Absenteeism in the health care work place has a problematic rippling effect on the other workers and patients. In hospitals and nursing homes, keeping each shift "comfortably" covered is no easy task. Because hospitals and nursing homes must function under a unique and high-pressured clinical setting, a specialized employee wellness program is needed to keep both health care workers and their patients healthy.

What happens when health care workers get sick? They don't show up for work leaving a strain on the remaining workers. Patient care is often prioritized so the most critical services are maintained while less necessary care can be postponed. Emergency procedures, medication and meals cannot wait. What other tasks can be put off? Showers, completing forms, answering questions and checking in on patients are temporarily put on the back burner. It is a difficult scenario for dedicated workers who hate to decline a patient's request when circumstances are beyond their control.

What happens when sick health care workers come back to work? Are they really better? Will they relapse and call in sick again? Are there factors in the work place contributing to their poor health? Do they have adequate health care as an employee of a health care institution? Is there a way to assist them without infringing on their privacy rights? Can health care administrators prevent the burnout that leads to high turnover rates in hospitals and nursing homes?

Health care workers also have a significant number of health problems. There is a high rate of smoking and obesity in nurses. The British Medical Journal has reported medical doctors die from suicide, poisonings and cirrhosis of the liver. In 2003, The Journal of the American Medical Association touched on the subject of sick doctors in the article, "Care of the Dying Doctor." An unhealthy staff is an overlooked epidemic that mirrors the rest of society.

Getting health care workers well and keeping them well takes the same effort that their patients have to take. They need to follow the same advice: healthy diet, physical fitness, and stress management. It is not easy in general, but the health care worker sees the tragic results of other people's stress: trauma, disease, suffering and death. Their continual exposure to other people's ill health forces them to carry the extra burden of caring for others as well as themselves.

Health care workers must not set their well being aside. A specialized health care worker wellness program can be implemented to reinforce healthy habits so they can inspire their patients to do the same. It requires an honest look at working conditions, and introducing positive incentives. Employee wellness programs have statistically shown positive benefits to a corporation's bottom line as well as employee morale.

Health care workers may have better knowledge of what it takes to promote health and it should be encouraged at work as well as home. This "bridging" allows the health care worker to remain consistent in their efforts all the time. Hospitals and nursing homes have the opportunity to invest in their health care workers with a unique wellness program that will help their workers and benefit the public.

One of the most underutilized tools in the insurance world for self employed premium victims is the modern Health Savings Account or HSA.

I find in my work that most of the issues can be tied to either having a lazy health insurance agent who is not well studied, or a customer who makes too many assumptions on what is and what is not included in the benefits. My hope is to clarify the process in which a consumer or agent should utilize to put together a smart and prudent HSA for themselves, and reap the tax advantaged benefits in the process.

HSA plans are designed to have a higher than normal deductible, and as a beneficial result, a much lower monthly premium to be paid. The deductibles are either for a single person (which can run up to $5,000) and family (up to $10,000) but when the deductibles are covered, the procedure expenses are paid 100%. The money which a person SAVES on monthly premium is supposed to be invested in to the Health Savings Account, which can take the form of a separate bank account at most major banks, or an investment fund approved for HSA deposits typically paying more interest benefit. A debit card is issued for the account chosen, and all prescriptions, medical procedures, dental, vision, and any other health related bill is paid from the account. As long as the account is used properly for medical expenses, the money invested into the account is tax advantaged: Up to $2850 for singles, $5650 for families, and is arguably the thrilling part of having one.

So what can possibly go wrong with the mathematics?

The obvious answer is more of a question, which is what happens if somebody needs major surgery (or these days, even simple outpatient surgery) before the HSA savings account has had enough time to build up to enough to cover deductibles and medications? Therefore, self-employed families should be especially careful with their cash flow ability when choosing the maximum deductible in the first place,

Having said that, another approach to policy design is to add enough ancillary and separate accident and critical care coverage to off-set a major shock, such as cancer, loss of limbs, any accident, and the most expensive surprises. This enables a person or family to keep the premiums somewhat at bay, but covers the very real possibility of needing $10,000 or $20,000 cash immediately to pay for an emergency room, or other catastrophe. There is no better policy combination that I know of than a federally mandated (standards) HSA Major Medical Plan combined with the correct ancillary items, when taken in to proportion of monthly premium benefit and overall safety from unexpected events.

The key to all of this for the self employed health insurance buyer is to work with a health agent who cares enough to dig in to the details of what ancillary policies would be best, covering everything from accidents and the top illnesses, to which discount program to use for dental and vision. If you do not have guarantees in all of these areas, coming up with large amounts of cash or credit for a surgery or other event could be horrible.

The HSA is one of the best weapons for the highest payers of health insurance, which are self employed individuals with no group plan to cover them. Take advantage of any of the top company plans, and choose your agent carefully. There are plenty of reliable health insurance companies out there. Find an agent that knows what ancillary tools to put in to perfect your HSA, and reap the premium and tax advantaged savings for you and yours.

Medical records are the documentation of the medical histories of patients. They includes the following information: demographics and personal circumstances of the patient, such as the name, birth date, age, civil status, etc. They also list the diseases, sickness and growth landmarks of the patient, as well as his allergies and preferences.

