Forget it, give up, I quit! Is this how you feel about making money online? I remember exactly how I felt when nothing was working and I wanted to quit.  Boy am I glad I didn’t give up now, it is amazing how a few small bits of information can dramatically change your results. I have often heard people say that it is only a few percent difference between being unsuccessful and an all time legend. When it comes to Internet Home Based Business Opportunities this is definitely the case.The reason why most people don’t achieve success with their online marketing is that they don’t treat is at a home based business. Most people see it as a bit of fun that probably isn’t going to work. If this is you then you need to either give up or lift your game.What if there really was a way to create an internet home business that could passively earn you 6 figures a year. Can you imagine how different your life would be? This is my plea to youDon’t give up without a fight – Believe me it will be worth it in the endI was in the exact same position that you are in today, infact every successful person online was originally in your position. What is my point? This isn’t an easy game to play, if it was then everyone would do it. But because it does take some work it is all the more plesuarable when you figure it out and start making serious money from home.Here is a 7 step plan on how to find the best Internet Home Based Business Opportunities and more importantly how to start making money.Step 1. Figure out what type of business you wantStep 2. Figure out what niche or market it is going to be inStep 3. Find a proven business plan or system that you can use (don’t try and invent the wheel again)Step 4. Get a mentor that has already achieved success with this planStep 5. Take massive actionStep 6. Test and measure everything that you do onlineStep 7. Enjoy your rewards

This week I received a phone call from a dear friend wanting advice on working from home. My friend lost his job last year due to cutbacks. He was forced to take a “so called” early retirement, even though he was not even close to retirement age. This seems to be the norm these days. People are being let go from positions they’ve held for years and are looking for ways to regain the lost income.My friend, knew that my company had evolved from a home base start and needed some pointers about how to get started in his new vocation. Here are a few of the questions asked and what I shared. Perhaps, you too, are facing a job or career change and considering working from home as an option. If so, I hope you find some of my responses helpful.Question:What is needed to start a business from home?Answer:First step is to check with your local township and state to see what types of license or permits may be needed. If you are going to be selling product, you may need to obtain a Resale Tax license so that you are not paying sales tax on product you purchase to resell. You will want to determine a name for your business. Most states require that you file for a “DBA” license or permit (doing business under an assumed name). There are fees associated with licenses and permits and the cost will vary from state to state. Your county clerk’s office is a good starting point for gleaning valuable insight into what your particular state/county/or township may require.Question:Will I need to pay quarterly taxes to the IRS from my earning, or can I just pay at the end of tax year?Answer:This is a question for an accountant. When setting up a home based business, I strongly urge you to contact a local accounting firm to assist with financial planning. An accountant can provide insight about whether you will want to be a sole proprietor, a Limited License corporation (LLC), or and INC. I personally opted for a LLC and hired an attorney to draft the necessary paperwork. Again, there are annual license fees involved for both LLC and INC businesses.Question:What expenses can I deduct with a home-based business?Answer:This will depend on your business type. My friend’s new company will provide a service which edits copy and offers “political ghost-writing”. There is no inventory involved and home office space is limited to one room of the house. When I started my business, it involved inventory and an office. I needed a place to store the stock I would be shipping as well as a packing area. The dedicated business areas within my home were tax deductible based on the square footage used. Any square footage you claim is usually depreciated over time and may affect any capital gain you might earn if you sold your home. For this reason, it’s important to work with your accountant to determine how a home business could affect your home equity.Here are some of the things I was able to deduct when I started my home business. You will want to consult with your accountant and/or legal firm based on your business type:1) A portion of my waste disposal bill. There was plenty of garbage related to business operations.2) The land and cell phones since they were used for business. I opted to have a separate land line installed just for business use.3) If you have a web site, you can deduct the fees associated with your internet connection. This also includes any fees assessed by your web hosting company.4) Don’t forget to deduct advertising costs. This includes business cards, search engine ads for your web site, newspaper ads, or ads placed in trade publications. Do you plan to give away printed material, product, or samples to advertise your company? You will want to deduct the related expenses.5) I was able to deduct a portion of my annual heating and utility bill based on the square footage of the home space I claimed as work related.6) Do you plan to accept credit cards or have a business banking account? All of the fees charged for the use of these accounts is deductible. This includes any PayPal fees that might be assessed and deducted from payments you received for services or goods.7) If you are mailing or shipping product or printed materials, keep all your receipts. This is also a deductible business expense.8) Office supplies, packing materials, cleaning supplies (after all, you do need to clean your work area), mileage and gas relating to work, licenses and permit fees…. all of these are business expenses you don’t want to overlook.9) And don’t forget about your business equipment! Your laptop, desktop computer, printers, copier, desk, print cartridges, and fax machine (if used for business) should be listed as business expenses when filing your tax return.10) Finally, don’t forget about business related software purchases, service maintenance for equipment, insurance for your car and any liability or additional home insurance you have to cover business equipment and stock.I have only covered some of the expenses that may be valid business deductions. If considering working from home, link up with an expert in your local area. The best thing I ever did when starting my company was to find a good accounting firm (and I’m not talking H & R block) and a specialized business attorney. You will also find a wealth of information and assistance at your local bank. My bank assisted with setting up my credit card gateway payments and business checking/savings accounts. You will be surprised at the many free services banks offer new businesses.

