covid-19. Credit. Chona Kasinger for The New York Times Image Staff at Little Havana Activities and Nutrition Centers of Dade County, Inc., prepare lunch for seniors in Miami. In the ensuing six weeks, large and shockingly lethal outbreaks have continued to ravage nursing homes across the nation, undeterred by urgent new safety requirements. Now a nationwide tally by The New York Times has found the number of people living in or connected to nursing homes who have died of the coronavirus to be at least 7,000, far higher than previously known. In New Jersey, 17 bodies piled up in a nursing home morgue, and more than a quarter of a Virginia home’s residents have died. At least 24 people at a facility in Maryland have died; more than 100 residents and workers have been infected at another in Kansas; and people have died in centers for military veterans in Florida, Nevada, New York, Maine, Massachusetts, Oregon and Washington. On Friday, New York officials for the first time disclosed the names of 72 long-term care facilities that have had five or more deaths, including the Cobble Hill Health Center in Brooklyn where 55 people have died. At least 14 nursing homes in New York City and its suburbs have recorded more than 25 coronavirus-related deaths. In New Jersey, officials revealed that infections have broken out in 394 long-term facilities — almost two-thirds of the state’s homes — and that more than 1,500 deaths were tied to nursing facilities. Overall, about a fifth of deaths from the virus in the United States have been tied to nursing homes or other long-term care facilities, the Times review of cases shows. And more than 36,500 residents and employees across the nation have contracted it. In interviews with more than two dozen workers in long-term care facilities as well as family members of residents and health care experts, a portrait emerged of a system unequipped to handle the onslaught and disintegrating further amid the growing crisis. “They’re death pits,” said Betsy McCaughey, a former lieutenant governor of New York who founded the Committee to Reduce Infection Deaths, an education campaign aimed at stopping hospital-acquired infections. “These nursing homes are already overwhelmed. They’re crowded and they’re understaffed. I can go to work today, wind up feeding them. Nursing Assistants, CNA’s, we’re the closest ones, we’re the front line.” The work of nursing assistants has always been difficult and low paying. But add coronavirus, and it’s become dangerous. TV announcers: “Across the country, nursing homes are especially vulnerable —” “One elder care facility, where 19 residents have died —” “In Palo Alto —” “In the New Orleans area —” “In DuPage County —” “In Sacramento County.” “Covid-19 spreading through our most vulnerable population.” We met up with caregivers from nursing homes in Northern California. They attend to the kind of patients who are most likely to die if they get the virus. “So can you do your job without touching people, or without —” “It’s impossible. It’s too late to turn around, you already done got crap all over you. You know, you just run to the bathroom, wash your face or whatever. And then go about your day. Social distance? Can’t do it. It’s impossible.” If this video were filmed at a different time, you’d be seeing footage of these workers with their patients. But nursing homes are closed to visitors right now to protect the people inside. Actually everything you’re seeing here we filmed from afar, following recommendations to slow the spread of Covid-19. But these caregivers can’t maintain that kind of distance in their work. And now, shortages of protective gear like masks are putting them at risk, not just for getting the virus but for spreading it. “If you want to speak, press star 6.” “We’re running out of supplies of masks in our building. And trying to take care of these patients without us also getting sick is worrisome.” “We’re rationing right now, masks, protective gear. But it’s like, what happens if we run out. It scares me.” “They gave us the N95 mask, and told us to maintain it. If the elastic comes off by accident or something, staple and reuse it.” “So you’re actually cleaning the N95 masks in between uses?” “Yeah, with — with alcohol.” “You like wipe off the outside of it or how do you do that?” “The outside, the inside and just let it air dry, and put it back in a Ziploc bag for the next day.” “A lot of people in this field, we have families. So you don’t want to take nothing home. My granddaughter, she’s special needs. So she has a low immune system. When she was born, she was really sick. So we’ve been cautious ever since she’s been born.” “I am very concerned of taking it home. My mom, she’s diabetic, and my dad also just beat cancer in the thyroid. I have asthma. So if I were to get Covid, It would affect my lungs. And how am I going to pay my bills. As a result, many nursing assistants work multiple jobs. And as they move between facilities, so can disease. “Usually when I finish the first job, I go right to the second job. I work 16 hours, that’s not including driving time. And I’m not the only one — majority of my co-workers, they work two jobs.” “I work home health care too, on top of taking care of my mom and my grandmother. I’m kind of worried because you don’t see the virus because they’re