Hospitals and health care service providers compile and store medical records of the patients for safekeeping, but it would be better for each patient to maintain and compile their own. Doing this will make them aware of their own health while at the same time become more interested and learning more about how their body reacts to certain diseases and external stimuli. This has been especially true for allergic reactions. A person with allergies should know what causes them and know how to deal with them properly.

Hospitals and health care providers, on the other hand, need the medical information so they can give continuous care to the patient. This continuity of care should not stop in case the patient transfers to another hospital or chooses another doctor. The previous hospital or doctor is required to turnover the medical records of the patient, so the new hospital or doctor can continue monitoring his health.

Doctors depend on this to come-up with better diagnostics of a sickness or disease. They need these records to avoid prescribing medications that can otherwise produce ill-effects to the patient instead of being a cure for the sickness. They also need it to give advice to patients with a weak disposition, so they can avoid possible contraction of diseases or illness he is vulnerable from. In times of emergency, for example, if the patient is unconscious, his medical records are all that the hospital or doctor can use as reference.

As already explained, medical records are very important and because personal information is stored in medical records. Indeed, there are legal and ethical rules that must be followed. Simply put, hospitals and doctors are required to keep patient information confidential and secure from unauthorized third parties. Also, patient records will be used solely for the continuous care of the health of the patient.

In order to understand the process of Medicaid qualification in Colorado, you first need to know how Medicaid treats your assets.

Basically, Medicaid breaks your assets down into two separate categories. The first are those assets which are "exempt" and the second are those assets which are "non-exempt" or countable.

Exempt assets are those which Medicaid will not take into account (at least for the time being). Generally the following assets are exempt:

* The home, up to $500,000 in equity. The home must be the principal place of residence. The nursing home resident may be required to show some "intent to return home," even if this never actually takes place.
* Household and personal belongings, such as furniture, appliances,jewelry and clothing.
* One vehicle of any value.
* Prepaid funeral plans and burial plots.
* Cash value of life insurance policies, as long as the face value of all policies added together does not exceed $1,500. If it does exceed $1,500 in total face amount, then the cash value in these policies is countable. Also, term life insurance is exempt.
* Cash (e.g. a small checking or savings account) not to exceed$2,000.

These are basically the assets which Medicaid will ignore, at least for now. Keep in mind, however, that the estate recovery unit may come back to recoup payments made to a Medicaid recipient after the death of the recipient and the recipient's spouse.All other assets which are not exempt (i.e. the ones not listed earlier) are countable. This includes checking accounts, savings accounts, certificates of deposit, money market accounts, stocks,mutual funds, bonds, IRAs, pensions, second cars and so on. While there are some minor exceptions to these rules, for the most part,all money and property, as well as any item that can be valued and turned into cash, is a countable asset, unless it is one of those listed earlier as exempt.

While the Medicaid rules themselves are complicated and somewhat tricky, for a single person it's safe to say that you will qualify for Medicaid so long as you have only exempt assets plus a small amount of cash.

For a married couple, the community spouse (i.e., the one not needing nursing home care) can generally keep $104,400. Of course,this does not mean there are not things which can be done to protect assets beyond these levels. Instead, this information is designed to review the basics in a way which a caseworker from Medicaid would do so.

Today I present to you a different kind of article. Today, instead of just putting facts across the page, I want to inject a little of creative writing, various ideas into my usual way of presenting information here. Bear with me, hoping you understand the message here. Yes, sometimes I can write words that might be a little confusing but that is not a problem on your end but here. I will explain that at a later date.

Some creative writing ventures in here, here on this white space, here in this computer space. Well, honesty be told, all of my writing is creative in one way or another, even my factual stories are presented in a very creative way to keep your interest, to keep my interest. After all, how much can you write about apples and not be bored of apples or any other topic for that matter?

So my story begins here,

Meanwhile, I went to look into my journal yesterday and was not surprised to find the writing, writings that came from my mind, heart, soul and spirit. These were writings of my thoughts, ideas and suggestions that flooded through, begging to come out onto paper. And yet day after day passed and not one word dared venture out onto the paper. After all,once the ideas or thoughts are on paper, it is so easy for people to steal or borrow them. So for years, I kept the journal private and now soon this year I will reveal it to the public.

Yesterday I visited again. Without too much hope in my heart, I entered the parking lot to this nursing home. Funny thing, this nursing home has had the reputation of being very good. That being very good, that is what interested me in it in the first place. Who would not be relieved to hear that a nursing home is very good? And indeed, this one was classified as being very good. I walked from the parking lot to the walkway of the building. It was a crystal clear day, and the weather was just begging people to come out and sit by the ocean. The invitation was nice and very timely but the smarter part of me kept saying, no, today is not the day for the ocean. Today is your visiting day. Do that first. Uhhghhg, the feelings I got after that order. Suddenly, I felt depressed, sad, and seemingly overwhelmed. I feel sad and overwhelmed every single time that I visit there. And now just the thought of going into another nursing home, another hospital or another medical center make me sick to my stomach. Perhaps I have too many memories of the extremely bad facilities. Perhaps I just did not read enough. Perhaps, perhaps and perhaps, these are the important bits of my description . Perhaps is a very prevalent word when it comes to talking with someone who is in a medical center or nursing home.