Providing the primary care for an elder loved one can be difficult. When you cannot deliver all the elder care yourself and support from friends, family, and community organizations is not enough, it may be useful to hire a home health care worker. He or she can offer care from a few hours a week to 24 hours a day, and can provide many other helpful services. Types of in-home health care services include:

General Health Management like administration of medication or other medical treatments
Personal care such as bathing, oral hygiene, dressing, and shaving
Nutrition help like preparing meals, assisting eating, and grocery shopping
Homemaking services including laundry, dishwashing, and light housework
Companionship for example reading to the senior or taking them on walks
Recruiting and Interviewing Applicants
There are many avenues for hiring a home health care employee. Generally, home health care workers can be hired directly or through an agency. Home health care agencies often have a staff that includes social workers and nurses that will manage your care. However hiring an independent home health care worker is generally more cost effective, it will also give you more control over the type of care you receive.

Senior home care workers should be carefully screened for proper training, qualifications, and temperament. Fully discuss the needs of the elder care recipient during an interview with a prospective home health care employee. There should be a written copy the job description and the type of experience you are looking for.

References

Have applicants fill out an employment form that includes the following information:

Full name
Address
Phone number
Date of birth
Social Security number
Educational background
Work history
Before hiring, you should ask to see the senior home care worker’s licenses and certificates, if applicable, and personal identification including their social security card, driver’s license, or photo ID.
References should be checked out thoroughly. Prospective employees should provide the employer with names, dates of employment, and phone numbers of previous employers and how to contact them. It is best to talk directly to previous employers, rather than just to accept letters of recommendations. Also ask the applicant to provide or sign off on conducting a criminal background check

Special Points to Consider

Make sure the person you are considering hiring knows how to carry out the tasks the elder care recipient requires, such as transferring the senior to and from a wheelchair or bed. Training may be available, but make sure the worker completes the training successfully before hiring him or her.

No one should be hired on a seven-day-a-week basis. Even the most dedicated employee will soon burn out. All employees need some time to take care of their personal needs. No worker should be on call 24-hours a day. If the elder care recipient needs frequent supervision or care during the night, a family member or second home health care worker should be able to help out or fill in.

Live-in assistance may seem to be more convenient and economic than hourly or per-day employees but there can be drawbacks. Food and lodging costs must be calculated into the total cost of care, and it could be difficult to dismiss someone without immediate housing alternatives. If you decide to utilize a live-in arrangement, the employee should have his own living quarters, free time, and ample sleep.

Job Expectations and Considerations

Before hiring a senior home health care worker, you should go over the tasks you expect them to perform and other issues, such as promptness, benefits, pay scale, holidays, vacations, absences, and notification time needed for either employer or employee before employment is terminated. If you work and are heavily dependent on the home health care worker, emphasize the importance of being informed as soon as possible if he or she is going to be late or absent so that you can make alternative arrangements. Be clear about notification needed for time off, or what to do in the case the home health care worker experiences a personal emergency that requires them to abruptly leave work. It is important to have a backup list of friends, family, other home care workers, or a home health care agency you can call on.

Be clear about issues concerning salary, payment schedule, and reimbursement or petty cash funds for out of pocket expenses.

You should spend the day with the home health care worker on his first day to make sure you are both in agreement over how to carry out daily tasks. It would also be helpful to supply the home health care worker with a list of information on the elder care recipient such as: special diets, likes, dislikes, mobility problems, health issues, danger signs to monitor, possible behavior problems and accompanying coping strategies, medication schedule, therapeutic exercises, eye glasses, dentures, and any prosthetics.

You should also provide the following information to your home health care worker: your contact information, emergency contacts, security precautions and access to keys, clothing, and locations of washing/cleaning supplies, medical supplies, light bulbs, flashlights, fuse box, and other important household items.