droplets, and you don’t know who’s coughing or sneezing on you. Even though I do try to sanitize, like along the way, going to my next client. But sometimes it’s just not enough I think. But who else is going to take care of them?” “Who else is going to take care of them?” We spoke with nursing home workers about their fear of catching and spreading coronavirus. Credit Credit. Elie Khadra for The New York Times It is a tragedy that is continuing to unfold, and one that even the dire figures that are known only partially capture. The number of cases at these facilities, which include nursing homes, assisted-living facilities, memory care facilities, retirement and senior communities and long-term rehabilitation facilities, is almost certainly still higher since many facilities, counties and states have not provided detailed information. The outbreaks have been spread across the sprawling senior care industry, including at publicly run facilities, those run by nonprofit groups and others managed by large corporations. Some nursing homes with clusters have a history of safety violations, persistent staffing problems and limited amenities. Other hard-hit facilities have sterling health records, luxurious living arrangements and pricey rents. The virus is known to be more deadly to aging, immune-compromised people, and small, confined settings like nursing homes, where workers frequently move from one room to the next, are particularly vulnerable to spreading infection. But oversights and failures also have contributed to the crisis. Virus tests and protective gear have been scarce inside many of these facilities, which are among the most overlooked players in the health care system. These homes, with staff members who receive less extensive training than those in hospitals, tend to struggle to slow infectious diseases. Employees are often poorly paid workers who move between multiple jobs and return home to communities at risk of contracting the virus. All of these factors have allowed the virus to thrive, making its way into at least 4,100 American nursing homes and other long-term care facilities, despite increasingly desperate efforts to stop the spread. Image Cleaners entered the Life Care Center of Kirkland, Wash., last month. The death of residents in late February at the facility was a first warning of the devastation the coronavirus could wreak inside an American nursing home. Credit. Grant Hindsley for The New York Times Facilities were late to require workers and residents to wear masks — and some were still not enforcing such policies, workers and family members said. Facing shortages of tests and of masks, homes often waited, they said, until residents were showing symptoms of Covid-19 before testing them for the virus and isolating them from others, even if they had contact with people who had been infected. “The residents and staff are being led to slaughter,” said Judith Regan, an editor and publishing executive whose 91-year-old father, Leo Regan, lives at the Long Island State Veterans Home at Stony Brook University. At least 57 residents and 37 staff members there have tested positive for the virus, and 32 residents have died. “He is on the Titanic, but there are no lifeboats,” Ms. Regan said. The months are represented by a number because the names are believed to by pagan. The return of the body back to ashes, and dust, leading to the souls rebirth in the next realm. The name derived from the Assyrian word Karibu meaning one who intercedes. Often found on the grave of children. When climbing it indicates peace. Innocence and purity. Messenger of God carrying souls to heaven. Power of God and guard the lamb against evil. If winged Mark the evangelist. Grief, death and earthly sorrow. The symbolic tree of human sadness. Nature’s lament. (Carried at Masonic funerals). Her tears turned to Lily of the Valley as they hit the ground. Purity also an apple represents the sins of Eve. The Knights Templar While believing that the pentagon offered protection from evil spirits, it was adapted by Christians, and made into a five pointed star to represent the five wounds Christ suffered on the cross. Symbolising judgement day. Palette and brushes, the artists accolade. Most used Christian symbol of faith around the world. Also of sacrifice. Sword, Symbolising justice, consistency and fortitude, martyrdom, courage, and warfare. The symbol of St. Cecillia, patron saint of musicians. Symbolic of worship in heaven. A broken chain means loss of a family member. Appears in different forms. Serpent, ancient Egyptian symbol for life and health. Steadfastness of Christ’s stability. Symbolic of cutting down a plant or person in the prime of life. Death and mourning. A lit torch signifies eternal life. A symbol of immortality, zeal, enlightenment. An upright life, the scholastic world and the betrayal of Some functions of the site may not be usable or the site may not look correct until you enable JavaScript. You can enable JavaScript by following this tutorial. Once JavaScript is enabled, this message will be removed. We believe that the brilliant histories of art belong to everyone, no matter their background.Lazare, Autun (France) Considering the Old Testament prohibitions against graven images, it is important to consider why Christian art developed in the first