I creeped up the walk. Turned into the curve, yes, it was a driveway from the parking lot. There at the ocean you would prepare to visit and then go up at exactly visitors' time. I think things over and I remember the things that bothered me, even about the good place. Yes , even about the good nursing home. This is what people do not realize. They do not realize that even the good nursing homes are bad. Why are they bad? They are bad because their first priority is getting paid and making more money and filling beds and making sure that each and every thing is paid for immediately and as quick as possible. Even the good ones have billing problems. In some of the good ones, what happens is that when the patient is alone in the facility --perhaps he or she has no visitors for an hour or so, while that patient is alone, there can be one or two or three specialists sent in to examine the patient even when the patient does not want the examination, even when the patient or family never asked for these extra examinations. The patient and family just have t o put up with this because they are unaware that it is happening.

For example, figure this one out. Patient has ulcers that came from bedsores. Patient had quite a few here and there. Patient was admitted to the hosital for heart failure and then sent to another nursing home, a good one. At this nursing home, instead of asking the family or patient where these sores were from or how he or she got them, they automatically sent a plastic surgeon to check the patient's sores and ulcers. When the family asked why that doctor had come for a consultation, the doctor replied that the patient had sores and they had to find out why he had sores and why so many. That is odd. The odd thing is that the sores were from a previous nursing home. And both the family and the patient knew this. Yet they had a consultation with a plastic surgeon to see why the patient had these sores. Now, of course the family wanted the patient to see a doctor, of course. But would it not make more sense for a skin specialist to be brought in, and would it make more sense to bring in an infections specialist ? Would it not made more sense to contact the family first and let them in on what was happening to the patient at that time when they were not in the nursing home? No skin specialist was brought in; no infections specialist was brought in. Even no heart specialist was brought in even though this patient had a history of heart disease, heart problems, heart stents, heart murmer and past congestive heart failure, this nursing home did not send a heart specialist but sent a plastic surgeon. Interesting? Yet, it is typical of what happens in the better nursing homes. There is not enough of the correct examinations and too much of the examinations that are not necessary.

And, that incident was a minor matter, not a major matter. But it was not a major matter because this was one of the better nursing homes. So what happens in one of the rehabiliation and care centers? What if you live in Staten Island and need to go to a rehabilitation and care center? Which one do you choose? Do you dare choose? In the past, I have visited many nursing homes and also some rehabilitation and care centers. And what I have found is that these things are synonmous with almost all nursing homes and especially with bad nursing homes. These things happen and these things exist:

1. Staff has no time for residents and patients. She seem to be busy running back and forth but it appears that the bulk of their time is spent filling out reports, conversing amongst each other and talking to doctors and filling out more reports.
2. When staff does have any time for residents, the staff seems impatient, and in a hurry. The residents wait and wait and wait for service here and there and when the service finally comes, the aids and staff are in too much of a hurry to give good, friendly service.
3. There is rampant kinds of different neglect and abuse in the bad rehabiliation and care centers to the point of the administrators and seniors and supervisors seemingly doing things that might be illegal, yet no one stops them and no one knows because these senior staff have so much power.
4. Everything is a secret. You will find out later. No one has the answers to the questions you ask and you just get pushed from one place to another.
5. Residents are basically prisoners. They have schedules that they do not want. They can not eat, or sleep when they want to. Most cannot go outside the place if they want to and there is everything else wrapped up in red tape.
6. Humans sit in urine and in feces in diapers for hours at a time. Humans beg to be brought to the bathroom but no one hears their cries.
7. Humans sit in hallways begging to get out of these places. And then more happens.

Is that the kind of place you want to visit in or live in ? And that is just a sample, a small sample of what is happening in those places.

This article might be a little shock to you. After you are shocked, the best thing that you can do for you and for your family is to prepare them and prepare yourself for the future and cover any what ifs that could or might happen.

After doing extensive research on the topic and after being a somewhat-constant visitor to many hospitals, medical centers, nursing homes and a rehabilitation and care center, I have come to the conclusion that nursing homes are not meant for human beings. The only human beings that most nursing homes can benefit are those humans that have absolutely no family, friends, co-workers or connections. And even then, those patients are not helped either but might be the ones that are most taken advantage of.

These are statements in general about various things that can, did and will happen in your local nursing homes, rehab centers and medical centers and hospitals.