Transportation

Another big consideration in hiring a senior home care worker is how he or she is going to get to work. If they do not have a reliable car or access to public transit, then you might want to consider hiring someone to drive him or her, which might be more economical than using taxis. Inform your insurance company if the home health care worker is going to drive your car when caring for the senior. Your insurance company will perform the necessary driving background checks. If the home health care worker is using his or her car to drive the elder care recipient, then discuss use of her or his car, and conduct a driving background check.

Insurance and Payroll

Check with an insurance company about the proper coverage for a worker in your home.

Make sure all the proper taxes are being drawn from the employee’s check by contacting the Internal Revenue Service, state treasury department, social security, and the labor department. If you do not want to deal with the complexities of the payroll withholdings yourself, than you can hire a payroll company for a fee.

Even if your home health care worker is working as a contractor, you are still obligated to report the earnings to the IRS. Talk to your accountant or financial adviser about making sure you are following IRS rules.

Ensuring Security

You should protect your private papers and valuables in a locked file cabinet, safe deposit box, or safe. If you are unable to pick up your mail on a daily basis, have someone you trust do it, or have it sent to a post box. You should check the phone bill for unusual items or unauthorized calls. You should put a block on your phone for 900 numbers, collect calls, and long-distance calls.

Keep checkbooks and credit cards locked up. Review credit card and bank statements on a monthly basis, and periodically request credit reports from credit reporting agencies. Lock up valuable possessions or keep an inventory of items accessible to people working in the house.

You can help to prevent elder abuse to your loved one by:

Make sure the home health care worker thoroughly understands his or her responsibilities, the elder care recipient’s medical problems and limitations, and how to cope with stressful situations.
Do not overburden the home health care worker.
Encourage openness over potential problems.
The following are possible signs of elder abuse or neglect:
Personality changes
Crying, whimpering, or refusing to talk
Sloppy appearance
Poor personal hygiene
Disorganized or dirty living conditions
Signs of inappropriate sedation, such as confusion, or excessive sleeping
Mysterious bruises, pressure sores, fractures, or burns
Weight loss
If you suspect abuse, act immediately. Do not wait until the situation turns tragic. Investigate the situation by talking to the elder care recipient in a safe situation, or install monitoring equipment. Examples of abusive behavior include yelling, threatening, or over controlling behavior that could involve isolating the senior from others. If the situation is serious, you should replace the home health care worker as quickly as possible. If you fear the elder care recipient is in danger, he or she should be separated from the home health care worker as soon as possible. Place the elder care recipient with a trusted relative or in a respite care facility. Make sure your loved one is safe before confronting the home health care worker, especially if there is concern about retaliation.
Report the situation to Adult Protective Services after ensuring the safety of the elder care recipient. The police should be contacted in the case of serious neglect, such as sexual abuse, physical injury, or misuse of funds.

Supervising a Home Health Care Worker

The most important thing to remember after hiring a home health care worker is to keep the lines of communication open. You should explain the job responsibilities clearly, and your responsibilities to the home health care worker. Do not forget that the home health care worker is there for the elder care recipient and not the rest of the family. For live-in arrangements, the maximum amount of privacy should be set up for the home health care worker’s living quarters. Meetings should be set up on a regular basis to assure that problems are nipped in the bud. If conflicts cannot be resolved after repeated attempts, than it is best to terminate the employee. In such a case, you may have to either place the elder care recipient in a nursing home temporarily or hire a home health care worker through an agency. Reserve funds should be kept on hand in the case of such an emergency.

General Eligibility Requirements for Home Care Benefits

Hiring a home health care worker directly is usually less expensive than hiring through a home health care agency; but if the elder care recipient is eligible and you wish to use assistance from Medicare, you must hire someone through a certified home health care agency. For the senior patient to be eligible, three or more services must be ordered by a physician. Other factors or eligibility are the required need for skilled nursing assistance, or one of the following therapies: physical, speech or occupational. The elder care recipient’s medical needs will determine asset and income requirements.

Hiring Home Health Care Workers through Home Health Care Agencies versus Independently

Different health professionals can assess the elder care recipient’s needs. A nurse or social worker can help with design and coordination of a home care plan. Your care manager, doctor, or discharge planner can help with services being covered by Medicare. They generally help make the arrangements with a home care agency.

You should ask the home health care agency how they supervise their employees, and what kind of training their employees receive. Find out the procedures for when an employee does not show up. Also ask about the fee schedule and what it covers, there may be a sliding fee schedule. Furthermore, find out if they have a policy for minimum or maximum hours. Ask the agency if there are any limitations on the types of tasks performed.

Especially if you have to pay for the care services yourself, find out if there are any hidden costs such as transportation. If all the costs for hiring a care worker through an agency become too much, you may want to consider hiring directly.

Hiring independent home health care workers is not only more economical than using an agency, but it also allows more direct control over the elder care.