place. The use of images will be a continuing issue in the history of Christianity. The best explanation for the emergence of Christian art in the early church is due to the important role images played in Greco-Roman culture. For example, there was a change in burial practices in the Roman world away from cremation to inhumation. Outside the city walls of Rome, adjacent to major roads, catacombs were dug into the ground to bury the dead. Families would have chambers or cubicula dug to bury their members. Wealthy Romans would also have sarcophagi or marble tombs carved for their burial. The Christian converts wanted the same things. Christian catacombs were dug frequently adjacent to non-Christian ones, and sarcophagi with Christian imagery were apparently popular with the richer Christians. We do not find in this early period images of the Nativity, Crucifixion, or Resurrection of Christ, for example. This absence of direct images of the life of Christ is best explained by the status of Christianity as a mystery religion. The story of the Crucifixion and Resurrection would be part of the secrets of the cult. For example, the story of Jonah—being swallowed by a great fish and then after spending three days and three nights in the belly of the beast is vomited out on dry ground—was seen by early Christians as an anticipation or prefiguration of the story of Christ’s own death and resurrection. Images of Jonah, along with those of Daniel in the Lion’s Den, the Three Hebrews in the Firey Furnace, Moses Striking the Rock, among others, are widely popular in the Christian art of the third century, both in paintings and on sarcophagi. The common subject of salvation echoes the major emphasis in the mystery religions on personal salvation. The appearance of these subjects frequently adjacent to each other in the catacombs and sarcophagi can be read as a visual litany: save me Lord as you have saved Jonah from the belly of the great fish, save me Lord as you have saved the Hebrews in the desert, save me Lord as you have saved Daniel in the Lion’s den, etc. The history of the early Church is marked by the struggle to establish a canonical set of texts and the establishment of orthodox doctrine. Within the civic cults there were no central texts and there were no orthodox doctrinal positions. The emphasis was on maintaining customary traditions. One accepted the existence of the gods, but there was no emphasis on belief in the gods. Schools of philosophy centered around the teachings or doctrines of a particular teacher. The schools of philosophy proposed specific conceptions of reality. Ancient philosophy was influential in the formation of Christian theology.Those experienced with later Christian imagery might mistake this for an image of the Last Supper, but instead this image does not tell any story. It conveys rather the idea that Christ is the true teacher. The dress, scroll, and gesture all establish the authority of Christ, who is placed in the center of his disciples. Christ is thus treated like the philosopher surrounded by his students or disciples. We believe that the brilliant histories of art belong to everyone, no matter their background. Smarthistory’s free, award-winning digital content unlocks the expertise of hundreds of leading scholars, making the history of art accessible and engaging to more people, in more places, than any other provider. Each of Daytime Non-Pyrotechnic Signals. A bright orange flag with a black square over a black circle is the simplest. VDS. It is usable, of course, only in daylight. It has the advantage of being a Fig. 11 Moisture protected flares should be carried any When another boat is in This simple gesture is seldom Daytime Pyrotechnic Devices. Orange smoke is a useful daytime signal. Hand-held or floating smoke Smoke flares To be usable, smoke flares must be kept dry. Keep them in airtight Some pyrotechnic devices require a. All hand-held pyrotechnic devices may produce hot ashes or slag when Nighttime Non-Pyrotechnic Signals. An electric distress light is available. This light automatically flashes the Flashed four to six It must show that it is Be sure the batteries are fresh. Dated Under the Inland Navigation Rules, a high intensity white light flashing Therefore, use strobe lights on Nighttime Pyrotechnic Devices. See Figure 11. Aerial and hand-held flares can be used at night or in the daytime. Obviously, they are more effective at night. Currently, the serviceable life of a pyrotechnic device is rated at 42 Pyrotechnic devices are expensive. Look at their dates before you buy them. Buy them with as much time Like smoke flares, aerial and hand-held flares may fail to work if they They will not function if they are or have But store them Aerial Again, use them only when there is a good chance A serious disadvantage of aerial flares is that they burn for only a short Never use a road Marine type flares are Aerial flares should be given the same respect as firearms since they are Don't allow children to play An obstruction miaht deflect the flare to Disposal of VDS. Keep outdated flares when you get new ones. They do not meet legal Many states have similar laws. Emergency Position. Radio Beacon (EPIRB). There is no requirement for recreational boats to have. Some Vessels carrying six or fewer passengers for hire EPIRB.