1. Nursing homes and rehab centers and some hospitals will insist that patients wear diapers --even when they do not medically need diapers.
2. Nursing homes and rehab centers will present some patients with contracts/policy admissions or enrollment papers that gives the facility practically complete control over all the assets, money an d real estate of the patient. The documents will give mass permission to the facility to investigage into the patient's entire life, financial, social, psychiatric, medical and more circumstances without even asking the patients' permission again. (They get the signature when the patient enrolls and most time the patient has no clue what the enrollment agreement /contract is.
3. Nursing homes and rehab centers, in some and lots of cases, will try to isolate the family members and co workers and friends from their relatives, patients so that the family members and friends are not witnesses to the nursing home lacks and neglects. The really bad nursing homes are those that want the patient to be separate from their immediate family members even from those family members that have been helpful, beneficial and good towards the patient or family member.
4. Nursing Homes and rehab centers, once they get your signature on Medicaid or Medicare applications, and once they get your application almost processed will ignore your requests to go home, to visit out of the nursing homes and your requests to be connected with people.
5. Rehabilitation and care centers that are bad or going bad will keep their public phones -- on the long term floors -- broken or out of order most times. THey know that is the connection with family members, yet the phones are always either busy, broken or both.
6. They will let patients sit for hours and hours in their own urine and excrement, ignoring their pleas for help and assistance.
7. They will let patients wait for hours on toilet bowls, having them wait to have assistance to come off the toilet bowl.
8. They will medicate patients that are witnesses and medicate patients who complain about conditions.
9. They will lie to families consistently and continuously. There was one case where they told the family member that a patient could walk 90 feet, yet when the family member went to watch the patient, the patient could walk only a few feet at one time and no where near 90 feet. They have lied to other patients about whether patients came out of the bed. For example, a nurse will say, yes she had breakfast in the dining room, but the truth is that she had breakfast in bed in her own room, still isolated from the rest of the population in the facility.
10. They will consistently lose patients' clothing, all the time. There are patients wearing other patients' clothing and there are tons of clothing lost for each year.
11. They will ignore your requests for help. They will make fun of patients, mimicking them when they want to do so.
12. They will take money from residents so that they can purchase cigarettes and other health-harming items for patients who are on oxygen, patients who are sick, and for patients who are not allowed out of the building.
13. Some will take your clothing and not issue any receipts.
14. Some will lose ALL the pants and some of the clothing. The method to their madness about them losing the pants, is this: If the resident has many pairs of pants then the resident can tell the place that he does not want to wear diapers. So, those facilities that want to keep residents isolated, will lose the residents pants so that the resident cannot leave his room. YOu are not permitted to leave your room without pants, of course, and it the place consistently loses their pants, the resident becomes more isolated and more unhappy.

Maintaining good health involves a good partnership between you and your health care team. It is important that you can communicate well with your doctors, your nurses and other health professionals so that you can make smart decisions.

You should also have one personal doctor who will do all the coordination with other medical practitioners for your medical care.

He or she will help you to understand any procedures of your health plan and recommend you the best care available for you.

When you make an appointment with your doctor or nurse practitioner, remember that it is very important to show up on time for. But if for any reasons that you cannot make it on time, do call the office any inform them. This will help your doctor's office to be more efficient for everyone.

Giving your doctor a concise and organized description of your illness is the very first most important information that your doctor needs. This has to come from you and definitely is your responsibility to do so to show that you care and want to participate in your health matter.

Your doctor will most probably continue to probe further into the illness by asking more questions. Responding and expressing clearly will help your doctor to a more accurate diagnosis to your illness.

Giving your doctor complete information about medications you have taken before or during the illness will be most helpful. Any allergies you may have should also be told to your doctor.

Other information that your doctor may want to know is about your social life and your work. Many a time illnesses are related to your job, family, drinking habits, sexual activity or even exposure to chemical or toxic substances. Thus you need to be as truthful as possible in your answers as they do play an important part in your diagnosis and treatment.

You too need to participate by asking your doctor questions. This will give you a better understanding of the condition of your health and the treatment that you may be receiving. Never worry about making a pest of yourself by asking questions. All good health professionals encourage their patients to ask questions and take an active role in their own health care. You may want to prepare yourself with a list of questions before going to see your doctor. This will ensure that you have all the questions in hand.

Last but most importantly you need to ask if your aren't absolutely sure about the doctor's advice, or medication instructions given to you. It would be wise to write down all instructions given. Don't depend on your memory. Call back if you are still not sure. But don't ever guess. It is your health that matters.

The woman looked at me and said, This place is like a prison; I am not coming back here. I looked at the place and from the outside and sometimes from the inside, the place looked pretty inviting, not homey but inviting. I knew that most of the staff was pleasant, friendly and somewhat professional. Though I was not affiliated with the place, I did have the opportunity to see inside the building and to notice what happens inside. I really wondered why she thought it was like a prison but I did not want to talk it over for hours as I was planning to have a pleasant day, peaceful, thinking on beautiful, serene things. Yet, her words kept haunting me. Why should those words haunt me and you? They should haunt us because with one stroke of fate, you or I or both of us can land in that place accidentally and then we two will discover what the place is really like inside, when the visitors leave, when the witnesses leave. What is a nursing home like when you have to live there as opposed to being there only as a visitor?

Well, here are some things that make residents and patients feel like they are in prison:

* Most of the residents, if they are wheelchair-bound, are literally bound from going where they want to go, when they want to go. They have so many time restrictions due to that there are not enough staff members to take them where they want to go to.
* This particular place even has restrictions on their clothing; prisoners do also. Prisoners have to wear the clothing that is given to them by the state or federal government. Residents in nursing homes are restricted to wear the clothing that the facility does not lose or to clothing that people from the outside bring to them because most of them cannot go shopping on their own. They need to get special passes to go out of the building.
* They are not free to come and go as they please, even though that might be their permanent home. Can you imagine being a grown person and needing to ask if you want to go outdoors and then when you ask you are told you need a pass, a special pass that needs to be signed by the nurses or social workers?
* In some facilities, the residents cannot even go from one floor to the next floor without an aide or person accompanying them. If they want to use the vending machines or if they want to go to the auditorium or go to activities, there is one rehab and care center that has elevators that are not wheelchair accessible in the fact that people in wheelchairs cannot reach the elevator buttons. They need someone to be in the elevator to press the buttons for them. So even if a resident does not need an aid because they are physically independent but need the wheelchair to help, this resident cannot be free to go to the lobby or other floors without asking an aide to help them.
* When they ask for help or an aid to accompany them somewhere in or out of the building, most times, the staff is never available. The residents have to wait and wait and wait and wait until finally, maybe, someone might be able to help them, maybe. And that is a very big maybe, because most times, they just wait and wait and then give up on going where they want to go.
* Everything they want to do is accompanied by a pass or written instructions or special rules. That is not a home, that is more like a prison. Residents need to get approval for practically anything and everything, including going to the restroom. Imagine really having to go to a restroom and needing to wait and wait and wait till someone comes to get you?