Why personal finance software is important

These days, technology has really revolutionized people’s way of life, including their financial life. Back in the day, most people used a pen and paper to document their earnings, spending, and finances.

What is personal finance software?

Home finance software refers to a financial tool that enables you to prepare a budget, track your expenses, and check your overall finances. These days, there is no valid reason why you should be disorganized and mired in debt because there are many good personal finance programs that you can use to keep track of your money, plan your future, and completely control your finances. If you have a PC or laptop, you are lucky because you can easily find good home finance software at little cost. Application programmers have now catered for the high demand for these applications as they now come with all sorts of functions and capabilities that can save your money, time and effort.

Analysis

You can now analyze your finances unaided. However, this kind of analysis can be much easier if you have some accounting background. Finance software will analyze your important financial details. Details such as your monthly expenses will stick out. Many personal finance applications also allow personalization. If there is one particular aspect you want to know about your finances, you can simply create a specialized analysis. Many personal finance programs can also give you a monthly analysis-an excellent way to see how you actually spend your money on a monthly basis.

Budget creation

We all know the importance of a personal budget. But creating a real budget that you’ll stick to is easier said than done. You can find a personal finance application that creates a realistic budget for you. Simply enter your basic information into the software and quickly create a simple budget.

Checkbook balances and bill payments

Sometimes you’ll fail to pay bills on time. When it happens, interest rates are more than likely to shoot up. Fortunately, you can avoid this mistake once and for all. Look for a personal finance application that’ll remind you when to pay your bills. Likewise, you can accomplish balancing your checkbook by just ticking a box. Sum up any amounts withdrawn from your account and check carefully anything that seems suspicious. Once you have everything on record, it becomes much easier to know how your finances are faring.

Trust yourself and no one else

When it comes to finances, it is best to keep track of all you have carefully. You may trust your finances with your financial adviser, but it is still important to know where every cent is at, always. With a personal finance application, your money will never be far away from you. Whether you are paying bills, balancing your checkbook, tracking your paycheck, or creating a personal budget, you should not live without personal finance software.

More and more people are choosing home health care as an alternative to entering assisted living facilities. There are different levels of care available to individuals who wish to remain in their homes but who need a little extra help. Having these options make it possible for lots of folks to stay in their houses longer and live their own lives. There are several compelling reasons families are choosing this for their loved ones.

Better for the Well-Being of the Patient

Studies have shown that being allowed to stay at home and to maintain some level of independence is better for the patient’s overall health. Feeling “put away” can cause feelings of depression or hopelessness, which in turn may cause increased health problems. If a patient has a say in their own care, they feel much better and their body can recover and heal more efficiently. This is true even if they do decide to enter a nursing home, but simply having the option is a big help.

Comfortable and Convenient

When the time comes when someone needs a little special attention or care, it is important for them to be as comfortable as possible. A big change in their health condition is stressful enough. Sometimes, the best decision is to make sure they can stay in their own home where everything is familiar, so that there aren’t as many drastic changes all at once.

Not having to pack a bag or decide what can stay or go is another benefit to home health care. Everything is as it always was, but now there is someone there to help with the details.

Affordable

The old stereotype about home health care is that it is not affordable except for the super-rich. This is not at all the case. An ever increasing number of health insurance providers are covering this type of care, and certain government programs can offer financial assistance.

Easier on Families

Home health care is a wonderful blessing for couples who need help for one person but not the other. The couple can stay together in their own home, but without the pressure of one person having to provide constant assistance to the other. The strain is off the partner, and the couple can simply enjoy being together. This also has health benefits for the partner.

Kids, grandkids, brothers and sisters might be helping out with the health care needs of an individual just so they can stay at home. With a home health care provider, the patient will receive professional assistance. The family members also benefit, because when they come to visit they can just spend quality time together instead of concerning themselves with all the health issues.

Home health care is a welcome option for many folks who are trying to decide how to plan for the future in light of their physical requirements. While a nursing home is still a very good option for many people, it is reassuring that there are choices out there to fit everyone’s individual needs.

With all the new information concerning HIPAA, which is scheduled to be fully implemented by April of 2005. you need to be aware of the confidentiality laws that govern your practice. One aspect of confidentiality concerns employment law. There are federal and state guidelines that address employment and discrimination laws.

The common law governs the relationship between employer and employees in terms of tort and contract duties. These rules are a part of agency law and the relationship between Principle (employer) and Agent (employee). In some instances, but not all, this law has been replaced by statutory enactments, principally on the Federal level. The balance and working relationship between employer and employee is greatly affected by government regulations. The terms of employment between management and the employee is regulated by federal statute designed to promote employer management and welfare of the employee. Federal law also controls and prohibits discrimination in employment based upon race, sex, religion, age, handicap or national origin. In addition, Congress has also mandated that employers provide their employees a safe and healthy environment to work in. All states have adopted Worker’s Compensation Acts that provide compensation to employees that have been injured during the course of their duties for the employer.