There are two million ways that bad rehab centers and nursing homes and EVEN good nursing homes are so much like prisons. They are more like prisons than prisons are. There are some prisons where the inmates have so much more freedom than nursing home residents have and that is the absolute truth. Do not doubt that for one moment. So could you even imagine, working your whole life so that you can have a good retirement life and then ending up in a place that has less freedom than your average prison has? No. You probably could not even imagine that , correct?

You can help.

Write here and leave your comments, ideas, suggestions and complaints. You can help. Write to me today to share your ideas, your hope, your understanding, your knowledge, your inside information and everything else you can share to make these prisons better today.

Many people believe that adding someone's name to your bank account can be an effective strategy for protection of assets when attempting to qualify for Colorado Medicaid. This is actually not the case, however. Consider the following situation:

Mrs. Jones' husband was diagnosed with Alzheimer's Disease three years ago and the disease has progressed to the point where he needs long-term nursing home care.

At the time of the diagnosis, she talked to some friends of the family who told her to go ahead and add the kids names to her bank accounts and mutual funds as a way to protect those assets from Medicaid. Now that her husband is in the nursing home she wonders
whether she did the right thing.

Adding someone else's name to a bank account or mutual fund does NOT transfer the ownership on that account. If Mrs. Jones had a bank account with $20,000 and she added her daughter's name to the account, the state would say that her daughter's name was added for convenience purposes only. In other words, the entire account still belongs to Mrs. Jones. So even though the child's name has been added, the practical effect, from a Colorado Medicaid standpoint, is that there has been no gift and the entire account still belongs to Mrs. Jones.

This is true whether we are talking about bank accounts, certificates of deposit, savings bonds, mutual funds or any other liquid asset. The law says there is no gift until the child actually takes the money out of the account. In other words, using this same example, if Mrs. Jones added her daughter's name to the account three years ago, there has been no gift made. If her daughter later takes some money out of the account and moves it into her own name, then the gift is made at the time the daughter takes the money out of the account.

This general rule is not true where real estate is concerned. That's because if someone's name is added to real estate, at the time the deed is signed and recorded, then a completed gift has been made.

Whether or not it makes sense to add someone's name to real estate or financial assets depends upon the facts and circumstances of each particular case, and laws can vary from state to state. Be sure to seek the advice of a competent professional before proceeding.

In order to understand the process of Medicaid qualification in Colorado, you first need to know how Medicaid treats your assets.

Basically, Medicaid breaks your assets down into two separate categories. The first are those assets which are "exempt" and the second are those assets which are "non-exempt" or countable.

Exempt assets are those which Medicaid will not take into account (at least for the time being). Generally the following assets are exempt:

* The home, up to $500,000 in equity. The home must be the principal place of residence. The nursing home resident may be required to show some "intent to return home," even if this never actually takes place.
* Household and personal belongings, such as furniture, appliances,jewelry and clothing.
* One vehicle of any value.
* Prepaid funeral plans and burial plots.
* Cash value of life insurance policies, as long as the face value of all policies added together does not exceed $1,500. If it does exceed $1,500 in total face amount, then the cash value in these policies is countable. Also, term life insurance is exempt.
* Cash (e.g. a small checking or savings account) not to exceed$2,000.

These are basically the assets which Medicaid will ignore, at least for now. Keep in mind, however, that the estate recovery unit may come back to recoup payments made to a Medicaid recipient after the death of the recipient and the recipient's spouse.All other assets which are not exempt (i.e. the ones not listed earlier) are countable. This includes checking accounts, savings accounts, certificates of deposit, money market accounts, stocks,mutual funds, bonds, IRAs, pensions, second cars and so on. While there are some minor exceptions to these rules, for the most part,all money and property, as well as any item that can be valued and turned into cash, is a countable asset, unless it is one of those listed earlier as exempt.

While the Medicaid rules themselves are complicated and somewhat tricky, for a single person it's safe to say that you will qualify for Medicaid so long as you have only exempt assets plus a small amount of cash.

For a married couple, the community spouse (i.e., the one not needing nursing home care) can generally keep $104,400. Of course,this does not mean there are not things which can be done to protect assets beyond these levels. Instead, this information is designed to review the basics in a way which a caseworker from Medicaid would do so.

Richard D. Hughes is a graduate of Indiana University and the University of Denver College of Law. He has hosted scores of seminars, workshops and panel discussions on a variety of topics including probate avoidance, tax savings, disability issues, asset protection strategies, Medicaid law and trust planning.

Today I present to you a different kind of article. Today, instead of just putting facts across the page, I want to inject a little of creative writing, various ideas into my usual way of presenting information here. Bear with me, hoping you understand the message here. Yes, sometimes I can write words that might be a little confusing but that is not a problem on your end but here. I will explain that at a later date.

Some creative writing ventures in here, here on this white space, here in this computer space. Well, honesty be told, all of my writing is creative in one way or another, even my factual stories are presented in a very creative way to keep your interest, to keep my interest. After all, how much can you write about apples and not be bored of apples or any other topic for that matter?

So my story begins here,

Meanwhile, I went to look into my journal yesterday and was not surprised to find the writing, writings that came from my mind, heart, soul and spirit. These were writings of my thoughts, ideas and suggestions that flooded through, begging to come out onto paper. And yet day after day passed and not one word dared venture out onto the paper. After all,once the ideas or thoughts are on paper, it is so easy for people to steal or borrow them. So for years, I kept the journal private and now soon this year I will reveal it to the public.

Yesterday I visited again. Without too much hope in my heart, I entered the parking lot to this nursing home. Funny thing, this nursing home has had the reputation of being very good. That being very good, that is what interested me in it in the first place. Who would not be relieved to hear that a nursing home is very good? And indeed, this one was classified as being very good. I walked from the parking lot to the walkway of the building. It was a crystal clear day, and the weather was just begging people to come out and sit by the ocean. The invitation was nice and very timely but the smarter part of me kept saying, no, today is not the day for the ocean. Today is your visiting day. Do that first. Uhhghhg, the feelings I got after that order. Suddenly, I felt depressed, sad, and seemingly overwhelmed. I feel sad and overwhelmed every single time that I visit there. And now just the thought of going into another nursing home, another hospital or another medical center make me sick to my stomach. Perhaps I have too many memories of the extremely bad facilities. Perhaps I just did not read enough. Perhaps, perhaps and perhaps, these are the important bits of my description . Perhaps is a very prevalent word when it comes to talking with someone who is in a medical center or nursing home.

I creeped up the walk. Turned into the curve, yes, it was a driveway from the parking lot. There at the ocean you would prepare to visit and then go up at exactly visitors' time. I think things over and I remember the things that bothered me, even about the good place. Yes , even about the good nursing home. This is what people do not realize. They do not realize that even the good nursing homes are bad. Why are they bad? They are bad because their first priority is getting paid and making more money and filling beds and making sure that each and every thing is paid for immediately and as quick as possible. Even the good ones have billing problems. In some of the good ones, what happens is that when the patient is alone in the facility --perhaps he or she has no visitors for an hour or so, while that patient is alone, there can be one or two or three specialists sent in to examine the patient even when the patient does not want the examination, even when the patient or family never asked for these extra examinations. The patient and family just have t o put up with this because they are unaware that it is happening.

For example, figure this one out. Patient has ulcers that came from bedsores. Patient had quite a few here and there. Patient was admitted to the hosital for heart failure and then sent to another nursing home, a good one. At this nursing home, instead of asking the family or patient where these sores were from or how he or she got them, they automatically sent a plastic surgeon to check the patient's sores and ulcers. When the family asked why that doctor had come for a consultation, the doctor replied that the patient had sores and they had to find out why he had sores and why so many. That is odd. The odd thing is that the sores were from a previous nursing home. And both the family and the patient knew this. Yet they had a consultation with a plastic surgeon to see why the patient had these sores. Now, of course the family wanted the patient to see a doctor, of course. But would it not make more sense for a skin specialist to be brought in, and would it make more sense to bring in an infections specialist ? Would it not made more sense to contact the family first and let them in on what was happening to the patient at that time when they were not in the nursing home? No skin specialist was brought in; no infections specialist was brought in. Even no heart specialist was brought in even though this patient had a history of heart disease, heart problems, heart stents, heart murmer and past congestive heart failure, this nursing home did not send a heart specialist but sent a plastic surgeon. Interesting? Yet, it is typical of what happens in the better nursing homes. There is not enough of the correct examinations and too much of the examinations that are not necessary.

And, that incident was a minor matter, not a major matter. But it was not a major matter because this was one of the better nursing homes. So what happens in one of the rehabiliation and care centers? What if you live in Staten Island and need to go to a rehabilitation and care center? Which one do you choose? Do you dare choose? In the past, I have visited many nursing homes and also some rehabilitation and care centers. And what I have found is that these things are synonmous with almost all nursing homes and especially with bad nursing homes. These things happen and these things exist:

1. Staff has no time for residents and patients. She seem to be busy running back and forth but it appears that the bulk of their time is spent filling out reports, conversing amongst each other and talking to doctors and filling out more reports.
2. When staff does have any time for residents, the staff seems impatient, and in a hurry. The residents wait and wait and wait for service here and there and when the service finally comes, the aids and staff are in too much of a hurry to give good, friendly service.
3. There is rampant kinds of different neglect and abuse in the bad rehabiliation and care centers to the point of the administrators and seniors and supervisors seemingly doing things that might be illegal, yet no one stops them and no one knows because these senior staff have so much power.
4. Everything is a secret. You will find out later. No one has the answers to the questions you ask and you just get pushed from one place to another.
5. Residents are basically prisoners. They have schedules that they do not want. They can not eat, or sleep when they want to. Most cannot go outside the place if they want to and there is everything else wrapped up in red tape.
6. Humans sit in urine and in feces in diapers for hours at a time. Humans beg to be brought to the bathroom but no one hears their cries.
7. Humans sit in hallways begging to get out of these places. And then more happens.