As I mentioned above, a relationship that is closely related to agency is the employee. and principle-independent contractor. In the employer-employee relationship, also called the (master-servant relationship), the employer has the right to control the physical conduct of the employee. A person who engages an independent contractor to do a specific job does not have the right to control the conduct of the independent contractor in the performance of his or her contract. The contract time to complete the job depends upon the employer’s time frame to complete the desired task(s), or job. Keep in mind that the employer may still be held liable for the torts committed by an employee within the scope of his or her employment. In contrast an employer ordinarily is not liable for torts committed by an independent contractor, but there are instances when the employer can be held liable for the acts of the independent contractor. Know your laws governing hiring a person as an independent contractor.

Labor law is not really applicable to your practice of Chiropractic in a practice setting. We will concentrate on employment and discrimination law. There are a number of Federal Statutes that prohibit discrimination in employment based upon race, sex, religion, national origin, age and handicap. The main framework of Federal employment discrimination law is Title VII of the 1964 Civil Rights Act, but also the Equal Pay Act, Discrimination in Employment Act of 1973, the Rehabilitation Act of 1973, and many Executive Orders. In all cases each state has enacted laws prohibiting the same discriminations as Federal Statutes.

Equal Pay Act: This act prohibits an employer from discriminating between employees on the basis of sex by paying unequal wages for the same work. The act also forbids the employer from paying wages at a rate less than the rate at which he pays for equal work at the same establishment. Once the employee has demonstrated that the employer pays unequal wages for equal work to members of the opposite sex, the burden of proof shifts to the employer to prove that the pay difference is based upon the following:

1. Seniority system
2. Merit system
3. A system that measures earnings by quantity or quality of production
4. Or any factor except sex.

Remedies may include recovery of back pay and enjoining the employer from further unlawful conduct and or sizeable fines.
Civil Rights Act of 1964: Title VII of the Civil Rights Act prohibits discrimination on the basis of race, color, sex, religion, or national origin in hiring, firing, compensating, promoting, training or employees. Each of the following could constitute a violation prohibited by the Act:

1. Employer utilizing a proscribed criteria in making an employment decision. Prima Facie evidence would show, if the employee was within a protected class, applied for an open position and was qualified for the position, was denied the job and the employed continued to try to fill the position. Once these criteria’s are established, the burden of proof shifts to the employer to justify a nondiscriminatory reason for the person’s rejection for the job.

2. An employer engages in conduct which appears to be neutral or non-discriminatory, but continues to continue past discriminatory practices.

3. The employer adopts rules, which are adverse to protected classes, which are not justified as being necessary to the practice business. The enforcement agency is the Equal Employment Opportunity Commission (EEOC). It has the right to file legal actions, resolve action through mediation, or other means prior to filing suit. Investigate all charges of discrimination and issue guidelines and regulations concerning the enforcement policy of discrimination law.

The Act provides three defenses: A bona fide seniority or merit system, an occupational qualification or a professionally developed ability test. Violations of this act include: enjoining the employer from engaging in unlawful conduct, or behavior. Affirmative action and reinstatement of employees and back wages from a date not more than two years prior to the filing of the charge with the EEOC.

Age Discrimination in Employment Act of 1976: This Act prohibits discrimination in hiring, firing, salaries, on the basis of age. Under Title VII it address all these areas and ages, but it is especially benefits individuals between the ages of 40-70 years. The language in this act is substantive for individuals between 40-70 years of age. The defenses and remedies are the same as the Civil Rights Act of 1964.

Employee Safety: In 1970 Congress enacted the Occupational Safety and Health Act. This Act ensured that every worker have a safe and healthful working environment. This Act established that OSHA develop standard, conduct inspections, monitor compliance and institute and enforce actions against non-compliance.

The Act makes each employer to provide a work environment that is free from recognized hazards that can cause or likely to cause death or serious physical harm to the employees. In addition, employers are required to comply with specific safety risks outlined by OSHA in their rules and regulations.

The Act also prohibits any employer from discharging or discriminating against an employee who exercises his rights under this Act.
The enforcement of this Act involves inspections and citations for the following:

1. Breach of general duty obligations
2. Breach of specific safety and health standards
3. Failure to keep proper records, make reports or post notices required under this Act

When a violation is discovered, a written citation, proposed penalty, and corrective date are given to the employer. Citations may be contested and heard by an administrative judge at a hearing. The Occupational Safety and Health Review Commission can grant a review of an administrative law judge’s decision. If not, than the decision of the judge becomes final. The affected party may appeal the decision to the US Circuit Court of Appeals.