Is that the kind of place you want to visit in or live in ? And that is just a sample, a small sample of what is happening in those places.

As you know, medical procedure prices are extremely high in the United States. As an alternative to high U.S. prices, we have medical and dental provider locations in India. Until the last few years, people looked at countries outside the U.S. and its hospitals as inferior imitations of those in developed countries. Western expatriates as well as wealthier Third World "natives", having very little trust in local hospitals or doctors, would fly to the United States for something as simple as an executive check-up.

In the past 30 years, the costs of health care have soared in developed countries, especially in the United States. Due to rapidly escalating health care costs, Americans, Europeans, Canadians and Australians in ever increasing numbers began to search for alternatives that could reduce their personal out of pocket medical expenses. In the last few years, millions of people from developed nations have chosen to become Medical Tourists.

Need a coronary bypass surgery that costs more than $150,000 in the U.S.? Simply pack your bags. Take a vacation, and pay $6,500. Need an elective Caesarean section? That's about $1,000 including a four day hospital stay in a private room. How about a breast augmentation with smooth saline implants? Breast implants will cost you $2,000. If you are willing to travel, the list of more affordable medical procedures is seemingly endless: cardiac surgery, orthopedic surgery, weight loss procedures, cancer treatments, cosmetic surgery, general surgery, medications, infertility treatments, dental, glasses, stress reduction programs, neurosurgery, laparoscopic procedures, sex reassignment surgery, experimental treatments and so much more.

International rates are very low compared to what is paid in the United States, Europe or Australia. In some cases, the savings from dental work alone can give people extra money for a luxury vacation. For example, a family can take an expensive, four-star, luxury vacation in a Mexican Oceanside Villa and pay for the trip with the savings they receive on getting their glasses, medications and dental work from local providers. Medical Tourism can certainly be a win-win proposition. While taking care of health needs at deep discounts, shopping excursions, river tours, sight-seeing, nature excursions, intellectual pursuits, religious pilgrimages, cruises, ancient site tours, safaris, hunting or fishing trips and trips to nearby beaches can all be arranged around a medical appointment schedule. Medical Tourism is a simple concept: people can combine medical treatments with vacations, and use the savings on the medical care to pay for the vacation.

As with everything, there is one major drawback. Although most Americans have gone to a physician in the U.S. with international training, the majority of Americans remain very skeptical about traveling to other countries for their medical care. Logic mandates that there are international hospitals and health care professionals that can match those in the United States. Thus, the key is weeding through thousands of potential sources for international medical care and finding the right clinical provider, location and overall travel package.

At Medical Discounts International (MDI), we help consumers find international sources of U.S. equivalent medical care at affordable prices. MDI evaluates health care providers on five criteria: (1) the locations current geo-political issues, safety, security and weather; (2) the cost of services performed including the cost of transportation, food and lodging; (3) the convenience for the patient; (4) the quality standards as set and evaluated by an objective third party, and finally, (5) the local tourist and vacation attractions.

Medical Tourism is not for everyone, but it is a viable option for people who can not afford the high costs of health care in the United States.

This article might be a little shock to you. After you are shocked, the best thing that you can do for you and for your family is to prepare them and prepare yourself for the future and cover any what ifs that could or might happen.

After doing extensive research on the topic and after being a somewhat-constant visitor to many hospitals, medical centers, nursing homes and a rehabilitation and care center, I have come to the conclusion that nursing homes are not meant for human beings. The only human beings that most nursing homes can benefit are those humans that have absolutely no family, friends, co-workers or connections. And even then, those patients are not helped either but might be the ones that are most taken advantage of.

These are statements in general about various things that can, did and will happen in your local nursing homes, rehab centers and medical centers and hospitals.

1. Nursing homes and rehab centers and some hospitals will insist that patients wear diapers --even when they do not medically need diapers.
2. Nursing homes and rehab centers will present some patients with contracts/policy admissions or enrollment papers that gives the facility practically complete control over all the assets, money an d real estate of the patient. The documents will give mass permission to the facility to investigage into the patient's entire life, financial, social, psychiatric, medical and more circumstances without even asking the patients' permission again. (They get the signature when the patient enrolls and most time the patient has no clue what the enrollment agreement /contract is.
3. Nursing homes and rehab centers, in some and lots of cases, will try to isolate the family members and co workers and friends from their relatives, patients so that the family members and friends are not witnesses to the nursing home lacks and neglects. The really bad nursing homes are those that want the patient to be separate from their immediate family members even from those family members that have been helpful, beneficial and good towards the patient or family member.
4. Nursing Homes and rehab centers, once they get your signature on Medicaid or Medicare applications, and once they get your application almost processed will ignore your requests to go home, to visit out of the nursing homes and your requests to be connected with people.
5. Rehabilitation and care centers that are bad or going bad will keep their public phones -- on the long term floors -- broken or out of order most times. THey know that is the connection with family members, yet the phones are always either busy, broken or both.
6. They will let patients sit for hours and hours in their own urine and excrement, ignoring their pleas for help and assistance.
7. They will let patients wait for hours on toilet bowls, having them wait to have assistance to come off the toilet bowl.
8. They will medicate patients that are witnesses and medicate patients who complain about conditions.
9. They will lie to families consistently and continuously. There was one case where they told the family member that a patient could walk 90 feet, yet when the family member went to watch the patient, the patient could walk only a few feet at one time and no where near 90 feet. They have lied to other patients about whether patients came out of the bed. For example, a nurse will say, yes she had breakfast in the dining room, but the truth is that she had breakfast in bed in her own room, still isolated from the rest of the population in the facility.
10. They will consistently lose patients' clothing, all the time. There are patients wearing other patients' clothing and there are tons of clothing lost for each year.
11. They will ignore your requests for help. They will make fun of patients, mimicking them when they want to do so.
12. They will take money from residents so that they can purchase cigarettes and other health-harming items for patients who are on oxygen, patients who are sick, and for patients who are not allowed out of the building.
13. Some will take your clothing and not issue any receipts.
14. Some will lose ALL the pants and some of the clothing. The method to their madness about them losing the pants, is this: If the resident has many pairs of pants then the resident can tell the place that he does not want to wear diapers. So, those facilities that want to keep residents isolated, will lose the residents pants so that the resident cannot leave his room. YOu are not permitted to leave your room without pants, of course, and it the place consistently loses their pants, the resident becomes more isolated and more unhappy.

Maintaining good health involves a good partnership between you and your health care team. It is important that you can communicate well with your doctors, your nurses and other health professionals so that you can make smart decisions.

You should also have one personal doctor who will do all the coordination with other medical practitioners for your medical care.

He or she will help you to understand any procedures of your health plan and recommend you the best care available for you.

When you make an appointment with your doctor or nurse practitioner, remember that it is very important to show up on time for. But if for any reasons that you cannot make it on time, do call the office any inform them. This will help your doctor's office to be more efficient for everyone.

Giving your doctor a concise and organized description of your illness is the very first most important information that your doctor needs. This has to come from you and definitely is your responsibility to do so to show that you care and want to participate in your health matter.

Your doctor will most probably continue to probe further into the illness by asking more questions. Responding and expressing clearly will help your doctor to a more accurate diagnosis to your illness.

Giving your doctor complete information about medications you have taken before or during the illness will be most helpful. Any allergies you may have should also be told to your doctor.

Other information that your doctor may want to know is about your social life and your work. Many a time illnesses are related to your job, family, drinking habits, sexual activity or even exposure to chemical or toxic substances. Thus you need to be as truthful as possible in your answers as they do play an important part in your diagnosis and treatment.

You too need to participate by asking your doctor questions. This will give you a better understanding of the condition of your health and the treatment that you may be receiving. Never worry about making a pest of yourself by asking questions. All good health professionals encourage their patients to ask questions and take an active role in their own health care. You may want to prepare yourself with a list of questions before going to see your doctor. This will ensure that you have all the questions in hand.

Last but most importantly you need to ask if your aren't absolutely sure about the doctor's advice, or medication instructions given to you. It would be wise to write down all instructions given. Don't depend on your memory. Call back if you are still not sure. But don't ever guess. It is your health that matters.

This next part of the series of articles is about questions. These are the questions that I need answered. And as I sit here, I wonder if anyone out there has the answers to these questions. Please contribute and please participate in this series of articles that was written with the intent to bring things out to the public, written with the intent to connect with readers, residents, patients and family members. It is written with the intent to break down the barriers of isolation that the system seemingly sets up to break down the connections that people have. The bottom line is that the first thing that happens inside of horrible nursing homes is that they isolate, medicate and then continue to take all of a person's freedom, assets, liberties. They begin by first putting the resident in diapers against their will. They convince the residents to wear diapers insinuating that if they do not wear diapers the resident will be made to sit in wet clothing for hours and hours. Most residents give up, give up their will to fight, to live and to have their dignity and most of them agree --against their will, to wear diapers even when the diapers are not medically necessary for the resident. I am not speaking about those residents who actually need diapers. I am speaking about those residents who do not medically need diapers but who are made to wear diapers just for the convenience of the staff and workers.

Help!

Thank you. I am trying to get your attention here and I hope that I got someone's attention. If you are sitting there wanting to go to another website now and not wanting to read any further, I beg you; I implore you to bear with me a little and please participate in this communication. Here are my questions:

* What would you do if a nurse insisted that you wear diapers but you know that you are not incontinent? How would you answer the nurse?
* Would you have any fear in saying --no, I do not need diapers?
* Have you been in that position in a nursing home or in a rehabilitation center?
* What would you do if you sat for hours pleading for help and yet no one helped you inside of that nursing home?
* What would you do if they insinuated that they would leave you for hours in wet and pooped clothing inside a nursing home if you did not agree to wear diapers?
* If they ask you to wear diapers, just in case you have an accident, and they keep repeating that to you even though you told them that you are not wearing diapers, isn't that some kind of problem for you? If you told them no once, shouldn't that one no be enough for them to understand that you are not incontinent?

These are some questions that some nursing home residents are asking us and they are needing our help to get answers for them. They need your help in seeing that they are not alone and in seeing that people are beginning to know what is happening inside those camps. I mean, inside those nursing homes and inside those rehabilitation and care centers.