Penalties for violations are both civil and criminal and may be as high as $1000.00 per violation per day, while criminal penalty be imposed as well for unlawful violations. OSHA may shut down a business for violations that create dangers of death or serious injury.

Worker’s Compensation: Most actions by injured employees against an employer are due to failure of the employer to use reasonable care under the circumstances for the safety of the employee. In such actions the employer has several well-established defenses available to him. They include defenses of the fellow servant rule. This rule does not make an employer liable for injuries sustained by an employee caused by the negligence of a fellow employee. If an employer establishes that the negligence of an employee contributed to the injury he sustained in the course of his employment, in many jurisdictions the employee cannot recover damages from the employer. Voluntary assumption of risk is the third defense. An employer in most jurisdictions is not liable to the employee for harm or injury caused by unsafe conditions of the premises if the employee, with knowledge of the facts and understanding the risks involved, voluntary inters into or continues in the employment of the employer.

Keep in mind that all states have enacted Worker’s Compensation Acts. These statutes create commissions or boards to determine whether an injured worker is entitled to receive compensation. Defenses above are not available in most jurisdictions to employers in proceeding under these statutes. The only requirement is that the employee be injured in the course of his employment.

Fair Labor and Standards Act: This act regulates the employment of child labor outside of agriculture. This act prohibits the employment of anyone less than 14 years of age in non-farm work. Fourteen and Fifteen years old may be employed for a limited number for hours outside of school hours, under specific conditions of non-hazardous occupations. Sixteen and seventeen year olds may work any non-hazardous jobs. Eighteen and older person may work in any job. This Act imposes wage and hour requirements upon covered employers. This act provides for a minimum hourly wage and overtime pay.

The world today has become surrounded by drug abuse as well as drug addiction. This escalating disorder has become so common, that its truth is based on misconceptions that people have concerning drug abuse as well as addiction. This paper briefly provides an overview of drug abuse as well as addiction, and at the same time looks at the aspects of epidemiology, social problems, pathophysiology, as well as ethical issues that might arise with medical emergency responders.

Drug abuse and drug addiction; exactly what does that mean and who is affected by it? There is a confusion between drug addiction and abuse. Drug abuse happens when there is usage of a substance, generally illicit drugs or alcohol, while drug addiction takes place in a broad variety of substances and activities. Addiction can be termed as the compulsive need for usage of substance forming habits, such as alcohol, nicotine and heroin, of which is eventually characterized by obviously physiological signs upon withdrawal as well as tolerance; widely: insistent compulsive use of known substances that are harmful to the user. Drug addiction is usually not a substance forming habit, it also includes things such as gambling, sex, video gaming, and even internet. All the same, the primary focus of society is still to do with drugs, tobacco and alcohol. Several characteristics of pathophysiology and epidemiology will be discussed together with the social implications that addiction causes as well as any ethical problems that lie with addiction and medical emergency service providers.

The addictive behavioral study is relatively new. Science just started to study behavioral addictiveness in the 1930. Prior to this, studies were being carried out by scientist on drug abuse that were plagued by misconception shadows as well as nature addiction. But with present day discoveries as well as information on how brain chemicals work and the methods of alteration, there is now a deeper understanding of alcohol and drug addiction. Drug addiction, according to Dr. Dryden-Edwards also referred to as chemical dependency or substance dependence, is an illness that is described by a destructive drug abuse pattern that leads to major problems which involve tolerance towards or substance withdrawal and other problems arising from substance use that could have implications to the sufferer, either by school performance, socially or in terms of work. More than 2.5% of humanity suffer from drug addiction at some point in their lives. Some of the commonly abused addictive substances are alcohol, anabolic steroids, amphetamines, cannabis, caffeine, ecstasy, cocaine, inhalants, hallucinogens, nicotine, phencyclidine, opiates, sedatives, anti-anxiety drugs, and or hypnotic. Despite the fact that alcohol and drug addiction is viewed as a mental health issue, there is no one particular determinant cause. However, several people believe that drug addiction and abuse is a genetic disease of which is a false fact. A person’s environment is cause for the development of a predisposition dependency drug.

Epidemiology

The socially associated risk factors of drug addiction and drug abuse encompass the male gender, between the age ranges of 18 and 44 years, heritage of Native American persons, low socioeconomic status as well as the marital status of the unmarried. State statistics reveal that residents from the western U.S are more at risk to substance dependency as well as abuse. While males are very prone to alcoholism development, females seem more vulnerable to alcoholism at fairly lower amounts of alcohol consumption, this is because females have a much lower body mass as compared to males. The combined medical, criminal, economical, as well as the social implications costs American taxpayer more than half a trillion dollars annually. Each year drug and alcohol abuses contributes to 100,000 American deaths, with tobacco contributes approximately 440,000 deaths annually. Individuals of all ages suffer the damaging consequences of drug as well as alcohol addiction and abuse. Babies can get affected while within the mother’s womb if the mother is to engage in drug or alcohol use, which as a result causes defects in birth as well as slows down the intellectual development in the later years of the child. As for Adolescents, they usually perform poorly in school and usually drop out while they are abusing drugs. Adolescent girls stand the risk of having unwanted pregnancies, sexually transmitted diseases, and violence. In addition, parents and adults are also affected, usually by having their cognitive abilities clouded. With all the vast exposure, the stage has easily been set for the next generation to simply step into the addictive lifestyle.

Pathophysiology

Drug addiction primarily affects the brain, but also affects the flow of a person’s organ systems. Drugs as well as mind changing substances which can be abused usually target the body’s natural system of reward either willingly or unwillingly causing entire euphoric effects for the drug user. These effects arise from the dopamine, which is a regulated neurotransmitter movement, emotion, cognition, motivation and pleasure feelings. The release of Dopamine is naturally rewarded to the body for natural behaviors as well as initiations for the cycle to repeat the behavior all over. The dopamine neurotransmitter fills the reward system that is often concealed in restricted amounts from routine activities such as sex or eating. The brain perceives this as a life-sustaining action as a result of the activated reward system. On introducing the chemical substance within a person’s system and the euphoric effects are realized, a person’s brain takes note of several significant happening events and teaches itself to do this action repeatedly until it is a habit. The consumption of illicit drugs can cause an individual to impulsively act when the brain’s reasoning system would normally delay or prevent a form of given action.

This reasoning system is circumvented, hence leading to the undesired action that can possibly have negative consequences on the drug user’s life. However, several drug effects as well as chemical substances are at times euphoric, and other times the substance causes depression, suicidal thoughts, and paranoia. Continuation of the drug causes the brain to become acclimatized to the surplus of dopamine within the reward system. This then leads to the decrease of dopamine release as well as the dopamine receptors numbers within the system itself. In turn, this affects the user’s ability to attain the desired effects of the drug usage. This response from the person’s brain causes the person to try and reactivate the receptors by adding the dosage or amount of the drug in order to attain the same dopamine high. This effect process is referred to as a tolerance. Long term drug abuse causes changes to occur to other systems parts within the brain. The neurotransmitter glutamate of which is a part of the reward systems can be changed and hence cause learning inability. When the brain reaches the maximum level of glutamate, it causes an off balance and the brain tries to compensate, of which as a result affects the drug user’s cognitive ability. Once the brain accustoms to the drug effects, dependence is made and drug abuse cessation causes a result known as withdrawal. While most withdrawal signs are very uncomfortable for the drug addict, there are several serious signs such as seizures, strokes, myocardial infraction, delirium tremens, and hallucinations.

Social, Ethical issues as well as the impact on emergency medical services (EMS)

The consequences of drug abuse and addiction are very evident in an individual social life. The addictions destructive behavior affects every area of their personal life, right from the genesis of the drug abuse. The addictions symptoms from a physical perspective include alteration of sleeping patterns as well as eating habits, which in turn contribute to both weight gain as well as loss. Frequent drug abuse tends to lead to failure in meeting important responsibilities at work, school or even home. Other drug addiction effects include domestic violence, family disintegration, child abuse, employment loss, and failure in school. People with addiction engage in risk taking, and with alterations in the reward system within the brain, the drug users expect positive reactions prior to them taking the substance that would satisfy their needs for the risks they take. Impulse control is difficult when drug choice is available to people with addiction. As a result this fuels the addiction even more.

The effect of the emergency medical service is immense. The calls from addiction range from medical overdosage to trauma. The emergency medical provider’s obligation in response to overdosed patients requires paramedics to find out how much as well as what the patients took, and what is the correct medication to give in order to reverse the condition that is being experienced by the patient or drug user. With the various emergency responses comes danger, with the possibility of violent outbreaks by the addicts or users. Therefore, paramedics must be aware of their surroundings while handling the patients. In addition, patients who experience withdrawals tend to hallucinate a complete event as well as incorporate the paramedics, thus causing the patient to react violently towards the care provider. Drug addiction is a very serious condition that can be considered as a psychiatric problem, of which needs to be treated with a sure diligence as well as suspicion.

Within the realm of the emergency medical service, the response rate of addiction is not considered an emergency condition. The incident will arise if an addict is experiencing withdrawal violent signs or has substance overdose, and the patient would appear in a state of agitation or even unconsciousness. There is no prearranged method in handling a patient that is experiencing problems related to addiction. The key element is in treating the symptoms of the patient. All patients require supplementary oxygen through non rebreathe if tolerance is acceptable. To assist in flushing out a normal saline of infusion, obtaining of intravenous access is a must. Should a patient or addict be in a state of agitation or seizure, administration of a sedative is required, such as versed or valium. Caution must be taken when administrating benzodiazepines because of the risks regarding failure or respiratory depression is present. Should a patient experiencing an opiate overdose as well as low breathing, Narcan 0.4 – 2 milligrams must be administered, but caution must be observed when administering the drug of which is done slowly in order for the patient to breathe sufficiently so as to sustain life. Should breathing and airway problems continue then intubation must be considered in order to secure the airway of the patient. Quick transport with due concern is suggested in order for the patient to be evaluated so as to have the hospital staff commence detoxification.

Conclusion

The drug abuse and addiction world is unforgiving and harsh, especially if an addict or user is unwilling to leave it behind. A number of people claim that the addiction is all within the head, and research has verified this notion. The brain effects from a formed learned pattern is similarly rewarded to such activities like drinking or eating.

A lot of people do not comprehend as to how and why other people become drug addicts. It is wrongfully presumed that drug users have no willpower or moral principles and cannot stop using drugs simply by choosing to alter their behavior. The reality is, drug addiction and abuse is a complex illness, and quitting it requires lots of good intentions. In actual fact, because drugs alter the brain in ways that raise drug abuse compulsiveness, quitting becomes hard, even for the willing addicts.

A lot of drug users also believe that they can control their drug abuse and addiction. Having a drug habit is a costly affair that leads to loss of belongings, money and even self-esteem. Curiosity is what drives some people abuse drugs, while others it is peer pressure, and another group of people become addicts of prescription drugs. While drug abuse normally leads to drug addiction, overcoming drug addiction is no easy task. So the question begs, is this drug abuse or is this drug addiction? These are two completely separate paths that lead to the same depressing outcome. In addition, the consequences of drug abuse as well as drug addiction become noticeable after a given period of time whereby compulsiveness and violence take over, furthermore, the physical toll which includes illness and depression at times could be debilitating. Therefore, the only method to reducing drug abuse as well as addiction is through educating or sensitizing the public. Avoidance is viewed as the best prevention.

Anyone in need of home health care deserves non-medical care or in home medical care that is compassionate whether the patient is a child, adult or elder. Home health care services are provided anywhere except for in nursing homes or a hospital. These services may even be provided at an assisted living facility, a school, apartment or house.

As far as care plans go, there are a wide variety of personal care and nursing services that are not just available, they are tailored for the needs of each individual recipient. Customized care plans and follow up assessments should be provided by a registered nurse.

Nursing Supervision and Case Management

The care that is provided by personal care assistants and home health aides is typically supervised by a registered nurse. One of these registered nurses should be on call at all times in order to assist the caregivers as well as to provide medical training and oversight and to implement the plans of care.

Elder or Adult Care

Are you aware of the fact that 75% of the health care costs in the US are incurred by only 12% of Americans? These people generally have some type of chronic illness. The benefits of this type of individualized home care include much more than just being able to keep someone at home for their illness as opposed to being institutionalized or put in a long term care facility. As far as cost goes, home care visits are roughly only 10% of what a single day in the hospital will cost.

Additionally, home health care has a track record that has been proven when it comes to things such as reducing readmissions to the hospital, expensive visits to the emergency room and in managing chronic illnesses. In addition, there is scientific evidence that has proven that patients are able to heal faster when they are in their own homes. Both morbidity and mortality rates are reduced in patients who take advantage of home health care. In fact, 90% of seniors facing long term care in nursing homes prefer to stay home and get the services of a home health care provider.

Private Elder Care Coordination, Planning and Management

This involves both advising and then assisting families when it comes to determining the necessities of an aging adult. These caregivers are able to navigate many of the long term type of care resources that are available in your area. The goal here is to educate and inform the family of what the options are and them to assist them with the implementation of their decision. Typically this is done by an RN who has been certified and specially trained in the area of geriatrics who can provide:

The services of being a liaison for family members who may live a great distance away
Educating and advocating for the patient
Assisting with paperwork and forms that are related to insurance, medical assistant and Medicare
Screening, arranging for and then monitoring any in home help or options for institutional or residential care options
Care planning that is tailored to the patient
In the long run home health care is a compassionate and caring choice for anyone who needs care and wishes to remain in their own home.